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Akoi Boré J, Timothy JWS, Tipton T, Kekoura I, Hall Y, Hood G, Longet S, Fornace K, Lucien MS, Fehling SK, Koivogui BK, Coggins SA, Laing ED, Broder CC, Magassouba NF, Strecker T, Rossman J, Konde K, Carroll MW. Serological evidence of zoonotic filovirus exposure among bushmeat hunters in Guinea. Nat Commun 2024; 15:4171. [PMID: 38755147 PMCID: PMC11099012 DOI: 10.1038/s41467-024-48587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
Human Ebola virus (EBOV) outbreaks caused by persistent EBOV infection raises questions on the role of zoonotic spillover in filovirus epidemiology. To characterise filovirus zoonotic exposure, we collected cross-sectional serum samples from bushmeat hunters (n = 498) in Macenta Prefecture Guinea, adjacent to the index site of the 2013 EBOV-Makona spillover event. We identified distinct immune signatures (20/498, 4.0%) to multiple EBOV antigens (GP, NP, VP40) using stepwise ELISA and Western blot analysis and, live EBOV neutralisation (5/20; 25%). Using comparative serological data from PCR-confirmed survivors of the 2013-2016 EBOV outbreak, we demonstrated that most signatures (15/20) were not plausibly explained by prior EBOV-Makona exposure. Subsequent data-driven modelling of EBOV immunological outcomes to remote-sensing environmental data also revealed consistent associations with intact closed canopy forest. Together our findings suggest exposure to other closely related filoviruses prior to the 2013-2016 West Africa epidemic and highlight future surveillance priorities.
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Affiliation(s)
| | - Joseph W S Timothy
- Faulty of Infectious & Tropical Diseases, London School of Hygiene Tropical Medicine, London, UK
| | - Tom Tipton
- Centre for Human Genetics & Pandemic Sciences Inst, University of Oxford, Oxford, UK
| | - Ifono Kekoura
- Ministère de la Santé et de l'hygiène publique, Conakry, Guinea
| | - Yper Hall
- UK Health Security Agency, Porton Down, UK
| | - Grace Hood
- Centre for Human Genetics & Pandemic Sciences Inst, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Centre for Human Genetics & Pandemic Sciences Inst, University of Oxford, Oxford, UK
| | - Kimberly Fornace
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | | | | | - Si'Ana A Coggins
- Department of Microbiology and Immunology, Uniformed Services University, MD, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University, MD, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University, MD, USA
| | | | - Thomas Strecker
- Institute of Virology, Philipps University, Marburg, Germany
| | - Jeremy Rossman
- School of Bioscience, University of Kent, Canterbury, UK
| | - Kader Konde
- Centre for Training and Research on Priority Diseases including Malaria in Guinea, Conakry, Guinea
| | - Miles W Carroll
- Centre for Human Genetics & Pandemic Sciences Inst, University of Oxford, Oxford, UK.
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Timothy JWS, Rogers E, Halliday KE, Mulbah T, Marks M, Zaizay Z, Giddings R, Kempf M, Marion E, Walker SL, Kollie KK, Pullan RL. Quantifying Population Burden and Effectiveness of Decentralized Surveillance Strategies for Skin-Presenting Neglected Tropical Diseases, Liberia. Emerg Infect Dis 2022; 28:1755-1764. [PMID: 35997318 PMCID: PMC9423900 DOI: 10.3201/eid2809.212126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated programmatic approaches for skin neglected tropical disease (NTD) surveillance and completed a robust estimation of the burden of skin NTDs endemic to West Africa (Buruli ulcer, leprosy, lymphatic filariasis morbidity, and yaws). In Maryland, Liberia, exhaustive case finding by community health workers of 56,285 persons across 92 clusters identified 3,241 suspected cases. A total of 236 skin NTDs (34.0 [95% CI 29.1–38.9]/10,000 persons) were confirmed by midlevel healthcare workers trained using a tailored program. Cases showed a focal and spatially heterogeneous distribution. This community health worker‒led approach showed a higher skin NTD burden than prevailing surveillance mechanisms, but also showed high (95.1%) and equitable population coverage. Specialized training and task-shifting of diagnoses to midlevel health workers led to reliable identification of skin NTDs, but reliability of individual diagnoses varied. This multifaceted evaluation of skin NTD surveillance strategies quantifies benefits and limitations of key approaches promoted by the 2030 NTD roadmap of the World Health Organization.
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Abstract
Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programs have implemented various approaches to improve detection and reporting of incident cases over recent decades. Regional incidence rates are currently in decline; however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programs are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluation.In this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa: (1) Passive case detection, (2) Data systems, (3) Clinical training, (4) Active case finding, (5) Burden estimation, and (6) Laboratory confirmation pathways. We discuss successes, challenges, and relevant case studies before highlighting opportunities for future development and evaluation including novel data collection tools, risk-based surveillance, and integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.
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Affiliation(s)
- Joseph W S Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA.
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Witek-McManus S, Simwanza J, Chisambi AB, Kepha S, Kamwendo Z, Mbwinja A, Samikwa L, Oswald WE, Kennedy DS, Timothy JWS, Legge H, Galagan SR, Emmanuel-Fabula M, Schaer F, Ásbjörnsdóttir K, Halliday KE, Walson JL, Juziwelo L, Bailey RL, Kalua K, Pullan RL. Epidemiology of soil-transmitted helminths following sustained implementation of routine preventive chemotherapy: Demographics and baseline results of a cluster randomised trial in southern Malawi. PLoS Negl Trop Dis 2021; 15:e0009292. [PMID: 33979325 PMCID: PMC8224978 DOI: 10.1371/journal.pntd.0009292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022] Open
Abstract
Malawi has successfully leveraged multiple delivery platforms to scale-up and sustain the implementation of preventive chemotherapy (PCT) for the control of morbidity caused by soil-transmitted helminths (STH). Sentinel monitoring demonstrates this strategy has been successful in reducing STH infection in school-age children, although our understanding of the contemporary epidemiological profile of STH across the broader community remains limited. As part of a multi-site trial evaluating the feasibility of interrupting STH transmission across three countries, this study aimed to describe the baseline demographics and the prevalence, intensity and associated risk factors of STH infection in Mangochi district, southern Malawi. Between October-December 2017, a community census was conducted across the catchment area of seven primary healthcare facilities, enumerating 131,074 individuals across 124 villages. A cross-sectional parasitological survey was then conducted between March-May 2018 in the censused area as a baseline for a cluster randomised trial. An age-stratified random sample of 6,102 individuals were assessed for helminthiasis by Kato-Katz and completed a detailed risk-factor questionnaire. The age-cluster weighted prevalence of any STH infection was 7.8% (95% C.I. 7.0%-8.6%) comprised predominantly of hookworm species and of entirely low-intensity infections. The presence and intensity of infection was significantly higher in men and in adults. Infection was negatively associated with risk factors that included increasing levels of relative household wealth, higher education levels of any adult household member, current school attendance, or recent deworming. In this setting of relatively high coverage of sanitation facilities, there was no association between hookworm and reported access to sanitation, handwashing facilities, or water facilities. These results describe a setting that has reduced the prevalence of STH to a very low level, and confirms many previously recognised risk-factors for infection. Expanding the delivery of anthelmintics to groups where STH infection persist could enable Malawi to move past the objective of elimination of morbidity, and towards the elimination of STH. Trial registration: NCT03014167.
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Affiliation(s)
- Stefan Witek-McManus
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - James Simwanza
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alvin B. Chisambi
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Stella Kepha
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
- Pwani University Bioscience Research Centre, Pwani University, Kilifi, Kenya
| | - Zachariah Kamwendo
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Alfred Mbwinja
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lyson Samikwa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - William E. Oswald
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David S. Kennedy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph W. S. Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hugo Legge
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sean R. Galagan
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Mira Emmanuel-Fabula
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Fabian Schaer
- DeWorm3, Division of Life Sciences, Natural History Museum, London, United Kingdom
| | - Kristjana Ásbjörnsdóttir
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Katherine E. Halliday
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine and Department of Paediatrics, University of Washington, Seattle, Washington, United States of America
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health & Population, Lilongwe, Malawi
| | - Robin L. Bailey
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rachel L. Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Timothy JWS, Beale MA, Rogers E, Zaizay Z, Halliday KE, Mulbah T, Giddings RK, Walker SL, Thomson NR, Kollie KK, Pullan RL, Marks M. Epidemiologic and Genomic Reidentification of Yaws, Liberia. Emerg Infect Dis 2021; 27:1123-1132. [PMID: 33754988 PMCID: PMC8007311 DOI: 10.3201/eid2704.204442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We confirmed endemicity and autochthonous transmission of yaws in Liberia after a population-based, community-led burden estimation (56,825 participants). Serologically confirmed yaws was rare and focal at population level (24 cases; 2.6 [95% CI 1.4-3.9] cases/10,000 population) with similar clinical epidemiology to other endemic countries in West Africa. Unsupervised classification of spatially referenced case finding data indicated that yaws was more likely to occur in hard-to-reach communities; healthcare-seeking was low among communities, and clinical awareness of yaws was low among healthcare workers. We recovered whole bacterial genomes from 12 cases and describe a monophyletic clade of Treponema pallidum subspecies pertenue, phylogenetically distinct from known TPE lineages, including those affecting neighboring nonhuman primate populations (Taï Forest, Côte d'Ivoire). Yaws is endemic in Liberia but exhibits low focal population prevalence with evidence of a historical genetic bottleneck and subsequent local expansion. Reporting gaps appear attributable to challenging epidemiology and low disease awareness.
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Timothy JWS, Hall Y, Akoi-Boré J, Diallo B, Tipton TRW, Bower H, Strecker T, Glynn JR, Carroll MW. Early transmission and case fatality of Ebola virus at the index site of the 2013-16 west African Ebola outbreak: a cross-sectional seroprevalence survey. Lancet Infect Dis 2019; 19:429-438. [PMID: 30799252 PMCID: PMC6437313 DOI: 10.1016/s1473-3099(18)30791-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/15/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND To date, epidemiological studies at the index site of the 2013-16 west African Ebola outbreak in Meliandou, Guinea, have been restricted in their scope. We aimed to determine the occurrence of previously undocumented Ebola virus disease (EVD) cases and infections, and to reconstruct transmission events. METHODS This cross-sectional seroprevalence survey of the adult population of Meliandou used a highly specific oral fluid test and detailed interviews of all households in the village and key informants. Each household was interviewed, with all members prompted to describe the events of the outbreak, any illness within the household, and possible contact with suspected cases. Information for deceased individuals was provided by relatives living in the same household. Symptoms were based on Ebola virus Makona variant EVD case definitions (focusing on fever, vomiting, and diarrhoea). For antibody testing, we used an Ebola virus glycoprotein IgG capture enzyme immunoassay developed from a previously validated assay. A maximum exposure level was assigned to every participant using a predetermined scale. We used a generalised linear model (logit function) to estimate odds ratios for the association of sociodemographic variables and exposure level with Ebola virus infection. We adjusted estimates for age and maximum exposure, as appropriate. FINDINGS Between June 22, and July 9, 2017, we enrolled 237 participants from 27 households in Meliandou. Two households refused to participate and one was absent. All adults in participating households who were present for the interview provided an oral fluid swab for testing, of which 224 were suitable for analysis. In addition to the 11 EVD deaths described previously, on the basis of clinical description and oral fluid testing, we found two probable EVD deaths and eight previously unrecognised anti-Ebola virus IgG-positive survivors, including one who had mild symptoms and one who was asymptomatic, resulting in a case fatality of 55·6% (95% CI 30·8-78·5) for adults. Health-care work (adjusted odds ratio 6·64, 1·54-28·56; p=0·001) and level of exposure (odds ratio adjusted for linear trend across five levels 2·79, 1·59-4·883; p<0·0001) were independent risk factors for infection. INTERPRETATION Ebola virus infection was more widespread in this spillover population than previously recognised (21 vs 11 cases). We show the first serological evidence of survivors in this population (eight anti-Ebola virus IgG seropositive) and report a case fatality lower than previously reported (55·6% vs 100% in adults). These data show the high community coverage achievable by using a non-invasive test and, by accurately documenting the beginnings of the west African Ebola virus outbreak, reveal important insight into transmission dynamics and risk factors that underpin Ebola virus spillover events. FUNDING US Food and Drug Administration, Wellcome Trust, and German Research Council.
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Affiliation(s)
| | - Yper Hall
- Research and Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Joseph Akoi-Boré
- Public Health England/Tropical Medicine Institute Berlin Reference Laboratory, Guéckédou, Guinea
| | - Boubacar Diallo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Thomas R W Tipton
- Research and Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Hilary Bower
- London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Strecker
- Institute of Virology, Philipps University, Marburg, Germany
| | - Judith R Glynn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Miles W Carroll
- Research and Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, UK
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Timothy JWS, Klas N, Sanghani HR, Al-Mansouri T, Hughes ATL, Kirshenbaum GS, Brienza V, Belle MDC, Ralph MR, Clapcote SJ, Piggins HD. Circadian Disruptions in the Myshkin Mouse Model of Mania Are Independent of Deficits in Suprachiasmatic Molecular Clock Function. Biol Psychiatry 2018; 84:827-837. [PMID: 28689605 PMCID: PMC6218650 DOI: 10.1016/j.biopsych.2017.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/06/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alterations in environmental light and intrinsic circadian function have strong associations with mood disorders. The neural origins underpinning these changes remain unclear, although genetic deficits in the molecular clock regularly render mice with altered mood-associated phenotypes. METHODS A detailed circadian and light-associated behavioral characterization of the Na+/K+-ATPase α3 Myshkin (Myk/+) mouse model of mania was performed. Na+/K+-ATPase α3 does not reside within the core circadian molecular clockwork, but Myk/+ mice exhibit concomitant disruption in circadian rhythms and mood. The neural basis of this phenotype was investigated through molecular and electrophysiological dissection of the master circadian pacemaker, the suprachiasmatic nuclei (SCN). Light input and glutamatergic signaling to the SCN were concomitantly assessed through behavioral assays and calcium imaging. RESULTS In vivo assays revealed several circadian abnormalities including lengthened period and instability of behavioral rhythms, and elevated metabolic rate. Grossly aberrant responses to light included accentuated resetting, accelerated re-entrainment, and an absence of locomotor suppression. Bioluminescent recording of circadian clock protein (PERIOD2) output from ex vivo SCN revealed no deficits in Myk/+ molecular clock function. Optic nerve crush rescued the circadian period of Myk/+ behavior, highlighting that afferent inputs are critical upstream mediators. Electrophysiological and calcium imaging SCN recordings demonstrated changes in the response to glutamatergic stimulation as well as the electrical output indicative of altered retinal input processing. CONCLUSIONS The Myshkin model demonstrates profound circadian and light-responsive behavioral alterations independent of molecular clock disruption. Afferent light signaling drives behavioral changes and raises new mechanistic implications for circadian disruption in affective disorders.
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Affiliation(s)
- Joseph W S Timothy
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester
| | - Natasza Klas
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester
| | | | | | - Alun T L Hughes
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester
| | - Greer S Kirshenbaum
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Vincent Brienza
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Mino D C Belle
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester
| | - Martin R Ralph
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Steven J Clapcote
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Hugh D Piggins
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester.
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