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bioRxiv2017

Sex-associated autosomal DNA methylation differences are wide-spread and stablethroughout childhood

Almost all species show sexual discordance in many traits and diseases. DNA methylation is known to contribute to these differences through well-established mechanisms including X-inactivation in females, imprinting and parent-of-origin effects. Here we investigate sex discordance in DNA methylation throughout childhood in a sample of 700 individuals from the Avon Longitudinal Study of Parents and Children. We show that autosomal sex-discordant methylation is widespread, affecting approximately 12,000 CpG sites at any given age, and stable; at least 8,500 sites are consistently different across all time points and a large proportion discordant in both the fetal and adult brain cortices. Just over 1,000 methylation differences change from birth to late adolescence, 90% of these between birth and around age seven. Sexually discordant CpG sites are enriched in genomic loci containing androgen but not estrogen targets and in genes involved in tissue development but not housekeeping functions. A methylation-derived sex score capturing the variance was calculated at each time point and found to be highly correlated between time points. This score is nominally associated with sex hormone levels in childhood as well as some phenotypes previously linked to sex hormone levels. These findings suggest that sex-discordant autosomal DNA methylation is widespread throughout the genome, likely due to the first androgen exposures in utero. It is then stably maintained from birth to late adolescence. Methylation variation at sex-discordant sites within the sexes, as summarized by the methylation sex score, likely reflects in utero androgen exposure which is relevant to human health.\n\nSignificance StatementAlthough we know that sex hormones are critical for establishing sexual discordance, less is known about how this discordance is achieved and maintained. Here we present evidence for widespread differences in DNA methylation between male and female children. We show that most of these differences are established prenatally, likely due to the first androgen exposures in utero, and then stably maintained throughout childhood, despite extreme fluctuations in the levels of these very same hormones. Our results support a role for DNA methylation as a means for recording and maintaining the effects of exposure to sex hormones and thus to better understand sexual variation and how it is driven by the prenatal environment.

epidemiology↗

bioRxiv2017

Assessing The Efficiency Of Catch-Up Campaigns For Introduction Of Pneumococcal Conjugate Vaccine; A Modelling Study Based On Data From Kilifi, Kenya

BackgroundThe World Health Organisation recommends the use of catch-up campaigns as part of the introduction of pneumococcal conjugate vaccines (PCVs) to accelerate herd protection and hence PCV impact. The value of a catch-up campaign is a trade-off between the costs of vaccinating additional age groups and the benefit of additional direct and indirect protection. There is a paucity of observational data, particularly from low-middle income countries to quantify the optimal breadth of such catch-up campaigns.\n\nMethodsIn Kilifi, Kenya PCV10 was introduced in 2011 using the 3-dose EPI infant schedule and a catch-up campaign in children <5 years old. We fitted a transmission dynamic model to detailed local data including nasopharyngeal carriage and invasive pneumococcal disease (IPD) to infer the marginal impact of the PCV catch-up campaign over hypothetical routine cohort vaccination in that setting, and to estimate the likely impact of alternative campaigns and their dose-efficiency.\n\nResultsWe estimated that, within 10 years of introduction, the catch-up campaign among <5y olds prevents an additional 65 (48 to 84) IPD cases, compared to PCV cohort introduction alone. Vaccination without any catch-up campaign prevented 155 (121 to 193) IPD cases and used 1321 (1058 to 1698) PCV doses per IPD case prevented. In the years after implementation, the PCV programme gradually accrues herd protection and hence its dose-efficiency increases: 10 years after the start of cohort vaccination alone the programme used 910 (732 to 1184) doses per IPD case averted. We estimated that a two-dose catch-up among <1y olds uses an additional 910 (732 to 1184) doses per additional IPD case averted. Furthermore, by extending a single dose catch-up campaign to children 1 to <2y old and subsequently to 2 to <5y olds the campaign uses an additional 412 (296 to 606) and 543 (403 to 763) doses per additional IPD case averted. These results were not sensitive to vaccine coverage, serotype competition, the duration of vaccine protection or the relative protection of infants.\n\nConclusionsWe find that catch-up campaigns are a highly dose-efficient way to accelerate population protection against pneumococcal disease.

epidemiology↗

bioRxiv2017

Diagnostic Prediction Tools For Bacteraemia Caused By 3rd Generation Cephalosporin-Resistant Enterobacteriaceae In Suspected Bacterial Infections: A Nested Case-Control Study

ObjectivesCurrent guidelines for empirical antibiotic treatment poorly predict the presence of 3rd generation cephalosporin resistant Enterobacteriaceae (3GC-R EB) as a cause of infection, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems to better predict the presence of 3GC-R EB as a cause of bacteraemia.\n\nMethodsA retrospective nested case-control study was performed that included patients [≥]18 years in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GC-R EB bacteraemia was matched to four control infection episodes within the same hospital, based on blood culture date and onset location (community or hospital). Starting from 32 described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GC-R EB bacteraemia.\n\nResults3GC-R EB bacteraemia occurred in 90 of 22,506 (0.4%) community-onset and in 82 of 8,110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes, respectively. The derived community-onset and hospital-onset scoring system consisted of 6 and 9 predictors, respectively, with c-statistics of 0.807 (95% confidence interval 0.756-0.855) and 0.842 (0.794-0.887). With selected score cutoffs, the models identified 3GC-R EB bacteraemia with equal sensitivity as existing guidelines, but reduced the proportion of patients classified as at risk for 3GC-R EB bacteraemia (i.e. eligible for empiric carbapenem therapy) with 40% in patients with community-onset and 49% in patients with hospital-onset infection.\n\nConclusionsThese prediction rules for 3GC-R EB bacteraemia may reduce unnecessary empiric carbapenem use.

epidemiology↗

bioRxiv2017

Physical Activity Phenotyping With Activity Bigrams, And Their Association With BMI

BackgroundAnalysis of physical activity usually focuses on a small number of summary statistics derived from accelerometer recordings: average counts per minute, and the proportion of time spent in moderate-vigorous physical activity or in sedentary behaviour. We show how bigrams, a concept from the field of text mining, can be used to describe how a persons activity levels change across (brief) time points. These variables can, for instance, differentiate between two people with the same time in moderate activity, where one person often stays in moderate activity from one moment to the next and the other does not.\n\nMethodsWe use data on 4810 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC). We generate a profile of bigram frequencies for each participant and test the association of each frequency with body mass index (BMI), as an exemplar.\n\nResultsWe found several associations between changes in bigram frequencies and BMI. For instance, a 1 standard deviation decrease in the number of adjacent minutes in sedentary then moderate activity (or vice versa), with a corresponding increase in the number of adjacent minutes in moderate then vigorous activity (or vice versa), was associated with a 2.36 kg/m2 lower BMI [95% CI: -3.47, -1.26], after accounting for the time spent at sedentary, low, moderate and vigorous activity.\n\nConclusionsActivity bigrams are novel variables that capture how a persons activity changes from one moment to the next. These variables can be used to investigate how sequential activity patterns associate with other traits.\n\nKey MessagesO_LIEpidemiologists typically use only a small number of variables to analyse the association of physical activity with other traits, such as the average counts per minute and the proportion of time spent in moderate-vigorous physical activity or being sedentary.\nC_LIO_LIWe demonstrate how activity bigrams can be used as a set of interpretable variables describing how a persons activity levels change from one moment to the next.\nC_LIO_LITesting the association of activity bigrams with exposures or outcomes can help us gain further understanding of how physical activity is associated with other traits; with further research they might provide evidence for more refined public health advice.\nC_LI

epidemiology↗

bioRxiv2017

DNA Methylation As A Marker For Prenatal Smoke Exposure In Adults

Prenatal cigarette smoke is an environmental stressor that has a profound effect on DNA methylation in the exposed offspring. We have previously shown that some of these effects persist throughout childhood and into adolescence. Of interest is whether these signals persist into adulthood.\n\nWe conducted an analysis to investigate associations between reported maternal smoking in pregnancy and DNA methylation in peripheral blood of women in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n=754; mean age 30 years). We observed associations at 15 CpG sites in 11 gene regions, MYO1G, FRMD4A, CYP1A1, CNTNAP2, ARL4C, AHRR, TIFAB, MDM4, AX748264, DRD1, FTO (FDR < 5%). All but two of these CpG sites have previously been identified in relation to prenatal smoke exposure in the offspring at birth and the majority showed persistent hypermethylation among the offspring of smokers.\n\nWe confirmed that most of these associations were not driven by own smoking and that they were still present 18 years later (N = 656; mean age 48 years). In addition, we replicated findings of a persistent methylation signal related to prenatal smoke exposure in peripheral blood among men in the ALSPAC cohort (N = 230; mean age 53 years). For both participant groups, there was a strong signal of association above that expected by chance at CpG sites previously associated with prenatal smoke exposure in newborns (Wilcoxon rank sum p-value < 2.2 x 10-4). Furthermore, we found that a prenatal smoking score, derived by combining methylation values at these CpG sites, could predict whether the mothers of the ALSPAC women smoked during pregnancy with an AUC 0.69 (95% 0.67, 0.73).

epidemiology↗

bioRxiv2017

Predicting The Impact Of Pneumococcal Conjugate Vaccine Programme Options In Vietnam: A Dynamic Transmission Model

BackgroundCatch-up campaigns (CCs) at the introduction of the pneumococcal conjugate vaccines (PCVs) may accelerate the impact of PCVs. However, limited vaccine supplies may delay vaccine introduction if additional doses are needed for such campaigns. We studied the relative impact of introducing PCV13 with and without catch-up campaign, and the implications of potential introduction delays.\n\nMethodsWe used a dynamic transmission model applied to the population of Nha Trang in Sout central Vietnam. Four strategies were considered: routine vaccination (RV) only, and RV alongside catch-up campaigns among <1y olds (CC1), <2y olds (CC2) and <5y olds (CC5). The model was parameterised with local data on human social contact rates, and was fitted to local carriage data. Post-PCV predictions were based on best estimates of parameters governing post-PCV dynamics, including serotype competition, vaccine efficacy and duration of protection.\n\nResultsOur model predicts elimination of vaccine-type (VT) carriage across all age groups within 10 years of introduction in all scenarios with near-complete replacement by non-VT. Most of the benefit of CCs is predicted to occur within the first 3 years after introduction, with the highest impact in the first year, when IPD incidence is predicted to be 11% (95%CrI 9 - 14%) lower than RV with CC1, 25% (21 - 30 %) lower with CC2 and 38% (32 - 46%) lower with CC5.\n\nHowever, CCs would only prevent more cases of IPD insofar such campaigns do not delay introduction by more than 31 (95%CrI 30 - 32) weeks with CC1, 58 (53 - 63) weeks with CC2 and 89 (78 - 101) weeks for CC5.\n\nConclusionCCs are predicted to offer a substantial additional reduction in pneumococcal disease burden over RV alone, if their implementation does not result in much introduction delay. Those findings are important to help guide vaccine introduction in countries that have not yet introduced PCV, particularly in Asia.

epidemiology↗

bioRxiv2017

Characteristics Of Human Encounters And Social Mixing Patterns Relevant To Infectious Diseases Spread By Close Contact: A Survey In Southwest Uganda

Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce. We undertook a social contact survey in rural Uganda, whereby participants were asked to recall details about the frequency, type, and socio-demographic characteristics of any conversational encounter that lasted for [≥]5 minutes (henceforth defined as contacts) during the previous day. An estimate of the number of casual contacts (i.e. <5 minutes) was also obtained. A total of 568 individuals were included. On average participants reported having routine contact with 7.2 individuals (range 1-25). Children aged 5-14 years had the highest frequency of contacts and the elderly ([≥]65 years) the fewest (P<0.001). A strong age-assortative pattern was seen, particularly outside the household and increasingly so for contacts occurring further away from home. Adults aged 25-64 years tended to travel more and further than others, and males travelled more frequently than females. Our study provides detailed information on contact patterns and their spatial characteristics in an African setting. It therefore fills an important knowledge gap that will help more accurately predict transmission dynamics and the impact of control strategies in such areas.

epidemiology↗

bioRxiv2017

Impact of rapid susceptibility testing and antibiotic selection strategy on the emergence and spread of antibiotic resistance in gonorrhea

BackgroundIncreasing antibiotic resistance limits treatment options for gonorrhea. We examined the extent to which a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles could slow the spread of resistance.\n\nMethodsWe developed a deterministic compartmental model describing gonorrhea transmission in a single-sex population with three antibiotics available to treat infections. Probabilities of resistance emergence on treatment and fitness costs associated with resistance were based on characteristics of ciprofloxacin, azithromycin, and ceftriaxone. We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with: (1) empiric treatment (azithromycin plus ceftriaxone), and treatment guided by POC tests determining susceptibility to (2) ciprofloxacin only and (3) all three antibiotics.\n\nFindingsBased on current gonococcal susceptibility patterns in the United States, the model indicated that continued empiric dual antibiotic treatment without POC testing resulted in >5% of isolates being resistant to both azithromycin and ceftriaxone within 15 years. When either POC test was used in 10% of identified cases, this was delayed by 5 years. The three antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, while the ciprofloxacin-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake. The main limitation of this study is that we made simplifying assumptions to describe gonorrhea transmission and the emergence and spread of resistance in the population.\n\nConclusionsRapid diagnostics that report antibiotic susceptibility have the potential to extend the usefulness of existing antibiotics for treatment of gonorrhea. Monitoring resistance patterns will be critical with the introduction of such tests.

epidemiology↗

bioRxiv2017

A mathematical model for Dengue and Chikungunya inMexico.

We present a model that incorporates two co-circulating viral diseases, Dengue and Chikungunya, where we allow secondary infections from either of the two diseases. We only consider one vector population, Ae. aegypti since in the Mexican region where we set our scenarios, only this species has been reported to transmit both viruses. We estimate the basic reproduction number and perform numerical simulations for different scenarios where we may observe coexistence of Dengue and Chikungunya; we also compare the results of the model with Dengue and Chikungunya data from Mexico 2015 and we obtain a good model fit. To complete our findings we perform a sensitivity analysis, and calculate the partial rank correlation coefficients (PRCCs) to determine the parameter values influence on the reproduction numbers and predict fate of the diseases.\n\nWe show that R0 for each one of the viruses is highly sensitive to the mosquito biting rate and the transmission rates for both diseases with positive influence and the average lifespan of mosquito along with the human recovery rate with negative influence on both diseases. Our results are consistent with those of previous authors.

epidemiology↗

bioRxiv2017

Role of inter-related population-level host traits in determining pathogen richness and zoonotic risk

Zoonotic diseases are an increasingly important source of human infectious diseases, and host pathogen richness of reservoir host species is a critical driver of spill-over risk. Population-level traits of hosts such as population size, host density and geographic range size have all been shown to be important determinants of host pathogen richness. However, empirically identifying the independent influences of these traits has proven difficult as many of these traits directly depend on each other. Here we develop a mechanistic, metapopulation, susceptible-infected-recovered model to identify the independent influences of these population-level traits on the ability of a newly evolved pathogen to invade and persist in host populations in the presence of an endemic pathogen. We use bats as a case study as they are highly social and an important source of zoonotic disease. We show that larger populations and group sizes had a greater influence on the chances of pathogen invasion and persistence than increased host density or the number of groups. As anthropogenic change affects these traits to different extents, this increased understanding of how traits independently determine pathogen richness will aid in predicting future zoonotic spill-over risk.

epidemiology↗

bioRxiv2017

Antibiotic Resistance Detection Is Essential For Gonorrhoea Point-Of-Care Testing: A Mathematical Modelling Study

Antibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC + R) and without (POC - R) resistance detection, culture, and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections, cases averted after 5 years, and compared how fast resistant infections spread in the populations. The proportion of resistant infections after 30 years is lowest for POC + R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HWM: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC - R (MSM: 100%, HMW: 99.73%). NAAT leads to 36 366 (median MSM) and 1 228 (median HMW) observed cases after 5 years. When compared with NAAT, POC + R results in most cases averted after 5 years (median MSM: 3 353, HMW: 118 per 100 000 persons). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than using culture. POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.

epidemiology↗

bioRxiv2017

Association Between Genetically Elevated Levels Of Inflammatory Biomarkers And Risk Of Schizophrenia: A Two-Sample Mendelian Randomisation Study

BackgroundPositive associations between inflammatory biomarkers and risk of psychiatric disorders, including schizophrenia, have been reported in observational studies. However, conventional observational studies are prone to bias such as reverse causation and residual confounding.\n\nMethodsIn this study, we used summary data to evaluate the association of genetically elevated C reactive protein (CRP), interleukin-1 receptor antagonist (IL-1Ra) and soluble interleukin-6 receptor (IL-6R) levels with schizophrenia in a two-sample Mendelian randomisation design.\n\nResultsThe pooled odds ratio estimate using 18 CRP genetic instruments was 0.90 (95% CI: 0.84; 0.97) per two-fold increment in CRP levels; consistent results were obtained using different Mendelian randomisation methods and a more conservative set of instruments. The odds ratio for soluble IL-6R was 1.06 (95% CI: 1.01; 1.12) per two-fold increment. Estimates for IL-1Ra were inconsistent among instruments and pooled estimates were imprecise and centred on the null.\n\nConclusionUnder Mendelian randomisation assumptions, our findings suggest a protective causal effect of CRP and a risk-increasing causal effect of soluble IL-6R (potentially mediated at least in part by CRP) on schizophrenia risk.

epidemiology↗

bioRxiv2017

Testing the principles of Mendelian randomization: Opportunities and complications on a genomewide scale

BackgroundMendelian randomization (MR) uses genetic variants as instrumental variables to assess whether observational associations between exposures and disease reflect causal relationships. MR requires genetic variants to be independent of factors that confound observational associations.\n\nMethodsUsing data from the Avon Longitudinal Study of Parents and Children, associations within and between 121 phenotypes and 13,720 genetic variants (from the NHGRI-EBI GWAS catalog) were examined to assess the validity of MR assumptions.\n\nResultsAmongst 7,260 pairwise comparisons between the 121 phenotypes, 2,188 (30%) provided evidence of association, where 363 were expected at the 5% level (observed:expected ratio=6.03; 95% CI: 5.42, 6.70; {chi}2=9682.29; d.f. =1, P[≤]1x10-50). Amongst 1,660,120 pairwise associations between phenotypes and genotypes, 86,748 (5.2%) gave evidence of association at the same threshold, where 83,006 were expected (observed:expected ratio=1.05; 95% CI: 1.04, 1.05; {chi}2=117.57; d.f. =1, P=2.15x10-27). Amongst 1,171,764 pairwise associations between the phenotypes and LD pruned independent genetic variants, 60,136 (5.1%) gave evidence of association, where 58,588 were expected (observed:expected ratio=1.03; 95% CI: 1.03, 1.08; {chi}2= 43.05; d.f. = 1, P=5.33x10-11).\n\nConclusionThese results confirm previously observed patterns of phenotypic correlation. They also provide evidence of a substantially lower level of association between genetic variants and phenotypes, with residual inflation the likely product of indistinguishable real genetic association, multiple variables measuring the same biological phenomena, or pleiotropy. These results reflect the favorable properties of genetic instruments for estimating causal relationships, but confirm the need for functional information or analytical methods to account for pleiotropic events.

epidemiology↗

bioRxiv2017

Disease as collider: a new case-only method to discover environmental factors in complex diseases with genetic risk estimation

BackgroundCase-only design for gene-environment interaction (CODGEI) relies on the rare disease assumption. A negative association due to collider bias appears between gene and environment when this assumption is not respected. Genetic risk estimation can quantify part of the predisposition of an individual to a disease.\n\nMethodsWe introduce Disease As Collider (DAC), a new case-only methodology to discover environmental factors using genetic risk estimation: a negative correlation between genetic risk and environment in cases provides a signature of a genuine environmental risk marker. Simulation of disease occurrence in a source population allows to estimate the statistical power of DAC and the influence of collider bias in CODGEI. We illustrate DAC in 831 type 1 diabetes (T1D) patients. Results: The power of DAC increases with sample size, prevalence and accuracy of genetic risk estimation. For a prevalence of 1% and a realistic genetic risk estimation, power of 80% is reached for a sample size under 3000. Collider bias offers an alternative interpretation to the results of CODGEI in a published study on breast cancer.\n\nConclusionDAC could provide a new line of evidence for discovering which environmental factors play a role in complex diseases or confirming results obtained in case-control studies. We discuss the circumstances needed for DAC to participate in the dissection of environmental determinants of disease. We provide guidance on the use of CODGEI regarding the rare disease assumption.\n\nO_LSTKey messagesC_LSTO_LIA complex disease is a collider between genetic determinants and environmental factors; it is a consequence of both.\nC_LIO_LICollider bias can affect the results of the case-only design for gene-environment interactions when the disease is common.\nC_LIO_LIUsing genetic risk estimation, collider bias can be used to discover or confirm the association between a disease and an environmental factor in a case-only setting.\nC_LIO_LIStatistical power of this approach is small when the disease is rare. Power increases with sample size, prevalence and genetic risk prediction accuracy.\nC_LI

epidemiology↗

bioRxiv2017

Increasing Antibiotic Susceptibility In Staphylococcus aureus In Boston, Massachusetts, 2000-2014: An Observational Study

BackgroundMethicillin resistant S. aureus (MRSA) has been declining over the past decade, but changes in S. aureus overall and the implications for trends in antibiotic resistance remain unclear.\n\nObjectiveTo determine whether the decline in rates of infection by MRSA has been accompanied by changes in rates of infection by methicillin susceptible, penicillin resistant S. aureus (MSSA) and penicillin susceptible S. aureus (PSSA). We test if these dynamics are associated with specific genetic lineages and evaluate gains and losses of resistance at the strain level.\n\nMethodsWe conducted a 15 year retrospective observational study at two tertiary care institutions in Boston, MA of 31,589 adult inpatients with S. aureus infections. Surveillance swabs and duplicate specimens were excluded. We also sequenced a sample of contemporary isolates (n = 180) obtained between January 2016 and July 2016. We determined changes in the annual rates of infection per 1,000 inpatient admissions by S. aureus subtype and in the annual mean antibiotic resistance by subtype. We performed phylogenetic analysis to generate a population structure and infer gain and loss of the genetic determinants of resistance.\n\nResultsOf the 43,954 S. aureus infections over the study period, 21,779 were MRSA, 17,565 MSSA and 4,610 PSSA. After multivariate adjustment, annual rates of infection by S. aureus declined from 2003 to 2014 by 2.9% (95% CI, 1.6%-4.3%), attributable to an annual decline in MRSA of 9.1% (95% CI, 6.3%-11.9%) and in MSSA by 2.2% (95% CI, 0.4%-4.0%). PSSA increased over this time period by 4.6% (95% CI, 3.0%-6.3%) annually. Resistance in S. aureus decreased from 2000 to 2014 by 0.86 antibiotics (95% CI, 0.81-0.91). By phylogenetic inference, 5/35 MSSA and 2/20 PSSA isolates in the common MRSA lineages ST5/USA100 and ST8/USA300 arose from the loss of genes conferring resistance.\n\nConclusions and relevanceAt two large tertiary care centers in Boston, MA, S. aureus infections have decreased in rate and have become more susceptible to antibiotics, with a rise in PSSA making penicillin an increasingly viable and important treatment option.

epidemiology↗

bioRxiv2017

Maternal BMI at the start of pregnancy and offspring epigenome-wide DNA methylation: Findings from the Pregnancy and Childhood Epigenetics (PACE) consortium.

Pre-pregnancy maternal obesity is associated with adverse offspring outcomes at birth and later in life. Epigenetic modifications such as DNA methylation could contribute, but data are scarce.\n\nWithin the Pregnancy and Childhood Epigenetics (PACE) Consortium, we meta-analysed the association between pre-pregnancy maternal BMI and methylation at over 450,000 sites in newborn blood DNA, across 19 cohorts (9,340 mother-newborn pairs). We attempted to infer causality by comparing effects of maternal versus paternal BMI and incorporating genetic variation. In four additional cohorts (1,817-mother-child pairs), we meta-analysed the association between maternal BMI at the start of pregnancy and blood methylation in adolescents.\n\nIn newborns, maternal BMI was associated with modest (<0.2% per BMI unit (1kg/m2), P<1.06*10-7) methylation variation at 9,044 sites throughout the genome. Adjustment for estimated cell proportions attenuated the number of significant CpGs to 104, including 86 sites common to the unadjusted model. These 86 sites map to several genes reported to be associated with adiposity-related and/or neuropsychiatric traits. At 72/86 sites, the direction of association was the same in newborns and adolescents, suggesting persistence of signals. However, we found evidence for a causal intrauterine effect of maternal BMI on newborn methylation at just 8/86 sites.\n\nIn conclusion, maternal adiposity is associated with modest variations in newborn blood DNA methylation, but the potential biological consequences of these variations are currently unclear.

epidemiology↗

bioRxiv2017

Modeling the consequences of regional heterogeneity in human papillomavirus (HPV) vaccination uptake on transmission in Switzerland

BackgroundCompleted human papillomavirus (HPV) vaccination by age 16 years among women in Switzerland ranges from 17 to 75% across 26 cantons. The consequences of regional heterogeneity in vaccination coverage on transmission and prevalence of HPV-16 are unclear.\n\nMethodsWe developed a deterministic, population-based model that describes HPV-16 transmission among young adults within and between the 26 cantons of Switzerland. We parameterized the model using sexual behavior data from Switzerland and data from the Swiss National Vaccination Coverage Survey. First, we investigated the general consequences of heterogeneity in vaccination uptake between two sub-populations. We then compared the predicted prevalence of HPV-16 after the introduction of heterogeneous HPV vaccination uptake in all of Switzerland with homogeneous vaccination at an uptake that is identical to the national average (52%).\n\nResultsHPV-16 prevalence in women is 3.34% when vaccination is introduced and begins to diverge across cantons, ranging from 0.14 to 1.09% after 15 years of vaccination. After the same time period, overall prevalence of HPV-16 in Switzerland is only marginally higher (0.55 %) with heterogeneous vaccination uptake than with homogeneous uptake (0.49%). Assuming inter-cantonal sexual mixing, cantons with low vaccination uptake benefit from a reduction in prevalence at the expense of cantons with high vaccination uptake.\n\nConclusionsRegional variations in uptake diminish the overall effect of vaccination on HPV-16 prevalence in Switzerland, although the effect size is small. Cantonal efforts towards HPV-prevalence reduction by increasing vaccination uptake are impaired by cantons with low vaccination uptake. Harmonization of cantonal vaccination programs would reduce inter-cantonal differences in HPV-16 prevalence.

epidemiology↗

bioRxiv2017

pomp-Astic Inference For Epidemic Models: Simple Vs. Complex

Infectious disease surveillance data often provides only partial information about the progression of the disease in the individual while disease transmission is often modelled using complex mathematical models for large populations, where variability only enters through a stochastic observation process. In this work it is shown that a rather simplistic, but truly stochastic transmission model, is competitive with respect to model fit when compared with more detailed deterministic transmission models and even preferable because the role of each parameter and its identifiability is clearly understood in the simpler model. The inference framework for the stochastic model is provided by iterated filtering methods which are readily implemented in the R package pomp. We illustrate our findings on German rotavirus surveillance data from 2001 to 2008 and calculate a model based estimate for the basic reproduction number R0 using these data.

epidemiology↗