J. Langley, V. Bianco, J. Domachowske, S. Madhi, S. Stoszek, K. Zaman, Agustin Bueso, A. Ceballos, Luis Cousin, Ulises D’Andrea, I. Dieussaert, J. Englund, S. Gandhi, O. Gruselle, G. Haars, Lisa Jose, N. Klein, Amanda Leach, Koen Maleux, Thi Lien-Anh Nguyen, T. Puthanakit, P. Silas, A. Tangsathapornpong, J. Teeratakulpisarn, T. Vesikari, Rachel A. Cohen
Abstract Background The true burden of lower respiratory tract infections (LRTIs) due to respiratory syncytial virus (RSV) remains unclear. This study aimed to provide more robust, multinational data on RSV-LRTI incidence and burden in the first 2 years of life. Methods This prospective, observational cohort study was conducted in Argentina, Bangladesh, Canada, Finland, Honduras, South Africa, Thailand, and United States. Children were followed for 24 months from birth. Suspected LRTIs were detected via active (through regular contacts) and passive surveillance. RSV and other viruses were detected from nasopharyngeal swabs using PCR-based methods. Results Of 2401 children, 206 (8.6%) had 227 episodes of RSV-LRTI. Incidence rates (IRs) of first episode of RSV-LRTI were 7.35 (95% confidence interval [CI], 5.88–9.08), 5.50 (95% CI, 4.21–7.07), and 2.87 (95% CI, 2.18–3.70) cases/100 person-years in children aged 0–5, 6–11, and 12–23 months. IRs for RSV-LRTI, severe RSV-LRTI, and RSV hospitalization tended to be higher among 0–5 month olds and in lower-income settings. RSV was detected for 40% of LRTIs in 0–2 month olds and for approximately 20% of LRTIs in older children. Other viruses were codetected in 29.2% of RSV-positive nasopharyngeal swabs. Conclusions A substantial burden of RSV-LRTI was observed across diverse settings, impacting the youngest infants the most. Clinical Trials Registration. NCT01995175.
{"title":"Incidence of Respiratory Syncytial Virus Lower Respiratory Tract Infections During the First 2 Years of Life: A Prospective Study Across Diverse Global Settings","authors":"J. Langley, V. Bianco, J. Domachowske, S. Madhi, S. Stoszek, K. Zaman, Agustin Bueso, A. Ceballos, Luis Cousin, Ulises D’Andrea, I. Dieussaert, J. Englund, S. Gandhi, O. Gruselle, G. Haars, Lisa Jose, N. Klein, Amanda Leach, Koen Maleux, Thi Lien-Anh Nguyen, T. Puthanakit, P. Silas, A. Tangsathapornpong, J. Teeratakulpisarn, T. Vesikari, Rachel A. Cohen","doi":"10.1093/infdis/jiac227","DOIUrl":"https://doi.org/10.1093/infdis/jiac227","url":null,"abstract":"Abstract Background The true burden of lower respiratory tract infections (LRTIs) due to respiratory syncytial virus (RSV) remains unclear. This study aimed to provide more robust, multinational data on RSV-LRTI incidence and burden in the first 2 years of life. Methods This prospective, observational cohort study was conducted in Argentina, Bangladesh, Canada, Finland, Honduras, South Africa, Thailand, and United States. Children were followed for 24 months from birth. Suspected LRTIs were detected via active (through regular contacts) and passive surveillance. RSV and other viruses were detected from nasopharyngeal swabs using PCR-based methods. Results Of 2401 children, 206 (8.6%) had 227 episodes of RSV-LRTI. Incidence rates (IRs) of first episode of RSV-LRTI were 7.35 (95% confidence interval [CI], 5.88–9.08), 5.50 (95% CI, 4.21–7.07), and 2.87 (95% CI, 2.18–3.70) cases/100 person-years in children aged 0–5, 6–11, and 12–23 months. IRs for RSV-LRTI, severe RSV-LRTI, and RSV hospitalization tended to be higher among 0–5 month olds and in lower-income settings. RSV was detected for 40% of LRTIs in 0–2 month olds and for approximately 20% of LRTIs in older children. Other viruses were codetected in 29.2% of RSV-positive nasopharyngeal swabs. Conclusions A substantial burden of RSV-LRTI was observed across diverse settings, impacting the youngest infants the most. Clinical Trials Registration. NCT01995175.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"74 1","pages":"374 - 385"},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87812847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Respiratory syncytial virus (RSV) around the globe: data to help guide wise use of vaccines and anti-virals.","authors":"G. Storch","doi":"10.1093/infdis/jiac228","DOIUrl":"https://doi.org/10.1093/infdis/jiac228","url":null,"abstract":"","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79664078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heather W Dolby, Sarah A Clifford, I. Laurenson, V. Fowler, C. Russell
Abstract We systematically evaluated randomized-controlled trials (RCTs) for Staphylococcus aureus bacteremia (SAB). There was intertrial heterogeneity in cohort characteristics, including bacteremia source, complicated SAB, and comorbidities. Reporting of cohort characteristics was itself variable, including bacteremia source and illness severity. Selection bias was introduced by exclusion criteria relating to comorbidities, illness severity, infection types, and source control. Mortality was lower in RCT control arms compared with observational cohorts. Differences in outcome definitions impedes meta-analysis. These issues complicate the interpretation and application of SAB RCT results. The value of these trials should be maximized by a standardized approach to recruitment, definitions, and reporting.
{"title":"Heterogeneity in Staphylococcus aureus Bacteraemia Clinical Trials Complicates Interpretation of Findings","authors":"Heather W Dolby, Sarah A Clifford, I. Laurenson, V. Fowler, C. Russell","doi":"10.1093/infdis/jiac219","DOIUrl":"https://doi.org/10.1093/infdis/jiac219","url":null,"abstract":"Abstract We systematically evaluated randomized-controlled trials (RCTs) for Staphylococcus aureus bacteremia (SAB). There was intertrial heterogeneity in cohort characteristics, including bacteremia source, complicated SAB, and comorbidities. Reporting of cohort characteristics was itself variable, including bacteremia source and illness severity. Selection bias was introduced by exclusion criteria relating to comorbidities, illness severity, infection types, and source control. Mortality was lower in RCT control arms compared with observational cohorts. Differences in outcome definitions impedes meta-analysis. These issues complicate the interpretation and application of SAB RCT results. The value of these trials should be maximized by a standardized approach to recruitment, definitions, and reporting.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"22 1","pages":"723 - 728"},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81799286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to Nalin.","authors":"D. Sack, J. Ateudjieu, A. Debes","doi":"10.1093/infdis/jiac208","DOIUrl":"https://doi.org/10.1093/infdis/jiac208","url":null,"abstract":"","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78917282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Cerebral malaria (CM) is a rare, but severe and frequently fatal outcome of infections with Plasmodium falciparum. Pathogenetic mechanisms include endothelial activation and sequestration of parasitized erythrocytes in the cerebral microvessels. Increased concentrations of glycosaminoglycans in urine and plasma of malaria patients have been described, suggesting involvement of endothelial glycocalyx. METHODS We used lectin histochemistry on postmortem samples to compare the distribution of multiple sugar epitopes on cerebral capillaries in children who died from CM and from non-malarial comas. RESULTS N-acetyl glucosamine residues detected by tomato lectin are generally reduced in children with CM compared to controls. We used the vascular expression of intercellular adhesion molecule-1 and mannose residues on brain capillaries of CM as evidence of local vascular inflammation, and both were expressed more highly in CM patients than controls. Sialic acid residues were found to be significantly reduced in patients with CM. By contrast, the levels of other sugar epitopes regularly detected on the cerebral vasculature were unchanged, and this suggests specific remodeling of cerebral microvessels in CM patients. CONCLUSIONS Our findings support and expand upon earlier reports of disruptions of the endothelial glycocalyx in children with severe malaria.
{"title":"Specific components associated with the endothelial glycocalyx are lost from brain capillaries in cerebral malaria.","authors":"C. Hempel, D. Milner, K. Seydel, T. Taylor","doi":"10.1093/infdis/jiac200","DOIUrl":"https://doi.org/10.1093/infdis/jiac200","url":null,"abstract":"BACKGROUND\u0000Cerebral malaria (CM) is a rare, but severe and frequently fatal outcome of infections with Plasmodium falciparum. Pathogenetic mechanisms include endothelial activation and sequestration of parasitized erythrocytes in the cerebral microvessels. Increased concentrations of glycosaminoglycans in urine and plasma of malaria patients have been described, suggesting involvement of endothelial glycocalyx.\u0000\u0000\u0000METHODS\u0000We used lectin histochemistry on postmortem samples to compare the distribution of multiple sugar epitopes on cerebral capillaries in children who died from CM and from non-malarial comas.\u0000\u0000\u0000RESULTS\u0000N-acetyl glucosamine residues detected by tomato lectin are generally reduced in children with CM compared to controls. We used the vascular expression of intercellular adhesion molecule-1 and mannose residues on brain capillaries of CM as evidence of local vascular inflammation, and both were expressed more highly in CM patients than controls. Sialic acid residues were found to be significantly reduced in patients with CM. By contrast, the levels of other sugar epitopes regularly detected on the cerebral vasculature were unchanged, and this suggests specific remodeling of cerebral microvessels in CM patients.\u0000\u0000\u0000CONCLUSIONS\u0000Our findings support and expand upon earlier reports of disruptions of the endothelial glycocalyx in children with severe malaria.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77560906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
TO THE EDITOR—With great interest, we read the article by Regan et al [1]. In their cohort study, the authors investigated the association between prenatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and increased risk of adverse pregnancy outcomes. These findings support previous studies that suggest maternal SARS-CoV-2 infection harms fetal health. However, there are some issues that should be discussed. First, SARS-CoV-2 infection may not be the only risk factor of adverse pregnancy outcomes after adjustment in this cohort. This study was based on de-identified administrative claims and electronic health records data from OptumLabs Data Warehouse [2]. However, some confounders recorded in electronic health records data were not considered in this study, such as parity. A comparative study showed that primary cesarean delivery contributes to the increasing rate of patients’ refusal to undergo vaginal delivery, thus inducing the secondary or repeat cesarean delivery [3]. Moreover, SARS-CoV-2–infected pregnancy complicated with high-risk gestational factors should be considered when evaluating the risk of adverse pregnancy outcomes. For example, previous studies indicated that maternal obesity is linked to a greater risk of preterm birth [4]. As a result, we suggest that importing the known residual confounders into the adjusted model would improve the precision of this study. Second, personal factors were effect modifiers for the association between coronavirus disease 2019 (COVID-19) and clinician-initiated events, including induced abortion, cesarean delivery, and clinician-initiated preterm birth. The administrative codes cannot reflect the exact condition. The preference of patients may influence the decisions of the doctors [3]. On the other hand, doctors may execute clinician-initiated events for COVID-19 patients for other reasons than SARS-CoV-2 infection. The personal factors were residual confounders to the outcomes. Owing to the large infected-to-uninfected ratio in this study, we propose that matching the infected and uninfected cases by time-dependent propensity score matching can minimize the impact of the residual confounders [5]. After sequential matching with timedependent propensity score, the effect of exposure can be identified by the Cox regression model used in this cohort.
{"title":"The Potential Confounders Hiding in a United States Cohort About Severe Acute Respiratory Syndrome Coronavirus 2 Infection During Pregnancy","authors":"Pei-Yun Shih, Y. Chou, J. Wei","doi":"10.1093/infdis/jiac193","DOIUrl":"https://doi.org/10.1093/infdis/jiac193","url":null,"abstract":"TO THE EDITOR—With great interest, we read the article by Regan et al [1]. In their cohort study, the authors investigated the association between prenatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and increased risk of adverse pregnancy outcomes. These findings support previous studies that suggest maternal SARS-CoV-2 infection harms fetal health. However, there are some issues that should be discussed. First, SARS-CoV-2 infection may not be the only risk factor of adverse pregnancy outcomes after adjustment in this cohort. This study was based on de-identified administrative claims and electronic health records data from OptumLabs Data Warehouse [2]. However, some confounders recorded in electronic health records data were not considered in this study, such as parity. A comparative study showed that primary cesarean delivery contributes to the increasing rate of patients’ refusal to undergo vaginal delivery, thus inducing the secondary or repeat cesarean delivery [3]. Moreover, SARS-CoV-2–infected pregnancy complicated with high-risk gestational factors should be considered when evaluating the risk of adverse pregnancy outcomes. For example, previous studies indicated that maternal obesity is linked to a greater risk of preterm birth [4]. As a result, we suggest that importing the known residual confounders into the adjusted model would improve the precision of this study. Second, personal factors were effect modifiers for the association between coronavirus disease 2019 (COVID-19) and clinician-initiated events, including induced abortion, cesarean delivery, and clinician-initiated preterm birth. The administrative codes cannot reflect the exact condition. The preference of patients may influence the decisions of the doctors [3]. On the other hand, doctors may execute clinician-initiated events for COVID-19 patients for other reasons than SARS-CoV-2 infection. The personal factors were residual confounders to the outcomes. Owing to the large infected-to-uninfected ratio in this study, we propose that matching the infected and uninfected cases by time-dependent propensity score matching can minimize the impact of the residual confounders [5]. After sequential matching with timedependent propensity score, the effect of exposure can be identified by the Cox regression model used in this cohort.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77685274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The coronavirus disease 2019 (COVID19) pandemic has focused an intense spotlight on respiratory precautions for healthcare workers managing patients with respiratory viral infections. Prevailing wisdom before the pandemic was that most respiratory viruses are transmitted by large respiratory droplets and fomites. These droplets were believed to have a carrying radius of 3–6 feet before rapidly falling to the ground by virtue of gravity. Surgical masks were presumed to provide adequate protection in most situations by providing a barrier between patients’ emissions and the mucous membranes of providers’ mouths and noses. Notwithstanding this framework, the United States Centers for Disease Control and Prevention’s (CDC) infection control guidelines include a hodgepodge of different personal protective equipment recommendations for different respiratory viruses [1]. These span the gamut from respirators, eye protection, gowns, and gloves to care for patients with emerging pathogens such as Middle East Respiratory Syndrome (MERS), avian influenza, and now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); surgical masks alone to care for patients with influenza; gloves and gowns alone without masks or eye protection to care for patients with respiratory syncytial virus (RSV); and nothing at all to care for immunocompetent adults with parainfluenza. This curious mix of recommendations appears to be the product of a handful of studies conducted predominantly in the 1980s and 1990s that evaluated the additive benefit of one or more of these precautions against one of these viruses, mostly RSV. None of the cited studies compared infection rates between viruses or provided evidence why one virus should be treated differently from another. Many of the source studies only reported on nosocomial infection rates in patients but did not consider infections in healthcare workers. And almost all the studies focused on pediatric populations. The suitability of these studies to support current infection control recommendations is dubious. For example, 2 key studies are cited to support the use of gloves and gown alone without a mask or eye protection to care for patients with RSV. The first was a quality improvement initiative in a children’s hospital designed to increase providers’ compliance with gloves and gowns over the course of 3 RSV seasons from 1982 to 1985. The investigators reported that an increase in glove and gown use from 39% to 81% of audits was associated with a 3-fold decrease in nosocomial RSV infections [2]. The investigators did not assess whether adding masks and eye protection could further decrease infections and the study only evaluated infections in patients; infections among staff members were not assessed. The second study was a prospective comparison of nosocomial RSV rates among children assigned to wards with different precaution sets over 3 RSV seasons [3]. Nosocomial RSV rates ranged from 26% of patients when using no p
{"title":"Optimizing and Unifying Infection Control Precautions for Respiratory Viral Infections","authors":"M. Klompas, C. Rhee","doi":"10.1093/infdis/jiac197","DOIUrl":"https://doi.org/10.1093/infdis/jiac197","url":null,"abstract":"The coronavirus disease 2019 (COVID19) pandemic has focused an intense spotlight on respiratory precautions for healthcare workers managing patients with respiratory viral infections. Prevailing wisdom before the pandemic was that most respiratory viruses are transmitted by large respiratory droplets and fomites. These droplets were believed to have a carrying radius of 3–6 feet before rapidly falling to the ground by virtue of gravity. Surgical masks were presumed to provide adequate protection in most situations by providing a barrier between patients’ emissions and the mucous membranes of providers’ mouths and noses. Notwithstanding this framework, the United States Centers for Disease Control and Prevention’s (CDC) infection control guidelines include a hodgepodge of different personal protective equipment recommendations for different respiratory viruses [1]. These span the gamut from respirators, eye protection, gowns, and gloves to care for patients with emerging pathogens such as Middle East Respiratory Syndrome (MERS), avian influenza, and now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); surgical masks alone to care for patients with influenza; gloves and gowns alone without masks or eye protection to care for patients with respiratory syncytial virus (RSV); and nothing at all to care for immunocompetent adults with parainfluenza. This curious mix of recommendations appears to be the product of a handful of studies conducted predominantly in the 1980s and 1990s that evaluated the additive benefit of one or more of these precautions against one of these viruses, mostly RSV. None of the cited studies compared infection rates between viruses or provided evidence why one virus should be treated differently from another. Many of the source studies only reported on nosocomial infection rates in patients but did not consider infections in healthcare workers. And almost all the studies focused on pediatric populations. The suitability of these studies to support current infection control recommendations is dubious. For example, 2 key studies are cited to support the use of gloves and gown alone without a mask or eye protection to care for patients with RSV. The first was a quality improvement initiative in a children’s hospital designed to increase providers’ compliance with gloves and gowns over the course of 3 RSV seasons from 1982 to 1985. The investigators reported that an increase in glove and gown use from 39% to 81% of audits was associated with a 3-fold decrease in nosocomial RSV infections [2]. The investigators did not assess whether adding masks and eye protection could further decrease infections and the study only evaluated infections in patients; infections among staff members were not assessed. The second study was a prospective comparison of nosocomial RSV rates among children assigned to wards with different precaution sets over 3 RSV seasons [3]. Nosocomial RSV rates ranged from 26% of patients when using no p","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86321846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Landry, D. Subedi, J. Barr, M. MacDonald, S. Dix, D. Kutey, D. Mansfield, G. Hamilton, B. Edwards, S. Joosten
Abstract Background Healthcare workers (HCWs) are at risk from aerosol transmission of severe acute respiratory syndrome coronavirus 2. The aims of this study were to (1) quantify the protection provided by masks (surgical, fit-testFAILED N95, fit-testPASSED N95) and personal protective equipment (PPE), and (2) determine if a portable high-efficiency particulate air (HEPA) filter can enhance the benefit of PPE. Methods Virus aerosol exposure experiments using bacteriophage PhiX174 were performed. An HCW wearing PPE (mask, gloves, gown, face shield) was exposed to nebulized viruses (108 copies/mL) for 40 minutes in a sealed clinical room. Virus exposure was quantified via skin swabs applied to the face, nostrils, forearms, neck, and forehead. Experiments were repeated with a HEPA filter (13.4 volume-filtrations/hour). Results Significant virus counts were detected on the face while the participants were wearing either surgical or N95 masks. Only the fit-testPASSED N95 resulted in lower virus counts compared to control (P = .007). Nasal swabs demonstrated high virus exposure, which was not mitigated by the surgical/fit-testFAILED N95 masks, although there was a trend for the fit-testPASSED N95 mask to reduce virus counts (P = .058). HEPA filtration reduced virus to near-zero levels when combined with fit-testPASSED N95 mask, gloves, gown, and face shield. Conclusions N95 masks that have passed a quantitative fit-test combined with HEPA filtration protects against high virus aerosol loads at close range and for prolonged periods of time.
{"title":"Fit-Tested N95 Masks Combined With Portable High-Efficiency Particulate Air Filtration Can Protect Against High Aerosolized Viral Loads Over Prolonged Periods at Close Range","authors":"S. Landry, D. Subedi, J. Barr, M. MacDonald, S. Dix, D. Kutey, D. Mansfield, G. Hamilton, B. Edwards, S. Joosten","doi":"10.1093/infdis/jiac195","DOIUrl":"https://doi.org/10.1093/infdis/jiac195","url":null,"abstract":"Abstract Background Healthcare workers (HCWs) are at risk from aerosol transmission of severe acute respiratory syndrome coronavirus 2. The aims of this study were to (1) quantify the protection provided by masks (surgical, fit-testFAILED N95, fit-testPASSED N95) and personal protective equipment (PPE), and (2) determine if a portable high-efficiency particulate air (HEPA) filter can enhance the benefit of PPE. Methods Virus aerosol exposure experiments using bacteriophage PhiX174 were performed. An HCW wearing PPE (mask, gloves, gown, face shield) was exposed to nebulized viruses (108 copies/mL) for 40 minutes in a sealed clinical room. Virus exposure was quantified via skin swabs applied to the face, nostrils, forearms, neck, and forehead. Experiments were repeated with a HEPA filter (13.4 volume-filtrations/hour). Results Significant virus counts were detected on the face while the participants were wearing either surgical or N95 masks. Only the fit-testPASSED N95 resulted in lower virus counts compared to control (P = .007). Nasal swabs demonstrated high virus exposure, which was not mitigated by the surgical/fit-testFAILED N95 masks, although there was a trend for the fit-testPASSED N95 mask to reduce virus counts (P = .058). HEPA filtration reduced virus to near-zero levels when combined with fit-testPASSED N95 mask, gloves, gown, and face shield. Conclusions N95 masks that have passed a quantitative fit-test combined with HEPA filtration protects against high virus aerosol loads at close range and for prolonged periods of time.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"70 1","pages":"199 - 207"},"PeriodicalIF":0.0,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84887233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elodie Ramond, A. Lepissier, Xiongqi Ding, C. Bouvier, X. Tan, Daniel Euphrasie, Pierre Monbernard, M. Dupuis, B. Saubaméa, I. Nemazanyy, X. Nassif, A. Ferroni, I. Sermet-Gaudelus, A. Charbit, Mathieu Coureuil, A. Jamet
BACKGROUND Staphylococcus aureus (Sa) dominates the lung microbiota of Cystic Fibrosis (CF) children and persistent clones are able to establish chronic infection for years, having a direct deleterious impact on lung function. However, in this context, the exact contribution of Sa to the decline in respiratory function in CF children is not elucidated. METHODS To investigate the contribution of persistent S. aureus clones in CF disease, we undertook the analysis of sequential isogenic isolates recovered from 15 young CF patients. RESULTS Using an Air-Liquid infection model, we observed a strong correlation between Sa adaption in the lung (late isolates), low toxicity and pro-inflammatory cytokine secretion. Conversely, early isolates appeared to be highly cytotoxic but did not promote cytokine secretion. We found that cytokine secretion was dependent on Staphylococcal protein A (Spa), which was selectively expressed in late compared to early isolates as a consequence of dysfunctional agr quorum-sensing system. Finally, we demonstrated the involvement of TNF-α receptor 1 signaling in the inflammatory response of airway epithelial cells to these lung-adapted Sa isolates. CONCLUSION Our results suggest an unexpected direct role of bacterial lung adaptation in the progression of chronic lung disease by promoting a pro-inflammatory response through acquired agr dysfunction.
{"title":"Lung-adapted Staphylococcus aureus isolates with dysfunctional agr system trigger a proinflammatory response.","authors":"Elodie Ramond, A. Lepissier, Xiongqi Ding, C. Bouvier, X. Tan, Daniel Euphrasie, Pierre Monbernard, M. Dupuis, B. Saubaméa, I. Nemazanyy, X. Nassif, A. Ferroni, I. Sermet-Gaudelus, A. Charbit, Mathieu Coureuil, A. Jamet","doi":"10.1093/infdis/jiac191","DOIUrl":"https://doi.org/10.1093/infdis/jiac191","url":null,"abstract":"BACKGROUND\u0000Staphylococcus aureus (Sa) dominates the lung microbiota of Cystic Fibrosis (CF) children and persistent clones are able to establish chronic infection for years, having a direct deleterious impact on lung function. However, in this context, the exact contribution of Sa to the decline in respiratory function in CF children is not elucidated.\u0000\u0000\u0000METHODS\u0000To investigate the contribution of persistent S. aureus clones in CF disease, we undertook the analysis of sequential isogenic isolates recovered from 15 young CF patients.\u0000\u0000\u0000RESULTS\u0000Using an Air-Liquid infection model, we observed a strong correlation between Sa adaption in the lung (late isolates), low toxicity and pro-inflammatory cytokine secretion. Conversely, early isolates appeared to be highly cytotoxic but did not promote cytokine secretion. We found that cytokine secretion was dependent on Staphylococcal protein A (Spa), which was selectively expressed in late compared to early isolates as a consequence of dysfunctional agr quorum-sensing system. Finally, we demonstrated the involvement of TNF-α receptor 1 signaling in the inflammatory response of airway epithelial cells to these lung-adapted Sa isolates.\u0000\u0000\u0000CONCLUSION\u0000Our results suggest an unexpected direct role of bacterial lung adaptation in the progression of chronic lung disease by promoting a pro-inflammatory response through acquired agr dysfunction.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86238757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Meister, M. Dreismeier, E. V. Blanco, Y. Brüggemann, N. Heinen, G. Kampf, D. Todt, H. Nguyen, J. Steinmann, W. Schmidt, E. Steinmann, D. Quast, S. Pfaender
Abstract Background The contribution of droplet-contaminated surfaces for virus transmission has been discussed controversially in the context of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. More importantly, the risk of fomite-based transmission has not been systematically addressed. Therefore, the aim of this study was to evaluate whether confirmed hospitalized coronavirus disease 2019 (COVID-19) patients can contaminate stainless steel carriers by coughing or intensive moistening with saliva and to assess the risk of SARS-CoV-2 transmission upon detection of viral loads and infectious virus in cell culture. Methods We initiated a single-center observational study including 15 COVID-19 patients with a high baseline viral load (cycle threshold value ≤25). We documented clinical and laboratory parameters and used patient samples to perform virus culture, quantitative polymerase chain reaction, and virus sequencing. Results Nasopharyngeal and oropharyngeal swabs of all patients were positive for viral ribonucleic acid on the day of the study. Infectious SARS-CoV-2 could be isolated from 6 patient swabs (46.2%). After coughing, no infectious virus could be recovered, however, intensive moistening with saliva resulted in successful viral recovery from steel carriers of 5 patients (38.5%). Conclusions Transmission of infectious SARS-CoV-2 via fomites is possible upon extensive moistening, but it is unlikely to occur in real-life scenarios and from droplet-contaminated fomites.
{"title":"Low Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission by Fomites: A Clinical Observational Study in Highly Infectious Coronavirus Disease 2019 Patients","authors":"T. Meister, M. Dreismeier, E. V. Blanco, Y. Brüggemann, N. Heinen, G. Kampf, D. Todt, H. Nguyen, J. Steinmann, W. Schmidt, E. Steinmann, D. Quast, S. Pfaender","doi":"10.1093/infdis/jiac170","DOIUrl":"https://doi.org/10.1093/infdis/jiac170","url":null,"abstract":"Abstract Background The contribution of droplet-contaminated surfaces for virus transmission has been discussed controversially in the context of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. More importantly, the risk of fomite-based transmission has not been systematically addressed. Therefore, the aim of this study was to evaluate whether confirmed hospitalized coronavirus disease 2019 (COVID-19) patients can contaminate stainless steel carriers by coughing or intensive moistening with saliva and to assess the risk of SARS-CoV-2 transmission upon detection of viral loads and infectious virus in cell culture. Methods We initiated a single-center observational study including 15 COVID-19 patients with a high baseline viral load (cycle threshold value ≤25). We documented clinical and laboratory parameters and used patient samples to perform virus culture, quantitative polymerase chain reaction, and virus sequencing. Results Nasopharyngeal and oropharyngeal swabs of all patients were positive for viral ribonucleic acid on the day of the study. Infectious SARS-CoV-2 could be isolated from 6 patient swabs (46.2%). After coughing, no infectious virus could be recovered, however, intensive moistening with saliva resulted in successful viral recovery from steel carriers of 5 patients (38.5%). Conclusions Transmission of infectious SARS-CoV-2 via fomites is possible upon extensive moistening, but it is unlikely to occur in real-life scenarios and from droplet-contaminated fomites.","PeriodicalId":22572,"journal":{"name":"The Indonesian Journal of Infectious Diseases","volume":"16 1","pages":"1608 - 1615"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82363869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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