Lancet Global Health最新文献

Strategies for more equitable engagement for African researchers. 非洲研究人员更公平参与的战略。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-14 DOI: 10.1016/S2214-109X(24)00427-3

Bamba Gaye, Ngoné Gaye, Gurbinder Singh, Naoufel Madani, Roberta Lamptey, Jamal Eddine Kohen, Abdoulaye Samb, Léon Tshilolo, Pasquale Maffia, Ibrahima Socé Fall, Modou Jobe

引用次数: 0

Effect of a community-based intervention for sexually transmitted infections on population-level prevalence among youth in Zimbabwe (STICH): a cluster-randomised trial. 以社区为基础的性传播感染干预措施对津巴布韦青年人群感染率的影响（STICH）：分组随机试验。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-14 DOI: 10.1016/S2214-109X(24)00373-5

Chido Dziva Chikwari, Ethel Dauya, Victoria Simms, Katharina Kranzer, Tsitsi Bandason, Anna Machiha, Owen Mugurungi, Primrose Musiyandaka, Tinashe Mwaturura, Nkazimulo Tshuma, Sarah Bernays, Constancia Mavodza, Mandikudza Tembo, Kevin Martin, Constance R S Mackworth-Young, Joanna Busza, Suzanna C Francis, Richard J Hayes, Rashida A Ferrand

Background: Young people are at particularly high risk of acquiring sexually transmitted infections (STIs). We conducted a trial to investigate the effect of a community-based intervention that included STI screening among youth on population-level prevalence of STIs in Zimbabwe.Methods: STICH was a parallel-arm, cluster-randomised controlled trial nested within CHIEDZA, a trial of community-based integrated HIV and sexual and reproductive health services for youth in Zimbabwe. STICH was conducted in Harare and Bulawayo provinces with eight clusters in each province, randomised 1:1 to control (existing health services) or to the intervention: community-based screening and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae (males and females) and Trichomonas vaginalis (females only) offered over 12 months to intervention cluster residents aged 16-24 years who were attending CHIEDZA. Outcomes were ascertained through a population-level survey immediately after the intervention period, which included young people aged 18-24 years who lived in randomly selected households in each of the 16 clusters. The primary outcome was population prevalence of any (one or more) of the three STIs; secondary outcomes were prevalence of each of the three STIs. The STICH trial is registered with ISRCTN registry, ISRCTN15013425, and the CHIEDZA trial is registered with ClinicalTrials.gov, NCT03719521.Findings: From Oct 6, 2021, to March 8, 2022, 6361 randomly sampled young people were recruited into the outcome survey (median age 20 years [IQR 19-22], 3500 female and 2101 male, 3066 in intervention clusters and 3295 in control clusters). 5601 participants were included in the primary outcome analysis (2756 in intervention clusters and 2845 in control clusters). In the intervention clusters, 612 (22·2%) of 2756 participants reported that they had attended CHIEDZA and 298 (10·8%) had been tested for C trachomatis and N gonorrhoeae. In the control clusters, 113 (4·0%) of 2845 participants had attended CHIEDZA and 40 (1·4%) had been tested for C trachomatis and N gonorrhoeae. In the outcome survey, the cluster-level geometric mean prevalence of the primary outcome (any of C trachomatis, N gonorrhoeae, and T vaginalis) was 19·07% (geometric standard deviation [GSD] 1·20) in the intervention arm versus 19·95% (GSD 1·10) in the control arm (risk ratio [RR] 0·93 [95% CI 0·78-1·10]; p=0·35). There was no difference between arms in geometric mean prevalence of C trachomatis (12·86% [GSD 1·14] in the intervention arm vs 12·94% [GSD 1·15] in the control arm, RR 0·97 [95% CI 0·84-1·11]; p=0·60) or T vaginalis (7·06% [GSD 1·48] vs 6·20% [1·38], RR 1·09 [95% CI 0·74-1·60]; p=0·66). N gonorrhoeae prevalence was significantly lower in the intervention arm, with a 43% risk reduction (geometric mean 1·65% [GSD 1·77] vs 2·87% [1·43], RR 0·57 [95% CI 0·34-0·96]; p=0·036).Interpretation:

背景：年轻人感染性传播疾病（STI）的风险特别高。我们在津巴布韦开展了一项试验，调查在青少年中开展包括性传播感染筛查在内的社区干预措施对性传播感染人群患病率的影响：STICH是一项平行臂、分组随机对照试验，嵌套于CHIEDZA试验中，CHIEDZA是一项针对津巴布韦青少年的社区艾滋病、性健康和生殖健康综合服务试验。STICH 在哈拉雷省和布拉瓦约省进行，每个省有 8 个群组，按 1:1 随机分配到对照组（现有医疗服务）或干预组：在 12 个月内为干预组中参加 CHIEDZA 的 16-24 岁居民提供沙眼衣原体和淋病奈瑟菌（男性和女性）以及阴道毛滴虫（仅女性）的社区筛查和治疗。干预期结束后立即进行的人口调查确定了干预结果，调查对象包括居住在 16 个群组中每个群组随机抽取的家庭中的 18-24 岁青少年。主要结果是三种性传播感染中任何一种（一种或多种）的人群感染率；次要结果是三种性传播感染中每一种的感染率。STICH试验已在ISRCTN注册机构ISRCTN15013425注册，CHIEDZA试验已在ClinicalTrials.gov注册机构NCT03719521注册：从2021年10月6日至2022年3月8日，共招募了6361名随机抽样的年轻人参与结果调查（中位年龄20岁[IQR 19-22]，女性3500人，男性2101人，干预群组3066人，对照群组3295人）。5601 名参与者被纳入主要结果分析（干预组 2756 人，对照组 2845 人）。在干预群组中，2756 名参与者中有 612 人（22-2%）表示参加过 CHIEDZA，298 人（10-8%）接受过沙眼衣原体和淋球菌检测。在对照组群中，2845 名参与者中有 113 人（4-0%）参加过 CHIEDZA，40 人（1-4%）接受过沙眼衣原体和淋球菌检测。在结果调查中，干预组主要结果（沙眼衣原体、淋球菌和阴道球菌中的任何一种）的群组级几何平均流行率为 19-07%（几何标准差 [GSD] 1-20），而对照组为 19-95%（几何标准差 1-10）（风险比 [RR] 0-93 [95% CI 0-78-1-10]；P=0-35）。干预组和对照组的沙眼衣原体几何平均感染率（干预组为 12-86% [GSD 1-14] vs 对照组为 12-94% [GSD 1-15]，RR 0-97 [95% CI 0-84-1-11]；P=0-60）或阴道球菌几何平均感染率（干预组为 7-06% [GSD 1-48] vs 对照组为 6-20% [1-38]，RR 1-09 [95% CI 0-74-1-60]；P=0-66）没有差异。干预组的淋球菌感染率明显降低，风险降低了 43%（几何平均数 1-65% [GSD 1-77] vs 2-87% [1-43]，RR 0-57 [95% CI 0-34-0-96]；P=0-036）：我们的研究表明，可治愈的性传播感染在人群中的发病率很高。基于社区的性传播感染筛查似乎降低了淋球菌在人群中的流行率，但没有降低沙眼衣原体或阴道球菌的流行率，这可能是由于干预覆盖率较低。今后需要对筛查干预措施对发病率、抗菌素耐药性和再感染率的影响进行研究：资助机构：医学研究委员会、经济与社会研究委员会、国际发展部、国家健康与护理研究所和惠康基金会。

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引用次数: 0

Estimates of resource use in the public-sector health-care system and the effect of strengthening health-care services in Malawi during 2015-19: a modelling study (Thanzi La Onse). 2015-19 年期间马拉维公共部门医疗保健系统资源使用估算及加强医疗保健服务的效果：一项模拟研究（Thanzi La Onse）。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-13 DOI: 10.1016/S2214-109X(24)00413-3

Timothy B Hallett, Tara D Mangal, Asif U Tamuri, Nimalan Arinaminpathy, Valentina Cambiano, Martin Chalkley, Joseph H Collins, Jonathan Cooper, Matthew S Gillman, Mosè Giordano, Matthew M Graham, William Graham, Iwona Hawryluk, Eva Janoušková, Britta L Jewell, Ines Li Lin, Robert Manning Smith, Gerald Manthalu, Emmanuel Mnjowe, Sakshi Mohan, Margherita Molaro, Wingston Ng'ambi, Dominic Nkhoma, Stefan Piatek, Paul Revill, Alison Rodger, Dimitra Salmanidou, Bingling She, Mikaela Smit, Pakwanja D Twea, Tim Colbourn, Joseph Mfutso-Bengo, Andrew N Phillips

Background: In all health-care systems, decisions need to be made regarding allocation of available resources. Evidence is needed for these decisions, especially in low-income countries. We aimed to estimate how health-care resources provided by the public sector were used in Malawi during 2015-19 and to estimate the effects of strengthening health-care services.Methods: For this modelling study, we used the Thanzi La Onse model, an individual-based simulation model. The scope of the model was health care provided by the public sector in Malawi during 2015-19. Health-care services were delivered during health-care system interaction (HSI) events, which we characterised as occurring at a particular facility level and requiring a particular number of appointments. We developed mechanistic models for the causes of death and disability that were estimated to account for approximately 81% of deaths and approximately 72% of disability-adjusted life-years (DALYs) in Malawi during 2015-19, according to the Global Burden of Disease (GBD) estimates; we computed DALYs incurred in the population as the sum of years of life lost and years lived with disability. The disease models could interact with one another and with the underlying properties of each person. Each person in the Thanzi La Onse model had specific properties (eg, sex, district of residence, wealth percentile, smoking status, and BMI, among others), for which we measured distribution and evolution over time using demographic and health survey data. We also estimated the effect of different types of health-care system improvement.Findings: We estimated that the public-sector health-care system in Malawi averted 41·2 million DALYs (95% UI 38·6-43·8) during 2015-19, approximately half of the 84·3 million DALYs (81·5-86·9) that the population would otherwise have incurred. DALYs averted were heavily skewed to children aged 0-4 years due to services averting DALYs that would be caused by acute lower respiratory tract infection, HIV or AIDS, malaria, or neonatal disorders. DALYs averted among adults were mostly attributed to HIV or AIDS and tuberculosis. Under a scenario whereby each appointment took the time expected and health-care workers did not work for longer than contracted, the health-care system in Malawi during 2015-19 would have averted only 19·1 million DALYs (95% UI 17·1-22·4), suggesting that approximately 21·3 million DALYS (20·0-23·6) of total effect were derived through overwork of health-care workers. If people becoming ill immediately accessed care, all referrals were successfully completed, diagnostic accuracy of health-care workers was as good as possible, and consumables (ie, medicines) were always available, 28·2% (95% UI 25·7-30·9) more DALYS (ie, 12·2 million DALYs [95% UI 10·9-13·8]) could be averted.Interpretation: The health-care system in Malawi provides substantial health gains wi

背景：在所有医疗保健系统中，都需要就可用资源的分配做出决定。这些决策需要证据，尤其是在低收入国家。我们旨在估算马拉维在 2015-19 年间如何使用公共部门提供的医疗资源，并估算加强医疗服务的效果：在这项建模研究中，我们使用了基于个人的模拟模型 Thanzi La Onse。该模型的范围是 2015-19 年间马拉维公共部门提供的医疗保健服务。医疗保健服务是在医疗保健系统互动（HSI）事件中提供的，我们将这些事件描述为发生在特定设施层面并需要特定预约次数的事件。根据全球疾病负担（GBD）的估算，2015-19 年间马拉维约有 81% 的死亡和 72% 的残疾调整寿命年数（DALYs）是由这些死亡和残疾原因造成的。疾病模型可以相互影响，也可以与每个人的基本属性相互影响。Thanzi La Onse 模型中的每个人都有特定的属性（如性别、居住地区、财富百分位数、吸烟状况和体重指数等），我们利用人口和健康调查数据测量了这些属性的分布和随时间的变化情况。我们还估算了不同类型的医疗保健系统改进的效果：我们估计，在 2015-19 年期间，马拉维公共部门的医疗保健系统避免了 4,120 万个残疾调整寿命年（95% UI 38-6-43-8），约占本应避免的 8,430 万个残疾调整寿命年（81-5-86-9）的一半。由于提供的服务避免了急性下呼吸道感染、艾滋病毒或艾滋病、疟疾或新生儿疾病造成的残疾调整寿命年数，0-4 岁儿童避免的残疾调整寿命年数偏高。成人中避免的残疾调整寿命年数主要归因于艾滋病毒或艾滋病和结核病。如果每次预约的时间都符合预期，且医护人员的工作时间不超过合同规定的时间，那么在 2015-19 年期间，马拉维的医疗保健系统仅能避免 1900 万残疾调整寿命年（95% UI 为 17-1-22-4），这表明约 2100-300 万残疾调整寿命年（20-0-23-6）的总效应是通过医护人员的过度工作产生的。如果生病的人能够立即得到治疗，所有转诊都能顺利完成，医护人员的诊断准确率尽可能高，而且耗材（即药品）总是能买到，那么可以避免的残疾调整寿命年数将增加 28-2%（95% UI 25-7-30-9）（即 1220 万残疾调整寿命年数 [95% UI 10-9-13-8]）：马拉维的医疗保健系统以稀缺的资源提供了巨大的健康收益。加强干预措施有可能增加这些收益，因此应优先进行调查和投资。基于个体的医疗保健服务提供模拟模型对于医疗保健系统的规划和加强很有价值：资金来源：惠康基金会、英国研究与创新组织、英国医学研究委员会和社区贾米尔。

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引用次数: 0

Access to antibiotics for pneumonia and sepsis in LMICs. 在低收入和中等收入国家获得抗生素治疗肺炎和败血症。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-08 DOI: 10.1016/S2214-109X(24)00418-2

Amy Sarah Ginsburg, Ken Duncan, Keith P Klugman, Padmini Srikantiah

引用次数: 0

Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial. 治疗呼吸机相关肺炎的短程抗生素治疗策略的成本效益：REGARD-VAP 试验的经济分析。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-04 DOI: 10.1016/S2214-109X(24)00327-9

Yiying Cai, Suchart Booraphun, Andrew Yunkai Li, Gyan Kayastha, Paul Anantharajah Tambyah, Ben S Cooper, Nicholas Graves, Yin Mo

Background: The REGARD-VAP trial showed that individualised shortened antibiotic therapy was non-inferior to usual care for mortality and pneumonia recurrence in patients with ventilator-associated pneumonia (VAP). We aimed to assess the cost-effectiveness of an individualised shortened antibiotic therapy approach in this planned economic analysis.

Methods: REGARD-VAP was a phase 4, multicentre, open-label, randomised trial to assess a short-course antibiotic treatment strategy for treatment of VAP. In this planned economic analysis, we fitted a decision tree with data from the REGARD-VAP trial to estimate the cost-effectiveness of individualised short-course therapy for VAP, compared to usual care from the health system perspective, in Nepal, Singapore, and Thailand. Incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits with 95% uncertainty intervals (UIs) were reported against relevant willingness-to-pay thresholds. Parameter uncertainties were evaluated using scenario analyses. A value of information analysis was conducted.

Findings: Adopting individualised short-course therapy was cost-effective for Nepal (ICER=US$1086; percentage cost-effectiveness=50·3%), Singapore (ICER=-$6069; percentage cost-effectiveness=55·2%), and Thailand (ICER=$263; percentage cost-effectiveness=60·5%). The associated incremental net monetary benefits were $41 (95% UI -2308 to 2390) in Nepal, $5156 (-45 805 to 56 117) in Singapore, and $804 (-6245 to 7852) in Thailand. Value of information analysis showed that reducing uncertainties for mortality probabilities, bed-day costs, and variable costs were valuable for decision making.

Interpretation: We found that an individualised short-course antibiotics strategy in patients with VAP is likely to be cost-effective in high-income, middle-income, and low-income settings, although with evident uncertainty. Considered alongside the positive externalities of reduced antimicrobial use, our findings foster confidence in policy makers contemplating adoption of short-course antibiotics.

Funding: UK Medical Research Council, Singapore National Medical Research Council, and Wellcome Trust.

背景：REGARD-VAP试验表明，在呼吸机相关性肺炎（VAP）患者的死亡率和肺炎复发率方面，个体化缩短抗生素治疗效果不劣于常规治疗。我们的目标是在这项计划经济分析中评估个体化缩短抗生素治疗方法的成本效益：REGARD-VAP 是一项 4 期、多中心、开放标签、随机试验，旨在评估治疗 VAP 的短程抗生素治疗策略。在这项计划中的经济分析中，我们利用 REGARD-VAP 试验的数据拟合了一个决策树，从卫生系统的角度估算了尼泊尔、新加坡和泰国 VAP 个体化短程治疗与常规治疗相比的成本效益。根据相关的支付意愿阈值，报告了增量成本效益比 (ICER) 和增量净货币收益及 95% 不确定性区间 (UI)。通过情景分析评估了参数的不确定性。还进行了信息价值分析：对尼泊尔（ICER=1086 美元；成本效益百分比=50-3%）、新加坡（ICER=-6069 美元；成本效益百分比=55-2%）和泰国（ICER=263 美元；成本效益百分比=60-5%）而言，采用个体化短程疗法具有成本效益。尼泊尔的相关增量净货币效益为 41 美元（95% UI -2308-2390），新加坡为 5156 美元（-45 805-56117），泰国为 804 美元（-6245-7852）。信息价值分析表明，降低死亡率概率、床日成本和可变成本的不确定性对决策很有价值：我们发现，在高收入、中等收入和低收入环境中，针对 VAP 患者的个体化短期抗生素治疗策略可能具有成本效益，尽管存在明显的不确定性。考虑到减少抗菌药物使用的积极外部效应，我们的研究结果增强了考虑采用短程抗生素的政策制定者的信心：资金来源：英国医学研究委员会、新加坡国家医学研究委员会和惠康基金会。

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引用次数: 0

Women at the front line of the Marburg virus disease response in Rwanda: balancing clinical care, public health, and family life. 卢旺达应对马尔堡病毒疾病第一线的妇女：兼顾临床护理、公共卫生和家庭生活。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-04 DOI: 10.1016/S2214-109X(24)00470-4

Tsion Firew, Louise Mwiseneza, Malaika Asabwe, Ineza Nadine Vanessa, Marie Henriette Uwintwari, Françoise Nizeyimana, Doris Lorette Uwamahoro

引用次数: 0

The cause of nodding syndrome remains unknown - Authors' reply. 点头综合征的病因仍然不明--作者回复。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI: 10.1016/S2214-109X(24)00366-8

Rodney Ogwang, Angela Vincent, Richard Idro

引用次数: 0

Microbiology testing capacity and antimicrobial drug resistance in surgical-site infections: a post-hoc, prospective, secondary analysis of the FALCON randomised trial in seven low-income and middle-income countries. 手术部位感染的微生物检测能力和抗菌药物耐药性：在七个低收入和中等收入国家进行的 FALCON 随机试验的事后、前瞻性二次分析。

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-01 Epub Date: 2024-09-05 DOI: 10.1016/S2214-109X(24)00330-9

Background: Surgical-site infection (SSI) is one of the most common health-care-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis to prevent SSIs and effective treatment are crucial to controlling antimicrobial resistance (AMR). This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms in low-income and middle-income countries (LMICs).

Methods: This analysis included patients undergoing abdominal surgery in seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) as part of the FALCON randomised controlled trial. Wound swabs were collected from patients diagnosed with SSI, as per US Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control definitions, were analysed alongside hospital-level data on local microbiological practices. An adjusted analysis was performed to identify perioperative factors associated with MDR. Testing capacity was assessed by the completion of swab testing in positively diagnosed SSIs.

Findings: Between Dec 10, 2018, and Sept 7, 2020, 5788 patients were recruited to the FALCON trial. 1163 patients were diagnosed with an SSI, of whom 905 (77·8%) received prophylactic antibiotics before surgery. In patients with SSIs, 935 of 1163 (80·4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab performed (35 hospitals). Of 228 patients swabbed, 200 (88·5%) had microorganisms detected. Escherichia coli (89 of 200, 37·9%) was the most common microorganism and 116 of 200 (58·0%) patients were not covered by the perioperative prophylactic antibiotic. MDR was found in 102 of 147 (69·4%) patients for whom data were available to determine MDR status. Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0·43, 95% CI 0·19-0·96) and regular availability of infection control teams (0·32, 0·11-0·93) were associated with a significant reduction in MDR.

Interpretation: Targeted perioperative antibiotic prophylaxis during contaminated abdominal surgery is insufficient in LMICs, with very few SSI organisms undergoing formal diagnosis. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams could support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR.

Funding: National Institute for Health and Care Research.

Translations: For the French and Spanish translations of the abstract see Supplementary Materials section.

背景：手术部位感染（SSI）是最常见的医疗相关感染之一，大大增加了抗生素的使用量。有针对性地使用抗生素预防 SSI 并进行有效治疗对控制抗菌药耐药性（AMR）至关重要。本研究旨在描述中低收入国家（LMICs）SSI 微生物的检测能力和多重耐药性（MDR）：这项分析包括在七个中低收入国家（贝宁、加纳、印度、墨西哥、尼日利亚、卢旺达和南非）接受腹部手术的患者，是 FALCON 随机对照试验的一部分。根据美国疾病控制和预防中心（CDC）的定义，从确诊为 SSI 的患者身上采集了伤口拭子。根据 CDC 和欧洲疾病预防与控制中心的定义，对微生物种类和 MDR 数据进行了分析，同时还分析了当地微生物学实践的医院级数据。还进行了调整分析，以确定与 MDR 相关的围手术期因素。检测能力根据阳性诊断 SSI 的拭子检测完成情况进行评估：2018年12月10日至2020年9月7日期间，FALCON试验共招募了5788名患者。1163名患者被确诊为SSI，其中905人（77%-8%）在手术前接受了预防性抗生素治疗。在 SSI 患者中，1163 人中有 935 人（80-4%）没有进行伤口拭子检查；195 人来自没有进行拭子检查的医院（15 家医院），740 人来自有能力但没有进行拭子检查的医院（35 家医院）。在 228 名接受拭抹的患者中，有 200 人（88-5%）检测到微生物。大肠埃希菌（200 例中有 89 例，占 37-9%）是最常见的微生物，200 例中有 116 例（占 58-0%）患者未使用围手术期预防性抗生素。在有数据可确定 MDR 状态的 147 例患者中，102 例（69-4%）发现了 MDR。调整后的分析发现，适当的预防性抗生素覆盖率（调整后的几率比0-43，95% CI 0-19-0-96）和感染控制小组的定期到位率（0-32，0-11-0-93）与MDR的显著减少有关：在低收入国家，腹部污染手术围术期针对性抗生素预防措施不足，只有极少数 SSI 微生物经过正式诊断。扩大检测能力、制定地方指南、成立感染控制小组，可以通过有针对性的抗生素预防措施预防SSI，从而减轻MDR的负担：国家健康与护理研究所：摘要的法文和西班牙文译文见 "补充材料 "部分。

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引用次数: 0

Impact of the 100 days mission for vaccines on COVID-19: a mathematical modelling study. 疫苗百日任务对 COVID-19 的影响：数学模型研究。

IF 34.3 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-01 DOI: 10.1016/s2214-109x(24)00286-9

Gregory Barnsley,Daniela Olivera Mesa,Alexandra B Hogan,Peter Winskill,Andrew A Torkelson,Damian G Walker,Azra C Ghani,Oliver J Watson

BACKGROUNDThe COVID-19 pandemic has underscored the beneficial impact of vaccines. It also highlighted the need for future investments to expedite an equitable vaccine distribution. The 100 Days Mission aims to develop and make available a new vaccine against a future pathogen with pandemic potential within 100 days of that pathogen threat being recognised. We assessed the value of this mission by estimating the impact that it could have had on the COVID-19 pandemic.METHODSUsing a previously published model of SARS-CoV-2 transmission dynamics fitted to excess mortality during the COVID-19 pandemic, we projected scenarios for three different investment strategies: rapid development and manufacture of a vaccine, increasing manufacturing capacity to eliminate supply constraints, and strengthening health systems to enable faster vaccine roll-outs and global equity. Each scenario was compared against the observed COVID-19 pandemic to estimate the public health and health-economic impacts of each scenario.FINDINGSIf countries implemented non-pharmaceutical interventions (NPIs) as they did historically, the 100 Days Mission could have averted an estimated 8·33 million deaths (95% credible interval [CrI] 7·70-8·68) globally, mostly in lower-middle income countries. This corresponds to a monetary saving of US$14·35 trillion (95% CrI 12·96-17·87) based on the value of statistical life-years saved. Investment in manufacturing and health systems further increases deaths averted to 11·01 million (95% CrI 10·60-11·49). Under an alternative scenario whereby NPIs are lifted earlier on the basis of vaccine coverage, the 100 Days Mission alone could have reduced restrictions by 12 600 days (95% CrI 12 300-13 100) globally while still averting 5·76 million deaths (95% CrI 4·91-6·81).INTERPRETATIONOur findings show the value of the 100 Days Mission and how these can be amplified through improvements in manufacturing and health systems equity. However, these investments must be enhanced by prioritising a more equitable global vaccine distribution.FUNDINGSchmidt Science Fellowship in partnership with the Rhodes Trust, WHO, UK Medical Research Council, Coalition for Epidemic Preparedness Innovations.

背景 COVID-19 大流行凸显了疫苗的有益影响。它还凸显了未来投资加快疫苗公平分配的必要性。百日任务 "的目标是在未来具有大流行潜力的病原体威胁被确认后的 100 天内，开发并提供针对该病原体的新疫苗。我们评估了这一任务的价值，估算了它对 COVID-19 大流行可能产生的影响。方法我们利用以前发表的 SARS-CoV-2 传播动态模型与 COVID-19 大流行期间的超额死亡率相匹配，预测了三种不同投资策略的情景：快速开发和制造疫苗、提高制造能力以消除供应限制，以及加强卫生系统以加快疫苗推广和实现全球公平。每种方案都与观察到的 COVID-19 大流行进行了比较，以估计每种方案对公共卫生和健康经济的影响。研究结果如果各国像历史上一样实施非药物干预措施（NPIs），"百日任务 "估计可以在全球范围内避免 800 万到 3300 万人死亡（95% 可信区间 [CrI] 7-70-8-68），其中大部分是中低收入国家。根据统计寿命年数节省的价值，这相当于节省了 14-35 万亿美元（95% 可信区间 [CrI] 12-96-17-87）。对制造业和卫生系统的投资将避免的死亡人数进一步增加到 1,100 万至 1,010 万（95% 中位数 10-60-11-49）。在另一种情况下，即根据疫苗覆盖率提前解除国家免疫方案，仅 "百日任务 "就可在全球范围内减少 12600 天的限制（95% 中值为 12 300-13 100），同时仍可避免 57600 万例死亡（95% 中值为 4-91-6-81）。然而，这些投资必须通过优先考虑更公平的全球疫苗分配来加强。资金来源施密特科学奖学金与罗兹信托基金、世界卫生组织、英国医学研究理事会、流行病防备创新联盟合作。

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引用次数: 0

Correction to Lancet Glob Health 2024; published online Sept 23. https://doi.org/10.1016/S2214-109X(24)00320-6. https://doi.org/10.1016/S2214-109X(24)00320-6.

IF 19.9 1区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Lancet Global Health

Pub Date : 2024-11-01 Epub Date: 2024-09-26 DOI: 10.1016/S2214-109X(24)00420-0

引用次数: 0