Epidemiology and Infection最新文献

The H3N2 canine influenza virus (CIV) emerged from an avian reservoir in Asia to circulate entirely among dogs for the last 20 years. The virus was first seen circulating outside Asian dog populations in 2015, in North America. Utilizing viral genomic data in addition to clinical reports and diagnostic testing data, we provide an updated analysis of the evolution and epidemiology of the virus in its canine host. CIV in dogs in North America is marked by a complex life history - including local outbreaks, regional lineage die-outs, and repeated reintroductions of the virus (with diverse genotypes) from different regions of Asia. Phylogenetic and Bayesian analysis reveal multiple CIV clades, and viruses from China have seeded recent North American outbreaks, with 2 or 3 introductions in the past 3 years. Genomic epidemiology confirms that within North America the virus spreads very rapidly among dogs in kennels and shelters in different regions - but then dies out locally. The overall epidemic therefore requires longer-distance dispersal of virus to maintain outbreaks over the long term. With a constant evolutionary rate over 20 years, CIV still appears best adapted to transmission in dense populations and has not gained properties for prolonged circulation among dogs.

Clostridiodes difficile's epidemiology has evolved over the past decades, being recognized as an important cause of disease in the community setting. Even so, there has been heterogeneity in the reports of CA-CDI. Therefore, the aim of this study was to assess the epidemiologic profile of CA-CDI.This systematic review and meta-analysis were conducted according to PRISMA checklist and Cochrane guidelines (CRD42023451134). Literature search was performed by an experienced librarian from inception to April 2023, searching in databases like MEDLINE, Scopus, Web of Science, EMBASE, CCRCC, CDSR, and ClinicalTrials. Observational studies that reported prevalence, incidence of CA-CDI, or indicators to calculate them were included. Pool analysis was performed using a binomial-normal model via the generalized linear mixed model. Subgroup analysis and publication bias were also explored. A total of 49 articles were included, obtaining a prevalence of 5% (95% CI 3-8) and an incidence of 7.53 patients (95% CI 4.45-12.74) per 100,000 person-years.In conclusion, this meta-analysis underscores that among the included studies, the prevalence of CA-CDI stands at 5%, with an incidence rate of 7.3 cases per 100,000 person-years. Noteworthy risk factors identified include prior antibiotic exposure and age.

Bartonella is a widely distributed Gram-negative bacterium that includes species that are capable of causing illness in humans. Rodents represent one of the main reservoirs of zoonotic pathogens, and monitoring their populations can provide valuable insights into human health. We conducted a surveillance study of rodents from two north-western states of Mexico (Baja California and Chihuahua) to investigate the prevalence and genetic diversity of Bartonella by polymerase chain reaction (PCR) amplification and sequencing of the citrate synthase (gltA) gene. A total of 586 rodents belonging to 28 species were captured, and 408 were tested for Bartonella spp. The overall Bartonella spp. prevalence was 39.71%. The prevalence found in Chihuahua was higher (42.80%) than in Baja California (32.52%), and rodents such as Neotoma albigula, Neotoma mexicana, Peromyscus boylii, and Chaetodipus baileyi had the highest prevalence. The gltA sequences revealed seven genetic variants, some of which were obtained from Peromyscus and Dipodomys rodents and were associated with Bartonella species of human health concern, such as B. grahamii and B. vinsonii subsp. arupensis. In addition, a sequence obtained from a Peromyscus maniculatus was clustered with Candidatus Bartonella rudakovii, a previously unreported association. This study provides valuable data and new insight into the Bartonella-hosts interactions in rodent species in north-western Mexico.

Our study aimed to describe the transmission dynamics and genotypic diversity of Mycobacterium tuberculosis in people deprived of liberty (PDL) in four Colombian prisons. Our cohort study included 64 PDL with bacteriologically confirmed pulmonary tuberculosis diagnosed in four Colombian prisons. The 132 isolates were genotyped using 24-mycobacterial interspersed repeated units-variable number tandem repeats (MIRUs-VNTR). A cluster was defined when ≥2 isolates from different PDL had the same genotype. Tuberculosis acquired in prison was considered when ≥2 persons were within the same cluster and had an epidemiological link. We mapped the place of residence before incarceration and within prisons. We assessed overcrowding and ventilation conditions in the prison that had clusters. We found that the most frequent genotypes were LAM (56.8%) and Haarlem (36.4%), and 45.3% of the PDL diagnosed with tuberculosis were clustered. Most PDL diagnosed in prison came from neighborhoods in Medellin with a high TB incidence. M. tuberculosis infection acquired in prison was detected in 19% of PDL, 9.4% had mixed infection, 3.1% reinfection, and 1.6% relapse. Clusters only appeared in one prison, in cell blocks with overcrowding >100%, and inadequate ventilation conditions. Prisons require the implementation of effective respiratory infection control measures to prevent M. tuberculosis transmission.

Children, adolescents, and young people living with HIV (CALWHIV), including those in resource-limited settings, may be at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, poorer coronavirus disease 2019 (COVID-19) outcomes, and multisystem inflammatory syndrome (MIS). We conducted a repeat SARS-CoV-2 seroprevalence survey among CALWHIV in Europe (n = 493) and South Africa (SA, n = 307), and HIV-negative adolescents in SA (n = 100), in 2020-2022. Blood samples were tested for SARS-CoV-2 antibody, questionnaires collected data on SARS-CoV-2 risk factors and vaccination status, and clinical data were extracted from health records. SARS-CoV-2 seroprevalence (95% CI) was 55% (50%-59%) in CALWHIV in Europe, 67% (61%-72%) in CALWHIV in SA, and 85% (77%-92%) among HIV-negative participants in SA. Among those unvaccinated at time of sampling (n = 769, 85%), seroprevalence was 40% (35%-45%), 64% (58%-70%), and 81% (71%-89%), respectively. Few participants (11% overall) had a known history of SARS-CoV-2-positive PCR or self-reported COVID-19. Three CALWHIV were hospitalized, two with COVID-19 (nonsevere disease) and one young adult with MIS. Although SARS-CoV-2 seroprevalence was high across all settings, even in unvaccinated participants, it was broadly comparable to general population estimates, and most infections were mild/asymptomatic. Results support policy decisions excluding CALWHIV without severe immunosuppression from high-risk groups for COVID-19.

Vaccination is one of the most cost-effective and successful public health interventions to prevent infectious diseases. Governments worldwide have tried to optimize vaccination coverage, including using vaccine mandates. This review of recent literature and policy aims to provide a comprehensive overview of Malaysia's childhood vaccination landscape. The document analysis was used to identify and examine information from government policy documents, official government media statements, mainstream news content, and research papers. Content analysis was then employed to analyze the gathered information. Despite the successes of Malaysia's National Immunization Programme, a resurgence of vaccine-preventable diseases has raised concerns about vaccine hesitancy and refusal. Several contributing factors have been identified, including a preference for alternative medicines, doubts about halal status, fear of vaccine injury, concerns about the vaccines' contents, conspiracy theories, as well as convenience and access barriers. While various initiatives have been implemented, Malaysia may consider using vaccine mandates, as several countries have recently done, as a potential policy intervention to address these challenges. This review benefits policymakers, epidemiologists, as well as researchers involved in regional or global policy planning and advocacy efforts. It also offers comprehensive insights into designing effective interventions and making informed policy decisions regarding childhood vaccination programmes.

Due to the risk of Shiga-toxin producing Escherichia coli (STEC) transmission, current guidance advises excluding young children from childcare settings until microbiologically clear. Children can shed STEC for a prolonged period, and the cost-effectiveness of exclusion has not been evaluated. Our decision tree analysis, including probabilistic sensitivity analysis, estimated comparative health system costs and effects of exclusion until microbiological clearance versus return to childcare setting before this. Due to the risk of secondary cases, return before microbiological clearance resulted in the incremental loss of 0.019 QALYs, but savings of £156. Using the willingness-to-pay threshold of £20000 per QALY, the incremental net monetary benefit of exclusion until microbiological clearance was £215. Exclusion until microbiological clearance remained cost-effective if the total costs for managing the exclusion were below £576. Return before microbiological clearance may, therefore, become cost-effective in cases where the costs of managing exclusion until microbiological clearance are high and/or the risk of secondary cases is very low. Broadening the decision perspective, including the costs of exclusion to the families, may also impact the recommendation. Further research is needed to assess the risk of STEC transmission from children who have clinically recovered and the impact of STEC and exclusion on families of the affected children.

In February 2023, 52 cases of gastrointestinal illness were reported in customers of Takeaway A, South Wales. Shigella flexneri serotype 2a was the causative organism. An outbreak investigation was conducted to determine the extent and vehicle of the outbreak.Following descriptive summary and environmental investigations, a case-control study was completed. Participants completed a telephone questionnaire on food, travel, and environmental exposures. A multivariable logistic regression model was built, including exposures with p-values < 0.2 and interactions identified on stratified analysis. Staff faecal samples were screened for Shigella sp.Thirty-one cases and 29 controls were included in the study. Eighty-seven per cent of cases and 76% of controls ate from Takeaway A on 10 February 2023. Coleslaw was the main factor associated with illness (aOR: 200, 95% CI: 12-3220) and an interaction with cabbage was identified (aOR: 886, 95% CI: 26-30034). Shigella sp. were not detected in any staff samples.Coleslaw was the most likely vehicle. Though the contamination route is unknown, a food handler is the most likely source. This large outbreak differs from recent European outbreaks, which primarily have been associated with sexual transmission. Although uncommon in the UK, S. flexneri should be considered as a cause of foodborne outbreaks.

Spatial analysis and disease mapping have the potential to enhance understanding of tuberculosis (TB) dynamics, whose spatial dynamics may be complicated by the mix of short and long-range transmission and long latency periods. TB notifications in Nam Dinh Province for individuals aged 15 and older from 2013 to 2022 were analyzed with a variety of spatio-temporal methods. The study commenced with an analysis of spatial autocorrelation to identify clustering patterns, followed by the evaluation of several candidate Bayesian spatio-temporal models. These models varied from simple assessments of spatial heterogeneity to more complex configurations incorporating covariates and interactions. The findings highlighted a peak in the TB notification rate in 2017, with 98 cases per 100,000 population, followed by a sharp decline in 2021. Significant spatial autocorrelation at the commune level was detected over most of the 10-year period. The Bayesian model that best balanced goodness-of-fit and complexity indicated that TB trends were associated with poverty: each percentage point increase in the proportion of poor households was associated with a 1.3% increase in TB notifications, emphasizing a significant socioeconomic factor in TB transmission dynamics. The integration of local socioeconomic data with spatio-temporal analysis could further enhance our understanding of TB epidemiology.

Epidemic preparedness requires clear procedures and guidelines when a rapid risk assessment of a communicable disease threat is requested. In an evaluation of past risk assessments, we found that modifications to existing guidelines, such as the European Centre for Disease Prevention and Control's (ECDC) rapid risk assessment operational tool, can strengthen this process. Therefore, we present alternative guidelines, in which we propose a unifying risk assessment terminology, describe how the risk question should be phrased by the risk manager, and redefine the probability and impact dimension of risk, including a methodology to express uncertainty. In our approach, probability refers to the probability of the introduction of a disease into a specified population in a specified time period, and impact combines the magnitude of spread and the severity of the health outcomes. Based on the collected evidence, both the probability of introduction and the magnitude of spread are quantitatively expressed by expert judgements, providing unambiguous risk assessment. We advise not to summarize the risk by a single qualification as 'low' or 'high'. These alternative guidelines, which are illustrated by a hypothetical example on mpox, have been implemented at Statens Serum Institut in Denmark and can benefit other public health institutes.