Epidemiology and Infection最新文献

COVID-19 vaccine effectiveness (VE) studies are limited in low- and middle-income countries. A case-control study was conducted among COVID-19 and other pneumonia patients admitted to a hospital in the Philippines during the pre-Omicron and Omicron periods. To elucidate factors associated with in-hospital death, 1782 COVID-19 patients were assessed. To estimate absolute VE for various severe outcomes, 1059 patients were assessed (869 [82.1%] COVID-19 cases; 190 [17.9%] controls). Factors associated with in-hospital death included older age, tuberculosis (adjusted odds ratio [aOR] 2.45 [95% confidence interval {95% CI} 1.69-3.57]), HIV (aOR 3.30 [95% CI 2.03-5.37]), and current smokers (aOR 2.65 [95% CI 1.72-4.10]). Pre-Omicron, the primary series provided high protection within a median of 2 months (hospitalization: 85.4% [95% CI 35.9-96.7%]; oxygen requirement: 91.0% [95% CI 49.4-98.4%]; invasive mechanical ventilation (IMV): 97.0% [95% CI 65.7-99.7%]; death: 96.5% [95% CI 67.1-99.6%]). During Omicron, the primary series provided moderate-high protection within a median of 6-9 months (hospitalization: 70.2% [95% CI 27.0-87.8%]; oxygen requirement: 71.4% [95% CI 29.3-88.4%]; IMV: 72.7% [95% CI -11.6-93.3%]; death: 58.9% [95% CI -82.8-90.8%]). Primary series VE against severe COVID-19 outcomes was consistently high for both pre-Omicron and Omicron in a setting where approximately half of the vaccinees received inactivated vaccines.

Abortion is one of the major threats to the livestock industry, and it also poses significant threats to public health since some of the abortifacient agents are considered zoonotic. Chlamydia abortus (C. abortus), Coxiella burnetii (C. burnetii), Listeria monocytogenes (L. monocytogenes), and Cache Valley virus (CVV) are recognized as important zoonotic and abortifacient agents of reproductive failure in small ruminants. This study determined the prevalence of these agents in ovine and caprine foetuses in Türkiye. A total of 1 226 foetuses were collected from the sheep (n = 1 144) and goats (n = 82) from different flocks between 2012 and 2017. Molecular detection methods were used to detect C. abortus, C. burnetii, and L. monocytogenes DNA and CVV RNA in aborted foetuses. In this study, C. abortus was the most prevalent abortifacient agent among the investigated ovine (264/1144) and caprine (12/82) foetuses, followed by C. burnetii with a frequency of 2.8% (32/1144) and 8.5% (7/82) in ovine and caprine foetuses, respectively. L. monocytogenes DNA was detected in 28 (2.4%) and 2 (2.4%) of the ovine and caprine foetuses, respectively. However, CVV RNA was not detected. Although the predominant mixed infection was C. abortus and C. burnetii, mixed infection of C. abortus and L. monocytogenes, and C. burnetii and L. monocytogenes were also found. The information presented in this study contributes to the understanding of the roles of C. abortus, C. burnetii, L. monocytogenes, and CVV in abortions in small ruminants, and could be beneficial for developing more effective control strategies.

This study investigated cases of pregnancy-related listeriosis in British Columbia (BC), Canada, from 2005 to 2014. We described all diagnosed cases in pregnant women (n = 15) and neonates (n = 7), estimated the excess healthcare costs associated with listeriosis, and calculated the fraction of stillbirths attributable to listeriosis, and mask cell sizes 1-5 due to data requirements. Pregnant women had a median gestational age of 31 weeks at listeriosis onset (range: 20-39) and on average delivered at a median of 37 weeks gestation (range: 20-40). Neonates experienced complications but no fatalities. Stillbirths occurred in 1-5 of 15 pregnant women with listeriosis, and very few (0.05-0.24%) of the 2,088 stillbirths in BC in the 10 years were attributed to listeriosis (exact numbers masked). Pregnant women and neonates with listeriosis had significantly more hospital visits, days in the hospital and physician visits than those without listeriosis. Pregnant women with listeriosis had 2.59 times higher mean total healthcare costs during their pregnancy, and neonates with listeriosis had 9.85 times higher mean total healthcare costs during their neonatal period, adjusting for various factors. Despite small case numbers and no reported deaths, these results highlight the substantial additional health service use and costs associated with individual cases of pregnancy-related listeriosis in BC.

This study explored the effect of SARS-CoV-2 infection and COVID-19 vaccination during pregnancy on neonatal outcomes among women from the general Dutch population. VASCO is an ongoing prospective cohort study aimed at assessing vaccine effectiveness of COVID-19 vaccination. Pregnancy status was reported at baseline and through regular follow-up questionnaires. As an extension to the main study, all female participants who reported to have been pregnant between enrolment (May-December 2021) and January 2023 were requested to complete an additional questionnaire on neonatal outcomes. Multivariable linear and logistic regression analyses were used to determine the associations between self-reported SARS-CoV-2 infection or COVID-19 vaccination during pregnancy and neonatal outcomes, adjusted for age, educational level, and presence of a medical risk condition. Infection analyses were additionally adjusted for COVID-19 vaccination before and during pregnancy, and vaccination analyses for SARS-CoV-2 infection before and during pregnancy. Of 312 eligible participants, 232 (74%) completed the questionnaire. In total, 196 COVID-19 vaccinations and 115 SARS-CoV-2 infections during pregnancy were reported. Infections were mostly first infections (86; 75%), caused by the Omicron variant (95; 83%), in women who had received ≥1 vaccination prior to infection (101; 88%). SARS-CoV-2 infection during pregnancy was not significantly associated with gestational age (β = 1.7; 95%CI: -1.6-5.0), birth weight (β = 82; -59 to 223), Apgar score <9 (odds ratio (OR): 1.3; 0.6-2.9), postpartum hospital stay (OR: 1.0; 0.6-1.8), or neonatal intensive care unit admission (OR: 0.8; 0.2-3.2). COVID-19 vaccination during pregnancy was not significantly associated with gestational age (β = -0.4; -4.0 to 3.2), birth weight (β = 88; -64 to 240), Apgar score <9 (OR: 0.9; 0.4-2.3), postpartum hospital stay (OR: 0.9; 0.5-1.7), or neonatal intensive care unit admission (OR: 1.6; 0.4-8.6). In conclusion, this study did not find an effect of SARS-CoV-2 infection or COVID-19 vaccination during pregnancy on any of the studied neonatal outcomes among a general Dutch, largely vaccinated, population. Together with data from other studies, this supports the safety of COVID-19 vaccination during pregnancy.

Our study aim was to identify high-risk areas of neonatal mortality associated with bacterial sepsis in the state of São Paulo, Southeast Brazil. We used a population-based study applying retrospective spatial scan statistics with data extracted from birth certificates linked to death certificates. All live births from mothers residing in São Paulo State from 2004 to 2020 were included. Spatial analysis using the Poisson model was adopted to scan high-rate clusters of neonatal mortality associated with bacterial sepsis (WHO-ICD10 A32.7, A40, A41, P36, P37.2 in any line of the death certificate). We found a prevalence of neonatal death associated with bacterial sepsis of 2.3/1000 live births. Clusters of high neonatal mortality associated with bacterial sepsis were identified mainly in the southeast region of the state, with four of them appearing as cluster areas for all birth weight categories (<1500 g, 1500 to <2500 g and ≥ 2500 g). The spatial analysis according to the birth weight showed some overlapping in the detected clusters, suggesting shared risk factors that need to be explored. Our study highlights the ongoing challenge of neonatal sepsis in the most developed state of a middle-income country and the importance of employing statistical techniques, including spatial methods, for enhancing surveillance and intervention strategies.

The rat lungworm Angiostrongylus cantonensis is a zoonotic metastrongyloid nematode currently considered an emerging pathogen. Originating in Southeast Asia, this nematode has spread to tropical and subtropical parts of the world via its invasive rodent and gastropod hosts.On the island of Tenerife in the Canary archipelago, the A. cantonensis invasion was recognized more than a decade ago. The endemic lizard Gallotia galloti has been identified as a paratenic host of this nematode in the Canary Island ecosystem. Because this lizard species is the most abundant reptile in Tenerife, we tested its suitability as a possible sentinel for A. cantonensis presence. Lizards were captured alive in nine localities, spanning an environmental gradient across the island. Tail muscle tissue was obtained by provoked caudal autotomy and tested for the nematode infection by a species-specific qPCR. Infection intensities were assessed by detecting A. cantonensis DNA quantities based on a calibrated standard curve. Of the 129 samples tested, 31 were positive. The prevalence varied among localities, with the highest (63.6%) recorded in a humid laurel forest. Even though the prevalence in Valle San Lorenzo was the lowest, this is the first record of A. cantonensis from the arid south of Tenerife. Variation in prevalence at different localities was significantly and positively correlated with increasing vegetation cover and negatively correlated with seasonal variability of precipitation, as determined by Spearman correlation coefficients. Fisher's exact test was used to determine the variation in the prevalence of A. cantonensis among adult males, females, and juveniles and showed no significant difference. Also, there was no significant difference in infection intensity between males and females (as determined by GEE-g). We demonstrated that provoking caudal autotomy can be an effective non-lethal method of A. cantonensis mapping in island ecosystems with abundant lizard species, particularly those with a sharp climatic and vegetation gradient, from xeric to humid conditions.

This study aimed to develop a predictive tool for identifying individuals with high antibody titers crucial for recruiting COVID-19 convalescent plasma (CCP) donors and to assess the quality and storage changes of CCP. A convenience sample of 110 plasma donors was recruited, of which 75 met the study criteria. Using univariate logistic regression and random forest, 6 significant factors were identified, leading to the development of a nomogram. Receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA) evaluated the nomogram's discrimination, calibration, and clinical utility. The nomogram indicated that females aged 18 to 26, blood type O, receiving 1 to 2 COVID-19 vaccine doses, experiencing 2 symptoms during infection, and donating plasma 41 to 150 days after symptom onset had higher likelihoods of high antibody titres. Nomogram's AUC was 0.853 with good calibration. DCA showed clinical benefit within 9% ~ 90% thresholds. CCP quality was qualified, with stable antibody titres over 6 months (P > 0.05). These findings highlight developing predictive tools to identify suitable CCP donors and emphasize the stability of CCP quality over time, suggesting its potential for long-term storage.

Despite global efforts to end tuberculosis (TB), the goal of preventing catastrophic health expenditure (CHE) due to TB remains unmet. This cross-sectional study was conducted in Guizhou Province, Southwest China. Data were collected from the Hospital Information System and a survey of TB patients who had completed standardized antituberculosis treatment between January and March 2021. Among the 2 283 participants, the average total expenditure and out-of-pocket expenditure were $1 506.6 (median = $760.5) and $683.6 (median = $437.8), respectively. Health insurance reimbursement reduced CHE by 16.8%, with a contribution rate of 24.9%, and the concentration index changed from -0.070 prereimbursement to -0.099 postreimbursement. However, the contribution of health insurance varied significantly across different economic strata, with contribution rates of 6.4% for the lowest economic group and 53.1% for the highest group. For patients from lower socioeconomic strata, health insurance contributed 10.7% to CHE in the prediagnostic phase and 23.5% during treatment. While social health insurance alleviated the financial burden for TB patients, it did not provide sufficient protection for those in lower economic strata or during the prediagnostic stage. This study underscores the need for more effective and equitable subsidy policies for TB patients .