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- Volume 26, Issue 4, 2011
Southern African Journal of Epidemiology and Infection - Volume 26, Issue 4, 2011
Volume 26, Issue 4, 2011
Author R. GlassSource: Southern African Journal of Epidemiology and Infection 26, pp 84 –190 (2011)More Less
Rotavirus was first detected by electron microscopy in young children with diarrhoea in South Africa in 1976, and 25 years later rotavirus vaccine was introduced into the routine childhood immunisation schedule in the country. Prof Barry Schoub played a role in both these events and in many milestones along that journey, from discovery to introduction. Several seminal findings were identified by Schoub et al in the early years after rotavirus identification in South Africa, including the antigenic relatedness of rotavirus strains, and several important epidemiological and clinical findings. This laid the foundation for the role that South Africa has played in pioneering rotavirus research work in, and for, Africa. Early efforts at establishing a regional network for rotavirus epidemiology and surveillance studies have expanded into a continent-wide network using standardised protocols with reporting to the World Health Organization. In addition, clinical studies conducted in South Africa paved the way for the national introduction of the vaccine, while also addressing specific questions of relevance to the global community, including safety in HIV-infected children and efficacy in an African population.
Source: Southern African Journal of Epidemiology and Infection 26 (2011)More Less
It is with pleasure that the editorial staff of The Southern African Journal of Epidemiology and Infection (SAJEI) presents this Festschrift edition as a tribute to Prof Barry David Schoub. During his outstanding career as medical virologist and national and international expert in the field of infectious diseases and their prevention, Prof Schoub was founding Director of the National Institute for Communicable Diseases (NICD), serving as Executive Director between 2002 and 2011, and, before that, Director of the National Institute of Virology (NIV) between 1982 and 2002. This Festschrift is presented to Prof Schoub in recognition of his invaluable contribution to infectious diseases in South Africa and internationally, and has been made possible by an academic grant from the Poliomyelitis Research Foundation (PRF), of which Barry has been an integral part for many years. We extend special thanks to Mr Roy Wiggill, former Chairperson of the PRF Board, the current Board Chairperson, Mr A Moffat, and members of the PRF Board for this generous gesture.
Author R.B. WiggillSource: Southern African Journal of Epidemiology and Infection 26 (2011)More Less
Prof Barry Schoub has made a tremendous contribution to the Poliomyelitis Research Foundation (PRF) over a period of 34 years.
The PRF laboratories, built in 1952 and headed initially by Prof James Gear under the PRF Board of Trustees (of which Mr George Cook was chairman), were taken over in 1976 by the state and became the National Institute of Virology (NIV). Prof Walter Prozesky was the founding director, and he was succeeded by Prof Schoub in 1978. With the creation of the National Health Laboratory Service (NHLS), the need for a specialised and dedicated public health institute was recognised. The National Institute for Communicable Diseases (NICD), incorporating the NIV, was established in 2002, and Prof Schoub was appointed as the first executive director.
Author W. ProzeskySource: Southern African Journal of Epidemiology and Infection 26 (2011)More Less
It was a momentous occasion when Barry Schoub joined our newly established Department of Medical Virology in Pretoria in August 1975 as Principal Specialist. Having just escaped the most intensive but hardly tender mentorship of the legendary Prof Jack Coetzee, I was starry-eyed when given the opportunity to develop my own "scientific playground". Then Barry came like a gift from heaven (with aiding and abetting by Prof Hendrik Koornhof). I had been able to recruit that most able electron microscopist, Mike Lecatsas, from Onderstepoort, and we built up our own instrument from a box of parts sold to us at a ridiculous price by the Electron Microscopy Unit at Wits. The rotavirus story had just broken and we charged into the field with the greatest enthusiasm.
Author L. MorrisSource: Southern African Journal of Epidemiology and Infection 26, pp 178 –179 (2011)More Less
It is indeed a pleasure for me to write in honour of Prof Barry Schoub on the occasion of his retirement and reflect on his impact on HIV vaccine research in South Africa. I have been at the National Institute for Communicable Diseases (NICD) (formerly National Institute for Virology) for 17 years, during which time I have had the benefit of having Barry as my Director.
Source: Southern African Journal of Epidemiology and Infection 26, pp 180 –181 (2011)More Less
My first recollection of Prof Barry Schoub was at a National Institute for Virology (NIV) journal club in November 1994. At that time, I was a lecturer at the University of the Witwatersrand and spending two to three days a week at the AIDS Research Unit at the NIV. This was my first experience of a journal club at the NIV, and I was struck how the Director of the NIV was rolling up his sleeves and presenting a paper to the gathered staff.
Author G. LecatsasSource: Southern African Journal of Epidemiology and Infection 26, pp 182 –183 (2011)More Less
Since the introduction of the first electron microscope in 1939, the development of the field of ultra-structure, in both the physical and biological sciences, has been dramatic in its elucidation of problems in both fields. Although the theoretical limit of the resolving power of the instrument 2°A was achieved early in its development, further refinements followed rapidly. Modern instruments are capable of reaching high vacuum levels in relatively short time periods and computerisation has made these instruments remarkably user friendly.
Lessons learnt from the global outbreak of a Darwinian masterpiece : virus influenza A (H1N1) 2009 JS Oxford : FestschriftAuthor J.S. OxfordSource: Southern African Journal of Epidemiology and Infection 26, pp 191 –194 (2011)More Less
Following the Second World War, the World Health Organization established a worldwide network of laboratories to track influenza viruses. The intention then, and now, was to give prior warning of the emergence of new antigenic and drug-resistant variants of this most unpredictable and global virus. The contribution of the South African National Institute for Communicable Diseases has been outstanding in this regard and, to some extent, has acted as a sentinel for the whole continent. Prof Barry Schoub, in turn, has been at the epicentre of this most academic and yet practical research and diagnostic centre.
Outbreaks in South Africa 2004-2011, the outbreak response Unit of the NICD, and the vision of an inspired leader : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 195 –197 (2011)More Less
The Outbreak Response Unit was established in 2004 by Prof Barry Schoub and was envisioned as a comprehensive unit for reporting of suspected communicable disease outbreaks, and for the provision of technical support for outbreak response within South Africa and the region, with special emphasis on optimising the role of the laboratory. The unit has grown in size and broadened in scope and expertise over the past seven years, and has responded to complex, high-profile and large outbreaks, including highly pathogenic influenza A H5N2 affecting ostriches, the new arenavirus (Lujo), cholera, the 2009 influenza pandemic, emergence of rabies in Limpopo province and Rift Valley fever, among many others.
The HIV-1 epidemic in South Africa : the leading edge and the measurement of incidence : FestschriftAuthor A.J. PurenSource: Southern African Journal of Epidemiology and Infection 26, pp 198 –201 (2011)More Less
The first reported cases of human immunodeficiency virus type 1 (HIV-1) infection in South Africa were seen in 1982. South Africa has currently the highest absolute number of cases of HIV in the world. Various HIV prevalence surveys, including sentinel surveys and household surveys, have been performed over the years, and the epidemic is characterised as generalised and mature. Multiple interventions, including a large-scale antiretroviral programme, have been introduced in South Africa to reduce the transmission of HIV. It is thus no longer sufficient to estimate prevalence to understand the dynamics of the epidemic. Knowledge of the HIV incidence, the leading edge of the epidemic, would be ideal. In particular, laboratory-based incidence estimates are seen as the answer. Several laboratory methods have been described, but these have turned out to be relatively imperfect, and various refinements have been described to obtain relatively useful data. Nevertheless, in the case of South Africa, high levels of incidence have been described based on observational and laboratory-based data. The continued incidence studies are critical to inform about the leading edge of the epidemic.
A brief history of the Special Pathogens Unit at the National Institute for Communicable Diseases of the National Health Laboratory Service : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 202 –204 (2011)More Less
The Poliomyelitis Research Foundation (PRF) laboratories were opened in 1953 on the Rietfontein Campus of the South African Institute for Medical Research (SAIMR), specifically to conduct research on virus diseases and produce vaccine. In 1976, the PRF laboratories were sold to the government to become the National Institute for Virology (NIV) under the Department of Health, with Prof OW Prozesky as the first Director. In 2001, the SAIMR was reconstituted as a statutory body, the National Health Laboratory Service (NHLS), with its peripheral laboratories being administered on a regional basis, and the central microbiological laboratories in Johannesburg being amalgamated with the NIV to form a new National Institute for Communicable Diseases (NICD). Prof BD Schoub, who had succeeded Prof Prozesky as Director of NIV in 1982, became the first Director of the NICD.
The quest to understand protective immunity to HIV-1 through studies on maternal-infant HIV-1 transmission : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 205 –209 (2011)More Less
Understanding immune processes that contribute to how some human hosts prevent the establishment of human immunodeficiency virus type 1 (HIV-1) infection upon exposure, or counter accelerated disease progression if infected, will provide the basis for the design of better-targeted interventions to curb HIV-1 infection. There is little doubt that new immune targets need to be identified aside from the usual emphasis on cytotoxic T lymphocyte and neutralising antibody responses, classic favourites and hallmark responses of the adaptive immune system. However, potential contenders reside within the innate immune system, a component under-studied by comparison and one that increasingly is not "playing by the rules" and delivering some welcome surprises.
Author R.C. BallardSource: Southern African Journal of Epidemiology and Infection 26, pp 210 –214 (2011)More Less
South Africa is suffering the most severe HIV epidemic on earth. Prior to emergence of HIV / AIDS, conventional sexually transmitted infections (STIs) were endemic in many underprivileged communities as a result of many social factors. Since conventional STIs may act as co-factors in both acquisition and transmission of HIV, it was initially thought that improved treatment of these infections would result in a reduction of HIV transmission. As the HIV epidemic matured, the aetiological agents causing genital ulcer disease changed, with genital herpes emerging as the most potent STI co-factor in HIV spread. Despite learning more about herpes simplex virus/HIV interactions, attempts to utilise this knowledge to design HIV prevention strategies proved disappointing. However, the lessons learned may prove to be valuable in the future.
Antimicrobial-resistant gonorrhoea in Africa : an important public health threat in need of a regional gonococcal antimicrobial surveillance programme : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 215 –220 (2011)More Less
According to the World Health Organization's (WHO) prevalence and incidence estimates for 2005, gonorrhoea is the second most common sexually transmitted bacterial infection worldwide. Antimicrobial resistance among gonococci is worsening and multidrug-resistant strains, no longer responsive to oral cephalosporins, are now circulating in the Western Pacific region and emerging in other parts of the world. Sustainable high-quality antimicrobial resistance surveillance programmes for Neisseria gonorrhoeae exist in only a few countries. With the exception of South Africa, gonococcal antimicrobial resistance surveillance data are few or absent for most of Africa. There is thus an urgent need to revitalise gonococcal laboratory-based surveillance on the continent. In order to respond to this challenge, renewal of the WHO Gonococcal Antimicrobial Surveillance Programme is now taking place in various regions of the world, including sub-Saharan Africa, where the National Institute for Communicable Diseases, a division of the National Health Laboratory Service, has been asked to play a leading role.
Evidence that prevention of carriage by pneumococcal capsular vaccines may be the mechanism of protection from pneumococcal pneumonia : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 221 –224 (2011)More Less
During the 1970s, a hexavalent pneumococcal polysaccharide vaccine (PPV-6) and a 13-valent (PPV-13) trial involving ∼12,000 Witwatersrand gold miners showed efficacy against pneumonia caused by vaccine types (VTs). The effect of PPV-6 and PPV-13 on nasopharyngeal carriage of pneumococcal serotypes in 600 and 200 miners, respectively, was evaluated, but was not previously published. Participants were randomised to receive PPV, meningococcal Group A vaccine (MVA) or saline placebo. Nasopharyngeal swabs were collected for pneumococcal serotype detection immediately before vaccine or placebo administration, one and 25 days after, and at the time of leaving the mine. Because PPVs failed to protect against serotype 3 carriage, analysis was confined to other VTs. PPV-6 caused a 70% reduction in percentage of VT carriage in PPV-6 recipients (6 VTs [6.9%] and 149 non-vaccine types [NVTs], versus 33 VTs [22.9%] and 111 NVTs in the MVA group [p<0.001]). A 70% reduction was also demonstrated when compared with carriage in placebo group (26 VTs [23.0%] and 87 NVTs [p<0.002]). In the PPV-13 study, there were six VTs (18.2%) in PPV-13 recipients and 10 VTs (35.7%) in the MVA group, resulting in a non-significant (p=0.15) 49% reduction in carriage. A 65% reduction in carriage (p=0.0054) was demonstrated when 51% carriage (18 VTs) in the placebo group was compared with 18.2% VT carriage in PPV-13 vaccinees. Data are consistent with the hypothesis that the impact of PPVs on pneumonia may be mediated through protection from carriage.
Seroprevalence of Toxoplasma gondii infection in HIV-positive and HIV-negative subjects in Gauteng, South Africa : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 225 –228 (2011)More Less
Toxoplasmosis is an infection of warm-blooded vertebrates caused by one of the most common parasites of humans, Toxoplasma gondii. T. gondii is an obligate intracellular protozoan parasite with a worldwide distribution and a varying prevalence between different continents and countries, and even within the same country. There is little known about T. gondii prevalence in Africa. In South Africa, there is limited information about the disease and detailed recent demographic data of groups at risk are missing. The seroprevalences of T. gondii antibodies in samples of selected populations, namely HIV-positive male and female subjects, and HIV-negative pregnant women in the Gauteng province, were therefore investigated and found to be 9.8% (95% confidence interval: 7.1%-13.4%) and 12.8 % (CI: 8.9%-15.8%), respectively. A more general population sample (but biased towards pregnant women) showed a 6.4% (CI: 4.5%-9%) seroprevalence. These results show that T. gondii infection is present in South Africa, but its prevalence is much lower than previously reported in this region. While the burden of disease has been reduced in recent times, a low prevalence means that more previously unexposed people are at risk of acquiring an acute infection, which may cause congenital disease in pregnant women, or which, in reactivation form, may ultimately be life-threatening in HIV / AIDS patients.
Times have changed! The molecular revolution in TB diagnostics and detection of drug resistance : FestschriftSource: Southern African Journal of Epidemiology and Infection 26, pp 229 –234 (2011)More Less
During the late 1970s, before Prof Schoub went to the National Institute of Allergy and Infectious Diseases in Bethesda, USA to study under the famous rotavirus expert Dr Kapikian, the young Barry Schoub and Prof Hendrik Koornhof shared an interest in the aetiology of gastroenteritis in infants and children and were joint authors of research papers on this topic. One of these was on experimental techniques in the determination of the aetiology of diarrhoeal disease. Although not involved in tuberculosis (TB) research at the time, Prof Koornhof was co-author with Drs Helmuth Kleeberg and H Palmhert of a laboratory manual on tuberculosis methods published in 1970, with a second edition in 1980. The review that follows below deals with recent developments in molecular tests in the field of TB diagnosis and management, an area of interest to the National Tuberculosis Reference Laboratory (NTBRL), where both Prof Koornhof and Dr Gerrit Coetzee work at present. This article is dedicated to Prof Schoub, with fond memories of a time when both he and Prof Koornhof realised the importance of modern and reliable methods required for their research at the time, and which continue to be the cornerstone of activities of the NTBRL and National Institute for Communicable Diseases at present.
Directing the NIV and the NICD : a three-decade odyssey through the world of communicable diseases : FestschriftAuthor Barry SchoubSource: Southern African Journal of Epidemiology and Infection 26, pp 235 –236 (2011)More Less
The word "odyssey" is defined in the Oxford Dictionary as "a long journey full of experiences." I have served as Director, for almost 30 years, of the two institutes which have served as national and the regional centres of excellence for communicable diseases: from April 1976 to 2002 at the National Institute for Virology (NIV) and, since January 2002, the National Institute for Communicable Diseases (NICD). This may or may not be a directorship record, but it certainly has been a long journey. Unquestionably it has been filled with many experiences. It is from these experiences that I feel that I have gained a certain degree of knowledge and, dare I say it, wisdom which could provide some lessons of value to public health institutions serving similar functions to that of the NICD.
Source: Southern African Journal of Epidemiology and Infection 26, pp 239 –240 (2011)More Less
The high levels of extended-spectrum β-lactamase (ESBL) Enterobacteriaceae in South Africa, especially documented for Klebsiella pneumoniae, in both the public sector (55-74%), as reported by Bamford et al in this edition of the SAJEI, and in the private sector (55-60%) shown previously, is disconcerting. Carbapenems are the cornerstone of therapy for patients with serious infections caused by ESBL-producing organisms.
Antimicrobial susceptibility patterns of selected bacteraemic isolates from South African public sector hospitals, 2010 : surveillance dataAuthors: C. Bamford, C. Bamford, K. Bonorchis, A. Ryan, J. Simpson, C. Bamford, K. Bonorchis, A. Ryan, J. Simpson, E. Elliott, R. Hoffmann, P. Naicker, N. Ismail, N. Mbelle, M. Nchabeleng, T. Nana, C. Sriruttan, S. Seetharam, J. Wadula, E. Elliott, R. Hoffmann, P. Naicker, N. Ismail, N. Ismail, N. Mbelle, M. Nchabeleng, N. Mbelle, M. Nchabeleng, T. Nana, C. Sriruttan, T. Nana, C. Sriruttan, S. Seetharam, J. Wadula, S. Seetharam and J. WadulaSource: Southern African Journal of Epidemiology and Infection 26, pp 243 –250 (2011)More Less
We report on antimicrobial susceptibility surveillance data for six key bloodstream pathogens (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus) identified in public sector hospitals in South Africa during 2010. Major findings include the accelerated emergence of carbapenem resistance among K. pneumoniae and Enterobacter species, with overall susceptibility rates of 98% and 96% for ertapenem, and above 99% for meropenem and imipenem. Levels of resistance among P. aeruginosa and A. baumannii remain high in all centres, with few changes since 2009. Large decreases in piperacillin-tazobactam susceptibility rates were noted at three institutions, probably related to methodological issues. S. aureus remains a major pathogen countrywide, with between 30-60% of isolates resistant to cloxacillin [methicillin-resistant S. aureus (MRSA)]. Ongoing surveillance for antimicrobial resistance is vital, and the use of a centralised data extraction system may aid in this.