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Akano A, Sadauki AH, Adelabu AM, Malgwi A, Fagbola M, Ogunbode O, Usman A, Ameh C, Balogun MS, Ilori E, Badaru S, Adetunji A, Adebayo A, Mba N, Iniobong A, Eze E, Akerele I, Grema B, Sodipo O, Enemuo E, Ochu C, Ihekweazu C, Adetifa I. Epidemiology of influenza in Nigeria: A secondary analysis of the sentinel surveillance data in Nigeria from 2010 - 2020. J Infect Public Health 2024; 17:495-502. [PMID: 38290192 DOI: 10.1016/j.jiph.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Influenza is a leading cause of morbidity and mortality globally. Little is known of the true burden and epidemiology of influenza in Africa. Nigeria has a sentinel surveillance system for influenza virus (IFV). This study seeks to describe the epidemiological characteristics of influenza cases in Nigeria through secondary data analysis of the sentinel surveillance data from 2010 to 2020. METHODOLOGY A retrospective secondary data analysis of data collected from patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) in the four Nigeria Influenza Sentinel Surveillance sites from January 2010 to December 2020. Data was cleaned and analyzed using Microsoft Excel and Epi info 7.2 for frequencies and proportions. The results of the analysis were summarized in tables and charts. RESULTS A total of 13,828 suspected cases of influenza were recorded at the sentinel sites during the study period. About 10.3% (1421/13,828) of these tested positive for IFV of which 1243 (87.5%) were ILI patients, 175 (12.3%) SARI patients, and 3 (0.2%) novel H1N1 patients. Males accounted for 54.2% (770/1421) of the confirmed cases. The median age of confirmed cases was 3 years (range: <1month-97 years). Children 0-4 years accounted for 69.3% (985/1421) of all cases. The predominant subtypes were B lineage not determined (32.3%), A/H1N1 pdm09 (28.8%) and A/H3 (23.0%). There were periods of sustained transmission in most years with 2011 having the highest number of cases. Overall, there were more cases around January to March and August to November. Heart disease and chronic shortness of breath were the most common co-morbidities identified among confirmed cases. CONCLUSION Influenza remains a significant cause of respiratory illness, especially among children aged less than 4 years. Influenza cases occur all year round with irregular seasonality in Nigeria. Children less than 4 years and those with co-morbidities should be prioritized for vaccination. Vaccine composition in the country should take cognizance of the prevailing strains which are type B (lineage not determined), A/H1N1 pdm09 and A/H3.
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Affiliation(s)
- Adejoke Akano
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria; Nigeria Field Epidemiology and Laboratory Training Programme, Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria.
| | - Aisha Habib Sadauki
- Nigeria Field Epidemiology and Laboratory Training Programme, Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Adeyemi Mark Adelabu
- Nigeria Field Epidemiology and Laboratory Training Programme, Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Arhyel Malgwi
- Nigeria Field Epidemiology and Laboratory Training Programme, Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Motunrayo Fagbola
- Nigeria Field Epidemiology and Laboratory Training Programme, Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Oladipo Ogunbode
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | | | | | | | - Elsie Ilori
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Sikiru Badaru
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Adewusi Adetunji
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Adedeji Adebayo
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Nwando Mba
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Akanimo Iniobong
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Emmanuel Eze
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | | | | | | | - Emeka Enemuo
- Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | - Chinwe Ochu
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Ifedayo Adetifa
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
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2
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Straily A, Tamunonengiyeofori I, Wiegand RE, Iriemenam NC, Okoye MI, Dawurung AB, Ugboaja NB, Tongha M, Parameswaran N, Greby SM, Alagi M, Akpan NM, Nwachukwu WE, Mba N, Martin DL, Secor WE, Swaminathan M, Adetifa I, Ihekweazu C. Schistosomiasis Seroprevalence among Children Aged 0-14 Years in Nigeria, 2018. Am J Trop Med Hyg 2024; 110:90-97. [PMID: 38011731 DOI: 10.4269/ajtmh.23-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/15/2023] [Indexed: 11/29/2023] Open
Abstract
The first nationally representative, population-based study of schistosomiasis seroprevalence in Nigeria was conducted using blood samples and risk-factor data collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). Schistosomiasis seroprevalence was estimated by analyzing samples for reactivity to schistosome soluble egg antigen (SEA) in a multiplex bead assay; NAIIS survey data were assessed to identify potential risk factors for seropositivity. The SEA antibody data were available for 31,459 children aged 0 to 14 years. Overall seroprevalence was 17.2% (95% CI: 16.3-18.1%). Seropositive children were identified in every age group, including children < 5 years, and seroprevalence increased with increasing age (P < 0.0001). Several factors were associated with increased odds of seropositivity, including being a boy (odds ratio [OR] = 1.34, 95% CI: 1.24-1.45), living in a rural area (OR = 2.2, 95% CI: 1.9-2.5), and animal ownership (OR = 1.67, 95% CI: 1.52-1.85). Access to improved sanitation and drinking water sources were associated with decreased odds of seropositivity (OR = 0.52, 95% CI: 0.47-0.58 and OR = 0.53, 95% CI: 0.47-0.60, respectively) regardless of whether the child lived in a rural (sanitation: adjusted odds ratio [aOR] = 0.7, 95% CI: 0.6-0.8; drinking water: aOR = 0.7, 95% CI: 0.6-0.8) or urban area (sanitation: aOR = 0.6, 95% CI: 0.5-0.7; drinking water: aOR = 0.5, 95% CI: 0.4-0.6), highlighting the importance of these factors for schistosomiasis prevention and control. These results identified additional risk populations (children < 5 years) and a new risk factor (animal ownership) and could be used to monitor the impact of control programs.
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Affiliation(s)
- Anne Straily
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nnaemeka C Iriemenam
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - McPaul I Okoye
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Nigeria
| | | | | | | | - Nishanth Parameswaran
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacie M Greby
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Matthias Alagi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Nseobong M Akpan
- Neglected Tropical Diseases, Federal Ministry of Health, Abuja, Nigeria
| | | | - Nwando Mba
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mahesh Swaminathan
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Ifedayo Adetifa
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
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3
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Yinka-Ogunleye A, Dalhat M, Akinpelu A, Aruna O, Garba F, Ahmad A, Adeleye A, Botson I, Oluwafemi B, Ogunbode O, Amao L, Ekripo U, Aliyu GG, Adetifa I, Ihekweazu C, Abubakar I. Mpox (monkeypox) risk and mortality associated with HIV infection: a national case-control study in Nigeria. BMJ Glob Health 2023; 8:e013126. [PMID: 38035733 PMCID: PMC10689363 DOI: 10.1136/bmjgh-2023-013126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Recent outbreaks of mpox are characterised by changes in the natural history of the disease, the demographic and clinical characteristics of the cases, and widening geographical distribution. We investigated the role of HIV and other sexually transmitted infections (STIs) coinfection among cases in the re-emergence of mpox to inform national and global response. METHODS We conducted a national descriptive and case-control study on cases in the 2017-2019 Nigerian mpox outbreak. Mpox cases were age, sex and geographical area matched each with two randomly selected controls from a representative national HIV/AIDS survey. Logistic regression was used to investigate the association between HIV infection and the risk of mpox acquisition and death. RESULTS Among 204 suspected mpox cases, 86 were confirmed (median age 31 years (IQR 27-38 years), mostly males (61 cases, 70.9%). Three-fifths of mpox cases had serological evidence of one or more STIs with 27.9% (24/86) coinfected with HIV. The case fatality rate was 9.4% (8/86) and 20.8% (5/24) overall and in HIV positive cases respectively. Mpox cases were more likely to have HIV coinfection compared with an age, gender and geography-matched control group drawn from the general population (OR 45 (95% CI 6.1 to 333.5, p=0.002) and when compared with non mpox rash cases (7.29 (95% CI 2.6 to 20.5, p<0.0001)). HIV coinfection and young age were associated with mortality among mpox cases (aOR 13.66 (95% CI 1.88 to 98.95, p=0.010) and aOR 0.90 (0.82-0.97, p=0.008), respectively). CONCLUSION HIV infection was associated with a higher risk of contracting and dying from mpox. Children are also at high risk of death. STIs in mpox cases may be suggestive of high-risk sexual behaviours among these individuals.
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Affiliation(s)
- Adesola Yinka-Ogunleye
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
- Institute of Global Health, University College London, London, UK
| | - Mahmood Dalhat
- African Field Epidemiology Network, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna, Nigeria
| | - Afolabi Akinpelu
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Olusola Aruna
- IHR Strengthening Programme in Nigeria, UK Health Security Agency, London, UK
| | - Fatima Garba
- African Field Epidemiology Network Nigeria, Abuja, Nigeria
| | - Adama Ahmad
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Adesola Adeleye
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Iliya Botson
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Bamidele Oluwafemi
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Oladipo Ogunbode
- Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Lateefat Amao
- Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Federal Capital Territory, Nigeria
| | - Udeme Ekripo
- University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Gambo Gumel Aliyu
- Epidemiology and Prevention, Institute of Human Virology, Baltimore, Maryland, USA
| | - Ifedayo Adetifa
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ibrahim Abubakar
- Institute of Global Health, University College London, London, UK
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4
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O’Toole Á, Neher RA, Ndodo N, Borges V, Gannon B, Gomes JP, Groves N, King DJ, Maloney D, Lemey P, Lewandowski K, Loman N, Myers R, Omah IF, Suchard MA, Worobey M, Chand M, Ihekweazu C, Ulaeto D, Adetifa I, Rambaut A. APOBEC3 deaminase editing in mpox virus as evidence for sustained human transmission since at least 2016. Science 2023; 382:595-600. [PMID: 37917680 PMCID: PMC10880385 DOI: 10.1126/science.adg8116] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Historically, mpox has been characterized as an endemic zoonotic disease that transmits through contact with the reservoir rodent host in West and Central Africa. However, in May 2022, human cases of mpox were detected spreading internationally beyond countries with known endemic reservoirs. When the first cases from 2022 were sequenced, they shared 42 nucleotide differences from the closest mpox virus (MPXV) previously sampled. Nearly all these mutations are characteristic of the action of APOBEC3 deaminases, host enzymes with antiviral function. Assuming APOBEC3 editing is characteristic of human MPXV infection, we developed a dual-process phylogenetic molecular clock that-inferring a rate of ~6 APOBEC3 mutations per year-estimates that MPXV has been circulating in humans since 2016. These observations of sustained MPXV transmission present a fundamental shift to the perceived paradigm of MPXV epidemiology as a zoonosis and highlight the need for revising public health messaging around MPXV as well as outbreak management and control.
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Affiliation(s)
- Áine O’Toole
- Institute of Ecology & Evolution, University of Edinburgh; Edinburgh, EH9 3FL, United Kingdom
| | - Richard A. Neher
- Biozentrum, University of Basel and Swiss Institute of Bioinformatics; Basel, Switzerland
| | - Nnaemeka Ndodo
- Nigeria Centers for Disease Control and Prevention; Abuja, Nigeria
| | - Vitor Borges
- National Institute of Health Doutor Ricardo Jorge (INSA); Lisbon, Portugal
| | - Ben Gannon
- UK Health Security Agency, Porton Down; Salisbury, United Kingdom
| | - João Paulo Gomes
- National Institute of Health Doutor Ricardo Jorge (INSA); Lisbon, Portugal
- Veterinary and Animal Research Centre (CECAV), Faculty of Veterinary Medicine, Lusófona University, Lisbon, Portugal
| | - Natalie Groves
- UK Health Security Agency; London, E14 5EA, United Kingdom
| | - David J King
- CBR Division, Defence Science and Technology Laboratory; Salisbury SP4 0JQ, United Kingdom
| | - Daniel Maloney
- Institute of Ecology & Evolution, University of Edinburgh; Edinburgh, EH9 3FL, United Kingdom
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven; Leuven, Belgium
| | | | - Nicholas Loman
- UK Health Security Agency; London, E14 5EA, United Kingdom
- University of Birmingham; Birmingham, United Kingdom
| | - Richard Myers
- UK Health Security Agency; London, E14 5EA, United Kingdom
| | - Ifeanyi F. Omah
- Institute of Ecology & Evolution, University of Edinburgh; Edinburgh, EH9 3FL, United Kingdom
- Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Marc A. Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California; Los Angeles, California, USA
| | - Michael Worobey
- Department of Ecology and Evolutionary Biology, University of Arizona; Tucson, Arizona, USA
| | - Meera Chand
- UK Health Security Agency; London, E14 5EA, United Kingdom
| | - Chikwe Ihekweazu
- Nigeria Centers for Disease Control and Prevention; Abuja, Nigeria
| | - David Ulaeto
- UK Health Security Agency; London, E14 5EA, United Kingdom
| | - Ifedayo Adetifa
- Nigeria Centers for Disease Control and Prevention; Abuja, Nigeria
| | - Andrew Rambaut
- Institute of Ecology & Evolution, University of Edinburgh; Edinburgh, EH9 3FL, United Kingdom
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5
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Elson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, Chondo E, Mburu E, Wakio M, Lore J, Maia M, Adetifa I, Orindi B, Bejon P, Fillinger U. National prevalence and risk factors for tungiasis in Kenya. Infect Dis Poverty 2023; 12:85. [PMID: 37723532 PMCID: PMC10506256 DOI: 10.1186/s40249-023-01131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans, the female of which burrows into the skin, causing pain and itching. The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens. The tungiasis research community is keen to develop survey methods to fill this gap. Here we used a school-based, thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya. METHODS We conducted the first nationally representative survey of tungiasis, including nine counties covering the major ecological zones of Kenya. A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school. Pupils were examined thoroughly for tungiasis. Two surveys were conducted, the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors. Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect. RESULTS The overall prevalence of tungiasis in the first survey was 1.35% [95% confidence interval (CI): 1.15-1.59%], and 0.89% in the second survey. The prevalence ranged from 0.08% (95% CI: 0.01-0.59%) in Taita Taveta county to 3.24% (95% CI: 2.35-4.44%) in Kajiado county. Tungiasis infection was associated with county of residence, male sex [adjusted odds ratio (aOR) = 2.01, 95% CI: 1.52-2.67], and lower age (aOR = 0.81, 95% CI: 0.75-0.88). For the first time we demonstrate an association with attending public schools rather than private schools (aOR = 5.62, 95% CI: 1.20-26.22) and lower socioeconomic status (aOR = 0.10, 95% CI: 0.03-0.33). Using a rapid screening method of the top of feet only, would have missed 62.9% of all cases, 78.9% of mild cases and 20.0% of severe cases. CONCLUSIONS Tungiasis is widely but heterogeneously distributed across Kenya. School-based surveys offer an efficient strategy for mapping tungiasis distribution.
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Affiliation(s)
- Lynne Elson
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | | | | | | | | - Marta Maia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ifedayo Adetifa
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Phillip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ulrike Fillinger
- International Centre for Insect Physiology and Ecology (Icipe), Nairobi, Kenya
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Ndodo N, Ashcroft J, Lewandowski K, Yinka-Ogunleye A, Chukwu C, Ahmad A, King D, Akinpelu A, Maluquer de Motes C, Ribeca P, Sumner RP, Rambaut A, Chester M, Maishman T, Bamidele O, Mba N, Babatunde O, Aruna O, Pullan ST, Gannon B, Brown CS, Ihekweazu C, Adetifa I, Ulaeto DO. Distinct monkeypox virus lineages co-circulating in humans before 2022. Nat Med 2023; 29:2317-2324. [PMID: 37710003 PMCID: PMC10504077 DOI: 10.1038/s41591-023-02456-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 09/16/2023]
Abstract
The 2022 global mpox outbreak raises questions about how this zoonotic disease established effective human-to-human transmission and its potential for further adaptation. The 2022 outbreak virus is related to an ongoing outbreak in Nigeria originally reported in 2017, but the evolutionary path linking the two remains unclear due to a lack of genomic data between 2018, when virus exportations from Nigeria were first recorded, and 2022, when the global mpox outbreak began. Here, 18 viral genomes obtained from patients across southern Nigeria in 2019-2020 reveal multiple lineages of monkeypox virus (MPXV) co-circulated in humans for several years before 2022, with progressive accumulation of mutations consistent with APOBEC3 activity over time. We identify Nigerian A.2 lineage isolates, confirming the lineage that has been multiply exported to North America independently of the 2022 outbreak originated in Nigeria, and that it has persisted by human-to-human transmission in Nigeria for more than 2 years before its latest exportation. Finally, we identify a lineage-defining APOBEC3-style mutation in all A.2 isolates that disrupts gene A46R, encoding a viral innate immune modulator. Collectively, our data demonstrate MPXV capacity for sustained diversification within humans, including mutations that may be consistent with established mechanisms of poxvirus adaptation.
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Affiliation(s)
| | - Jonathan Ashcroft
- UK Public Health Rapid Support Team, UK Health Security Agency/London School of Hygiene & Tropical Medicine, London, UK
| | - Kuiama Lewandowski
- UK Health Security Agency, Research & Evaluation Services, Porton Down, UK
| | | | | | - Adama Ahmad
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - David King
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK
| | | | - Carlos Maluquer de Motes
- Department of Microbial Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Paolo Ribeca
- UK Health Security Agency, London, UK
- Biomathematics and Statistics Scotland, Edinburgh, UK
| | - Rebecca P Sumner
- Department of Microbial Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Andrew Rambaut
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
| | - Michael Chester
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK
| | - Tom Maishman
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK
| | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Olusola Aruna
- UK Health Security Agency, International Health Regulations (IHR) Strengthening Project, British High Commission, Abuja, Nigeria
| | - Steven T Pullan
- UK Health Security Agency, Research & Evaluation Services, Porton Down, UK
| | - Benedict Gannon
- UK Public Health Rapid Support Team, UK Health Security Agency/London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - David O Ulaeto
- CBR Division, Defence Science and Technology Laboratory, Salisbury, UK.
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7
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Adetifa I, Muyembe JJ, Bausch DG, Heymann DL. Mpox neglect and the smallpox niche: a problem for Africa, a problem for the world. Lancet 2023; 401:1822-1824. [PMID: 37146622 PMCID: PMC10154003 DOI: 10.1016/s0140-6736(23)00588-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/07/2023]
Abstract
Mpox (formerly known as monkeypox) is a zoonotic viral disease endemic in parts of Africa. In May, 2022, the world was alerted to circulation of monkeypox virus in many high-income countries outside of Africa. Continued spread resulted in a WHO declaration of a Public Health Emergency of International Concern. Although there has been much attention on the global outbreak, most of the focus has been on high-income countries outside of Africa, despite the fact that monkeypox virus has been causing disease in parts of Africa for at least 50 years. Furthermore, the long-term consequences of this event, especially the risk that mpox fills the niche vacated through smallpox eradication, have not been sufficiently considered. The heart of the problem is the historical neglect of mpox in Africa where the disease is endemic, and the actual and potential consequences if this neglect is left uncorrected.
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Affiliation(s)
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Daniel G Bausch
- FIND, Geneva, Switzerland; Global Health Security Department, London School of Hygiene & Tropical Medicine, London, UK.
| | - David L Heymann
- Global Health Security Department, London School of Hygiene & Tropical Medicine, London, UK
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8
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Ochu CL, Ntoimo L, Onoh I, Okonofua F, Meremikwu M, Mba S, Iniobong A, Nwafor O, Dalhat M, Ohonsi C, Arinze C, Esu E, Igumbor EU, Dan-Nwafor C, Ilori E, Adetifa I. Predictors of Lassa fever diagnosis in suspected cases reporting to health facilities in Nigeria. Sci Rep 2023; 13:6545. [PMID: 37085507 PMCID: PMC10121657 DOI: 10.1038/s41598-023-33187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/08/2023] [Indexed: 04/23/2023] Open
Abstract
Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group 40-49 years (aOR = 1.40; 95% CI 1.21-1.62), males (aOR = 1.11; 95% CI 1.03-1.20), those with formal education (aOR = 1.33; 95% CI 1.13-1.56), artisans (aOR = 1.70; 95% CI 1.28-2.27), religious leaders (aOR = 1.62; 95% CI 1.04-2.52), farmers (aOR = 1.48; 95% CI 1.21-1.81), and symptomatic individuals (aOR = 2.36; 95% CI 2.09-2.68). Being a health worker (aOR = 0.69; 95% CI 0.53-0.91), a teacher (aOR = 0.69; 95% CI 0.53-0.89) and cases reporting in the 3rd quarter (aOR = 0.79; 95% CI 0.69-0.92) had lower odds. In a sex-disaggregated analysis, female farmers had higher odds of positivity (aOR = 2.43; 95% CI 1.76-3.38; p < 0.001) than male farmers (aOR = 1.52; 95% CI 1.19-1.96; p < 0.01). Fever (aOR = 2.39; 95% CI 2.00-2.84) and gastrointestinal (GI) symptoms (aOR = 2.15; 95% CI 1.94-2.37) had the highest odds among symptoms. Combination of fever and GI symptoms (aOR = 2.15; 95% CI 1.50-3.10), fever and neurological symptoms (aOR = 6.37; 95% CI 1.49-27.16), fever and musculo-skeletal symptoms (aOR = 2.95; 95% CI 1.37-6.33), fever and cardiopulmonary symptoms (aOR = 1.81; 95% CI 1.24-2.64), and cardiopulmonary and general symptoms (aOR = 1.50; 95% CI 1.19-1.89) were also predictive. Cumulative LF CPR appears high with clearly identified predictors. Targeted interventions with heightened index of suspicion for sociodemographic categories predictive of LF in suspected cases are recommended. Ethnographic and further epidemiological studies could aid better understanding of these associations.
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Affiliation(s)
- Chinwe Lucia Ochu
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Lorretta Ntoimo
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Ikenna Onoh
- Department of Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Martin Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Sandra Mba
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Akanimo Iniobong
- Department of Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Obinna Nwafor
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Mahmood Dalhat
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna, Kaduna State, Nigeria
| | - Cornelius Ohonsi
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chinedu Arinze
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ehimario Uche Igumbor
- Centre for Infectious Disease Research, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chioma Dan-Nwafor
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria.
| | - Elsie Ilori
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ifedayo Adetifa
- The Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
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9
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Tohme RA, Scobie HM, Okunromade O, Olaleye T, Shuaib F, Jegede T, Yahaya R, Nnaemeka N, Lawal B, Egwuenu A, Parameswaran N, Cooley G, An Q, Coughlin M, Okposen BB, Adetifa I, Bolu O, Ihekweazu C. Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children? Vaccines (Basel) 2023; 11:vaccines11030663. [PMID: 36992247 DOI: 10.3390/vaccines11030663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.
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Affiliation(s)
- Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | | | - Faisal Shuaib
- National Primary Healthcare Development Agency, Area 11, Garki, Abuja 900247, Nigeria
| | - Tunde Jegede
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | - Ridwan Yahaya
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | - Ndodo Nnaemeka
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | - Bola Lawal
- Nigeria Center for Disease Control, Abuja 900211, Nigeria
| | | | - Nishanth Parameswaran
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Gretchen Cooley
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Qian An
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Melissa Coughlin
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Bassey B Okposen
- National Primary Healthcare Development Agency, Area 11, Garki, Abuja 900247, Nigeria
| | | | - Omotayo Bolu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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10
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Penfold S, Adegnika AA, Asogun D, Ayodeji O, Azuogu BN, Fischer WA, Garry RF, Grant DS, Happi C, N'Faly M, Olayinka A, Samuels R, Sibley J, Wohl DA, Accrombessi M, Adetifa I, Annibaldis G, Camacho A, Dan-Nwafor C, Deha ARE, DeMarco J, Duraffour S, Goba A, Grais R, Günther S, Honvou ÉJJP, Ihekweazu C, Jacobsen C, Kanneh L, Momoh M, Ndiaye A, Nsaibirni R, Okogbenin S, Ochu C, Ogbaini E, Logbo ÉPMA, Sandi JD, Schieffelin JS, Verstraeten T, Vielle NJ, Yadouleton A, Yovo EK. A prospective, multi-site, cohort study to estimate incidence of infection and disease due to Lassa fever virus in West African countries (the Enable Lassa research programme)-Study protocol. PLoS One 2023; 18:e0283643. [PMID: 36996258 PMCID: PMC10062557 DOI: 10.1371/journal.pone.0283643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa and causes 5000 fatalities every year. The true prevalence and incidence rates of LF are unknown as infections are often asymptomatic, clinical presentations are varied, and surveillance systems are not robust. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries. The core protocol described here harmonises key study components, such as eligibility criteria, case definitions, outcome measures, and laboratory tests, which will maximise the comparability of data for between-country analyses. METHOD We are conducting a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site will assess the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (nmin = 1000 per site) will be drawn from the LF cohort (nmin = 5000 per site). During recruitment participants will complete questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples will be collected to determine IgG LASV serostatus. LF disease cohort participants will be contacted biweekly to identify acute febrile cases, from whom blood samples will be drawn to test for active LASV infection using RT-PCR. Symptom and treatment data will be abstracted from medical records of LF cases. LF survivors will be followed up after four months to assess sequelae, specifically sensorineural hearing loss. LASV infection cohort participants will be asked for a blood sample every six months to assess LASV serostatus (IgG and IgM). DISCUSSION Data on LASV infection and LF disease incidence in West Africa from this research programme will determine the feasibility of future Phase IIb or III clinical trials for LF vaccine candidates.
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Affiliation(s)
| | - Ayola Akim Adegnika
- Fondation pour la Recherche Scientifique (FORS), Cotonou, Bénin
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Danny Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | - Benedict N Azuogu
- Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - William A Fischer
- Institute of Global Health and Infectious Diseases, The University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, United States of America
| | - Robert F Garry
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | | | | | | | | | | | | | - David A Wohl
- Institute of Global Health and Infectious Diseases, The University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, United States of America
| | | | | | - Giuditta Annibaldis
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | | | - Jean DeMarco
- Institute of Global Health and Infectious Diseases, The University of North Carolina (UNC) at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sophie Duraffour
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | - Stephan Günther
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | - Christine Jacobsen
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Mambu Momoh
- Kenema Government Hospital (KGH), Kenema, Sierra Leone
| | | | | | - Sylvanus Okogbenin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chinwe Ochu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ephraim Ogbaini
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | | | - John S Schieffelin
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | | | - Nathalie J Vielle
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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11
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Dalhat MM, Olayinka A, Meremikwu MM, Dan-Nwafor C, Iniobong A, Ntoimo LF, Onoh I, Mba S, Ohonsi C, Arinze C, Esu EB, Nwafor O, Oladipupo I, Onoja M, Ilori E, Okonofua F, Ochu CL, Igumbor EU, Adetifa I. Epidemiological trends of Lassa fever in Nigeria, 2018-2021. PLoS One 2022; 17:e0279467. [PMID: 36584167 PMCID: PMC9803109 DOI: 10.1371/journal.pone.0279467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lassa fever is a viral haemorrhagic fever endemic in Nigeria. Improved surveillance and testing capacity have revealed in an increased number of reported cases and apparent geographic spread of Lassa fever in Nigeria. We described the recent four-year trend of Lassa fever in Nigeria to improve understanding of its epidemiology and inform the design of appropriate interventions. METHODS We analysed the national surveillance data on Lassa fever maintained by the Nigeria Centre for Diseases Control (NCDC) and described trends, sociodemographic, geographic distribution, and clinical outcomes. We compared cases, positivity, and clinical outcomes in the period January 2018 to December 2021. RESULTS We found Lassa fever to be reported throughout the year with more than half the cases reported within the first quarter of the year, a recent increase in numbers and geographic spread of the virus, and male and adult (>18 years) preponderance. Case fatality rates were worse in males, the under-five and elderly, during off-peak periods, and among low reporting states. CONCLUSION Lassa fever is endemic in Nigeria with a recent increase in numbers and geographical distribution. Sustaining improved surveillance, enhanced laboratory diagnosis and improved case management capacity during off-peak periods should remain a priority. Attention should be paid to the very young and elderly during outbreaks. Further research efforts should identify and address specific factors that determine poor clinical outcomes.
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Affiliation(s)
- Mahmood M. Dalhat
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna State, Kaduna, Nigeria
| | - Adebola Olayinka
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Martin M. Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Chioma Dan-Nwafor
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Akanimo Iniobong
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Lorretta F. Ntoimo
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye, Nigeria
| | - Ikenna Onoh
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Sandra Mba
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Cornelius Ohonsi
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Chinedu Arinze
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Ekpereonne B. Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Obinna Nwafor
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | | | - Michael Onoja
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Chinwe L. Ochu
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Ehimario U. Igumbor
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- Centre for Infectious Disease Research, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ifedayo Adetifa
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
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12
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Elimian K, Yennan S, Musah A, Cheshi ID, King C, Dunkwu L, Mohammed AL, Ekeng E, Akande OW, Ayres S, Gandi B, Pembi E, Saleh F, Omar AN, Crawford E, Olopha OO, Nnaji R, Muhammad B, Luka-Lawal R, Ihueze AC, Olatunji D, Ojukwu C, Akinpelu AM, Adaga E, Abubakar Y, Nwadiuto I, Ngishe S, Alowooye AB, Nwogwugwu PC, Kamaldeen K, Abah HN, Chukwuebuka EH, Yusuff HA, Mamadu I, Mohammed AA, Peter S, Abbah OC, Oladotun PM, Oifoh S, Olugbile M, Agogo E, Ndodo N, Babatunde O, Mba N, Oladejo J, Ilori E, Alfvén T, Myles P, Ochu CL, Ihekweazu C, Adetifa I. Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020-October 2021: a retrospective analysis of national surveillance data. BMJ Open 2022; 12:e063703. [PMID: 36123095 PMCID: PMC9486350 DOI: 10.1136/bmjopen-2022-063703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic. DESIGN A retrospective analysis of national surveillance data. SETTING 33 of 37 states (including the Federal Capital Territory) in Nigeria. PARTICIPANTS Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data. OUTCOME MEASURES Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs. RESULTS Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5-14 years and women aged 25-44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96). CONCLUSIONS Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country.
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Affiliation(s)
- Kelly Elimian
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Anwar Musah
- Department of Risk and Disaster Reduction, University College London, London, UK
| | | | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Eme Ekeng
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Stephanie Ayres
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Fatima Saleh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | | | | | | | | | | | | | - Ene Adaga
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Yusuf Abubakar
- Zamfara State Ministry of Health, Zamfara State, Nigeria
| | | | - Samuel Ngishe
- Public Health, Ministry of Health, Benue State, Makurdi, Nigeria
| | | | | | | | | | | | | | - Ibrahim Mamadu
- World Health Organization Country Office for Nigeria, Abuja, Nigeria
| | | | - Sarah Peter
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | | | | | | | - Nwando Mba
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Puja Myles
- Clinical Practice Research Datalink, London, UK
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13
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Happi C, Adetifa I, Mbala P, Njouom R, Nakoune E, Happi A, Ndodo N, Ayansola O, Mboowa G, Bedford T, Neher RA, Roemer C, Hodcroft E, Tegally H, O’Toole Á, Rambaut A, Pybus O, Kraemer MUG, Wilkinson E, Isidro J, Borges V, Pinto M, Gomes JP, Freitas L, Resende PC, Lee RTC, Maurer-Stroh S, Baxter C, Lessells R, Ogwell AE, Kebede Y, Tessema SK, de Oliveira T. Urgent need for a non-discriminatory and non-stigmatizing nomenclature for monkeypox virus. PLoS Biol 2022; 20:e3001769. [PMID: 35998195 PMCID: PMC9451062 DOI: 10.1371/journal.pbio.3001769] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [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] [Revised: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
The current nomenclature for monkeypox virus is stigmatising and misleading. This Perspective article proposes a practical and neutral system of nomenclature that will allow efficient communication without the risk of further misconceptions, discrimination and stigmatisation.
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Affiliation(s)
- Christian Happi
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University; Ede, Osun State, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun State, Nigeria
- * E-mail: (CH); (TO)
| | | | - Placide Mbala
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Richard Njouom
- Virology Unit, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Anise Happi
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University; Ede, Osun State, Nigeria
| | | | | | - Gerald Mboowa
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Trevor Bedford
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
- Howard Hughes Medical Institute, Seattle, Washington, United States of America
| | - Richard A. Neher
- Biozentrum, University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Cornelius Roemer
- Biozentrum, University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Emma Hodcroft
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Geneva Center of Emerging Viral Diseases, HUG, University of Geneva, Geneva, Switzerland
| | - Houriiyah Tegally
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Áine O’Toole
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Rambaut
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, United Kingdom
| | - Oliver Pybus
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
| | - Moritz U. G. Kraemer
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Eduan Wilkinson
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Joana Isidro
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health (INSA), Lisbon, Portugal
| | - Vítor Borges
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health (INSA), Lisbon, Portugal
| | - Miguel Pinto
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health (INSA), Lisbon, Portugal
| | - João Paulo Gomes
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health (INSA), Lisbon, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Lisbon, Portugal
| | - Lucas Freitas
- GISAID at Laboratorio de vírus respiratórios-IOC/FIOCRUZ, Rio de Janeiro, Brazil
| | - Paola C. Resende
- GISAID at Laboratorio de vírus respiratórios-IOC/FIOCRUZ, Rio de Janeiro, Brazil
| | - Raphael T. C. Lee
- GISAID at Bioinformatics Institute and ID labs A*STAR, Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Department of Biological Sciences and YLL School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl Baxter
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Ahmed E. Ogwell
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Yenew Kebede
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Sofonias K. Tessema
- Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail: (CH); (TO)
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14
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Etyang AO, Adetifa I, Omore R, Misore T, Ziraba AK, Ng’oda MA, Gitau E, Gitonga J, Mugo D, Kutima B, Karanja H, Toroitich M, Nyagwange J, Tuju J, Wanjiku P, Aman R, Amoth P, Mwangangi M, Kasera K, Ng’ang’a W, Akech D, Sigilai A, Karia B, Karani A, Voller S, Agoti CN, Ochola-Oyier LI, Otiende M, Bottomley C, Nyaguara A, Uyoga S, Gallagher K, Kagucia EW, Onyango D, Tsofa B, Mwangangi J, Maitha E, Barasa E, Bejon P, Warimwe GM, Scott JAG, Agweyu A. SARS-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021. PLOS Glob Public Health 2022; 2:e0000883. [PMID: 36962821 PMCID: PMC10021917 DOI: 10.1371/journal.pgph.0000883] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. METHODS We selected random age-stratified population-based samples at HDSSs in Kisumu, Nairobi and Kilifi, in Kenya. Blood samples were collected from participants between 01 Dec 2020 and 27 May 2021. No participant had received a COVID-19 vaccine. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Locally-validated assay sensitivity and specificity were 93% (95% CI 88-96%) and 99% (95% CI 98-99.5%), respectively. We adjusted prevalence estimates using classical methods and Bayesian modelling to account for the sampling scheme and assay performance. RESULTS We recruited 2,559 individuals from the three HDSS sites, median age (IQR) 27 (10-78) years and 52% were female. Seroprevalence at all three sites rose steadily during the study period. In Kisumu, Nairobi and Kilifi, seroprevalences (95% CI) at the beginning of the study were 36.0% (28.2-44.4%), 32.4% (23.1-42.4%), and 14.5% (9.1-21%), and respectively; at the end they were 42.0% (34.7-50.0%), 50.2% (39.7-61.1%), and 24.7% (17.5-32.6%), respectively. Seroprevalence was substantially lower among children (<16 years) than among adults at all three sites (p≤0.001). CONCLUSION By May 2021 in three broadly representative populations of unvaccinated individuals in Kenya, seroprevalence of anti-SARS-CoV-2 IgG was 25-50%. There was wide variation in cumulative incidence by location and age.
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Affiliation(s)
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Omore
- Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Thomas Misore
- Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | | | | | - Evelyn Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - John Gitonga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Daisy Mugo
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Henry Karanja
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - James Tuju
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | | | - Wangari Ng’ang’a
- Presidential Policy and Strategy Unit, The Presidency, Government of Kenya, Nairobi, Kenya
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Angela Karani
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shirine Voller
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Amek Nyaguara
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | | | | | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - George M. Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - J. Anthony G. Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Idoko OT, Usuf E, Okomo U, Wonodi C, Jambo K, Kampmann B, Madhi S, Adetifa I. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Africa: Current Considerations and Future Projections. Clin Infect Dis 2022; 75:S136-S140. [PMID: 35749696 PMCID: PMC9376270 DOI: 10.1093/cid/ciac401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Indexed: 01/19/2023] Open
Abstract
The burden of severe Covid-19 has been relatively low in sib-Saharan Africa compared to Europe and the Americas. However, SARS-CoV-2 sero-prevalence data has demonstrated that there has been more widespread transmission than can be deduced from reported cases. This could be attributed to under reporting due to low testing capacity or high numbers of asymptomatic SARS-CoV-2 infection in communities. Recent data indicates that prior SARS-CoV-2 exposure is protective against reinfection and that vaccination of previously SARS-CoV-2 infected individuals induces robust cross-reactive antibody responses. Considering these data, calls for a need for a re-think of the COVID-19 vaccination strategy in sub-Saharan African settings with high SARSCoV-2 population exposure but limited available vaccine doses. A potential recommendation would be to prioritize rapid and widespread vaccination of the first dose, while waiting for more vaccines to become available.
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Affiliation(s)
- Olubukola T Idoko
- Faculty of Infectious and Tropical disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Effua Usuf
- Faculty of Infectious and Tropical disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Faculty of Infectious and Tropical disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chizoba Wonodi
- International Health, Health Systems Center, John Hopkins University, Baltimore, USA
| | - Kondwani Jambo
- Viral Immunology Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Beate Kampmann
- Faculty of Infectious and Tropical disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ifedayo Adetifa
- Faculty of Infectious and Tropical disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Sparrow E, Adetifa I, Chaiyakunapruk N, Cherian T, Fell DB, Graham BS, Innis B, Kaslow DC, Karron RA, Nair H, Neuzil KM, Saha S, Smith PG, Srikantiah P, Were F, Zar HJ, Feikin D. WHO preferred product characteristics for monoclonal antibodies for passive immunization against respiratory syncytial virus (RSV) disease in infants - Key considerations for global use. Vaccine 2022; 40:3506-3510. [PMID: 35184927 PMCID: PMC9176315 DOI: 10.1016/j.vaccine.2022.02.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/03/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
World Health Organization (WHO) preferred product characteristics describe preferences for product attributes that would help optimize value and use to address global public health needs, with a particular focus on low- and middle-income countries. Having previously published preferred product characteristics for both maternal and paediatric respiratory syncytial virus (RSV) vaccines, WHO recently published preferred product characteristics for monoclonal antibodies to prevent severe RSV disease in infants. This article summarizes the key attributes from the preferred product characteristics and discusses key considerations for future access and use of preventive RSV monoclonal antibodies.
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Affiliation(s)
- Erin Sparrow
- World Health Organization, Switzerland; School of Public Health and Community Medicine, UNSW Sydney, Australia.
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Kenya; London School of Hygiene & Tropical Medicine, UK
| | | | | | - Deshayne B Fell
- School of Epidemiology & Public Health, University of Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Canada
| | | | | | | | - Ruth A Karron
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Harish Nair
- Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, UK
| | | | - Samir Saha
- Child Health Research Foundation and Bangladesh Institute of Child Health, Bangladesh
| | | | | | - Fred Were
- School of Medicine, University of Nairobi, Kenya
| | - Heather J Zar
- Department of Paediatrics and Child Health, and SA-MRC unit on Child and Adolescent Health, University of Cape Town, South Africa
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17
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Abouyannis M, FitzGerald R, Ngama M, Mwangudzah H, Nyambura YK, Ngome S, Riako D, Babu L, Lewa F, Else L, Dily Penchala S, Orindi B, Mumba N, Kalama B, Ndungu FM, Adetifa I, Khoo S, Lalloo DG, Casewell NR, Hamaluba M. TRUE-1: Trial of Repurposed Unithiol for snakebite Envenoming phase 1 (safety, tolerability, pharmacokinetics and pharmacodynamics in healthy Kenyan adults). Wellcome Open Res 2022; 7:90. [PMID: 35372700 PMCID: PMC8961198 DOI: 10.12688/wellcomeopenres.17682.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Snakebites affect over 5 million people each year, and over 100,000 per year die as a result. The only available treatment is antivenom, which has many shortcomings including high cost, intravenous administration, and high risk of adverse events. One of the most abundant and harmful components of viper venoms are the zinc-dependent snake venom metalloproteinases (SVMPs). Unithiol is a chelating agent which is routinely used to treat heavy metal poisoning.
In vivo experiments in small animal models have demonstrated that unithiol can prevent local tissue damage and death caused by a certain viper species. This phase I clinical trial will assess the safety of ascending doses of unithiol with a view for repurposing for snakebite indication. Methods: This open label, single agent, phase I clinical trial of a repurposed drug has a primary objective to evaluate the safety of escalating doses of unithiol, and a secondary objective to describe its pharmacokinetics. In total, 64 healthy Kenyan volunteers from Kilifi County will be dosed in consecutive groups of eight, with dose escalation decisions dependent on review of safety data by an independent data safety monitoring board. Four groups will receive ascending single oral doses, two will receive multiple oral doses, and two will receive single intravenous doses. Follow-up will be for 6-months and includes full adverse event reporting. Pharmacokinetic analysis will define the Cmax, Tmax, half-life and renal elimination. Conclusions: This clinical trial will assess the safety and tolerability of a promising oral therapeutic in a relevant setting where snakebites are prevalent. Unithiol is likely to be safer than antivenom, is easier to manufacture, has activity against diverse snake species, and can be administered orally, and thus shows promise for repurposing for tropical snakebite. Pan African Clinical Trials Registry: PACTR202103718625048 (3/3/2021)
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Affiliation(s)
- Michael Abouyannis
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool, UK
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | - Richard FitzGerald
- NIHR Royal Liverpool and Broadgreen CRF, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | | | | | - Samson Ngome
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | - Debra Riako
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | | | - Frida Lewa
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | - Laura Else
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Sujan Dily Penchala
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Noni Mumba
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | - Betty Kalama
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | | | - Ifedayo Adetifa
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Saye Khoo
- NIHR Royal Liverpool and Broadgreen CRF, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - David G. Lalloo
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mainga Hamaluba
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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18
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Otieno GP, Bottomley C, Khagayi S, Adetifa I, Ngama M, Omore R, Ogwel B, Owor BE, Bigogo G, Ochieng JB, Onyango C, Juma J, Mwenda J, Tabu C, Tate JE, Addo Y, Britton T, Parashar UD, Breiman RF, Verani JR, Nokes DJ. Impact of the Introduction of Rotavirus Vaccine on Hospital Admissions for Diarrhea Among Children in Kenya: A Controlled Interrupted Time-Series Analysis. Clin Infect Dis 2021; 70:2306-2313. [PMID: 31544211 PMCID: PMC7245159 DOI: 10.1093/cid/ciz912] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/15/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023] Open
Abstract
Background Monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs). Methods Hospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre– and post–vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post–vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes). Results Between January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8–80%) reduction in RVHs observed in the first year post–vaccine introduction in Kilifi and a 59% (95% CI, 20–79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46–93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61–92%); this reduction was sustained at both sites into the third year. Conclusions A substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.
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Affiliation(s)
- Grieven P Otieno
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | | | - Sammy Khagayi
- KEMRI-Centre for Global Health Research, Kisumu, Kenya
| | - Ifedayo Adetifa
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Pediatrics and Child Health, College of Medicine University of Lagos, Lagos, Nigeria
| | - Mwanajuma Ngama
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Richard Omore
- KEMRI-Centre for Global Health Research, Kisumu, Kenya
| | - Billy Ogwel
- KEMRI-Centre for Global Health Research, Kisumu, Kenya
| | - Betty E Owor
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | | | | | - Clayton Onyango
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Jane Juma
- KEMRI-Centre for Global Health Research, Kisumu, Kenya
| | - Jason Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Jacqueline E Tate
- Centers for Disease Control and Prevention, Emory University, Atlanta, Georgia, USA
| | - Yaw Addo
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Tuck Britton
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Centers for Disease Control and Prevention, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | | | - D James Nokes
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,School of Life Sciences and Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
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19
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Smith EL, Wheeler I, Adler H, Ferreira DM, Sá-Leão R, Abdullahi O, Adetifa I, Becker-Dreps S, Esposito S, Farida H, Kandasamy R, Mackenzie GA, Nuorti JP, Nzenze S, Madhi SA, Ortega O, Roca A, Safari D, Schaumburg F, Usuf E, Sanders EAM, Grant LR, Hammitt LL, O'Brien KL, Gounder P, Bruden DJT, Stanton MC, Rylance J. Upper airways colonisation of Streptococcus pneumoniae in adults aged 60 years and older: A systematic review of prevalence and individual participant data meta-analysis of risk factors. J Infect 2020; 81:540-548. [PMID: 32562794 PMCID: PMC7532703 DOI: 10.1016/j.jinf.2020.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/11/2022]
Abstract
Systematic review and meta-analysis of 18 studies and more than 6000 participants. Adults over the age of 60 had a pooled prevalence of pneumococcal carriage of 9%. Risk factors: contact with children, smoking and residing in a nursing home.
Background Colonisation with Streptococcus pneumoniae can lead to invasive pneumococcal disease and pneumonia. Pneumococcal acquisition and prevalence of colonisation are high in children. In older adults, a population susceptible to pneumococcal disease, colonisation prevalence is reported to be lower, but studies are heterogeneous. Methods This is a systematic review and meta-analysis of prevalence of, and risk factors for, pneumococcal colonisation in adults ≥ 60 years of age (PROSPERO #42016036891). We identified peer-reviewed studies reporting the prevalence of S. pneumoniae colonisation using MEDLINE and EMBASE (until April 2016), excluding studies of acute disease. Participant-level data on risk factors were sought from each study. Findings Of 2202 studies screened, 29 were analysable: 18 provided participant-level data (representing 6290 participants). Prevalence of detected pneumococcal colonisation was 0–39% by conventional culture methods and 3–23% by molecular methods. In a multivariate analysis, colonisation was higher in persons from nursing facilities compared with the community (odds ratio (OR) 2•30, 95% CI 1•26–4•21 and OR 7•72, 95% CI 1•15–51•85, respectively), in those who were currently smoking (OR 1•69, 95% CI 1•12–2•53) or those who had regular contact with children (OR 1•93, 95%CI 1•27–2•93). Persons living in urban areas had significantly lower carriage prevalence (OR 0•43, 95%CI 0•27–0•70). Interpretation Overall prevalence of pneumococcal colonisation in older adults was higher than expected but varied by risk factors. Future studies should further explore risk factors for colonisation, to highlight targets for focussed intervention such as pneumococcal vaccination of high-risk groups. Funding No funding was required.
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Affiliation(s)
- Emma L Smith
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - India Wheeler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hugh Adler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Raquel Sá-Leão
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Osman Abdullahi
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - Ifedayo Adetifa
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Sylvia Becker-Dreps
- Departments of Family Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Helmia Farida
- Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Rama Kandasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford OX3 7LE, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford OX3 7LE, United Kingdom
| | - Grant A Mackenzie
- Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia; Faculty of Infectious and Tropical Diseases, The London School of Hygiene & Tropical Medicine, United Kingdom; Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - J Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland; Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Susan Nzenze
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - Anna Roca
- Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia
| | - Dodi Safari
- Eijkman Institute for Molecular Biology, Jl. Diponegoro no. 69 Jakarta, Indonesia
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Effua Usuf
- Medical Research Council The Gambia Unit at LSHTM, Banjul, The Gambia
| | - Elisabeth A M Sanders
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Lindsay R Grant
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine L O'Brien
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Prabhu Gounder
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, Center for Disease Control and Prevention, Anchorage, Alaska
| | - Dana J T Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, Center for Disease Control and Prevention, Anchorage, Alaska
| | | | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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20
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Njuguna P, Maitland K, Nyaguara A, Mwanga D, Mogeni P, Mturi N, Mohammed S, Mwambingu G, Ngetsa C, Awuondo K, Lowe B, Adetifa I, Scott JAG, Williams TN, Atkinson S, Osier F, Snow RW, Marsh K, Tsofa B, Peshu N, Hamaluba M, Berkley JA, Newton CRJ, Fondo J, Omar A, Bejon P. Observational study: 27 years of severe malaria surveillance in Kilifi, Kenya. BMC Med 2019; 17:124. [PMID: 31280724 PMCID: PMC6613255 DOI: 10.1186/s12916-019-1359-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/04/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Many parts of Africa have witnessed reductions in Plasmodium falciparum transmission over the last 15 years. Since immunity to malaria is acquired more rapidly at higher transmission, the slower acquisition of immunity at lower transmission may partially offset the benefits of reductions in transmission. We examined the clinical spectrum of disease and predictors of mortality after sustained changes in transmission intensity, using data collected from 1989 to 2016. METHODS We conducted a temporal observational analysis of 18,000 children, aged 14 days to 14 years old, who were admitted to Kilifi County Hospital, Kenya, from 1989 to 2016 with malaria. We describe the trends over time of the clinical and laboratory criteria for severe malaria and associated risk of mortality. RESULTS During the time periods 1989-2003, 2004-2008, and 2009-2016, Kilifi County Hospital admitted averages of 657, 310, and 174 cases of severe malaria per year including averages of 48, 14, and 12 malaria-associated deaths per year, respectively. The median ages in years of children admitted with cerebral malaria, severe anaemia, and malaria-associated mortality were 3.0 (95% confidence interval (CI) 2.2-3.9), 1.1 (95% CI 0.9-1.4), and 1.1 (95% CI 0.3-2.2) in the year 1989, rising to 4.9 (95% CI 3.9-5.9), 3.8 (95% CI 2.5-7.1), and 5 (95% CI 3.3-6.3) in the year 2016. The ratio of children with cerebral malaria to severe anaemia rose from 1:2 before 2004 to 3:2 after 2009. Hyperparasitaemia was a risk factor for death after 2009 but not in earlier time periods. CONCLUSION Despite the evidence of slower acquisition of immunity, continued reductions in the numbers of cases of severe malaria resulted in lower overall mortality. Our temporal data are limited to a single site, albeit potentially applicable to a secular trend present in many parts of Africa.
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Affiliation(s)
- Patricia Njuguna
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK
| | - Amek Nyaguara
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Daniel Mwanga
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Polycarp Mogeni
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Shebe Mohammed
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Gabriel Mwambingu
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Caroline Ngetsa
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Kenedy Awuondo
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Brett Lowe
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,London School of Hygiene and Tropical Medicine, London, UK
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK
| | - Sarah Atkinson
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Department of Paediatrics, University of Oxford, Oxford, UK
| | - Faith Osier
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Robert W Snow
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kevin Marsh
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Norbert Peshu
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - Mainga Hamaluba
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Charles R J Newton
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - John Fondo
- Kilifi County Department of Health, Kilifi, Kenya
| | - Anisa Omar
- Kilifi County Department of Health, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, CGMR-C, KEMRI, PO Box 230, Kilifi, Kenya.
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Ojal J, Griffiths U, Hammitt LL, Adetifa I, Akech D, Tabu C, Scott JAG, Flasche S. Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya. Lancet Glob Health 2019; 7:e644-e654. [PMID: 31000132 PMCID: PMC6484775 DOI: 10.1016/s2214-109x(18)30562-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use. METHODS In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI). FINDINGS We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130-25 256) deaths and 101 513 (4386-196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70-411) in 2032. INTERPRETATION Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya. FUNDING Wellcome Trust and Gavi, the Vaccine Alliance.
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Affiliation(s)
- John Ojal
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; UNICEF Health Section, Programme Division, New York, NY, USA
| | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya
| | | | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Silaba M, Ooko M, Bottomley C, Sande J, Benamore R, Park K, Ignas J, Maitland K, Mturi N, Makumi A, Otiende M, Kagwanja S, Safari S, Ochola V, Bwanaali T, Bauni E, Gleeson F, Deloria Knoll M, Adetifa I, Marsh K, Williams TN, Kamau T, Sharif S, Levine OS, Hammitt LL, Scott JAG. Effect of 10-valent pneumococcal conjugate vaccine on the incidence of radiologically-confirmed pneumonia and clinically-defined pneumonia in Kenyan children: an interrupted time-series analysis. Lancet Glob Health 2019; 7:e337-e346. [PMID: 30784634 PMCID: PMC6379823 DOI: 10.1016/s2214-109x(18)30491-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/20/2018] [Accepted: 10/23/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCV) are highly protective against invasive pneumococcal disease caused by vaccine serotypes, but the burden of pneumococcal disease in low-income and middle-income countries is dominated by pneumonia, most of which is non-bacteraemic. We examined the effect of 10-valent PCV on the incidence of pneumonia in Kenya. METHODS We linked prospective hospital surveillance for clinically-defined WHO severe or very severe pneumonia at Kilifi County Hospital, Kenya, from 2002 to 2015, to population surveillance at Kilifi Health and Demographic Surveillance System, comprising 45 000 children younger than 5 years. Chest radiographs were read according to a WHO standard. A 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PCV10) was introduced in Kenya in January, 2011. In Kilifi, there was a three-dose catch-up campaign for infants (aged <1 year) and a two-dose catch-up campaign for children aged 1-4 years, between January and March, 2011. We estimated the effect of PCV10 on the incidence of clinically-defined and radiologically-confirmed pneumonia through interrupted time-series analysis, accounting for seasonal and temporal trends. FINDINGS Between May 1, 2002 and March 31, 2015, 44 771 children aged 2-143 months were admitted to Kilifi County Hospital. We excluded 810 admissions between January and March, 2011, and 182 admissions during nurses' strikes. In 2002-03, the incidence of admission with clinically-defined pneumonia was 2170 per 100 000 in children aged 2-59 months. By the end of the catch-up campaign in 2011, 4997 (61·1%) of 8181 children aged 2-11 months had received at least two doses of PCV10 and 23 298 (62·3%) of 37 416 children aged 12-59 months had received at least one dose. Across the 13 years of surveillance, the incidence of clinically-defined pneumonia declined by 0·5% per month, independent of vaccine introduction. There was no secular trend in the incidence of radiologically-confirmed pneumonia over 8 years of study. After adjustment for secular trend and season, incidence rate ratios for admission with radiologically-confirmed pneumonia, clinically-defined pneumonia, and diarrhoea (control condition), associated temporally with PCV10 introduction and the catch-up campaign, were 0·52 (95% CI 0·32-0·86), 0·73 (0·54-0·97), and 0·63 (0·31-1·26), respectively. Immediately before PCV10 was introduced, the annual incidence of clinically-defined pneumonia was 1220 per 100 000; this value was reduced by 329 per 100 000 at the point of PCV10 introduction. INTERPRETATION Over 13 years, admissions to Kilifi County Hospital for clinically-defined pneumonia decreased sharply (by 27%) in association with the introduction of PCV10, as did the incidence of radiologically-confirmed pneumonia (by 48%). The burden of hospital admissions for childhood pneumonia in Kilifi, Kenya, has been reduced substantially by the introduction of PCV10. FUNDING Gavi, The Vaccine Alliance and Wellcome Trust.
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Affiliation(s)
- Micah Silaba
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Michael Ooko
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joyce Sande
- Aga Khan University Hospital, Nairobi, Kenya
| | - Rachel Benamore
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James Ignas
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Imperial College, London, UK
| | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Kilifi County Hospital, Kilifi, Kenya
| | - Anne Makumi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Victor Ochola
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Tahreni Bwanaali
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Evasius Bauni
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Oxford University, Oxford, UK
| | - Fergus Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford University, Oxford, UK
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin Marsh
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Oxford University, Oxford, UK
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Imperial College, London, UK; INDEPTH Network, Accra, Ghana
| | | | | | - Orin S Levine
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Oxford University, Oxford, UK; INDEPTH Network, Accra, Ghana.
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Morter R, Adetifa I, Antonio M, Touray F, de Jong BC, Gower CM, Gehre F. Examining human paragonimiasis as a differential diagnosis to tuberculosis in The Gambia. BMC Res Notes 2018; 11:31. [PMID: 29334998 PMCID: PMC5769439 DOI: 10.1186/s13104-018-3134-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/06/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Paragonimiasis is a foodborne trematode infection of the lungs caused by Paragonimus spp., presenting clinically with similar symptoms to active tuberculosis (TB). Worldwide, an estimated 20.7 million people are infected with paragonimiasis, but relatively little epidemiological data exists for Africa. Given a recently reported case, we sought to establish whether paragonimiasis should be considered as an important differential diagnosis for human TB in The Gambia, West Africa. RESULTS We developed a novel PCR-based diagnostic test for Paragonimus species known to be found in West Africa, which we used to examine archived TB negative sputum samples from a cross-sectional study of volunteers with tuberculosis-like symptoms from communities in the Western coastal region of The Gambia. Based on a "zero patient" design for detection of rare diseases, 300 anonymised AFB smear negative sputum samples, randomly selected from 25 villages, were screened for active paragonimiasis by molecular detection of Paragonimus spp. DNA. No parasite DNA was found in any of the sputa of our patient group. Despite the recent case report, we found no evidence of active paragonimiasis infection masking as TB in the Western region of The Gambia.
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Affiliation(s)
- Richard Morter
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia, Fajara, The Gambia
- School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Ifedayo Adetifa
- Disease Control and Elimination Theme, Medical Research Council (MRC) Unit The Gambia, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia, Fajara, The Gambia
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Touray
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia, Fajara, The Gambia
| | - Bouke C. de Jong
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia, Fajara, The Gambia
- Department of Medicine, New York University, New York, USA
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte M. Gower
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Florian Gehre
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit The Gambia, Fajara, The Gambia
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Ojal J, Flasche S, Hammitt LL, Akech D, Kiti MC, Kamau T, Adetifa I, Nurhonen M, Scott JAG, Auranen K. Sustained reduction in vaccine-type invasive pneumococcal disease despite waning effects of a catch-up campaign in Kilifi, Kenya: A mathematical model based on pre-vaccination data. Vaccine 2017; 35:4561-4568. [PMID: 28729018 PMCID: PMC5571446 DOI: 10.1016/j.vaccine.2017.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 01/22/2023]
Abstract
We predict a substantial decline in the carriage prevalence of vaccine serotypes. About a 56% reduction in invasive pneumococcal disease is also predicted. The decline is predicted to be sustainable ten years post-vaccination. The current vaccination schedule is unlikely to achieve elimination of vaccine serotypes.
Background In 2011, Kenya introduced the 10-valent pneumococcal conjugate vaccine together with a catch-up campaign for children aged <5 years in Kilifi County. In a post-vaccination surveillance study based in Kilifi, there was a substantial decline in invasive pneumococcal disease (IPD). However, given the continued circulation of the vaccine serotypes it is possible that vaccine-serotype disease may re-emerge once the effects of the catch-up campaign wear off. Methods We developed a compartmental, age-structured dynamic model of pneumococcal carriage and invasive disease for three serotype groups: the 10-valent vaccine serotypes and two groups of non-vaccine serotypes based on their susceptibility to mutual competition. The model was calibrated to age- and serotype-specific data on carriage and IPD in the pre-vaccination era and used to predict carriage prevalence and IPD up to ten years post-vaccination in Kilifi. The model was validated against the observed carriage prevalence after vaccine introduction. Results The model predicts a sustained reduction in vaccine-type pneumococcal carriage prevalence from 33% to 8% in infants and from 30% to 8% in 1–5 year olds over the 10-year period following vaccine introduction. The incidence of IPD is predicted to decline across all age groups resulting in an overall reduction of 56% in the population, corresponding to 10.4 cases per 100,000 per year. The vaccine-type IPD incidence is estimated to decline by 83% while non-vaccine-type IPD incidence is predicted to increase by 52%. The model's predictions of carriage prevalence agrees well with the observed data in the first five years post-vaccination. Conclusion We predict a sustained and substantial decline in IPD through PCV vaccination and that the current regimen is insufficient to fully eliminate vaccine-serotype circulation in the model. We show that the observed impact is likely to be sustained despite waning effects of the catch-up campaign.
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Affiliation(s)
- John Ojal
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya
| | - Moses C Kiti
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya
| | - Tatu Kamau
- Kenya Ministry of Health, Nairobi, Kenya
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Markku Nurhonen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Finland
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kari Auranen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Finland; Department of Mathematics and Statistics, University of Turku, Finland
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Foster-Nyarko E, Kwambana B, Ceesay F, Jawneh K, Darboe S, Mulwa SN, Ceesay B, Secka OO, Adetifa I, Antonio M. Incidence of macrolide-lincosamide-streptogramin B resistance amongst beta-haemolytic streptococci in The Gambia. BMC Res Notes 2017; 10:106. [PMID: 28231812 PMCID: PMC5324333 DOI: 10.1186/s13104-017-2427-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 02/14/2017] [Indexed: 01/21/2023] Open
Abstract
Background In West Africa, penicillin, macrolide and lincosamide resistance among beta-haemolytic streptococci (BHS) isolates has rarely been described. However, such data are critical to detect and track the emergence of antibiotic resistance. Methods Beta-haemolytic streptococci were cultured from clinical specimens from patients attending the clinic at the Medical Research Council Unit The Gambia (n = 217) and kept at −70 °C. Of these, 186 were revived and tested for penicillin susceptibility by disc diffusion and E-test methods, and the D-test for determination of constitutive and inducible macrolide–lincosamide (MLSB) resistance phenotypes. Results The majority of BHS isolates from infections were group A streptococci (GAS) (126/186, 67.7%). Of these, 16% were from invasive disease (30/186). Other BHS isolated included lancefield groups B (19, 10.2%); C (9/186, 4.8%), D (3/186, 1.6%), F (5/186, 2.7%), G (16/186, 8.6%) and non-typeable (8/186, 4.3%). Prevalence of BHS isolated from blood cultures ranges from 0% (2005) to 0.5% (2010). Most (85, 45.7%) of the isolates were from wound infections. Of the 186 BHS isolates, none was resistant to penicillin and 14 (6.1%) were resistant to erythromycin. Of these, 8 (4.3%) demonstrated constitutive MLSB resistance, and 5 (2.7%) were inducible MLSB resistant. All the inducible MLSB isolates were GAS, and majority of the constitutive MLSB isolates (6/8, 75.0%) were non-GAS. Conclusions Beta-haemolytic streptococci, predominantly GAS are associated with a wide range of infections in The Gambia. It is reassuring that macrolide and lincosamide resistance is relatively low. However, monitoring of MLSB resistance is necessary with the global spread of resistant BHS strains.
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Affiliation(s)
- Ebenezer Foster-Nyarko
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Brenda Kwambana
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Fatima Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Kaddijatou Jawneh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Saffiatou Darboe
- Clinical Microbiology Department, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Sarah N Mulwa
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Buntung Ceesay
- Clinical Microbiology Department, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Ousman O Secka
- Clinical Microbiology Department, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Ifedayo Adetifa
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. .,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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Gehre F, Otu J, Kendall L, Forson A, Kwara A, Kudzawu S, Kehinde AO, Adebiyi O, Salako K, Baldeh I, Jallow A, Jallow M, Dagnra A, Dissé K, Kadanga EA, Idigbe EO, Onubogu C, Onyejepu N, Gaye-Diallo A, Ba-Diallo A, Rabna P, Mane M, Sanogo M, Diarra B, Dezemon Z, Sanou A, Senghore M, Kwambana-Adams BA, Demba E, Faal-Jawara T, Kumar S, Tientcheu LD, Jallow A, Ceesay S, Adetifa I, Jaye A, Pallen MJ, D'Alessandro U, Kampmann B, Adegbola RA, Mboup S, Corrah T, de Jong BC, Antonio M. The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance. BMC Med 2016; 14:160. [PMID: 27806714 PMCID: PMC5094099 DOI: 10.1186/s12916-016-0704-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/28/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data. METHODS Following GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009-2013 and tested for first- and second-line drug resistance. RESULTS From the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients. CONCLUSIONS West African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.
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Affiliation(s)
- Florian Gehre
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Jacob Otu
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Lindsay Kendall
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Audrey Forson
- University of Ghana Medical School, Accra, Ghana.,Korle-Bu Teaching Hospital, Accra, Ghana
| | - Awewura Kwara
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,The Miriam Hospital, Providence, RI, USA
| | | | - Aderemi O Kehinde
- College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Oyo, 23402, Nigeria
| | | | - Kayode Salako
- University College Hospital, Ibadan, Oyo, 23402, Nigeria
| | - Ignatius Baldeh
- National Public Health Laboratory Services, Banjul, The Gambia
| | - Aisha Jallow
- National Public Health Laboratory Services, Banjul, The Gambia
| | - Mamadou Jallow
- National Public Health Laboratory Services, Banjul, The Gambia
| | - Anoumou Dagnra
- Laboratoire National de Reference Mycobacteria, Lome, Togo
| | - Kodjo Dissé
- Laboratoire National de Reference Mycobacteria, Lome, Togo
| | | | | | | | | | | | - Awa Ba-Diallo
- Laboratoire Bactériologie Virologie Aristide Le Dantec Sénégal, Dakar, Senegal
| | - Paulo Rabna
- National Institute of Public Health, Bissau, Guinea-Bissau
| | - Morto Mane
- National Institute of Public Health, Bissau, Guinea-Bissau
| | - Moumine Sanogo
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bassirou Diarra
- SEREFO Program, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Zingue Dezemon
- Centre Muraz and the National TB Program, Ouagadougou, Burkina Faso
| | - Adama Sanou
- Centre Muraz and the National TB Program, Ouagadougou, Burkina Faso
| | - Madikay Senghore
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Brenda A Kwambana-Adams
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Edward Demba
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Tutty Faal-Jawara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Samrat Kumar
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Leopold D Tientcheu
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Department of Biochemistry, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Adama Jallow
- National Tuberculosis/Leprosy Control Program, Banjul, The Gambia
| | - Samba Ceesay
- Health Services, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Ifedayo Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Disease Control and Elimination, Medical Research Council Unit, Serrekunda, The Gambia
| | - Assan Jaye
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Mark J Pallen
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Umberto D'Alessandro
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Disease Control and Elimination, Medical Research Council Unit, Serrekunda, The Gambia.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia.,Department of Paediatrics, Imperial College London, London, UK
| | | | - Souleymane Mboup
- Laboratoire Bactériologie Virologie Aristide Le Dantec Sénégal, Dakar, Senegal
| | - Tumani Corrah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | | | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia, Banjul, The Gambia. .,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK. .,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Ofori-Anyinam B, Kanuteh F, Agbla SC, Adetifa I, Okoi C, Dolganov G, Schoolnik G, Secka O, Antonio M, de Jong BC, Gehre F. Impact of the Mycobaterium africanum West Africa 2 Lineage on TB Diagnostics in West Africa: Decreased Sensitivity of Rapid Identification Tests in The Gambia. PLoS Negl Trop Dis 2016; 10:e0004801. [PMID: 27387550 PMCID: PMC4936735 DOI: 10.1371/journal.pntd.0004801] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/02/2016] [Indexed: 01/19/2023] Open
Abstract
Background MPT64 rapid speciation tests are increasingly being used in diagnosis of tuberculosis (TB). Mycobacterium africanum West Africa 2 (Maf 2) remains an important cause of TB in West Africa and causes one third of disease in The Gambia. Since the introduction of MPT64 antigen tests, a higher than expected rate of suspected non-tuberculous mycobacteria (NTM) was seen among AFB smear positive TB suspects, which led us to prospectively assess sensitivity of the MPT64 antigen test in our setting. Methodology/Principal Findings We compared the abundance of mRNA encoded by the mpt64 gene in sputa of patients with untreated pulmonary TB caused by Maf 2 and Mycobacterium tuberculosis (Mtb). Subsequently, prospectively collected sputum samples from presumptive TB patients were inoculated in the BACTEC MGIT 960 System. One hundred and seventy-three acid fast bacilli (AFB)-positive and blood agar negative MGIT cultures were included in the study. Cultures were tested on the day of MGIT positivity with the BD MGIT TBc Identification Test. A random set of positives and all negatives were additionally tested with the SD Bioline Ag MPT64 Rapid. MPT64 negative cultures were further incubated at 37°C and retested until positive. Bacteria were spoligotyped and assigned to different lineages. Maf 2 isolates were 2.52-fold less likely to produce a positive test result and sensitivity ranged from 78.4% to 84.3% at the beginning and end of the recommended 10 day testing window, respectively. There was no significant difference between the tests. We further showed that the decreased rapid test sensitivity was attributable to variations in mycobacterial growth behavior and the smear grades of the patient. Conclusions/Significance In areas where Maf 2 is endemic MPT64 tests should be cautiously used and MPT64 negative results confirmed by a second technique, such as nucleic acid amplification tests, to avoid their misclassification as NTMs. Diagnostics for rapid confirmation of positive liquid cultures presumptive of Mycobacterium tuberculosis bacteria, based on the detection of the MPT64 antigen, are being used in many TB diagnostic laboratories worldwide. Of note, diagnostic performance of these tests in West Africa, where TB is uniquely caused by the geographically restricted Mycobacterium africanum (Maf 1 and 2) and Mycobacterium tuberculosis lineages, has not been properly assessed. Although M. tuberculosis and M. africanum are genetically related, they differ in various aspects. Amongst several differences, Maf 2 grows significantly slower than Mtb bacteria. Because secretion of the MTP64 protein is dependent on the bacterial growth rate, we found that the MPT64 rapid test performance for detecting Maf 2 was lower in our setting in The Gambia. These findings might be relevant for other West African Maf 2 endemic countries where this rapid test is commonly used, as Maf 2 infected patients might have been missed in the past. Our finding emphasizes the need to thoroughly consider the presence of bacterial variants specific to certain regions during product development and implementation of novel diagnostic tests.
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Affiliation(s)
- Boatema Ofori-Anyinam
- Mycobacteriology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
| | - Fatoumatta Kanuteh
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
| | - Schadrac C. Agbla
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
| | - Ifedayo Adetifa
- Disease Control and Elimination Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Okoi
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
| | - Gregory Dolganov
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford University, Stanford, California, United States of America
| | - Gary Schoolnik
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford University, Stanford, California, United States of America
| | - Ousman Secka
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
- Division of Microbiology & Immunity, Warwick Medical School, Coventry, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bouke C. de Jong
- Mycobacteriology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
- Division of Infectious Diseases, New York University, New York, New York, United States of America
| | - Florian Gehre
- Mycobacteriology Unit, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Vaccines and Immunity Theme, Medical Research Council (MRC) Unit, Serrekunda, The Gambia
- * E-mail:
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Foster-Nyarko E, Kwambana B, Aderonke O, Ceesay F, Jarju S, Bojang A, McLellan J, Jafali J, Kampmann B, Ota MO, Adetifa I, Antonio M. Associations between nasopharyngeal carriage of Group B Streptococcus and other respiratory pathogens during early infancy. BMC Microbiol 2016; 16:97. [PMID: 27230066 PMCID: PMC4882866 DOI: 10.1186/s12866-016-0714-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 05/19/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In West Africa, the carriage of Group B Streptococcus (GBS), among infants is poorly characterised. We investigated co-carriage of GBS with other respiratory pathogens in the infants' nasopharynx in The Gambia. METHODS We assessed the carriage, serotypes and antibiotic susceptibility of Beta-haemolytic Streptococci (BHS) groups A-G; along with the carriage of Streptococcus pneumoniae; Haemophilus influenzae; Staphylococcus aureus and Moraxella catarrhalis in 1200 two-month old infants. RESULTS The BHS prevalence was 20.0 % and GBS dominated (13.8 %), particularly serotypes V and II; serotype V being negatively associated with H. Influenzae carriage (OR 0.41 [95 % CI: 0.18-0.93], p = 0.033). Although co-colonization of GBS and other BHS was not seen, colonization with GBS was positively associated with S. aureus (OR 1.89 [95 % CI: 1.33-2.69], P < 0.001) and negatively associated with S. pneumoniae (OR 0.47 [95 % CI: 0.33-0.67], p < 0.001) and M. catarrhalis (OR 0.61 [95 % CI: 0.40-0.92], p = 0.017). ≥ 89 % of GBS isolates were susceptible to most antibiotics tested, except for tetracycline resistance, which was 89 %. CONCLUSION This study provides baseline data on the carriage of GBS in two month old infants from West Africa. The dominant serotypes of GBS in this setting are serotypes V and II. This may be important for future GBS vaccine development for the West African sub-region.
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Affiliation(s)
| | - Brenda Kwambana
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Odutola Aderonke
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Fatima Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Sheikh Jarju
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Abdoulie Bojang
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Jessica McLellan
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - James Jafali
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Martin O Ota
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia
- Current Address: WHO Regional Office for Africa, Brazzaville, Congo
| | - Ifedayo Adetifa
- Disease Control and Elimination Theme, Medical Research Council Unit, Banjul, The Gambia
- Current Address: Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit, Banjul, The Gambia.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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Doughty EL, Sergeant MJ, Adetifa I, Antonio M, Pallen MJ. Culture-independent detection and characterisation of Mycobacterium tuberculosis and M. africanum in sputum samples using shotgun metagenomics on a benchtop sequencer. PeerJ 2014; 2:e585. [PMID: 25279265 PMCID: PMC4179564 DOI: 10.7717/peerj.585] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/28/2014] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis remains a major global health problem. Laboratory diagnostic methods that allow effective, early detection of cases are central to management of tuberculosis in the individual patient and in the community. Since the 1880s, laboratory diagnosis of tuberculosis has relied primarily on microscopy and culture. However, microscopy fails to provide species- or lineage-level identification and culture-based workflows for diagnosis of tuberculosis remain complex, expensive, slow, technically demanding and poorly able to handle mixed infections. We therefore explored the potential of shotgun metagenomics, sequencing of DNA from samples without culture or target-specific amplification or capture, to detect and characterise strains from the Mycobacterium tuberculosis complex in smear-positive sputum samples obtained from The Gambia in West Africa. Eight smear- and culture-positive sputum samples were investigated using a differential-lysis protocol followed by a kit-based DNA extraction method, with sequencing performed on a benchtop sequencing instrument, the Illumina MiSeq. The number of sequence reads in each sputum-derived metagenome ranged from 989,442 to 2,818,238. The proportion of reads in each metagenome mapping against the human genome ranged from 20% to 99%. We were able to detect sequences from the M. tuberculosis complex in all eight samples, with coverage of the H37Rv reference genome ranging from 0.002X to 0.7X. By analysing the distribution of large sequence polymorphisms (deletions and the locations of the insertion element IS6110) and single nucleotide polymorphisms (SNPs), we were able to assign seven of eight metagenome-derived genomes to a species and lineage within the M. tuberculosis complex. Two metagenome-derived mycobacterial genomes were assigned to M. africanum, a species largely confined to West Africa; the others that could be assigned belonged to lineages T, H or LAM within the clade of "modern" M. tuberculosis strains. We have provided proof of principle that shotgun metagenomics can be used to detect and characterise M. tuberculosis sequences from sputum samples without culture or target-specific amplification or capture, using an accessible benchtop-sequencing platform, the Illumina MiSeq, and relatively simple DNA extraction, sequencing and bioinformatics protocols. In our hands, sputum metagenomics does not yet deliver sufficient depth of coverage to allow sequence-based sensitivity testing; it remains to be determined whether improvements in DNA extraction protocols alone can deliver this or whether culture, capture or amplification steps will be required. Nonetheless, we can foresee a tipping point when a unified automated metagenomics-based workflow might start to compete with the plethora of methods currently in use in the diagnostic microbiology laboratory.
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Affiliation(s)
- Emma L. Doughty
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Martin J. Sergeant
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Martin Antonio
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Medical Research Council Unit, Fajara, The Gambia
| | - Mark J. Pallen
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Affiliation(s)
- I Abubakar
- Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, University College London, London, UK
| | - S Sridhar
- Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Eisenhut
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - A Roy
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - R J Harris
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - L C Rodrigues
- London School of Hygiene and Tropical Medicine, London, UK
| | - P Mangtani
- London School of Hygiene and Tropical Medicine, London, UK
| | - I Adetifa
- Medical Research Council, Fajara, Gambia
| | - A Lalvani
- Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK
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Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, Snell L, Mangtani P, Adetifa I, Lalvani A, Abubakar I. Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ 2014; 349:g4643. [PMID: 25097193 PMCID: PMC4122754 DOI: 10.1136/bmj.g4643] [Citation(s) in RCA: 336] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children. DESIGN Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts. SETTING Community congregate settings and households. INCLUSION CRITERIA Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays. DATA EXTRACTION Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis. RESULTS The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77). CONCLUSIONS BCG protects against M tuberculosis infection as well as progression from infection to disease.Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- A Roy
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK
| | - M Eisenhut
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - R J Harris
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK
| | - L C Rodrigues
- London School of Hygiene and Tropical Medicine, London, UK
| | - S Sridhar
- Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - S Habermann
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - L Snell
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - P Mangtani
- London School of Hygiene and Tropical Medicine, London, UK
| | - I Adetifa
- Medical Research Council, Fajara, Gambia
| | - A Lalvani
- Tuberculosis Research Centre, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - I Abubakar
- Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, University College London, London, UK
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Odutola A, Antonio M, Owolabi O, Bojang A, Foster-Nyarko E, Donkor S, Adetifa I, Taylor S, Bottomley C, Greenwood B, Ota M. Comparison of the prevalence of common bacterial pathogens in the oropharynx and nasopharynx of gambian infants. PLoS One 2013; 8:e75558. [PMID: 24086570 PMCID: PMC3781055 DOI: 10.1371/journal.pone.0075558] [Citation(s) in RCA: 24] [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: 06/04/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022] Open
Abstract
Background CRM- based pneumococcal conjugate vaccines generally have little impact on the overall prevalence of pneumococcal carriage because of serotype replacement. In contrast, protein vaccines could substantially reduce the overall prevalence of pneumococcal carriage with potential microbiological and clinical consequences. Therefore, trials of pneumococcal protein vaccines need to evaluate their impact on carriage of other potentially pathogenic bacteria in addition to the pneumococcus. Methods As a prelude to a trial of an investigational pneumococcal vaccine containing pneumococcal polysaccharide conjugates and pneumococcal proteins, the prevalence of carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella species and Staphylococcus aureus in the nasopharynx of 1030 Gambian infants (median age 35 weeks) was determined. An oropharyngeal swab was obtained at the same time from the first 371 infants enrolled. Standard microbiological techniques were used to evaluate the bacterial flora of the pharynx and to compare that found in the oropharynx and in the nasopharynx. Results The overall pneumococcal carriage rate was high. Isolation rates of S. pneumoniae and Moraxella species were significantly higher using nasopharyngeal rather than oropharyngeal swabs (76.1% [95% CI 73.4%,78.7%] vs. 21.3% [95% CI 17.2%,25.8%] and 48.9% [95% CI 45.8%, 52.0%] vs. 20.5% % [95% CI 16.5%,25.0%] respectively). In contrast, S. aureus and H. influenzae were isolated more frequently from oropharyngeal than from nasopharyngeal swabs (65.0% [95% CI 59.9%, 69.8%] vs. 33.6% [95% CI 30.7%, 36.5%] and 31.8% [95% CI 16.5%, 25.0%] vs. 22.4% [95% CI 19.9%, 25.1%] respectively). No group A β haemolytic streptococci were isolated. Conclusion Collection of an oropharyngeal swab in addition to a nasopharyngeal swab will provide little additional information on the impact of a novel pneumococcal vaccine on pneumococcal carriage but it might provide additional, valuable information on the impact of the vaccine on the overall microbiota of the pharynx.
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Affiliation(s)
- Aderonke Odutola
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
- * E-mail:
| | - Martin Antonio
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Olumuyiwa Owolabi
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Abdoulie Bojang
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
| | | | - Simon Donkor
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Ifedayo Adetifa
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
| | - Sylvia Taylor
- Global Epidemiology, GlaxoSmithKline Vaccines, Wavre, Belgium
| | - Christian Bottomley
- Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brian Greenwood
- Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Martin Ota
- Vaccinology Theme, Medical Research Council Unit, Banjul, The Gambia
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Abubakar I, Zignol M, Falzon D, Raviglione M, Ditiu L, Masham S, Adetifa I, Ford N, Cox H, Lawn SD, Marais BJ, McHugh TD, Mwaba P, Bates M, Lipman M, Zijenah L, Logan S, McNerney R, Zumla A, Sarda K, Nahid P, Hoelscher M, Pletschette M, Memish ZA, Kim P, Hafner R, Cole S, Migliori GB, Maeurer M, Schito M, Zumla A. Drug-resistant tuberculosis: time for visionary political leadership. The Lancet Infectious Diseases 2013; 13:529-39. [DOI: 10.1016/s1473-3099(13)70030-6] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Individuals with human immunodeficiency virus (HIV) infection are at an increased risk of developing active tuberculosis (TB). It is known that treatment of latent TB infection (LTBI), also referred to as TB preventive therapy or chemoprophylaxis, helps to prevent progression to active disease in HIV negative populations. However, the extent and magnitude of protection (if any) associated with preventive therapy in those infected with HIV should be quantified. This present study is an update of the original review. OBJECTIVES To determine the effectiveness of TB preventive therapy in reducing the risk of active tuberculosis and death in HIV-infected persons. SEARCH STRATEGY This review was updated using the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, AIDSLINE, AIDSTRIALS, AIDSearch, NLM Gateway and AIDSDRUGS (publication date from 01 July 2002 to 04 April 2008). We also scanned reference lists of articles and contacted authors and other researchers in the field in an attempt to identify additional studies that may be eligible for inclusion in this review. SELECTION CRITERIA We included randomized controlled trials in which HIV positive individuals were randomly allocated to TB preventive therapy or placebo, or to alternative TB preventive therapy regimens. Participants could be tuberculin skin test positive or negative, but without active tuberculosis. DATA COLLECTION AND ANALYSIS Three reviewers independently applied the study selection criteria, assessed study quality and extracted data. Effects were assessed using relative risk for dichotomous data and mean differences for continuous data. MAIN RESULTS 12 trials were included with a total of 8578 randomized participants. TB preventive therapy (any anti-TB drug) versus placebo was associated with a lower incidence of active TB (RR 0.68, 95% CI 0.54 to 0.85). This benefit was more pronounced in individuals with a positive tuberculin skin test (RR 0.38, 95% CI 0.25 to 0.57) than in those who had a negative test (RR 0.89, 95% CI 0.64 to 1.24). Efficacy was similar for all regimens (regardless of drug type, frequency or duration of treatment). However, compared to INH monotherapy, short-course multi-drug regimens were much more likely to require discontinuation of treatment due to adverse effects. Although there was reduction in mortality with INH monotherapy versus placebo among individuals with a positive tuberculin skin test (RR 0.74, 95% CI 0.55 to 1.00) and with INH plus rifampicin versus placebo regardless of tuberculin skin test status (RR 0.69, 95% CI 0.50 to 0.95), overall, there was no evidence that TB preventive therapy versus placebo reduced all-cause mortality (RR 0.94, 95% CI 0.85 to 1.05). AUTHORS' CONCLUSIONS Treatment of latent tuberculosis infection reduces the risk of active TB in HIV positive individuals especially in those with a positive tuberculin skin test. The choice of regimen will depend on factors such as availability, cost, adverse effects, adherence and drug resistance. Future studies should assess these aspects. In addition, trials evaluating the long-term effects of anti-tuberculosis chemoprophylaxis, the optimal duration of TB preventive therapy, the influence of level of immunocompromise on effectiveness and combination of anti-tuberculosis chemoprophylaxis with antiretroviral therapy are needed.
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Affiliation(s)
| | - Ifedayo Adetifa
- Medical Research Council (UK) LaboratoriesBacterial Diseases ProgrammeAtlantic Boulevard, FajaraPO Box 273BanjulGambia
| | - Sasha Shepperd
- University of OxfordDepartment of Public HealthOxfordUKOX3 7LF
| | - Jimmy Volmink
- Stellenbosch UniversityFaculty of Health SciencesPO Box 19063TygerbergSouth Africa7505
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de Jong BC, Adetifa I, Walther B, Hill PC, Antonio M, Ota M, Adegbola RA. Differences between tuberculosis cases infected with Mycobacterium africanum, West African type 2, relative to Euro-American Mycobacterium tuberculosis: an update. ACTA ACUST UNITED AC 2009; 58:102-5. [PMID: 20002176 DOI: 10.1111/j.1574-695x.2009.00628.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mycobacterium africanum (MAF) is a common cause of human pulmonary tuberculosis in West Africa. We previously described phenotypic differences between MAF and Mycobacterium tuberculosis (MTB) among 290 patients. In the present analysis, we compared 692 tuberculosis patients infected with the two most common lineages within the (MTB) complex found in the Gambia, namely MAF West African type 2 (39% prevalence) and Euro-American MTB (55% prevalence). We identified additional phenotypic differences between infections with these two organisms. MAF patients were more likely to be older and HIV infected. In addition, they had worse disease on chest X-ray, despite complaining of cough for an equal duration, and were more likely severely malnourished. In this cohort, the prevalence of MAF did not change significantly over a 7-year period.
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Affiliation(s)
- Bouke C de Jong
- Bacterial Diseases Programme, MRC Laboratories, Banjul, The Gambia.
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Abstract
BACKGROUND The most prevalent haematologic disturbance associated with HIV in children (apart from CD4 lymphocytopenia) is anaemia. Anaemia associated with HIV arises from multiple mechanisms, including the direct inhibitory effect of HIV on red cell precursors, other locally prevalent and/or opportunistic infections, micronutrient deficiency, anaemia of chronic disease, and as a consequence of medicines given for HIV and/or other concurrent illnesses. Iron deficiency is the most common cause of nutritional anaemia globally. There is significant geographical overlap of areas of the world where iron deficiency anaemia (IDA) and paediatric HIV are distributed. Given the high prevalence of IDA, it is likely that many HIV-infected children also are iron deficient. The contribution of iron deficiency to anaemia in HIV-infected children has been described but is incompletely understood. Currently, iron supplementation for anaemic infants and children is routinely practiced without any obvious effect in most developing countries, which bear most of the burden of global paediatric HIV infections.Because iron deficiency and IDA are common in HIV-infected children in high-prevalence areas and because there are concerns about possible deleterious effects of iron, this review aims to assess the evidence for iron supplementation for reducing morbidity and mortality in HIV-infected children. OBJECTIVES To determine whether iron supplementation improves clinical, immunologic, and virologic outcomes in children infected with HIV SEARCH STRATEGY: We used the comprehensive search strategy developed specifically by the Cochrane HIV/AIDS Review Group to identify HIV/AIDS randomised controlled trials, and searched the following electronic databases: MEDLINE (searched November 2007); Embase (searched December 2007); and CENTRAL (December 2007). This search was supplemented with a search of AIDSearch (searched December 2007) and NLM Gateway (searched December 2007) to identify relevant conference abstracts, as well as a search of the reference lists of all eligible articles. The search was not limited by language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs) of iron supplementation in any form and dose in HIV-infected children aged 12 years and younger. DATA COLLECTION AND ANALYSIS We independently screened the results of the search to select potentially relevant studies and to retrieve the full articles. We independently applied the inclusion criteria to the potentially relevant studies. No studies were identified that fulfilled the selection criteria. MAIN RESULTS No RCTs of iron supplementation in HIV-infected children were found. IMPLICATIONS FOR CLINICAL PRACTICE The current clinical practice of iron supplementation in HIV-infected children is based on weak evidence comprising observational studies and expert opinions. IMPLICATIONS FOR RESEARCH High-quality RCTs of iron supplementation are urgently required, especially in areas with significant overlap of high prevalence of HIV, iron deficiency anaemia, and malaria. Policy makers should prioritise funding for these trials.
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Affiliation(s)
- Ifedayo Adetifa
- Tuberculosis Office, Medical Research Council Laboratories, Atlantic Boulevard, Fajara, PO Box 273, Banjul, Gambia.
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