The development of an effective vaccine against SARS-CoV-2, the etiologic agent of COVID-19, is a global priority. Here, we compared the protective capacity of intranasal and intramuscular delivery of a chimpanzee adenovirus-vectored vaccine encoding a pre-fusion stabilized spike protein (ChAd-SARS-CoV-2-S) in Golden Syrian hamsters. While immunization with ChAd-SARS-CoV-2-S induced robust spike protein specific antibodies capable of neutralizing the virus, antibody levels in serum were higher in hamsters vaccinated by an intranasal compared to intramuscular route. Accordingly, against challenge with SARS-CoV-2, ChAd-SARS-CoV-2-S immunized hamsters were protected against less weight loss and had reduced viral infection in nasal swabs and lungs, and reduced pathology and inflammatory gene expression in the lungs, compared to ChAd-Control immunized hamsters. Intranasal immunization with ChAd-SARS-CoV-2-S provided superior protection against SARS-CoV-2 infection and inflammation in the upper respiratory tract. These findings support intranasal administration of the ChAd-SARS-CoV-2-S candidate vaccine to prevent SARS-CoV-2 infection, disease, and possibly transmission.

Although the results of this study are based on samples collected from one hospital, the high diversity observed along with the lack of any equivalence in the genetic backgrounds of the major MSSA and MRSA clones, emphasizes the urgent need for standardized surveillance combined with the application of well-validated typing methods to assess the occurrence of MRSA and subsequently to control its spread.

Human rotavirus remains a major cause of gastroenteritis worldwide despite the availability of effective vaccines. In this study, we investigated the genetic diversity of rotaviruses circulating in Lebanon. We genetically characterized the VP4 and VP7 genes encoding the outer capsid proteins of 132 rotavirus-associated gastroenteritis specimens, previously identified in hospitalized children (<5 years) from 2011 to 2013 in Lebanon. These included 43 vaccine-breakthrough specimens and the remainder were from non-vaccinated subjects. Phylogenetic analysis of VP4 and VP7 genes revealed distinct clustering compared to the vaccine strains, and several substitutions were identified in the antigenic epitopes of Lebanese specimens. No unique changes were identified in the breakthrough specimens compared to non-breakthroughs that could explain the occurrence of infection in vaccinated children. Further, we report the emergence of a rare P[8] OP354-like strain with a G9 VP7 in Lebanon, possessing high genetic variability in their VP4 compared to vaccine strains. Therefore, human rotavirus strains circulating in Lebanon and globally have accumulated numerous substitutions in their antigenic sites compared to those currently used in the licensed vaccines. The successful spread and continued genetic drift of these strains over time might undermine the effectiveness of the vaccines. The effect of such changes in the antigenic sites on vaccine efficacy remains to be assessed.

BackgroundThe protracted Syrian war resulted in the largest refugee crisis of our time. The most vulnerable are children who face separation from parents, interruption of schooling and child labour. This study explores the living and working conditions of Syrian children in Lebanon.MethodsIn this cross-sectional study, we randomly selected 153 informal tented settlements and conducted interviewer-administered surveys among Syrian refugee working children in the Bekaa Valley in Lebanon. Those aged 8–18 completed a questionnaire on sociodemographic and occupational characteristics; those aged 4–8 years were surveyed through a household questionnaire.ResultsWe surveyed 1902 households, including 12 708 individuals and 4377 working children. Female-headed households were poorer and more food-insecure than male-headed households. Among working children (4–18 years), the average age of starting work was 10.9 years and 74.8% worked in agriculture. Compared with boys, girls earned less and were less likely to be enrolled in school. For 96.3% of working children aged 8–18 years, forced exodus to Lebanon was associated with a first child labour experience. Working conditions were harsh and worse for girls who compared to boys were less likely to receive their salary on time and take time off work. Girls worked longer in the sun and cold and were more likely to report having a health symptom at work, working under pressure and using sharp or heavy objects at work. Seventy-nine children reported knowing another child who died following a work accident.ConclusionChildren, as young as 4, are forced to work, and many are compelled to forgo educational opportunities in favour of harsh and harmful labour due to difficult economic conditions. State policies facilitating access to work for adult refugees will help families meet basic needs and decrease their dependence on child labour as a coping strategy.

IntroductionGlobally, rotavirus (RV) is the leading cause of gastroenteritis (GE) in children. Longitudinal data about changes in RV genotype distribution and vaccine effectiveness (VE) are scarce. This study was conducted in Lebanon over 3 consecutive RV seasons to estimate the rate of RVGE hospitalization, identify RV genotypes, determine the seasonal and geographical variations, and calculate RV VE.Materials and MethodsThis prospective, multicenter, hospital-based surveillance study was conducted between 2011 and 2013 and enrolled children (<5 years) admitted for GE. Socio-demographic and clinical data about the current episode of GE at admission were collected. Genotypes were determined from stool samples testing positive for RV by PCR.ResultsOf 1,414 cases included in the final analysis, 83% were <2 years old and 55.6% were boys. Median duration of hospitalization was 4 days and 91.6% of GE cases were severe (Vesikari score ≥11). PCR testing showed that 30.3% of subjects were RV-positive of which 62.1% had fever versus 71.1% of RV-negative subjects (P = 0.001). RV was predominantly detected in the cold season from November till March (69.9%). G and P genotype pairs for all RV-positive stool specimens showed a predominance of G1P[8] in 36% (n = 154) of specimens, G9P[8] in 26.4% (n = 113), and G2P[4] in 17.8% (n = 76). RV-negative subjects were more likely to be RV-vaccinated (21%) compared to the RV-positive subjects (11.3%) (P<0.001), with a vaccine breakthrough rate of 18.8%. The ratio of RV1-vaccinated for each RV5-vaccinated subject was 7.8 and VE against RV disease was 68.4% (95%CI, 49.6%-80.2%).ConclusionRV is a major cause of GE requiring hospitalization of children under 5 years of age in Lebanon. A few genotypes predominated over the three RV seasons studied. Mass RV vaccination will likely decrease the burden of hospitalization due to RV. VE is similar to what has been observed for other middle-income countries.

Introduction: Over the past decade methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a major cause of healthcare associated infections. Recently, however, epidemiology of this pathogen has changed drastically with the emergence of new clones in the community. Efficient epidemiological typing methods are essential to monitor and limit the occurrence and spread of epidemic clones. Methodology: A total of sixty S. aureus isolates were collected from the Jordan University hospital in Amman-Jordan. All isolates were characterized using Staphylococcus protein A (spa) typing and pulsed-field gel electrophoresis (PFGE). Samples were tested for their susceptibility patterns against seven antimicrobial agents and for their potential to form biofilms. Results: spa typing showed that spa type t044 was the most common representing 28% of the isolates studied and 38% of the MRSA population. PFGE revealed fourty-six pulsotypes among the sixty tested isolates clustering similar spa types together. The predominant resistance was detected against levofloxacin, chloramphenicol and clindamycin. One MSSA isolate typed as spa t955 showed biofilm formation potential through protein deposition.. Conclusion: The study results are based on one hospital, but the findings of this and other studies conducted in the region indicate that there is an urgent need for standardized surveillances combined with the application of well-validated typing methods to assess the occurrence of MRSA and to control its spread.

BackgroundThe emergence of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has caused a change in MRSA epidemiology worldwide. In the Middle East, the persistent spread of CA-MRSA isolates that were associated with multilocus sequence type (MLST) clonal complex 80 and with staphylococcal cassette chromosome mec (SCCmec) type IV (CC80-MRSA-IV), calls for novel approaches for infection control that would limit its spread.Methodology/Principal FindingsIn this study, the epidemiology of CC80-MRSA-IV was investigated in Jordan and Lebanon retrospectively covering the period from 2000 to 2011. Ninety-four S. aureus isolates, 63 (67%) collected from Lebanon and 31 (33%) collected from Jordan were included in this study. More than half of the isolates (56%) were associated with skin and soft tissue infections (SSTIs), and 73 (78%) were Panton-Valentine Leukocidin (PVL) positive. Majority of the isolates (84%) carried the gene for exofoliative toxin d (etd), 19% had the Toxic Shock Syndrome Toxin-1 gene (tst), and seven isolates from Jordan had a rare combination being positive for both tst and PVL genes. spa typing showed the prevalence of type t044 (85%) and pulsed-field gel electrophoresis (PFGE) recognized 21 different patterns. Antimicrobial susceptibility testing showed the prevalence (36%) of a unique resistant profile, which included resistance to streptomycin, kanamycin, and fusidic acid (SKF profile).ConclusionsThe genetic diversity among the CC80 isolates observed in this study poses an additional challenge to infection control of CA-MRSA epidemics. CA-MRSA related to ST80 in the Middle East was distinguished in this study from the ones described in other countries. Genetic diversity observed, which may be due to mutations and differences in the antibiotic regimens between countries may have led to the development of heterogeneous strains. Hence, it is difficult to maintain “the European CA-MRSA clone” as a uniform clone and it is better to designate as CC80-MRSA-IV isolates.

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