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Travel to far-flung, global locations is growing in popularity. Prepare your patients for safe and healthy international travel with these five things to remember.
Bacterial STIs increased in incidence when men who have sex with men began using HIV preexposure prophylaxis (PrEP) medications, a study found.
Mari Morgan, Vicky Watts, David Allen, Daniele Curtis, Amir Kirolos, Neil Macdonald, Ellie Maslen, Deb Morgan, Ayoub Saei, James Sedgwick, Janet Stevenson, Deborah Turbitt, Roberto Vivancos, Catriona Waugh, Chris Williams and Valerie Decraene
During October and November 2016, over 1,000 customers and staff reported gastroenteritis after eating at all 23 branches of a restaurant group in the United Kingdom. The outbreak coincided with a new menu launch and norovirus was identified as the causative agent. We conducted four retrospective cohort studies; one among all restaurant staff and three in customers at four branches. We investigated the dishes consumed, reviewed recipes, interviewed chefs and inspected restaurants to identify common ingredients and preparation methods for implicated dishes. Investigations were complicated by three public health agencies concurrently conducting multiple analytical studies, the complex menu with many shared constituent ingredients and the high media attention. The likely source was a contaminated batch of a nationally distributed ingredient, but analytical studies were unable to implicate a single ingredient. The most likely vehicle was a new chipotle chilli product imported from outside the European Union, that was used uncooked in the implicated dishes. This outbreak exemplifies the possibility of rapid spread of infectious agents within a restaurant supply chain, following introduction of a contaminated ingredient. It underlines the importance of appropriate risk assessments and control measures being in place, particularly for new ingredients and ready-to-eat foods.
On 26 June 2018, an outbreak of circulating vaccine-derived poliovirus type 1 (cVDPV1) was declared in Papua New Guinea following laboratory confirmation of cVDPV1 isolation in two healthy community contacts of the index case. Since the declaration, a total of 26 confirmed cVDPV1 cases have been reported in the following nine provinces: Eastern Highlands (six), Enga (five), East Sepik (four), Madang (three), Morobe (three), Jiwaka (two), Gulf (one), Southern Highlands (one), and National Capital District (NCD) (one). The last laboratory-confirmed case reported having experienced the onset of paralysis in late October 2018. Environmental surveillance continues on a bimonthly basis in Port Moresby and Lae to complement active acute flaccid paralysis (AFP) case search efforts. To date, there have been five rounds of Supplementary Immunisation Activities (SIA) conducted from July to December 2018. Consultants from WHO and UNICEF have been deployed to provide technical support during pre-campaign preparations and implementation to ensure high quality SIAs and improve AFP case detection. The first round of SIA targeted children under five years of age in three high-risk provinces. The second round included children under five years of age in all nine provinces. The third and fourth rounds of SIA included National Immunisation Days (NIDs) which were aimed at children less than 15 years of age and achieved a coverage of 93% and 97% respectively. The fifth round of SIA was a sub-national campaign conducted in four priority provinces (NCD, Central, Enga, and Angoram district in East Sepik province). Planning is currently ongoing for additional NIDs in 2019.
Louise Logan, Ibidun Fakoya, Alison Howarth, Gary Murphy, Anne M Johnson, Alison J Rodger, Fiona Burns and Anthony Nardone
Men who have sex with men (MSM) are at risk of HIV and are an important population to monitor and ameliorate combination prevention efforts.
To estimate HIV prevalence and identify factors associated with frequent HIV testing (≥ 2 HIV tests in the last year) and pre-exposure prophylaxis (PrEP) use among MSM in London.
For this cross-sectional study, MSM recruited from 22 social venues provided oral-fluid samples for anonymous HIV antibody (Ab) testing and completed a questionnaire. Factors associated with frequent HIV testing and PrEP use were identified through logistic regression.
Of 767 men recruited, 545 provided an eligible oral specimen. Among these, 38 MSM (7.0%) were anti-HIV positive including five (13.2%; 5/38) who reported their status as negative. Condomless anal sex within the previous 3 months was reported by 60.1% (412/685) men. Frequent HIV testing was associated with, in the past year, a reported sexually transmitted infection (adjusted odds ratio (AOR): 5.05; 95% confidence interval (CI): 2.66–9.58) or ≥ 2 casual condomless partners (AOR 2–4 partners: 3.65 (95% CI: 1.87–7.10); AOR 5–10 partners: 3.34(95% CI: 1.32–8.49). Age ≥ 35 years was related to less frequent HIV testing (AOR 35–44 years: 0.34 (95% CI: 0.16–0.72); AOR ≥ 45 years: 0.29 (95% CI: 0.12–0.69). PrEP use in the past year was reported by 6.2% (46/744) of MSM and associated with ≥ 2 casual condomless sex partners (AOR: 2.86; 95% CI: 1.17–6.98) or chemsex (AOR: 2.31; 95% CI: 1.09–4.91).
This bio-behavioural study of MSM found high rates of behaviours associated with increased risk of HIV transmission. Combination prevention, including frequent HIV testing and use of PrEP, remains crucial in London.
David A M C van de Vijver, Ann-Kathrin Richter, Charles A B Boucher, Barbara Gunsenheimer-Bartmeyer, Christian Kollan, Brooke E Nichols, Christoph D Spinner, Jürgen Wasem, Knud Schewe and Anja Neumann
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-who-have-sex-with-men (MSM). The high cost of PrEP has until recently been a primary barrier to its use. In 2017, generic PrEP became available, reducing the costs by 90%.
Our objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.
We calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV) epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective using a 40-year time horizon starting in 2018.
PrEP can avert 21,000 infections (interquartile range (IQR): 16,000–27,000) in the short run (after 2 years scale-up and 10 years full implementation). HIV care is predicted to cost EUR 36.2 billion (IQR: 32.4–40.4 billion) over the coming 40 years. PrEP can increase costs by at most EUR 150 million within the first decade after introduction. Ten years after introduction, PrEP can become cost-saving, accumulating to savings of HIV-related costs of EUR 5.1 billion (IQR: 3.5–6.9 billion) after 40 years. In a sensitivity analysis, PrEP remained cost-saving even at a 70% price reduction of antiretroviral drug treatment and a lower effectiveness of PrEP.
Introduction of PrEP in Germany is predicted to result in substantial health benefits because of reductions in HIV infections. Short-term financial investments in providing PrEP will result in substantial cost-savings in the long term.
Jukka-Pekka Pietilä, Taru Meri, Heli Siikamäki, Elisabet Tyyni, Anne-Marie Kerttula, Laura Pakarinen, T Sakari Jokiranta and Anu Kantele
Despite the global distribution of the intestinal protozoan Dientamoeba fragilis, its clinical picture remains unclear. This results from underdiagnosis: microscopic screening methods either lack sensitivity (wet preparation) or fail to reveal Dientamoeba (formalin-fixed sample).
In a retrospective study setting, we characterised the clinical picture of dientamoebiasis and compared it with giardiasis. In addition, we evaluated an improved approach to formalin-fixed samples for suitability in Dientamoeba diagnostics.
This study comprised four parts: (i) a descriptive part scrutinising rates of Dientamoeba findings; (ii) a methodological part analysing an approach to detect Dientamoeba-like structures in formalin samples; (iii) a clinical part comparing demographics and symptoms between patients with dientamoebiasis (n = 352) and giardiasis (n = 272), and (iv) a therapeutic part (n = 89 patients) investigating correlation between faecal eradication and clinical improvement.
The rate of Dientamoeba findings increased 20-fold after introducing criteria for Dientamoeba-like structures in formalin-fixed samples (88.9% sensitivity and 83.3% specificity). A further increase was seen after implementing faecal PCR. Compared with patients with giardiasis, the symptoms in the Dientamoeba group lasted longer and more often included abdominal pain, cramping, faecal urgency and loose rather than watery stools. Resolved symptoms correlated with successful faecal eradication (p
Theresa Enkirch, Ettore Severi, Harry Vennema, Lelia Thornton, Jonathan Dean, Maria-Louise Borg, Anna Rita Ciccaglione, Roberto Bruni, Iva Christova, Siew Lin Ngui, Koye Balogun, Vratislav Němeček, Mia Kontio, Mária Takács, Andrea Hettmann, Rita Korotinska, Arthur Löve, Ana Avellón, Milagros Muñoz-Chimeno, Rita de Sousa, Denisa Janta, Jevgenia Epštein, Sofieke Klamer, Vanessa Suin, Stephan W Aberle, Heidemarie Holzmann, Kassiani Mellou, Josefine Lundberg Ederth, Lena Sundqvist, Anne-Marie Roque-Afonso, Sanj
Sequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)-wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive.
The objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses.
In 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases’ samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods.
Of 31 EU/EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths.
While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.
Barbara Bartolini, Cesare EM Gruber, Marion Koopmans, Tatjana Avšič, Sylvia Bino, Iva Christova, Roland Grunow, Roger Hewson, Gulay Korukluoglu, Cinthia Menel Lemos, Ali Mirazimi, Anna Papa, Maria Paz Sanchez-Seco, Aisha V. Sauer, Hervè Zeller, Carla Nisii, Maria Rosaria Capobianchi, Giuseppe Ippolito, Chantal B. Reusken and Antonino Di Caro
Crimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging infectious disease threat in the European Union. Since 2000, the incidence and geographic range of confirmed CCHF cases have markedly increased, following changes in the distribution of its main vector, Hyalomma ticks.
To review scientific literature and collect experts’ opinion to analyse relevant aspects of the laboratory management of human CCHF cases and any exposed contacts, as well as identify areas for advancement of international collaborative preparedness and laboratory response plans.
We conducted a literature review on CCHF molecular diagnostics through an online search. Further, we obtained expert opinions on the key laboratory aspects of CCHF diagnosis. Consulted experts were members of two European projects, EMERGE (Efficient response to highly dangerous and emerging pathogens at EU level) and EVD-LabNet (Emerging Viral Diseases-Expert Laboratory Network).
Consensus was reached on relevant and controversial aspects of CCHF disease with implications for laboratory management of human CCHF cases, including biosafety, diagnostic algorithm and advice to improve lab capabilities. Knowledge on the diffusion of CCHF can be obtained by promoting syndromic approach to infectious diseases diagnosis and by including CCHFV infection in the diagnostic algorithm of severe fevers of unknown origin.
No effective vaccine and/or therapeutics are available at present so outbreak response relies on rapid identification and appropriate infection control measures. Frontline hospitals and reference laboratories have a crucial role in the response to a CCHF outbreak, which should integrate laboratory, clinical and public health responses.
Measles is still spreading in the United States, and clinicians need to prepare for seeing their own first patient.
Dr Paul Sax shares what he thinks is most interesting and useful about the findings that STI risk is elevated in PrEP users.
Anthrax -- Cote d'IvoireCitation: Gogarten JF, Dux A, Mubemba B, et al. Tropical rainforest flies carrying pathogens form stable associations with social non‐human primates. Mol Ecol [prepublication] .AbstractLiving in groups provides benefits but incurs costs such as attracting disease vectors. For example, synanthropic flies associate with human settlements, and higher fly densities increase pathogen transmission. We investigated whether such associations also exist in highly mobile non‐human primate
Ebola -- DR Congo- Since the beginning of vaccination on 8 Aug 2018, 69 827 people have been vaccinated, including 20 241 in Beni, 16 390 in Katwa, 7860 in Butembo, 6008 in Mabalako, 2626 in Kalunguta, 2080 in Komanda, 1911 in Goma, 1755 in Oicha, 1663 in Mandima, 1157 in Karisimbi, 877 in Vuhovi, 873 in Kayina, 842 in Kyondo, 750 in Masereka, 700 in Lubero, 599 in Mutwanga, 560 in Rutshuru, 527 in Nyankunde, 524 in Biena, 442 in Musienene, 434 in Bunia, 355 to Tchomia, 167 to Kirotshe, 125 to Nyiragongo, 114
Ebola -- DR Congo- Since the beginning of vaccination on 8 Aug 2018, 72 248 people have been vaccinated, including 24 435 in Beni [North Kivu], 17 527 in Katwa [North Kivu], 8099 in Butembo [North Kivu], 6008 in Mabalako [North Kivu], 2686 in Kalunguta [North Kivu], 2150 in Komanda [Ituri], 1981 in Goma [North Kivu], 1821 in Oicha [North Kivu], 1663 in Mandima [Ituri], 1157 in Karisimbi [North Kivu], 943 in Kayina [North Kivu], 877 in Vuhovi [North Kivu], 842 in Kyondo [North Kivu], 750 in Masereka [North
Ebola -- DR Congo- In the last 21 days, 97 new cases have been reported. The 3 main households for this period are Katwa (33 cases, or 34%), Masereka (18 cases, or 18.6%), and Mandima (15 cases, or 15.5%).- This increase in cases was expected, given the paralysis of the response in the town of Butembo after the armed attacks against the 2 CTEs. In addition, the community dialogue is starting to bear fruit. We are seeing an increase in alerts reported by the community, which makes it possible to detect
Ebola -- DR Congo- Laboratories play a central role in the response to the Ebola outbreak. The positive result of a sample taken from a patient will trigger a series of interventions around the patient to minimize the risk of contamination of relatives and the spread of the epidemic. These interventions include the transfer of the patient from the transit center to the Ebola treatment center, the vaccination of the patient's contacts, the disinfection of his household and the health centers through which the
Ebola -- DR Congo- The National Institute of Biomedical Research (INRB) and the World Health Organization (WHO) have published preliminary results of a study on the efficacy of the rVSV-ZEBOV-GP vaccine to control the Ebola outbreak. The objective of the study was to better understand if the vaccine was effective and help prevent the number of cases when used as part of the belt vaccination strategy. A more detailed analysis is being prepared and will be published in a scientific journal.- The researchers
Ebola -- DR Congo- Response activities were temporarily paralyzed in Butembo and nearby health areas on Sat 4 May 2019 following a demonstration by motorcycle taxi drivers who had placed wooden barricades on the main road arteries of Butembo town. Protesters also attacked handwashing devices throughout the city.- The day before, Fri 3 May 2019, the teams of safe and dignified burials (EDS [in French]) of the civil protection of North Kivu were called to carry out the EDS of a woman living in Katwa recently
Ebola -- DR CongoIn addition to not paying their risk premiums, the nurses have also lashed out at attacks and violence that they continue to suffer as a result of their involvement in the response to the Ebola virus disease that has already resulted in hundreds of deaths. Thus, they decided to continue the suspension of prevention activities, including prenatal consultation (CPN), preschool consultation (CPS) and routine vaccinations, as it has been for nearly 3 months now in the city of Butembo."The
Ebola -- DR CongoThe attacks are just the latest in a series of violent offensives launched by militant groups in the DRC's North Kivu and Ituri provinces. The provinces are home to more than 1 million displaced persons and dozens of paramilitary and terrorist groups. Throughout the year-long battle against Ebola, violent attacks have shortly been followed by a spike in cases as the attacks temporarily halt disease surveillance and vaccination efforts.The violence has also caused international actors,
Lumpy Skin Disease -- IndiaAn unidentified disease affecting cattle has emerged as a major cause of concern for farmers of Mayurbhanj district [map at ].The worst hit are the marginal farmers of Khunta block. With a few healthy bullocks left in the area, the farmers have to shell out between Rs 1000 and Rs 1400 per hour [USD 13.90 to 19.46] on tractors to prepare their fields for transplanting paddy saplings. However, the poor farmers, who cannot afford to spend on tractors, have not yet started farming activities
Poisoning -- MalaysiaThe Malaysia Ministry of Health is reporting a methanol poisoning cluster believed linked to counterfeit alcohol.For the period of 11-21 Jun 2019, 3 methanol poisoning clusters were reported to the National Crisis Preparedness and Response Center (CPRC). The incidents involved 19 cases from the following states: Penang (8), Johor (6) and Negeri Sembilan (5). The cause of the methanol poisoning was believed to be due to the counterfeit liquor branded by Myanmar Whiskey, Miludeer Beer,
Monkeypox, Hepatitis B, Other Human Disease, Tuberculosis, Zika virus, HIV/AIDS, Rubella, Measles, MRSA, Crimean-Congo Hemorrhagic Fever, Chagas -- NigeriaEditorials and perspectivesMonkeypox -- Enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication eraEskild Petersen, Ibrahim Abubakar, Chikwe Ihekweazu, David Heymann, Francine Ntoumi, Lucille Blumberg, Danny Asogun, Victor Mukonka, Swaib Abubaker Lule, Matthew Bates, Isobella Honeyborne, Sayoki Mfinanga, Peter Mwaba, Osman Dar, Francesco Vairo, Maowia Mukhtar, Richard Kock, Timothy D. McHugh, Giuseppe Ippolito,
Crimean-Congo Hemorrhagic Fever -- PakistanPakistan has faced a number of significant healthcare challenges over the past decade. In 2000, one of these events -- a deadly epidemic of Crimean Congo haemorrhagic fever (CCHF) -- struck Pakistan. The people of Pakistan are at a very high risk of acquiring CCHF, due to a number of factors which emerge from a scoping review of the literature. First, the underdeveloped healthcare system of the country is currently not prepared to cope with challenges of this nature. Healthcare professionals
Not Yet Classified -- Saudi ArabiaThe Hajj, or annual pilgrimage to Mecca, Saudi Arabia, is scheduled for 9-14 Aug 2019, which enables those planning on attending this worldwide event have ample time to appropriately prepare for the trip. The Hajj is one of the world's largest mass gatherings each year and is associated with unique health risks.More than 2 million Muslims from over 183 countries make Hajj each year, with approximately 11 000 Hajj pilgrims traveling from the United States.Before attending the Hajj, both
Meningitis - Neisseria -- NigeriaHighlights:- This is the 9th situation report for 2018/2019 season- The National Technical Working Group for Cerebrospinal Meningitis has been monitoring cases and ensuring preparedness and coordination of response across the states- States in the meningitis belt were formally placed on alert on the 8th of November 2018- As at epi week 6 [ending 9 Feb 2019], 3 new suspected cases [were] reported.- Beginning from 1 Oct 2018 to 12 Feb 2019, a total of 206 suspected cases have been
Polio -- PakistanNew wild poliovirus reported this week:AFP cases: 5Environment: 20New cVDPV poliovirus reported this week:AFP cases: 2Environment: 5Others: 4Headlines- A 2nd cVDPV2 outbreak has been reported in Angola this year ; the earlier outbreak was detected in Lunda Norte province; for which an outbreak response is in progress (in close coordination with DRC). The Global Polio Eradication Initiative (GPEI) Outbreak Preparedness and Response Task Team (OPRTT) is also supporting
Other Plant Disease -- GhanaThe Ghana Cocoa Board (Cocobod) has urged farmers to fully welcome the National Cocoa Rehabilitation Program as they prepare to clear cocoa affected with swollen shoot. Their checks have revealed that out of a total of 1.9 million hectares [about 4.7 million acres] of cocoa farms surveyed, 315 800 hectares [about 780 000 acres] have been affected by the swollen shoot virus disease. The Western North Region alone had 214 500 hectares [about 530 000 acres] of affected farms.Cocobod have
Clinicians should screen adolescents, adults, and pregnant people, and offer PrEP to those at high risk for HIV infection, according to the US Preventive Services Task Force.
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Lumbalpunktur af patienter i blodfortyndende behandling (2019)
Reply to Barner and Bruno-Murtha
23.09.2019Clinical Infectious Diseases Advance Access
False-negative Results of Human Immunodeficiency Virus (HIV) Rapid Testing in HIV Controllers
21.09.2019Clinical Infectious Diseases Advance Access
Resistance of Influenza Virus to Antiviral Medications
20.09.2019Clinical Infectious Diseases Advance Access
Oseltamivir resistance in severe influenza A(H1N1)pdm09 pneumonia and acute respiratory distress syndrome: a French multicenter observational cohort study
20.09.2019Clinical Infectious Diseases Advance Access
Baloxavir marboxil in Japanese pediatric patients with influenza: safety and clinical and virologic outcomes
20.09.2019Clinical Infectious Diseases Advance Access
Hvorfor anbefaler Professor Thomas Benfield artiklen"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvad synes Professor Niels Obel om"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
Hvad synes Professor Thomas Benfield om"Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial."?
Hvad synes Professor Morten Sodemann om"Evidence-based clinical guidelines for immigrants and refugees."?
Hvorfor anbefaler Professor Niels Obel artiklen"Use of statins and risk of AIDS-defining and non-AIDS-defining malignancies among HIV-1 infected patients on antiretroviral therapy."?
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