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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
Vector mosquito biting intensity is an important measure to understand malaria transmission. Human landing catch (HLC) is an effective but labour-intensive, expensive, and potentially hazardous entomological surveillance tool. The Centres for Disease Control light trap (CDC-LT) and the human decoy trap (HDT) are exposure-free alternatives. This study compared the CDC-LT and HDT against HLC for measuring Anopheles biting in rural Tanzania and assessed their suitability as HLC proxies.
Methods
Indoor mosquito surveys using HLC and CDC-LT and outdoor surveys using HLC and HDT were conducted in 2017 and in 2019 in Ulanga, Tanzania in 19 villages, with one trap/house/night. Species composition, sporozoite rates and density/trap/night were compared. Aggregating the data by village and month, the Bland–Altman approach was used to assess agreement between trap types.
Results
Overall, 66,807 Anopheles funestus and 14,606 Anopheles arabiensis adult females were caught with 6,013 CDC-LT, 339 indoor-HLC, 136 HDT and 195 outdoor-HLC collections. Indoors, CDC-LT caught fewer An. arabiensis (Adjusted rate ratio [Adj.RR] = 0.35, 95% confidence interval [CI]: 0.27–0.46, p < 0.001) and An. funestus (Adj.RR = 0.63, 95%CI: 0.51–0.79, p < 0.001) than HLC per trap/night. Outdoors, HDT caught fewer An. arabiensis (Adj.RR = 0.04, 95%CI: 0.01–0.14, p < 0.001) and An. funestus (Adj.RR = 0.10, 95%CI: 0.07–0.15, p < 0.001) than HLC. The bias and variability in number of mosquitoes caught by the different traps were dependent on mosquito densities. The relative efficacies of both CDC-LT and HDT in comparison to HLC declined with increased mosquito abundance. The variability in the ratios was substantial for low HLC counts and decreased as mosquito abundance increased. The numbers of sporozoite positive mosquitoes were low for all traps.
Conclusions
CDC-LT can be suitable for comparing mosquito populations between study arms or over time if accuracy in the absolute biting rate, compared to HLC, is not required. CDC-LT is useful for estimating sporozoite rates because large numbers of traps can be deployed to collect adequate mosquito samples. The present design of the HDT is not amenable for use in large-scale entomological surveys. Use of HLC remains important for estimating human exposure to mosquitoes as part of estimating the entomological inoculation rate (EIR).
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
In Ethiopia, thousands of seasonal migrant workers travel from non-malaria or mild malaria transmission areas to malaria-endemic areas for seasonal farm activities. Most of these migrants stay in the farm areas for land preparation, plowing, planting, weeding, and harvesting for a specific period and return to their living areas. However, there is limited evidence of how seasonal migrant workers contribute to the transmission of malaria to new or less malaria transmission areas.
Methods
A cross-sectional study was conducted at the departure phase of seasonal migrant workers in the Metema district from September 2018 to October 2019. A total of 1208 seasonal migrant workers were interviewed during their departure from farm sites to their homes. The face-to-face interviews were performed using a pretested structured questionnaire. Moreover, blood samples were collected from each study participant for microscopic malaria parasite examination. The data were fitted with the logistic regression model to estimate the predictors of malaria transmission.
Results
At departure to home, the prevalence of malaria among seasonal migrant workers was 17.5% (15.6–19.45%). Approximately 71.80% (177/212) of the cases were Plasmodium falciparum, and 28.20% (35/212) were Plasmodium vivax. Most seasonal migrant workers 934 (77.4%) were from rural residences and highlanders 660 (55%). Most 661 (55.4%) of the migrants visited two and more farm sites during their stay at development corridors for harvesting activities. Approximately 116 (54.7%) asymptomatic malaria cases returned to the Dembia 46 (21.7%), Chilaga 46 (19.8%) and Metema 28 (13.2%) districts.
Conclusion
In this study, asymptomatic malaria remains high among seasonal migrant workers departing to home from malaria endemic areas. This may fuel a resurgence of malaria transmission in the high lands and cause challenges to the country's malaria prevention and elimination efforts. Hence, tailored interventions for seasonal migrant workers could be in place to enhance malaria control and elimination in Ethiopia, such as asymptomatic malaria test and treat positive cases at departure and transit, and integration between malaria officers at their origin and departure for further follow-up to decrease any risk of spread at the origin.
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
Usage of mosquito bed nets and the practice of other prevention methods are essential for the prevention of malaria in endemic areas. Proper community knowledge about malaria and prompt treatment-seeking behaviour for early diagnosis and treatment are crucial for eliminating the disease. This study aimed to assess the awareness, treatment-seeking behaviour, and prevention practices towards malaria in Abu Ushar, Gezira State, Sudan.
Methods
A community-based, cross-sectional study was conducted in March 2021, including 310 households in Abu Ushar, Aljazeera, Sudan. Data were collected through face-to-face interviews with head of the household using an interviewer-administered questionnaire. Data were entered and analysed using R software.
Results
A total of 310 households were enrolled in this study. Sixty per cent had children under the age of 5 years. The majority of these households (94.8%) had a history of malaria in the past 12 months. Overall, awareness of malaria was good; 197 (63.5%) households had bed nets in their houses; 75.8% of total households identified fever with shivering as a symptom of malaria. Regarding treatment-seeking behaviour, 77.9% seek treatment from the nearby primary health centre, and 60% seek treatment within the first day. Only 45.3% stated that everyone in the household sleeps under bed nets.
Conclusion
High awareness about malaria and preventive measures was found among participants in households. Most households had previous infections with malaria. Therefore, an interventional programme should be established in this area to reduce this high rate of malaria.
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
Nutrient acquisition and allocation integrate foraging and life-history traits in insects. To compensate for the lack of a particular nutrient at different life stages, insects may acquire these through supplementary feeding, for example, on vertebrate secretions, in a process known as puddling. The mosquito Anopheles arabiensis emerges undernourished, and as such, requires nutrients for both metabolism and reproduction. The purpose of this study was to assess whether An. arabiensis engage in puddling on cattle urine to obtain nutrients to improve life history traits.
Methods
To determine whether An. arabiensis are attracted to the odour of fresh, 24 h, 72 h and 168 h aged cattle urine, host-seeking and blood-fed (48 h post-blood meal) females were assayed in a Y-tube olfactometer, and gravid females assessed in an oviposition assay. Combined chemical and electrophysiological analyses were subsequently used to identify the bioactive compounds in all four age classes of cattle urine. Synthetic blends of bioactive compounds were evaluated in both Y-tube and field assays. To investigate the cattle urine, and its main nitrogenous compound, urea, as a potential supplementary diet for malaria vectors, feeding parameters and life history traits were measured. The proportion of female mosquitoes and the amount of cattle urine and urea imbibed, were assessed. Following feeding, females were evaluated for survival, tethered flight and reproduction.
Results
Host-seeking and blood-fed An. arabiensis were attracted to the natural and synthetic odour of fresh and aged cattle urine in both laboratory and field studies. Gravid females were indifferent in their response to cattle urine presence at oviposition sites. Host-seeking and blood-fed females actively imbibed cattle urine and urea, and allocated these resources according to life history trade-offs to flight, survival or reproduction, as a function of physiological state.
Conclusions
Anopheles arabiensis acquire and allocate cattle urine to improve life history traits. Supplementary feeding on cattle urine affects vectorial capacity directly by increasing daily survival and vector density, as well as indirectly by altering flight activity, and thus should be considered in future models.
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
The World Health Organization (WHO) recommends surveillance of molecular markers of resistance to anti-malarial drugs. This is particularly important in the case of mass drug administration (MDA), which is endorsed by the WHO in some settings to combat malaria. Dihydroartemisinin-piperaquine (DHA-PPQ) is an artemisinin-based combination therapy which has been used in MDA. This review analyses the impact of MDA with DHA-PPQ on the evolution of molecular markers of drug resistance. The review is split into two parts. Section I reviews the current evidence for different molecular markers of resistance to DHA-PPQ. This includes an overview of the prevalence of these molecular markers in Plasmodium falciparum Whole Genome Sequence data from the MalariaGEN Pf3k project. Section II is a systematic literature review of the impact that MDA with DHA-PPQ has had on the evolution of molecular markers of resistance. This systematic review followed PRISMA guidelines. This review found that despite being a recognd surveillance tool by the WHO, the surveillance of molecular markers of resistance following MDA with DHA-PPQ was not commonly performed. Of the total 96 papers screened for eligibility in this review, only 20 analysed molecular markers of drug resistance. The molecular markers published were also not standardized. Overall, this warrants greater reporting of molecular marker prevalence following MDA implementation. This should include putative pfcrt mutations which have been found to convey resistance to DHA-PPQ in vitro.
Læs mere Tjek på PubMedMalaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
Malaria is a major cause of morbidity and mortality globally, especially in sub-Saharan Africa. Widespread resistance to pyrethroids threatens the gains achieved by vector control. To counter resistance to pyrethroids, third-generation indoor residual spraying (3GIRS) products have been developed. This study details the results of a multi-country cost and cost-effectiveness analysis of indoor residual spraying (IRS) programmes using Actellic®300CS, a 3GIRS product with pirimiphos-methyl, in sub-Saharan Africa in 2017 added to standard malaria control interventions including insecticide-treated bed nets versus standard malaria control interventions alone.
Methods
An economic evaluation of 3GIRS using Actellic®300CS in a broad range of sub-Saharan African settings was conducted using a variety of primary data collection and evidence synthesis methods. Four IRS programmes in Ghana, Mali, Uganda, and Zambia were included in the effectiveness analysis. Cost data come from six IRS programmes: one in each of the four countries where effect was measured plus Mozambique and a separate programme conducted by AngloGold Ashanti Malaria Control in Ghana. Financial and economic costs were quantified and valued. The main indicator for the cost was cost per person targeted. Country-specific case incidence rate ratios (IRRs), estimated by comparing IRS study districts to adjacent non-IRS study districts or facilities, were used to calculate cases averted in each study area. A deterministic analysis and sensitivity analysis were conducted in each of the four countries for which effectiveness evaluations were available. Probabilistic sensitivity analysis was used to generate plausibility bounds around the incremental cost-effectiveness ratio estimates for adding IRS to other standard interventions in each study setting as well as jointly utilizing data on effect and cost across all settings.
Results
Overall, IRRs from each country indicated that adding IRS with Actellic®300CS to the local standard intervention package was protective compared to the standard intervention package alone (IRR 0.67, [95% CI 0.50–0.91]). Results indicate that Actellic®300CS is expected to be a cost-effective (> 60% probability of being cost-effective in all settings) or highly cost-effective intervention across a range of transmission settings in sub-Saharan Africa.
Discussion
Variations in the incremental costs and cost-effectiveness likely result from several sources including: variation in the sprayed wall surfaces and house size relative to household population, the underlying malaria burden in the communities sprayed, the effectiveness of 3GIRS in different settings, and insecticide price. Programmes should be aware that current recommendations to rotate can mean variation and uncertainty in budgets; programmes should consider this in their insecticide-resistance management strategies.
Conclusions
The optimal combination of 3GIRS delivery with other malaria control interventions will be highly context specific. 3GIRS using Actellic®300CS is expected to deliver acceptable value for money in a broad range of sub-Saharan African malaria transmission settings.
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
To sustain high universal Long-Lasting Insecticidal Nets (LLINs) coverage, affordable nets that provide equivalent or better protection than standard LLINs, are required. Test facilities evaluating new LLINs require compliance to Good Laboratory Practice (GLP) standards to ensure the quality and integrity of test data. Following GLP principles allows for the reconstruction of activities during the conduct of a study and minimizes duplication of efficacy testing. This case study evaluated the efficacy of two LLINs: SafeNet NF® and SafeNet® LLIN.
Methods
The study was conducted according to GLP principles and followed World Health Organization guidelines for evaluating LLINs. The LLINs were assessed in experimental huts against wild, pyrethroid-resistant Anopheles arabiensis mosquitoes. Nets were either unwashed or washed 20 times and artificially holed to simulate a used torn net. Blood-feeding inhibition and mortality were compared with a positive control (Interceptor® LLIN) and an untreated net.
Results
Mosquito entry in the huts was reduced compared to negative control for the unwashed SafeNet NF, washed Safenet LLIN and the positive control arms. Similar exiting rates were found for all the treatment arms. Significant blood-feeding inhibition was only found for the positive control, both when washed and unwashed. All insecticide treatments induced significantly higher mortality compared to an untreated net. Compared to the positive control, the washed and unwashed SafeNet NF® resulted in similar mortality. For the SafeNet® LLINs the unwashed net had an equivalent performance, but the mortality for the washed net was significantly lower than the positive control.
Internal audits of the study confirmed that all critical phases complied with Standard Operating Procedures (SOPs) and the study plan. The external audit confirmed that the study complied with GLP standards.
Conclusions
SafeNet NF® and SafeNet® LLIN offered equivalent protection to the positive control (Interceptor® LLIN). However, further research is needed to investigate the durability, acceptability, and residual efficacy of these nets in the community. This study demonstrated that GLP-compliant evaluation of LLINs can be successfully conducted by African research institutions.
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Sawai Singh Rathore, Sharvi Oberoi, Jonathan Hilliard, Ritesh Raja, Noman Khurshid Ahmed, Yogesh Vishwakarma, Kinza Iqbal, Chandani Kumari, Felipe Velasquez‐Botero, María Alejandra Nieto‐Salazar, Guillermo Andrés Moreno Cortes, Edwin Akomaning, Islam elFatih Mohamed Musa
Tropical Medicine & International Health, 11.06.2022
Tilføjet 12.06.2022
Mariёlle Kloek, Caroline A. Bulstra, Sungai T. Chabata, Elizabeth Fearon, Isaac Taramusi, Sake J. de Vlas, Frances M. Cowan, Jan A. C. Hontelez
Tropical Medicine & International Health, 10.06.2022
Tilføjet 12.06.2022
Ritah F. Mutagonda, Hellen Siril, Sylvia Kaaya, Theresia Amborose, Tausi Haruna, Aisa Mhalu, David Urassa, Expeditho Mtisi, Candida Moshiro, Edith Tarimo, Gladys Reuben Mahiti, Agape Minja, Magreth Somba, Francis August, Ferdinand Mugusi
Tropical Medicine & International Health, 10.06.2022
Tilføjet 12.06.2022
BMC Infectious Diseases, 10.06.2022
Tilføjet 11.06.2022
Abstract
Background
The empirical prescription of antibiotics to inpatients with Coronavirus Disease 2019 (COVID-19) is frequent despite uncommon bacterial coinfections. Current knowledge of the effect of antibiotics on the survival of hospitalized children with COVID-19 is limited.
Objective
To characterize the survival experience of children with laboratory-positive COVID-19 in whom antibiotics were prescribed at hospital admission.
Methods
A retrospective cohort study was conducted in Mexico, with children hospitalized due to COVID-19 from March 2020 to December 2021. Data from 1601 patients were analyzed using the Kaplan–Meier method and the log-rank test. We computed hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the effect of the analyzed exposures on disease outcomes.
Results
Antibiotics were prescribed to 13.2% (
(n)
= 211) of enrolled children and a higher mortality rate [14.9 (95% CI 10.1–19.8) vs. 8.3 (95% CI 6.8–9.8)] per 1000 person-days,
(p)
< 0.001) was found among them. At any given cut-off, survival functions were lower in antibiotic-positive inpatients (
(p)
< 0.001). In the multiple model, antibiotic prescription was associated with a 50% increase in the risk of fatal outcome (HR = 1.50, 95% CI 1.01–2.22). A longer interval between illness onset and healthcare-seeking and pneumonia at hospital admission was associated with a poorer prognosis.
Conclusions
Our results suggest that antibiotic prescription in children hospitalized due to COVID-19 is associated with decreased survival. If later replicated, these findings highlight the need for rational antibiotics in these patients.
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Malefu Moleleki, Mignon du Plessis, Kedibone Ndlangisa, Cayla Reddy, Orienka Hellferscee, Omphe Mekgoe, Meredith McMorrow, Sibongile Walaza, Cheryl Cohen, Stefano Tempia, Anne von Gottberg, Nicole Wolter
International Journal of Infectious Diseases, 11.06.2022
Tilføjet 11.06.2022
: We describe the use of a multi-pathogen platform, TaqMan array card (TAC) real-time PCR, for the detection of pathogens in patients hospitalized with severe respiratory illness (SRI).
Læs mere Tjek på PubMedWei Huang, Zhixiong Fang, Si Luo, Sha Lin, Lei Xu, Bo Yan, Yang yang, Xuhui Liu, Lu Xia, Xiaoyong Fan, Shuihua Lu
International Journal of Infectious Diseases, 11.06.2022
Tilføjet 11.06.2022
Moeinadin Safavi, Salameh Taghipour, Mohammad Vasei, Hamid Eshaghi, Mohammad Taghi Haghi Ashtiani
Journal of Medical Virology, 11.06.2022
Tilføjet 11.06.2022
Mohammad Rudiansyah, Saade Abdalkareem Jasim, Zeinab Gol Mohammad pour, Sara Sohrabi Athar, Ali Salimi Jeda, Rumi iqbal doewes, Abduladheem Turki Jalil, D.O. Bokov, Yasser Fakri Mustafa, Mina Noroozbeygi, Sajad Karampoor, Rasoul Mirzaei
Journal of Medical Virology, 11.06.2022
Tilføjet 11.06.2022
Qiao Liu, Beibei Qiu, Guoli Li, Tingting Yang, Bilin Tao, Leonardo Martinez, Limei Zhu, Jianming Wang, Xuhua Mao, Wei Lu
Clinical Microbiology and Infection, 10.06.2022
Tilføjet 11.06.2022
Tuberculosis recurrence after an initial successful treatment episode can occur from either reinfection or relapse. In a population-based sample and whole genome sequencing (WGS) in eastern China, we aimed to evaluate risk factors for tuberculosis recurrence, and assess the proportion of recurrence due to either reinfection or relapse.
Læs mere Tjek på PubMedSulien Al Khalili, Fatma Al Yaquobi, Bader Al Abri, Khalsa Al Thuhli, Sabria Al Marshoudi, Bader Al Rawahi, Seif Al-Abri
International Journal of Infectious Diseases, 10.06.2022
Tilføjet 11.06.2022
Tuberculosis (TB) remains a major public health issue. Elimination mandates collaboration between decision makers, practitioners and the community. Few studies address the knowledge, attitude and practice (KAP) from countries with low incidence.
Læs mere Tjek på PubMedLancet Infectious Diseases, 11.06.2022
Tilføjet 11.06.2022
Goepfert PA, Fu B, Chabanon A-L, et al. Safety and immunogenicity of SARS-CoV-2 recombinant protein vaccine formulations in healthy adults: interim results of a randomised, placebo-controlled, phase 1–2, dose-ranging study. Lancet Infect Dis 2021; 21: 1257–70—In figure 4 of this Article, the diamond and triangle symbols were inverted in the key; the diamond represents high dose and the triangle represents placebo. Additionally, in panel B of figure 4 (for participants aged 18–49 years), the placebo datapoints were omitted.
Læs mere Tjek på PubMedKolawole I. Ayeni, David Berry, Lukas Wisgrill, Benedikt Warth, Chibundu N. Ezekiel
Trends in Microbiology, 10.06.2022
Tilføjet 11.06.2022
The gut microbiome of neonates, infants, and toddlers (NITs) is very dynamic, and only begins to stabilize towards the third year of life. Within this period, exposure to xenobiotics may perturb the gut environment, thereby driving or contributing to microbial dysbiosis, which may negatively impact health into adulthood. Despite exposure of NITs globally, but especially in Africa, to copious amounts and types of xenobiotics – such as mycotoxins, pesticide residues, and heavy metals – little is known about their influence on the early-life microbiome or their effects on acute or long-term health.
Læs mere Tjek på PubMedTekalign Kejela, Fili Dekosa
Tropical Medicine & International Health, 10.06.2022
Tilføjet 10.06.2022
Malaria Journal, 10.06.2022
Tilføjet 10.06.2022
Abstract
Background
Despite the low to moderate intensity of malaria transmission present in Ethiopia, malaria is still a leading public health problem. Current vector control interventions, principally long-lasting insecticidal nets and indoor residual spraying, when deployed alone or in combination, are insufficient to control the dominant vector species due to their exophagic and exophilic tendencies. Zooprophylaxis presents a potential supplementary vector control method for malaria; however, supporting evidence for its efficacy has been mixed.
Methods
To identify risk factors of malaria and to estimate the association between cattle and Anopheles vector abundance as well as malaria risk, a cross-sectional study was conducted in a village near Arba Minch, Ethiopia. Epidemiological surveys (households = 95, individuals = 463), mosquito collections using CDC light traps and a census of cattle and human populations were conducted. To capture environmental conditions, land cover and water bodies were mapped using satellite imagery. Risk factor analyses were performed through logistic, Poisson, negative binomial, and spatial weighted regression models.
Results
The only risk factor associated with self-reported malaria illness at an individual level was being a child aged 5 or under, where they had three times higher odds than adults. At the household level, variables associated with malaria vector abundance, especially those indoors, included socioeconomic status, the proportion of children in a household and cattle population density.
Conclusions
Study results are limited by the low abundance of malaria vectors found and use of self-reported malaria incidence. Environmental factors together with a household’s socioeconomic status and host availability played important roles in the risk of malaria infection in southwest Ethiopia. Cattle abundance in the form of higher cattle to human ratios may act as a protective factor against mosquito infestation and malaria risk. Humans should remain indoors to maximize potential protection against vectors and cattle kept outside of homes.
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Liu, J., Hung, P., Liang, C., Zhang, J., Qiao, S., Campbell, B. A., Olatosi, B., Torres, M. E., Hikmet, N., Li, X.
BMJ Open, 10.06.2022
Tilføjet 10.06.2022
Introduction
The COVID-19 pandemic has affected communities of colour the hardest. Non-Hispanic black and Hispanic pregnant women appear to have disproportionate SARS-CoV-2 infection and death rates.
Methods and analysis
We will use the socioecological framework and employ a concurrent triangulation, mixed-methods study design to achieve three specific aims: (1) examine the impacts of the COVID-19 pandemic on racial/ethnic disparities in severe maternal morbidity and mortality (SMMM); (2) explore how social contexts (eg, racial/ethnic residential segregation) have contributed to the widening of racial/ethnic disparities in SMMM during the pandemic and identify distinct mediating pathways through maternity care and mental health; and (3) determine the role of social contextual factors on racial/ethnic disparities in pregnancy-related morbidities using machine learning algorithms. We will leverage an existing South Carolina COVID-19 Cohort by creating a pregnancy cohort that links COVID-19 testing data, electronic health records (EHRs), vital records data, healthcare utilisation data and billing data for all births in South Carolina (SC) between 2018 and 2021 (>200 000 births). We will also conduct similar analyses using EHR data from the National COVID-19 Cohort Collaborative including >270 000 women who had a childbirth between 2018 and 2021 in the USA. We will use a convergent parallel design which includes a quantitative analysis of data from the 2018–2021 SC Pregnancy Risk Assessment and Monitoring System (unweighted n>2000) and in-depth interviews of 40 postpartum women and 10 maternal care providers to identify distinct mediating pathways.
Ethics and dissemination
The study was approved by institutional review boards at the University of SC (Pro00115169) and the SC Department of Health and Environmental Control (DHEC IRB.21-030). Informed consent will be provided by the participants in the in-depth interviews. Study findings will be disseminated with key stakeholders including patients, presented at academic conferences and published in peer-reviewed journals.
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Phiri, M. M., MacPherson, E. E., Panulo, M., Chidziwisano, K., Kalua, K., Chirambo, C. M., Kawalazira, G., Gundah, Z., Chunda, P., Morse, T.
BMJ Open, 10.06.2022
Tilføjet 10.06.2022
Objective
Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and capacity but are the most accessible and play a crucial role in responding to the COVID-19 pandemic. This study assessed health facility preparedness for COVID-19 and the impact of the pandemic on health service delivery and frontline workers.
Setting
Primary and maternal healthcare in Blantyre District, Malawi.
Participants
We conducted regular visits to 31 healthcare facilities and a series of telephone-based qualitative interviews with frontline workers (n=81 with 38 participants) between August 2020 and May 2021.
Results
Despite significant financial and infrastructural constraints, health centres continued to remain open. The majority of frontline health workers received training and access to preventative COVID-19 materials. Nevertheless, we found disruptions to key services and a reduction in clients attending facilities. Key barriers to implementing COVID-19 prevention measures included periodic shortages of resources (soap, hand sanitiser, water, masks and staff). Frontline workers reported challenges in managing physical distancing and in handling suspected COVID-19 cases. We found discrepancies between reported behaviour and practice, particularly with consistent use of masks, despite being provided. Frontline workers felt COVID-19 had negatively impacted their lives. They experienced fatigue and stress due to heavy workloads, stigma in the community and worries about becoming infected with and transmitting COVID-19.
Conclusion
Resource (human and material) inadequacy shaped the health facility capacity for support and response to COVID-19, and frontline workers may require psychosocial support to manage the impacts of the COVID-19 pandemic.
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Zhao, G., Luo, Y., Xu, J.
BMJ Open, 10.06.2022
Tilføjet 10.06.2022
Objective
To understand the sexual behaviours and HIV testing uptake of sexually experienced male college students in China.
Design
A cross-sectional study was conducted between September and November of 2020 among male college students.
Setting
Hangzhou, China.
Participants
Male students who had sexual experience in the previous year were investigated.
Outcome measures
Sexual risk behaviour was defined as having multiple sexual partners or having unprotected sex.
Results
More than half of the sexually experienced male students (556, 53.2%) had their first sexual intercourse under the age of 18 years old. Among participants, 32.82% (343/1045) had causal sex in the last 6 months; 4.21% (44/1045) had paid sex; 37.32% (390/1045) had sex with other men and had two or more sexual partners in last half year; and 33.33% (130/390) used psychoactive drugs during same-sex intercourse. Only 33.5% (350/1045) of male students had undertaken an HIV test before.
Conclusion
Male college students especially men who have sex with men were at risk because they tended to be sexually adventurous, have sex at an early age, have sex with multiple sexual partners and practice unprotected sex. Furthermore, they had a low HIV testing uptake. This highlights the importance of carrying out targeted and timely HIV risk education towards college students.
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Wang, L., Tang, J., Chen, X., Zhao, J., Tang, W., Liao, B., Nian, W.
BMJ Open, 10.06.2022
Tilføjet 10.06.2022
Introduction
Neoantigens derived from tumour somatic mutations are recognised as ideal vaccine targets. Tumour neoantigens have been studied in a wide range of tumours. Most of research on neoantigens has focused just on a unique tumour and a single mutated gene. Currently, a few studies have reported using a mixture of neoantigen peptides derived from multiple genetic mutation sites in the treatment of genomic unstable advanced solid malignancies. The trial aims to evaluate the safety and efficacy of individualised tumour neoantigen peptide mixtures in the treatment of genomic unstable advanced solid malignant tumours.
Methods and analysis
This is a prospective, non-randomised, open, single-centre, single-arm, phase I trial. Patients with genomic unstable advanced solid malignancies are eligible for study participations. 20 patients will be included in the trial. Through the whole exome and transcriptome sequencing analysis of the fresh blood and tumour tissues of the enrolled patients, the 20 25-33aa antigen peptides with the highest mutation scores of the patients will be screened out, and the corresponding new antigen peptides will be synthesised and prepared. Patients will be treated with their own individualised neoantigen polypeptide combined with a polypeptide adjuvant (human granulocyte-macrophage colony-stimulating factor). The primary endpoint is safety indicators, including general and specific adverse events which will be monitored continuously. Secondary endpoints are progression-free survival, objective response rate, objective duration of remission, 1-year survival rate and overall survival.
Ethics and dissemination
This study has received approval from the Ethics Committee of Chongqing University Cancer Hospital on 21 November 2019 (207/2019). The findings of this trial will be disseminated through national and international presentations and peer-reviewed publications.
Trial registration number
ChiCTR1900025364.
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Dev, R., Raparelli, V., Bacon, S. L., Lavoie, K. L., Pilote, L., Norris, C. M., for the iCARE Study Team
BMJ Open, 10.06.2022
Tilføjet 10.06.2022
Objective
Given the role of sociocultural gender in shaping human behaviours, the main objective of this study was to examine whether sex and gender-related factors were associated with the public’s adherence to COVID-19-recommended protective health behaviours.
Design
This was a retrospective analysis of the survey that captured data on people’s awareness, attitudes and behaviours as they relate to the COVID-19 policies.
Setting
Data from the International COVID-19 Awareness and Responses Evaluation survey collected between March 2020 and February 2021 from 175 countries.
Participants
Convenience sample around the world.
Main outcome measures
We examined the role of sex and gender-related factors in relation to non-adherence of protective health behaviours including: (1) hand washing; (2) mask wearing; and (3) physical distancing. Multivariable logistic regression was conducted to determine the factors associated with non-adherence to behaviours.
Results
Among 48 668 respondents (mean age: 43 years; 71% female), 98.3% adopted hand washing, 68.5% mask wearing and 76.9% physical distancing. Compared with males, females were more likely to adopt hand washing (OR=1.97, 95% CI: 1.71 to 2.28) and maintain physical distancing (OR=1.28, 95% CI: 1.22 to 1.34). However, in multivariable sex-stratified models, females in countries with higher Gender Inequality Indexes (GII) were less likely to report hand washing (adjusted OR (aOR)=0.47, 95% CI: 0.21 to 1.05). Females who reported being employed (aOR=0.22, 95% CI: 0.10 to 0.48) and in countries with low/medium GIIs (aOR=0.18, 95% CI 0.06 to 0.51) were less likely to report mask wearing. Females who reported being employed were less likely to report physical distancing (aOR=0.39, 95% CI: 0.32 to 0.49).
Conclusion
While females showed greater adherence to COVID-19 protective health behaviours, gender-related factors, including employment status and high country-wide gender inequality, were independently associated with non-adherence. These findings may inform public health and vaccination policies in current as well as future pandemics.
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Evans, S., Olive, L., Dober, M., Knowles, S., Fuller-Tyszkiewicz, M., O, E., Gibson, P., Raven, L., Gearry, R., McCombie, A., van Niekerk, L., Chesterman, S., Romano, D., Mikocka-Walus, A.
BMJ Open, 10.06.2022
Tilføjet 10.06.2022
Introduction
Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD.
Methods and analysis
Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition.
Ethics and dissemination
This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences.
Trial registration number
ACTRN12621001316897.
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Mitsuo Uchida, Takenori Yamauchi
PLoS One Infectious Diseases, 10.06.2022
Tilføjet 10.06.2022
by Mitsuo Uchida, Takenori Yamauchi
Introduction Although influenza surveillance systems have been used to monitor influenza epidemics, these systems generally evaluate diagnostic information obtained from medical institutions and they do not include patients who have not been examined. In contrast, community based epidemiological studies target people with influenza-like illness (ILI) that self-reported influenza-like symptoms whether they have medical examinations or not. Because the criteria for influenza surveillance systems and ILI differ, there is a gap between them. The purpose of this study was to clarify this gap using school-based survey data. Methods Questionnaires about both ILI and the influenza diagnosis history during the 2018/19 season were administered to the guardians of 11,684 elementary schoolchildren in a single city in Japan. Based on their responses, a Bayesian model was constructed to estimate the probability of infection, ILI onset, and diagnosis at medical institutions. Results Responses were obtained from guardians of 10,309 children (88.2%). Of these, 3,380 children (32.8%) had experienced ILI, with 2,380 (23.1%) diagnosed as influenza at a medical institution. Bayesian estimation showed that the probability of influenza cases being diagnosed among ILI symptomatic children was 70% (95% credible interval, 69–71%). Of the infected children, 5% were without ILI symptoms, with 11% of these patients diagnosed with influenza. Conclusions This epidemiological study clarified the proportion gap between ILI and influenza diagnosis among schoolchildren. These results may help to establish epidemic control measures and secure sufficient medical resources.
Læs mere Tjek på PubMedTroy Ganz, Sarah Sanderson, Connor Baush, Melanie Mejia, Manoj Gandhi, Jared Auclair
PLoS One Infectious Diseases, 10.06.2022
Tilføjet 10.06.2022
by Troy Ganz, Sarah Sanderson, Connor Baush, Melanie Mejia, Manoj Gandhi, Jared Auclair
Clinical evidence for asymptomatic cases of coronavirus disease (COVID-19) has reinforced the significance of effective surveillance testing programs. Quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) assays are considered the ‘gold standard’ for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. However, the labor and resource requirements can be prohibitive with respect to large testing volumes associated with the pandemic. Pooled testing algorithms may serve to increase testing capacity with more efficient resource utilization. Due to the lack of carefully curated cohorts, there is limited evidence for the applicability of RT-PCR pooling in asymptomatic COVID-19 cases. In this study, we compared the analytical sensitivity of the TaqMan™ SARS-CoV-2 Pooling Assay to detect one positive sample in a pool of five anterior nares swabs in symptomatic and asymptomatic cohorts at an institute of higher education. Positive pools were deconvoluted and each individual sample was retested using the TaqPath™ COVID-19 Combo Kit. Both assays target the open reading frame (ORF) 1ab, nucleocapsid (N), and spike (S) gene of the strain that originated in Wuhan, Hubei, China. Qualitative results demonstrated absolute agreement between pooled and deconvoluted samples in both cohorts. Independent t-test performed on Ct shifts supported an insignificant difference between cohorts with p-values of 0.306 (Orf1ab), 0.147 (N), and 0.052 (S). All negative pools were correctly reported as negative. Pooled PCR testing up to five samples is a valid method for surveillance testing of students and staff in a university setting, especially when the prevalence is expected to be low.
Læs mere Tjek på PubMedVanya Rangelova, Ralitsa Raycheva, Sara Sariyan, Ani Kevorkyan
PLoS One Infectious Diseases, 10.06.2022
Tilføjet 10.06.2022
by Vanya Rangelova, Ralitsa Raycheva, Sara Sariyan, Ani Kevorkyan
As a member state of the European Union, where vaccines against COVID-19 are available and affordable, Bulgaria reports the lowest immunization coverage and the most pronounced vaccine distrust. The present study aimed to assess the self-reported adverse reactions following COVID-19 vaccination as a possible tool to increase the trust in vaccines. A cross-sectional survey-based study, covering 761 vaccinated respondents, was conducted in Plovdiv (469 with an mRNA vaccine and 292 with an adenoviral vector vaccine). Descriptive statistics parametric and non-parametric methods were applied. Statistical significance was set at p<0.05. The median age of the respondents was 42 years, females (72.5%). At least one adverse reaction was reported in 89.9% of those immunized with mRNA vaccine and 93.8% in the adenoviral vector vaccine group (p>0.05). They were mild to moderate and resolved within several days. The levels of local reactions were comparable: 91.7% in those who received mRNA and 89.7% in those who received an adenoviral vector vaccine (p = 0.366). The most common types of systemic reactions were fatigue, headache, and muscle pains. An association was found between the systemic reactions and the type of vaccine administered: 59.7% in mRNA recipients and 89.4% in adenoviral vector vaccinees (p<0.001). None of the registered systemic reactions required medical attention. There were 3 reports of generalized urticaria after an mRNA and 2 after an adenoviral vector vaccine. The reported reactions are relatively high but expected and no adverse events have been reported that are not listed in the official Summary of Product Characteristics.
Læs mere Tjek på PubMedNina Hangartner, Stefania Di Gangi, Christoph Elbl, Oliver Senn, Fadri Bisatz, Thomas Fehr
PLoS One Infectious Diseases, 10.06.2022
Tilføjet 10.06.2022
by Nina Hangartner, Stefania Di Gangi, Christoph Elbl, Oliver Senn, Fadri Bisatz, Thomas Fehr
During the first year of the COVID-19 pandemic, healthcare facilities worldwide struggled to adequately care for the increasing number of COVID-19 patients while maintaining quality of care for all other patients. The aim of this study was to investigate the displacement and underuse of non-COVID-19 patient care in a medical department of a tertiary hospital in Switzerland. In this retrospective cross-sectional study, internal medicine admissions from 2017 to 2020, emergency outpatient visits from 2019 to 2020 and COVID-19 admissions in 2020 were analyzed and compared using a regression model. Internal medicine admissions were also stratified by diagnosis. A questionnaire was used to assess the pandemic experience of local general practitioners, referring hospitals, and nursing homes. The total number of admissions decreased during the 1st and 2nd waves of the pandemic but increased between the two waves. Elective admissions decreased in 2020 compared to pre-pandemic years: they represented 25% of total admissions in 2020 versus 30% of the total admissions during 2017–2019, p
Læs mere Tjek på PubMedLuke Bracegirdle, Alexander Jackson, Ryan Beecham, Maria Burova, Elsie Hunter, Laura G. Hamilton, Darshni Pandya, Clare Morden, Michael P. W. Grocott, Andrew Cumpstey, Ahilanandan Dushianthan, the REACT COVID-19 Investigators
PLoS One Infectious Diseases, 10.06.2022
Tilføjet 10.06.2022
by Luke Bracegirdle, Alexander Jackson, Ryan Beecham, Maria Burova, Elsie Hunter, Laura G. Hamilton, Darshni Pandya, Clare Morden, Michael P. W. Grocott, Andrew Cumpstey, Ahilanandan Dushianthan, the REACT COVID-19 Investigators
Background Acute hypoxic respiratory failure (AHRF) is a hallmark of severe COVID-19 pneumonia and often requires supplementary oxygen therapy. Critically ill COVID-19 patients may require invasive mechanical ventilation, which carries significant morbidity and mortality. Understanding of the relationship between dynamic changes in blood oxygen indices and clinical variables is lacking. We evaluated the changes in blood oxygen indices–PaO2, PaO2/FiO2 ratio, oxygen content (CaO2) and oxygen extraction ratio (O2ER) in COVID-19 patients through the first 30-days of intensive care unit admission and explored relationships with clinical outcomes. Methods and findings We performed a retrospective observational cohort study of all adult COVID-19 patients in a single institution requiring invasive mechanical ventilation between March 2020 and March 2021. We collected baseline characteristics, clinical outcomes and blood oxygen indices. 36,383 blood gas data points were analysed from 184 patients over 30-days. Median participant age was 59.5 (IQR 51.0, 67.0), BMI 30.0 (IQR 25.2, 35.5) and the majority were men (62.5%) of white ethnicity (70.1%). Median duration of mechanical ventilation was 15-days (IQR 8, 25). Hospital survival at 30-days was 72.3%. Non-survivors exhibited significantly lower PaO2 throughout intensive care unit admission: day one to day 30 averaged mean difference -0.52 kPa (95% CI: -0.59 to -0.46, p<0.01). Non-survivors exhibited a significantly lower PaO2/FiO2 ratio with an increased separation over time: day one to day 30 averaged mean difference -5.64 (95% CI: -5.85 to -5.43, p<0.01). While all patients had sub-physiological CaO2, non-survivors exhibited significantly higher values. Non-survivors also exhibited significantly lower oxygen extraction ratio with an averaged mean difference of -0.08 (95% CI: -0.09 to -0.07, p<0.01) across day one to day 30. Conclusions As a novel cause of acute hypoxic respiratory failure, COVID-19 offers a unique opportunity to study a homogenous cohort of patients with hypoxaemia. In mechanically ventilated adult COVID-19 patients, blood oxygen indices are abnormal with substantial divergence in PaO2/FiO2 ratio and oxygen extraction ratio between survivors and non-survivors. Despite having higher CaO2 values, non-survivors appear to extract less oxygen implying impaired oxygen utilisation. Further exploratory studies are warranted to evaluate and improve oxygen extraction which may help to improve outcomes in severe hypoxaemic mechanically ventilated COVID-19 patients.
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