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Hayon J, Lupo S, Poveda C, Jones KM, Qian Q, Wu H, Giordano TP, Fleischmann CJ, Bern C, Whitman JD, Clark EH. Adaptation of Chagas Disease Screening Recommendations for a Community of At-risk HIV in the United States. Clin Infect Dis 2024; 78:453-456. [PMID: 37805935 DOI: 10.1093/cid/ciad616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023] Open
Abstract
Chagas disease (CD), caused by Trypanosoma cruzi, is underdiagnosed in the United States. Improved screening strategies are needed, particularly for people at risk for life-threatening sequelae of CD, including people with human immunodeficiency virus (HIV, PWH). Here we report results of a CD screening strategy applied at a large HIV clinic serving an at-risk population.
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Affiliation(s)
- Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Sofia Lupo
- McGovern School of Medicine, University of Texas, Houston, Texas, USA
| | - Cristina Poveda
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital Center for Vaccine Development, Houston, Texas, USA
| | - Kathryn M Jones
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital Center for Vaccine Development, Houston, Texas, USA
| | - Qian Qian
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hulin Wu
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Thomas P Giordano
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Charles J Fleischmann
- Department of Laboratory Medicine, University of California SanFrancisco School of Medicine, San Francisco, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California SanFrancisco School of Medicine, San Francisco, California, USA
| | - Eva H Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
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Kelly EA, Echeverri Alegre JI, Promer K, Hayon J, Iordanov R, Rangwalla K, Zhang JJ, Fang Z, Huang C, Bittencourt CE, Reed S, Andrade RM, Bern C, Clark EH, Whitman JD. Chagas Disease Diagnostic Practices at Four Major Hospital Systems in California and Texas. J Infect Dis 2024; 229:198-202. [PMID: 37853514 PMCID: PMC11032249 DOI: 10.1093/infdis/jiad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is a parasitic disease that affects ∼300 000 people living in the United States. CD leads to cardiac and/or gastrointestinal disease in up to 30% of untreated people. However, end-organ damage can be prevented with early diagnosis and antiparasitic therapy. METHODS We reviewed electronic health records of patients who underwent testing for CD at four hospital systems in California and Texas between 2016 and 2020. Descriptive analyses were performed as a needs assessment for improving CD diagnosis. RESULTS In total, 470 patients were tested for CD. Cardiac indications made up more than half (60%) of all testing, and the most frequently cited cardiac condition was heart failure. Fewer than 1% of tests were ordered by obstetric and gynecologic services. Fewer than half (47%) of patients had confirmatory testing performed at the Centers for Disease Control and Prevention. DISCUSSION Four major hospitals systems in California and Texas demonstrated low overall rates of CD diagnostic testing, testing primarily among older patients with end-organ damage, and incomplete confirmatory testing. This suggests missed opportunities to diagnose CD in at-risk individuals early in the course of infection when antiparasitic treatment can reduce the risk of disease progression and prevent vertical transmission.
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Affiliation(s)
- Emily A Kelly
- Department of Laboratory Medicine, University of California, SanFrancisco, San Francisco, California, USA
| | | | - Katherine Promer
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
| | - Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Roumen Iordanov
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Khuzaima Rangwalla
- School of Medicine, University of California, SanFrancisco, San Francisco, California, USA
| | - Jerry J Zhang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Zian Fang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Cindy Huang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | | | - Sharon Reed
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Rosa M Andrade
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Eva H Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, SanFrancisco, San Francisco, California, USA
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Moser MS, Fleischmann CJ, Kelly EA, Prince HE, Bern C, Whitman JD. Concordance of Results by Three Chagas Disease Antibody Assays in U.S. Clinical Specimens. J Clin Microbiol 2023; 61:e0181422. [PMID: 36853034 PMCID: PMC10035296 DOI: 10.1128/jcm.01814-22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Matthew S. Moser
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Charles J. Fleischmann
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily A. Kelly
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey D. Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
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Moser MS, Fleischmann CJ, Kelly EA, Townsend RL, Stramer SL, Bern C, Whitman JD. Evaluation of InBios Chagas Detect Fast, a Novel Enzyme-Linked Immunosorbent Assay for the Detection of Anti-Trypanosoma cruzi Antibodies. J Clin Microbiol 2023; 61:e0176222. [PMID: 36853062 PMCID: PMC10035310 DOI: 10.1128/jcm.01762-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Matthew S. Moser
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Charles J. Fleischmann
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily A. Kelly
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Susan L. Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey D. Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
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5
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Iniguez E, Saha S, Petrellis G, Menenses C, Herbert S, Gonzalez-Rangel Y, Rowland T, Aronson NE, Rose C, Haines LR, Acosta-Serrano A, Serafim TD, Oliveira F, Srikantiah S, Bern C, Valenzuela JG, Kamhawi S. A composite recombinant salivary proteins biomarker for Phlebotomus argentipes provides a surveillance tool post-elimination of visceral leishmaniasis in India. J Infect Dis 2022; 226:1842-1851. [PMID: 36052609 DOI: 10.1093/infdis/jiac354] [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: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Incidence of visceral leishmaniasis (VL) in the Indian subcontinent (ISC) has declined by more than 95% since initiation of the elimination program in 2005. As the ISC transitions to the post-elimination surveillance phase, an accurate measurement of human-vector contact is needed to assure long-term success. To develop this tool, we identified PagSP02 and PagSP06 from saliva of Phlebotomus argentipes, the vector of Leishmania donovani in the ISC, as immunodominant proteins in humans. We also established the absence of cross-reactivity with Ph. papatasi saliva, the only other human-biting sand fly in the ISC. Importantly, by combining recombinant rPagSP02 and rPagSP06 we achieved greater antibody recognition and specificity than single salivary proteins. The Receiver Operating Characteristics curve for rPagSP02 + rPagSP06 predicts exposure to Ph. argentipes bites with 90% specificity and 87% sensitivity compared to negative control sera (P >0.0001). Overall, rPagSP02 + rPagSP06 provides an effective surveillance tool for monitoring vector control efforts post-VL elimination.
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Affiliation(s)
- Eva Iniguez
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Samiran Saha
- Department of Biotechnology, Institute of Science, Visva Bharati University, West Bengal, India
| | - Georgios Petrellis
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA.,Laboratory of Microbiology, Parasitology and Hygiene, University of Antwerp, Antwerp, Belgium
| | - Claudio Menenses
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Samantha Herbert
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Yvonne Gonzalez-Rangel
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Tobin Rowland
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Naomi E Aronson
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Clair Rose
- Department of Parasitology and Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lee Rafuse Haines
- Department of Parasitology and Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Alvaro Acosta-Serrano
- Department of Parasitology and Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tiago D Serafim
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Fabiano Oliveira
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Sridhar Srikantiah
- Bihar Technical Support Program, CARE India Solutions for Sustainable Development, Patna, India
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jesus G Valenzuela
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Shaden Kamhawi
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
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Win S, Miranda-Schaeubinger M, Gustavo Durán Saucedo R, Carballo Jimenez P, Flores J, Mercado-Saavedra B, Camila Telleria L, Raafs A, Verastegui M, Bern C, Tinajeros F, Heymans S, Marcus R, Gilman RH, Mukherjee M. Early identification of patients with Chagas disease at risk of developing cardiomyopathy using 2-D speckle tracking strain. IJC Heart & Vasculature 2022; 41:101060. [PMID: 35647262 PMCID: PMC9136131 DOI: 10.1016/j.ijcha.2022.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022]
Abstract
What is already known about this subject? Speckle-tracking strain echocardiography (STE) is added to conventional echocardiography and has been shown to detect subclinical myocardial contractile dysfunction before a reduction in LVEF. What does this study add? In this study, we evaluate the utility of LV STE for predicting worsening CCC in patients with Chagas disease. How might this impact on clinical practice? Screening for changes in STE-based Global Longitudinal Strain (GLS) may provide a non-invasive approach to identify patients who could benefit from earlier management, such as more frequent follow-up or initiation of treatment.
Background Chagas disease is an endemic protozoan disease with high prevalence in Latin America. Of those infected, 20–30% will develop chronic Chagas cardiomyopathy (CCC) however, prediction using existing clinical criteria remains poor. In this study, we investigated the utility of left ventricular (LV) echocardiographic speckle-tracking global longitudinal strain (GLS) for early detection of CCC. Methods and results 139 asymptomatic T. cruzi seropositive subjects with normal heart size and normal LV ejection fraction (EF) (stage A or B) were enrolled in this prospective observational study and underwent paired echocardiograms at baseline and 1-year follow-up. Progressors were participants classified as stage C or D at follow-up due to development of symptoms of heart failure, cardiomegaly, or decrease in LVEF. LV GLS was calculated as the average peak systolic strain of 16 LV segments. Measurements were compared between participants who progressed and did not progress by two-sample t-test, and the odds of progression assessed by multivariable logistic regression. Of the 139 participants, 69.8% were female, mean age 55.8 ± 12.5 years, with 12 (8.6%) progressing to Stage C or D at follow-up. Progressors tended to be older, male, with wider QRS duration. LV GLS was −19.0% in progressors vs. –22.4% in non-progressors at baseline, with 71% higher odds of progression per +1% of GLS (adjusted OR 1.71, 95% CI 1.20–2.44, p = 0.003). Conclusion Baseline LV GLS in participants with CCC stage A or B was predictive of progression within 1-year and may guide timing of clinical follow-up and promote early detection or treatment.
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Affiliation(s)
- Sithu Win
- University of California San Francisco, San Francisco, CA, USA
- Corresponding author.
| | | | | | | | - Jorge Flores
- Universidad Católica Boliviana San Pablo, Bolivia
| | | | | | - Anne Raafs
- Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Division of Cardiology, Maastricht, Netherlands
| | | | - Caryn Bern
- University of California San Francisco, San Francisco, CA, USA
| | | | - Stephane Heymans
- Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Division of Cardiology, Maastricht, Netherlands
| | - Rachel Marcus
- MedStar Heart & Vascular Institute, Baltimore, MD, USA
| | - Robert H. Gilman
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica Mukherjee
- Johns Hopkins University, Division of Cardiology, Baltimore, MD, USA
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7
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Garrett DO, Longley AT, Aiemjoy K, Yousafzai MT, Hemlock C, Yu AT, Vaidya K, Tamrakar D, Saha S, Bogoch II, Date K, Saha S, Islam MS, Sayeed KMI, Bern C, Shakoor S, Dehraj IF, Mehmood J, Sajib MSI, Islam M, Thobani RS, Hotwani A, Rahman N, Irfan S, Naga SR, Memon AM, Pradhan S, Iqbal K, Shrestha R, Rahman H, Hasan MM, Qazi SH, Kazi AM, Saddal NS, Jamal R, Hunzai MJ, Hossain T, Marks F, Carter AS, Seidman JC, Qamar FN, Saha SK, Andrews JR, Luby SP. Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project. Lancet Glob Health 2022; 10:e978-e988. [PMID: 35714648 PMCID: PMC9210262 DOI: 10.1016/s2214-109x(22)00119-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 06/12/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Precise enteric fever disease burden data are needed to inform prevention and control measures, including the use of newly available typhoid vaccines. We established the Surveillance for Enteric Fever in Asia Project (SEAP) to inform these strategies. METHODS From September, 2016, to September, 2019, we conducted prospective clinical surveillance for Salmonella enterica serotype Typhi (S Typhi) and Paratyphi (S Paratyphi) A, B, and C at health facilities in predetermined catchment areas in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients eligible for inclusion were outpatients with 3 or more consecutive days of fever in the last 7 days; inpatients with suspected or confirmed enteric fever; patients with blood culture-confirmed enteric fever from the hospital laboratories not captured by inpatient or outpatient enrolment and cases from the laboratory network; and patients with non-traumatic ileal perforation under surgical care. We used a hybrid surveillance model, pairing facility-based blood culture surveillance with community surveys of health-care use. Blood cultures were performed for enrolled patients. We calculated overall and age-specific typhoid and paratyphoid incidence estimates for each study site. Adjusted estimates accounted for the sensitivity of blood culture, the proportion of eligible individuals who consented and provided blood, the probability of care-seeking at a study facility, and the influence of wealth and education on care-seeking. We additionally calculated incidence of hospitalisation due to typhoid and paratyphoid. FINDINGS A total of 34 747 patients were enrolled across 23 facilitates (six tertiary hospitals, surgical wards of two additional hospitals, and 15 laboratory network sites) during the study period. Of the 34 303 blood cultures performed on enrolled patients, 8705 (26%) were positive for typhoidal Salmonella. Adjusted incidence rates of enteric fever considered patients in the six tertiary hospitals. Adjusted incidence of S Typhi, expressed per 100 000 person-years, was 913 (95% CI 765-1095) in Dhaka. In Nepal, the adjusted typhoid incidence rates were 330 (230-480) in Kathmandu and 268 (202-362) in Kavrepalanchok. In Pakistan, the adjusted incidence rates per hospital site were 176 (144-216) and 103 (85-126). The adjusted incidence rates of paratyphoid (of which all included cases were due to S Paratyphi A) were 128 (107-154) in Bangladesh, 46 (34-62) and 81 (56-118) in the Nepal sites, and 23 (19-29) and 1 (1-1) in the Pakistan sites. Adjusted incidence of hospitalisation was high across sites, and overall, 2804 (32%) of 8705 patients with blood culture-confirmed enteric fever were hospitalised. INTERPRETATION Across diverse communities in three south Asian countries, adjusted incidence exceeded the threshold for "high burden" of enteric fever (100 per 100 000 person-years). Incidence was highest among children, although age patterns differed across sites. The substantial disease burden identified highlights the need for control measures, including improvements to water and sanitation infrastructure and the implementation of typhoid vaccines. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA.
| | - Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Aiemjoy
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Shampa Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sadia Shakoor
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Rozina S Thobani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Seema Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Shiva R Naga
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | - Sailesh Pradhan
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | | | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | | | - Saqib H Qazi
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Abdul M Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Raza Jamal
- National Institute of Child Health, Karachi, Pakistan
| | - Mohammed J Hunzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tanvir Hossain
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK; University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Alice S Carter
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | | | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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Abstract
Geographic scale estimates of disease in older Latin America–born US residents may be useful for prevention and early recognition of chronic sequelae. We combined American Community Survey data with age-specific Trypanosoma cruzi prevalence derived from US surveys and World Health Organization reports to yield estimates of Chagas disease in the United States, which we mapped at the local level. In addition, we used blood donor data to estimate the relative prevalence of autochthonous T. cruzi infection. Our estimates indicate that 288,000 infected persons, including 57,000 Chagas cardiomyopathy patients and 43,000 infected reproductive-age women, currently live in the United States; 22–108 congenital infections occur annually. We estimated ≈10,000 prevalent cases of locally acquired T. cruzi infection. Mapping shows marked geographic heterogeneity of T. cruzi prevalence and illness. Reliable demographic and geographic data are key to guiding prevention and management of Chagas disease. Population-based surveys in high prevalence areas could improve the evidence base for future estimates. Knowledge of the demographics and geographic distribution of affected persons may aid practitioners in recognizing Chagas disease.
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Forsyth CJ, Manne-Goehler J, Bern C, Whitman J, Hochberg NS, Edwards M, Marcus R, Beatty NL, Castro-Sesquen YE, Coyle C, Stigler Granados P, Hamer D, Maguire JH, Gilman RH, Meymandi S. Recommendations for Screening and Diagnosis of Chagas Disease in the United States. J Infect Dis 2022; 225:1601-1610. [PMID: 34623435 PMCID: PMC9071346 DOI: 10.1093/infdis/jiab513] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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] [Received: 06/30/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chagas disease affects an estimated 326 000-347 000 people in the United States and is severely underdiagnosed. Lack of awareness and clarity regarding screening and diagnosis is a key barrier. This article provides straightforward recommendations, with the goal of simplifying identification and testing of people at risk for US healthcare providers. METHODS A multidisciplinary working group of clinicians and researchers with expertise in Chagas disease agreed on 6 main questions, and developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, after reviewing the relevant literature on Chagas disease in the United States. RESULTS Individuals who were born or resided for prolonged time periods in endemic countries of Mexico and Central and South America should be tested for Trypanosoma cruzi infection, and family members of people who test positive should be screened. Women of childbearing age with risk factors and infants born to seropositive mothers deserve special consideration due to the risk of vertical transmission. Diagnostic testing for chronic T. cruzi infection should be conducted using 2 distinct assays. CONCLUSIONS Increasing provider-directed screening for T. cruzi infection is key to addressing this neglected public health challenge in the United States.
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Affiliation(s)
- Colin J Forsyth
- Drugs for Neglected Diseases initiative, New York, New York, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachussetts, USA
| | - Morven Edwards
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rachel Marcus
- Medstar Union Memorial Hospital, Washington, District of Columbia, USA
- Latin American Society of Chagas, Washington, District of Columbia, USA
| | - Norman L Beatty
- Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christina Coyle
- Division of Infectious Diseases, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | | | - Davidson Hamer
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - James H Maguire
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease, Olive View-University of California, Los Angeles Medical Center, Sylmar, California, USA
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10
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Clark EH, Marquez C, Whitman JD, Bern C. Screening for Chagas disease should be included in entry-to-care testing for at-risk people with HIV living in the United States. Clin Infect Dis 2022; 75:901-906. [PMID: 35180299 DOI: 10.1093/cid/ciac154] [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: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Chagas disease screening of at-risk populations is essential to identify infected individuals and facilitate timely treatment before end-organ damage occurs. Co-infected people with HIV (PWH) are at risk for dangerous sequelae, specifically Trypanosoma cruzi reactivation disease. Recently published national recommendations indicate that at-risk PWH, particularly those from endemic areas or born to women from endemic areas, should be screened via a sensitive anti-T. cruzi IgG assay. However, immunocompromised patients with negative serologic results may warrant further investigation. Reactivation should be suspected in at-risk, untreated PWH with low CD4 cell counts presenting with acute neurologic or cardiac symptoms; these patients should be promptly evaluated and treated. One pragmatic solution to improve Chagas disease screening among PWH and thereby reduce T. cruzi -related morbidity and mortality is to incorporate Chagas disease screening into the panel of tests routinely performed during the entry-to-care evaluation for at-risk PWH.
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Affiliation(s)
- Eva H Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Carina Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Jeffrey D Whitman
- Department of Clinical Laboratory Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA
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11
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Ballard SB, Requena D, Mayta H, Sanchez GJ, Oyola-Lozada MG, Colquechagua Aliaga FD, Cabrera L, Vittet Mondonedo MD, Taquiri C, Tilley CAPTDH, Simons CDRMP, Meza RA, Bern C, Saito M, Figueroa-Quintanilla DA, Gilman RH. Enteropathogen Changes After Rotavirus Vaccine Scale-up. Pediatrics 2022; 149:183843. [PMID: 34918158 PMCID: PMC9647525 DOI: 10.1542/peds.2020-049884] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To inform next steps in pediatric diarrhea burden reduction by understanding the shifting enteropathogen landscape after rotavirus vaccine implementation. METHODS We conducted a case-control study of 1788 medically attended children younger than 5 years, with and without gastroenteritis, after universal rotavirus vaccine implementation in Peru. We tested case and control stools for 5 viruses, 19 bacteria, and parasites; calculated coinfection-adjusted attributable fractions (AFs) to determine pathogen-specific burdens; and evaluated pathogen-specific gastroenteritis severity using Clark and Vesikari scales. RESULTS Six pathogens were independently positively associated with gastroenteritis: norovirus genogroup II (GII) (AF 29.1, 95% confidence interval [CI]: 28.0-32.3), rotavirus (AF 8.9, 95% CI: 6.8-9.7), sapovirus (AF 6.3, 95% CI: 4.3-7.4), astrovirus (AF 2.8, 95% CI: 0.0-4.0); enterotoxigenic Escherichia coli heat stable and/or heat labile and heat stable (AF 2.4, 95% CI: 0.6-3.1), and Shigella spp. (AF 2.0, 95% CI: 0.4-2.2). Among typeable rotavirus cases, we most frequently identified partially heterotypic strain G12P[8] (54 of 81, 67%). Mean severity was significantly higher for norovirus GII-positive cases relative to norovirus GII-negative cases (Vesikari [12.7 vs 11.8; P < .001] and Clark [11.7 vs 11.4; P = .016]), and cases in the 6- to 12-month age range relative to cases in other age groups (Vesikari [12.7 vs 12.0; P = .0002] and Clark [12.0 vs 11.4; P = .0016]). CONCLUSIONS Norovirus is well recognized as the leading cause of pediatric gastroenteritis in settings with universal rotavirus vaccination. However, sapovirus is often overlooked. Both norovirus and sapovirus contribute significantly to the severe pediatric disease burden in this setting. Decision-makers should consider multivalent vaccine acquisition strategies to target multiple caliciviruses in similar countries after successful rotavirus vaccine implementation.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland,Naval Medical Research Unit No. 6, Callao, Peru,Address correspondence to Sarah-Blythe Ballard, MD, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Room W5515, Baltimore, MD 21205. E-mail:
| | - David Requena
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Holger Mayta
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Asociación Benéfica PRISMA, Lima, Peru
| | - Gerardo J. Sanchez
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria G. Oyola-Lozada
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Macarena D. Vittet Mondonedo
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carmen Taquiri
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - CAPT Drake H. Tilley
- Naval Medical Research Unit No. 6, Callao, Peru,Fleet Surgical Team SEVEN, Okinawa, Japan
| | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Mayuko Saito
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Robert H. Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Asociación Benéfica PRISMA, Lima, Peru
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12
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Kelly EA, Echeverri Alegre JI, Promer K, Hayon J, Iordanov R, Zhang JJ, Fang Z, Huang C, Bittencourt C, Reed SL, Andrade R, Bern C, Clark E, Whitman J. 742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas.
Methods
Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site.
Results
We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site.
Conclusion
These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US.
Disclosures
Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)
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Affiliation(s)
- Emily A Kelly
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | - Zian Fang
- University of California, Irvine, Irvine, CA
| | - Cindy Huang
- University of California, Irvine, Irvine, CA
| | | | | | | | - Caryn Bern
- University of California, San Francisco, San Francisco, CA
| | - Eva Clark
- Baylor College of Medicine, Houston, TX
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13
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Forsyth C, Manne-Goehler J, Manne-Goehler J, Bern C, Whitman J, Edwards MS, Hochberg N, Marcus R, Beatty N, Castro Y, Coyle C, Granados PS, Hamer DH, Maguire J, Gilman R, Meymandi S. 1210. Recommendations for Screening and Diagnosis of Chagas Disease in the United States. Open Forum Infect Dis 2021. [PMCID: PMC8644607 DOI: 10.1093/ofid/ofab466.1402] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Over 300,000 people in the United States are infected with Trypanosoma cruzi, the protozoan parasite that causes Chagas disease (CD). Only about 1% of estimated U.S. cases have been identified, usually through blood donor screening, and most people are unaware they have the infection. Screening is critical for increasing case detection and ensuring patients receive appropriate and timely care, but awareness of CD management strategies among healthcare providers is low. Diagnostic guidelines for CD in the United States are needed to increase provider-directed screening and diagnosis. Methods Screening recommendations were prepared by the U.S. Chagas Diagnostic Working Group, which consists of clinicians, researchers, and public health experts involved in CD programs. The group agreed on six main questions based on the PICO method (Population, Intervention, Comparison, and Outcome). Subgroups discussed each and proposed initial recommendations, which were then shared and validated within the larger group. The recommendations used the GRADE methodology, assigning two sets of ratings: 1) strength of the recommendation, and 2) quality of the evidence. Results The group recommended screening anyone who was born or lived for >6 months in South America, Central America and Mexico (Figure 1). Recent community-based studies found a prevalence of 1-3.8% in this population. Within this population, having a family member with CD, or having clinical conditions suggestive of CD, including electrocardiographic abnormalities, suggest an elevated risk. Screening women of childbearing age and infants born to seropositive women is important for preventing congenital transmission. Test performance may vary depending on several factors, including whether patients are from South America, Central America or Mexico. Confirmation therefore requires positive results on at least two serological tests based on different antigens or formats, in line with Pan American Health Organization (PAHO) recommendations. Once CD is confirmed, patients should receive an electrocardiogram and echocardiogram to monitor for development of cardiac complications. Conclusion These CD screening recommendations are meant to be a resource for U.S. healthcare providers to simplify testing of at-risk patients. Disclosures Jen Manne-Goehler, MD, DSc, Regeneron (Individual(s) Involved: Self): Scientific Research Study Investigator Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)
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Affiliation(s)
- Colin Forsyth
- Drugs for Neglected Diseases initiative, New York, New York
| | | | | | - Caryn Bern
- University of California, San Francisco, San Francisco, California
| | - Jeffrey Whitman
- University of California, San Francisco, San Francisco, California
| | | | | | - Rachel Marcus
- Medstar Union Memorial Hospital, Washington, District of Columbia
| | | | | | | | | | | | - James Maguire
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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14
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Clark EH, Bern C. Chagas Disease in People with HIV: A Narrative Review. Trop Med Infect Dis 2021; 6:tropicalmed6040198. [PMID: 34842854 PMCID: PMC8628961 DOI: 10.3390/tropicalmed6040198] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 01/18/2023] Open
Abstract
Many questions remain unanswered regarding the epidemiology, pathophysiology, diagnosis, treatment, and monitoring of Trypanosoma cruzi infection in people with HIV (PWH). The reported prevalence of T. cruzi infection in PWH living in endemic countries ranges from 1-28% and is likely similar in at-risk US populations. While classic cardiac and gastrointestinal presentations of chronic Chagas disease occur in PWH, PWH are additionally at risk for a severe and often fatal form of T. cruzi-mediated disease called reactivation disease. T. cruzi reactivation typically occurs in PWH with low CD4 counts and poor virologic control. National HIV guidelines in several endemic South American countries recommend that all PWH be screened for T. cruzi infection at the time of HIV diagnosis; however, this recommendation is not widely implemented. The early detection of T. cruzi infection in PWH is critical as the sequelae of Chagas disease, including T. cruzi reactivation, may be preventable through the restoration of robust cellular immunity via the initiation of antiretroviral therapy and the appropriate use of antitrypanosomal therapy.
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Affiliation(s)
- Eva H. Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Caryn Bern
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA 94158, USA;
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15
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Reimer-McAtee MJ, Mejia C, Clark T, Terle J, Pajuelo MJ, Cabeza J, Lora MH, Valencia E, Castro R, Lozano D, Bern C, Torrico F, Gilman RH. HIV and Chagas Disease: An Evaluation of the Use of Real-Time Quantitative Polymerase Chain Reaction to Measure Levels of Trypanosoma cruzi Parasitemia in HIV Patients in Cochabamba, Bolivia. Am J Trop Med Hyg 2021; 105:643-650. [PMID: 34398818 PMCID: PMC8592353 DOI: 10.4269/ajtmh.20-1141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/11/2021] [Indexed: 11/07/2022] Open
Abstract
This cross-sectional study evaluated epidemiologic characteristics of persons living with HIV (PWH) coinfected with Trypanosoma cruzi in Cochabamba, Bolivia, and estimated T. cruzi parasitemia by real-time quantitative polymerase chain reaction (qPCR) in patients with and without evidence of reactivation by direct microscopy. Thirty-two of the 116 HIV patients evaluated had positive serology for T. cruzi indicative of chronic Chagas disease (27.6%). Sixteen of the 32 (50%) patients with positive serology were positive by quantitative polymerase chain reaction (qPCR), and four of the 32 (12.5%) were positive by direct microscopy. The median parasite load by qPCR in those with CD4+ < 200 was 168 parasites/mL (73-9951) compared with 28.5 parasites/mL (15-1,528) in those with CD4+ ≥ 200 (P = 0.89). There was a significant inverse relationship between the degree of parasitemia estimated by qPCR from blood clot and CD4+ count on the logarithmic scale (rsBC= -0.70, P = 0.007). The correlation between T. cruzi estimated by qPCR+ blood clot and HIV viral load was statistically significant with rsBC = 0.61, P = 0.047. Given the significant mortality of PWH and Chagas reactivation and that 57% of our patients with CD4+ counts < 200 cells/mm3 showed evidence of reactivation, we propose that screening for chronic Chagas disease be considered in PWH in regions endemic for Chagas disease and in the immigrant populations in nonendemic regions. Additionally, our study showed that PWH with advancing immunosuppression have higher levels of estimated parasitemia measured by qPCR and suggests a role for active surveillance for Chagas reactivation with consideration of treatment with antitrypanosomal therapy until immune reconstitution can be achieved.
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Affiliation(s)
- Melissa J. Reimer-McAtee
- Division of Infectious Diseases, University of Texas Health Science Center, McGovern School of Medicine, Houston, Texas
| | - Carolina Mejia
- Colectivo de Estudios Aplicados y Desarrollo Salud y Medio Ambiente, Cochabamba, Bolivia
| | - Taryn Clark
- Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Medical Center, Brooklyn, New York; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jules Terle
- Department of Emergency Medicine, Louisiana State University, New Orleans, Louisiana
| | - Monica J. Pajuelo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Laboratory of Infectious Diseases, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeanne Cabeza
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Edward Valencia
- Laboratory of Infectious Diseases, Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Castro
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Daniel Lozano
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Caryn Bern
- University of California in San Francisco, San Francisco, California
| | - Faustino Torrico
- Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Robert H. Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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16
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Castro-Sesquen YE, Tinajeros F, Bern C, Galdos-Cardenas G, Malaga ES, Valencia Ayala E, Hjerrild K, Clipman SJ, Lescano AG, Bayangos T, Castillo W, Menduiña MC, Talaat KR, Gilman RH. The Immunoglobulin M-Shed Acute Phase Antigen (SAPA)-test for the Early Diagnosis of Congenital Chagas Disease in the Time of the Elimination Goal of Mother-to-Child Transmission. Clin Infect Dis 2021; 73:e477-e484. [PMID: 32667981 DOI: 10.1093/cid/ciaa986] [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: 03/24/2020] [Accepted: 07/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Diagnosis of congenital Chagas disease (CChD) in most endemic areas is based on low-sensitive microscopy at birth and 9-month immunoglobulin G (IgG), which has poor adherence. We aim to evaluate the accuracy of the Immunoglobulin M (IgM)-Shed Acute Phase Antigen (SAPA) test in the diagnosis of CChD at birth. METHODS Two cohort studies (training and validation cohorts) were conducted in 3 hospitals in the department of Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease, and all infants born to seropositive mothers were followed for up to 9 months to diagnose CChD. A composite reference standard was used to determine congenital infection and was based on the parallel use of microscopy, quantitative polymerase chain reaction (qPCR), and IgM-trypomastigote excreted-secreted antigen (TESA) blot at birth and/or 1 month, and/or the detection of anti-Trypanosoma cruzi IgG at 6 or 9 months. The diagnostic accuracy of the IgM-SAPA test was calculated at birth against the composite reference standard. RESULTS Adherence to the 6- or 9-month follow-up ranged from 25.3% to 59.7%. Most cases of CChD (training and validation cohort: 76.5% and 83.7%, respectively) were detected during the first month of life using the combination of microscopy, qPCR, and/or IgM-TESA blot. Results from the validation cohort showed that when only 1 infant sample obtained at birth was evaluated, the qPCR and the IgM-SAPA test have similar accuracy (sensitivity: range, 79.1%-97.1% and 76.7%-94.3%, respectively, and specificity: 99.5% and 92.6%, respectively). CONCLUSIONS The IgM-SAPA test has the potential to be implemented as an early diagnostic tool in areas that currently rely only on microscopy.
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Affiliation(s)
- Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Freddy Tinajeros
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Asociación Benéfica PRISMA, Lima, Peru
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Gerson Galdos-Cardenas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edith S Malaga
- Infectious Diseases Research Laboratory, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Edward Valencia Ayala
- Infectious Diseases Research Laboratory, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Steven J Clipman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrés G Lescano
- Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tabitha Bayangos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Kawsar R Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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17
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Bowman NM, Balasubramanian S, Gilman RH, Parobek C, Calderon M, Waltmann A, Messenger LA, Sanchez L, Bern C, Juliano JJ. Deep sequencing to detect diversity of Trypanosoma cruzi infection in patients co-infected with HIV and Chagas disease. J Infect Dis 2021; 225:243-247. [PMID: 34240175 DOI: 10.1093/infdis/jiab350] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, can reactivate and cause severe acute disease in immunocompromised patients such as those infected with HIV. We conducted amplicon deep sequencing of a 327-base pair fragment of the tcscd5 gene using an Ion Torrent PGM directly from clinical samples from HIV patients with high parasitemia. We describe the within host diversity, both characterizing the discrete typing unit (DTUs) of the infections and confirming the presence of multi-strain infections, directly from clinical samples. This method can rapidly provide information on the genetic diversity of T. cruzi infection, which can have direct impacts on clinical disease.
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Affiliation(s)
- Natalie M Bowman
- University of North Carolina at Chapel Hill School of Medicine, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC, United States
| | - Sujata Balasubramanian
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States
| | - Christian Parobek
- University of North Carolina at Chapel Hill School of Medicine, NC, United States
| | | | - Andreea Waltmann
- University of North Carolina at Chapel Hill, Institute of Global Health and Infectious Diseases, Chapel Hill, NC, United States
| | - Louisa A Messenger
- London School of Hygiene and Tropical Medicine, Department of Disease Control, Keppel Street, London, United Kingdom
| | - Leny Sanchez
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Caryn Bern
- University of California-San Francisco School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Jonathan J Juliano
- University of North Carolina at Chapel Hill School of Medicine, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC, United States
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18
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Gonçalves R, Landivar D, Grover Sañez Liendo E, Mamani Fernandez J, Ismail HM, Paine MJI, Courtenay O, Bern C. Improving houses in the Bolivian Chaco increases effectiveness of residual insecticide spraying against infestation with Triatoma infestans, vector of Chagas disease. Trop Med Int Health 2021; 26:1127-1138. [PMID: 34114721 DOI: 10.1111/tmi.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Failure to control domestic Triatoma infestans in the Chaco is attributed to vulnerable adobe construction, which provides vector refuges and diminishes insecticide contact. We conducted a pilot to test the impact of housing improvement plus indoor residual spraying (IRS) on house infestation and vector abundance in a rural community in the Bolivian Chaco. METHODS The intervention included three arms: housing improvement + IRS [HI], assisted IRS [AS] in which the team helped to clear the house pre-IRS and routine IRS [RS]. HI used locally available materials, traditional construction techniques and community participation. Vector parameters were assessed by Timed Manual Capture for 2 person-hours per house at baseline and medians of 114, 173, 314, 389 and 445 days post-IRS-1. A second IRS round was applied at a median of 314 days post-IRS-1. RESULTS Post-intervention infestation indices and abundance fell in all three arms. The mean odds of infestation was 0.29 (95% CL 0.124, 0.684) in the HI relative to the RS arm. No difference was observed between AS and RS. Vector abundance was reduced by a mean 44% (24.8, 58.0) in HI compared to RS, with no difference between AS and RS. Median delivered insecticide concentrations per house were lower than the target of 50 mg/m2 in >90% of houses in all arms. CONCLUSION Housing improvement using local materials and community participation is a promising strategy to improve IRS effectiveness in the Bolivian Chaco. A larger trial is needed to quantify the impact on reinfestation over time.
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Affiliation(s)
- Raquel Gonçalves
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, UK
| | | | | | | | - Hanafy M Ismail
- Liverpool School of Tropical Medicine, Department of Vector Biology, Liverpool, UK
| | - Mark J I Paine
- Liverpool School of Tropical Medicine, Department of Vector Biology, Liverpool, UK
| | - Orin Courtenay
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, UK
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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19
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Gonçalves R, Logan RAE, Ismail HM, Paine MJI, Bern C, Courtenay O. Indoor residual spraying practices against Triatoma infestans in the Bolivian Chaco: contributing factors to suboptimal insecticide delivery to treated households. Parasit Vectors 2021; 14:327. [PMID: 34134775 PMCID: PMC8207695 DOI: 10.1186/s13071-021-04831-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 06/09/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Indoor residual spraying (IRS) of insecticides is a key method to reduce vector transmission of Trypanosoma cruzi, causing Chagas disease in a large part of South America. However, the successes of IRS in the Gran Chaco region straddling Bolivia, Argentina, and Paraguay, have not equalled those in other Southern Cone countries. AIMS This study evaluated routine IRS practices and insecticide quality control in a typical endemic community in the Bolivian Chaco. METHODS Alpha-cypermethrin active ingredient (a.i.) captured onto filter papers fitted to sprayed wall surfaces, and in prepared spray tank solutions, were measured using an adapted Insecticide Quantification Kit (IQK™) validated against HPLC quantification methods. The data were analysed by mixed-effects negative binomial regression models to examine the delivered insecticide a.i. concentrations on filter papers in relation to the sprayed wall heights, spray coverage rates (surface area / spray time [m2/min]), and observed/expected spray rate ratios. Variations between health workers and householders' compliance to empty houses for IRS delivery were also evaluated. Sedimentation rates of alpha-cypermethrin a.i. post-mixing of prepared spray tanks were quantified in the laboratory. RESULTS Substantial variations were observed in the alpha-cypermethrin a.i. concentrations delivered; only 10.4% (50/480) of filter papers and 8.8% (5/57) of houses received the target concentration of 50 mg ± 20% a.i./m2. The delivered concentrations were not related to those in the matched spray tank solutions. The sedimentation of alpha-cypermethrin a.i. in the surface solution of prepared spray tanks was rapid post-mixing, resulting in a linear 3.3% loss of a.i. content per minute and 49% loss after 15 min. Only 7.5% (6/80) of houses were sprayed at the WHO recommended rate of 19 m2/min (± 10%), whereas 77.5% (62/80) were sprayed at a lower than expected rate. The median a.i. concentration delivered to houses was not significantly associated with the observed spray coverage rate. Householder compliance did not significantly influence either the spray coverage rates or the median alpha-cypermethrin a.i. concentrations delivered to houses. CONCLUSIONS Suboptimal delivery of IRS is partially attributable to the insecticide physical characteristics and the need for revision of insecticide delivery methods, which includes training of IRS teams and community education to encourage compliance. The IQK™ is a necessary field-friendly tool to improve IRS quality and to facilitate health worker training and decision-making by Chagas disease vector control managers.
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Affiliation(s)
- Raquel Gonçalves
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Rhiannon A E Logan
- Liverpool School of Tropical Medicine, Department of Vector Biology, Faculty of Biological Sciences, Pembroke Place, Liverpool, L3 5QA, UK
| | - Hanafy M Ismail
- Liverpool School of Tropical Medicine, Department of Vector Biology, Faculty of Biological Sciences, Pembroke Place, Liverpool, L3 5QA, UK
| | - Mark J I Paine
- Liverpool School of Tropical Medicine, Department of Vector Biology, Faculty of Biological Sciences, Pembroke Place, Liverpool, L3 5QA, UK
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Orin Courtenay
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK.
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20
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Sanchez L, Messenger LA, Bhattacharyya T, Gilman RH, Mayta H, Colanzi R, Bozo R, Verástegui M, Miles MA, Bern C. Congenital Chagas disease in Santa Cruz Department, Bolivia, is dominated by Trypanosoma cruzi lineage V. Trans R Soc Trop Med Hyg 2021; 116:80-84. [PMID: 34134129 DOI: 10.1093/trstmh/trab089] [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: 01/31/2021] [Revised: 04/15/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study identified Trypanosoma cruzi discrete typing units (DTUs) in maternal and infant specimens collected from two hospitals in Bolivia, using conventional genotyping and DTU-specific serotyping. METHODS Specimens from 142 mothers were used, including 24 seronegative and 118 seropositive individuals; 29 women transmitted T. cruzi to their infants. Maternal and infant parasite loads were determined by quantitative real-time PCR. Maternal sera were tested with an in-house parasite lysate ELISA and serotyped by a lineage-specific peptide ELISA, targeting the trypomastigote small surface antigen (TSSA). Trypanosoma cruzi genotypes in infected infants were determined by a triple PCR-RFLP assay. RESULTS All infant specimens were genotyped as TcV. Maternal parasite loads and absorbance values by the lysate ELISA were significantly higher for transmitters compared with non-transmitters. Among seropositive mothers, 65.3% had positive results by the TSSA II/V/VI peptide ELISA. No significant difference in reactivity to TSSA II/V/VI was observed for transmitters compared with non-transmitters (79.3% vs 60.7%, respectively). CONCLUSIONS Our findings reinforce the difficulty in obtaining sufficient sample numbers and parasite DNA to investigate the interaction between parasite genetics and the risk of congenital transmission and argue for the inclusion of DTU-specific serotyping in prospective studies.
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Affiliation(s)
- Leny Sanchez
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú
| | - Louisa A Messenger
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Tapan Bhattacharyya
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Robert H Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, Maryland 21205, USA
| | - Holger Mayta
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú
| | - Rony Colanzi
- Hospital Japonés de Tercer Nivel, Santa Cruz de la Sierra, Plurinational State of Bolivia
| | - Ricardo Bozo
- Hospital Municipal Camiri, Camiri, Plurinational State of Bolivia
| | - Manuela Verástegui
- Laboratorio de Investigación en Enfermedades Infecciosas, Departamento de Ciencias Celulares y Moleculares, Universidad Peruana Cayetano Heredia, Lima Av. Honorio Delgado 430, San Martín de Porres 15102, Perú
| | - Michael A Miles
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St, San Francisco, California 94158, USA
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21
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Castro-Sesquen YE, Saldaña A, Patino Nava D, Bayangos T, Paulette Evans D, DeToy K, Trevino A, Marcus R, Bern C, Gilman RH, Talaat KR. Use of a Latent Class Analysis in the Diagnosis of Chronic Chagas Disease in the Washington Metropolitan Area. Clin Infect Dis 2021; 72:e303-e310. [PMID: 32766826 DOI: 10.1093/cid/ciaa1101] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The diversity of individuals at risk for Trypanosoma cruzi infection in the United States poses challenges for diagnosis. We evaluated the diagnostic accuracy of Food and Drug Administration (FDA)-cleared tests in the Washington Metropolitan area (WMA). METHODS In total, 1514 individuals were evaluated (1078 from Mexico, Central and northern South America [TcI-predominant areas], and 436 from southern South America [TcII/V/VI-predominant areas]). Optical density (OD) values from the Hemagen EIA and Chagatest v.3 Wiener, and categorical results of the IgG-TESA-blot (Western blot with trypomastigote excretory-secretory antigen), and the Chagas detect plus (CDP), as well as information of area of origin were used to determine T. cruzi serostatus using latent class analysis. RESULTS We detected 2 latent class (LC) of seropositives with low (LC1) and high (LC2) antibody levels. A significantly lower number of seropositives were detected by the Wiener, IgG-TESA-blot, and CDP in LC1 (60.6%, P < .001, 93.1%, P = .014, and 84.9%, P = .002, respectively) as compared to LC2 (100%, 100%, and 98.2%, respectively). LC1 was the main type of seropositives in TcI-predominant areas, representing 65.0% of all seropositives as opposed to 22.8% in TcII/V/VI-predominant areas. The highest sensitivity was observed for the Hemagen (100%, 95% confidence interval [CI]: 96.2-100.0), but this test has a low specificity (90.4%, 95% CI: 88.7-91.9). The best balance between positive (90.9%, 95% CI: 83.5-95.1), and negative (99.9%, 95% CI: 99.4-99.9) predictive values was obtained with the Wiener. CONCLUSIONS Deficiencies in current FDA-cleared assays were observed. Low antibody levels are the main type of seropositives in individuals from TcI-predominant areas, the most frequent immigrant group in the United States.
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Affiliation(s)
- Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonella Saldaña
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dhayanna Patino Nava
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tabitha Bayangos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diana Paulette Evans
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelly DeToy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alexia Trevino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Marcus
- MedStar Washington Hospital Center, Washington, D.C., USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kawsar R Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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22
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Whitman JD, Pham P, Bern C, Dekker EM, Haller BL, Jain V, Winston LG. Significant and sustained decrease in non-SARS-CoV-2 respiratory viral infections during COVID-19 public health interventions. medRxiv 2021:2021.05.11.21256147. [PMID: 34013283 PMCID: PMC8132257 DOI: 10.1101/2021.05.11.21256147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Public health interventions to decrease the spread of SARS-CoV-2 were largely implemented in the United States during spring 2020. This study evaluates the additional effects of these interventions on non-SARS-CoV-2 respiratory viral infections from a single healthcare system in the San Francisco Bay Area. The results of a respiratory pathogen multiplex polymerase chain reaction panel intended for inpatient admissions were analyzed by month between 2019 and 2020. We found major decreases in the proportion and diversity of non-SARS-CoV-2 respiratory viral illnesses in all months following masking and shelter-in-place ordinances. These findings suggest real-world effectiveness of nonpharmaceutical interventions on droplet-transmitted respiratory infections.
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Affiliation(s)
- Jeffrey D. Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Phong Pham
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Elaine M. Dekker
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Barbara L. Haller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vivek Jain
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Lisa G. Winston
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
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23
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Esaryk EE, Wesson P, Fields J, Rios-Fetchko F, Lindan C, Bern C, Fernández A. Variation in SARS-CoV-2 Infection Risk and Socioeconomic Disadvantage Among a Mayan-Latinx Population in Oakland, California. JAMA Netw Open 2021; 4:e2110789. [PMID: 34019089 PMCID: PMC8140375 DOI: 10.1001/jamanetworkopen.2021.10789] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines variation in SARS-CoV-2 infection risk and socioeconomic disadvantage among a Mayan-Latinx population in the Fruitvale, California, community.
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Affiliation(s)
- Erin E Esaryk
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jessica Fields
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- University of California San Francisco Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco
- University of California San Francisco Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco
| | - Francine Rios-Fetchko
- University of California San Francisco Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco
- University of California San Francisco Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco
- Latinx Center for Excellence, University of California, San Francisco
| | - Christina Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alicia Fernández
- University of California San Francisco Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco
- University of California San Francisco Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco
- Latinx Center for Excellence, University of California, San Francisco
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24
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Dubey P, Das A, Priyamvada K, Bindroo J, Mahapatra T, Mishra PK, Kumar A, Franco AO, Rooj B, Sinha B, Pradhan S, Banerjee I, Kumar M, Bano N, Kumar C, Prasad C, Chakraborty P, Kumar R, Kumar N, Kumar A, Singh AK, Kundan K, Babu S, Shah H, Karthick M, Roy N, Gill NK, Dwivedi S, Chaudhuri I, Hightower AW, Chapman LAC, Singh C, Sharma MP, Dhingra N, Bern C, Srikantiah S. Development and Evaluation of Active Case Detection Methods to Support Visceral Leishmaniasis Elimination in India. Front Cell Infect Microbiol 2021; 11:648903. [PMID: 33842396 PMCID: PMC8024686 DOI: 10.3389/fcimb.2021.648903] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
As India moves toward the elimination of visceral leishmaniasis (VL) as a public health problem, comprehensive timely case detection has become increasingly important, in order to reduce the period of infectivity and control outbreaks. During the 2000s, localized research studies suggested that a large percentage of VL cases were never reported in government data. However, assessments conducted from 2013 to 2015 indicated that 85% or more of confirmed cases were eventually captured and reported in surveillance data, albeit with significant delays before diagnosis. Based on methods developed during these assessments, the CARE India team evolved new strategies for active case detection (ACD), applicable at large scale while being sufficiently effective in reducing time to diagnosis. Active case searches are triggered by the report of a confirmed VL case, and comprise two major search mechanisms: 1) case identification based on the index case's knowledge of other known VL cases and searches in nearby houses (snowballing); and 2) sustained contact over time with a range of private providers, both formal and informal. Simultaneously, house-to-house searches were conducted in 142 villages of 47 blocks during this period. We analyzed data from 5030 VL patients reported in Bihar from January 2018 through July 2019. Of these 3033 were detected passively and 1997 via ACD (15 (0.8%) via house-to-house and 1982 (99.2%) by light touch ACD methods). We constructed multinomial logistic regression models comparing time intervals to diagnosis (30-59, 60-89 and ≥90 days with <30 days as the referent). ACD and younger age were associated with shorter time to diagnosis, while male sex and HIV infection were associated with longer illness durations. The advantage of ACD over PCD was more marked for longer illness durations: the adjusted odds ratios for having illness durations of 30-59, 60-89 and >=90 days compared to the referent of <30 days for ACD vs PCD were 0.88, 0.56 and 0.42 respectively. These ACD strategies not only reduce time to diagnosis, and thus risk of transmission, but also ensure that there is a double check on the proportion of cases actually getting captured. Such a process can supplement passive case detection efforts that must go on, possibly perpetually, even after elimination as a public health problem is achieved.
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Affiliation(s)
- Pushkar Dubey
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Aritra Das
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Khushbu Priyamvada
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Joy Bindroo
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Tanmay Mahapatra
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Prabhas Kumar Mishra
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Ankur Kumar
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Ana O. Franco
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Basab Rooj
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Bikas Sinha
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Sreya Pradhan
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Indranath Banerjee
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Manash Kumar
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Nasreen Bano
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Chandan Kumar
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Chandan Prasad
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Parna Chakraborty
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Rakesh Kumar
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Niraj Kumar
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Aditya Kumar
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Abhishek Kumar Singh
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Kumar Kundan
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Sunil Babu
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Hemant Shah
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Morchan Karthick
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Nupur Roy
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Naresh Kumar Gill
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Shweta Dwivedi
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Indrajit Chaudhuri
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | | | - Lloyd A C. Chapman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chandramani Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | | | - Neeraj Dhingra
- National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Caryn Bern
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Sridhar Srikantiah
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
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25
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Bindroo J, Priyamvada K, Chapman LAC, Mahapatra T, Sinha B, Banerjee I, Mishra PK, Rooj B, Kundan K, Roy N, Gill NK, Hightower A, Sharma MP, Dhingra N, Bern C, Srikantiah S. Optimizing Village-Level Targeting of Active Case Detection to Support Visceral Leishmaniasis Elimination in India. Front Cell Infect Microbiol 2021; 11:648847. [PMID: 33842395 PMCID: PMC8024562 DOI: 10.3389/fcimb.2021.648847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background India has made major progress in improving control of visceral leishmaniasis (VL) in recent years, in part through shortening the time infectious patients remain untreated. Active case detection decreases the time from VL onset to diagnosis and treatment, but requires substantial human resources. Targeting approaches are therefore essential to feasibility. Methods We analyzed data from the Kala-azar Management Information System (KAMIS), using village-level VL cases over specific time intervals to predict risk in subsequent years. We also graphed the time between cases in villages and examined how these patterns track with village-level risk of additional cases across the range of cumulative village case-loads. Finally, we assessed the trade-off between ACD effort and yield. Results In 2013, only 9.3% of all villages reported VL cases; this proportion shrank to 3.9% in 2019. Newly affected villages as a percentage of all affected villages decreased from 54.3% in 2014 to 23.5% in 2019, as more surveillance data accumulated and overall VL incidence declined. The risk of additional cases in a village increased with increasing cumulative incidence, reaching approximately 90% in villages with 12 cases and 100% in villages with 45 cases, but the vast majority of villages had small cumulative case numbers. The time-to-next-case decreased with increasing case-load. Using a 3-year window (2016-2018), a threshold of seven VL cases at the village level selects 329 villages and yields 23% of cases reported in 2019, while a threshold of three cases selects 1,241 villages and yields 46% of cases reported in 2019. Using a 6-year window increases both effort and yield. Conclusion Decisions on targeting must consider the trade-off between number of villages targeted and yield and will depend upon the operational efficiencies of existing programs and the feasibility of specific ACD approaches. The maintenance of a sensitive, comprehensive VL surveillance system will be crucial to preventing future VL resurgence.
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Affiliation(s)
- Joy Bindroo
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Khushbu Priyamvada
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Lloyd A. C. Chapman
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanmay Mahapatra
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Bikas Sinha
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Indranath Banerjee
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Prabhas Kumar Mishra
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Basab Rooj
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Kumar Kundan
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
| | - Nupur Roy
- National Vector-Borne Disease Control Programme, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Naresh Kumar Gill
- National Vector-Borne Disease Control Programme, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | | | | | - Neeraj Dhingra
- National Vector-Borne Disease Control Programme, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA, United States
| | - Sridhar Srikantiah
- Bihar Technical Support Program, CARE-India Solutions for Sustainable Development, Patna, India
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26
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Balcerek J, Trejo E, Levine K, Couey P, Kornberg ZV, Rogine C, Young C, Li PJ, Shy BR, Taylor JE, Bakhtary S, Friedlander T, Lynch KL, Bern C, Esensten JH. Hospital-Based Donor Recruitment and Predonation Serologic Testing for COVID-19 Convalescent Plasma. Am J Clin Pathol 2021; 155:515-521. [PMID: 33399201 PMCID: PMC7929413 DOI: 10.1093/ajcp/aqaa268] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives Serologic testing for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in potential donors of coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) may not be performed until after blood donation. A hospital-based recruitment program for CCP may be an efficient way to identify potential donors prospectively Methods Patients who recovered from known or suspected COVID-19 were identified and recruited through medical record searches and public appeals in March and April 2020. Participants were screened with a modified donor history questionnaire and, if eligible, were asked for consent and tested for SARS-CoV-2 antibodies (IgG and IgM). Participants positive for SARS-CoV-2 IgG were referred for CCP collection. Results Of 179 patients screened, 128 completed serologic testing and 89 were referred for CCP donation. IgG antibodies to SARS-CoV-2 were detected in 23 of 51 participants with suspected COVID-19 and 66 of 77 participants with self-reported COVID-19 confirmed by polymerase chain reaction (PCR). The anti–SARS-CoV-2 IgG level met the US Food and Drug Administration criteria for “high-titer” CCP in 39% of participants confirmed by PCR, as measured by the Ortho VITROS IgG assay. A wide range of SARS-CoV-2 IgG levels were observed. Conclusions A hospital-based CCP donor recruitment program can prospectively identify potential CCP donors. Variability in SARS-CoV-2 IgG levels has implications for the selection of CCP units for transfusion.
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Affiliation(s)
| | - Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine
| | | | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine
| | - Zoe V Kornberg
- School of Medicine, University of California San Francisco
| | - Camille Rogine
- School of Medicine, University of California San Francisco
| | | | - P Jonathan Li
- School of Medicine, University of California San Francisco
| | | | | | | | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics
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Garlapati R, Iniguez E, Serafim TD, Mishra PK, Rooj B, Sinha B, Valenzuela JG, Srikantiah S, Bern C, Kamhawi S. Towards a Sustainable Vector-Control Strategy in the Post Kala-Azar Elimination Era. Front Cell Infect Microbiol 2021; 11:641632. [PMID: 33768013 PMCID: PMC7985538 DOI: 10.3389/fcimb.2021.641632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
Visceral leishmaniasis (VL) is a potentially deadly parasitic disease. In the Indian sub-continent, VL is caused by Leishmania donovani and transmitted via the bite of an infected Phlebotomus argentipes female sand fly, the only competent vector species in the region. The highest disease burden is in the northern part of the Indian sub-continent, especially in the state of Bihar. India, Bangladesh, and Nepal embarked on an initiative, coordinated by World Health Organization, to eliminate VL as a public health problem by the year 2020. The main goal is to reduce VL incidence below one case per 10,000 people through early case-detection, prompt diagnosis and treatment, and reduction of transmission using vector control measures. Indoor residual spraying, a major pillar of the elimination program, is the only vector control strategy used by the government of India. Though India is close to its VL elimination target, important aspects of vector bionomics and sand fly transmission dynamics are yet to be determined. To achieve sustained elimination and to prevent a resurgence of VL, knowledge gaps in vector biology and behavior, and the constraints they may pose to current vector control methods, need to be addressed. Herein, we discuss the successes and failures of previous and current vector-control strategies implemented to combat kala-azar in Bihar, India, and identify gaps in our understanding of vector transmission towards development of innovative tools to ensure sustained vector control in the post-elimination period.
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Affiliation(s)
- Rajesh Garlapati
- Bihar Technical Support Program, CARE India Solutions for Sustainable Development, Patna, India
| | - Eva Iniguez
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Tiago D Serafim
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Prabhas K Mishra
- Bihar Technical Support Program, CARE India Solutions for Sustainable Development, Patna, India
| | - Basab Rooj
- Bihar Technical Support Program, CARE India Solutions for Sustainable Development, Patna, India
| | - Bikas Sinha
- Bihar Technical Support Program, CARE India Solutions for Sustainable Development, Patna, India
| | - Jesus G Valenzuela
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Sridhar Srikantiah
- Bihar Technical Support Program, CARE India Solutions for Sustainable Development, Patna, India
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Shaden Kamhawi
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
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Castro-Sesquen YE, Saldaña A, Patino Nava D, Paulette Evans D, Bayangos T, DeToy K, Trevino A, Marcus R, Bern C, Gilman RH, Talaat KR. Evaluation of 2 Lateral Flow Rapid Tests in the Diagnosis of Chagas Disease in the Washington Metropolitan Area. Open Forum Infect Dis 2021; 8:ofab096. [PMID: 33884277 PMCID: PMC8047845 DOI: 10.1093/ofid/ofab096] [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: 10/02/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022] Open
Abstract
We compared the accuracy of the Stat-Pak and Chagas Detect Plus with a latent class analysis. Sensitivity values of 89.7% and 91.9% and specificities of 97.1% and 80.3%, respectively, were seen in the serodiagnosis of Chagas disease in Hispanic immigrants, revealing the limitations of these tests in diverse populations.
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Affiliation(s)
- Yagahira E Castro-Sesquen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonella Saldaña
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dhayanna Patino Nava
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diana Paulette Evans
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tabitha Bayangos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelly DeToy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alexia Trevino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Marcus
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kawsar R Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lynch KL, Whitman JD, Lacanienta NP, Beckerdite EW, Kastner SA, Shy BR, Goldgof GM, Levine AG, Bapat SP, Stramer SL, Esensten JH, Hightower AW, Bern C, Wu AHB. Magnitude and Kinetics of Anti-Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Responses and Their Relationship to Disease Severity. Clin Infect Dis 2021; 72:301-308. [PMID: 33501951 PMCID: PMC7454426 DOI: 10.1093/cid/ciaa979] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [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: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can be detected indirectly by measuring the host immune response. For some viruses, antibody concentrations correlate with host protection and viral neutralization, but in rare cases, antiviral antibodies can promote disease progression. Elucidation of the kinetics and magnitude of the SARS-CoV-2 antibody response is essential to understand the pathogenesis of coronavirus disease 2019 (COVID-19) and identify potential therapeutic targets. METHODS Sera (n = 533) from patients with real-time polymerase chain reaction-confirmed COVID-19 (n = 94 with acute infections and n = 59 convalescent patients) were tested using a high-throughput quantitative immunoglobulin M (IgM) and immunoglobulin G (IgG) assay that detects antibodies to the spike protein receptor binding domain and nucleocapsid protein. Individual and serial samples covered the time of initial diagnosis, during the disease course, and following recovery. We evaluated antibody kinetics and correlation between magnitude of the response and disease severity. RESULTS Patterns of SARS-CoV-2 antibody production varied considerably. Among 52 patients with 3 or more serial specimens, 44 (84.6%) and 42 (80.8%) had observed IgM and IgG seroconversion at a median of 8 and 10 days, respectively. Compared to those with milder disease, peak measurements were significantly higher for patients admitted to the intensive care unit for all time intervals between 6 and 20 days for IgM, and all intervals after 5 days for IgG. CONCLUSIONS High-sensitivity assays with a robust dynamic range provide a comprehensive picture of host antibody response to SARS-CoV-2. IgM and IgG responses were significantly higher in patients with severe than mild disease. These differences may affect strategies for seroprevalence studies, therapeutics, and vaccine development.
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Affiliation(s)
- Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Noreen P Lacanienta
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Erica W Beckerdite
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Shannon A Kastner
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brian R Shy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Goldgof
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Andrew G Levine
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sagar P Bapat
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersberg, Maryland, USA
| | - Jonathan H Esensten
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
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Priyamvada K, Bindroo J, Sharma MP, Chapman LAC, Dubey P, Mahapatra T, Hightower AW, Bern C, Srikantiah S. Visceral leishmaniasis outbreaks in Bihar: community-level investigations in the context of elimination of kala-azar as a public health problem. Parasit Vectors 2021; 14:52. [PMID: 33451361 PMCID: PMC7810196 DOI: 10.1186/s13071-020-04551-y] [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: 10/06/2020] [Accepted: 12/13/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND With visceral leishmaniasis (VL) incidence at its lowest level since the 1960s, increasing attention has turned to early detection and investigation of outbreaks. METHODS Outbreak investigations were triggered by recognition of case clusters in the VL surveillance system established for the elimination program. Investigations included ascertainment of all VL cases by date of fever onset, household mapping and structured collection of risk factor data. RESULTS VL outbreaks were investigated in 13 villages in 10 blocks of 7 districts. Data were collected for 20,670 individuals, of whom 272 were diagnosed with VL between 2012 and 2019. Risk was significantly higher among 10-19 year-olds and adults 35 or older compared to children younger than 10 years. Outbreak confirmation triggered vector control activities and heightened surveillance. VL cases strongly clustered in tolas (hamlets within villages) in which > 66% of residents self-identified as scheduled caste or scheduled tribe (SC/ST); 79.8% of VL cases occurred in SC/ST tolas whereas only 24.2% of the population resided in them. Other significant risk factors included being an unskilled non-agricultural laborer, migration for work in a brick kiln, living in a kuccha (mud brick) house, household crowding, habitually sleeping outside or on the ground, and open defecation. CONCLUSIONS Our data highlight the importance of sensitive surveillance with triggers for case cluster detection and rapid, careful outbreak investigations to better respond to ongoing and new transmission. The strong association with SC/ST tolas suggests that efforts should focus on enhanced surveillance in these disadvantaged communities.
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Affiliation(s)
| | - Joy Bindroo
- CARE-India Solutions for Sustainable Development, Patna, India
| | | | - Lloyd A C Chapman
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Pushkar Dubey
- CARE-India Solutions for Sustainable Development, Patna, India
| | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Brown Y, Saldaña A, Patino Nava D, Bayangos T, Evans D, Detoy K, Marcus R, Bern C, Gilman R, Talaat K. Challenges in the diagnosis of chronic Chagas disease in the U.S.: Experience from a community-based study in the Washington Metropolitan area. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Yu AT, Shakya R, Adhikari B, Tamrakar D, Vaidya K, Maples S, Date K, Bogoch II, Bern C, Qamar F, Yousafzai MT, Garrett DO, Longley AT, Hemlock C, Luby S, Aiemjoy K, Andrews JR. A Cluster-based, Spatial-sampling Method for Assessing Household Healthcare Utilization Patterns in Resource-limited Settings. Clin Infect Dis 2020; 71:S239-S247. [PMID: 33258933 PMCID: PMC7705878 DOI: 10.1093/cid/ciaa1310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/01/2022] Open
Abstract
BACKGROUND Implementation of population-based surveys is resource intensive and logistically demanding, especially in areas with rapidly changing demographics and incomplete or no enumeration of the underlying population and their residences. To remove the need for pre-enumeration and to simplify field logistics for the population healthcare utilization survey used for the Surveillance for Enteric Fever in Asia Project in Nepal, we incorporated a geographic information system-based geosurvey and field mapping system into a single-stage cluster sampling approach. METHODS A survey was administered to ascertain healthcare-seeking behavior in individuals with recent suspected enteric fever. Catchment areas were based on residential addresses of enteric fever patients using study facilities; clusters were randomly selected from digitally created grids using available satellite images and all households within clusters were offered enrollment. A tablet-compatible geosurvey and mapping system that allowed for data-syncing and use in areas without cellular data was created using the ArcGIS suite of software. RESULTS Between January 2017 and November 2018, we surveyed 25 521 households in Nepal (16 769 in urban Kathmandu and 8752 in periurban Kavrepalanchok), representing 84 202 individuals. Overall, the survey participation rate was 90.9%, with geographic heterogeneity in participation rates within each catchment area. Areas with higher average household wealth had lower participation rates. CONCLUSION A geographic information system-based geosurvey and field mapping system allowed creation of a virtual household map at the same time as survey administration, enabling a single-stage cluster sampling method to assess healthcare utilization in Nepal for the Surveillance for Enteric Fever in Asia Project . This system removed the need for pre-enumeration of households in sampling areas, simplified logistics and could be replicated in future community surveys.
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Affiliation(s)
- Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Rajani Shakya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Bikram Adhikari
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Stace Maples
- Stanford Geospatial Center, Stanford University, Stanford, California, USA
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | | | | | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Ashley T Longley
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
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Tamrakar D, Vaidya K, Yu AT, Aiemjoy K, Naga SR, Cao Y, Bern C, Shrestha R, Karmacharya BM, Pradhan S, Qamar FN, Saha S, Date K, Longley AT, Hemlock C, Luby S, Garrett DO, Bogoch II, Andrews JR. Spatial Heterogeneity of Enteric Fever in 2 Diverse Communities in Nepal. Clin Infect Dis 2020; 71:S205-S213. [PMID: 33258932 PMCID: PMC7705881 DOI: 10.1093/cid/ciaa1319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/13/2022] Open
Abstract
BACKGROUND Typhoid fever is endemic in the urban Kathmandu Valley of Nepal; however, there have been no population-based studies of typhoid outside of this community in the past 3 decades. Whether typhoid immunization should be prioritized in periurban and rural communities has been unclear. METHODS We performed population-based surveillance for enteric fever in 1 urban catchment (Kathmandu) and 1 periurban and rural catchment (Kavrepalanchok) as part of the Surveillance for Enteric Fever in Asia Project (SEAP). We recruited individuals presenting to outpatient and emergency departments at 2 study hospitals with suspected enteric fever and performed blood cultures. Additionally, we conducted a household survey in each catchment area to characterize care seeking for febrile illness. We evaluated spatial heterogeneity in febrile illness, care seeking, and enteric fever incidence. RESULTS Between September 2016 and September 2019, we enrolled 5736 participants with suspected enteric fever at 2 study hospitals. Among these, 304 (5.3%) were culture positive for Salmonella Typhi (249 [81.9%]) or Paratyphi A (55 [18.1%]). Adjusted typhoid incidence in Kathmandu was 484 per 100 000 person-years and in Kavrepalanchok was 615 per 100 000 person-years. While all geographic areas for which estimates could be made had incidence >200 per 100 000 person-years, we observed spatial heterogeneity with up to 10-fold variation in incidence between communities. CONCLUSIONS In urban, periurban, and rural communities in and around Kathmandu, we measured a high but heterogenous incidence of typhoid. These findings provide some support for the introduction of conjugate vaccines in Nepal, including outside urban areas, alongside other measures to prevent enteric fever.
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Affiliation(s)
- Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Shiva Ram Naga
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Yanjia Cao
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | - Sailesh Pradhan
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu (Children’s) Hospital, Dhaka, Bangladesh
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley T Longley
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
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Elnaiem DEA, Dakein O, Alawad AMA, Alsharif B, Khogali A, Jibreel T, Osman OF, Has’san H, Atia AM, Elhag M, Den Boer M, Ritmeijer K, Bern C, Alvar J, Khalid N, Courtenay O. Outdoor Residual Insecticide Spraying (ODRS), a New Approach for the Control of the Exophilic Vectors of Human Visceral Leishmaniasis: Phlebotomus orientalis in East Africa. PLoS Negl Trop Dis 2020; 14:e0008774. [PMID: 33079934 PMCID: PMC7598920 DOI: 10.1371/journal.pntd.0008774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/30/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
Visceral Leishmaniasis (VL) due to Leishmania donovani is a neglected protozoan parasitic disease in humans, which is usually fatal if untreated. Phlebotomus orientalis, the predominant VL vector in East Africa, is a highly exophilic/exophagic species that poses a major challenge to current Integrated Vector Management (IVM). Here we report results of pilot studies conducted in rural villages in Gedarif state, Sudan, to evaluate outdoor residual spraying of 20mg active ingredient (a.i.) /m2 deltamethrin insecticide applied to the characteristic household compound boundary reed fence and to the outside of household buildings (Outdoor Residual Insecticide Spraying, ODRS), and as an alternative, spraying restricted to the boundary fence only (Restricted Outdoor Residual Insecticide Spraying, RODRS). Four to six clusters of 20 households were assigned to insecticide treatments or control in three experiments. Changes in sand fly numbers were monitored over 2,033 trap-nights over 43–76 days follow-up in four sentinel houses per cluster relative to unsprayed control clusters. Sand fly numbers were monitored by sticky traps placed on the ground on the inside (“outdoor”) and the outside (“peridomestic”) of the boundary fence, and by CDC light traps suspended outdoors in the household compound. The effects of ODRS on sand fly numbers inside sleeping huts were monitored by insecticide knockdown. After a single application, ODRS reduced P. orientalis abundance by 83%-99% in outdoor and peridomestic trap locations. ODRS also reduced numbers of P. orientalis found resting inside sleeping huts. RODRS reduced outdoor and peridomestic P. orientalis by 60%-88%. By direct comparison, RODRS was 58%-100% as effective as ODRS depending on the trapping method. These impacts were immediate on intervention and persisted during follow-up, representing a large fraction of the P. orientalis activity season. Relative costs of ODRS and RODRS delivery were $5.76 and $3.48 per household, respectively. The study demonstrates the feasibility and high entomological efficacy of ODRS and RODRS, and the expected low costs relative to current IVM practises. These methods represent novel sand fly vector control tools against predominantly exophilic/exophagic sand fly vectors, aimed to lower VL burdens in Sudan, with potential application in other endemic regions in East Africa. Phlebotomus orientalis is the predominant vector of visceral leishmaniasis (VL, kala azar) in Sudan and other countries of East Africa, where the disease causes high morbidity and mortality. This sylvatic sand fly species is abundant in wild habitats characterized by presence of black cotton soil and vegetation dominated by Balanites aegyptiaca and/or Acacia seyal trees. In villages, the vector bites people in the household yard and in nearby peri-domestic locations, exhibiting limited indoor resting behaviour. The marked exophagic and exophilic behaviours of P. orientalis represent a profound challenge for VL control by excluding indoor residual spraying of insecticides (IRS) and compromising the efficacy of insecticide-impregnated bednets (ITNs). In this study, we evaluated the entomological efficacy of residual pyrethroid applied outdoors to household boundary fences and the exterior walls of household huts (outdoor residual insecticide spraying, ODRS), to reduce the abundance of P. orientalis inside and outside houses. We also evaluated the entomological impact of a restricted outdoor residual insecticide spraying (RODRS), whereby insecticide was applied only to the boundary fence. The study was carried out in June 2016-June 2017 in Jebel-Algana and Umsalala villages, Gedarif state, eastern Sudan, which are highly endemic for VL. The results showed that a single ODRS application of 20mg a.i. /m2 2.8% deltamethrin provided average reductions of 83%-99% in outdoor and peridomestic P. orientalis sand fly numbers relative to unsprayed control clusters. RODRS reduced outdoor and peridomestic P. orientalis by 60%-88%. The average cost of ODRS and RODRS per household were $5.76 and $3.48, respectively. The costs of these community-based control measures were substantially lower than the costs of LLINs, which is the only evidence-based tool used to protect against VL in the area. Future studies should evaluate the impact of ODRS/RODRS transmission of VL incidence in endemic villages and in seasonal agricultural farms.
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Affiliation(s)
- Dia-Eldin A. Elnaiem
- Department of Natural Sciences, University of Maryland Eastern Shore, MD, United States of America
- * E-mail: (DEAE); (OC)
| | - Osman Dakein
- Department of Zoology, Faculty of Science, University of Khartoum, Sudan
- Kala azar Research Centre, Faculty of Medicine and Health Sciences, University for Gedarif, Gedarif, Sudan
| | - Ahmed Mohammed-Ali Alawad
- Ministry of Health, Gedarif state, Sudan
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | - Bashir Alsharif
- Departamento de Entomologia, CPqAM, Fundação Oswaldo Cruz, Recife, Brasil and Dept of Medical Entomology, National Public Health Laboratory, Ministry of Health, Sudan
| | - Altayeb Khogali
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | - Tayseer Jibreel
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | - Omran F. Osman
- Department of Zoology, Faculty of Science, University of Khartoum, Sudan
| | - Hassan Has’san
- Ministry of Health, Gedarif state, Sudan
- Blue Nile Health Institute, Gezira University, Wad Medani, Sudan
| | | | - Mousab Elhag
- Director, Directorate of Communicable Diseases, Federal Ministry of Health, Khartoum, Sudan
| | | | | | - Caryn Bern
- University of California San Francisco, San Francisco, California, United States of America
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Noteila Khalid
- Department of Zoology, Ibn Sina University, Khartoum, Sudan
| | - Orin Courtenay
- Zeeman Institute and School of Life Sciences, University of Warwick, Coventry, CV4 7AL, United Kingdom
- * E-mail: (DEAE); (OC)
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Labayo HKM, Pajuelo MJ, Tohma K, Ford-Siltz LA, Gilman RH, Cabrera L, Mayta H, Sanchez GJ, Cornejo AT, Bern C, Dapat C, Nochi T, Parra GI, Oshitani H, Saito M. Norovirus-specific immunoglobulin A in breast milk for protection against norovirus-associated diarrhea among infants. EClinicalMedicine 2020; 27:100561. [PMID: 33043286 PMCID: PMC7536734 DOI: 10.1016/j.eclinm.2020.100561] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Norovirus (NV) causes acute gastroenteritis in infants. Humoral and fecal immunoglobulin A (IgA) responses have been correlated with protection against NV; however, the role of breast milk IgA against NV infection and associated diarrhea is still unknown. This study aimed to evaluate the protective role of NV-specific IgA (NV-IgA) in breast milk. METHODS Ninety-five breast milk samples collected from mothers enrolled in a 2016-2017 Peruvian birth cohort study were tested for total IgA and NV-IgA by ELISA using GII·4 variants and non-GII·4 genotype virus-like particles (VLPs). Breast milk samples were grouped according to the NV infection and diarrheal status of infants: NV positive with diarrhea (NV+D+, n=18); NV positive without diarrhea (NV+D-, n=37); and NV negative without diarrhea (NV-D-, n=40). The percent positivity and titer of NV-IgA were compared among groups. The cross-reactivity was estimated based on the correlation of ratio between NV-IgA against GII·4 variants and non-GII·4 genotype VLPs. FINDINGS NV-IgA had high positivity rates against different VLPs, especially against GII (89-100%). The NV+D- group had higher percent positivity (89% vs. 61%, p=0·03) and median titer (1:100 vs 1:50, p=0·03) of NV-IgA than the NV+D+ group against GI·1 VLPs. A relatively high correlation between different GII·4 variants (0·87) and low correlation between genogroups (0·23-0·37) were observed. INTERPRETATION Mothers with high positivity rates and titers of NV-IgA in breast milk had NV infected infants with reduced diarrheal symptoms. Antigenic relatedness to the genetic diversity of human norovirus was suggested.Funding National Institute of Allergy and Infectious Diseases, National Institute of Health: 1R01AI108695-01A1 and the Japan Society for the Promotion of Science (Fostering Joint International Research B):19KK0241.
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Affiliation(s)
| | - Monica J. Pajuelo
- Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kentaro Tohma
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Maryland, USA
| | - Lauren A. Ford-Siltz
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Maryland, USA
| | | | | | - Holger Mayta
- Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gerardo J. Sanchez
- Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Anniuska Toledo Cornejo
- Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Caryn Bern
- University of California-San Francisco, San Francisco, USA
| | - Clyde Dapat
- Department of Virology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Tomonori Nochi
- Functional Morphology, Tohoku University, Graduate School of Agriculture, Sendai, Japan
| | - Gabriel I. Parra
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Maryland, USA
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Mayuko Saito
- Department of Virology, Tohoku University, Graduate School of Medicine, Sendai, Japan
- Corresponding author: Mayuko Saito, M.D., M.P.H., Ph.D., Department of Virology, Tohoku University Graduate School of Medicine, Seiryo-machi 2-1, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. Tel./Fax: +81-(0)22-717-8211; fax: +81-(0)22-717-8212
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36
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Whitman JD, Hiatt J, Mowery CT, Shy BR, Yu R, Yamamoto TN, Rathore U, Goldgof GM, Whitty C, Woo JM, Gallman AE, Miller TE, Levine AG, Nguyen DN, Bapat SP, Balcerek J, Bylsma SA, Lyons AM, Li S, Wong AWY, Gillis-Buck EM, Steinhart ZB, Lee Y, Apathy R, Lipke MJ, Smith JA, Zheng T, Boothby IC, Isaza E, Chan J, Acenas DD, Lee J, Macrae TA, Kyaw TS, Wu D, Ng DL, Gu W, York VA, Eskandarian HA, Callaway PC, Warrier L, Moreno ME, Levan J, Torres L, Farrington LA, Loudermilk RP, Koshal K, Zorn KC, Garcia-Beltran WF, Yang D, Astudillo MG, Bernstein BE, Gelfand JA, Ryan ET, Charles RC, Iafrate AJ, Lennerz JK, Miller S, Chiu CY, Stramer SL, Wilson MR, Manglik A, Ye CJ, Krogan NJ, Anderson MS, Cyster JG, Ernst JD, Wu AHB, Lynch KL, Bern C, Hsu PD, Marson A. Evaluation of SARS-CoV-2 serology assays reveals a range of test performance. Nat Biotechnol 2020; 38:1174-1183. [PMID: 32855547 PMCID: PMC7740072 DOI: 10.1038/s41587-020-0659-0] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022]
Abstract
Appropriate use and interpretation of serological tests for assessments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure, infection and potential immunity require accurate data on assay performance. We conducted a head-to-head evaluation of ten point-of-care-style lateral flow assays (LFAs) and two laboratory-based enzyme-linked immunosorbent assays to detect anti-SARS-CoV-2 IgM and IgG antibodies in 5-d time intervals from symptom onset and studied the specificity of each assay in pre-coronavirus disease 2019 specimens. The percent of seropositive individuals increased with time, peaking in the latest time interval tested (>20 d after symptom onset). Test specificity ranged from 84.3% to 100.0% and was predominantly affected by variability in IgM results. LFA specificity could be increased by considering weak bands as negative, but this decreased detection of antibodies (sensitivity) in a subset of SARS-CoV-2 real-time PCR-positive cases. Our results underline the importance of seropositivity threshold determination and reader training for reliable LFA deployment. Although there was no standout serological assay, four tests achieved more than 80% positivity at later time points tested and more than 95% specificity.
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Affiliation(s)
- Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Hiatt
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Cody T Mowery
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Brian R Shy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ruby Yu
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tori N Yamamoto
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ujjwal Rathore
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Goldgof
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline Whitty
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan M Woo
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Antonia E Gallman
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, USA
| | - Tyler E Miller
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrew G Levine
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David N Nguyen
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Sagar P Bapat
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Joanna Balcerek
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sophia A Bylsma
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA
| | - Ana M Lyons
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Stacy Li
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Allison Wai-Yi Wong
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
| | - Eva Mae Gillis-Buck
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Zachary B Steinhart
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Youjin Lee
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan Apathy
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Mitchell J Lipke
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Anne Smith
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tina Zheng
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ian C Boothby
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Erin Isaza
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Program in Quantitative Biology, University of California, San Francisco, San Francisco, CA, USA
| | - Jackie Chan
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Dante D Acenas
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Jinwoo Lee
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Trisha A Macrae
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Than S Kyaw
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - David Wu
- Medical Scientist Training Program, University of California, San Francisco, San Francisco, CA, USA
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
| | - Dianna L Ng
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vanessa A York
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Haig Alexander Eskandarian
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Perri C Callaway
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Infectious Diseases and Immunity Graduate Group, University of California, Berkeley, Berkeley, CA, USA
| | - Lakshmi Warrier
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mary E Moreno
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Justine Levan
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leonel Torres
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lila A Farrington
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rita P Loudermilk
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kanishka Koshal
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Diane Yang
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael G Astudillo
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Gelfand
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Michael R Wilson
- Biomedical Sciences Graduate Program, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Aashish Manglik
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, USA
| | - Chun Jimmie Ye
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Institute of Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Nevan J Krogan
- J. David Gladstone Institutes, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Mark S Anderson
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jason G Cyster
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
- Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, USA
| | - Joel D Ernst
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Patrick D Hsu
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA.
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, USA.
- Center for Computational Biology, University of California, Berkeley, Berkeley, CA, USA.
| | - Alexander Marson
- J. David Gladstone Institutes, San Francisco, CA, USA.
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA.
- Innovative Genomics Institute, University of California, Berkeley, Berkeley, CA, USA.
- Diabetes Center, University of California, San Francisco, San Francisco, CA, USA.
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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37
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Mondal D, Bern C, Ghosh D, Rashid M, Molina R, Chowdhury R, Nath R, Ghosh P, Chapman LAC, Alim A, Bilbe G, Alvar J. Quantifying the Infectiousness of Post-Kala-Azar Dermal Leishmaniasis Toward Sand Flies. Clin Infect Dis 2020; 69:251-258. [PMID: 30357373 PMCID: PMC6603265 DOI: 10.1093/cid/ciy891] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/17/2018] [Indexed: 01/03/2023] Open
Abstract
Background On the Indian subcontinent, visceral leishmaniasis (VL) incidence is on track to reach elimination goals by 2020 in nearly all endemic districts. Although not included in official targets, previous data suggest post-kala-azar dermal leishmaniasis (PKDL) patients can act as an infection reservoir. Methods We conducted xenodiagnosis on 47 PKDL patients and 15 VL patients using laboratory-reared Phlebotomus argentipes. In direct xenodiagnosis, flies were allowed to feed on the patient’s skin for 15 minutes. For indirect xenodiagnosis, flies were fed through a membrane on the patient’s blood. Five days later, blood-fed flies were dissected and examined by microscopy and/or polymerase chain reaction (PCR). A 3-mm skin snip biopsy (PKDL) or venous blood (VL) was processed by quantitative PCR. Results Twenty-seven PKDL patients (57.4%) had positive results by direct and/or indirect xenodiagnosis. Direct was significantly more sensitive than indirect xenodiagnosis (55.3% vs 6.4%, P < .0001). Those with positive xenodiagnosis had median skin parasite loads >1 log10 unit higher than those with negative results (2.88 vs 1.66, P < .0001). In a multivariable model, parasite load, nodular lesions, and positive skin microscopy were significantly associated with positive xenodiagnosis. Blood parasite load was the strongest predictor for VL. Compared to VL, nodular PKDL was more likely and macular PKDL less likely to result in positive xenodiagnosis, but neither difference reached statistical significance. Conclusions Nodular and macular PKDL, and VL, can be infectious to sand flies. Active PKDL case detection and prompt treatment should be instituted and maintained as an integral part of VL control and elimination programs.
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Affiliation(s)
- Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine
| | - Debashis Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Masud Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Ricardo Molina
- World Health Organization Collaborating Centre for Leishmaniasis, Laboratory of Medical Entomology, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Rupen Nath
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Prakash Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | | | - Abdul Alim
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Graeme Bilbe
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Jorge Alvar
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
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38
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Whitman JD, Hiatt J, Mowery CT, Shy BR, Yu R, Yamamoto TN, Rathore U, Goldgof GM, Whitty C, Woo JM, Gallman AE, Miller TE, Levine AG, Nguyen DN, Bapat SP, Balcerek J, Bylsma SA, Lyons AM, Li S, Wong AWY, Gillis-Buck EM, Steinhart ZB, Lee Y, Apathy R, Lipke MJ, Smith JA, Zheng T, Boothby IC, Isaza E, Chan J, Acenas DD, Lee J, Macrae TA, Kyaw TS, Wu D, Ng DL, Gu W, York VA, Eskandarian HA, Callaway PC, Warrier L, Moreno ME, Levan J, Torres L, Farrington LA, Loudermilk R, Koshal K, Zorn KC, Garcia-Beltran WF, Yang D, Astudillo MG, Bernstein BE, Gelfand JA, Ryan ET, Charles RC, Iafrate AJ, Lennerz JK, Miller S, Chiu CY, Stramer SL, Wilson MR, Manglik A, Ye CJ, Krogan NJ, Anderson MS, Cyster JG, Ernst JD, Wu AHB, Lynch KL, Bern C, Hsu PD, Marson A. Test performance evaluation of SARS-CoV-2 serological assays. medRxiv 2020. [PMID: 32511497 PMCID: PMC7273265 DOI: 10.1101/2020.04.25.20074856] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Serological tests are crucial tools for assessments of SARS-CoV-2 exposure, infection and potential immunity. Their appropriate use and interpretation require accurate assay performance data. Method: We conducted an evaluation of 10 lateral flow assays (LFAs) and two ELISAs to detect anti-SARS-CoV-2 antibodies. The specimen set comprised 128 plasma or serum samples from 79 symptomatic SARS-CoV-2 RT-PCR-positive individuals; 108 pre-COVID-19 negative controls; and 52 recent samples from individuals who underwent respiratory viral testing but were not diagnosed with Coronavirus Disease 2019 (COVID-19). Samples were blinded and LFA results were interpreted by two independent readers, using a standardized intensity scoring system. Results: Among specimens from SARS-CoV-2 RT-PCR-positive individuals, the percent seropositive increased with time interval, peaking at 81.8–100.0% in samples taken >20 days after symptom onset. Test specificity ranged from 84.3–100.0% in pre-COVID-19 specimens. Specificity was higher when weak LFA bands were considered negative, but this decreased sensitivity. IgM detection was more variable than IgG, and detection was highest when IgM and IgG results were combined. Agreement between ELISAs and LFAs ranged from 75.7–94.8%. No consistent cross-reactivity was observed. Conclusion: Our evaluation showed heterogeneous assay performance. Reader training is key to reliable LFA performance, and can be tailored for survey goals. Informed use of serology will require evaluations covering the full spectrum of SARS-CoV-2 infections, from asymptomatic and mild infection to severe disease, and later convalescence. Well-designed studies to elucidate the mechanisms and serological correlates of protective immunity will be crucial to guide rational clinical and public health policies.
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Affiliation(s)
- Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joseph Hiatt
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Cody T Mowery
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Brian R Shy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ruby Yu
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Tori N Yamamoto
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ujjwal Rathore
- J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Gregory M Goldgof
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Caroline Whitty
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jonathan M Woo
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Antonia E Gallman
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Howard Hughes Medical Institute, University of California, San Francisco
| | - Tyler E Miller
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrew G Levine
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David N Nguyen
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sagar P Bapat
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Joanna Balcerek
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sophia A Bylsma
- Department of Bioengineering, University of California, Berkeley, Berkeley CA 94720 USA
| | - Ana M Lyons
- Department of Integrative Biology, University of California, Berkeley, Berkeley CA 94720 USA
| | - Stacy Li
- Department of Integrative Biology, University of California, Berkeley, Berkeley CA 94720 USA
| | - Allison Wai-Yi Wong
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA
| | - Eva Mae Gillis-Buck
- Department of Surgery, University of California, San Francisco, CA 94143, USA
| | - Zachary B Steinhart
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Youjin Lee
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - Ryan Apathy
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Mitchell J Lipke
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jennifer Anne Smith
- Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Tina Zheng
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,Department of Neurology, University of California, San Francisco, CA 94158, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ian C Boothby
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Department of Dermatology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Erin Isaza
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Program in Quantitative Biology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jackie Chan
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - Dante D Acenas
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - Jinwoo Lee
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Trisha A Macrae
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,School of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Than S Kyaw
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA
| | - David Wu
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA.,Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA
| | - Dianna L Ng
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Department of Pathology, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Vanessa A York
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Haig Alexander Eskandarian
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Perri C Callaway
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA.,Infectious Diseases and Immunity Graduate Group, University of California Berkeley, Berkeley, CA, USA
| | - Lakshmi Warrier
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Mary E Moreno
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Justine Levan
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Leonel Torres
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Lila A Farrington
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Rita Loudermilk
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Kanishka Koshal
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94158, USA
| | | | - Diane Yang
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael G Astudillo
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Gelfand
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA 94143, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
| | | | - Michael R Wilson
- Biomedical Sciences Graduate Program, University of California, San Francisco, CA 94143, USA.,Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Aashish Manglik
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA 94158
| | - Chun Jimmie Ye
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Institute of Computational Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Nevan J Krogan
- J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA 94158, USA.,Quantitative Biosciences Institute, University of California, San Francisco, CA 94158, USA
| | - Mark S Anderson
- Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jason G Cyster
- Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Howard Hughes Medical Institute, University of California, San Francisco
| | - Joel D Ernst
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick D Hsu
- Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Department of Bioengineering, University of California, Berkeley, Berkeley CA 94720 USA
| | - Alexander Marson
- J. David Gladstone Institutes, San Francisco, CA 94158, USA.,Department of Microbiology and Immunology, University of California, San Francisco, CA 94143, USA.,Innovative Genomics Institute, University of California, Berkeley, CA 94720, USA.,Diabetes Center, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
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Whitman JD, Townsend RL, Bern C, Stramer SL. Evaluation of matrix effects and prolonged storage on Trypanosoma cruzi serology in blood donor specimens. Transfusion 2020; 60:1149-1153. [PMID: 32163175 DOI: 10.1111/trf.15736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Blood products appropriately stored for research protocols provide an invaluable resource for amassing large numbers of specimens for clinical research, especially for low-prevalence diseases, such as Chagas disease. STUDY DESIGN AND METHODS We evaluated serologic results of 500 blood donation plasma component (PC) specimens confirmed as Trypanosoma cruzi seropositive by Food and Drug Administration-recommended algorithms. Subsets were retested using the T. cruzi enzyme-linked immunosorbent assay (ELISA; Ortho Clinical Diagnostics) and PRISM Chagas assay (Abbott Laboratories). Initial results for vacutainer-derived venous serum (VS) and PC specimens with matching results were also compared. RESULTS On initial testing, matrix effects between VS and PC were observed with ELISA demonstrating a mean change in the PC of -0.39 signal/cutoff ratio (S/CO) (p < 0.0001) and PRISM of +0.35 S/CO (p = 0.008). In matched PC specimens between current (retest) versus initial test results, both ELISA and PRISM had a decrease in mean S/COs of -0.76 (p < 0.0001) and - 0.90 (p < 0.0001), respectively. When the change in S/CO for matched PC specimens was analyzed as a function of time, PRISM showed no significant S/CO decrease (Y = -0.002941*X - 0.6250; p = 0.20; R2 = 0.005), whereas the ELISA showed a significant S/CO decrease in more recently collected specimens (Y = 0.007183*X-1.516; p < 0.0001; R2 = 0.06). CONCLUSION While T. cruzi serology results showed minor but significant differences in matrix effects between initial VS and PC testing values, and minor changes in PC test values over time, our data validate the use of PC specimens for head-to-head test performance comparison studies with the caveat that these limitations are assessed for appropriate study design.
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Affiliation(s)
- Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland
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40
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Abstract
Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.
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Affiliation(s)
- Caryn Bern
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Jeffrey D Whitman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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41
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Noazin S, Lee JA, Malaga ES, Valencia Ayala E, Condori BJ, Roca C, Lescano AG, Bern C, Castillo W, Mayta H, Menduiña MC, Verastegui MR, Tinajeros F, Gilman RH. Trypomastigote Excretory Secretory Antigen Blot Is Associated With Trypanosoma cruzi Load and Detects Congenital T. cruzi Infection in Neonates, Using Anti-Shed Acute Phase Antigen Immunoglobulin M. J Infect Dis 2019; 219:609-618. [PMID: 30252099 DOI: 10.1093/infdis/jiy562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/18/2018] [Indexed: 11/14/2022] Open
Abstract
Background Congenital Trypanosoma cruzi infection accounts for an estimated 22% of new cases of Chagas disease in Latin America. However, neonatal diagnosis is challenging, as 9-month follow-up for immunoglobulin G testing is poor, quantitative polymerase chain reaction (qPCR) analysis is not routinely performed, and the micromethod misses ≥40% of congenital infections. Methods Biorepository samples from new mothers and their infants from Piura, Peru, (an area of nonendemicity), and Santa Cruz, Bolivia (an area of endemicity) were accessed. Infant specimens were assessed using the micromethod, qPCR analysis, and a trypomastigote excretory secretory antigen (TESA) blot for detection of immunoglobulin M (IgM)-specific shed acute phase antigen (SAPA) bands, using qPCR as the gold standard. Results When compared to qPCR, IgM TESA blot was both sensitive and specific for congenital Chagas disease diagnosis. Cumulative sensitivity (whether only 4 bands or all 6 bands were present) was 80% (95% confidence interval [CI], 59%-92%). Specificity was 94% (95% CI, 92%-96%) in the area of endemicity and 100% in the area of nonendemicity. SAPA bands occurred sequentially and in pairs, and parasite loads correlated highly with the number of SAPA bands present. The micromethod detected infection in fewer than half of infected infants. Conclusions The IgM TESA blot for detection of SAPA bands is rapid, relatively inexpensive, and more sensitive than the micromethod and may be a useful point-of-care test for detection of congenital T. cruzi infection.
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Affiliation(s)
- Sassan Noazin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica A Lee
- School of Medical Sciences, University of Manchester, United Kingdom
| | - Edith S Malaga
- Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy
| | - Edward Valencia Ayala
- Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy
| | - Beth J Condori
- Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy
| | - Cristian Roca
- Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy
| | - Andres G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Walter Castillo
- Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy
| | - Holger Mayta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy.,Asociación Benéfica PRISMA, Lima, Peru
| | | | - Manuela R Verastegui
- Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy.,Asociación Benéfica PRISMA, Lima, Peru
| | | | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Infectious Diseases Research Laboratory, Department of Cellular Molecular Sciences, School of Science and Philosophy.,Asociación Benéfica PRISMA, Lima, Peru
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Sánchez GJ, Mayta H, Pajuelo MJ, Neira K, Xiaofang L, Cabrera L, Ballard SB, Crabtree JE, Kelleher D, Cama V, Bern C, Oshitani H, Gilman RH, Saito M. Epidemiology of Sapovirus Infections in a Birth Cohort in Peru. Clin Infect Dis 2019; 66:1858-1863. [PMID: 29309577 PMCID: PMC5982808 DOI: 10.1093/cid/cix1103] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/21/2017] [Indexed: 01/08/2023] Open
Abstract
Background Sapovirus is one of the primary viral causes of acute gastroenteritis (AGE), especially where rotavirus vaccination has been implemented. The characteristics and impact of natural infection at the community level, however, have not been well documented. Methods Stool samples were analyzed from 100 children randomly selected from a community-based birth cohort study in Peru. All diarrheal and 1 nondiarrheal stools collected trimonthly from children up to age 2 years (n = 1669) were tested for sapovirus detection. Viral shedding duration was determined by testing additional weekly samples (n = 440) collected before and after a sapovirus-positive sample. Results The incidence of sapovirus infection in the first and second years of life was 4.3 and 11.1 per 100 child-months, respectively. By age 2 years, 82% of children had at least 1 sapovirus infection, and 64% had at least 1 sapovirus-associated diarrhea episode. The median shedding period was 18.5 days. In 112 of 175 infections, 14 genotypes from 4 genogroups (GI, GII, GIV, and GV) were determined. Among genogroups, GI were more frequently found in symptomatic infections than in asymptomatic infections (odds ratio, 3.1; 95% confidence interval, 1.3–7.4). Fifty-nine children had serial sapovirus infections, but only 3 had repeated infection of the same genotype. Conclusions Sapovirus was frequently detected in children with AGE at the community level during the first 2 years of life. Serial sapovirus infections by multiple genotypes in a child suggest genotype-specific immunity from each infection, which needs to be taken into account for vaccine development.
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Affiliation(s)
- Gerardo J Sánchez
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Holger Mayta
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Asociación Benéfica PRISMA, Lima, Perú
| | - Monica J Pajuelo
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen Neira
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liu Xiaofang
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Sarah Blythe Ballard
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jean E Crabtree
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, United Kingdom
| | - Dermot Kelleher
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Vitaliano Cama
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California-San Francisco
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Robert H Gilman
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Asociación Benéfica PRISMA, Lima, Perú
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bhattacharyya T, Messenger LA, Bern C, Mertens P, Gilleman Q, Zeippen N, Bremer Hinckel BC, Murphy N, Gilman RH, Miles MA. Severity of Chagasic Cardiomyopathy Is Associated With Response to a Novel Rapid Diagnostic Test for Trypanosoma cruzi TcII/V/VI. Clin Infect Dis 2019; 67:519-524. [PMID: 29438471 PMCID: PMC6070114 DOI: 10.1093/cid/ciy121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/07/2018] [Indexed: 02/06/2023] Open
Abstract
Background Trypanosoma cruzi causes Chagas disease in the Americas. The outcome of infection ranges from lifelong asymptomatic status to severe disease. Relationship between T. cruzi lineage (TcI-TcVI) infection history and prognosis is not understood. We previously described peptide-based lineage-specific enzyme-linked immunosorbent assay (ELISA) with trypomastigote small surface antigen (TSSA). Methods A novel rapid diagnostic test (RDT; Chagas Sero K-SeT) that incorporates a peptide that corresponds to the TSSA II/V/VI common epitope was developed and validated by comparison with ELISA. Patients from Bolivia and Peru, including individuals with varying cardiac pathology, and matched mothers and neonates, were then tested using Chagas Sero K-SeT. Results Chagas Sero K-SeT and ELISA results, with a Bolivian subset of cardiac patients, mothers, and neonates, were in accord. In adult chronic infections (n = 121), comparison of severity class A (no evidence of Chagas cardiomyopathy) with class B (electrocardiogram suggestive of Chagas cardiomyopathy) and class C/D (decreased left ventricular ejection fraction; moderate/severe Chagas cardiomyopathy) revealed a statistically significant increase in Chagas Sero K-SeT reactivity with increasing severity (χ2 for trend, 7.39; P = .007). In Peru, Chagas Sero K-SeT detected the sporadic TcII/V/VI infections. Conclusions We developed a low cost RDT that can replace ELISA for identification of TSSA II/V/VI immunoglobulin G. Most importantly, we show that response to this RDT is associated with severity of Chagas cardiomyopathy and thus may have prognostic value. Repeated challenge with T. cruzi infection may both exacerbate disease progression and boost the immune response to the TSSApep-II/V/VI epitope.
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Affiliation(s)
- Tapan Bhattacharyya
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Louisa A Messenger
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | | | | | | | - Bruno C Bremer Hinckel
- Coris BioConcept, Gembloux, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Niamh Murphy
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael A Miles
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
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Goyal V, Burza S, Pandey K, Singh SN, Singh RS, Strub-Wourgaft N, Das VNR, Bern C, Hightower A, Rijal S, Sunyoto T, Alves F, Lima N, Das P, Alvar J. Field effectiveness of new visceral leishmaniasis regimens after 1 year following treatment within public health facilities in Bihar, India. PLoS Negl Trop Dis 2019; 13:e0007726. [PMID: 31557162 PMCID: PMC6782108 DOI: 10.1371/journal.pntd.0007726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/08/2019] [Accepted: 08/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND An earlier open label, prospective, non-randomized, non-comparative, multi-centric study conducted within public health facilities in Bihar, India (CTRI/2012/08/002891) measured the field effectiveness of three new treatment regimens for visceral leishmaniasis (VL): single dose AmBisome (SDA), and combination therapies of AmBisome and miltefosine (AmB+Milt) and miltefosine and paromomycin (Milt+PM) up to 6 months follow-up. The National Vector Borne Disease Control Program (NVBDCP) recommended an extended follow up at 12 months post-treatment of the original study cohort to quantify late relapses. METHODS The 1,761 patients enrolled in the original study with the three new regimens were contacted and traced between 10 and 36 months following completion of treatment to determine their health status and any occurrence of VL relapse. RESULTS Of 1,761 patients enrolled in the original study, 1,368 were traced at the extended follow-up visit: 711 (80.5%), 295 (83.2%) and 362 (71.5%) patients treated with SDA, AmB+Milt and Milt+PM respectively. Of those traced, a total of 75 patients were reported to have relapsed by the extended follow-up; 45 (6.3%) in the SDA, 25 (8.5%) in the AmB+Milt and 5 (1.4%) in the Milt+PM arms. Of the 75 relapse cases, 55 had already been identified in the 6-months follow-up and 20 were identified as new cases of relapse at extended follow-up; 7 in the SDA, 10 in the AmB+Milt and 3 in the Milt+PM arms. CONCLUSION Extending follow-up beyond the standard 6 months identified additional relapses, suggesting that 12-month sentinel follow-up may be useful as a programmatic tool to better identify and quantify relapses. With limited drug options, there remains an urgent need to develop effective new chemical entities (NCEs) for VL.
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Affiliation(s)
- Vishal Goyal
- Drugs for Neglected Diseases initiative (DNDi), New York, United States of America
- * E-mail:
| | - Sakib Burza
- Médecins Sans Frontières (MSF), New Delhi, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | | | | | | | - Vidya Nand Rabi Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | - Caryn Bern
- University of California San Francisco, San Francisco, California, United States of America
| | | | - Suman Rijal
- Drugs for Neglected Diseases initiative (DNDi), New Delhi, India
| | | | - Fabiana Alves
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences (RMRI), Patna, Bihar, India
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Andrews JR, Vaidya K, Bern C, Tamrakar D, Wen S, Madhup S, Shrestha R, Karmacharya B, Amatya B, Koju R, Adhikari SR, Hohmann E, Ryan ET, Bogoch II. High Rates of Enteric Fever Diagnosis and Lower Burden of Culture-Confirmed Disease in Peri-urban and Rural Nepal. J Infect Dis 2019; 218:S214-S221. [PMID: 28961918 PMCID: PMC6226739 DOI: 10.1093/infdis/jix221] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In South Asia, data on enteric fever are sparse outside of urban areas. We characterized enteric fever diagnosis patterns and the burden of culture-confirmed cases in peri-urban and rural Nepal. Methods We used national reports to estimate enteric fever diagnosis rates over 20 years (1994-2014) and conducted a prospective study of patients presenting with a >72-hour history of fever to 4 peri-urban and rural healthcare facilities (during August 2013-June 2016). We compared clinical characteristics of patients with culture-confirmed Salmonella Typhi or Paratyphi infection to those of patients without enteric fever. We used generalized additive models with logistic link functions to evaluate associations of age and population density with culture positivity. Results National rates of enteric fever diagnosis were high, reaching 18.8 cases per 1000 during 2009-2014. We enrolled 4309 participants with acute febrile illness. Among those with a provisional clinical diagnosis, 55% (1334 of 2412) received a diagnosis of enteric fever; however, only 4.1% of these had culture-confirmed typhoidal Salmonella infection. Culture positivity was highest among young adults and was strongly associated with higher population density (P < .001). Conclusions Enteric fever diagnosis rates were very high throughout Nepal, but in rural settings, few patients had culture-confirmed disease. Expanded surveillance may inform local enteric fever treatment and prevention strategies.
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Affiliation(s)
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Shawn Wen
- D-Lab, Massachusetts Institute of Technology, Cambridge
| | - Surendra Madhup
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Bibush Amatya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | - Rajendra Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel
| | | | - Elizabeth Hohmann
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
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Chowdhury R, Chowdhury V, Faria S, Akter S, Dash AP, Bhattacharya SK, Maheswary NP, Bern C, Akhter S, Alvar J, Kroeger A, Boelaert M, Banu Q. Effect of insecticide-treated bed nets on visceral leishmaniasis incidence in Bangladesh. A retrospective cohort analysis. PLoS Negl Trop Dis 2019; 13:e0007724. [PMID: 31525195 PMCID: PMC6762203 DOI: 10.1371/journal.pntd.0007724] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/26/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is a parasitic disease, transmitted by the sand fly species Phlebotomus argentipes in the Indian sub-continent. Effective vector control is highly desirable to reduce vector density and human and vector contact in the endemic communities with the aim to curtail disease transmission. We evaluated the effect of long lasting insecticide treated bed nets (LLIN) and bed nets impregnated with slow-release insecticide tablet K-O TAB 1-2-3 (jointly insecticide-treated nets or ITN) on VL incidence in a highly endemic sub-district (upazila) in Bangladesh. METHODS Several distributions of LLIN or K-O TAB 1-2-3 for self-impregnation of bed nets at home took place in Fulbaria upazila, Mymensigh district from 2004 to 2008 under three research projects, respectively funded by CDC, Atlanta, USA (2004) and WHO-TDR, Geneva, Switzerland (2006 & 2008). We included all households (n = 8142) in the 20 villages that had benefited in the past from one of these interventions (1295 donated LLIN and 11,918 local bed nets impregnated with K-O TAB 1-2-3) in the "exposed cohort". We recruited a "non-exposed cohort" in villages with contemporaneously similar incidence rates who had not received such vector control interventions (7729 HHs from nine villages). In both cohorts, we visited all families house to house and ascertained any VL cases for the 3 year period before and after the intervention. We evaluated the incidence rate (IR) of VL in both cohorts as primary endpoint, applying the difference-in-differences method. RESULTS The study identified 1011 VL cases (IR 140.47/10,000 per year [py]) before the intervention, of which 534 and 477 cases in the intervention and control areas respectively. The IR was 144.13/10,000 py (534/37050) and 136.59/10,000 py (477/34923) in the intervention and control areas respectively, with no significant difference (p = 0.3901) before the intervention. After the intervention, a total of 555 cases (IR 77.11/10,000 py) were identified of which 178 (IR 48.04/10,000 py) in the intervention and 377 (107.95/10,000 py) in the control area. The intervention area had a significant lower IR than the control area during follow up, rate difference = -59.91, p<0.0001. The IR during follow up was significantly reduced by 96.09/10,000 py in the intervention area (p<0.0001) and 28.63/10,000 py in control area (p<0.0001) compared to baseline. There was a strong and significant overall effect of the ITN intervention, δ = -67.45, p <0.0001. Sex (OR = 1.36, p<0.0001) and age (OR = 0.99, p<0.0001) also had a significant effect on VL incidence. Male had a higher risk of VL than female and one year increase in age decreased the likelihood of VL by about 0.92%. Two third of the VL incidence occurred in the age range 2 to 30 years (median age of VL patients was 17 years). CONCLUSION VL incidence rate was significantly lower in the ITN intervention cohort compared to control in Bangladesh. Some bias due to more intense screen-and-treat activities or other interventions in the intervention area cannot be ruled out. Nonetheless, given their feasibility and sustainability, ITNs should be considered for integrated vector control during the maintenance phase of the VL elimination programme.
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Affiliation(s)
- Rajib Chowdhury
- International Center for Diarrhoea Disease Research, Bangladesh (icddr,b), Mohakhali, Bangladesh
- National Institute of Preventive and Social Medicine, Mohakhali, Bangladesh
- * E-mail:
| | | | - Shyla Faria
- Directorate General of Health Services (DGHS), Mohakhali, Bangladesh
| | - Sakila Akter
- National Institute of Preventive and Social Medicine, Mohakhali, Bangladesh
| | | | | | | | - Caryn Bern
- UCSF School of Medicine, San Francisco California, United States of America
| | - Shireen Akhter
- National Institute of Preventive and Social Medicine, Mohakhali, Bangladesh
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Axel Kroeger
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
- University of Freiburg, Centre for Medicine and Society/Anthropology, Freiburg, Germany
| | | | - Qamar Banu
- Asian University for Women, Chittatong, Bangladesh
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Waltmann A, Willcox AC, Balasubramanian S, Borrini Mayori K, Mendoza Guerrero S, Salazar Sanchez RS, Roach J, Condori Pino C, Gilman RH, Bern C, Juliano JJ, Levy MZ, Meshnick SR, Bowman NM. Hindgut microbiota in laboratory-reared and wild Triatoma infestans. PLoS Negl Trop Dis 2019; 13:e0007383. [PMID: 31059501 PMCID: PMC6522061 DOI: 10.1371/journal.pntd.0007383] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 09/25/2018] [Revised: 05/16/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022] Open
Abstract
Triatomine vectors transmit Trypanosoma cruzi, the etiological agent of Chagas disease in humans. Transmission to humans typically occurs when contaminated triatomine feces come in contact with the bite site or mucosal membranes. In the Southern Cone of South America, where the highest burden of disease exists, Triatoma infestans is the principal vector for T. cruzi. Recent studies of other vector-borne illnesses have shown that arthropod microbiota influences the ability of infectious agents to colonize the insect vector and transmit to the human host. This has garnered attention as a potential control strategy against T. cruzi, as vector control is the main tool of Chagas disease prevention. Here we characterized the microbiota in T. infestans feces of both wild-caught and laboratory-reared insects and examined the relationship between microbial composition and T. cruzi infection using highly sensitive high-throughput sequencing technology to sequence the V3-V4 region of the 16S ribosomal RNA gene on the MiSeq Illumina platform. We collected 59 wild (9 with T. cruzi infection) and 10 lab-reared T. infestans (4 with T. cruzi infection) from the endemic area of Arequipa, Perú. Wild T. infestans had greater hindgut bacterial diversity than laboratory-reared bugs. Microbiota of lab insects comprised a subset of those identified in their wild counterparts, with 96 of the total 124 genera also observed in laboratory-reared insects. Among wild insects, variation in bacterial composition was observed, but time and location of collection and development stage did not explain this variation. T. cruzi infection in lab insects did not affect α- or β-diversity; however, we did find that the β-diversity of wild insects differed if they were infected with T. cruzi and identified 10 specific taxa that had significantly different relative abundances in infected vs. uninfected wild T. infestans (Bosea, Mesorhizobium, Dietzia, and Cupriavidus were underrepresented in infected bugs; Sporosarcina, an unclassified genus of Porphyromonadaceae, Nestenrenkonia, Alkalibacterium, Peptoniphilus, Marinilactibacillus were overrepresented in infected bugs). Our findings suggest that T. cruzi infection is associated with the microbiota of T. infestans and that inferring the microbiota of wild T. infestans may not be possible through sampling of T. infestans reared in the insectary. Chagas disease in humans is caused by the parasite Trypanosoma cruzi and it is endemic to the Americas. Poor populations are most at risk. The parasite infects an estimated six million people of 21 endemic countries in the Americas, with 30,000 new infections yearly. The main mode of transmission is vector-borne by triatomine bugs, which tend to live in close association with humans. The main Chagas disease vector in the Southern Cone of South America, where the highest burden of disease exists, is Triatoma infestans. As blood-sucking insects, triatomines become infected when they bite a T. cruzi-positive human and once infected they transmit the parasites in their feces. Controlling the vector populations is the main strategy of Chagas disease transmission reduction efforts. Microbiota-mediated methods to control this vector-borne disease are now being explored to determine whether microbes typically found in the vectors’ gut have a detrimental effect on T. cruzi and how they may be used to modify the vector and curb the ability for T. cruzi to be transmitted to humans. To advance this new field, we first must gain better knowledge of the gut microbiota of triatomines. Our study is the first to use sensitive high-throughput methods to study the gut microbes of T. infestans, using both laboratory-reared and wild insects. We have found that the microbial composition of T. infestans in the laboratory does not reflect the complete collection of gut microbes of wild T. infestans and inferring the gut microbiota profile of wild insects through studying lab insects alone may not be possible. We also found evidence that in wild insects T. cruzi affects the composition of the gut microbiota and identified some bacterial taxa which may be important in modulating the T.infestans-T.cruzi relationship.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Alexandra C. Willcox
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sujata Balasubramanian
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katty Borrini Mayori
- Zoonotic Disease Research Laboratory, Unidad de Una Salud, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Sandra Mendoza Guerrero
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Renzo S. Salazar Sanchez
- Zoonotic Disease Research Laboratory, Unidad de Una Salud, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Jeffrey Roach
- Microbiome Core Facility, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carlos Condori Pino
- Zoonotic Disease Research Laboratory, Unidad de Una Salud, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, California, United States of America
| | - Jonathan J. Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Steven R. Meshnick
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Natalie M. Bowman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Affiliation(s)
- Caryn Bern
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California.
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Mayta H, Romero YK, Pando A, Verastegui M, Tinajeros F, Bozo R, Henderson-Frost J, Colanzi R, Flores J, Lerner R, Bern C, Gilman RH. Improved DNA extraction technique from clot for the diagnosis of Chagas disease. PLoS Negl Trop Dis 2019; 13:e0007024. [PMID: 30633743 PMCID: PMC6329489 DOI: 10.1371/journal.pntd.0007024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022] Open
Abstract
Background The detection of Trypanosoma cruzi genetic material in clinical samples is considered an important diagnostic tool for Chagas disease. We have previously demonstrated that PCR using clot samples yields greater sensitivity than either buffy coat or whole blood samples. However, phenol-chloroform DNA extraction from clot samples is difficult and toxic. The objective of the present study was to improve and develop a more sensitive method to recover parasite DNA from clot samples for the diagnosis of Chagas disease. Methodology/Principal findings A total of 265 match pair samples of whole blood–guanidine (GEB) and clot samples were analyzed; 150 were from Chagas seropositive subjects. DNA was extracted from both whole blood-guanidine samples, using a previously standardized methodology, and from clot samples, using a newly developed methodology based on a combination of the FastPrep technique and the standard method for GEB extraction. A qPCR targeting the nuclear satellite sequences was used to compare the sample source and the extraction method. Of the 150 samples from Chagas positive individuals by serology, 47 samples tested positive by qPCR with DNA extracted by both GEB and clot, but an additional 13 samples tested positive only in DNA extracted from clot. No serology-negative samples resulted positive when tested by qPCR. Conclusions The new methodology for DNA extraction from clot samples improves the molecular diagnosis of Chagas disease. Detection of nucleic acid has become an important tool for the diagnosis of Chagas disease. Whole blood samples are usually the source of DNA and qPCR the preferred technique to demonstrate the presence of T. cruzi DNA. Although DNA extracted from clot samples has shown higher sensitivity than from whole blood, DNA extraction is performed using phenol-chloroform, which has biohazard issues. We theorize that a clot traps parasites, making it a better source of DNA for Chagas diagnosis using PCR. The present study describes a new DNA extraction methodology from clot samples which avoids the use of phenol-chloroform. The new methodology was compared to the internationally standardized diagnostic method, which is based on extraction of DNA from whole blood preserved with guanidine EDTA and a commercial kit.
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Affiliation(s)
- Holger Mayta
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,A.B Prisma, Lima, Perú
| | - Yomara K Romero
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alejandra Pando
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Manuela Verastegui
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ricardo Bozo
- Hospital Municipal Camiri, Camiri, Plurinational State of Bolivia
| | | | - Rony Colanzi
- Hospital Universitario Japones, Santa Cruz de la Sierra, Plurinational State of Bolivia
| | - Jorge Flores
- Hospital San Juan de Dios, Santa Cruz de la Sierra, Plurinational State of Bolivia
| | - Richard Lerner
- Pan American Zoonotic Research and Prevention, Framingham, Massachusetts, United States of America
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, United States of America
| | - Robert H Gilman
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,A.B Prisma, Lima, Perú
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Chapman LAC, Morgan ALK, Adams ER, Bern C, Medley GF, Hollingsworth TD. Age trends in asymptomatic and symptomatic Leishmania donovani infection in the Indian subcontinent: A review and analysis of data from diagnostic and epidemiological studies. PLoS Negl Trop Dis 2018; 12:e0006803. [PMID: 30521526 PMCID: PMC6283524 DOI: 10.1371/journal.pntd.0006803] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Age patterns in asymptomatic and symptomatic infection with Leishmania donovani, the causative agent of visceral leishmaniasis (VL) in the Indian subcontinent (ISC), are currently poorly understood. Age-stratified serology and infection incidence have been used to assess transmission levels of other diseases, which suggests that they may also be of use for monitoring and targeting control programmes to achieve elimination of VL and should be included in VL transmission dynamic models. We therefore analysed available age-stratified data on both disease incidence and prevalence of immune markers with the aim of collating the currently available data, estimating rates of infection, and informing modelling and future data collection. METHODOLOGY/PRINCIPAL FINDINGS A systematic literature search yielded 13 infection prevalence and 7 VL incidence studies meeting the inclusion criteria. Statistical tests were performed to identify trends by age, and according to diagnostic cut-off. Simple reversible catalytic models with age-independent and age-dependent infection rates were fitted to the prevalence data to estimate infection and reversion rates, and to test different hypotheses about the origin of variation in these rates. Most of the studies showed an increase in infection prevalence with age: from ≲10% seroprevalence (<20% Leishmanin skin test (LST) positivity) for 0-10-year-olds to >10% seroprevalence (>20% LST-positivity) for 30-40-year-olds, but overall prevalence varied considerably between studies. VL incidence was lower amongst 0-5-year-olds than older age groups in most studies; most showing a peak in incidence between ages 5 and 20. The age-independent catalytic model provided the best overall fit to the infection prevalence data, but the estimated rates for the less parsimonious age-dependent model were much closer to estimates from longitudinal studies, suggesting that infection rates may increase with age. CONCLUSIONS/SIGNIFICANCE Age patterns in asymptomatic infection prevalence and VL incidence in the ISC vary considerably with geographical location and time period. The increase in infection prevalence with age and peaked age-VL-incidence distribution may be due to lower exposure to infectious sandfly bites in young children, but also suggest that acquired immunity to the parasite increases with age. However, poor standardisation of serological tests makes it difficult to compare data from different studies and draw firm conclusions about drivers of variation in observed age patterns.
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Affiliation(s)
- Lloyd A. C. Chapman
- Zeeman Institute, University of Warwick, Coventry, United Kingdom
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alex L. K. Morgan
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- School of Biological Sciences, University of Edinburgh, Edinbugh, United Kingdom
| | - Emily R. Adams
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Graham F. Medley
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T. Déirdre Hollingsworth
- Zeeman Institute, University of Warwick, Coventry, United Kingdom
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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