Cross-sectional study of population-specific streptococcal antibody titres in Uganda

Emmy Okello; Meghna Murali; Joselyn Rwebembera; Jenifer Atala; Asha C. Bowen; Nada Harik; Gloria Kaudha; Samalie Kitooleko; Chris Longenecker; Emma Ndagire; Isaac Otim Omara; Linda Mary Oyella; Tom Parks; Jafesi Pulle; Craig Sable; Rachel Sarnacki; Elizabeth Stein; Meghan Zimmerman; Nicholas de Klerk; Jonathan Carapetis; Andrea Beaton

doi:10.1136/archdischild-2020-318859

Cross-sectional study of population-specific streptococcal antibody titres in Uganda

Emmy Okello, Meghna Murali, Joselyn Rwebembera, Jenifer Atala, Asha C. Bowen, Nada Harik, Gloria Kaudha, Samalie Kitooleko, Chris Longenecker, Emma Ndagire, Isaac Otim Omara, Linda Mary Oyella, Tom Parks, Jafesi Pulle, Craig Sable, Rachel Sarnacki, Elizabeth Stein, Meghan Zimmerman, Nicholas de Klerk, Jonathan CarapetisAndrea Beaton

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

OBJECTIVE: Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. DESIGN: This was an observational cross-sectional study. SETTING: This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. PATIENTS: Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4%) of the remaining were children aged 5-15 years. MAIN OUTCOME MEASURES: ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established. RESULTS: The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. CONCLUSIONS: The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.

Original language	English
Pages (from-to)	825-829
Number of pages	5
Journal	Archives of Disease in Childhood
Volume	105
Issue number	9
DOIs	https://doi.org/10.1136/archdischild-2020-318859
Publication status	Published - Sept 2020

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Okello, E., Murali, M., Rwebembera, J., Atala, J., Bowen, A. C., Harik, N., Kaudha, G., Kitooleko, S., Longenecker, C., Ndagire, E., Omara, I. O., Oyella, L. M., Parks, T., Pulle, J., Sable, C., Sarnacki, R., Stein, E., Zimmerman, M., de Klerk, N., ... Beaton, A. (2020). Cross-sectional study of population-specific streptococcal antibody titres in Uganda. Archives of Disease in Childhood, 105(9), 825-829. https://doi.org/10.1136/archdischild-2020-318859

@article{cd53a8c74902450fb136ae6437c39eeb,

title = "Cross-sectional study of population-specific streptococcal antibody titres in Uganda",

abstract = "OBJECTIVE: Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. DESIGN: This was an observational cross-sectional study. SETTING: This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. PATIENTS: Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4\%) of the remaining were children aged 5-15 years. MAIN OUTCOME MEASURES: ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80\% upper limit values were established. RESULTS: The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. CONCLUSIONS: The estimated Ugandan paediatric population standardised 80\% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.",

keywords = "cardiology, epidemiology",

author = "Emmy Okello and Meghna Murali and Joselyn Rwebembera and Jenifer Atala and Bowen, \{Asha C.\} and Nada Harik and Gloria Kaudha and Samalie Kitooleko and Chris Longenecker and Emma Ndagire and Omara, \{Isaac Otim\} and Oyella, \{Linda Mary\} and Tom Parks and Jafesi Pulle and Craig Sable and Rachel Sarnacki and Elizabeth Stein and Meghan Zimmerman and \{de Klerk\}, Nicholas and Jonathan Carapetis and Andrea Beaton",

year = "2020",

month = sep,

doi = "10.1136/archdischild-2020-318859",

language = "English",

volume = "105",

pages = "825--829",

journal = "Archives of Disease in Childhood",

issn = "0003-9888",

publisher = "BMJ Publishing Group",

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Okello, E, Murali, M, Rwebembera, J, Atala, J, Bowen, AC, Harik, N, Kaudha, G, Kitooleko, S, Longenecker, C, Ndagire, E, Omara, IO, Oyella, LM, Parks, T, Pulle, J, Sable, C, Sarnacki, R, Stein, E, Zimmerman, M, de Klerk, N , Carapetis, J & Beaton, A 2020, 'Cross-sectional study of population-specific streptococcal antibody titres in Uganda', Archives of Disease in Childhood, vol. 105, no. 9, pp. 825-829. https://doi.org/10.1136/archdischild-2020-318859

TY - JOUR

T1 - Cross-sectional study of population-specific streptococcal antibody titres in Uganda

AU - Okello, Emmy

AU - Murali, Meghna

AU - Rwebembera, Joselyn

AU - Atala, Jenifer

AU - Bowen, Asha C.

AU - Harik, Nada

AU - Kaudha, Gloria

AU - Kitooleko, Samalie

AU - Longenecker, Chris

AU - Ndagire, Emma

AU - Omara, Isaac Otim

AU - Oyella, Linda Mary

AU - Parks, Tom

AU - Pulle, Jafesi

AU - Sable, Craig

AU - Sarnacki, Rachel

AU - Stein, Elizabeth

AU - Zimmerman, Meghan

AU - de Klerk, Nicholas

AU - Carapetis, Jonathan

AU - Beaton, Andrea

PY - 2020/9

Y1 - 2020/9

N2 - OBJECTIVE: Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. DESIGN: This was an observational cross-sectional study. SETTING: This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. PATIENTS: Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4%) of the remaining were children aged 5-15 years. MAIN OUTCOME MEASURES: ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established. RESULTS: The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. CONCLUSIONS: The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.

AB - OBJECTIVE: Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. DESIGN: This was an observational cross-sectional study. SETTING: This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. PATIENTS: Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4%) of the remaining were children aged 5-15 years. MAIN OUTCOME MEASURES: ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established. RESULTS: The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. CONCLUSIONS: The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.

KW - cardiology

KW - epidemiology

UR - https://www.scopus.com/pages/publications/85088257445

U2 - 10.1136/archdischild-2020-318859

DO - 10.1136/archdischild-2020-318859

M3 - Article

C2 - 32601082

AN - SCOPUS:85088257445

SN - 0003-9888

VL - 105

SP - 825

EP - 829

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

IS - 9

ER -

Cross-sectional study of population-specific streptococcal antibody titres in Uganda

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