Objectives: Nipah and Hendra are deadly zoonotic diseases with pandemic potential. To date, no human vaccine or monoclonal antibody (mAb) has been licensed to prevent disease caused by these pathogens. The aim of this scoping review was to identify and describe all Phase I, II, and III clinical trials of vaccine candidates or mAbs candidates designed to prevent Nipah and Hendra in humans and to compare the characteristics of the vaccine candidates to characteristics outlined in the Target Product Profile drafted by the World Health Organisation as part of the WHO Research & Development Blueprint for Action to Prevent Epidemics.
Methods: We searched 23 clinical trial registries, the Cochrane Central Register of Clinical Trials, and grey literature up to June 2023 to identify vaccine and mAb candidates being evaluated in registered clinical trials. Vaccine candidate and trial characteristics were double-extracted for evaluation and the vaccine candidate characteristics were compared with the preferred and critical criteria of the World Health Organisation's Target Product Profile for Nipah virus vaccine.
Results: Three vaccine candidates (Hendra Virus Soluble Glycoprotein Vaccine [HeV-sG-V], PHV02, and mRNA-1215) and one mAb (m102.4) had a registered human clinical trial by June 2023. All trials were phase 1, dose-ranging trials taking place in the United States of America or Australia and enrolling healthy adults. Although all vaccine candidates meet the dose regimen and route of administration criteria of the Target Product Profile, other criteria such as measures of efficacy and reactogenicity will need to be evaluated in the future as evidence becomes available.
Conclusion: Multiple vaccine candidates and one mAb candidate have reached the stage of human clinical trials and are reviewed here. Monitoring progress during evaluation of these candidates and candidates entering clinical trials in the future can help highlight many of the challenges that remain.
目标:尼帕(Nipah)和亨德拉(Hendra)是致命的人畜共患病,具有大流行的潜力。迄今为止,还没有任何人类疫苗或单克隆抗体 (mAb) 获准用于预防由这些病原体引起的疾病。此次范围界定审查的目的是确定并描述所有旨在预防人类尼帕病和亨德拉病的候选疫苗或 mAb 的 I、II 和 III 期临床试验,并将候选疫苗的特征与世界卫生组织起草的目标产品简介中概述的特征进行比较,该目标产品简介是世界卫生组织预防流行病研发行动蓝图的一部分:我们检索了 23 个临床试验登记处、Cochrane 临床试验中央登记处以及截至 2023 年 6 月的灰色文献,以确定在已登记的临床试验中接受评估的候选疫苗和 mAb。对候选疫苗和试验特征进行双重提取评估,并将候选疫苗特征与世界卫生组织尼帕病毒疫苗目标产品简介中的首选标准和关键标准进行比较:结果:到2023年6月,三种候选疫苗(亨德拉病毒可溶性糖蛋白疫苗[HeV-sG-V]、PHV02和mRNA-1215)和一种mAb(m102.4)已注册人类临床试验。所有试验都是在美国或澳大利亚进行的第一阶段剂量范围试验,并招募了健康成年人。尽管所有候选疫苗都符合《目标产品简介》中的剂量方案和给药途径标准,但其他标准,如疗效和致反应性的衡量标准,还需要在未来获得证据后进行评估:多种候选疫苗和一种候选 mAb 已进入人体临床试验阶段,本文将对其进行回顾。在对这些候选疫苗和未来进入临床试验的候选疫苗进行评估的过程中,对进展情况进行监测有助于突出仍然存在的许多挑战。
{"title":"Current progress towards prevention of Nipah and Hendra disease in humans: A scoping review of vaccine and monoclonal antibody candidates being evaluated in clinical trials.","authors":"Valerie Rodrigue, Katie Gravagna, Jacqueline Yao, Vaidehi Nafade, Nicole E Basta","doi":"10.1111/tmi.13979","DOIUrl":"10.1111/tmi.13979","url":null,"abstract":"<p><strong>Objectives: </strong>Nipah and Hendra are deadly zoonotic diseases with pandemic potential. To date, no human vaccine or monoclonal antibody (mAb) has been licensed to prevent disease caused by these pathogens. The aim of this scoping review was to identify and describe all Phase I, II, and III clinical trials of vaccine candidates or mAbs candidates designed to prevent Nipah and Hendra in humans and to compare the characteristics of the vaccine candidates to characteristics outlined in the Target Product Profile drafted by the World Health Organisation as part of the WHO Research & Development Blueprint for Action to Prevent Epidemics.</p><p><strong>Methods: </strong>We searched 23 clinical trial registries, the Cochrane Central Register of Clinical Trials, and grey literature up to June 2023 to identify vaccine and mAb candidates being evaluated in registered clinical trials. Vaccine candidate and trial characteristics were double-extracted for evaluation and the vaccine candidate characteristics were compared with the preferred and critical criteria of the World Health Organisation's Target Product Profile for Nipah virus vaccine.</p><p><strong>Results: </strong>Three vaccine candidates (Hendra Virus Soluble Glycoprotein Vaccine [HeV-sG-V], PHV02, and mRNA-1215) and one mAb (m102.4) had a registered human clinical trial by June 2023. All trials were phase 1, dose-ranging trials taking place in the United States of America or Australia and enrolling healthy adults. Although all vaccine candidates meet the dose regimen and route of administration criteria of the Target Product Profile, other criteria such as measures of efficacy and reactogenicity will need to be evaluated in the future as evidence becomes available.</p><p><strong>Conclusion: </strong>Multiple vaccine candidates and one mAb candidate have reached the stage of human clinical trials and are reviewed here. Monitoring progress during evaluation of these candidates and candidates entering clinical trials in the future can help highlight many of the challenges that remain.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"354-364"},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-03-13DOI: 10.1111/tmi.13980
Ganga S Moorthy, Matthew P Rubach, Michael J Maze, Regina P Refuerzo, Gabriel M Shirima, AbdulHamid S Lukambagire, Rebecca F Bodenham, Shama Cash-Goldwasser, Kate M Thomas, Philoteus Sakasaka, Nestory Mkenda, Thomas R Bowhay, Jamie L Perniciaro, William L Nicholson, Gilbert J Kersh, Rudovick R Kazwala, Blandina T Mmbaga, Joram J Buza, Venance P Maro, Daniel T Haydon, John A Crump, Jo E B Halliday
Background: In northern Tanzania, Q fever, spotted fever group (SFG) rickettsioses, and typhus group (TG) rickettsioses are common causes of febrile illness. We sought to describe the prevalence and risk factors for these zoonoses in a pastoralist community.
Methods: Febrile patients ≥2 years old presenting to Endulen Hospital in the Ngorongoro Conservation Area were enrolled from August 2016 through October 2017. Acute and convalescent blood samples were collected, and a questionnaire was administered. Sera were tested by immunofluorescent antibody (IFA) IgG assays using Coxiella burnetii (Phase II), Rickettsia africae, and Rickettsia typhi antigens. Serologic evidence of exposure was defined by an IFA titre ≥1:64; probable cases by an acute IFA titre ≥1:128; and confirmed cases by a ≥4-fold rise in titre between samples. Risk factors for exposure and acute case status were evaluated.
Results: Of 228 participants, 99 (43.4%) were male and the median (interquartile range) age was 27 (16-41) years. Among these, 117 (51.3%) had C. burnetii exposure, 74 (32.5%) had probable Q fever, 176 (77.2%) had SFG Rickettsia exposure, 134 (58.8%) had probable SFG rickettsioses, 11 (4.8%) had TG Rickettsia exposure, and 4 (1.8%) had probable TG rickettsioses. Of 146 participants with paired sera, 1 (0.5%) had confirmed Q fever, 8 (5.5%) had confirmed SFG rickettsioses, and none had confirmed TG rickettsioses. Livestock slaughter was associated with acute Q fever (adjusted odds ratio [OR] 2.54, 95% confidence interval [CI] 1.38-4.76) and sheep slaughter with SFG rickettsioses case (OR 4.63, 95% CI 1.08-23.50).
Discussion: Acute Q fever and SFG rickettsioses were detected in participants with febrile illness. Exposures to C. burnetii and to SFG Rickettsia were highly prevalent, and interactions with livestock were associated with increased odds of illness with both pathogens. Further characterisation of the burden and risks for these diseases is warranted.
{"title":"Prevalence and risk factors for Q fever, spotted fever group rickettsioses, and typhus group rickettsioses in a pastoralist community of northern Tanzania, 2016-2017.","authors":"Ganga S Moorthy, Matthew P Rubach, Michael J Maze, Regina P Refuerzo, Gabriel M Shirima, AbdulHamid S Lukambagire, Rebecca F Bodenham, Shama Cash-Goldwasser, Kate M Thomas, Philoteus Sakasaka, Nestory Mkenda, Thomas R Bowhay, Jamie L Perniciaro, William L Nicholson, Gilbert J Kersh, Rudovick R Kazwala, Blandina T Mmbaga, Joram J Buza, Venance P Maro, Daniel T Haydon, John A Crump, Jo E B Halliday","doi":"10.1111/tmi.13980","DOIUrl":"10.1111/tmi.13980","url":null,"abstract":"<p><strong>Background: </strong>In northern Tanzania, Q fever, spotted fever group (SFG) rickettsioses, and typhus group (TG) rickettsioses are common causes of febrile illness. We sought to describe the prevalence and risk factors for these zoonoses in a pastoralist community.</p><p><strong>Methods: </strong>Febrile patients ≥2 years old presenting to Endulen Hospital in the Ngorongoro Conservation Area were enrolled from August 2016 through October 2017. Acute and convalescent blood samples were collected, and a questionnaire was administered. Sera were tested by immunofluorescent antibody (IFA) IgG assays using Coxiella burnetii (Phase II), Rickettsia africae, and Rickettsia typhi antigens. Serologic evidence of exposure was defined by an IFA titre ≥1:64; probable cases by an acute IFA titre ≥1:128; and confirmed cases by a ≥4-fold rise in titre between samples. Risk factors for exposure and acute case status were evaluated.</p><p><strong>Results: </strong>Of 228 participants, 99 (43.4%) were male and the median (interquartile range) age was 27 (16-41) years. Among these, 117 (51.3%) had C. burnetii exposure, 74 (32.5%) had probable Q fever, 176 (77.2%) had SFG Rickettsia exposure, 134 (58.8%) had probable SFG rickettsioses, 11 (4.8%) had TG Rickettsia exposure, and 4 (1.8%) had probable TG rickettsioses. Of 146 participants with paired sera, 1 (0.5%) had confirmed Q fever, 8 (5.5%) had confirmed SFG rickettsioses, and none had confirmed TG rickettsioses. Livestock slaughter was associated with acute Q fever (adjusted odds ratio [OR] 2.54, 95% confidence interval [CI] 1.38-4.76) and sheep slaughter with SFG rickettsioses case (OR 4.63, 95% CI 1.08-23.50).</p><p><strong>Discussion: </strong>Acute Q fever and SFG rickettsioses were detected in participants with febrile illness. Exposures to C. burnetii and to SFG Rickettsia were highly prevalent, and interactions with livestock were associated with increased odds of illness with both pathogens. Further characterisation of the burden and risks for these diseases is warranted.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"365-376"},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-03-12DOI: 10.1111/tmi.13987
Ai Ling Oh, Mohd Makmor-Bakry, Farida Islahudin, Chuo Yew Ting, Swee Kim Chan, Siew Teck Tie
Objectives: Treatment interruption is associated with poor tuberculosis (TB) treatment outcomes and increased drug resistance. To address the issue, we aimed to investigate the characteristics, predictors and consequences of treatment interruption.
Methods: We conducted a retrospective cohort study by retrieving 4 years (2018-2021) of TB patients' records at 10 public health clinics in Sarawak, Malaysia. Adult patients (≥18 years) with drug-susceptible TB were selected. Treatment interruption was defined as ≥2 weeks of cumulative interruption during treatment. The Chi-square test, Mann-Whitney U test, Kaplan-Meier and Cox proportional hazards regression were used to analyse the data, with p < 0.05 being considered statistically significant.
Results: Out of 2953 eligible patients, 475 (16.1%) experienced TB treatment interruption. Interruptions were most frequent during the intensive phase (46.9%, n = 223), with the greatest risk within the first 4 weeks of treatment. The median time to interruption was 2 weeks in the intensive phase and the cumulative interruption probability at the end of the intensive phase was 12.9%. Notably, treatment interruption occurred during both intensive and continuation phases for 144 patients (30.3%), while the remaining 108 (22.7%) experienced interruptions only during the continuation phase with a median time to interruption of 16 weeks. Three predictors were identified to increase the risk of treatment interruption: adverse drug reaction (aHR = 8.53, 95% Cl: 6.73-10.82), smoking (aHR = 2.67, 95% Cl: 2.03-3.53) and illicit drug use (aHR = 1.88, 95% Cl: 1.03-3.45). Conversely, underlying diabetes was associated with a reduced likelihood of treatment interruption (aHR = 0.72, 95% Cl: 0.58-0.90). Treatment interruption led to significant differences in treatment restarts (62.3% vs. 0.7%), changes in medications (47.8% vs. 4.9%), prolonged treatment duration (247 days [IQR = 105] vs. 194 days [IQR = 44.3]) and lower successful outcomes (86.5% vs. 99.9%).
Conclusion: Understanding the temporal characteristics, predictors and negative consequences of treatment interruption can guide the development of time-relevant approaches to mitigate the problem.
{"title":"Characteristics, predictors and consequences of tuberculosis treatment interruption: A multicentre retrospective cohort study.","authors":"Ai Ling Oh, Mohd Makmor-Bakry, Farida Islahudin, Chuo Yew Ting, Swee Kim Chan, Siew Teck Tie","doi":"10.1111/tmi.13987","DOIUrl":"10.1111/tmi.13987","url":null,"abstract":"<p><strong>Objectives: </strong>Treatment interruption is associated with poor tuberculosis (TB) treatment outcomes and increased drug resistance. To address the issue, we aimed to investigate the characteristics, predictors and consequences of treatment interruption.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study by retrieving 4 years (2018-2021) of TB patients' records at 10 public health clinics in Sarawak, Malaysia. Adult patients (≥18 years) with drug-susceptible TB were selected. Treatment interruption was defined as ≥2 weeks of cumulative interruption during treatment. The Chi-square test, Mann-Whitney U test, Kaplan-Meier and Cox proportional hazards regression were used to analyse the data, with p < 0.05 being considered statistically significant.</p><p><strong>Results: </strong>Out of 2953 eligible patients, 475 (16.1%) experienced TB treatment interruption. Interruptions were most frequent during the intensive phase (46.9%, n = 223), with the greatest risk within the first 4 weeks of treatment. The median time to interruption was 2 weeks in the intensive phase and the cumulative interruption probability at the end of the intensive phase was 12.9%. Notably, treatment interruption occurred during both intensive and continuation phases for 144 patients (30.3%), while the remaining 108 (22.7%) experienced interruptions only during the continuation phase with a median time to interruption of 16 weeks. Three predictors were identified to increase the risk of treatment interruption: adverse drug reaction (aHR = 8.53, 95% Cl: 6.73-10.82), smoking (aHR = 2.67, 95% Cl: 2.03-3.53) and illicit drug use (aHR = 1.88, 95% Cl: 1.03-3.45). Conversely, underlying diabetes was associated with a reduced likelihood of treatment interruption (aHR = 0.72, 95% Cl: 0.58-0.90). Treatment interruption led to significant differences in treatment restarts (62.3% vs. 0.7%), changes in medications (47.8% vs. 4.9%), prolonged treatment duration (247 days [IQR = 105] vs. 194 days [IQR = 44.3]) and lower successful outcomes (86.5% vs. 99.9%).</p><p><strong>Conclusion: </strong>Understanding the temporal characteristics, predictors and negative consequences of treatment interruption can guide the development of time-relevant approaches to mitigate the problem.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"434-445"},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-03-13DOI: 10.1111/tmi.13982
Pedro Arcos González, Julián Cabria Fernández, Rick Kye Gan, Ángel Fernández Camporro, José Antonio Cernuda Martínez
Aim: This study aimed to investigate the impact of communicable diseases with epidemic potential in complex emergency (CE) situations, focusing on the epidemiological profile of incidence and mortality and exploring underlying factors contributing to increased epidemic risks.
Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines, we conducted a scoping review of articles published between 1990 and 2022. The search included terms related to complex emergencies, communicable diseases, outbreaks, and epidemics. We identified 92 epidemics related to CE occurring in 32 different countries.
Results: Communicable diseases like Shigellosis, Cholera, Measles, Meningococcal meningitis, Yellow Fever, and Malaria caused significant morbidity and mortality. Diarrhoeal diseases, particularly Cholera and Shigellosis, had the highest incidence rates. Shigella specifically had an incidence of 241.0 per 1000 (people at risk), with a mortality rate of 11.7 per 1000, while Cholera's incidence was 13.0 per 1000, with a mortality rate of 0.22 per 1000. Measles followed, with an incidence of 25.0 per 1000 and a mortality rate of 0.76 per 1000. Meningococcal Meningitis had an incidence rate of 1.3 per 1000 and a mortality rate of 0.13 per 1000. Despite their lower incidences, yellow fever at 0.8 per 1000 and malaria at 0.4 per 1000, their high case fatality rates of 20.1% and 0.4% remained concerning in CE. The qualitative synthesis reveals that factors such as water, sanitation, and hygiene, shelter and settlements, food and nutrition, and public health and healthcare in complex emergencies affect the risk of epidemics.
Conclusion: Epidemics during complex emergencies could potentially lead to a public health crisis. Between 1990 and 2022, there have been no statistically significant changes in the trend of incidence, mortality, or fatality rates of epidemic diseases in CE. It is crucial to understand that all epidemics identified in CE are fundamentally preventable.
{"title":"The epidemiological profile of incidence and mortality from epidemics in complex humanitarian emergencies from 1990 to 2022 - A scoping review.","authors":"Pedro Arcos González, Julián Cabria Fernández, Rick Kye Gan, Ángel Fernández Camporro, José Antonio Cernuda Martínez","doi":"10.1111/tmi.13982","DOIUrl":"10.1111/tmi.13982","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate the impact of communicable diseases with epidemic potential in complex emergency (CE) situations, focusing on the epidemiological profile of incidence and mortality and exploring underlying factors contributing to increased epidemic risks.</p><p><strong>Methods: </strong>Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines, we conducted a scoping review of articles published between 1990 and 2022. The search included terms related to complex emergencies, communicable diseases, outbreaks, and epidemics. We identified 92 epidemics related to CE occurring in 32 different countries.</p><p><strong>Results: </strong>Communicable diseases like Shigellosis, Cholera, Measles, Meningococcal meningitis, Yellow Fever, and Malaria caused significant morbidity and mortality. Diarrhoeal diseases, particularly Cholera and Shigellosis, had the highest incidence rates. Shigella specifically had an incidence of 241.0 per 1000 (people at risk), with a mortality rate of 11.7 per 1000, while Cholera's incidence was 13.0 per 1000, with a mortality rate of 0.22 per 1000. Measles followed, with an incidence of 25.0 per 1000 and a mortality rate of 0.76 per 1000. Meningococcal Meningitis had an incidence rate of 1.3 per 1000 and a mortality rate of 0.13 per 1000. Despite their lower incidences, yellow fever at 0.8 per 1000 and malaria at 0.4 per 1000, their high case fatality rates of 20.1% and 0.4% remained concerning in CE. The qualitative synthesis reveals that factors such as water, sanitation, and hygiene, shelter and settlements, food and nutrition, and public health and healthcare in complex emergencies affect the risk of epidemics.</p><p><strong>Conclusion: </strong>Epidemics during complex emergencies could potentially lead to a public health crisis. Between 1990 and 2022, there have been no statistically significant changes in the trend of incidence, mortality, or fatality rates of epidemic diseases in CE. It is crucial to understand that all epidemics identified in CE are fundamentally preventable.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"343-353"},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cholangiocarcinoma (CCA) caused by Opisthorchis viverrini is a well-known and significant public health issue in northeastern Thailand; however, a link between pesticide exposure (PE) and CCA risk has not yet been established. Therefore, our research objective was to investigate the relationship between PE and CCA risk.
Methods: A hospital-based matched case-control study was carried out. All cases (in-patients) and controls (out-patients) were volunteers at a tertiary hospital in northeast Thailand. Between 2015 and 2019, 178 incident cases of pathologically-confirmed CCA and 356 controls were selected from the check-up clinic from the Srinagarind Hospital outpatient database (two controls per case). The recruited controls were individually-matched to the CCA cases based on sex, age (±5 years) and admission date (±3 months). During face-to-face interviews, a standardised pre-tested questionnaire was used to collect data. Multivariable conditional logistic regression was used to analyse the data.
Results: The respective frequency of PE between the 178 CCA cases and 356 controls was 77.0% versus 87.6% for never used, 14.6% versus 5.3% for have used but stopped and 8.4% versus 7.0% for currently using. After adjusting for the highest educational attainment, smoking behaviour, alcohol use and family history of cancer, PE was not significantly associated with CCA (p-value = 0.086). Using volunteers who have never used PE as the reference group, the respective odds of developing CCA for those who have ever used but have since stopped and are currently using was 2.04 (adjusted OR = 2.04; 95% CI: 1.03-4.04) versus 0.83 (adjusted OR = 0.83; 95% CI: 0.39-1.76) times more likely to develop CCA than those who had never used PE.
Conclusion: There is no association between PE and the risk of CCA. Notwithstanding the finding, future research should focus on enhancing PE assessment methods that consider complex chemical mixtures, chemicals of interest, historical exposure and exposure pathways. Moreover, there is need for more extensive and longer population-based cohort studies that include younger, non-occupationally exposed individuals during periods of developmental susceptibility.
背景:在泰国东北部,由Opisthorchis viverrini引起的胆管癌(CCA)是一个众所周知的重大公共卫生问题;然而,农药暴露(PE)与CCA风险之间的关系尚未确定。因此,我们的研究目标是调查 PE 与 CCA 风险之间的关系:方法:我们开展了一项基于医院的匹配病例对照研究。所有病例(住院患者)和对照组(门诊患者)均为泰国东北部一家三甲医院的志愿者。2015 年至 2019 年期间,从斯利那加林德医院门诊病人数据库的检查门诊中选取了 178 例经病理证实的 CCA 病例和 356 例对照(每个病例有两名对照)。根据性别、年龄(±5 岁)和入院日期(±3 个月),所招募的对照组与 CCA 病例单独匹配。在面对面的访谈中,采用预先测试的标准化问卷收集数据。采用多变量条件逻辑回归分析数据:178例CCA病例和356例对照组之间的PE频率分别为:从未使用过的77.0%对87.6%,使用过但已停止的14.6%对5.3%,正在使用的8.4%对7.0%。在对最高教育程度、吸烟行为、饮酒和癌症家族史进行调整后,PE 与 CCA 的关系并不明显(p 值 = 0.086)。以从未使用过 PE 的志愿者为参照组,曾经使用过 PE 但后来停止使用且目前正在使用 PE 的志愿者患 CCA 的几率分别是从未使用过 PE 的志愿者的 2.04 倍(调整后 OR = 2.04;95% CI:1.03-4.04)和 0.83 倍(调整后 OR = 0.83;95% CI:0.39-1.76):结论:PE 与罹患 CCA 的风险之间没有关联。尽管有上述发现,但今后的研究应侧重于改进 PE 评估方法,以考虑复杂的化学混合物、相关化学品、历史接触和接触途径。此外,还需要开展更广泛、更长期的人群队列研究,将发育易感期的非职业接触者纳入研究范围。
{"title":"Pesticide exposure and risk of cholangiocarcinoma: A hospital-based matched case-control study.","authors":"Ake Pugkhem, Supot Kamsa-Ard, Siriporn Kamsa-Ard, Vor Luvira, Varisara Luvira, Vajarabhongsa Bhudhisawasdi","doi":"10.1111/tmi.13983","DOIUrl":"10.1111/tmi.13983","url":null,"abstract":"<p><strong>Background: </strong>Cholangiocarcinoma (CCA) caused by Opisthorchis viverrini is a well-known and significant public health issue in northeastern Thailand; however, a link between pesticide exposure (PE) and CCA risk has not yet been established. Therefore, our research objective was to investigate the relationship between PE and CCA risk.</p><p><strong>Methods: </strong>A hospital-based matched case-control study was carried out. All cases (in-patients) and controls (out-patients) were volunteers at a tertiary hospital in northeast Thailand. Between 2015 and 2019, 178 incident cases of pathologically-confirmed CCA and 356 controls were selected from the check-up clinic from the Srinagarind Hospital outpatient database (two controls per case). The recruited controls were individually-matched to the CCA cases based on sex, age (±5 years) and admission date (±3 months). During face-to-face interviews, a standardised pre-tested questionnaire was used to collect data. Multivariable conditional logistic regression was used to analyse the data.</p><p><strong>Results: </strong>The respective frequency of PE between the 178 CCA cases and 356 controls was 77.0% versus 87.6% for never used, 14.6% versus 5.3% for have used but stopped and 8.4% versus 7.0% for currently using. After adjusting for the highest educational attainment, smoking behaviour, alcohol use and family history of cancer, PE was not significantly associated with CCA (p-value = 0.086). Using volunteers who have never used PE as the reference group, the respective odds of developing CCA for those who have ever used but have since stopped and are currently using was 2.04 (adjusted OR = 2.04; 95% CI: 1.03-4.04) versus 0.83 (adjusted OR = 0.83; 95% CI: 0.39-1.76) times more likely to develop CCA than those who had never used PE.</p><p><strong>Conclusion: </strong>There is no association between PE and the risk of CCA. Notwithstanding the finding, future research should focus on enhancing PE assessment methods that consider complex chemical mixtures, chemicals of interest, historical exposure and exposure pathways. Moreover, there is need for more extensive and longer population-based cohort studies that include younger, non-occupationally exposed individuals during periods of developmental susceptibility.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"390-404"},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amit Aryal, Emma Clarke‐Deelder, Souksanh Phommalangsy, Sengchanh Kounnavong, Günther Fink
BackgroundDespite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID‐19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR.MethodsWe utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty.ResultsPoverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26–0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37–0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34–0.72) and afford care (aOR 0.50, 95% CI 0.34–0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35–3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings.ConclusionsThe results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.
背景尽管老挝人民民主共和国(PDR)的经济在过去 20 年中取得了大幅增长,但收入不平等和贫困的程度仍然很高,而且 COVID-19 大流行很可能加剧了这种状况。在这篇文章中,我们利用新的调查数据来评估社会经济地位在多大程度上与在老挝获得优质医疗服务相关。调查于 2022 年 5 月至 8 月间进行。调查的主要结果包括:是否拥有通常的医疗保健来源、是否将政府卫生中心(而非医院或私人诊所)作为通常的医疗保健来源、是否接受过预防性保健服务、是否有未得到满足的医疗保健需求、最近医疗保健就诊的质量以及是否有信心在需要时获得并负担得起医疗保健服务。贫困程度用家庭资产所有权来衡量。我们使用 logit 模型来评估贫困与医疗系统绩效指标之间的关联,并通过城市居住地与贫困的交互作用来评估这些关联在城市与农村地区之间的差异。结果贫困与以下因素呈负相关:有固定的医疗服务提供者(调整后的几率比(aOR)为 0.45,95% CI 为 0.26-0.78)、接受预防性医疗服务(aOR 为 0.54,95% CI 为 0.37-0.80)、对接受医疗服务的能力(aOR 为 0.50,95% CI 为 0.34-0.72)以及在需要时负担得起医疗服务(aOR 为 0.50,95% CI 为 0.34-0.73)的信心。贫困与将政府管理的医疗中心作为通常的医疗来源或医疗服务呈正相关(aOR 2.16,95% CI 1.35-3.48)。贫困与用户最近一次到医疗机构就诊的体验或感知到的医疗质量没有明显关联。在农村和城市环境中,贫困与获得优质医疗服务之间的关系没有发现差异。 结论本文介绍的结果表明,尽管老挝为普及医疗服务做出了重大努力,但在获得医疗服务方面仍存在社会经济差异。全民医疗保健政策可能并未惠及贫困人口,因此可能需要采取更多有针对性的措施来满足他们的医疗保健需求。
{"title":"Health system inequities in Lao People's Democratic Republic: Evidence from a nationally representative phone survey","authors":"Amit Aryal, Emma Clarke‐Deelder, Souksanh Phommalangsy, Sengchanh Kounnavong, Günther Fink","doi":"10.1111/tmi.13997","DOIUrl":"https://doi.org/10.1111/tmi.13997","url":null,"abstract":"BackgroundDespite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID‐19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR.MethodsWe utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty.ResultsPoverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26–0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37–0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34–0.72) and afford care (aOR 0.50, 95% CI 0.34–0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35–3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings.ConclusionsThe results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":"61 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to Abstracts of the 13th European Congress on Tropical Medicine and International Health (ECTMIH 2023), Shaping the future of equitable and sustainable planetary health, 20–23 November 2023, UtrechtStatic Poster Abstracts","authors":"","doi":"10.1111/tmi.13999","DOIUrl":"https://doi.org/10.1111/tmi.13999","url":null,"abstract":"","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":"72 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140810340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marília Antônia Oliveira da Trindade, Álvaro Luan Santana Fonseca, Isabelle Helena Lima Dias, Sergei Rodrigo Magalhães de Sousa, Martin Johannes Enk, Karla Valéria Batista Lima, Ricardo Jose de Paula Souza e Guimarães
ObjectivesThis study evaluated the occurrence of Schistosoma mansoni and soil‐transmitted helminths in an endemic area in the Eastern Brazilian Amazon, analysing prevalence and spatial distribution.MethodsThe study was conducted in four localities of Primavera Municipality, in Pará state. Data was obtained from the Decit 40/2012 project and the participants were divided into five age range categories for evaluation: children, adolescents, young adults, adults and elderly individuals. For the diagnostic tests, Kato–Katz slides were prepared to detect S. mansoni and soil‐transmitted helminths eggs. The spatial distribution map and the Kernel Density Estimation were performed to assess the presence and location of infections.ResultsStool samples revealed the presence of hookworms, S. mansoni, Ascaris lumbricoides and Trichuris trichiura eggs. Mono‐, bi‐ and poly‐parasitic infections were observed, with a significant prevalence of hookworm monoparasitism.ConclusionsThe high frequency of children infected with soil‐transmitted helminths confirms their significance as an ongoing public health problem in the poorest municipalities of Brazil. The Geographic Information System plays a crucial role in environmental surveillance and in the control of epidemics and endemic diseases, enabling accurate assessment and informed decision‐making for their control.
{"title":"Geospatial analysis and prevalence of Schistosoma mansoni and soil‐transmitted helminth infections in an endemic area in Eastern Brazilian Amazon","authors":"Marília Antônia Oliveira da Trindade, Álvaro Luan Santana Fonseca, Isabelle Helena Lima Dias, Sergei Rodrigo Magalhães de Sousa, Martin Johannes Enk, Karla Valéria Batista Lima, Ricardo Jose de Paula Souza e Guimarães","doi":"10.1111/tmi.13993","DOIUrl":"https://doi.org/10.1111/tmi.13993","url":null,"abstract":"ObjectivesThis study evaluated the occurrence of <jats:italic>Schistosoma mansoni</jats:italic> and soil‐transmitted helminths in an endemic area in the Eastern Brazilian Amazon, analysing prevalence and spatial distribution.MethodsThe study was conducted in four localities of Primavera Municipality, in Pará state. Data was obtained from the Decit 40/2012 project and the participants were divided into five age range categories for evaluation: children, adolescents, young adults, adults and elderly individuals. For the diagnostic tests, Kato–Katz slides were prepared to detect <jats:italic>S. mansoni</jats:italic> and soil‐transmitted helminths eggs. The spatial distribution map and the Kernel Density Estimation were performed to assess the presence and location of infections.ResultsStool samples revealed the presence of hookworms, <jats:italic>S. mansoni</jats:italic>, <jats:italic>Ascaris lumbricoides</jats:italic> and <jats:italic>Trichuris trichiura</jats:italic> eggs. Mono‐, bi‐ and poly‐parasitic infections were observed, with a significant prevalence of hookworm monoparasitism.ConclusionsThe high frequency of children infected with soil‐transmitted helminths confirms their significance as an ongoing public health problem in the poorest municipalities of Brazil. The Geographic Information System plays a crucial role in environmental surveillance and in the control of epidemics and endemic diseases, enabling accurate assessment and informed decision‐making for their control.","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140799110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Nascimento Silva, Glaucia Cota, Kathiaja Miranda Souza, Marina Gonçalves de Freitas, Janaína de Pina Carvalho, Endi Lanza Galvão
BackgroundAntibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease.MethodsThe study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta‐analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool.ResultsAmong 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high‐risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post‐treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as ‘very low,’ emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups.ConclusionsPEP is an alternative practice reported in the literature, used in accidents with high‐risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.
{"title":"Efficacy of antibiotic prophylaxis to preventing brucellosis in accidental exposure: A systematic review","authors":"Sarah Nascimento Silva, Glaucia Cota, Kathiaja Miranda Souza, Marina Gonçalves de Freitas, Janaína de Pina Carvalho, Endi Lanza Galvão","doi":"10.1111/tmi.13992","DOIUrl":"https://doi.org/10.1111/tmi.13992","url":null,"abstract":"BackgroundAntibiotic prophylaxis to prevent brucellosis after accidental exposure to <jats:italic>Brucella</jats:italic> is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to <jats:italic>Brucella</jats:italic> in preventing human brucellosis disease.MethodsThe study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta‐analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool.ResultsAmong 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high‐risk accidental exposure to <jats:italic>Brucella</jats:italic> in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post‐treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as ‘very low,’ emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups.ConclusionsPEP is an alternative practice reported in the literature, used in accidents with high‐risk exposure to <jats:italic>Brucella</jats:italic>. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":"8 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140799124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Özge Çaydaşı, Eyüp Arslan, Esra Adıyeke, Taha Yusuf Kuzan, Fatma Yılmaz Karadağ, Derya Öztürk Engin
Crimean-Congo haemorrhagic fever (CCHF) is a zoonotic viral infection which is an important public health problem in Turkey. CCHF causes fever and bleeding and can lead to severe health outcomes. The study aims to report a case of a male patient with severe CCHF, hemophagocytic lymphohistiocytosis (HLH) treated with steroids and portal vein thrombosis.
{"title":"A case of Crimean-Congo haemorrhagic fever complicated with portal vein thrombosis and hemophagocytosis","authors":"Özge Çaydaşı, Eyüp Arslan, Esra Adıyeke, Taha Yusuf Kuzan, Fatma Yılmaz Karadağ, Derya Öztürk Engin","doi":"10.1111/tmi.13995","DOIUrl":"https://doi.org/10.1111/tmi.13995","url":null,"abstract":"Crimean-Congo haemorrhagic fever (CCHF) is a zoonotic viral infection which is an important public health problem in Turkey. CCHF causes fever and bleeding and can lead to severe health outcomes. The study aims to report a case of a male patient with severe CCHF, hemophagocytic lymphohistiocytosis (HLH) treated with steroids and portal vein thrombosis.","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":"19 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140578702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}