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39 emner vises.
Ignacio, Rachel A. Bender; Shapiro, Adrienne E.; Nance, Robin M.; Whitney, Bridget M.; Delaney, J.A. Joseph A.C.; Bamford, Laura; Wooten, Darcy; Karris, Maile Y.; Mathews, William C.; Kim, Hyang Nina; Keruly, Jeanne; Burkholder, Greer; Napravnik, Sonia; Mayer, Kenneth H.; Jacobson, Jeffrey; Saag, Michael; Moore, Richard D.; Eron, Joseph J.; Willig, Amanda L.; Christopoulos, Katerina A.; Martin, Jeffrey; Hunt, Peter W.; Crane, Heidi M.; Kitahata, Mari M.; Cachay, Edward
AIDS, 26.10.2022
Tilføjet 24.06.2022
Objectives:
To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.
Design:
Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020.
Methods:
We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.
Results:
Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40–59), 18% had a current CD4+ count less than 350, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity.
Conclusion:
Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ or current low CD4+ : CD8+ ratio had greater risk of COVID-19.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedChad R Wells, Alison P Galvani
Lancet Infectious Diseases, 24.06.2022
Tilføjet 24.06.2022
Over the course of the first year of COVID-19 vaccination, between Dec 8, 2020, and Dec 8, 2021, 8·33 billion doses were administered among 4·36 billion people globally.1 In their study in The Lancet Infectious Diseases, by fitting a mathematical model to excess mortality, Oliver J Watson and colleagues2 estimated that in 185 countries and territories 31·4 million COVID-19-related deaths would have occurred during this timeframe in the absence of COVID-19 vaccination. They estimated that 19·8 million deaths were averted by COVID-19 vaccination.
Læs mere Tjek på PubMedDavid L Heymann, Marie-Paule Kieny, Ramanan Laxminarayan
Lancet Infectious Diseases, 24.06.2022
Tilføjet 24.06.2022
With rising incomes and the increased availability of antibiotics globally, per-capita consumption of antibiotics in middle-income countries is fast approaching the rates in high-income countries.1 Antimicrobial resistance has emerged as a major source of morbidity and mortality worldwide, and now is estimated to cause more deaths than malaria or HIV/AIDS.2 Existing and new vaccines could help avert a substantial proportion of current antibiotic use, and there is now considerable evidence linking vaccination with decreased use of antibiotics and averted cases of antimicrobial resistance.
Læs mere Tjek på PubMedOliver J Watson, Gregory Barnsley, Jaspreet Toor, Alexandra B Hogan, Peter Winskill, Azra C Ghani
Lancet Infectious Diseases, 24.06.2022
Tilføjet 24.06.2022
COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage.
Læs mere Tjek på PubMedFrancine Ntoumi, Peter G Kremsner
Lancet Infectious Diseases, 24.06.2022
Tilføjet 24.06.2022
In The Lancet Infectious Diseases, Aaron M Samuels and colleagues1 assessed the efficacy of fractional RTS,S/AS01E (hereafter referred to as RTS,S) vaccines doses against malaria. The study design of this clinical trial was based on findings from a phase 2a controlled human malaria infection (CHMI) study assessing vaccine efficacy in adults,2 and from a study evaluating the effect of a change in the vaccine regimen on the quality of antibody responses.3
Læs mere Tjek på PubMedAaron M Samuels, Daniel Ansong, Simon K Kariuki, Samuel Adjei, Anne Bollaerts, Christian Ockenhouse, Nelli Westercamp, Cynthia K Lee, Lode Schuerman, Dennis K Bii, Lawrence Osei-Tutu, Martina Oneko, Marc Lievens, Maame Anima Attobrah Sarfo, Cecilia Atieno, Danielle Morelle, Ashura Bakari, Tony Sang, Erik Jongert, Maame Fremah Kotoh-Mortty, Kephas Otieno, François Roman, Patrick Boakye Yiadom Buabeng, Yaw Ntiamoah, Opokua Ofori-Anyinam, Tsiri Agbenyega, RTS,S study group
Lancet Infectious Diseases, 24.06.2022
Tilføjet 24.06.2022
The Fx012-14 regimen was not superior to the standard regimen over 12 months after dose three. All RTS,S/AS01E regimens provided substantial, similar protection against clinical malaria, suggesting potential flexibility in the recommended dosing regimen and schedule. This, and the effect of annual boosters, will be further evaluated through 50 months of follow-up.
Læs mere Tjek på PubMedKayoko Shioda, Ben Lopman
Lancet, 9.04.2022
Tilføjet 24.06.2022
Counts of reported cases have been the key metric to monitor the COVID-19 pandemic. However, since the beginning, it has been clear that reported cases represent only a fraction of all SARS-CoV-2 infections.1 In The Lancet, COVID-19 Cumulative Infection Collaborators, writing on behalf of the Institute for Health Metrics and Evaluation, report a comprehensive set of global and location-specific estimates of daily and cumulative SARS-CoV-2 infections and the proportion of the population infected for 190 countries and territories up to Nov 14, 2021.
Læs mere Tjek på PubMedRosemary Morgan, Denise Nacif Pimenta, Sabina Rashid
Lancet, 3.03.2022
Tilføjet 24.06.2022
2 years into the COVID-19 pandemic, it is clear that gender differences exist, and that women, men, and gender minorities are differentially impacted by the pandemic.1 Emmanuela Gakidou and colleagues' Article2 in The Lancet provides additional data to reinforce this fact. Much of the research on the impacts of COVID-19 (outside of those whose work focuses on sex and gender differences) has focused on the direct health-related impacts of COVID-19, such as the fact that more men have been hospitalised and died from COVID-19-attributable causes than women.
Læs mere Tjek på PubMedJessamy Bagenal, Benjamin Burlton, Florence Costalas, Bethany Gomersall, Joanna Palmer, Paula Preyzner
Lancet, 25.06.2022
Tilføjet 24.06.2022
During the COVID-19 pandemic health professionals have found themselves working in a landscape that has been utterly transformed, for good and ill. There have been remarkable advances, such as accelerated research to produce effective treatments and vaccines, and increased use of digital health care. There are also ongoing challenges in many health-care settings, such as staff shortages, the pressures of long waiting lists for routine care, and an exhausted health workforce. Yet whatever the innovations and adversities, compassion and connection remain fundamental to establishing a positive, healing relationship between health-care workers and patients.
Læs mere Tjek på PubMedTalha Burki
Lancet, 25.06.2022
Tilføjet 24.06.2022
1 month ago, North Korea declared its first COVID-19 cases. Information is scare, but the outbreak now appears to be huge, amid a food crisis and without mass vaccination. Talha Burki reports.
Læs mere Tjek på PubMedDaniel Pan, Shirley Sze, Joshua Nazareth, Christopher A Martin, Amani Al-Oraibi, Rebecca F Baggaley, Laura B Nellums, T Déirdre Hollingsworth, Julian W Tang, Manish Pareek
Lancet, 16.06.2022
Tilføjet 24.06.2022
Monkeypox cases are increasing rapidly in the UK. The UK Health and Safety Agency (UKHSA) defines a probable case of monkeypox as “a person with an unexplained rash on any part of their body plus one or more classical symptom or symptoms of monkeypox infection since March 15, 2022 and either: has an epidemiological link to a confirmed or probable case of monkeypox in the 21 days before symptom onset; or reported a travel history to west or central Africa in the 21 days before symptom onset; or is a gay, bisexual or other man who has sex with men.
Læs mere Tjek på PubMedEsmita Charani, Martin McKee, Manica Balasegaram, Marc Mendelson, Sanjeev Singh, Alison H Holmes
Lancet, 25.06.2022
Tilføjet 24.06.2022
Christopher J L Murray and colleagues1 provide a compelling contribution to the understanding of the burden of disease attributable to bacterial antimicrobial resistance (AMR) in 2019. Focusing on 23 bacterial pathogens, they used two-stage spatiotemporal modelling to estimate this burden to be larger than diseases such as HIV and malaria, with the highest rates in sub-Saharan Africa. This new information should raise this issue higher on the global health agenda. They also, however, highlight the scarcity of high-quality data for infectious diseases and antibiotic consumption, with the authors having to rely on antibiotics sales data for an indication of antibiotic consumption.
Læs mere Tjek på PubMedTimothy R Walsh, Rabaab Zahra, Kenneth Iregbu, Sharon J Peacock, Andrew Stewardson
Lancet, 25.06.2022
Tilføjet 24.06.2022
Christopher J L Murray and colleagues1 provide a sobering analysis on the burden of common antimicrobial-resistant infections and a warning that, as a global community, we are rapidly surrendering any advantage we had on treating infections such as pneumonia and sepsis.2
Læs mere Tjek på PubMedDenis Mukwege, Prudence Mitangala, Aline Byabene, Emmanuel Busha, Yves Van Laethem, Olivier Vandenberg
Lancet, 25.06.2022
Tilføjet 24.06.2022
Christopher J L Murray and colleagues1 report on the dramatically high burden of antimicrobial resistance (AMR) worldwide, particularly in low-income and middle-income countries. The authors also emphasise the insufficient data on the prevalence of bacterial infections and AMR in low-resource settings. Although the figures presented are striking, they do not sufficiently depict the suffering of patients living in these locations and the frustration of clinicians unable to treat an infection that is typically easily curable elsewhere.
Læs mere Tjek på PubMedCOVID-19 Cumulative Infection Collaborators
Lancet, 9.04.2022
Tilføjet 24.06.2022
COVID-19 has already had a staggering impact on the world up to the beginning of the omicron (B.1.1.529) wave, with over 40% of the global population infected at least once by Nov 14, 2021. The vast differences in cumulative proportion of the population infected across locations could help policy makers identify the transmission-prevention strategies that have been most effective, as well as the populations at greatest risk for future infection. This information might also be useful for targeted transmission-prevention interventions, including vaccine prioritisation.
Læs mere Tjek på PubMedLuisa S Flor, Joseph Friedman, Cory N Spencer, John Cagney, Alejandra Arrieta, Molly E Herbert, Caroline Stein, Erin C Mullany, Julia Hon, Vedavati Patwardhan, Ryan M Barber, James K Collins, Simon I Hay, Stephen S Lim, Rafael Lozano, Ali H Mokdad, Christopher J L Murray, Robert C Reiner, Reed J D Sorensen, Annie Haakenstad, David M Pigott, Emmanuela Gakidou
Lancet, 3.03.2022
Tilføjet 24.06.2022
The most significant gender gaps identified in our study show intensified levels of pre-existing widespread inequalities between women and men during the COVID-19 pandemic. Political and social leaders should prioritise policies that enable and encourage women to participate in the labour force and continue their education, thereby equipping and enabling them with greater ability to overcome the barriers they face.
Læs mere Tjek på PubMedShuofeng Yuan , Zi-Wei Ye , Ronghui Liang , Kaiming Tang , Anna Jinxia Zhang , Gang Lu , Chon Phin Ong , Vincent Kwok Man Poon , Chris Chung-Sing Chan , Bobo Wing-Yee Mok , Zhenzhi Qin , Yubin Xie , Allen Wing-Ho Chu , Wan-Mui Chan , Jonathan Daniel Ip , Haoran Sun , Jessica Oi-Ling Tsang , Terrence Tsz-Tai Yuen , Kenn Ka-Heng Chik , Chris Chun-Yiu Chan , Jian-Piao Cai , Cuiting Luo , Lu Lu , Cyril Chik-Yan Yip , Hin Chu , Kelvin Kai-Wang To , Honglin Chen , Dong-Yan Jin , Kwok-Yung Yuen , Jasper Fuk-Woo Chan
Science, 23.06.2022
Tilføjet 24.06.2022
BMC Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
Abstract
Introduction
The Bacille-Calmette–Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia.
Method
Bacille-Calmette–Guerin immunization coverage and geographical information data were obtained from five different Demographic and Health Surveys, conducted in Ethiopia between 2000 and 2019. Data for independent variables were obtained from publicly available sources. Bayesian geostatistical models were used to predict the spatial distribution of BCG vaccination coverage in Ethiopia.
Result
The overall national BCG vaccination coverage between 2000 and 2019 was 65.5%. The BCG vaccine coverage was 53.5% in 2000, 56.9% in 2005, 64.4% in 2011, 79.6% in 2016, and 79.0% in 2019. BCG vaccination coverage increased by 47.6% in Ethiopia from 2000 to 2019, but substantial geographical inequalities in BCG coverage remained at sub-national and local levels. High vaccination coverage was observed in northern, western, and central parts of Ethiopia. Climatic and demographic factors such as temperature, altitude, and population density were positively associated with BCG vaccination coverage. Whereas, healthcare access factors such as distance to health facilities and travel time to the nearest cities were negatively associated with BCG vaccine coverage in Ethiopia.
Conclusion
Despite substantial progress in national BCG vaccination coverage, marked spatial variation in BCG coverage persists throughout the country at sub-national and local levels. Healthcare access and climatic and demographic factors determined the spatial distribution of BCG vaccination coverage. Maintaining a high level of vaccination coverage across geographical areas is important to prevent TB in Ethiopia.
Læs mere Tjek på PubMed
Malaria Journal, 23.06.2022
Tilføjet 24.06.2022
Abstract
Background
India has made considerable progress in malaria reduction over the past two decades, with government-sponsored indoor residual spraying (IRS) and insecticide-treated bed net (ITN) or long-lasting insecticidal nets (LLIN) distribution being the main vector-related prevention efforts. Few investigations have used non-participant observational methods to assess malaria control measures while they were being implemented, nor documented people’s perceptions and acceptance of IRS or LLINs in India, and none have done so in the northeast region. This study evaluated household (HH)-level operation of IRS and distribution of LLINs by India’s National Vector Borne Disease Control Programme (NVBDCP) in 50 villages of Meghalaya state, and documented their acceptance and use.
Methods
Study field teams accompanied the government health system teams during August-October, 2019 and 2020 to observe deployment of LLINs, and record HH-level data on LLIN numbers and use. In addition, NVBDCP spray teams were followed during 2019–2021 to observe IRS preparation and administration. HH members were interviewed to better understand reasons for acceptance or refusal of spraying.
Results
A total of 8386 LLINs were distributed to 2727 HHs in 24 villages from five Primary Health Centres, representing 99.5% of planned coverage. Interviews with 80 HH residents indicated that they appreciated the LLIN dissemination programme, and generally made regular and appropriate use of LLINs, except during overnight travel or when working in agricultural fields. However, HH-level IRS application, which was observed at 632 HHs, did not always follow standard insecticide preparation and safety protocols. Of 1,079 occupied HHs visited by the spray team, 632 (58.6%) refused to allow any spraying. Only 198 (18.4%) HHs agreed to be sprayed, comprising 152 (14.1%) that were only partly sprayed, and 46 (4.3%) that were fully sprayed. Reasons for refusal included: inadequate time to rearrange HH items, young children were present, annoying smell, staining of walls, and threat to bee-keeping or Eri silk moth cultivation.
Conclusions
These findings are among the first in India that independently evaluate people's perceptions and acceptance of ongoing government-sponsored IRS and LLIN programmes for malaria prevention. They represent important insights for achieving India's goal of malaria elimination by 2030.
Læs mere Tjek på PubMed
Malaria Journal, 23.06.2022
Tilføjet 24.06.2022
Abstract
Background
Coronavirus disease 2019 (COVID-19) often causes atypical clinical manifestations similar to other infectious diseases. In malaria-endemic areas, the pandemic situation will very likely result in co-infection of COVID-19 and malaria, although reports to date are still few. Meanwhile, this disease will be challenging to diagnose in areas with low malaria prevalence because the symptoms closely resemble COVID-19.
Case presentation
A 23-year-old male patient presented to the hospital with fever, anosmia, headache, and nausea 1 week before. He was diagnosed with COVID-19 and treated for approximately 10 days, then discharged to continue self-quarantine at home. 2 weeks later, he returned to the hospital with a fever raised intermittently every 2 days and marked by a chilling-fever-sweating cycle. A laboratory test for malaria and a nasopharyngeal swab for SARS CoV-2 PCR were conducted, confirming both diagnoses. The laboratory examination showed markedly elevated D-dimer. He was treated with dihydroartemisinin-piperaquine (DHP) 4 tablets per day for 3 days and primaquine 2 tablets per day for 14 days according to Indonesian National Anti-malarial Treatment Guidelines. After 6 days of treatment, the patient had no complaints, and the results of laboratory tests had improved. This report describes the key points in considering the differential diagnosis and prompt treatment of malaria infection during the pandemic of COVID-19 in an endemic country to prevent the worse clinical outcomes. COVID-19 and malaria may also cause a hypercoagulable state, so a co-infection of those diseases may impact the prognosis of the disease.
Conclusion
This case report shows that considering the possibility of a co-infection in a COVID-19 patient who presents with fever can prevent delayed treatment that can worsen the disease outcome. Paying more attention to a history of travel to malaria-endemic areas, a history of previous malaria infection, and exploring anamnesis regarding the fever patterns in patients are important points in making a differential diagnosis of malaria infection during the COVID-19 pandemic.
Læs mere Tjek på PubMed
Molaei G, Eisen L, Price K, et al.
Journal of Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractNative and invasive tick species pose a serious public health concern in the United States. Range expansion of several medically important tick species has resulted in an increasing number of communities at risk for exposure to ticks and tickborne pathogens.
Læs mere Tjek på PubMedCunningham C, Karron R, Muresan P, et al.
Journal of Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
ABSTRACTBackgroundThis United States-based study compared two candidate vaccines: RSV/ΔNS2/Δ1313/I1314L, attenuated by NS2 gene-deletion and temperature-sensitivity mutation in the polymerase gene; and RSV/276, attenuated by M2-2 deletion.MethodsRSV-seronegative children aged 6-24 months received RSV/ΔNS2/Δ1313/I1314L [106 plaque-forming units (PFU)], RSV/276 [105 PFU] or placebo intranasally. Participants were monitored for vaccine shedding, reactogenicity, and RSV serum antibodies, and followed over the subsequent RSV-season.ResultsEnrollment occurred September 2017-October 2019. During 28 days post-inoculation, upper respiratory illness (URI) and/or fever occurred in 64% of RSV/ΔNS2/Δ1313/I1314L, 84% RSV/276, and 58% placebo recipients. Symptoms were generally mild. Cough was more common in RSV/276 recipients than RSV/ΔNS2/Δ1313/I1314L (48% v. 12%; p = 0.012) or placebo recipients (17%; p = 0.084). There were no lower respiratory illness or serious adverse events. Eighty-eight and 96% of RSV/ΔNS2/Δ1313/I1314L and RSV/276 recipients were infected with vaccine (shed vaccine and/or had ≥4-fold rises in RSV antibodies). Serum RSV-neutralizing titers and anti-RSV F IgG titers increased ≥4-fold in 60% and 92% of RSV/ΔNS2/Δ1313/I1314L and RSV/276 vaccinees, respectively. Exposure to community RSV during the subsequent winter was associated with strong anamnestic RSV-antibody responses.ConclusionsBoth vaccines had excellent infectivity and were well-tolerated. RSV/276 induced an excess of mild cough. Both vaccines were immunogenic and primed for strong anamnestic responses.
Læs mere Tjek på PubMedVarese A, Mazzitelli B, Díaz F, et al.
Journal of Infectious Diseases, 20.06.2022
Tilføjet 24.06.2022
AbstractInfection by the SARS-CoV-2 variant Omicron is usually asymptomatic or mild and appears to be poorly immunogenic at least in unvaccinated individuals. Here, we found that healthcare workers vaccinated with two doses of Sputnik V and a booster dose of ChAdOx1 mount a vigorous neutralizing-antibody response after Omicron breakthrough infection.
Læs mere Tjek på PubMedGuirakhoo F, Wang S, Wang C, et al.
Journal of Infectious Diseases, 20.06.2022
Tilføjet 24.06.2022
AbstractThe highly transmissible Omicron variant has caused high rates of breakthrough infections in those previously vaccinated with ancestral strain COVID-19 vaccines. Here, we demonstrate that a booster dose of UB-612 vaccine candidate delivered 7-9 months after primary vaccination increased neutralizing antibody levels by 131-, 61- and 49-fold against ancestral SARS-CoV-2, Omicron BA.1, and BA.2 variants, respectively. Based on the RBD protein-binding antibody responses, the UB-612 third dose booster may lead to an estimated ∼95% efficacy against symptomatic COVID-19 caused by the ancestral strain. Our results support UB-612 as a potential potent booster against current and emerging SARS-CoV-2 variants.
Læs mere Tjek på PubMedBoucau J, Uddin R, Marino C, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractWe enrolled seven individuals with recurrent symptoms or antigen test conversion following nirmatrelvir-ritonavir treatment. High viral loads (median 6.1 log10 copies/mL) were detected after rebound for a median of 17 days after initial diagnosis. Three had culturable virus for up to 16 days after initial diagnosis. No known resistance-associated mutations were identified.
Læs mere Tjek på PubMedBouton T, Atarere J, Turcinovic J, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractBackgroundIn January 2022, United States guidelines shifted to recommend isolation for 5 days from symptom onset, followed by 5 days of mask wearing. However, viral dynamics and variant and vaccination impact on culture conversion are largely unknown.MethodsWe conducted a longitudinal study on a university campus, collecting daily anterior nasal swabs for at least 10 days for RT-PCR and culture, with antigen rapid diagnostic testing (RDT) on a subset. We compared culture positivity beyond day 5, time to culture conversion, and cycle threshold trend when calculated from diagnostic test, from symptom onset, by SARS-CoV-2 variant, and by vaccination status. We evaluated sensitivity and specificity of RDT on days 4-6 compared to culture.ResultsAmong 92 SARS-CoV-2 RT-PCR positive participants, all completed the initial vaccine series, 17 (18.5%) were infected with Delta and 75 (81.5%) with Omicron. Seventeen percent of participants had positive cultures beyond day 5 from symptom onset with the latest on day 12. There was no difference in time to culture conversion by variant or vaccination status. For 14 sub-study participants, sensitivity and specificity of day 4-6 RDT were 100% and 86% respectively.ConclusionsThe majority of our Delta- and Omicron-infected cohort culture-converted by day 6, with no further impact of booster vaccination on sterilization or cycle threshold decay. We found that rapid antigen testing may provide reassurance of lack of infectiousness, though guidance to mask for days 6-10 is supported by our finding that 17% of participants remained culture positive after isolation.
Læs mere Tjek på PubMedOhlsen E, Yankey D, Pezzi C, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractThe National Immunization Survey Adult COVID Module used a random-digit-dialed phone survey during April 22, 2021–January 29, 2022 to quantify COVID-19 vaccination, intent, attitudes, and barriers by detailed race/ethnicity, interview language, and nativity. Foreign-born respondents overall and within racial/ethnic categories had higher vaccination coverage (80.9%), higher intent to be vaccinated (4.2%), and lower hesitancy towards COVID-19 vaccination (6.0%) than US-born respondents (72.6%, 2.9%, and 15.8%, respectively). Vaccination coverage was significantly lower for certain subcategories of national origin or heritage (e.g., Jamaican (68.6%), Haitian (60.7%), Somali (49.0%) in weighted estimates). Respondents interviewed in Spanish had lower vaccination coverage than interviewees in English but higher intent to be vaccinated and lower reluctance. Collection and analysis of nativity, detailed race/ethnicity and language information allow identification of disparities among racial/ethnic subgroups. Vaccination programs could use such information to implement culturally and linguistically appropriate focused interventions among communities with lower vaccination coverage.
Læs mere Tjek på PubMedGoodman K, Baghdadi J, Magder L, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
ABSTRACTBackgroundEmpiric antibiotic use among hospitalized U.S. adults is largely undescribed. Identifying factors associated with broad-spectrum empiric therapy may inform antibiotic stewardship interventions and facilitate benchmarking.MethodsWe performed a retrospective cohort study of adults discharged in 2019 from 928 hospitals in the Premier Healthcare Database. “Empiric” Gram-negative antibiotics were defined by administration before Day 3 of hospitalization. Multivariable logistic regression models with random-effects by hospital were used to evaluate associations between patient and hospital characteristics and empiric receipt of broad-spectrum, compared to narrow-spectrum, Gram-negative antibiotics.Results2,928,657 of 8,017,740 (37%) hospitalized adults received empiric Gram-negative antibiotics. Among 1,781,306 who received broad-spectrum therapy, 30% did not have a common infectious syndrome present-on-admission (pneumonia, urinary tract infection, sepsis, or bacteremia), or surgery or an ICU stay in the empiric window. Holding other factors constant, males were 22% more likely (aOR 1.22, 95% CI: 1.22–1.23), and all non-White racial groups were 6%-13% less likely (aOR range: 0.87–0.94), to receive broad-spectrum therapy. There were significant prescribing differences by region, with the highest adjusted odds of broad-spectrum therapy in the U.S. West South Central. Even after model adjustment, there remained substantial inter-hospital variability: among patients receiving empiric therapy, the probability of receiving broad-spectrum antibiotics varied as much as 34 + percentage-points due solely to the admitting hospital (95% interval of probabilities: 43% - 77%).ConclusionsEmpiric Gram-negative antibiotic use is highly variable across U.S. regions, and there is high, unexplained inter-hospital variability. Sex and racial disparities in the receipt of broad-spectrum therapy warrant further investigation.
Læs mere Tjek på PubMedTemte J, Barlow S, Temte E, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractBackgroundConcurrent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and another respiratory virus in individuals can document contemporaneous circulation. We used an ongoing, community-based study of school-aged children and their households to evaluate SARS-CoV-2 co-detections with other respiratory viruses in a non-medically attended population over a two-year period.MethodsHousehold enrollment was predicated on an acute respiratory illness in a child residing in that household who was also a kindergarten through 12th grade student in the participating school district. Demographic, symptom and household composition data, and self-collected nasal specimens were obtained on the recruitment day, and 7 and 14 days later, from the index child and all other household members. All specimens were tested for SARS-CoV-2/influenza A/B by RT-PCR. Day 0 specimens from the index children were simultaneously tested for 17 viruses using a commercial respiratory pathogen panel (RPP). To assess viral co-detections involving SARS-CoV-2, all household specimens were tested via RPP if the index child’s Day 0 specimen tested positive to any of the 17 viral targets in RPP and any household member tested positive for SARS-CoV-2.ResultsOf 2,109 participants (497 index children in 497 households with 1,612 additional household members), two (0.1%) were positive for both SARS-CoV-2 and influenza A; an additional 11 (0.5%) were positive for SARS-CoV-2 and another RPP-covered respiratory virus. Co-detections predominantly affected school-aged children (12 out of 13 total) and were noted in 11 of 497 households.ConclusionsSARS-CoV-2 co-detections with other respiratory viruses were uncommon and predominated in school-aged children.
Læs mere Tjek på PubMedHeysell S, Mpagama S, Ogarkov O, et al.
Clinical Infectious Diseases, 22.06.2022
Tilføjet 24.06.2022
AbstractBackgroundTreatment of rifampin-resistant and/or multidrug-resistant tuberculosis (RR/MDR-TB) requires multiple drugs and outcomes remain suboptimal. Some drugs are associated with improved outcome, however whether particular pharmacokinetic-pharmacodynamic relationships predict outcome is unknown.MethodsAdults with pulmonary RR/MDR-TB in Tanzania, Bangladesh and Russian Federation receiving therapy with local regimens were enrolled from June, 2016 to July, 2018. Serum was collected after two, four, and eight weeks for each drug’s area under the concentration-time curve (AUC0-24) and quantitative susceptibility of the Mycobacterium tuberculosis isolate measured by minimum inhibitory concentrations (MIC). Individual drug AUC0-24/MIC targets were assessed by adjusted odds ratios (OR) for association with favorable treatment outcome and hazard ratios (HR) for time to sputum culture conversion. K-means clustering algorithm separated the cohort of the most common multidrug regimen into four clusters by AUC0-24/MIC exposures.ResultsAmong 290 patients, 62 (21%) experienced treatment failure, including 30 deaths. Moxifloxacin AUC0-24/MIC target of 58 was associated with favorable treatment outcome [OR 3.75 (1.21, 11.56), p = 0·022], while levofloxacin AUC0-24/MIC of 118.3, clofazimine AUC0-24/MIC of 50.5, and pyrazinamide AUC0-24 of 379 mg*h/L were associated with faster culture conversion [HR > 1·0, p < 0.05]. Other individual drug exposures were not predictive. Clustering by AUC0-24/MIC revealed those with lowest multidrug exposures had slowest culture conversion.ConclusionAmidst multidrug regimens for RR/MDR-TB, serum pharmacokinetics and M. tuberculosis MICs were variable, yet defined parameters to certain drugs – fluoroquinolones, pyrazinamide, clofazimine – were predictive and should be optimized to improve clinical outcome.
Læs mere Tjek på PubMedKamau A, Musau M, Mwakio S, et al.
Clinical Infectious Diseases, 22.06.2022
Tilføjet 24.06.2022
AbstractBackgroundIntermittent preventive treatment (IPTp) to pregnant women with sulfadoxine–pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining and there are concerns that IPTp may have reduced impact in areas of high resistance. Here we sought to determine the protection afforded by SP as part of IPTp against birth outcomes in an area with high levels of SP resistance on the Kenyan coast.MethodsA secondary analysis of surveillance data on deliveries at the Kilifi County hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths.ResultsAmong 27,786 deliveries, three or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio (aOR): 0.73; 95% CI: 0.64, 0.83; p < 0.001) compared to no-dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR: 0.79; 95% CI: 0.65, 0.97; p= 0.044) compared to women who did not take any dose of IPTp-SP.ConclusionsThe continued, significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.
Læs mere Tjek på PubMedMangalore R, Ashok A, Lee S, et al.
Clinical Infectious Diseases, 22.06.2022
Tilføjet 24.06.2022
ABSTRACTTherapeutic drug monitoring (TDM) of beta-lactam antibiotics is recommended to address the variability in exposure observed in critical illness. However, the impact of TDM-guided dosing on clinical outcomes remains unknown. We conducted systematic review and meta-analysis on TDM-guided dosing and clinical outcomes (all-cause mortality, clinical cure, microbiological cure, treatment failure, hospital and ICU length of stay, target attainment, antibiotic-related adverse events, and emergence of resistance) in critically ill patients with suspected or proven sepsis. Eleven studies (n = 1463 participants) were included. TDM-guided dosing was associated with improved clinical cure (Relative Risk 1.17; 95% Confidence Interval [1.04, 1.31]), microbiological cure (1.14; [1.03, 1.27]), treatment failure (0.79; [0.66, 0.94]), and target attainment (1.85; [1.08, 3.16]). No associations with mortality and length of stay were found. TDM-guided dosing improved clinical and microbiological cure, and treatment response. Larger, prospective randomized trials are required to better assess the utility of beta-lactam TDM in critically ill patients.
Læs mere Tjek på PubMedWebster R, Mitchell H, Peters J, et al.
Clinical Infectious Diseases, 22.06.2022
Tilføjet 24.06.2022
AbstractBackgroundBlocking the transmission of parasites from humans to mosquitoes is a key component of malaria control. Tafenoquine exhibits activity against all stages of the malaria parasite and may have utility as a transmission blocking agent. We aimed to characterize the transmission blocking activity of low dose tafenoquine.MethodsHealthy adults were inoculated with P. falciparum 3D7-infected erythrocytes on day 0. Piperaquine was administered on days 9 and 11 to clear asexual parasitemia while allowing gametocyte development. A single 50 mg oral dose of tafenoquine was administered on day 25. Transmission was determined by enriched membrane feeding assays pre-dose and at 1, 4 and 7 days post-dose. Artemether-lumefantrine was administered following the final assay. Outcomes were the reduction in mosquito infection and gametocytemia post-tafenoquine, and safety parameters.ResultsSix participants were enrolled, and all were infective to mosquitoes pre-tafenoquine, with a median 86% (range: 22–98) of mosquitoes positive for oocysts and 57% (range: 4–92) positive for sporozoites. By day 4 post-tafenoquine, the oocyst and sporozoite positivity rate had reduced by a median 35% (IQR: 16–46) and 52% (IQR: 40–62), respectively, and by day 7, 81% (IQR 36–92) and 77% (IQR 52–98), respectively. The decline in gametocyte density post-tafenoquine was not significant. No significant participant safety concerns were identified.ConclusionLow dose tafenoquine (50 mg) reduces P. falciparum transmission to mosquitoes, with a delay in effect.
Læs mere Tjek på PubMedJunho Cho, William F. C. Rigby, Ambrose L. Cheung
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Junho Cho, William F. C. Rigby, Ambrose L. Cheung
Patients with cystic fibrosis (CF) often suffer recurrent bronchial bacterial infections that lead to deterioration of lung function over time. The infections in CF patients are often due to S. aureus and P. aeruginosa that colonize the airways. Significantly, methicillin-resistant S. aureus (MRSA) makes it challenging for treatment in CF patients due to its feature of multiple antibiotic resistance. In bronchial airways, cationic antimicrobial peptides are often present in mucosa cells, neutrophils, and macrophages that interfere with bacterial proliferation. The major mechanism for resistance to the bactericidal activity of cationic peptides in S. aureus is mediated by the GraRS two-component system that activates expression of MprF and DltABCD to increase surface positive charge to repel interactions with cationic peptides. We recently found that VraG, a membrane permease component of the VraFG efflux pumps, harbors a long 200-residue extracellular loop (EL) that utilizes K380 to interact with the negatively charged 9-residue extracellular loop of the membrane sensor GraS to control mprF expression in a community-acquired MRSA strain JE2. In this study, we extended this observation to a CF MRSA strain CF32A1 where we affirmed that the EL loop of VraG controls GraS-mediated signal transduction; however, in contrast to community acquired MRSA strain JE2, the CF MRSA strain CF32A1 requires both K380 and K388 in the EL of VraG to properly modulate signal transduction mediated by GraS. This effect was not attributable to the several single nucleotide polymorphisms that exist between VraG and GraS in the two MRSA strains.
Læs mere Tjek på PubMedMuluneh Ademe, Tadesse Kebede, Solomon Teferra, Melkam Alemayehu, Friehiwot Girma, Tamrat Abebe
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Muluneh Ademe, Tadesse Kebede, Solomon Teferra, Melkam Alemayehu, Friehiwot Girma, Tamrat Abebe
Introduction Neurotropic pathogens such as Toxoplasma gondii (T. gondii) which result in chronic infections in the brain are associated with mental illnesses. In view of this, a growing body of literature has revealed the possible interaction of schizophrenia and T. gondii infection. Method A case-control study was conducted from February 2018 to January 2019 among 47 Schizophrenia patients and 47 age and sex-matched controls. Data was collected using a structured questionnaire. Serum was used for serological analysis of anti-T. gondii IgG and IgM antibodies through chemiluminescent immunoassay. Proportions and mean with standard deviations (SD) were used as descriptive measures and variables with p-values
Læs mere Tjek på PubMedJessica Mooney, Jessica Price, Carolyn Bain, John Tanko Bawa, Nikki Gurley, Amresh Kumar, Guwani Liyanage, Rouden Esau Mkisi, Chris Odero, Karim Seck, Evan Simpson, William P. Hausdorff
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Jessica Mooney, Jessica Price, Carolyn Bain, John Tanko Bawa, Nikki Gurley, Amresh Kumar, Guwani Liyanage, Rouden Esau Mkisi, Chris Odero, Karim Seck, Evan Simpson, William P. Hausdorff
Background Live oral rotavirus vaccines (LORVs) have significantly reduced rotavirus hospitalizations and deaths worldwide. However, LORVs are less effective in low- and middle-income countries (LMICs). Next-generation rotavirus vaccines (NGRVs) may be more effective but require administration by injection or a neonatal oral dose, adding operational complexity. Healthcare providers (HPs) were interviewed to assess rotavirus vaccine preferences and identify delivery issues as part of an NGRV value proposition. Objective Determine HP vaccine preferences about delivering LORVs compared to injectable (iNGRV) and neonatal oral (oNGRV) NGRVs. Methods 64 HPs from Ghana, Kenya, Malawi, Peru, and Senegal were interviewed following a mixed-method guide centered on three vaccine comparisons: LORV vs. iNGRV; LORV vs. oNGRV; oNGRV vs. iNGRV. HPs reviewed attributes for each vaccine in the comparisons, then indicated and explained their preference. Additional questions elicited views about co-administering iNGRV+LORV for greater public health impact, a possible iNGRV-DTP-containing combination vaccine, and delivering neonatal doses. Results Almost all HPs preferred oral vaccine options over iNGRV, with many emphasizing an aversion to additional injections. Despite this strong preference, HPs described challenges delivering oral doses. Preferences for LORV vs. oNGRV were split, marked by disparate views on rotavirus disease epidemiology and the safety, need, and feasibility of delivering neonatal vaccines. Although overwhelmingly enthusiastic about an iNGRV-DTP-containing combination option, several HPs had concerns. HP views were divided on the feasibility of co-administering iNGRV+LORV, citing challenges around logistics and caregiver sensitization. Conclusion Our findings provide valuable insights on delivering NGRVs in routine immunization. Despite opposition to injectables, openness to co-administering LORV+iNGRV to improve efficacy suggests future HP support of iNGRV if adequately informed of its advantages. Rationales for LORV vs. oNGRV underscore needs for training on rotavirus epidemiology and stronger service integration. Expressed challenges delivering existing LORVs merit further examination and indicate need for improved delivery.
Læs mere Tjek på PubMedPhimon Atsawasuwan, Dhammacari Martin Del Campo, Laura Martin Del Campo, Grace Viana, Sriram Ravindran, Veerasathpurush Allareddy, Shrihari Kadkol
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Phimon Atsawasuwan, Dhammacari Martin Del Campo, Laura Martin Del Campo, Grace Viana, Sriram Ravindran, Veerasathpurush Allareddy, Shrihari Kadkol
COVID-19 has impacted and increased risks for healthcare providers, including orthodontists. There is no information regarding the potential transmission risks in the orthodontic community. This study aims to compare the positivity rate of SARS-CoV-2 infection in orthodontic patients at the University of Illinois Chicago (UIC) orthodontic clinic to the positivity rate of the local population in Chicago. All orthodontic patients who sought treatment at the UIC orthodontic clinic from June 16 to October 31, 2021, were invited to participate in the study. Three milliliters of saliva from the participants were collected in the sample collection tubes and subjected to a polymerase chain reaction (PCR) based assay to detect SAR-CoV-2. All participants’ age, sex, history of COVID-19 infection, and vaccination status were recorded. The COVID-19 positivity rates of Chicago, Cook County of Illinois, and the orthodontic clinic at UIC were compared. One thousand four hundred and thirty-seven orthodontic patients aged 6 to 70 years old (41.8% males and 58.2% females) participated in the study. Among all participants, nine participants tested positive for SARS-CoV-2 (5 males and 4 females). During the study, the average COVID-19 positivity rate at the UIC orthodontic clinic was 0.626%. All of the positive participants were asymptomatic, and two of the participants had a history of COVID-19 infection. Among all positive participants, three participants had received complete COVID-19 vaccination. An increased frequency of positive cases at the orthodontic clinic was observed during the time of high positivity rate in Chicago and Cook County. A potential risk of COVID-19 transmission from patients to orthodontic providers remains, even with asymptomatic and vaccinated patients.
Læs mere Tjek på PubMedJun Seung Lee, Kyung Hoon Sun, Yongjin Park
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Jun Seung Lee, Kyung Hoon Sun, Yongjin Park
Background In this study, a hydrogel comprising poly (vinyl alcohol)/pectin (PVA/PET) was prepared by the addition of Melia azedarach extract for epithelial restoration. M. azedarach extract (MAE) contains volatile organic plant-derived compounds with antimicrobial properties. MAE has a variety of physiological properties, including antimicrobial, insecticidal, and anti-inflammatory activity. This study aimed to investigate whether MAE-loaded PVA/PET hydrogels have protective effects against burn wound healing. Methods and findings To mix M. azedarach with the gel, nanoparticles containing M. azedarach were prepared using chitosan/maltodextrin as the wall material. A PVA/PET hydrogel containing M. azedarach was developed and its applicability as a wound dressing was evaluated. In the in vitro scratch assay, MAE treatment showed a scratch recovery-promoting effect comparable to that of the positive control TGF-β1. The MAE-PVA/PET hydrogel was found to be non-toxic, and the antibacterial activity of the hydrogel was excellent against both gram-positive and gram-negative bacteria. Furthermore, as the formulated hydrogel demonstrated strong antimicrobial activity, its wound-healing efficacy was investigated in vivo using a rat model. Conclusion MAE was found to be effective against burn wounds and to have antimicrobial activity in vitro and in vivo.
Læs mere Tjek på PubMedJohn Bosco Isunju, Solomon Tsebeni Wafula, Rawlance Ndejjo, Rebecca Nuwematsiko, Pamela Bakkabulindi, Aisha Nalugya, James Muleme, Winnie Kansiime Kimara, Simon P. S. Kibira, Joana Nakiggala, Richard K. Mugambe, Esther Buregyeya, Tonny Ssekamatte, Rhoda K. Wanyenze
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by John Bosco Isunju, Solomon Tsebeni Wafula, Rawlance Ndejjo, Rebecca Nuwematsiko, Pamela Bakkabulindi, Aisha Nalugya, James Muleme, Winnie Kansiime Kimara, Simon P. S. Kibira, Joana Nakiggala, Richard K. Mugambe, Esther Buregyeya, Tonny Ssekamatte, Rhoda K. Wanyenze
Background Healthcare providers (HCPs) are at an elevated occupational health risk of hepatitis B virus infections. Post-exposure prophylaxis (PEP) is one of the measures recommended to avert this risk. However, there is limited evidence of HCPs’ awareness of hepatitis B PEP. Therefore, this study aimed to establish awareness of hepatitis B PEP among HCPs in Wakiso, a peri-urban district that surrounds Uganda’s capital, Kampala. Methods A total of 306 HCPs, selected from 55 healthcare facilities (HCFs) were interviewed using a validated structured questionnaire. The data were collected and entered using the Kobo Collect mobile application. Multivariable binary logistic regression was used to establish the factors associated with awareness of hepatitis B PEP. Results Of the 306 HCPs, 93 (30.4%) had ever heard about hepatitis B PEP and 16 (5.2%) had ever attended training where they were taught about hepatitis B PEP. Only 10.8% were aware of any hepatitis B PEP options, with 19 (6.2%) and 14 (4.6%) mentioning hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine, respectively as PEP options. Individuals working in the maternity department were less likely to be aware of hepatitis B PEP (AOR = 0.10, 95% CI = 0.02–0.53). There was a positive association between working in a healthcare facility in an urban setting and awareness of hepatitis B PEP (AOR = 5.48, 95% CI = 1.42–21.20). Hepatitis B screening and vaccination were not associated with awareness of PEP. Conclusions Only one-tenth of the HCPs were aware of any hepatitis B PEP option. Awareness of hepatitis B PEP is associated with the main department of work and working in a healthcare facility in an urban setting. This study suggests a need to sensitise HCPs, especially those in rural HCFs and maternity wards on hepatitis B PEP. The use of innovative strategies such as e-communication channels, including mobile text messaging might be paramount in bridging the awareness gap.
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