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Mentzer AJ, Dilthey AT, Pollard M, Gurdasani D, Karakoc E, Carstensen T, Muhwezi A, Cutland C, Diarra A, da Silva Antunes R, Paul S, Smits G, Wareing S, Kim H, Pomilla C, Chong AY, Brandt DYC, Nielsen R, Neaves S, Timpson N, Crinklaw A, Lindestam Arlehamn CS, Rautanen A, Kizito D, Parks T, Auckland K, Elliott KE, Mills T, Ewer K, Edwards N, Fatumo S, Webb E, Peacock S, Jeffery K, van der Klis FRM, Kaleebu P, Vijayanand P, Peters B, Sette A, Cereb N, Sirima S, Madhi SA, Elliott AM, McVean G, Hill AVS, Sandhu MS. High-resolution African HLA resource uncovers HLA-DRB1 expression effects underlying vaccine response. Nat Med 2024; 30:1384-1394. [PMID: 38740997 DOI: 10.1038/s41591-024-02944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/25/2024] [Indexed: 05/16/2024]
Abstract
How human genetic variation contributes to vaccine effectiveness in infants is unclear, and data are limited on these relationships in populations with African ancestries. We undertook genetic analyses of vaccine antibody responses in infants from Uganda (n = 1391), Burkina Faso (n = 353) and South Africa (n = 755), identifying associations between human leukocyte antigen (HLA) and antibody response for five of eight tested antigens spanning pertussis, diphtheria and hepatitis B vaccines. In addition, through HLA typing 1,702 individuals from 11 populations of African ancestry derived predominantly from the 1000 Genomes Project, we constructed an imputation resource, fine-mapping class II HLA-DR and DQ associations explaining up to 10% of antibody response variance in our infant cohorts. We observed differences in the genetic architecture of pertussis antibody response between the cohorts with African ancestries and an independent cohort with European ancestry, but found no in silico evidence of differences in HLA peptide binding affinity or breadth. Using immune cell expression quantitative trait loci datasets derived from African-ancestry samples from the 1000 Genomes Project, we found evidence of differential HLA-DRB1 expression correlating with inferred protection from pertussis following vaccination. This work suggests that HLA-DRB1 expression may play a role in vaccine response and should be considered alongside peptide selection to improve vaccine design.
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Affiliation(s)
- Alexander J Mentzer
- Centre for Human Genetics, University of Oxford, Oxford, UK.
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
| | - Alexander T Dilthey
- Centre for Human Genetics, University of Oxford, Oxford, UK
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital of Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | | | | | | | | | - Allan Muhwezi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Clare Cutland
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amidou Diarra
- Groupe de Recherche Action en Santé (GRAS) 06 BP 10248, Ouagadougou, Burkina Faso
| | | | - Sinu Paul
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Gaby Smits
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan Wareing
- Microbiology Department, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | | | | | - Amanda Y Chong
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Debora Y C Brandt
- Department of Integrative Biology, University of California at Berkeley, California, CA, USA
| | - Rasmus Nielsen
- Department of Integrative Biology, University of California at Berkeley, California, CA, USA
| | - Samuel Neaves
- Avon Longitudinal Study of Parents and Children at University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicolas Timpson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Austin Crinklaw
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | - Anna Rautanen
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Dennison Kizito
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tom Parks
- Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Kate E Elliott
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Tara Mills
- Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Katie Ewer
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Nick Edwards
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Segun Fatumo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- The Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine London, London, UK
| | - Emily Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine London, London, UK
| | - Sarah Peacock
- Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Katie Jeffery
- Microbiology Department, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Bjorn Peters
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alessandro Sette
- Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Sodiomon Sirima
- Groupe de Recherche Action en Santé (GRAS) 06 BP 10248, Ouagadougou, Burkina Faso
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine London, London, UK
| | - Gil McVean
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Adrian V S Hill
- Centre for Human Genetics, University of Oxford, Oxford, UK
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Manjinder S Sandhu
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK.
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Butler-Laporte G, Auckland K, Noor Z, Kabir M, Alam M, Carstensen T, Wojcik GL, Chong AY, Pomilla C, Noble JA, McDevitt SL, Smits G, Wareing S, van der Klis FRM, Jeffery K, Kirkpatrick BD, Sirima S, Madhi S, Elliott A, Richards JB, Hill AVS, Duggal P, Sandhu MS, Haque R, Petri WA, Mentzer AJ. Targeting hepatitis B vaccine escape using immunogenetics in Bangladeshi infants. medRxiv 2023:2023.06.26.23291885. [PMID: 37425840 PMCID: PMC10327284 DOI: 10.1101/2023.06.26.23291885] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Hepatitis B virus (HBV) vaccine escape mutants (VEM) are increasingly described, threatening progress in control of this virus worldwide. Here we studied the relationship between host genetic variation, vaccine immunogenicity and viral sequences implicating VEM emergence. In a cohort of 1,096 Bangladeshi children, we identified human leukocyte antigen (HLA) variants associated with response vaccine antigens. Using an HLA imputation panel with 9,448 south Asian individuals DPB1*04:01 was associated with higher HBV antibody responses (p=4.5×10-30). The underlying mechanism is a result of higher affinity binding of HBV surface antigen epitopes to DPB1*04:01 dimers. This is likely a result of evolutionary pressure at the HBV surface antigen 'a-determinant' segment incurring VEM specific to HBV. Prioritizing pre-S isoform HBV vaccines may tackle the rise of HBV vaccine evasion.
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Affiliation(s)
- Guillaume Butler-Laporte
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Kathryn Auckland
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Zannatun Noor
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mamun Kabir
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Masud Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tommy Carstensen
- Wellcome Trust Sanger Institute, University of Cambridge, Hinxton, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Genevieve L Wojcik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amanda Y Chong
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Cristina Pomilla
- Wellcome Trust Sanger Institute, University of Cambridge, Hinxton, United Kingdom
| | - Janelle A Noble
- Children’s Hospital Oakland Research Institute, Oakland, California, USA
- Department of Pediatrics, University of California, San Francisco, California, USA
| | | | - Gaby Smits
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan Wareing
- Microbiology Department, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | - Fiona RM van der Klis
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Katie Jeffery
- Microbiology Department, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | - Beth D Kirkpatrick
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont College of Medicine, Vermont, USA
| | - Sodiomon Sirima
- Groupe de Recherche Action en Santé (GRAS) 06 BP 10248 Ouagadougou, Burkina Faso
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Elliott
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - J Brent Richards
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- 5 Prime Sciences Inc, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Twin Research, King’s College London, London, United Kingdom
| | - Adrian VS Hill
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Manjinder S Sandhu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - William A Petri
- Department of Medicine, Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
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3
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Cicconi P, Wells C, McCarthy B, Wareing S, Andersson MI, Fox J, Lwanga J, Pal N, Burns F, Woodward C, Malek R, Sabin CA, Dorrell L. Re-valuation of annual cytology using HPV self-sampling to upgrade prevention (REACH UP): A feasibility study in women living with HIV in the UK. HIV Med 2022; 23:390-396. [PMID: 35243750 PMCID: PMC9314078 DOI: 10.1111/hiv.13257] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022]
Abstract
Introduction Current UK guidelines for cervical cancer screening are based on the assumption that most women living with HIV (WLWH) are also high‐risk (HR) human papillomavirus (HPV)‐positive. We aimed to provide data on prevalence of HR‐HPV in WLWH in the UK and to assess feasibility and acceptability of HR‐HPV self‐sampling in this group. Methods Women living with HIV attending six HIV services in London/south of England, with no history of cervical cancer, were enrolled. Participants self‐collected a vaginal swab for the detection of HR‐HPV, completed a survey about sexual/gynaecological history, attitudes towards annual screening and perception of HR‐HPV self‐sampling, and were asked to have their annual cervical smear. Results In all, 67 women were included: 86.5% were of black ethnicity, the median (range) age was 47 (24–60) years, median CD4 T‐cell count was 683 cells/µL [interquartile range (IQR): 527–910], and 95.4% had viral load ≤ 50 copies/mL. All performed the vaginal swab. Eighteen (27%) had no cervical smear results; none of these women attended HIV services where this was routinely offered. No cervical samples were positive for HR‐HPV. Three‐quarters (75.8%) of participants reported adherence to annual screening, with only one woman (1.5%) attending irregularly. On visual analogue scales (from 0 to 100), median (IQR) acceptability and necessity of smear tests were 100 (75–100) and 100 (85–100), respectively. Conclusions Our results suggest that the prevalence of HR‐HPV in WLWH in the UK may be low. Self‐sampling seems to be acceptable, suggesting, if validated, its potential role in supporting less frequent smear testing and improving screening uptake in WLWH.
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Affiliation(s)
- Paola Cicconi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Wells
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Blanka McCarthy
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan Wareing
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Monique Ingrid Andersson
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Nisha Pal
- The Garden Clinic, Upton Hospital, Slough, UK
| | - Fiona Burns
- Institute for Global Health University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Clare Woodward
- HIV and Genitourinary Medicine, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, UK
| | - Ramona Malek
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Caroline Anne Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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Wareing S, Sethares KA, Chin E, Ayotte B. Entry and Passage Variables Associated with Nursing Home Adjustment in Older Adults with Dementia. Geriatr Nurs 2021; 42:1084-1092. [PMID: 34418841 DOI: 10.1016/j.gerinurse.2021.06.016] [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: 04/05/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
A theory-guided non-experimental, descriptive, correlational design was used to evaluate how entry and passage variables were related to nursing home adjustment for individuals with dementia. Older adults with dementia may be unable to speak for themselves, therefore proxy responses of Certified Nursing Assistants (CNAs) provided the data for completion of the Nursing Home Adjustment Scale.1 Guided by the Meleis' Theory of Transitions, entry level factors (i.e. age, previous residence, gender, and choice), and passage variables (i.e. length of stay, extent of dementia, functional abilities, and depression) were entered into a regression equation as predictors of nursing home adjustment. Information about extent of dementia, functional abilities and depression was derived from the Minimum Data Set (MDS) maintained for all residents per Medicare and Medicaid guidelines. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 26.0 software. Results indicated an inverse relationship between nursing home adjustment and depression as measured by the PHQ-9. There was no support for relationships among other variables. CNA proxy responses were found to be reliable in that they were significantly correlated with nursing responses on the same measure. This study supports the use of CNA proxy responses as a method to evaluate the experience of individuals with dementia.
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Affiliation(s)
- Susan Wareing
- Tristan Medical LLC, University of Massachusetts Dartmouth, United States.
| | | | | | - Brian Ayotte
- University of Massachusetts Dartmouth, United States
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5
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Brown JS, Khan A, Wareing S, Schache AG. A new classification of mandibular fractures. Int J Oral Maxillofac Surg 2021; 51:78-90. [PMID: 34092451 DOI: 10.1016/j.ijom.2021.02.012] [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: 07/01/2020] [Revised: 11/11/2020] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Abstract
There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II+condyle, III; body/symphysis, IIIc; III+condyle, IV; multiple fractures not including condyle, IVc; IV+condyle, V; bilateral condyle±other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18-23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.
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Affiliation(s)
- J S Brown
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
| | - A Khan
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - S Wareing
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - A G Schache
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Wareing S, Sethares KA. Personal, social and cultural factors affecting elders' transitions to long term care: Certified nursing assistant perspectives. Appl Nurs Res 2021; 59:151419. [PMID: 33947513 DOI: 10.1016/j.apnr.2021.151419] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/19/2022]
Abstract
A focus group methodology was employed to elicit information from Certified Nursing Assistants (CNAs) about their views of the personality, social, institutional and cultural factors that affect the success or failure of elders' adaptation to nursing home life. The focus group (N = 6) was conducted in one long-term care facility. CNAs identified three themes that represent the process of successful adaptation to the nursing home. Emotional displacement was followed by a period of assimilation and acceptance. Resident personality, social, institutional and cultural characteristics that may affect each stage of the process are described. This study supports previous findings regarding the contribution of social-environmental elements in the adjustment process. CNA perceptions of factors that assist elders during the transition process proved to be a valuable source of information.
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Affiliation(s)
- Susan Wareing
- University of Massachusetts Dartmouth, Tristan Medical LLC, United States of America.
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Ainsworth M, Andersson M, Auckland K, Baillie JK, Barnes E, Beer S, Beveridge A, Bibi S, Blackwell L, Borak M, Bown A, Brooks T, Burgess-Brown NA, Camara S, Catton M, Chau KK, Christott T, Clutterbuck E, Coker J, Cornall RJ, Cox S, Crawford-Jones D, Crook DW, D'Arcangelo S, Dejnirattsai W, Dequaire JMM, Dimitriadis S, Dingle KE, Doherty G, Dold C, Dong T, Dunachie SJ, Ebner D, Emmenegger M, Espinosa A, Eyre DW, Fairhead R, Fassih S, Feehily C, Felle S, Fernandez-Cid A, Fernandez Mendoza M, Foord TH, Fordwoh T, Fox McKee D, Frater J, Gallardo Sanchez V, Gent N, Georgiou D, Groves CJ, Hallis B, Hammond PM, Hatch SB, Harvala HJ, Hill J, Hoosdally SJ, Horsington B, Howarth A, James T, Jeffery K, Jones E, Justice A, Karpe F, Kavanagh J, Kim DS, Kirton R, Klenerman P, Knight JC, Koukouflis L, Kwok A, Leuschner U, Levin R, Linder A, Lockett T, Lumley SF, Marinou S, Marsden BD, Martinez J, Martins Ferreira L, Mason L, Matthews PC, Mentzer AJ, Mobbs A, Mongkolsapaya J, Morrow J, Mukhopadhyay SMM, Neville MJ, Oakley S, Oliveira M, Otter A, Paddon K, Pascoe J, Peng Y, Perez E, Perumal PK, Peto TEA, Pickford H, Ploeg RJ, Pollard AJ, Richardson A, Ritter TG, Roberts DJ, Rodger G, Rollier CS, Rowe C, Rudkin JK, Screaton G, Semple MG, Sienkiewicz A, Silva-Reyes L, Skelly DT, Sobrino Diaz A, Stafford L, Stockdale L, Stoesser N, Street T, Stuart DI, Sweed A, Taylor A, Thraves H, Tsang HP, Verheul MK, Vipond R, Walker TM, Wareing S, Warren Y, Wells C, Wilson C, Withycombe K, Young RK. Performance characteristics of five immunoassays for SARS-CoV-2: a head-to-head benchmark comparison. Lancet Infect Dis 2020; 20:1390-1400. [PMID: 32979318 PMCID: PMC7511171 DOI: 10.1016/s1473-3099(20)30634-4] [Citation(s) in RCA: 260] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic in 2020. Testing is crucial for mitigating public health and economic effects. Serology is considered key to population-level surveillance and potentially individual-level risk assessment. However, immunoassay performance has not been compared on large, identical sample sets. We aimed to investigate the performance of four high-throughput commercial SARS-CoV-2 antibody immunoassays and a novel 384-well ELISA. METHODS We did a head-to-head assessment of SARS-CoV-2 IgG assay (Abbott, Chicago, IL, USA), LIAISON SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Saluggia, Italy), Elecsys Anti-SARS-CoV-2 assay (Roche, Basel, Switzerland), SARS-CoV-2 Total assay (Siemens, Munich, Germany), and a novel 384-well ELISA (the Oxford immunoassay). We derived sensitivity and specificity from 976 pre-pandemic blood samples (collected between Sept 4, 2014, and Oct 4, 2016) and 536 blood samples from patients with laboratory-confirmed SARS-CoV-2 infection, collected at least 20 days post symptom onset (collected between Feb 1, 2020, and May 31, 2020). Receiver operating characteristic (ROC) curves were used to assess assay thresholds. FINDINGS At the manufacturers' thresholds, for the Abbott assay sensitivity was 92·7% (95% CI 90·2-94·8) and specificity was 99·9% (99·4-100%); for the DiaSorin assay sensitivity was 96·2% (94·2-97·7) and specificity was 98·9% (98·0-99·4); for the Oxford immunoassay sensitivity was 99·1% (97·8-99·7) and specificity was 99·0% (98·1-99·5); for the Roche assay sensitivity was 97·2% (95·4-98·4) and specificity was 99·8% (99·3-100); and for the Siemens assay sensitivity was 98·1% (96·6-99·1) and specificity was 99·9% (99·4-100%). All assays achieved a sensitivity of at least 98% with thresholds optimised to achieve a specificity of at least 98% on samples taken 30 days or more post symptom onset. INTERPRETATION Four commercial, widely available assays and a scalable 384-well ELISA can be used for SARS-CoV-2 serological testing to achieve sensitivity and specificity of at least 98%. The Siemens assay and Oxford immunoassay achieved these metrics without further optimisation. This benchmark study in immunoassay assessment should enable refinements of testing strategies and the best use of serological testing resource to benefit individuals and population health. FUNDING Public Health England and UK National Institute for Health Research.
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8
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Andersson MI, Arancibia-Carcamo CV, Auckland K, Baillie JK, Barnes E, Beneke T, Bibi S, Brooks T, Carroll M, Crook D, Dingle K, Dold C, Downs LO, Dunn L, Eyre DW, Gilbert Jaramillo J, Harvala H, Hoosdally S, Ijaz S, James T, James W, Jeffery K, Justice A, Klenerman P, Knight JC, Knight M, Liu X, Lumley SF, Matthews PC, McNaughton AL, Mentzer AJ, Mongkolsapaya J, Oakley S, Oliveira MS, Peto T, Ploeg RJ, Ratcliff J, Robbins MJ, Roberts DJ, Rudkin J, Russell RA, Screaton G, Semple MG, Skelly D, Simmonds P, Stoesser N, Turtle L, Wareing S, Zambon M. SARS-CoV-2 RNA detected in blood products from patients with COVID-19 is not associated with infectious virus. Wellcome Open Res 2020; 5:181. [PMID: 33283055 PMCID: PMC7689603 DOI: 10.12688/wellcomeopenres.16002.2] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood. Methods: We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=462 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples. Results: We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/494 (0%, 95%CI 0-0.7%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA. There was a relationship between RT-PCR negativity and the presence of total SARS-CoV-2 antibody (p=0.02). Conclusions: vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19.
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Affiliation(s)
- Monique I. Andersson
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Carolina V. Arancibia-Carcamo
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Kathryn Auckland
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - J. Kenneth Baillie
- Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Eleanor Barnes
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Tom Beneke
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Sagida Bibi
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Tim Brooks
- Porton Down, Public Health England, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, UK
| | - Miles Carroll
- Porton Down, Public Health England, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, UK
| | - Derrick Crook
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Kate Dingle
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Christina Dold
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Louise O. Downs
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Laura Dunn
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - David W. Eyre
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Big Data Institute, Roosevelt Drive, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Javier Gilbert Jaramillo
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Heli Harvala
- NHS Blood and Transfusion, 26 Margaret St, Marylebone, London, W1W 8NB, UK
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Sarah Hoosdally
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Samreen Ijaz
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Tim James
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Anita Justice
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Paul Klenerman
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Julian C. Knight
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Michael Knight
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Xu Liu
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Sheila F. Lumley
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Philippa C. Matthews
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Anna L. McNaughton
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Alexander J. Mentzer
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | | | - Sarah Oakley
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Marta S. Oliveira
- NHS Blood and Transplant, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Timothy Peto
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Rutger J. Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Jeremy Ratcliff
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Melanie J. Robbins
- Component Development Laboratory, NHS Blood and Transplant, Cambridge Donor Centre, Cambridge, CB2 0PT, UK
| | - David J. Roberts
- NHS Blood and Transplant, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Justine Rudkin
- Big Data Institute, Roosevelt Drive, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Nuffield Department of Population Health, University Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Rebecca A. Russell
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Gavin Screaton
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Donal Skelly
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Peter Simmonds
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Nicole Stoesser
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Susan Wareing
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Maria Zambon
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
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9
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Lumley SF, Eyre DW, McNaughton AL, Howarth A, Hoosdally S, Hatch SB, Kavanagh J, Chau KK, Downs LO, Cox S, Dunn L, Justice A, Wareing S, Dingle K, Rudkin J, Auckland K, Fyfe A, Bolton J, Paton R, Mentzer AJ, Jeffery K, Andersson MI, James T, Peto TEA, Marsden BD, Screaton G, Cornall RJ, Klenerman P, Ebner D, Stuart DI, Crook DW, Stoesser N, Kennedy SH, Thompson C, Gupta S, Matthews PC. SARS-CoV-2 antibody prevalence, titres and neutralising activity in an antenatal cohort, United Kingdom, 14 April to 15 June 2020. Euro Surveill 2020; 25:2001721. [PMID: 33094717 PMCID: PMC7651878 DOI: 10.2807/1560-7917.es.2020.25.41.2001721] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022] Open
Abstract
SARS-CoV-2 IgG screening of 1,000 antenatal serum samples in the Oxford area, United Kingdom, between 14 April and 15 June 2020, yielded a 5.3% seroprevalence, mirroring contemporaneous regional data. Among the 53 positive samples, 39 showed in vitro neutralisation activity, correlating with IgG titre (Pearson's correlation p<0.0001). While SARS-CoV-2 seroprevalence in pregnancy cohorts could potentially inform population surveillance, clinical correlates of infection and immunity in pregnancy, and antenatal epidemiology evolution over time need further study.
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Affiliation(s)
- Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
| | - David W Eyre
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- These authors contributed equally to this work
| | - Alison Howarth
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sarah Hoosdally
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephanie B Hatch
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - James Kavanagh
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kevin K Chau
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Louise O Downs
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stuart Cox
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Laura Dunn
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Anita Justice
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Susan Wareing
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kate Dingle
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Justine Rudkin
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Kathryn Auckland
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander Fyfe
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Jai Bolton
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Robert Paton
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Alexander J Mentzer
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katie Jeffery
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Monique I Andersson
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tim E A Peto
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Brian D Marsden
- Structural Genomics Consortium, Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford, United Kingdom
- The Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building, Roosevelt Dr, Headington, Oxford, United Kingdom
- Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Gavin Screaton
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Richard J Cornall
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniel Ebner
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - David I Stuart
- Structural Genomics Consortium, Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford, United Kingdom
- The Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building, Roosevelt Dr, Headington, Oxford, United Kingdom
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Derrick W Crook
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicole Stoesser
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Craig Thompson
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Sunetra Gupta
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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10
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Wareing J, Wareing S, Power A, Chambers P. “Pseudoaneurysm” of a nasogastric tube. Br J Oral Maxillofac Surg 2020; 58:1052-1053. [DOI: 10.1016/j.bjoms.2020.03.015] [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] [Received: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
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11
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Andersson MI, Arancibia-Carcamo CV, Auckland K, Baillie JK, Barnes E, Beneke T, Bibi S, Brooks T, Carroll M, Crook D, Dingle K, Dold C, Downs LO, Dunn L, Eyre DW, Gilbert Jaramillo J, Harvala H, Hoosdally S, Ijaz S, James T, James W, Jeffery K, Justice A, Klenerman P, Knight JC, Knight M, Liu X, Lumley SF, Matthews PC, McNaughton AL, Mentzer AJ, Mongkolsapaya J, Oakley S, Oliveira MS, Peto T, Ploeg RJ, Ratcliff J, Robbins MJ, Roberts DJ, Rudkin J, Russell RA, Screaton G, Semple MG, Skelly D, Simmonds P, Stoesser N, Turtle L, Wareing S, Zambon M. SARS-CoV-2 RNA detected in blood products from patients with COVID-19 is not associated with infectious virus. Wellcome Open Res 2020; 5:181. [PMID: 33283055 PMCID: PMC7689603 DOI: 10.12688/wellcomeopenres.16002.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/13/2023] Open
Abstract
Background: Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood. Methods: We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=462 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples. Results: We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/494 (0%, 95%CI 0-0.7%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA. Conclusions: vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19.
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Affiliation(s)
- Monique I. Andersson
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Carolina V. Arancibia-Carcamo
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Kathryn Auckland
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - J. Kenneth Baillie
- Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Eleanor Barnes
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Tom Beneke
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Sagida Bibi
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Tim Brooks
- Porton Down, Public Health England, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, UK
| | - Miles Carroll
- Porton Down, Public Health England, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, UK
| | - Derrick Crook
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Kate Dingle
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Christina Dold
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Louise O. Downs
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Laura Dunn
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - David W. Eyre
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Big Data Institute, Roosevelt Drive, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Javier Gilbert Jaramillo
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Heli Harvala
- NHS Blood and Transfusion, 26 Margaret St, Marylebone, London, W1W 8NB, UK
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Sarah Hoosdally
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Samreen Ijaz
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Tim James
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - William James
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Katie Jeffery
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Anita Justice
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Paul Klenerman
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Julian C. Knight
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Michael Knight
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Xu Liu
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Sheila F. Lumley
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Philippa C. Matthews
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Anna L. McNaughton
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Alexander J. Mentzer
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | | | - Sarah Oakley
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Marta S. Oliveira
- NHS Blood and Transplant, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Timothy Peto
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre (BRC), John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Rutger J. Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Jeremy Ratcliff
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Melanie J. Robbins
- Component Development Laboratory, NHS Blood and Transplant, Cambridge Donor Centre, Cambridge, CB2 0PT, UK
| | - David J. Roberts
- NHS Blood and Transplant, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Justine Rudkin
- Big Data Institute, Roosevelt Drive, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Nuffield Department of Population Health, University Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Rebecca A. Russell
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Gavin Screaton
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Malcolm G. Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Donal Skelly
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Peter Simmonds
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Nicole Stoesser
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Nuffield Department of Medicine, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Susan Wareing
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Maria Zambon
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
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12
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McNaughton AL, Lourenço J, Hattingh L, Adland E, Daniels S, Van Zyl A, Akiror CS, Wareing S, Jeffery K, Ansari MA, Klenerman P, Goulder PJR, Gupta S, Jooste P, Matthews PC. HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model. BMC Med 2019; 17:43. [PMID: 30786896 PMCID: PMC6383254 DOI: 10.1186/s12916-019-1269-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sustainable Development Goals set a challenge for the elimination of hepatitis B virus (HBV) infection as a public health concern by the year 2030. Deployment of a robust prophylactic vaccine and enhanced interventions for prevention of mother to child transmission (PMTCT) are cornerstones of elimination strategy. However, in light of the estimated global burden of 290 million cases, enhanced efforts are required to underpin optimisation of public health strategy. Robust analysis of population epidemiology is particularly crucial for populations in Africa made vulnerable by HIV co-infection, poverty, stigma and poor access to prevention, diagnosis and treatment. METHODS We here set out to evaluate the current and future role of HBV vaccination and PMTCT as tools for elimination. We first investigated the current impact of paediatric vaccination in a cohort of children with and without HIV infection in Kimberley, South Africa. Second, we used these data to inform a new parsimonious model to simulate the ongoing impact of preventive interventions. By applying these two approaches in parallel, we are able to determine both the current impact of interventions, and the future projected outcome of ongoing preventive strategies over time. RESULTS Existing efforts have been successful in reducing paediatric prevalence of HBV infection in this setting to < 1%, demonstrating the success of the existing vaccine campaign. Our model predicts that, if consistently deployed, combination efforts of vaccination and PMTCT can significantly reduce population prevalence (HBsAg) by 2030, such that a major public health impact is possible even without achieving elimination. However, the prevalence of HBV e-antigen (HBeAg)-positive carriers will decline more slowly, representing a persistent population reservoir. We show that HIV co-infection significantly reduces titres of vaccine-mediated antibody, but has a relatively minor role in influencing the projected time to elimination. Our model can also be applied to other settings in order to predict impact and time to elimination based on specific interventions. CONCLUSIONS Through extensive deployment of preventive strategies for HBV, significant positive public health impact is possible, although time to HBV elimination as a public health concern is likely to be substantially longer than that proposed by current goals.
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Affiliation(s)
- Anna L. McNaughton
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - José Lourenço
- Department of Zoology, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Louise Hattingh
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Emily Adland
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Samantha Daniels
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Anriette Van Zyl
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Connie S. Akiror
- Global Healthcare Public Foundation, Makindu Lane, Kololo, Kampala, Uganda
| | - Susan Wareing
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - M. Azim Ansari
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Paul Klenerman
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - Philip J. R. Goulder
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Sunetra Gupta
- Department of Zoology, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Pieter Jooste
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Philippa C. Matthews
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
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13
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Sharp CP, Gregory WF, Hattingh L, Malik A, Adland E, Daniels S, van Zyl A, Carlson JM, Wareing S, Ogwu A, Shapiro R, Riddell L, Chen F, Ndung'u T, Goulder PJR, Klenerman P, Simmonds P, Jooste P, Matthews PC. PARV4 prevalence, phylogeny, immunology and coinfection with HIV, HBV and HCV in a multicentre African cohort. Wellcome Open Res 2017; 2:26. [PMID: 28497124 PMCID: PMC5423528 DOI: 10.12688/wellcomeopenres.11135.1] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: The seroprevalence of human parvovirus-4 (PARV4) varies considerably by region. In sub-Saharan Africa, seroprevalence is high in the general population, but little is known about the transmission routes or the prevalence of coinfection with blood-borne viruses, HBV, HCV and HIV.
Methods: To further explore the characteristics of PARV4 in this setting, with a particular focus on the prevalence and significance of coinfection, we screened a cohort of 695 individuals recruited from Durban and Kimberley (South Africa) and Gaborone (Botswana) for PARV4 IgG and DNA, as well as documenting HIV, HBV and HCV status.
Results: Within these cohorts, 69% of subjects were HIV-positive. We identified no cases of HCV by PCR, but 7.4% were positive for HBsAg. PARV4 IgG was positive in 42%; seroprevalence was higher in adults (69%) compared to children (21%) (p<0.0001) and in HIV-positive (52%) compared to HIV-negative individuals (24%) (p<0.0001), but there was no association with HBsAg status. We developed an on-line tool to allow visualization of coinfection data (
https://purl.oclc.org/coinfection-viz). We identified five subjects who were PCR-positive for PARV4 genotype-3.
Ex vivo CD8+ T cell responses spanned the entire PARV4 proteome and we propose a novel HLA-B*57:03-restricted epitope within the NS protein.
Conclusions: This characterisation of PARV4 infection provides enhanced insights into the epidemiology of infection and co-infection in African cohorts, and provides the foundations for planning further focused studies to elucidate transmission pathways, immune responses, and the clinical significance of this organism.
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Affiliation(s)
- Colin P Sharp
- Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK.,Edinburgh Genomics, University of Edinburgh, Edinburgh, EH9 3FL, UK
| | | | - Louise Hattingh
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | - Amna Malik
- Department of Paediatrics, University of Oxford, Oxford, OX1 3SY, UK
| | - Emily Adland
- Department of Paediatrics, University of Oxford, Oxford, OX1 3SY, UK
| | - Samantha Daniels
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | - Anriette van Zyl
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | | | - Susan Wareing
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Anthony Ogwu
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lynn Riddell
- Northampton General Hospital NHS Trust, Northampton, NN1 5BD, UK
| | - Fabian Chen
- Royal Berkshire Hospital, Reading, RG1 5AN, UK
| | - Thumbi Ndung'u
- HIV Pathogenesis Program, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4041, South Africa
| | | | - Paul Klenerman
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK.,NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
| | - Pieter Jooste
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | - Philippa C Matthews
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
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14
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Jooste P, van Zyl A, Adland E, Daniels S, Hattingh L, Brits A, Wareing S, Goedhals D, Jeffery K, Andersson M, Goulder P, Matthews PC. Screening, characterisation and prevention of Hepatitis B virus (HBV) co-infection in HIV-positive children in South Africa. J Clin Virol 2016; 85:71-74. [PMID: 27838494 PMCID: PMC5142290 DOI: 10.1016/j.jcv.2016.10.017] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND In South Africa, the first HBV vaccine dose is administered at age 6 weeks, leaving a potential window for vertical transmission. Insights into HBV seroprevalence in the vulnerable HIV-infected group are important to drive improvements in surveillance, treatment and prevention. OBJECTIVES We set out to implement a screening program for HBV among HIV-infected children and adolescents in Kimberley, South Africa. Our aims were to demonstrate that screening is feasible and sustainable, to establish the prevalence of HBV, to characterise the HBV cases we identified, and to inform discussion about the infant vaccination schedule. STUDY DESIGN We tested all HIV positive children (age 0-16) for Hepatitis B surface antigen (HBsAg), delivering this testing as part of routine state-funded care. We followed up HBsAg-positive cases with an extended panel of HBV serology tests, and HBV DNA viral load quantification. RESULTS Our screening campaign was successfully incorporated into routine out-patient care. Among 625 patients tested, we found five positive for HBsAg (0.8%), of whom three were Hepatitis B e-antigen positive. Two additional children initially tested HBsAg-positive but were negative on repeat testing. Antiviral therapy in the HBsAg children was reviewed and adjusted if required. CONCLUSIONS The results testify to the overall success of the HBV vaccine campaign. However, we have demonstrated that ongoing vigilance is required to detect cases and prevent transmission events. Further evaluation of the optimum timing of the first vaccine HBV vaccine dose is required; a vaccine dose at birth could reduce prevalence further.
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Affiliation(s)
- Pieter Jooste
- Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa
| | - Anriette van Zyl
- Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa
| | - Emily Adland
- Department of Paediatrics, Peter Medawar Building, South Parks Road, Oxford OX1 3SY, UK
| | - Samantha Daniels
- Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa
| | - Louise Hattingh
- Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa
| | - Alethea Brits
- Department of Paediatrics, Kimberley Hospital, Kimberley, South Africa
| | - Susan Wareing
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Dominique Goedhals
- Department of Medical Microbiology and Virology, National Health Laboratory Service, University of the Free State, Bloemfontein, South Africa
| | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Philip Goulder
- Department of Paediatrics, Peter Medawar Building, South Parks Road, Oxford OX1 3SY, UK
| | - Philippa C Matthews
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK; Nuffield Department of Medicine, Peter Medawar Building, South Parks Road, Oxford OX1 3SY, UK.
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Abstract
Jembrana disease virus (JDV) is a newly recognised bovine lentivirus causing an acute disease syndrome in Bali cattle (Bos javanicus) in Indonesia. We evaluated the effect of JDV infection on the antibody response to chicken ovalbumin (cOVA) and Brucella abortus Strain 19 in Bali cattle. In infected cattle the IgG and IgM response to cOVA was suppressed and delayed and the IgG response to B. abortus Strain 19 was delayed. The results indicate that the humoral immune response is suppressed and delayed in JDV infected cattle.
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Affiliation(s)
- S Wareing
- Division of Veterinary and Biomedical Sciences, Murdoch University, WA, Australia.
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16
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Read S, Wareing S, Parmar S, Gray J, Desselberger U. The development of a specimen exchange system for quality assessment of polymerase chain reaction tests. Commun Dis Public Health 1998; 1:56-8. [PMID: 9718843] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A programme of external quality assessment of polymerase chain reaction (PCR) assays through regular exchange of appropriate clinical or spiked specimens between Oxford and Cambridge public health laboratories began in February 1997. We report on 60 specimens included in the exchange. These covered most of the molecular diagnostic assays in use at present. In two cases discrepant results were obtained. We conclude that the exchange of specimens under code between laboratories that use molecular techniques as a diagnostic service is an inexpensive way of achieving regular external quality assessment.
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Affiliation(s)
- S Read
- Oxford Public Health Laboratory, John Radcliffe Hospital, Headington
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