Epidemiology and Infection最新文献

Candida auris has emerged as a major nosocomial pathogen due to multidrug resistance (MDR), outbreak potential, and high mortality in critically ill patients. Identifying risk factors for C. auris candidemia is essential for prevention and infection control. In this single-centre, retrospective case-control study, we analysed adults with C. auris candidemia (n = 52) and matched controls (n = 104) hospitalized between February 2019 and October 2024. Matching was based on hospital unit and blood culture timing. Clinical and epidemiological variables were compared, and multivariate logistic regression identified independent risk factors. Antifungal susceptibility and 14- and 28-day all-cause mortality were evaluated as secondary outcomes. Independent risk factors included recent hospitalization (odds ratio (OR): 7.93), prolonged hospital stay (OR: 1.01), prior broad-spectrum antibiotic use (OR: 46.20), central venous catheter (CVC) (OR: 3.88), sepsis (OR: 9.43), and high Candida Colonization Index (OR: 14.10). All-cause mortality at 14 and 28 days was 30.8% and 46.2%, respectively. Fluconazole resistance was 96%, while 8.7% of isolates were pandrug resistant. C. auris candidemia represents a serious clinical challenge with substantial mortality and modifiable risk factors. Strengthening antimicrobial stewardship, colonization surveillance, and early recognition in high-risk patients may reduce its impact.

Zinc supplementation is a critical adjunct therapy for managing acute childhood diarrhoea, particularly in low-income countries (LICs) and lower middle-income countries (LMICs). However, adherence to the recommended zinc regimen remains a major challenge, limiting its effectiveness in real-world settings. This systematic review and meta-analysis aimed to estimate the pooled adherence rates to zinc supplementation for diarrhoea in children under 5 and identify key determinants of adherence. A comprehensive search of PubMed, Embase, Scopus, Google Scholar, ProQuest, and CINAHL was conducted between 2000 and 2024. A total of 10 observational studies were included, with pooled adherence of 63.45% (95% CI: 51.62-75.28) for 10 days regimen and 34.58% (95% CI: 7.08-62.09) for 14 days regimen, along with high heterogeneity. Sensitivity analysis confirmed robustness of these estimates. Key factors associated with adherence included caregiver education, provider counselling, medication acceptability, and economic constraints related to caregiver buying capacity. Doi plot asymmetry suggested possible publication bias for 10 and 14 days regimen. Overall, adherence to zinc therapy remains sub-optimal, particularly for 14 days regimen compared to 10 days regimen. Targeted interventions addressing behavioural, provider, and formulation related barriers are urgently needed to optimize zinc adherence and improve diarrhoea outcomes globally.

Trypanosoma cruzi, the etiological agent of Chagas disease, is a vector-borne parasite traditionally associated with sylvatic environments. We investigated the prevalence of T. cruzi in triatomines collected from El Paso County, Texas, and southern New Mexico. Specimens were morphologically identified as Triatoma rubida and subjected to quantitative PCR for parasite detection. Molecular sequencing of satellite and microsatellite DNA targets was performed to confirm species identity and assess strain lineage. Infected vectors were collected from both sylvatic and urban locations, including Franklin Mountains State Park and residential areas in El Paso (TX) and Las Cruces (NM). Of the 26 triatomines tested, 88.5% were positive for T. cruzi, representing a significant increase compared to a previous regional study, which reported an infection rate of 63.3%. The high prevalence of T. cruzi-infected T. rubida, particularly in urban and peri-urban areas of El Paso and Las Cruces, underscores the increasing public health significance of Chagas disease along the U.S.-Mexico border. These findings highlight the urgent need for sustained vector surveillance, advanced molecular characterization, and focused public health interventions to reduce transmission risks and raise clinical awareness in affected regions.

This nationwide retrospective study in Japan aimed to identify risk factors and diagnostic indicators for congenital syphilis (CS) and improve diagnostic accuracy. Data were collected from 230 pregnant women diagnosed with syphilis and their infants between 2015 and 2024. Of these, 49 infants were diagnosed with definite or highly probable CS, while 73 infants with excluded CS served as the control group. Multivariable logistic regression analysis revealed two significant risk factors for CS: maternal treatment not completed more than 4 weeks before delivery (odds ratio [OR]: 7.20; 95% confidence interval [CI]: 1.38-37.56; p = 0.02) and elevated total IgM levels in the infant (>20 mg/dL) (OR: 65.31; 95% CI: 4.53-941.39; p = 0.002). When using infant rapid plasma reagin (RPR) ≥1 as a diagnostic indicator, sensitivity was 93.8% (n = 48). In contrast, the infant-to-mother RPR ratio ≥1 showed a lower sensitivity of 34.3%, with fewer cases available for analysis (n = 35) due to limited maternal data. These findings indicate that delayed maternal treatment and high total IgM levels in the infant are significant risk factors, while the infant's RPR titre serves as a useful diagnostic indicator for CS.

Early in the COVID-19 pandemic, Denmark launched COVIDmeter, a national participatory surveillance platform collecting real-time, self-reported symptoms from a community cohort, aimed to support early signal detection of COVID-like illness. This study describes the community cohort, the reported symptoms among persons testing positive and evaluates COVIDmeter's performance in detecting trends compared to other established surveillance indicators. A total of 143000 individuals registered as participants, of whom 98% completed at least one weekly questionnaire, resulting in approximately 5.8 million responses over the period from March 2020 to March 2023. Of those who tested positive, the most commonly reported symptoms overall were headache, fatigue, muscle or body aches, cough and fever. Trends in COVID-like illness followed similar patterns to other indicators, with COVID-like illness peaks often preceding increases in incidence and hospital admissions, suggesting early detection potential. The study demonstrated that participatory surveillance can serve as an early detection tool for tracking infection trends, particularly in the early stages of a pandemic. While subject to limitations such as selection bias and self-reporting inaccuracies and participatory symptom surveillance proved to be a rapid, scalable and cost-effective complement to traditional surveillance independent of virus testing, this highlights its relevance for future pandemic preparedness.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a significant public health concern, disproportionately affecting socioeconomically disadvantaged populations, including individuals experiencing poverty, homelessness, incarceration, and injection drug use. This scoping review synthesizes existing literature on factors influencing CA-MRSA occurrence and community transmission in these populations. A comprehensive search of PubMed, MEDLINE, and Scopus for studies published between January 2000 and February 2024 identified 3,223 articles, of which 40 met the inclusion criteria. Findings indicate that the CA-MRSA burden remains high, with community transmission influenced by factors, such as limited access to hygiene resources, structural barriers to care, and social network dynamics. Surveillance and intervention strategies remain largely healthcare-focused, with limited data on community-level transmission and risk. This review highlights the urgent need for targeted public health interventions and the adoption of expanded, innovative surveillance methods, such as genomic epidemiology, to better track and mitigate CA-MRSA transmission in vulnerable populations. As antibiotic resistance continues to rise, future research should prioritize longitudinal studies and community-based surveillance to develop effective, population-specific infection prevention, and control strategies.

This study assesses the seroprevalence of Rift Valley fever (RVF) in ruminants in Dhobley, Somalia, following a 2021 outbreak in Kenya. Among 142 ruminants sampled, 4.9% were seropositive for RVF virus (RVFV) antibody, with IgM antibodies (1.4%) indicating recent exposure, though no cases were RT-PCR-positive. Unregulated livestock movement and limited surveillance pose significant risks for future outbreaks, underscoring the need for enhanced surveillance systems and One Health strategies.

In England, Shiga toxin-producing Escherichia coli (STEC) serogroup O26 has recently emerged as a public health concern, despite fewer than half of diagnostic laboratories in England having the capability to detect non-O157 STEC. STEC O26 cases frequently report exposure to farms or nurseries. We describe the epidemiology of STEC O26 and examine evidence for a relationship between O26 and exposure to these settings. We analysed national surveillance data describing laboratory-confirmed STEC cases and public health incidents over the past 10 years to explore the incidence, clinical outcomes, and association with farms and nurseries for STEC O26 cases compared to STEC O157 and other serogroups. Between 2014 and 2023, the proportion of STEC notifications which were STEC O26 increased from 2% (19/956) to 12% (234/1946). After adjusting for age, we found no difference in the likelihood of farm or nursery attendance between O26 and O157 cases but a significantly higher risk of HUS in O26 (adjusted risk ratio 3.13 (2.18-4.51)). We demonstrate that STEC O26 is associated with the same risk of farm or nursery attendance as other STEC serogroups but a higher risk of severe morbidity. Our findings reinforce the need for improved surveillance of non-O157 STEC.

Acute gastrointestinal illness (AGI) remains a significant public health issue and differences in risk based on a comprehensive set of sociodemographic characteristics remain poorly understood. Thus, this retrospective cohort study was conducted to identify the risk of incurring an AGI-related emergency department (ED) visit or inpatient hospitalization based on various sociodemographic factors. Linked respondents of Canadian Community Health Survey cycles 2.1, 3.1, and 2007-2015 were followed from their interview date until 31 December 2017, using the National Ambulatory Care Reporting System (NACRS) and the Discharge Abstract Database (DAD) to capture emergency ED visits and hospitalizations due to AGI, respectively. Effects of identified potential risk factors for the incidence of AGI-related ED visits or hospitalizations were estimated Cox proportional hazards regression to generate hazard ratios (HRs) with 95% confidence intervals (CIs). A total of 190,700 respondents were linked to NACRS and 470,700 were linked to DAD. Six per cent of respondents visited an ED and 2% were hospitalized for AGI. Fully-adjusted estimates revealed that high-risk groups with the strongest effects were people with poor self-perceived health (ED visits: HR 1.47 (95% CI 1.40-1.54), hospitalizations: HR 1.92 (95% CI 1.82-2.02)), and people living with at least one chronic condition (ED visits: HR 1.54 (95% CI 1.47-1.61), hospitalizations: HR 1.65 (95% CI 1.57-1.73)). This study identified risk factors for requiring hospital care for AGI in the Canadian context. Additional research is needed to investigate mechanisms for differential exposure to pathogens by sociodemographic characteristics that might lead to increased risks of AGI.