Journal of Epidemiology and Global Health最新文献

Background: Healthcare-associated infections (HCAIs) pose a serious threat to healthcare systems. Accurately determining the incidence of HCAIs is crucial for planning and implementing efficient interventions, as they are associated with a wide range of challenges. The objective of this study was to assess and update the incidence rates of HCAIs in Iran in 2023, using data from the Iranian Nosocomial Infection Surveillance (INIS) system, a nationwide hospital-based surveillance program.

Methods: The Iranian Center for Communicable Diseases Control (ICDC) evaluated data from 1,066 hospitals using the INIS software. Hospitals' trained infection control staff collected all information and entered it into the INIS. HCAIs were diagnosed based on the CDC/NHSN case definition criteria. We calculated incidence rate (per 100 admissions and per 1,000 patient-days).

Results: We reported 170,948 HCAIs among 11,043,373 hospitalized patients, with an incidence rate of 4.95 per 1,000 patient-days, and the crude mortality rate of 19.85%. Looking at the relative frequencies, Pneumonia was the most frequent infection (28.32%), followed by urinary tract infections (UTIs) (26.6%), and surgical site infections (SSIs) (21.85%). HCAI rates were highest in intensive care units (ICUs), transplant wards, and burn units, with major surgeries like cardiovascular, neurosurgeries, and orthopedics having the highest SSI rates. The most common microorganisms were Klebsiella spp. (16.56%) and E. coli (14.6%), with high proportions of multidrug-resistance (MDR) including MRSA (43.2%), VRE (65.24%), and KPC (74.21%).

Conclusions: This study reveals a high incidence of HCAIs in Iranian hospitals in 2023, with pneumonia, UTIs, and SSIs being most common. The high proportion of MDR pathogens underscores the need for enhanced infection control, antibiotic stewardship program, and continuous staff education to reduce HCAIs and improve patient outcomes.

Background: Air pollution is among the top five environmental risk factors for human health worldwide. However, our understanding of the physiological responses to PM₁₀ exposure over medium-term lag periods remains limited. This study aims to examine the medium-term lag-response associations-using lagging time windows of up to 21 days-between PM₁₀ exposure and all-cause mortality in Valencia and London from 2002 to 2006.

Methods: We used a time-stratified case-crossover design; building on the methodologies of Tobias et al. and Bhaskaran et al., we applied a fixed-effects conditional quasi-Poisson regression model to quantify the association between PM₁₀ exposure and all-cause mortality. We also analyzed three different temporal lag methodological models for the exposure-mortality relationships.

Results: We found distinct differences in the relative risk (RR) patterns of PM₁₀ exposure and all-cause mortality. In Valencia, the RR varied significantly, with confidence intervals that were wider than in London, where the RR remained more stable, fluctuating closely around 1. Significant associations were observed at early lag periods in both cities, consistent with Tobias et al. Notably, Valencia showed a significant peak in RR at lag 14, which was not observed in London. Subgroup analysis in Valencia also indicated delayed effects in younger populations. Scenario 3 (cumulative lag model) is conceptually closer to the cumulative progression of health risks associated with PM₁₀ exposure and produces higher RR estimates compared to Scenario 1 and 2.

Conclusions: This study highlights the critical importance of addressing medium-term lag-response associations and methodological variations in environmental epidemiology. The findings have important clinical and public health implications and offer insights for risk assessment, healthcare planning, and the development of policies to mitigate the health impacts of PM₁₀ exposure.

Background: Corneal dystrophies are inherited disorders that can lead to significant visual impairment and often require surgical intervention in advanced stages. Fuchs endothelial corneal dystrophy (FECD) is the most frequently diagnosed type in Western countries and remains a leading global indication for corneal transplantation. In contrast, non-Fuchs dystrophies represent a diverse group of less common entities, each with distinct clinical features, surgical considerations, and regional variations in incidence and management. Despite their relevance, long-term data on the full spectrum of corneal dystrophies remain scarce. This study aimed to evaluate the distribution and temporal trends in dystrophy types and associated surgical procedures over eight decades at a tertiary referral center in Germany.

Methods: This retrospective analysis included 3 827 histopathologically confirmed corneal dystrophy specimens identified from an archive of 58 150 ophthalmic specimens collected between 1945 and 2024. Extracted data included dystrophy type, patient age at surgery, sex assigned at birth and associated surgical procedures. Distribution and temporal trends were analyzed descriptively.

Results: FECD accounted for 90.3% (n = 3 455) of all cases, with a more than 15-fold increase in annual cases between 2003 and 2024. Its surgical management transitioned from exclusive use of penetrating keratoplasty (PKP) to posterior lamellar keratoplasty in over 99% of cases by 2024. Among non-Fuchs dystrophies (n = 372), granular (21.2%), macular (17.5%), and lattice dystrophy (17.2%) were most frequent. These exhibited greater surgical variability, reflecting their heterogeneity across 21 non-Fuchs dystrophy types in this study. Stromal and epithelial-stromal dystrophies were predominantly managed with PKP, whereas superficial epithelial and basement membrane dystrophies were increasingly treated with phototherapeutic or manual superficial keratectomy. Limbo-keratoplasty was introduced in the early 2000s for recurrent subepithelial and epithelial-stromal types.

Conclusion: This study provides unique insights into the type distribution and surgical management of corneal dystrophies over eight decades in a German center, encompassing nearly all IC3D-classified entities. The marked increase in FECD specimen numbers and the shift toward lamellar keratoplasty reflect evolving clinical practices and rising demand on corneal transplantation services. The broader clinical spectrum and procedural diversity among non-Fuchs dystrophies underscore the ongoing need for pathology-specific management strategies tailored to population-specific needs.

Objective: This study aims to analyze the epidemiological characteristics, spatial and temporal distribution patterns, and trends in the evolution of scrub typhus (ST) in Jiangsu Province from 2006 to 2023. Scrub typhus was chosen for this study due to its increasing incidence in Jiangsu Province, its substantial health burden on rural populations, and its relevance as a vector-borne disease influenced by environmental and seasonal factors.

Methods: Data on ST cases in Jiangsu Province from 2006 to 2023 were obtained from the China Disease Control and Prevention Information System. Descriptive statistics were used to summarize the overall epidemiological trends. Spatial autocorrelation analysis (Global and Local Moran's I) assessed the overall and local distribution patterns of ST cases. while spatial-temporal hotspot analysis identified regions with significant clustering of cases over time, providing insights into potential high-risk areas.

Results: A total of 16,998 ST cases were reported in Jiangsu Province, with an average annual incidence rate of 1.13 per 100,000. The gender distribution showed a male-to-female ratio of 1:1.20. The ages of affected individuals ranged from 3 months to 97 years, with a mean age of 60 years. Farmers represented the largest occupational group, accounting for 84.68% of the cases. The incidence rate showed a significant upward trend (χ²trend = 8484.517, p < 0.001). Peak incidence occurred primarily between October and November. The global Moran's I index ranged from 0.071 to 0.345. Local autocorrelation analysis revealed that Yancheng and Nantong cities were high-high clustering areas. Spatial-temporal hotspot analysis revealed that hotspots were predominantly located in the northern and central regions of Jiangsu, while the southern region was identified as a cold spot. These hotspots displayed oscillating patterns, with new hotspots emerging in specific areas. Standard deviation ellipse analysis indicated that the epidemic spread continued to expand along the north-south axis, while the east-west axis showed relative stability. Spatial-temporal scanning analysis identified four high-incidence spatial-temporal clustering zones.

Conclusion: The incidence of ST in Jiangsu Province exhibited a significant upward trend, with distinct seasonal peaks between October and November. The epidemic demonstrated a pronounced transmission along the north-south axis, spatial-temporal clustering, and a shifting center of gravity. It is recommended to strengthen surveillance in high-risk areas and implement targeted prevention and control measures during high-risk seasons, particularly for vulnerable populations, to effectively curb the spread of the epidemic.

Culture-negative infective endocarditis (CNE) remains a significant diagnostic challenge in cardiology and infectious disease, often leading to delayed or empirical treatment. Metagenomic next-generation sequencing (mNGS) has emerged as a complementary diagnostic tool capable of identifying fastidious, unexpected, or novel pathogens without prior assumptions. This narrative review synthesizes evidence from 152 studies (2015-2024), evaluating mNGS within existing diagnostic frameworks for culture-negative IE. Compared to conventional diagnostics (blood cultures, PCR, 16 S rRNA sequencing), mNGS demonstrates enhanced detection capabilities for polymicrobial infections and rare pathogens, though methodological heterogeneity across studies precludes definitive performance comparisons. Performance varies substantially based on sample type, sequencing platform, and bioinformatic pipelines. Real-world applications reveal persistent challenges, including cost barriers, interpretive complexities in low-biomass samples, and contamination risks. Integration with host-response biomarkers and AI-driven interpretation platforms shows promise for advancing clinical utility. For mNGS to be effectively integrated into routine CNE care, standardization, regulatory clarity, and equitable implementation will be essential.

Background: In Mali, the screening, diagnosis, and treatment of epilepsy face significant challenges due to a shortage of qualified health workers in rural areas, limited access to health services, and cultural barriers. This study assessed how mHealth platforms can support task shifting to community health workers (Relais) to screen and treat epilepsy at the community level.

Methods: We conducted a cohort study involving persons with epilepsy (PWE) and Relais in 17 villages in the Nonkon health area of the Kolokani Health District, approximately 105 km northwest of Bamako, the capital city of Mali. Relais collected data using mobile phones equipped with an "Epi-Collect" application specifically designed for epilepsy management, enabling Relais to record patient information digitally. All collected data was securely stored in "telesante.ml," a telemedicine platform utilized by healthcare professionals.

Results: Out of 64 patients suspected of having epilepsy by the Relais and indexed on the platform, 61 patients were confirmed by the neurologist through remote evaluation, resulting in a confirmation rate of 95%. After an 18-month follow-up, the patient retention rate was 86.89% (53 out of 61). At baseline, 98.36% (60 out of the 61) experienced at least one seizure per month. However, after six months of treatment, 89.28% (50 out of 56 at month six) PWE had no seizures in the last month (p < 0.0001).

Conclusion: This study demonstrates the insightful effectiveness of leveraging an mHealth platform to empower community Relais to manage epilepsy in rural Mali. The Relais demonstrated a high capacity for screening, with neurologists confirming most suspected cases they identified. This innovative approach resulted in excellent patient outcomes, including a high retention rate over the follow-up period and statistically significant reduction in seizures. While challenges such as mobile network coverage and varying literacy levels among Relais were encountered, the findings strongly support this mHealth strategy as a viable solution to bridge the healthcare gap, significantly improving access to and management of epilepsy for remote and hard-to-reach populations.

Background: The tolerance of inactivated SARS-CoV-2 vaccines in people living with HIV (PLWH) remains unclear. We aimed to evaluate the tolerance of inactivated SARS-CoV-2 vaccines in PLWH.

Methods: This retrospective cohort study recruited 3327 PLWH for questionnaires and laboratory testing. Subjects were screened to ensure they were receiving antiretroviral therapy for PLWH without SARS-CoV-2 infection. Poisson regression analyses were conducted to assess the association between vaccination and HIV viral rebound, estimating absolute risk difference and relative risk (RR).

Results: A total of 724 PLWH without SARS-CoV-2 infection participated in this study. No significant increase in HIV viral rebound risk was observed after vaccination in the 1/2-dose, 3-dose, and 4-dose groups compared to the 0-dose group. The RRs for the 1/2-dose, 3-dose, and 4-dose groups were 1.22 (95% confidence interval [CI]: 0.55, 2.72), 0.90 (95% CI: 0.48, 1.69), and 1.01 (95% CI: 0.35, 2.89), respectively. Similar results were observed across subgroups. Post-vaccination adverse reactions were minimal, occurring in 2.16% of cases, mostly fatigue and muscle soreness.

Conclusion: Our study suggests that inactivated SARS-CoV-2 vaccines do not adversely affect the risk of HIV viral rebound and were well-tolerated in PLWH.

Background: Respiratory syncytial virus (RSV) can lead to serious respiratory illnesses in both children and adults, particularly affecting older individuals and those with chronic health issues. Due to its symptoms resembling other respiratory viruses and irregular RSV standard-of-care testing, RSV cases in adults frequently remain unreported.

Methods: We retrospectively estimated the incidence of hospitalisations and deaths attributable to RSV in adults in Norway using a time-series model-based approach. Data were obtained from the Norwegian Patient Registry and Norwegian Cause of Death Registry to estimate RSV-attributable hospitalisations and deaths, respectively, among adults from 2010 to 2019. A quasi-Poisson time-series regression model was applied to estimate RSV annual (age- and risk-stratifications) hospitalisation incidence rates (IRs) and mortality rates (per 100,000 person-years).

Results: Annual RSV-attributable hospitalisation IRs for adults aged ≥ 65 years with risk factors were 289-517 for cardiorespiratory, 243-434 for cardiovascular, and 178-318 per 100,000 person-years for respiratory hospitalisations. RSV-attributable hospitalisations represented 1-3% of total cardiorespiratory hospitalisations. Adults aged 18-44 years with risk factors had similar rates as those aged ≥ 65 years without risk factors. RSV-attributable mortality rates for adults aged ≥ 65 years were 19-35 for cardiorespiratory, 11-19 for respiratory, and 10-18 per 100,000 person-years for cardiovascular deaths. RSV-attributable deaths accounted for 1-5% of total cardiorespiratory deaths.

Conclusions: RSV significantly contributes to hospitalisations and deaths in adults in Norway, particularly among older adults and younger adults with underlying diseases. The introduction of RSV vaccines can have a substantial public health impact in reducing the burden of RSV-attributable cardiovascular and respiratory events.