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Tropical Medicine

Cluster-Randomized Trial: Twice-Yearly Azithromycin Reduces Mortality in Children Aged 1 to 59 Months in Niger – New England Journal of Medicine

24 Aug, 2024 | 19:44h | UTC

Study Design and Population: This adaptive cluster-randomized trial evaluated the impact of twice-yearly azithromycin distribution on childhood mortality in rural communities in Niger. A total of 1273 communities were assigned to three groups: children aged 1 to 59 months receiving azithromycin, infants aged 1 to 11 months receiving azithromycin and placebo for older children, and a placebo group. The study included 382,586 children and followed mortality over 419,440 person-years.

Main Findings: The study found a significant 14% reduction in mortality among children aged 1 to 59 months in the azithromycin group compared to placebo (11.9 vs. 13.9 deaths per 1000 person-years; P<0.001). However, azithromycin did not significantly reduce mortality in infants aged 1 to 11 months when compared to placebo (22.3 vs. 23.9 deaths per 1000 person-years).

Implications for Practice: Azithromycin distribution to children aged 1 to 59 months effectively reduces mortality in rural sub-Saharan Africa. However, targeting only infants may not yield significant benefits. Continuous monitoring for antimicrobial resistance is essential.

Reference: O’Brien KS, Arzika AM, Amza A, et al. (2024). Azithromycin to reduce mortality — an adaptive cluster-randomized trial. N Engl J Med, 391(8), 699-709. DOI: https://doi.org/10.1056/NEJMoa2312093

 

Phase 2 RCT: Preventive subcutaneous L9LS monoclonal antibody reduces malaria incidence by 66-70% in Malian children – N Engl J Med

7 May, 2024 | 15:31h | UTC

This phase 2 randomized clinical trial investigated the safety and efficacy of the monoclonal antibody L9LS in preventing Plasmodium falciparum infection and clinical malaria in children aged 6 to 10 years in Mali. The trial was structured in two parts: initial dose assessment in adults followed by a randomized, placebo-controlled test in children over a 6-month malaria season. A total of 225 children participated, divided equally among three groups to receive either 150 mg of L9LS, 300 mg of L9LS, or a placebo. Results demonstrated a significant reduction in the rate of P. falciparum infection—66% efficacy with the 150-mg dose and 70% efficacy with the 300-mg dose. Similarly, efficacy against clinical malaria was 67% with the 150-mg dose and 77% with the 300-mg dose. Both doses were well-tolerated with no safety concerns reported, underscoring the potential of L9LS as a preventative treatment against malaria in endemic regions.

 

Reference (link to abstract – $ for full-text):

Kayentao, K. et al. (2024). Subcutaneous Administration of a Monoclonal Antibody to Prevent Malaria. N Engl J Med, 390(17), 1549-1559. DOI: 10.1056/NEJMoa2312775

 

M-A | Most dengue infections are asymptomatic and could significantly contribute to the transmission of the disease

9 Aug, 2023 | 15:21h | UTC

Global prevalence of asymptomatic dengue infections – a systematic review and meta-analysis – International Journal of Infectious Diseases

 

M-A | The global prevalence of human fascioliasis

8 Aug, 2023 | 13:10h | UTC

The global prevalence of human fascioliasis: a systematic review and meta-analysis – Therapeutic Advances in Infectious Disease

 

Global Burden of Disease Study | Understanding global trends of infectious diseases in younger population, 1990-2019

10 Jul, 2023 | 13:54h | UTC

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019 – The Lancet

News Release: Global efforts to reduce infectious diseases must extend beyond early childhood – Murdoch Children’s Research Institute

Commentary: Global infectious disease burden shifting from younger to older youth – CIDRAP

 

RCT | Single-Dose VLA1553 Chikungunya vaccine shows high immunogenicity and seems safe

23 Jun, 2023 | 13:38h | UTC

Safety and immunogenicity of a single-shot live-attenuated chikungunya vaccine: a double-blind, multicentre, randomised, placebo-controlled, phase 3 trial – The Lancet

News Release: First phase 3 trial of a chikungunya vaccine candidate finds it is generally safe and provokes an immune response – The Lancet

 

Commentary on Twitter

 

Cohort Study | Dengue patients at high risk of cholecystitis and pancreatitis within 30 days

21 Jun, 2023 | 13:34h | UTC

Risks of Acute Cholecystitis, Acute Pancreatitis, and Acute Appendicitis in Patients with Dengue Fever: A Population-Based Cohort Study in Taiwan

 

RCT | NmCV-5 pentavalent meningococcal vaccine shows non-inferiority to quadrivalent MenACWY-D in Mali and Gambia

30 May, 2023 | 11:46h | UTC

Meningococcal ACWYX Conjugate Vaccine in 2-to-29-Year-Olds in Mali and Gambia – New England Journal of Medicine

 

Commentary on Twitter

 

Phase 2a RCT | Emodepside demonstrates superior efficacy to albendazole in treating Trichuris trichiura and Hookworm Infection

25 May, 2023 | 11:33h | UTC

Emodepside for Trichuris trichiura and Hookworm Infection – New England Journal of Medicine (link to abstract – $ for full-text)

 

Liver cystic echinococcosis: a parasitic review

25 May, 2023 | 11:19h | UTC

Liver cystic echinococcosis: a parasitic review – Therapeutic Advances in Infectious Disease

 

RCT | Safety of integrated MDA of azithromycin, albendazole and ivermectin vs. standard treatment regimens

10 May, 2023 | 15:24h | UTC

Safety of integrated mass drug administration of azithromycin, albendazole and ivermectin versus standard treatment regimens: a cluster-randomised trial in Ethiopia – eClinicalMedicine

 

Burden of typhoid and paratyphoid fever in India

25 Apr, 2023 | 14:32h | UTC

Burden of Typhoid and Paratyphoid Fever in India – New England Journal of Medicine

Related: The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017 – The Lancet Infectious Diseases

 

Commentary on Twitter

 

Cluster RCT | Long-lasting insecticidal nets compared for malaria control

12 Apr, 2023 | 13:04h | UTC

Efficacy of pyriproxyfen-pyrethroid long-lasting insecticidal nets (LLINs) and chlorfenapyr-pyrethroid LLINs compared with pyrethroid-only LLINs for malaria control in Benin: a cluster-randomised, superiority trial – The Lancet

Invited Commentary: Getting ahead of insecticide-resistant malaria vector mosquitoes – The Lancet (free registration required)

 

WHO Report | Dengue & Chikungunya cases spreading beyond known transmission zones in the Americas

10 Apr, 2023 | 14:04h | UTC

Geographical expansion of cases of dengue and chikungunya beyond the historical areas of transmission in the Region of the Americas – World Health Organization

Commentary: WHO: Concerning Spread of Dengue, Chikungunya in Latin America – JAMA

 

RCT | Sulfadoxine-pyrimethamine vs. dihydroartemisinin-piperaquine for preventive treatment of malaria in pregnant women in Africa

13 Mar, 2023 | 14:43h | UTC

Effect of monthly intermittent preventive treatment with dihydroartemisinin–piperaquine with and without azithromycin versus monthly sulfadoxine–pyrimethamine on adverse pregnancy outcomes in Africa: a double-blind randomised, partly placebo-controlled trial – The Lancet

Commentary: New antimalarial prevents malaria more effectively than current treatments but does not improve birth outcomes – News Medical / Liverpool School of Tropical Medicine

 

RCT | Combination of intravenous doxycycline and azithromycin better than either drug alone for severe scrub typhus

8 Mar, 2023 | 14:36h | UTC

Summary:

The study aimed to compare the efficacy of intravenous doxycycline, azithromycin, or a combination of both drugs in treating severe scrub typhus. The study randomized 794 patients with severe scrub typhus and at least one organ involvement to receive a 7-day course of intravenous doxycycline, azithromycin, or both.

The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. The study found that combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for treating severe scrub typhus than monotherapy with either drug alone.

Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: A combination therapy is found to be more effective on severe scrub typhus – University of Oxford

 

Commentary on Twitter

 

Early diagnostic indicators of dengue vs. other febrile illnesses in Asia and Latin America: a multicenter, prospective, observational study

8 Mar, 2023 | 14:16h | UTC

Summary:
The IDAMS study is a large, prospective, observational study conducted in eight countries in Asia and Latin America to investigate early diagnostic indicators of dengue compared to other febrile illnesses. The study included 7428 patients with undifferentiated fever, of whom 2694 were diagnosed with laboratory-confirmed dengue and 2495 with other febrile illnesses.

Platelet count, white blood cell count, and their changes over time were strongly associated with dengue, while cough and rhinitis were strongly associated with other febrile illnesses. The study found that a set of 14 clinical and three laboratory predictors can distinguish between dengue and other febrile illnesses during the early phase of symptoms, with sensitivities of 80-87% and specificities of 80-91%. The study also found that models that include laboratory markers outperform those based solely on clinical variables.

The study’s results provide important information for updating guidelines on the management of febrile illnesses, particularly in resource-limited settings where distinguishing between dengue and other febrile illnesses is crucial for patient management.

Article: Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study – The Lancet Global Health

Invited Commentary: Differentiating dengue from other febrile illnesses: a dilemma faced by clinicians in dengue endemic countries – The Lancet Global Health

 

Commentary on Twitter

 

Mpox outbreak in advanced HIV cases | Global case series reveals higher mortality and clinical complications

23 Feb, 2023 | 13:44h | UTC

Summary: This article discusses a case series investigating monkeypox (mpox) in people with HIV and low CD4 cell counts. The mpox outbreak in 2022 has affected a significant percentage of people living with HIV, and data suggest worse clinical outcomes and higher mortality in those with more advanced HIV. The case series includes data from 382 confirmed mpox cases in people living with HIV from 19 countries. The individuals included were predominantly cisgender men, with a median age of 35. Most individuals were adherent to antiretroviral therapy, and the median CD4 count was 211 cells per mm3. Severe complications were more common in those with lower CD4 cell counts, including necrotizing skin lesions, lung involvement, secondary infections, and sepsis. Approximately 28% of individuals were hospitalized, and 25% of those hospitalized died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. The study reinforces the importance of HIV and CD4 testing in mpox cases, prioritization of preventive mpox vaccination in people with HIV and a CD4 cell count of less than 200 cells per mm3, and the use of potential mpox antivirals where available. The authors suggest that a severe, disseminated, and necrotizing form of mpox should be considered an AIDS-defining condition in CDC and WHO HIV disease classifications. Clinicians should also be aware that starting antiretroviral therapy in people with advanced HIV and mpox could contribute to deterioration and possible death, possibly as part of an immune reconstitution syndrome.

Article: Mpox in people with advanced HIV infection: a global case series – The Lancet (free registration required)

News Release: Clinicians identify severe form of mpox with high mortality in people with advanced HIV – Queen Mary University of London

Commentaries:

Expert comment – Severe form of mpox identified in people with advanced HIV – London School of Hygiene & Tropical Medicine

Mpox: Clinicians identify severe form with high mortality in advanced HIV patients – The BMJ

 

Commentary from the author on Twitter (thread – click for more)

 

M-A | Oral manifestation of the monkeypox virus

23 Feb, 2023 | 13:42h | UTC

Oral manifestation of the monkeypox virus: a systematic review and meta-analysis – eClinicalMedicine

 

Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment

23 Feb, 2023 | 13:13h | UTC

Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment – Expert Opinion on Pharmacotherapy

 

Eight countries eliminated a neglected tropical disease in 2022

14 Feb, 2023 | 10:45h | UTC

Eight countries eliminated a neglected tropical disease in 2022 – Nature

Original report: WHO Global report on neglected tropical diseases 2023

 

Brief Review | Mpox — A rapidly evolving disease

10 Feb, 2023 | 13:56h | UTC

Mpox—A Rapidly Evolving Disease – JAMA Dermatology

Related:

Surveillance, case investigation and contact tracing for mpox (monkeypox): interim guidance, 22 December 2022 – World Health Organization

Rapid review on monkeypox policies among the G20 nations: relevance to policy and practitioner – F1000 Research

Clinical features and management of individuals admitted to hospital with monkeypox and associated complications across the UK: a retrospective cohort study – The Lancet Infectious Diseases

Monkeypox (hMPXV infection): A practical review – American Journal of Medicine

Monkeypox in pregnancy: virology, clinical presentation, and obstetric management – American Journal of Obstetrics & Gynecology

WHO renames “monkeypox” as “mpox” to help destigmatize the disease.

Monkeypox – The Lancet

Study shows there is substantial monkeypox transmission before symptoms appear.

Global monkeypox case hospitalisation rates: A rapid systematic review and meta-analysis – eClinicalMedicine

Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series – The Lancet

Monkeypox — A Sobering Sentinel for Pandemic Preparedness and Sexual Health System Capacity – New England Journal of Medicine

CDC study shows healthcare workers have a low risk of infection after exposure to patients with monkeypox.

Monkeypox – New England Journal of Medicine

Diagnosis and Management of Monkeypox: A Review for the Emergency Clinician – Annals of Emergency Medicine

Monkeypox: disease epidemiology, host immunity and clinical interventions.

Monkeypox: A clinical update for paediatricians – Journal of Pediatrics and Child Health

Cohort Study | Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain.

CDC Report | Epidemiologic and clinical characteristics of Monkeypox cases in the US.

Update on the Monkeypox Outbreak – JAMA

Antivirals with Activity Against Monkeypox: A Clinically Oriented Review – Clinical Infectious Diseases

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series – The BMJ

WHO Declares Global Public Health Emergency Over Monkeypox Virus Outbreak – Health Policy Watch

Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022 – New England Journal of Medicine

Monkeypox: A Contemporary Review for Healthcare Professionals – Open Forum Infectious Diseases

 

Video | Malaria — Epidemiology, treatment, and prevention

8 Feb, 2023 | 12:37h | UTC

Malaria — Epidemiology, Treatment, and Prevention | NEJM

 

WHO Global report on neglected tropical diseases 2023

31 Jan, 2023 | 14:09h | UTC

Global report on neglected tropical diseases 2023 – World Health Organization

News Release: More countries eliminate neglected tropical diseases but investments key to sustain progress – World Health Organization

 

Commentary on Twitter

 

SR | Interventions to improve sanitation for preventing diarrhea

27 Jan, 2023 | 12:15h | UTC

Interventions to improve sanitation for preventing diarrhoea – Cochrane Library

Summary: Interventions to improve sanitation for preventing diarrhoea – Cochrane Library

 

Commentary on Twitter

 

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