Seasonality of Pneumococcal Nasopharyngeal Carriage in Rural Gambia Determined within the Context of a Cluster Randomized Pneumococcal Vaccine Trial.

BACKGROUND: We conducted an ancillary study among individuals who had participated in a PCV-7 trial in rural Gambia, to determine the influence of season on the prevalence of pneumococcal carriage. METHODS: 636 individuals above 30 months of age were followed from 4 to 20 months after vaccination with PCV-7 or meningococcal-conjugate-vaccine. Nasopharyngeal swabs were collected periodically between November 2006 and June 2008. Overall, 4,495 NPS were collected. RESULTS: Prevalence of pneumococcal nasopharyngeal carriage in the study subjects (median age 11 years) was 55.0%; this prevalence decreased linearly with increasing age (p = 0.001). Prevalence of carriage was significantly higher during the dry than the rainy season for any pneumococcal carriage [57.6% versus 47.8% (p<0.001)], pneumococcal vaccine serotype carriage [10.3% versus 6.5% (p< 0.001)] and non-vaccine serotype carriage [49.7% versus 42.7% (p<0.001)]. Differences remained significant in the adjusted analysis. CONCLUSIONS: In areas of Africa with marked variation in rainfall, seasonality of pneumococcal carriage needs to be considered when interpreting carriage data

Perspectives of TB survivors and policymakers on post-TB disability

Background: An international multistakeholder participatory workshop was hosted in the Gambia, West Africa, in November 2021. Objectives: To explore the experiences, challenges and recommendations of workshop participants on health and wellbeing after TB treatment. Methods: An exploratory, descriptive, qualitative approach was used for data collection through facilitator-guided group discussions. Workshop participants included adolescent and adult TB survivors, and representatives of TB advocacy groups and the policy sector. Discussions were audio-recorded and transcribed verbatim, and the data were analysed using a deductive thematic approach. Results: Overall, 38 participants (22 women) from six West African countries participated in the workshop, comprising 33 TB survivors and advocacy group representatives and 5 participants from the policy sector. Although some TB survivors noted improved ability to carry out physical activities, others continued to experience detrimental effects on their family life, social interactions, physical health and ongoing stigma. Policymakers emphasised the lack of data and clear guidelines on post-TB disability. Conclusions: Some TB survivors continue to suffer detrimental effects of the illness even after treatment completion. However, available data on post-TB disability is inadequate to support policy adoption. Therefore, there is an urgent need for increased advocacy, awareness and research to bridge knowledge gaps

Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB): A Diagnostic Accuracy Study for Pediatric Tuberculosis.

Introduction: An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study. Methods: This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor's and all relevant local ethics committees. As a diagnostic accuracy study for a disease with an imperfect reference standard, RaPaed-TB was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB

Distribution of samples collected in the dry season.

<p>The bar graph shows the distribution of participants based on their percentage of samples collected in dry season. The line graph represents the corresponding cumulative percentage (of the total samples) for the samples collected in the dry season. Interpretations </p><p></p><p></p><p>More subjects, 229(36%), had 70%-79% of their total samples collected in the dry season</p><p></p><p></p><p>68%(435/636) of the participants had at least 70% their total samples collected in the dry season.</p><p></p><p></p><p>Majority of the participants, 78%(498/363), had 60%-89% of their samples collected in the dry season.</p><p></p><p></p><p></p

Monthly prevalence of pneumococcal nasopharyngeal carriage among different age groups during the follow-up period; a) VT pneumococcal carriage and b) NVT pneumococcal carriage and c) Any Type pneumococcal carriage.

<p>Monthly prevalence of pneumococcal nasopharyngeal carriage among different age groups during the follow-up period; a) VT pneumococcal carriage and b) NVT pneumococcal carriage and c) Any Type pneumococcal carriage.</p

Characteristics of the individuals participating in the longitudinal study.

<p>Characteristics of the individuals participating in the longitudinal study.</p

Distribution of samples by season.

<p>Distribution of samples by season.</p

Prevalence of nasopharyngeal carriage in dry and rainy seasons in the study villages by age group for the different study endpoints.

<p>Prevalence of nasopharyngeal carriage in dry and rainy seasons in the study villages by age group for the different study endpoints.</p