Epidemiology and Infection最新文献

There is a positive association between bacteraemia with Streptococcus bovis-Streptococcus equinus complex (SBSEC) and colorectal cancer (CRC). However, the relationship between the timing of SBSEC bacteraemia and CRC is not well-established. Associations with other gastrointestinal cancers have also been suggested. Using national registries, we retrospectively examined the incidence of CRC and other gastrointestinal cancers after SBSEC-bacteraemia in Sweden 2010-2019, and analysed the timing, characteristics, and prognosis of diagnosed CRC. Individuals with SBSEC-bacteraemia were matched to randomly selected controls from the general population at a 1:10 ratio. Cox-regression determined CRC hazard ratios (HR). In total, 908 individuals with SBSEC-bacteraemia were identified and 9,080 controls, of whom 75/908 (8.3%) and 168/9080 (1.9%) respectively had previously diagnosed CRC (p < 0.01). During follow-up of individuals without previous CRC, CRC was diagnosed in 45/833 (5.4%) individuals with SBSEC and 114/8912 (1.3%) controls (p < 0.01). The HR of CRC diagnosis for SBSEC was 10.3 (95% CI 6.7-15.8) overall and 19.8 (95% CI 11.1-35.3) during the first year of follow-up. In conclusion, there was an increased incidence of CRC, and most were diagnosed within the first year. Neither the tumour location, -stage, or -grade of diagnosed CRC nor the rates of other gastrointestinal cancers differed significantly.

Our study assessed the link between gastrointestinal (GI) infections in England and the Eat Out to Help Out scheme (EOHO), a government subsidy created to encourage people to eat out during COVID-19 pandemic (03-30 August 2020). We studied national laboratory data between January 2015 and December 2020. We used time series change point analysis to see if there were shifts in reported cases of specific GI infections (Campylobacter spp., Escherichia coli O157, and non-typhoidal Salmonella spp.) associated with the timing of the scheme. Our analysis uniquely applied the Pruned Exact Linear Time method, with generalized linear models to a national dataset of GI infections. This revealed increases in cases closely aligned to the timing of the easing of COVID-19 restrictions, prior to the introduction of the EOHO scheme. Our study showed the scheme had no measurable impact, as there was no significant change on reported cases. Substantial reductions in cases after the first lockdown, followed by an increase as restrictions were phased out, show the wider impact of COVID-19 control measures, for example, public information campaigns aimed at improving hand-hygiene. These findings highlight the complicated interactions between COVID-19 control measures, the public's behaviour, and the spread of GI infections.

Syphilis has re-emerged as a public health threat during the 21st century, and updated knowledge of the epidemic and its drivers is needed to halt this worrying development. We present data on the incidence of syphilis in the south Swedish region Skåne from 2007 to 2022 to determine the burden of disease, changes in risk groups, as well as routes for testing. To get a picture of the burden of syphilis, both early (notifiable) syphilis and cases of non-notifiable (late) symptomatic syphilis were included in this register-based study. Mann-Kendall trend analysis (MK) was used to determine statistical significance over time. In all, 584 cases of syphilis were included in the study. The overall syphilis incidence in Skåne increased from 3.1 cases/100000 population in 2007 to 6.3 in 2022 (MK z-stat: 2.57; p = 0.010). The highest increase in absolute numbers was among men who have sex with men (MSM), from eight cases annually in 2007 to 62 in 2022, but also for heterosexually transmitted men and women, with under ten cases yearly from 2007 through 2019 to 22 cases in 2022. We also found that transmission within Sweden was common, indicating that local measures are needed to curb this epidemic.

Despite efforts by the Volta River Authority (VRA) to provide services for schistosomiasis control in communities along Ghana's Volta Basin, high rates of transmission and re-infection persist in the region. To strengthen intervention effectiveness, the VRA partnered with the University of Health and Allied Sciences to conduct implementation research aimed at developing context-specific, evidence-based quality improvement strategies. This mixed-method study evaluates the reach, effectiveness, adoption, implementation, and maintenance of the VRA's quality improvement intervention for their mass drug administration (MDA) for schistosomiasis. Baseline and endline surveys were analysed using STATA and qualitative data from in-depth interviews (IDIs) and focus group discussions (FGDs) were coded and analysed thematically using Taguette. Urogenital schistosomiasis prevalence decreased by 87.83% in Shai Osudoku, 88.98% in South Tongu, and 90.96% in Asuogyaman after the intervention. The findings revealed high training levels among district health management staff and community drug distributors, high health worker satisfaction with the training, and positive community reception of the intervention. However, praziquantel side effects and related opportunity costs may have posed a barrier to drug uptake. Moreover, re-infection remains a challenge, which could be attributed to high domestic and economic reliance on the Volta River.

This study assessed the impact and cost-effectiveness of pre-exposure prophylaxis (PrEP) in reducing HIV infections and HIV-related deaths among four key populations in China: men who have sex with men (MSM). Female sex workers (FSW), people who inject drugs (PWID), and HIV-negative partners of serodiscordant couples (SDC). Decision-analytic Markov models simulated HIV transmission and progression in cohorts of 100,000 adults over 40 years under three strategies: no PrEP, daily oral PrEP, and on-demand oral PrEP evaluated nationaly and high-incidence provinces. Cost-effectiveness was measured using a willingness-to-pay threshold of US$37,653 per QALY. Across all populations, on-demand PrEP was the most cost-effective strategy. Among MSM, it was cost-effective both nationwide (ICER: $4,554/QALY) and in high-incidence provinces (ICER: $1,045-2,129/QALY), reducing new infections by 24.7%. Daily PrEP was also const-effective for MSM nationally and prevented 19.9% of infections. For FSW, on-demand PrEP was cost-effective in high-incidence provinces (ICER: $25,399-37,045/QALY), reducing infections by 21.8%-22.5%. For PWID, it was cost-effective in high-incidence provinces (ICER: $10,361-29,560/QALY), reducing infections by 15.5%-17.9%. For HIV-negative partners of SDC, on-demand PrEP was cost-effective both nationally and in high-incidence provinces, reducing infections by 24.0%. Overall, on-demand PrEP offers substantial health and economic benefits, particularly for HIV-negative partners of SDC and high-incidence regions.

This cross-sectional study investigated how care home size influences COVID-19 transmission dynamics, focusing on outbreaks in England during the second wave of COVID-19 (Wave 2; December 2020 to March 2021) and the Omicron wave (December 2021 to February 2022). Using data from the UK Health Security Agency and the Care Quality Commission, positive SARS-CoV-2 test results were matched to care home registration and occupancy data, examining outbreak trajectories in homes of varying sizes and resident age groups. The study included over 90,000 positive cases across the two waves. Small care homes (SCHs, with 10 or fewer beds), predominantly housing younger adults, showed significantly higher early positivity rates: 42% of residents were positive at outbreak detection, rising to 61% by day 7. In contrast, larger homes had early positivity rates of only 3-6%. These findings suggest that SCHs, often designed for communal living, facilitate rapid within-home transmission similar to household settings. The study concludes that outbreak control strategies in SCHs should differ from those in larger care homes, emphasizing proportionate, individualized approaches that consider resident vulnerability and minimize disruption to social support systems. These results have broader implications for managing future infectious disease outbreaks and support the development of tailored guidance based on care home size and resident demographics.

Effectiveness of nirsevimab against respiratory syncytial virus (RSV) hospitalization during the 2024/2025 season in Spain was estimated using a test-negative design (TND) and hospital-based respiratory infections surveillance data. Children born between 1 April 2024 and 31 March 2025 and hospitalized with severe respiratory infection between the start of the 2024 immunization campaign (regionally variable, between 16 September and 1 October 2024) and 31 March 2025 were systematically RT-PCR RSV-tested within 10 days of symptom onset and classified as cases if positive or controls if negative. Nirsevimab effectiveness ((1 - odds ratio) × 100) was estimated using logistic regression, adjusted for admission week, age, sex, high-risk factors, and regional RSV hospitalization rate. We included 199 cases (68.8% immunized) and 360 controls (86.4% immunized). Overall effectiveness was 65.5% (95% confidence interval: 45.2 to 78.3). Effectiveness was similar among infants born before and after the campaign start (63.6% vs. 70.4%, respectively). We found an unexpected early decrease in effectiveness with increasing time since immunization and age, albeit with wide confidence intervals for some groups. Strong age-period-cohort effects and potential sources of bias were identified, highlighting the need to further explore methodological challenges of implementing the TND in the dynamic population of newborns.

Respiratory infections trigger asthma exacerbations. Despite being less severely affected by COVID-19 than adults, the subsequent lockdowns had a great impact on children. Previous studies showed a decrease in asthma exacerbations during the COVID-19 lockdowns, but findings from secondary care settings are scarce. We aimed to elucidate the trends in frequency and characteristics of asthma exacerbations in children presenting on an emergency department (ED) of a secondary care setting before, during, and after the COVID-19 pandemic. A retrospective analysis was conducted using data from ED visits between January 2018 and November 2022 for asthma exacerbations in children. The incidence of ED visits, hospital admissions, paediatric intensive care unit (PICU) admissions, administered medication, and demographic information were compared. A total of 1121 exacerbations were reported in 670 children, of whom 476 (42%) were admitted to hospital and 44 (3.9%) required PICU admission. We observed a decrease in ED visits for asthma exacerbations during the pandemic but an increased risk in hospital admissions and PICU transfers for exacerbations. This suggests a more severe course of exacerbations. Barriers to health care and lower viral exposure may contribute to this.

Google Trends is used in research and surveillance as a proxy for community infection incidence. Signals are difficult to validate, as most surveillance biases towards severe outcomes and certain demographics.Using Winter COVID-19 Infection Study (WCIS) data in England, symptom prevalence is estimated via generalized additive model with multilevel-regression and poststratification. Symptom duration was estimated using interval censored time delay modelling, converting prevalence to incidence. Google Trends and WCIS incidence and growth rates were compared using cross-correlation.Google Trends and WCIS agreement varied by symptom and age group. The national maximum growth rate cross-correlation for sore throat was 0.81, with 90% prediction intervals of [0.69, 0.90]. Google Trends growth rates generally lagged the WCIS growth rates across symptoms (cough: -5.0 days [-8.0, 0.0], fever: -3.0 days [-6.0, 1.0], loss of smell: -9.0 days [-13, -3.0], shortness of breath: -12 days [-16, -5.0], and sore throat: -4.0 days [-5.0, -2.0]).This work shows Google Trends and community symptom incidence can align, although substantial variation between symptoms and age groups exists, underscoring utility in predicting other surveillance indicators.