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Environmental detection of eumycetoma pathogens using multiplex real-time PCR for soil DNA in Sennar State, Sudan. 利用苏丹森纳尔州土壤 DNA 的多重实时 PCR 技术,对埃米克特瘤病原体进行环境检测。
IF 4.5 Q1 Medicine Pub Date : 2023-12-19 DOI: 10.1186/s41182-023-00563-3
Hiroki Hashizume, Suguru Taga, Masayuki K Sakata, Mahmoud Hussein, Emmanuel Edwar Siddig, Toshifumi Minamoto, Ahmed Hassan Fahal, Satoshi Kaneko

Background: Mycetoma is a chronic disease affecting the skin and subcutaneous tissue endemic in the tropical and subtropical regions. Several bacteria and fungi can cause mycetoma, but fungal mycetoma (eumycetoma) is challenging because the treatment requires a combination of a long-term antifungal agent and surgery. Although the transmission route has not yet been elucidated, infection from the soil is a leading hypothesis. However, there are few soil investigation studies, and the geographical distribution of mycetoma pathogens is not well documented. Here, we used multiplex real-time PCR technology to identify three fungal species from soil samples.

Methods: In total, 64 DNA samples were extracted from soil collected in seven villages in an endemic area in Sennar State, Sudan, in 2019. Primers and fluorescent probes specifically targeting the ribosomal DNA of Madurella mycetomatis, Falciformispora senegalensis, and F. tompkinsii were designed.

Results: Multiplex real-time PCR was performed and identified the major pathogen, M. mycetomatis that existed in most sites (95%). In addition, two other pathogens were identified from some sites. This is the first report on the use of this technique for identifying the eumycetoma causative microorganisms.

Conclusions: This study demonstrated that soil DNA investigation can elucidate the risk area of mycetoma-causative agents. The results will contribute to the design of prevention measures, and further large-scale studies may be effective in understanding the natural habitats of mycetoma pathogens.

背景:霉菌瘤是一种影响皮肤和皮下组织的慢性疾病,是热带和亚热带地区的地方病。几种细菌和真菌都可引起霉菌瘤,但真菌性霉菌瘤(真菌瘤)的治疗具有挑战性,因为治疗需要结合长期抗真菌药物和手术。虽然传播途径尚未明确,但从土壤中感染是一个主要假设。然而,土壤调查研究很少,霉菌瘤病原体的地理分布也没有很好的记录。在此,我们利用多重实时 PCR 技术从土壤样本中鉴定了三种真菌:方法:2019 年,我们从苏丹森纳尔州一个地方病流行区的七个村庄采集的土壤中总共提取了 64 份 DNA 样本。设计了专门针对Madurella mycetomatis、Falciformispora senegalensis和F. tompkinsii核糖体DNA的引物和荧光探针:结果:进行了多重实时 PCR 检测,确定了主要病原体霉浆菌存在于大多数地点(95%)。此外,还在一些地点发现了另外两种病原体。这是第一份使用该技术鉴定真菌瘤致病微生物的报告:结论:这项研究表明,土壤 DNA 调查可以阐明霉菌瘤致病因子的风险区域。研究结果将有助于制定预防措施,进一步的大规模研究可能会有效了解霉菌瘤病原体的自然栖息地。
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引用次数: 0
Vaccine inequity: a threat to Africa's recovery from COVID-19. 疫苗不公平:对非洲从 COVID-19 中恢复的威胁。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2023-12-19 DOI: 10.1186/s41182-023-00564-2
Calvin R Wei, Samuel Kamande, Godwin C Lang'at

Background: Vaccine inequity is a reality facing the Sub-Saharan Africa region as vaccine nationalism from high-income countries (HICs) leads to limited access to the lifesaving vaccines needed to end the pandemic. In Africa, a significant portion of the population has yet to be vaccinated against Covid-19; however, the barriers to accessing such vaccines, including capacity challenges, still persist despite the implementation of the COVAX facility meant to support the lower- and middle-income countries (LMICs) to boost vaccination.

Methods: This study involved a systemic narrative review where literature search was conducted using the NCBI's PMC and BMC databases based on defined keywords. Three authors were involved in the literature search and consensus was applied to settle disagreements and validate the findings.

Results: In this systematic narrative review, we report that vaccine nationalism remains a challenge for LMICs as HICs still hoard vaccines and even bypass COVAX to procure doses directly from the manufacturers. Factors that promote vaccine hesitancy in Africa include misinformation regarding the Covid-19 vaccine, a lack of trust in politicians and the pharmaceutical industry, and concerns about vaccine safety and efficacy. The policies implemented to enhance vaccine coverage in Africa, such as mandates, community engagement, and partnerships, all seek to promote equity of vaccination and ending Covid-19.

Conclusion: Covid-19 vaccine inequity persists and contributes to prolonged pandemic in LMICs. In response, African governments have taken certain measures to enhance vaccine uptake but more needs to be done to address resistance to vaccines.

背景:疫苗不公平是撒哈拉以南非洲地区面临的一个现实问题,因为高收入国家(HICs)的疫苗民族主义导致获得终止大流行病所需的救命疫苗的机会有限。在非洲,很大一部分人口尚未接种 Covid-19 疫苗;然而,尽管实施了旨在支持中低收入国家(LMICs)加强疫苗接种的 COVAX 基金,但获得此类疫苗的障碍(包括能力挑战)依然存在:本研究进行了系统的叙述性综述,根据定义的关键词使用 NCBI 的 PMC 和 BMC 数据库进行了文献检索。三位作者参与了文献检索,并达成了共识,以解决分歧并验证研究结果:在这篇系统叙述性综述中,我们报告了疫苗民族主义仍是低收入国家面临的挑战,因为高收入国家仍在囤积疫苗,甚至绕过 COVAX 直接从制造商处采购疫苗。在非洲,促使人们对疫苗犹豫不决的因素包括有关科维-19 疫苗的错误信息、对政治家和制药业缺乏信任以及对疫苗安全性和有效性的担忧。为提高疫苗在非洲的覆盖率而实施的政策,如授权、社区参与和合作伙伴关系等,都旨在促进疫苗接种的公平性和终结Covid-19:结论:Covid-19 疫苗接种不公平现象持续存在,导致大流行病在低收入和中等收入国家长期存在。为此,非洲各国政府采取了一些措施来提高疫苗接种率,但还需要做更多工作来解决疫苗耐受性问题。
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引用次数: 0
Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018-2022. 严重急性呼吸道感染成年患者的死亡特征:2018-2022年孟加拉国COVID-19大流行前和COVID-19大流行期间。
IF 3.6 Q1 TROPICAL MEDICINE Pub Date : 2023-12-19 DOI: 10.1186/s41182-023-00565-1
Md Zakiul Hassan, Md Ariful Islam, Homayra Rahman Shoshi, Md Kamal Hossain, Tahmina Shirin, Fahmida Chowdhury

Background: Severe acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors.

Methods: We analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018-February 2020 as the pre-pandemic period and March 2020-February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients.

Results: We enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p < 0.001). Pre-pandemic, influenza was detected in 14% (37/264) of SARI deaths. Influenza was detected during the pandemic in 2.3% (12/521), SARS-CoV-2 in 41.8% (218/521), and both viruses in only one SARI death. History of smoking and the presence of 1 or more co-morbid conditions independently attributed to SARI deaths in adults in the pre-pandemic period. SARI deaths in such patients were also associated with respiratory difficulties on admission in both pre-pandemic (aHR 2.36; 95% CI:1.65-3.36) and pandemic period (aHR 2.30; 95% CI: 1.57-3.35) after accounting for age, sex, smoking status, presence of 1 or more co-morbid conditions, and detection of influenza and SARS-CoV-2 viruses.

Conclusions: During the pandemic, SARI mortality increased; influenza-associated mortality declined, and SARS-CoV-2 caused over a third of SARI deaths. Post-discharge mortality was higher than in-hospital mortality during both periods. Limiting premature discharge and strengthening post-discharge monitoring and nursing services could reduce unexpected deaths. Formative research to better understand post-discharge mortality is essential to reduce SARI deaths.

背景:严重急性呼吸道感染(SARI)是全球死亡的主要原因之一,在 COVID-19 大流行期间达到高峰。我们分析了孟加拉国大流行前期与 SARI 相关的死亡病例,以确定导致死亡的因素:我们分析了孟加拉国九家三级医院的医院流感监测数据。我们将 2018 年 3 月至 2020 年 2 月视为大流行前期,2020 年 3 月至 2022 年 2 月视为大流行期,并将成年(≥ 18 岁)参与者纳入研究范围。监测医生确定了符合 WHO-SARI 病例定义的住院患者,并收集了出院时和出院后 30 天的人口统计学、临床特征和结果。我们对采集的鼻咽和口咽拭子进行了流感和 SARS-CoV-2 病毒的 rRT-PCR 检测。我们使用多变量考克斯回归模型计算了这些成人患者中与 SARI 死亡相关因素的危险比 (HR):我们共收治了大流行前的 4392 名 SARI 患者和大流行期间的 3824 名 SARI 患者。与大流行前的 6.01% (264) [院内:2.01% (89);出院后:4% (175)]相比,大流行期间的病死率更高:13.62% (521) [院内:6.45% (247);出院后:7.17% (274)](P 结论:在大流行期间,SARI 患者的病死率比大流行前更高:大流行期间,SARI 死亡率上升;流感相关死亡率下降,SARS-CoV-2 导致的 SARI 死亡占三分之一以上。在这两个时期,出院后死亡率均高于院内死亡率。限制过早出院、加强出院后监测和护理服务可以减少意外死亡。为更好地了解出院后死亡率而开展的形成性研究对于减少 SARI 死亡至关重要。
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引用次数: 0
Differential cardiomyocyte transcriptomic remodeling during in vitro Trypanosoma cruzi infection using laboratory strains provides implications on pathogenic host responses 利用实验室菌株在体外感染克氏锥虫期间心肌细胞转录组重塑的差异对致病宿主反应的影响
IF 4.5 Q1 Medicine Pub Date : 2023-12-01 DOI: 10.1186/s41182-023-00552-6
Katherine-Sofia Candray-Medina, Y. Nakagama, Masamichi Ito, Shun Nakagama, E. Tshibangu-Kabamba, Norihiko Takeda, Yuki Sugiura, Y. Nitahara, Yu Michimuko-Nagahara, N. Kaku, Yoko Onizuka, C. Arias, M. Mejía, Karla Alas, Susana Peña, Yasuhiro Maejima, Issei Komuro, J. Nakajima-Shimada, Yasutoshi Kido
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引用次数: 0
Distribution of helminth eggs in environmental and stool samples of farming households along Akaki River in Addis Ababa, Ethiopia. 埃塞俄比亚亚的斯亚贝巴Akaki河沿岸农户环境和粪便样本中寄生虫卵的分布情况。
IF 4.5 Q1 Medicine Pub Date : 2023-11-24 DOI: 10.1186/s41182-023-00558-0
Bethlhem Kinfu Gurmassa, Sirak Robele Gari, Ephrem Tefera Solomon, Michaela L Goodson, Claire L Walsh, Bitew K Dessie, Bezatu Mengistie Alemu

Background: Helminth infections are a public health issue in countries with poor sanitation facilities. However, there little information on the epidemiological association between helminths in wastewater and soil samples and rates of helminth infection among farming households along the Akaki River in Addis Ababa, Ethiopia.

Methods: A cross-sectional study was conducted between November 2021 and February 2022. A stratified random sampling technique was used to select farming households. The sample size for each district was determined by a proportionate allocation to the number of households. From wastewater-irrigated farms, 70 wastewater samples, 28 soil samples, and 86 farmers' stool samples were collected and analyzed for helminths. A questionnaire was used to gather ethnographic data, about farming households, whereas wastewater and soil sample analysis was used to generate quantitative data on helminth loads. The data were systematically analysed by developing themes, and bias evaluated using triangulation validation methodologies. Potential pathways to helminth infection were evaluated by measuring. Total number of helminth eggs in wastewater, soil samples and farmer's stools was investigated using Poisson regression.

Results: In this study, 82.9% of wastewater samples, 57.1% of soil samples, and 18.6% of farmers' stool samples contained helminth eggs. The most prevalent helminth was Ascaris lumbricoides in all samples (wastewater 67%, soil 25%, and stool 10.5%), followed by hookworm (wastewater 10%, soil 21.4%, and stool 6.9%) and Trichuris trichiura eggs (wastewater 5.7%, soil 10.7%, and stool 1.2%). There was a positive association between the total number of helminth eggs in wastewater and soil samples with counts in farmers' stool. The Poisson regression coefficients for wastewater and soil were, 1.63 (95% CI = 1.34-1.92) and 1.70 (95% CI = 1.39-2.01), (p < 0.05).

Conclusions: This research has shown a clear association between the total helminth eggs in wastewater and soil samples and farmer stools along the Akaki River. Therefore, an integrated approach is essential to address the issue in this area and prevent the spread of further helminth infections.

背景:在卫生设施差的国家,寄生虫感染是一个公共卫生问题。然而,关于埃塞俄比亚亚的斯亚贝巴Akaki河沿岸农户中废水和土壤样本中的蠕虫与蠕虫感染率之间的流行病学关联的信息很少。方法:在2021年11月至2022年2月期间进行横断面研究。采用分层随机抽样方法对农户进行抽样。每个地区的样本量由按比例分配的家庭数量决定。从废水灌溉农场收集了70份废水样本、28份土壤样本和86份农民粪便样本,并对其进行了蠕虫分析。使用问卷收集有关农户的人种学数据,而使用废水和土壤样本分析来生成关于蠕虫负荷的定量数据。通过开发主题对数据进行系统分析,并使用三角测量验证方法评估偏倚。通过测量来评估寄生虫感染的潜在途径。采用泊松回归法对污水、土壤样品和农民粪便中的蠕虫卵总数进行了调查。结果:82.9%的污水样本、57.1%的土壤样本和18.6%的农民粪便样本中含有蠕虫卵。所有样本中最常见的蠕虫是类蚓蛔虫(废水67%,土壤25%,粪便10.5%),其次是钩虫(废水10%,土壤21.4%,粪便6.9%)和毛滴虫卵(废水5.7%,土壤10.7%,粪便1.2%)。污水中虫卵总数、土壤样品中虫卵总数与农民粪便中虫卵数呈正相关。废水和土壤的泊松回归系数分别为1.63 (95% CI = 1.34 ~ 1.92)和1.70 (95% CI = 1.39 ~ 2.01)。(p)结论:赤明河流域废水和土壤样品中总虫卵与农民粪便有明显的相关性。因此,必须采取综合办法来解决这一领域的问题,防止寄生虫感染进一步蔓延。
{"title":"Distribution of helminth eggs in environmental and stool samples of farming households along Akaki River in Addis Ababa, Ethiopia.","authors":"Bethlhem Kinfu Gurmassa, Sirak Robele Gari, Ephrem Tefera Solomon, Michaela L Goodson, Claire L Walsh, Bitew K Dessie, Bezatu Mengistie Alemu","doi":"10.1186/s41182-023-00558-0","DOIUrl":"10.1186/s41182-023-00558-0","url":null,"abstract":"<p><strong>Background: </strong>Helminth infections are a public health issue in countries with poor sanitation facilities. However, there little information on the epidemiological association between helminths in wastewater and soil samples and rates of helminth infection among farming households along the Akaki River in Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted between November 2021 and February 2022. A stratified random sampling technique was used to select farming households. The sample size for each district was determined by a proportionate allocation to the number of households. From wastewater-irrigated farms, 70 wastewater samples, 28 soil samples, and 86 farmers' stool samples were collected and analyzed for helminths. A questionnaire was used to gather ethnographic data, about farming households, whereas wastewater and soil sample analysis was used to generate quantitative data on helminth loads. The data were systematically analysed by developing themes, and bias evaluated using triangulation validation methodologies. Potential pathways to helminth infection were evaluated by measuring. Total number of helminth eggs in wastewater, soil samples and farmer's stools was investigated using Poisson regression.</p><p><strong>Results: </strong>In this study, 82.9% of wastewater samples, 57.1% of soil samples, and 18.6% of farmers' stool samples contained helminth eggs. The most prevalent helminth was Ascaris lumbricoides in all samples (wastewater 67%, soil 25%, and stool 10.5%), followed by hookworm (wastewater 10%, soil 21.4%, and stool 6.9%) and Trichuris trichiura eggs (wastewater 5.7%, soil 10.7%, and stool 1.2%). There was a positive association between the total number of helminth eggs in wastewater and soil samples with counts in farmers' stool. The Poisson regression coefficients for wastewater and soil were, 1.63 (95% CI = 1.34-1.92) and 1.70 (95% CI = 1.39-2.01), (p < 0.05).</p><p><strong>Conclusions: </strong>This research has shown a clear association between the total helminth eggs in wastewater and soil samples and farmer stools along the Akaki River. Therefore, an integrated approach is essential to address the issue in this area and prevent the spread of further helminth infections.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correction: RNA purification-free detection of SARS-CoV-2 using reverse transcription loop-mediated isothermal amplification (RT-LAMP). 更正:利用逆转录环介导的等温扩增(RT-LAMP)无RNA纯化检测SARS-CoV-2。
IF 4.5 Q1 Medicine Pub Date : 2023-11-22 DOI: 10.1186/s41182-023-00555-3
Meng Yee Lai, Jeyanthi Suppiah, Ravindran Thayan, Ilyiana Ismail, Nur Izati Mustapa, Tuan Suhaila Tuan Soh, Affah Haji Hassan, Kalaiarasu M Peariasamy, Yee Leng Lee, Yee Ling Lau
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引用次数: 0
Measuring training effectiveness of laboratory biosafety program offered at African Center for Integrated Laboratory Training in 22 President's Emergency Plan for AIDS Relief supported countries (2008-2014). 衡量非洲综合实验室培训中心在22个总统艾滋病紧急救援计划支持国家提供的实验室生物安全方案的培训效果(2008-2014年)。
IF 4.5 Q1 Medicine Pub Date : 2023-11-21 DOI: 10.1186/s41182-023-00557-1
Ritu Shrivastava, Thomas Stevens, Larry Westerman, David Bressler, Elsie van Schalkwyk, Cristina Bressler, Ken Ugwu, Christina Mwangi, Joel Peter Opio, Joseph Nkodyo, Jane W Mwangi, Monte D Martin, Shanna Nesby-O'Dell

Introduction: The African Center for Integrated Laboratory Training (ACILT) in Johannesburg, South Africa offered a laboratory biosafety program to improve laboratory biosafety practices in 22 President's Emergency Plan for AIDS Relief (PEPFAR) supported countries. This manuscript evaluates the transference of newly gained knowledge and skills to the participants' place of employment for HIV and TB diagnostic laboratory programs. It also serves as a follow-on to a previously published manuscript that measured training effectiveness for all courses offered at ACILT.

Methods: ACILT offered 20 Laboratory Biosafety and Infrastructure courses (2008-2014), also referred as biosafety course/course comprising of 14 core laboratory safety elements to 402 participants from 22 countries. In 2015, participants received 22 e-questions divided into four categories: (1) Safety Policies, (2) Management's Engagement, (3) Safety Programs and (4) Assessments of Safety Practices to determine retrospectively the training effectiveness of biosafety practices in their place of employment 6 months before and after attending their course. We used Kirkpatrick model to assess the transference of knowledge, skills and obstructive factors.

Results: 20% (81/402) of the participants completed the e-questionnaire. The overall percentage of positive responses indicating implementation of new safety practices increased from 50% to 84%. Improvement occurred in all four categories after attending the course, with the greatest increases in Safety Policies (67-94%) and Safety Programs (43-91%). Creating a safety committee, allocating resources, and establishing a facility safety policy were important drivers for implementing and maintaining laboratory safety practices. In addition, accredited laboratories and countries with national safety regulations or policies had a higher percentage of improvements. The most reported challenges were inadequate funding and lack of management enforcement.

Conclusions: PEPFAR and other partners' investments in training institutions, such as ACILT, were effective in building sustainable country ownership to strengthen biosafety practices and were leveraged to combat zoonotic diseases and COVID-19. Although support continues at the national/regional level, a standardized, coordinated and continent-wide sustainable approach to offer a biosafety program-like ACILT is missing. Continuous offerings of biosafety programs similar to ACILT could contribute to sustainable strengthening of laboratory biosafety, QMS and pandemic preparedness.

简介:位于南非约翰内斯堡的非洲综合实验室培训中心(ACILT)提供了一个实验室生物安全项目,以便在22个得到总统艾滋病紧急救援计划(PEPFAR)支持的国家改进实验室生物安全做法。这份手稿评估了新获得的知识和技能转移到参与者的工作场所的艾滋病毒和结核病诊断实验室方案。它也是先前出版的手稿的后续,该手稿衡量了ACILT提供的所有课程的培训效果。方法:ACILT举办了20期(2008-2014)实验室生物安全与基础设施课程(又称生物安全课程/包含14个核心实验室安全要素的课程),共22个国家402人参加。2015年,参与者收到了22个电子问题,分为四类:(1)安全政策,(2)管理层参与,(3)安全计划和(4)安全实践评估,以回顾性地确定他们参加课程前后6个月的生物安全实践培训效果。我们使用Kirkpatrick模型来评估知识、技能和阻碍因素的转移。结果:20%(81/402)的参与者完成了电子问卷。表明实施了新的安全措施的积极答复的总体百分比从50%增加到84%。参加课程后,所有四个类别都有所改善,其中安全政策(67% -94%)和安全计划(43% -91%)的增幅最大。创建安全委员会、分配资源和建立设施安全政策是实施和维护实验室安全实践的重要驱动因素。此外,认可的实验室和有国家安全法规或政策的国家有更高的改进百分比。报告最多的挑战是资金不足和缺乏管理执法。结论:总统防治艾滋病紧急救援计划和其他合作伙伴对ACILT等培训机构的投资,有效地建立了可持续的国家自主权,加强了生物安全实践,并被用于抗击人畜共患疾病和COVID-19。虽然在国家/区域一级继续提供支持,但目前还缺乏一种标准化、协调和全大陆范围的可持续方法来提供类似ACILT的生物安全规划。持续提供类似ACILT的生物安全项目有助于持续加强实验室生物安全、质量管理体系和大流行防范。
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引用次数: 0
The landscape of drug resistance in Plasmodium falciparum malaria in the Democratic Republic of Congo: a mapping systematic review. 刚果民主共和国恶性疟原虫疟疾耐药情况:制图系统回顾。
IF 4.5 Q1 Medicine Pub Date : 2023-11-15 DOI: 10.1186/s41182-023-00551-7
Nadine Kalenda Kayiba, Evariste Tshibangu-Kabamba, Angel Rosas-Aguirre, Natsuko Kaku, Yu Nakagama, Akira Kaneko, Dieudonné Mvumbi Makaba, Doudou Yobi Malekita, Brecht Devleesschauwer, Joris Losimba Likwela, Pius Kabututu Zakayi, Patrick DeMol, Georges Mvumbi Lelo, Marie-Pierre Hayette, Paul Lusamba Dikassa, Yasutoshi Kido, Niko Speybroeck

Context: The Democratic Republic of Congo (DRC), one of the most malaria-affected countries worldwide, is a potential hub for global drug-resistant malaria. This study aimed at summarizing and mapping surveys of malaria parasites carrying molecular markers of drug-resistance across the country.

Methods: A systematic mapping review was carried out before July 2023 by searching for relevant articles through seven databases (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline and Web of Science).

Results: We identified 1541 primary studies of which 29 fulfilled inclusion criteria and provided information related to 6385 Plasmodium falciparum clinical isolates (collected from 2000 to 2020). We noted the PfCRT K76T mutation encoding for chloroquine-resistance in median 32.1% [interquartile interval, IQR: 45.2] of analyzed malaria parasites. The proportion of parasites carrying this mutation decreased overtime, but wide geographic variations persisted. A single isolate had encoded the PfK13 R561H substitution that is invoked in artemisinin-resistance emergence in the Great Lakes region of Africa. Parasites carrying various mutations linked to resistance to the sulfadoxine-pyrimethamine combination were widespread and reflected a moderate resistance profile (PfDHPS A437G: 99.5% [IQR: 3.9]; PfDHPS K540E: 38.9% [IQR: 47.7]) with median 13.1% [IQR: 10.3] of them being quintuple IRN-GE mutants (i.e., parasites carrying the PfDHFR N51I-C59R-S108N and PfDHPS A437G-K540E mutations). These quintuple mutants tended to prevail in eastern regions of the country. Among circulating parasites, we did not record any parasites harboring mutations related to mefloquine-resistance, but we could suspect those with decreased susceptibility to quinine, amodiaquine, and lumefantrine based on corresponding molecular surrogates.

Conclusions: Drug resistance poses a serious threat to existing malaria therapies and chemoprevention options in the DRC. This review provides a baseline for monitoring public health efforts as well as evidence for decision-making in support of national malaria policies and for implementing regionally tailored control measures across the country.

背景:刚果民主共和国(DRC)是世界上受疟疾影响最严重的国家之一,是全球耐药疟疾的潜在中心。本研究旨在总结和绘制全国携带耐药分子标记的疟原虫的调查结果。方法:通过PubMed、Embase、Scopus、African Journal Online、African Index Medicus、Bioline和Web of Science等7个数据库检索2023年7月前的相关文献,进行系统的图谱回顾。结果:我们确定了1541项初步研究,其中29项符合纳入标准,并提供了与6385株恶性疟原虫临床分离株(收集于2000年至2020年)相关的信息。我们发现PfCRT K76T突变编码氯喹耐药,在所分析的疟原虫中位数为32.1%[四分位数间隔,IQR: 45.2]。携带这种突变的寄生虫的比例随着时间的推移而下降,但广泛的地理差异仍然存在。单个分离株编码了在非洲大湖地区出现的青蒿素耐药中所使用的PfK13 R561H替代。携带与磺胺多辛-乙胺嘧啶联合抗性相关的各种突变的寄生虫广泛存在,反映了中等抗性谱(PfDHPS A437G: 99.5% [IQR: 3.9];PfDHPS K540E: 38.9% [IQR: 47.7]),中位数为13.1% [IQR: 10.3]为五重IRN-GE突变体(即携带PfDHFR N51I-C59R-S108N和PfDHPS A437G-K540E突变的寄生虫)。这些五重突变体倾向于在该国东部地区流行。在流行的寄生虫中,我们没有记录到任何寄生虫携带与甲氟喹耐药相关的突变,但我们可以根据相应的分子替代物怀疑这些寄生虫对奎宁、阿莫地喹和氟苯曲明的敏感性降低。结论:耐药性对刚果民主共和国现有的疟疾治疗和化学预防方案构成严重威胁。这项审查为监测公共卫生工作提供了基线,并为支持国家疟疾政策和在全国实施适合区域的控制措施的决策提供了证据。
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引用次数: 0
The new wave of Congo virus in Pakistan: emerging threat. 巴基斯坦新一波刚果病毒:新出现的威胁。
IF 4.5 Q1 Medicine Pub Date : 2023-11-14 DOI: 10.1186/s41182-023-00559-z
Isra Masood, Muhammad Junaid Tahir, Ather Naeem, Oadi N Shrateh, Ali Ahmed

Congo virus, or Crimean-Congo hemorrhagic fever (CCHF), is a tick-borne disease caused by a single-stranded RNA virus (genus nairovirus, Bunyaviridae family). It spreads through infected ticks' bites or contact with viremic individuals or livestock. Factors supporting its spread include hot, humid climates, limited pesticide use, poor animal control, inadequate irrigation during monsoons, and vector control deficiencies. Nosocomial transmission in under-resourced hospitals poses a threat to healthcare workers. Decades of CCHF cases persist in Pakistan due to these factors, with six deaths reported by June 2023. To combat the epidemic, Pakistan should raise awareness, improve irrigation, establish surveillance systems, and implement livestock quarantine and vaccination.

刚果病毒或克里米亚-刚果出血热(CCHF)是一种由单链RNA病毒(纳罗病毒属,布尼亚病毒科)引起的蜱传疾病。它通过被感染的蜱虫叮咬或与病毒携带者或牲畜接触传播。支持其传播的因素包括炎热潮湿的气候、有限的农药使用、不良的动物控制、季风期间灌溉不足以及病媒控制不足。资源不足的医院的院内传播对卫生保健工作者构成威胁。由于这些因素,巴基斯坦数十年来一直存在CCHF病例,截至2023年6月报告有6人死亡。为防治疫情,巴基斯坦应提高认识,改善灌溉,建立监测系统,实施牲畜检疫和疫苗接种。
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引用次数: 0
Influence of women empowerment on childhood (12-23 months) immunization coverage: Recent evidence from 17 sub-Saharan African countries. 增强妇女权能对儿童(12-23个月)免疫覆盖率的影响:来自17个撒哈拉以南非洲国家的最新证据。
IF 4.5 Q1 Medicine Pub Date : 2023-11-14 DOI: 10.1186/s41182-023-00556-2
Abigail Amoah, Jacob Issaka, Castro Ayebeng, Joshua Okyere

Background: There is a global consensus that child immunization plays an important role in promoting the health and well-being of children. Despite the quintessential role of immunization, not all children receive full immunization coverage. We examined the association between women empowerment and childhood immunization coverage in sub-Saharan Africa (SSA).

Methods: The most recent Demographic and Health Survey data of 17 SSA countries were used for the analysis, with a sample of 19,223. The outcome and exposure variables were full immunization coverage and women empowerment, respectively. Full immunization was computed from percentage of children between the ages of 12 and 23 months who had received the following vaccines at any point in time: one dose of Bacille Calmette-Guérin, three doses of the vaccine protecting against diphtheria, pertussis, and tetanus or the tetravalent/pentavalent vaccine, three doses of the polio vaccine, and one dose of the measles vaccine (either as a standalone measles vaccine or as part of a combination with other immunogens). Women's empowerment was an index of labour participation, acceptance towards spousal violence, decision-making capacity and general knowledge level. Descriptive analysis and multilevel logistic regression were performed. Results were reported in adjusted odds ratio with a corresponding 95% confidence interval.

Results: The study found that 56.6% of children were fully immunized. Children of employed mothers were 1.16 times more likely to be fully immunized. Children of mothers with higher acceptance toward violence were less likely to be fully immunized [aOR = 0.90, CI 0.81, 0.99]. The odds of full immunization were higher among children born to mothers with high [aOR = 1.11, CI 1.01, 1.22] decision-making capacity. Higher odds of full immunization were found among children born to mothers with medium [aOR = 1.24, CI 1.13, 1.36] to high [aOR = 1.44, CI 1.27, 1.63] general knowledge level.

Conclusions: We conclude that empowering women through livelihood empowerment interventions can increase their decision-making capacity and foster their resolve to ensure the full immunization of their children. This can be achieved by consciously investing in initiatives such as vocational training programs, job placement services, or support for entrepreneurship initiatives to encourage and support women's workforce participation.

背景:全球一致认为,儿童免疫在促进儿童健康和福祉方面发挥着重要作用。尽管免疫发挥着至关重要的作用,但并非所有儿童都能获得全面免疫覆盖。我们研究了撒哈拉以南非洲(SSA)妇女赋权与儿童免疫覆盖率之间的关系。方法:使用17个SSA国家最新的人口与健康调查数据进行分析,样本为19,223人。结果和暴露变量分别是完全免疫覆盖率和妇女赋权。全面免疫是根据在任何时间点接种过下列疫苗的12至23个月儿童的百分比计算的:一剂卡介苗-谷氏疫苗、三剂白喉、百日咳和破伤风疫苗或四价/五价疫苗、三剂小儿麻痹症疫苗和一剂麻疹疫苗(作为单独的麻疹疫苗或与其他免疫原组合使用的一部分)。赋予妇女权力是劳动参与、对配偶暴力的接受程度、决策能力和一般知识水平的指标。进行描述性分析和多水平逻辑回归。结果以校正后的优势比和相应的95%置信区间进行报道。结果:研究发现56.6%的儿童完全免疫。有工作的母亲的孩子获得充分免疫的可能性是前者的1.16倍。母亲对暴力的接受程度越高,其子女接受完全免疫的可能性越小[aOR = 0.90, CI 0.81, 0.99]。决策能力高[aOR = 1.11, CI 1.01, 1.22]的母亲所生的儿童获得全面免疫的几率更高。一般知识水平中[aOR = 1.24, CI 1.13, 1.36]至高[aOR = 1.44, CI 1.27, 1.63]的母亲所生儿童获得全面免疫的几率较高。结论:我们的结论是,通过生计赋权干预措施赋予妇女权力,可以提高她们的决策能力,并增强她们确保子女全面免疫的决心。这可以通过有意识地投资于诸如职业培训计划、就业安置服务或支持创业倡议等举措来实现,以鼓励和支持妇女参与劳动力。
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Tropical Medicine and Health
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