European Journal of Public Health最新文献

Despite global initiatives to eliminate dog-mediated human rabies by 2030, the Arabian Peninsula faces challenges due to insufficient data. This review addresses the current rabies situation and knowledge gaps in the region and proposes One Health interventions. Employing a mixed-method approach combining scoping and systematic review, the study commenced with a Delphi discussion to identify knowledge gaps and set objectives. The literature search encompassed published articles and grey literature. The spatial and temporal distribution of rabies was analysed, alongside quantitative meta-analyses to assess prevalence. Rabies virus gene sequences from the NCBI database were examined for reservoir hosts and evolutionary patterns. The final Delphi discussion with experts focused on addressing knowledge gaps and formulating One Health interventions. The first reported human rabies case in this region occurred in Saudi Arabia in 1980. Yemen reported the highest number of cases (439), followed by Iraq (249), Saudi Arabia (91), Jordan (14), and Oman (9). Fox bites accounted for the most cases (47.4%), followed by dog (36.8%) and wild animal (15.8%) bites. The virus was detected in at least 21 animal species. Phylogenetic analysis detected a single strain with two clades, with foxes being the primary virus reservoir. However, the experts expressed scepticism about the accuracy of rabies reports in scientific literature. To achieve the 2030 goal of eliminating dog-mediated human rabies, a stepwise approach towards rabies elimination assessment is crucial in the region. Enhanced surveillance, awareness campaigns, and access to post exposure prophylaxis are essential to address the disease burden.

Middle East respiratory syndrome coronavirus (MERS-CoV) is an important zoonotic pathogen. The aim of this paper is to report one polymerase chain reaction (PCR)-positive case of MERS-CoV in a 27-year-old man who was involved in a nationwide longitudinal surveillance study of certain zoonotic diseases in Jordan including MERS-CoV. Whole-blood and nasal swab samples were collected from the man and five camels in the vicinity of his living area. The samples were subjected to enzyme-linked immunosorbent assay (ELISA) and real-time reverse-transcription PCR (RT-PCR) to detect MERS-CoV-specific antibodies and MERS-CoV genetic material, respectively. Genomic sequencing and phylogenetic analysis were also performed to detect similarities with known strains of the virus in the region. In January 2021, an ongoing surveillance study detected a MERS-CoV-positive nasal swab sample from an asymptomatic male and camels using RT-PCR. Phylogenetically, the MERS-CoV isolated in this case belonged to clade B and is clustered with other strains originating in the Arabian Peninsula. The case report represents the first PCR-positive case of MERS-CoV in an asymptomatic individual in Jordan, indicating active circulation of the virus within the population.

Preventing local transmission of malaria from imported cases is crucial for achieving and maintaining malaria elimination. This study aimed to investigate the epidemiological characteristics of imported malaria cases and assess the distribution of malaria vectors in Qatar. Data from January 2016 to December 2022 on imported malaria, including demographic and epidemiological characteristics, travel-related information, and diagnostic results, were collected and analysed using descriptive statistics. Field surveys conducted in 2021-22 collected mosquitoes using various traps across Qatar. The collected samples underwent morphological and molecular characterization at Qatar University. A total of 2693 cases were reported, with a mean incidence of 13.5/100 000 population, decreasing from 18.8/100 000 in 2016 to 5.5/100 000 in 2020. Most cases were Plasmodium vivax (57.4%) followed by P. falciparum (40.4%). The median age was 32.9 ± 12.5 years, primarily males (86.7%), expatriates (99.6%) and notified during the hot months (July to September). Cases were mainly imported from the Eastern Mediterranean Region followed by the African and South-East Asia Region with no deaths and indigenous cases. Anopheles stephensi was identified as a widely distributed species, but none carried the Plasmodium pathogen. Despite no reports of local transmission, the presence of An. stephensi and favourable environmental conditions pose a risk in Qatar. Strengthening surveillance for imported malaria and reviewing epidemic protocols are necessary. Conventional field studies are imperative to address knowledge gaps in Anopheles mosquito ecology and biting habits in Qatar, accurately assessing the risk of local malaria transmission to support Qatar's malaria-free status.

Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne disease with a case fatality rate of up to 40% in humans, posing a significant health threat. This study investigates the 2022-23 CCHF outbreaks in Iraq, the highest recorded to date, and analyzes potential factors at the human-animal-environmental interface. Data from the Iraqi government, the World Health Organization, and the World Bank were used to analyze CCHF trends and affecting factors. This included epidemiological reports, clinical data, tick infestation and seroprevalence studies, and climate data. Descriptive and statistical analyses examined case trends, geographic and demographic characteristics, clinical manifestations, risk factors, seasonal patterns, and influencing factors. A sudden rise in CCHF cases began in southern Iraq in April 2022 and expanded across all governorates, with a shift toward urban areas. Higher incidence was observed among males, aged 25-44, and those involved in slaughtering. The most common clinical manifestation was fever (97%), followed by hemorrhagic symptoms (54%). Bleeding from the gums or mouth and subcutaneous bleeding were more frequent in patients with fatal outcomes. Seasonal patterns showed peaks during spring and fall, correlating with tick activity and potentially exacerbated by climate change. Tick infestation and seroprevalence studies indicated a high prevalence of Hyalomma ticks and CCHF seropositivity among domestic animals in southern Iraq (60%), consistent with the distribution of CCHF human cases. Iraq's ongoing CCHF outbreak demands multidisciplinary One Health strategies. The Iraqi government has adopted such a control strategy, contributing to regional and global efforts to enhance pandemic preparedness.

The Chikungunya virus (CHIKV) presents substantial public health challenges in the Eastern Mediterranean Region (EMR), with its prevalence and interaction with other arboviruses (ABVs) remaining poorly understood. This systematic review and meta-analysis aimed to assess the prevalence of CHIKV and its association with other ABVs, such as dengue virus (DENV), Rift Valley fever virus (RVFV), malaria, and yellow fever virus (YFV), in the EMR. We systematically searched databases including PubMed, Embase, Web of Science, Scopus, Cochrane Library, CINAHL, PsycINFO, and ScienceDirect to identify epidemiological studies that report CHIKV prevalence and provide odds ratios (ORs) for CHIKV compared to other ABVs. Data analysis was performed using a random-effects model. Heterogeneity was evaluated using the χ2 test and I2 statistic. The GRADE approach was used to evaluate the quality of the studies while the AXIS tool, NOS tool, and AHRQ checklist assessed the risk of bias. The meta-analysis revealed a significant prevalence of CHIKV in the EMR. However, the studies exhibited heterogeneity, indicating variability in the results. A comparison of CHIKV with other ABVs did not show any statistically significant differences in prevalence. The meta-analysis found a notable prevalence of CHIKV in the EMR. The results also indicated that the prevalence of CHIKV is comparable to that of other ABVs in the region. These findings provide an overview of the burden of CHIKV in the EMR.

Bartonella is a vector-borne zoonotic pathogen, which could also be transmitted directly and cause a variety of clinical illnesses. This study aimed to investigate the prevalence of Bartonella in countries in the WHO Eastern Mediterranean Region (WHO-EMR) region. We searched using the keywords Bartonella and the name of each country in the WHO-EMR in databases such as PubMed, ISI (Web of Science), Scopus, and Google Scholar, with a publication date range of 1990-2022 and limited to English articles. We evaluated the quality of the studies using the STROBE 6-item checklist and used the random effects model to integrate the findings of the included studies. A total of 45 papers out of 240 were included in the analysis. The results showed the prevalence of Bartonella infection among endocarditis patients was 3.8% (95% CI: 0.2-7.4) and the seroprevalence of Bartonella among other people was 27.5% (95% CI: 13.5-41.5). The overall prevalence of Bartonella spp. among animals, as determined by molecular, serological, and culture methods, was 11.9% (95% CI: 5.7-18.2), 38.9% (95% CI: 27.5-50.2), and 1.7% (95% CI: 0.5-2.9), respectively. Furthermore, the prevalence of Bartonella spp. in ectoparasites was 3.9% (95% CI: 3.5-5.2), with fleas (6.2%) showing a higher prevalence compared to lice (4.9%) and ticks (1.0%). The detection of Bartonella in all animal and ectoparasites species and human populations in the WHO-EMR with prevalence ranging from 0.3% to 23% is concerning, emphasizes the importance of conducting more comprehensive studies to gain a deeper understanding of the spread of Bartonella in these areas.

The discontinuation of futile therapy is increasingly discussed in Polish clinical practice. Given the need to ensure patient well-being, it is essential to consider whether all clinical options resulting from medical progress should be used for every patient and on what grounds decisions to limit therapy should be based. The aim of our study was to determine the opinions of Polish medical doctors on this topic. We anonymously surveyed physicians across various specialties. An analysis of the collected data was carried out using descriptive and analytical methods. A total of 323 physicians participated in the study; 93% of them were aware of the problem of futile therapy in adults, with intensivists being significantly more aware (P = 0.002). Additionally, 95% of respondents supported the idea of discontinuing futile therapy, and over 68% used the therapy discontinuation protocol. Among the most common reasons for undertaking futile therapy, respondents cited fear of legal liability (93.5%), as well as fear of being accused of unethical behavior (62.2%) and fear before talking to the patient/patient's family and their reactions (57.9%). Respondents also identified factors that would facilitate making decisions about limiting futile therapy, including precise qualification criteria for limiting therapy and education in this area (95.3%), the patient's declaration of will (87.5%), and a clear legal act (81.3%). The majority of study participants supported the idea of limiting futile therapy, and this issue is well known among Polish physicians.

Breast cancer screening programmes can lead to better disease outcomes, but women from deprived backgrounds are less likely to participate and more likely to present with late-stage cancer. This study aimed to explore associations between deprivation and breast cancer screening outcomes in Ireland during 2009-2018. Data on all female breast cancer cases diagnosed in Ireland during 2009-2018 were extracted from the National Cancer Registry Ireland. Associations between area-level deprivation, using the Pobal Haase-Pratschke deprivation index, and detection of breast cancer through BreastCheck, Ireland's breast screening programme, and stage of screen-detected breast cancer were explored. Unadjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Among screening eligible women in Ireland in 2009-2018, there was no difference in risk of breast cancer detection through BreastCheck across deprivation quintiles (RR for most compared to least deprived group: 1.01, 95% CI: 0.96-1.06). In women with screen-detected breast cancer, the risk of late-stage cancer detection increased with deprivation in 2009-2013 (RR for most compared to least deprived group: 1.45, 95% CI: 1.10-1.93), but no association was observed between deprivation and cancer stage in 2014-2018. Notwithstanding its limitations, including the risk of confounding by uncontrolled variables, this study suggests screening eligible women in Ireland have had similar outcomes from breast cancer screening, regardless of deprivation level, since the national roll-out of BreastCheck. Associations between deprivation and screening outcomes should continue to be monitored to ensure Ireland's breast cancer screening programme is helping to reduce health inequities.