Tropical Medicine and Infectious Disease最新文献

Hand, Foot, and Mouth Disease (HFMD) predominantly affects children under the age of five and remains a significant public health concern in the Asia-Pacific region. HFMD outbreaks are closely linked to seasonal changes and meteorological factors, particularly in tropical and subtropical areas. In Thailand, a total of 657,570 HFMD cases were reported between 2011 and 2022 (12 years). This study aimed to identify the high- and low-risk HFMD outbreak areas using machine learning models: Logistic Regression (LR), Support Vector Machine (SVM), Decision Tree (DT), Random Forests (RF), Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost). Our findings showed that the XGBoost model outperformed the other models in predicting unseen data and defining the best model. The best model can be used to detect high-risk outbreak areas and to explore the relationship between meteorological factors and HFMD outbreaks. The results highlighted the seasonal distribution of high-risk HFMD outbreak months across different provinces in Thailand, with average maximum temperature, average rainfall, and average vapor pressure identified as the most influential factors. Furthermore, the best model was used to analyze HFMD outbreaks during the COVID-19 pandemic, showing a notable reduction in high-risk outbreak months and areas, likely due to the control measures implemented during this period. Overall, our model shows great potential as a tool for warnings, providing useful insights to help public health officials reduce the impact of HFMD outbreaks.

Tabletop exercises offer a structured opportunity to assess strengths and potential gaps in preparedness and response plans in a safe learning environment. The New York City Health + Hospitals System-Wide Special Pathogens Program conducted an innovative and multidisciplinary tabletop exercise involving escalating scenarios of highly pathogenic avian influenza (HPAI) H5N1 in 2023. The goals were to assess patient screening processes for infectious diseases within healthcare facilities, infection prevention and control strategies, risk communication, and notification and involvement of public health stakeholders. Participants reflected on previous outbreak responses, discussed the importance of risk communication, and shared insights on tools and resources that would better support healthcare professionals in identifying and managing patients with HPAI/H5N1 infection. Key takeaways included establishing clear protocols for HPAI/H5N1 management, providing timely education to healthcare professionals, and assessing useful communication modalities.

Methods: The exercise included escalating scenarios involving a single case of HPAI/H5N1 advancing to community transmission. Key participants spanned clinical departments, infection prevention and control, emergency management, and local public health stakeholders. Structured discussions targeted triggers for escalation, infection prevention strategies, and communication pathways.

Results: Findings highlighted the need for tailored screening criteria, robust infection prevention protocols, clear communication strategies, and collaboration with public health authorities. Specific improvements included refining triage and isolation protocols, enhancing staff education, and leveraging syndromic surveillance systems.

Conclusion: This exercise underscored the importance of proactive planning, multidisciplinary collaboration, and integration of biosafety measures to strengthen healthcare system resilience against HPAI/H5N1.

Malaria incidence (MI) has significantly declined in Nepal, and this study aimed to investigate the spatiotemporal distribution and drivers of MI at the ward level. Data for malaria cases were obtained from the National Surveillance System from 2013 to 2021. Data for covariates, including annual mean temperature, annual mean precipitation, and distance to the nearest city, were obtained from publicly available sources. A Bayesian spatial model was used to identify factors associated with the spatial distribution of MI. Between 2013 and 2021, 7278 malaria cases were reported in Nepal, with a crude incidence rate of 3.0 cases per 100,000 person-years at risk (PYR). MI showed a seasonal variation, with the highest number of cases reported between May and September. The annual MI decreased in recent years from 1.9 per 100,000 PYR in 2018 to 0.1 per 100,000 PYR in 2021. Spatial clustering of MI was observed at the ward level, with most hotspot areas detected in the western Terai plains and upper river valley (URV) areas. Incidence was associated with annual mean precipitation in mm (β = 0.201; 95% CrI: 0.042, 0.360). The shift of the malaria hotspots to the URVs presents a challenge for implementing timely prevention and control activities.

Background: The vaccination programmes after the 2nd World War and the application of safe and effective vaccines were expected to eliminate infectious diseases within the World Health Organization (WHO) European Region. However, epidemiological indexes show isolated cases and local epidemiology outbreaks of viral measles, that draw attention to re-evaluate the effectiveness and obstacles of infectious disease eradication programmes.

Methodology: This study analyses the available Polish governmental epidemiological data concerning the WHO European Region for the years 2003-2014 and evaluates the effectiveness of the WHO Measles Eradication Programme implementation, since 2001. Most of these epidemiological data are either available in Polish or scattered in governmental reports only. Thus, we have compiled selected available data to present an overview focusing on Poland's measles epidemiological situation.

Results: The analysis of the available data clearly shows that infection cases of measles are on the rise in the European Region or are steady at a relatively high level depending on the country. The critical factors to prevent measles are maintaining a vaccination level at a minimum of 95% using two doses of MMR, adequate infection detection, rapid reporting, controlling and enforcing identification, and mass media campaigns to inform societies about the necessity of measles vaccination and the safety of using MMR.

Conclusions: Besides the current SARS-CoV-2 pandemics, measles is possibly the most dominating infectious disease on the rise in the European Region, including Poland. The eradication programme modifications to increase its effectiveness are of upmost importance, as measles is one of the most infectious diseases with acute syndromes, especially affecting children.

Neurocognitive impairment is an important cause of HIV-associated morbidity. The advent of antiretroviral therapy (ART) has shifted the spectrum of HIV-associated cognitive impairment from HIV-associated dementia to milder forms of cognitive impairment. Independent replication of HIV within the central nervous system in those on effective ART with peripheral suppression is a recognised phenomenon known as cerebrospinal fluid (CSF) HIV RNA escape. CSF HIV RNA escape is independently associated with neurocognitive impairment but has also been detected in asymptomatic persons with HIV. The current consensus for management of CSF HIV RNA escape is based on expert opinion rather than empirical evidence. The current evidence suggests having a low threshold to investigate for CSF HIV RNA escape and optimising ART based on resistance profiles. The use of central nervous system (CNS) penetration effectiveness scores is no longer recommended. The evidence for statins, SSRIs, minocycline, lithium and valproate is limited to small-scale studies. There are potential new developments in the form of nanoparticles, Janus Kinase inhibitors and latency reversal agents.

Inadequate access to timely diagnosis and linkage to treatment are major barriers to tuberculosis (TB) care. New point-of-care diagnostics that do not rely solely on sputum samples are needed to make up for lost time, bringing TB testing closer to service recipients and addressing current sputum sampling limitations. Urine-based TB lipoarabinomannan tests and tongue dorsum swabs have demonstrated potential as alternatives to sputum-based molecular testing. We conducted a study to ascertain the perceived value of these non-sputum-based TB tests among stakeholders from the TB community, including TB service recipients and healthcare providers, in India, South Africa, and Viet Nam. Our results showed that there was a high degree of enthusiasm among various end-users for both novel sample types. It is important to generate both qualitative and quantitative evidence to support optimal uptake and implementation of these potential new sample types for TB testing.

Schistosomiasis remains a major public health concern in Africa, despite global efforts to eliminate the disease by 2030. This study estimates the burden, trends, and inequalities of schistosomiasis in Africa from 1990 to 2021, and projects future prevalence to inform the WHO's elimination strategies. Data from the Global Burden of Disease Study (GBD 2021) were used to calculate annual average percentage change (AAPC) and annual percentage change (APC), with spatial global autocorrelation analysis performed to examine temporal and spatial trends. Five modeling algorithms were constructed to predict disease burden in Africa from 2022 to 2041. The age-standardized prevalences rate (ASPR) of schistosomiasis in Africa decreased from 18,495.51 per 100,000 in 1990 to 9,461.76 per 100,000 in 2021. The total number of cases, disability-adjusted life-years (DALYs), and mortality accounted for 84.25%, 87.92% and 87.28% of the global totals, respectively. ARIMA modeling predicts that by 2030, the ASPR will reach 3.99%. Despite progress, the burden remains significant, and intensified efforts are needed, particularly in high-burden regions like West Africa, to meet the WHO's 2030 elimination targets.

Introduction: Human malaria is a zoonosis considered a serious global public health problem caused by five species of protozoa of the genus Plasmodium spp., which are transmitted by mosquito vectors belonging to the genus Anopheles spp.

Objective: To verify whether there is a relationship between the age-standardized malaria mortality rate in Brazil and age-period-cohort effect variables, sociodemographic differences, and indicators of sustainable development.

Methods: Data on malaria mortality in Brazil from 2000 to 2022 were analyzed using sociodemographic factors such as ethnicity, region of residence, and sustainable development indicators.

Results: Statistical data demonstrated that from 2000 to 2022, there was a reduction in malaria mortality; the 0-4 years age group was more susceptible to death, and the infection affected more men, Indigenous people, and residents of the North Region. Environmental factors such as CO₂ emissions and sanitation predict mortality in specific regions. The North and Northeast Regions had higher mortality rates. In the North, low CO₂ emissions, deforestation, weak urban sanitation, a lower GDP, and a higher Gini index were related to high mortality; the latter was also a factor in high rates of deforestation and solid waste collection in the Central West and Northeast Regions. The number of consultations and professionals was a predictive factor for high rates in the three regions mentioned. The Southeast Region had the lowest mortality rate and lowest health expenditure, while the Northeast and Midwest Regions had the highest expenditure in this sector.

Conclusions: This study can contribute to the direction of public policy due to the specificities of each region in Brazil.

Background: Severe yellow fever (YF) can result in acute liver failure (ALF) and high mortality. The role of therapeutic plasma exchange (TPE) in managing YF-ALF remains unclear. This study evaluated the impact of TPE strategies in severe YF.

Methods: This observational case-series study evaluated three groups of patients classified according to treatment: G1 (standard intensive care support [ICS]), G2 (ICS + high-volume-TPE [HV-TPE]), and G3 (ICS + intensive TPE). HV-TPE was performed during 3 consecutive days with extra sessions of one plasma-volume, if necessary, whereas intensive TPE consisted of one plasma volume/session performed twice daily, with additional fresh frozen plasma infusion. Hemostatic agents, including tranexamic acid, platelets, and cryoprecipitate, were administered as needed. TPE was de-escalated based on clinical and laboratory parameters. The primary outcome was mortality.

Results: Sixty-six patients were included (G1: 41, G2: 11, G3: 14). Groups had similar baseline characteristics. Mortality was significantly lower in G3 (14%) compared to G2 (82%) and G1 (85%) (p < 0.001). Additionally, G3 patients showed a higher frequency of undetectable YF viral load.

Conclusions: Intensive TPE is a feasible and effective intervention for severe YF, achieving an 84% reduction in mortality. The limitations of our results are the small sample size, observational and single-center study. Further studies are warranted to elucidate intensive TPE's role in YF management.

This study aimed to assess the diagnostic utility of VIDAS^® DENGUE NS1 Ag and anti-DENV IgM and IgG assays in parallel for an early and accurate diagnosis and classification of dengue virus (DENV) infection. For this retrospective cross-sectional study, 190 patients with suspected dengue were tested using VIDAS^® NS1, IgM, and IgG assays, requested in parallel, regardless of symptom onset timing, and classified into primary and secondary infections. Results were analyzed to determine diagnostic accuracy and correlation with disease severity. Parallel testing effectively differentiated between primary and secondary DENV infection. Secondary dengue cases with warning signs showed significantly elevated IgG levels (p = 0.026). Notably, NS1-negative (possible secondary cases) had higher IgM and IgG levels than NS1-positive cases (p < 0.01), suggesting that NS1 negativity might indicate an amplified immune response. In conclusion, VIDAS^® Dengue diagnostic assays not only enhance the diagnostic accuracy of dengue infection but also offer valuable insights into serological patterns, especially in secondary cases. These assays could be used not only to confirm diagnosis but also to stratify patients by risk, particularly in cases of secondary dengue, where IgG levels might indicate a higher risk for severe outcomes.