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Mwamba GN, Nzaji MK, Hoff NA, Mukadi PK, Musene KK, Gerber SK, Halbrook M, Sinai C, Fuller T, Numbi OL, Wemakoy EO, Tamfum JJM, Mukadi DN, Mapatano MA, Rimoin AW, Dikassa PSL. Nutritional Status Link with Polioseronegativity Among Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC). J Multidiscip Healthc 2024; 17:1219-1229. [PMID: 38524863 PMCID: PMC10960541 DOI: 10.2147/jmdh.s437351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/08/2024] [Indexed: 03/26/2024] Open
Abstract
Background Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC. Methods In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA. Results Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.96; [1.52-2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20-2.24]) and the non-administration of vitamin A (OR=1.55; [1.20-2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.80. [1.38-2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10-2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30-2.55]) were significantly associated with seronegativity to all polioserotypes. Conclusion This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.
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Affiliation(s)
- Guillaume N Mwamba
- Department of Public Health, Faculty of Medicine, University of Kamina, Kamina, Democratic Republic of the Congo
- Expanded Program on Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Michel Kabamba Nzaji
- Department of Public Health, Faculty of Medicine, University of Kamina, Kamina, Democratic Republic of the Congo
- Expanded Program on Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Patrick K Mukadi
- National Institute of Biomedical Research (INRB), Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Kamy Kaminye Musene
- UCLA-DRC Health Research and Training Program, UCLA-DRC, Kinshasa, Democratic Republic of the Congo
| | - Sue K Gerber
- Polio Eradication program, The Bill and Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Megan Halbrook
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Cyrus Sinai
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Trevon Fuller
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Oscar Luboya Numbi
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, 1825, Democratic Republic of the Congo
| | - Emile Okitolonda Wemakoy
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Jacques Muyembe Tamfum
- National Institute of Biomedical Research (INRB), Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Dalau Nkamba Mukadi
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Mala Ali Mapatano
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Nutrition, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Paul-Samson Lusamba Dikassa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Mwamba GN, Kabamba M, Hoff NA, Mukadi PK, Musene KK, Gerber SK, Halbrook M, Sinai C, Fuller T, Voorman A, Mawaw PM, Numbi OL, Wemakoy EO, Mechael PN, Tamfum JJM, Mapatano MA, Rimoin AW, Lusamba Dikassa PS. Prediction Model with Validation for Polioseronegativity in Malnourished Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC). Pragmat Obs Res 2023; 14:155-165. [PMID: 38146546 PMCID: PMC10749540 DOI: 10.2147/por.s437485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023] Open
Abstract
Background Malnutrition is identified as a risk factor for insufficient polio seroconversion in the context of a vaccine-derived poliovirus (VDPV) outbreak-prone region. In the Democratic Republic of Congo (DRC), underweight decreased from 31% (in 2001) to 26% (in 2018). Since 2004, VDPV serotype 2 outbreaks (cVDPV2) have been documented and were geographically limited around the Haut-Lomami and Tanganyika Provinces. Methods To develop and validate a predictive model for poliomyelitis vaccine response in malnourished infants, a cross-sectional household study was carried out in the Haut-Lomami and Tanganyika provinces. Healthy children aged 6 to 59 months (n=968) were enrolled from eight health zones (HZ) out of 27, in March 2018. We performed a bivariate and multivariate logistics analysis. Final models were selected using a stepwise Wald method, and variables were selected based on the criterion p < 0.05. The association between nutritional variables, explaining polio seronegativity for the three serotypes, was assessed using the receiver operating characteristic curve (ROC curve). Results Factors significantly associated with seronegativity to the three polio serotypes were underweight, non-administration of vitamin A, and the age group of 12 to 59 months. The sensitivity was 10.5%, and its specificity was 96.4% while the positive predictive values (PPV) and negative (PNV) were 62.7% and 65.3%, respectively. We found a convergence of the curves of the initial sample and two split samples. Based on the comparison of the overlapping confidence intervals of the ROC curve, we concluded that our prediction model is valid. Conclusion This study proposed the first tool which variables are easy to collect by any health worker in charge of vaccination or in charge of nutrition. It will bring on top, the collaboration between the Immunization and the Nutritional programs in DRC integration policy, and its replicability in other low- and middle-income countries with endemic poliovirus.
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Affiliation(s)
- Guillaume Ngoie Mwamba
- Department of Public Health, University of Kamina, Kamina, Haut-Lomami, Democratic Republic of the Congo
- Expanded Programme on Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Michel Kabamba
- Department of Public Health, University of Kamina, Kamina, Haut-Lomami, Democratic Republic of the Congo
- Expanded Programme on Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Patrick K Mukadi
- National Institute of Biomedical Research (INRB), Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Kamy Kaminye Musene
- Health Research and Training Program, UCLA-DRC, Kinshasa, Democratic Republic of the Congo
| | - Sue K Gerber
- Polio eradication program, The Bill and Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Megan Halbrook
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Cyrus Sinai
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Trevon Fuller
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Arie Voorman
- Polio eradication program, The Bill and Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Paul Makan Mawaw
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Haut-Katanga, 1825, Democratic Republic of the Congo
| | - Oscar Luboya Numbi
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Haut-Katanga, 1825, Democratic Republic of the Congo
| | - Emile Okitolonda Wemakoy
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Patricia N Mechael
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jean Jacques Muyembe Tamfum
- National Institute of Biomedical Research (INRB), Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Mala Ali Mapatano
- Department of Nutrition, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Paul-Samson Lusamba Dikassa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Halbrook M, Gadoth A, Shankar A, Zheng H, Campbell EM, Hoff NA, Muyembe JJ, Wemakoy EO, Rimoin AW, Switzer WM. Correction: Human T-cell lymphotropic virus type 1 transmission dynamics in rural villages in the Democratic Republic of the Congo with high nonhuman primate exposure. PLoS Negl Trop Dis 2023; 17:e0011046. [PMID: 36607890 PMCID: PMC9821508 DOI: 10.1371/journal.pntd.0011046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pntd.0008923.].
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Halbrook M, Gadoth A, Shankar A, Zheng H, Campbell EM, Hoff NA, Muyembe JJ, Wemakoy EO, Rimoin AW, Switzer WM. Human T-cell lymphotropic virus type 1 transmission dynamics in rural villages in the Democratic Republic of the Congo with high nonhuman primate exposure. PLoS Negl Trop Dis 2021; 15:e0008923. [PMID: 33507996 PMCID: PMC7872225 DOI: 10.1371/journal.pntd.0008923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/09/2021] [Accepted: 10/26/2020] [Indexed: 01/09/2023] Open
Abstract
The Democratic Republic of the Congo (DRC) has a history of nonhuman primate (NHP) consumption and exposure to simian retroviruses yet little is known about the extent of zoonotic simian retroviral infections in DRC. We examined the prevalence of human T-lymphotropic viruses (HTLV), a retrovirus group of simian origin, in a large population of persons with frequent NHP exposures and a history of simian foamy virus infection. We screened plasma from 3,051 persons living in rural villages in central DRC using HTLV EIA and western blot (WB). PCR amplification of HTLV tax and LTR sequences from buffy coat DNA was used to confirm infection and to measure proviral loads (pVLs). We used phylogenetic analyses of LTR sequences to infer evolutionary histories and potential transmission clusters. Questionnaire data was analyzed in conjunction with serological and molecular data. A relatively high proportion of the study population (5.4%, n = 165) were WB seropositive: 128 HTLV-1-like, 3 HTLV-2-like, and 34 HTLV-positive but untypeable profiles. 85 persons had HTLV indeterminate WB profiles. HTLV seroreactivity was higher in females, wives, heads of households, and increased with age. HTLV-1 LTR sequences from 109 persons clustered strongly with HTLV-1 and STLV-1 subtype B from humans and simians from DRC, with most sequences more closely related to STLV-1 from Allenopithecus nigroviridis (Allen's swamp monkey). While 18 potential transmission clusters were identified, most were in different households, villages, and health zones. Three HTLV-1-infected persons were co-infected with simian foamy virus. The mean and median percentage of HTLV-1 pVLs were 5.72% and 1.53%, respectively, but were not associated with age, NHP exposure, village, or gender. We document high HTLV prevalence in DRC likely originating from STLV-1. We demonstrate regional spread of HTLV-1 in DRC with pVLs reported to be associated with HTLV disease, supporting local and national public health measures to prevent spread and morbidity.
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Affiliation(s)
- Megan Halbrook
- University of California Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
| | - Adva Gadoth
- University of California Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
| | - Anupama Shankar
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - HaoQiang Zheng
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ellsworth M. Campbell
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nicole A. Hoff
- University of California Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Anne W. Rimoin
- University of California Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
- * E-mail: (AWR); (WMS)
| | - William M. Switzer
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail: (AWR); (WMS)
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Hughes CM, Liu L, Davidson WB, Radford KW, Wilkins K, Monroe B, Metcalfe MG, Likafi T, Lushima RS, Kabamba J, Nguete B, Malekani J, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Reynolds MG, Schmid DS, McCollum AM. A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo. Am J Trop Med Hyg 2020. [PMID: 33289470 DOI: 10.4269/ajtmh.200589] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Recent enhanced monkeypox (MPX) surveillance in the Democratic Republic of Congo, where MPX is endemic, has uncovered multiple cases of MPX and varicella zoster virus (VZV) coinfections. The purpose of this study was to verify if coinfections occur and to characterize the clinical nature of these cases. Clinical, epidemiological, and laboratory results were used to investigate MPX/VZV coinfections. A coinfection was defined as a patient with at least one Orthopoxvirus/MPX-positive sample and at least one VZV-positive sample within the same disease event. Between September 2009 and April 2014, 134 of the 1,107 (12.1%) suspected MPX cases were confirmed as MPX/VZV coinfections. Coinfections were more likely to report symptoms than VZV-alone cases and less likely than MPX-alone cases. Significantly higher lesion counts were observed for coinfection cases than for VZV-alone but less than MPX-alone cases. Discernible differences in symptom and rash severity were detected for coinfection cases compared with those with MPX or VZV alone. Findings indicate infection with both MPX and VZV could modulate infection severity. Collection of multiple lesion samples allows for the opportunity to detect coinfections. As this program continues, it will be important to continue these procedures to assess variations in the proportion of coinfected cases over time.
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Affiliation(s)
- Christine M Hughes
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindy Liu
- 2Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,3Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Whitni B Davidson
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kay W Radford
- 4Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G Metcalfe
- 3Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Toutou Likafi
- 5Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Joelle Kabamba
- 7U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- 5Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- 8Department of Biology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- 9Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- 9Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Mary G Reynolds
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D Scott Schmid
- 4Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea M McCollum
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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6
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Hughes CM, Liu L, Davidson WB, Radford KW, Wilkins K, Monroe B, Metcalfe MG, Likafi T, Lushima RS, Kabamba J, Nguete B, Malekani J, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Reynolds MG, Schmid DS, McCollum AM. A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo. Am J Trop Med Hyg 2020; 104:604-611. [PMID: 33289470 PMCID: PMC7866336 DOI: 10.4269/ajtmh.20-0589] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022] Open
Abstract
Recent enhanced monkeypox (MPX) surveillance in the Democratic Republic of Congo, where MPX is endemic, has uncovered multiple cases of MPX and varicella zoster virus (VZV) coinfections. The purpose of this study was to verify if coinfections occur and to characterize the clinical nature of these cases. Clinical, epidemiological, and laboratory results were used to investigate MPX/VZV coinfections. A coinfection was defined as a patient with at least one Orthopoxvirus/MPX-positive sample and at least one VZV-positive sample within the same disease event. Between September 2009 and April 2014, 134 of the 1,107 (12.1%) suspected MPX cases were confirmed as MPX/VZV coinfections. Coinfections were more likely to report symptoms than VZV-alone cases and less likely than MPX-alone cases. Significantly higher lesion counts were observed for coinfection cases than for VZV-alone but less than MPX-alone cases. Discernible differences in symptom and rash severity were detected for coinfection cases compared with those with MPX or VZV alone. Findings indicate infection with both MPX and VZV could modulate infection severity. Collection of multiple lesion samples allows for the opportunity to detect coinfections. As this program continues, it will be important to continue these procedures to assess variations in the proportion of coinfected cases over time.
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Affiliation(s)
- Christine M. Hughes
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindy Liu
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Whitni B. Davidson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kay W. Radford
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G. Metcalfe
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- Department of Biology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D. Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Kayiba NK, Yobi DM, Tshibangu-Kabamba E, Tuan VP, Yamaoka Y, Devleesschauwer B, Mvumbi DM, Okitolonda Wemakoy E, De Mol P, Mvumbi GL, Hayette MP, Rosas-Aguirre A, Speybroeck N. Spatial and molecular mapping of Pfkelch13 gene polymorphism in Africa in the era of emerging Plasmodium falciparum resistance to artemisinin: a systematic review. Lancet Infect Dis 2020; 21:e82-e92. [PMID: 33125913 DOI: 10.1016/s1473-3099(20)30493-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
The spread of Plasmodium falciparum isolates carrying mutations in the kelch13 (Pfkelch13) gene associated with artemisinin resistance (PfART-R) in southeast Asia threatens malaria control and elimination efforts. Emergence of PfART-R in Africa would result in a major public health problem. In this systematic review, we investigate the frequency and spatial distribution of Pfkelch13 mutants in Africa, including mutants linked to PfART-R in southeast Asia. Seven databases were searched (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline, and Web of Science) for relevant articles about polymorphisms of the Pfkelch13 gene in Africa before January, 2019. Following PRISMA guidelines, 53 studies that sequenced the Pfkelch13 gene of 23 100 sample isolates in 41 sub-Saharan African countries were included. The Pfkelch13 sequence was highly polymorphic (292 alleles, including 255 in the Pfkelch13-propeller domain) but with mutations occurring at very low relative frequencies. Non-synonymous mutations were found in only 626 isolates (2·7%) from west, central, and east Africa. According to WHO, nine different mutations linked to PfART-R in southeast Asia (Phe446Ile, Cys469Tyr, Met476Ile, Arg515Lys, Ser522Cys, Pro553Leu, Val568Gly, Pro574Leu, and Ala675Val) were detected, mainly in east Africa. Several other Pfkelch13 mutations, such as those structurally similar to southeast Asia PfART-R mutations, were also identified, but their relevance for drug resistance is still unknown. This systematic review shows that Africa, thought to not have established PfART-R, reported resistance-related mutants in the past 5 years. Surveillance using PfART-R molecular markers can provide valuable decision-making information to sustain the effectiveness of artemisinin in Africa.
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Affiliation(s)
- Nadine K Kayiba
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium; Department of Public Health, University of Mbujimayi, Mbujimayi, DR Congo; Department of Epidemiology and Biostatistics, University of Kinshasa, Kinshasa, DR Congo
| | - Doudou M Yobi
- Department of Basic Sciences, University of Kinshasa, Kinshasa, DR Congo
| | - Evariste Tshibangu-Kabamba
- Department of Basic Sciences, University of Mbujimayi, Mbujimayi, DR Congo; Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
| | - Vo P Tuan
- Department of Endoscopy, Cho Ray Hospital, Ho Chi Minh, Vietnam; Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Dieudonné M Mvumbi
- Department of Basic Sciences, University of Kinshasa, Kinshasa, DR Congo
| | | | - Patrick De Mol
- Department of Parasitology and Mycology, University Hospital of Liège, Liège, Belgium
| | - Georges L Mvumbi
- Department of Basic Sciences, University of Kinshasa, Kinshasa, DR Congo
| | - Marie-Pierre Hayette
- Department of Parasitology and Mycology, University Hospital of Liège, Liège, Belgium
| | - Angel Rosas-Aguirre
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Niko Speybroeck
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.
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8
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Steffen I, Lu K, Hoff NA, Mulembakani P, Okitolonda Wemakoy E, Muyembe-Tamfum JJ, Ndembi N, Brennan CA, Hackett J, Switzer WM, Saragosti S, Mbensa GO, Laperche S, Rimoin AW, Simmons G. Seroreactivity against Marburg or related filoviruses in West and Central Africa. Emerg Microbes Infect 2020; 9:124-128. [PMID: 31913767 PMCID: PMC6968259 DOI: 10.1080/22221751.2019.1709563] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A serological survey of 2,430 archived serum samples collected between 1997 and 2012 was conducted to retrospectively determine the prevalence of Marburg virus in five African countries. Serum samples were screened for neutralizing antibodies in a pseudotype micro-neutralization assay and confirmed by enzyme-linked immunosorbent assay (ELISA). Surprisingly, a seroprevalence for Marburg virus of 7.5 and 6.3% was found in Cameroon and Ghana, respectively, suggesting the circulation of filoviruses or related viruses outside of known endemic areas that remain undetected by current surveillance efforts. However, due to the lack of validated assays and appropriate positive controls, these results must be considered preliminary.
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Affiliation(s)
- Imke Steffen
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kai Lu
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Prime Mulembakani
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | | | | | - Guy O Mbensa
- Centre National de Transfusion Sanguine, Kinshasa, Democratic Republic of Congo
| | - Syria Laperche
- Institut National de la Transfusion Sanguine, Paris, France
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
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9
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Babakazo P, Kabamba-Tshilobo J, Wemakoy EO, Lubula L, Manya LK, Ilunga BK, Disasuani W, Nkwembe E, Kavunga-Membo H, Changachanga JC, Muhemedi S, Tamfum JJM, Tempia S. Evaluation of the influenza sentinel surveillance system in the Democratic Republic of Congo, 2012-2015. BMC Public Health 2019; 19:1652. [PMID: 31823763 PMCID: PMC6902419 DOI: 10.1186/s12889-019-8008-2] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). METHODS We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012-2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: < 60% weak performance; 60-79% moderate performance; ≥80% good performance. RESULTS During 2012-2015, we enrolled and tested 4339 patients with influenza-like illness (ILI) and 2869 patients with severe acute respiratory illness (SARI) from 11 sentinel sites situated in 5 of 11 provinces. Influenza viruses were detected in 446 (10.3%) samples from patients with ILI and in 151 (5.5%) samples from patients with SARI with higher detection during December-May. Data quality and completeness was > 90% for all evaluated indicators. Other strengths of the system were timeliness, simplicity, stability and utility that scored > 70% each. Representativeness, flexibility and acceptability had moderate performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. CONCLUSIONS The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.
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Affiliation(s)
- Pélagie Babakazo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Joelle Kabamba-Tshilobo
- Influenza and Monkeypox Program, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Léopold Lubula
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Léonie Kitoko Manya
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Benoit Kebela Ilunga
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Wally Disasuani
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Edith Nkwembe
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Hugo Kavunga-Membo
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude Changachanga
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Saleh Muhemedi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
- MassGenics, Duluth, GA, USA.
- Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.
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10
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Alfonso VH, Bratcher A, Ashbaugh H, Doshi R, Gadoth A, Hoff N, Mukadi P, Ghanem A, Cheng A, Gerber S, Mwamba GN, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Rimoin AW. Changes in childhood vaccination coverage over time in the Democratic Republic of the Congo. PLoS One 2019; 14:e0217426. [PMID: 31125375 PMCID: PMC6534301 DOI: 10.1371/journal.pone.0217426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/11/2019] [Accepted: 05/11/2019] [Indexed: 11/19/2022] Open
Abstract
Despite increased vaccination rates, the burden, morbidity and mortality associated with vaccine preventable diseases remains high. In the Democratic Republic of the Congo (DRC), potentially unreliable data and geographically varied program provision call for a better understanding of vaccination coverage and its changes over time at the country and province level. To assess changes in the proportion of children who were fully vaccinated over time in the DRC, vaccination histories for children 12-59 months of age were obtained from both the 2007 and 2013-2014 Demographic and Health Surveys (DHS). Changes were assessed, both at the country- and province-levels, to identify potential geographic variations. Vaccination coverage improved 70% between the DHS waves: 26% compared to 44% of 12-59 month-old children met full vaccination criteria in 2007 and 2013-2014, respectively (n2007 = 3032 and n2013-14 = 6619). Similarly, there was an overall trend across both DHS waves where as year of birth increased, so did vaccination coverage. There was geographic variation in immunization changes with most central and eastern provinces increasing in coverage and most northern, western and southern provinces having decreased vaccination coverage at the second time point. Using nationally representative data, we identified significant changes over time in vaccination coverage which may help to inform future policy, interventions and research to improve vaccination rates among children in the DRC. This study is the first of its kind for the population of DRC and provides an important initial step towards better understanding trends in vaccination coverage over time.
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Affiliation(s)
- Vivian H. Alfonso
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
- McKing Consulting, Atlanta, Georgia, United States of America
| | - Anna Bratcher
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hayley Ashbaugh
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Reena Doshi
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Adva Gadoth
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Nicole Hoff
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Patrick Mukadi
- National Institute for Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Angie Ghanem
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Alvan Cheng
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | | | - Anne W. Rimoin
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
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11
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Rimoin AW, Lu K, Bramble MS, Steffen I, Doshi RH, Hoff NA, Mukadi P, Nicholson BP, Alfonso VH, Olinger G, Sinai C, Yamamoto LK, Ramirez CM, Okitolonda Wemakoy E, Kebela Illunga B, Pettitt J, Logue J, Bennett RS, Jahrling P, Heymann DL, Piot P, Muyembe-Tamfum JJ, Hensley LE, Simmons G. Ebola Virus Neutralizing Antibodies Detectable in Survivors of theYambuku, Zaire Outbreak 40 Years after Infection. J Infect Dis 2019; 217:223-231. [PMID: 29253164 PMCID: PMC5853670 DOI: 10.1093/infdis/jix584] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 12/24/2022] Open
Abstract
The first reported outbreak of Ebola virus disease occurred in 1976 in Yambuku, Democratic Republic of Congo. Antibody responses in survivors 11 years after infection have been documented. However, this report is the first characterization of anti-Ebola virus antibody persistence and neutralization capacity 40 years after infection. Using ELISAs we measured survivor’s immunological response to Ebola virus Zaire (EBOV) glycoprotein and nucleoprotein, and assessed VP40 reactivity. Neutralization of EBOV was measured using a pseudovirus approach and plaque reduction neutralization test with live EBOV. Some survivors from the original EBOV outbreak still harbor antibodies against all 3 measures. Interestingly, a subset of these survivors’ serum antibodies could still neutralize live virus 40 years postinitial infection. These data provide the longest documentation of both anti-Ebola serological response and neutralization capacity within any survivor cohort, extending the known duration of response from 11 years postinfection to at least 40 years after symptomatic infection.
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Affiliation(s)
- Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Kai Lu
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Matthew S Bramble
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles.,Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia
| | - Imke Steffen
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Reena H Doshi
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Nicole A Hoff
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Vivian H Alfonso
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Gerrard Olinger
- Integrated Research Facility at Fort Detrick.,Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Cyrus Sinai
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Lauren K Yamamoto
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | | | | | | | - James Logue
- Integrated Research Facility at Fort Detrick
| | | | | | - David L Heymann
- Chatham House Center on Global Health Security, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lisa E Hensley
- Integrated Research Facility at Fort Detrick.,Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Graham Simmons
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
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12
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Petersen BW, Kabamba J, McCollum AM, Lushima RS, Wemakoy EO, Muyembe Tamfum JJ, Nguete B, Hughes CM, Monroe BP, Reynolds MG. Vaccinating against monkeypox in the Democratic Republic of the Congo. Antiviral Res 2019; 162:171-177. [PMID: 30445121 PMCID: PMC6438175 DOI: 10.1016/j.antiviral.2018.11.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 01/02/2023]
Abstract
Healthcare-associated transmission of monkeypox has been observed on multiple occasions in areas where the disease is endemic. Data collected by the US Centers for Disease Control and Prevention (CDC) from an ongoing CDC-supported program of enhanced surveillance in the Tshuapa Province of the Democratic Republic of the Congo, where the annual incidence of human monkeypox is estimated to be 3.5-5/10,000, suggests that there is approximately one healthcare worker infection for every 100 confirmed monkeypox cases. Herein, we describe a study that commenced in February 2017, the intent of which is to evaluate the effectiveness, immunogenicity, and safety of a third-generation smallpox vaccine, IMVAMUNE®, in healthcare personnel at risk of monkeypox virus (MPXV) infection. We describe procedures for documenting exposures to monkeypox virus infection in study participants, and outline lessons learned that may be of relevance for studies of other investigational medical countermeasures in hard to reach, under-resourced populations.
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Affiliation(s)
| | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | | | - Robert Shongo Lushima
- Hemorrhagic Fever and Monkeypox Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Mary G Reynolds
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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13
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Bramble MS, Hoff N, Gilchuk P, Mukadi P, Lu K, Doshi RH, Steffen I, Nicholson BP, Lipson A, Vashist N, Sinai C, Spencer D, Olinger G, Wemakoy EO, Illunga BK, Pettitt J, Logue J, Marchand J, Varughese J, Bennett RS, Jahrling P, Cavet G, Serafini T, Ollmann Saphire E, Vilain E, Muyembe-Tamfum JJ, Hensely LE, Simmons G, Crowe JE, Rimoin AW. Pan-Filovirus Serum Neutralizing Antibodies in a Subset of Congolese Ebolavirus Infection Survivors. J Infect Dis 2018; 218:1929-1936. [PMID: 30107445 PMCID: PMC6217721 DOI: 10.1093/infdis/jiy453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/28/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
One year after a Zaire ebolavirus (EBOV) outbreak occurred in the Boende Health Zone of the Democratic Republic of the Congo during 2014, we sought to determine the breadth of immune response against diverse filoviruses including EBOV, Bundibugyo (BDBV), Sudan (SUDV), and Marburg (MARV) viruses. After assessing the 15 survivors, 5 individuals demonstrated some degree of reactivity to multiple ebolavirus species and, in some instances, Marburg virus. All 5 of these survivors had immunoreactivity to EBOV glycoprotein (GP) and EBOV VP40, and 4 had reactivity to EBOV nucleoprotein (NP). Three of these survivors showed serologic responses to the 3 species of ebolavirus GPs tested (EBOV, BDBV, SUDV). All 5 samples also exhibited ability to neutralize EBOV using live virus, in a plaque reduction neutralization test. Remarkably, 3 of these EBOV survivors had plasma antibody responses to MARV GP. In pseudovirus neutralization assays, serum antibodies from a subset of these survivors also neutralized EBOV, BDBV, SUDV, and Taï Forest virus as well as MARV. Collectively, these findings suggest that some survivors of naturally acquired ebolavirus infection mount not only a pan-ebolavirus response, but also in less frequent cases, a pan-filovirus neutralizing response.
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Affiliation(s)
- Matthew S Bramble
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Nicole Hoff
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Pavlo Gilchuk
- Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Kai Lu
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Reena H Doshi
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Imke Steffen
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Allen Lipson
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Neerja Vashist
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Cyrus Sinai
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - D’andre Spencer
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Garrard Olinger
- Boston University, School of Medicine, Department of Medicine, Massachusetts
| | | | - Benoit Kebela Illunga
- Direction de la Lutte Contre les Maladies, Ministère de la Sante, Kinshasa, Democratic Republic of the Congo
| | - James Pettitt
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - James Logue
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Jonathan Marchand
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Justin Varughese
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Richard S Bennett
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Peter Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | | | | | - Erica Ollmann Saphire
- Skaggs Institute for Chemical Biology, La Jolla, California
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, California
| | - Eric Vilain
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | | | - Lisa E Hensely
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
- Emerging Viral Pathogens Section, NIAID, NIH, Frederick, Maryland
| | - Graham Simmons
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - James E Crowe
- Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Pediatrics and Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
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14
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Babakazo P, Lubula L, Disasuani W, Manya LK, Nkwembe E, Mitongo N, Kavunga-Membo H, Changachanga JC, Muhemedi S, Ilunga BK, Wemakoy EO, Tamfum JJM, Kabamba-Tshilobo J, Tempia S. The national and provincial burden of medically attended influenza-associated influenza-like illness and severe acute respiratory illness in the Democratic Republic of Congo, 2013-2015. Influenza Other Respir Viruses 2018; 12:695-705. [PMID: 30120818 PMCID: PMC6185889 DOI: 10.1111/irv.12601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Estimates of influenza-associated outpatient consultations and hospitalizations are severely limited in low- and middle-income countries, especially in Africa. METHODS We conducted active prospective surveillance for influenza-like illness (ILI) and severe acute respiratory illness (SARI) at 5 healthcare facilities situated in Kinshasa Province during 2013-2015. We tested upper respiratory tract samples for influenza viruses using a reverse transcription-polymerase chain reaction assay. We estimated age-specific numbers and rates of influenza-associated ILI outpatient consultations and SARI hospitalizations for Kinshasa Province using a combination of administrative and influenza surveillance data. These estimates were extrapolated to each of the remaining 10 provinces accounting for provincial differences in prevalence of risk factors for pneumonia and healthcare-seeking behavior. Rates were reported per 100 000 population. RESULTS During 2013-2015, the mean annual national number of influenza-associated ILI outpatient consultations was 1 003 212 (95% Confidence Incidence [CI]: 719 335-1 338 050 - Rate: 1205.3; 95% CI: 864.2-1607.5); 199 839 (95% CI: 153 563-254 759 - Rate: 1464.0; 95% CI: 1125.0-1866.3) among children aged <5 years and 803 374 (95% CI: 567 772-1 083 291 - Rate: 1154.5; 95% CI: 813.1-1556.8) among individuals aged ≥5 years. The mean annual national number of influenza-associated SARI hospitalizations was 40 361 (95% CI: 24 014-60 514 - Rate: 48.5; 95% CI: 28.9-72.7); 25 452 (95% CI: 19 146-32 944 - Rate: 186.5; 95% CI: 140.3-241.3) among children aged <5 years and 14 909 (95% CI: 4868-27 570 - Rate: 21.4; 95% CI: 28.9-72.7) among individuals aged ≥5 years. CONCLUSIONS The burden of influenza-associated ILI outpatient consultations and SARI hospitalizations was substantial and was highest among hospitalized children aged <5 years.
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Affiliation(s)
- Pélagie Babakazo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Léopold Lubula
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Wally Disasuani
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Léonie Kitoko Manya
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Edith Nkwembe
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Naomi Mitongo
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Hugo Kavunga-Membo
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude Changachanga
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Saleh Muhemedi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Benoit Kebela Ilunga
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Joelle Kabamba-Tshilobo
- Influenza and Monkeypox Program, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,MassGenics, Duluth, Georgia
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15
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Shiferaw ML, Doty JB, Maghlakelidze G, Morgan J, Khmaladze E, Parkadze O, Donduashvili M, Wemakoy EO, Muyembe JJ, Mulumba L, Malekani J, Kabamba J, Kanter T, Boulanger LL, Haile A, Bekele A, Bekele M, Tafese K, McCollum AA, Reynolds MG. Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases. Emerg Infect Dis 2018; 23. [PMID: 29155663 PMCID: PMC5711328 DOI: 10.3201/eid2313.170601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Preventing zoonotic diseases requires coordinated actions by government authorities responsible for human and animal health. Constructing the frameworks needed to foster intersectoral collaboration can be approached in many ways. We highlight 3 examples of approaches to implement zoonotic disease prevention and control programs. The first, rabies control in Ethiopia, was implemented using an umbrella approach: a comprehensive program designed for accelerated impact. The second, a monkeypox program in Democratic Republic of the Congo, was implemented in a stepwise manner, whereby incremental improvements and activities were incorporated into the program. The third approach, a pathogen discovery program, applied in the country of Georgia, was designed to characterize and understand the ecology, epidemiology, and pathogenesis of a new zoonotic pathogen. No one approach is superior, but various factors should be taken into account during design, planning, and implementation.
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Nolen LD, Osadebe L, Katomba J, Likofata J, Mukadi D, Monroe B, Doty J, Hughes CM, Kabamba J, Malekani J, Bomponda PL, Lokota JI, Balilo MP, Likafi T, Lushima RS, Ilunga BK, Nkawa F, Pukuta E, Karhemere S, Tamfum JJM, Nguete B, Wemakoy EO, McCollum AM, Reynolds MG. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerg Infect Dis 2018; 22:1014-21. [PMID: 27191380 PMCID: PMC4880088 DOI: 10.3201/eid2206.150579] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
During the outbreak, 50% of household members living with an infected person developed symptom of monkeypox infection. A 600-fold increase in monkeypox cases occurred in the Bokungu Health Zone of the Democratic Republic of the Congo during the second half of 2013; this increase prompted an outbreak investigation. A total of 104 possible cases were reported from this health zone; among 60 suspected cases that were tested, 50 (48.1%) cases were confirmed by laboratory testing, and 10 (9.6%) tested negative for monkeypox virus (MPXV) infection. The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%. Nine families showed >1 transmission event, and >6 transmission events occurred within this health zone. Mean incubation period was 8 days (range 4–14 days). The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases. Community education and training are needed to prevent transmission of MPXV infection during outbreaks.
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Voorman A, Hoff NA, Doshi RH, Alfonso V, Mukadi P, Muyembe-Tamfum JJ, Wemakoy EO, Bwaka A, Weldon W, Gerber S, Rimoin AW. Polio immunity and the impact of mass immunization campaigns in the Democratic Republic of the Congo. Vaccine 2017; 35:5693-5699. [PMID: 28882442 PMCID: PMC5628608 DOI: 10.1016/j.vaccine.2017.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In order to prevent outbreaks from wild and vaccine-derived poliovirus, maintenance of population immunity in non-endemic countries is critical. METHODS We estimated population seroprevalence using dried blood spots collected from 4893 children 6-59months olds in the 2013-2014 Demographic and Health Survey in the Democratic Republic of the Congo (DRC). RESULTS Population immunity was 81%, 90%, and 70% for poliovirus types 1, 2, and 3, respectively. Among 6-59-month-old children, 78% reported at least one dose of polio in routine immunization, while only 15% had three doses documented on vaccination cards. All children in the study had been eligible for at least two trivalent oral polio vaccine campaigns at the time of enrollment; additional immunization campaigns seroconverted 5.0%, 14%, and 5.5% of non-immune children per-campaign for types 1, 2, and 3, respectively, averaged over relevant campaigns for each serotype. CONCLUSIONS Overall polio immunity was high at the time of the study, though pockets of low immunity cannot be ruled out. The DRC still relies on supplementary immunization campaigns, and this report stresses the importance of the quality and coverage of those campaigns over their quantity, as well as the importance of routine immunization.
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Affiliation(s)
- Arend Voorman
- The Bill and Melinda Gates Foundation, Seattle 98109, USA
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles 90095, USA
| | - Reena H Doshi
- Department of Epidemiology, University of California, Los Angeles 90095, USA
| | - Vivian Alfonso
- Department of Epidemiology, University of California, Los Angeles 90095, USA
| | - Patrick Mukadi
- National Institute for Biomedical Research (INRB), Kinshasa, The Democratic Republic of the Congo
| | | | | | - Ado Bwaka
- Expanded Programme on Immunization, McKing Consulting, Kinshasa, The Democratic Republic of the Congo
| | - William Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta 30329, USA
| | - Sue Gerber
- The Bill and Melinda Gates Foundation, Seattle 98109, USA
| | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles 90095, USA.
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18
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Doshi RH, Eckhoff P, Cheng A, Hoff NA, Mukadi P, Shidi C, Gerber S, Wemakoy EO, Muyembe-Tafum JJ, Kominski GF, Rimoin AW. Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo. Vaccine 2017; 35:6187-6194. [PMID: 28966000 DOI: 10.1016/j.vaccine.2017.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. METHODS We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. RESULTS Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. DISCUSSION Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | | | - Alvan Cheng
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Patrick Mukadi
- Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Calixte Shidi
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Sue Gerber
- Polio Program, Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA.
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of Congo.
| | | | - Gerald F Kominski
- Department of Health Policy and Management, UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
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Ashbaugh HR, Kuang B, Gadoth A, Alfonso VH, Mukadi P, Doshi RH, Hoff NA, Sinai C, Mossoko M, Kebela BI, Muyembe JJ, Wemakoy EO, Rimoin AW. Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system. Trop Med Int Health 2017; 22:1141-1153. [PMID: 28653456 DOI: 10.1111/tmi.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ebola virus disease (EVD) can be clinically severe and highly fatal, making surveillance efforts for early disease detection of paramount importance. In areas with limited access to laboratory testing, the Integrated Disease Surveillance and Response (IDSR) strategy in the Democratic Republic of Congo (DRC) may be a vital tool in improving outbreak response. METHODS Using DRC IDSR data from the nation's four EVD outbreak periods from 2007-2014, we assessed trends of Viral Hemorrhagic Fever (VHF) and EVD differential diagnoses reportable through IDSR. With official case counts from active surveillance of EVD outbreaks, we assessed accuracy of reporting through the IDSR passive surveillance system. RESULTS Although the active and passive surveillance represent distinct sets of data, the two were correlated, suggesting that passive surveillance based only on clinical evaluation may be a useful predictor of true cases prior to laboratory confirmation. There were 438 suspect VHF cases reported through the IDSR system and 416 EVD cases officially recorded across the outbreaks examined. CONCLUSION Although collected prior to official active surveillance cases, case reporting through the IDSR during the 2007, 2008 and 2012 outbreaks coincided with official EVD epidemic curves. Additionally, all outbreak areas experienced increases in suspected cases for both malaria and typhoid fever during EVD outbreaks, underscoring the importance of training health care workers in recognising EVD differential diagnoses and the potential for co-morbidities.
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Affiliation(s)
- Hayley R Ashbaugh
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Brandon Kuang
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Adva Gadoth
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Vivian H Alfonso
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Patrick Mukadi
- School of Medicine, Kinshasa University, Kinshasa, Democratic Republic of Congo
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Cyrus Sinai
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Mathias Mossoko
- Direction for Disease Control, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Benoit Ilunga Kebela
- Direction for Disease Control, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Jean-Jacques Muyembe
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of Congo
| | | | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, USA
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McMorrow ML, Wemakoy EO, Tshilobo JK, Emukule GO, Mott JA, Njuguna H, Waiboci L, Heraud JM, Rajatonirina S, Razanajatovo NH, Chilombe M, Everett D, Heyderman RS, Barakat A, Nyatanyi T, Rukelibuga J, Cohen AL, Cohen C, Tempia S, Thomas J, Venter M, Mwakapeje E, Mponela M, Lutwama J, Duque J, Lafond K, Nzussouo NT, Williams T, Widdowson MA. Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries. J Infect Dis 2015; 212:853-60. [PMID: 25712970 PMCID: PMC4826902 DOI: 10.1093/infdis/jiv100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Background. Data on causes of death due to respiratory illness in Africa are limited. Methods. From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)–associated deaths identified from influenza surveillance during 2009–2012. Results. Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%–25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%–5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus–negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0–4 years, 462 (43.1%) involved people aged 5–49 years, and 209 (19.5%) involved people aged ≥50 years. Conclusions. Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.
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Affiliation(s)
- Meredith L McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland
| | | | | | | | - Joshua A Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-Kenya, Nairobi
| | - Henry Njuguna
- Centers for Disease Control and Prevention-Kenya, Nairobi
| | - Lilian Waiboci
- Centers for Disease Control and Prevention-Kenya, Nairobi
| | | | | | | | - Moses Chilombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | | | - Thierry Nyatanyi
- Division of Epidemic Infectious Diseases, Rwanda Biomedical Center
| | | | - Adam L Cohen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Centers for Disease Control and Prevention-South Africa
| | - Juno Thomas
- Outbreak Response Unit, National Institute for Communicable Diseases
| | - Marietjie Venter
- Centers for Disease Control and Prevention-South Africa Zoonoses Research Unit, Department of Medical Virology, University of Pretoria Centre for Respiratory Diseases and Meningitis
| | - Elibariki Mwakapeje
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Ministry of Health and Social Welfare-Tanzania
| | - Marcelina Mponela
- Ministry of Health and Social Welfare-Tanzania Centers for Disease Control and Prevention-Tanzania, Dar es Salaam
| | - Julius Lutwama
- Centers for Disease Control and Prevention-Tanzania, Dar es Salaam Uganda Virus Research Institute, Entebbe
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Battelle, Atlanta, Georgia
| | - Kathryn Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Thelma Williams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
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Kugelman JR, Johnston SC, Mulembakani PM, Kisalu N, Lee MS, Koroleva G, McCarthy SE, Gestole MC, Wolfe ND, Fair JN, Schneider BS, Wright LL, Huggins J, Whitehouse CA, Wemakoy EO, Muyembe-Tamfum JJ, Hensley LE, Palacios GF, Rimoin AW. Genomic variability of monkeypox virus among humans, Democratic Republic of the Congo. Emerg Infect Dis 2014; 20:232-9. [PMID: 24457084 PMCID: PMC3901482 DOI: 10.3201/eid2002.130118] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Monkeypox virus is a zoonotic virus endemic to Central Africa. Although active disease surveillance has assessed monkeypox disease prevalence and geographic range, information about virus diversity is lacking. We therefore assessed genome diversity of viruses in 60 samples obtained from humans with primary and secondary cases of infection from 2005 through 2007. We detected 4 distinct lineages and a deletion that resulted in gene loss in 10 (16.7%) samples and that seemed to correlate with human-to-human transmission (p = 0.0544). The data suggest a high frequency of spillover events from the pool of viruses in nonhuman animals, active selection through genomic destabilization and gene loss, and increased disease transmissibility and severity. The potential for accelerated adaptation to humans should be monitored through improved surveillance.
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Affiliation(s)
| | | | - Prime M. Mulembakani
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Neville Kisalu
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Michael S. Lee
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Galina Koroleva
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Sarah E. McCarthy
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Marie C. Gestole
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Nathan D. Wolfe
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Joseph N. Fair
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Bradley S. Schneider
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Linda L. Wright
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - John Huggins
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Chris A. Whitehouse
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Emile Okitolonda Wemakoy
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Jean Jacques Muyembe-Tamfum
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
| | - Lisa E. Hensley
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA (J.R. Kugelman, S.C. Johnston, M.S. Lee, G. Koroleva, S.E. McCarthy, M.C. Gestole, J. Huggins, C.A. Whitehouse, G.F. Palacios)
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (P.M. Mulembakani, E.O. Wemakoy)
- University of California, Los Angeles, California, USA (N. Kisalu, A.W. Rimoin)
- Global Viral Forecasting (now known as Metabiota), San Francisco, California, USA (N.D. Wolfe, J.N, Fair, B.S. Schneider)
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA (L.L. Wright)
- National Institute of Biomedical Research, Kinshasa (J.J. Muyembe-Tamfum)
- US Food and Drug Administration, Silver Spring, Maryland, USA (L.E. Hensley)
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22
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Switzer WM, Tang S, Ahuka-Mundeke S, Shankar A, Hanson DL, Zheng H, Ayouba A, Wolfe ND, LeBreton M, Djoko CF, Tamoufe U, Esteban A, Heneine W, Peeters M, Wright LL, Muyembe-Tamfum JJ, Wemakoy EO, Mulembakani P, Hoff NA, Rimoin AW. Novel simian foamy virus infections from multiple monkey species in women from the Democratic Republic of Congo. Retrovirology 2012; 9:100. [PMID: 23217108 PMCID: PMC3524035 DOI: 10.1186/1742-4690-9-100] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/11/2012] [Indexed: 12/02/2022] Open
Abstract
Background Zoonotic transmission of simian retroviruses in Central Africa is ongoing and can result in pandemic human infection. While simian foamy virus (SFV) infection was reported in primate hunters in Cameroon and Gabon, little is known about the distribution of SFV in Africa and whether human-to-human transmission and disease occur. We screened 3,334 plasmas from persons living in rural villages in central Democratic Republic of Congo (DRC) using SFV-specific EIA and Western blot (WB) tests. PCR amplification of SFV polymerase sequences from DNA extracted from buffy coats was used to measure proviral loads. Phylogenetic analysis was used to define the NHP species origin of SFV. Participants completed questionnaires to capture NHP exposure information. Results Sixteen (0.5%) samples were WB-positive; 12 of 16 were from women (75%, 95% confidence limits 47.6%, 92.7%). Sequence analysis detected SFV in three women originating from Angolan colobus or red-tailed monkeys; both monkeys are hunted frequently in DRC. NHP exposure varied and infected women lived in distant villages suggesting a wide and potentially diverse distribution of SFV infections across DRC. Plasmas from 22 contacts of 8 WB-positive participants were all WB negative suggesting no secondary viral transmission. Proviral loads in the three women ranged from 14 – 1,755 copies/105 cells. Conclusions Our study documents SFV infection in rural DRC for the first time and identifies infections with novel SFV variants from Colobus and red-tailed monkeys. Unlike previous studies, women were not at lower risk for SFV infection in our population, providing opportunities for spread of SFV both horizontally and vertically. However, limited testing of close contacts of WB-positive persons did not identify human-to-human transmission. Combined with the broad behavioral risk and distribution of NHPs across DRC, our results suggest that SFV infection may have a wider geographic distribution within DRC. These results also reinforce the potential for an increased SFV prevalence throughout the forested regions of Africa where humans and simians co-exist. Our finding of endemic foci of SFV infection in DRC will facilitate longitudinal studies to determine the potential for person-to-person transmissibility and pathogenicity of these zoonotic retroviral infections.
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Affiliation(s)
- William M Switzer
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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