1
|
Dangor Z, Benson N, Berkley JA, Bielicki J, Bijsma MW, Broad J, Buurman ET, Cross A, Duffy EM, Holt KE, Iroh Tam PY, Jit M, Karampatsas K, Katwere M, Kwatra G, Laxminarayan R, Le Doare K, Mboizi R, Micoli F, Moore CE, Nakabembe E, Naylor NR, O'Brien S, Olwagen C, Reddy D, Rodrigues C, Rosen DA, Sadarangani M, Srikantiah P, Tennant SM, Hasso-Agopsowicz M, Madhi SA. Vaccine value profile for Klebsiella pneumoniae. Vaccine 2024:S0264-410X(24)00248-2. [PMID: 38503661 DOI: 10.1016/j.vaccine.2024.02.072] [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: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
Klebsiella pneumoniae causes community- and healthcare-associated infections in children and adults. Globally in 2019, an estimated 1.27 million (95% Uncertainty Interval [UI]: 0.91-1.71) and 4.95 million (95% UI: 3.62-6.57) deaths were attributed to and associated with bacterial antimicrobial resistance (AMR), respectively. K. pneumoniae was the second leading pathogen in deaths attributed to AMR resistant bacteria. Furthermore, the rise of antimicrobial resistance in both community- and hospital-acquired infections is a concern for neonates and infants who are at high risk for invasive bacterial disease. There is a limited antibiotic pipeline for new antibiotics to treat multidrug resistant infections, and vaccines targeted against K. pneumoniae are considered to be of priority by the World Health Organization. Vaccination of pregnant women against K. pneumoniae could reduce the risk of invasive K.pneumoniae disease in their young offspring. In addition, vulnerable children, adolescents and adult populations at risk of K. pneumoniae disease with underlying diseases such as immunosuppression from underlying hematologic malignancy, chemotherapy, patients undergoing abdominal and/or urinary surgical procedures, or prolonged intensive care management are also potential target groups for a K. pneumoniae vaccine. A 'Vaccine Value Profile' (VVP) for K.pneumoniae, which contemplates vaccination of pregnant women to protect their babies from birth through to at least three months of age and other high-risk populations, provides a high-level, holistic assessment of the available information to inform the potential public health, economic and societal value of a pipeline of K. pneumoniae vaccines and other preventatives and therapeutics. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public-private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the WHO. All contributors have extensive expertise on various elements of the K.pneumoniae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
Collapse
Affiliation(s)
- Ziyaad Dangor
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nicole Benson
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, UK
| | - Julia Bielicki
- Centre for Neonatal and Paediatric Infection, St George's, University of London, UK; Paediatric Research Centre (PRC), University of Basel Children's Hospital, Basel, Switzerland
| | - Merijn W Bijsma
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Pediatrics, Amsterdam Neuroscience, Meibergdreef, Amsterdam, the Netherlands
| | | | - Ed T Buurman
- CARB-X, Boston University, Boston, MA 02215, USA
| | - Alan Cross
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erin M Duffy
- CARB-X, Boston University, Boston, MA 02215, USA
| | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Michael Katwere
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gaurav Kwatra
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George's, University of London, UK; UK Health Security Agency, Porton Down, UK; World Health Organization, Geneva, Switzerland
| | - Robert Mboizi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, St George's, University of London, UK
| | - Eve Nakabembe
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Upper Mulago Hill Road, P.O. Box 7072 Kampala, Uganda
| | - Nichola R Naylor
- UK Health Security Agency, Porton Down, UK; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Seamus O'Brien
- Global Antibiotic Research & Development Partnership (GARDP), Geneva, Switzerland
| | - Courtney Olwagen
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Denasha Reddy
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Charlene Rodrigues
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Dept of Paediatrics, Imperial College Healthcare NHS Trust, London, UK; Pathogen Genomics Programme, UK Health Security Agency, London, UK
| | - David A Rosen
- Department of Pediatrics and Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Padmini Srikantiah
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mateusz Hasso-Agopsowicz
- Department of Immunization, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
2
|
Ogbuanu IU, Otieno K, Varo R, Sow SO, Ojulong J, Duduyemi B, Kowuor D, Cain CJ, Rogena EA, Onyango D, Akelo V, Tippett Barr BA, terKuile F, Kotloff KL, Tapia MD, Keita AM, Juma J, Assefa N, Assegid N, Acham Y, Madrid L, Scott JAG, Arifeen SE, Gurley ES, Mahtab S, Dangor Z, Wadula J, Dutoit J, Madhi SA, Mandomando I, Torres-Fernandez D, Kincardett M, Mabunda R, Mutevedzi P, Madewell ZJ, Blau DM, Whitney CG, Samuels AM, Bassat Q. Burden of child mortality from malaria in high endemic areas: Results from the CHAMPS network using minimally invasive tissue sampling. J Infect 2024; 88:106107. [PMID: 38290664 DOI: 10.1016/j.jinf.2024.01.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Malaria is a leading cause of childhood mortality worldwide. However, accurate estimates of malaria prevalence and causality among patients who die at the country level are lacking due to the limited specificity of diagnostic tools used to attribute etiologies. Accurate estimates are crucial for prioritizing interventions and resources aimed at reducing malaria-related mortality. METHODS Seven Child Health and Mortality Prevention Surveillance (CHAMPS) Network sites collected comprehensive data on stillbirths and children <5 years, using minimally invasive tissue sampling (MITS). A DeCoDe (Determination of Cause of Death) panel employed standardized protocols for assigning underlying, intermediate, and immediate causes of death, integrating sociodemographic, clinical, laboratory (including extensive microbiology, histopathology, and malaria testing), and verbal autopsy data. Analyses were conducted to ascertain the strength of evidence for cause of death (CoD), describe factors associated with malaria-related deaths, estimate malaria-specific mortality, and assess the proportion of preventable deaths. FINDINGS Between December 3, 2016, and December 31, 2022, 2673 deaths underwent MITS and had a CoD attributed from four CHAMPS sites with at least 1 malaria-attributed death. No malaria-attributable deaths were documented among 891 stillbirths or 924 neonatal deaths, therefore this analysis concentrates on the remaining 858 deaths among children aged 1-59 months. Malaria was in the causal chain for 42.9% (126/294) of deaths from Sierra Leone, 31.4% (96/306) in Kenya, 18.2% (36/198) in Mozambique, 6.7% (4/60) in Mali, and 0.3% (1/292) in South Africa. Compared to non-malaria related deaths, malaria-related deaths skewed towards older infants and children (p < 0.001), with 71.0% among ages 12-59 months. Malaria was the sole infecting pathogen in 184 (70.2%) of malaria-attributed deaths, whereas bacterial and viral co-infections were identified in the causal pathway in 24·0% and 12.2% of cases, respectively. Malnutrition was found at a similar level in the causal pathway of both malaria (26.7%) and non-malaria (30.7%, p = 0.256) deaths. Less than two-thirds (164/262; 62.6%) of malaria deaths had received antimalarials prior to death. Nearly all (98·9%) malaria-related deaths were deemed preventable. INTERPRETATION Malaria remains a significant cause of childhood mortality in the CHAMPS malaria-endemic sites. The high bacterial co-infection prevalence among malaria deaths underscores the potential benefits of antibiotics for severe malaria patients. Compared to non-malaria deaths, many of malaria-attributed deaths are preventable through accessible malaria control measures.
Collapse
Affiliation(s)
| | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Rosauro Varo
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | - Babatunde Duduyemi
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | | | | | - Emily A Rogena
- School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Victor Akelo
- US Centers for Disease Control and Prevention--Kenya, Kisumu, Kenya
| | | | - Feiko terKuile
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Jane Juma
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nardos Assegid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yenework Acham
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (ICDDR,B), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (ICDDR,B), Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie Dutoit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inácio Mandomando
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | - David Torres-Fernandez
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Milton Kincardett
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rita Mabunda
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Aaron M Samuels
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Quique Bassat
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
3
|
Mahtab S, Blau DM, Madewell ZJ, Ogbuanu I, Ojulong J, Lako S, Legesse H, Bangura JS, Bassat Q, Mandomando I, Xerinda E, Fernandes F, Varo R, Sow SO, Kotloff KL, Tapia MD, Keita AM, Sidibe D, Onyango D, Akelo V, Gethi D, Verani JR, Revathi G, Scott JAG, Assefa N, Madrid L, Bizuayehu H, Tirfe TT, El Arifeen S, Gurley ES, Islam KM, Alam M, Zahid Hossain M, Dangor Z, Baillie VL, Hale M, Mutevedzi P, Breiman RF, Whitney CG, Madhi SA. Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. Lancet Child Adolesc Health 2024; 8:201-213. [PMID: 38281495 PMCID: PMC10864189 DOI: 10.1016/s2352-4642(23)00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sandra Lako
- Aberdeen Women's Centre, Freetown, Sierra Leone
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain; Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Diakaridia Sidibe
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Dickson Gethi
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hiwot Bizuayehu
- Department of Microbiology, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
| |
Collapse
|
4
|
Verwey C, Dangor Z, Madhi SA. Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children: Rationale and Progress to Date. Paediatr Drugs 2024; 26:101-112. [PMID: 38032456 PMCID: PMC10891269 DOI: 10.1007/s40272-023-00606-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection (LRTI) in children, and is associated with long-term pulmonary sequelae for up to 30 years after infection. The mainstay of RSV management is supportive therapy such as supplemental oxygen. Palivizumab (Synagis™-AstraZeneca), a monoclonal antibody targeting the RSV F protein site II, has been licensed for the prevention of RSV in high-risk groups since 1998. There has been recent promising progress in preventative strategies that include vaccines and long-acting, high-potency monoclonal antibodies. Nirsevimab (Beyfortus™-AstraZeneca/Sanofi), a monoclonal antibody with an extended half-life, has recently been registered in the European Union and granted licensure by the US Food and Drug Administration. Furthermore, a pre-fusion sub-unit protein vaccine has been granted licensure for pregnant women, aimed at protecting their young infants, following established safety and efficacy in clinical trials (Abrysvo™-Pfizer). Also, multiple novel antiviral therapeutic options are in early phase clinical trials. The next few years have the potential to change the landscape of LRTI through improvements in the prevention and management of RSV LRTI. Here, we discuss these new approaches, current research, and clinical trials in novel therapeutics, monoclonal antibodies, and vaccines against RSV infection in infants and children.
Collapse
Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Du Toit J, Storath K, Dunn I, Makekeng P, Moosa M, Mothibi K, Umuneza N, Rees CA, Blau D, Lala S, Adam Y, Velaphi S, Hale M, Swart P, Wadula J, Mothibi L, Wise A, Baba V, Jaglal P, Mahtab S, Madhi S, Dangor Z. Experience on postmortem minimally invasive tissue sampling to ascertain the cause of death determination in South African children: A case for implementing as standard of care. S Afr Med J 2024; 114:e1538. [PMID: 38525575 DOI: 10.7196/samj.2024.v114i2.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024] Open
Abstract
Determining the death burden for prioritising public health interventions necessitates detailed data on the causal pathways to death. Postmortem minimally invasive tissue sampling (MITS), incorporating histology, molecular and microbial culture diagnostics, enhances cause-of-death attribution, particularly for infectious deaths. MITS proves a valid alternative to full diagnostic autopsies, especially in low- and middle-income countries. In Soweto, South Africa (SA), the Child Health and Mortality Prevention Surveillance (CHAMPS) programme has delineated over 1 000 child and stillbirth deaths since 2017. This SA CHAMPS site supports advocating for the use of postmortem MITS as routine practice, for more granular insights into under-5 mortality causes. This knowledge is crucial for SA's pursuit of Sustainable Development Goal 3.2, targeting reduced neonatal and under-5 mortality rates. This commentary explores the public health advantages and ethicolegal considerations surrounding implementing MITS as standard of care for stillbirths, neonatal and paediatric deaths in SA. Furthermore, based on the data from CHAMPS, we present three pragmatic algorithmic approaches to the wide array of testing options for cost-effectiveness and scalability of postmortem MITS in South African state facilities.
Collapse
Affiliation(s)
- J Du Toit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - K Storath
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - I Dunn
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - P Makekeng
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - M Moosa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - K Mothibi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - N Umuneza
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - C A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, USA; Department of Emergency Medicine, Children's Healthcare of Atlanta, USA.
| | - D Blau
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, USA.
| | - S Lala
- Office for Teaching and Learning; and Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Y Adam
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, and Chris Hani Baragwanath Academic HospitalJohannesburg, South Africa.
| | - S Velaphi
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
| | - M Hale
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - P Swart
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - J Wadula
- epartment of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - L Mothibi
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - A Wise
- Rahima Moosa Mother and Child Hospital, Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
| | - V Baba
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - P Jaglal
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - S Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - S Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Z Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
6
|
Garcia Gomez E, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Chowdhury MAI, Islam KM, Assefa N, Scott JAG, Madrid L, Tilahun Y, Orlien S, Kotloff KL, Tapia MD, Keita AM, Mehta A, Magaço A, Torres-Fernandez D, Nhacolo A, Bassat Q, Mandomando I, Ogbuanu I, Cain CJ, Luke R, Kamara SIB, Legesse H, Madhi S, Dangor Z, Mahtab S, Wise A, Adam Y, Whitney CG, Mutevedzi PC, Blau DM, Breiman RF, Tippett Barr BA, Rees CA. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months. PLOS Glob Public Health 2024; 4:e0002494. [PMID: 38329969 PMCID: PMC10852234 DOI: 10.1371/journal.pgph.0002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
Collapse
Affiliation(s)
- Elisa Garcia Gomez
- Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | | | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kazi Munisul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Stian Orlien
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Torres-Fernandez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Dianna M. Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | | |
Collapse
|
7
|
Trotter CL, Alderson M, Dangor Z, Ip M, Le Doare K, Nakabembe E, Procter SR, Sekikubo M, Lambach P. Vaccine value profile for Group B streptococcus. Vaccine 2023; 41 Suppl 2:S41-S52. [PMID: 37951694 DOI: 10.1016/j.vaccine.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 11/14/2023]
Abstract
Group B streptococcus (GBS) is a major global cause of neonatal meningitis, sepsis and pneumonia, with an estimated 91,000 infant deaths per year and an additional 46,000 stillbirths. GBS infection in pregnancy is also associated with adverse maternal outcomes and preterm births. As such, the World Health Organization (WHO) prioritised the development of a GBS vaccine suitable for use in pregnant women and use in LMICs, where the burden of disease is highest. Several GBS vaccines are in clinical development. The WHO Defeating Meningitis by 2030 has set a target of 2026 for vaccine licensure. This 'Vaccine Value Profile' (VVP) for GBS is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations, and in collaboration with stakeholders from the WHO regions of AFR, AMR, EUR, WPR. All contributors have extensive expertise on various elements of the GBS VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
Collapse
Affiliation(s)
- Caroline L Trotter
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
| | - Mark Alderson
- PATH, 2201 Westlake Avenue, Suite,200, Seattle, WA 98121, USA.
| | - Ziyaad Dangor
- WITS VIDA Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, 30 Chris Hani Road, Diepkloof, Soweto, 1862 Johannesburg, South Africa.
| | - Margaret Ip
- The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | - Kirsty Le Doare
- St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Eve Nakabembe
- Makerere University School of Medicine, P.O. Box 7072, Kampala, Uganda.
| | - Simon R Procter
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Musa Sekikubo
- Makerere University School of Medicine, P.O. Box 7072, Kampala, Uganda.
| | - Philipp Lambach
- World Health Organization, Avenue Appia, Geneva CH-1211, Switzerland.
| |
Collapse
|
8
|
Founou LL, Khan UB, Medugu N, Pinto TCA, Darboe S, Chendi Z, Founou RC, To KN, Jamrozy D, Karampatsas K, Carr VR, Pepper K, Dangor Z, Ip M, Le Doare K, Bentley SD. Molecular epidemiology of Streptococcus agalactiae in non-pregnant populations: a systematic review. Microb Genom 2023; 9. [PMID: 38019122 DOI: 10.1099/mgen.0.001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) has recently emerged as an important pathogen among adults. However, it is overlooked in this population, with all global efforts being directed towards its containment among pregnant women and neonates. This systematic review assessed the molecular epidemiology and compared how the lineages circulating among non-pregnant populations relate to those of pregnant and neonatal populations worldwide. A systematic search was performed across nine databases from 1 January 2000 up to and including 20 September 2021, with no language restrictions. The Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool (PCAT) was used to assess the quality of included studies. The global population structure of GBS from the non-pregnant population was analysed using in silico typing and phylogenetic reconstruction tools. Twenty-four articles out of 13 509 retrieved across 9 databases were eligible. Most studies were conducted in the World Health Organization European region (12/24, 50 %), followed by the Western Pacific region (6/24, 25 %) and the Americas region (6/24, 25 %). Serotype V (23%, 2310/10240) and clonal complex (CC) 1 (29 %, 2157/7470) were the most frequent serotype and CC, respectively. The pilus island PI1 : PI2A combination (29 %, 3931/13751) was the most prevalent surface protein gene, while the tetracycline resistance tetM (55 %, 5892/10624) was the leading antibiotic resistance gene. This study highlights that, given the common serotype distribution identified among non-pregnant populations (V, III, Ia, Ib, II and IV), vaccines including these six serotypes will provide broad coverage. The study indicates advanced molecular epidemiology studies, especially in resource-constrained settings for evidence-based decisions. Finally, the study shows that considering all at-risk populations in an inclusive approach is essential to ensure the sustainable containment of GBS.
Collapse
Affiliation(s)
- Luria Leslie Founou
- Reproductive, Maternal, Newborn and Child Health (ReMARCH) Research Unit, Centre of Expertise and Biological Diagnostic of Cameroon Research Institute (CEDBCAM-RI), Yaoundé, Cameroon
- Bioinformatics and Applied Machine Learning Research Unit, EDEN Biosciences Research Institute (EBRI), EDEN Foundation, Yaoundé, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4041, South Africa
| | - Uzma Basit Khan
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Nubwa Medugu
- Department of Medical Microbiology and Parasitology, National Hospital Abuja, Abuja, Nigeria
| | - Tatiana C A Pinto
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Saffiatou Darboe
- Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Zhu Chendi
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong, PR China
| | - Raspail Carrel Founou
- Antibiotic Resistance Infectious Diseases (ARID) Research Unit, Centre of Expertise and Biological Diagnostic of Cameroon Research Institute (CEDBCAM-RI), Yaoundé, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4041, South Africa
- Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Ka-Ning To
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Dorota Jamrozy
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | | | - Victoria R Carr
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, SE1 9RT, UK
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Kevin Pepper
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Ziyaad Dangor
- Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Ip
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong, PR China
| | - Kirsty Le Doare
- Medical Research Council Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stephen D Bentley
- Department of Pathology, University of Cambridge, Cambridge, UK
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| |
Collapse
|
9
|
Khan M, Solomon F, Izu A, Bengura P, Okudo G, Maroane B, Lala N, Dangor Z. The burden of poisoning in children hospitalised at a tertiary-level hospital in South Africa. Front Public Health 2023; 11:1279036. [PMID: 37927861 PMCID: PMC10623415 DOI: 10.3389/fpubh.2023.1279036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Globally, childhood poisoning, accounts for a significant proportion of emergency department admissions. There is a paucity of data from low- and middle-income countries on poisoning in children. Objective To describe the incidence, case fatality rate, and types of poisoning in children admitted to a tertiary-level hospital in Johannesburg, South Africa. Methods This was a retrospective descriptive study of children hospitalised with poisoning from January 2016 to December 2021 at Chris Hani Baragwanath Academic Hospital. Children were identified from a discharge summary database using ICD-10 codes that describe poisoning. Trends in incidence of poison exposure were reported. Results Of the 60,901 admissions during the study period, 2,652 (4.4%) children were diagnosed with poisoning. Most (71.3%) children were less than 5 years of age and 55% were male. The incidence of poisoning per 100,000 was highest at 108.4 (95% CI: 104.3-112.6) in 2019 and decreased to 77.3 (95% CI: 73.9-80.7) in 2020 and 59.6 (95% CI: 56.3-62.5) in 2021. Main causes of poisoning were organic solvents (37.6%), medications (32.9%), and pesticides (17.5%). The overall case fatality rate was 2.1%. In a multivariate analysis, poisoning secondary to pesticides (aOR: 13.9; 95% CI: 4.52-60.8; p < 0.001), and unspecified agents (aOR: 12.7; 95% CI: 3.27-62.8; p < 0.001) were associated with an increased odds of death. Conclusion We report a high prevalence of poisoning in children hospitalised in this tertiary-level hospital in South Africa. Public health measures to reduce the burden of organic solvents, medications and pesticide poisoning are urgently warranted.
Collapse
Affiliation(s)
- Mahtaab Khan
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatima Solomon
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Pepukai Bengura
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Okudo
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Basetsana Maroane
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nilesh Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
10
|
Rees CA, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Rahman A, Alam M, Scott JAG, Assefa N, Madrid L, Belachew A, Leulseged H, Kotloff KL, Sow SO, Tapia MD, Keita AM, Sidibe D, Sitoe A, Varo R, Ajanovic S, Bassat Q, Mandomando I, Tippett Barr BA, Ogbuanu I, Cain CJ, Bassey IA, Luke R, Gassama K, Madhi S, Dangor Z, Mahtab S, Velaphi S, du Toit J, Mutevedzi PC, Blau DM, Breiman RF, Whitney CG. Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. EClinicalMedicine 2023; 63:102198. [PMID: 37692079 PMCID: PMC10484959 DOI: 10.1016/j.eclinm.2023.102198] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods We conducted a retrospective, descriptive study examining clinical data for children aged 1-59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016-June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | | | - Zachary J. Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muntasir Alam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Nega Assefa
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Anteneh Belachew
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie du Toit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, GA, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, GA, United States of America
| |
Collapse
|
11
|
Izu A, Nunes MC, Solomon F, Baillie V, Serafin N, Verwey C, Moore DP, Laubscher M, Ncube M, Olwagen C, Dangor Z, Madhi SA. All-cause and pathogen-specific lower respiratory tract infection hospital admissions in children younger than 5 years during the COVID-19 pandemic (2020-22) compared with the pre-pandemic period (2015-19) in South Africa: an observational study. Lancet Infect Dis 2023; 23:1031-1041. [PMID: 37141913 PMCID: PMC10151031 DOI: 10.1016/s1473-3099(23)00200-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Non-pharmaceutical interventions affected the circulation of and illness due to endemic respiratory pathogens during the COVID-19 pandemic. We investigated the incidence of admissions to hospital for overall and specific pathogen-associated lower respiratory tract infection (LRTI) during the COVID-19 pandemic compared with incidence in the pre-pandemic period. METHODS In this observational study, we analysed surveillance data for children younger than 5 years from two public hospitals in Soweto, South Africa, for all-cause LRTI, respiratory syncytial virus (RSV), influenza, human metapneumovirus, and Bordetella pertussis from Jan 1, 2015 to Dec 31, 2022. Data were obtained from an electronic database that includes information for all admissions to the general paediatric wards at the two hospitals, automatically identified by a computer program. We excluded children admitted to hospital with incidental SARS-CoV-2 infection or COVID-19 without LRTI diagnosis. Incidence during COVID-19 pandemic years (2020, 2021, and 2022) were compared with pre-pandemic rates (2015-19). FINDINGS Overall, there were 42 068 all-cause hospital admissions, including 18 303 all-cause LRTI hospital admissions, from Jan 1, 2015, to Dec 31, 2022, 17 822 (42·4%) of whom were female, 23 893 (57·0%) were male, and 353 (0·8%) had missing data. All-cause LRTI incidence risk ratio (IRR) was 30% lower in 2020 (IRR 0·70, 95% CI 0·67-0·74) and 13% lower in 2021 (0·87, 0·83-0·91), but 16% higher in 2022 (1·16, 1·11-1·21) compared with the pre-pandemic period. Furthermore, compared with the pre-pandemic period, incidence of RSV-associated LRTI (0·52, 0·45-0·58), influenza-associated LRTI (0·05, 0·02-0·11), and pulmonary tuberculosis (0·52, 0·41-0·65) were lower in 2020, with similar trends observed for human-metapneumovirus-associated LRTI, pertussis, and invasive pneumococcal disease (IPD). Compared with the pre-pandemic period, by 2022, RSV-associated LRTI incidence was similar (1·04, 0·95-1·14) and influenza-associated LRTI showed a non-significant increase (1·14, 0·92-1·39), whereas incidence remained lower for tuberculosis (0·79, 0·65-0·94) and IPD (0·51, 0·24-0·99). In 2022, the incidence of COVID-19-associated LRTI hospital admission (65 per 100 000 children younger than 5 years) was lower than pre-pandemic RSV-associated LRTI (0·23, 0·19-0·27) but higher than pre-pandemic influenza-associated LRTI (1·19, 0·97-1·45), although the difference was not significant. All-cause LRTI death in 2022 (57 per 100 000 children younger than 5 years) was 28% higher than in the pre-pandemic period (1·28, 1·03-1·58). INTERPRETATION The higher incidence of all-cause LRTI admissions to hospital in 2022 compared with the pre-pandemic period is partly due to ongoing COVID-19 admission to hospital, and could worsen if other endemic respiratory pathogens revert to pre-pandemic incidence. Interventions, including the introduction of vaccines for people who are pregnant that aim to prevent RSV and possibly COVID-19 in young children, are warranted. FUNDING The Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa; Center of Excellence in Respiratory Pathogens, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale, Université Claude Bernard Lyon, Lyon, France
| | - Fatima Solomon
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Natali Serafin
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - David P Moore
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Marius Laubscher
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Musawenkosi Ncube
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Courtney Olwagen
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Science, National Research Foundation: Vaccine Preventable Diseases, Department of Science, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
12
|
Birkhead M, Otido S, Mabaso T, Mopeli K, Tlhapi D, Verwey C, Dangor Z. Ultrastructure for the diagnosis of primary ciliary dyskinesia in South Africa, a resource-limited setting. Front Pediatr 2023; 11:1247638. [PMID: 37645034 PMCID: PMC10461090 DOI: 10.3389/fped.2023.1247638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction International guidelines recommend a multi-faceted approach for successful diagnoses of primary ciliary dyskinesia (PCD). In the absence of a gold standard test, a combination of genetic testing/microscopic analysis of structure and function/nasal nitric oxide measurement is used. In resource-limited settings, often none of the above tests are available, and in South Africa, only transmission electron microscopy (TEM) is available in central anatomical pathology departments. The aim of this study was to describe the clinical and ultrastructural findings of suspected PCD cases managed by pediatric pulmonologists at a tertiary-level state funded hospital in Johannesburg. Methods Nasal brushings were taken from 14 children with chronic respiratory symptoms in keeping with a PCD phenotype. Ultrastructural analysis in accordance with the international consensus guidelines for TEM-PCD diagnostic reporting was undertaken. Results TEM observations confirmed 43% (6) of the clinically-suspected cases (hallmark ultrastructural defects in the dynein arms of the outer doublets), whilst 57% (8) required another PCD testing modality to support ultrastructural observations. Of these, 25% (2) had neither ultrastructural defects nor did they present with bronchiectasis. Of the remaining cases, 83% (5) had very few ciliated cells (all of which were sparsely ciliated), together with goblet cell hyperplasia. There was the apparent absence of ciliary rootlets in 17% (1) case. Discussion In resource-limited settings in which TEM is the only available testing modality, confirmatory and probable diagnoses of PCD can be made to facilitate early initiation of treatment of children with chronic respiratory symptoms.
Collapse
Affiliation(s)
- Monica Birkhead
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases – a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Samuel Otido
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Theodore Mabaso
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Keketso Mopeli
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Dorcas Tlhapi
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
13
|
Mopeli K, Mabaso T, Alli N, Dangor Z, Verwey C. Diffuse alveolar haemorrhage in children hospitalised in a tertiary‑level hospital: A retrospective descriptive study. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.282. [PMID: 37622106 PMCID: PMC10446159 DOI: 10.7196/ajtccm.2023.v29i2.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/03/2023] [Indexed: 08/26/2023] Open
Abstract
Background Diffuse alveolar haemorrhage (DAH) is considered a rare condition in children. There is no consensus on the management of DAH syndromes in Africa or other low- and middle-income countries. In this brief report, the clinical characteristics, management and outcomes of children treated for DAH in the Chris Hani Baragwanath Academic Hospital paediatric pulmonology unit in Johannesburg, South Africa are described. Fifteen children were included in this case series, of whom 11 (73.3%) presented with severe microcytic anaemia. Of the 11 children who had bronchoalveolar lavage, 9 (81.8%; 60.0% of the total) had haemosiderin-laden macrophages on microscopy. Only 5 children had a lung biopsy, of whom 3 (60.0%) had capillaritis. All the children were started on oral prednisone at presentation, and 11 (73.3%) received additional complementary treatment. Nine children (60.0%) had normal haemoglobin levels 1 year after initiation of treatment. Our series supports previous reports that DAH is uncommon in children. A large proportion of our patients responded well to treatment despite some resource limitations. What the study adds The study provides additional data on children presenting with diffuse alveolar haemorrhage in a South African tertiary hospital. What are the implications of the findings There is a need for South African pulmonologists to come together and conduct a national audit of these patients in different hospitals to determine the incidence in our country, as well as to inform a management plan in the presence or absence of specialised tests.
Collapse
Affiliation(s)
- K Mopeli
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - T Mabaso
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Alli
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | - Z Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
14
|
Dangor Z, Seale AC, Baba V, Kwatra G. Early-onset group B streptococcal disease in African countries and maternal vaccination strategies. Front Public Health 2023; 11:1214844. [PMID: 37457277 PMCID: PMC10338870 DOI: 10.3389/fpubh.2023.1214844] [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: 04/30/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Invasive group B streptococcal (GBS) disease is the commonest perinatally-acquired bacterial infection in newborns; the burden is higher in African countries where intrapartum antibiotic prophylaxis strategies are not feasible. In sub-Saharan Africa, almost one in four newborns with GBS early-onset disease will demise, and one in ten survivors have moderate or severe neurodevelopmental impairment. A maternal GBS vaccine to prevent invasive GBS disease in infancy is a pragmatic and cost-effective preventative strategy for Africa. Hexavalent polysaccharide protein conjugate and Alpha family surface protein vaccines are undergoing phase II clinical trials. Vaccine licensure may be facilitated by demonstrating safety and immunological correlates/thresholds suggestive of protection against invasive GBS disease. This will then be followed by phase IV effectiveness studies to assess the burden of GBS vaccine preventable disease, including the effect on all-cause neonatal infections, neonatal deaths and stillbirths.
Collapse
Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna C. Seale
- Bill and Melinda Gates Foundation, Seattle, WA, United States
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Vuyelwa Baba
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| |
Collapse
|
15
|
Verwey C, Ramocha L, Laubscher M, Baillie V, Nunes M, Gray D, Hantos Z, Dangor Z, Madhi S. Pulmonary sequelae in 2-year-old children after hospitalisation for respiratory syncytial virus lower respiratory tract infection during infancy: an observational study. BMJ Open Respir Res 2023; 10:10/1/e001618. [PMID: 37169402 DOI: 10.1136/bmjresp-2023-001618] [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: 01/05/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of hospitalisation for lower respiratory tract infection (LRTI) in children. RSV LRTI during early childhood may increase susceptibility to recurrent wheezing and asthma. RESEARCH QUESTION The aim of this study was to describe the pulmonary sequelae at 1 and 2 years of age following RSV LRTI hospitalisation during the first year of life in term infants. STUDY DESIGN AND METHODS A longitudinal case-control study was undertaken from April 2016 to December 2019. Cases constituted children hospitalised with PCR-confirmed RSV LRTI during infancy and controls were children not previously hospitalised with LRTI. A questionnaire detailing environmental and medical history, as well as a modified International Study of Asthma and Allergies (ISAAC) questionnaire, was administered, and pulmonary function testing, including oscillometry, tidal breath flow-volume loops and multiple breath wash-out, was performed, at one and two years of age. RESULTS One (n=308) and two-year-old (n=214) cases were more likely than one (n=292) and two-year-old (n=209) controls to have experienced clinical pulmonary symptoms, including wheezing ((55% vs 24%; p<0.001) and (61% vs 16%; p<0.001)), received treatment for wheezing ((17 vs 8%; p<0.001) and (51 vs 6%; p<0.001)) and had any admissions for wheezing ((31 vs 6%; p<0.001) and (46 vs 1.4%; p<0.001)) or any LRTI ((24 vs 2%; p<0.001) and (32 vs 1.4%; p<0.001)), after the initial RSV hospitalisation. RSV LRTI during infancy was associated with an increase in airway resistance by two years (22.46 vs 20.76 hPa.s.l-1 (p=0.022)), along with a decrease in compliance at both one (-4.61 vs -3.09 hPa.s/l (p<0.001)) and two years (-0.99 vs 0.33 hPa.s/l1 (p<0.001)). There was an increased work of breathing at one year, but this was no longer present at two years. INTERPRETATION RSV LRTI during infancy in cases was associated with more clinical and pulmonary function sequelae through to two years of age.
Collapse
Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
| | - Lesego Ramocha
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
| | - Marius Laubscher
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Marta Nunes
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Diane Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Zoltán Hantos
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| |
Collapse
|
16
|
Dangor Z, Lala S, Verwey C, Reubenson G, White D, Moore D, Jeena P, Masekela R, Zar H. Bronchiolitis versus bronchopneumonia: navigating antibiotic use within the LRTI spectrum. S Afr Med J 2023; 113:20-23. [PMID: 37278266 DOI: 10.7196/samj.2023.v113i6.709] [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: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 06/07/2023] Open
Abstract
Bronchiolitis, a common reason for infant hospitalisation in South Africa (SA), is caused by viral pathogens. Bronchiolitis is typically an illness of mild to moderate severity that occurs in well-nourished children. Hospitalised SA infants frequently have severe disease and/or coexisting medical conditions, and these cases of bronchiolitis may have bacterial co-infection that requires antibiotic therapy. However, the existence of widespread antimicrobial resistance in SA warrants the judicious use of antibiotics. This commentary describes: (i) common clinical pitfalls leading to an incorrect diagnosis of bronchopneumonia; and (ii) considerations for antibiotic therapy in hospitalised infants with bronchiolitis. If antibiotics are prescribed, the indication for their use should be clearly stated, and antibiotic therapy must be stopped promptly if investigations indicate that bacterial co-infection is unlikely. Until more robust data emerge, we recommend a pragmatic management strategy to inform antibiotic use in hospitalised SA infants with bronchiolitis in whom bacterial co-infection is suspected.
Collapse
|
17
|
Dangor Z, Kwatra G, Pawlowski A, Fisher PB, Izu A, Lala SG, Johansson-Lindbom B, Madhi SA. Association of infant Rib and Alp1 surface protein N-terminal domain immunoglobulin G and invasive Group B Streptococcal disease in young infants. Vaccine 2023; 41:1679-1683. [PMID: 36754766 PMCID: PMC9996286 DOI: 10.1016/j.vaccine.2023.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Vaccine development for Group B Streptococcus (GBS), a common cause of invasive disease in early-infancy and adverse pregnancy outcomes, include exploring widely-expressed GBS surface proteins as vaccine epitopes. We investigated the association between natural infant serum IgG against the RibN and Alp1N domains and risk of invasive GBS disease caused by isolates expressing these proteins. METHODS We analyzed maternal and infant serum samples from GBS disease cases and infants born to GBS-colonized women controls. Bayesian modelling was used to calculate the GBS homotypic IgG concentration associated with risk reduction of invasive disease in the infant. RESULTS PCR-based typing of 85 GBS invasive isolates showed 46 and 24 possessing the gene for Rib and Alp1, respectively. These were matched to 46 and 36 infant controls whose mothers were colonized with GBS expressing Rib and Alp1, respectively. RibN IgG geometric mean concentrations (GMC) were lower in cases than controls among infants (0.01; 95 %CI: 0.01-0.02 vs 0.04; 95 %CI: 0.03-0.06; p < 0.001), no significant difference was found between maternal RibN IgG GMC in cases compared to controls. Alp1N IgG GMC was also lower in infant cases (0.02; 95 %CI: 0.01-0.03) than controls (0.05; 95 %CI: 0.04-0.07; p < 0.001); albeit not so in mothers. An infant IgG threshold ≥ 0.428 and ≥ 0.112 µg/mL was associated with 90 % risk reduction of invasive GBS disease due to Rib and Alp1 expressing strains, respectively. DISCUSSION Lower serum RibN and Alp1N IgG GMC were evident in infants with invasive GBS disease compared with controls born to women colonized with GBS expressing the homotypic protein. These data support the evaluation of Alp family proteins as potential vaccine candidates against invasive GBS disease.
Collapse
Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa; Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | | | - Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa
| | - Sanjay G Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Bengt Johansson-Lindbom
- Immunology Section, BMC D14, Lund University, Lund, Sweden; MinervaX ApS, DK-2200 Copenhagen N, Denmark
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa; African Leadership in Vaccinology Expertise University of the Witwatersrand, South Africa.
| |
Collapse
|
18
|
Gonçalves BP, Procter SR, Paul P, Chandna J, Lewin A, Seedat F, Koukounari A, Dangor Z, Leahy S, Santhanam S, John HB, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Sánchez Yanotti C, Horváth-Puhó E, Sørensen HT, van de Beek D, Bijlsma MW, Gardner WM, Kassebaum N, Trotter C, Bassat Q, Madhi SA, Lambach P, Jit M, Lawn JE. Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden. Lancet Glob Health 2022; 10:e807-e819. [PMID: 35490693 PMCID: PMC9090904 DOI: 10.1016/s2214-109x(22)00093-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets. METHODS We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and estimated the burden for 183 countries in 2020 regarding: maternal GBS colonisation, iGBS cases and deaths in infants younger than 3 months, children surviving iGBS affected by NDI, and maternal iGBS cases. We analysed the proportion of stillbirths with GBS and applied this to the UN-estimated stillbirth risk per country. Excess preterm births associated with maternal GBS colonisation were calculated using meta-analysis and national preterm birth rates. FINDINGS Data from the seven systematic reviews, published in 2017, that informed the previous burden estimation (a total of 515 data points) were combined with new data (17 data points) from large multicountry studies on neurodevelopmental impairment (two studies) and stillbirths (one study). A posterior median of 19·7 million (95% posterior interval 17·9-21·9) pregnant women were estimated to have rectovaginal colonisation with GBS in 2020. 231 800 (114 100-455 000) early-onset and 162 200 (70 200-394 400) late-onset infant iGBS cases were estimated to have occurred. In an analysis assuming a higher case fatality rate in the absence of a skilled birth attendant, 91 900 (44 800-187 800) iGBS infant deaths were estimated; in an analysis without this assumption, 58 300 (26 500-125 800) infant deaths from iGBS were estimated. 37 100 children who recovered from iGBS (14 600-96 200) were predicted to develop moderate or severe NDI. 40 500 (21 500-66 200) maternal iGBS cases and 46 200 (20 300-111 300) GBS stillbirths were predicted in 2020. GBS colonisation was also estimated to be potentially associated with considerable numbers of preterm births. INTERPRETATION Our analysis provides a comprehensive assessment of the pregnancy-related GBS burden. The Bayesian approach enabled coherent propagation of uncertainty, which is considerable, notably regarding GBS-associated preterm births. Our findings on both the acute and long-term consequences of iGBS have public health implications for understanding the value of investment in maternal GBS immunisation and other preventive strategies. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Bronner P Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, Kenyan Medical Research Institute, Wellcome Trust, Kilifi, Kenya; Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, Kenyan Medical Research Institute, Wellcome Trust, Kilifi, Kenya
| | | | | | | | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - William M Gardner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Departments of Global Health and Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology and National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
19
|
Paul P, Chandna J, Procter SR, Dangor Z, Leahy S, Santhanam S, John HB, Bassat Q, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Yanotti CS, Seedat F, Horváth-Puhó E, Hossain AT, Sadeq-ur Rahman Q, Jit M, Newton CR, Milner K, Gonçalves BP, Lawn JE. Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina. EClinicalMedicine 2022; 47:101358. [PMID: 35747160 PMCID: PMC9142788 DOI: 10.1016/j.eclinm.2022.101358] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/04/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Data are limited regarding long-term consequences of invasive GBS (iGBS) disease in early infancy, especially from low- and middle-income countries (LMIC) where most cases occur. We aimed to estimate risk of neurodevelopmental impairment (NDI) in children with a history of iGBS disease. METHODS A multi-country matched cohort study was undertaken in South Africa, India, Mozambique, Kenya, and Argentina from October 2019 to April 2021. The exposure of interest was defined as a history of iGBS disease (sepsis or meningitis) before 90 days of age, amongst children now aged 1·5-18 years. Age and sex-matched, children without history of GBS were also recruited. Age-appropriate, culturally-adapted assessments were used to define NDI across multiple domains (cognitive, motor, hearing, vision, emotional-behaviour, growth). Pooled NDI risk was meta-analysed across sites. Association of iGBS exposure and NDI outcome was estimated using modified Poisson regression with robust variance estimator. FINDINGS Amongst 138 iGBS survivors and 390 non-iGBS children, 38·1% (95% confidence interval [CI]: 30·0% - 46·6%) of iGBS children had any NDI, compared to 21·7% (95% CI: 17·7% - 26·0%) of non- iGBS children, with notable between-site heterogeneity. Risk of moderate/severe NDI was 15·0% (95% CI: 3·4% - 30·8%) among GBS-meningitis, 5·6% (95% CI: 1·5% - 13·7%) for GBS-sepsis survivors. The adjusted risk ratio (aRR) for moderate/severe NDI among iGBS survivors was 1.27 (95% CI: 0.65, 2.45), when compared to non-GBS children. Mild impairment was more frequent in iGBS (27.6% (95% CI: 20.3 - 35.5%)) compared to non-GBS children (12.9% (95% CI: 9.7% - 16.4%)). The risk of emotional-behavioural problems was similar irrespective of iGBS exposure (aRR=0.98 (95% CI: 0.55, 1.77)). INTERPRETATION Our findings suggest that iGBS disease is on average associated with a higher risk of moderate/severe NDI, however substantial variation in risk was observed between sites and data are consistent with a wide range of values. Our study underlines the importance of long-term follow-up for at-risk neonates and more feasible, standardised assessments to facilitate diagnosis in research and clinical practice. FUNDING This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene &Tropical Medicine.
Collapse
Affiliation(s)
- Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Corresponding author.
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | | | | | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - A.K.M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles R. Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children's Research Institute
- Department of Paediatrics, University of Melbourne
| | - Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
20
|
Car KP, Nakwa F, Solomon F, Velaphi SC, Tann CJ, Izu A, Lala SG, Madhi SA, Dangor Z. The association between early-onset sepsis and neonatal encephalopathy. J Perinatol 2022; 42:354-358. [PMID: 35001084 DOI: 10.1038/s41372-021-01290-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We evaluated the association between early-onset sepsis and neonatal encephalopathy in a low-middle-income setting. METHODS We undertook a retrospective study in newborns with gestational age ≥35 weeks and/or birth weight ≥2500 grams, diagnosed with neonatal encephalopathy. Early-onset sepsis was defined as culture-confirmed sepsis or probable sepsis. RESULTS Of 10,182 hospitalised newborns, 1027 (10.1%) were diagnosed with neonatal encephalopathy, of whom 52 (5.1%) had culture-confirmed and 129 (12.5%) probable sepsis. The case fatality rate for culture-confirmed sepsis associated neonatal encephalopathy was threefold higher compared to neonatal encephalopathy without sepsis (30.8% vs. 10.5%, p < 0.001). Predictors of mortality for culture-confirmed sepsis associated neonatal encephalopathy included severe neonatal encephalopathy (aOR 6.51, 95%CI: 1.03-41.44) and seizures (aOR 10.64, 95%CI: 1.05-107.39). CONCLUSION In this setting, 5% of neonatal encephalopathy cases was associated with culture-confirmed sepsis and a high case fatality rate.
Collapse
Affiliation(s)
- Kathleen P Car
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Nakwa
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatima Solomon
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso C Velaphi
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cally J Tann
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Institute for Women's Health, University College London, London, UK
| | - Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
21
|
Harden LM, Leahy S, Lala SG, Paul P, Chandna J, Lowick S, Mbatha S, Jaye T, Laughton B, Ghoor A, Sithole P, Msayi J, Kumalo N, Msibi TN, Madhi SA, Lawn JE, Dangor Z. South African Children: A Matched Cohort Study of Neurodevelopmental Impairment in Survivors of Invasive Group B Streptococcus Disease Aged 5 to 8 Years. Clin Infect Dis 2022; 74:S5-S13. [PMID: 34725706 PMCID: PMC8776309 DOI: 10.1093/cid/ciab814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a 5-country study. METHODS We identified children aged 5-8 years with a history of iGBS and children with no history of iGBS between October 2019 and January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate or Severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing, and vision. Secondary outcomes included mild NDI, any emotional-behavioral problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. RESULTS In total, 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Among iGBS survivors 13 (30.2%) had meningitis, and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and 5 (4.3%) non-iGBS children had moderate or severe NDI. Children who survived iGBS were 5.56 (95% confidence interval [CI]: 1.07-28.93; P = .041) times more likely to have moderate or severe NDI at 5-8 years than non-iGBS children. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (P < .05), as well as a lower median DQ for the language GMDS-ER subscale and performance GMDS-ER subscale (P < .05). CONCLUSIONS Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5-8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns.
Collapse
Affiliation(s)
- Lois M Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamara Jaye
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Sithole
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Msayi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntombifuthi Kumalo
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepiso N Msibi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
22
|
Aerts C, Leahy S, Mucasse H, Lala S, Bramugy J, Tann CJ, Madhi SA, Bardají A, Bassat Q, Dangor Z, Lawn JE, Jit M, Procter SR. Quantifying the Acute Care Costs of Neonatal Bacterial Sepsis and Meningitis in Mozambique and South Africa. Clin Infect Dis 2022; 74:S64-S69. [PMID: 34725702 PMCID: PMC8776306 DOI: 10.1093/cid/ciab815] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sepsis and meningitis are among the leading causes of neonatal deaths in sub-Saharan Africa (SSA). Neonatal sepsis caused ~400 000 deaths globally in 2015, half occurring in Africa. Despite this, there are few published data on the acute costs of neonatal sepsis or meningitis, with none in SSA. METHODS We enrolled neonates admitted to 2 hospitals in South Africa and Mozambique between 16 April 2020 and 1 April 2021. In South Africa all cases were microbiologically confirmed, but in Mozambique both clinically suspected and microbiologically confirmed cases were included. Data were collected on healthcare resource use and length of stay, along with information on household expenditure and caregiving. We used unit costs of healthcare resources in local currencies to estimate healthcare provider costs per patient and costs per household. Results were converted to 2019 international dollars (I$). RESULTS We enrolled 11 neonates in Mozambique and 18 neonates in South Africa. Mean length of stay was 10 days (median, 9 [interquartile range {IQR}, 4-14) and 16 days (median, 15 [IQR, 13-18]), respectively. In Mozambique we estimated mean household costs of I$49.62 (median, 10.19 [IQR, 5.10-95.12]) and hospitalization costs of I$307.58 (median, 275.12 [IQR, 149.43-386.12]). In South Africa these costs were I$52.31 (median, 30.82 [IQR, 19.25-73.08]) and I$684.06 (median, 653.62 [IQR, 543.33-827.53]), respectively. CONCLUSIONS We found substantial costs associated with acute neonatal bacterial (all-cause) sepsis and meningitis in SSA. Our estimates will inform economic evaluations of interventions to prevent neonatal invasive bacterial infections.
Collapse
Affiliation(s)
- Céline Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Shannon Leahy
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sanjay Lala
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Cally J Tann
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Neonatal Medicine, University College London Hospitals, London, United Kingdom
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Correspondence: S. R. Procter, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK ()
| |
Collapse
|
23
|
Chandna J, Liu WH, Dangor Z, Leahy S, Sridhar S, John HB, Mucasse H, Bassat Q, Bardaji A, Abubakar A, Nasambu C, Newton CR, Sánchez Yanotti C, Libster R, Milner K, Paul P, Lawn JE. Emotional and Behavioral Outcomes in Childhood for Survivors of Invasive Group B Streptococcus Disease in Infancy: Findings From 5 Low- and Middle-Income Countries. Clin Infect Dis 2022; 74:S35-S43. [PMID: 34725686 PMCID: PMC8776308 DOI: 10.1093/cid/ciab821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Survivors of invasive group B Streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopmental impairment. However, the limited studies to date have a median follow-up to 18 months and have mainly focused on moderate or severe neurodevelopmental impairment, with no previous studies on emotional-behavioral problems among iGBS survivors. METHODS In this multicountry, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique, and South Africa. Children without an iGBS history were matched to iGBS survivors for sex and age. Our primary outcomes were emotional-behavioral problems and psychopathological conditions as measured with the Child Behavior Checklist (CBCL). The CBCL was completed by the child's primary caregiver. RESULTS Between October 2019 and April 2021, 573 children (mean age, 7.18 years) were assessed, including 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention, and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of clinically significant psychopathological conditions defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). CONCLUSIONS Our findings suggested that school-aged iGBS survivors experienced increased mild emotional behavioral problems that may affect children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioral assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.
Collapse
Affiliation(s)
- Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wan-Hsin Liu
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Division of General Paediatrics, Department of Paediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Azucena Bardaji
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
| | - Charles R Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | | | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children’s Research Institute 2, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
24
|
Verwey C, Gray DM, Dangor Z, Ferrand RA, Ayuk AC, Marangu D, Kwarteng Owusu S, Mapani MK, Goga A, Masekela R. Bronchiectasis in African children: Challenges and barriers to care. Front Pediatr 2022; 10:954608. [PMID: 35958169 PMCID: PMC9357921 DOI: 10.3389/fped.2022.954608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Bronchiectasis (BE) is a chronic condition affecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.
Collapse
Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross Warm Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.,The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Adaeze C Ayuk
- Department of Pediatrics, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Sandra Kwarteng Owusu
- Department of Child Health, School of Medicine and Dentistry, Komfo Anokje Teaching Hospital, Kwane Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ameena Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Johannesburg, South Africa.,Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| |
Collapse
|
25
|
Kufa T, Jassat W, Cohen C, Tempia S, Masha M, Wolter N, Walaza S, von Gottburg A, Govender NP, Hunt G, Shonhiwa AM, Ebonwu J, Ntshoe G, Maruma W, Bapela P, Ndhlovu N, Mathema H, Modise M, Shuping L, Manana PN, Moore D, Dangor Z, Verwey C, Madhi SA, Saloojee H, Zar HJ, Blumberg L. Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa. Influenza Other Respir Viruses 2021; 16:34-47. [PMID: 34796674 PMCID: PMC9664941 DOI: 10.1111/irv.12916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction We describe epidemiology and outcomes of confirmed SARS‐CoV‐2 infection and positive admissions among children <18 years in South Africa, an upper‐middle income setting with high inequality. Methods Laboratory and hospital COVID‐19 surveillance data, 28 January ‐ 19 September 2020 was used. Testing rates were calculated as number of tested for SARS‐CoV‐2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In‐hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in‐hospital and whose death was judged SARS‐CoV‐2 related by attending physician. Findings 315 570 children aged <18 years were tested for SARS‐CoV‐2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS‐CoV‐2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case‐fatality). In‐hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08–4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08–15.54)], age 10–14 years [aOR 4.20 (95% CI1.07–16.44)], age 15–17 years [aOR 4.86 (95% 1.28–18.51)] vs age 1–4 years; admission to a public hospital [aOR 5.07(95% 2.01–12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19–34.89)] vs none. Conclusions Children with underlying conditions were at greater risk of severe SARS‐CoV‐2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.
Collapse
Affiliation(s)
- Tendesayi Kufa
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Waasila Jassat
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Cheryl Cohen
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stefano Tempia
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
- Influenza Division, National Center for Immunization and Respiratory DiseasesUS Centers for Disease Control and PreventionAtlantaGeorgiaUSA
- MassGenicsDuluthGeorgiaUSA
| | - Maureen Masha
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Nicole Wolter
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sibongile Walaza
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Anne von Gottburg
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nelesh P. Govender
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Gillian Hunt
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Joy Ebonwu
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Genevie Ntshoe
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of Health Systems and Public Health, Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | - Wellington Maruma
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Poncho Bapela
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Nomathamsanqa Ndhlovu
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Hlengani Mathema
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Motshabi Modise
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Liliwe Shuping
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| | - Pinky N. Manana
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
- School of PathologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - David Moore
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ziyaad Dangor
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Charl Verwey
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Shabir A. Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), Faculty of Health Science JohannesburgUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science JohannesburgUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Haroon Saloojee
- Department of Pediatrics and Child HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Heather J. Zar
- Dept of Paediatrics and Child Health, Red Cross Children's Hospital, and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Lucille Blumberg
- National Institute for Communicable DiseasesNational Health Laboratory ServicesJohannesburgSouth Africa
| |
Collapse
|
26
|
Dangor Z, Kwatra G, Izu A, Khan M, Lala SG, Madhi SA. Infant serotype specific anti-capsular immunoglobulin G antibody and risk of invasive group B Streptococcal disease. Vaccine 2021; 39:6813-6816. [PMID: 34688499 DOI: 10.1016/j.vaccine.2021.10.022] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Past studies have mainly investigated the association of serotype-specific capsular IgG in the mother and risk reduction of invasive Group B Streptococcus (GBS) in their young infants. The efficiency of transplacental transfer of IgG could be affected by multiple maternal factors. Hence, investigation of infant serum GBS anti-capsular IgG and risk reduction for invasive GBS disease may be more robust and generalizable. In a matched case-control study, infant serum serotype-specific capsular polysaccharide Ia and III IgG concentrations were analyzed in infants with invasive GBS cases and healthy controls born to women with recto-vaginal colonization by the homotypic serotype. Using Bayesian modeling, an antibody concentration of 2.5 µg/mL and 1 µg/mL predicted a 90% reduced risk of invasive disease for serotype Ia and III, respectively. These data contribute to the possible licensure of a GBS polysaccharide-protein conjugate vaccine, targeted at pregnant women, based on serological correlates of protection against invasive GBS disease.
Collapse
Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Gaurav Kwatra
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa
| | - Mahtaab Khan
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sanjay G Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
27
|
Alli HD, Ally N, Mayet I, Dangor Z, Madhi SA. Global prevalence and clinical outcomes of tubercular uveitis: a systematic review and meta-analysis. Surv Ophthalmol 2021; 67:770-792. [PMID: 34626620 DOI: 10.1016/j.survophthal.2021.10.001] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Tubercular uveitis (TBU) is an inflammation/infection of the eye secondary to Mycobacterium tuberculosis infection. The difficulty in making the diagnosis has resulted in variable prevalence and clinical response rates. We aimed to determine the global prevalence of TBU in uveitis patients stratified by TB high-burden countries (HBCs) and non-HBCs and by geographic regions and the clinical response of TBU to antitubercular treatment We performed a systematic review and meta-analysis of TBU studies published in PubMed, Scopus and EMBASE, up to June 30, 2020. A random effects model was used for all meta-analyses. Of 5,018 articles identified, 70 prevalence studies (65,607 uveitis and 3,166 TBU cases) and 18 clinical outcome studies (1,570 TBU cases; 1,304 responded to anti-tubercular therapy [ATT]) were analyzed. The overall weighted prevalence of TBU was 4.0% (95% CI, 3-5); in TB HBCs it was 7.0% (95% CI, 5-11), non-HBCs 3.0% (95% CI, 2-4), and sub-Saharan Africa 11.0% (95% CI, 8-15). The overall weighted clinical response was 82.0% (95% CI, 75-89). Despite the difficulty in diagnosing TBU, the prevalence is expectantly higher in HBCs, and sub-Saharan Africa and the clinical outcome is poor. Standardization of diagnostic criteria and ATT is warranted in future cohort studies.
Collapse
Affiliation(s)
- Hassan D Alli
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Naseer Ally
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ziyaad Dangor
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA), Faculty of Health Sciences, University of the Witwatersrand, South Africa
| |
Collapse
|
28
|
Lukhele ST, Kwatra G, Ismail A, Allam M, Dangor Z, Madhi SA. Investigation of Possible Nosocomial-Associated Invasive Group B Streptococcus Disease Using Whole-Genome Sequencing: A Report of 3 Cases. J Pediatric Infect Dis Soc 2021; 10:880-882. [PMID: 34129035 DOI: 10.1093/jpids/piab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022]
Abstract
We investigated possible nosocomial transmission of 3 invasive cases of Group B Streptococcus serotype III disease in newborns delivered in the same facility. All cases were of the same sequence type and clonal complex. Genomic variation was detected within the core genome and capsular region, indicating different sources of acquisition.
Collapse
Affiliation(s)
- Sindiswa T Lukhele
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.,Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Mushal Allam
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Paul P, Procter SR, Dangor Z, Bassat Q, Abubakar A, Santhanam S, Libster R, Gonçalves BP, Madhi SA, Bardají A, Mwangome E, Mabrouk A, John HB, Sánchez Yanotti C, Chandna J, Sithole P, Mucasse H, Katana PV, Koukounari A, Harden LM, Aerts C, Ghoor A, Leahy S, Mbatha S, Lowick S, Lala SG, Bramugy J, Newton C, Hossain AKMT, Sadeq-ur Rahman Q, Lambach P, Jit M, Lawn JE. Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa. Gates Open Res 2021; 4:138. [PMID: 34368637 PMCID: PMC8313848 DOI: 10.12688/gatesopenres.13185.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 01/26/2023] Open
Abstract
Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.
Collapse
Affiliation(s)
- Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon R. Procter
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- National Technical and Scientific Research Council, Buenos Aires, Argentina
| | - Bronner P. Gonçalves
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Shabir A. Madhi
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Mwangome
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Adam Mabrouk
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pamela Sithole
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Humberto Mucasse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Patrick V. Katana
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Artemis Koukounari
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celine Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G. Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charles Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - A. K. M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- Division of Epidemiology and Biostatistics, School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
30
|
Ealand C, Peters J, Jacobs O, Sewcharran A, Ghoor A, Golub J, Brahmbhatt H, Martinson N, Dangor Z, Lala SG, Kana B. Detection of Mycobacterium tuberculosis Complex Bacilli and Nucleic Acids From Tongue Swabs in Young, Hospitalized Children. Front Cell Infect Microbiol 2021; 11:696379. [PMID: 34195103 PMCID: PMC8238041 DOI: 10.3389/fcimb.2021.696379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/21/2021] [Indexed: 01/24/2023] Open
Abstract
Diagnosis of tuberculosis in pediatric patients remains challenging due to inherent difficulties associated with obtaining respiratory samples for molecular and culture-based testing. To address this, recent studies have highlighted the utility of tongue swabs to detect Mycobacterium tuberculosis genomic DNA in the oral epithelia of tuberculosis infected adults. It is unknown whether tongue swabs have similar utility for diagnosis of childhood tuberculosis and if the presence of DNA in these swabs was associated with whole bacilli. We therefore sought to conduct a preliminary assessment of the utility of tongue swabs to detect tubercle bacilli and their associated genetic material in young children. For this, we recruited hospitalized children with clinically diagnosed tuberculosis (n = 26) or lower respiratory tract infection (LRTI, n = 9). These categories were blinded for downstream laboratory tests, which included PCR, spoligotyping, smear microscopy, and culture. Mtb genomic DNA was detected by PCR only in clinically diagnosed TB cases [11/26 (31.4%)] and not in cases with LRTI. Of these, 5/11 [45.5%] were associated with a spoligotype. Spoligotyping also detected an additional six specimens that were negative by PCR. Using smear microscopy, 19/26 [73.1%] and 4/9 [44.4] were Mtb positive in the tuberculosis or LRTI categories respectively. We noted positive results on all three tests in 5/26 [19.2%] in the tuberculosis category and 0/9 in the LRTI category. All specimens were culture negative. Collectively, these preliminary data present a compelling case for broader testing of tongue swabs to diagnose tuberculosis in children where obtaining standard sputum specimens is not easy.
Collapse
Affiliation(s)
- Christopher Ealand
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Julian Peters
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Olivia Jacobs
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Astika Sewcharran
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Golub
- Center for TB Research, Johns Hopkins University, Baltimore, MD, United States
| | - Heena Brahmbhatt
- United States Agency for International Development (USAID), South Africa, Pretoria, South Africa.,Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Center for TB Research, Johns Hopkins University, Baltimore, MD, United States.,Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bavesh Kana
- Department of Science and Innovation/National Research Foundation (DSI/NRF) Centre of Excellence for Biomedical TB Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| |
Collapse
|
31
|
Nunes MC, Baillie VL, Kwatra G, Bhikha S, Verwey C, Menezes C, Cutland CL, Moore DP, Dangor Z, Adam Y, Mathivha R, Velaphi SC, Tsitsi M, Aguas R, Madhi SA. SARS-CoV-2 infection among healthcare workers in South Africa: a longitudinal cohort study. Clin Infect Dis 2021; 73:1896-1900. [PMID: 33949670 PMCID: PMC8135922 DOI: 10.1093/cid/ciab398] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 11/14/2022] Open
Abstract
From April to September 2020, we investigated severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) infections in a cohort of 396 healthcare workers
(HCWs) from 5 departments at Chris Hani Baragwanath Hospital, South Africa.
Overall, 34.6% of HCWs had polymerase chain reaction–confirmed SARS-CoV-2
infection (132.1 [95% confidence interval, 111.8–156.2] infections per
1000 person-months); an additional 27 infections were identified by serology.
HCWs in the internal medicine department had the highest rate of infection
(61.7%). Among polymerase chain reaction–confirmed cases, 10.4% remained
asymptomatic, 30.4% were presymptomatic, and 59.3% were symptomatic.
Collapse
Affiliation(s)
- Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sutika Bhikha
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Colin Menezes
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Cutland
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David P Moore
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics & Gynaecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rudo Mathivha
- Department of Intensive Care, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso C Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Merika Tsitsi
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ricardo Aguas
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | |
Collapse
|
32
|
Dangor Z, Khan M, Kwatra G, Izu A, Nakwa F, Ramdin T, Fredericks J, Lala SG, Madhi SA. The Association Between Breast Milk Group B Streptococcal Capsular Antibody Levels and Late-onset Disease in Young Infants. Clin Infect Dis 2021; 70:1110-1114. [PMID: 31056692 DOI: 10.1093/cid/ciz360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/30/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Animal-model studies have demonstrated less group B streptococcal (GBS) invasive disease and gastrointestinal colonization after enteral administration of serotype-specific capsular antibodies. There is, however, a paucity of information on the association of breast milk GBS serotype-specific capsular antibodies and risks for invasive disease in infants. The aim of this study was to explore the association between natural secretory immunoglobulin A (sIgA) capsular antibodies in breast milk and the occurrence of late-onset disease (LOD) in young infants. METHODS A matched case-control study was undertaken in infants <3 months of age in Johannesburg, South Africa. Breast milk samples were collected on cases and controls matched for gestational age, maternal age, and human immunodeficiency virus status at time of enrollment. Capsular serotype Ia, Ib, III, and V sIgA antibody concentrations were measured using the fluorescence-based micro-bead immunosorbent assay. RESULTS Breast milk samples were available for 31 LOD cases (8 serotype Ia and 23 serotype III), 21 recto-vaginally colonized matched controls (10 serotype Ia and 11 serotype III), and 84 serotype Ia and 105 serotype III noncolonized matched controls. Using a Bayesian model to estimate the probability of disease, there were 90% reductions in the risks of developing serotypes Ia and III LOD with sIgA concentrations ≥0.14 µg/mL and ≥2.52 µg/mL, respectively. CONCLUSIONS Breast milk sIgA capsular antibodies were associated with lower risks for LOD in young infants. The ability of GBS polysaccharide-protein conjugate vaccines currently under development to induce sIgA responses warrant investigation as potential mediators of protection against LOD.
Collapse
Affiliation(s)
- Ziyaad Dangor
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa.,Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Mahtaab Khan
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Alane Izu
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Firdose Nakwa
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanusha Ramdin
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy Fredericks
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal Human Immunodeficiency Virus Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| |
Collapse
|
33
|
Dangor Z, Verwey C, Lala SG, Mabaso T, Mopeli K, Parris D, Gray DM, Chang AB, Zar HJ. Lower Respiratory Tract Infection in Children: When Are Further Investigations Warranted? Front Pediatr 2021; 9:708100. [PMID: 34395346 PMCID: PMC8356913 DOI: 10.3389/fped.2021.708100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Theodore Mabaso
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Keketso Mopeli
- Department of Paediatrics and Child Health, Division of Pulmonology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Parris
- Department of Paeditrics, University of Pretoria, Pretoria, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
34
|
Madhi SA, Izu A, Kwatra G, Jones S, Dangor Z, Wadula J, Moultrie A, Adam Y, Pu W, Henry O, Briner C, Cutland CL. Association of Group B streptococcus serum serotype-specific anti-capsular IgG concentration and risk reduction for invasive Group B streptococcus disease in South African infants: an observational birth-cohort, matched case-control study. Clin Infect Dis 2020; 73:e1170-e1180. [PMID: 33341870 DOI: 10.1093/cid/ciaa1873] [Citation(s) in RCA: 7] [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] [Received: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Licensure of a Group B streptococcus (GBS) polysaccharide-protein conjugate vaccine for protecting infants against invasive GBS disease (IGbsD) will likely need to be based on demonstrating vaccine safety in pregnant women, and benchmarking immunogenicity against a serological threshold associated with risk reduction of IGbsD. We investigated the association between naturally-derived GBS serotype-Ia and III IgG and risk reduction of IGbsD in infants' ≤90 days of age. METHODS In a matched case-control study (ClinicalTrials.gov NCT02215226), IGbsD cases were identified from a cohort of 38,233 mother-newborn dyads. Mothers colonized vaginally with serotype-Ia or III at birth, and their healthy infants were eligible as matched controls. GBS serotype-specific anti-capsular IgG was measured on maternal and cord blood/infant sera by multiplex Luminex assay; and the IgG threshold associated with 90% risk reduction of IGbsD derived by estimating absolute disease risk. RESULTS In infants born ≥34 weeks gestational age, cord-blood IgG geometric mean concentrations (GMC) were lower in cases than controls for serotype-Ia (0.05 vs. 0.50µg/ml; p=0.004) and III (0.20 vs. 0.38µg/ml; p=0.078). Cord-blood IgG concentration ≥1.04 and ≥1.53µg/ml were associated with 90% risk reduction of serotype-Ia and III IGbsD, respectively. The maternal sera IgG threshold associated with 90% risk reduction was ≥2.31 and ≥3.41µg/ml for serotype-Ia and III, respectively. CONCLUSIONS The threshold associated with a reduced risk for serotype-Ia and III IGbsD identified on infant sera supports the case for licensure of a GBS polysaccharide-protein conjugate vaccine based on immunogenicity evaluation benchmarked against the defined thresholds.
Collapse
Affiliation(s)
- Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Stephanie Jones
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.,Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanette Wadula
- National Health Laboratory Services, Department of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Andrew Moultrie
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynecology, Chris Hani-Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Carmen Briner
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Clare L Cutland
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| |
Collapse
|
35
|
Paul P, Procter SR, Dangor Z, Bassat Q, Abubakar A, Santhanam S, Libster R, Gonçalves BP, Madhi SA, Bardají A, Mwangome E, Mabrouk A, John HB, Sánchez Yanotti C, Chandna J, Sithole P, Mucasse H, Katana PV, Koukounari A, Harden LM, Aerts C, Ghoor A, Leahy S, Mbatha S, Lowick S, Lala SG, Bramugy J, Newton C, Hossain AKMT, Sadeq-ur Rahman Q, Lambach P, Jit M, Lawn JE. Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa. Gates Open Res 2020; 4:138. [PMID: 34368637 PMCID: PMC8313848 DOI: 10.12688/gatesopenres.13185.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 09/05/2023] Open
Abstract
Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.
Collapse
Affiliation(s)
- Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon R. Procter
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- National Technical and Scientific Research Council, Buenos Aires, Argentina
| | - Bronner P. Gonçalves
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Shabir A. Madhi
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Mwangome
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Adam Mabrouk
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pamela Sithole
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Humberto Mucasse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Patrick V. Katana
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Artemis Koukounari
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celine Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G. Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charles Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - A. K. M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- Division of Epidemiology and Biostatistics, School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
36
|
Verwey C, Nunes MC, Dangor Z, Madhi SA. Pulmonary function sequelae after respiratory syncytial virus lower respiratory tract infection in children: A systematic review. Pediatr Pulmonol 2020; 55:1567-1583. [PMID: 32364320 DOI: 10.1002/ppul.24804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/23/2020] [Indexed: 01/08/2023]
Abstract
Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) during early childhood may be associated with subsequent pulmonary sequelae, including recurrent wheezing and asthma. We undertook a systematic review to investigate the pulmonary function sequelae following RSV LRTI in the first 3 years of life. The systematic review protocol was registered on PROSPERO (CRD42018087168). PubMed, Scopus, Cochrane Library, and World Health Organization Global Index Medicus, as well as ClinicalTrials.gov and Cochrane Central Register of Controlled Trials, were searched up until 15 June 2019 for published and unpublished interventional and observational studies with the end-point outcome of pulmonary function testing (PFT) after a proven RSV LRTI in the first 3 years of life. Two independent reviewers screened all the titles, abstracts and full texts. Data were extracted using a standardized data extraction form. Corresponding authors were contacted for additional information if required. All studies were assessed for risk of bias using the Newcastle-Ottawa quality assessment scale. The final analysis included 31 studies. Thirteen studies using spirometry reported no association between RSV LRTI and pulmonary function sequelae. The remaining 16 reported abnormal spirometry; 12 obstructive airways disease, three restrictive lung disease, and one mixed lung disease. The heterogeneity in PFT techniques, different ages at testing, and methods used for reporting outcomes made direct comparisons or pooled effect estimates impossible. Children with confirmed RSV LRTI during the first 3 years of life often have abnormal PFTs, favoring obstructive airways disease. The evidence, however, is not overwhelming with conflicting results between studies.
Collapse
Affiliation(s)
- Charl Verwey
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine-Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
37
|
Ji W, Liu H, Madhi SA, Cunnington M, Zhang Z, Dangor Z, Zhou H, Mu X, Jin Z, Wang A, Qin X, Gao C, Zhu Y, Feng X, She S, Yang S, Liu J, Lei J, Jiang L, Liu Z, Li G, Li Q, Deng Q, Gao K, Fang Y. Clinical and Molecular Epidemiology of Invasive Group B Streptococcus Disease among Infants, China. Emerg Infect Dis 2019; 25:2021-2030. [PMID: 31600132 PMCID: PMC6810193 DOI: 10.3201/eid2511.181647] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Invasive group B Streptococcus (GBS) remains a leading cause of illness and death among infants globally. We conducted prospective and retrospective laboratory-based surveillance of GBS-positive cultures from infants <3 months of age in 18 hospitals across China during January 1, 2015-December 31, 2017. The overall incidence of GBS was 0.31 (95% CI 0.27-0.36) cases/1,000 live births; incidence was 0-0.76 cases/1,000 live births across participating hospitals. The case-fatality rate was 2.3%. We estimated 13,604 cases of GBS and 1,142 GBS-associated deaths in infants <90 days of age annually in China. GBS isolates were most commonly serotype III (61.5%) and clonal complex 17 (40.6%). Enhanced active surveillance and implementation of preventive strategies, such as maternal GBS vaccination, warrants further investigation in China to help prevent these infections.
Collapse
Affiliation(s)
| | | | - Shabir A. Madhi
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Marianne Cunnington
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Zilu Zhang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Ziyaad Dangor
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Haijian Zhou
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Xiaoping Mu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Zhengjiang Jin
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Aimin Wang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Xiaosong Qin
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Chunyan Gao
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Yuning Zhu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Xiaodan Feng
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Shangyang She
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Shuhua Yang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Jing Liu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Jine Lei
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Lan Jiang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Zeshi Liu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Gang Li
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Qiuhong Li
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Qiulian Deng
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Kankan Gao
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | | |
Collapse
|
38
|
Velaphi SC, Westercamp M, Moleleki M, Pondo T, Dangor Z, Wolter N, von Gottberg A, Shang N, Demirjian A, Winchell JM, Diaz MH, Nakwa F, Okudo G, Wadula J, Cutland C, Schrag SJ, Madhi SA. Surveillance for incidence and etiology of early-onset neonatal sepsis in Soweto, South Africa. PLoS One 2019; 14:e0214077. [PMID: 30970036 PMCID: PMC6457488 DOI: 10.1371/journal.pone.0214077] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/06/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Globally, over 400,000 neonatal deaths in 2015 were attributed to sepsis, however, the incidence and etiologies of these infections are largely unknown in low-middle income countries. We aimed to determine incidence and etiology of community-acquired early-onset (<72 hours age) sepsis (EOS) using culture and molecular diagnostics. METHODS This was a prospective observational study, in which we conducted a surveillance for pathogens using a combination of blood culture and a polymerase chain reaction (PCR)-based test. Blood culture was performed on all neonates with suspected EOS. Among the subset fulfilling criteria for protocol-defined EOS, blood and nasopharyngeal (NP) respiratory swabs were tested by quantitative real-time reverse-transcriptase PCR using a Taqman Array Card (TAC) with 15 bacterial and 12 viral targets. Blood and NP samples from 312 healthy newborns were also tested by TAC to estimate background positivity rates. We used variant latent-class methods to attribute etiologies and calculate pathogen-specific proportions and incidence rates. RESULTS We enrolled 2,624 neonates with suspected EOS and from these 1,231 newborns met criteria for protocol-defined EOS (incidence- 39.3/1,000 live-births). Using the partially latent-class modelling, only 26.7% cases with protocol-defined EOS had attributable etiology, and the largest pathogen proportion were Ureaplasma spp. (5.4%; 95%CI: 3.6-8.0) and group B Streptococcus (GBS) (4.8%; 95%CI: 4.1-5.8), and no etiology was attributable for 73.3% of cases. Blood cultures were positive in 99/1,231 (8.0%) with protocol-defined EOS (incidence- 3.2/1,000 live-births). Leading pathogens on blood culture included GBS (35%) and viridans streptococci (24%). Ureaplasma spp. was the most common organism identified on TAC among cases with protocol-defined EOS. CONCLUSION Using a combination of blood culture and a PCR-based test the common pathogens isolated in neonates with sepsis were Ureaplasma spp. and GBS. Despite documenting higher rates of protocol-defined EOS and using a combination of tests, the etiology for EOS remains elusive.
Collapse
Affiliation(s)
- Sithembiso C. Velaphi
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Westercamp
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Malefu Moleleki
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service (NHLS), and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tracy Pondo
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Ziyaad Dangor
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service (NHLS), and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service (NHLS), and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nong Shang
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Alicia Demirjian
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Jonas M. Winchell
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Maureen H. Diaz
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Firdose Nakwa
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Okudo
- Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- Department of Clinical Microbiology and Infectious Diseases, NHLS, South Africa and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie J. Schrag
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
39
|
Price CA, Green-Thompson L, Mammen VG, Madhi SA, Lala SG, Dangor Z. Knowledge gaps among South African healthcare providers regarding the prevention of neonatal group B streptococcal disease. PLoS One 2018; 13:e0205157. [PMID: 30289900 PMCID: PMC6173416 DOI: 10.1371/journal.pone.0205157] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate obstetric healthcare provider knowledge regarding the prevention of group B streptococcal disease in South African infants. METHODS Questionnaires exploring knowledge, attitudes and beliefs around group B streptococcal prevention were administered to consenting doctors and maternity nurses in a tertiary academic hospital. Qualitative assessments (focus groups) were undertaken with junior doctors and nurses. RESULTS 238 participants completed the questionnaire: 150 (63.0%) doctors and 88 (37.0%) nurses. Overall, 22.7% of participants correctly identified the risk-based prevention protocol recommended at this hospital. Most doctors (68.0%) and nurses (94.3%) could not correctly list a single risk factor. A third of doctors did not know the correct antibiotic protocols, and most (80.0%) did not know the recommended timing of antibiotics in relation to delivery. Focus group discussions highlighted the lack of knowledge, awareness and effective implementation of protocols regarding disease prevention. CONCLUSIONS Our study highlighted knowledge gaps on the risk-based prevention strategy in a setting which has consistently reported among the highest incidence of invasive group B streptococcal disease globally. In these settings, education and prioritization of the risk-based intrapartum antibiotic strategy is warranted, but an alternative vaccine-based strategy may prove more effective in preventing invasive group B streptococcal disease in the long-term.
Collapse
Affiliation(s)
- Caris A. Price
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Lionel Green-Thompson
- Office of Teaching and Learning, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vijay G. Mammen
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G. Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
40
|
Chaya S, Dangor Z, Solomon F, Nzenze SA, Izu A, Madhi SA. Incidence of tuberculosis meningitis in a high HIV prevalence setting: time-series analysis from 2006 to 2011. Int J Tuberc Lung Dis 2018; 20:1457-1462. [PMID: 27776585 DOI: 10.5588/ijtld.15.0845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING This study was undertaken at a tertiary hospital in Soweto, a peri-urban low-middle income setting. Mycobacterium tuberculosis meningitis (TBM) is a severe manifestation of extra-pulmonary tuberculosis. OBJECTIVE To describe the incidence, mortality and clinical features of TBM in human immunodeficiency virus (HIV) infected and non-infected children in South Africa from 2006 to 2011. DESIGN A retrospective, cross-sectional descriptive study. METHODS Electronic databases and individual patient records of all children with a discharge diagnosis of TBM were reviewed to yield incidence rate ratios (IRR) in HIV-infected and non-infected children. Clinical, laboratory and radiological characteristics were compared between HIV-infected and non-infected children with TBM. RESULTS Overall TBM incidence per 100 000 population in 2006 was 6.9 (95%CI 4.4-10.3) and 9.8 (95%CI 6.9-13.6) in 2009, but had subsequently declined to 3.1 (95%CI 1.6-5.5) by 2011. There was a significant reduction in the IRR of TBM among HIV-infected children (IRR 0.916, P = 0.036). The overall case fatality ratio was 6.7%. Clinical features, cerebrospinal fluid and computed tomography brain findings were similar in HIV-infected and non-infected children. CONCLUSION TBM incidence decreased over the study period from 2006 to 2011, and was temporally associated with an increase in the uptake of antiretroviral treatment in HIV-infected individuals.
Collapse
Affiliation(s)
- S Chaya
- Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Medical Research Council, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Z Dangor
- Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Medical Research Council, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - F Solomon
- Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Medical Research Council, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - S A Nzenze
- Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Medical Research Council, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - A Izu
- Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Medical Research Council, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - S A Madhi
- Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Medical Research Council, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa, National Institute for Communicable Diseases, Division of National Health Laboratory Service, Centre for Vaccines and Immunology, Sandringham, South Africa
| |
Collapse
|
41
|
Kohli-Lynch M, Russell NJ, Seale AC, Dangor Z, Tann CJ, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, O’Sullivan C, Nakwa F, Ben Hamouda H, Soua H, Giorgakoudi K, Ladhani S, Lamagni T, Rattue H, Trotter C, Lawn JE. Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2017; 65:S190-S199. [PMID: 29117331 PMCID: PMC5848372 DOI: 10.1093/cid/cix663] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. METHODS We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. RESULTS We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. CONCLUSIONS GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities.
Collapse
Affiliation(s)
- Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- King’s College London, United Kingdom
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Ziyaad Dangor
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, and
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, and
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, and
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Catherine O’Sullivan
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
| | - Firdose Nakwa
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hechmi Ben Hamouda
- Department of Neonatology, University Hospital Tahar Sfar, Mahdia, Tunisia
| | - Habib Soua
- Department of Neonatology, University Hospital Tahar Sfar, Mahdia, Tunisia
| | | | | | | | - Hilary Rattue
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
| | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| |
Collapse
|
42
|
Dzanibe S, Adrian PV, Mlacha SZK, Dangor Z, Kwatra G, Madhi SA. Reduced Transplacental Transfer of Group B Streptococcus Surface Protein Antibodies in HIV-infected Mother-Newborn Dyads. J Infect Dis 2017; 215:415-419. [PMID: 27932617 DOI: 10.1093/infdis/jiw566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/28/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
We evaluated the effect of maternal HIV infection on transplacental antibody transfer specific to 8 group B Streptococcus (GBS) surface proteins among 81 HIV-uninfected and 83 HIV-infected mother-newborn pairs using a multiplex immunoassay. Significantly lower antibody titers were detected in HIV-infected mothers and HIV-exposed uninfected newborns compared to HIV-uninfected mother-newborn dyads. Maternal HIV infection was also associated with reduced transplacental transfer of antibodies for Sip (25.8%), Foldase (30.4%), gba0392 (36.5%), gbs0393 (32.9%), gbs1539 (39.2%), gbs2106 (35.7%), and BibA (19.4%); P < .003. This reduced transplacental antibody might contribute to increased susceptibility for invasive GBS disease in HIV-exposed uninfected infants.
Collapse
Affiliation(s)
- Sonwabile Dzanibe
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.,MRC, Respiratory and Meningeal Pathogens Research Unit
| | - Peter V Adrian
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.,MRC, Respiratory and Meningeal Pathogens Research Unit
| | - Sheila Z Kimaro Mlacha
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.,MRC, Respiratory and Meningeal Pathogens Research Unit
| | - Ziyaad Dangor
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.,MRC, Respiratory and Meningeal Pathogens Research Unit.,Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.,MRC, Respiratory and Meningeal Pathogens Research Unit
| | - Shabir A Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.,MRC, Respiratory and Meningeal Pathogens Research Unit.,National Institutes for Communicable Diseases, Johannesburg, South Africa
| |
Collapse
|
43
|
Madhi SA, Dangor Z. Prospects for preventing infant invasive GBS disease through maternal vaccination. Vaccine 2017; 35:4457-4460. [PMID: 28237500 DOI: 10.1016/j.vaccine.2017.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 11/26/2022]
Abstract
Group B streptococcus (GBS) is a leading cause of neonatal sepsis, with the highest incidence (1.3 per 1000 live births) reported from Africa. Although the incidence of invasive GBS disease is reportedly low in South Asia, there is disconnect between prevalence of maternal recto-vaginal colonization and the incidence of early-onset disease (EOD). This is possibly due to case-ascertainment biases that omit investigation of newborns dying on day-0 of life, which accounts for >90% of EOD. Furthermore, GBS is associated with approximately 15% of all infection related stillbirths. Vaccination of pregnant women with a serotype-specific polysaccharide epitope vaccine could possibly protect against EOD and late-onset disease (LOD) in their infants through transplacental transfer of serotype-specific capsular antibody. Furthermore, vaccination of pregnant women might also protect against impaired neurodevelopment following GBS associated neonatal sepsis, and fetal loss/stillbirths. Licensure of a GBS vaccine might be feasible based on safety evaluation and a sero-correlate of protection, with vaccine effectiveness subsequently being demonstrated in phase IV studies. A randomized-controlled trial would, however, be best suited as a vaccine-probe to fully characterize the contribution of GBS to neonatal sepsis associated morbidity and mortality and adverse fetal outcomes.
Collapse
Affiliation(s)
- Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Ziyaad Dangor
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| |
Collapse
|
44
|
Dangor Z, Nunes MC, Kwatra G, Lala SG, Madhi SA. Vaccination of HIV-infected pregnant women: implications for protection of their young infants. Trop Dis Travel Med Vaccines 2017; 3:1. [PMID: 28883971 PMCID: PMC5530931 DOI: 10.1186/s40794-016-0044-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/18/2016] [Indexed: 12/02/2022]
Abstract
Background The prevention of mother to child transmission of HIV has resulted in reduced burden of pediatric HIV-infection, but the prevalence of maternal HIV infection remains high in sub-Saharan African countries. HIV-exposed-uninfected infants have an increased risk of morbidity and mortality due to infectious diseases than HIV-unexposed infants, particularly during the first six months of life, which in part might be due to lower levels of pathogen-specific protective antibodies acquired transplacentally from their mothers. This could be mitigated by vaccinating pregnant women to boost antibody levels; although vaccine responses among HIV-infected pregnant women might differ compared to HIV-uninfected women. We reviewed studies that compared natural and vaccine-induced antibody levels to different epitopes between HIV-infected and HIV-uninfected pregnant women. Findings Most studies reported lower baseline/pre-vaccination antibody levels in HIV-infected pregnant women, which may not be reversed by antiretroviral therapy during pregnancy. There were only few studies on vaccination of HIV-infected pregnant women, mainly on influenza virus and group B Streptococcus (GBS) vaccines. Immunogenicity studies on influenza vaccines indicated that HIV-infected pregnant women had lower vaccine induced hemagglutination inhibition antibody titers and a decreased likelihood of seroconversion compared to HIV-uninfected women; and while higher CD4+ T-lymphocyte levels were associated with better immune responses to vaccination, HIV viral load was not associated with responses. Furthermore, infants born to influenza vaccinated HIV-infected pregnant women also had lower antibody levels and a lower proportion of HIV-exposed infants had titers above the putative correlate of protection compared to HIV-unexposed infants. The immunogenicity of a CRM197-conjugated trivalent GBS vaccine was also lower in HIV-infected pregnant women compared to HIV-uninfected women, irrespective of CD4+ T-lymphocyte counts. Conclusions Poorer immunogenicity of vaccines reported in HIV-infected compared to HIV-uninfected pregnant women might compromise the potential benefits to their young infants. Alternate vaccination strategies, including vaccines with higher antigen concentration, adjuvanted vaccines or multiple doses schedules might be required in HIV-infected pregnant women to optimize antibody transferred to their fetuses.
Collapse
Affiliation(s)
- Ziyaad Dangor
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.,National Institute for Communicable Diseases: a division of National Health Laboratory Service, Johannesburg, South Africa
| |
Collapse
|
45
|
Nishihara Y, Dangor Z, French N, Madhi S, Heyderman R. Challenges in reducing group B Streptococcus disease in African settings. Arch Dis Child 2017; 102:72-77. [PMID: 27831912 PMCID: PMC5256401 DOI: 10.1136/archdischild-2016-311419] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 01/06/2023]
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis in high-income settings and is associated with high rates of neonatal mortality and morbidity. There is now increasing evidence to suggest that there is a high GBS disease burden in resource-limited countries, and it is therefore critically important to identify suitable and practical preventive strategies. In Europe and North America, intrapartum antibiotic prophylaxis (IAP) has led to a dramatic reduction of early-onset GBS disease. However, the methods for identifying pregnant women who should receive IAP and how to reduce late-onset GBS disease are not without controversy and are challenging for most sub-Saharan African countries. GBS vaccines are approaching phase III trials but are still under development. This review aims to explore the current evidence related to strategies for reducing invasive GBS disease in an African setting, the development of a GBS vaccine and whether preventative measures against GBS disease can be practically implemented.
Collapse
Affiliation(s)
- Yo Nishihara
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ziyaad Dangor
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Neil French
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Shabir Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Robert Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Division of Infection and Immunity, University College London, London, UK
| |
Collapse
|
46
|
Dangor Z, Cutland CL, Izu A, Kwatra G, Trenor S, Lala SG, Madhi SA. Temporal Changes in Invasive Group B Streptococcus Serotypes: Implications for Vaccine Development. PLoS One 2016; 11:e0169101. [PMID: 28036363 PMCID: PMC5201280 DOI: 10.1371/journal.pone.0169101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 10/27/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There is a paucity of longitudinal data on the serotype-specific burden of invasive group B Streptococcus (GBS) disease from low-middle income countries, which could inform selection of vaccine epitopes. METHODS From 2005 to 2014, infants less than 90 days of age with invasive GBS disease were identified through sentinel laboratory and hospital admission surveillance at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. RESULTS We identified 820 cases of invasive GBS disease, including 55% among newborns <7 days age (i.e. early-onset disease; EOD). The overall incidence (per 1,000 live births) of invasive GBS disease was 2.59 (95% CI: 2.42-2.77), including 1.41 (95% CI: 1.28-1.55) for EOD and 1.18 (95% CI: 1.06-1.30) in infants 7-89 days age (late-onset disease). Year-on-year, from 2005 to 2014, we observed a 9.4% increase in incidence of serotype Ia invasive disease (RR: 1.09; 95% CI: 1.04-1.15; p<0.001), and a 7.4% decline in serotype III invasive disease (RR: 0.93; 95% CI: 0.90-0.96; p<0.001). Overall, serotypes Ia (28.2%), III (55.4%) and V (7.9%) were the commonest disease causing serotypes. CONCLUSIONS The incidence of invasive GBS disease has remained persistently high in our setting, with some changes in serotype distribution, albeit mainly involving the same group of dominant serotypes.
Collapse
Affiliation(s)
- Ziyaad Dangor
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Clare L. Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alane Izu
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siobhan Trenor
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G. Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases: a division of National Health Laboratory Service, Johannesburg, South Africa
| |
Collapse
|
47
|
Abstract
This exploratory study addresses the issue of woman abuse in South Africa and the resources for victimized women and children, or their absence. It provides documentation for the expansion of social, health, and legal services on behalf of this at-risk population. Ethnographic interviews were conducted with a convenience sample of 37 South African women from various community settings and institutions in the Johannesburg region, and interview data were grouped in categories. Two focus groups addressed issues that emerged from interview data. This study affirms the need for national survey data and in-depth research with abused women themselves to obtain a fuller picture of the personal, familial, and societal costs of violence against women. An unvarnished acknowledgment of domestic violence and its physical, emotional, and social toll on community stability and health is integral to the new South Africa's pursuit of political and economic reform.
Collapse
|
48
|
Dangor Z, Kwatra G, Izu A, Adrian P, Cutland CL, Velaphi S, Ballot D, Reubenson G, Zell ER, Lala SG, Madhi SA. Correlates of protection of serotype-specific capsular antibody and invasive Group B Streptococcus disease in South African infants. Vaccine 2015; 33:6793-9. [PMID: 26478200 DOI: 10.1016/j.vaccine.2015.10.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/11/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaccinating pregnant women may prevent invasive Group B Streptococcus (GBS) disease in their young infants. In a low-middle income setting, we sought to determine an association between natural maternal antibody responses and the development of invasive GBS disease. METHODS We undertook a matched case-control study in Johannesburg, South Africa. Maternal and infant antibody concentrations were compared between serotype-specific Ia and III GBS cases and well-baby controls in which the mother was colonized with the same serotype. RESULTS The median maternal serotype Ia and III antibody concentrations (in μg/mL) were 0.05 (IQR: 0.02-0.24; n=27) and 0.14 (IQR: 0.08-0.33; n=29) in cases, and 0.29 (IQR: 0.06-1.60; n=43) and 0.29 (IQR: 0.13-0.58; n=31) in homotypic controls, respectively. A smaller proportion of cases as compared to homotypic controls had higher serotype Ia and III maternal antibody concentrations. Using Bayesian modeling, we demonstrated that the risk of invasive GBS disease was less than 10% with maternal antibody concentrations ≥ 6 μg/mL and ≥ 3 μg/mL for serotypes Ia and III, respectively. CONCLUSIONS Maternal capsular antibody concentrations are associated with the risk of invasive GBS disease in infants. In a low-middle income setting with a high burden of invasive disease, we have demonstrated a sero-correlate of protection for GBS serotypes Ia and III which could facilitate vaccine licensure.
Collapse
Affiliation(s)
- Ziyaad Dangor
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Gaurav Kwatra
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa
| | - Alane Izu
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa
| | - Peter Adrian
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Daynia Ballot
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Gary Reubenson
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Sanjay G Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; National Institute for Communicable Diseases: A Division of National Health Laboratory Service, South Africa.
| |
Collapse
|
49
|
Dangor Z, Kwatra G, Izu A, Adrian P, Cutland CL, Velaphi S, Ballot D, Reubenson G, Zell ER, Lala SG, Madhi SA. Association between maternal Group B Streptococcus surface-protein antibody concentrations and invasive disease in their infants. Expert Rev Vaccines 2015; 14:1651-60. [PMID: 26364978 DOI: 10.1586/14760584.2015.1085307] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Group B Streptococcus (GBS) surface-proteins have been shown to be immunogenic and potential vaccine candidates. We aim to determine the association between maternal IgG antibodies to select GBS surface-proteins and invasive GBS disease in their infants. METHODS Using a matched case-control study, maternal antibody levels for GBS-immunogenic bacterial adhesin, fibrinogen-binding protein A and pilus-island (PI) PI-1, PI-2a, PI-2b were compared between infants with invasive GBS disease and well-baby controls. RESULTS The absolute risk of disease did not differ between cases and colonized controls with increasing antibody concentrations for these surface-proteins. There was, however, a relative risk reduction in invasive disease associated with fibrinogen-binding protein A, with an adjusted odds ratio of 0.04 (95% CI: 0.01-0.69) at antibody levels ≥10,000 AU/ml. CONCLUSION We have not demonstrated an association between naturally occurring fibrinogen-binding protein A, GBS-immunogenic bacterial adhesin, and PI surface-protein antibodies and the risk of invasive disease in young infants. These surface-proteins may not be suitable GBS vaccine candidates.
Collapse
Affiliation(s)
- Ziyaad Dangor
- a 1 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,b 2 Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,c 3 Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- a 1 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,b 2 Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alane Izu
- a 1 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,b 2 Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Adrian
- a 1 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,b 2 Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Cutland
- a 1 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,b 2 Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- c 3 Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daynia Ballot
- c 3 Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gary Reubenson
- c 3 Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sanjay G Lala
- c 3 Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- a 1 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,b 2 Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,e 5 National Institute for Communicable Diseases: a division of National Health Laboratory Service, Centre for Vaccines and Immunology, Sandringham, South Africa
| |
Collapse
|
50
|
Nan C, Dangor Z, Cutland CL, Edwards MS, Madhi SA, Cunnington MC. Maternal group B Streptococcus-related stillbirth: a systematic review. BJOG 2015; 122:1437-45. [PMID: 26177561 DOI: 10.1111/1471-0528.13527] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited epidemiological data on the association between maternal rectovaginal group B Streptococcus (GBS) colonisation and stillbirth makes assessment of antenatal interventions for GBS stillbirth difficult. OBJECTIVES To systematically review the existing literature and evaluate the incidence of GBS-related stillbirth by region up to March 2015. SEARCH STRATEGY A systematic review of the published literature was completed using PubMed/MEDLINE, EMBASE, LILACS, and Cochrane Library, with Medical Subject Headings (MeSH) and search terms based upon the Centers for Disease Control and Prevention's (CDC) Active Bacterial Core Surveillance (ABCs) GBS-related stillbirth definition and chorioamnionitis. SELECTION CRITERIA Studies reporting original data on GBS-related stillbirth occurring ≥20 weeks of gestation, with GBS confirmed by autopsy or by culture from the placenta, amniotic fluid, or other normally sterile site samples from the stillborn. DATA COLLECTION AND ANALYSIS Descriptive analyses were performed with the absolute GBS-related stillbirth rates and proportion of stillbirths attributed to GBS calculated per study where possible. Differences in stillbirth definitions did not allow for pooled estimates to be calculated. MAIN RESULTS Seventeen studies reported GBS-related stillbirth rates varying from 0.04 to 0.9 per 1000 births, with the proportion of stillbirths associated with GBS ranging from 0 to 12.1%. Most studies reported data from before the year 2000 and from high-income countries. CONCLUSIONS The sparsely available epidemiological evidence was not reported consistently, emphasising the importance of standardised stillbirth definitions and diagnostic methods to optimally assess the effectiveness of any future antenatal interventions. Timing of stillbirth, GBS serotype, and global diversity were gaps in the current evidence. TWEETABLE ABSTRACT Systematic review finds Group B Streptococcus causes up to 12.1% of stillbirths, but more research is needed.
Collapse
Affiliation(s)
- C Nan
- Cassandra Nan, Research Consultant, Maastricht, the Netherlands
| | - Z Dangor
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - C L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - M S Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - S A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | |
Collapse
|