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Cooper LV, Stuart JM, Okot C, Asiedu-Bekoe F, Afreh OK, Fernandez K, Ronveaux O, Trotter CL. Corrigendum to "Reactive vaccination as a control strategy for pneumococcal meningitis outbreaks in the African meningitis belt: Analysis of outbreak data from Ghana" [Vaccine 37(37) (2019) 5657-5663]. Vaccine 2023; 41:7491-7492. [PMID: 37945491 DOI: 10.1016/j.vaccine.2023.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Laura V Cooper
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - James M Stuart
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Katya Fernandez
- World Health Organization Health Emergencies Programme, Geneva, Switzerland
| | - Olivier Ronveaux
- World Health Organization Health Emergencies Programme, Geneva, Switzerland
| | - Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Asturias EJ, Bai X, Bettinger JA, Borrow R, Castillo DN, Caugant DA, Chacon GC, Dinleyici EC, Echaniz-Aviles G, Garcia L, Glennie L, Harrison LH, Howie RL, Itsko M, Lucidarme J, Marin JEO, Marjuki H, McNamara LA, Mustapha MM, Robinson JL, Romeu B, Sadarangani M, Sáez-Llorens X, Sáfadi MAP, Stephens DS, Stuart JM, Taha MK, Tsang RSW, Vazquez J, De Wals P. Meningococcal disease in North America: Updates from the Global Meningococcal Initiative. J Infect 2022; 85:611-622. [PMID: 36273639 PMCID: PMC11091909 DOI: 10.1016/j.jinf.2022.10.022] [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: 09/21/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
This review summarizes the recent Global Meningococcal Initiative (GMI) regional meeting, which explored meningococcal disease in North America. Invasive meningococcal disease (IMD) cases are documented through both passive and active surveillance networks. IMD appears to be decreasing in many areas, such as the Dominican Republic (2016: 18 cases; 2021: 2 cases) and Panama (2008: 1 case/100,000; 2021: <0.1 cases/100,000); however, there is notable regional and temporal variation. Outbreaks persist in at-risk subpopulations, such as people experiencing homelessness in the US and migrants in Mexico. The recent emergence of β-lactamase-positive and ciprofloxacin-resistant meningococci in the US is a major concern. While vaccination practices vary across North America, vaccine uptake remains relatively high. Monovalent and multivalent conjugate vaccines (which many countries in North America primarily use) can provide herd protection. However, there is no evidence that group B vaccines reduce meningococcal carriage. The coronavirus pandemic illustrates that following public health crises, enhanced surveillance of disease epidemiology and catch-up vaccine schedules is key. Whole genome sequencing is a key epidemiological tool for identifying IMD strain emergence and the evaluation of vaccine strain coverage. The Global Roadmap on Defeating Meningitis by 2030 remains a focus of the GMI.
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Affiliation(s)
- Edwin J Asturias
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Xilian Bai
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Julie A Bettinger
- Vaccine Evaluation Center, British Colombia Children's Hospital Research Institute, and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK.
| | | | | | | | | | - Gabriela Echaniz-Aviles
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Luis Garcia
- Center for State Control of Drugs, Medical Devices and Equipment, Cuba
| | | | - Lee H Harrison
- Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca L Howie
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | - Mark Itsko
- WDS Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | | | - Henju Marjuki
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | - Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | | | | | - Belkis Romeu
- Center for State Control of Drugs, Medical Devices and Equipment, Cuba
| | - Manish Sadarangani
- Vaccine Evaluation Center, British Colombia Children's Hospital Research Institute, and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xavier Sáez-Llorens
- Hospital del Niño - Dr José Renán Esquivel, Distinguished Investigator at Senacyt (SNI) and Cevaxin, Panama City, Panama
| | - Marco A P Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - David S Stephens
- Robert W. Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | | | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | - Raymond S W Tsang
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Julio Vazquez
- National Centre of Microbiology, Institute of Health Carlos III, Madrid, Spain
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Pilat EK, Stuart JM, French CE. Tobacco smoking and meningococcal disease in adolescents and young adults: a systematic review and meta-analysis. J Infect 2021; 82:135-144. [PMID: 33610686 DOI: 10.1016/j.jinf.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Systematically review the evidence on the association between active and passive tobacco smoking and invasive meningococcal disease (IMD) in adolescents and young adults aged 15-to-24-years. METHODS Electronic searches were conducted in Ovid MEDLINE, EMBASE, and Web of Science to June 2020. Reference lists were hand-searched. Two independent reviewers screened articles for eligibility. Risk of bias was assessed using an adapted Risk of Bias in Non-Randomised Studies - of Interventions tool. Meta-analyses were conducted using random-effects models. RESULTS Of 312 records identified, 13 studies were included. Five studies provided data on the association between active smoking and IMD in the target age group; pooled odds ratio (OR): 1.45 (95% CI: 0.93-2.26). The overall OR, including eight studies with a wider participant age range, was 1.45 (95% CI: 1.12-1.88). For passive smoking, the equivalent ORs were 1.56 (95% CI: 1.09-2.25) and 1.30 (95% CI: 1.06-1.59) respectively. All studies were at high risk of bias. CONCLUSIONS Active and passive smoking may be associated with IMD in adolescents and young adults. Since active smoking has also been linked to meningococcal carriage, and passive smoking to IMD in young children, smoking cessation should be encouraged to reduce transmission and IMD risk in all ages.
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Affiliation(s)
- Ellie K Pilat
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
| | - James M Stuart
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
| | - Clare E French
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
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Rodgers E, Bentley SD, Borrow R, Bratcher HB, Brisse S, Brueggemann AB, Caugant DA, Findlow J, Fox L, Glennie L, Harrison LH, Harrison OB, Heyderman RS, van Rensburg MJ, Jolley KA, Kwambana-Adams B, Ladhani S, LaForce M, Levin M, Lucidarme J, MacAlasdair N, Maclennan J, Maiden MCJ, Maynard-Smith L, Muzzi A, Oster P, Rodrigues CMC, Ronveaux O, Serino L, Smith V, van der Ende A, Vázquez J, Wang X, Yezli S, Stuart JM. The global meningitis genome partnership. J Infect 2020; 81:510-520. [PMID: 32615197 DOI: 10.1016/j.jinf.2020.06.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
Genomic surveillance of bacterial meningitis pathogens is essential for effective disease control globally, enabling identification of emerging and expanding strains and consequent public health interventions. While there has been a rise in the use of whole genome sequencing, this has been driven predominately by a subset of countries with adequate capacity and resources. Global capacity to participate in surveillance needs to be expanded, particularly in low and middle-income countries with high disease burdens. In light of this, the WHO-led collaboration, Defeating Meningitis by 2030 Global Roadmap, has called for the establishment of a Global Meningitis Genome Partnership that links resources for: N. meningitidis (Nm), S. pneumoniae (Sp), H. influenzae (Hi) and S. agalactiae (Sa) to improve worldwide co-ordination of strain identification and tracking. Existing platforms containing relevant genomes include: PubMLST: Nm (31,622), Sp (15,132), Hi (1935), Sa (9026); The Wellcome Sanger Institute: Nm (13,711), Sp (> 24,000), Sa (6200), Hi (1738); and BMGAP: Nm (8785), Hi (2030). A steering group is being established to coordinate the initiative and encourage high-quality data curation. Next steps include: developing guidelines on open-access sharing of genomic data; defining a core set of metadata; and facilitating development of user-friendly interfaces that represent publicly available data.
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Affiliation(s)
- Elizabeth Rodgers
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK.
| | - Stephen D Bentley
- Wellcome Sanger Institute, Parasites and microbes, Hinxton CB10 1SA, UK
| | - Ray Borrow
- Public Health England, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ, UK
| | | | - Sylvain Brisse
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Angela B Brueggemann
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jamie Findlow
- Pfizer Limited, Walton Oaks, Dorking Road, Tadworth, Surrey KT20 7NS, UK
| | - LeAnne Fox
- Meningitis and Vaccine Preventable Disease Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, United States
| | - Linda Glennie
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Robert S Heyderman
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection & Immunity, University College London, London, UK
| | | | - Keith A Jolley
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK
| | - Brenda Kwambana-Adams
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection & Immunity, University College London, London, UK
| | - Shamez Ladhani
- Public Health England, Immunisation and Countermeasures Division, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | | | | | - Jay Lucidarme
- Public Health England, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ, UK
| | - Neil MacAlasdair
- Wellcome Sanger Institute, Parasites and microbes, Hinxton CB10 1SA, UK
| | - Jenny Maclennan
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK
| | | | | | | | | | | | | | | | - Vinny Smith
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK
| | - Arie van der Ende
- Department of Medical Microbiology and Infection Prevention, University of Amsterdam, Amsterdam UMC and, the Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands
| | | | - Xin Wang
- Meningitis and Vaccine Preventable Disease Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, United States
| | - Saber Yezli
- Ministry of Health, The Global Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia
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Cooper LV, Stuart JM, Okot C, Asiedu-Bekoe F, Afreh OK, Fernandez K, Ronveaux O, Trotter CL. Reactive vaccination as a control strategy for pneumococcal meningitis outbreaks in the African meningitis belt: Analysis of outbreak data from Ghana. Vaccine 2019; 37:5657-5663. [PMID: 29371015 DOI: 10.1016/j.vaccine.2017.12.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
Streptococcus pneumoniae is increasingly recognised as an important cause of bacterial meningitis in the African meningitis belt. The World Health Organization sets guidelines for response to outbreaks of meningococcal meningitis, but there are no current guidelines for outbreaks where S. pneumoniae is implicated. We aimed to evaluate the impact of using a similar response to target outbreaks of vaccine-preventable pneumococcal meningitis in the meningitis belt. Here, we adapt a previous model of reactive vaccination for meningococcal outbreaks to estimate the potential impact of reactive vaccination in a recent pneumococcal meningitis outbreak in the Brong-Ahafo region of central Ghana using weekly line list data on all suspected cases over a period of five months. We determine the sensitivity and specificity of various epidemic thresholds and model the cases and deaths averted by reactive vaccination. An epidemic threshold of 10 suspected cases per 100,000 population per week performed the best, predicting large outbreaks with 100% sensitivity and more than 85% specificity. In this outbreak, reactive vaccination would have prevented a lower number of cases per individual vaccinated (approximately 15,300 doses per case averted) than previously estimated for meningococcal outbreaks. Since the burden of death and disability from pneumococcal meningitis is higher than that from meningococcal meningitis, there may still be merit in considering reactive vaccination for outbreaks of pneumococcal meningitis. More outbreak data are needed to refine our model estimates. Whatever policy is followed, we emphasize the importance of timely laboratory confirmation of suspected cases to enable appropriate decisions about outbreak response.
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Affiliation(s)
- Laura V Cooper
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - James M Stuart
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Katya Fernandez
- World Health Organization Health Emergencies Programme, Geneva, Switzerland
| | - Olivier Ronveaux
- World Health Organization Health Emergencies Programme, Geneva, Switzerland
| | - Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Waite TD, Telisinghe L, Gobin M, Ronveaux O, Fernandez AK, Stuart JM, Scholten RJPM. Rapid diagnostic tests for bacterial meningitis applicable in sub-Saharan Africa. Hippokratia 2019. [DOI: 10.1002/14651858.cd011634.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Thomas D Waite
- Public Health England; Field Epidemiology Services; 2 Rivergate Bristol UK BS1 6EH
| | - Lilanganee Telisinghe
- London School of Hygiene and Tropical Medicine; Department of Clinical Research, Faculty of Infectious and Tropical Diseases; Keppel Street London UK WC1E 7HT
| | - Maya Gobin
- Public Health England; Field Epidemiology Services; 2 Rivergate Bristol UK BS1 6EH
| | - Olivier Ronveaux
- World Health Organization; Control of Epidemic Diseases; 20 Avenue Appia Geneva Switzerland 1211
| | - Ana-Katya Fernandez
- World Health Organization; Pandemic and Epidemic Diseases (PED); 20 Avenue Appia Geneva Switzerland 1211
| | - James M Stuart
- London School of Hygiene and Tropical Medicine; Infectious and Tropical Diseases Department; Keppel Street London UK WC1E 7HT
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Cochrane Netherlands; Room Str. 6.126 P.O. Box 85500 Utrecht Netherlands 3508 GA
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Cooper LV, Robson A, Trotter CL, Aseffa A, Collard JM, Daugla DM, Diallo A, Hodgson A, Jusot JF, Omotara B, Sow S, Hassan-King M, Manigart O, Nascimento M, Woukeu A, Chandramohan D, Borrow R, Maiden MCJ, Greenwood B, Stuart JM. Risk factors for acquisition of meningococcal carriage in the African meningitis belt. Trop Med Int Health 2019; 24:392-400. [PMID: 30729627 PMCID: PMC6563094 DOI: 10.1111/tmi.13203] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate potential risk factors for acquisition in seven countries of the meningitis belt. METHODS Households were followed up every 2 weeks for 2 months, then monthly for a further 4 months. Pharyngeal swabs were collected from all available household members at each visit and questionnaires completed. Risks of acquisition over the whole study period and for each visit were analysed by a series of logistic regressions. RESULTS Over the course of the study, acquisition was higher in: (i) 5-to 14-year olds, as compared with those 30 years or older (OR 3.6, 95% CI 1.4-9.9); (ii) smokers (OR 3.6, 95% CI 0.98-13); and (iii) those exposed to wood smoke at home (OR 2.6 95% CI 1.3-5.6). The risk of acquisition from one visit to the next was higher in those reporting a sore throat during the dry season (OR 3.7, 95% CI 2.0-6.7) and lower in those reporting antibiotic use (OR 0.17, 95% CI 0.03-0.56). CONCLUSIONS Acquisition of meningococcal carriage peaked in school age children. Recent symptoms of sore throat during the dry season, but not during the rainy season, were associated with a higher risk of acquisition. Upper respiratory tract infections may be an important driver of epidemics in the meningitis belt.
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Affiliation(s)
| | | | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Jean-Marc Collard
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger.,Bactériologie expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | | | | | - Babatunji Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Samba Sow
- Centre pour les Vaccins en Développement, Bamako, Mali
| | - Musa Hassan-King
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier Manigart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Nascimento
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Arouna Woukeu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ray Borrow
- Public Health England Vaccine Evaluation Unit, Manchester, UK
| | | | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - James M Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Greenwood BM, Aseffa A, Caugant DA, Diallo K, Kristiansen PA, Maiden MCJ, Stuart JM, Trotter CL. Narrative review of methods and findings of recent studies on the carriage of meningococci and other Neisseria species in the African Meningitis Belt. Trop Med Int Health 2018; 24:143-154. [PMID: 30461138 PMCID: PMC7380001 DOI: 10.1111/tmi.13185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/28/2022]
Abstract
Objective To review the findings of studies of pharyngeal carriage of Neisseria meningitidis and related species conducted in the African meningitis belt since a previous review published in 2007. Methods PubMed and Web of Science were searched in July 2018 using the terms ‘meningococcal OR Neisseria meningitidis OR lactamica AND carriage AND Africa’, with the search limited to papers published on or after 1st January 2007. We conducted a narrative review of these publications. Results One hundred and thirteen papers were identified using the search terms described above, 20 of which reported new data from surveys conducted in an African meningitis belt country. These papers described 40 surveys conducted before the introduction of the group A meningococcal conjugate vaccine (MenAfriVacR) during which 66 707 pharyngeal swabs were obtained. Carriage prevalence of N. meningitidis varied substantially by time and place, ranging from <1% to 24%. The mean pharyngeal carriage prevalence of N. meningitidis across all surveys was 4.5% [95% CI: 3.4%, 6.8%] and that of capsulated N. meningitidis was 2.8% [95% CI: 1.9%; 5.2%]. A study of households provided strong evidence for meningococcal transmission within and outside households. The introduction of MenAfriVac® led to marked reductions in carriage of the serogroup A meningococcus in Burkina Faso and Chad. Conclusions Recent studies employing standardised methods confirm the findings of older studies that carriage of N. meningitidis in the African meningitis belt is highly variable over time and place, but generally occurs with a lower prevalence and shorter duration than reported from industrialised countries.
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Affiliation(s)
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Kanny Diallo
- Department of Bacteriology, Noguchi Memorial Research Institute, University of Legon, Accra, Legon
| | | | | | - James M Stuart
- London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline L Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Abstract
The introduction of a serogroup A meningococcal conjugate vaccine in the African meningitis belt has been a remarkable success. Meningitis due to the serogroup A meningococcus, previously responsible for most epidemics, has fallen by 99% in vaccinated countries. Success must, however, not distract from the continuing burden of meningitis in this region of Africa. The number of all meningitis epidemics at health district level has fallen by 60% following vaccination, but epidemics due to other meningococcal serogroups continue and may be increasing. The introduction of low cost multivalent conjugate vaccines must be given high public health priority.
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Affiliation(s)
- James M Stuart
- a London School of Hygiene and Tropical Medicine , London , UK
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10
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Basta NE, Berthe A, Keita M, Onwuchekwa U, Tamboura B, Traore A, Hassan-King M, Manigart O, Nascimento M, Stuart JM, Trotter C, Blake J, Carr AD, Gray SJ, Newbold LS, Deng Y, Wolfson J, Halloran ME, Greenwood B, Borrow R, Sow SO. Meningococcal carriage within households in the African meningitis belt: A longitudinal pilot study. J Infect 2017; 76:140-148. [PMID: 29197599 PMCID: PMC5790055 DOI: 10.1016/j.jinf.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/22/2017] [Indexed: 10/29/2022]
Abstract
OBJECTIVES Carriers of Neisseria meningitidis are a key source of transmission. In the African meningitis belt, where risk of meningococcal disease is highest, a greater understanding of meningococcal carriage dynamics is needed. METHODS We randomly selected an age-stratified sample of 400 residents from 116 households in Bamako, Mali, and collected pharyngeal swabs in May 2010. A month later, we enrolled all 202 residents of 20 of these households (6 with known carriers) and collected swabs monthly for 6 months prior to MenAfriVac vaccine introduction and returned 10 months later to collect swabs monthly for 3 months. We used standard bacteriological methods to identify N. meningitidis carriers and fit hidden Markov models to assess acquisition and clearance overall and by sex and age. RESULTS During the cross-sectional study 5.0% of individuals (20/400) were carriers. During the longitudinal study, 73 carriage events were identified from 1422 swabs analyzed, and 16.3% of individuals (33/202) were identified as carriers at least once. The majority of isolates were non-groupable; no serogroup A carriers were identified. CONCLUSIONS Our results suggest that the duration of carriage with any N. meningitidis averages 2.9 months and that males and children acquire and lose carriage more frequently in an urban setting in Mali. Our study informed the design of a larger study implemented in seven countries of the African meningitis belt.
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Affiliation(s)
- Nicole E Basta
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
| | - Abdoulaye Berthe
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Mahamadou Keita
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Boubou Tamboura
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Awa Traore
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Musa Hassan-King
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Olivier Manigart
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali; London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Maria Nascimento
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - James M Stuart
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - Jayne Blake
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Anthony D Carr
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Stephen J Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Lynne S Newbold
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Yangqing Deng
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA; Department of Biostatistics, University of Washington, Seattle, Washington 98195, USA
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Samba O Sow
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
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Cooper LV, Boukary RM, Aseffa A, Mihret W, Collard JM, Daugla D, Hodgson A, Sokhna C, Omotara B, Sow S, Quaye SL, Diallo K, Manigart O, Maiden MCJ, Findlow H, Borrow R, Stuart JM, Greenwood BM, Trotter CL. Investigation of correlates of protection against pharyngeal carriage of Neisseria meningitidis genogroups W and Y in the African meningitis belt. PLoS One 2017; 12:e0182575. [PMID: 28796795 PMCID: PMC5552120 DOI: 10.1371/journal.pone.0182575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Serum bactericidal antibody titres that correlate with protection against invasive meningococcal disease have been characterised. However, titres that are associated with protection against acquisition of pharyngeal carriage of Neisseria meningitidis are not known. METHODS Sera were obtained from the members of a household in seven countries of the African meningitis belt in which a pharyngeal carrier of N. meningitidis had been identified during a cross-sectional survey. Serum bactericidal antibody titres at baseline were compared between individuals in the household of the carrier who became a carrier of a meningococcus of the same genogroup during six months of subsequent follow-up and household members who did not become a carrier of a meningococcus of this genogroup during this period. RESULTS Serum bacterial antibody titres were significantly higher in carriers of a serogroup W or Y meningococcus at the time of recruitment than in those who were not a carrier of N. meningitidis of the same genogroup. Serum bactericidal antibody titres to a strain of N. meningitis of the same genogroup as the index cases were no different in individuals who acquired carriage with a meningococcus of the same genogroup as the index case than in those who did not become a carrier during six months of follow-up. CONCLUSION Serum bacterial antibody titres to N. meningitidis of genogroup W or Y in the range of those acquired by natural exposure to meningococci of these genogroups, or with cross-reactive bacteria, are not associated with protection against acquisition of carriage with meningococci of either of these genogroups.
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Affiliation(s)
- Laura V. Cooper
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Wude Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Doumagoum Daugla
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | | | - Cheikh Sokhna
- Institut de Recherche pour le Développement, Dakar, Senegal
| | - Babatunji Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Samba Sow
- Centre pour les Vaccins en Développement, Bamako, Mali
| | | | - Kanny Diallo
- Centre pour les Vaccins en Développement, Bamako, Mali
| | - Olivier Manigart
- Faculty of Infectious Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Helen Findlow
- Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom
| | - Ray Borrow
- Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom
| | - James M. Stuart
- Faculty of Infectious Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brian M. Greenwood
- Faculty of Infectious Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline L. Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Trotter CL, Lingani C, Fernandez K, Cooper LV, Bita A, Tevi-Benissan C, Ronveaux O, Préziosi MP, Stuart JM. Impact of MenAfriVac in nine countries of the African meningitis belt, 2010-15: an analysis of surveillance data. Lancet Infect Dis 2017; 17:867-872. [PMID: 28545721 DOI: 10.1016/s1473-3099(17)30301-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In preparation for the introduction of MenAfriVac, a meningococcal group A conjugate vaccine developed for the African meningitis belt, an enhanced meningitis surveillance network was established. We analysed surveillance data on suspected and confirmed cases of meningitis to quantify vaccine impact. METHODS We compiled and analysed surveillance data for nine countries in the meningitis belt (Benin, Burkina Faso, Chad, Côte d'Ivoire, Ghana, Mali, Niger, Nigeria, and Togo) collected and curated by the WHO Inter-country Support Team between 2005 and 2015. The incidence rate ratios (IRRs) of suspected and confirmed cases in vaccinated and unvaccinated populations were estimated with negative binomial regression models. The relative risk of districts reaching the epidemic threshold of ten per 100 000 per week was estimated according to district vaccination status. FINDINGS The incidence of suspected meningitis cases declined by 57% (95% CI 55-59) in vaccinated compared with unvaccinated populations, with some heterogeneity observed by country. We observed a similar 59% decline in the risk of a district reaching the epidemic threshold. In fully vaccinated populations, the incidence of confirmed group A disease was reduced by more than 99%. The IRR for non-A serogroups was higher after completion of MenAfriVac campaigns (IRR 2·76, 95% CI 1·21-6·30). INTERPRETATION MenAfriVac introduction has led to substantial reductions in the incidence of suspected meningitis and epidemic risk, and a substantial effect on confirmed group A meningococcal meningitis. It is important to continue strengthening surveillance to monitor vaccine performance and remain vigilant against threats from other meningococcal serogroups and other pathogens. FUNDING World Health Organization.
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Affiliation(s)
- Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - Clément Lingani
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Katya Fernandez
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Laura V Cooper
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - André Bita
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Carol Tevi-Benissan
- Immunization and Vaccine Development Unit, Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Olivier Ronveaux
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Préziosi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - James M Stuart
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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13
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Diallo K, Gamougam K, Daugla DM, Harrison OB, Bray JE, Caugant DA, Lucidarme J, Trotter CL, Hassan-King M, Stuart JM, Manigart O, Greenwood BM, Maiden MCJ. Hierarchical genomic analysis of carried and invasive serogroup A Neisseria meningitidis during the 2011 epidemic in Chad. BMC Genomics 2017; 18:398. [PMID: 28532434 PMCID: PMC5441073 DOI: 10.1186/s12864-017-3789-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background Serogroup A Neisseria meningitidis (NmA) was the cause of the 2011 meningitis epidemics in Chad. This bacterium, often carried asymptomatically, is considered to be an “accidental pathogen”; however, the transition from carriage to disease phenotype remains poorly understood. This study examined the role genetic diversity might play in this transition by comparing genomes from geographically and temporally matched invasive and carried NmA isolates. Results All 23 NmA isolates belonged to the ST-5 clonal complex (cc5). Ribosomal MLST comparison with other publically available NmA:cc5 showed that isolates were closely related, although those from Chad formed two distinct branches and did not cluster with other NmA, based on their MLST profile, geographical and temporal location. Whole genome MLST (wgMLST) comparison identified 242 variable genes among all Chadian isolates and clustered them into three distinct phylogenetic groups (Clusters 1, 2, and 3): no systematic clustering by disease or carriage source was observed. There was a significant difference (p = 0.0070) between the mean age of the individuals from which isolates from Cluster 1 and Cluster 2 were obtained, irrespective of whether the person was a case or a carrier. Conclusions Whole genome sequencing provided high-resolution characterization of the genetic diversity of these closely related NmA isolates. The invasive meningococcal isolates obtained during the epidemic were not homogeneous; rather, a variety of closely related but distinct clones were circulating in the human population with some clones preferentially colonizing specific age groups, reflecting a potential age-related niche adaptation. Systematic genetic differences were not identified between carriage and disease isolates consistent with invasive meningococcal disease being a multi-factorial event resulting from changes in host-pathogen interactions along with the bacterium. Electronic supplementary material The online version of this article (doi:10.1186/s12864-017-3789-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kanny Diallo
- Centre pour les Vaccins en Développement, Bamako, Mali. .,Department of Zoology, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, OX1 3SY, Oxford, UK.
| | | | | | - Odile B Harrison
- Department of Zoology, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, OX1 3SY, Oxford, UK
| | - James E Bray
- Department of Zoology, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, OX1 3SY, Oxford, UK
| | | | - Jay Lucidarme
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | - Caroline L Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - James M Stuart
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Martin C J Maiden
- Department of Zoology, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, OX1 3SY, Oxford, UK
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15
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Lingani C, Bergeron-Caron C, Stuart JM, Fernandez K, Djingarey MH, Ronveaux O, Schnitzler JC, Perea WA. Meningococcal Meningitis Surveillance in the African Meningitis Belt, 2004-2013. Clin Infect Dis 2016; 61 Suppl 5:S410-5. [PMID: 26553668 PMCID: PMC4639499 DOI: 10.1093/cid/civ597] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. An enhanced meningitis surveillance network was established across the meningitis belt of sub-Saharan Africa in 2003 to rapidly collect, disseminate, and use district weekly data on meningitis incidence. Following 10 years’ experience with enhanced surveillance that included the introduction of a group A meningococcal conjugate vaccine, PsA-TT (MenAfriVac), in 2010, we analyzed the data on meningitis incidence and case fatality from countries reporting to the network. Methods. After de-duplication and reconciliation, data were extracted from the surveillance bulletins and the central database held by the World Health Organization Inter-country Support Team in Burkina Faso for countries reporting consistently from 2004 through 2013 (Benin, Burkina Faso, Chad, Democratic Republic of Congo, Ghana, Côte d'Ivoire, Mali, Niger, Nigeria, Togo). Results. The 10 study countries reported 341 562 suspected and confirmed cases over the 10-year study period, with a marked peak in 2009 due to a large epidemic of group A Neisseria meningitidis (NmA) meningitis. Case fatality was lowest (5.9%) during this year. A mean of 71 and 67 districts annually crossed the alert and epidemic thresholds, respectively. The incidence rate of NmA meningitis fell >10-fold, from 0.27 per 100 000 in 2004–2010 to 0.02 per 100 000 in 2011–2013 (P < .0001). Conclusions. In addition to supporting timely outbreak response, the enhanced meningitis surveillance system provides a global overview of the epidemiology of meningitis in the region, despite limitations in data quality and completeness. This study confirms a dramatic fall in NmA incidence after the introduction of PsA-TT.
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Affiliation(s)
- Clément Lingani
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | | | - James M Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Katya Fernandez
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Mamoudou H Djingarey
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Olivier Ronveaux
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Johannes C Schnitzler
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - William A Perea
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
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Manigart O, Trotter C, Findlow H, Aseffa A, Mihret W, Moti Demisse T, Yeshitela B, Osei I, Hodgson A, Quaye SL, Sow S, Coulibaly M, Diallo K, Traore A, Collard JM, Moustapha Boukary R, Djermakoye O, Mahamane AE, Jusot JF, Sokhna C, Alavo S, Doucoure S, Ba EH, Dieng M, Diallo A, Daugla DM, Omotara B, Chandramohan D, Hassan-King M, Nascimento M, Woukeu A, Borrow R, Stuart JM, Greenwood B. Correction: A Seroepidemiological Study of Serogroup A Meningococcal Infection in the African Meningitis Belt. PLoS One 2016; 11:e0158938. [PMID: 27379429 PMCID: PMC4933368 DOI: 10.1371/journal.pone.0158938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0147928.].
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17
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Liu TT, Achrol AS, Mitchell LA, Du WA, Loya JJ, Rodriguez SA, Feroze A, Westbroek EM, Yeom KW, Stuart JM, Chang SD, Harsh GR, Rubin DL. Computational Identification of Tumor Anatomic Location Associated with Survival in 2 Large Cohorts of Human Primary Glioblastomas. AJNR Am J Neuroradiol 2016; 37:621-8. [PMID: 26744442 DOI: 10.3174/ajnr.a4631] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 05/27/2015] [Accepted: 08/02/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Tumor location has been shown to be a significant prognostic factor in patients with glioblastoma. The purpose of this study was to characterize glioblastoma lesions by identifying MR imaging voxel-based tumor location features that are associated with tumor molecular profiles, patient characteristics, and clinical outcomes. MATERIALS AND METHODS Preoperative T1 anatomic MR images of 384 patients with glioblastomas were obtained from 2 independent cohorts (n = 253 from the Stanford University Medical Center for training and n = 131 from The Cancer Genome Atlas for validation). An automated computational image-analysis pipeline was developed to determine the anatomic locations of tumor in each patient. Voxel-based differences in tumor location between good (overall survival of >17 months) and poor (overall survival of <11 months) survival groups identified in the training cohort were used to classify patients in The Cancer Genome Atlas cohort into 2 brain-location groups, for which clinical features, messenger RNA expression, and copy number changes were compared to elucidate the biologic basis of tumors located in different brain regions. RESULTS Tumors in the right occipitotemporal periventricular white matter were significantly associated with poor survival in both training and test cohorts (both, log-rank P < .05) and had larger tumor volume compared with tumors in other locations. Tumors in the right periatrial location were associated with hypoxia pathway enrichment and PDGFRA amplification, making them potential targets for subgroup-specific therapies. CONCLUSIONS Voxel-based location in glioblastoma is associated with patient outcome and may have a potential role for guiding personalized treatment.
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Affiliation(s)
- T T Liu
- From the Stanford Center for Biomedical Informatics Research and Biomedical Informatics Training Program (T.T.L., D.L.R.) Department of Radiology (T.T.L., L.A.M., W.A.D., K.W.Y., D.L.R.)
| | - A S Achrol
- Stanford Institute for Neuro-Innovation and Translational Neurosciences (A.S.A.) Institute for Stem Cell Biology and Regenerative Medicine (A.S.A.) Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California
| | - L A Mitchell
- Department of Radiology (T.T.L., L.A.M., W.A.D., K.W.Y., D.L.R.)
| | - W A Du
- Department of Radiology (T.T.L., L.A.M., W.A.D., K.W.Y., D.L.R.)
| | - J J Loya
- Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California
| | - S A Rodriguez
- Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California
| | - A Feroze
- Department of Neurological Surgery (A.F.), University of Washington School of Medicine, Seattle, Washington
| | - E M Westbroek
- Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California
| | - K W Yeom
- Department of Radiology (T.T.L., L.A.M., W.A.D., K.W.Y., D.L.R.)
| | - J M Stuart
- Biomolecular Engineering (J.M.S.), University of California Santa Cruz, Santa Cruz, California
| | - S D Chang
- Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California
| | - G R Harsh
- Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California
| | - D L Rubin
- From the Stanford Center for Biomedical Informatics Research and Biomedical Informatics Training Program (T.T.L., D.L.R.) Department of Radiology (T.T.L., L.A.M., W.A.D., K.W.Y., D.L.R.)
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Diallo K, Trotter C, Timbine Y, Tamboura B, Sow SO, Issaka B, Dano ID, Collard JM, Dieng M, Diallo A, Mihret A, Ali OA, Aseffa A, Quaye SL, Bugri A, Osei I, Gamougam K, Mbainadji L, Daugla DM, Gadzama G, Sambo ZB, Omotara BA, Bennett JS, Rebbetts LS, Watkins ER, Nascimento M, Woukeu A, Manigart O, Borrow R, Stuart JM, Greenwood BM, Maiden MCJ. Pharyngeal carriage of Neisseria species in the African meningitis belt. J Infect 2016; 72:667-677. [PMID: 27018131 PMCID: PMC4879866 DOI: 10.1016/j.jinf.2016.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 01/04/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 12/29/2022]
Abstract
Objectives Neisseria meningitidis, together with the non-pathogenic Neisseria species (NPNs), are members of the complex microbiota of the human pharynx. This paper investigates the influence of NPNs on the epidemiology of meningococcal infection. Methods Neisseria isolates were collected during 18 surveys conducted in six countries in the African meningitis belt between 2010 and 2012 and characterized at the rplF locus to determine species and at the variable region of the fetA antigen gene. Prevalence and risk factors for carriage were analyzed. Results A total of 4694 isolates of Neisseria were obtained from 46,034 pharyngeal swabs, a carriage prevalence of 10.2% (95% CI, 9.8–10.5). Five Neisseria species were identified, the most prevalent NPN being Neisseria lactamica. Six hundred and thirty-six combinations of rplF/fetA_VR alleles were identified, each defined as a Neisseria strain type. There was an inverse relationship between carriage of N. meningitidis and of NPNs by age group, gender and season, whereas carriage of both N. meningitidis and NPNs was negatively associated with a recent history of meningococcal vaccination. Conclusion Variations in the prevalence of NPNs by time, place and genetic type may contribute to the particular epidemiology of meningococcal disease in the African meningitis belt. A prevalence of 10.2% of Neisseria infection was observed during the study. Five Neisseria species were identified in nasopharyngeal samples. High level of genetic diversity was observed in carried isolates. Inverse relationship between carriage of Neisseria meningitidis and non-pathogenic Neisseria.
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Affiliation(s)
- Kanny Diallo
- Centre pour les Vaccins en Développement, Bamako, Mali; Department of Zoology, University of Oxford, Oxford, UK.
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Samba O Sow
- Centre pour les Vaccins en Développement, Bamako, Mali
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Ibrahim D Dano
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Marietou Dieng
- Institut de Recherche pour le Développement, Dakar, Senegal
| | | | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Oumer A Ali
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | - Isaac Osei
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | | | | | | | | | | | | | | | | | - Arouna Woukeu
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | - James M Stuart
- London School of Hygiene & Tropical Medicine, London, UK
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Manigart O, Trotter C, Findlow H, Assefa A, Mihret W, Moti Demisse T, Yeshitela B, Osei I, Hodgson A, Quaye SL, Sow S, Coulibaly M, Diallo K, Traore A, Collard JM, Moustapha Boukary R, Djermakoye O, Mahamane AE, Jusot JF, Sokhna C, Alavo S, Doucoure S, Ba EH, Dieng M, Diallo A, Daugla DM, Omotara B, Chandramohan D, Hassan-King M, Nascimento M, Woukeu A, Borrow R, Stuart JM, Greenwood B. A Seroepidemiological Study of Serogroup A Meningococcal Infection in the African Meningitis Belt. PLoS One 2016; 11:e0147928. [PMID: 26872255 PMCID: PMC4752490 DOI: 10.1371/journal.pone.0147928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/11/2016] [Indexed: 12/31/2022] Open
Abstract
The pattern of epidemic meningococcal disease in the African meningitis belt may be influenced by the background level of population immunity but this has been measured infrequently. A standardised enzyme-linked immunosorbent assay (ELISA) for measuring meningococcal serogroup A IgG antibodies was established at five centres within the meningitis belt. Antibody concentrations were then measured in 3930 individuals stratified by age and residence from six countries. Seroprevalence by age was used in a catalytic model to determine the force of infection. Meningococcal serogroup A IgG antibody concentrations were high in each country but showed heterogeneity across the meningitis belt. The geometric mean concentration (GMC) was highest in Ghana (9.09 μg/mL [95% CI 8.29, 9.97]) and lowest in Ethiopia (1.43 μg/mL [95% CI 1.31, 1.57]) on the margins of the belt. The force of infection was lowest in Ethiopia (λ = 0.028). Variables associated with a concentration above the putative protective level of 2 μg/mL were age, urban residence and a history of recent vaccination with a meningococcal vaccine. Prior to vaccination with the serogroup A meningococcal conjugate vaccine, meningococcal serogroup A IgG antibody concentrations were high across the African meningitis belt and yet the region remained susceptible to epidemics.
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Affiliation(s)
- Olivier Manigart
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Medical Research Council Unit, Fajara, The Gambia
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Helen Findlow
- Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom
| | - Abraham Assefa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Wude Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | - Isaac Osei
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | - Samba Sow
- Centre pour les Vaccins en Développement, Bamako, Mali
| | | | - Kanny Diallo
- Centre pour les Vaccins en Développement, Bamako, Mali
| | - Awa Traore
- Centre pour les Vaccins en Développement, Bamako, Mali
| | | | | | | | | | | | - Cheikh Sokhna
- Institut de Recherche pour le Développement, Dakar, Senegal
| | - Serge Alavo
- Institut de Recherche pour le Développement, Dakar, Senegal
| | | | - El Hadj Ba
- Institut de Recherche pour le Développement, Dakar, Senegal
| | - Mariétou Dieng
- Institut de Recherche pour le Développement, Dakar, Senegal
| | | | | | - Babatunji Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Daniel Chandramohan
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Musa Hassan-King
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maria Nascimento
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Arouna Woukeu
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ray Borrow
- Public Health England Vaccine Evaluation Unit, Manchester, United Kingdom
| | - James M. Stuart
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brian Greenwood
- Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Irurzun-Lopez M, Erondu NA, Djibo A, Griffiths U, Stuart JM, Fernandez K, Ronveaux O, Le Gargasson JB, Gessner BD, Colombini A. The actual and potential costs of meningitis surveillance in the African meningitis belt: Results from Chad and Niger. Vaccine 2015; 34:1133-8. [PMID: 26603955 DOI: 10.1016/j.vaccine.2015.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of serogroup A meningococcal conjugate vaccine in the African meningitis belt required strengthened surveillance to assess long-term vaccine impact. The costs of implementing this strengthening had not been assessed. METHODOLOGY The ingredients approach was used to retrospectively determine bacterial meningitis surveillance costs in Chad and Niger in 2012. Resource use and unit cost data were collected through interviews with staff at health facilities, laboratories, government offices and international partners, and by reviewing financial reports. Sample costs were extrapolated to national level and costs of upgrading to desired standards were estimated. RESULTS Case-based surveillance had been implemented in all 12 surveyed hospitals and 29 of 33 surveyed clinics in Niger, compared to six out of 21 clinics surveyed in Chad. Lumbar punctures were performed in 100% of hospitals and clinics in Niger, compared to 52% of the clinics in Chad. The total costs of meningitis surveillance were US$ 1,951,562 in Niger and US$ 338,056 in Chad, with costs per capita of US$ 0.12 and US$ 0.03, respectively. Laboratory investigation was the largest cost component per surveillance functions, comprising 51% of the total costs in Niger and 40% in Chad. Personnel resources comprised the biggest expense type: 37% of total costs in Niger and 26% in Chad. The estimated annual, incremental costs of upgrading current systems to desired standards were US$ 183,299 in Niger and US$ 605,912 in Chad, which are 9% and 143% of present costs, respectively. CONCLUSIONS Niger's more robust meningitis surveillance system costs four times more per capita than the system in Chad. Since Chad spends less per capita, fewer activities are performed, which weakens detection and analysis of cases. Countries in the meningitis belt are diverse, and can use these results to assess local costs for adapting surveillance systems to monitor vaccine impact.
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Affiliation(s)
- Maite Irurzun-Lopez
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1).
| | - Ngozi A Erondu
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2)
| | - Ali Djibo
- Faculté de Médecine Université de Niamey, Niger(3)
| | - Ulla Griffiths
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2)
| | - James M Stuart
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom(2); World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Katya Fernandez
- World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Olivier Ronveaux
- World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland(4)
| | - Jean-Bernard Le Gargasson
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
| | - Bradford D Gessner
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
| | - Anaïs Colombini
- Agence de Médecine Préventive, Bât. JB Say, 4e étage, aile A, 13 chemin du Levant, 01210 Ferney-Voltaire, France(1)
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21
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Trotter CL, Cibrelus L, Fernandez K, Lingani C, Ronveaux O, Stuart JM. Response thresholds for epidemic meningitis in sub-Saharan Africa following the introduction of MenAfriVac®. Vaccine 2015; 33:6212-7. [PMID: 26463444 DOI: 10.1016/j.vaccine.2015.09.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since 2010, countries in the African meningitis belt have been introducing a new serogroup A meningococcal conjugate vaccine (MenAfriVac(®)) through mass campaigns. With the subsequent decline in meningitis due to Neisseria meningitidis serogroup A (NmA) and relative increase in meningitis due to other serogroups, mainly N. meningitidis serogroup W (NmW), the World Health Organisation (WHO) initiated a review of the incidence thresholds that guide response to meningitis epidemics in the African meningitis belt. METHODS Meningitis surveillance data from African meningitis belt countries from 2002 to 2013 were used to construct a single NmW dataset. The performance of different weekly attack rates, used as thresholds to initiate vaccination response, on preventing further cases was estimated. The cumulative seasonal attack rate used to define an epidemic was also varied. RESULTS Considerable variation in effect at different thresholds was observed. In predicting epidemics defined as a seasonal cumulative incidence of 100/10(5) population, an epidemic threshold of 10 cases/10(5) population/week performed well. Based on this same epidemic threshold, with a 6 week interval between crossing the epidemic threshold and population protection from a meningococcal vaccination campaign, an estimated 17 cases per event would be prevented by vaccination. Lowering the threshold increased the number of cases per event potentially prevented, as did shortening the response interval. If the interval was shortened to 4 weeks at the threshold of 10/10(5), the number of cases prevented would increase to 54 per event. CONCLUSIONS Accelerating time to vaccination could prevent more cases per event than lowering the threshold. Once the meningitis epidemic threshold is crossed, it is of critical importance that vaccination campaigns, where appropriate, are initiated rapidly.
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Affiliation(s)
| | - Laurence Cibrelus
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Katya Fernandez
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Clément Lingani
- World Health Organization, AFRO Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Olivier Ronveaux
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - James M Stuart
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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22
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Gamougam K, Daugla DM, Toralta J, Ngadoua C, Fermon F, Page AL, Djingarey MH, Caugant DA, Manigart O, Trotter CL, Stuart JM, Greenwood BM. Continuing effectiveness of serogroup A meningococcal conjugate vaccine, Chad, 2013. Emerg Infect Dis 2015; 21:115-8. [PMID: 25536336 PMCID: PMC4285275 DOI: 10.3201/eid2101.140256] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2011, vaccination with a serogroup A meningococcal polysaccharide conjugate vaccine was implemented in 3 of 23 regions in Chad. Cases of meningitis declined dramatically in vaccinated areas, but an epidemic continued in the rest of Chad. In 2012, the remaining Chad population was vaccinated, and the epidemic was halted.
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Waite TD, Telisinghe L, Gobin M, Ronveaux O, Fernandez AK, Stuart JM, Scholten RJPM. Rapid diagnostic tests for bacterial meningitis applicable in sub-Saharan Africa. Hippokratia 2015. [DOI: 10.1002/14651858.cd011634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Thomas D Waite
- Public Health England; Field Epidemiology Services; 2 Rivergate Bristol UK BS1 6EH
| | | | - Maya Gobin
- Public Health England; Field Epidemiology Services; 2 Rivergate Bristol UK BS1 6EH
| | - Olivier Ronveaux
- World Health Organization; Control of Epidemic Diseases; 20 Avenue Appia Geneva Switzerland 1211
| | - Ana-Katya Fernandez
- World Health Organization; Pandemic and Epidemic Diseases (PED); 20 Avenue Appia Geneva Switzerland 1211
| | - James M Stuart
- London School of Hygiene and Tropical Medicine; Infectious and Tropical Diseases Department; Keppel Street London UK WC1E 7HT
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care / University Medical Center Utrecht; Dutch Cochrane Centre; Room Str. 6.126 P.O. Box 85500 Utrecht Netherlands 3508 GA
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Waldram A, McKerr C, Gobin M, Adak G, Stuart JM, Cleary P. Control selection methods in recent case-control studies conducted as part of infectious disease outbreaks. Eur J Epidemiol 2015; 30:465-71. [PMID: 25762171 DOI: 10.1007/s10654-015-0005-x] [Citation(s) in RCA: 9] [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: 09/09/2014] [Accepted: 02/20/2015] [Indexed: 02/01/2023]
Abstract
Successful investigation of national outbreaks of communicable disease relies on rapid identification of the source. Case-control methodologies are commonly used to achieve this. We assessed control selection methods used in recently published case-control studies for methodological and resource issues to determine if a standard approach could be identified. Neighbourhood controls were the most frequently used method in 53 studies of a range of different sizes, infections and settings. The most commonly used method of data collection was face to face interview. Control selection issues were identified in four areas: method of identification of controls, appropriateness of controls, ease of recruitment of controls, and resource requirements. Potential biases arising from the method of control selection were identified in half of the studies assessed. There is a need to develop new ways of selecting controls in a rapid, random and representative manner to improve the accuracy and timeliness of epidemiological investigations and maximise the effectiveness of public health interventions. Innovative methods such as prior recruitment of controls could improve timeliness and representativeness of control selection.
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Affiliation(s)
- Alison Waldram
- Field Epidemiology Service Liverpool, Public Health England, Liverpool, UK,
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van de Venter EC, Oliver I, Stuart JM. Timeliness of epidemiological outbreak investigations in peer-reviewed European publications, January 2003 to August 2013. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.6.21035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- E C van de Venter
- Public Health England, Bristol, United Kingdom
- South West Public Health Training Programme, Health Education South West, Bristol, United Kingdom
| | - I Oliver
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - J M Stuart
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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26
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Ferraro CF, Trotter CL, Nascimento MC, Jusot JF, Omotara BA, Hodgson A, Ali O, Alavo S, Sow S, Daugla DM, Stuart JM. Household crowding, social mixing patterns and respiratory symptoms in seven countries of the African meningitis belt. PLoS One 2014; 9:e101129. [PMID: 24988195 PMCID: PMC4079295 DOI: 10.1371/journal.pone.0101129] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/03/2014] [Indexed: 12/24/2022] Open
Abstract
Objectives To describe the variation in household crowding and social mixing patterns in the African meningitis belt and to assess any association with self-reported recent respiratory symptoms. Methods In 2010, the African Meningococcal Carriage Consortium (MenAfriCar) conducted cross-sectional surveys in urban and rural areas of seven countries. The number of household members, rooms per household, attendance at social gatherings and meeting places were recorded. Associations with self-reported recent respiratory symptoms were analysed by univariate and multivariate regression models. Results The geometric mean people per room ranged from 1.9 to 2.8 between Ghana and Ethiopia respectively. Attendance at different types of social gatherings was variable by country, ranging from 0.5 to 1.5 per week. Those who attended 3 or more different types of social gatherings a week (frequent mixers) were more likely to be older, male (OR 1.27, p<0.001) and live in urban areas (OR 1.45, p<0.001). Frequent mixing and young age, but not increased household crowding, were associated with higher odds of self-reported respiratory symptoms (aOR 2.2, p<0.001 and OR 2.8, p<0.001 respectively). A limitation is that we did not measure school and workplace attendance. Conclusion There are substantial variations in household crowding and social mixing patterns across the African meningitis belt. This study finds a clear association between age, increased social mixing and respiratory symptoms. It lays the foundation for designing and implementing more detailed studies of social contact patterns in this region.
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Affiliation(s)
- Claire F. Ferraro
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline L. Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Maria C. Nascimento
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean-François Jusot
- Unité d'Epidémiologie, Centre de Recherches Médicales et Sanitaires (CERMES), Niamey, Niger
| | | | - Abraham Hodgson
- Navrongo Health Research Centre, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Ghana
| | - Oumer Ali
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Serge Alavo
- L'institut de recherche pour le développement, Dakar, Senegal
| | - Samba Sow
- Center for Vaccine Development-Mali (CVD-MALI), Bamako, Mali
| | | | - James M. Stuart
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Daugla DM, Gami JP, Gamougam K, Naibei N, Mbainadji L, Narbé M, Toralta J, Kodbesse B, Ngadoua C, Coldiron ME, Fermon F, Page AL, Djingarey MH, Hugonnet S, Harrison OB, Rebbetts LS, Tekletsion Y, Watkins ER, Hill D, Caugant DA, Chandramohan D, Hassan-King M, Manigart O, Nascimento M, Woukeu A, Trotter C, Stuart JM, Maiden M, Greenwood BM. Effect of a serogroup A meningococcal conjugate vaccine (PsA-TT) on serogroup A meningococcal meningitis and carriage in Chad: a community study [corrected]. Lancet 2014; 383:40-47. [PMID: 24035220 PMCID: PMC3898950 DOI: 10.1016/s0140-6736(13)61612-8] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [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: 12/02/2022]
Abstract
BACKGROUND A serogroup A meningococcal polysaccharide-tetanus toxoid conjugate vaccine (PsA-TT, MenAfriVac) was licensed in India in 2009, and pre-qualified by WHO in 2010, on the basis of its safety and immunogenicity. This vaccine is now being deployed across the African meningitis belt. We studied the effect of PsA-TT on meningococcal meningitis and carriage in Chad during a serogroup A meningococcal meningitis epidemic. METHODS We obtained data for the incidence of meningitis before and after vaccination from national records between January, 2009, and June, 2012. In 2012, surveillance was enhanced in regions where vaccination with PsA-TT had been undertaken in 2011, and in one district where a reactive vaccination campaign in response to an outbreak of meningitis was undertaken. Meningococcal carriage was studied in an age-stratified sample of residents aged 1-29 years of a rural area roughly 13-15 and 2-4 months before and 4-6 months after vaccination. Meningococci obtained from cerebrospinal fluid or oropharyngeal swabs were characterised by conventional microbiological and molecular methods. FINDINGS Roughly 1·8 million individuals aged 1-29 years received one dose of PsA-TT during a vaccination campaign in three regions of Chad in and around the capital N'Djamena during 10 days in December, 2011. The incidence of meningitis during the 2012 meningitis season in these three regions was 2·48 per 100,000 (57 cases in the 2·3 million population), whereas in regions without mass vaccination, incidence was 43·8 per 100,000 (3809 cases per 8·7 million population), a 94% difference in crude incidence (p<0·0001), and an incidence rate ratio of 0·096 (95% CI 0·046-0·198). Despite enhanced surveillance, no case of serogroup A meningococcal meningitis was reported in the three vaccinated regions. 32 serogroup A carriers were identified in 4278 age-stratified individuals (0·75%) living in a rural area near the capital 2-4 months before vaccination, whereas only one serogroup A meningococcus was isolated in 5001 people living in the same community 4-6 months after vaccination (adjusted odds ratio 0·019, 95% CI 0·002-0·138; p<0·0001). INTERPRETATION PSA-TT was highly effective at prevention of serogroup A invasive meningococcal disease and carriage in Chad. How long this protection will persist needs to be established. FUNDING The Bill & Melinda Gates Foundation, the Wellcome Trust, and Médecins Sans Frontères.
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Affiliation(s)
- D M Daugla
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - J P Gami
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - K Gamougam
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - N Naibei
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - L Mbainadji
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - M Narbé
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - J Toralta
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - B Kodbesse
- Centre de Support en Santé International (CSSI), N'Djamena, Chad
| | - C Ngadoua
- Ministry of Public Health, N'Djamena, Chad
| | - M E Coldiron
- Epicentre, Médecins sans Frontères, Paris, France
| | - F Fermon
- Epicentre, Médecins sans Frontères, Paris, France
| | - A-L Page
- Epicentre, Médecins sans Frontères, Paris, France
| | - M H Djingarey
- WHO Intercountry Support Team, Ougadougou, Burkina Faso
| | - S Hugonnet
- Department of Pandemic and Epidemic Diseases, WHO, Geneva, Switzerland
| | - O B Harrison
- Department of Zoology, University of Oxford, Oxford, UK
| | - L S Rebbetts
- Department of Zoology, University of Oxford, Oxford, UK
| | - Y Tekletsion
- Department of Zoology, University of Oxford, Oxford, UK
| | - E R Watkins
- Department of Zoology, University of Oxford, Oxford, UK
| | - D Hill
- Department of Zoology, University of Oxford, Oxford, UK
| | - D A Caugant
- Norwegian Institute for Public Health, Oslo, Norway
| | - D Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - M Hassan-King
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - O Manigart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - M Nascimento
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - A Woukeu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - C Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - J M Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - McJ Maiden
- Department of Zoology, University of Oxford, Oxford, UK
| | - B M Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Basta NE, Stuart JM, Nascimento MC, Manigart O, Trotter C, Hassan-King M, Chandramohan D, Sow SO, Berthe A, Bedru A, Tekletsion YK, Collard JM, Jusot JF, Diallo A, Basséne H, Daugla DM, Gamougam K, Hodgson A, Forgor AA, Omotara BA, Gadzama GB, Watkins ER, Rebbetts LS, Diallo K, Weiss NS, Halloran ME, Maiden MCJ, Greenwood B. Methods for identifying Neisseria meningitidis carriers: a multi-center study in the African meningitis belt. PLoS One 2013; 8:e78336. [PMID: 24194921 PMCID: PMC3806823 DOI: 10.1371/journal.pone.0078336] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/19/2013] [Indexed: 11/21/2022] Open
Abstract
Objective Detection of meningococcal carriers is key to understanding the epidemiology of Neisseria meningitidis, yet no gold standard has been established. Here, we directly compare two methods for collecting pharyngeal swabs to identify meningococcal carriers. Methods We conducted cross-sectional surveys of schoolchildren at multiple sites in Africa to compare swabbing the posterior pharynx behind the uvula (U) to swabbing the posterior pharynx behind the uvula plus one tonsil (T). Swabs were cultured immediately and analyzed using molecular methods. Results One thousand and six paired swab samples collected from schoolchildren in four countries were analyzed. Prevalence of meningococcal carriage was 6.9% (95% CI: 5.4-8.6%) based on the results from both swabs, but the observed prevalence was lower based on one swab type alone. Prevalence based on the T swab or the U swab alone was similar (5.2% (95% CI: 3.8-6.7%) versus 4.9% (95% CI: 3.6-6.4%) respectively (p=0.6)). The concordance between the two methods was 96.3% and the kappa was 0.61 (95% CI: 0.50-0.73), indicating good agreement. Conclusions These two commonly used methods for collecting pharyngeal swabs provide consistent estimates of the prevalence of carriage, but both methods misclassified carriers to some degree, leading to underestimates of the prevalence.
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Affiliation(s)
- Nicole E. Basta
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
- Research and Policy for Infectious Disease Dynamics, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - James M. Stuart
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maria C. Nascimento
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Olivier Manigart
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Musa Hassan-King
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | | | - Ahmed Bedru
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Yenenesh K. Tekletsion
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | | | - Aldiouma Diallo
- Instiutut de Recherche pour le Développement, Dakar, Senegal
| | - Hubert Basséne
- Instiutut de Recherche pour le Développement, Dakar, Senegal
| | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | | | - Babatunji A. Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Galadima B. Gadzama
- Department of Medical Microbiology, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | | | - Lisa S. Rebbetts
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Kanny Diallo
- Centre pour le Développement des Vaccins, Bamako, Mali
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Noel S. Weiss
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | | | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ibarz-Pavón AB, MacLennan J, Andrews NJ, Gray SJ, Urwin R, Clarke SC, Walker AM, Evans MR, Kroll JS, Neal KR, Ala'Aldeen D, Crook DW, Cann K, Harrison S, Cunningham R, Baxter D, Kaczmarski E, McCarthy ND, Jolley KA, Cameron JC, Stuart JM, Maiden MCJ. Changes in serogroup and genotype prevalence among carried meningococci in the United Kingdom during vaccine implementation. J Infect Dis 2011; 204:1046-53. [PMID: 21881120 PMCID: PMC3164428 DOI: 10.1093/infdis/jir466] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/13/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Herd immunity is important in the effectiveness of conjugate polysaccharide vaccines against encapsulated bacteria. A large multicenter study investigated the effect of meningococcal serogroup C conjugate vaccine introduction on the meningococcal population. METHODS Carried meningococci in individuals aged 15-19 years attending education establishments were investigated before and for 2 years after vaccine introduction. Isolates were characterized by multilocus sequence typing, serogroup, and capsular region genotype and changes in phenotypes and genotypes assessed. RESULTS A total of 8462 meningococci were isolated from 47 765 participants (17.7%). Serogroup prevalence was similar over the 3 years, except for decreases of 80% for serogroup C and 40% for serogroup 29E. Clonal complexes were associated with particular serogroups and their relative proportions fluctuated, with 12 statistically significant changes (6 up, 6 down). The reduction of ST-11 complex serogroup C meningococci was probably due to vaccine introduction. Reasons for a decrease in serogroup 29E ST-254 meningococci (from 1.8% to 0.7%) and an increase in serogroup B ST-213 complex meningococci (from 6.7% to 10.6%) were less clear. CONCLUSIONS Natural fluctuations in carried meningococcal genotypes and phenotypes a can be affected by the use of conjugate vaccines, and not all of these changes are anticipatable in advance of vaccine introduction.
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Affiliation(s)
| | | | | | - Stephen J. Gray
- Meningococcal Reference Unit, Health Protection Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary
| | | | - Stuart C. Clarke
- Division of Infection, Inflammation and Immunity, University of Southampton, School of Medicine, Southampton National Institute for Health Research Biomedical Research Unit in Respiratory Medicine, and Health Protection Agency, Southampton
| | | | - Meirion R. Evans
- Department of Primary Care and Public Health, Cardiff University
| | - J. Simon Kroll
- Imperial College School of Medicine, Norfolk Place, London
| | - Keith R. Neal
- University of Nottingham, Epidemiology and Public Health, Community Health Sciences, Queen's Medical Centre
| | - Dlawer Ala'Aldeen
- Division of Microbiology, School of Molecular Medicine, University Hospital, Nottingham
| | - Derrick W. Crook
- Nuffield Department of Clinical and Laboratory Sciences, John Radcliffe Hospital, Headley Way, University of Oxford
| | - Kathryn Cann
- Nuffield Department of Clinical and Laboratory Sciences, John Radcliffe Hospital, Headley Way, University of Oxford
| | | | | | - David Baxter
- Division of Epidemiology and Health Sciences, Medical School, The University of Manchester
| | - Edward Kaczmarski
- Meningococcal Reference Unit, Health Protection Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary
| | | | | | | | - James M. Stuart
- School of Social and Community Medicine, University of Bristol, United Kingdom
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Close RM, Ejidokun OO, Verlander NQ, Fraser G, Meltzer M, Rehman Y, Muir P, Ninis N, Stuart JM. Early diagnosis model for meningitis supports public health decision making. J Infect 2011; 63:32-8. [PMID: 21652009 DOI: 10.1016/j.jinf.2011.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 01/12/2011] [Revised: 03/14/2011] [Accepted: 03/29/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a predictive model for rapid differential diagnosis of meningitis and meningococcal septicaemia to support public health decisions on chemoprophylaxis for contacts. METHODS Prospective study of suspected cases of acute meningitis and meningococcal septicaemia admitted to hospitals in the South West, West Midlands and London Regions of England from July 2008 to June 2009. Epidemiological, clinical and laboratory variables on admission were recorded. Logistic regression was used to derive a predictive model. RESULTS Of the 719 suspect cases reported, 385 confirmed cases were included in analysis. Peripheral blood polymorphonuclear count of >16 × 10(9)/l, serum C-reactive protein of >100 mg/l and haemorrhagic rash were strongly and independently associated with diagnosis of bacterial meningitis and meningococcal septicaemia. Using a simple scoring system, the presence of any one of these factors gave a probability of >95% in predicting the final diagnosis. CONCLUSION We have developed a model using laboratory and clinical factors, but not dependent on availability of CSF, for differentiating acute bacterial from viral meningitis within a few hours of admission to hospital. This scoring system is recommended in public health management of suspected cases of meningitis and meningococcal septicaemia to inform decisions on chemoprophylaxis.
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Affiliation(s)
- Rebecca M Close
- Health Protection Agency South West, Gloucester Business Park Brockworth, Gloucester GL3 4AB, UK.
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Wallensten A, Oliver I, Ricketts K, Kafatos G, Stuart JM, Joseph C. Windscreen wiper fluid without added screenwash in motor vehicles: a newly identified risk factor for Legionnaires' disease. Eur J Epidemiol 2010; 25:661-5. [PMID: 20532623 DOI: 10.1007/s10654-010-9471-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [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: 12/11/2009] [Accepted: 05/27/2010] [Indexed: 11/25/2022]
Abstract
A source of infection is rarely identified for sporadic cases of Legionnaires' disease. We found that professional drivers are five times more commonly represented among community acquired sporadic cases in England and Wales than expected. We therefore investigated possible risk exposures in relation to driving or spending time in a motor vehicle. A case control study including all surviving community acquired sporadic cases in England and Wales with onset between 12 July 2008 and 9 March 2009 was carried out. Cases were contacted by phone and controls were consecutively recruited by sequential digital dialling matched by area code, sex and age group. Those who consented were sent a questionnaire asking questions on driving habits, potential sources in vehicles and known risk factors. The results were analysed using logistic regression. 75 cases and 67 controls were included in the study. Multivariable analysis identified two exposures linked to vehicle use associated with an increased risk of Legionnaires' disease: Driving through industrial areas (OR 7.2, 95%CI 1.5-33.7) and driving or being a passenger in a vehicle with windscreen wiper fluid not containing added screenwash (OR 47.2, 95%CI 3.7-603.6). Not adding screenwash to windscreen wiper fluid is a previously unidentified risk factor and appears to be strongly associated with community acquired sporadic cases of Legionnaires' disease. We estimated that around 20% of community acquired sporadic cases could be attributed to this exposure. A simple recommendation to use screenwash may mitigate transmission of Legionella bacteria to drivers and passengers.
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Kanabar PN, Vaske CJ, Yeang CH, Yildiz FH, Stuart JM. Inferring disease-related pathways using a probabilistic epistasis model. Pac Symp Biocomput 2009:480-491. [PMID: 19209724 DOI: 10.1142/9789812836939_0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present a probabilistic model called a Joint Intervention Network (JIN) for inferring interactions among a chosen set of regulator genes. The input to the method are expression changes of downstream indicator genes observed under the knock-out of the regulators. JIN can use any number of perturbation combinations for model inference (e.g. single, double, and triple knock-outs). RESUITS/CONCLUSIONS: We applied JIN to a Vibrio cholerae regulatory network to uncover mechanisms critical to its environmental persistence. V. cholerae is a facultative human pathogen that causes cholera in humans and responsible for seven pandemics. We analyzed the expression response of 17 V. cholerae biofilm indicator genes under various single and multiple knock-outs of three known biofilm regulators. Using the inferred network, we were able to identify new genes involved in biofilm formation more accurately than clustering expression profiles.
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Affiliation(s)
- P N Kanabar
- Department of Biomolecular Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA 95062, USA
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Abstract
This rise in recorded incidence from 2001 to 2005 was particularly marked among the elderly. Pneumonia is an important cause of illness and death in England. To describe trends in pneumonia hospitalizations, we extracted information on all episodes of pneumonia that occurred from April 1997 through March 2005 recorded in the Hospital Episode Statistics (HES) database by searching for International Classification of Diseases 10th revision codes J12–J18 in any diagnostic field. The age-standardized incidence of hospitalization with a primary diagnosis of pneumonia increased by 34% from 1.48 to 1.98 per 1,000 population between 1997–98 and 2004–05. The increase was more marked in older adults, in whom the mortality rate was also highest. The proportion of patients with recorded coexisting conditions (defined by using the Charlson Comorbidity Index score) increased over the study period. The rise in pneumonia hospital admissions was not fully explained by demographic change or increasing coexisting conditions. It may be attributable to other population factors, changes in HES coding, changes to health service organization, other biologic phenomenon, or a combination of these effects.
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Maiden MCJ, Ibarz-Pavón AB, Urwin R, Gray SJ, Andrews NJ, Clarke SC, Walker AM, Evans MR, Kroll JS, Neal KR, Ala'aldeen DAA, Crook DW, Cann K, Harrison S, Cunningham R, Baxter D, Kaczmarski E, Maclennan J, Cameron JC, Stuart JM. Impact of meningococcal serogroup C conjugate vaccines on carriage and herd immunity. J Infect Dis 2008; 197:737-43. [PMID: 18271745 DOI: 10.1086/527401] [Citation(s) in RCA: 346] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In 1999, meningococcal serogroup C conjugate (MCC) vaccines were introduced in the United Kingdom for those under 19 years of age. The impact of this intervention on asymptomatic carriage of meningococci was investigated to establish whether serogroup replacement or protection by herd immunity occurred. METHODS Multicenter surveys of carriage were conducted during vaccine introduction and on 2 successive years, resulting in a total of 48,309 samples, from which 8599 meningococci were isolated and characterized by genotyping and phenotyping. RESULTS A reduction in serogroup C carriage (rate ratio, 0.19) was observed that lasted at least 2 years with no evidence of serogroup replacement. Vaccine efficacy against carriage was 75%, and vaccination had a disproportionate impact on the carriage of sequence type (ST)-11 complex serogroup C meningococci that (rate ratio, 0.06); these meningococci also exhibited high rates of capsule expression. CONCLUSIONS The impact of vaccination with MCC vaccine on the prevalence of carriage of group C meningococci was consistent with herd immunity. The high impact on the carriage of ST-11 complex serogroup C could be attributed to high levels of capsule expression. High vaccine efficacy against disease in young children, who were not protected long-term by the schedule initially used, is attributed to the high vaccine efficacy against carriage in older age groups.
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Affiliation(s)
- Martin C J Maiden
- Dept. of Zoology, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom.
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Gjini AB, Stuart JM, Cartwright K, Cohen J, Jacobs M, Nichols T, Ninis N, Prempeh H, Whitehouse A, Heyderman RS. Quality of in-hospital care for adults with acute bacterial meningitis: a national retrospective survey. QJM 2006; 99:761-9. [PMID: 17071621 DOI: 10.1093/qjmed/hcl111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most adults with bacterial meningitis and meningococcal septicaemia present to junior doctors who have limited experience of these conditions. In contrast to paediatric practice, data from industrialized countries with regard to current hospital management practice are lacking. AIM To examine whether current practice meets recommended standards in hospital management of community-acquired bacterial meningitis and meningococcal septicaemia among adults. DESIGN National audit of medical records. METHODS We conducted a survey of all patients with acute bacterial meningitis and meningococcal septicaemia admitted to 18 randomly selected acute hospitals in England and Wales between 1 January 2000 and 31 December 2001. All stages of care, including pre-hospital management, initial hospital assessment, record keeping, and ongoing hospital and public health management, were assessed. RESULTS We identified 212 cases of bacterial meningitis and meningococcal septicaemia; 190 cases remained in the final analysis. Clinical record keeping did not meet acceptable standards in 33% of cases. Parenteral antibiotics were given within 1 h of hospital arrival in 56% of cases, increasing to 79% among those with an initial differential diagnosis that included bacterial meningitis or meningococcal septicaemia. A full severity of illness assessment was made in 27%. The quality of clinical practice varied widely between hospitals. This was most pronounced in the timeliness of consultant review (p < 0.0005). DISCUSSION The quality of adult clinical practice for bacterial meningitis and meningococcal septicaemia needs improvement. This study provides a tool for developing targeted interventions to improve quality of care and outcome among adults with life-threatening infections, both in the UK and in other countries.
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Affiliation(s)
- A B Gjini
- Social Medicine Department, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK.
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Orr HJ, Christensen H, Smyth B, Dance DAB, Carrington D, Paul I, Stuart JM. Case-control study for risk factors for Q Fever in southwest England and Northern Ireland. Euro Surveill 2006; 11:13-14. [PMID: 29208118 DOI: 10.2807/esm.11.10.00655-en] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases.
We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls.
Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5% level (P=0.05, odds ratio (OR) 3.4). Long term illness appeared to be significantly protective (P=0.03, OR 0.3). In multivariable analysis the strength of association between occupational exposure and illness remained high (OR 3.6, 95% confidence interval (CI) 0.9 to 14.8) and smoking emerged as a possible risk factor.
This is the first case-control study to identify occupational exposure to animals or animal products as the most likely route of infection in sporadic cases as opposed to outbreaks.
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Affiliation(s)
- H J Orr
- Health Protection Agency South West, Stonehouse, Gloucestershire, England, United Kingdom
| | - H Christensen
- Health Protection Agency South West, Stonehouse, Gloucestershire, England, United Kingdom
| | - B Smyth
- Communicable Disease Surveillance Centre Northern Ireland, Belfast, Northern Ireland, United Kingdom
| | - D AB Dance
- Health Protection Agency South West, Stonehouse, Gloucestershire, England, United Kingdom
| | - D Carrington
- Health Protection Agency South West Regional Laboratory, Bristol, England, United Kingdom
| | - I Paul
- Health Protection Agency South West Regional Laboratory, Bristol, England, United Kingdom
| | - J M Stuart
- Health Protection Agency South West, Stonehouse, Gloucestershire, England, United Kingdom
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MacLennan J, Kafatos G, Neal K, Andrews N, Cameron JC, Roberts R, Evans MR, Cann K, Baxter DN, Maiden MC, Stuart JM. Social behavior and meningococcal carriage in British teenagers. Emerg Infect Dis 2006; 12:950-7. [PMID: 16707051 PMCID: PMC3373034 DOI: 10.3201/eid1206.051297] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [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] [Indexed: 11/22/2022] Open
Abstract
Understanding predisposing factors for meningococcal carriage may identify targets for public health interventions. Before mass vaccination with meningococcal group C conjugate vaccine began in autumn 1999, we took pharyngeal swabs from ≈14,000 UK teenagers and collected information on potential risk factors. Neisseria meningitidis was cultured from 2,319 (16.7%) of 13,919 swabs. In multivariable analysis, attendance at pubs/clubs, intimate kissing, and cigarette smoking were each independently and strongly associated with increased risk for meningococcal carriage (p<0.001). Carriage in those with none of these risk factors was 7.8%, compared to 32.8% in those with all 3. Passive smoking was also linked to higher risk for carriage, but age, sex, social deprivation, home crowding, or school characteristics had little or no effect. Social behavior, rather than age or sex, can explain the higher frequency of meningococcal carriage among teenagers. A ban on smoking in public places may reduce risk for transmission.
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Affiliation(s)
| | | | - Keith Neal
- University of Nottingham, Nottingham, United Kingdom
| | - Nick Andrews
- Health Protection Agency, London, United Kingdom
| | | | | | | | - Kathy Cann
- Thames Valley Local Health Protection Unit, Aylesbury, United Kingdom
| | | | | | - James M. Stuart
- Health Protection Agency Southwest, Stonehouse, United Kingdom
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Gjini AB, Stuart JM, Lawlor DA, Cartwright KAV, Christensen H, Ramsay M, Heyderman RS. Changing epidemiology of bacterial meningitis among adults in England and Wales 1991-2002. Epidemiol Infect 2006; 134:567-9. [PMID: 16638165 PMCID: PMC2870433 DOI: 10.1017/s0950268805005595] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2005] [Indexed: 11/06/2022] Open
Abstract
We examined the epidemiology of community-acquired bacterial meningitis among adults in England and Wales between 1991 and 2002. Among 3169 cases, meningococcal infection was predominant among young adults and pneumococcal meningitis among older adults. Whilst infection due to most causes decreased, the incidence of tuberculous (TB) meningitis doubled over the 12 years. The mortality rate among meningococcal and pneumococcal infections fell from 0.45/10(5) to 0.31/10(5) (P=0.0001). This study demonstrates important changes in the epidemiology of bacterial meningitis among UK adults. Improvements in clinical management, childhood vaccination programmes and the re-emergence of tuberculosis are likely to be drivers of these changes.
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Affiliation(s)
- A B Gjini
- Department of Cellular and Molecular Medicine, School of Medical Sciences, University of Bristol, UK
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Hahné SJM, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I, Heuberger S, Santamaria M, Stuart JM. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. BMJ 2006; 332:1299-303. [PMID: 16740557 PMCID: PMC1473099 DOI: 10.1136/bmj.332.7553.1299] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To review the evidence for effectiveness of treatment with antibiotics before admission in reducing case fatality from meningococcal disease. DESIGN Systematic review. DATA SOURCES Cochrane register of trials and systematic reviews, database of abstracts of reviews of effectiveness, health technology assessment, and national research register in England and Wales, Medline, Embase, and CAB Health. INCLUDED STUDIES Studies describing vital outcome of at least 10 cases of meningococcal disease classified by whether or not antibiotics were given before admission to hospital. RESULTS 14 observational studies met the review criteria. Oral antibiotic treatment given before admission was associated with reduced mortality among cases (combined risk ratio 0.17, 95% confidence interval 0.07 to 0.44). In seven studies in which all included patients were seen in primary care, the association between parenteral antibiotics before admission and outcome was inconsistent (chi2 for heterogeneity 11.02, P = 0.09). After adjustment for the proportion given parenteral antibiotics before admission, there was no residual heterogeneity. A higher proportion of patients given parenteral antibiotics before admission was associated with reduced mortality after such treatment and vice versa (P = 0.04). CONCLUSION Confounding by severity is the most likely explanation both for the beneficial effect of oral antibiotics and the harmful effect observed in some studies of parenteral antibiotics. We cannot conclude whether or not antibiotics given before admission have an effect on case fatality. The data are consistent with benefit when a substantial proportion of cases are treated.
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Affiliation(s)
- Susan J M Hahné
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
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Clark T, Duffell E, Stuart JM, Heyderman RS. Lumbar puncture in the management of adults with suspected bacterial meningitis—a survey of practice. J Infect 2006; 52:315-9. [PMID: 16209888 DOI: 10.1016/j.jinf.2005.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 06/30/2005] [Accepted: 07/23/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults. METHODS A questionnaire was sent to secondary care clinicians (excluding junior house officers) in general internal and emergency medicine at three acute NHS healthcare trusts in the south west of England. The questionnaire recorded the experience of the clinician and asked questions related to case scenarios representing common presentations of bacterial meningitis or meningococcal disease. RESULTS The response rate was 42% (108/260). Nearly all of the respondents (91%) reported regularly managing patients with suspected meningitis. Most respondents considered that (i) brain computerised tomography (CT) was necessary prior to undertaking LP (78%, 60/77), (ii) LP was a useful first line investigation in a patient with meningococcal shock.(80%, 84/105), (iii) LP could be performed safely in a man with a falling level of consciousness if the CT brain was normal (89/106, 84%). Early antibiotic administration was considered important, other management priorities such as oxygen therapy, volume resuscitation, and critical care involvement were not emphasised. CONCLUSIONS Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed.
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Affiliation(s)
- Tristan Clark
- Department of Pathology and Microbiology, University of Bristol, Bristol, UK
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Jones M, Boccia D, Kealy M, Salkin B, Ferrero A, Nichols G, Stuart JM. Cryptosporidium outbreak linked to interactive water feature, UK: importance of guidelines. ACTA ACUST UNITED AC 2006; 11:3-4. [PMID: 29208122 DOI: 10.2807/esm.11.04.00612-en] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A need for national guidelines relating to interactive water features was highlighted following three outbreaks of cryptosporidiosis in the United Kingdom, all of which were related to public water features. In August 2003 the Health Protection Agency South West of England was notified of an outbreak of cryptosporidiosis associated with an interactive water feature designed for water play within an adventure park. The water feature was implicated following samples with a high coliform count and the presence of faecal coliforms. A case was defined as any child (younger than 16 years of age) who had visited the park during August and who subsequently had gastrointestinal symptoms and a faecal sample positive for cryptosporidium. Seventy one children were identified in the cohort. This outbreak of cryptosporidiosis was characterised by a very high attack rate (89%), relatively severe in duration (median 8 days) and had a relatively high hospital admission (16% of cases). The epidemic curve was consistent with a point source of infection, which corresponded to the date 80% of the cohort visited the park. This outbreak has similarities to two other cryptosporidiosis outbreaks reported in England in 2003 that involved public water features. These outbreaks raise issues about the operation and maintenance of water-based recreational attractions that very often involve children. The paper reflects on the basic control measures that can be taken and highlights the need for guidelines, especially since such attractions are becoming increasingly common. The Pool Water Treatment Advisory Group in United Kingdom has now produced guidelines.
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Affiliation(s)
- M Jones
- Health Protection Agency South West, Stonehouse, United Kingdom
| | - D Boccia
- European Programme for Intervention Epidemiology Training.,Health Protection Agency Centre for Infections, London, United Kingdom
| | - M Kealy
- Peninsula Health ProtectionUnit, Dartigton, United Kingdom
| | - B Salkin
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - A Ferrero
- East Devon Council, Sidmouth, United Kingdom
| | - G Nichols
- Health Protection Agency Centre for Infections, London, United Kingdom
| | - J M Stuart
- Health Protection Agency South West, Stonehouse, United Kingdom
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Tully J, Viner RM, Coen PG, Stuart JM, Zambon M, Peckham C, Booth C, Klein N, Kaczmarski E, Booy R. Risk and protective factors for meningococcal disease in adolescents: matched cohort study. BMJ 2006; 332:445-50. [PMID: 16473859 PMCID: PMC1382533 DOI: 10.1136/bmj.38725.728472.be] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine biological and social risk factors for meningococcal disease in adolescents. DESIGN Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner. SETTING Six contiguous regions of England, which represent some 65% of the country's population. PARTICIPANTS 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls. METHODS Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression. RESULTS 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection. CONCLUSIONS Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority.
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Affiliation(s)
- Joanna Tully
- Academic Centre for Child Health, Queen Mary's School of Medicine and Dentistry at Barts and the London, University of London, London E1 1BB
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Coen PG, Tully J, Stuart JM, Ashby D, Viner RM, Booy R. Is it exposure to cigarette smoke or to smokers which increases the risk of meningococcal disease in teenagers? Int J Epidemiol 2006; 35:330-6. [PMID: 16394119 DOI: 10.1093/ije/dyi295] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Passive smoking appears to increase the risk of meningococcal disease (MD) in adolescents. Whether this effect is attributable to exposure to cigarette smoke or contact with smokers is unknown. METHODS We conducted a prospective population-based case-control study with age, sex matched-controls in 1:1 matching. Participants were 15-19 year old with MD recruited at hospital admission in six regions (65% of the population of England) from January 1999 through June 2000, and their matched controls. Data on potential risk factors were gathered by confidential interview, including seven passive smoking variables. Factor analysis was performed to assess the dimensionality of the passive smoking exposure variables. The data were analysed with univariate and multivariate conditional logistic regression. RESULTS 144 case-control pairs were recruited (51% male; median age 17.6). Factor analysis identified two independent factors representing passive smoking (P < 0.01), one associated with 'exposure to smoke', the other with 'smoker contact'. Only smoker contact was a significant risk factor for MD (OR = 1.8; 95% CI 1.0-3.3; P = 0.05). In multivariate analysis this factor was still associated with MD independently of potential confounders such as active smoker status and household crowding. CONCLUSION Contact with smokers is associated with increased risk of MD in adolescents. This is more likely to be due to higher carriage rates in smokers than to exposure to smoke and emphasizes the importance of public health measures to stop smoking. In epidemiological studies that assess risk from passive smoking, exposure to smoke should be differentiated where possible from contact with smokers.
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Affiliation(s)
- Pietro G Coen
- Academic Department of Child Health, Queen Mary, University of London, Royal London Hospital, UK.
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Abstract
As a model for molecular mimicry, we study patients infected with human T-lymphotropic virus type 1 (HTLV-1) who develop a neurological disease called HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a disease with important biological similarities to multiple sclerosis (MS) (Khan et al. 2001; Levin et al. 1998, 2002a; Levin and Jacobson 1997). The study of HAM/TSP, a disease associated with a known environmental agent (HTLV-1), allows for the direct comparison of the infecting agent with host antigens. Neurological disease in HAM/TSP patients is associated with immune responses to HTLV-1-tax (a regulatory and immunodominant protein) and human histocompatibility leukocyte antigen (HLA) DRB1*0101 (Bangham 2000; Jacobson et al. 1990; Jeffery et al. 1999; Lal 1996). Recently, we showed that HAM/TSP patients make antibodies to heterogeneous nuclear ribonuclear protein A1 (hnRNP A1), a neuron-specific autoantigen (Levin et al. 2002a). Monoclonal antibodies to tax cross-reacted with hnRNP A1, indicating molecular mimicry between the two proteins. Infusion of cross-reactive antibodies with an ex vivo system completely inhibited neuronal firing indicative of their pathogenic nature (Kalume et al. 2004; Levin et al. 2002a). These data demonstrate a clear link between chronic viral infection and autoimmune disease of the central nervous system (CNS) in humans and, we believe, in turn will give insight into the pathogenesis of MS.
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Affiliation(s)
- S M Lee
- Department of Neurology, University of Tennessee Health Sciences Center, Memphis 38163, USA
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Jones M, Boccia D, Kealy M, Salkin B, Ferrero A, Nichols G, Stuart JM. Cryptosporidium outbreak linked to interactive water feature, UK: importance of guidelines. Euro Surveill 2006; 11:126-8. [PMID: 16645247] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
A need for national guidelines relating to interactive water features was highlighted following three outbreaks of cryptosporidiosis in the United Kingdom, all of which were related to public water features. In August 2003 the Health Protection Agency South West of England was notified of an outbreak of cryptosporidiosis associated with an interactive water feature designed for water play within an adventure park. The water feature was implicated following samples with a high coliform count and the presence of faecal coliforms. A case was defined as any child (younger than 16 years of age) who had visited the park during August and who subsequently had gastrointestinal symptoms and a faecal sample positive for cryptosporidium. Seventy one children were identified in the cohort. This outbreak of cryptosporidiosis was characterised by a very high attack rate (89%), relatively severe in duration (median 8 days) and had a relatively high hospital admission (16% of cases). The epidemic curve was consistent with a point source of infection, which corresponded to the date 80% of the cohort visited the park. This outbreak has similarities to two other cryptosporidiosis outbreaks reported in England in 2003 that involved public water features. These outbreaks raise issues about the operation and maintenance of water-based recreational attractions that very often involve children. The paper reflects on the basic control measures that can be taken and highlights the need for guidelines, especially since such attractions are becoming increasingly common. The Pool Water Treatment Advisory Group in United Kingdom has now produced guidelines.
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Affiliation(s)
- M Jones
- Health Protection Agency South West, Stonehouse, United Kingdom
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Orr HJ, Christensen H, Smyth B, Dance DAB, Carrington D, Paul I, Stuart JM. Case-control study for risk factors for Q fever in southwest England and Northern Ireland. Euro Surveill 2006; 11:260-2. [PMID: 17130654] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Q fever (Coxiella burnetti) is thought to account for 1% (700 cases) of community acquired pneumonia in the United Kingdom each year, and can result in serious complications such as endocarditis. Although outbreaks have frequently been reported worldwide, the causes are often not clearly identified and there have been few studies of risk factors in sporadic cases. We conducted a matched case-control study. Cases of acute Q fever in people aged over 15 years in southwest England and Northern Ireland were identified from January 2002 to December 2004. Controls were matched for age, sex and the general practice at which they were registered. Questionnaires asking about contact with animals, and leisure and work activities, were posted to cases and controls. Questionnaires were completed by 39/50 (78%) of the cases and 90/180 (50%) of the controls. In the single variable analysis, occupational exposure to animals or animal products was the only risk factor associated with cases at the 5% level (P=0.05, odds ratio (OR) 3.4). Long term illness appeared to be significantly protective (P=0.03, OR 0.3). In multivariable analysis the strength of association between occupational exposure and illness remained high (OR 3.6, 95% confidence interval (CI) 0.9 to 14.8) and smoking emerged as a possible risk factor. This is the first case-control study to identify occupational exposure to animals or animal products as the most likely route of infection in sporadic cases as opposed to outbreaks.
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Affiliation(s)
- H J Orr
- Health Protection Agency South West, Stonehouse, Gloucestershire, England, United Kingdom
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47
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Smith A, Lamagni TL, Oliver I, Efstratiou A, George RC, Stuart JM. Invasive group A streptococcal disease: should close contacts routinely receive antibiotic prophylaxis? Lancet Infect Dis 2005; 5:494-500. [PMID: 16048718 DOI: 10.1016/s1473-3099(05)70190-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Group A streptococci (Streptococcus pyogenes) causes a wide range of illnesses from non-invasive disease--eg, pharyngitis--to more severe invasive infections--eg, necrotising fasciitis and toxic shock-like syndrome. There remains uncertainty about the risk of secondary cases of invasive disease occurring among close contacts of an index case and how best to manage that risk. We do not consider that currently available evidence justifies the routine administration of chemoprophylaxis to close contacts. We suggest that the appropriate response should be to routinely inform all household contacts of a patient with invasive group A streptococcal disease about the clinical manifestations of invasive disease and to seek immediate medical attention if they develop such symptoms.
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Affiliation(s)
- A Smith
- Health Protection Agency, Centre for Infections, London, UK.
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48
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Purcell B, Samuelsson S, Hahné SJM, Ehrhard I, Heuberger S, Camaroni I, Charlett A, Stuart JM. Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review. BMJ 2004; 328:1339. [PMID: 15178612 PMCID: PMC420283 DOI: 10.1136/bmj.328.7452.1339] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To summarise the evidence for the role of antibiotics in preventing further cases of meningococcal disease through chemoprophylaxis given to the index patient, household contacts, and children in day care settings after a single case. DESIGN Systematic review. METHODS Studies were identified by searching Embase (1983-2003), Medline (1965-2003), and CAB Health (1973-2003) and by contacting the World Health Organization and the European meningococcal disease surveillance network and examining references of identified papers. The review included all studies with at least 10 cases in which outcomes were compared between treated and untreated groups. MAIN OUTCOME MEASURE Subsequent cases of meningococcal disease 1-30 days after onset of disease in the index patient. RESULTS Four observational studies and one small trial met the inclusion criteria. Meta-analysis of studies on chemoprophylaxis given to household contacts showed a significant reduction in risk (risk ratio 0.11, 95% confidence interval 0.02 to 0.58). The number needed to treat to prevent a case was estimated as 218 (121 to 1135). Primary outcome data were not available in studies of chemoprophylaxis given to the index patient: when prophylaxis had not been given, rate of carriage after discharge from hospital was estimated as 3% (0 to 6), probably an underestimate of the true rate. No studies of chemoprophylaxis in day care settings were identified that met the inclusion criteria. CONCLUSION There have been no high quality experimental trials looking at control policies for meningococcal disease. The best available evidence is from retrospective studies. The risk of meningococcal disease in household contacts of a patient can be reduced by an estimated 89% if they take antibiotics known to eradicate meningococcal carriage. Chemoprophylaxis should be recommended for the index patient and all household contacts.
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Affiliation(s)
- Bernadette Purcell
- Communicable Disease Surveillance Centre South West, Gloucester GL10 3RF
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49
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Gjini A, Stuart JM, George RC, Nichols T, Heyderman RS. Capture-recapture analysis and pneumococcal meningitis estimates in England. Emerg Infect Dis 2004; 10:87-93. [PMID: 15078602 DOI: 10.3201/eid1001.030123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To improve estimates of disease incidence and deaths from pneumococcal meningitis among adults in England, we performed a capture-recapture analysis for 1996 through 1999. We compared data from Hospital Episode Statistics (HES) and the Public Health Laboratory Services (PHLS) for incidence estimates and from HES and the Office for National Statistics (ONS) for estimates of deaths. Estimated sensitivities for the examined systems were 46% (95% confidence interval [CI] 42% to 50%) for HES and 40% [95% CI 37% to 44%] for PHLS. Sensitivities for mortality rates were found to be similar, 48% [95% CI 41% to 55%] for HES and 49% [95% CI 42% to 56%] for ONS. Stratification analysis showed that the sensitivity in those >85 years of age was significantly lower than the sensitivity for other ages. The estimated case-fatality rate was 24% [95% CI 21% to 26%]. These estimates indicate that a cost-benefit analysis of adult pneumococcal vaccination programs is required.
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Affiliation(s)
- Ardiana Gjini
- Department of Pathology and Microbiology, School of Medical Sciences, University of Bristol, Bristol, United Kingdom.
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50
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Davison KL, Andrews N, White JM, Ramsay ME, Crowcroft NS, Rushdy AA, Kaczmarski EB, Monk PN, Stuart JM. Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk? Arch Dis Child 2004; 89:256-60. [PMID: 14977705 PMCID: PMC1719829 DOI: 10.1136/adc.2003.031369] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the risk of further cases in educational settings in order to inform policy on managing cases and clusters of meningococcal disease. METHODS Between 1 April 1995 and 31 March 2001, surveillance in preschool and school settings in England and Wales identified 114 clusters of meningococcal disease. Twenty clusters were reported in preschool settings, 43 in primary, 46 in secondary, and five in independent schools. Seventy three clusters (64%) consisted of two or more confirmed cases, of which 30 had two or more serogroup C cases. Following the introduction of the national meningococcal serogroup C vaccination programme in 1999, no serogroup C clusters were observed between April 2000 and March 2001. RESULTS The relative risk of further cases in the four weeks after a single case compared with the background rate was raised in all settings, ranging from RR 27.6 (95% CI 15.2 to 39.9) in preschool settings to RR 3.6 (95% CI 2.5 to 4.6) in secondary schools. Absolute risk estimates ranged from 70/100 000 in preschool settings to 3.0/100 000 in secondary schools. The relative risk of clustering was similar for serogroup B and C strains. Most (68%) second cases occurred within seven days of the first case. CONCLUSIONS Although there was a higher risk of further cases of meningococcal disease in schools and especially in preschool settings, it is not known whether widespread antibiotic use after single cases reduces risk of further cases and if there is a real risk of harm. Evidence of risk reduction is needed to inform public health policy.
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Affiliation(s)
- K L Davison
- Immunisation Department, HPA Communicable Disease Surveillance Centre, London NW9 5EQ, UK.
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