Wh i i f ti f h H h ld t i i f i tWho acquires infection ... · Wh i i f ti f h H h ld t i i f i...
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Wh i if ti f h H h ldt i i f i t Who acquires infection from whom: Household transmission of respiratory syncytial virus (RSV) syncytial virus (RSV) Munywoki PK 1* Koech DC 1 Kibirige NA 1 Cane PA 2 Medley GF 3 Nokes DJ 1, 3 Munywoki PK , Koech DC , Kibirige, NA , Cane PA , Medley GF , Nokes DJ 1 Kenya Medical Research Institute, Kenya; 2 Health Protection Agency, UK ; 3 University of Warwick, UK * [email protected] Methodology Background Fig. 1: WAIFW Matrix RSV is a major cause of childhood ARI worldwide. In infected Kilifi around 1-2 in every 100 infants are admitted with RSV di severe RSV disease per year infant Currently no licensed RSV vaccines exists => susceptible infant ld immunological immaturity and maternal antibodies are the major obstacles > for vaccine targeting 1 3yr age group older major obstacles => for vaccine targeting 1-3yr age group. Need to carefully evaluate alternative approaches, such as Distribution of study HHs targeting older infants, household siblings, school children or mothers or mothers. Potential impact of such strategies will be intimately linked to WAIFW (Who Acquires Infection From Whom): which groups are most important in infecting the infant A schema of the prospective household study St d I l t ti Obj ti which groups are most important in infecting the infant. Study Implementation Objectives Determine the proportion of primary infant infections that i f ld ibli f h h Sensitization & HH recruitment prior to id i Ot+N 2009 arise from elder siblings or from the mother epidemic – Oct + Nov 2009 Estimate the household (HH) reproductive potential of Eligible HHs had an infant plus ≥1older siblings RSV and risk of transmission per contact F ll f 6 th f ll RSV id i Quantify rates of infection and recovery of RSV and other Follow up for 6 months, one full RSV epidemic Quantify rates of infection and recovery of RSV and other respiratory viruses (RV) in the HH; stratify for age i.e. Surveillance methods for RV infection infants, older children & adults • Home visits: Nasopharyngeal flocked swab (NFS) and illness assessment twice a week + Evaluate the diagnostic performance of oral fluid (OF) in (NFS) and illness assessment twice-a-week + OF collection once-a-week. Evaluate the diagnostic performance of oral fluid (OF) in detecting infection using RT-PCR methods OF collection once a week. • Clinic visits: For clinical assessment and Fig 2: Matsangoni map showing distribution of the recruited treatment. Samples only collected if due Fig. 2: Matsangoni map showing distribution of the recruited households (navy blue). Insert (Kilifi Epi-DSS map) R l Results 3. Households retention 1. Baseline characteristics of the cohort 6. Prevalence of viruses in AR1 vs. non-ARI Characteristic Description Frequency (%) Fig. 5: Prevalence of the identified 50 30 Month of consent (n=596) Nov ’09 Dec 444 (74.5) 76 (12.6) of the identified respiratory viruses in the ARI cases 0 40 seholds 20 sitive ARI (N=572) Jan Feb 44 (7.4) 30 (5.0) in the ARI cases relative to non-ARI in randomly 20 30 of Hous rus pos Non-ARI (N=446) Feb Apr Jun’10 30 (5.0) 1 (0.2) 1 (0 2) in randomly selected samples 10 2 No. 10 % Vi Jun 10 1 (0.2) Age groups (n=591) Under 1 1t 4 70 (11.8) 101 (17 1) 0 01 Nov 01 Dec 01 Jan 01 Feb 01 Mar 01 Apr 01 May 01 Jun 0 Rhi RSV Ad C PIV FLU hMPV 1 to 4 5 to 9 101 (17.1) 107 (18.1) 01 Nov 01 Dec 01 Jan 01 Feb 01 Mar 01 Apr 01 May 01 Jun Date Fig. 3: HH retention over the follow up period Rhino RSV Adeno Corona PIV FLU hMPV 4 HH sizes and age at enrollment 10 to 19 20 to 29 140 (23.7) 72 (12.2) 7. Infection patterns within one HH 4. HH sizes and age at enrollment 30 to 39 Above 40 53 (9.0) 48 (8.1) 10 70 6 6 (a) (b) (c) (d) RSV A Mum Rhino Mum Fig. 6: Infection patterns of RSV A, Above 40 48 (8.1) Sex (n=558) Male 262 (47.0) Occupation (n=596) Unemployed 274 (46 0) 8 ds 60 0 nts 5 en 5 (a) (b) (c) (d) B1 B2 B1 B2 Rhinovirus, Adenovirus and Occupation (n=596) Unemployed Pupils F 274 (46.0) 187 (31.4) 70 (11 7) 6 ousehold 40 50 articipan 4 3 x childre 4 3 nf S nf S Coronavirus OC43 within a household of Farmers Employed 70 (11.7) 65 (10.9) 4 No. of ho 20 30 No. of pa 2 3 . of inde 2 3 I Dec'09 J F M A M Jun'10 I Dec'09 J F M A M Jun'10 5 members ; infant (1 month), sister (2yrs), b th 1 (6 ) Education (n=592) None Nursery 269 (45.4) 68 (11.5) 2 N 2 10 N 1 No 1 Adeno B2 Mum Coronavirus (OC43) B2 Mum brother 1 (6 yrs), brother 2 (9 yrs) and mother (29 yrs) at Class 1 to 3 Class 4 to 8 100 (16.9) 140 (23 7) 0 0 20 30 40 5 15 25 35 10 Household sizes 0 0 20 40 60 80 100 10 30 50 70 90 Age in years 0 0 2 4 6 8 10 Age in Months 0 Apr'09 Jun Aug Oct Dec Feb'10 Birth date S B1 S B1 mother (29 yrs) at start of sampling on 21/12/2009) First Class 4 to 8 Secondary 140 (23.7) 15 (2.5) Relation to index child Siblings 198 (37 1) Fig. 4: (a) HH sizes and (b) age distribution of the cohort at recruitment. (c) Age and (d) birth dates of the index children. The red line indicates the median. The Inf Dec'09 J F M A M Jun'10 Inf Dec'09 J F M A M Jun'10 21/12/2009) . First HH with complete viral screen Relation to index child (n=534) Siblings Parents C i 198 (37.1) 115 (21.5) 107 (20 0) index child was the youngest child in the HH at recruitment. Date Date 5. Home visits, NFS, OF and ARI by relation Cousin Others 107 (20.0) 114 (21.3) Conclusion Live in same house (n=533) as index child 293 (55.0) Sleep in same room (n=530) as index child 201 (37.9) Early results are encouraging that methods will Relation to Number of Sleep same bed (n=530) as index child 134 (25.3) Early results are encouraging that methods will yield data to explore the study objectives Relation to Index child Number of Participants Home visits NFS (%) OF (%) ARI (%) 2. Summary data Rhinovirus RSV adenovirus and corona virus Self 56 2052 1767 (89.7) 980 (99.4) 842 (42.7) Brother 96 3389 3035 (89 6) 1657 (97 8) 884 (26 1) 60 households recruited giving a total of 596 individuals Rhinovirus, RSV, adenovirus and corona virus (OC43) are the most prevalent viruses in the Brother 96 3389 3035 (89.6) 1657 (97.8) 884 (26.1) Sister 88 3229 2859 (88.5) 1594 (98.7) 727 (22.5) 13 (22%) households lost to follow up cohort Mother 65 2307 1967 (85.3) 1117 (96.8) 139 (6.0) Father 41 1346 904 (67 1) 545 (81 0) 54 (4 0) 13 (22%) households lost to follow up Total of 19 816 home visits resulting in 16 284 NFS and These viruses could help in elucidating Father 41 1346 904 (67.1) 545 (81.0) 54 (4.0) Cousin 106 4092 3353 (81.9) 1911 (93.4) 696 (17.0) Total of 19,816 home visits resulting in 16,284 NFS and 9,226 OF being taken => from 554 participants transmission events within households Uncle/aunt 70 2579 1694 (66.3) 1020 (79.8) 226 (8.9) Others 32 928 705 (76.0) 402 (86.6) 56 (6.0) In 3,624 visits the participants had symptoms of acute Support: Wellcome Trust Others 32 928 705 (76.0) 402 (86.6) 56 (6.0) Total 554 19,816 16,284 (82) 9,226 (93) 3,624 (18) respiratory infection (ARI) Support: Wellcome Trust (ref 084633) Table: Frequency distribution of home visits, NFS, OF and ARI over the study period by relation to the index child. period by relation to the index child.
Transcript of Wh i i f ti f h H h ld t i i f i tWho acquires infection ... · Wh i i f ti f h H h ld t i i f i...
Wh i i f ti f h H h ld t i i f i tWho acquires infection from whom: Household transmission of respiratory syncytial virus (RSV)syncytial virus (RSV)
Munywoki PK1* Koech DC1 Kibirige NA1 Cane PA2 Medley GF3 Nokes DJ1, 3Munywoki PK , Koech DC , Kibirige, NA , Cane PA , Medley GF , Nokes DJ ,
1 Kenya Medical Research Institute, Kenya; 2 Health Protection Agency, UK ; 3 University of Warwick, UK* [email protected]
MethodologyBackgroundFig. 1: WAIFW MatrixRSV is a major cause of childhood ARI worldwide. In
infected
gKilifi around 1-2 in every 100 infants are admitted with
RSV disevere RSV disease per year
infantCurrently no licensed RSV vaccines exists => susceptible
infant
ld
immunological immaturity and maternal antibodies are the major obstacles > for vaccine targeting 1 3yr age group oldermajor obstacles => for vaccine targeting 1-3yr age group.
Need to carefully evaluate alternative approaches, such as
Distribution of study HHstargeting older infants, household siblings, school children or mothers yor mothers.
Potential impact of such strategies will be intimately linked to WAIFW (Who Acquires Infection From Whom): which groups are most important in infecting the infant
A schema of the prospective household study
St d I l t tiObj tiwhich groups are most important in infecting the infant.
Study ImplementationObjectivesDetermine the proportion of primary infant infections that i f ld ibli f h h
Sensitization & HH recruitment prior to id i O t + N 2009arise from elder siblings or from the mother epidemic – Oct + Nov 2009
Estimate the household (HH) reproductive potential of Eligible HHs had an infant plus ≥1older siblings( ) p pRSV and risk of transmission per contact
F ll f 6 th f ll RSV id iQuantify rates of infection and recovery of RSV and other
Follow up for 6 months, one full RSV epidemic Quantify rates of infection and recovery of RSV and other
respiratory viruses (RV) in the HH; stratify for age i.e. Surveillance methods for RV infectioninfants, older children & adults • Home visits: Nasopharyngeal flocked swab
(NFS) and illness assessment twice a week +Evaluate the diagnostic performance of oral fluid (OF) in
(NFS) and illness assessment twice-a-week + OF collection once-a-week.Evaluate the diagnostic performance of oral fluid (OF) in
detecting infection using RT-PCR methodsOF collection once a week.
• Clinic visits: For clinical assessment and Fig 2: Matsangoni map showing distribution of the recruitedtreatment. Samples only collected if due
Fig. 2: Matsangoni map showing distribution of the recruited households (navy blue). Insert (Kilifi Epi-DSS map)
R lResults 3. Households retention1. Baseline characteristics of the cohort 6. Prevalence of viruses in AR1 vs. non-ARI
Characteristic Description Frequency (%) Fig. 5: Prevalence of the identified
50 30
Month of consent (n=596) Nov ’09Dec
444 (74.5)76 (12.6)
of the identified respiratory viruses in the ARI cases0
40se
hold
s
20sitiv
e ARI (N=572)
Jan Feb
( )44 (7.4)30 (5.0)
in the ARI cases relative to non-ARI in randomly20
30 o
f Hou
s
rus p
os Non-ARI (N=446)
FebApr
Jun’10
30 (5.0)1 (0.2)1 (0 2)
in randomly selected samples
102
No.
10
% V
i
Jun 10 1 (0.2)Age groups (n=591) Under 1
1 t 470 (11.8)
101 (17 1)
0
01 Nov 01 Dec 01 Jan 01 Feb 01 Mar 01 Apr 01 May 01 Jun
0Rhi RSV Ad C PIV FLU hMPV1 to 4
5 to 9 101 (17.1)107 (18.1)
01 Nov 01 Dec 01 Jan 01 Feb 01 Mar 01 Apr 01 May 01 JunDate
Fig. 3: HH retention over the follow up period
Rhino RSV Adeno Corona PIV FLU hMPV
4 HH sizes and age at enrollment10 to 1920 to 29
140 (23.7)72 (12.2)
g f p p7. Infection patterns within one HH
4. HH sizes and age at enrollment30 to 39
Above 40
( )53 (9.0)48 (8.1) 10 70 6 6
(a) (b) (c) (d)RSV A
Mum Rhino
Mum
Fig. 6: Infection patterns of RSV A, Above 40 48 (8.1)
Sex (n=558) Male 262 (47.0)Occupation (n=596) Unemployed 274 (46 0)
8ds
600nts
5
en
5
(a) (b) (c) (d)
B1
B2
B1
B2
p f ,Rhinovirus, Adenovirus and Occupation (n=596) Unemployed
PupilsF
274 (46.0)187 (31.4)70 (11 7)
6ou
seho
ld
4050
artic
ipan 4
3x ch
ildre
43 nf
S
nfS Coronavirus OC43
within a household of Farmers
Employed70 (11.7)65 (10.9)
4N
o. o
f ho
2030
No.
of p
a
23
. of i
nde
23 I
Dec'09 J F M A M Jun'10
I
Dec'09 J F M A M Jun'105 members ; infant (1 month), sister (2yrs), b th 1 (6 )Education (n=592) None
Nursery269 (45.4)68 (11.5)
2N 2
10N
1
No
1
Adeno
B2
Mum Coronavirus (OC43)
B2
Mum brother 1 (6 yrs),
brother 2 (9 yrs) and mother (29 yrs) aty
Class 1 to 3Class 4 to 8
( )100 (16.9)140 (23 7)
0
0 20 30 405 15 25 3510
Household sizes
0
0 20 40 60 80 10010 30 50 70 90
Age in years
0
0 2 4 6 8 10Age in Months
0
Apr'09 Jun Aug Oct Dec Feb'10
Birth date SB
1
SB
1 mother (29 yrs) at start of sampling on 21/12/2009) FirstClass 4 to 8
Secondary140 (23.7)
15 (2.5)Relation to index child Siblings 198 (37 1)
Fig. 4: (a) HH sizes and (b) age distribution of the cohort at recruitment. (c) Age and (d) birth dates of the index children. The red line indicates the median. The
Inf
Dec'09 J F M A M Jun'10
Inf
Dec'09 J F M A M Jun'10
21/12/2009) . First HH with complete viral screenRelation to index child
(n=534)Siblings Parents C i
198 (37.1)115 (21.5)107 (20 0)
index child was the youngest child in the HH at recruitment. Date Date
5. Home visits, NFS, OF and ARI by relation CousinOthers
107 (20.0)114 (21.3) Conclusiony
Live in same house (n=533) as index child 293 (55.0)Sleep in same room (n=530) as index child 201 (37.9) Early results are encouraging that methods willRelation to Number ofp ( ) ( )Sleep same bed (n=530) as index child 134 (25.3) Early results are encouraging that methods will
yield data to explore the study objectives Relation to
Index child
Number of
Participants Home visits NFS (%) OF (%) ARI (%)
2. Summary data y p y j
Rhinovirus RSV adenovirus and corona virusSelf 56 2052 1767 (89.7) 980 (99.4) 842 (42.7)
Brother 96 3389 3035 (89 6) 1657 (97 8) 884 (26 1)
60 households recruited giving a total of 596 individualsRhinovirus, RSV, adenovirus and corona virus
(OC43) are the most prevalent viruses in the Brother 96 3389 3035 (89.6) 1657 (97.8) 884 (26.1)
Sister 88 3229 2859 (88.5) 1594 (98.7) 727 (22.5)g g
13 (22%) households lost to follow upcohortMother 65 2307 1967 (85.3) 1117 (96.8) 139 (6.0)
Father 41 1346 904 (67 1) 545 (81 0) 54 (4 0)13 (22%) households lost to follow up
Total of 19 816 home visits resulting in 16 284 NFS andThese viruses could help in elucidating
Father 41 1346 904 (67.1) 545 (81.0) 54 (4.0)
Cousin 106 4092 3353 (81.9) 1911 (93.4) 696 (17.0)Total of 19,816 home visits resulting in 16,284 NFS and
9,226 OF being taken => from 554 participantstransmission events within householdsUncle/aunt 70 2579 1694 (66.3) 1020 (79.8) 226 (8.9)
Others 32 928 705 (76.0) 402 (86.6) 56 (6.0)g p p
In 3,624 visits the participants had symptoms of acute Support: Wellcome TrustOthers 32 928 705 (76.0) 402 (86.6) 56 (6.0)
Total 554 19,816 16,284 (82) 9,226 (93) 3,624 (18)3,6 v s ts t e pa t c pa ts ad sy pto s o acuterespiratory infection (ARI)
Support: Wellcome Trust (ref 084633)Table: Frequency distribution of home visits, NFS, OF and ARI over the study
period by relation to the index child. ( e 08 633)period by relation to the index child.
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