Journal of Epidemiology and Global Health最新文献

Background: Despite continued efforts to manage and control Tuberculosis (TB) in China, it remains a major health concern. Bone tuberculosis (Bone-TB), a common form of extrapulmonary tuberculosis, still adds considerably to the global TB case load. Diagnosing Bone-TB is often difficult as its symptoms can be similar to other bone or joint diseases, which leads to delayed detection and treatment. Currently, comprehensive reports on the epidemiological aspects of Bone-TB in China are scarce.

Methods: This retrospective study analyzed demographic and clinical data from 2,191 patients diagnosed with Bone-TB in Southwest China between January 2011 and September 2023.This study fully reveals the characteristics of Bone-TB in Southwest China.

Results: The overall trend of bone tuberculosis was a slow rise. Among 2191 patients, males, farmers, aged 42-68 years, and people with HIV and diabetes are the priority groups for the prevention and treatment of Bone-TB. The majority of the infected spines (1556/2191) were located in the thoracic vertebra (759/2191) and lumbar vertebra (715/2191). Forty-nine (2.24%) patients had drug-resistant TB (DR-TB). Forty-five (2.05%) died during the treatment. The total and actual hospitalization. Costs amounted to $3,837.10 and $1,914.35 (p < 0.01). Patients with DR-TB incurred the highest costs, amounting to $4,968.37. Cervical TB, with a prevalence of 5 patients (6.10%), exhibited the highest rates of catastrophic expenditures.

Conclusions: From 2011 to 2023, the yearly occurrence of Bone-TB in southwestern China exhibited a rising pattern, marked by notable distinctions in terms of gender, age, and regional variations, indicating localized clustering characteristics.

Background: Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates have remained unacceptably high. Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia. However, the pooled effect of malnutrition and anemia on HIV-related death related to children receiving ART was not investigated in sub-Saharan Africa.

Methods: We searched multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, and Web of Science) for observational studies published between January 1, 2010, and April 24, 2024 that reported the risk factors or effects of undernutrition and, anemia on HIV-related mortality among children. Study selection, data extraction, and quality evaluation were carried out separately by two reviewers. A meta-analysis was conducted using random effect models.

Results: The review included 27 studies with a combined total of 61,796 study participants. The study findings showed that severe wasting (HR: 2.49; 95% CI: 1.87-3.30), being underweight (HR: 2.11; 95% CI: 1.64-2.72), and Anemia (HR: 2.58; 95% CI: 2.08-3.19) were highly linked to HIV-related death among children. The risk of death due to anemia was greater among children under the age of 5 years than older children.

Conclusion: Undernutrition and anemia in sub-Saharan African children increased the risk of HIV-related death. The impact of malnutrition and anemia among under 5 years old children with HIV/AIDS was more pronounced, suggesting that these conditions at this early age can have more serious consequences for a child's survival. The importance of combining nutrition with HIV treatment programs in sub-Saharan African countries is crucial.

Background: Klebsiella pneumoniae is a common opportunistic pathogen in humans, often associated with both virulence and antimicrobial resistance (AMR) phenotypes. K. pneumoniae have a highly plastic genome and can act as a vehicle for disseminating genetic information. Aiming to assess the impact of the human-animal-environment interface on AMR dissemination in K. pneumoniae we sampled and genome sequenced organisms from a range of environments and compared their genetic composition.

Methods: Representative K. pneumoniae isolated from clinical specimens (n = 59), livestock samples (n = 71), and hospital sewage samples (n = 16) during a two-year surveillance study were subjected to whole genome sequencing. We compared the taxonomic and genomic distribution of K. pneumoniae, AMR gene abundance, virulence gene composition, and mobile genetic elements between the three sources.

Results: The K. pneumoniae isolates originating from livestock were clonally distinct from those derived from clinical/hospital effluent samples. Notably, the clinical and hospital sewage isolates typically possessed a greater number of resistance/virulence genes than those from animals. Overall, we observed a limited overlap of K. pneumoniae clones, AMR genes, virulence determinants, and plasmids between the different settings.

Conclusion: In this setting, the spread of XDR and hypervirulent clones of K. pneumoniae appears to be restricted to humans with no obvious association with non-clinical sources. Emergent clones of K. pneumoniae carrying both resistance and virulence determinants are likely to have emerged in hospital settings rather than in animal or natural environments. These data challenge the current view of AMR transmission in K. pneumoniae in a One-Health context.

Introduction: We implemented two cross-sectional reproductive age mortality surveys in 2007-2008 and 2018-2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys.

Methods: We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher's exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests.

Results: All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1-9.7)] and CRVS three times [RR 3.4 (2.4-4.7)] more likely to identify maternal deaths than health records in 2007-08. In 2018-19, CRVS [RR 0.8 (0.7-0.9)] and surveillance [RR 0.7 (0.6-0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2-1.5)]; CRVS [RR 1.3 (1.1-1.5)] and the community survey/surveillance [RR 1.4 (1.2-1.6)].

Conclusion: Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.

Introduction: The COVID-19 pandemic overwhelmed health systems, resulting in a surge in excess deaths. This study clustered countries based on excess mortality to understand their response to the pandemic and the influence of various factors on excess mortality within each cluster.

Materials and methods: This ecological study is part of the COVID-19 MORtality (C-MOR) Consortium. Mortality data were gathered from 21 countries and were previously used to calculate weekly all-cause excess mortality. Thirty exposure variables were considered in five categories as factors potentially associated with excess mortality: population factors, health care resources, socioeconomic factors, air pollution, and COVID-19 policy. Estimation of Latent Class Linear Mixed Model (LCMM) was used to cluster countries based on response trajectory and Generalized Linear Mixture Model (GLMM) for each cluster was run separately.

Results: Using LCMM, two clusters were reached. Among 21 countries, Brazil, the USA, Georgia, and Poland were assigned to a separate cluster, with the mean of excess mortality z-score in 2020 and 2021 around 4.4, compared to 1.5 for all other countries assigned to the second cluster. In both clusters the population incidence of COVID-19 had the greatest positive relationship with excess mortality while interactions between the incidence of COVID-19, fully vaccinated people, and stringency index were negatively associated with excess mortality. Moreover, governmental variables (government revenue and government effectiveness) were the most protective against excess mortality.

Conclusion: This study highlighted that clustering countries based on excess mortality can provide insights to gain a broader understanding of countries' responses to the pandemic and their effectiveness.

Background: COVID-19 vaccination has become a pivotal global strategy in managing the pandemic. Despite COVID-19 no longer being classified as a Public Health Emergency of International Concern, the virus continues affecting people worldwide. This study aimed to evaluate risk factors and vaccine effectiveness on COVID-19-related hospital admissions, intensive care unit (ICU) admission and mortality within the Andalusian population throughout the pandemic.

Methods: From March 2020 to April 2022, 671,229 individuals, out of 9,283,485 with electronic health records in Andalusia, experienced SARS-CoV-2 infection and were included in the analysis. Data on demographics, medical history, vaccine administration, and hospitalization records were collected. Associations between medical history, COVID-19 vaccines, and COVID-19 outcomes were assessed.

Results: Our study identified 48,196 hospital admissions, 5,057 ICU admissions, and 11,289 deaths linked to COVID-19. Age, male sex, and chronic diseases were identified as risk factors, while the COVID-19 vaccine demonstrated protective effects, although with reduced effectiveness during the omicron variant period. However, the risk for these outcomes increased over time after receiving the last vaccine dose, particularly after six months, especially among those aged 60 or older.

Conclusion: The global health challenge of COVID-19 persists, marked by emerging variants with higher virulence and severity, particularly among the unvaccinated and those beyond six months post-vaccination, especially those aged 60 and above. These findings highlight the need for robust surveillance systems targeting new variants and administering booster doses, particularly for individuals aged 60 or older with underlying health conditions, to mitigate the global burden of COVID-19.

Objective: This study investigates the key factors contributing to the dengue outbreak in Oman.

Methods: Data on climate (e.g., temperature, humidity, wind pace), population traits (e.g., populace density), and vector dynamics (e.g., mosquito density) within the Seeb district of Oman from 2022 to 2023 were gathered. The partial least squares structural equation modeling (PLS-SEM) was performed to study which variables affect dengue outbreaks.

Results: The results indicate that climatic factors significantly affect the dengue vector (β = -0.361, p < 0.001) but do not directly impact the dengue outbreak. Population characteristics, however, have a more substantial impact on dengue transmission, with a total effect (β = 0.231, p = 0.002) being relatively higher than that of the vector itself (total effect: β = 0.116, p < 0.001).

Conclusions: Even with ongoing vector intervention efforts, the study underscores the need to include innovative public health interventions when considering environmental and demographic factors. More advantageous surveillance and focused interventions in excessive-threat regions are essential to mitigate the effect of dengue in Oman.

Purpose: Tribal Nations disproportionately lack access to safe drinking water and can be adversely affected by other water quality and environmental concerns. Such conditions could lead to an increase in the transmission of waterborne, environmental and hygiene related infections. We collected saliva samples from attendees at two Tribal Nation annual festivals and tested them for salivary immunoglobulin G (IgG) responses to selected common infections using an in-house multiplex immunoassay. Antibody responses were compared to responses from a previously conducted study in the midwestern United States.

Methods: We collected and tested 531 samples from Tribal Nation sites and used data on 453 previously analyzed samples from the Midwest site. Logistic and linear regression models were used to model a binary classification of seropositivity and the intensity of the antibody response, respectively.

Results: Seroprevalence of chronic infections (Helicobacter pylori and Toxoplasma gondii) were generally consistent with estimates from population-based studies. Compared to the Midwest site, one of the Tribal Nation sites had consistently higher median antibody responses to several noroviruses. The Tribal Nation sites had a lower seroprevalence of hepatitis E virus antibodies. At the Tribal Nation sites, farm residents had higher antibody responses to Cryptosporidium spp., bottled water consumption was associated with lower responses to Cryptosporidium spp., animal contact was associated with T. gondii seropositivity, and recent diarrhea was associated with higher norovirus antibody responses. Helicobacter pylori seropositivity was associated with reduced odds of reporting allergies.

Conclusion: This study demonstrated the application of a multiplex salivary immunoassay in Tribal Nations to provide insights regarding selected common pathogens which are transmitted through different transmission pathways including person-to-person contacts, contaminated food, soil and drinking water.

Objectives: To assess the carriage of methicillin-resistant Staphylococcus aureus-encoding genes (MRSA) among French Hajj pilgrim cohorts.

Methods: A prospective cohort study was conducted on pilgrims from Marseille during the 2014 to 2018 Hajj. Respiratory samples were collected before and after the pilgrimage. S. aureus and then MRSA-encoding genes were identified using real-time PCR.

Results: A total of 606 pilgrims were included with a sex ratio of 1:1.3 with a median age of 61 years (interquartile = 56-66 years, range = 21-88 years). A total of 511/606 (84.3%) pilgrims presented at least one respiratory symptom during their pilgrimage. Cough was the most frequent symptom occurring in 76.2% of pilgrims, followed by sore throat (57.6%), rhinitis (54.6%), and voice failure (36.3%). 87 (14.4%) were positive with S. aureus before travelling. On return, 130/606 (21.4%) participants were positive. The acquisition rate of S. aureus was 13.0% (79/606). The prevalence of MRSA pre- and post-travel and acquisition rate was 4.1% (25/606), 10.6% (62/606), and 8.2% (50/606), respectively. All MRSA were positive with mecA gene. No case was positive with mecC.

Conclusion: Our study highlights the importance of surveillance and infection control measures during mass gatherings such as the Hajj to mitigate the spread of infectious pathogens, including antimicrobial-resistant bacteria like MRSA. Further research is warranted to elucidate the specific factors contributing to S. aureus and MRSA transmission during the pilgrimage and to inform targeted interventions aimed at reducing the burden of MRSA infection among pilgrims.

Introduction: Tuberculosis (TB) is a significant contributor to morbidity and mortality. With a progressively aging population, TB is increasingly encountered in older adults. Understanding the clinical presentation and optimal treatment strategies for TB in this population is essential.

Method: Clinical, radiological features, treatment, and outcome of patients aged 75 and above who were diagnosed with tuberculosis at King Abdulaziz Medical City in Riyadh in the period between January 2015 to December 2021wereevaluated retrospectively.

Results: Among 92 elderly tuberculosis patients, most were male (76.1%) with a mean age of 82.5 years. Pulmonary TB was diagnosed in 52.2% of patients, Extra Pulmonary TB in 32.6%, and Disseminated TB in 15.2%. Comorbidities included Diabetes Mellitus (59.8%) and Congestive Heart Failure (41.3%). The most common presentation symptoms included cough (51.1%), fever (43.5%), dyspnea (39.1%), and weight loss (31.5%). Delay of TB diagnosis for up to 3 months was observed in 31.5% of patients. Weight loss and male gender were significant predictors of delayed diagnosis. Laboratory findings varied among TB types, with disseminated TB showing higher eosinophilia and thrombocytopenia. Completion of an initial RIPE treatment protocol was achieved in 67.6% of patients. Mortality during treatment occurred in 23.9% of patients. Pulmonary TB was associated with higher mortality compared to extrapulmonary TB (p = 0.007).

Conclusion: Tuberculosis is associated with high mortality in patients above the age of 75. There is still a substantial delay in TB diagnosis in the elderly. RIPE regimen is frequently changed due to side effects. Alternative regimen choices were quite variable. More studies on tuberculosis in this patient's population are needed to define the most effective therapeutic approach.