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Rakotomanana F, Dreyfus A, Randrianarisoa MM, Raberahona M, Chevallier E, Andriamasy HE, Bernardson BA, Ranaivomanana P, Ralaitsilanihasy F, Rasoamaharo M, Randrianirisoa SAN, Razafindranaivo TA, Rakotobe L, Ratefiharimanana A, Randriamanana DA, Rakotondrazanany H, Cauchoix B, Baril L, Rakotosamimanana N, Randremanana RV. Prevalence of pulmonary tuberculosis and HIV infections and risk factors associated to tuberculosis in detained persons in Antananarivo, Madagascar. Sci Rep 2024; 14:8640. [PMID: 38622161 PMCID: PMC11018834 DOI: 10.1038/s41598-024-58309-y] [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: 04/25/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
The incidence rate of tuberculosis in prisons is estimated to be 8 times greater than that in the general population in Madagascar. Our objectives were to estimate the prevalence of pulmonary tuberculosis and HIV infection among prisoners and to identify risk factors associated with tuberculosis. We conducted a cross-sectional study at the central prison of Antananarivo from March to July 2021. Individual male and female inmates aged ≥ 13 years who had lived in the prison for at least three months prior to the study period were included as participants. Acid-fast bacilli detection by microscopy and/or culture, an intradermal tuberculin test, a chest X-ray, and a rapid diagnostic orientation test for HIV were performed. Among 748 participants, 4 (0.5%) were confirmed to have pulmonary tuberculosis. Overall, 14 (1.9%) patients had "confirmed" or "probable" tuberculosis [0.90-2.84, 95% CI]. The proportion of participants with latent tuberculosis infection was 69.6% (517/743) based on a positive tuberculin test without clinical symptoms or radiography images indicating tuberculosis. Out of 745 HIV screening tests, three showed reactive results (0.4%). Age (OR = 4.4, 95% CI [1.4-14.0]) and prior tuberculosis treatment (or episodes) were found to be associated with confirmed and probable tuberculosis.
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Affiliation(s)
- Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar.
| | - Anou Dreyfus
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurestrasse 270, 8057, Zürich, Switzerland
| | - Mirella M Randrianarisoa
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101, Antananarivo, Madagascar
| | - Elodie Chevallier
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Harizaka E Andriamasy
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Barivola A Bernardson
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Paulo Ranaivomanana
- Unité des Mycobactéries, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | | | - Miangaly Rasoamaharo
- Imagerie Médicale, Hôpital Joseph Ravoahangy Andrianavalona, 101, Antananarivo, Madagascar
| | | | | | - Liva Rakotobe
- Programme National de Lutte Contre L'IST SIDA, 101, Antananarivo, Madagascar
| | | | | | | | | | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
- Medical Department for Infectious Diseases, French National Agency for Medicines and Health Products Safety (ANSM), 93200, Saint Denis, France
| | | | - Rindra V Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
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Leblanc C, Kassié D, Ranaivoharimina M, Rakotomanana EFN, Mangahasimbola RT, Randrianarijaona A, Ramiandrasoa R, Nely AJ, Razafindraibe NP, Andriamandimby SF, Ranoaritiana DB, Rajaonarivony V, Randrianasolo L, Baril L, Mattern C, Ratovoson R, Guis H. Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar. PLoS Negl Trop Dis 2024; 18:e0012064. [PMID: 38551968 PMCID: PMC11006160 DOI: 10.1371/journal.pntd.0012064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/10/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.
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Affiliation(s)
- Claire Leblanc
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- General Paediatrics and Paediatric Infectious Disease Unit, Nantes University Hospital, Nantes, France
| | - Daouda Kassié
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
| | - Mendrika Ranaivoharimina
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Anjasoa Randrianarijaona
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ravo Ramiandrasoa
- Vaccination Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alphonse José Nely
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
- WHO Madagascar, Antananarivo 101, Madagascar
| | | | - Soa Fy Andriamandimby
- National Laboratory of Rabies, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Dany Bakoly Ranoaritiana
- Direction of Health Monitoring, Epidemiological Surveillance and Response (DVSSER), Ministry of Public Health, Antananarivo, Madagascar
| | - Virginie Rajaonarivony
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Chiarella Mattern
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Ceped (Institut de Recherche pour le Développement, Université de Paris, INSERM), Paris, France
| | - Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Hélène Guis
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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3
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Andrianaivoarimanana V, Savin C, Birdsell DN, Vogler AJ, Le Guern AS, Rahajandraibe S, Brémont S, Rahelinirina S, Sahl JW, Ramasindrazana B, Rakotonanahary RJL, Rakotomanana F, Randremanana R, Maheriniaina V, Razafimbia V, Kwasiborski A, Balière C, Ratsitorahina M, Baril L, Keim P, Caro V, Rasolofo V, Spiegel A, Pizarro-Cerda J, Wagner DM, Rajerison M. Multiple Introductions of Yersinia pestis during Urban Pneumonic Plague Epidemic, Madagascar, 2017. Emerg Infect Dis 2024; 30:289-298. [PMID: 38270131 PMCID: PMC10826772 DOI: 10.3201/eid3002.230759] [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] [Indexed: 01/26/2024] Open
Abstract
Pneumonic plague (PP) is characterized by high infection rate, person-to-person transmission, and rapid progression to severe disease. In 2017, a PP epidemic occurred in 2 Madagascar urban areas, Antananarivo and Toamasina. We used epidemiologic data and Yersinia pestis genomic characterization to determine the sources of this epidemic. Human plague emerged independently from environmental reservoirs in rural endemic foci >20 times during August-November 2017. Confirmed cases from 5 emergences, including 4 PP cases, were documented in urban areas. Epidemiologic and genetic analyses of cases associated with the first emergence event to reach urban areas confirmed that transmission started in August; spread to Antananarivo, Toamasina, and other locations; and persisted in Antananarivo until at least mid-November. Two other Y. pestis lineages may have caused persistent PP transmission chains in Antananarivo. Multiple Y. pestis lineages were independently introduced to urban areas from several rural foci via travel of infected persons during the epidemic.
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Affiliation(s)
| | | | | | - Amy J. Vogler
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Anne-Sophie Le Guern
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Soloandry Rahajandraibe
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Sylvie Brémont
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Soanandrasana Rahelinirina
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Jason W. Sahl
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Beza Ramasindrazana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Rado Jean Luc Rakotonanahary
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Fanjasoa Rakotomanana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Rindra Randremanana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Viviane Maheriniaina
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Vaoary Razafimbia
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Aurelia Kwasiborski
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Charlotte Balière
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Maherisoa Ratsitorahina
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Laurence Baril
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Paul Keim
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Valérie Caro
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Voahangy Rasolofo
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - André Spiegel
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
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4
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De Santis O, Pothin E, Bouscaren N, Irish SR, Jaffar-Bandjee MC, Menudier L, Ramis J, Schultz C, Lamaurt F, Wisniak A, Bertolotti A, Hafsia S, Dussart P, Baril L, Mavingui P, Flahault A. Investigation of Dengue Infection in Asymptomatic Individuals during a Recent Outbreak in La Réunion. Viruses 2023; 15:v15030742. [PMID: 36992451 PMCID: PMC10058293 DOI: 10.3390/v15030742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/15/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
The number of dengue cases has increased dramatically over the past 20 years and is an important concern, particularly as the trends toward urbanization continue. While the majority of dengue cases are thought to be asymptomatic, it is unknown to what extent these contribute to transmission. A better understanding of their importance would help to guide control efforts. In 2019, a dengue outbreak in La Reunion resulted in more than 18,000 confirmed cases. Between October 2019 and August 2020, 19 clusters were investigated in the south, west, and east of the island, enabling the recruitment of 605 participants from 368 households within a 200 m radius of the home of the index cases (ICs). No active asymptomatic infections confirmed by RT-PCR were detected. Only 15% were possible asymptomatic dengue infections detected by the presence of anti-dengue IgM antibodies. Only 5.3% of the participants had a recent dengue infection confirmed by RT-PCR. Although the resurgence of dengue in La Réunion is very recent (2016), the rate of anti-dengue IgG positivity, a marker of past infections, was already high at 43% in this study. Dengue transmission was focal in time and space, as most cases were detected within a 100-m radius of the ICs, and within a time interval of less than 7 days between infections detected in a same cluster. No particular demographic or socio-cultural characteristics were associated with dengue infections. On the other hand, environmental risk factors such as type of housing or presence of rubbish in the streets were associated with dengue infections.
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Affiliation(s)
- Olga De Santis
- Inserm CIC1410, CHU de La Réunion, 97410 Saint Pierre, France
- Global Health Institute, University of Geneva, 1209 Geneva, Switzerland
- Correspondence:
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
- Department of Public Health, Faculty of Medicine, University of Basel, 4051 Basel, Switzerland
| | | | - Seth R. Irish
- Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
- Department of Public Health, Faculty of Medicine, University of Basel, 4051 Basel, Switzerland
| | | | | | - Julie Ramis
- UMR Processus Infectieux en Milieu Insulaire et Tropical, Cyroi, 97400 Saint Denis, France
| | - Cédric Schultz
- Inserm CIC1410, CHU de La Réunion, 97410 Saint Pierre, France
| | - Florence Lamaurt
- Inserm CIC1410, CHU de La Réunion, 97410 Saint Pierre, France
- Institut de santé publique, d’épidémiologie et de développement (ISPED), Université de Bordeaux, 33000 Bordeaux, France
| | - Ania Wisniak
- Global Health Institute, University of Geneva, 1209 Geneva, Switzerland
| | - Antoine Bertolotti
- Inserm CIC1410, CHU de La Réunion, 97410 Saint Pierre, France
- Service des Maladies Infectieuses—Dermatologie, CHU de La Réunion, 97410 Saint Pierre, France
| | - Sarah Hafsia
- UMR Processus Infectieux en Milieu Insulaire et Tropical, Cyroi, 97400 Saint Denis, France
| | - Philippe Dussart
- Unité de Virologie, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar
| | - Laurence Baril
- Unité d’épidémiologie, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar
| | - Patrick Mavingui
- UMR Processus Infectieux en Milieu Insulaire et Tropical, Cyroi, 97400 Saint Denis, France
| | - Antoine Flahault
- Global Health Institute, University of Geneva, 1209 Geneva, Switzerland
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5
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Su YCF, Ma JZJ, Ou TP, Pum L, Krang S, Raftery P, Kinzer MH, Bohl J, Ieng V, Kab V, Patel S, Sar B, Ying WF, Jayakumar J, Horm VS, Boukli N, Yann S, Troupin C, Heang V, Garcia-Rivera JA, Sengdoeurn Y, Heng S, Lay S, Chea S, Darapheak C, Savuth C, Khalakdina A, Ly S, Baril L, Manning JE, Simone-Loriere E, Duong V, Dussart P, Sovann L, Smith GJD, Karlsson EA. Genomic epidemiology of SARS-CoV-2 in Cambodia, January 2020 to February 2021. Virus Evol 2022; 9:veac121. [PMID: 36654682 PMCID: PMC9838690 DOI: 10.1093/ve/veac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/05/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The first case of coronavirus disease 2019 (COVID-19) in Cambodia was confirmed on 27 January 2020 in a traveller from Wuhan. Cambodia subsequently implemented strict travel restrictions, and although intermittent cases were reported during the first year of the COVID-19 pandemic, no apparent widespread community transmission was detected. Investigating the routes of severe acute respiratory coronavirus 2 (SARS-CoV-2) introduction into the country was critical for evaluating the implementation of public health interventions and assessing the effectiveness of social control measures. Genomic sequencing technologies have enabled rapid detection and monitoring of emerging variants of SARS-CoV-2. Here, we detected 478 confirmed COVID-19 cases in Cambodia between 27 January 2020 and 14 February 2021, 81.3 per cent in imported cases. Among them, fifty-four SARS-CoV-2 genomes were sequenced and analysed along with representative global lineages. Despite the low number of confirmed cases, we found a high diversity of Cambodian viruses that belonged to at least seventeen distinct PANGO lineages. Phylogenetic inference of SARS-CoV-2 revealed that the genetic diversity of Cambodian viruses resulted from multiple independent introductions from diverse regions, predominantly, Eastern Asia, Europe, and Southeast Asia. Most cases were quickly isolated, limiting community spread, although there was an A.23.1 variant cluster in Phnom Penh in November 2020 that resulted in a small-scale local transmission. The overall low incidence of COVID-19 infections suggests that Cambodia's early containment strategies, including travel restrictions, aggressive testing and strict quarantine measures, were effective in preventing large community outbreaks of COVID-19.
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Affiliation(s)
- Yvonne C F Su
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Jordan Z J Ma
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Tey Putita Ou
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
- Ecole Doctorale GAIA, University of Montpelier, 641 Av. du Doyen Gaston Giraud, Montpellier 34000, France
| | - Leakhena Pum
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Sidonn Krang
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Philomena Raftery
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Michael H Kinzer
- United States Centers for Disease Control and Prevention, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Jennifer Bohl
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Vanra Ieng
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Vannda Kab
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Sarika Patel
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Borann Sar
- United States Centers for Disease Control and Prevention, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Wong Foong Ying
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Jayanthi Jayakumar
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Viseth Srey Horm
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Narjis Boukli
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Sokhoun Yann
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Cecile Troupin
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Vireak Heang
- Sequencing Mini-Platform, Institut Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
- Naval Medical Research Unit TWO, Lot#: 80, 289 Samdach Penn Nout, Phnom Penh 120407, Cambodia
| | - Jose A Garcia-Rivera
- Naval Medical Research Unit TWO, Lot#: 80, 289 Samdach Penn Nout, Phnom Penh 120407, Cambodia
| | - Yi Sengdoeurn
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Seng Heng
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Sreyngim Lay
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sophana Chea
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Chau Darapheak
- National Institute for Public Health, Lot#: 80, 289 Samdach Penn Nouth St (289), Phnom Penh 120407, Cambodia
| | - Chin Savuth
- National Institute for Public Health, Lot#: 80, 289 Samdach Penn Nouth St (289), Phnom Penh 120407, Cambodia
| | - Asheena Khalakdina
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Sowath Ly
- Epidemiology and Public Health Unit, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Laurence Baril
- Direction, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Jessica E Manning
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | | | - Veasna Duong
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Philippe Dussart
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Ly Sovann
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Gavin J D Smith
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
- Centre for Outbreak Preparedness, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- SingHealth Duke-NUS Global Health Institute, SingHealth Duke-NUS Academic Medical Centre, 8 College Rd 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Erik A Karlsson
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
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6
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Ratovoson R, Garchitorena A, Kassie D, Ravelonarivo JA, Andrianaranjaka V, Razanatsiorimalala S, Razafimandimby A, Rakotomanana F, Ohlstein L, Mangahasimbola R, Randrianirisoa SAN, Razafindrakoto J, Dentinger CM, Williamson J, Kapesa L, Piola P, Randrianarivelojosia M, Thwing J, Steinhardt LC, Baril L. Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial. BMC Med 2022; 20:322. [PMID: 36192774 PMCID: PMC9531497 DOI: 10.1186/s12916-022-02530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains a leading cause of morbidity and mortality worldwide, with progress in malaria control stalling in recent years. Proactive community case management (pro-CCM) has been shown to increase access to diagnosis and treatment and reduce malaria burden. However, lack of experimental evidence may hinder the wider adoption of this intervention. We conducted a cluster randomized community intervention trial to assess the efficacy of pro-CCM at decreasing malaria prevalence in rural endemic areas of Madagascar. METHODS Twenty-two fokontany (smallest administrative unit) of the Mananjary district in southeast Madagascar were selected and randomized 1:1 to pro-CCM (intervention) or conventional integrated community case management (iCCM). Residents of all ages in the intervention arm were visited by a community health worker every 2 weeks from March to October 2017 and screened for fever; those with fever were tested by a rapid diagnostic test (RDT) and treated if positive. Malaria prevalence was assessed using RDTs on all consenting study area residents prior to and following the intervention. Hemoglobin was measured among women of reproductive age. Intervention impact was assessed via difference-in-differences analyses using logistic regressions in generalized estimating equations. RESULTS A total of 27,087 and 20,475 individuals participated at baseline and endline, respectively. Malaria prevalence decreased from 8.0 to 5.4% in the intervention arm for individuals of all ages and from 6.8 to 5.7% in the control arm. Pro-CCM was associated with a significant reduction in the odds of malaria positivity in children less than 15 years (OR = 0.59; 95% CI [0.38-0.91]), but not in older age groups. There was no impact on anemia among women of reproductive age. CONCLUSION This trial suggests that pro-CCM approaches could help reduce malaria burden in rural endemic areas of low- and middle-income countries, but their impact may be limited to younger age groups with the highest malaria burden. TRIAL REGISTRATION NCT05223933. Registered on February 4, 2022.
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Affiliation(s)
- Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
| | - Andres Garchitorena
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France
| | - Daouda Kassie
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Centre de Coopération International en Recherche Agronomique pour le Développement (CIRAD), Montpellier, France
| | - Jemima A Ravelonarivo
- Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Present address: Humanity & inclusion, Toliara, Madagascar
| | - Voahangy Andrianaranjaka
- Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Present address: Mention Biochimie Fondamentale et Appliquée, Domaine Sciences et Technologie, Faculté des Sciences, Université d'Antananarivo, Antananarivo, Madagascar
| | | | - Avotra Razafimandimby
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Reziky Mangahasimbola
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Catherine M Dentinger
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. President's Malaria Initiative, US Centers for Disease Control and Prevention, Antananarivo, Madagascar
| | - John Williamson
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurent Kapesa
- U.S. President's Malaria Initiative, USAID, Antananarivo, Madagascar
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Milijaona Randrianarivelojosia
- Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Faculté des Sciences, Université de Toliara, Toliara, Madagascar
| | - Julie Thwing
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura C Steinhardt
- U.S. President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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7
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ten Bosch Q, Andrianaivoarimanana V, Ramasindrazana B, Mikaty G, Rakotonanahary RJL, Nikolay B, Rahajandraibe S, Feher M, Grassin Q, Paireau J, Rahelinirina S, Randremanana R, Rakotoarimanana F, Melocco M, Rasolofo V, Pizarro-Cerdá J, Le Guern AS, Bertherat E, Ratsitorahina M, Spiegel A, Baril L, Rajerison M, Cauchemez S. Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar. PLoS Biol 2022; 20:e3001736. [PMID: 35969599 PMCID: PMC9410560 DOI: 10.1371/journal.pbio.3001736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/25/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
During outbreaks, the lack of diagnostic “gold standard” can mask the true burden of infection in the population and hamper the allocation of resources required for control. Here, we present an analytical framework to evaluate and optimize the use of diagnostics when multiple yet imperfect diagnostic tests are available. We apply it to laboratory results of 2,136 samples, analyzed with 3 diagnostic tests (based on up to 7 diagnostic outcomes), collected during the 2017 pneumonic (PP) and bubonic plague (BP) outbreak in Madagascar, which was unprecedented both in the number of notified cases, clinical presentation, and spatial distribution. The extent of these outbreaks has however remained unclear due to nonoptimal assays. Using latent class methods, we estimate that 7% to 15% of notified cases were Yersinia pestis-infected. Overreporting was highest during the peak of the outbreak and lowest in the rural settings endemic to Y. pestis. Molecular biology methods offered the best compromise between sensitivity and specificity. The specificity of the rapid diagnostic test was relatively low (PP: 82%, BP: 85%), particularly for use in contexts with large quantities of misclassified cases. Comparison with data from a subsequent seasonal Y. pestis outbreak in 2018 reveal better test performance (BP: specificity 99%, sensitivity: 91%), indicating that factors related to the response to a large, explosive outbreak may well have affected test performance. We used our framework to optimize the case classification and derive consolidated epidemic trends. Our approach may help reduce uncertainties in other outbreaks where diagnostics are imperfect. The response to the 2017 plague outbreak in Madagascar was complicated by the lack of a perfect or "gold standard" diagnostic. This study shows how multiple, imperfect diagnostic tests can be used to improve the response to an outbreak.
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Affiliation(s)
- Quirine ten Bosch
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
- Quantitative Veterinary Epidemiology, Department of Animal Sciences, Wageningen University and Research, Wageningen, the Netherlands
- * E-mail:
| | | | | | - Guillain Mikaty
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | | | - Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
| | | | - Maxence Feher
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | - Quentin Grassin
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | - Juliette Paireau
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
| | | | - Rindra Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | - Feno Rakotoarimanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | - Marie Melocco
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | | | - Javier Pizarro-Cerdá
- Yersinia Research Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 6047, F-75015 Paris, France
- National Reference Laboratory for Plague and other Yersiniosis, Institut Pasteur, F-75015 Paris, France
- World Health Organization Collaborating Center for Plague FRA-140, Institut Pasteur, F-75015 Paris, France
| | - Anne-Sophie Le Guern
- Yersinia Research Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 6047, F-75015 Paris, France
- National Reference Laboratory for Plague and other Yersiniosis, Institut Pasteur, F-75015 Paris, France
- World Health Organization Collaborating Center for Plague FRA-140, Institut Pasteur, F-75015 Paris, France
| | - Eric Bertherat
- World Health Organization, Health Emergency Programme, Department of Infectious Hazard Management, Geneva, Switzerland
| | - Maherisoa Ratsitorahina
- Direction, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Directorate of Health and Epidemiological Surveillance, Ministry of Public Health, Antananarivo, Madagascar
| | - André Spiegel
- Direction, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | | | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
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Ouldali N, Bagheri H, Salvo F, Antona D, Pariente A, Leblanc C, Tebacher M, Micallef J, Levy C, Cohen R, Javouhey E, Bader-Meunier B, Ovaert C, Renolleau S, Hentgen V, Kone-Paut I, Deschamps N, De Pontual L, Iriart X, Guen CGL, Angoulvant F, Belot A, Donzeau A, Aridi LE, Lety S, Leboucher B, Baur A, Jeusset L, Selegny M, Fedorczuk C, Lajus M, Bensaid P, Laoudi Y, Pons C, Robert AC, Beaucourt C, De Pontual L, Richard M, Goisque E, Iriart X, Brissaud O, Segretin P, Molimard J, Orecel MC, Benoit G, Bongiovanni L, Guerder M, Pouyau R, De Guillebon De Resnes JM, Mezgueldi E, Cour-Andlauer F, Horvat C, Poinsot P, Frachette C, Ouziel A, Gillet Y, Barrey C, Brouard J, Villedieu F, Ro V, Elanga N, Gajdos V, Basmaci R, Mutar H, Rouget S, Nattes E, Hau I, Biscardi S, Jurdi HE, Jung C, Semama D, Huet F, Zoccarato AM, Sarakbi M, Mortamet G, Bost-Bru C, Bassil J, Vinit C, Hentgen V, Leroux P, Bertrand V, Parrod C, Craiu I, Kone-Paut I, Durand P, Tissiere P, Claude C, Morelle G, Guiddir T, Borocco C, Delion F, Guillot C, Leteurtre S, Dubos F, Jouancastay M, Martinot A, Voeusler V, Languepin J, Garrec N, Demersay AC, Morand A, Bosdure E, Vanel N, Ughetto F, Michel F, Caujolle M, Blonde R, Nguyen J, Vignaud O, Masserot-Lureau C, Gouraud F, Araujo C, Ingrao T, Naji S, Sehaba M, Roche C, Carbasse A, Milesi C, Mazeghrane M, Haupt S, Schweitzer C, Romefort B, Launay E, Guen CGL, Ali A, Blot N, Tran A, Rancurel A, Afanetti M, Odorico S, Talmud D, Chosidow A, Romain AS, Grimprel E, Pouletty M, Gaschignard J, Corseri O, Faye A, Gaschignard J, Melki I, Ducrocq C, Benzoïd C, Lokmer J, Dauger S, Chomton M, Deho A, Lebourgeois F, Renolleau S, Lesage F, Moulin F, Dupic L, Pinhas Y, Debray A, Chalumeau M, Abadie V, Frange P, Cohen JF, Allali S, Curtis W, Belhadjer Z, Auriau J, Méot M, Houyel L, Bonnet D, Delacourt C, Meunier BB, Quartier P, Shaim Y, Baril L, Crommelynck S, Jacquot B, Blanc P, Maledon N, Robert B, Loeile C, Cazau C, Loron G, Gaga S, Vittot C, Nabhani LE, Buisson F, Prudent M, Flodrops H, Mokraoui F, Escoda S, Deschamps N, Bonnemains L, Mahi SL, Mertes C, Terzic J, Helms J, Idier C, Chenichene S, Ursulescu NM, Beaujour G, Hakim A, Miquel A, Rey A, Wiedermann A, Charbonneau A, Veauvy-Juven A, Ferry A, Mandelcwajg A, Rousseau A, Prenant A, Bourneuf AL, Filleron A, Robine A, Félix A, Parizel A, Labarre A, Cantais A, Ros B, Coulon B, Biot B, Dalichoux B, Fournier B, Cagnard B, Vanel B, Brossier D, Ménager B, Ozanne B, Marie-Jeanne C, Bergerot C, Chavy C, Guidon C, Fabre C, Galeotti C, Baker C, Ballot-Schmit C, Belleau C, Charasse C, Favel C, Toumi C, Ferrandiz C, Couturier C, Pouchoux C, Chomton-Cailliez M, Kevorkian-Verguet C, Brunet C, Manteau C, Mougey C, Santy C, Fitament C, Petriat C, Rebelle C, Charron C, Dartus M, Toulorge D, Guillou-Debuisson C, Bartebin D, Klein V, Broustal E, Desselas E, Marteau E, Bouvrot E, Delacroix E, Coinde E, Elnabhani L, Amouyal E, Chaillou E, Gabilly-Bernard E, Ruiz E, Thibault E, Robin E, Darrieux E, Blondel E, Socchi F, Cazassus F, Bajolle F, Lacin F, Madhi F, Zekre F, Guerin F, Boussicault G, Ginies H, Magloire G, Arnold G, Coulognon I, Sicard-Cras I, Kahn JE, Bordet J, Fausser JL, Baleine JF, Brice J, Gendras J, Pekin K, Norbert K, Karsenty C, Savary L, Martinat L, Lesniewski L, Charbonnier L, Alexandre L, Percheron L, Vincenti M, Selegny M, Lanzini M, Grisval M, Mercy M, Lampin ME, Desgranges M, Duperril M, Orcel MC, Audier M, Favier M, Carpentier M, Balcean M, Bonnet M, Jouret M, Delattre M, Levy M, Valensi M, Shum M, Dumortier M, Gelin M, Nemmouchi M, Williaume M, Sebaha M, Genetay-Stanescu N, Giroux N, Crassard N, Derridj N, Lachaume N, Werner O, Guilluy O, Richer O, Tirel O, Pauvert A, Casha P, Perez N, Gras P, Leger PL, Pinchou M, Mornand P, Largo P, Ibanez RC, Roulland C, Albarazi SH, Bichali S, Faton S, Schott A, Walser S, Guillaume S, Vincent S, Galene-Gromez S, Kozisek S, Maugard T, Blanc T, Navarro T, Lauvray T, Kovacs T, Launay V, Despert V, Lhostis V, Gall V, Micaelli X, Benadjaoud Y, Matoussi Z, Géniaux H, Facile A, Pietri T, Palassin P, Pinel S, Chouchana L, Callot D, Boulay C. Correction to “Hyper inflammatory syndrome following COVID-19 mRNA vaccine in children: A national post-authorization pharmacovigilance study”. Lancet Reg Health Eur 2022. [PMID: 35967266 PMCID: PMC9364716 DOI: 10.1016/j.lanepe.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rakotomanana F, Dreyfus A, Raberahona M, Chevallier E, Randrianarisoa M, Andrianasy H, Bernardson B, Ranaivomanana P, Raitsilanihasy F, Rasoamaharo M, Randrianirisoa S, Rakotosamimanana N, Baril L, Randremanana R. 248 - Prévalence de la tuberculose et infection VIH en milieu carcéral, Antananarivo Madagascar. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Berthelot S, Mallet M, Blais S, Moore L, Guertin JR, Boulet J, Boilard C, Fortier C, Huard B, Mokhtari A, Lesage A, Lévesque É, Baril L, Olivier P, Vachon K, Yip O, Bouchard M, Simonyan D, Létourneau M, Pineault A, Vézo A, Stelfox HT. Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12778. [PMID: 35865131 PMCID: PMC9292471 DOI: 10.1002/emp2.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/20/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time. Methods TDABC was applied to a retrospective cohort of patients with upper respiratory tract infections, urinary tract infections, unspecified abdominal pain, lower back pain and limb lacerations who visited an ED in Québec City (Canada) during fiscal year 2015–2016. The calculated cost of care was the product of the time required to complete each care procedure and the cost per minute of each human resource or equipment involved. Costing based on durations estimated by care professionals were compared to those based on objective measurements in the field. Results Overall, 220 care episodes were included and 3080 time measurements of 75 different processes were collected. Differences between costs calculated using estimated and measured times were statistically significant for all conditions except lower back pain and ranged from $4.30 to $55.20 (US) per episode. Differences were larger for conditions requiring more advanced procedures, such as imaging or the attention of ED professionals. Conclusions The greater the use of advanced procedures or the involvement of ED professionals in the care, the greater is the discrepancy between estimated‐time‐based and measured‐time‐based costing. TDABC should be applied using objective measurement of the time per procedure.
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Affiliation(s)
- Simon Berthelot
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine familiale et de médecine d'urgence Faculté de médecine Québec Canada
| | | | | | - Lynne Moore
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine sociale et préventive Faculté de médecine Université Laval Québec Canada
| | - Jason R. Guertin
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine sociale et préventive Faculté de médecine Université Laval Québec Canada
| | | | | | | | | | | | | | | | - Laurence Baril
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine familiale et de médecine d'urgence Faculté de médecine Québec Canada
| | | | | | - Olivia Yip
- CHU de Québec‐Université Laval Québec Canada
| | | | | | | | | | - Adrien Vézo
- CHU de Québec‐Université Laval Québec Canada
| | - Henry T. Stelfox
- Department of Critical Care and the O'Brien Institute for Public Health McCaig Tower University of Calgary Calgary Alberta Canada
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Praet N, Asante KP, Bozonnat MC, Akité EJ, Ansah PO, Baril L, Boahen O, Mendoza YG, Haine V, Kariuki S, Lamy M, Maleta K, Mungwira R, Ndeketa L, Oduro A, Ogutu B, Olewe F, Oneko M, Orsini M, Roman F, Bahmanyar ER, Rosillon D, Schuerman L, Sing'oei V, Terlouw DJ, Wéry S, Otieno W, Pirçon JY. Assessing the safety, impact and effectiveness of RTS,S/AS01 E malaria vaccine following its introduction in three sub-Saharan African countries: methodological approaches and study set-up. Malar J 2022; 21:132. [PMID: 35468801 PMCID: PMC9036501 DOI: 10.1186/s12936-022-04144-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Following a 30-year development process, RTS,S/AS01E (GSK, Belgium) is the first malaria vaccine to reach Phase IV assessments. The World Health Organization-commissioned Malaria Vaccine Implementation Programme (MVIP) is coordinating the delivery of RTS,S/AS01E through routine national immunization programmes in areas of 3 countries in sub-Saharan Africa. The first doses were given in the participating MVIP areas in Malawi on 23 April, Ghana on 30 April, and Kenya on 13 September 2019. The countries participating in the MVIP have little or no baseline incidence data on rare diseases, some of which may be associated with immunization, a deficit that could compromise the interpretation of possible adverse events reported following the introduction of a new vaccine in the paediatric population. Further, effects of vaccination on malaria transmission, existing malaria control strategies, and possible vaccine-mediated selective pressure on Plasmodium falciparum variants, could also impact long-term malaria control. To address this data gap and as part of its post-approval commitments, GSK has developed a post-approval plan comprising of 4 complementary Phase IV studies that will evaluate safety, effectiveness and impact of RTS,S/AS01E through active participant follow-up in the context of its real-life implementation. Methods EPI-MAL-002 (NCT02374450) is a pre-implementation safety surveillance study that is establishing the background incidence rates of protocol-defined adverse events of special interest. EPI-MAL-003 (NCT03855995) is an identically designed post-implementation safety and vaccine impact study. EPI-MAL-005 (NCT02251704) is a cross-sectional pre- and post-implementation study to measure malaria transmission intensity and monitor the use of other malaria control interventions in the study areas, and EPI-MAL-010 (EUPAS42948) will evaluate the P. falciparum genetic diversity in the periods before and after vaccine implementation. Conclusion GSK’s post-approval plan has been designed to address important knowledge gaps in RTS,S/AS01E vaccine safety, effectiveness and impact. The studies are currently being conducted in the MVIP areas. Their implementation has provided opportunities and posed challenges linked to conducting large studies in regions where healthcare infrastructure is limited. The results from these studies will support ongoing evaluation of RTS,S/AS01E’s benefit-risk and inform decision-making for its potential wider implementation across sub-Saharan Africa. Graphic abstract ![]()
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Affiliation(s)
- Nicolas Praet
- GSK, Wavre, Belgium. .,Janssen Pharmaceutica NV, Beerse, Belgium.
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Kintampo, Ghana.,London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Patrick Odum Ansah
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
| | | | - Owusu Boahen
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Kintampo, Ghana
| | | | | | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | | | - Kenneth Maleta
- University of Malawi College of Medicine, Mangochi, Malawi
| | - Randy Mungwira
- University of Malawi College of Medicine, Mangochi, Malawi
| | - Latif Ndeketa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Abraham Oduro
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
| | - Bernhards Ogutu
- Centre for Research in Therapeutic Sciences (CREATES), Strathmore University, Nairobi, Kenya.,Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya
| | - Fredrick Olewe
- Centre for Research in Therapeutic Sciences (CREATES), Strathmore University, Nairobi, Kenya
| | - Martina Oneko
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | | | | | | | | | | | - Valentine Sing'oei
- KEMRI-Walter Reed Project, US Army Medical Research Directorate-Kenya, Kombewa, Kenya
| | - Dianne J Terlouw
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Walter Otieno
- KEMRI-Walter Reed Project, US Army Medical Research Directorate-Kenya, Kombewa, Kenya
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Courtemanche J, Baril L, Clément A, Bédard MA, Plourde M, Émond M. Is it possible to identify patients at low risk of having a true penicillin allergy? CAN J EMERG MED 2022; 24:366-368. [PMID: 35301689 DOI: 10.1007/s43678-022-00286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jacob Courtemanche
- Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada.
| | - Laurence Baril
- Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Audrey Clément
- Département de Médecine Familiale et de Médecine d'urgence, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Marc-Antoine Bédard
- Département de Médecine, Service d'immunologie-allergie, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Miville Plourde
- Département de Médecine d'urgence, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Département de Médecine d'urgence, CHU de Québec - Université Laval, Québec, QC, Canada
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Nouvet E, Grandjean Lapierre S, Knoblauch A, Baril L, Andriamiadanarivo A, Raberahona M, Mattern C, Donelle L, Andriantsoa JR. Consent to Research in Madagascar: Challenges, Strategies, and Priorities for Future
Research. Canadian Journal of Bioethics 2022. [DOI: 10.7202/1087201ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Baril L, Nguyen E, Dufresne-Santerre L, Émond V, Émond M, Berthelot S, Gagnon AP, Nadeau A, Carmichael PH, Mercier E. Pain induced by investigations and procedures commonly administered to older adults in the emergency department: a prospective cohort study. Emerg Med J 2021; 38:825-829. [PMID: 34344731 DOI: 10.1136/emermed-2020-210535] [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: 08/24/2020] [Accepted: 07/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to assess the level of pain induced by common interventions performed in older adults consulting to the ED. METHODS We conducted a prospective multicentre observational cohort study in two academic EDs (Quebec City, Canada) between June 2018 and December 2019. A convenience sample of well-oriented and haemodynamically stable older adults (≥65 years old) who underwent at least two interventions during their ED stay was recruited. The level of pain was assessed using an 11-point Numerous Rating Scale (NRS) and is presented using median and IQR or categorised as no pain (0), mild (1-3), moderate (4-6) or severe pain (7-10). RESULTS A total of 318 patients were included. The mean age was 77.8±8.0 years old and 54.4% were female . The number of pain assessments per intervention ranged between 22 (urinary catheterisation) and 240 (intravenous catheter). All imaging investigations (X-rays, CT and bedside ultrasound) were associated with a median level of pain of 0. The median level of pain for other interventions was as follows: blood samplings (n=231, NRS 1 (IQR 0-3)), intravenous catheters (n=240, NRS 2 (IQR 0-4)), urinary catheterisations (n=22, NRS 4.5 (IQR 2-6)), cervical collars (n=50, NRS 5 (IQR 0-8)) and immobilisation mattresses (n=34, NRS 5 (IQR 0-8)). Urinary catheterisations (63.8%), cervical collars (56.0%) and immobilisation mattresses (52.9%) frequently induced moderate or severe pain. CONCLUSIONS Most interventions administered to older adults in the ED are associated with no or low pain intensity. However, urinary catheterisation and spinal motion restriction devices are frequently associated with moderate or severe pain.
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Affiliation(s)
- Laurence Baril
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Elisabeth Nguyen
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Virginie Émond
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Emergency Department, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Simon Berthelot
- Emergency Department, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Ann-Pier Gagnon
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - Alexandra Nadeau
- Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgences - Soins Intensifs, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.,VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
| | | | - Eric Mercier
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada .,VITAM - Centre de recherche en santé durable de l'Université Laval, Quebec City, Quebec, Canada
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Bâtie C, Kassie D, Randravatsilavo DNRM, Baril L, Waret Szkuta A, Goutard FL. Perception of Drug Vendors and Pig and Poultry Farmers of Imerintsiatosika, in Madagascar, Toward Risks Related to Antibiotic Usage: A Q-Method Approach. Front Vet Sci 2020; 7:490. [PMID: 32974396 PMCID: PMC7472779 DOI: 10.3389/fvets.2020.00490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance is a One Health issue that must be tackled worldwide. In order to implement effective communication strategies in Madagascar, a better understanding must be gained of practices and perceptions related to antimicrobial use at the smallholder farm level. Our study used a semi-qualitative approach, called Q methodology, to identify patterns of opinion on antimicrobial use, or its alternatives, among pig and poultry smallholders and drug vendors in the commune of Imerintsiatosika, in Madagascar. Twenty-nine breeders and 23 drug vendors were asked to rank, respectively, 38 and 45 statements, produced from semi-structured interviews and secondary data, through a 7 grade scale from -3 (totally disagree) to +3 (totally agree) about antimicrobial use, related risks and alternatives. The interview ended with a discussion around extreme statements. The Q-sortings were analyzed by factor analysis and Principal Component Analysis. Regarding antimicrobial use, antimicrobial resistance and alternatives, the breeders and drug vendors were divided according to three discourses: "A: confidence in antibiotics" (respectively, 13 and 6 individuals), "B: belief in alternatives" (7 and 7 individuals), and "C: moderate approach to antibiotic use" (6 and 6 individuals), explaining, respectively, 57 and 60% of total variance. Group A was associated with the use of antibiotics as a preventive measure, poor knowledge of resistance and low trust in alternatives. Group B considered the preventive use of antibiotics to be a major problem for antimicrobial resistance and believed that alternatives, such as vaccines, were useful preventive methods. Group C seemed to have a hazy opinion. The presence of three main points of view offers the possibility to adapt awareness messages. Group B might also be used as a showcase to reduce the amounts of antibiotics used by the two other groups. This study revealed different practices and risk perceptions related to antimicrobial use that must be better characterized and accurately quantified.
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Affiliation(s)
- Chloé Bâtie
- CIRAD BIOS, UMR ASTRE, Univ Montpellier, INRAE, Montpellier, France
| | - Daouda Kassie
- CIRAD BIOS, UMR ASTRE, Univ Montpellier, INRAE, Montpellier, France.,Unité d'Épidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Laurence Baril
- Unité d'Épidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Flavie Luce Goutard
- CIRAD BIOS, UMR ASTRE, Univ Montpellier, INRAE, Montpellier, France.,Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
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Randremanana RV, Raberahona M, Randria MJDD, Rajerison M, Andrianaivoarimanana V, Legrand A, Rasoanaivo TF, Randriamparany R, Mayouya-Gamana T, Mangahasimbola R, Bourner J, Salam A, Gillesen A, Edwards T, Schoenhals M, Baril L, Horby P, Olliaro P. An open-label, randomized, non-inferiority trial of the efficacy and safety of ciprofloxacin versus streptomycin + ciprofloxacin in the treatment of bubonic plague (IMASOY): study protocol for a randomized control trial. Trials 2020; 21:722. [PMID: 32807214 PMCID: PMC7429934 DOI: 10.1186/s13063-020-04642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background Bubonic plague is the primary manifestation of infection with Yersinia pestis, accounting for 90% of all plague cases and with 75% of global cases reported in Madagascar. All drugs in use for treating plague are registered based on experimental data and anecdotal evidence, and no regimen currently recommended is supported by a randomized clinical trial. The IMASOY trial intends to fill this knowledge gap by comparing two 10-day regimens included in the national guidelines in Madagascar. The primary objective of the trial is to test the hypothesis that ciprofloxacin monotherapy is non-inferior to streptomycin followed by ciprofloxacin for the treatment of bubonic plague, thus avoiding the need for injectable, potentially toxic, aminoglycosides. Methods A two-arm parallel-group randomized control trial will be conducted across peripheral health centres in Madagascar in five districts. Males and non-pregnant females of all ages with suspected bubonic or pneumonic plague will be recruited over the course of three plague ‘seasons’. The primary endpoint of the trial is to assess the proportion of patients with bubonic plague who have a therapeutic response to treatment (defined as alive, resolution of fever, 25% reduction in the size of measurable buboes, has not received an alternative treatment and no clinical decision to continue antibiotics) as assessed on day 11. Discussion If successful, the trial has the potential to inform the standard of care guidelines not just in Madagascar but in other countries afflicted by plague. The trial is currently ongoing and expected to complete recruitment in 2022. Trial registration ClinicalTrials.gov NCT04110340. Registered on 1 October 2019
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Affiliation(s)
| | - Mihaja Raberahona
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana Antananarivo - Centre d'Infectiologie Charles Mérieux, University of Antananarivo, Antananarivo, Madagascar
| | | | | | | | - Agathe Legrand
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | | | | | | | | | | | - Tansy Edwards
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Laurence Baril
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
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17
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Salam AP, Raberahona M, Andriantsalama P, Read L, Andrianarintsiferantsoa F, Razafinambinintsoa T, Rakotomalala R, Hasiniatsy RNE, Razafimandimby D, Castle L, Funk A, Mangahasimbola RT, Renaud B, Bertherat E, Lovering A, Heraud JM, Andrianaivoarimanana V, Frédérique R, Razanajatovo N, Baril L, Fontanet A, Rajerison M, Horby P, Randria M, Randremanana R. Factors Influencing Atypical Clinical Presentations during the 2017 Madagascar Pneumonic Plague Outbreak: A Prospective Cohort Study. Am J Trop Med Hyg 2020; 102:1309-1315. [PMID: 32274983 PMCID: PMC7253123 DOI: 10.4269/ajtmh.19-0576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In late 2017, Madagascar experienced a large urban outbreak of pneumonic plague, the largest outbreak to date this century. During the outbreak, there were widespread reports of plague patients presenting with atypical symptoms, such as prolonged duration of illness and upper respiratory tract symptoms. Reported mortality among plague cases was also substantially lower than that reported in the literature (25% versus 50% in treated patients). A prospective multicenter observational study was carried out to investigate potential reasons for these atypical presentations. Few subjects among our cohort had confirmed or probable plague, suggesting that, in part, there was overdiagnosis of plague cases by clinicians. However, 35% subjects reported using an antibiotic with anti-plague activity before hospital admission, whereas 55% had antibiotics with anti-plague activity detected in their serum at admission. Although there may have been overdiagnosis of plague by clinicians during the outbreak, the high frequency of community antibiotic may partly explain the relatively few culture-positive sputum samples during the outbreak. Community antibiotic use may have also altered the clinical presentation of plague patients. These issues make accurate detection of patients and the development of clinical case definitions and triage algorithms in urban pneumonic plague outbreaks difficult.
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Affiliation(s)
- Alex P Salam
- University of Oxford, Oxford, United Kingdom.,United Kingdom Public Health Rapid Support Team, London, United Kingdom
| | | | | | - Liam Read
- North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | | | | | | | | | - Anna Funk
- Institut Pasteur Paris, Paris, France
| | | | | | | | | | | | | | | | | | - Laurence Baril
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Arnaud Fontanet
- Institut Pasteur Paris, Paris, France.,Conservatoire National des Arts et Métiers, Paris, France
| | | | - Peter Horby
- University of Oxford, Oxford, United Kingdom
| | - Mamy Randria
- Centre Hospitalier Befelatanana, Antananarivo, Madagascar
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18
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Vallès X, Stenseth NC, Demeure C, Horby P, Mead PS, Cabanillas O, Ratsitorahina M, Rajerison M, Andrianaivoarimanana V, Ramasindrazana B, Pizarro-Cerda J, Scholz HC, Girod R, Hinnebusch BJ, Vigan-Womas I, Fontanet A, Wagner DM, Telfer S, Yazdanpanah Y, Tortosa P, Carrara G, Deuve J, Belmain SR, D’Ortenzio E, Baril L. Human plague: An old scourge that needs new answers. PLoS Negl Trop Dis 2020; 14:e0008251. [PMID: 32853251 PMCID: PMC7451524 DOI: 10.1371/journal.pntd.0008251] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Yersinia pestis, the bacterial causative agent of plague, remains an important threat to human health. Plague is a rodent-borne disease that has historically shown an outstanding ability to colonize and persist across different species, habitats, and environments while provoking sporadic cases, outbreaks, and deadly global epidemics among humans. Between September and November 2017, an outbreak of urban pneumonic plague was declared in Madagascar, which refocused the attention of the scientific community on this ancient human scourge. Given recent trends and plague's resilience to control in the wild, its high fatality rate in humans without early treatment, and its capacity to disrupt social and healthcare systems, human plague should be considered as a neglected threat. A workshop was held in Paris in July 2018 to review current knowledge about plague and to identify the scientific research priorities to eradicate plague as a human threat. It was concluded that an urgent commitment is needed to develop and fund a strong research agenda aiming to fill the current knowledge gaps structured around 4 main axes: (i) an improved understanding of the ecological interactions among the reservoir, vector, pathogen, and environment; (ii) human and societal responses; (iii) improved diagnostic tools and case management; and (iv) vaccine development. These axes should be cross-cutting, translational, and focused on delivering context-specific strategies. Results of this research should feed a global control and prevention strategy within a "One Health" approach.
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Affiliation(s)
- Xavier Vallès
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Nils Chr. Stenseth
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, Oslo, Norway
- Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Christian Demeure
- Yersinia Research Unit, National Reference Centre “Plague & Other Yersinioses,” WHO Collaborating Research and Reference Centre for Yersinia, Institut Pasteur, Paris, France
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul S. Mead
- Bacterial Diseases Branch, Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Oswaldo Cabanillas
- Control de Epidemia Desastres y Otras Emergencias Sanitarias, Oficina General de Epidemiologia, Ministerio de Salud, Perúu
| | - Mahery Ratsitorahina
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Minoarisoa Rajerison
- Plague Unit, Central Laboratory for Plague, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Beza Ramasindrazana
- Plague Unit, Central Laboratory for Plague, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Javier Pizarro-Cerda
- Yersinia Research Unit, National Reference Centre “Plague & Other Yersinioses,” WHO Collaborating Research and Reference Centre for Yersinia, Institut Pasteur, Paris, France
| | - Holger C. Scholz
- Reference Laboratory for Plague, Bundeswehr Institute of Microbiology, Munich, Germany
| | - Romain Girod
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - B. Joseph Hinnebusch
- Rocky Mountain Laboratories, National Institute of Health, National Institutes of Allergy and Infectious Diseases, Hamilton, Montana, United States of America
| | - Ines Vigan-Womas
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
- PACRI unit, Conservatoire National des Arts et Métiers, Paris, France
| | - David M. Wagner
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Sandra Telfer
- School of Biological Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Yazdan Yazdanpanah
- REACTing, Inserm, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Pablo Tortosa
- Université de La Réunion, Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical, La Réunion, France
| | - Guia Carrara
- REACTing, Inserm, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Jane Deuve
- Department of International Affairs, Institut Pasteur, Paris, France
| | - Steven R. Belmain
- Natural Resources Institute, University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Eric D’Ortenzio
- REACTing, Inserm, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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19
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Ratovoson R, Masquelier B, Andriatahina T, Mangahasimbola R, Andrianirina Z, Pison G, Baril L. Inequalities in cause-specific mortality in children and adolescents in the Moramanga health survey, Madagascar. Int J Public Health 2020; 65:781-790. [PMID: 32566965 DOI: 10.1007/s00038-020-01409-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES One child or young adolescent dies every 10 min in Madagascar and large disparities in survival persist. We estimated cause-specific mortality in a cohort of children aged 0-14 in the Moramanga district and explored how causes of death shape these inequalities. METHODS Children were followed prospectively between 2012 and 2017. Causes of death were established based on verbal autopsies. Incidence rate ratios were estimated in Poisson regression models. RESULTS The risk of dying before age 15 was 68.1 per thousand live births. Risks of dying were highest in the first year of life (31.2‰) and lowest in children aged 10-14 (6.4‰). The male-to-female sex ratios of mortality increased with age and reached 2.3 among adolescents aged 10-14. Communicable, nutritional and neonatal causes accounted for 79.5% of deaths below age 5 and 47.0% above age 5. Mortality was positively associated with household poverty, lack of education of the household head, and rural residence. CONCLUSIONS Interventions should be designed with an equity lens to reduce large disparities in survival and be tailored to the needs of each age-group.
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Affiliation(s)
- Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Ambatofotsikely Avaradoha, Po Box 1274, 101, Antananarivo, Madagascar. .,UR 15 DEMOSUD, Institut national d'études démographiques, Paris, France.
| | - Bruno Masquelier
- UR 15 DEMOSUD, Institut national d'études démographiques, Paris, France.,Centre de Recherche en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Reziky Mangahasimbola
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Ambatofotsikely Avaradoha, Po Box 1274, 101, Antananarivo, Madagascar
| | - Zo Andrianirina
- Pediatric and Neonatal Unit, Soavinandriana Hospital, Antananarivo, Madagascar
| | - Gilles Pison
- UR 15 DEMOSUD, Institut national d'études démographiques, Paris, France.,Eco-Anthropology Research Unit, National Museum of Natural History, Paris, France
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Ambatofotsikely Avaradoha, Po Box 1274, 101, Antananarivo, Madagascar.,Institut Pasteur of Cambodia, Phnom Penh, Cambodia
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20
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Raberahona M, Monge F, Andrianiaina RH, Randria MJDD, Ratefiharimanana A, Rakatoarivelo RA, Randrianary L, Randriamilahatra E, Rakotobe L, Mattern C, Andriananja V, Rajaonarison H, Randrianarisoa M, Rakotomanana E, Pourette D, Andriamahenina HZ, Dezé C, Boukli N, Baril L, Vallès X. Is Madagascar at the edge of a generalised HIV epidemic? Situational analysis. Sex Transm Infect 2020; 97:27-32. [PMID: 32423946 DOI: 10.1136/sextrans-2019-054254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/20/2020] [Accepted: 04/18/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the epidemiological situation of the HIV/AIDS epidemic and to identify the main drivers for vulnerability in Madagascar. DESIGN Literature review, qualitative research and situational analysis. DATA SOURCES Search of electronic bibliographic databases, national repositories of documentation from 1998 to 2018. Search keywords included Madagascar, HIV, sexually transmitted infections, men who have sex with men (MSM), sex workers (SWs), transactional sex (TS), injecting drug users (IDUs), vulnerability and sexual behaviour. Qualitative sources were interviews and focus group discussions. REVIEW METHODS Studies focused on HIV and/or vulnerability of HIV in Madagascar in general, and key populations (KPs) and HIV/AIDS response were taken into account. National reports from key HIV response actors were included. RESULTS Madagascar is characterised by a low HIV/AIDS epidemic profile in the general population (GP) (0.3%) combined with a high prevalence of HIV among KPs (SWs, MSM and IDUs).An increase in HIV prevalence among KP has been observed during recent years. Hospital-based data suggest an increase in HIV prevalence among the GP. The vulnerability traits are inconsistent use of condoms, multipartner relationships and other contextual factors like widespread TS and gender inequality. A high prevalence/incidence of sexually transmitted infections could indicate a high vulnerability to HIV/AIDS. However, there are no reports of HIV prevalence of >1% in antenatal consultation. CONCLUSION There is not enough evidence to make a conclusion about the HIV epidemiological situation in Madagascar due to the scarcity of the epidemiological data. However, Madagascar may be closer to a turning point towards a high-prevalence epidemic with severe consequences, particularly when taking into account its socioeconomical fragility and underlying vulnerabilities. More precise epidemiological data and improved HIV/AIDS diagnosis and case management should be a public health priority.
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Affiliation(s)
- Mihaja Raberahona
- Infectious Diseases, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | | | | | | | - Lanto Randrianary
- Directorate for Sexually Transmitted Diseases Control, Government of Madagascar Ministry of Public Health, Antananarivo, Madagascar
| | - Emma Randriamilahatra
- Directorate for Sexually Transmitted Diseases Control, Government of Madagascar Ministry of Public Health, Antananarivo, Madagascar
| | - Liva Rakotobe
- Directorate for Sexually Transmitted Diseases Control, Government of Madagascar Ministry of Public Health, Antananarivo, Madagascar
| | - Chiarella Mattern
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,CEPED, IRD, Université Paris Descartes, INSERM, Paris, France
| | - Volatiana Andriananja
- Infectious Diseases, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Mirella Randrianarisoa
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Elliott Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Charlotte Dezé
- Ambassade de France à Madagascar, Ministère de l'Europe et des Affaires Étrangères de France, Antananarivo, Madagascar
| | - Narjis Boukli
- Virology, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Xavier Vallès
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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21
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Manning JE, Bohl JA, Lay S, Chea S, Sovann L, Sengdoeurn Y, Heng S, Vuthy C, Kalantar K, Ahyong V, Tan M, Sheu J, Tato CM, DeRisi JL, Baril L, Duong V, Dussart P, Karlsson EA. Rapid metagenomic characterization of a case of imported COVID-19 in Cambodia. bioRxiv 2020:2020.03.02.968818. [PMID: 32511296 PMCID: PMC7217139 DOI: 10.1101/2020.03.02.968818] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rapid production and publication of pathogen genome sequences during emerging disease outbreaks provide crucial public health information. In resource-limited settings, especially near an outbreak epicenter, conventional deep sequencing or bioinformatics are often challenging. Here we successfully used metagenomic next generation sequencing on an iSeq100 Illumina platform paired with an open-source bioinformatics pipeline to quickly characterize Cambodia's first case of COVID-2019.
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Affiliation(s)
- Jessica E. Manning
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Jennifer A. Bohl
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sreyngim Lay
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sophana Chea
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Ly Sovann
- Cambodian Center for Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Yi Sengdoeurn
- Cambodian Center for Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Seng Heng
- Cambodian Center for Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Chan Vuthy
- Cambodian Center for Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Vida Ahyong
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Michelle Tan
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Jonathan Sheu
- Chan Zuckerberg Initiative, Redwood City, California, USA
| | | | | | | | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Erik A. Karlsson
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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22
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Rajerison M, Melocco M, Andrianaivoarimanana V, Rahajandraibe S, Rakotoarimanana F, Spiegel A, Ratsitorahina M, Baril L. Performance of plague rapid diagnostic test compared to bacteriology: a retrospective analysis of the data collected in Madagascar. BMC Infect Dis 2020; 20:90. [PMID: 32000692 PMCID: PMC6993518 DOI: 10.1186/s12879-020-4812-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/21/2020] [Indexed: 11/11/2022] Open
Abstract
Background Plague is a highly fatal disease caused by Yersinia pestis. Late diagnosis hampers disease outcome and effectiveness of control measures, induces death and disease spread. Advance on its diagnosis was the use of lateral flow rapid diagnostic test (RDT). Methods We assessed the performance of the plague RDT based on Y. pestis F1 antigen detection more than 15 years after its deployment in Madagascar. We compared the RDT with bacteriological culture results, using data from plague notified cases collected during the periods for which both tests were performed independently and systematically. Results Used with bubonic plague (BP) patient samples, RDTs had a sensitivity of 100% (95% CI: 99.7–100%), a specificity of 67% (95% CI: 64–70%) with a good agreement between bacteriology and RDT results (86%; κ = 0.70, 95% CI 0.67–0.73). For pneumonic plague (PP), RDT had a sensitivity of 100% (95% CI: 91–100%) and a specificity of 59% (95% CI: 49–68%) and concordance between the bacteriological and plague RDT results was moderate (70%; κ = 0.43, 95% CI 0.32–0.55). Analysis focusing on the 2017–2018 plague season including the unprecedented epidemic of PP showed that RDT used on BP samples still had a sensitivity of 100% (95% CI: 85–100%) and a specificity of 82% (95% CI: 48–98%) with a very good agreement with bacteriology 94% (κ = 0.86, 95% CI 0.67–1); for PP samples, concordance between the bacteriological and plague RDT results was poor (61%; κ = − 0.03, 95% CI -0.17 – 0.10). Conclusions RDT performance appeared to be similar for the diagnosis of BP and PP except during the 2017 PP epidemic where RDT performance was low. This RDT, with its good sensitivity on both plague clinical forms during a normal plague season, remained a potential test for alert. Particularly for BP, it may be of great value in the decision process for the initiation of therapy. However, for PP, RDT may deliver false negative results due to inconsistent sample quality. Plague diagnosis could be improved through the development of next generation of RDTs.
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Affiliation(s)
| | - Marie Melocco
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, 101, Madagascar
| | | | | | - Feno Rakotoarimanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, 101, Madagascar
| | - André Spiegel
- Direction, Institut Pasteur de Madagascar, Antananarivo, 101, Madagascar
| | | | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, 101, Madagascar
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23
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Ratovoson R, Randremanana R, Rakotomanana F, Andriamandimby SF, Mangahasimbola R, Masquelier B, Richard V, Piola P, Pison G, Baril L. Cohort Profile: Moramanga health survey in urban and rural areas in Madagascar (MHURAM project). Int J Epidemiol 2019; 48:1754-1755i. [PMID: 31665291 DOI: 10.1093/ije/dyz215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,DemoSud Research Unit, Institut National d'Etudes Démographiques, Paris, France
| | - Rindra Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Reziky Mangahasimbola
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bruno Masquelier
- DemoSud Research Unit, Institut National d'Etudes Démographiques, Paris, France.,Center for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Vincent Richard
- Direction of International Affairs, Institut Pasteur, Paris, France
| | - Patrice Piola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Gilles Pison
- DemoSud Research Unit, Institut National d'Etudes Démographiques, Paris, France.,Eco-Anthropology Research Unit, National Museum of Natural History, Paris, France
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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24
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Baril L, Vallès X, Stenseth NC, Rajerison M, Ratsitorahina M, Pizarro-Cerdá J, Demeure C, Belmain S, Scholz H, Girod R, Hinnebusch J, Vigan-Womas I, Bertherat E, Fontanet A, Yazadanpanah Y, Carrara G, Deuve J, D'ortenzio E, Angulo JOC, Mead P, Horby PW. Can we make human plague history? A call to action. BMJ Glob Health 2019; 4:e001984. [PMID: 31799005 PMCID: PMC6861124 DOI: 10.1136/bmjgh-2019-001984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Xavier Vallès
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Nils Christian Stenseth
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, Oslo, Norway
- Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing, China
| | - Minoarisoa Rajerison
- Plague Unit, Central Laboratory for Plague, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Maherisoa Ratsitorahina
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Javier Pizarro-Cerdá
- Yersinia Research Unit, National Reference Centre 'Plague & Other Yersinioses', World Health Organization Collaborating Reference and Research Centre for Yersinia, Institut Pasteur, Paris, France
| | - Christian Demeure
- Yersinia Research Unit, National Reference Centre 'Plague & Other Yersinioses', World Health Organization Collaborating Reference and Research Centre for Yersinia, Institut Pasteur, Paris, France
| | - Steve Belmain
- Natural Resources Institute, University of Greenwich, Kent, UK
| | - Holger Scholz
- Reference Laboratory for Plague, Bundeswehr Institute of Microbiology, Munich, Germany
| | - Romain Girod
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Joseph Hinnebusch
- Rocky Mountain Laboratories, National Institute of Health, National Instittute of Allergy and Infectious Diseases, Hamilton, Ohio, USA
| | - Ines Vigan-Womas
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Eric Bertherat
- Alert and Response Operations Programme, Communicable Disease Surveillance and Response Department, World Health Organization, Geneve, Switzerland
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Conservatoire National des Arts et Métiers, Paris, France
| | | | - Guia Carrara
- REACTing, Inserm, Université Paris Diderot, Paris, France
| | - Jane Deuve
- Department of International Affairs, Institut Pasteur, Paris, France
| | - Eric D'ortenzio
- REACTing, Inserm, Université Paris Diderot, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Jose Oswaldo Cabanillas Angulo
- Control de Epidemia Desastres y Otras Emergencias Sanitarias, Oficina General de Epidemiologia, Ministerio de Salud de Perú, Lima, Peru
| | - Paul Mead
- Bacterial Diseases Branch, Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Peter W Horby
- Epidemic diseases Research Group Oxford (ERGO), Nutfield Department of Medicine, University of Oxford, Oxford, UK
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Safaeian M, Castellsagué X, Hildesheim A, Wacholder S, Schiffman MH, Bozonnat MC, Baril L, Rosillon D. Risk of HPV-16/18 Infections and Associated Cervical Abnormalities in Women Seropositive for Naturally Acquired Antibodies: Pooled Analysis Based on Control Arms of Two Large Clinical Trials. J Infect Dis 2019; 218:84-94. [PMID: 29718393 DOI: 10.1093/infdis/jiy112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/11/2018] [Indexed: 11/12/2022] Open
Abstract
Background Studies on the role of antibodies produced after infection with human papillomavirus 18 (HPV-18) and subsequent protection from HPV-18 infection have been conflicting, mainly due to inadequate sample size. Methods We pooled data from the control arms of the Costa Rica Vaccine Trial and the PATRICIA trial. Using Poisson regression we compared the risk of newly detected 1-time HPV-18 infection, HPV-18 1-year persistent infection (12MPI), and HPV-18-associated atypical squamous cells of undetermined significance or greater (ASC-US+) lesions between HPV-18 seropositive and seronegative women. Results High HPV-18 antibodies at enrollment was associated with reduced subsequent HPV-18 detection (P trend = 0.001; relative rate [RR] = 0.69; 95% confidence interval [CI], 0.47-1.01 for the third quartile; RR = 0.63; 95% CI, 0.43-0.94 for the fourth quartile, compared to seronegative). The risk of 12MPI showed a decreasing trend with increasing antibodies (P trend = 0.06; RR = 0.72; 95% CI, 0.29-1.77; RR = 0.42; 95% CI, 0.13-1.32 for the third and fourth quartiles, respectively). Lastly, we observed a significant decreased risk of HPV-18 ASC-US+ with increasing antibody (P trend = 0.01; RR = 0.46; 95% CI, 0.21-0.97 for the fourth quartile). We also observed a significant decreased risk of HPV-16 infection, 12MPI, and ASC-US+ with increasing HPV-16 antibody level. Conclusions High HPV-18 naturally acquired antibodies were associated with partial protection from future HPV-18 infections and associated lesions. Clinical Trials Registration NCT00128661 and NCT001226810.
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Affiliation(s)
- Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xavier Castellsagué
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain.,Centros de Investigación Biomédica en Red, Epidemiología y Salud Pública, Madrid, Spain
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sholom Wacholder
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark H Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Rosillon D, Baril L, Del Rosario-Raymundo MR, Wheeler CM, Skinner SR, Garland SM, Salmeron J, Lazcano-Ponce E, Vallejos CS, Stoney T, Ter Harmsel B, Lim TYK, Quek SC, Minkina G, McNeil SA, Bouchard C, Fong KL, Money D, Ilancheran A, Savicheva A, Cruickshank M, Chatterjee A, Fiander A, Martens M, Bozonnat MC, Struyf F, Dubin G, Castellsagué X. Risk of newly detected infections and cervical abnormalities in adult women seropositive or seronegative for naturally acquired HPV-16/18 antibodies. Cancer Med 2019; 8:4938-4953. [PMID: 31273942 PMCID: PMC6712465 DOI: 10.1002/cam4.1879] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infections with human papillomavirus (HPV) types 16 and 18 account for ~70% of invasive cervical cancers but the degree of protection from naturally acquired anti-HPV antibodies is uncertain. We examined the risk of HPV infections as defined by HPV DNA detection and cervical abnormalities among women >25 years in the Human Papilloma VIrus Vaccine Immunogenicity ANd Efficacy trial's (VIVIANE, NCT00294047) control arm. METHODS Serum anti-HPV-16/18 antibodies were determined at baseline and every 12 months in baseline DNA-negative women (N = 2687 for HPV-16 and 2705 for HPV-18) by enzyme-linked immunosorbent assay (ELISA) from blood samples. HPV infections were identified by polymerase chain reaction (PCR) every 6-months, and cervical abnormalities were confirmed by cytology every 12 months. Data were collected over a 7-year period. The association between the risk of type-specific infection and cervical abnormalities and serostatus was assessed using Cox proportional hazard models. RESULTS Risk of newly detected HPV-16-associated 6-month persistent infections (PI) (hazard ratio [HR] = 0.56 [95%CI:0.32; 0.99]) and atypical squamous cells of undetermined significance (ASC-US+) (HR = 0.28 [0.12; 0.67]) were significantly lower in baseline seropositive vs baseline seronegative women. HPV-16-associated incident infections (HR = 0.81 [0.56; 1.16]) and 12-month PI (HR = 0.53 [0.24; 1.16]) showed the same trend. A similar trend of lower risk was observed in HPV-18-seropositive vs -seronegative women (HR = 0.95 [0.59; 1.51] for IIs, HR = 0.43 [0.16; 1.13] for 6-month PIs, HR = 0.31 [0.07; 1.36] for 12-month PIs, and HR = 0.61 [0.23; 1.61] for ASC-US+). CONCLUSIONS Naturally acquired anti-HPV-16 antibodies were associated with a decreased risk of subsequent infection and cervical abnormalities in women >25 years. This possible protection was lower than that previously reported in 15- to 25-year-old women.
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Affiliation(s)
| | | | | | | | - Susan Rachel Skinner
- Vaccines Trials Group, Telethon Kids Institute, Perth, Western Australia, Australia.,Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Suzanne Marie Garland
- The Royal Women's Hospital, The Royal Children's Hospital, Murdoch Childrens Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | | | | | | | - Tanya Stoney
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Bram Ter Harmsel
- Department of Gynecology, Roosevelt Kliniek, Leiden, Delft, The Netherlands
| | | | - Swee Chong Quek
- ASC Clinic for Women, Gleneagles Hospital, Singapore City, Singapore
| | | | - Shelly Ann McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celine Bouchard
- Clinique de Recherche en Santé des Femmes, Québec City, Québec, Canada
| | - Kah Leng Fong
- Singapore General Hospital, Singapore City, Singapore
| | - Deborah Money
- The Women's Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arunachalam Ilancheran
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Alevtina Savicheva
- Laboratory of Microbiology, DO Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia
| | - Margaret Cruickshank
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, NHS Grampian, Scotland, UK
| | - Archana Chatterjee
- Department of Pediatrics, University of South Dakota Sanford School of Medicine/Sanford Children's Specialty Clinic, Sioux Falls, South Dakota
| | - Alison Fiander
- Leading Safe Choices Programme, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | | | | | | | - Xavier Castellsagué
- Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain
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Randremanana R, Andrianaivoarimanana V, Nikolay B, Ramasindrazana B, Paireau J, Ten Bosch QA, Rakotondramanga JM, Rahajandraibe S, Rahelinirina S, Rakotomanana F, Rakotoarimanana FM, Randriamampionona LB, Razafimbia V, De Dieu Randria MJ, Raberahona M, Mikaty G, Le Guern AS, Rakotonjanabelo LA, Ndiaye CF, Rasolofo V, Bertherat E, Ratsitorahina M, Cauchemez S, Baril L, Spiegel A, Rajerison M. Epidemiological characteristics of an urban plague epidemic in Madagascar, August-November, 2017: an outbreak report. Lancet Infect Dis 2019; 19:537-545. [PMID: 30930106 PMCID: PMC6483974 DOI: 10.1016/s1473-3099(18)30730-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/01/2018] [Accepted: 11/21/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Madagascar accounts for 75% of global plague cases reported to WHO, with an annual incidence of 200-700 suspected cases (mainly bubonic plague). In 2017, a pneumonic plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic plagues, particularly in urban settings. METHODS Clinically suspected plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. FINDINGS 2414 clinically suspected plague cases were reported, including 1878 (78%) pneumonic plague cases, 395 (16%) bubonic plague cases, one (<1%) septicaemic case, and 140 (6%) cases with unspecified clinical form. 386 (21%) of 1878 notified pneumonic plague cases were probable and 32 (2%) were confirmed. 73 (18%) of 395 notified bubonic plague cases were probable and 66 (17%) were confirmed. The case fatality ratio was higher among confirmed cases (eight [25%] of 32 cases) than probable (27 [8%] of 360 cases) or suspected pneumonic plague cases (74 [5%] of 1358 cases) and a similar trend was seen for bubonic plague cases (16 [24%] of 66 confirmed cases, four [6%] of 68 probable cases, and six [2%] of 243 suspected cases). 351 (84%) of 418 confirmed or probable pneumonic plague cases were concentrated in Antananarivo, the capital city, and Toamasina, the main seaport. All 50 isolated Yersinia pestis strains were susceptible to the tested antibiotics. INTERPRETATION This predominantly urban plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future plague outbreaks. FUNDING US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.
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Affiliation(s)
- Rindra Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR 2000, CNRS, Paris, France
| | | | - Juliette Paireau
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR 2000, CNRS, Paris, France
| | - Quirine Astrid Ten Bosch
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR 2000, CNRS, Paris, France
| | | | | | | | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Feno M Rakotoarimanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Vaoary Razafimbia
- Directorate of Health and Epidemiological Surveillance, Ministry of Public Health, Antananarivo, Madagascar
| | - Mamy Jean De Dieu Randria
- Department of Infectiology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Department of Infectiology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Guillain Mikaty
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | - Anne-Sophie Le Guern
- Yersinia Research Unit, National Reference Laboratory for Plague, WHO Collaborating Centre, Institut Pasteur, Paris, France
| | | | | | | | | | - Maherisoa Ratsitorahina
- Directorate of Health and Epidemiological Surveillance, Ministry of Public Health, Antananarivo, Madagascar
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR 2000, CNRS, Paris, France.
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - André Spiegel
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Abstract
INTRODUCTION The number of new vaccine introductions (NVIs) in low and middle-income countries (LMICs) has markedly increased since 2010, raising challenges to often overstretched and underfunded health care systems. AREAS COVERED We present an overview of some of these challenges, focusing on programmatic decisions, delivery strategy, information and communication, pharmacovigilance and post-licensure evaluation. We also highlight field-based initiatives that may facilitate NVI. EXPERT COMMENTARY Some new vaccines targeting populations other than infants require alternative delivery strategies. NVIs impact upon existing supply chain management, in particular vaccines with novel characteristics. A lack of understanding about immunization and misconceptions may be detrimental to NVI, as well as insufficient or poorly trained health care workforce. Many barriers exist to achieving good vaccination coverage. Real-world evaluation of vaccine safety, effectiveness and impact in LMICs may be limited by lack of robust demographic and disease epidemiology data, as well as limited health care and surveillance infrastructure. A thorough planning phase is crucial to define the most suitable delivery strategy based on the vaccine's and country's specificities. A communication plan and social mobilization are essential. Implementation research and innovative approaches applied to logistics, delivery, communication and program evaluation can facilitate NVI.
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Affiliation(s)
| | | | - Viviane Jusot
- b Safety Evaluation and Risk Management , GSK , Wavre , Belgium
| | - Marina Bakker
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands.,d PHARMO Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Laurence Baril
- a Research and Development , GSK , Wavre , Belgium.,e Institut Pasteur de Madagascar , Antananarivo , Madagascar
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Hampson K, Ventura F, Steenson R, Mancy R, Trotter C, Cooper L, Abela-Ridder B, Knopf L, Ringenier M, Tenzin T, Ly S, Tarantola A, Moyengar R, Oussiguéré A, Bonfoh B, Narayana DHA, Sudarshan MK, Muturi M, Mwatondo A, Wambura G, Andriamandimby SF, Baril L, Edosoa GT, Traoré A, Jayme S, Kotzé J, Gunesekera A, Chitnis N, Hattendorf J, Laager M, Lechenne M, Zinsstag J, Changalucha J, Mtema Z, Lugelo A, Lushasi K, Yurachai O, Metcalf CJE, Rajeev M, Blanton J, Costa GB, Sreenivasan N, Wallace R, Briggs D, Taylor L, Thumbi SM, Huong NTT. The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study. Lancet Infect Dis 2019; 19:102-111. [PMID: 30472178 PMCID: PMC6300480 DOI: 10.1016/s1473-3099(18)30512-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/18/2018] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. METHODS We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. FINDINGS We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. INTERPRETATION Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. FUNDING World Health Organization.
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Rajeev M, Edosoa G, Hanitriniaina C, Andriamandimby SF, Guis H, Ramiandrasoa R, Ratovoson R, Randrianasolo L, Andriamananjara M, Heraud JM, Baril L, Metcalf CJE, Hampson K. Healthcare utilization, provisioning of post-exposure prophylaxis, and estimation of human rabies burden in Madagascar. Vaccine 2018; 37 Suppl 1:A35-A44. [PMID: 30509692 PMCID: PMC7612383 DOI: 10.1016/j.vaccine.2018.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/15/2018] [Accepted: 11/02/2018] [Indexed: 11/18/2022]
Abstract
In Madagascar, dog-mediated rabies has been endemic for over a century, however there is little data on its incidence or impact. We collected data over a 16-month period on provisioning of post-exposure prophylaxis (PEP) at a focal clinic in the Moramanga District and determined the rabies status of biting animals using clinical and laboratory diagnosis. We find that animal rabies cases are widespread, and clinic-based triage and investigation are effective ways to increase detection of rabies exposures and to rule out non-cases. A high proportion of rabies-exposed persons from Moramanga sought (84%) and completed PEP (90% of those that initiated PEP), likely reflecting the access and free provisioning of PEP in the district. Current clinic vial sharing practices demonstrate the potential for intradermal administration of PEP in endemic African settings, reducing vaccine use by 50% in comparison to intramuscular administration. A high proportion of PEP demand was attributed to rabies cases, with approximately 20% of PEP administered to probable rabies exposures and an additional 20% to low-to-no risk contacts with confirmed/probable animal or human cases. Using a simplified decision tree and our data on rabies exposure status and health-seeking behavior, we estimated an annual incidence of 42-110 rabies exposures and 1-3 deaths per 100,000 persons annually. Extrapolating to Madagascar, we estimate an annual burden of 282-745 human rabies deaths with current PEP provisioning averting 1499-3958 deaths each year. Data from other clinics and districts are needed to improve these estimates, particularly given that PEP availability is currently limited to only 31 clinics in the country. A combined strategy of mass dog vaccination, enhanced surveillance, and expanded access to PEP along with more judicious guidelines for administration could effectively reduce and eventually eliminate the burden of rabies in Madagascar.
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Affiliation(s)
- Malavika Rajeev
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States.
| | - Glenn Edosoa
- Service de Lutte contre les Maladies Épidémiques et Négligées, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Chantal Hanitriniaina
- Mention Zoologie et Biodiversité Animale, Faculté des Sciences, Université d'Antananarivo, Antananarivo, Madagascar
| | | | - Helene Guis
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar; CIRAD, UMR ASTRE, Antananarivo, Madagascar; ASTRE, Univ Montpellier, CIRAD, INRA, Montpellier, France
| | - Ravo Ramiandrasoa
- Vaccination Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mamitiana Andriamananjara
- Direction des Services Vétérinaires, Ministère chargé de l'Agriculture et de l'Élevage, Antananarivo, Madagascar
| | | | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
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Willame C, Lin L, Vetter V, Baril L, Praet N. Reply to Lee et al.'s letter to the editor pertaining to our publication entitled "Pain caused by measles, mumps, and rubella vaccines: A systematic literature review". Vaccine 2018; 36:6589-6590. [PMID: 30348362 DOI: 10.1016/j.vaccine.2018.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022]
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D’Ortenzio E, Lemaître N, Brouat C, Loubet P, Sebbane F, Rajerison M, Baril L, Yazdanpanah Y. Plague: Bridging gaps towards better disease control. Med Mal Infect 2018; 48:307-317. [DOI: 10.1016/j.medmal.2018.04.393] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/13/2018] [Indexed: 01/14/2023]
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Mader R, Guis H, Rakotondramanga J, Girod R, Nantenaina Raharimalala F, Baril L. Integrating entomoligical covariates in a predictive model of malaria incidence in Farafangana, Madagascar: Limitations and benefits. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ramarokoto T, Randrianasolo L, Randriamampionona L, Valentini Randrianasolo S, Bernardson B, Ramarokoto C, Rakotondramanga J, Randremanana R, Piola P, Baril L. Évaluation d’un système d’alerte précoce pour le paludisme par l’utilisation d’une technologie mHealth avec les agents communautaires dans des zones rurales reculées de 2013–2017, à Madagascar. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nari-Vony T, Rakotondramanga J, Randrianasolo L, Randriamampionona L, Razanajatovo N, Ratsitorahina M, Heraud JM, Baril L. Utilisation des analyses spatiales et données géographiques pour améliorer la surveillance de syndromes grippaux (« Influenza-Like Illness ») à Madagascar. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Willame C, Henry O, Lin L, Vetter V, Baril L, Praet N. Pain caused by measles, mumps, and rubella vaccines: A systematic literature review. Vaccine 2018; 35:5551-5558. [PMID: 28893478 DOI: 10.1016/j.vaccine.2017.08.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/06/2016] [Revised: 08/04/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE The risk of post-vaccination adverse events (AEs) is a primary public health concern. Among the AEs, pain is a significant source of anxiety for both children and their parents. This review describes and assesses the intensity of pain experienced by children post-vaccination with widely used Measles-Mumps-Rubella (MMR) vaccines. METHODS A systematic literature search was conducted in Pubmed, Embase and Cochrane to identify publications describing immediate pain at injection site (primary objective) or pain within days (secondary objective) after 2 specific MMR vaccines. Immediate pain ('acute pain' according to the Brighton Collaboration case definition) was defined as pain occurring at the time or within 5min of injection. RESULTS Four studies, which compared the intensity of immediate injection site pain experienced by children after MMR vaccination, were identified. Various pain assessment tools and methods were used to quantify the intensity of pain, including the median difference in Visual Analog Scale scores between vaccine groups. All four studies showed significantly less immediate pain caused by Priorix (GSK Vaccines) compared with M-M-R II (Merck & Co., Inc.). CONCLUSIONS To our knowledge, this review summarizes for the first time the available scientific evidence on the intensity of pain following different MMR vaccines. It highlights that MMR vaccines can differ in terms of immediate pain. Further research may be needed to better understand the underlying reason for this observation. In this context, it is very important to understand which physicochemical properties are most relevant for the immediate pain profile of a vaccine to thereby support the development of vaccines with the best possible immediate pain profile.
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Affiliation(s)
- Corinne Willame
- Business & Decision Life Sciences, Rue Saint Lambert 141, 1200 Brussels, Belgium(1).
| | - Ouzama Henry
- GSK, 2301 Renaissance Blvd., King of Prussia, Philadelphia, PA 19406-2772, USA.
| | - Lan Lin
- GSK, Avenue Fleming 20, 1300 Wavre, Belgium.
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Randrianasolo L, Randriamampionona L, Randrianasolo S, Ramarokoto T, Randremanana R, Baril L, Piola P. Utilisation de la surveillance sentinelle et des nouvelles technologies d’information pour estimer les causes de décès à Madagascar. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cohet C, Rosillon D, Willame C, Haguinet F, Marenne MN, Fontaine S, Buyse H, Bauchau V, Baril L. Challenges in conducting post-authorisation safety studies (PASS): A vaccine manufacturer's view. Vaccine 2017; 35:3041-3049. [PMID: 28465097 DOI: 10.1016/j.vaccine.2017.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/14/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
Post-authorisation safety studies (PASS) of vaccines assess or quantify the risk of adverse events following immunisation that were not identified or could not be estimated pre-licensure. The aim of this perspective paper is to describe the authors' experience in the design and conduct of twelve PASS that contributed to the evaluation of the benefit-risk of vaccines in real-world settings. We describe challenges and learnings from selected PASS of rotavirus, malaria, influenza, human papillomavirus and measles-mumps-rubella-varicella vaccines that assessed or identified potential or theoretical risks, which may lead to changes to risk management plans and/or to label updates. Study settings include the use of large healthcare databases and de novo data collection. PASS methodology is influenced by the background incidence of the outcome of interest, vaccine uptake, availability and quality of data sources, identification of the at-risk population and of suitable comparators, availability of validated case definitions, and the frequent need for case ascertainment in large databases. Challenges include the requirement for valid exposure and outcome data, identification of, and access to, adequate data sources, and mitigating limitations including bias and confounding. Assessing feasibility is becoming a key step to confirm that study objectives can be met in a timely manner. PASS provide critical information for regulators, public health agencies, vaccine manufacturers and ultimately, individuals. Collaborative approaches and synergistic efforts between vaccine manufacturers and key stakeholders, such as regulatory and public health agencies, are needed to facilitate access to data, and to drive optimal study design and implementation, with the aim of generating robust evidence.
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Willame C, Baril L, van den Bosch J, Ferreira GLC, Williams R, Rosillon D, Cohet C. Importance of feasibility assessments before implementing non-interventional pharmacoepidemiologic studies of vaccines: lessons learned and recommendations for future studies. Pharmacoepidemiol Drug Saf 2016; 25:1397-1406. [PMID: 27601179 PMCID: PMC5157751 DOI: 10.1002/pds.4081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 01/27/2023]
Abstract
Purpose Investigational and marketed vaccines are increasingly evaluated, and manufacturers are required to put in place mechanisms to monitor long‐term benefit–risk profiles. However, generating such evidence in real‐world settings remains challenging, especially when rare adverse events are assessed. Planning of an appropriate study design is key to conducting a valid study. The aim of this paper is to illustrate how feasibility assessments support the generation of robust pharmacoepidemiological data. Methods Following an initiative launched by the International Society for Pharmacoepidemiology in May 2014, a working group including members of the private and public sectors, was formed to assess the value of conducting feasibility assessments as a necessary step before embarking on larger‐scale post‐licensure studies. Based on five real‐life examples of feasibility assessments, lessons learned and recommendations were issued by the working group to support scientific reasoning and decision making when designing pharmacoepidemiologic vaccine studies. Results The working group developed a toolbox to provide a pragmatic approach to conducting feasibility assessments. The toolbox contains two main components: the scientific feasibility and the operational feasibility. Both components comprise a series of specific questions aimed at overcoming methodological and operational challenges. Conclusions A feasibility assessment should be formalized as a necessary step prior to the actual start of any pharmacoepidemiologic study. It should remain a technical evaluation and not a hypothesis testing. The feasibility assessment report may facilitate communication with regulatory agencies toward improving the quality of study protocols and supporting the endorsement of study objectives and methods addressing regulatory commitments. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Affiliation(s)
- Corinne Willame
- Business and Decision Life Sciences on behalf of GSK Vaccines, Wavre, Belgium
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Skinner SR, Wheeler CM, Romanowski B, Castellsagué X, Lazcano-Ponce E, Del Rosario-Raymundo MR, Vallejos C, Minkina G, Pereira Da Silva D, McNeil S, Prilepskaya V, Gogotadze I, Money D, Garland SM, Romanenko V, Harper DM, Levin MJ, Chatterjee A, Geeraerts B, Struyf F, Dubin G, Bozonnat MC, Rosillon D, Baril L. Progression of HPV infection to detectable cervical lesions or clearance in adult women: Analysis of the control arm of the VIVIANE study. Int J Cancer 2016; 138:2428-38. [PMID: 26685704 PMCID: PMC4787275 DOI: 10.1002/ijc.29971] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 11/03/2015] [Accepted: 11/13/2015] [Indexed: 11/23/2022]
Abstract
The control arm of the phase III VIVIANE (Human PapillomaVIrus: Vaccine Immunogenicity ANd Efficacy; NCT00294047) study in women >25 years was studied to assess risk of progression from cervical HPV infection to detectable cervical intraepithelial neoplasia (CIN). The risk of detecting CIN associated with the same HPV type as the reference infection was analysed using Kaplan–Meier and multivariable Cox models. Infections were categorised depending upon persistence as 6‐month persistent infection (6MPI) or infection of any duration. The 4‐year interim analysis included 2,838 women, of whom 1,073 (37.8%) experienced 2,615 infections of any duration and 708 (24.9%) experienced 1,130 6MPIs. Infection with oncogenic HPV types significantly increased the risk of detecting CIN grade 2 or greater (CIN2+) versus non‐oncogenic types. For 6MPI, the highest risk was associated with HPV‐33 (hazard ratio [HR]: 31.9 [8.3–122.2, p < 0.0001]). The next highest risk was with HPV‐16 (21.1 [6.3–70.0], p < 0.0001). Similar findings were seen for infections of any duration. Significant risk was also observed for HPV‐18, HPV‐31, and HPV‐45. Concomitant HPV infection or CIN grade 1 or greater associated with a different oncogenic HPV type increased risk. Most women (79.3%) with an HPV infection at baseline cleared detectable infections of any duration, and 69.9% cleared a 6MPI. The risk of progression of HPV infection to CIN2+ in women >25 years in this study was similar to that in women 15–25 years in PATRICIA. What's New? Which HPV infections lead to cancer in women over 25 years? Most cervical cancer follows persistent oncogenic HPV infection, but most HPV infections clear naturally. Thus, to best predict patient outcomes, it's imperative to understand how HPV infections progress to CINs. This study confirmed that in women over 25 years, persistent infection with HPV‐33 or HPV‐16 meant the greatest chance of developing a CIN—the same as was found in women 15–25 years, in an earlier analysis.
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Affiliation(s)
- S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, WA and Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain
| | | | | | | | | | | | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Center and Capital Health, Dalhousie University, Halifax, NS, Canada
| | - Vera Prilepskaya
- Scientific Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | - Deborah Money
- University of British Columbia, The Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Children's Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | | | - Diane M Harper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA and University of Louisville School of Medicine, Louisville, KT, USA
| | - Myron J Levin
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Archana Chatterjee
- Department of Pediatrics, University of South Dakota Sanford School of Medicine/Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
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Willame C, Rosillon D, Zima J, Angelo MG, Stuurman AL, Vroling H, Boggon R, Bunge EM, Pladevall-Vila M, Baril L. Risk of new onset autoimmune disease in 9- to 25-year-old women exposed to human papillomavirus-16/18 AS04-adjuvanted vaccine in the United Kingdom. Hum Vaccin Immunother 2016; 12:2862-2871. [PMID: 27428517 PMCID: PMC5137515 DOI: 10.1080/21645515.2016.1199308] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To assess the risk of autoimmune disease (AD) in 9-25 year-old women within 1 year after the first AS04-HPV-16/18vaccine dose, a retrospective, observational database cohort study was conducted using CPRD GOLD. From CPRD GOLD 4 cohorts (65,000 subjects each) were retrieved: 1 exposed female cohort (received ≥1 AS04-HPV-16/18 vaccine dose between Sep2008-Aug2010) and 3 unexposed cohorts: historical female (Sep2005-Aug2007), concurrent male, and historical male. Co-primary endpoints were confirmed neuroinflammatory/ophthalmic AD and other AD, secondary endpoints were confirmed individual AD. Risk of new onset of AD was compared between cohorts (reference: historical cohort) using Poisson regression. The main analysis using confirmed cases showed no neuroinflammatory/ophthalmic AD cases in the female exposed cohort. Incidence rate ratio (IRR) (95% CI) of other AD was 1.41 (0.86 to 2.31) in female and 1.77 (0.94 to 3.35) in male cohorts when compared to the female and male historical cohort, respectively. Secondary endpoints were evaluated for diseases with >10 cases, which were Crohn's disease (IRR: 1.21 [0.37 to 3.95] for female and 4.22 [0.47 to 38.02] for male cohorts), autoimmune thyroiditis (IRR: 3.75 [1.25 to 11.31] for female and no confirmed cases for male cohorts) and type 1 diabetes (IRR: 0.30 [0.11 to 0.83] for female and 2.46 [1.08 to 5.60] for male cohorts). Analysis using confirmed and non-confirmed cases showed similar results, except for autoimmune thyroiditis in females, IRR: 1.45 (0.79 to 2.64). There was no evidence of an increased risk of AD in women aged 9 to 25 years after AS04-HPV-16/18 vaccination.
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Affiliation(s)
- Corinne Willame
- a Business & Decision Life Sciences on behalf of GSK Vaccines , Wavre , Belgium
| | | | | | | | - Anke L Stuurman
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands
| | - Hilde Vroling
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands
| | | | - Eveline M Bunge
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands
| | - Manel Pladevall-Vila
- e RTI Health Solutions , Barcelona , Spain.,f Center for Health Policy and Health Services Research , Henry Ford Health System , Detroit , MI , USA
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Herrant M, Loucoubar C, Boufkhed S, Bassène H, Sarr FD, Baril L, Mercereau-Puijalon O, Mécheri S, Sakuntabhai A, Paul R. Risk factors associated with asthma, atopic dermatitis and rhinoconjunctivitis in a rural Senegalese cohort. Allergy Asthma Clin Immunol 2015; 11:24. [PMID: 26306096 PMCID: PMC4547418 DOI: 10.1186/s13223-015-0090-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background The World Allergy Organization estimates that 40 % of the world’s population is affected by allergic diseases. The International Study of Asthma and Allergies in Childhood has completed Phase III and it has now become clear that these diseases have increased in developing countries, especially Africa, where prevalence rates were formerly low. Despite an increase in studies in Africa, few sub-Saharan West African countries are represented; the focus has remained on urban populations and little attention has been paid to rural sub-Saharan Africa. Methods We performed an allergy survey in a birth cohort of children aged less than 15 years in rural Senegal and implemented an ISAAC questionnaire. We carried out a complete blood count and serological analyses for IgE levels against common allergens and mosquito saliva. Results The prevalence rates of asthma, rhinoconjunctivitis (RC) and
atopic dermatitis (AD) were 12.8, 12.5 and 12.2 % respectively. Specific IgE (sIgE) levels against mosquito spp. salivary gland antigens were significantly associated with AD; sIgE levels against selected true grasses (Poaceae) were significantly associated with RC. sIgE levels against house dust mite spp. were not associated with asthma, but were significantly correlated with mosquito IgE levels. Such cross-reactivity may blur the association between HDM sIgE and asthma. Consumption of seafood, storing whey cream, using plant fibre bedding and presence of carpet were significantly associated with increased risk of RC. The association of seafood may be the result of histamine intoxication from molluscs prepared by putrefaction. Cat presence and dog contact were associated with increased risk of asthma. Cow contact was associated with increased risk of AD. Conclusions Our allergy study in rural West Africa revealed lower prevalence rates than the majority of African urban settings. Although several associated known risk factors were identified, there were associations specific to the region. The identification of probable artefactual dietary phenomena is a challenge for robust diagnosis of allergic disease. The association AD with mosquito saliva, a common allergen in rural settings, warrants specific attention. Further studies in rural Africa are needed to address the aetiology of allergy in a non-urban environment. Electronic supplementary material The online version of this article (doi:10.1186/s13223-015-0090-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magali Herrant
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France.,Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Cheikh Loucoubar
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France.,Institut Pasteur de Dakar, Group of Biostatistics, Bioinformatics and Modeling, Dakar, Senegal
| | - Sabah Boufkhed
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Hubert Bassène
- Institut de Recherche pour le Développement (IRD), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, URMITE CNRS-IRD 198 UMR 6236, Dakar, Senegal
| | - Fatoumata Diene Sarr
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Laurence Baril
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | | | - Salaheddine Mécheri
- Institut Pasteur, Unité de Biologie des Interactions Hôte Parasite, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 2581, 75724 Paris Cedex 15, France
| | - Anavaj Sakuntabhai
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France
| | - Richard Paul
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France
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Baril L, Rosillon D, Willame C, Angelo MG, Zima J, van den Bosch JH, Van Staa T, Boggon R, Bunge EM, Hernandez-Diaz S, Chambers CD. Risk of spontaneous abortion and other pregnancy outcomes in 15-25 year old women exposed to human papillomavirus-16/18 AS04-adjuvanted vaccine in the United Kingdom. Vaccine 2015. [PMID: 26206268 DOI: 10.1016/j.vaccine.2015.07.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed the risk of spontaneous abortion (SA) after inadvertent exposure to HPV-16/18-vaccine during pregnancy using an observational cohort design. METHODS The study population included women aged 15-25 years registered with the Clinical Practice Research Datalink General Practice OnLine Database in the United Kingdom (UK), who received at least one HPV-16/18-vaccine dose between 1st September 2008 and 30th June 2011. Exposed women had the first day of gestation between 30 days before and 45 days (90 days for the extended exposure period) after any HPV-16/18-vaccine dose. Non-exposed women had the first day of gestation 120 days-18 months after the last dose. SA defined as foetal loss between weeks 1 and 23 of gestation (UK definition). RESULTS The frequency of SA was 11.6% (among 207 exposed) and 9.0% (632 non-exposed), women: hazard ratio (HR) adjusted for age at first day of gestation 1.30 (95% confidence interval: 0.79-2.12). Sensitivity analysis per number of doses administered (-30 to +45-day risk period) showed a HR for SA of 1.11 (0.64-1.91) for 18/178 women with one dose during the risk period versus 2.55 (1.09-5.93) in 6/29 women with two doses within a 4-5 weeks period. The proportion of pre-term/full-term/postterm deliveries, small/large for gestational age infants, and birth defects was not significantly different between exposed and non-exposed women. Results were consistent using a (United States) SA definition of foetal loss between weeks 1-19 and/or the extended risk period. CONCLUSION There was no evidence of an increased risk of SA and other adverse pregnancy outcomes in young women inadvertently HPV-16/18-vaccinated around gestation. Nevertheless, women who are pregnant or trying to become pregnant are advised to postpone vaccination until completion of pregnancy.
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Affiliation(s)
- Laurence Baril
- GSK Vaccines, 20, Avenue Fleming, B-1300 Wavre, Belgium.
| | | | | | | | - Julia Zima
- GSK Vaccines, 20, Avenue Fleming, B-1300 Wavre, Belgium
| | | | | | | | - Eveline M Bunge
- Pallas, Health Research and Consultancy, Rotterdam, The Netherlands
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Castellsagué X, Paavonen J, Jaisamrarn U, Wheeler CM, Skinner SR, Lehtinen M, Naud P, Chow SN, Del Rosario-Raymundo MR, Teixeira JC, Palmroth J, de Carvalho NS, Germar MJV, Peters K, Garland SM, Szarewski A, Poppe WAJ, Romanowski B, Schwarz TF, Tjalma WAA, Bosch FX, Bozonnat MC, Struyf F, Dubin G, Rosillon D, Baril L. Risk of first cervical HPV infection and pre-cancerous lesions after onset of sexual activity: analysis of women in the control arm of the randomized, controlled PATRICIA trial. BMC Infect Dis 2014; 14:551. [PMID: 25927224 PMCID: PMC4251672 DOI: 10.1186/s12879-014-0551-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More information is needed about time between sexual initiation and human papillomavirus (HPV) infection and development of cervical precancer. METHODS The objectives were to investigate the time between first sexual activity and detection of first cervical HPV infection or development of first cervical intraepithelial neoplasia (CIN), and associated factors in women from the double-blind, multinational, 4-year PATRICIA trial. PATRICIA enroled women aged 15-25 years with no more than 6 lifetime sexual partners. Women were randomized 1:1 to the HPV-16/18 AS04-adjuvanted vaccine or to control, but only women from the control arm who began sexual intercourse during the study or within 6 months before enrolment, and had no HPV infection detected before the recorded date of their first sexual intercourse, were included in the present analysis. The time between onset of sexual activity and detection of the first cervical HPV infection or development of the first CIN lesion was analyzed using Kaplan-Meier and univariate and multivariable Cox proportional-hazards models. RESULTS A total of 9337 women were enroled in the control arm of PATRICIA of whom 982 fulfilled the required inclusion criteria for analysis. A cumulative total of 28%, 44%, and 62% of the subjects had HPV infection within 12, 24, and 48 months, respectively. The overall incidence rate was 27.08 per 100 person-years. The most common oncogenic types associated with 6-month persistent infection were HPV-16 (incidence rate: 2.74 per 100 person-years), HPV-51 (2.70), HPV-52 (1.66), HPV-66 (1.14), and HPV-18 (1.09). Increased infection risk was associated with more lifetime sexual partners, being single, Chlamydia trachomatis history, and duration of hormone use. CIN1+ and CIN2+ lesions were most commonly associated with HPV-16, with an overall incidence rate of 1.87 and 1.07 per 100 person-years, respectively. Previous cervical HPV infection was most strongly associated with CIN development. CONCLUSIONS More than 25% of women were infected with HPV within 1 year of beginning sexual activity. Without underestimating the value of vaccination at older ages, our findings emphasize its importance before sexual initiation. TRIAL REGISTRATION clinicaltrials.gov: NCT00122681 .
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Affiliation(s)
- Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Avda. Gran via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland.
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, WA and Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, NSW, Australia.
| | - Matti Lehtinen
- University of Tampere, School of Public Health, Tampere, Finland.
| | - Paulo Naud
- Hospital de Clínicas de Porto Alegre, Department of Gynecology & Obstetrics Federal University of Rio Grande do Sul - UFRGS/HCPA, Porto Alegre, Brazil.
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
| | | | - Julio C Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Campinas, Sao Paulo, Brazil.
| | - Johanna Palmroth
- Central Hospital of North Carelian, Department of Obstetrics and Gynecology, Joensuu, Finland.
| | - Newton S de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Parana, Brazil.
| | - Maria Julieta V Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippines General Hospital, Manila, Philippines.
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany.
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Children's Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Willy A J Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Leuven, Belgium.
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany.
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic and Gynaecological Oncology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium.
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Avda. Gran via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. .,Network on Cooperative Cancer Research, RTICC, Catalonia, Spain.
| | | | | | - Gary Dubin
- GlaxoSmithKline Vaccines, King of Prussia, PA, USA.
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Angelo MG, Taylor S, Struyf F, Tavares Da Silva F, Arellano F, David MP, Dubin G, Rosillon D, Baril L. Strategies for continuous evaluation of the benefit–risk profile of HPV-16/18-AS04-adjuvanted vaccine. Expert Rev Vaccines 2014; 13:1297-306. [DOI: 10.1586/14760584.2014.959931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Castellsagué X, Naud P, Chow SN, Wheeler CM, Germar MJV, Lehtinen M, Paavonen J, Jaisamrarn U, Garland SM, Salmerón J, Apter D, Kitchener H, Teixeira JC, Skinner SR, Limson G, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WAJ, Bosch FX, de Carvalho NS, Peters K, Tjalma WAA, Safaeian M, Raillard A, Descamps D, Struyf F, Dubin G, Rosillon D, Baril L. Risk of newly detected infections and cervical abnormalities in women seropositive for naturally acquired human papillomavirus type 16/18 antibodies: analysis of the control arm of PATRICIA. J Infect Dis 2014; 210:517-34. [PMID: 24610876 PMCID: PMC4111909 DOI: 10.1093/infdis/jiu139] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We examined risk of newly detected human papillomavirus (HPV) infection and cervical abnormalities in relation to HPV type 16/18 antibody levels at enrollment in PATRICIA (Papilloma Trial Against Cancer in Young Adults; NCT00122681). METHODS Using Poisson regression, we compared risk of newly detected infection and cervical abnormalities associated with HPV-16/18 between seronegative vs seropositive women (15-25 years) in the control arm (DNA negative at baseline for the corresponding HPV type [HPV-16: n = 8193; HPV-18: n = 8463]). RESULTS High titers of naturally acquired HPV-16 antibodies and/or linear trend for increasing antibody levels were significantly associated with lower risk of incident and persistent infection, atypical squamous cells of undetermined significance or greater (ASCUS+), and cervical intraepithelial neoplasia grades 1/2 or greater (CIN1+, CIN2+). For HPV-18, although seropositivity was associated with lower risk of ASCUS+ and CIN1+, no association between naturally acquired antibodies and infection was demonstrated. Naturally acquired HPV-16 antibody levels of 371 (95% confidence interval [CI], 242-794), 204 (95% CI, 129-480), and 480 (95% CI, 250-5756) EU/mL were associated with 90% reduction of incident infection, 6-month persistent infection, and ASCUS+, respectively. CONCLUSIONS Naturally acquired antibodies to HPV-16, and to a lesser extent HPV-18, are associated with some reduced risk of subsequent infection and cervical abnormalities associated with the same HPV type.
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Affiliation(s)
- Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia, IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Paulo Naud
- Department of Gynecology and Obstetrics, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan
| | - Cosette M Wheeler
- Department of Pathology and Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque
| | - Maria Julieta V Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, The Philippines
| | | | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Finland
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Childrens Research Institute Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, Mexico
| | - Dan Apter
- Family Federation of Finland, Sexual Health Clinic, Helsinki, Finland
| | - Henry Kitchener
- Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, United Kingdom
| | - Julio C Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Sao Paulo, Brazil
| | - S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, Western Australia Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Genara Limson
- College of Medicine, University of the Philippines, Philippine General Hospital, Makati Medical Centre, Makati City, The Philippines
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Fred Y Aoki
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Germany
| | - Willy A J Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Belgium
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia, IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Catalonia, Spain Network on Cooperative Cancer Research, RTICC, Catalonia, Spain
| | - Newton S de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Brazil
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic-Gynecologic Oncology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, Maryland
| | | | | | | | - Gary Dubin
- GlaxoSmithKline Vaccines, King of Prussia, Pennsylvania
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Angelo MG, David MP, Zima J, Baril L, Dubin G, Arellano F, Struyf F. Pooled analysis of large and long-term safety data from the human papillomavirus-16/18-AS04-adjuvanted vaccine clinical trial programme. Pharmacoepidemiol Drug Saf 2014; 23:466-79. [PMID: 24644063 PMCID: PMC4230467 DOI: 10.1002/pds.3554] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/24/2013] [Accepted: 11/05/2013] [Indexed: 12/21/2022]
Abstract
Purpose The purpose of this study is to further evaluate the safety of the human papillomavirus (HPV)-16/18-AS04-adjuvanted vaccine (HPV-16/18-vaccine Cervarix®, GlaxoSmithKline, Belgium) through a pooled analysis of data from 42 completed/ongoing clinical studies. Methods Unsolicited adverse events (AEs) were reported for 30 days after each dose. Medically significant conditions, serious AEs (SAEs), potential immune-mediated diseases (pIMDs) and pregnancy outcomes were captured until study completion. Events leading to subject withdrawal were reviewed. Relative risks compared incidences of spontaneous abortion and pIMDs in controlled studies. Results Thirty one thousand one hundred seventy-three adolescent girls/women received HPV-16/18-vaccine alone (HPV group), 2166 received HPV-16/18-vaccine coadministered with another vaccine and 24 241 were controls. Mean follow-up was 39 months (range 0–113.3). Incidences of unsolicited AEs reported within 30 days after any dose were similar between HPV and Control groups (30.8%/29.7%). During the entire study period, reports of medically significant conditions (25.0%/28.3%) and SAEs (7.9%/9.3%) were also similarly distributed between groups. Deaths were rare: HPV (alone/coadministered) n = 25, controls n = 20 (n = 18 in blinded groups). pIMDs within 1 year were reported by 0.2% of HPV-16/18 vaccinees and controls. For each pIMD event category, no increased relative risks were reported for HPV-16/18 vaccinees versus controls. Coadministration did not change the overall safety profile. Pregnancy outcomes and withdrawal rates were similar between groups. Conclusions Analysis of safety data arising from 57 580 subjects and 96 704 HPV-16/18-vaccine doses shows that the incidences and distribution of AEs were similar among HPV-16/18-vaccine recipients and controls. No new safety signals were identified. The data confirm previous findings that HPV-16/18-vaccine has an acceptable benefit-risk profile in adolescent girls and adult women.
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Angelo MG, Zima J, Tavares Da Silva F, Baril L, Arellano F. Post-licensure safety surveillance for human papillomavirus-16/18-AS04-adjuvanted vaccine: more than 4 years of experience. Pharmacoepidemiol Drug Saf 2014; 23:456-65. [PMID: 24644078 PMCID: PMC4265196 DOI: 10.1002/pds.3593] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 11/25/2022]
Abstract
Purpose To summarise post-licensure safety surveillance over more than 4 years of routine use of the human papillomavirus-16/18-AS04-adjuvanted vaccine (HPV-16/18 vaccine: Cervarix®, GlaxoSmithKline, Belgium). Methods We describe global post-licensure passive surveillance data based on routine pharmacovigilance from 18 May 2007 until 17 November 2011 and enhanced surveillance implemented during the 2-year national immunisation programme in the UK (school years 2008–2010). Results Spontaneous reports from countries worldwide showed a similar pattern for the most frequently reported adverse events after HPV-16/18 vaccination. No patterns or trends were observed for potential immune-mediated diseases after vaccination. Observed incidences of Bell's palsy and confirmed Guillain–Barré syndrome were within the expected range in the general population. Outcomes of pregnancy in women who were inadvertently exposed to HPV-16/18 vaccine during pregnancy, were in line with published reports for similar populations. Enhanced surveillance of adverse events in the UK triggered a review of cases of anaphylaxis, angioedema and syncope reports, leading to an update to the prescribing information. Conclusion Collaborative partnerships between industry and national regulatory agencies facilitated rapid notification and transfer of safety information, allowing for rapid responses in the event of a safety signal of adverse event of concern. More than 4 years of post-licensure experience may provide confidence to providers and the public about the safety profile of HPV-16/18 vaccine in routine use. The safety profile appears to be consistent with pre-licensure data reporting that HPV-16/18 vaccine has an acceptable benefit–risk profile in adolescent girls and women.
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Jaisamrarn U, Castellsagué X, Garland SM, Naud P, Palmroth J, Del Rosario-Raymundo MR, Wheeler CM, Salmerón J, Chow SN, Apter D, Teixeira JC, Skinner SR, Hedrick J, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WAJ, Bosch FX, de Carvalho NS, Germar MJ, Peters K, Paavonen J, Bozonnat MC, Descamps D, Struyf F, Dubin GO, Rosillon D, Baril L. Natural history of progression of HPV infection to cervical lesion or clearance: analysis of the control arm of the large, randomised PATRICIA study. PLoS One 2013; 8:e79260. [PMID: 24260180 PMCID: PMC3834039 DOI: 10.1371/journal.pone.0079260] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The control arm of PATRICIA (PApilloma TRIal against Cancer In young Adults, NCT00122681) was used to investigate the risk of progression from cervical HPV infection to cervical intraepithelial neoplasia (CIN) or clearance of infection, and associated determinants. METHODS AND FINDINGS Women aged 15-25 years were enrolled. A 6-month persistent HPV infection (6MPI) was defined as detection of the same HPV type at two consecutive evaluations over 6 months and clearance as ≥2 type-specific HPV negative samples taken at two consecutive intervals of approximately 6 months following a positive sample. The primary endpoint was CIN grade 2 or greater (CIN2+) associated with the same HPV type as a 6MPI. Secondary endpoints were CIN1+/CIN3+ associated with the same HPV type as a 6MPI; CIN1+/CIN2+/CIN3+ associated with an infection of any duration; and clearance of infection. The analyses included 4825 women with 16,785 infections (3363 women with 6902 6MPIs). Risk of developing a CIN1+/CIN2+/CIN3+ associated with same HPV type as a 6MPI varied with HPV type and was significantly higher for oncogenic versus non-oncogenic types. Hazard ratios for development of CIN2+ were 10.44 (95% CI: 6.96-15.65), 9.65 (5.97-15.60), 5.68 (3.50-9.21), 5.38 (2.87-10.06) and 3.87 (2.38-6.30) for HPV-16, HPV-33, HPV-31, HPV-45 and HPV-18, respectively. HPV-16 or HPV-33 6MPIs had ~25-fold higher risk for progression to CIN3+. Previous or concomitant HPV infection or CIN1+ associated with a different HPV type increased risk. Of the different oncogenic HPV types, HPV-16 and HPV-31 infections were least likely to clear. CONCLUSIONS Cervical infections with oncogenic HPV types increased the risk of CIN2+ and CIN3+. Previous or concomitant infection or CIN1+ also increased the risk. HPV-16 and HPV-33 have by far the highest risk of progression to CIN3+, and HPV-16 and HPV-31 have the lowest chance of clearance.
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Affiliation(s)
- Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Suzanne M. Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Childrens Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Paulo Naud
- Department of Gynecology & Obstetrics, Federal University of Rio Grande do Sul, UFRGS/HCPA - Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Johanna Palmroth
- Central Hospital of North Carelian, Department of Obstetrics and Gynecology, Joensuu, Finland
| | | | - Cosette M. Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, Mexico
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan
| | - Dan Apter
- Family Federation of Finland, Sexual Health Clinic, Helsinki, Finland
| | - Julio C. Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Campinas, Sao Paulo, Brazil
| | - S. Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, Western Australia
- Sydney University Discipline of Paediatrics and Child Health, Children’s Hospital, Westmead, Sydney, New South Wales, Australia
| | - James Hedrick
- Kentucky Pediatric and Adult Research, Bardstown, Kentucky, United States of America
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fred Y. Aoki
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tino F. Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Willy A. J. Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Leuven, Belgium
| | - F. Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP, L’Hospitalet de Llobregat, Catalonia, Spain
- Network on Cooperative Cancer Research, RTICC, Catalonia, Spain
| | - Newton S. de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Parana, Brazil
| | - Maria Julieta Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland
| | | | | | | | - Gary O. Dubin
- GlaxoSmithKline Vaccines, King of Prussia, Pennsylvania, United States of America
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Herrant M, Loucoubar C, Bassène H, Gonçalves B, Boufkhed S, Diene Sarr F, Fontanet A, Tall A, Baril L, Mercereau-Puijalon O, Mécheri S, Sakuntabhai A, Paul R. Asthma and atopic dermatitis are associated with increased risk of clinical Plasmodium falciparum malaria. BMJ Open 2013; 3:bmjopen-2013-002835. [PMID: 23883878 PMCID: PMC3731724 DOI: 10.1136/bmjopen-2013-002835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the impact of atopy and allergy on the risk of clinical malaria. DESIGN A clinical and immunological allergy cross-sectional survey in a birth cohort of 175 children from 1 month to 14 years of age followed for up to 15 years in a longitudinal open cohort study of malaria in Senegal. Malaria incidence data were available for 143 of these children (aged 4 months to 14 years of age) for up to 15 years. Mixed-model regression analysis was used to determine the impact of allergy status on malaria incidence, adjusting for age, gender, sickle-cell trait and force of infection. MAIN OUTCOME MEASURES Asthma, allergic rhinoconjunctivitis and atopic dermatitis status, the number of clinical Plasmodium falciparum malaria episodes since birth and associated parasite density. RESULTS 12% of the children were classified as asthmatic and 10% as having atopic dermatitis. These groups had respectively a twofold (OR 2.12 95%; CI 1.46 to 3.08; p=8×10(-5)) and threefold (OR 3.15; 1.56 to 6.33; p=1.3×10(-3)) increase in the risk of clinical P falciparum malaria once older than the age of peak incidence of clinical malaria (3-4 years of age). They also presented with higher P falciparum parasite densities (asthma: mean 105.3 parasites/μL±SE 41.0 vs 51.3±9.7; p=6.2×10(-3). Atopic dermatitis: 135.4±70.7 vs 52.3±11.0; p=0.014). There was no effect of allergy on the number of non-malaria clinical presentations. Individuals with allergic rhinoconjunctivitis did not have an increased risk of clinical malaria nor any difference in parasite densities. CONCLUSIONS These results demonstrate that asthma and atopic dermatitis delay the development of clinical immunity to P falciparum. Despite the encouraging decrease in malaria incidence rates in Africa, a significant concern is the extent to which the increase in allergy will exacerbate the burden of malaria. Given the demonstrated antiparasitic effect of antihistamines, administration to atopic children will likely reduce the burden of clinical malaria in these children, increase the efficacy of first-line treatment antimalarials and alleviate the non-infectious consequences of atopy.
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Affiliation(s)
- Magali Herrant
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, CNRS URA3012, Paris, France
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Cheikh Loucoubar
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, CNRS URA3012, Paris, France
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
- INSERM, U946, Genetic Variation and Human Diseases Unit,Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Paris, France
| | - Hubert Bassène
- Institut de Recherche pour le Développement (IRD), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, URMITE CNRS-IRD 198 UMR 6236, Dakar, Sénégal
| | - Bronner Gonçalves
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Sabah Boufkhed
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Fatoumata Diene Sarr
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Arnaud Fontanet
- Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
- Conservatoire National des Arts et Métiers, Paris, France
| | - Adama Tall
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Laurence Baril
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | | | - Salaheddine Mécheri
- Institut Pasteur, Unité de Biologie des Interactions Hôte Parasite, Paris, France
- Centre National de la Recherche Scientifique, Unité de Recherche Associée 2581, Paris, France
| | - Anavaj Sakuntabhai
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, CNRS URA3012, Paris, France
- Complex Systems Group, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Richard Paul
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, CNRS URA3012, Paris, France
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