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Whistler T, Sangwichian O, Jorakate P, Sawatwong P, Surin U, Piralam B, Thamthitiwat S, Promkong C, Peruski L. Identification of Gram negative non-fermentative bacteria: How hard can it be? PLoS Negl Trop Dis 2019; 13:e0007729. [PMID: 31568511 PMCID: PMC6786646 DOI: 10.1371/journal.pntd.0007729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/10/2019] [Accepted: 08/25/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The prevalence of bacteremia caused by Gram negative non-fermentative (GNNF) bacteria has been increasing globally over the past decade. Many studies have investigated their epidemiology but focus on the common GNNF including Pseudomonas aeruginosa and Acinetobacter baumannii. Knowledge of the uncommon GNNF bacteremias is very limited. This study explores invasive bloodstream infection GNNF isolates that were initially unidentified after testing with standard microbiological techniques. All isolations were made during laboratory-based surveillance activities in two rural provinces of Thailand between 2006 and 2014. METHODS A subset of GNNF clinical isolates (204/947), not identified by standard manual biochemical methodologies were run on the BD Phoenix automated identification and susceptibility testing system. If an organism was not identified (12/204) DNA was extracted for whole genome sequencing (WGS) on a MiSeq platform and data analysis performed using 3 web-based platforms: Taxonomer, CGE KmerFinder and One Codex. RESULTS The BD Phoenix automated identification system recognized 92% (187/204) of the GNNF isolates, and because of their taxonomic complexity and high phenotypic similarity 37% (69/187) were only identified to the genus level. Five isolates grew too slowly for identification. Antimicrobial sensitivity (AST) data was not obtained for 93/187 (50%) identified isolates either because of their slow growth or their taxa were not in the AST database associated with the instrument. WGS identified the 12 remaining unknowns, four to genus level only. CONCLUSION The GNNF bacteria are of increasing concern in the clinical setting, and our inability to identify these organisms and determine their AST profiles will impede treatment. Databases for automated identification systems and sequencing annotation need to be improved so that opportunistic organisms are better covered.
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Affiliation(s)
- Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Possawat Jorakate
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Pongpun Sawatwong
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Uraiwan Surin
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Barameht Piralam
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Somsak Thamthitiwat
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Chidchanok Promkong
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Tomczyk S, McCracken JP, Contreras CL, Lopez MR, Bernart C, Moir JC, Escobar K, Reyes L, Arvelo W, Lindblade K, Peruski L, Bryan JP, Verani JR. Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala. BMC Public Health 2019; 19:499. [PMID: 31053069 PMCID: PMC6498661 DOI: 10.1186/s12889-019-6824-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. Methods We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician’s discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. Results Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. Conclusions Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.
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Affiliation(s)
- Sara Tomczyk
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Carmen Lucia Contreras
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Quetzaltenango Health Area, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Kenneth Escobar
- Western Regional Hospital San Juan de Dios, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Lisette Reyes
- Santa Rosa Health Area, Ministry of Public Health and Social Welfare, Cuilapa, Guatemala
| | - Wences Arvelo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kim Lindblade
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Joe P Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
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3
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Albetkova A, Isadore J, Ridderhof J, Ned-Sykes R, Maryogo-Robinson L, Blank E, Cognat S, Dolmazon V, Gasquet P, Rayfield M, Peruski L. Critical gaps in laboratory leadership to meet global health security goals. Bull World Health Organ 2018; 95:547-547A. [PMID: 28804163 PMCID: PMC5537757 DOI: 10.2471/blt.17.195883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Adilya Albetkova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America (USA)
| | - Jocelyn Isadore
- Association of Public Health Laboratories, Silver Spring, USA
| | - John Ridderhof
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, USA
| | - Renee Ned-Sykes
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Eric Blank
- Association of Public Health Laboratories, Silver Spring, USA
| | | | | | | | - Mark Rayfield
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America (USA)
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America (USA)
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4
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Gilbert A, Greenberg L, Moran D, Alvarez D, Alvarado M, Garcia DL, Peruski L. Antibody response of cattle to vaccination with commercial modified live rabies vaccines in Guatemala. Prev Vet Med 2014; 118:36-44. [PMID: 25466762 DOI: 10.1016/j.prevetmed.2014.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 10/07/2014] [Accepted: 10/17/2014] [Indexed: 01/31/2023]
Abstract
Vampire bat rabies is a public and animal health concern throughout Latin America. As part of an ecological study of vampire bat depredation on cattle in southern Guatemala, we conducted a vaccine seroconversion study among three dairy farms. The main objectives of this cross sectional and cohort study were to understand factors associated with bat bites among cattle, to determine whether unvaccinated cattle had evidence of rabies virus exposure and evaluate whether exposure was related to bat bite prevalence, and to assess whether cattle demonstrate adequate seroconversion to two commercial vaccines used in Guatemala. In 2012, baseline blood samples were collected immediately prior to intramuscular inoculation of cattle with one of two modified live rabies vaccines. Post vaccination blood samples were collected 13 and 393 days later. Sera were tested for rabies virus neutralizing antibodies (rVNA) by the rapid fluorescent focus inhibition test (RFFIT). Across two years of study, 36% (254/702) of inspected cattle presented gross evidence of vampire bat bites. Individual cattle with a bat bite in 2012 were more likely have a bat bite in 2013. Prior to vaccination, 12% (42/350) of cattle sera demonstrated rVNA, but bite status in 2012 was not associated with presence of rVNA. Vaccine brand was the only factor associated with adequate rVNA response of cattle by day 13. However, vaccine brand and rVNA status at day 13 were associated with an adequate rVNA titer on day 393, with animals demonstrating an adequate titer at day 13 more likely to have an adequate titer at day 393. Our findings support stable levels of vampire bat depredation and evidence of rVNA in unvaccinated cattle. Brand of vaccine may be an important consideration impacting adequate rVNA response and long-term maintenance of rVNA in cattle. Further, the results demonstrate that initial response to vaccination is associated with rVNA status over one year following vaccination.
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Affiliation(s)
- Amy Gilbert
- National Wildlife Research Center, USDA/APHIS/Wildlife Services, 4101 La Porte Avenue, Fort Collins, CO 80521, USA.
| | - Lauren Greenberg
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - David Moran
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Danilo Alvarez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Marlon Alvarado
- Ministerio de Agricultura, Ganadería y Alimentación, Guatemala City, Guatemala
| | - Daniel L Garcia
- Centers for Disease Control and Prevention Regional Office for Central America and Panama, Guatemala City, Guatemala.
| | - Leonard Peruski
- Centers for Disease Control and Prevention Regional Office for Central America and Panama, Guatemala City, Guatemala.
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5
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Wallace RM, Bhavnani D, Russell J, Zaki S, Muehlenbachs A, Hayden-Pinneri K, Aplícano RM, Peruski L, Vora NM, Elson D, Lederman E, Leeson B, McLaughlin T, Waterman S, Fonseca-Ford M, Blanton J, Franka R, Velasco-Villa A, Niezgoda M, Orciari L, Recuenco S, Damon I, Hanlon C, Jackson F, Dyer J, Wadhwa A, Robinson L. Rabies death attributed to exposure in Central America with symptom onset in a U.S. detention facility - Texas, 2013. MMWR Morb Mortal Wkly Rep 2014; 63:446-9. [PMID: 24848216 PMCID: PMC4584916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
On June 7, 2013, a man was diagnosed in a Texas hospital with rabies. He had been detained in a U.S. detention facility during his infectious period. To identify persons exposed to rabies who might require rabies postexposure prophylaxis (PEP), CDC and the Texas Department of State Health Services (DSHS) conducted investigations at four detention facilities, one medical clinic, and two hospitals. In all, 25 of 742 persons assessed for rabies exposure were advised to receive PEP. Early diagnosis of rabies is essential for implementation of appropriate hospital infection control measures and for rapid assessment of potential contacts for PEP recommendations.
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Affiliation(s)
- Ryan M. Wallace
- EIS officer, CDC,Corresponding author: Ryan M. Wallace, , 404-639-2018
| | - Darlene Bhavnani
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - John Russell
- Texas A&M Health Science Center, Christus Spohn Hospital, Corpus Christi, Texas
| | - Sherif Zaki
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Atis Muehlenbachs
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | | | - Leonard Peruski
- Division of Global Health Protection, Center for Global Health, CDC
| | | | - Diana Elson
- Public Health, Safety, and Preparedness Unit, Immigrations and Customs Enforcement
| | - Edith Lederman
- Public Health, Safety, and Preparedness Unit, Immigrations and Customs Enforcement
| | - Ben Leeson
- Texas A&M Health Science Center, Christus Spohn Hospital, Corpus Christi, Texas
| | - Thomas McLaughlin
- Texas A&M Health Science Center, Christus Spohn Hospital, Corpus Christi, Texas
| | - Steve Waterman
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Maureen Fonseca-Ford
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jesse Blanton
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Richard Franka
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Andres Velasco-Villa
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Michael Niezgoda
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Lillian Orciari
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Sergio Recuenco
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Inger Damon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Cathleen Hanlon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Felix Jackson
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jessie Dyer
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Ashutosh Wadhwa
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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6
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Harris JR, Lindsley MD, Henchaichon S, Poonwan N, Naorat S, Prapasiri P, Chantra S, Ruamcharoen F, Chang LS, Chittaganpitch M, Mehta N, Peruski L, Maloney SA, Park BJ, Baggett HC. High prevalence of cryptococcal infection among HIV-infected patients hospitalized with pneumonia in Thailand. Clin Infect Dis 2011; 54:e43-50. [PMID: 22198791 PMCID: PMC7108015 DOI: 10.1093/cid/cir903] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is a major cause of death among HIV-infected patients. Cryptococcal antigenemia (CrAg+) in the absence of CM can represent early-stage cryptococcosis during which antifungal treatment might improve outcomes. However, patients without meningitis are rarely tested for cryptococcal infection. We evaluated Cryptococcus species as a cause of acute respiratory infection in hospitalized patients in Thailand and evaluated clinical characteristics associated with CrAg+. METHODS We tested banked serum samples from 704 human immunodeficiency virus (HIV)-infected and 730 HIV-uninfected patients hospitalized with acute respiratory infection from 2004 through 2009 in 2 rural provinces in Thailand for the presence of CrAg+. Retrospective chart reviews were conducted for CrAg+ patients to distinguish meningeal and nonmeningeal cryptococcosis and to identify clinical characteristics associated with CrAg+ in patients with and without evidence of CM. RESULTS CrAg+ was found in 92 HIV-infected patients (13.1%); only tuberculosis (19.3%) and rhinovirus (16.5%) were identified more frequently. No HIV-uninfected patients were CrAg+. Of 70 CrAg+ patients with medical charts available, 37 (52.9%) had no evidence of past or existing CM at hospitalization; 30 of those patients (42.9% of all CrAg+) had neither past nor existing CM, nor any alternate etiology of infection identified. Dyspnea was more frequent among CrAg+ patients without CM than among CrAg- patients (P = .0002). CONCLUSIONS Cryptococcus species were the most common pathogens detected in HIV-infected patients hospitalized with acute respiratory infection in Thailand. Few clinical differences were found between antigenemic and nonantigenemic HIV-infected patients. Health care providers in Thailand should evaluate HIV-infected patients hospitalized with acute respiratory infection for cryptococcal antigenemia, even in the absence of meningitis.
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Affiliation(s)
- Julie R Harris
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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7
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Marin N, Pittayawonganon C, Thammawijaya P, Kiatkulwiwat W, Prapasiri P, Baggett H, Peruski L, Thamthitiwat S. Neonatal BCG Bacteremia - Thailand 2006–2007. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.1350] [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: 11/16/2022] Open
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8
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Heller MB, Bunning ML, France ME, Niemeyer DM, Peruski L, Naimi T, Talboy PM, Murray PH, Pietz HW, Kornblum J, Oleszko W, Beatrice ST. Laboratory response to anthrax bioterrorism, New York City, 2001. Emerg Infect Dis 2002; 8:1096-102. [PMID: 12396923 PMCID: PMC2730291 DOI: 10.3201/eid0810.020376] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory's (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and and quality control are also described.
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Affiliation(s)
| | | | - Martin E.B. France
- Warfighting Concepts and Architecture Integration Division (J-8), The Joint Staff, Washington, D.C., USA
| | - Debra M. Niemeyer
- Joint Program Office for Biological Defense, Falls Church, Virginia, USA
| | | | - Tim Naimi
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Harald W. Pietz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Kornblum
- New York City Department of Health, New York, New York, USA
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9
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Naficy AB, Abu-Elyazeed R, Holmes JL, Rao MR, Savarino SJ, Kim Y, Wierzba TF, Peruski L, Lee YJ, Gentsch JR, Glass RI, Clemens JD. Epidemiology of rotavirus diarrhea in Egyptian children and implications for disease control. Am J Epidemiol 1999; 150:770-7. [PMID: 10512431 DOI: 10.1093/oxfordjournals.aje.a010080] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [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: 11/12/2022] Open
Abstract
Reliable epidemiologic data are essential for formulating effective policy to control rotavirus disease through immunization. The objective of this study was to describe the epidemiology of rotavirus diarrhea in a population-based cohort of children under 3 years of age residing in Abu Homos, Egypt, in 1995-1996. Rotavirus diarrhea incidence rates (episodes per person-year) were 0.13 for infants aged <6 months, 0.61 for those aged 6-11 months, 0.17 for those aged 12-23 months, and 0.15 for those aged 24-35 months. Fifty-six percent of children with rotavirus diarrhea had clinical dehydration; 90% of rotavirus diarrheal episodes occurred between July and November. In infants under 1 year of age, receipt of breast milk was associated with a lower incidence of rotavirus diarrhea. No other sociodemographic or environmental factor was found to be significantly associated with rotavirus diarrhea. Of 46 rotavirus isolates with strains identified, 41 (89%) were G serotypes 1 and 2. Rotavirus diarrhea was a major cause of morbidity in this cohort. Promotion of breastfeeding may exert a protective effect in young infants in this setting, but improvements in water and sanitation are unlikely to be effective preventive measures. The use of effective immunization against rotavirus in early infancy should be considered a public health priority.
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Affiliation(s)
- A B Naficy
- Epidemiology Branch, National Institute of Child Health and Human Development, Bethesda, MD 20852, USA
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10
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Savarino SJ, Hall ER, Bassily S, Brown FM, Youssef F, Wierzba TF, Peruski L, El-Masry NA, Safwat M, Rao M, El Mohamady H, Abu-Elyazeed R, Naficy A, Svennerholm AM, Jertborn M, Lee YJ, Clemens JD. Oral, inactivated, whole cell enterotoxigenic Escherichia coli plus cholera toxin B subunit vaccine: results of the initial evaluation in children. PRIDE Study Group. J Infect Dis 1999; 179:107-14. [PMID: 9841829 DOI: 10.1086/314543] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [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] [Indexed: 11/03/2022] Open
Abstract
Two randomized, double-blinded trials assessed the safety and immunogenicity of an oral, killed enterotoxigenic Escherichia coli (ETEC) plus cholera toxin B subunit vaccine in Egyptian children. Two doses of vaccine or E. coli K-12 were given 2 weeks apart to 105 6- to 12-year-olds and 97 2- to 5-year-olds. Safety was monitored for 3 days after each dose. Blood was collected before immunization and 7 days after each dose to measure immune responses. Few children reported postdosing symptoms, with no differences in the frequency of symptoms between treatment groups. Most vaccinees had an IgA antibody-secreting cell response against colonization factor antigen I (100%, 6-12 years; 95%, 2-5 years), coli surface antigen 2 (92%, 6-12 years; 83%, 2-5 years), and coli surface antigen 4 (93%, 6-12 years). Vaccination evoked a >/=4-fold rise in antitoxic IgA and IgG titers in 93% and 81% of children, respectively. In conclusion, the oral ETEC vaccine was safe and immunogenic in 2- to 12-year-old children, justifying further evaluation in infants.
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Affiliation(s)
- S J Savarino
- US Naval Medical Research Unit Number 3, Bethesda, MD, USA.
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11
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Savarino SJ, Brown FM, Hall E, Bassily S, Youssef F, Wierzba T, Peruski L, El-Masry NA, Safwat M, Rao M, Jertborn M, Svennerholm AM, Lee YJ, Clemens JD. Safety and immunogenicity of an oral, killed enterotoxigenic Escherichia coli-cholera toxin B subunit vaccine in Egyptian adults. J Infect Dis 1998; 177:796-9. [PMID: 9498468 DOI: 10.1086/517812] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Enterotoxigenic Escherichia coli (ETEC) is the leading cause of bacterial diarrhea in young children in developing countries. The safety and immunogenicity of a killed, oral ETEC vaccine consisting of whole cells plus recombinantly produced cholera toxin B subunit (rCTB) was evaluated in Egypt, which is endemic for ETEC diarrhea. Seventy-four healthy Egyptian adults (21-45 years old) were randomized and received two doses of the ETEC/rCTB vaccine (E003) or placebo 2 weeks apart. The frequency of adverse events after either dose did not differ by treatment group, and no severe adverse events were reported. After vaccination, peripheral blood IgA B cell responses to CTB (100%) and to vaccine colonization factor antigens CFA/I (94%), CS4 (100%), CS2 (81%), and CS1 (69%) were significantly higher than response rates for the placebo group. These favorable results in Egyptian adults indicate that the ETEC/rCTB vaccine is a promising candidate for evaluation in younger age groups in this setting.
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Affiliation(s)
- S J Savarino
- US Naval Medical Research Unit No. 3, Cairo, Egypt.
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12
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Oyofo BA, el-Etr SH, Wasfy MO, Peruski L, Kay B, Mansour M, Campbell JR, Svennerholm AM, Churilla AM, Murphy JR. Colonization factors of enterotoxigenic E. coli (ETEC) from residents of northern Egypt. Microbiol Res 1995; 150:429-36. [PMID: 8564370 DOI: 10.1016/s0944-5013(11)80027-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Infection caused by enterotoxigenic Escherichia coli (ETEC) poses a serious health problem to children in developing countries. Colonization of the small intestinal mucosa by ETEC strains is mediated by antigenically specific fimbriae, also known as colonization factor antigens (CFA). The importance of this study arises from reports that active and passive immunization with ETEC strains harboring CFAs induced protective immunity against diarrhea in animal models with preformed antibodies. In humans, ETEC containing CFA/I, II, III and IV have been identified. The aim of this study was to define CFAs of ETEC isolated in Alexandria, Egypt. One hundred and seven ETEC isolates from 132 human residents in Alexandria, Egypt were isolated during a birth cohort study. ETEC isolates were screened for heat labile (LT) and heat stable (ST) toxins using a 32P oligonucleotide hybridization probe and a GM1 ELISA. These isolates were examined using monoclonal antibodies against CFA/I, II, III, IV, and against the putative colonization antigens PCF0159 and PCF0166, CS 7 and CS 17. CFAs were found in 48% of ETEC strains. CFA/I was found in 18% of the strains, CFA/II in 10% and CFA/IV in 14%. CFA III was not found. All fifteen strains expressing CFA/IV expressed CS6 and produced ST. CFA/IV was not found in non-ST producing strains, while CFA/I was absent in ST-only producing strains.
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Affiliation(s)
- B A Oyofo
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
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