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Severity outcomes of SARS-CoV-2 infection in the Omicron and pre-Omicron periods, in unvaccinated first-time test positive adults less than 65 years old without comorbidity, in Sweden 瑞典 65 岁以下未接种疫苗的首次检测呈阳性且无合并症的成年人在 Omicron 和 Omicron 前感染 SARS-CoV-2 的严重程度。
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-23 DOI: 10.1016/j.jiph.2024.102502

Background

The COVID-19 pandemic has had several phases with varying characteristics. We aimed to compare severity outcomes in different phases in a population with limited bias from risk factors.

Methods

In a nationwide observational study of all unvaccinated first-time COVID-19 test positive individuals in Sweden aged 18–64 years without comorbidity, from week 45 of 2020 to week 5 of 2022, variant periods with certain variants constituting ≥ 92 % of all whole genome-sequenced cases nationwide, were compared regarding hospitalisation (with main discharge code of COVID-19), severe illness (use of high-flow nasal oxygen or admission to intensive care unit), and death due to COVID-19. Logistic regression was used to estimate odds ratios (ORs) for comparison of these outcomes between variant periods, using adjustments for variant period, age, sex, country of birth, place of residence, income, and education.

Findings

The study included 789,133 individuals, including 15,145 hospitalised individuals. Among all individuals, the adjusted ORs for hospitalisation were 1.7 for the Alpha period vs the Pre-variant period (week 45–52 2020), 1.8 for the Delta period vs the Alpha period, and 0.1 for the Omicron period vs the Delta period (all comparisons significant). Among hospitalised individuals, the adjusted ORs for severe illness were 1.4 for the Alpha period vs the Pre-variant period, 1.7 for the Delta period vs the Alpha period, and 0.5 for the Omicron period vs the Delta period (all comparisons significant), and the adjusted ORs for death were 1.1 for the Alpha period vs the Pre-variant period (non-significant), 1.8 for the Delta period vs the Alpha period (significant), and 0.1 for the Omicron period vs the Delta period (non-significant).

Interpretation

In this population with limited bias from risk factors, vaccination, and previous infection, disease severity increased from the pre-variant to the Delta period and then decreased with the Omicron period, among all individuals and among hospitalised individuals. These severity outcome differences should be considered when the pandemic is evaluated.

背景:COVID-19大流行分为几个阶段,其特征各不相同。我们旨在比较不同阶段人群的严重程度结果,因为风险因素造成的偏差有限:在一项全国范围的观察性研究中,我们对瑞典所有 18-64 岁首次 COVID-19 检测呈阳性且无合并症的未接种者进行了研究,研究时间为 2020 年第 45 周至 2022 年第 5 周,比较了因 COVID-19 而住院(主要出院代码为 COVID-19)、重症(使用高流量鼻氧或入住重症监护室)和死亡的变异期,其中某些变异占全国所有全基因组测序病例的比例≥ 92%。通过对不同时期、年龄、性别、出生国、居住地、收入和教育程度等因素进行调整,采用逻辑回归法估算出这些结果在不同时期间比较的几率比(ORs):研究共纳入 789 133 人,包括 15 145 名住院患者。在所有患者中,阿尔法期与变异前期(2020 年第 45-52 周)的住院调整 OR 值分别为 1.7、德尔塔期与阿尔法期的调整 OR 值分别为 1.8、奥米克隆期与德尔塔期的调整 OR 值分别为 0.1(所有比较均显著)。在住院患者中,阿尔法期与变异前期相比,重症的调整OR为1.4,德尔塔期与阿尔法期相比,重症的调整OR为1.7,奥克隆期与德尔塔期相比,重症的调整OR为0.5(所有比较均显著),阿尔法期与变异前期相比,死亡的调整OR为1.1(不显著),德尔塔期与阿尔法期相比,死亡的调整OR为1.8(显著),奥克隆期与德尔塔期相比,死亡的调整OR为0.1(不显著):在这一受风险因素、疫苗接种和既往感染影响有限的人群中,从变异前到德尔塔期,所有个体和住院个体的疾病严重程度均有所上升,然后随着奥米克伦期的到来而下降。在对大流行进行评估时,应考虑到这些严重程度结果的差异。
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引用次数: 0
Unexpected arboviruses found in an epidemiological surveillance of acute tropical febrile syndrome in the department of Meta, Eastern Colombia 在哥伦比亚东部梅塔省急性热带发热综合征流行病学监测中发现的意外虫媒病毒
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-23 DOI: 10.1016/j.jiph.2024.102510

Background

Nonspecific acute tropical febrile illnesses (NEATFI) are common in the Latin American tropics. Dengue, Chikungunya, Zika, Mayaro, and Usutu, among others, can coexist in the American tropics. This study aimed to surveil the arboviruses that cause| acute febrile syndrome in patients in the Meta department, Colombia.

Methods

Between June 2021 and February 2023, an epidemiological surveillance study was conducted in the Llanos of the Meta department in Eastern Colombia.

Results

One hundred patients in the acute phase with typical prodromal symptoms of NEATFI infection who attended the emergency department of the Villavicencio Departmental Hospital were included. ELISA tests were performed for Dengue, Usutu, Chikungunya, and Mayaro. RT-qPCR was performed to detect the arboviruses Usutu, Dengue, Zika, Mayaro, and Oropouche. The seroprevalence for the Chikungunya, Mayaro, and Usutu viruses was 41 % (28/68), 40 % (27/67), and 62 % (47/75), respectively. Seroconversion for Chikungunya was observed in one patient; two seroconverted to Mayaro and one to Usutu. The NS5 gene fragment of the Usutu virus was detected in nine febrile patients. RT-qPCR of the remaining arboviruses was negative. The clinical symptoms of the nine Usutu-positive patients were very similar to those of Dengue, Chikungunya, Zika, and Mayaro infections.

Conclusions

The pervasive detection of unexpected viruses such as Usutu and Mayaro demonstrated the importance of searching for other viruses different from Dengue. Because Usutu infection and Mayaro fever have clinical features like Dengue, a new algorithm should be proposed to improve the accuracy of acute tropical fevers.

背景拉丁美洲热带地区常见非特异性急性热带发热疾病(NEATFI)。登革热、基孔肯雅热、寨卡病毒、马雅罗病毒和乌苏图病毒等可在美洲热带地区共存。本研究旨在调查引起哥伦比亚梅塔省患者急性发热综合征的虫媒病毒。研究方法在 2021 年 6 月至 2023 年 2 月期间,在哥伦比亚东部梅塔省的拉诺斯地区开展了一项流行病学监测研究。对登革热、乌苏图、基孔肯雅和马雅罗病毒进行了 ELISA 检测。对乌苏图、登革热、寨卡、马亚罗和奥罗普切虫媒病毒进行了 RT-qPCR 检测。基孔肯雅病毒、马亚罗病毒和乌苏图病毒的血清流行率分别为 41%(28/68)、40%(27/67)和 62%(47/75)。一名患者出现了基孔肯雅病毒血清转换;两名患者出现了玛雅罗病毒血清转换,一名患者出现了乌苏图病毒血清转换。在九名发热患者中检测到了乌苏图病毒的 NS5 基因片段。其余虫媒病毒的 RT-qPCR 检测结果均为阴性。九名乌苏图病毒阳性患者的临床症状与登革热、基孔肯雅病毒、寨卡病毒和马雅洛病毒感染的症状非常相似。由于Usutu感染和Mayaro热具有类似登革热的临床特征,因此应提出一种新的算法来提高急性热带热病的准确性。
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引用次数: 0
Comparing pill counts and patient self-reports versus DBS tenofovir concentrations as ART adherence measurements with virologic outcomes and HIV drug resistance in a cohort of adolescents and young adults failing ART in Harare, Zimbabwe 在津巴布韦哈拉雷一组接受抗逆转录病毒疗法失败的青少年中,将药片计数、患者自我报告与 DBS 替诺福韦浓度作为衡量抗逆转录病毒疗法依从性的指标,与病毒学结果和艾滋病毒耐药性进行比较
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-17 DOI: 10.1016/j.jiph.2024.102500

Background

Monitoring adherence presents a challenge in adolescents and it is prudent to explore several options for determining their level of adherence. This study sought to determine ART adherence levels in adolescents and young adults (on a tenofovir-containing regimen) failing ART as measured by self-reports, pill counts and DBS tenofovir concentrations and to compare levels of agreement among the methods and determine the ability of each method to predict virological suppression.

Methods

This was a cohort study involving 107 adolescents and young adults between 10 and 24 years failing ART with viral load > 400copies/ml at enrolment. Pill count (PC) records, self-reports (SR) and DBS tenofovir concentrations (done by liquid Chromatography with tandem mass spectrometry (LC-MS/MS)) were used to determine adherence in adolescent participants failing ART in Harare. The latter was used as the reference method with a cut-off of 64 ng/ml. Determination of DBS tenofovir concentrations was also performed to rule out inadequate viral response due to low cumulative drug exposure despite high adherence (≥90 %). Longitudinal analysis was performed to determine the correlation of viral loads (VL) with adherence. The Kappa (k) coefficient was used to evaluate the level of agreement among the 3 methods.

Results

Poor level of agreement was found between PC records and DBS tenofovir concentrations (k = −0.115). Moderate agreement was found between DBS and SR methods (k = 0.0557). Slight agreement was found between PC and SR methods (k = 0.0078). Adherence was dependent on age at HIV diagnosis (p = 0.0184) and ART initiation (p = 0.0265). Participants who were adherent were six times more likely to be suppressed at end point than their non-adherent counterparts (OR=5.7 CI 2.1 – 16.5, p < 0.0001).

Conclusions

Self-reported measure of adherence and pill counts exhibited poor agreement with the reference method used i.e. DBS tenofovir concentrations and are thus not effective methods of predicting virological suppression.

Trial identification

Participants in the present study were a subset of those in the PESU intervention ClinicalTrials.gov Identifier: NCT02833441

背景监测青少年的依从性是一项挑战,因此有必要探索几种确定青少年依从性水平的方法。本研究试图通过自我报告、药片计数和 DBS 替诺福韦浓度来确定抗逆转录病毒疗法失败的青少年和年轻成人(使用含替诺福韦的治疗方案)的抗逆转录病毒疗法依从性水平,并比较各种方法之间的一致程度,确定每种方法预测病毒学抑制的能力。哈拉雷地区采用药丸计数(PC)记录、自我报告(SR)和DBS替诺福韦浓度(通过液相色谱-串联质谱法(LC-MS/MS)测定)来确定抗逆转录病毒疗法失败的青少年参与者的依从性。后者被用作参考方法,临界值为 64 纳克/毫升。此外,还对 DBS 替诺福韦浓度进行了测定,以排除病毒应答不充分的情况,因为尽管坚持率高(≥90%),但累积药物暴露量较低。为确定病毒载量(VL)与依从性的相关性,进行了纵向分析。结果发现 PC 记录与 DBS 替诺福韦浓度之间的一致性较差(k = -0.115)。DBS 和 SR 方法之间的一致性中等(k = 0.0557)。PC 和 SR 方法之间存在轻微的一致性(k = 0.0078)。依从性取决于 HIV 诊断年龄(p = 0.0184)和抗逆转录病毒疗法起始年龄(p = 0.0265)。结论自我报告的依从性和药片数量与所使用的参考方法(即 DBS 替诺福韦)的一致性较差。本研究的参与者是 PESU 干预临床试验的一个子集:NCT02833441
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引用次数: 0
Association between human leukocyte antigen alleles and COVID-19 disease severity 人类白细胞抗原等位基因与 COVID-19 疾病严重程度之间的关系
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-15 DOI: 10.1016/j.jiph.2024.102498

Background

the human leukocyte antigen (HLA) loci have been widely characterized to be associated with viral infectious diseases. Several studies including various ethnic groups and populations suggested associations between certain HLA alleles and SARS-CoV-2 infection. Despite the numerous associations identified, the role of HLA polymorphisms in determining the individual response to SARS-CoV-2 infection is controversial among different Saudi populations.

Method

Here, we performed HLA typing by next-generation sequencing to investigate if variations in polymorphic HLA genes are linked to COVID-19 severity in the Saudi population. Namely, we analyzed HLA loci at allele level in 575 Saudi patients with SARS-CoV-2 infection. HLA class I and class II frequencies in patients were compared with allele frequency data from healthy Saudi population.

Results

in our cohort HLA-A* 02:01:01 G was associated with mild disease but was not associated with moderate and severe disease. HLA-B* 51:01:01 G was protective from severe disease while HLA-B* 50:01:01 G, HLA-C* 06:02:01 G and HLA-DRB1 * 07:01:01 G were associated with risk to severe disease as well as the total COVID-19 cohort. HLA-DRB1 * 15:01:01 G was associated with risk to all severity groups.

Conclusion

in conclusion, we found significant associations between HLA alleles and COVID-19 disease severity in Saudis. Further studies are warranted to include HLA typing in the workup for any new COVID-19 patients.

背景人类白细胞抗原(HLA)位点被广泛认为与病毒性传染病有关。包括不同种族和人群在内的多项研究表明,某些 HLA 等位基因与 SARS-CoV-2 感染之间存在关联。在此,我们通过下一代测序技术进行了 HLA 分型,以研究多态 HLA 基因的变异是否与沙特人群中 COVID-19 的严重程度有关。也就是说,我们对 575 名沙特籍 SARS-CoV-2 感染者的等位基因水平的 HLA 位点进行了分析。结果在我们的队列中,HLA-A* 02:01:01 G 与轻度疾病相关,但与中度和重度疾病无关。HLA-B* 51:01:01 G 对重症具有保护作用,而 HLA-B* 50:01:01 G、HLA-C* 06:02:01 G 和 HLA-DRB1 * 07:01:01 G 则与重症风险以及 COVID-19 队列总体相关。总之,我们发现沙特人的 HLA 等位基因与 COVID-19 疾病严重程度之间存在显著关联。有必要开展进一步研究,将 HLA 分型纳入所有 COVID-19 新患者的检查中。
{"title":"Association between human leukocyte antigen alleles and COVID-19 disease severity","authors":"","doi":"10.1016/j.jiph.2024.102498","DOIUrl":"10.1016/j.jiph.2024.102498","url":null,"abstract":"<div><h3>Background</h3><p>the human leukocyte antigen (HLA) loci have been widely characterized to be associated with viral infectious diseases. Several studies including various ethnic groups and populations suggested associations between certain HLA alleles and SARS-CoV-2 infection. Despite the numerous associations identified, the role of HLA polymorphisms in determining the individual response to SARS-CoV-2 infection is controversial among different Saudi populations.</p></div><div><h3>Method</h3><p>Here, we performed HLA typing by next-generation sequencing to investigate if variations in polymorphic HLA genes are linked to COVID-19 severity in the Saudi population. Namely, we analyzed HLA loci at allele level in 575 Saudi patients with SARS-CoV-2 infection. HLA class I and class II frequencies in patients were compared with allele frequency data from healthy Saudi population.</p></div><div><h3>Results</h3><p>in our cohort HLA-A* 02:01:01 G was associated with mild disease but was not associated with moderate and severe disease. HLA-B* 51:01:01 G was protective from severe disease while HLA-B* 50:01:01 G, HLA-C* 06:02:01 G and HLA-DRB1 * 07:01:01 G were associated with risk to severe disease as well as the total COVID-19 cohort. HLA-DRB1 * 15:01:01 G was associated with risk to all severity groups.</p></div><div><h3>Conclusion</h3><p>in conclusion, we found significant associations between HLA alleles and COVID-19 disease severity in Saudis. Further studies are warranted to include HLA typing in the workup for any new COVID-19 patients.</p></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1876034124002326/pdfft?md5=7e6313c714f41d33d96daa6559291463&pid=1-s2.0-S1876034124002326-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemics and diversity of norovirus variants with acute gastroenteritis outbreak in Hongshan District, Wuhan City, China, 2021-2023 2021-2023 年武汉市洪山区急性肠胃炎疫情诺如病毒变种的流行情况和多样性
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-14 DOI: 10.1016/j.jiph.2024.102499

Background

Norovirus is the predominant pathogen causing foodborne illnesses and acute gastroenteritis (AGE) outbreaks worldwide, imposing a significant disease burden. This study aimed to investigate the epidemiological characteristics and genotypic diversity of norovirus outbreaks in Hongshan District, Wuhan City.

Methods

A total of 463 AGE cases from 39 AGE-related outbreaks in Hongshan District between January 1, 2021, and June 30, 2023, were included in the study. Reverse transcription-polymerase chain reaction (RT-PCR) was used to identify norovirus types GI and GII in anal swab samples from all cases. Norovirus-positive samples were sequenced and analyzed for the open reading frame (ORF) 1/ORF2 hinge region.

Results

26 norovirus infectious outbreaks were reported among 39 acute diarrheal outbreaks, including 14 outbreaks in kindergartens, 8 in elementary schools, and 4 in universities. Based on clinical symptoms and epidemiological investigations, a total of 1295 individuals were identified as having been exposed to norovirus, yielding an attack rate of 35.75 %. A higher proportion of outbreaks was observed during the winter and spring seasons (38.46 %). Additionally, norovirus-positive samples were subjected to sequencing and analysis of the open reading frame (ORF) 1/ORF2 hinge region. Genotypic data for norovirus was successfully obtained from 18 (69.23 %) of the infectious outbreaks, revealing 10 distinct recombinant genotypes. GII.4 Sydney 2012 [P31] and GII.17[P17] were the predominant strains in 2021 and 2022, GII.3 [P12] emerged as the dominant strain in 2023.

Conclusion

Norovirus outbreaks in Hongshan District predominantly occurred in crowded educational institutions, with peaks in the cold season and a high attack rate in universities. GII.3 [P12] has become the locally predominant strain.

背景诺如病毒是导致全球食源性疾病和急性胃肠炎(AGE)暴发的主要病原体,造成了严重的疾病负担。本研究旨在调查武汉市洪山区诺如病毒暴发的流行病学特征和基因型多样性。研究方法:本研究共纳入洪山区2021年1月1日至2023年6月30日期间39起AGE相关暴发的463例AGE病例。采用反转录聚合酶链反应(RT-PCR)技术对所有病例的肛拭子样本中的诺如病毒GI型和GII型进行鉴定。对诺如病毒阳性样本进行了测序,并分析了开放阅读框(ORF)1/ORF2铰链区。结果 在39起急性腹泻疫情中,共报告了26起诺如病毒感染性疫情,其中14起发生在幼儿园,8起发生在小学,4起发生在大学。根据临床症状和流行病学调查,共有 1295 人被确认感染了诺如病毒,感染率为 35.75%。冬春季节的爆发比例更高(38.46%)。此外,对诺如病毒阳性样本进行了测序和开放阅读框(ORF)1/ORF2 铰链区分析。成功地从 18 个(69.23 %)感染性疫情中获得了诺如病毒的基因型数据,发现了 10 个不同的重组基因型。结论洪山区诺如病毒暴发主要发生在人群密集的教育机构,在寒冷季节达到高峰,高校发病率较高。GII.3[P12]已成为当地的优势毒株。
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引用次数: 0
Incidence of acute liver failure and its associated mortality in patients with dengue infection: A systematic review and meta-analysis 登革热感染患者急性肝功能衰竭的发生率及其相关死亡率:系统回顾与荟萃分析
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-14 DOI: 10.1016/j.jiph.2024.102497

Acute liver failure (ALF) is a devastating consequence of dengue infection. This systematic review and meta-analysis assessed the incidence of ALF in dengue infection and its associated mortality. We systematically searched the EMBASE and MEDLINE databases from inception to December 2023 for observational studies reporting ALF incidence and mortality in dengue patients. Twenty-one studies encompassing 26,839 dengue-infected patients were included. Meta-analysis revealed a pooled incidence of ALF in cases of general dengue infection of 2.0 % (95 % CI, 1.2–3.0 %), with 1.2 % (95 % CI, 0.6–2.1 %) in adults and 5.0 % (95 % CI, 1.5–10.2 %) in children. ALF incidence was 17.3 % (95 % CI, 6.5 %−31.5 %) in severe dengue and 7.4 % (95 % CI, 0.8–18.5 %) in dengue shock syndrome. The pooled mortality rate of dengue-associated ALF was 47.0 % (95 % CI, 32.9–61.2 %). These findings underscore the detrimental impact of dengue infection on the development of the relatively uncommon, albeit life-threatening, condition of ALF.

急性肝衰竭(ALF)是登革热感染的一种破坏性后果。本系统综述和荟萃分析评估了登革热感染中 ALF 的发病率及其相关死亡率。我们系统地检索了 EMBASE 和 MEDLINE 数据库中从开始到 2023 年 12 月报告登革热患者 ALF 发病率和死亡率的观察性研究。共纳入 21 项研究,涵盖 26,839 名登革热感染者。Meta 分析显示,在一般登革热感染病例中,ALF 的总发病率为 2.0 %(95 % CI,1.2-3.0 %),其中成人为 1.2 %(95 % CI,0.6-2.1 %),儿童为 5.0 %(95 % CI,1.5-10.2 %)。严重登革热的 ALF 发生率为 17.3%(95% CI,6.5%-31.5%),登革热休克综合征的 ALF 发生率为 7.4%(95% CI,0.8%-18.5%)。登革热相关 ALF 的总死亡率为 47.0%(95% CI,32.9-61.2%)。这些发现强调了登革热感染对 ALF 这种相对不常见但却危及生命的疾病的不利影响。
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引用次数: 0
Increased risk of chronic fatigue syndrome following pneumonia: A population-based Cohort study 肺炎后患慢性疲劳综合征的风险增加:基于人群的队列研究
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-14 DOI: 10.1016/j.jiph.2024.102495

Background

Chronic fatigue syndrome (CFS) has been linked to several conditions, including infections, immune system changes, or emotional stress. Our study aimed to assess the risk of CFS after a pneumonia diagnosis using data from National Health Insurance Research Database of Taiwan.

Methods

In this nested case-control study, we identified 2,000,000 adult patients from a nationwide population-based health insurance claims database spanning from January 1, 2000, to December 31, 2017. Each case diagnosed with a pathogenic infection was matched with a corresponding control using propensity scores. We excluded individuals under 20 years of age, those with a history of pathogenic infections before the index date, or those with more than one potential pathogen. To estimate hazard ratios (HR) and the adjusted hazard ratio (aHR) with their respective 95 % confidence intervals (CI), we applied univariable and multivariable Cox proportional hazard models. The multivariable analysis incorporated adjustments for age, sex, and comorbidity-related confounders.

Results

The relationship between infection and the subsequent risk of CFS was assessed using Cox proportional hazards regression analysis. The incidence density rates were 6.13 and 8.70 per 1000 person‐years among the non‐pulmonary infection and pulmonary infection populations, respectively (adjusted hazard ratio [HR] = 1.4, 95 % confidence interval [CI] 1.32–1.5). Patients infected with Pseudomonas, Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, and influenza virus exhibited a significantly higher risk of CFS than those without these pathogens (p < 0.05). Additionally, patients with pneumonia had a significantly increased risk of thromboembolism compare with control group (p < 0.05).

背景 慢性疲劳综合征(CFS)与多种疾病有关,包括感染、免疫系统变化或情绪压力。在这项巢式病例对照研究中,我们从 2000 年 1 月 1 日至 2017 年 12 月 31 日的全国人口健康保险理赔数据库中确定了 200 万名成年患者。每个确诊为病原体感染的病例都与相应的对照组进行了倾向评分匹配。我们排除了年龄在 20 岁以下、在指数日期前有病原体感染史或有一种以上潜在病原体感染的病例。为了估算危险比(HR)和调整后危险比(aHR)及其各自的 95% 置信区间(CI),我们采用了单变量和多变量 Cox 比例危险模型。多变量分析纳入了对年龄、性别和合并症相关混杂因素的调整。结果使用 Cox 比例危险回归分析评估了感染与 CFS 后继风险之间的关系。非肺部感染人群和肺部感染人群的发病密度分别为每千人年6.13例和8.70例(调整后危险比[HR] = 1.4,95%置信区间[CI] 1.32-1.5)。感染假单胞菌、肺炎克雷伯菌、流感嗜血杆菌、肺炎链球菌和流感病毒的患者患 CFS 的风险明显高于未感染这些病原体的患者(P < 0.05)。此外,与对照组相比,肺炎患者发生血栓栓塞的风险明显增加(p < 0.05)。
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引用次数: 0
Epidemiological and clinical characteristics of monkeypox among people with and without HIV in Peru: a national observational study 秘鲁艾滋病毒感染者和非艾滋病毒感染者中猴痘的流行病学和临床特征:一项全国性观察研究
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-10 DOI: 10.1016/j.jiph.2024.102494

Background

In Latin America, Peru has the second highest number of cases of monkeypox (Mpox), of which more than 50 % are Human Immunodeficiency Virus (HIV)-positive. Here, we compared the epidemiological and clinical characteristics of Mpox between people with and without HIV in Peru.

Methods

We conducted a national retrospective study using data on confirmed cases of Mpox reported by the Peruvian National Surveillance System from 15 June 2022 to 31 December 2023.

Results

A total of 3561 confirmed cases of Mpox were included. Of these, 2123 (60 %) patients were people living with HIV (PLWH), with increased odds for those aged 30 years or older, homosexual (adjusted odds ratio [aOR] 8.58 [6.95–10.59], p<0.0001), bisexual (aOR=4.44 [3.46–5.69], p<0.0001), sex workers (aOR=2.24 [1.07–4.68], p=0.032), people with a history of syphilis (aOR=2.07 [1.66–2.58], p<0.001), and hospitalized (aOR=3.08 [2.03–4.68], p<0.001). PLWH were more likely to have proctitis (aOR=1.73 [1.26–2.37], p=0.001). The overall mortality was 20 of 3561 (0.56 %). Among PLWH and Mpox, more deaths occurred in hospitalized (p<0.001) and non-ART (p<0.001) individuals.

Conclusion

Our findings highlight that HIV infection among Mpox cases in Peru is associated with high-risk sexual behaviour and a high likelihood of hospitalization.

背景在拉丁美洲,秘鲁的猴痘病例数量位居第二,其中50%以上为人类免疫缺陷病毒(HIV)阳性。在此,我们比较了秘鲁猴痘的流行病学特征和临床特征。方法我们利用秘鲁国家监测系统在2022年6月15日至2023年12月31日期间报告的猴痘确诊病例数据,开展了一项全国性的回顾性研究。结果共纳入3561例猴痘确诊病例。其中,2123 例(60%)患者为艾滋病毒感染者(PLWH),年龄在 30 岁或以上、同性恋(调整后的几率比 [aOR] 8.58 [6.95-10.59],p<0.0001)、双性恋(aOR=4.44 [3.46-5.69],p<0.0001)、性工作者(aOR=2.24 [1.07-4.68],p=0.032)、有梅毒病史者(aOR=2.07 [1.66-2.58],p<0.001)和住院者(aOR=3.08 [2.03-4.68],p<0.001)。PLWH 更有可能患有直肠炎(aOR=1.73 [1.26-2.37],p=0.001)。总死亡率为 3561 例中的 20 例(0.56%)。在 PLWH 和 Mpox 中,住院(p<0.001)和非ART(p<0.001)患者的死亡人数更多。
{"title":"Epidemiological and clinical characteristics of monkeypox among people with and without HIV in Peru: a national observational study","authors":"","doi":"10.1016/j.jiph.2024.102494","DOIUrl":"10.1016/j.jiph.2024.102494","url":null,"abstract":"<div><h3>Background</h3><p>In Latin America, Peru has the second highest number of cases of monkeypox (Mpox), of which more than 50 % are Human Immunodeficiency Virus (HIV)-positive. Here, we compared the epidemiological and clinical characteristics of Mpox between people with and without HIV in Peru.</p></div><div><h3>Methods</h3><p>We conducted a national retrospective study using data on confirmed cases of Mpox reported by the Peruvian National Surveillance System from 15 June 2022 to 31 December 2023.</p></div><div><h3>Results</h3><p>A total of 3561 confirmed cases of Mpox were included. Of these, 2123 (60 %) patients were people living with HIV (PLWH), with increased odds for those aged 30 years or older, homosexual (adjusted odds ratio [aOR] 8.58 [6.95–10.59], p&lt;0.0001), bisexual (aOR=4.44 [3.46–5.69], p&lt;0.0001), sex workers (aOR=2.24 [1.07–4.68], p=0.032), people with a history of syphilis (aOR=2.07 [1.66–2.58], p&lt;0.001), and hospitalized (aOR=3.08 [2.03–4.68], p&lt;0.001). PLWH were more likely to have proctitis (aOR=1.73 [1.26–2.37], p=0.001). The overall mortality was 20 of 3561 (0.56 %). Among PLWH and Mpox, more deaths occurred in hospitalized (p&lt;0.001) and non-ART (p&lt;0.001) individuals.</p></div><div><h3>Conclusion</h3><p>Our findings highlight that HIV infection among Mpox cases in Peru is associated with high-risk sexual behaviour and a high likelihood of hospitalization.</p></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1876034124002284/pdfft?md5=f76920b8c3c8e6ca3cb5b5f5ac7bcfcf&pid=1-s2.0-S1876034124002284-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Potential impact of nirsevimab and bivalent maternal vaccine against RSV bronchiolitis in infants: A population-based modelling study 尼舍单抗和二价母体疫苗对预防婴儿 RSV 支气管炎的潜在影响:基于人群的模型研究。
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-08 DOI: 10.1016/j.jiph.2024.102492
Mónica López-Lacort , Ana Corberán-Vallet , Francisco J. Santonja , Cintia Muñoz-Quiles , Javier Díez-Domingo , Alejandro Orrico-Sánchez

Background

A new monoclonal antibody (nirsevimab; Beyfortus®) and a bivalent prefusion RSV vaccine (Abrysvo®) for maternal immunization have been approved recently. This is a modelling study to estimate the potential impact of different immunization programs with these products on RSV-bronchiolitis.

Methods

Population-based real-world data from primary care and hospitalizations were considered. RSV bronchiolitis dynamics in absence of these immunization scenarios were explained by a multivariate age-structured Bayesian model. Then, the potential impact was simulated under different assumptions including the most recent clinical trial data. Differences in endpoints, populations, and timeframes between trials make the two products’ efficacy difficult to compare.

Results

A seasonal with catch-up program, assuming a constant effectiveness of 79.5 % during the first 5 months followed by a linear decay to 0 by month 10 with nirsevimab, would prevent between 5121 and 8,846RSV bronchiolitis per 100,000 infants-years. Assuming 77.3 % effectiveness with the same decay, between 976and 16,86RSV-hospitalizations per 100,000 infants-years could be prevented depending on the uptake. A year-round maternal immunization program, with 51 % of effectiveness during the first 6 months followed by a linear decay to 0 by month 10 would prevent between 3,246and 5,606RSV bronchiolitis cases per 100,000 infants-years. Assuming 56.9 % effectiveness with the same decay, between 713 and 1231 RSV-hospitalizations per 100,000 infants-years could be prevented.

Conclusions

Our results suggest that each strategy would effectively reduce RSV-bronchiolitis.

背景:最近批准了一种新的单克隆抗体(nirsevimab;Beyfortus®)和一种用于母体免疫的二价前灌注 RSV 疫苗(Abrysvo®)。这是一项模拟研究,旨在估算使用这些产品的不同免疫计划对 RSV 支气管炎的潜在影响:方法:考虑了来自初级保健和住院治疗的基于人口的真实世界数据。通过一个多变量年龄结构贝叶斯模型解释了在没有这些免疫方案的情况下,RSV 支气管炎的动态变化。然后,根据不同的假设(包括最新的临床试验数据)模拟了潜在的影响。由于不同试验的终点、人群和时间范围存在差异,因此很难对两种产品的疗效进行比较:结果:假定尼舍单抗在前 5 个月的有效率恒定为 79.5%,第 10 个月的有效率线性下降为 0,则每 10 万婴儿年可预防 5121 至 8846 例 RSV 支气管炎。假设疗效为 77.3%,且衰减相同,则每 10 万名婴儿年可预防 976 至 1686 例 RSV 住院治疗,具体取决于接种率。全年实施的孕产妇免疫接种计划在前 6 个月的有效率为 51%,然后在第 10 个月时线性衰减为 0,则每 10 万婴儿年可预防 3,246 至 5,606 例 RSV 支气管炎。假设效果为 56.9%,且衰减相同,则每 10 万婴儿年可预防 713 到 1231 例 RSV 住院治疗:我们的研究结果表明,每种策略都能有效减少 RSV 支气管炎。
{"title":"Potential impact of nirsevimab and bivalent maternal vaccine against RSV bronchiolitis in infants: A population-based modelling study","authors":"Mónica López-Lacort ,&nbsp;Ana Corberán-Vallet ,&nbsp;Francisco J. Santonja ,&nbsp;Cintia Muñoz-Quiles ,&nbsp;Javier Díez-Domingo ,&nbsp;Alejandro Orrico-Sánchez","doi":"10.1016/j.jiph.2024.102492","DOIUrl":"10.1016/j.jiph.2024.102492","url":null,"abstract":"<div><h3>Background</h3><p>A new monoclonal antibody (nirsevimab; Beyfortus®) and a bivalent prefusion RSV vaccine (Abrysvo®) for maternal immunization have been approved recently. This is a modelling study to estimate the potential impact of different immunization programs with these products on RSV-bronchiolitis.</p></div><div><h3>Methods</h3><p>Population-based real-world data from primary care and hospitalizations were considered. RSV bronchiolitis dynamics in absence of these immunization scenarios were explained by a multivariate age-structured Bayesian model. Then, the potential impact was simulated under different assumptions including the most recent clinical trial data. Differences in endpoints, populations, and timeframes between trials make the two products’ efficacy difficult to compare.</p></div><div><h3>Results</h3><p>A seasonal with catch-up program, assuming a constant effectiveness of 79.5 % during the first 5 months followed by a linear decay to 0 by month 10 with nirsevimab, would prevent between 5121 and 8,846RSV bronchiolitis per 100,000 infants-years. Assuming 77.3 % effectiveness with the same decay, between 976and 16,86RSV-hospitalizations per 100,000 infants-years could be prevented depending on the uptake. A year-round maternal immunization program, with 51 % of effectiveness during the first 6 months followed by a linear decay to 0 by month 10 would prevent between 3,246and 5,606RSV bronchiolitis cases per 100,000 infants-years. Assuming 56.9 % effectiveness with the same decay, between 713 and 1231 RSV-hospitalizations per 100,000 infants-years could be prevented.</p></div><div><h3>Conclusions</h3><p>Our results suggest that each strategy would effectively reduce RSV-bronchiolitis.</p></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1876034124002260/pdfft?md5=e63986ac4a0de54c7f9089a5b5a4d6f4&pid=1-s2.0-S1876034124002260-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mapping the path to excellence: Evaluation of the diagnostic and treatment tools for invasive fungal infections in the balkans 绘制卓越之路:评估巴尔干地区侵袭性真菌感染的诊断和治疗工具。
IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-07-06 DOI: 10.1016/j.jiph.2024.102493
Nikola Pantić , Aleksandra Barać , Vasilika Mano , Amela Dedeić-Ljubović , Ivan Malkodanski , Ozren Jaksić , Despoina Gkentzi , Mirjana Mitrović , Oxana Munteanu , Dijana Šišević , Zlate Stojanoski , Oana Popescu , Jelena Todorović , Oliver A. Cornely , Jon Salmanton-García

Background

In the Balkans, rising concerns about invasive fungal infections over the past decade stem from various factors. Primarily, there has been a notable uptick in immunocompromised individuals, including those with chronic illnesses like immunological and hematological diseases. Thus, it is essential to assess the region's laboratory capabilities and the availability of antifungals. This evaluation is vital for gauging the preparedness to diagnose and treat fungal infections effectively, thus minimizing their public health impact.

Methods

Data were collected via an online questionnaire targeting healthcare professionals specializing in relevant fields across diverse healthcare settings in Balkan countries. The survey covered various aspects, including diagnostic methods, imaging techniques, and available antifungal armamentarium.

Results

Responses were obtained from 50 institutions across the Balkans. While conventional diagnostic methods like microscopy (96 %) and culture (100 %) diagnostics were widely available, access to newer diagnostic tools such as molecular assays (61 %) were limited, often relying on outsourced services. Imaging modalities like ultrasound (100 %) and CT scans (93 %) were universally accessible. A variety of antifungal drugs were available, including amphotericin B formulations (80 %), echinocandins (79 %), and triazoles (100 %). However, access to newer agents like posaconazole (62 %) and isavuconazole (45 %) was inconsistent. Therapeutic drug monitoring (53 %) services were also limited.

Conclusion

The study underscores the need for equitable access to diagnostic facilities and antifungal treatments across healthcare settings in the Balkan geographic region. Improving access to molecular diagnostic tools and essential antifungal drugs, as well as implementing therapeutic drug monitoring, would optimize the management of fungal infections in the region.

背景:在巴尔干地区,过去十年来人们对侵袭性真菌感染的关注日益增加,这源于各种因素。主要原因是免疫力低下的人明显增多,包括患有免疫病和血液病等慢性疾病的人。因此,评估该地区的实验室能力和抗真菌药物供应情况至关重要。这项评估对于衡量有效诊断和治疗真菌感染的准备情况至关重要,从而将真菌感染对公共卫生的影响降至最低:方法:通过在线问卷调查收集数据,调查对象为巴尔干国家不同医疗机构中相关领域的专业医护人员。调查涉及各个方面,包括诊断方法、成像技术和现有的抗真菌设备:结果:巴尔干地区的 50 家机构提供了答复。虽然显微镜(96%)和培养(100%)等传统诊断方法已广泛使用,但分子检测(61%)等新型诊断工具的使用却很有限,通常依赖于外包服务。超声波(100%)和 CT 扫描(93%)等成像方式已普及。抗真菌药物种类繁多,包括两性霉素 B 制剂(80%)、棘白菌素类(79%)和三唑类(100%)。然而,新药如泊沙康唑(62%)和异武康唑(45%)的供应并不稳定。治疗药物监测服务(53%)也很有限:这项研究强调了在巴尔干地区的各种医疗机构中公平使用诊断设施和抗真菌治疗的必要性。改善分子诊断工具和基本抗真菌药物的获取,以及实施治疗药物监测,将优化该地区真菌感染的管理。
{"title":"Mapping the path to excellence: Evaluation of the diagnostic and treatment tools for invasive fungal infections in the balkans","authors":"Nikola Pantić ,&nbsp;Aleksandra Barać ,&nbsp;Vasilika Mano ,&nbsp;Amela Dedeić-Ljubović ,&nbsp;Ivan Malkodanski ,&nbsp;Ozren Jaksić ,&nbsp;Despoina Gkentzi ,&nbsp;Mirjana Mitrović ,&nbsp;Oxana Munteanu ,&nbsp;Dijana Šišević ,&nbsp;Zlate Stojanoski ,&nbsp;Oana Popescu ,&nbsp;Jelena Todorović ,&nbsp;Oliver A. Cornely ,&nbsp;Jon Salmanton-García","doi":"10.1016/j.jiph.2024.102493","DOIUrl":"10.1016/j.jiph.2024.102493","url":null,"abstract":"<div><h3>Background</h3><p>In the Balkans, rising concerns about invasive fungal infections over the past decade stem from various factors. Primarily, there has been a notable uptick in immunocompromised individuals, including those with chronic illnesses like immunological and hematological diseases. Thus, it is essential to assess the region's laboratory capabilities and the availability of antifungals. This evaluation is vital for gauging the preparedness to diagnose and treat fungal infections effectively, thus minimizing their public health impact.</p></div><div><h3>Methods</h3><p>Data were collected via an online questionnaire targeting healthcare professionals specializing in relevant fields across diverse healthcare settings in Balkan countries. The survey covered various aspects, including diagnostic methods, imaging techniques, and available antifungal armamentarium.</p></div><div><h3>Results</h3><p>Responses were obtained from 50 institutions across the Balkans. While conventional diagnostic methods like microscopy (96 %) and culture (100 %) diagnostics were widely available, access to newer diagnostic tools such as molecular assays (61 %) were limited, often relying on outsourced services. Imaging modalities like ultrasound (100 %) and CT scans (93 %) were universally accessible. A variety of antifungal drugs were available, including amphotericin B formulations (80 %), echinocandins (79 %), and triazoles (100 %). However, access to newer agents like posaconazole (62 %) and isavuconazole (45 %) was inconsistent. Therapeutic drug monitoring (53 %) services were also limited.</p></div><div><h3>Conclusion</h3><p>The study underscores the need for equitable access to diagnostic facilities and antifungal treatments across healthcare settings in the Balkan geographic region. Improving access to molecular diagnostic tools and essential antifungal drugs, as well as implementing therapeutic drug monitoring, would optimize the management of fungal infections in the region.</p></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1876034124002272/pdfft?md5=ac8d82a1ecd297e08bda0459c1f13963&pid=1-s2.0-S1876034124002272-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Infection and Public Health
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