Ribqa Akhtar, Nayab Mahmood, M. Alam, M. Naeem, S. Zaidi, Salman Sharif, Zainab Khattak, Y. Arshad, A. Khurshid, G. Mujtaba, L. Rehman, M. Angez, S. Shaukat, N. Mushtaq, M. Umair, A. Ikram, M. Salman
BACKGROUND Pakistan is among three countries endemic for wild poliovirus (WPV1) circulation, still struggling for eradication of poliomyelitis. Active clinical and environmental surveillance systems with meticulous laboratory investigations provide insights into poliovirus transmission patterns and genomic diversity to inform decisions for strategic operations required to achieve eradication. METHODS We analyzed epidemiological and virological data at molecular level to comprehend the current epidemiological status of WPV1 in Pakistan during 2015-2017. Stool specimens of AFP patients and sewage samples collected from 60 active environmental sites. Viral culturing, intratypic differentiation by real time-PCR and nucleic acid sequencing of VP1 region of poliovirus genome to determine the genetic relatedness among WPV1 strains were applied. The phylogenetic analysis were done using BEAST v2.3.0 [1] . RESULTS Poliovirus isolates were grouped into eleven distinct clusters which had ≥95% nucleotide homology in VP1 coding region. Most burden of poliovirus was shared by three major reservoirs i.e. Karachi, Peshawar and Quetta block (64.2% in 2015; 75.4% in 2016 and 76.7% in 2017). CONCLUSIONS Environmental surveillance reveals importations and pockets of unimmunized children which dictate intensive target mop-up campaigns in such areas to contain poliovirus transmission. Decrease in number of orphan isolates reflects effective combination of AFP and ES surveillance working in Pakistan. The genetic data reflects sustained transmission within reservoir areas, further expanded by periodic importations to areas of high immunity reflected by immediate termination of imported viruses. However, it is suggestive that Pakistan is at-risk unless the entire country including Afghanistan attain a polio-free status. Improved immunization coverage with high quality surveillance is vital for global certification.
{"title":"Genetic Epidemiology reveals three chronic reservoir areas with recurrent population mobility challenging poliovirus eradication in Pakistan.","authors":"Ribqa Akhtar, Nayab Mahmood, M. Alam, M. Naeem, S. Zaidi, Salman Sharif, Zainab Khattak, Y. Arshad, A. Khurshid, G. Mujtaba, L. Rehman, M. Angez, S. Shaukat, N. Mushtaq, M. Umair, A. Ikram, M. Salman","doi":"10.1093/cid/ciz1037","DOIUrl":"https://doi.org/10.1093/cid/ciz1037","url":null,"abstract":"BACKGROUND\u0000Pakistan is among three countries endemic for wild poliovirus (WPV1) circulation, still struggling for eradication of poliomyelitis. Active clinical and environmental surveillance systems with meticulous laboratory investigations provide insights into poliovirus transmission patterns and genomic diversity to inform decisions for strategic operations required to achieve eradication.\u0000\u0000\u0000METHODS\u0000We analyzed epidemiological and virological data at molecular level to comprehend the current epidemiological status of WPV1 in Pakistan during 2015-2017. Stool specimens of AFP patients and sewage samples collected from 60 active environmental sites. Viral culturing, intratypic differentiation by real time-PCR and nucleic acid sequencing of VP1 region of poliovirus genome to determine the genetic relatedness among WPV1 strains were applied. The phylogenetic analysis were done using BEAST v2.3.0 [1] .\u0000\u0000\u0000RESULTS\u0000Poliovirus isolates were grouped into eleven distinct clusters which had ≥95% nucleotide homology in VP1 coding region. Most burden of poliovirus was shared by three major reservoirs i.e. Karachi, Peshawar and Quetta block (64.2% in 2015; 75.4% in 2016 and 76.7% in 2017).\u0000\u0000\u0000CONCLUSIONS\u0000Environmental surveillance reveals importations and pockets of unimmunized children which dictate intensive target mop-up campaigns in such areas to contain poliovirus transmission. Decrease in number of orphan isolates reflects effective combination of AFP and ES surveillance working in Pakistan. The genetic data reflects sustained transmission within reservoir areas, further expanded by periodic importations to areas of high immunity reflected by immediate termination of imported viruses. However, it is suggestive that Pakistan is at-risk unless the entire country including Afghanistan attain a polio-free status. Improved immunization coverage with high quality surveillance is vital for global certification.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83327060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Comorbidities like diabetes or COPD increase patients' susceptibility to infections, but it is unclear how the onset of comorbidity impacts antibiotic use. We aimed to estimate rates of antibiotic use before and after diagnosis of comorbidity in primary care to identify opportunities for antibiotic stewardship. METHODS We analysed UK primary care records from the Clinical Practice Research Datalink (CPRD) database. Adults registered between 2008-2015 without prior comorbidity diagnoses were eligible for inclusion. Monthly adjusted rates of antibiotic prescribing were estimated for patients with new-onset stroke, coronary heart disease, heart failure, peripheral arterial disease, asthma, chronic kidney disease, diabetes or COPD in the 12 months before and after diagnosis, and for controls without comorbidity. RESULTS 106,540 / 1,071,94 (9.9%) eligible patients were diagnosed with comorbidity. Antibiotic prescribing rates increased 1.9-2.3 fold in the 4-9 months preceding diagnosis of asthma, heart failure and COPD, before declining to stable levels within 2 months after diagnosis. A less marked trend was seen for diabetes (Rate ratio 1.55, 95%-CI: 1.48-1.61). Prescribing rates for patients with vascular conditions increased immediately before diagnosis and remained 30-39% higher than baseline afterwards. Rates of prescribing to controls increased by 17-28% in the months just before and after consultation. CONCLUSIONS Antibiotic prescribing increased rapidly before diagnosis of conditions presenting with respiratory symptoms (COPD, heart failure, asthma), and declined afterwards. This suggests onset of respiratory symptoms may be misdiagnosed as infection. Earlier diagnosis of these comorbidities could reduce avoidable antibiotic prescribing.
{"title":"Antibiotic prescribing before and after the diagnosis of comorbidity: a cohort study using primary care electronic health records.","authors":"P. Rockenschaub, A. Hayward, L. Shallcross","doi":"10.1093/cid/ciz1016","DOIUrl":"https://doi.org/10.1093/cid/ciz1016","url":null,"abstract":"BACKGROUND\u0000Comorbidities like diabetes or COPD increase patients' susceptibility to infections, but it is unclear how the onset of comorbidity impacts antibiotic use. We aimed to estimate rates of antibiotic use before and after diagnosis of comorbidity in primary care to identify opportunities for antibiotic stewardship.\u0000\u0000\u0000METHODS\u0000We analysed UK primary care records from the Clinical Practice Research Datalink (CPRD) database. Adults registered between 2008-2015 without prior comorbidity diagnoses were eligible for inclusion. Monthly adjusted rates of antibiotic prescribing were estimated for patients with new-onset stroke, coronary heart disease, heart failure, peripheral arterial disease, asthma, chronic kidney disease, diabetes or COPD in the 12 months before and after diagnosis, and for controls without comorbidity.\u0000\u0000\u0000RESULTS\u0000106,540 / 1,071,94 (9.9%) eligible patients were diagnosed with comorbidity. Antibiotic prescribing rates increased 1.9-2.3 fold in the 4-9 months preceding diagnosis of asthma, heart failure and COPD, before declining to stable levels within 2 months after diagnosis. A less marked trend was seen for diabetes (Rate ratio 1.55, 95%-CI: 1.48-1.61). Prescribing rates for patients with vascular conditions increased immediately before diagnosis and remained 30-39% higher than baseline afterwards. Rates of prescribing to controls increased by 17-28% in the months just before and after consultation.\u0000\u0000\u0000CONCLUSIONS\u0000Antibiotic prescribing increased rapidly before diagnosis of conditions presenting with respiratory symptoms (COPD, heart failure, asthma), and declined afterwards. This suggests onset of respiratory symptoms may be misdiagnosed as infection. Earlier diagnosis of these comorbidities could reduce avoidable antibiotic prescribing.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"53 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79867861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pneumonia and Electronic Health Records-a window into disease, a mirror of our behavior, or just another streetlight?","authors":"B. Jones, Makoto M. Jones","doi":"10.1093/cid/ciz1053","DOIUrl":"https://doi.org/10.1093/cid/ciz1053","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89214393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tackling Infectious Diarrhea in Hematopoietic Cell Transplantation.","authors":"Jennifer L. Saullo, C. Polage","doi":"10.1093/cid/ciz1072","DOIUrl":"https://doi.org/10.1093/cid/ciz1072","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"243 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75993890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Cowling, Ranawaka A.P.M Perera, V. Fang, D. Chu, A. P. Hui, Anita P C Yeung, J. Peiris, W. Wong, E. L. Chan, S. Chiu
BACKGROUND Studies that correlate maternal antibodies with protection from influenza A or B virus infection in young infants in areas with prolonged influenza circulation are lacking. METHODS We conducted a prospective, observational study to evaluate the effects of maternal-transferred antibodies against influenza A and B viruses against laboratory-confirmed influenza in a cohort born over 24 months. Cord blood samples were retrieved at birth and infants were actively followed for the first 6 months of life. Nasal swabs were collected and tested for influenza A and B by RT-PCR whenever an illness episode was identified. Cord blood samples were tested by the hemagglutination inhibition (HAI) assay to viruses that circulated during the follow-up period. RESULTS 1162 infants were born to 1140 recruited women: 1092 (94%) infants completed 6 months of follow-up. Proportions of cord blood with HAI antibodies titers ≥40 against A(H1N1), A(H3N2), B/Victoria and B/Yamagata were 31%, 24%, 31% and 54%, respectively. Only 4% of women had maternal influenza vaccination. Cord blood antigen-specific HAI titers ≥40 were found to correlate with protection from infection only for influenza B/Yamagata. No influenza B virus infection occurred in infants ≤60 days of life. Proportional hazards analysis showed that a cord blood HAI titer of 40 was associated with 83% (95% confidence interval: 44%, 95%) reduction in the risk of influenza B/Yamagata infections compared to a cord blood titer <10. CONCLUSIONS We documented that maternal immunity against influenza B/Yamagata was conferred to infants within the first 6 months of life.
{"title":"Maternal antibodies against influenza in cord blood and protection against laboratory-confirmed influenza in infants.","authors":"B. Cowling, Ranawaka A.P.M Perera, V. Fang, D. Chu, A. P. Hui, Anita P C Yeung, J. Peiris, W. Wong, E. L. Chan, S. Chiu","doi":"10.1093/cid/ciz1058","DOIUrl":"https://doi.org/10.1093/cid/ciz1058","url":null,"abstract":"BACKGROUND\u0000Studies that correlate maternal antibodies with protection from influenza A or B virus infection in young infants in areas with prolonged influenza circulation are lacking.\u0000\u0000\u0000METHODS\u0000We conducted a prospective, observational study to evaluate the effects of maternal-transferred antibodies against influenza A and B viruses against laboratory-confirmed influenza in a cohort born over 24 months. Cord blood samples were retrieved at birth and infants were actively followed for the first 6 months of life. Nasal swabs were collected and tested for influenza A and B by RT-PCR whenever an illness episode was identified. Cord blood samples were tested by the hemagglutination inhibition (HAI) assay to viruses that circulated during the follow-up period.\u0000\u0000\u0000RESULTS\u00001162 infants were born to 1140 recruited women: 1092 (94%) infants completed 6 months of follow-up. Proportions of cord blood with HAI antibodies titers ≥40 against A(H1N1), A(H3N2), B/Victoria and B/Yamagata were 31%, 24%, 31% and 54%, respectively. Only 4% of women had maternal influenza vaccination. Cord blood antigen-specific HAI titers ≥40 were found to correlate with protection from infection only for influenza B/Yamagata. No influenza B virus infection occurred in infants ≤60 days of life. Proportional hazards analysis showed that a cord blood HAI titer of 40 was associated with 83% (95% confidence interval: 44%, 95%) reduction in the risk of influenza B/Yamagata infections compared to a cord blood titer <10.\u0000\u0000\u0000CONCLUSIONS\u0000We documented that maternal immunity against influenza B/Yamagata was conferred to infants within the first 6 months of life.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82599053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Leruez-Ville, T. Guilleminot, J. Stirnemann, L. Salomon, E. Spaggiari, V. Faure-Bardon, J. Magny, Y. Ville
BACKGROUND In women seronegative before pregnancy, cCMV related sequelae are exclusively seen in those infected in the first trimester of pregnancy. Up to 30% of infected neonates following maternal primary infection in the first trimester suffer long-term sequelae. Maternal parity is an established risk factor of cCMV in previously seronegative women. OBJECTIVE to quantify the risk of cCMV and related sequelae following primary infection in the first trimester in subsequent pregnancies in a population of women seronegative at their first pregnancy. METHODS 739 women seronegative at their first pregnancy had at least one of 971 subsequent pregnancies and deliveries managed at our institution. All women had CMV IgG and IgM testing at 11-14 weeks' of each pregnancy. RESULTS 15.6% (115/739) of women seroconverted between 2 consecutive pregnancies. 29% (33/115) of seroconversions occurred in the periconceptional period or in the first trimester. The risks for cCMV and related sequelae (neurologic and/or hearing loss) following maternal infection in the first trimester were respectively 24 and 6-fold higher (RR [95%CI] =24 [10.8-62.3] and 6 [1.5-24]) than the general pregnant population. 88% (29/33) and 92% (11/12) of, respectively, all primary maternal infections and fetal infections in the 1st trimester occurred when the inter-pregnancy interval was ≤2 years. CONCLUSION Women seronegative at their first pregnancy with a subsequent pregnancy within 2 years have the highest risk of delivering a child with cCMV-related sequelae. These women should be made aware of the risk and given the opportunity of serology screening in the first trimester.
{"title":"Quantifying the burden of congenital CMV infection (cCMV) with long-term sequelae in subsequent pregnancies of women seronegative at their first pregnancy.","authors":"M. Leruez-Ville, T. Guilleminot, J. Stirnemann, L. Salomon, E. Spaggiari, V. Faure-Bardon, J. Magny, Y. Ville","doi":"10.1093/cid/ciz1067","DOIUrl":"https://doi.org/10.1093/cid/ciz1067","url":null,"abstract":"BACKGROUND\u0000In women seronegative before pregnancy, cCMV related sequelae are exclusively seen in those infected in the first trimester of pregnancy. Up to 30% of infected neonates following maternal primary infection in the first trimester suffer long-term sequelae. Maternal parity is an established risk factor of cCMV in previously seronegative women.\u0000\u0000\u0000OBJECTIVE\u0000to quantify the risk of cCMV and related sequelae following primary infection in the first trimester in subsequent pregnancies in a population of women seronegative at their first pregnancy.\u0000\u0000\u0000METHODS\u0000739 women seronegative at their first pregnancy had at least one of 971 subsequent pregnancies and deliveries managed at our institution. All women had CMV IgG and IgM testing at 11-14 weeks' of each pregnancy.\u0000\u0000\u0000RESULTS\u000015.6% (115/739) of women seroconverted between 2 consecutive pregnancies. 29% (33/115) of seroconversions occurred in the periconceptional period or in the first trimester. The risks for cCMV and related sequelae (neurologic and/or hearing loss) following maternal infection in the first trimester were respectively 24 and 6-fold higher (RR [95%CI] =24 [10.8-62.3] and 6 [1.5-24]) than the general pregnant population. 88% (29/33) and 92% (11/12) of, respectively, all primary maternal infections and fetal infections in the 1st trimester occurred when the inter-pregnancy interval was ≤2 years.\u0000\u0000\u0000CONCLUSION\u0000Women seronegative at their first pregnancy with a subsequent pregnancy within 2 years have the highest risk of delivering a child with cCMV-related sequelae. These women should be made aware of the risk and given the opportunity of serology screening in the first trimester.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77152128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-13DOI: 10.1101/2020.10.08.20208579
K. Hughes, D. Middleton, M. Nowalk, G. Balasubramani, E. Martin, M. Gaglani, H. Talbot, M. Patel, J. Ferdinands, R. Zimmerman, F. Silveira, R. Zimmerman, D. Middleton, F. Silveira, K. Hughes, H. Eng, Theresa M. Sax, Sean G. Saul, Charles Rinaldo, Balasubramani Goundappa, M. Nowalk, Lori Steiffel, J. Williams, Monika Johnson, M. Gaglani, Kempapura Murthy, T. McNeal, Shekar Ghamande, V. Escobedo, Anne Robertson, Lydia Clipper, A. Rao, K-H Chang, Marcus Volz, K. Walker, A. Arroliga, A. Monto, Emily K. Martin, R. Malosh, J. Petrie, A. Lauring, Caroline K. Cheng, H. Segaloff, E. McSpadden, Emileigh Johnson, Rachel K Truscon, L. Lamerato, S. Davis, M. Zervos, H. Talbot, Dayna Wyatt, Yuwei Zhu, Zhouwen Liu, Rendie Mchenry, N. Halasa, Sandra Alvarez Calvillo, Stephanie Longmire, Laura S. Stewart, J. Ferdinands, A. Fry, E. Alyanak, Emily R Smith, Courtney Strickland, Sarah M. Spencer, B. Flannery, J. Chung, Xiyan Xu, Stephen L. Lindstrom, L. Berman, W. Sessions, Rebecca J. Kondor, M. Patel
Background: Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the non-immunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE against influenza-associated hospitalization among IC adults. Methods: We analyzed data from adults [≥] 18 years hospitalized with acute respiratory illness (ARI) during the 2017-2018 influenza season at 10 hospitals in the United States. IC adults were identified using pre-specified case-definitions, utilizing electronic medical record data. VE was evaluated with a test-negative case-control design using multivariate logistic regression with PCR-confirmed influenza as the outcome and vaccination status as the exposure, adjusting for age, enrolling site, illness onset date, race, days from onset to specimen collection, self-reported health, and self-reported hospitalizations. Results: Of 3,524 adults hospitalized with ARI, 1,210 (34.3%) had an immunocompromising condition. IC adults were more likely to be vaccinated than non-IC (69.5% vs 65.2%), and less likely to have influenza (22% vs 27.8%). The mean age did not differ among IC and non-IC (61.4 vs 60.8 years old). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% CI, 21% to 44%). VE among IC vs non-IC adults was lower at 5% (-29% to 31%) vs. 41% (27% to 52%) (p<0.05 for interaction term). Conclusions: VE in one influenza season was very low among IC individuals. Future efforts should include evaluation of VE among the different immunocompromising conditions and whether enhanced vaccines improve the suboptimal effectiveness among the immunocompromised.
{"title":"Effectiveness of Influenza Vaccine for Preventing Laboratory-Confirmed Influenza Hospitalizations in Immunocompromised Adults","authors":"K. Hughes, D. Middleton, M. Nowalk, G. Balasubramani, E. Martin, M. Gaglani, H. Talbot, M. Patel, J. Ferdinands, R. Zimmerman, F. Silveira, R. Zimmerman, D. Middleton, F. Silveira, K. Hughes, H. Eng, Theresa M. Sax, Sean G. Saul, Charles Rinaldo, Balasubramani Goundappa, M. Nowalk, Lori Steiffel, J. Williams, Monika Johnson, M. Gaglani, Kempapura Murthy, T. McNeal, Shekar Ghamande, V. Escobedo, Anne Robertson, Lydia Clipper, A. Rao, K-H Chang, Marcus Volz, K. Walker, A. Arroliga, A. Monto, Emily K. Martin, R. Malosh, J. Petrie, A. Lauring, Caroline K. Cheng, H. Segaloff, E. McSpadden, Emileigh Johnson, Rachel K Truscon, L. Lamerato, S. Davis, M. Zervos, H. Talbot, Dayna Wyatt, Yuwei Zhu, Zhouwen Liu, Rendie Mchenry, N. Halasa, Sandra Alvarez Calvillo, Stephanie Longmire, Laura S. Stewart, J. Ferdinands, A. Fry, E. Alyanak, Emily R Smith, Courtney Strickland, Sarah M. Spencer, B. Flannery, J. Chung, Xiyan Xu, Stephen L. Lindstrom, L. Berman, W. Sessions, Rebecca J. Kondor, M. Patel","doi":"10.1101/2020.10.08.20208579","DOIUrl":"https://doi.org/10.1101/2020.10.08.20208579","url":null,"abstract":"Background: Yearly influenza immunization is recommended for immunocompromised (IC) individuals, although immune responses are lower than that for the non-immunocompromised and the data on vaccine effectiveness (VE) in the IC is scarce. We evaluated VE against influenza-associated hospitalization among IC adults. Methods: We analyzed data from adults [≥] 18 years hospitalized with acute respiratory illness (ARI) during the 2017-2018 influenza season at 10 hospitals in the United States. IC adults were identified using pre-specified case-definitions, utilizing electronic medical record data. VE was evaluated with a test-negative case-control design using multivariate logistic regression with PCR-confirmed influenza as the outcome and vaccination status as the exposure, adjusting for age, enrolling site, illness onset date, race, days from onset to specimen collection, self-reported health, and self-reported hospitalizations. Results: Of 3,524 adults hospitalized with ARI, 1,210 (34.3%) had an immunocompromising condition. IC adults were more likely to be vaccinated than non-IC (69.5% vs 65.2%), and less likely to have influenza (22% vs 27.8%). The mean age did not differ among IC and non-IC (61.4 vs 60.8 years old). The overall VE against influenza hospitalization, including immunocompetent adults, was 33% (95% CI, 21% to 44%). VE among IC vs non-IC adults was lower at 5% (-29% to 31%) vs. 41% (27% to 52%) (p<0.05 for interaction term). Conclusions: VE in one influenza season was very low among IC individuals. Future efforts should include evaluation of VE among the different immunocompromising conditions and whether enhanced vaccines improve the suboptimal effectiveness among the immunocompromised.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78109959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Haahr, M. M. Tetens, R. Dessau, K. Krogfelt, J. Bodilsen, N. S. Andersen, J. Møller, Casper Roed, C. Christiansen, S. Ellermann-Eriksen, J. Bangsborg, K. Hansen, T. Benfield, C. Ø. Andersen, N. Obel, A. Lebech, L. Omland
BACKGROUND Lyme neuroborreliosis (LNB) caused by the tick-borne spirochetes of the Borrelia burgdorferi sensu lato species complex has been suggested to be associated with a range of neurological disorders. In a nationwide population-based cohort-study we examined the association between LNB and dementia, Alzheimer's disease, Parkinson's disease, motor neuron disease, epilepsy and Guillain-Barré syndrome. METHODS We used national registers to identify all Danish residents diagnosed during 1986-2016 with LNB (n=2,067) and a gender and age matched comparison cohort from the general population (n=20,670), and calculated risk estimates and hazard ratios (HR). RESULTS We observed no long-term increased risk of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases or epilepsy. However, within the first year eight (0.4%) of the LNB patients developed epilepsy compared with 20 (0.1%) of the comparison cohort (difference 0.3%, 95% CI: 0.02% to 0.6%). In the LNB group 11 (0.5%) patients were diagnosed with Guillain-Barré syndrome within the first year after LNB diagnosis compared with 0 (0.0%) in the comparison cohort. After the first year, the risk of Guillain-Barré was not increased. CONCLUSION LNB patients did not have increased long-term risk of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, epilepsy or Guillain-Barré. Although absolute risk is low, LNB patients might have an increased short-term risk of epilepsy and Guillain-Barré syndrome.
{"title":"Risk of neurological disorders in patients with European Lyme neuroborreliosis. A nationwide population-based cohort study.","authors":"R. Haahr, M. M. Tetens, R. Dessau, K. Krogfelt, J. Bodilsen, N. S. Andersen, J. Møller, Casper Roed, C. Christiansen, S. Ellermann-Eriksen, J. Bangsborg, K. Hansen, T. Benfield, C. Ø. Andersen, N. Obel, A. Lebech, L. Omland","doi":"10.1093/cid/ciz997","DOIUrl":"https://doi.org/10.1093/cid/ciz997","url":null,"abstract":"BACKGROUND\u0000Lyme neuroborreliosis (LNB) caused by the tick-borne spirochetes of the Borrelia burgdorferi sensu lato species complex has been suggested to be associated with a range of neurological disorders. In a nationwide population-based cohort-study we examined the association between LNB and dementia, Alzheimer's disease, Parkinson's disease, motor neuron disease, epilepsy and Guillain-Barré syndrome.\u0000\u0000\u0000METHODS\u0000We used national registers to identify all Danish residents diagnosed during 1986-2016 with LNB (n=2,067) and a gender and age matched comparison cohort from the general population (n=20,670), and calculated risk estimates and hazard ratios (HR).\u0000\u0000\u0000RESULTS\u0000We observed no long-term increased risk of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases or epilepsy. However, within the first year eight (0.4%) of the LNB patients developed epilepsy compared with 20 (0.1%) of the comparison cohort (difference 0.3%, 95% CI: 0.02% to 0.6%). In the LNB group 11 (0.5%) patients were diagnosed with Guillain-Barré syndrome within the first year after LNB diagnosis compared with 0 (0.0%) in the comparison cohort. After the first year, the risk of Guillain-Barré was not increased.\u0000\u0000\u0000CONCLUSION\u0000LNB patients did not have increased long-term risk of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, epilepsy or Guillain-Barré. Although absolute risk is low, LNB patients might have an increased short-term risk of epilepsy and Guillain-Barré syndrome.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89359475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnostic Stewardship for Clostridiodes difficile testing: From Laxatives to Diarrhea and Beyond.","authors":"C. Rock, L. Maragakis","doi":"10.1093/cid/ciz982","DOIUrl":"https://doi.org/10.1093/cid/ciz982","url":null,"abstract":"","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78607240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Martinello, J. Yee, S. Bartlett, P. Read, D. Baker, J. Post, R. Finlayson, M. Bloch, J. Doyle, D. Shaw, M. Hellard, K. Petoumenos, Lanni Lin, P. Marks, T. Applegate, G. Dore, G. Matthews
BACKGROUND Micro-elimination of HCV among people living with HIV may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV co-infected adults in Australia following universal DAA access. METHODS The CEASE prospective cohort study enrolled HIV/HCV positive adults, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up: 2.63 years). Factors associated with DAA uptake were analysed. RESULTS Between July 2014 and March 2017, 402 HIV/HCV antibody-positive participants were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% current injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95%CI 78%, 86%) in 2014 to 8% (95%CI 6%, 12%) in 2018. Reinfection was reported in only five participants for a reinfection incidence of 0.81 per 100-person years (95% CI 0.34, 1.94). CONCLUSIONS High uptake and effectiveness of unrestricted DAA therapy in Australia has permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that micro-elimination is feasible.
{"title":"Moving towards hepatitis C micro-elimination among people living with HIV in Australia: the CEASE study.","authors":"M. Martinello, J. Yee, S. Bartlett, P. Read, D. Baker, J. Post, R. Finlayson, M. Bloch, J. Doyle, D. Shaw, M. Hellard, K. Petoumenos, Lanni Lin, P. Marks, T. Applegate, G. Dore, G. Matthews","doi":"10.1093/cid/ciz985","DOIUrl":"https://doi.org/10.1093/cid/ciz985","url":null,"abstract":"BACKGROUND\u0000Micro-elimination of HCV among people living with HIV may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV co-infected adults in Australia following universal DAA access.\u0000\u0000\u0000METHODS\u0000The CEASE prospective cohort study enrolled HIV/HCV positive adults, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up: 2.63 years). Factors associated with DAA uptake were analysed.\u0000\u0000\u0000RESULTS\u0000Between July 2014 and March 2017, 402 HIV/HCV antibody-positive participants were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% current injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95%CI 78%, 86%) in 2014 to 8% (95%CI 6%, 12%) in 2018. Reinfection was reported in only five participants for a reinfection incidence of 0.81 per 100-person years (95% CI 0.34, 1.94).\u0000\u0000\u0000CONCLUSIONS\u0000High uptake and effectiveness of unrestricted DAA therapy in Australia has permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that micro-elimination is feasible.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85286713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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