Open Forum Infectious Diseases最新文献

Health care, veterinary, and research facilities produce tremendous amounts of waste and account for a significant proportion of their institutions' energy and water use. The majority of municipal solid waste produced by these facilities gets unsustainably disposed of, including exportation to lower-income countries, and most of the plastic waste is nonrecyclable and nondegradable. The produced waste not only results in excessive carbon emissions harming planetary health but also poses direct harm to human health, broadens global inequities, and produces avoidable economic costs. Greening up laboratories by reducing waste production and water and energy use offers many benefits and does not have to be time or resource intensive. Sustainable practices to green up laboratories include reusing materials, decreasing energy use by choosing low-energy settings and shutting off equipment when not in use, installing low-flow faucets to decrease water use, proper sorting of waste, environmentally conscious purchases of supplies, and avoiding unnecessary medical and veterinary tests.

Background: There is conflicting evidence regarding the impact of chronic hepatitis B virus (HBV) on SARS-CoV-2 outcomes. Additionally, the impact of SARS-CoV-2 vaccination and variant periods on outcomes in HBV/SARS-CoV-2 coinfection remain unexplored.

Methods: We utilized the TriNetX database to compare adults with HBV/SARS-CoV-2 (vs SARS-CoV-2 alone) across 97 US healthcare systems from 2020 to 2023. We assessed the odds of all inpatient hospitalizations, intensive care unit admissions, mechanical ventilation, 30-day, 90-day, and overall mortality. In sensitivity analyses, we excluded HIV, hepatitis C virus, and transplant cases and stratified the HBV/SARS-CoV-2 cohort by cirrhosis status. We applied propensity score matching to address confounding and reported odds ratios (OR) with 95% confidence intervals (CI).

Results: Of 4 206 774 individuals with SARS-CoV-2, about 0.2% (8293) were HBV/SARS-CoV-2. Individuals with HBV/SARS-CoV-2 (vs SARS-CoV-2 alone) had higher odds of intensive care unit admissions (OR, 1.18; 95% CI, 1.02-1.36), 90-day (OR, 1.22; 95% CI, 1.01-1.41) and overall mortality (OR, 1.18; 95% CI, 1.06-1.33). In sensitivity analyses, those with HBV/SARS-CoV-2 and cirrhosis had a 2.0- to 2.50-fold higher odds of adverse outcomes. Notably, even individuals with HBV/SARS-CoV-2 without cirrhosis had higher odds of mortality. Vaccinated (vs unvaccinated) individuals with HBV/SARS-CoV-2 had 57%, 54%, and 29% reduction in 30-day, 90-day, and overall mortality, respectively. The pre-Delta variant period was associated with higher odds of hospitalization compared to the Omicron but not the Delta period.

Conclusions: Chronic HBV was associated with worse SARS-CoV-2 outcomes, whereas SARS-CoV-2 vaccination reduced the likelihood of adverse outcomes.

Background: Household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may play a key role in times of increased infection, particularly among children. We aimed to determine the prevalence of SARS-CoV-2 antibodies and identify risk factors associated with SARS-CoV-2 antibody positivity in children.

Methods: Unvaccinated children aged 18 months to 11 years between August 2022 and June 2023 underwent oral fluid testing for SARS-CoV-2 antibodies. Caregivers completed electronic surveys at 4 major healthcare practices in Northern and Central New Jersey. Information was collected on demographics, household size, vaccination status, and prior SARS-CoV-2-related illness. Multivariable logistic regression determined individual and household-level factors associated with SARS-CoV-2 antibody positivity.

Results: A total of 870 children provided tests and corresponding surveys. Children were predominantly Hispanic (37%) or non-Hispanic Black (30%), and on average 5.7 years old. Overall SARS-CoV-2 antibody positivity was 68%. Risk factors for SARS-CoV-2 positivity include Hispanic or non-Hispanic Black race/ethnicity (adjusted odds ratios [aOR], 2.29 and 1.95 vs. White race/ethnicity; P < .01) and later enrollment in the study period. Children from households with ≥1 vaccinated adult were 52% less likely to be antibody positive than those from households with no vaccinated adults (aOR: 0.38, [95% confidence interval 0.2 to 0.69]).

Conclusions: There is high burden of SARS-CoV-2 infection among children over time. Adult vaccination appears to be a protective factor in helping to mitigate coronavirus disease 2019 (COVID-19) infection among children. Increased vaccination of adults in the community can help inform COVID-19 prevention strategies for minors in the household.

Background: HIV pre-exposure prophylaxis (PrEP) is highly effective but not widely used by men who have sex with men (MSM; 27%) in China.

Methods: In June 2023, an online cross-sectional survey with a discrete choice experiment (DCE) was distributed to PrEP-eligible MSM in China who were at least 18 years old. The DCE explored attributes of PrEP modality (daily pill, on-demand pill, injections, implants), clinical care model (same-day, 2-visit, telehealth prescription), medication pickup (clinic, community health center, pharmacy, MSM-focused community-based organization, home delivery), enhanced support (self-management, smartphone app, text reminder, anonymous peer support group), and cost.

Results: A total of 1013 MSM completed the survey; the average age was 31 years, and a quarter had used PrEP. The most influential attributes were cost (relative importance: 64.6%), followed by PrEP modality (27.7%), medication pickup (4.0%), enhanced support (3.5%), and clinical care model (0.2%). The most preferred ways to access PrEP were no-cost on-demand pill, medication home delivery, self-management, and telehealth. The predicted uptake of on-demand PrEP was higher than other modalities, increasing from 22% with no subsidy to 79% with full subsidy, holding the other 3 attributes constant.

Conclusions: Chinese MSM have strong preferences regarding accessing PrEP: Low cost is a critical priority, especially important because medication and clinical care are currently entirely unsubsidized in China. Preferences for on-demand PrEP and home delivery indicate methods that the health care system can utilize to best meet the needs of MSM and factors that should be incorporated into future interventions.

Background: Improved diagnostic testing (DT) of infections may optimize outcomes for solid organ transplant recipients (SOTR), but a comprehensive analysis is lacking.

Methods: We conducted a systematic literature review across multiple databases, including EMBASE and MEDLINE(R), of studies published between 1 January 2012-11 June 2022, to examine the evidence behind DT in SOTR. Eligibility criteria included the use of conventional diagnostic methods (culture, biomarkers, directed-polymerase chain reaction [PCR]) or advanced molecular diagnostics (broad-range PCR, metagenomics) to diagnose infections in hospitalized SOTR. Bias was assessed using tools such as the Cochrane Handbook and PRISMA 2020.

Results: Of 2362 studies, 72 were eligible and evaluated heterogeneous SOT populations, infections, biospecimens, DT, and outcomes. All studies exhibited bias, mainly in reporting quality. Median study sample size was 102 (range, 11-1307). Culture was the most common DT studied (N = 45 studies, 62.5%), with positive results in a median of 27.7% (range, 0%-88.3%). Biomarkers, PCR, and metagenomics were evaluated in 7, 19, and 3 studies, respectively; only 6 reported sensitivity, specificity, and positive/negative predictive values. Directed-PCR performed well for targeted pathogens, but only 1 study evaluated broad-range PCR. Metagenomics approaches detected numerous organisms but required clinical adjudication, with too few studies (N = 3) to draw conclusions. Turnaround time was shorter for PCR/metagenomics than conventional diagnostic methods (N = 4 studies, 5.6%). Only 6 studies reported the impact of DT on outcomes like antimicrobial use and length of stay.

Conclusions: We identified considerable evidence gaps in infection-related DT among SOT, particularly molecular DT, highlighting the need for further research.

Background: Establishing correlates of protection often requires large cohorts. A rapid and adaptable case-control study design can be used to identify antibody correlates of protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in serum and saliva.

Methods: We designed a case-control study to compare antibody levels between cases of SARS-CoV-2 infection within 5 days of symptom onset and uninfected controls. Controls were matched on age, number of coronavirus disease 2019 vaccine doses, time since last dose, and past episodes of infection. We quantified anti-SARS-CoV-2 and seasonal coronavirus immunoglobulin (Ig) G in serum and saliva at inclusion, 1 month, and 6 months.

Results: We included 90 cases and 62 controls between February and September 2022. A boost and decay pattern of serum antibodies was observed in cases at 1 and 6 months, respectively, but not in controls. Anti-SARS-CoV-2 antibody levels were significantly higher in controls at inclusion both in serum (particularly antinucleocapsid IgG: 4.14 times higher compared with cases; 95% CI, 2.46-6.96) and saliva (particularly antispike for Delta variant IgG: 4.89 times higher compared with cases; 95% CI, 2.91-9.89). Saliva antibodies generally outperformed serum antibodies for case/control differentiation.

Conclusions: In this case-control study, we provided evidence of correlates of protection of anti-SARS-CoV-2 IgG in saliva and serum, with saliva antibodies often outperforming serum. The finding that antibodies in saliva are a better correlate of protection than antibodies in serum may inform vaccine development by highlighting the importance of robust induction of mucosal immune responses. This study design may be used during future epidemics for the prompt assessment of correlates of protection.

Background: Lymphocytic choriomeningitis virus (LCMV) infection in immunocompromised hosts can result in disseminated disease, meningoencephalitis, and death. Published cases in transplant recipients have been traced to transmission from infected donors. We report 2 cases of serious, non-donor-derived LCMV infection in solid organ transplant recipients.

Methods: Initial identification of LCMV infection was done by using metagenomic next-generation sequencing (mNGS). Subsequent evaluations and confirmatory testing involved molecular diagnostics, serology, and phylogenetic analysis. A detailed epidemiologic investigation was conducted.

Results: LCMV was detected by mNGS in 2 solid organ transplant recipients from distinct donors. A heart transplant recipient (from donor 1) died of progressive, disseminated LCMV infection, while a kidney transplant recipient (from donor 2) with LCMV meningoencephalitis survived. A multistate laboratory and epidemiologic investigation of both donors and all their organ recipients was initiated. Postmortem samples were obtained from both donors, and pretransplant and/or posttransplant samples were obtained from 5 of the 6 organ recipients. mNGS, serologic, and real-time reverse-transcription polymerase chain reaction testing confirmed LCMV infection in both solid organ transplant recipients. Epidemiologic investigation revealed significant pretransplant rodent exposures for both LCMV-infected recipients. Laboratory studies for the other organ recipients from both donors were negative for LCMV infection.

Conclusions: Our investigations suggest that LCMV infection in 2 solid organ transplant recipients originated from rodent exposure preceding transplantation and were not donor derived. Although uncommon, healthcare providers should be aware of LCMV-associated serious and life-threatening illness in immunocompromised hosts. Diagnostic modalities are limited to reference laboratories.

Background: Infections by Streptococcus pneumoniae and influenza viruses are vaccine-preventable diseases causing great morbidity and mortality. We evaluated pneumococcal and influenza vaccination practices during pre-international travel health consultations.

Methods: We evaluated data on pretravel visits over a 10-year period (1 July 2012 through 31 June 2022) from 31 sites in Global TravEpiNet (GTEN), a consortium of US healthcare facilities providing pretravel health consultations. Data were collected using an online structured questionnaire utilized by GTEN providers. We obtained summary statistics and performed multivariable logistic regression models to identify characteristics associated with receiving the vaccinations.

Results: At 116 865 pretravel visits, 28 754 (25%) travelers were eligible to receive pneumococcal vaccination and 56 150 (48%) travelers were eligible to receive influenza vaccination. A total of 19 557 (68%) pneumococcal vaccine-eligible travelers were not offered the vaccine at the pretravel visit. Among influenza vaccine-eligible travelers, 8592 (15%) were not offered the vaccine, and an additional 16 931 (30%) travelers declined the vaccine. Influenza vaccine was not available for 8014 (14%) eligible travelers. Nonadministration of the influenza vaccine was most frequent in the months of April through September. Compared to nonacademic centers or centers in the South or Midwest, travelers seen in academic centers or centers in the Northeast were more likely to receive either vaccine.

Conclusions: Increasing awareness of global influenza transmission patterns and improving access to routine vaccines at the pretravel encounter may enhance vaccination for respiratory pathogens in departing US international travelers.

Background: Lyme disease is the most common vector-borne disease in the United States; however, its frequency is not reliably measured through surveillance. Electronic health records (EHR) might capture the frequency and characteristics of Lyme disease cases more accurately. We queried EHR from 1 health system to describe the epidemiology of Lyme disease cases in Wisconsin during 2016-2019.

Methods: Within a cohort of persons evaluated for Lyme disease, we applied a Lyme disease case definition based on first-line antibiotics within 14 days of a Lyme disease diagnosis code or test order or on the same day as a related keyword in clinical notes. We compared characteristics of cases to those of cases reported through surveillance and reviewed medical charts to assess case definition validity.

Results: Among 67 289 possible Lyme disease events in the cohort, 13 494 (20.1%) met our Lyme disease case definition. Cases were more common among males, children 5-9 years, older adults, White non-Hispanic persons, and in the summer months. EHR-based Lyme disease incidence was 4-8 times that reported through surveillance. The EHR definition had moderately high sensitivity (83.4%) and specificity (71.1%) for confirmed and probable Lyme disease.

Conclusions: EHR queries show promise to capture the incidence of Lyme disease more completely and provide more robust clinical information than public health surveillance. Demographic and seasonal characteristics of EHR-identified cases were comparable to those identified through surveillance. Further algorithm refinement might improve accuracy of measuring Lyme disease in EHR systems.