المؤلفون: Bennett, Aisleen, Pollock, Louisa, Bar-Zeev, Naor, Lewnard, Joseph A, Jere, Khuzwayo C, Lopman, Benjamin, Iturriza-Gomara, Miren, Pitzer, Virginia E, Cunliffe, Nigel A

المصدر: The Lancet Infectious Diseases. 21(5)

مصطلحات موضوعية: Medical Microbiology, Biomedical and Clinical Sciences, Clinical Research, Prevention, Vaccine Related, Digestive Diseases, Biodefense, Pediatric, Infectious Diseases, Immunization, Foodborne Illness, Aetiology, 3.4 Vaccines, 2.4 Surveillance and distribution, Prevention of disease and conditions, and promotion of well-being, Infection, Good Health and Well Being, Adolescent, Adult, Child, Child, Preschool, Cohort Studies, Databases, Factual, Diarrhea, Family Characteristics, Feces, Female, Humans, Immunoglobulin A, Incidence, Malawi, Male, Middle Aged, Prospective Studies, Rotavirus, Rotavirus Infections, Rotavirus Vaccines, Vaccination, Young Adult, Clinical Sciences, Public Health and Health Services, Microbiology, Clinical sciences, Medical microbiology, Epidemiology

الوصف: BackgroundRotavirus vaccine effectiveness is reduced among children in low-income countries. Indirect (transmission-mediated) effects of rotavirus vaccine might contribute to the total population effect of vaccination. We aimed to examine risk factors for transmission of rotavirus to household contacts in Blantyre, Malawi, and estimated the effectiveness of rotavirus vaccine in preventing transmission of infection to household contacts.MethodsIn this prospective household cohort study, we recruited children born after Sept 17, 2012, and aged at least 6 weeks (vaccine-eligible children) with acute rotavirus gastroenteritis and their household contacts, in four government health facilities in Blantyre, Malawi. Clinical data, a bulk stool sample, and 1-2 mL of serum were collected from case children at presentation. Clinical data and stool samples were also prospectively collected from household contacts over 14 days from presentation. A single stool sample was collected from control households containing asymptomatic children who were frequency age-matched to case children. Samples were tested for rotavirus using semi-quantitative real-time PCR and for anti-rotavirus IgA using a semi-quantitative sandwich ELISA. Risk factors for household transmission of rotavirus infection and clinical disease, including disease severity and faecal shedding density, were identified using mixed effects logistic regression. Vaccine effectiveness against transmission was estimated as 1 minus the ratio of secondary attack rates in vaccinated and counterfactual unvaccinated populations, using vaccine effectiveness estimates from the associated diarrhoeal surveillance platform to estimate the counterfactual secondary attack rate without vaccination.FindingsBetween Feb 16, 2015, and Nov 11, 2016, we recruited 196 case households (705 members) and 55 control households (153 members). Household secondary attack rate for rotavirus infection was high (434 [65%] of 665 individuals) and secondary attack rate for clinical disease was much lower (37 [5%] of 698). Asymptomatic infection in control households was common (40 [28%] of 144). Increasing disease severity in an index child (as measured by Vesikari score) was associated with increased risk of transmission of infection (odds ratio 1·17 [95% CI 1·06-1·30) and disease (1·28 [1·08-1·52]) to household contacts. Estimated vaccine effectiveness against transmission was 39% (95% CI 16-57).InterpretationRotavirus vaccine has the potential to substantially reduce household rotavirus transmission. This finding should be considered in clinical and health economic assessments of vaccine effectiveness.FundingWellcome Trust, US National Institutes of Health, and US National Institute of Allergy and Infectious Diseases.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3nb539r0Test

المؤلفون: Horne, Bri'Anna, Badji, Henry, Bhuiyan, Md Taufiqur Rahman, Romaina Cachique, Lucero, Cornick, Jennifer, Hotwani, Aneeta, Juma, Jane, Ochieng, John Benjamin, Abdou, Mahamadou, Apondi, Evans, Atlas, Hannah E, Awuor, Alex O, Baker, Kate S, Ceesay, Bubacarr E, Charles, Mary, Cunliffe, Nigel A, Feutz, Erika, Galagan, Sean R, Guindo, Ibrehima, Hossain, M Jahangir, Iqbal, Junaid, Jallow, Fatima, Keita, Noumou Yakhouba, Khanam, Farhana, Kotloff, Karen L, Maiden, Victor, Manzanares Villanueva, Katia, Mito, Oscar, Mosharraf, Md Parvej, Nkeze, Joseph, Ikumapayi, Usman N, Paredes Olortegui, Maribel, Pavlinac, Patricia B, Pinedo Vasquez, Tackeshy, Qadri, Firdausi, Qamar, Farah Naz, Qureshi, Sonia, Rahman, Nazia, Sangare, Aminata, Sen, Sunil, Peñataro Yori, Pablo, Yousafzai, Mohammad Tahir, Ahmed, Dilruba, Jere, Khuzwayo C, Kosek, Margaret N, Omore, Richard, Permala-Booth, Jasnehta, Secka, Ousman, Tennant, Sharon M

مصطلحات موضوعية: Shigella, children, diarrhea, dysentery, microbiology

الوصف: Funder: UKRI; DOI: https://doi.org/10.13039/100014013Test ; BACKGROUND: Shigella is a major cause of diarrhea in young children worldwide. Multiple vaccines targeting Shigella are in development, and phase 3 clinical trials are imminent to determine efficacy against shigellosis. METHODS: The Enterics for Global Health (EFGH) Shigella surveillance study is designed to determine the incidence of medically attended shigellosis in 6- to 35-month-old children in 7 resource-limited settings. Here, we describe the microbiological methods used to isolate and identify Shigella. We developed a standardized laboratory protocol for isolation and identification of Shigella by culture. This protocol was implemented across all 7 sites, ensuring consistency and comparability of results. Secondary objectives of the study are to determine the antibiotic resistance profiles of Shigella, compare isolation of Shigella from rectal swabs versus whole stool, and compare isolation of Shigella following transport of rectal swabs in Cary-Blair versus a modified buffered glycerol saline transport medium. CONCLUSIONS: Data generated from EFGH using culture methods described herein can potentially be used for microbiological endpoints in future phase 3 clinical trials to evaluate vaccines against shigellosis and for other clinical and public health studies focused on these organisms.

وصف الملف: application/pdf; text/xml; application/zip

العلاقة: https://www.repository.cam.ac.uk/handle/1810/366300Test

الإتاحة: https://www.repository.cam.ac.uk/handle/1810/366300Test

المؤلفون: Mategula, Donnie, Ndalama, Maureen, Lefu, Clement, Chinkhumba, Jobiba, Ndeketa, Latif, Munthali, Vitumbiko, Chitala, Clifford, Malemia, Thandizo, Million, Gertrude, Mbutuka, Ishmail, Mhone, Ranken, Makwenda, Ethel, James, Mussa, Bwanali, Cornelius, Kazembe, Gift, Manundo, Abell, Chauluka, Evance, Chitalo, Salama, Alumando, Ethel, Longwe, Dalitso, Matandika, Maggie, Jonasi, Paul, Thindwa, Agra, Phiri, Deborah, Wachepa, Richard, Kawonga, Flywell, Maiden, Victor, Charles, Mary, Kapindula, Ida, Witte, Desiree, Turner, Ann M, Bronowski, Christina, Baker, Kate, Bar-Zeev, Naor, Gordon, Melita A, Dube, Queen, Cunliffe, Nigel A, Jere, Khuzwayo C, Cornick, Jennifer

مصطلحات موضوعية: Malawi, Shigella, diarrhea, health care-seeking behavior, surveillance

الوصف: Funder: NIHR Global Health Research ; Funder: NIHR Health Protection Research ; BACKGROUND: Malawi is among 7 countries participating in the Enterics for Global Health (EFGH) Shigella surveillance study, which aims to determine the incidence of medically attended diarrhea attributed to Shigella, a leading bacterial cause of diarrhea in children in low-resource settings. METHODS: We describe the EFGH study site in the densely populated informal settlement of Ndirande Township, Blantyre, Malawi. We explore the site's geographical location, demographic characteristics, and the healthcare-seeking behavior of its population, particularly for childhood diarrhea. We also describe the management of childhood diarrhea at the health facility, and the associated challenges to attaining optimum adherence to local and national guidelines at the site. CONCLUSIONS: Our overarching aim is to improve global health through understanding and mitigating the impact of diarrhea attributed to Shigella.

وصف الملف: application/pdf; application/zip; text/xml

العلاقة: https://www.repository.cam.ac.uk/handle/1810/366301Test

الإتاحة: https://www.repository.cam.ac.uk/handle/1810/366301Test

المؤلفون: Horne, Bri’Anna, Badji, Henry, Bhuiyan, Md Taufiqur Rahman, Romaina Cachique, Lucero, Cornick, Jennifer, Hotwani, Aneeta, Juma, Jane, Ochieng, John Benjamin, Abdou, Mahamadou, Apondi, Evans, Atlas, Hannah E, Awuor, Alex O, Baker, Kate S, Ceesay, Bubacarr E, Charles, Mary, Cunliffe, Nigel A, Feutz, Erika, Galagan, Sean R, Guindo, Ibrehima, Hossain, M Jahangir, Iqbal, Junaid, Jallow, Fatima, Keita, Noumou Yakhouba, Khanam, Farhana, Kotloff, Karen L, Maiden, Victor, Manzanares Villanueva, Katia, Mito, Oscar, Mosharraf, Md Parvej, Nkeze, Joseph, Ikumapayi, Usman N, Paredes Olortegui, Maribel, Pavlinac, Patricia B, Pinedo Vasquez, Tackeshy, Qadri, Firdausi, Qamar, Farah Naz, Qureshi, Sonia, Rahman, Nazia, Sangare, Aminata, Sen, Sunil, Peñataro Yori, Pablo, Yousafzai, Mohammad Tahir, Ahmed, Dilruba, Jere, Khuzwayo C, Kosek, Margaret N, Omore, Richard, Permala-Booth, Jasnehta, Secka, Ousman, Tennant, Sharon M

مصطلحات موضوعية: diarrhea, microbiology, dysentery, children, Shigella

الوصف: Funder: UKRI; DOI: https://doi.org/10.13039/100014013Test ; Abstract Background Shigella is a major cause of diarrhea in young children worldwide. Multiple vaccines targeting Shigella are in development, and phase 3 clinical trials are imminent to determine efficacy against shigellosis. Methods The Enterics for Global Health (EFGH) Shigella surveillance study is designed to determine the incidence of medically attended shigellosis in 6- to 35-month-old children in 7 resource-limited settings. Here, we describe the microbiological methods used to isolate and identify Shigella. We developed a standardized laboratory protocol for isolation and identification of Shigella by culture. This protocol was implemented across all 7 sites, ensuring consistency and comparability of results. Secondary objectives of the study are to determine the antibiotic resistance profiles of Shigella, compare isolation of Shigella from rectal swabs versus whole stool, and compare isolation of Shigella following transport of rectal swabs in Cary-Blair versus a modified buffered glycerol saline transport medium. Conclusions Data generated from EFGH using culture methods described herein can potentially be used for microbiological endpoints in future phase 3 clinical trials to evaluate vaccines against shigellosis and for other clinical and public health studies focused on these organisms.

وصف الملف: application/pdf; text/xml; application/zip

العلاقة: https://www.repository.cam.ac.uk/handle/1810/366277Test

الإتاحة: https://www.repository.cam.ac.uk/handle/1810/366277Test

المؤلفون: Horne, Bri Anna, Badji, Henry, Hotwani, Aneeta, Iqbal, Junaid, Qamar, Farah, Yousafzai, Mohammad Tahir, Qureshi, Sonia, Juma, Jane, Charles, Mary, Cunliffe, Nigel A

المصدر: Department of Paediatrics and Child Health

مصطلحات موضوعية: Shigella, Children, DIarrhea, Dysentery, Microbiology, standardized laboratory, Infectious Disease, Laboratory Medicine, Pediatrics

الوصف: Background: Shigella is a major cause of diarrhea in young children worldwide. Multiple vaccines targeting Shigella are in development, and phase 3 clinical trials are imminent to determine efficacy against shigellosis.Methods: The Enterics for Global Health (EFGH) Shigella surveillance study is designed to determine the incidence of medically attended shigellosis in 6- to 35-month-old children in 7 resource-limited settings. Here, we describe the microbiological methods used to isolate and identify Shigella. We developed a standardized laboratory protocol for isolation and identification of Shigella by culture. This protocol was implemented across all 7 sites, ensuring consistency and comparability of results. Secondary objectives of the study are to determine the antibiotic resistance profiles of Shigella, compare isolation of Shigella from rectal swabs versus whole stool, and compare isolation of Shigella following transport of rectal swabs in Cary-Blair versus a modified buffered glycerol saline transport medium.Conclusions: Data generated from EFGH using culture methods described herein can potentially be used for microbiological endpoints in future phase 3 clinical trials to evaluate vaccines against shigellosis and for other clinical and public health studies focused on these organisms

العلاقة: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/1499Test; https://academic.oup.com/ofid/article/11/Supplement_1/S25/7634615Test

الإتاحة: https://doi.org/10.1093/ofid/ofad576Test
https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/1499Test
https://academic.oup.com/ofid/article/11/Supplement_1/S25/7634615Test

المؤلفون: Babb, Courtney, Badji, Henry, Bhuiyan, Md Taufiqur Rahman, Cornick, Jennifer, Qureshi, Sonia, Sonye, Catherine, Lopez, Wagner V Shapiama, Adnan, Mehreen, Atlas, Hannah E, Begum, Kehkashan, Brennhofer, Stephanie A, Ceesay, Bubacarr E, Ceesay, Abdoulie K, Cunliffe, Nigel A, Bardales, Paul F Garcia, Haque, Shahinur, Horne, Bri'Anna, Hossain, M Jahangir, Iqbal, Junaid, Islam, Md Taufiqul

المصدر: Open Forum Infectious Diseases; 2024 Supplement, Vol. 11, pS65-S75, 11p

مصطلحات موضوعية: SHIGELLOSIS, SHIGELLA, BIOMARKERS, ERYTHROCYTES, DIARRHEA, LEUCOCYTES

مستخلص: Background The measurement of fecal inflammatory biomarkers among individuals presenting to care with diarrhea could improve the identification of bacterial diarrheal episodes that would benefit from antibiotic therapy. We reviewed prior literature in this area and describe our proposed methods to evaluate 4 biomarkers in the Enterics for Global Health (EFGH) Shigella surveillance study. Methods We systematically reviewed studies since 1970 from PubMed and Embase that assessed the diagnostic characteristics of inflammatory biomarkers to identify bacterial diarrhea episodes. We extracted sensitivity and specificity and summarized the evidence by biomarker and diarrhea etiology. In EFGH, we propose using commercial enzyme-linked immunosorbent assays to test for myeloperoxidase, calprotectin, lipocalin-2, and hemoglobin in stored whole stool samples collected within 24 hours of enrollment from participants in the Bangladesh, Kenya, Malawi, Pakistan, Peru, and The Gambia sites. We will develop clinical prediction scores that incorporate the inflammatory biomarkers and evaluate their ability to identify Shigella and other bacterial etiologies of diarrhea as determined by quantitative polymerase chain reaction (qPCR). Results Forty-nine studies that assessed fecal leukocytes (n = 39), red blood cells (n = 26), lactoferrin (n = 13), calprotectin (n = 8), and myeloperoxidase (n = 1) were included in the systematic review. Sensitivities were high for identifying Shigella , moderate for identifying any bacteria, and comparable across biomarkers. Specificities varied depending on the outcomes assessed. Prior studies were generally small, identified red and white blood cells by microscopy, and used insensitive gold standard diagnostics, such as conventional bacteriological culture for pathogen detection. Conclusions Our evaluation of inflammatory biomarkers to distinguish diarrhea etiologies as determined by qPCR will provide an important addition to the prior literature, which was likely biased by the limited sensitivity of the gold standard diagnostics used. We will determine whether point-of-care biomarker tests could be a viable strategy to inform treatment decision making and increase appropriate targeting of antibiotic treatment to bacterial diarrhea episodes. [ABSTRACT FROM AUTHOR]

: Copyright of Open Forum Infectious Diseases is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Benedicto-Matambo, Prisca, Avolio, Lindsay N, Badji, Henry, Batool, Rabab, Khanam, Farhana, Munga, Stephen, Tapia, Milagritos D, Yori, Pablo Peñataro, Awuor, Alex O, Ceesay, Bubacarr E, Cornick, Jennifer, Cunliffe, Nigel A, Bardales, Paul F Garcia, Heaney, Christopher D, Hotwani, Aneeta, Ireen, Mahzabeen, Islam, Md Taufiqul, Jallow, Ousman, Kaminski, Robert W, Lopez, Wagner V Shapiama

المصدر: Open Forum Infectious Diseases; 2024 Supplement, Vol. 11, pS58-S64, 7p

مصطلحات موضوعية: SHIGELLA, DRIED blood spot testing, SHIGELLA flexneri, IMMUNE response, DIARRHEA

مستخلص: Background Molecular diagnostics on human fecal samples have identified a larger burden of shigellosis than previously appreciated by culture. Evidence of fold changes in immunoglobulin G (IgG) to conserved and type-specific Shigella antigens could be used to validate the molecular assignment of type-specific Shigella as the etiology of acute diarrhea and support polymerase chain reaction (PCR)–based microbiologic end points for vaccine trials. Methods We will test dried blood spots collected at enrollment and 4 weeks later using bead-based immunoassays for IgG to invasion plasmid antigen B and type-specific lipopolysaccharide O-antigen for Shigella flexneri 1b, 2a, 3a, and 6 and Shigella sonnei in Shigella -positive cases and age-, site-, and season-matched test-negative controls from all sites in the Enterics for Global Health (EFGH) Shigella surveillance study. Fold antibody responses will be compared between culture-positive, culture-negative but PCR-attributable, and PCR-positive but not attributable cases and test-negative controls. Age- and site-specific seroprevalence distributions will be identified, and the association between baseline antibodies and Shigella attribution will be estimated. Conclusions The integration of these assays into the EFGH study will help support PCR-based attribution of acute diarrhea to type-specific Shigella , describe the baseline seroprevalence of conserved and type-specific Shigella antibodies, and support correlates of protection for immunity to Shigella diarrhea. These insights can help support the development and evaluation of Shigella vaccine candidates. [ABSTRACT FROM AUTHOR]

: Copyright of Open Forum Infectious Diseases is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Zeller, Mark, Heylen, Elisabeth, Damanka, Susan, Pietsch, Corinna, Donato, Celeste, Tamura, Tsutomu, Kulkarni, Ruta, Arora, Ritu, Cunliffe, Nigel, Maunula, Leena, Potgieter, Christiaan, Tamim, Sana, De Coster, Sarah, Zhirakovskaya, Elena, Bdour, Salwa, O'Shea, Helen, Kirkwood, Carl D., Seheri, Mapaseka, Nyaga, Martin Monene, Mphahlele, Jeffrey, Chitambar, Shobha D., Dagan, Ron, Armah, George, Tikunova, Nina, Van Ranst, Marc, Matthijnssens, Jelle

المساهمون: Departments of Faculty of Veterinary Medicine, Food Hygiene and Environmental Health, Leena Maunula / Principal Investigator, Food and Environmental Virology Research Group

مصطلحات موضوعية: OP354-like P[8], rotaviruses, emerging viruses, reassortment, GROUP-A ROTAVIRUS, STRAIN DIVERSITY, VACCINATION PROGRAMS, GLOBAL SPREAD, G12 STRAINS, VP4 GENE, CHILDREN, GENOTYPES, DIARRHEA, BELGIUM, 413 Veterinary science, 1182 Biochemistry, cell and molecular biology, 1184 Genetics, developmental biology, physiology

الوصف: The majority of human group A rotaviruses possess the P[8] VP4 genotype. Recently, a genetically distinct subtype of the P[8] genotype, also known as OP354-like P[8] or lineage P[8]-4, emerged in several countries. However, it is unclear for how long the OP354-like P[8] gene has been circulating in humans and how it has spread. In a global collaborative effort 98 (near-) complete OP354-like P[8] VP4 sequences were obtained and used for phylogeographic analysis to determine the viral migration patterns. During the sampling period, 1988-2012, we found that South and East Asia acted as a source from which strains with the OP354-like P[8] gene were seeded to Africa, Europe, and North America. The time to the most recent common ancestor (TMRCA) of all OP354-like P[8] genes was estimated at 1987. However, most OP354-like P[8] strains were found in three main clusters with TMRCAs estimated between 1996 and 2001. The VP7 gene segment of OP354-like P[8] strains showed evidence of frequent reassortment, even in localized epidemics, suggesting that OP354-like P[8] genes behave in a similar manner on the evolutionary level as other P[8] subtypes. The results of this study suggest that OP354-like P[8] strains have been able to disperse globally in a relatively short time period. This, in combination with a relatively large genetic distance to other P[8] subtypes, might result in a lower vaccine effectiveness, underscoring the need for a continued surveillance of OP354-like P[8] strains, especially in countries where rotavirus vaccination programs are in place. ; Peer reviewed

وصف الملف: application/pdf

العلاقة: M.Z. was supported by the Institute for the Promotion of Innovation through Science and Technology in Flanders (IWT Vlaanderen).; Zeller , M , Heylen , E , Damanka , S , Pietsch , C , Donato , C , Tamura , T , Kulkarni , R , Arora , R , Cunliffe , N , Maunula , L , Potgieter , C , Tamim , S , De Coster , S , Zhirakovskaya , E , Bdour , S , O'Shea , H , Kirkwood , C D , Seheri , M , Nyaga , M M , Mphahlele , J , Chitambar , S D , Dagan , R , Armah , G , Tikunova , N , Van Ranst , M & Matthijnssens , J 2015 , ' Emerging OP354-Like P[8] Rotaviruses Have Rapidly Dispersed from Asia to Other Continents ' , Molecular Biology and Evolution , vol. 32 , no. 8 , pp. 2060-2071 . https://doi.org/10.1093/molbev/msv088Test; ORCID: /0000-0002-0841-5353/work/29734872; 84965154626; b13f889c-d48a-490e-a561-8a9f6d388369; http://hdl.handle.net/10138/326453Test; 000360586500012

الإتاحة: http://hdl.handle.net/10138/326453Test

المؤلفون: Ahmed, Tahmeed, Chisti, Mohammod Jobayer, Rahman, Muhammad Waliur, Alam, Tahmina, Ahmed, Dilruba, Parvin, Irin, Kabir, Md Farhad, Sazawal, Sunil, Dhingra, Pratibha, Dutta, Arup, Deb, Saikat, Chouhan, Aishwarya, Sharma, Anil Kumar, Jaiswal, Vijay Kumar, Dhingra, Usha, Walson, Judd L, Singa, Benson O, Pavlinac, Patricia B, McGrath, Christine J, Nyabinda, Churchil, Deichsel, Emily L, Anyango, Maurine, Kariuki, Kevin Mwangi, Rwigi, Doreen, Tornberg-Belanger, Stephanie N, Kotloff, Karen L, Sow, Samba O, Tapia, Milagritos D, Haidara, FadimaCheick, Mehta, Ashka, Coulibaly, Flanon, Badji, Henry, Permala-Booth, Jasnehta, Tennant, Sharon M, Malle, Dramane, Bar-Zeev, Naor, Dube, Queen, Freyne, Bridget, Cunliffe, Nigel, Ndeketa, Latif, Witte, Desiree, Ndamala, Chifundo, Cornick, Jennifer, Qamar, Farah Naz, Yousafzai, Mohammad Tahir, Qureshi, Shahida, Shakoor, Sadia, Thobani, Rozina, Hotwani, Aneeta, Kabir, Furqan, Mohammed, Jan, Manji, Karim, Duggan, Christopher P, Kisenge, Rodrick, Sudfeld, Christopher R, Kibwana, Upendo, Somji, Sarah, Bakari, Mohamed, Msemwa, Cecylia, Samma, Abraham, Bahl, Rajiv, De Costa, Ayesha, Simon, Jonathon, Ashorn, Per, ABCD, Antibiotics Children Diarrhea

المساهمون: Tampere University, Clinical Medicine

المصدر: JAMA NETWORK OPEN
JAMA Network Open

مصطلحات موضوعية: Diarrhea, Male, Dehydration, Research, Malnutrition, Administration, Oral, Infant, General Medicine, Azithromycin, 3121 Internal medicine, Pediatrics, Drug Administration Schedule, Anti-Bacterial Agents, Online Only, Child Development, Treatment Outcome, Double-Blind Method, 3123 Gynaecology and paediatrics, Acute Disease, Ambulatory Care, Health Resources, Humans, Female, Original Investigation

الوصف: Key Points Question Does the addition of azithromycin to the standard case management of acute watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished reduce mortality and improve linear growth? Findings This randomized clinical trial of 8266 children was unable to detect a survival benefit for children from the addition of azithromycin to the standard World Health Organization (WHO) case management of acute watery diarrhea in low-resource settings. Meaning In low-resource settings, adherence to current WHO case management protocols for watery diarrhea remains appropriate; antibiotic use is not warranted.
Importance World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth. Objective To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth. Design, Setting, and Participants The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat. Interventions Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea. Main Outcomes and Measures Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. Results A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was –0.16 (0.59) in the azithromycin group and −0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis. Conclusions and Relevance The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged. Trial Registration ClinicalTrials.gov Identifier: NCT03130114
This randomized clinical trial examines whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth.

وصف الملف: application/pdf; fulltext

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e2ea0b879be342e65b9353adaed53570Test
http://livrepository.liverpool.ac.uk/3150536/1/ABCD_JAMA.pdfTest

المؤلفون: Hungerford, Daniel, Vivancos, Roberto, Read, Jonathan M, Pitzer, Virginia E, Cunliffe, Nigel A, French, Neil, Iturriza-Gómara, Miren, Fischer, Thea Kølsen

المصدر: Hungerford , D , Vivancos , R , Read , J M , Pitzer , V E , Cunliffe , N A , French , N , Iturriza-Gómara , M , EuroRotaNet network members & Fischer , T K 2016 , ' In-season and out-of-season variation of rotavirus genotype distribution and age of infection across 12 European countries before the introduction of routine vaccination, 2007/08 to 2012/13 ' , Eurosurveillance , vol. 21 , no. 2 , 30106 . https://doi.org/10.2807/1560-7917.ES.2016.21.2.30106Test

مصطلحات موضوعية: Antigens, Viral, Diarrhea, Europe, Feces, Female, Gastroenteritis, Genotype, Hospitalization, Hospitals, Humans, Infant, Population Surveillance, Rotavirus, Rotavirus Infections, Rotavirus Vaccines, Seasons, Vaccination, Journal Article, Research Support, Non-U.S. Gov't

الوصف: The EuroRotaNet surveillance network has conducted rotavirus genotype surveillance since 2007 in 16 European countries. Using epidemiological and microbiological data from 39,786 genotyped rotavirus-positive specimens collected between September 2007 and August 2013, we assessed genotype distribution and age distribution of rotavirus gastroenteritis (RVGE) cases in and out of peak season in 12 countries which were yet to implement routine rotavirus vaccination. In multinomial multivariate logistic regression, adjusting for year, country and age, the odds of infection caused by genotype-constellation 2 DS-1-like stains (adjusted multinomial odds ratio (aM-OR) = 1.25; 95% confidence interval (CI): 1.13-1.37; p < 0.001), mixed or untypable genotypes (aM-OR = 1.55; 95% CI: 1.40-1.72; p < 0.001) and less common genotypes (aM-OR = 2.11; 95% CI:1.78-2.51; p < 0.001) increased out of season relative to G1P[8]. Age varied significantly between seasons; the proportion of RVGE cases younger than 12 months in the United Kingdom increased from 34% in season to 39% out of season (aM-OR = 1.66; 95% CI: 1.20-2.30), and the proportion five years and older increased from 9% in season to 17% out of season (aM-OR = 2.53; 95% CI: 1.67-3.82). This study provides further understanding of the rotavirus ecology before vaccine introduction, which will help interpret epidemiological changes in countries introducing or expanding rotavirus vaccination programmes.

وصف الملف: application/pdf

العلاقة: https://portal.findresearcher.sdu.dk/da/publications/d2555336-bd43-4712-b1cb-e38237e8bf40Test

الإتاحة: https://doi.org/10.2807/1560-7917.ES.2016.21.2.30106Test
https://portal.findresearcher.sdu.dk/da/publications/d2555336-bd43-4712-b1cb-e38237e8bf40Test
https://findresearcher.sdu.dk/ws/files/129612358/In_season_and_out_of_season_variation_of_rotavirus_genotype_distribution_and_age_of_infection_across_12_European_countries_before_the_introduction_of_routine_vaccination_2007_08_to_2012_13.pdfTest