Permethrin-treated baby wraps for the prevention of malaria: results of a randomized controlled pilot study in rural Uganda.

BACKGROUND: Progress against malaria has stalled and may even be slipping backwards in high-burden countries. This is due to a range of factors including insecticide resistance and mosquito feeding behaviours that limit contact with widely-employed interventions including long-lasting insecticidal nets and indoor-residual spraying. Thus, further innovations in malaria control are urgently needed. METHODS: The pilot was a randomized, placebo-controlled pilot study of permethrin-treated baby wraps-known locally as lesus-in children 6-18 months of age at a single site in rural western Uganda. Fifty mother-infant pairs were assigned to permethrin-treated or untreated lesus in a 1:1 allocation. Participants and clinical staff were blinded to group assignments through use of sham treatment and re-treatment of lesus. Participants attended scheduled clinic visits every 2 weeks for a total 12 weeks. The primary outcome of interest was the safety of the intervention, assessed as changes in the frequency of use, rates of discontinuation, and incidence of adverse events, such as skin rash. Secondary outcomes included acceptability and feasibility of the intervention as measured through participant satisfaction and completion of study activities, respectively. RESULTS: Overall, rates of retention and participation were relatively high with 86.0% (43 of 50) of participants completing all scheduled visits, including 18 (75.0%) and 25 (96.2%) in the intervention and control arms respectively. By the conclusion of the 12-week follow-up period, one adverse event (0.35 events per 100 person-weeks, one-sided 95% CI 0.0-1.65) was reported. Satisfaction with the lesu was high in both groups. In each study arm, there were five incident RDT positive results, but the only PCR-positive results were observed in the control group (n = 2). CONCLUSIONS: Permethrin-treated baby wraps were well-tolerated and broadly acceptable. Adverse events were infrequent and mild. These findings support future trials seeking to determine the efficacy of treated wraps to prevent P. falciparum malaria infection in young children as a complementary tool to existing household-based interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04102592, Registered 25 September 2019. Available at: https://clinicaltrials.gov/ct2/show/NCT04102592

Correction: Association between breastfeeding, host genetic factors, and calicivirus gastroenteritis in a Nicaraguan birth cohort.

[This corrects the article DOI: 10.1371/journal.pone.0267689.]

Akkermansia muciniphila Associated with Improved Linear Growth among Young Children, Democratic Republic of the Congo

To investigate the association between enteric pathogens, fecal microbes, and child growth, we conducted a prospective cohort study of 236 children 3 pathogens in their feces. We observed larger increases in height-for-age-z-scores from baseline to the 6-month follow-up among children with Akkermansia muciniphila in their feces (coefficient 0.02 [95% CI 0.0001–0.04]; p = 0.04). Children with Cryptosporidium in their feces had larger declines in weight-for-height/length z-scores from baseline to the 6-month follow-up (coefficient –0.03 [95% CI –0.05 to –0.005]; p = 0.02). Our study showed high prevalence of enteric pathogens among this pediatric cohort and suggests A. muciniphila can potentially serve as a probiotic to improve child growth

Minimally Invasive Saliva Testing to Monitor Norovirus Infection in Community Settings.

BackgroundNorovirus is a leading cause of acute gastroenteritis worldwide. Routine norovirus diagnosis requires stool collection. The goal of this study was to develop and validate a noninvasive method to diagnose norovirus to complement stool diagnostics and to facilitate studies on transmission.MethodsA multiplex immunoassay to measure salivary immunoglobulin G (IgG) responses to 5 common norovirus genotypes (GI.1, GII.2, GII.4, GII.6, and GII.17) was developed. The assay was validated using acute and convalescent saliva samples collected from Peruvian children <5 years of age with polymerase chain reaction (PCR)-diagnosed norovirus infections (n = 175) and controls (n = 32). The assay sensitivity and specificity were calculated to determine infection status based on fold rise of salivary norovirus genotype-specific IgG using norovirus genotype from stool as reference.ResultsThe salivary assay detected recent norovirus infections and correctly assigned the infecting genotype. Sensitivity was 71% and specificity was 96% across the evaluated genotypes compared to PCR-diagnosed norovirus infection.ConclusionsThis saliva-based assay will be a useful tool to monitor norovirus transmission in high-risk settings such as daycare centers or hospitals. Cross-reactivity is limited between the tested genotypes, which represent the most commonly circulating genotypes

The other <i>Campylobacters</i>: Not innocent bystanders in endemic diarrhea and dysentery in children in low-income settings

<div><p>Background</p><p><i>Campylobacter</i> is one of the main causes of gastroenteritis worldwide. Most of the current knowledge about the epidemiology of this food-borne infection concerns two species, <i>C</i>. <i>coli</i> and <i>C</i>. <i>jejuni</i>. Recent studies conducted in developing countries and using novel diagnostic techniques have generated evidence of the increasing burden and importance of other <i>Campylobacter</i> species, i.e. non-<i>C</i>. <i>coli/jejuni</i>. We performed a nested case-control study to compare the prevalence of <i>C</i>. <i>coli/jejuni</i> and other <i>Campylobacter</i> in children with clinical dysentery and severe diarrhea as well as without diarrhea to better understand the clinical importance of infections with <i>Campylobacter</i> species other than <i>C</i>. <i>coli/jejuni</i>.</p><p>Methodology/Principal findings</p><p>Our nested case-control study of 439 stool samples included dysenteric stools, stools collected during severe diarrhea episodes, and asymptomatic stools which were systematically selected to be representative of clinical phenotypes from 9,160 stools collected during a birth cohort study of 201 children followed until two years of age. Other <i>Campylobacter</i> accounted for 76.4% of the 216 <i>Campylobacter</i> detections by qPCR and were more prevalent than <i>C</i>. <i>coli/jejuni</i> across all clinical groups. Other <i>Campylobacter</i> were also more prevalent than <i>C</i>. <i>coli/jejuni</i> across all age groups, with older children bearing a higher burden of other <i>Campylobacter</i>. Biomarkers of intestinal inflammation and injury (methylene blue, fecal occult test, myeloperoxidase or MPO) showed a strong association with dysentery, but mixed results with infection. MPO levels were generally higher among children infected with <i>C</i>. <i>coli/jejuni</i>, but <i>Shigella</i>-infected children suffering from dysentery recorded the highest levels (26,224 ng/mL); the lowest levels (10,625 ng/mL) were among asymptomatic children infected with other <i>Campylobacter</i>. Adjusting for age, sex, and <i>Shigella</i> infection, dysentery was significantly associated with <i>C</i>. <i>coli/jejuni</i> but not with other <i>Campylobacter</i>, whereas severe diarrhea was significantly associated with both <i>C</i>. <i>coli/jejuni</i> and other <i>Campylobacter</i>. Compared to asymptomatic children, children suffering from dysentery had a 14.6 odds of <i>C</i>. <i>coli/jejuni</i> infection (p-value < 0.001, 95% CI 5.5–38.7) but were equally likely to have other <i>Campylobacter</i> infections–odds ratio of 1.3 (0.434, 0.7–2.4). Children suffering from severe diarrhea were more likely than asymptomatic children to test positive for both <i>C</i>. <i>coli/jejuni</i> and other <i>Campylobacter</i>–OR of 2.8 (0.034, 1.1–7.1) and 1.9 (0.018, 1.1–3.1), respectively. Compared to the <i>Campylobacter</i>-free group, the odds of all diarrhea given <i>C</i>. <i>coli/jejuni</i> infection and other <i>Campylobacter</i> infection were 8.8 (<0.001, 3.0–25.7) and 2.4 (0.002, 1.4–4.2), respectively. Eliminating other <i>Campylobacter</i> in this population would eliminate 24.9% of the diarrhea cases, which is almost twice the population attributable fraction of 15.1% due to <i>C</i>. <i>coli/jejuni</i>.</p><p>Conclusions/Significance</p><p>Eighty-seven percent of the dysentery and 59.5% of the severe diarrhea samples were positive for <i>Campylobacter</i>, <i>Shigella</i>, or both, emphasizing the importance of targeting these pathogens to limit the impact of dysentery and severe diarrhea in children. Notably, the higher prevalence of other <i>Campylobacter</i> compared to <i>C</i>. <i>coli/jejuni</i>, their increasing burden during early childhood, and their association with severe diarrhea highlight the importance of these non-<i>C</i>. <i>coli/jejuni Campylobacter</i> species and suggest a need to clarify their importance in the etiology of clinical disease across different epidemiological contexts.</p></div

List of primers and probes used for the detection of <i>Campylobacter</i> (genus specific), <i>Campylobacte</i>r <i>coli/jejuni</i>, and <i>Shigella</i>.

<p>List of primers and probes used for the detection of <i>Campylobacter</i> (genus specific), <i>Campylobacte</i>r <i>coli/jejuni</i>, and <i>Shigella</i>.</p

Prevalence of <i>Campylobacter</i> and <i>Shigella</i> among children suffering from dysentery and severe diarrhea in peri-urban communities in Loreto, Peru.

<p>Prevalence of <i>Campylobacter</i> and <i>Shigella</i> among children suffering from dysentery and severe diarrhea in peri-urban communities in Loreto, Peru.</p

<i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical outcome (asymptomatic infection, dysentery, severe diarrhea) using the qPCR assay.

<p><i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical outcome (asymptomatic infection, dysentery, severe diarrhea) using the qPCR assay.</p

Study population characteristics by clinical outcome (control, dysentery, and severe diarrhea).

<p>Study population characteristics by clinical outcome (control, dysentery, and severe diarrhea).</p

Comparison of <i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical group (control, dysentery, severe diarrhea) using qPCR and culture.

<p>Comparison of <i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical group (control, dysentery, severe diarrhea) using qPCR and culture.</p