Epidemiology and Infection最新文献

Tuberculosis (TB) remains a significant public health concern in China. Using data from the Global Burden of Disease (GBD) study 2021, we analyzed trends in age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (DALYs) for TB from 1990 to 2021. Over this period, HIV-negative TB showed a marked decline in ASIR (AAPC = -2.34%, 95% CI: -2.39, -2.28) and ASMR (AAPC = -0.56%, 95% CI: -0.62, -0.59). Specifically, drug-susceptible TB (DS-TB) showed reductions in both ASIR and ASMR, while multidrug-resistant TB (MDR-TB) showed slight decreases. Conversely, extensively drug-resistant TB (XDR-TB) exhibited upward trends in both ASIR and ASMR. TB co-infected with HIV (HIV-DS-TB, HIV-MDR-TB, HIV-XDR-TB) showed increasing trends in recent years. The analysis also found an inverse correlation between ASIRs and ASMRs for HIV-negative TB and the Socio-Demographic Index (SDI). Projections from 2022 to 2035 suggest continued increases in ASIR and ASMR for XDR-TB, HIV-DS-TB, HIV-MDR-TB, and HIV-XDR-TB. The rising burden of XDR-TB and HIV-TB co-infections presents ongoing challenges for TB control in China. Targeted prevention and control strategies are urgently needed to mitigate this burden and further reduce TB-related morbidity and mortality.

This study analyzed standardized excess mortality due to specific causes during the Covid-19 pandemic across 33 European countries, using Eurostat data (2016-2021) and Our World in Data databases. Causes included circulatory and respiratory diseases, neoplasms, transport accidents, and "other" causes (e.g., diabetes, dementia, ill-defined conditions). Additional variables such as vaccination rates, economic and health indicators, demographics, and government stringency measures were also examined. Key findings include: (1) Most European countries (excluding Central and Eastern Europe), recorded lower than expected excess mortality from circulatory and respiratory diseases, neoplasms, and transport accidents. Ireland had the lowest excess respiratory mortality in both 2020 and 2021; (2) Croatia, Cyprus, Malta, and Turkey showed significant positive excess mortality from "other" causes, potentially linked to public health restrictions, with Turkey as an exception; (3) Regression analysis found that higher human development index and vaccination rates were associated with lower excess mortality. Policy Implications are: (1) Statistically significant positive or negative cause-specific excess mortality may indicate future health trends; (2) The pandemic and government stringency measures negatively affected mortality from "other" causes; (3) Strengthening health system resilience, investing in digital medicine, directing aid to countries with weaker systems, and supporting disadvantaged groups are key recommendations.

Cryptosporidium parvum is a well-established cause of gastrointestinal illness in both humans and animals and often causes outbreaks at animal contact events, despite the availability of a code of practice that provides guidance on the safe management of these events. We describe a large C. parvum outbreak following a lamb-feeding event at a commercial farm in Wales in 2024, alongside findings from a cohort study to identify high-risk exposures. Sixty-seven cases were identified, 57 were laboratory-confirmed C. parvum, with similar genotypes. Environmental investigations found a lack of adherence to established guidance. The cohort study identified 168 individuals with cryptosporidiosis-like illness from 540 exposure questionnaires (distributed via email to 790 lead bookers). Cases were more likely to have had closer contact with lambs (odds ratio (OR) kissed lambs = 2.4, 95% confidence interval (95% CI): 1.2-4.8). A multivariable analysis found cases were more likely to be under 10 years (adjusted OR (aOR) = 4.5, 95% CI: 2.0-10.0) and have had visible faeces on their person (aOR = 3.6, 95% CI: 2.1-6.2). We provide evidence that close contact at lamb-feeding events presents an increased likelihood of illness, suggesting that farms should limit animal contact at these events and that revisions to established codes of practice may be necessary. Enhancing risk awareness among farmers and visitors is needed, particularly regarding children.

Acute infection with Toxoplasma gondii in pregnant people can lead to vertical transmission to the foetus and congenital toxoplasmosis. As part of risk assessment, the epidemiology of toxoplasmosis among pregnant people must be quantitatively elucidated. Herein, we investigated the risk of primary T. gondii infection during pregnancy in Japan, estimating the incidence of T. gondii infection among pregnant people as well as that of congenital toxoplasmosis. We used a compartment model that captured the infection dynamics in pregnant people, analysing prescription data for spiramycin in Japan, together with local serological testing results and the screening rate of primary T. gondii infection during pregnancy. The nationwide risk of T. gondii infection pregnant people in Japan was estimated to be 0.016% per month. Among prefectures investigated, the risk estimate was highest in Tokyo with 0.030% per month. Nationally, the number of T. gondii infections among pregnant people in the years 2019, 2020, and 2021 was estimated to be 1507, 1440, and 1388 infections, respectively. The nationwide number of cases of congenital toxoplasmosis in each year was estimated at 613, 588, and 567 cases, respectively. Our study indicated that T. gondii infection continues to place a substantial burden on public health in Japan.

Case-control studies can provide attribution estimates of the likely sources of zoonotic pathogens. We applied a meta-analytical model within a Bayesian estimation framework to pool population attributable fractions (PAFs) from European case-control studies of sporadic campylobacteriosis and salmonellosis. The input data were obtained from two existing systematic reviews, supplemented with additional literature searches, covering the period 2000-2021. In total, 12 studies on Campylobacter providing data for 180 PAFs referring to 5983 cases and 13213 controls, and five studies on Salmonella providing data for 75 PAFs referring to 2908 cases and 5913 controls, were included. All these studies were conducted in Western or Northern European countries. Both pathogens were estimated as being predominantly linked to food- and waterborne transmission, which explained nearly half of the cases, with Campylobacter being mainly attributable to poultry (meat), and Salmonella to poultry (eggs and meat) and pig (meat), as specific foodborne exposures. When also considering contact with animals, around 60% of cases could be explained by the larger group of zoonotic transmission pathways. While environmental transmission was also sizeable (around 10%), about a quarter of cases could be explained by factors such as travel, underlying diseases/medicine use, person-to-person transmission and occupational exposure.

Dengue, the most prevalent urban arbovirus in the world, has triggered recurrent epidemics in Rio de Janeiro, Brazil, since the 1980s. This study aimed to describe the spatial-temporal patterns of dengue spread during the epidemic years of 2002, 2008, 2011, 2012, 2013, and 2024 in Rio de Janeiro. This is an ecological study using secondary data on notified confirmed dengue cases aggregated by neighbourhood. The incidence rates were estimated via the local empirical Bayes method. The local spatial autocorrelation indicators assessed incidence clusters, and the monthly geographic trajectory was outlined for each year. The results revealed changes in the spatial distribution of dengue over time, with clusters of high incidences predominating in the northern and central neighbourhoods in 2002 and 2008, and in the western zone in 2011, 2012, and 2013. In 2024, the distribution was predominant throughout the city, with emphasis in the central and western zones. The monthly geographic centre of dengue cases shifted from the west to the north during the peak of the epidemic. These results highlight the heterogeneous nature of dengue transmission in Rio de Janeiro. The incorporation of spatial and temporal analyses in epidemiological studies can enhance targeted and localized dengue control strategies.

Monkeypox (mpox) has re-emerged as global public health concern including in several non-endemic countries. This study aims to characterize monkeypox virus (MPXV) genomes in Indonesia, to explore viral evolution and transmission. Genomic analysis was conducted on 53 isolates from Indonesian mpox patients between 2023 and 2024. All sequences belonged to Clade IIb, with identified sub-clades including A.1.1, B.1, B.1.3, and C.1 - of which C.1 became dominant during this period. Out of 87 mpox-confirmed cases, 60.9% (53/87) were successfully sequenced and submitted to the Global Initiative on Sharing All Influenza Data (GISAID). The majority of cases in Indonesia occurred among males (95.4%), men who have sex with men (59.8%), and people living with HIV/AIDS (71.3%). Notably, a large portion of cases had no travel history, suggesting local transmission. Initially, only clade IIb (B.1) was detected in October 2022. By August 2023, lineage diversity had increased, with B.1.3 and C.1 emerging as the predominant sub-clades. A time-calibrated phylogenetic tree revealed genetic relatedness and shared ancestry within clade IIb. Integrating genomic and epidemiological data offers valuable insights to improve mpox surveillance and public health response in Indonesia and the broader region.

The aim of this study was to describe how the detection of protozoan and helminth parasites has been affected by the introduction of polymerase chain reaction (PCR) and changes in test algorithms. We extracted data about faecal samples tested for parasites (n = 114839) at five Norwegian clinical microbiology laboratories. Samples were classified into prePCR or postPCR depending on whether they were submitted before or after the introduction of PCR, and into diagnostic episodes (n = 99320). The number of diagnostic episodes increased 3.7-fold from prePCR to postPCR. Giardia positive episodes doubled, the positivity rate decreased from 2.0% to 1.3%. Cryptosporidium was hardly detected prePCR and increased to a positivity rate of 1.2%. Entamoeba histolytica was rarely found. Episodes examined for helminths decreased 51%, the number of positive episodes decreased 34%. Samples from immigrants were more likely to be positive for Giardia, E. histolytica, or helminths and less likely to be Cryptosporidium positive. During the COVID-19 pandemic, the number of Giardia and helminth-positive episodes decreased. Cryptosporidium-positive episodes remained unchanged. The implementation of multiplex PCR for protozoa led to a doubling of Giardia cases and a better test for Cryptosporidium. Fewer microscopy examinations raise concerns that helminth infections may be overlooked.

During pregnancy, colonization by genital mycoplasmas may be associated with adverse outcomes. This study was conducted to investigate the prevalence of four species of Mollicutes (Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum, and Ureaplasma urealyticum) in pregnant women receiving high-risk prenatal care and to evaluate possible associated factors. Data collection included the application of a questionnaire and the collection of cervical swabs from pregnant women. Species identification was performed by real-time PCR. The overall prevalence of Mollicutes was 60.97%. 55.9% of pregnant women were colonized by Ureaplasma spp., and 19.51% by Mycoplasma spp. The prevalence rates by species were 48.78% for U. parvum, 11.59% for U. urealyticum, 18.9% for M. hominis, and 1.22% for M. genitalium. Age, 12 years of schooling or more, age at first sexual intercourse up to 14 years, third trimester of pregnancy, having undergone infertility treatment, presence of STI, and groin lymph nodes were associated with a higher prevalence of microorganisms. The results presented are of utmost importance for understanding the prevalence of these microorganisms, the characteristics of colonized pregnant women, and planning screening strategies and interventions that minimize the negative impacts of these infections.

Lower COVID-19 vaccination coverage was observed among some populations with a migration background in the Netherlands. This study examined determinants of being unvaccinated against COVID-19 in the primary vaccination round in adults and in the 2022 autumn booster round in persons aged ≥60 years, among four populations of non-Dutch origin with below average vaccination coverage: Moroccan, Turkish, Surinamese and Dutch-Caribbean, and persons of Dutch origin. We performed a population-wide register-based study, examining associations between potential determinants and being unvaccinated using multivariable logistic regression and computing population attributable fractions. Being a migrant with two foreign-born parents, younger age, living in highly/extremely urban areas and having a lower income, lower education level and low medical risk for severe COVID-19 were risk factors for being unvaccinated in all populations. Substantial differences in the (strength of) determinants and population attributable fractions between populations were also observed. Socioeconomic status only partially mediated the association with being a migrant with two foreign-born parents. These findings illustrate that interventions targeting specific ethnic minority and migrant populations need further study with the aim to optimize the impact of vaccination programmes and improve health equity. To understand reasons behind non-uptake and design (community-based) interventions, qualitative and survey-based research is needed.