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1. Risk of COVID-19 after natural infection or vaccinationResearch in context

Author

Anne-Marie Rick, Matthew B. Laurens, Ying Huang, Chenchen Yu, Thomas C.S. Martin, Carina A. Rodriguez, Christina A. Rostad, Rebone M. Maboa, Lindsey R. Baden, Hana M. El Sahly, Beatriz Grinsztejn, Glenda E. Gray, Cynthia L. Gay, Peter B. Gilbert, Holly E. Janes, James G. Kublin, Yunda Huang, Brett Leav, Ian Hirsch, Frank Struyf, Lisa M. Dunkle, Kathleen M. Neuzil, Lawrence Corey, Paul A. Goepfert, Stephen R. Walsh, Dean Follmann, Karen L. Kotloff, Atoya Adams, Eric Miller, Bruce G. Rankin, Steven Shinn, Marshall Nash, Sinikka L. Green, Colleen Jacobsen, Jayasree Krishnankutty, Sikhongi Phungwayo, Richard M. Glover, II, Stacy Slechta, Troy Holdeman, Robyn Hartvickson, Amber Grant, Terry L. Poling, Terry D. Klein, Thomas C. Klein, Tracy R. Klein, William B. Smith, Richard L. Gibson, Jennifer Winbigler, Elizabeth Parker, Priyantha N. Wijewardane, Eric Bravo, Jeffrey Thessing, Michelle Maxwell, Amanda Horn, Catherine Mary Healy, Christine Akamine, Laurence Chu, R. Michelle Chouteau, Michael J. Cotugno, George H. Bauer, Jr., Greg Hachigian, Masaru Oshita, Michael Cancilla, Kristen Kiersey, William Seger, Mohammed Antwi, Allison Green, Anthony Kim, Michael Desjardins, Jennifer A. Johnson, Amy Sherman, Judith Borger, Nafisa Saleem, Joel Solis, Martha Carmen Medina, Westly Keating, Edgar Garcia, Cynthia Bueno, Nathan Segall, Douglas S. Denham, Thomas Weiss, Ayoade Avworo, Parke Hedges, Cynthia Becher Strout, Rica Santiago, Yvonne Davis, Patty Howenstine, Alison Bondell, Kristin Marks, Tina Wang, Timothy Wilkin, Mary Vogler, Carrie Johnston, Michele P. Andrasik, Jessica G. Andriesen, Gail Broder, Niles Eaton, Huub G. Gelderblom, Rachael McClennen, Nelson Michael, Merlin Robb, Carrie Sopher, Vicki E. Miller, Fredric Santiago, Blanca Gomez, Insiya Valika, Amy Starr, Valeria D. Cantos, Sheetal Kandiah, Carlos del Rio, Nadine Rouphael, Srilatha Edupuganti, Evan J. Anderson, Andres Camacho-Gonzalez, Satoshi Kamidani, Meghan Teherani, David J. Diemert, Elissa Malkin, Marc Siegel, Afsoon Roberts, Gary Simon, Bindu Balani, Carolene Stephenson, Steven Sperber, Cristina Cicogna, Marcus J. Zervos, Paul Kilgore, Mayur Ramesh, Erica Herc, Kate Zenlea, Abram Burgher, Ann M. Milliken, Joseph D. Davis, Brendan Levy, Sandra Kelman, Matthew W. Doust, Denise Sample, Sandra Erickson, Shane G. Christensen, Christopher Matich, James Longe, John Witbeck, James T. Peterson, Alexander Clark, Gerald Kelty, Issac Pena-Renteria, Michael J. Koren, Darlene Bartilucci, Alpa Patel, Carolyn Tran, Christina Kennelly, Robert Brownlee, Jacob Coleman, Hala Webster, Carlos A. Fierro, Natalia Leistner, Amy Thompson, Celia Gonzalez, Lisa A. Jackson, Janice Suyehira, Milton Haber, Maria M. Regalado, Veronica Procasky, Alisha Lutat, Carl P. Griffin, Ripley R. Hollister, Jeremy Brown, Melody Ronk, Wayne L. Harper, Lisa Cohen, Lynn Eckert, Matthew Hong, Rambod Rouhbakhsh, Elizabeth Danford, John Johnson, Richard Calderone, Shishir K. Khetan, Oyebisi Olanrewaju, Nan Zhai, Kimberly Nieves, Allison O'Brien, Paul S. Bradley, Amanda Lilienthal, Jim Callis, Adam B. Brosz, Andrea Clement, Whitney West, Luke Friesen, Paul Cramer, Frank S. Eder, Ryan Little, Victoria Engler, Heather Rattenbury-Shaw, David J. Ensz, Allie Oplinger, Brandon J. Essink, Jay Meyer, Frederick Raiser, III, Kimberly Mueller, Keith W. Vrbicky, Charles Harper, Chelsie Nutsch, Wendell Lewis, III, Cathy Laflan, Jordan L. Whatley, Nicole Harrell, Amie Shannon, Crystal Rowell, Christopher Dedon, Mamodikoe Makhene, Gregory M. Gottschlich, Kate Harden, Melissa Gottschlich, Mary Smith, Richard Powell, Murray A. Kimmel, Simmy Pinto, Timothy P. Vachris, Mark Hutchens, Stephen Daniels, Margaret Wells, Mimi Van Der Leden, Peta-Gay Jackson-Booth, Mira Baron, Pamela Kane, Shannen Seversen, Mara Kryvicky, Julia Lord, Jamshid Saleh, Matthew Miles, Rafael Lupercio, John W. McGettigan, Jr., Walter Patton, Riemke Brakema, Karin Choquette, Jonlyn McGettigan, Judith L. Kirstein, Marcia Bernard, Mary Beth Manning, Joan Rothenberg, Toby Briskin, Denise Roadman, Sharita Tedder-Edwards, Howard I. Schwartz, Surisday Mederos, Shobha Swaminathan, Amesika Nyaku, Tilly Varughese, Michelle DallaPiazza, Sharon E. Frey, Irene Graham, Getahun Abate, Daniel Hoft, Leland N. Allen, III, Leslie A. Edwards, William S. Davis, Jr., Jessica M. Mena, Mark E. Kutner, Jorge Caso, Maria Hernandez Moran, Marianela Carvajal, Janet Mendez, Larkin T. Wadsworth, III, Michael R. Adams, Leslie Iverson, Joseph L. Newberg, Laura Pearlman, Paul J. Nugent, Michele D. Reynolds, Jennifer Bashour, Robert Schmidt, Neil P. Sheth, Kenneth Steil, Ramy J. Toma, William Kirby, Pink Folmar, Samantha Williams, Paul Pickrell, Stefanie Mott, Carol Ann Linebarger, Hussain Malbari, David Pampe, Veronica G. Fragoso, Lisa Holloway, Cecilia McKeown-Bragas, Teresa Becker, Barton G. Williams, William H. Jones, Jesse L. Clark, Steven Shoptaw, Michele Vertucci, Will Hernandez, Stephen A. Spector, Amaran Moodley, Jill Blumenthal, Lisa Stangl, Karen Deutsch, Kathleen M. Mullane, David Pitrak, Cheryl Nuss, Judy Pi, Carl Fichtenbaum, Margaret Powers-Fletcher, Michelle Saemann, Sharon Kohrs, Thomas B. Campbell, Andrew Lauria, Jose C. Mancilla, Hillary Dunlevy, Richard M. Novak, Andrea Wendrow, Scott Borgetti, Ben Ladner, Lisa Chrisley, Cheryl Young, Susanne Doblecki-Lewis, Maria L. Alcaide, Jose Gonzales-Zamora, Stephen Morris, David Wohl, Joseph Eron, Jr., Ian Frank, Debora Dunbar, David Metzger, Florence Momplaisir, Judith Martin, Alejandro Hoberman, Timothy Shope, Gysella Muniz, Richard Rupp, Amber Stanford, Megan Berman, Laura Porterfield, Michael Lewis, Elham Ghadishah, Joseph Yusin, Mai Pham, Clarence B. Creech, II, Shannon Walker, Stephanie Rolsma, Robert Samuels, Isaac Thomsen, Spyros A. Kalams, Greg Wilson, Gregg H. Lucksinger, Kevin Parks, Ryan Israelsen, Jaleh Ostovar, Kary Kelly, Jeffrey S. Overcash, Hanh Chu, Kia Lee, Luis I. De La Cruz, Steve Clemons, Elizabeth Everette, Suzanna Studdard, Gowdhami Mohan, Stefanie Tyson, Alyssa-Kay Peay, Danyel Johnson, Gregory J. Feldman, May-Yin Suen, Jacqueline Muenzner, Joseph Boscia, Farhan Siddiqui, John Sanders, James Peacock, Julio Nasim, Michael L. Levin, Julie Hussey, Marcy Kulic, Mark M. McKenzie, Teresa Deese, Erica Osmundsen, Christy Sweet, Valentine M. Ebuh, Elwaleed Elnagar, Georgette Ebuh, Genevieve Iwuala, Laurie J. Han-Conrad, Todd Simmons, Denis Tarakjian, Jeremy Ackermann, Mark S. Adams, José O. Alemán, Mohamed S. Al-Ibrahim, David R. Andes, Jeb Andrews, Roberto C. Arduino, Martín Bäcker, Diana Badillo, Emma Bainbridge, Teresa A. Batteiger, Jose A. Bazan, Roger J. Bedimo, Jorge A. Benitez, Annette R. Bennett, David I. Bernstein, Kristin Bialobok, Rebecca Boas, Judith Brady, Cynthia Brown, Catherine A. Bunce, Robert S. Call, Wesley Campbell, Ellie Carmody, Christopher Carpenter, Steven E. Carsons, Marvin Castellon, Mario Castro, Hannah Catan, Jennifer Chang, Mouna G. Chebib, Corey M. Chen, Margaret Cheng, Brian D.W. Chow, Annie Ciambruschini, Joseph P. Connor, James H. Conway, Maureen Cooney, Marcel Curlin, Claudia De La Matta Rodriguez, Jon F. Dedon, Emily Degan, Michelle Dickey, Craig Dietz, Jennifer L. Dong, Brenda Dorcely, Michael P. Dube, Carmel B. Dyer, Benjamin Eckhardt, Edward Ellerbeck, Evan C. Ewers, Amy Falk, Brittany Feijoo, Uriel R. Felsen, Tom Fiel, David Fitz-Patrick, Charles M. Fogarty, Stacy Ford, Lina M. Forero, Elizabeth Formentini, Doris Franco-Vitteri, Robert W. Frenck, Jr., Elie Gharib, Suzanne Gharib, Rola G. Rucker, James N. Goldenberg, Luis H. González, Brett Gray, Rusty Greene, Robert M. Grossberg, Juan V. Guanira-Carranza, Alfredo Gilberto Guerreros Benavides, Clint C. Guillory, Shauna H. Gunaratne, David Halpert, Holli Hamilton, William R. Hartman, Sheryl L. Henderson, Ramin Herati, Laura Hernandez Guarin, Robin Hilder, Ken Ho, Leila Hojat, Sybil G. Hosek, Jeffrey M. Jacobson, Melanie Jay, Diane H. Johnson, Kathleen S. Jones, Edward C. Jones-López, Jessica E. Justman, Scott Kahney, Lois Katz, Melinda Katz, Daniel Kaul, Michael C. Keefer, Ashley Kennedy, Jennifer Knishinsky, Laura Kogelman, Susan L. Koletar, Angelica Kottkamp, Maryrose Laguio-Vila, Raphael J. Landovitz, Jessica L. Lee, Albert Liu, Eneyda Giuvanela Llerena Zegarra, Anna S. Lok, James Lovell, Ronald Lubelchek, John Lucaj, Gary Luckasen, Annie Luetkemeyer, Njira Lucia Lugogo, Janine Maenza, Carlos Malvestutto, Monica Mauri, Ryan C. Maves, Kenneth H. Mayer, Michael J. McCartney, Margaret E. McCort, M. Juliana McElrath, Meredith McNairy, Fernando L. Merino, Eric A. Meyerowitz, Carol L. Mitchell, Cynthia L. Monaco, Sauda Muhammad, Sigridh Muñoz-Gómez, Sonal Munsiff, Paul Nee, Nicole L. Nollen, Asif Noor, Claudio Nuñez Lagos, Jason F. Okulicz, Patrick A. Oliver, Jessica Ortega, Steven Palmer, Lalitha Parameswaran, Purvi Parikh, Susan Parker, Reza Parungao, Juana R. Pavie, Rebecca P. Madan, Henry Peralta, Jennifer Petts, Kristen K. Pierce, E. Javier Pretell Alva, Lawrence J. Purpura, Vanessa Raabe, Sergio E. Recuenco, Tamara Richards, Sharon A. Riddler, Barbara Rizzardi, Rachel Rokser, Charlotte-Paige Rolle, Adam Rosen, Jeffrey Rosen, Lena R. Freese, María E. Santolaya, Linda M. Schipani, Adam Schwartz, Tiffany Schwasinger-Schmidt, Hyman Scott, Beverly E. Sha, Shivanjali Shankaran, Adrienne E. Shapiro, Stephan C. Sharp, Bo Shopsin, Matthew D. Sims, Stephanie Skipper, Derek M. Smith, Michael J. Smith, M. Mahdee Sobhanie, Brit Sovic, Stephanie Sterling, Robert Striker, Karla Beatriz Tafur Bances, Kawsar R. Talaat, Edward M. Tavel, Jr., Hong V. Tieu, Christian Tomaszewski, Ryan Tomlinson, Juan P. Torres, Julian A. Torres, John J. Treanor, Sade Tukuru, Robert J. Ulrich, Gregory C. Utz, Veronica Viar, Roberto A. Viau Colindres, Edward E. Walsh, Mary C. Walsh, Emmanuel B. Walter, Jessica L. Weidler, Yi H. Wu, Kinara S. Yang, Juan Luis Yrivarren Giorza, Arthur L. Zemanek, Kevin Zhang, Barry S. Zingman, Richard Gorman, Carmen A. Paez, Edith Swann, Simbarashe G. Takuva, Alex Greninger, Pavitra Roychoudhury, Robert W. Coombs, Keith R. Jerome, Flora Castellino, Xiaomi Tong, Corrina Pavetto, Teletha Gipson, Tina Tong, Marina Lee, James Zhou, Michael Fay, Kelly McQuarrie, Chimeremma Nnadi, Obiageli Sogbetun, Nina Ahmad, Ian De Proost, Cyrus Hoseyni, Paul Coplan, Najat Khan, Peter Ronco, Dawn Furey, Jodi Meck, Johan Vingerhoets, Boerries Brandenburg, Jerome Custers, Jenny Hendriks, Jarek Juraszek, Anne Marit de Groot, Griet Van Roey, Dirk Heerwegh, Ilse Van Dromme, Jorge F. Méndez Galván, Monica B. Carrascal, Adriana Sordo Duran, Laura Ruy Sanchez Guerrero, Martha Cecilia Gómora Madrid, Alejandro Quintín Barrat Hernández, Sharzhaad Molina Guizar, Denisse Alejandra González Estrada, Silvano Omar Martínez Pérez, Zindy Yazmín Zárate Hinojosa, Guillermo Miguel Ruiz-Palacios, Aurelio Cruz-Valdez, Janeth Pacheco-Flores, Anyela Lara, Secia Díaz-Miralrio, María José Reyes Fentanes, Jocelyn Zuleica Olmos Vega, Daniela Pineda Méndez, Karina Cano Martínez, Winniberg Stephany Alvarez León, Vida Veronica Ruiz Herrera, Eduardo Gabriel Vázquez Saldaña, Laura Julia Camacho Choza, Karen Sofia Vega Orozco, Sandra Janeth Ortega Domínguez, Jorge A. Chacón, Juan J. Rivera, Erika A. Cutz, Maricruz E. Ortegón, María I. Rivera, David Browder, Cortney Burch, Terri Moye, Paul Bondy, Lesley Browder, Rickey D. Manning, James W. Hurst, Rodney E. Sturgeon, Paul H. Wakefield, John A. Kirby, James Andersen, Szheckera Fearon, Rosa Negron, Amy Medina, John M. Hill, Vivek Rajasekhar, Hayes Williams, LaShondra Cade, Rhodna Fouts, Connie Moya, Corey G. Anderson, Naomi Devine, James Ramsey, Ashley Perez, David Tatelbaum, Michael Jacobs, Kathleen Menasche, Vincent Mirkil, Peter J. Winkle, Amina Z. Haggag, Michelle Haynes, Marysol Villegas, Sabina Raja, Robert Riesenberg, Stanford Plavin, Mark Lerman, Leana Woodside, Maria Johnson, C. Mary Healy, Jennifer A. Whitaker, Wendy A. Keitel, Robert L. Atmar, Gary Horwith, Robin Mason, Lisa Johnson, Tambra Dora, Deborah Murray, Logan Ledbetter, Beverly Ewing, Kathryn E. Stephenson, Chen S. Tan, Rebecca Zash, Jessica L. Ansel, Kate Jaegle, Caitlin J. Guiney, Jeffrey A. Henderson, Marcia O'Leary, Kendra Enright, Jill Kessler, Pete Ducheneaux, Asha Inniss, Donald M. Brandon, William B. Davis, Daniel T. Lawler, Yaa D. Oppong, Ryan P. Starr, Scott N. Syndergaard, Rozeli Shelly, Mashrur Islam Majumder, Danny Sugimoto, Jeffrey Dugas, Sr., Dolores Rijos, Sandra Shelton, Stephan Hong, Howard Schwartz, Nelia Sanchez-Crespo, Jennifer Schwartz, Terry Piedra, Barbara Corral, Carmen Medina, Michael E. Dever, Mitul Shah, Michael Delgado, Tameika Scott, Lisa S. Usdan, Lora J. McGill, Valerie K. Arnold, Carolyn Scatamacchia, Codi M. Anthony, Rajan Merchant, Anelgine C. Yoon, Janet Hill, Lucy Ng-Price, Teri Thompson-Seim, Ronald Ackerman, Jamie Ackerman, Florida Aristy, Nzeera Ketter, Jon Finley, Mildred Stull, Monica Murray, Zainab Rizvi, Sonia Guerrero, Yogesh K. Paliwal, Amit Paliwal, Sarah Gordon, Bryan Gordon, Cynthia Montano-Pereira, Christopher Galloway, Candice Montros, Lily Aleman, Samira Shairi, Wesley Van Ever, George H. Freeman, Esther L. Harmon, Marshall A. Cross, Kacie Sales, Catherine Q. Gular, Matthew Hepburn, Nathan Alderson, Shana Harshell, Siham Mahgoub, Celia Maxwell, Thomas Mellman, Karl M. Thompson, Glenn Wortman, Jeff Kingsley, April Pixler, LaKondria Curry, Sarah Afework, Austin Swanson, Jeffry Jacqmein, Maggie Bowers, Dawn Robison, Victoria Mosteller, Janet Garvey, Mary Easley, Rebecca J. Kurnat, Raymond Cornelison, Shanda Gower, William Schnitz, Destiny S. Heinzig-Cartwright, Derek Lewis, Fred E. Newton, Aeiress Duhart, Breanz Watkins, Brandy Ball, Jill York, Shelby Pickle, David B. Musante, William P. Silver, Linda R. Belhorn, Nicholas A. Viens, David Dellaero, Priti Patel, Kendra Lisec, Beth Safirstein, Luz Zapata, Lazaro Gonzalez, Evelyn Quevedo, Farah Irani, Joseph Grillo, Amy Potts, Julie White, Patrick Flume, Gary Headden, Brandie Taylor, Ashley Warden, Amy Chamberlain, Robert Jeanfreau, Susan Jeanfreau, Paul G. Matherne, Amy Caldwell, Jessica Stahl, Mandy Vowell, Lauren Newhouse, Vladimir Berthaud, Zudi-Mwak Takizala, Genevieve Beninati, Kimberly Snell, Sherrie Baker, James Walker, Tavane Harrison, Meagan Miller, Janet Otto, Roni Gray, Christine Wilson, Tiffany Nemecek, Hannah Harrington, Sally Eppenbach, Wendell Lewis, Tana Bourgeois, Lyndsea Folsom, Gregory Holt, Mehdi Mirsaeidi, Rafael Calderon, Paola Lichtenberger, Jalima Quintero, Becky Martinez, Lilly Immergluck, Erica Johnson, Austin Chan, Norberto Fas, LaTeshia Thomas-Seaton, Saadia Khizer, Jonathan Staben, Tatiana Beresnev, Maryam Jahromi, Mary A. Marovich, Julia Hutter, Martha Nason, Julie Ledgerwood, John Mascola, Mark Leibowitz, Fernanda Morales, Mike Delgado, Rosario Sanchez, Norma Vega, Germán Áñez, Gary Albert, Erin Coston, Chinar Desai, Haoua Dunbar, Mark Eickhoff, Jenina Garcia, Margaret Kautz, Angela Lee, Maggie Lewis, Alice McGarry, Irene McKnight, Joy Nelson, Patrick Newingham, Patty Price-Abbott, Patty Reed, Diana Vegas, Bethanie Wilkinson, Katherine Smith, Wayne Woo, Iksung Cho, Gregory M. Glenn, Filip Dubovsky, David L. Fried, Lynne A. Haughey, Ariana C. Stanton, Lisa Stevens Rameaka, David Rosenberg, Lee Tomatsu, Viviana Gonzalez, Millie Manalo, Bernard Grunstra, Donald Quinn, Phillip Claybrook, Shelby Olds, Amy Dye, Kevin D. Cannon, Mesha M. Chadwick, Bailey Jordan, Morgan Hussey, Hannah Nevarez, Colleen F. Kelley, Michael Chung, Caitlin Moran, Paulina Rebolledo, Christina Bacher, Elizabeth Barranco-Santana, Jessica Rodriguez, Rafael Mendoza, Karen Ruperto, Odette Olivieri, Enrique Ocaña, Paul E. Wylie, Renea Henderson, Natasa Jenson, Fan Yang, Amy Kelley, Kenneth Finkelstein, David Beckmann, Tanya Hutchins, Sebastian Garcia Escallon, Kristen Johnson, Teresa S. Sligh, Parul Desai, Vincent Huynh, Carlos Lopez, Erika Mendoza, Jeffrey Adelglass, Jerome G. Naifeh, Kristine J. Kucera, Waseem Chughtai, Shireen H. Jaffer, Matthew G. Davis, Jennifer Foley, Michelle L. Burgett, Tammi L. Shlotzhauer, Sarah M. Ingalsbe-Geno, Daniel Duncanson, Kelly Kush, Lori Nesbitt, Cora Sonnier, Jennifer McCarter, Michael B. Butcher, James Fry, Donna Percy, Karen Freudemann, Bruce C. Gebhardt, Padma N. Mangu, Debra B. Schroeck, Rajesh K. Davit, Gayle D. Hennekes, Benjamin J. Luft, Melissa Carr, Sharon Nachman, Alison Pellecchia, Candace Smith, Bruno Valenti, Maria I. Bermudez, Noris Peraita, Ernesto Delgado, Alicia Arrazcaeta, Natalie Ramirez, Carmen Amador, Horacio Marafioti, Lyly Dang, Lauren Clement, Jennifer Berry, Mohammed Allaw, Georgettea Geuss, Chelsea Miles, Zachary Bittner, Melody Werne, Cornell Calinescu, Shannon Rodman, Joshua Rindt, Erin Cooksey, Kristina Harrison, Deanna Cooper, Manisha Horton, Amanda Philyaw, William Jennings, Hilario Alvarado, Michele Baka, Malina Regalado, Linda Murray, Sherif Naguib, Justin Singletary, Sha-Wanda Richmond, Sarah Omodele, Emily Oppenheim, Reuben Martinez, Victoria Andriulis, Leonard Singer, Jeanne Blevins, Meagan Thomas, Christine Hull, Isabel Pereira, Gina Rivero, Tracy Okonya, Frances Downing, Paulina Miller, Margaret Rhee, Katherine Stapleton, Jeffrey Klein, Rosamond Hong, Suzanne Swan, Tami Wahlin, Elizabeth Bennett, Amy Salzl, Sharine Phan, Jewel J. White, Amanda Occhino, Ruth Paiano, Morgan McLaughlin, Elisa Swieboda, Veronica Garcia-Fragoso, Maria G. Becerra, Toni White, Christine B. Turley, Andrew McWilliams, Tiffany Esinhart, Natasha Montoya, Shamika Huskey, Leena Paul, Karen Tashima, Jennie Johnson, Marguerite Neill, Martha Sanchez, Natasha Rybak, Maria Mileno, Stuart H. Cohen, Monica Ruiz, Dean M. Boswell, Elizabeth E. Robison, Trina L. Reynolds, Sonja Neumeister, Carmen D. Zorrilla, Juana Rivera, Jessica Ibarra, Iris García, Dianca Sierra, Wanda Ramon, Suzanne Fiorillo, Rebecca Pitotti, Victoria R. Anderson, Jose Castillo Mancilla, Nga Le, Patricia L. Winokur, Dilek Ince, Theresa Hegmann, Jeffrey Meier, Jack Stapleton, Laura Stulken, Monica McArthur, Andrea Berry, Milagritos Tapia, Elizabeth Hammershaimb, Toni Robinson, Rosa MacBryde, Susan Kline, Joanne L. Billings, Winston Cavert, Les B. Forgosh, Timothy W. Schacker, Tyler D. Bold, Dima Dandachi, Taylor Nelson, Andres Bran, Grant Geiger, S. Hasan Naqvi, Diana F. Florescu, Richard Starlin, David Kline, Andrea Zimmer, Anum Abbas, Natasha Wilson, Joseph J. Eron, Michael Sciaudone, A. Lina Rosengren, John S. Kizer, Sarah E. Rutstein, Elizabeth Bruce, Claudia Espinosa, Lisa J. Sanders, Kami Kim, Denise Casey, Barbara S. Taylor, Thomas Patterson, Ruth S. Pinilla, Delia Bullock, Philip Ponce, Jan Patterson, R. Scott McClelland, Dakotah C. Lane, Anna Wald, Frank James, Elizabeth Duke, Kirsten Hauge, Jessica Heimonen, Erin A. Goecker, Youyi Fong, Carol Kauffman, Kathleen Linder, Kimberly Nofz, Andrew McConnell, Robert J. Buynak, Angella Webb, Taryn Petty, Stephanie Andree, Erica Sanchez, Nolan Mackey, Clarisse Baudelaire, Sarah Dzigiel, Adrienna Marquez, Kim Quillin, Michelle King, Vanessa Abad, Jennifer Knowles, Michael Waters, Karla Zepeda, Jordan Coslet, Dalia Tovar, Marian E. Shaw, Mark A. Turner, Cory J. Huffine, Esther S. Huffine, Julie A. Ake, Elizabeth Secord, Eric McGrath, Phillip Levy, Brittany Stewart, Charnell Cromer, Ayanna Walters, Grant Ellsworth, Caroline Greene, Sarah Galloway, Shashi Kapadia, Elliot DeHaan, Clint Wilson, Jason Milligan, Danielle Raley, Joseph Bocchini, Bruce McClenathan, Mary Hussain, Evelyn Lomasney, Evelyn Hall, Sherry Lamberth, Christy Schmeck, Vickie Leathers, Deborah A. Theodore, Angela R. Branche, Daniel S. Graciaa, Timothy J. Hatlen, Jacqueline Miller, Jerald Sadoff, Ann R. Falsey, and Magdalena E. Sobieszczyk

Subjects
COVID-19, Natural infection, Hybrid immunity, Vaccination, Medicine, Medicine (General), R5-920
Abstract

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

Published
2023
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2. Assessment of the Dissemination of COVID-19–Related Articles Across Social Media: Altmetrics Study

Author

Haley Tornberg, Carine Moezinia, Chapman Wei, Simone A Bernstein, Chaplin Wei, Refka Al-Beyati, Theodore Quan, and David J Diemert

Subjects
Medicine
Abstract

BackgroundThe use of social media assists in the distribution of information about COVID-19 to the general public and health professionals. Alternative-level metrics (ie, Altmetrics) is an alternative method to traditional bibliometrics that assess the extent of dissemination of a scientific article on social media platforms. ObjectiveOur study objective was to characterize and compare traditional bibliometrics (citation count) with newer metrics (Altmetric Attention Score [AAS]) of the top 100 Altmetric-scored articles on COVID-19. MethodsThe top 100 articles with the highest AAS were identified using the Altmetric explorer in May 2020. AAS, journal name, and mentions from various social media platforms (Twitter, Facebook, Wikipedia, Reddit, Mendeley, and Dimension) were collected for each article. Citation counts were collected from the Scopus database. ResultsThe median AAS and citation count were 4922.50 and 24.00, respectively. TheNew England Journal of Medicine published the most articles (18/100, 18%). Twitter was the most frequently used social media platform with 985,429 of 1,022,975 (96.3%) mentions. Positive correlations were observed between AAS and citation count (r2=0.0973; P=.002). ConclusionsOur research characterized the top 100 COVID-19–related articles by AAS in the Altmetric database. Altmetrics could complement traditional citation count when assessing the dissemination of an article regarding COVID-19. International Registered Report Identifier (IRRID)RR2-10.2196/21408

Published
2023
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3. A randomized, controlled Phase 1b trial of the Sm-TSP-2 Vaccine for intestinal schistosomiasis in healthy Brazilian adults living in an endemic area.

Author

David J Diemert, Rodrigo Correa-Oliveira, Carlo Geraldo Fraga, Frederico Talles, Marcella Rezende Silva, Shital M Patel, Shirley Galbiati, Jessie K Kennedy, Jordan S Lundeen, Maria Flavia Gazzinelli, Guangzhao Li, Lara Hoeweler, Gregory A Deye, Maria Elena Bottazzi, Peter J Hotez, Hana M El Sahly, Wendy A Keitel, Jeffrey Bethony, and Robert L Atmar

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BackgroundRecombinant Schistosoma mansoni Tetraspanin-2 formulated on Alhydrogel (Sm-TSP-2/Alhydrogel) is being developed to prevent intestinal and hepatic disease caused by S. mansoni. The tegumentary Sm-TSP-2 antigen was selected based on its unique recognition by cytophilic antibodies in putatively immune individuals living in areas of ongoing S. mansoni transmission in Brazil, and preclinical studies in which vaccination with Sm-TSP-2 protected mice following infection challenge.MethodsA randomized, observer-blind, controlled, Phase 1b clinical trial was conducted in 60 healthy adults living in a region of Brazil with ongoing S. mansoni transmission. In each cohort of 20 participants, 16 were randomized to receive one of two formulations of Sm-TSP-2 vaccine (adjuvanted with Alhydrogel only, or with Alhydrogel plus the Toll-like receptor-4 agonist, AP 10-701), and 4 to receive Euvax B hepatitis B vaccine. Successively higher doses of antigen (10 μg, 30 μg, and 100 μg) were administered in a dose-escalation fashion, with progression to the next dose cohort being dependent upon evaluation of 7-day safety data after all participants in the preceding cohort had received their first dose of vaccine. Each participant received 3 intramuscular injections of study product at intervals of 2 months and was followed for 12 months after the third vaccination. IgG and IgG subclass antibody responses to Sm-TSP-2 were measured by qualified indirect ELISAs at pre- and post-vaccination time points through the final study visit.ResultsSm-TSP-2/Alhydrogel administered with or without AP 10-701 was well-tolerated in this population. The most common solicited adverse events were mild injection site tenderness and pain, and mild headache. No vaccine-related serious adverse events or adverse events of special interest were observed. Groups administered Sm-TSP-2/Alhydrogel with AP 10-701 had higher post-vaccination levels of antigen-specific IgG antibody. A significant dose-response relationship was seen in those administered Sm-TSP-2/Alhydrogel with AP 10-701. Peak anti-Sm-TSP-2 IgG levels were observed approximately 2 weeks following the third dose, regardless of Sm-TSP-2 formulation. IgG levels fell to low levels by Day 478 in all groups except the 100 μg with AP 10-701 group, in which 57% of subjects (4 of 7) still had IgG levels that were ≥4-fold higher than baseline. IgG subclass levels mirrored those of total IgG, with IgG1 being the predominant subclass response.ConclusionsVaccination of adults with Sm-TSP-2/Alhydrogel in an area of ongoing S. mansoni transmission was safe, minimally reactogenic, and elicited significant IgG and IgG subclass responses against the vaccine antigen. These promising results have led to initiation of a Phase 2 clinical trial of this vaccine in an endemic region of Uganda.Trial registrationNCT03110757.

Published
2023
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5. Characterization of T cell responses to co-administered hookworm vaccine candidates Na-GST-1 and Na-APR-1 in healthy adults in Gabon.

Author

Yoanne D Mouwenda, Madeleine E Betouke Ongwe, Friederike Sonnet, Koen A Stam, Lucja A Labuda, Sophie De Vries, Martin P Grobusch, Frejus J Zinsou, Yabo J Honkpehedji, Jean-Claude Dejon Agobe, David J Diemert, Remko van Leeuwen, Maria E Bottazzi, Peter J Hotez, Peter G Kremsner, Jeffrey M Bethony, Simon P Jochems, Ayola A Adegnika, Marguerite Massinga Loembe, and Maria Yazdanbakhsh

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

Two hookworm vaccine candidates, Na-GST-1 and Na-APR-1, formulated with Glucopyranosyl Lipid A (GLA-AF) adjuvant, have been shown to be safe, well tolerated, and to induce antibody responses in a Phase 1 clinical trial (Clinicaltrials.gov NCT02126462) conducted in Gabon. Here, we characterized T cell responses in 24 Gabonese volunteers randomized to get vaccinated three times with Na-GST-1 and Na-APR-1 at doses of 30μg (n = 8) or 100μg (n = 10) and as control Hepatitis B (n = 6). Blood was collected pre- and post-vaccination on days 0, 28, and 180 as well as 2-weeks after each vaccine dose on days 14, 42, and 194 for PBMCs isolation. PBMCs were stimulated with recombinant Na-GST-1 or Na-APR-1, before (days 0, 28 and 180) and two weeks after (days 14, 42 and 194) each vaccination and used to characterize T cell responses by flow and mass cytometry. A significant increase in Na-GST-1 -specific CD4+ T cells producing IL-2 and TNF, correlated with specific IgG antibody levels, after the third vaccination (day 194) was observed. In contrast, no increase in Na-APR-1 specific T cell responses were induced by the vaccine. Mass cytometry revealed that, Na-GST-1 cytokine producing CD4+ T cells were CD161+ memory cells expressing CTLA-4 and CD40-L. Blocking CTLA-4 enhanced the cytokine response to Na-GST-1. In Gabonese volunteers, hookworm vaccine candidate, Na-GST-1, induces detectable CD4+ T cell responses that correlate with specific antibody levels. As these CD4+ T cells express CTLA-4, and blocking this inhibitory molecules resulted in enhanced cytokine production, the question arises whether this pathway can be targeted to enhance vaccine immunogenicity.

Published
2021
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6. Correction: Safety and immunogenicity of the Na-GST-1 hookworm vaccine in Brazilian and American adults.

Author

David J Diemert, Janaína Freire, Vanderson Valente, Carlo Geraldo Fraga, Frederico Talles, Shannon Grahek, Doreen Campbell, Amar Jariwala, Maria Victoria Periago, Martin Enk, Maria Flávia Gazzinelli, Maria Elena Bottazzi, Robert Hamilton, Jill Brelsford, Anna Yakovleva, Guangzhao Li, Jin Peng, Rodrigo Correa-Oliveira, Peter Hotez, and Jeffrey Bethony

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

[This corrects the article DOI: 10.1371/journal.pntd.0005574.].

Published
2020
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7. Safety and immunogenicity of the Na-APR-1 hookworm vaccine in infection-naïve adults

Author

David J, Diemert, Maria, Zumer, Doreen, Campbell, Shannon, Grahek, Guangzhao, Li, Jin, Peng, Maria, Elena Bottazzi, Peter, Hotez, and Jeffrey, Bethony

Subjects
Adult, Ancylostomatoidea, Vaccines, General Veterinary, General Immunology and Microbiology, Public Health, Environmental and Occupational Health, Aluminum Hydroxide, Antibodies, Neutralizing, Hookworm Infections, Immunogenicity, Vaccine, Lipid A, Infectious Diseases, Adjuvants, Immunologic, Immunoglobulin G, Tobacco, Animals, Humans, Molecular Medicine, Peptide Hydrolases
Abstract

The Necator americanus hemoglobinase, aspartic protease-1 (Na-APR-1), facilitates the ability of adult hookworms to parasitize the intestine of their human hosts. A recombinant version of APR-1 protected laboratory animals against hookworm infection by inducing neutralizing antibodies that block the protein's enzymatic activity and thereby impair blood feeding. A catalytically inactive version of the wild-type hemoglobinase (Na-APR-1(M74)) was expressed by infiltrating Nicotiana benthamiana tobacco plants with an Agrobacterium tumefaciens strain engineered to express the vaccine antigen, which was adjuvanted with aluminum hydroxide adjuvant (Alhydrogel).An open-label dose-escalation Phase 1 clinical trial was conducted in 40 healthy, hookworm-naïve adult volunteers in the United States. Participants received 30 or 100 µg of recombinant Na-APR-1(M74) with Alhydrogel or with Alhydrogel co-administered with one of two doses (2.5 or 5.0 µg) of an aqueous formulation of Glucopyranosyl Lipid A (GLA-AF). Intramuscular injections of study vaccine were administered on days 0, 56, and 112.Na-APR-1(M74)/Alhydrogel was well-tolerated; the most frequent adverse events were mild or moderate injection site tenderness and pain, and mild or moderate nausea and headache. No serious adverse events or adverse events of special interest related to vaccination were observed. Significantly higher levels of antigen-specific IgG antibodies were induced in those who received 100 µg Na-APR-1(M74) than those who received 30 µg of antigen. Adding GLA-AF to Na-APR-1(M74)/Alhydrogel resulted in higher levels of IgG against Na-APR-1(M74) in both the 30 and 100 µg Na-APR-1(M74) groups in comparison to the non-GLA formulations at the same antigen dose.Vaccination of hookworm-naïve adults with recombinant Na-APR-1(M74) was well-tolerated, safe, and induced significant IgG responses against the vaccine antigen Na-APR-1(M74). Given these favorable results, clinical trials of this product were initiated in hookworm-endemic areas of Gabon and Brazil.

Published
2022

8. Immunogenicity of the BA.1 and BA.4/BA.5 SARS-CoV-2 Bivalent Boosts: Preliminary Results from the COVAIL Randomized Clinical Trial

Author

Angela R. Branche, Nadine G. Rouphael, Cecilia Losada, Lindsey R. Baden, Evan J. Anderson, Anne F. Luetkemeyer, David J. Diemert, Patricia L. Winokur, Rachel M. Presti, Angelica C. Kottkamp, Ann R. Falsey, Sharon E. Frey, Richard Rupp, Martín Bäcker, Richard M. Novak, Emmanuel B. Walter, Lisa A. Jackson, Susan J. Little, Lilly C. Immergluck, Siham M. Mahgoub, Jennifer A. Whitaker, Tara M. Babu, Paul A. Goepfert, Dahlene N. Fusco, Robert L. Atmar, Christine M. Posavad, Antonia Netzl, Derek J. Smith, Kalyani Telu, Jinjian Mu, Mat Makowski, Mamodikoe K. Makhene, Sonja Crandon, David C. Montefiori, Paul C. Roberts, and John H. Beigel

Subjects
Article
Abstract

In a randomized clinical trial, we compare early neutralizing antibody responses after boosting with bivalent SARS-CoV-2 mRNA vaccines based on either BA.1 or BA.4/BA.5 Omicron spike protein combined with wildtype spike. Responses against SARS-CoV-2 variants exhibited the greatest reduction in titers against currently circulating Omicron subvariants for both bivalent vaccines.

Published
2023

9. Safety and immunogenicity of the Na-GST-1 hookworm vaccine in Brazilian and American adults.

Author

David J Diemert, Janaína Freire, Vanderson Valente, Carlos Geraldo Fraga, Frederico Talles, Shannon Grahek, Doreen Campbell, Amar Jariwala, Maria Victoria Periago, Martin Enk, Maria Flávia Gazzinelli, Maria Elena Bottazzi, Robert Hamilton, Jill Brelsford, Anna Yakovleva, Guangzhao Li, Jin Peng, Rodrigo Correa-Oliveira, Peter Hotez, and Jeffrey Bethony

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

Necator americanus Glutathione-S-Transferase-1 (Na-GST-1) plays a role in the digestion of host hemoglobin by adult N. americanus hookworms. Vaccination of laboratory animals with recombinant Na-GST-1 is associated with significant protection from challenge infection. Recombinant Na-GST-1 was expressed in Pichia pastoris and adsorbed to aluminum hydroxide adjuvant (Alhydrogel) according to current Good Manufacturing Practice. Two Phase 1 trials were conducted in 142 healthy adult volunteers in the United States and Brazil, first in hookworm-naïve individuals and then in residents of a N. americanus endemic area in Brazil. Volunteers received one of three doses of recombinant Na-GST-1 (10, 30, or 100 μg) adjuvanted with Alhydrogel, adjuvanted with Alhydrogel and co-administered with an aqueous formulation of Glucopyranosyl Lipid A (GLA-AF), or the hepatitis B vaccine. Vaccinations were administered via intramuscular injection on days 0, 56, and 112. Na-GST-1/Alhydrogel was well tolerated in both hookworm-naïve and hookworm-exposed adults, with the most common adverse events being mild to moderate injection site pain and tenderness, and mild headache and nausea; no vaccine-related severe or serious adverse events were observed. Antigen-specific IgG antibodies were induced in a dose-dependent fashion, with increasing levels observed after each vaccination in both trials. The addition of GLA-AF to Na-GST-1/Alhydrogel did not result in significant increases in specific IgG responses. In both the US and Brazil studies, the predominant IgG subclass induced against Na-GST-1 was IgG1, with lesser amounts of IgG3. Vaccination of both hookworm-naïve and hookworm-exposed adults with recombinant Na-GST-1 was safe, well tolerated, and resulted in significant antigen-specific IgG responses. Based on these results, this vaccine will be advanced into clinical trials in children and eventual efficacy studies.ClinicalTrials.gov (NCT01261130 for the Brazil trial and NCT01385189 for the US trial).

Published
2017
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10. A Comparison of the Quality of Informed Consent for Clinical Trials of an Experimental Hookworm Vaccine Conducted in Developed and Developing Countries.

Author

David J Diemert, Lucas Lobato, Ashley Styczynski, Maria Zumer, Amanda Soares, and Maria Flávia Gazzinelli

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

Informed consent is one of the principal ethical requirements of conducting clinical research, regardless of the study setting. Breaches in the quality of the informed consent process are frequently described in reference to clinical trials conducted in developing countries, due to low levels of formal education, a lack of familiarity with biomedical research, and limited access to health services in these countries. However, few studies have directly compared the quality of the informed consent process in developed and developing countries using the same tool and in similar clinical trials. This study was conducted to compare the quality of the informed consent process of a series of clinical trials of an investigational hookworm vaccine that were performed in Brazil and the United States. A standardized questionnaire was used to assess the ethical quality of the informed consent process in a series of Phase 1 clinical trials of the Na-GST-1/Alhydrogel hookworm vaccine that were conducted in healthy adults in Brazil and the United States. In Brazil, the trial was conducted at two sites, one in the hookworm non-endemic urban area of Belo Horizonte, Minas, and one in the rural, resource-limited town of Americaninhas, both in the state of Minas Gerais; the American trial was conducted in Washington, DC. A 32-question survey was administered after the informed consent document was signed at each of the three trial sites; it assessed participants' understanding of information about the study presented in the document as well as the voluntariness of their decision to participate. 105 participants completed the questionnaire: 63 in Americaninhas, 18 in Belo Horizonte, and 24 in Washington, DC. Overall knowledge about the trial was suboptimal: the mean number of correct answers to questions about study objectives, methods, duration, rights, and potential risks and benefits, was 45.6% in Americaninhas, 65.2% in Belo Horizonte, and 59.1% in Washington, DC. Although there was no difference in the rate of correct answers between participants in Belo Horizonte and Washington, DC, there was a significant gap between participants at these two locations compared to Americaninhas (p = 0.0002 and p = 0.0001, respectively), which had a lower percentage of correct answers. Attitudes towards participating in the clinical trial also differed by site: while approximately 40% had doubts about participating in Washington, DC and Belo Horizonte, only 1.5% had concerns in Americaninhas. Finally, in Belo Horizonte and Washington, high percentages cited a desire to help others as motivation for participating, whereas in Americaninhas, the most common reason for participating was personal interest (p = 0.001). Understanding of information about a Phase 1 clinical trial of an experimental hookworm vaccine following informed consent was suboptimal, regardless of study site. Although overall there were no differences in knowledge between Brazil and the US, a lower level of understanding about the trial was seen in participants at the rural, resource-limited Brazilian site. These findings demonstrate the need for educational interventions directed at potential clinical trial participants, both in developing and developed countries, in order to improve understanding of the informed consent document.

Published
2017
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11. The Global Economic and Health Burden of Human Hookworm Infection.

Author

Sarah M Bartsch, Peter J Hotez, Lindsey Asti, Kristina M Zapf, Maria Elena Bottazzi, David J Diemert, and Bruce Y Lee

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BACKGROUND:Even though human hookworm infection is highly endemic in many countries throughout the world, its global economic and health impact is not well known. Without a better understanding of hookworm's economic burden worldwide, it is difficult for decision makers such as funders, policy makers, disease control officials, and intervention manufacturers to determine how much time, energy, and resources to invest in hookworm control. METHODOLOGY/PRINCIPLE FINDINGS:We developed a computational simulation model to estimate the economic and health burden of hookworm infection in every country, WHO region, and globally, in 2016 from the societal perspective. Globally, hookworm infection resulted in a total 2,126,280 DALYs using 2004 disability weight estimates and 4,087,803 DALYs using 2010 disability weight estimates (excluding cognitive impairment outcomes). Including cognitive impairment did not significantly increase DALYs worldwide. Total productivity losses varied with the probability of anemia and calculation method used, ranging from $7.5 billion to $138.9 billion annually using gross national income per capita as a proxy for annual wages and ranging from $2.5 billion to $43.9 billion using minimum wage as a proxy for annual wages. CONCLUSION:Even though hookworm is classified as a neglected tropical disease, its economic and health burden exceeded published estimates for a number of diseases that have received comparatively more attention than hookworm such as rotavirus. Additionally, certain large countries that are transitioning to higher income countries such as Brazil and China, still face considerable hookworm burden.

Published
2016
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12. The Right Tool for the Job: Detection of Soil-Transmitted Helminths in Areas Co-endemic for Other Helminths.

Author

Maria V Periago, Renata C Diniz, Simone A Pinto, Anna Yakovleva, Rodrigo Correa-Oliveira, David J Diemert, and Jeffrey M Bethony

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

Due to the recent increased use of the McMaster (MM) fecal egg counting method for assessing benzimidazole drug efficacy for treating soil-transmitted helminth (STH) infections, the aim of the current study was to determine the operational value of including the MM method alongside the Kato-Katz (KK) fecal thick smear to increase the diagnostic sensitivity when STHs are co-endemic with trematode helminths (e.g., Schistosoma mansoni).A cross-sectional study was conducted in school-aged children aged 4-18 years in the northeastern region of the State of Minas Gerais (Brazil), where Necator americanus, Ascaris lumbricoides, Trichuris trichiura, and S. mansoni are co-endemic. One fecal sample from each participant was collected and transported to the field laboratory for analysis. Coprological diagnosis was performed on each fecal sample by three different methods: Formalin-Ether Sedimentation (FES), KK and the MM technique. The diagnostic sensitivity and negative predictive value (NPV) of each technique was calculated using the combination of all three techniques as the composite standard. In order to determine the agreement between the three techniques Fleiss´ kappa was used. Both the Cure Rate (CR) and the Fecal Egg Count Reduction (FECR) were calculated using the two quantification techniques (i.e., the MM and KK).Fecal samples from 1260 children were analyzed. The KK had higher diagnostic sensitivity than the MM for the detection of both A. lumbricoides (KK 97.3%, MM 69.5%) and hookworm (KK 95.1%, MM 80.8%). The CR of a single dose of mebendazole varied significantly between the KK and MM for both A. lumbricoides (p = 0.016) and hookworm (p = 0.000), with lower rates obtained with the KK. On the other hand, the FECR was very similar between both techniques for both A. lumbricoides and hookworm.The MM did not add any diagnostic value over the KK in areas where both STHs and trematodes were co-endemic. The lower sensitivity of the MM would have an important impact on the administration of selective school-based treatment in this area since if only the MM were used, 36 (13.9%) children diagnosed with A. lumbricoides would have gone untreated.

Published
2015
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13. Correction: Microproteinuria during Infection: A Biomarker for Advanced Renal and Hepatobiliary Pathologies from Chronic Opisthorchiasis.

Author

Prasert Saichua, Paiboon Sithithaworn, Amar R. Jariwala, David J. Diemert, Jiraporn Sithithaworn, Banchob Sripa, Thewarach Laha, Eimorn Mairiang, Chawalit Pairojkul, Maria Victoria Periago, Narong Khuntikeo, Jason Mulvenna, and Jeffrey M. Bethony

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Published
2013
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14. Microproteinuria during Opisthorchis viverrini infection: a biomarker for advanced renal and hepatobiliary pathologies from chronic opisthorchiasis.

Author

Prasert Saichua, Paiboon Sithithaworn, Amar R Jariwala, David J Diemert, Jiraporn Sithithaworn, Banchob Sripa, Thewarach Laha, Eimorn Mairiang, Chawalit Pairojkul, Maria Victoria Periago, Narong Khuntikeo, Jason Mulvenna, and Jeffrey M Bethony

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

Approximately 680 million people are at risk of infection with Opisthorchis viverrini (OV) and Clonorchis sinensis, with an estimated 10 million infected with OV in Southeast Asia alone. While opisthorchiasis is associated with hepatobiliary pathologies, such as advanced periductal fibrosis (APF) and cholangiocarcinoma (CCA), animal models of OV infection show that immune-complex glomerulonephritis is an important renal pathology that develops simultaneously with hepatobiliary pathologies. A cardinal sign of immune-complex glomerulonephritis is the urinary excretion of immunoglobulin G (IgG) (microproteinuria). In community-based studies in OV endemic areas along the Chi River in northeastern Thailand, we observed that over half of the participants had urine IgG against a crude OV antigen extract (OV antigen). We also observed that elevated levels of urine IgG to OV antigen were not associated with the intensity of OV infection, but were likely the result of immune-complex glomerulonephritis as seen in animal models of OV infection. Moreover, we observed that urine IgG to OV antigen was excreted at concentrations 21 times higher in individuals with APF and 158 times higher in individuals with CCA than controls. We also observed that elevated urine IgG to OV antigen could identify APF+ and CCA+ individuals from non-cases. Finally, individuals with urine IgG to OV antigen had a greater risk of APF as determined by Odds Ratios (OR = 6.69; 95%CI: 2.87, 15.58) and a greater risk of CCA (OR = 71.13; 95%CI: 15.13, 334.0) than individuals with no detectable level of urine IgG to OV antigen. Herein, we show for the first time the extensive burden of renal pathology in OV endemic areas and that a urine biomarker could serve to estimate risk for both renal and hepatobiliary pathologies during OV infection, i.e., serve as a "syndromic biomarker" of the advanced pathologies from opisthorchiasis.

Published
2013
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15. Assessing the Dissemination of COVID-19 Articles Across Social Media With Altmetric and PlumX Metrics: Correlational Study (Preprint)

Author

Haley N Tornberg, Carine Moezinia, Chapman Wei, Simone A Bernstein, Chaplin Wei, Refka Al-Beyati, Theodore Quan, and David J Diemert

Abstract

BACKGROUND The use of social media assists in the distribution of COVID-19 information to the general public and health professionals. Alternative-level metrics (ie, altmetrics) and PlumX metrics are new bibliometrics that can assess how many times a scientific article has been shared and how much a scientific article has spread within social media platforms. OBJECTIVE Our objective was to characterize and compare the traditional bibliometrics (ie, citation count and impact factors) and new bibliometrics (ie, Altmetric Attention Score [AAS] and PlumX score) of the top 100 COVID-19 articles with the highest AASs. METHODS The top 100 articles with highest AASs were identified with Altmetric Explorer in May 2020. The AASs, journal names, and the number of mentions in various social media databases of each article were collected. Citation counts and PlumX Field-Weighted Citation Impact scores were collected from the Scopus database. Additionally, AASs, PlumX scores, and citation counts were log-transformed and adjusted by +1 for linear regression, and Spearman correlation coefficients were used to determine correlations. RESULTS The median AAS, PlumX score, and citation count were 4922.50, 37.92, and 24.00, respectively. The New England Journal of Medicine published the most articles (18/100, 18%). The highest number of mentions (985,429/1,022,975, 96.3%) were found on Twitter, making it the most frequently used social media platform. A positive correlation was observed between AAS and citation count (r2=0.0973; P=.002), and between PlumX score and citation count (r2=0.8911; P CONCLUSIONS Our study demonstrated that citation count weakly correlated with AASs and strongly correlated with PlumX scores, with regard to COVID-19 articles at this point in time. Altmetric and PlumX metrics should be used to complement traditional citation counts when assessing the dissemination and impact of a COVID-19 article.

Published
2020

16. Health education through analogies: preparation of a community for clinical trials of a vaccine against hookworm in an endemic area of Brazil.

Author

Maria Flavia Gazzinelli, Lucas Lobato, Leonardo Matoso, Renato Avila, Rita de Cassia Marques, Ami Shah Brown, Rodrigo Correa-Oliveira, Jeffrey M Bethony, and David J Diemert

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BACKGROUND: Obtaining informed consent for clinical trials is especially challenging when working in rural, resource-limited areas, where there are often high levels of illiteracy and lack of experience with clinical research. Such an area, a remote field site in the northeastern part of the state of Minas Gerais, Brazil, is currently being prepared for clinical trials of experimental hookworm vaccines. This study was conducted to assess whether special educational tools can be developed to increase the knowledge and comprehension of potential clinical trial participants and thereby enable them to make truly informed decisions to participate in such research. METHODOLOGY/PRINCIPAL FINDINGS: An informational video was produced to explain the work of the research team and the first planned hookworm vaccine trial, using a pedagogical method based on analogies. Seventy-two adults living in a rural community of Minas Gerais were administered a structured questionnaire that assessed their knowledge of hookworm, of research and of the planned hookworm vaccine trial, as well as their attitudes and perceptions about the researchers and participation in future vaccine trials. The questionnaire was administered before being shown the educational video and two months after and the results compared. After viewing the video, significant improvements in knowledge related to hookworm infection and its health impact were observed: using a composite score combining related questions for which correct answers were assigned a value of 1 and incorrect answers a value of 0, participants had a mean score of 0.76 post-video compared to 0.68 pre-video (p = 0.0001). Similar improvements were seen in understanding the purpose of vaccination and the possible adverse effects of an experimental vaccine. Although 100% of participants expressed a positive opinion of the researchers even before viewing the film and over 90% said that they would participate in a hookworm vaccine trial, an increase in the number who expressed fear of being vaccinated with a novel vaccine was seen after viewing the video (51.4% post-video versus 29.2% pre-video). Increases were also seen in the proportion who thought that participation in a vaccine trial would be inconvenient or disrupt their daily activities. CONCLUSIONS/SIGNIFICANCE: Even in rural, resource-limited populations, educational tools can be specially designed that significantly improve understanding and therefore the likelihood of obtaining truly informed consent for participation in clinical research. The observed changes in the knowledge and perceptions of the research participants about hookworm infection and the experimental hookworm vaccine demonstrate that the video intervention was successful in increasing understanding and that the subjects acquired knowledge pertinent to the planned research.

Published
2010
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17. Impact of a Plasmodium falciparum AMA1 vaccine on antibody responses in adult Malians.

Author

Alassane Dicko, David J Diemert, Issaka Sagara, Moussa Sogoba, Mohamed B Niambele, Mahamadoun H Assadou, Ousmane Guindo, Beh Kamate, Mounirou Baby, Mady Sissoko, Elissa M Malkin, Michael P Fay, Mahamadou A Thera, Kazutoyo Miura, Amagana Dolo, Dapa A Diallo, Gregory E Mullen, Carole A Long, Allan Saul, Ogobara Doumbo, and Louis H Miller

Subjects
Medicine, Science
Abstract

Apical Membrane Antigen 1 (AMA1) of Plasmodium falciparum merozoites is a leading blood-stage malaria vaccine candidate. Protection of Aotus monkeys after vaccination with AMA1 correlates with antibody responses.A randomized, controlled, double-blind phase 1 clinical trial was conducted in 54 healthy Malian adults living in an area of intense seasonal malaria transmission to assess the safety and immunogenicity of the AMA1-C1 malaria vaccine. AMA1-C1 contains an equal mixture of yeast-expressed recombinant proteins based on sequences from the FVO and 3D7 clones of P. falciparum, adsorbed on Alhydrogel. The control vaccine was the hepatitis B vaccine (Recombivax). Participants were enrolled into 1 of 3 dose cohorts (n = 18 per cohort) and randomized 2:1 to receive either AMA1-C1 or Recombivax. Participants in the first, second, and third cohorts randomized to receive AMA1-C1 were vaccinated with 5, 20 and 80 microg of AMA1-C1, respectively. Vaccinations were administered on days 0, 28, and 360, and participants were followed until 6 months after the final vaccination. AMA1-C1 was well tolerated; no vaccine-related severe or serious adverse events were observed. AMA1 antibody responses to the 80 microg dose increased rapidly from baseline levels by days 14 and 28 after the first vaccination and continued to increase after the second vaccination. After a peak 14 days following the second vaccination, antibody levels decreased to baseline levels one year later at the time of the third vaccination that induced little or no increase in antibody levels.Although the AMA1-C1 vaccine candidate was well-tolerated and induced antibody responses to both vaccine and non-vaccine alleles, the antibody response after a third dose given at one year was lower than the response to the initial vaccinations. Additionally, post-vaccination increases in anti-AMA1 antibody levels were not associated with significant changes in in vitro growth inhibition of P. falciparum.ClinicalTrials.gov NCT00343005.

Published
2007
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18. Cestode and Trematode Infections

Author

David J. Diemert

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, 030231 tropical medicine, Medicine, business, 030217 neurology & neurosurgery
Published
2017

19. List of Contributors

Author

Fredrick M. Abrahamian, Michael J. Aldape, Edelweiss Aldasoro, Upton D. Allen, Hythem Al-Sum, Milan J. Anadkat, Katherine Anders, Emmanouil Angelakis, Brian John Angus, Anastasia Antoniadou, Fabio Arena, Joop E. Arends, Jose R. Arribas, Andrew W. Artenstein, John C. Atherton, John N. Aucott, Tar-Ching Aw, Hilary M. Babcock, Robin Bailey, Thomas C. Bailey, Adam Z. Banks, David J. Barillo, Ernie-Paul Barrette, Martijn P. Bauer, Roger Bayston, C. Ben Beard, Justin Beardsley, Nick J. Beeching, Rodolfo E. Bégué, Guido Beldi, Constance A. Benson, Elie F. Berbari, Jean-Michel Berenger, Christoph Berger, Jose I. Bernardino, Jacques Bille, Alexander C. Billioux, Ari Bitnun, Iain Blair, Stéphane Blanche, Thomas P. Bleck, Chantal P. Bleeker-Rovers, Gijs Bleijenberg, Karen C. Bloch, Johannes Blum, Emily A. Blumberg, Robert A. Bonomo, Marc J.M. Bonten, Rafik Bourayou, Emilio Bouza, K. Ashley Brandt, Florence Bretelle, Sylvain Brisse, Warwick J. Britton, Itzhak Brook, Matthijs C. Brouwer, Sarah K. Browne, Amy E. Bryant, Silja Bühler, Eileen M. Bulger, R. Mark L. Buller, Leah A. Burke, Christian Burri, Marcus W. Butler, Thierry Calandra, David P. Calfee, Antonia Calvo-Cano, D. William Cameron, Joseph A. Carcillo, Gail Carson, Stephen T. Chambers, Remi N. Charrel, Vinh Chau Van Nguyen, Stéphane Chevaliez, Tom M. Chiller, Eirini Christaki, Kevin K. Chung, David B. Clifford, Nathan Clumeck, Jonathan Cohen, John Collinge, Christopher P. Conlon, Curdin Conrad, Fiona J. Cooke, Jennifer Rittenhouse Cope, G. Ralph Corey, John H. Cross, Burke A. Cunha, Cheston B. Cunha, Benoit D'Journo, George L. Daikos, Johannes M.A. Daniels, Robert N. Davidson, Nicholas P.J. Day, Kevin M. De Cock, Thushan I. de Silva, Henry J.C. de Vries, Stéphane de Wit, Julie Delaloye, David W. Denning, David T. Dennis, Shireesha Dhanireddy, Elodi J. Dielubanza, David J. Diemert, Mehmet Doganay, Tom Doherty, Christiane Dolecek, Arjen M. Dondorp, Abby Douglas, Michel Drancourt, Grégory Dubourg, Michael N. Dudley, Guillaume Durand, Benjamin J. Eckhardt, Androulla Efstratiou, Miquel B. Ekkelenkamp, Ambika Eranki, Hakan Erdem, Gerome V. Escota, Heather L. Evans, Alice Chijioke Eziefula, Florence Fenollar, Alan Fenwick, Joshua Fierer, Roger G. Finch, James M. Fleckenstein, Christina Forstner, Federico Foschi, Pierre-Edouard Fournier, Martyn A. French, Kenneth L. Gage, Lynne S. Garcia, Joaquim Gascon, Arturo S. Gastañaduy, Philippe Gautret, William M. Geisler, Khalil G. Ghanem, Tommaso Giani, Maddalena Giannella, Bruce L. Gilliam, Michel Gilliet, Carol A. Glaser, Youri Glupczynski, John W. Gnann, Ellie J.C. Goldstein, Bruno Gottstein, Frederique Gouriet, Patti E. Gravitt, Michael D. Green, Stephen T. Green, Andreas H. Groll, Roy M. Gulick, Arjun Gupta, Gilbert Habib, Stephan Harbarth, Marianne Harris, Frederick G. Hayden, David J. Hetem, Philip C. Hill, Bernard Hirschel, Aimee C. Hodowanec, Louis Hoffart, Christian Hoffmann, Steven M. Holland, Peter W. Horby, David J. Horne, Sami Hraiech, Mark W. Hull, Angela Huttner, Richard J.M. Ingram, Jasmin Islam, Michael G. Ison, Scott H. James, Claire Jenkins, Stephen G. Jenkins, Jørgen Skov Jensen, Christine Johnston, Theodore B. Jones, Stephen J. Jordan, Kathleen G. Julian, Yasuyuki Kato, Carol A. Kauffman, Keith S. Kaye, Michael P. Keane, James Keeney, Paul Kelly, Stephen J. Kent, Winfried V. Kern, Yoav Keynan, Andrea A. Kim, Isabelle Koné-Paut, Chris Kosmidis, Aloys C.M. Kroes, Frank P. Kroon, Thomas G. Ksiazek, F. Matthew Kuhlmann, Ed J. Kuijper, Jennie H. Kwon, George B. Kyei, Karine Lacombe, Philippe Lagacé-Wiens, Jean-Christophe Lagier, Theresa Lamagni, Luce Landraud, Fanny Lanternier, Kerry L. LaPlante, Stephen D. Lawn, Steven J. Lawrence, Hakan Leblebicioglu, Nelson Lee, James E. Leggett, Philippe Lehours, Pierre-Yves Levy, Rainer G. Leyh, Rebecca A. Lillis, Direk Limmathurotsakul, Jennifer Lin, H.D. Alan Lindquist, Benjamin A. Lipsky, Christina Liscynesky, David Looney, Olivier Lortholary, Franklin D. Lowy, Benjamin J. Luft, Philip A. Mackowiak, Paul A. MacPherson, Valérie Maghraoui-Slim, Patrick W. Mallon, Julie E. Mangino, Oriol Manuel, Oscar Marchetti, Kristen M. Marks, Kieren A. Marr, Jeanne Marrazzo, Jonas Marschall, David H. Martin, Frédéric Matonti, Richard S. Matulewicz, Kenneth H. Mayer, Russell J. McCulloh, Rose McGready, Rennatus Mdodo, Simon Mead, Francis Mégraud, Graeme Meintjes, Sarah C. Metcalf, Marian G. Michaels, Giovanni Battista Migliori, Michael A. Miles, Alastair Miller, Matthew J. Mimiaga, Marie-Paule Mingeot-Leclercq, Elizabeth Ann Misch, Makedonka Mitreva, Julio S.G. Montaner, Caroline B. Moore, Patricia Muñoz, Jose Muñoz, Clinton K. Murray, Didier Musso, Mable Mutengo, Misha M. Mutizwa, Kurt G. Naber, Pavithra Natarajan, Santiago Neme, Paul N. Newton, Ronald A. Nichols, Lindsay E. Nicolle, François Nosten, Luigi D. Notarangelo, Thomas B. Nutman, Paul Nyirjesy, P. Ronan O'Connell, Steven M. Opal, L. Peter Ormerod, Douglas R. Osmon, Marie Boulze Pankert, Giuseppe Pantaleo, Laurent Papazian, Diane M. Parente, Philippe Parola, Shadi Parsaei, Manuel A. Pascual, Rupa Patel, Eleni Patrozou, Jean-Michel Pawlotsky, Sharon J. Peacock, Jean-Claude Pechère, Ivan Pelegrin, Barry S. Peters, Edgar J.G. Peters, Jeannine M. Petersen, Lyle R. Petersen, Vidmantas Petraitis, Luu-Ly Pham, Albert Picado, Adrian Pilatz, Benoit Pilmis, María-Jesús Pinazo, Mathias W. Pletz, Jason M. Pogue, Evelyn L. Polgreen, Philip M. Polgreen, Klara M. Posfay-Barbe, William G. Powderly, Rachel Presti, Guy Prod'hom, Mirja Puolakkainen, Thomas C. Quinn, Didier Raoult, Raymund R. Razonable, Robert C. Read, Robert R. Redfield, Rob J. Rentenaar, Steven J. Reynolds, Camillo Ribi, Malcolm D. Richardson, Michele L. Ritter, Antoine Roch, Jürgen Kurt Rockstroh, Amanda Rojek, José R. Romero, Suzan H.M. Rooijakkers, Daniel Rosenbluth, Sergio D. Rosenzweig, Gian Maria Rossolini, Ethan Rubinstein, Greg Ryan, Steven A. Safren, Vikrant V. Sahasrabuddhe, Pekka A.I. Saikku, Mohammad M. Sajadi, Michelle R. Salvaggio, Carlos A.Q. Santos, Michael J. Satlin, Anthony J. Schaeffer, Christoph Schimmer, Robert T. Schooley, Richard F. Schumacher, Beverly E. Sha, Daniel S. Shapiro, Gerard Sheehan, David M. Shlaes, Shmuel Shoham, Cameron P. Simmons, Dennis W. Simon, Matthew S. Simon, Kari A. Simonsen, Mary P.E. Slack, Tyrel T. Smith, Jack D. Sobel, Maria Souli, Shruti Sridhar, James M. Steckelberg, Dennis L. Stevens, Heather Strah, A. Willem Sturm, Somnuek Sungkanuparph, Sarah J. Tabrizi, Evelina Tacconelli, Chen Sabrina Tan, Randy A. Taplitz, Guillemette Thomas, Lora D. Thomas, Franck Thuny, Guy Thwaites, Frederic Tissot, Tone Tønjum, Francesca J. Torriani, Christian Toso, Paul M. Tulkens, Allan R. Tunkel, Claire E. Turner, Andrew P. Ustianowski, Françoise van Bambeke, Reinout van Crevel, Diederik van de Beek, Christian van Delden, Menno M. van der Eerden, Jos W.M. van der Meer, Tom van der Poll, Jakko van Ingen, Jos van Putten, Bernard P. Vaudaux, Sten H. Vermund, Raphael P. Viscidi, Kumar Visvanathan, Govinda S. Visvesvara, Lorenz von Seidlein, Florian M.E. Wagenlehner, Anna Wald, Thomas J. Walsh, David C. Warhurst, David W. Warnock, David A. Warrell, Mary J. Warrell, Adilia Warris, Richard R. Watkins, David J. Weatherall, Rainer Weber, Wolfgang Weidner, Jonathan R. White, Peter J. White, James Whitehorn, Richard J. Whitley, Christopher J.M. Whitty, Willem Joost Wiersinga, Mark H. Wilcox, Thomas N. Williams, Cara C. Wilson, Mary Elizabeth Wilson, Hilmar Wisplinghoff, Robin Wood, Richard G. Wunderink, David Wyles, Zhi-Tao Yang, Jonathan S. Yoder, Najam A. Zaidi, Andrea J. Zimmer, Jane N. Zuckerman, and Alimuddin Zumla

Published
2017

20. Optimization of PLA compounds using novel nucleating agents and plasticizers

Author

M. Schmitt, B. Bergmann, A. Holzer, K. Moser, J. Diemert, and Peter Elsner

Subjects
chemistry.chemical_classification, Toughness, Materials science, Charpy impact test, Plasticizer, Polyethylene glycol, Polymer, law.invention, chemistry.chemical_compound, chemistry, law, Compounding, Heat deflection temperature, Crystallization, Composite material
Abstract

Biopolymers such as Polylacticacid (PLA) by politicians and the press are often referred as the materials of the future. However, this overlooks the fact that the material properties of many biopolymers are not yet equal to those of conventional industrial polymers. For this reason, their use is currently limited to the packaging and medical sectors. Unmodified PLA has relatively low heat and impact resistance, which is insufficient for most technical applications. The aim of this work is to improve the characteristics of PLA by optimizing the crystallization properties through the addition of novel nucleating agents (twin-screw compounding). The assessment is carried out using DSC analysis and the resulting calculated thermodynamic parameters. Subsequently chosen compounds are selected for measuring mechanical properties. The methods used for measuring these properties are tensile tests, the Charpy impact test, and the measurement of the heat deflection temperature (HDT). The results show that sorbitol is the most effective nucleating agent for the nucleation of PLA 4032D, with regard to the optimization of the heat resistance and toughness of the material. However the best crystallization rates from the melt can only be achieved by the further addition of polyethylene glycol (PEG) as a plasticizer. The combined influence of sorbitol and PEG in PLA 4032D, can improve the impact properties by more than 500 % to a value of 131.3 kJ/m2 (reference sample 21.8 kJ/m2) and the heat resistance by about 20 % to 65.9 °C (reference sample 54.0 °C).

Published
2016

21. Hookworm Vaccines

Author

S. Plotkin, D. J. Diemert, J. M. Bethony, and P. J. Hotez

Subjects
Necatoriasis, Microbiology (medical), Hookworm Infections, Vaccines, Vaccines, Synthetic, Ancylostoma, Infectious Diseases, Necator americanus, Antigens, Helminth, Animals, Humans, Intestinal Diseases, Parasitic
Abstract

Hookworm infection caused by the soil-transmitted nematodes Necator americanus and Ancylostoma duodenale is one of the most common parasitic infections worldwide. Although not directly responsible for substantial mortality, it causes significant morbidity in the form of chronic anemia and protein malnutrition. Current global control efforts based on periodic mass anthelmintic administration are unsustainable, and new control strategies must be developed. This review describes progress in the development of vaccines against hookworm infection, including the preclinical and initial clinical testing of the N. americanus Ancylostoma Secreted Protein-2 Hookworm Vaccine. Plans call for eventual development of a vaccine that will combine at least 2 hookworm antigens--one targeting the larval stage of the life cycle and another targeting the adult worm living in the gastrointestinal tract.

Published
2008

22. Confirmation by 16S rRNA PCR of the COBAS AMPLICOR CT/NG Test for Diagnosis of Neisseria gonorrhoeae Infection in a Low-Prevalence Population

Author

Pierre Lebel, David J. Diemert, and Michael Libman

Subjects
Male, Microbiology (medical), Population, Cervix Uteri, Urine, medicine.disease_cause, DNA, Ribosomal, Polymerase Chain Reaction, Sensitivity and Specificity, law.invention, Gonorrhea, Urethra, Predictive Value of Tests, law, RNA, Ribosomal, 16S, Prevalence, medicine, Humans, education, Polymerase chain reaction, education.field_of_study, biology, Bacteriology, Gold standard (test), 16S ribosomal RNA, biology.organism_classification, Virology, Molecular biology, Neisseria gonorrhoeae, Culture Media, Female, Neisseriaceae, Reagent Kits, Diagnostic, Neisseria
Abstract

The COBAS AMPLICOR CT/NG test is widely used for the diagnosis of Neisseria gonorrhoeae infection using genital swabs or urine samples. Although highly specific, cross-reactivity occurs with some nonpathogenic strains of Neisseria and Lactobacillus species. In low-prevalence populations, even highly specific assays may require confirmatory testing of positive results. We assessed the positive predictive value (PPV) of this test in a low-prevalence (0.5%) setting. Genital and urine specimens testing positive using the COBAS AMPLICOR NG test were retested using an investigational 16S rRNA PCR assay. Additionally, 737 specimens were tested in parallel by both culture and the above PCR protocol. Of 9,772 specimens tested in-house, 168 were positive by the AMPLICOR test; in addition, 62 AMPLICOR-positive specimens were referred to our laboratory for confirmatory testing, yielding 230 positive specimens. Of these, 72 were confirmed positive by 16S rRNA PCR, yielding a specificity of 98.7% and a PPV of 31.3%. Specificity was similar for all specimen types, whereas PPV varied with prevalence: specimens from males, females, urine specimens, and genital swabs had PPVs of 70.8, 13.3, 51.9, and 20.1%, respectively. The PPV was higher when the initial AMPLICOR optical density (OD) was ≥3.5 versus initial and repeat OD readings in an equivocal zone of ≥0.2 to P < 0.001). On repeat testing of specimens with ODs in the equivocal zone, 54 gave ODs of ≥0.2 and P = 0.004). Comparing PCR to culture as the “gold standard,” specificity increased from 96.8 to 99.9% when 16S rRNA PCR was performed on specimens positive by the COBAS AMPLICOR NG test. Confirmatory testing with a more specific method such as 16S rRNA PCR should be considered in low-prevalence populations, especially for specimens with an OD in the equivocal zone.

Published
2002

23. Contributors

Author

Charles S. Abrams, Frank J. Accurso, Nezam H. Afdhal, Cem Akin, Allen J. Aksamit, Qais Al-Awqati, Ban Mishu Allos, David Altshuler, Michael J. Aminoff, Jeffrey L. Anderson, Karl E. Anderson, Larry J. Anderson, Karen H. Antman, Aśok C. Antony, Gerald B. Appel, Frederick R. Appelbaum, William P. Arend, Paul Arguin, James O. Armitage, Cheryl A. Armstrong, M. Amin Arnaout, Robert Arnold, David Atkins, William L. Atkinson, Dennis Ausiello, Bruce R. Bacon, Grover C. Bagby, Barbara J. Bain, Dean F. Bajorin, Mark Ballow, Robert W. Baloh, Jonathan Barasch, Richard L. Barbano, Murray G. Baron, Elizabeth Barrett-Connor, Michael J. Barry, Bruce A. Barshop, John G. Bartlett, Mary Barton, Robert C. Basner, Stephen G. Baum, Daniel G. Bausch, Arnold S. Bayer, Hasan Bazari, John H. Beigel, George A. Beller, Robert M. Bennett, Joseph R. Berger, Paul Berk, Nancy Berliner, James L. Bernat, Philip J. Bierman, Bruce R. Bistrian, Joseph J. Biundo, Charles D. Blanke, Joel N. Blankson, Martin J. Blaser, William A. Blattner, Thomas P. Bleck, William E. Boden, C. Richard Boland, Jean Bolognia, Robert Bonomo, Larry Borish, Patrick J. Bosque, Randall Brand, Itzhak Brook, Enrico Brunetti, David M. Buchner, Pierre A. Buffet, H. Franklin Bunn, Peter A. Calabresi, David P. Calfee, Hugh Calkins, Douglas Cameron, Michael Camilleri, Grant W. Cannon, Maria Domenica Cappellini, Blase A. Carabello, Edgar M. Carvalho, Agustin Castellanos, Naga P. Chalasani, Henry Chambers, Mary Charlson, William P. Cheshire, Patrick F. Chinnery, David C. Christiani, David R. Clemmons, Jeffrey Cohen, Myron S. Cohen, Steven P. Cohen, Steven L. Cohn, Robert Colebunders, Joseph M. Connors, Deborah J. Cook, C. Ralph Corey, Kenneth H. Cowan, William A. Craig, Simon L. Croft, Mary K. Crow, John A. Crump, Mark R. Cullen, Gary C. Curhan, Inger K. Damon, Troy E. Daniels, Nancy Davidson, Lisa M. DeAngelis, Malcolm M. DeCamp, Carlos Del Rio, George D. Demetri, Robert H. Demling, Patricia A. Deuster, Robert B. Diasio, David J. Diemert, Kathleen B. Digre, John M. Douglas, Jeffrey M. Drazen, Stephen C. Dreskin, W. Lawrence Drew, George L. Drusano, Thomas D. DuBose, F. Daniel Duffy, Herbert L. DuPont, Madeleine Duvic, Kathryn M. Edwards, N. Lawrence Edwards, Lawrence H. Einhorn, Ronald J. Elin, George M. Eliopoulos, Perry Elliott, Jerrold J. Ellner, Louis J. Elsas, Dirk M. Elston, Ezekiel J. Emanuel, Gregory F. Erickson, Armin Ernst, Joel D. Ernst, David S. Ettinger, Amelia Evoli, Douglas O. Faigel, Gary W. Falk, Murray J. Favus, Gene Feder, Stephan D. Fihn, Gary S. Firestein, Neil Fishman, Lee A. Fleisher, Marsha D. Ford, Chris E. Forsmark, Vance G. Fowler, Jay W. Fox, Manuel A. Franco, Martyn A. French, Karen Freund, Linda P. Fried, Cem Gabay, Kenneth L. Gage, Robert F. Gagel, John N. Galgiani, Patrick G. Gallagher, Eithan Galun, Leonard Ganz, Guadalupe Garcia-Tsao, Jonathan D. Gates, William M. Geisler, Tony P. George, Dale N. Gerding, M. Eric Gershwin, Morie A. Gertz, Gordon D. Ginder, Jeffrey Ginsberg, Geoffrey S. Ginsburg, Michael Glogauer, John W. Gnann, Matthew R. Golden, Lee Goldman, Ellie J. Goldstein, Lawrence T. Goodnough, Jörg J. Goronzy, Eduardo Gotuzzo, Deborah Grady, Leslie C. Grammer, F. Anthony Greco, Harry B. Greenberg, Peter K. Gregersen, Robert C. Griggs, Lisa M. Guay-Woodford, Richard L. Guerrant, Colleen Hadigan, John D. Hainsworth, Anders Hamsten, Kenneth R. Hande, H. Hunter Handsfield, Göran K. Hansson, Rashidul Haque, Raymond C. Harris, Stephen Crane Hauser, Frederick G. Hayden, Letha Healey, Douglas C. Heimburger, Erik L. Hewlett, David R. Hill, Nicholas S. Hill, L. David Hillis, Jack Hirsh, V. Michael Holers, Steven M. Holland, Steven Hollenberg, Edward W. Hook, Laurence Huang, Leonard D. Hudson, Steven E. Hyman, Michael Iannuzzi, Robert D. Inman, Sharon K. Inouye, Karl L. Insogna, Silvio E. Inzucchi, Eric M. Isselbacher, Ahmedin Jemal, Joanna Jen, Dennis M. Jensen, Michael D. Jensen, Robert T. Jensen, Mariell Jessup, Stuart Johnson, Ralph F. Józefowicz, Stephen G. Kaler, Moses R. Kamya, Hagop Kantarjian, David R. Karp, Daniel L. Kastner, David A. Katzka, Debra K. Katzman, Carol A. Kauffman, Kenneth Kaushansky, Emmet B. Keeffe, Morton Kern, Gerald T. Keusch, David H. Kim, Matthew Kim, Louis V. Kirchhoff, Michael J. Klag, Samuel Klein, David S. Knopman, Tamsin A. Knox, Albert I. Ko, Rami S. Komrokji, Dimitrios P. Kontoyiannis, Barbara S. Koppel, Kevin Korenblat, Bruce R. Korf, Neil J. Korman, Joseph A. Kovacs, Monica Kraft, Christopher M. Kramer, Donna M. Krasnewich, Peter J. Krause, Henry M. Kronenberg, Ernst J. Kuipers, Paul Ladenson, Donald W. Landry, Nancy E. Lane, Anthony E. Lang, Richard A. Lange, George V. Lawry, Thomas H. Lee, William M. Lee, James Leggett, Adam Lerner, Stuart Levin, Stephanie M. Levine, Gary R. Lichtenstein, Henry W. Lim, Aldo A.M. Lima, Andrew H. Limper, Geoffrey S.F. Ling, Alan F. List, William C. Little, Richard F. Loeser, Bennett Lorber, Donald E. Low, Daniel R. Lucey, James R. Lupski, Henry T. Lynch, Jeffrey M. Lyness, Bruce W. Lytle, C. Ronald MacKenzie, Harriet MacMillan, Robert D. Madoff, Mark W. Mahowald, Atul Malhotra, Lionel A. Mandell, Peter Manu, Marsha D. Marcus, Ariane J. Marelli, Maurie Markman, Andrew R. Marks, Kieren A. Marr, Thomas J. Marrie, Paul Martin, Joel B. Mason, Barry M. Massie, Henry Masur, Eric L. Matteson, Toby Maurer, Emeran A. Mayer, Stephen A. McClave, F. Dennis McCool, Charles E. McCulloch, Michael A. McGuigan, John McHutchison, William McKenna, Vallerie McLaughlin, John J.V. McMurray, Mary McNaughton-Collins, Kenneth McQuaid, Frederick W. Miller, Kenneth L. Minaker, Jonathan W. Mink, Daniel R. Mishell, William E. Mitch, Mark E. Molitch, Bruce A. Molitoris, José G. Montoya, Fred Morady, Jeffrey A. Moscow, Andrew H. Murr, Robert J. Myerburg, Stanley Naguwa, Stanley J. Naides, Theodore E. Nash, Avindra Nath, Eric G. Neilson, Lawrence S. Neinstein, Thomas B. Newman, William L. Nichols, Lynnette K. Nieman, Dennis E. Niewoehner, S. Ragnar Norrby, David A. Norris, Susan O’Brien, Francis G. O’Connor, Patrick G. O’Connor, James R. O'Dell, Anne E. O'Donnell, Jae K. Oh, Jeffrey E. Olgin, Jeffrey W. Olin, Walter A. Orenstein, Douglas R. Osmon, Catherine M. Otto, Stephen A. Paget, Mark Papania, Peter G. Pappas, Pankaj Jay Pasricha, David L. Paterson, Carlo Patrono, Jean-Michel Pawlotsky, Richard D. Pearson, Eli N. Perencevich, Trish M. Perl, Michael C. Perry, William A. Petri, Marc A. Pfeffer, Perry J. Pickhardt, Gerald B. Pier, David S. Pisetsky, Marshall R. Posner, Charlene Prather, Basil A. Pruitt, Reed E. Pyeritz, Thomas C. Quinn, Jai Radhakrishnan, Ganesh Raghu, Margaret V. Ragni, Srinivasa N. Raja, S. Vincent Rajkumar, Didier Raoult, Robert W. Rebar, Annette C. Reboli, K. Rajender Reddy, Donald A. Redelmeier, Susan E. Reef, Neil M. Resnick, David B. Reuben, Herbert Y. Reynolds, Emanuel P. Rivers, Robert A. Rizza, Lewis R. Roberts, Jean-Marc Rolain, José R. Romero, G. David Roodman, Clifford Rosen, Karen Rosene-Montella, Philip J. Rosenthal, Marc E. Rothenberg, Hope S. Rugo, James A. Russell, Anil K. Rustgi, Robert A. Salata, Jane E. Salmon, Renato M. Santos, Michael N. Sawka, Andrew I. Schafer, William Schaffner, W. Michael Scheld, Eileen Schneider, Thomas J. Schnitzer, Robert T. Schooley, David L. Schriger, Steven A. Schroeder, Lynn M. Schuchter, Sam Schulman, Lawrence B. Schwartz, Robert S. Schwartz, Carlos Seas, Steven A. Seifert, Julian L. Seifter, Clay F. Semenkovich, Carol E. Semrad, F. John Service, George M. Shaw, Pamela J. Shaw, Robert S. Sherwin, Michael E. Shy, Wilmer L. Sibbitt, Ellen Sidransky, Robert F. Siliciano, Michael S. Simberkoff, David L. Simel, Karl Skorecki, Arthur S. Slutsky, Eric J. Small, Gerald W. Smetana, Frederick S. Southwick, Robert F. Spiera, Stanley M. Spinola, Pawel Stankiewicz, Paul Stark, Lynne S. Steinbach, Martin H. Steinberg, Theodore S. Steiner, David S. Stephens, David A. Stevens, William G. Stevenson, Arthur E. Stillman, James K. Stoller, John H. Stone, Edwin P. Su, Roland W. Sutter, Morton N. Swartz, Ronald S. Swerdloff, Megan Sykes, Thomas A. Tami, Susan M. Tarlo, Victoria M. Taylor, Ayalew Tefferi, Paul S. Teirstein, Sam R. Telford, Margaret Tempero, Michael J. Thun, Nina Tolkoff-Rubin, Antonella Tosti, John J. Treanor, Ronald B. Turner, Arthur C. Upton, Greet Van den Berghe, John Varga, Adrian Vella, Joseph G. Verbalis, Ronald G. Victor, Angela Vincent, Paul A. Volberding, Julie M. Vose, Robert M. Wachter, Edward H. Wagner, Edward E. Walsh, Thomas J. Walsh, Christina Wang, Christine Wanke, Stephen I. Wasserman, Heiner Wedemeyer, Geoffrey A. Weinberg, David A. Weinstein, Robert S. Weinstein, Roger D. Weiss, Martin Weisse, Jeffrey I. Weitz, Samuel A. Wells, Richard P. Wenzel, Victoria P. Werth, Sterling G. West, Cornelia M. Weyand, A. Clinton White, Christopher J. White, Perrin C. White, Richard J. Whitley, Michael P. Whyte, Samuel Wiebe, Jeanine P. Wiener-Kronish, Jennifer E. Wildes, Alexander Wilmer, William Winkenwerder, Joseph I. Wolfsdorf, Gary P. Wormser, John J. Wysolmerski, Myron Yanoff, Neal S. Young, William F. Young, Alan S.L. Yu, Mark L. Zeidel, Peter Zimetbaum, and Justin A. Zivin

Published
2012

24. Contributors

Author

Saad H. Abdalla, Gustavo Olszanski Acrani, Rakesh Aggarwal, Ban Mishu Allos, Miriam J. Alter, Jon K. Andrus, Juana Angel, Gregory M. Anstead, Eduardo Arathoon, Eurico Arruda, Ray R. Arthur, Robert L. Atmar, Patrick Banura, Alan G. Barbour, Alan D.T. Barrett, Dan Bausch, Steven L. Berk, Pascal O. Bessong, Frank J. Bia, Tihana Bicanic, Robert E. Black, Thomas P. Bleck, Andrea K. Boggild, William Bonnez, Joseph S. Bresee, Corrie Brown, Lillian B. Brown, Enrico Brunetti, Fabrizio Bruschi, Amy E. Bryant, Carlos C. (Kent) Campbell, Carlos Castillo-Solorzano, Martin S. Cetron, Ding-Shinn Chen, Pei-Jer Chen, Xiang-Sheng Chen, Thomas Cherian, K.B. Chua, Myron S. Cohen, Graham S. Cooke, Chester R. Cooper, Edward S. Cooper, Christina M. Coyle, John H. Cross†, David A.B. Dance, Mustapha A. Danesi, Chandler R. Dawson, Catherine de Martel, Ciro A. De Quadros, Anastacio de Queiroz Sousa, Nilanthi R. de Silva, Alexandre Leite de Souza, Christoph Dehio, David J. Diemert, Rebecca Dillingham, John E. Donelson, J. Stephen Dumler, Joseph A. Duncan, Herbert L. DuPont, Marlene L. Durand, Mark L. Eberhard, Joshua C. Eby, Charles Edwards, Rachel B. Eidex, Jerrold J. Ellner, Delia A. Enría, Onder Ergonul, Mary K. Estes, Ahmed Hassan Fahal, Paul E. Farmer, A.S.G. Faruque, Charles Feldman, Heinz Feldmann, Kimberley K. Fox, Silvia Franceschi, Manuel A. Franco, Charles F. Fulhorst, Hector H. Garcia, Robert M. Genta, Robert H. Gilman, Roger I. Glass, Jerome Goddard, Eduardo Gotuzzo, John R. Graybill, Harry B. Greenberg, Paul D. Griffiths, Duane J. Gubler, Richard L. Guerrant, Yezid Gutierrez, Erik L. Hewlett, David L. Heymann, David R. Hill, Mei-Shang Ho, Achim M. Hoerauf, Paul S. Hoffman, Stephen L. Hoffman, Michael R. Holbrook, Thomas L. Holland, Donald R. Hopkins, Duane R. Hospenthal, Peter J. Hotez, S. David Hudnall, James M. Hughes, Kao-Pin Hwang, Raul E. Isturiz, Peter B. Jahrling, Shahid Jameel, Selma M.B. Jeronimo, Edward C. Jones-Lopez, Anna Kabanova, Gagandeep Kang, Christopher L. Karp, James W. Kazura, Peter Kern, Gerald T. Keusch, Jay S. Keystone, Mehnaaz S. Khuroo, Mohammad S. Khuroo, Ik-Sang Kim, Charles H. King, Louis V. Kirchhoff, Amy D. Klion, Keith P. Klugman, Dennis J. Kopecko, Margaret Kosek, Frederick T. Koster, Phyllis E. Kozarsky, Thomas G. Ksiazek, Jens H. Kuhn, Albert J. Lastovica, James W. LeDuc, Peter A. Leone, Paul N. Levett, Michael Levin, Myron M. Levine, Aldo A.M. Lima, Gerhard Lindeque, David L. Longworth, David Mabey, J. Dick Maclean†, Alan J. Magill, Ismael Maguilnik, Ciro Maguiña, James H. Maguire, Siddhartha Mahanty, Shinji Makino, Christian W. Mandl, Thomas J. Marrie, Barry J. Marshall, Gregory J. Martin, Tadahiko Matsumoto, Steven D. Mawhorter, James S. McCarthy, Michael R. McGinnis, Paul S. Mead, Wayne M. Meyers, Robert F. Miller, Samuel I. Miller, James N. Mills, Thomas P. Monath, Christopher C. Moore, Thomas A. Moore, J.C. Morrill, J. Glenn Morris, Megan Murray, K. Darwin Murrell, G. Balakrish Nair, Theodore E. Nash, Barnett R. Nathan, Ricardo Negroni, Anne Nicholson-Weller, Marcio Nucci, Thomas B. Nutman, Nigel O’Farrell, Juan P. Olano, Eng Eong Ooi, Luis S. Ortega, Ynés R. Ortega, Mark A. Pallansch, Jean W. Pape, Georgios Pappas, Julie Parsonnet, Geoffrey Pasvol, Sharon J. Peacock, Richard D. Pearson, Rosanna W. Peeling, David A. Pegues, Jacques Pépin, C.J. Peters, Kristine M. Peterson, William A. Petri, Françoise Portaels, José Luiz Proença-Módena, Thomas C. Quinn, G. Raghurama Rao, Didier Raoult, Rino Rappuoli, John H. Rex, Steven J. Reynolds, José M.C. Ribeiro, Emmanuel Roilides, Pierre E. Rollin, Allan R. Ronald, Paul A. Rota, Sharon L. Roy, Ernesto Ruiz-Tiben, Edward T. Ryan, Debasish Saha, Mohammed A. Salam, Amidou Samie, Julius Schachter, Peter M. Schantz, W. Michael Scheld, Elizabeth P. Schlaudecker, David A. Schwartz, Joseph D. Schwartzman, Arlene C. Seña, Daniel J. Sexton, Truman W. Sharp, Wun-Ju Shieh, Shmuel Shoham, Afzal A. Siddiqui, Upinder Singh, David W. Smith, Michael B. Smith, Bonnie L. Smoak, A. George Smulian, Cynthia B. Snider, Tom Solomon, Samba O. Sow, P. Frederick Sparling, Lisa A. Spencer, Lawrence R. Stanberry, J. Erin Staples, Robert Steffen, Theodore S. Steiner, Mark C. Steinhoff, Dennis L. Stevens, Kathryn N. Suh, Khuanchai Supparatpinyo, Paul J. Szaniszlo, Milagritos D. Tapia, Herbert B. Tanowitz, Sam R. Telford, Robert B. Tesh, Nathan M. Thielman, Fernando J. Torres-Vélez, Joseph D. Tucker, Luis M. Valdez, Jesus G. Valenzuela, Diederik van de Beek, Pedro F.C. Vasconcelos, Govinda S. Visvesvara, Victoria Wahl-Jensen, David H. Walker, Douglas S. Walsh, Thomas J. Walsh, David A. Walton, Peter D. Walzer, Cirle A. Warren, Scott C. Weaver, Louis M. Weiss, Peter F. Weller, A. Clinton White, Nicholas J. White, Robert J. Wilkinson, Mary E. Wilson, Murray Wittner, Anita K.M. Zaidi, and Sherif R. Zaki

Published
2011

25. Contributors

Author

George J. Alangaden, Michael J. Aldape, Jérôme Allardet-Servent, Upton D. Allen, Heidi S.M. Ammerlaan, Emmanouil Angelakis, Andrew Artenstein, David Asboe, Kingsley B. Asiedu, John C. Atherton, Tar-Ching Aw, Seema Baid-Agrawal, Robin Bailey, Christopher Bandel, Philip S. Barie, David J. Barillo, Pierre-Alexandre Bart, Roger Bayston, C. Ben Beard, Nick J. Beeching, Rodolfo E. Bégué, Yves Benhamou, Constance A. Benson, Elie F. Berbari, Anthony R. Berendt, Madhav P. Bhatta, Jacques Bille, Ari Bitnun, Finn T. Black, Iain Blair, Stéphane Blanche, Thomas P. Bleck, Chantal P. Bleeker-Rovers, Gijs Bleijenberg, Karen C. Bloch, Marc J.M. Bonten, Charles A.B. Boucher, Rafik Bourayou, Emilio S. Bouza, William R. Bowie, Barry D. Brause, Sylvain Brisse, Warwick Britton, Itzhak Brook, David W.G. Brown, Christian Brun-Buisson, James C.M. Brust, Amy E. Bryant, André Bryskier, R. Mark L Buller, Karen Bush, Thierry Calandra, D. William Cameron, Michel Caraël, Michael J. Carr, Inmaculada Casas, Stephen T. Chambers, Katarina G. Chiller, Tom M. Chiller, Peter L. Chiodini, Ian Chopra, Anthony C. Chu, Kevin K. Chung, Benjamin M. Clark, Nathan Clumeck, Clay J. Cockerell, Jonathan Cohen, John Collinge, Christopher P. Conlon, G. Ralph Corey, Alan Cross, John H. Cross, Judith Currier, Carmel M. Curtis, Gina Dallabetta, Robert N. Davidson, Jane Davies, Jeremy Day, Nicholas P.J. Day, Cillian F. De Gascun, Stéphane de Wit, Jean Delmont, David T. Dennis, David J. Diemert, Mehmet Doganay, Tom Doherty, Christiane Dolecek, Stéphane Y. Donati, Arjen M. Dondorp, Barbara Doudier, Michel Drancourt, Dimitri M. Drekonja, Richard H. Drew, Jay S. Duker, J. Stephen Dummer, Charles N. Edwards, Miquel B. Ekkelenkamp, Mark C. Enright, Paul R. Epstein, Veronique Erard, Alice Chijioke Eziefula, Mark B. Feinberg, Florence Fenollar, Alan Fenwick, Luis Fernandez, Joshua Fierer, Roger G. Finch, Charles W. Flexner, Ad C. Fluit, Elizabeth Lee Ford-Jones, Pierre-Edouard Fournier, Victoria Fraser, Martyn A. French, Jon S. Friedland, Joseph M. Fritz, E. Yoko Furuya, Kenneth L. Gage, Lynne S. Garcia, Arturo S. Gastañaduy, Khalil G. Ghanem, Maddalena Giannella, Carol A. Glaser, Marshall J. Glesby, Sarah Glover, Youri Glupczynski, John W. Gnann, Andrew F. Goddard, Ellie J.C. Goldstein, Iveth J. González, Sherwood L. Gorbach, Bruno Gottstein, Ravi Gowda, John D. Grabenstein, John M. Grange, Michael D. Green, Stephen T. Green, Danielle T. Greenblatt, Brian Greenwood, Aric L. Gregson, Andreas H. Groll, Aditya K. Gupta, Kok-Ann Gwee, William Hall, Scott M. Hammer, Sajeev Handa, Diane Hanfelt-Goade, Alexandre Harari, Marianne Harris, Barry J. Hartman, Roderick J. Hay, David K. Henderson, Lisa E. Hensley, Luke Herbert, David R. Hill, Timothy J. Hills, John David Hinze, Hans H. Hirsch, Bernard Hirschel, Andy I.M. Hoepelman, Steven M. Holland, Mary M. Horgan, Robin Howe, James M. Hughes, Mark W. Hull, Clark B. Inderlied, Michael G. Ison, Peter J. Jenks, James R. Johnson, Theodore Jones, Mettassebia Kanno, Carol Kauffman, Patrick Kelly, Jason S. Kendler, Yoav Keynan, Ali S. Khan, Grace T. Kho, George R. Kinghorn, Paul E. Klapper, Jan AJW Kluytmans, Menno Kok, Isabelle Koné-Paut, John N. Krieger, Aloys C.M. Kroes, Frank P. Kroon, Christine J. Kubin, Alberto M. La Rosa, Tahaniyat Lalani, David G. Lalloo, Harold Lambert, Luce Landraud, Stephen D. Lawn, Phillipe Lehours Pharm, Marc Leone, Itzchak Levi, Alexandra M. Levitt, H. D. Alan Lindquist, Graham Lloyd, David J. Looney, Franklin D. Lowy, Benjamin J. Luft, William A. Lynn, Mark J. Macielag, Philip A. Mackowiak, Paul A. MacPherson, Valérie Maghraoui-Slim, Janice Main, Vincent Mallet, Julie E. Mangino, Oriol Manuel, Oscar Marchetti, Kristen Marks, Kieren A. Marr, Claude Martin, Pablo Martín-Rabadán, Augusto Julio Martinez, Ellen M. Mascini, Kenneth H. Mayer, Joseph B. McCormick, Rose McGready, Michael W. McKendrick, Simon Mead, Francis Mégraud, André Z. Meheus, Graeme Meintjes, Marian G. Michaels, Michael Miles, Alastair Miller, Matthew J. Mimiaga, Marie-Paule Mingeot-Leclercq, Thomas G. Mitchell, Pamela A. Moise, Julio Montaner, Caroline B. Moore, Philippe Moreillon, Peter Morgan-Capner, Valentina Montessori, Peter Moss, Patricia Muñoz, Kurt G. Naber, Sammy Nakhla, Jai P. Narain, Dilip Nathwani, Paul Newton, Chinh Nguyen, Lindsay E. Nicolle, Michael S. Niederman, Gary J. Noel, S. Ragnar Norrby, François Nosten, Luigi Daniele Notarangelo, Paul Nyirjesy, P. Ronan O'Connell, Jon S. Odorico, Edmund L.C. Ong, Steven M. Opal, L. Peter Ormerod, Douglas R. Osmon, Eric A. Ottesen, Gustavo Palacios, Giuseppe Pantaleo, Laurent Papazian, Philippe Parola, Manuel A. Pascual, Eleni Patrozou, Carlos Paya, Sharon J. Peacock, Jean-Claude Pechère, Mark D. Perkins, Barry Peters, Gaby E. Pfyffer, Paul A. Pham, Peter Piot, Geraldine Placko-Parola, Stainslas Pol, Klara M. Posfay-Barbe, William G. Powderly, Anton Pozniak, Guy Prod'hom, Thomas C. Quinn, Daniel W. Rahn, Aadia I. Rana, Didier Raoult, Raul Raz, Raymund Razonable, Robert C. Read, Stephen J. Reynolds, Malcolm D. Richardson, Christopher C. Robinson, Suzan H.M. Rooijakkers, Daniel Rosenbluth, Sergio D. Rosenzweig, Clarisse Rovery, Robert H. Rubin, Bina Rubinovitch, Kathleen H. Rubins, Ethan Rubinstein, Greg Ryan, Stephen Ryder, Steven Safren, Vikrant V. Sahasrabuddhe, Pekka A.I. Saikku, George Sakoulas, Juan Carlos Salazar, Michelle R. Salvaggio, Kirsten Schaffer, Franz-Josef Schmitz, Robert T. Schooley, Richard-Fabian Schumacher, Euan M. Scrimgeour, James Seddon, Harald Seifert, Graham R. Serjeant, Beverly E. Sha, Keerti V. Shah, Daniel S. Shapiro, Gerard Sheehan, Shmuel Shoham, Cameron P. Simmons, Kari A. Simonsen, Neeraj Singh, Mary P.E. Slack, Jack D. Sobel, Madhuri M. Sopirala, Lisa A. Spacek, Shiranee Sriskandan, Samuel L. Stanley, James M. Steckelberg, Iain Stephenson, Dennis L. Stevens, Walter L. Straus, Willem Sturm, Richard C. Summerbell, Joseph S. Susa, Sarah J. Tabrizi, Marc A. Tack, Randy Taplitz, Pablo Tebas, Marleen Temmerman, Steven F.T. Thijsen, Lora D. Thomas, Gail Thomson, Guy E. Thwaites, Umberto Tirelli, Nina E. Tolkoff-Rubin, Tone Tønjum, Francesca J. Torriani, Gregory C. Townsend, Gloria Trallero Masó, Paul M. Tulkens, Allan R. Tunkel, Emanuela Vaccher, Anaïs Vallet-Pichard, Françoise Van Bambeke, Diederik van de Beek, Jos W.M. van der Meer, Anton M. van Loon, Jos van Putten, Bernard P. Vaudaux, Sten H. Vermund, Hans Verstraelen, Paul Verweij, Raphael P. Viscidi, Kumar Visvanathan, Govinda S. Visvesvara, Lorenz von Seidlein, Florian M.E. Wagenlehner, Victoria Wahl-Jensen, Thomas J. Walsh, David C. Warhurst, David W. Warnock, David A. Warrell, Mary J. Warrell, Adilia Warris, Rainer Weber, Wolfgang Weidner, Vivienne C. Weston, Estella Whimbey, Michael Whitby, Peter J. White, Christopher J.M. Whitty, Rob J.L. Willems, Emrys Williams, Cara Wilson, Mary E. Wilson, Richard E. Winn, Kevin L. Winthrop, Martin J. Wiselka, Hilmar Wisplinghoff, Cameron R. Wolfe, Robin Wood, Natalie Wright, James R. Yankaskas, Najam A. Zaidi, Jonathan M. Zenilman, Yaobi Zhang, Arie J. Zuckerman, Jane Nicola Zuckerman, and Alimuddin Zumla

Published
2010

26. Development of High Temperature Resistant Stereocomplex PLA for Injection Moulding.

Author

Körber S, Moser K, and Diemert J

Abstract

In this study, the production of stereocomplex PLA formulations (sc-PLA) by compounding and subsequent injection moulding at different mould temperatures was investigated. Several selective nucleating agents were identified and compounded with different poly(L-lactide)/poly(D-lactide) (PLLA/PDLA) ratios on a co-rotating twin screw extruder. The effect of nucleating agents (NA) on the crystallisation behaviour of the compound was systematically investigated by DSC analysis. The crystallisation behaviour of NA-21 (aluminium complex of a phosphoric ester), also in combination with talc, under cooling rates of up to 70 K/min was analysed. The wide-angle X-ray diffraction (WAXD) results showed a complete stereocomplex (sc) crystal formation on all specimens containing NA-21 even at the highest cooling rates. The thermo-mechanical testing of sc-PLA shows a Young's modulus of approx. 3 GPa, yield stress of 30-40 MPa, elongation of 1%, and a heat deflection temperature (HDT-B) up to 180 °C. Processing sc-PLA exclusively via the processing route of compounding and injection moulding will open new areas of application for PLA at higher temperatures.

Published
2022
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