International Journal of Infectious Diseases最新文献

Background: Influenza pandemic plans often recommend non-pharmaceutical interventions (NPIs) in household settings, including hand hygiene and face masks. We reviewed the evidence supporting the recommendations of these measures to prevent the spread of influenza in households.

Methods: We performed systematic reviews between 26 May and 30 August 2022 in Medline, PubMed, EMBASE, and CENTRAL to identify evidence for the effectiveness of selected measures recommended by representative national influenza pandemic plans. We prioritized evidence from randomized controlled trials conducted during influenza pandemics and seasonal influenza epidemics. Fixed-effects models were used to estimate the overall effects. Systematic reviews were registered in the OSF registry (https://osf.io/8kyth).

Results: We selected 9 NPIs for evidence review. We identified 9 randomized-controlled trials related to hand hygiene and face masks in household settings. 2 studies reported that measures could delay the introduction of influenza virus infections into households. However, we did not identify evidence from randomized controlled trials that indicated a substantial effect of hand hygiene and face masks in preventing the spread of influenza within households.

Conclusion: Limited evidence indicated that within-household measures may likely be effective only when implemented before or as soon as possible after symptom onset in an infected case. Improving the evidence base for NPIs in households and elsewhere is a continuing priority.

Funding: World Health Organization and the Strategic Topic Grants Scheme.

A panel of experts convened by the International Society for Infectious Diseases (ISID) has reviewed and consolidated current recommendations for preventing vascular catheter infections, particularly central line-associated bloodstream infections (CLABSIs). This review provides healthcare professionals with insights into key issues such as the rates of CLABSI in high-income countries and low- and middle-income countries, the attributable extra length of stay, cost and mortality, and risk factors. This position paper highlights evidence-based strategies for preventing infections, applicable to both high-income and low- and middle-income countries.

Objectives: To unravel the still unexplored HBV-replicative kinetics in antiHBc-positive/HBsAg-negative people-with-HIV (PWH) suspending TDF/TAF.

Methods: 101 antiHBc-positive/HBsAg-negative PWH switching to TDF/TAF-sparing therapy were included. Serum HBV-DNA and HBV-RNA were quantified by droplet-digital-PCR at switching (T0), within 12-months (T1) and 12-24 months post-switch (T2).

Results: At T0, 33.7% had cryptic HBV-DNA (undetected by commercial assays, median[IQR]:2[1-5]IU/ml) and 22% were positive to HBV-RNA alone (median[IQR]:4[3-4]IU/ml), indicating an active HBV-reservoir despite HBsAg-negativity and TDF/TAF-pressure. Notably, antiHBs-titer<100mIU/ml independently correlated with cryptic HBV-DNA at T0 (OR[95%CI]:2.6[1.02-6.5], P=0.04). After TDF/TAF-withdrawal, the rate of PWH achieving HBV-DNA>10IU/ml increased from 12.9% at T1 to 42.6% at T2 (P<0.0001). Likewise, a rise from 2% to 11% was observed for HBV-DNA>100IU/ml (P=0.02); median(IQR) HBV-DNA: 579(425-770)IU/ml. Notably, HBV-DNA>10IU/ml at T2 occurred in 70% of PWH with cryptic HBV-DNA, in 38.5% with HBV-RNA alone and in 25% negative to both HBV-markers at T0 (P=0.01). Cryptic HBV-DNA at T0 and lower nadir CD4+T-cell-count independently predicted HBV-DNA>10IU/ml at T2 (OR[95%CI]:8.2[1.7-40.6], P=0.01; OR[95%CI]:8.1[1.3-52.1], P=0.03). Lastly, persistent HBV-DNA positivity was independently associated with a reduced CD4+T-cell recovery at T2 (OR[95%CI]:0.07[0.01-0.77], P=0.03).

Conclusions: This study underlines the importance to regularly monitor antiHBc-positive/HBsAg-negative PWH undergoing TDF/TAF-sparing regimen and the role of highly-sensitive HBV markers in optimizing their management.

Objectives: This study assesses the global, regional, and national burden of hepatitis B (HBV) and hepatitis C (HCV) related to injecting drug use (IDU) from 1990 to 2021.

Methods: Data from the global burden of disease study 2021 were analyzed to quantify deaths, age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and age-standardized DALYs rates (ASDR) due to HBV and HCV from IDU across 204 countries. Trends was evaluated using estimated annual percentage change. Analyzing the association between ASDR and SDI using a loess regression model.

Results: From 1990 to 2021, the global burden of deaths and DALYs due to HBV and HCV attributed to IDU showed an increasing trend, especially among males, whose mortality rates were significantly higher than females. In 2021, global deaths due to HBV from IDU were 13,050.8, with an ASMR of 0.15 per 100,000 and an ASDR of 5.3, both showing an increasing trend with estimated annual percentage changes (EAPCs) of 1.09 and 0.96, respectively. HCV deaths reached 231,764.4, with an ASMR of 2.68 (EAPC: 0.38) and a relatively stable ASDR trend (EAPC: 0.01). Although raw death rates for HCV have increased, the ASMR and ASDR have remained stable or slightly declined, highlighting different trends across sexes and regions. India had the highest national deaths, while the highest ASDRs were in the Republic of Moldova (HBV) and Mongolia (HCV). South Asia recorded the highest regional deaths for both HBV and HCV. Positive correlations between ASDRs for HBV and HCV with SDI were observed.

Conclusion: The burden of HBV and HCV due to IDU has increased from 1990 to 2021, especially among males, with significant regional and national disparities. Targeted drug prohibition interventions and policies are needed.

Objectives: Approximately 40% of tuberculosis (TB) cases remain undiagnosed globally. Lower lung field tuberculosis (LLF TB) presents atypically and is often misidentified as other lung diseases, leading to diagnostic delays in resource-limited settings. It may contribute to increased TB transmission and mortality. We aimed to identify microbiological determinants of LLF TB and evaluate treatment responses to optimize care.

Methods: We conducted an observational cohort study in Lima, Peru, enrolling adults with microbiologically confirmed pulmonary TB (PTB) diagnosed by GeneXpert MTB/RIF assay or sputum culture. Mycobacterium tuberculosis (MTB) lineage was determined using whole-genome sequencing (WGS). Due to the delayed chest radiograph (CXR) changes in LLF TB compared to non-LLF TB, we measured changes in the St. George's Respiratory Questionnaire (SGRQ) score at two-month treatment mark and evaluated World Health Organization (WHO)-specified final treatment outcomes. We used logistic regression to evaluate the associations between LLF TB and microbiological determinants and treatment outcomes. We used linear regression to assess whether the change in SGRQ scores over the first 2 months of treatment varied by LLF TB status.

Results: Among 1,316 PTB patients, 84 (6%) had LLF TB. Compared to non-LLF TB patients, LLF TB patients were more likely to be smear-negative (adjusted odds ratio [aOR] [95% CI]=2.04 [1.28-3.23], p=0.002) and to be infected with Lineage 2 (aOR [95% CI]= 1.95 (95% CI: 1.07 to 3.41; p=0.024). People with LLF TB had less improvement in SGRQ scores after two months of treatment (adjusted score difference [95% CI] = -6.29 [-10.99 to -1.59], p = 0.009), while they experienced better final outcomes compared to non-LLF TB patients, though this difference did not reach statistical significance (adjusted odds ratio [aOR] = 0.43 [95% CI: 0.13 to 1.05], p = 0.103).

Conclusion: Patients with LLF TB are more likely than those with upper lung lesions to be sputum-negative on conventional tests, to be infected with Lineage 2, and to show less clinical improvement after treatment.

Objectives: We evaluated all-cause healthcare utilization among those with vaccine-associated myocarditis, compared to vaccinees without post-vaccination myocarditis.

Methods: We conducted a retrospective cohort study in individuals aged 12 and older who received COVID-19 mRNA vaccination in British Columbia. Exposure was defined as an ED visit or hospitalization for myocarditis within 21 days post-vaccination. The primary outcome was healthcare utilization. Ratios of rate ratios (RRRs) for exposure-associated healthcare utilization were calculated using a difference-in-differences (DiD) analysis.

Results: In the post-index period, the exposed and unexposed groups showed substantial utilization rate difference (RD = 15.30 [95% CI, 14.47-16.13). A 51% overall increase in healthcare utilization was observed over 18 months among exposed individuals (RRR, 1.51 [95%CI, 1.08-2.11]). In the initial six months, healthcare utilization surpassed the 18-month estimate, exhibiting a 125% increase (RRR, 2.25 [95%CI, 1.43-3.52]), while the last 12 months showed no statistically significant change (RRR, 1.03 [95%CI, 0.72-1.47]). An additional 9.1 (95%CI, 8.53-9.71) visits per person were attributed to vaccine-associated myocarditis over 18 months (total excess = 938.26 healthcare visits).

Conclusion: The initial surge in healthcare visits post-exposure, mainly outpatient follow-ups, followed by a return to baseline rates, indicates a positive prognosis and supports the vaccine's safety profile.

Introduction: Autoantibodies (AAbs) directed against interferon alpha (aIFNα), nuclear antigens (ANAs), cardiolipin (aCL), and beta 2 glycoprotein 1 (aβ2GP1), have been demonstrated to significantly correlate with the severity of acute COVID-19. However, whether SARS-CoV-2 infection induces these AAbs and whether they are associated with long COVID remains unclear.

Methods: The potential induction of aIFNα, ANAs, aCL, and aβ2GP1 by SARS-CoV-2 was assessed by measuring these AAbs in 224 pre- and post-infection paired serum samples from the Johns Hopkins Hospital Emergency Department (JHHED). The relationship between these AAbs and long COVID was assessed using 60 serum samples from participants in the Outpatient SARS-CoV-2 Mild and Asymptomatic Infection Response and Transmission (OutSMART) study.

Results: We found no evidence that these AAbs were induced in the JHHED cohort and no significant difference in their prevalence between patients with (n=30) and without (n=30) long COVID in the OutSMART cohort.

Conclusions: These findings do not support the hypotheses that SARS-CoV-2 induces these AAbs or that they are related to long COVID.

Background: Tuberculosis (TB) remains a Global Health challenge, with diagnostic delays contributing significantly to its spread. This study investigates the differences in diagnostic delays between native and migrant TB patients in Italy, examining patient-related diagnostic delay (PDD), health system-related diagnostic delay (HDD), and total diagnostic delay (TDD).

Methods: We conducted a retrospective, multicenter, cross-sectional study of TB cases in ten Italian hospitals from 2018 to 2023. We compared PDD, HDD, and TDD between native and migrant populations. Socio-demographic data and clinical histories were analyzed to identify factors contributing to diagnostic delays.

Results: We included 669 TB patients (390 migrants and 279 natives). Migrants experienced significantly longer PDD (median 90 vs. 10 days, p<0.0001) but shorter HDD (median 5 vs. 40 days, p<0.0001) compared to natives, resulting in a longer TDD (median 96 vs. 65 days, p<0.0001). Furthermore, migrants had higher Timika scores, longer sputum conversion times, and were more frequently lost to follow-up.

Conclusions: Migrants face longer PDD, emphasizing substantial barriers to healthcare access. Natives experience longer HDD, reflecting neglect of TB in low-endemic regions. Future research should focus on the impact of social determinants and training for healthcare providers on TB diagnosis and develop strategies to reduce diagnostic delays.

Objective: Given the complex role of immunity in dengue severity, we aimed to review the clinical course of dengue infection in immunocompromised patients.

Methods: We conducted a systematic review of studies reporting outcomes among immunocompromised patients with laboratory-confirmed dengue infection. Meta-analysis using the Mantel-Haenszel method (fixed effects) was performed for studies with control groups. We registered the study with PROSPERO (No. CRD42021258930).

Results: We included 115 studies. Among these, 30 studies compared immunocompromised (cases) and non-immunocompromised (control) patients, focusing mainly on children (n=22 studies) with malnutrition (n=18). Immunocompromised patients had a higher likelihood of dengue complications (OR 1.87; 95% CI: 1.04 - 3.35]) but a lower likelihood of severe dengue (OR 0.83; 95% CI: 0.69 - 1.00]. No significant difference in mortality was observed. In the 85 studies focused solely on immunocompromised patients, severe dengue and mortality rates were 9% and 4%, respectively, mostly among adult solid organ transplant recipients and those with inflammatory diseases. Immunosuppressive treatment alterations and temporary graft dysfunction were reported.

Conclusions: Immunocompromised patients have an increased risk of dengue-related complications. However, definitive conclusions about the comparative severity of dengue across different immunocompromised patient groups are limited by a lack of robust data, highlighting the need for well-designed future studies.