Group B streptococcus serotype prevalence in reproductive-age women at a tertiary care military medical center relative to global serotype distribution

<p>Abstract</p> <p>Background</p> <p>Group B <it>Streptococcus </it>(GBS) serotype (Ia, Ib, II-IX) correlates with pathogen virulence and clinical prognosis. Epidemiological studies of seroprevalence are an important metric for determining the proportion of serotypes in a given population. The purpose of this study was to evaluate the prevalence of individual GBS serotypes at Madigan Healthcare System (Madigan), the largest military tertiary healthcare facility in the Pacific Northwestern United States, and to compare seroprevalences with international locations.</p> <p>Methods</p> <p>To determine serotype distribution at Madigan, we obtained GBS isolates from standard-of-care anogenital swabs from 207 women of indeterminate gravidity between ages 18-40 during a five month interval. Serotype was determined using a recently described molecular method of polymerase chain reaction by capsular polysaccharide synthesis (cps) genes associated with pathogen virulence.</p> <p>Results</p> <p>Serotypes Ia, III, and V were the most prevalent (28%, 27%, and 17%, respectively). A systematic review of global GBS seroprevalence, meta-analysis, and statistical comparison revealed strikingly similar serodistibution at Madigan relative to civilian-sector populations in Canada and the United States. Serotype Ia was the only serotype consistently higher in North American populations relative to other geographic regions (p < 0.005). The number of non-typeable isolates was significantly lower in the study (p < 0.005).</p> <p>Conclusion</p> <p>This study establishes PCR-based serotyping as a viable strategy for GBS epidemiological surveillance. Our results suggest that GBS seroprevalence remains stable in North America over the past two decades.</p

Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials.

BACKGROUND: The ChAdOx1 nCoV-19 (AZD1222) vaccine has been approved for emergency use by the UK regulatory authority, Medicines and Healthcare products Regulatory Agency, with a regimen of two standard doses given with an interval of 4-12 weeks. The planned roll-out in the UK will involve vaccinating people in high-risk categories with their first dose immediately, and delivering the second dose 12 weeks later. Here, we provide both a further prespecified pooled analysis of trials of ChAdOx1 nCoV-19 and exploratory analyses of the impact on immunogenicity and efficacy of extending the interval between priming and booster doses. In addition, we show the immunogenicity and protection afforded by the first dose, before a booster dose has been offered. METHODS: We present data from three single-blind randomised controlled trials-one phase 1/2 study in the UK (COV001), one phase 2/3 study in the UK (COV002), and a phase 3 study in Brazil (COV003)-and one double-blind phase 1/2 study in South Africa (COV005). As previously described, individuals 18 years and older were randomly assigned 1:1 to receive two standard doses of ChAdOx1 nCoV-19 (5 × 1010 viral particles) or a control vaccine or saline placebo. In the UK trial, a subset of participants received a lower dose (2·2 × 1010 viral particles) of the ChAdOx1 nCoV-19 for the first dose. The primary outcome was virologically confirmed symptomatic COVID-19 disease, defined as a nucleic acid amplification test (NAAT)-positive swab combined with at least one qualifying symptom (fever ≥37·8°C, cough, shortness of breath, or anosmia or ageusia) more than 14 days after the second dose. Secondary efficacy analyses included cases occuring at least 22 days after the first dose. Antibody responses measured by immunoassay and by pseudovirus neutralisation were exploratory outcomes. All cases of COVID-19 with a NAAT-positive swab were adjudicated for inclusion in the analysis by a masked independent endpoint review committee. The primary analysis included all participants who were SARS-CoV-2 N protein seronegative at baseline, had had at least 14 days of follow-up after the second dose, and had no evidence of previous SARS-CoV-2 infection from NAAT swabs. Safety was assessed in all participants who received at least one dose. The four trials are registered at ISRCTN89951424 (COV003) and ClinicalTrials.gov, NCT04324606 (COV001), NCT04400838 (COV002), and NCT04444674 (COV005). FINDINGS: Between April 23 and Dec 6, 2020, 24 422 participants were recruited and vaccinated across the four studies, of whom 17 178 were included in the primary analysis (8597 receiving ChAdOx1 nCoV-19 and 8581 receiving control vaccine). The data cutoff for these analyses was Dec 7, 2020. 332 NAAT-positive infections met the primary endpoint of symptomatic infection more than 14 days after the second dose. Overall vaccine efficacy more than 14 days after the second dose was 66·7% (95% CI 57·4-74·0), with 84 (1·0%) cases in the 8597 participants in the ChAdOx1 nCoV-19 group and 248 (2·9%) in the 8581 participants in the control group. There were no hospital admissions for COVID-19 in the ChAdOx1 nCoV-19 group after the initial 21-day exclusion period, and 15 in the control group. 108 (0·9%) of 12 282 participants in the ChAdOx1 nCoV-19 group and 127 (1·1%) of 11 962 participants in the control group had serious adverse events. There were seven deaths considered unrelated to vaccination (two in the ChAdOx1 nCov-19 group and five in the control group), including one COVID-19-related death in one participant in the control group. Exploratory analyses showed that vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 after vaccination was 76·0% (59·3-85·9). Our modelling analysis indicated that protection did not wane during this initial 3-month period. Similarly, antibody levels were maintained during this period with minimal waning by day 90 (geometric mean ratio [GMR] 0·66 [95% CI 0·59-0·74]). In the participants who received two standard doses, after the second dose, efficacy was higher in those with a longer prime-boost interval (vaccine efficacy 81·3% [95% CI 60·3-91·2] at ≥12 weeks) than in those with a short interval (vaccine efficacy 55·1% [33·0-69·9] at <6 weeks). These observations are supported by immunogenicity data that showed binding antibody responses more than two-fold higher after an interval of 12 or more weeks compared with an interval of less than 6 weeks in those who were aged 18-55 years (GMR 2·32 [2·01-2·68]). INTERPRETATION: The results of this primary analysis of two doses of ChAdOx1 nCoV-19 were consistent with those seen in the interim analysis of the trials and confirm that the vaccine is efficacious, with results varying by dose interval in exploratory analyses. A 3-month dose interval might have advantages over a programme with a short dose interval for roll-out of a pandemic vaccine to protect the largest number of individuals in the population as early as possible when supplies are scarce, while also improving protection after receiving a second dose. FUNDING: UK Research and Innovation, National Institutes of Health Research (NIHR), The Coalition for Epidemic Preparedness Innovations, the Bill & Melinda Gates Foundation, the Lemann Foundation, Rede D'Or, the Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Access to Productive Resources: The Catalyst to Rural Women’s Poverty Alleviation. A case of South Africa

Access to productive resources is a critical medium to development. However, rural women in post-apartheid South Africa are experiencing hardships in laying hold of such resources. The pertinent questions the article seeks to interrogate are: who should determine the resource needs of rural women? Are the one size fit all programmes ideal for alleviating rural women’s poverty. This article critically evaluates data collected from secondary sources namely policy documents, journal articles, international reports and declarations. Firstly, the article outlines the meaning of poverty. This is followed by an overview of rural poverty in South Africa. Further, the article makes an assessment of some of the programmes that have been put in place by the post-apartheid South African government to alleviate rural poverty. The article concludes by recommending that there is need for policy makers to have closer collaboration and linkages with their communities in order to get direct information on what poverty means to them and what they need to get out of the catastrophic situation.Key words: access, poverty alleviation, productive resources, rural women, South Afric

Grass species composition, yield and quality under and outside tree crowns in a semi-arid rangeland in south-western Zimbabwe

A two-year study was conducted in lightly grazed areas of Matopos Research Station, Zimbabwe, to evaluate the impact of widely spaced trees on understorey grass composition, yield and quality. The study trees were Terminalia sericea and Acacia karroo. Ordination techniques using grass density and biomass as indices separated quadrats according to soil type but not grass species according to understorey or open areas or according to tree species. Grass yield under tree crowns was similar to open areas, in contrast with most reports where understorey areas had higher yields. The high understorey grass quality that has been reported from savanna areas exhibiting grass composition differences was not expressed. Selective grazing of palatable perennial grasses growing in association with tree crowns and their eventual replacement by low-yielding and less-palatable grasses that normally grow in open areas is proposed as an explanation of the unique tree-grass interaction scenario of this study. In areas where this replacement has occurred, recovery may require management interventions.Keywords: annual grasses; botany; crude protein; grasses; Matopos Research Station; quality; semi-arid; soil fertility; species composition; tree-grass interaction; trees; understorey grasses; yield; Zimbabwe; acacia karroo; associations; biomass; composition; grass; grass density; grass quality; grazing; interaction; management; ordination; palatable; perennial grass; rangeland; recovery; savanna; selective grazing; technique; terminalia sericea; tree species; understoreyAfrican Journal of Range & Forage Science, Vol. 15(1 & 2), pp. 23–3

Impact of tree crowns on grass quality and structure in a semi-arid rangeland in southwestern Zimbabwe

Understorey areas in semi-arid rangelands can be a habitat for high-yielding palatable grasses. Selective grazing of these grasses can result in their replacement by less palatable grass species, normally found in open areas. An experiment, at Matopos Research Station, sought to establish whether the understorey micro-environment improves the quality and structure of open-area grasses that invade understorey areas. Herbaceous quality (ash, nitrogen, neutral detergent fibre, acid detergent fibre) and structure (height, leaf:stem ratio, tuft circumference, tiller number) of the dominant species of open-area grasses were measured. Tuft circumference and tiller numbers were the only measurements that differed between the same species growing under tree crowns and in open areas in one of the three sites. The appropriate management responses to changes in understorey species composition are discussed.Keywords: Acacia karroo; botany; grass; grass quality; grass structure; Matopos Research Station; palatability; rangelands; re-establishment; selective grazing; semi-arid; Terminalia sericea; tree crowns; trees; understorey grasses; Zimbabwe; ash; change; composition; fibre; grasses; grazing; habitat; management; measurements; neutral detergent fibre; nitrogen; numbers; rangeland; response; species composition; structure; tiller; understoreyAfrican Journal of Range & Forage Science, Vol. 15(3), pp. 97–10

Exploring the Role of Community Involvement in Reducing the Burden of Schistosomiasis and Other Neglected Tropical Diseases in Malawi: Where are We in the Fight Against Neglected Tropical Diseases?

Adriano Focus Lubanga,1,2 Akim Nelson Bwanali,1,3 Leonard Eston Munthali,2 Mzati Mphepo,3 Gertrude Diana Chumbi,2 Melina Kangoma,2 Yankho Matola,2 Byenala Kaonga,2 Chitemwa Sithando Moyo2 1Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Lilongwe, Malawi; 2Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi; 3Department of Clinical Services, Queen Elizabeth Central Hospital, Blantyre, MalawiCorrespondence: Adriano Focus Lubanga, Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Anderson House, Area 43, P.O Box 31045, Lilongwe, Malawi, Tel +265992744497, Email [email protected]; [email protected]: Schistosomiasis has been endemic in Malawi since 1947. Despite the longevity of endemicity of the disease, it still maintains a high burden in Malawi. This could be attributed to insufficient coverage of preventive and therapeutic mass drug administration (MDA) which mainly targets school-aged children, leaving out adults who also bear a high burden of the disease. Additionally, despite well documented impact of community involvement in boosting up the effectiveness of health programmes, there is minimal community involvement in schistosomiasis control and prevention programmes. Therefore, this perspective seeks to discuss the historical background of schistosomiasis in Malawi, gaps in community engagement and participation and suggest ways of enhancing the role of the community in prevention and control programmes. Amongst other challenges, the control programmes are centralised, leading to minimal input at the district and community level as well as low awareness of schistosomiasis control and prevention methods at the community level. It is of utmost significance therefore to provide comprehensive schistosomiasis health education to the communities and devise a thorough outline of the specific roles and responsibilities of all stakeholders including community members in the fight against schistosomiasis and other neglected tropical diseases.Keywords: schistosomiasis, community prevention, water, sanitation, hygiene, neglected tropical disease

The effects of HIV on the sensitivity of a whole blood IFN-gamma release assay in Zambian adults with active tuberculosis.

BACKGROUND: Interferon gamma release assays (IGRA) are replacing the tuberculin skin test (TST) as a diagnostic tool for Mycobacterium tuberculosis infection. However research into the test's performance in the high HIV-TB burden setting is scarce. This study aimed to define the sensitivity of an IGRA, QuantiFERON-TB Gold In-Tube (QGIT), in adult Zambian patients with active smear-positive tuberculosis. Secondary outcomes focussed on the effect of HIV on the test's performance. PRINCIPAL FINDINGS: Patients attending government health clinics were recruited within 1 month of starting treatment for TB. Subjects were tested with QGIT and TST. T lymphocyte counts were estimated (CD3(+), CD4(+), CD8(+)). QGIT was performed for 112 subjects. 83/112 were QGIT positive giving an overall sensitivity of 74% [95%CI: 66,82]. A marked decrease in sensitivity was observed in HIV positive patients with 37/59 (63%) being QGIT positive compared to 31/37 (84%) HIV negative patients [chi(2) p = 0.033]. Low CD4(+) count was associated with increases in both indeterminate and false-negative results. Low CD4(+) count in combination with high/normal CD8(+) count was associated with false-negative results. TST was recorded for 92 patients, 62/92 were positive, giving a sensitivity of 67% [95%CI: 58,77]. Although there was little difference in the overall sensitivities, agreement between TST and QGIT was poor. CONCLUSIONS: QGIT was technically feasible with results in HIV negative subjects comparable to those achieved elsewhere. However, where under-treated HIV is prevalent, an increased proportion of both indeterminate and false-negative QGIT results can be expected in patients with active TB. The implications of this for the diagnosis of LTBI by QGIT is unclear. The diagnostic and prognostic relevance of IGRAs in high burden settings needs to be better characterised