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Evaluation of remote radiologist-interpreted point-of-care ultrasound for suspected dengue patients in a primary health care facility in Colombia. 对哥伦比亚初级卫生保健机构中疑似登革热患者的远程放射科医生解读护理点超声的评估。
IF 8.1 1区 医学 Pub Date : 2023-09-28 DOI: 10.1186/s40249-023-01141-9
Lyda Osorio, Iñigo Prieto, Daniela Zuluaga, Deliana Ropero, Neelesh Dewan, Jonathan D Kirsch

Background: Early identification of plasma leakage may guide treatment decisions in dengue patients. This study evaluated the value of point-of-care ultrasound (POCUS) to detect plasma leakage and predict hospitalization or referral to a higher level of care in suspected dengue patients under routine conditions at a primary care facility in Colombia.

Methods: We conducted a cohort study between April 2019 and March 2020 in a primary care hospital in Cali, Colombia. We prospectively included and followed 178 patients who were at least 2 years old with fever of less than 10 days and clinician-suspected dengue. A trained general practitioner performed a standardized POCUS protocol. Images were quality-rated and overread by an expert radiologist, and her results and those of the general practitioner were compared using the Kappa index. Logistic regression was used to identify factors associated with plasma leakage at enrollment and explore its prognostic value regarding hospital admission or referral to a higher level of care.

Results: Half (49.6%) POCUS images were of suitable quality to be interpreted. The proportion of plasma leakage reported by the radiologist was 85.1% (95% CI: 78.6-90.2%) and 47.2% by the study physician (Kappa = 0.25, 95% CI: 0.15-0.35). The most frequent ultrasound findings were ascites (hepatorenal 87.2%, splenorenal 64%, or pelvic 21.8%) and gallbladder wall thickening (10.5%). Plasma leakage was higher in subjects with thrombocytopenia (aOR = 4, 95% CI: 1.3-12.1) and lower in patients 30-59 years old (aOR = 0.1, 95% CI: 0.0-0.4) than in those 18 years old or younger. POCUS evidence of plasma leakage (aOR = 8.2, 95% CI: 2.2-29.9), thrombocytopenia (aOR = 6.3, 95% CI: 2.4-16.0) and pulse pressure (aOR = 1.1, 95% CI: 1.07-1.2) were associated with hospital admission or referral to a higher level of care.

Conclusions: Ultrasound is useful to detect plasma leakage in primary care and, challenges remain to guarantee high-quality images and diagnostic accuracy, for which a standardized dengue POCUS protocol and training program is needed.

背景:早期发现血浆渗漏可能指导登革热患者的治疗决策。这项研究评估了护理点超声(POCUS)在哥伦比亚初级保健机构常规条件下检测血浆渗漏并预测疑似登革热患者住院或转诊到更高水平护理的价值。方法:我们于2019年4月至2020年3月在哥伦比亚卡利的一家初级保健医院进行了一项队列研究。我们前瞻性地纳入并跟踪了178名年龄至少为2岁、发烧时间小于10天且临床医生怀疑登革热的患者。经过培训的全科医生执行了标准化POCUS方案。放射科医生对图像进行了质量评级和高估,并使用Kappa指数将她的结果与全科医生的结果进行了比较。在入组时使用Logistic回归来确定与血浆渗漏相关的因素,并探讨其对入院或转诊到更高水平护理的预后价值。结果:一半(49.6%)的POCUS图像具有合适的解释质量。放射科医生报告的血浆渗漏比例为85.1%(95%置信区间:78.6-90.2%),研究医生报告的为47.2%(Kappa = 0.25,95%CI:0.15-0.35)。最常见的超声检查结果是腹水(肝肾87.2%,脾肾64%,或盆腔21.8%)和胆囊壁增厚(10.5%)。血小板减少症(aOR = 4,95%可信区间:1.3-12.1)和30-59岁患者更低(aOR = 0.1、95%可信区间:0.0-0.4)。血浆渗漏的POCUS证据(aOR = 8.2,95%可信区间:2.2-29.9)、血小板减少症(aOR = 6.3,95%CI:2.4-16.0)和脉冲压力(aOR = 1.1,95%可信区间:1.07-1.2)与入院或转诊到更高级别的护理相关。结论:超声有助于检测初级保健中的血浆渗漏,但要保证高质量的图像和诊断准确性仍然存在挑战,为此需要一个标准化的登革热POCUS方案和培训计划。
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引用次数: 0
Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study. 马达加斯加农村女性生殖器血吸虫病、人类乳头状瘤病毒感染和宫颈癌症:一项横断面研究。
IF 8.1 1区 医学 Pub Date : 2023-09-25 DOI: 10.1186/s40249-023-01139-3
Jean-Marc Kutz, Pia Rausche, Tahinamandranto Rasamoelina, Sonya Ratefiarisoa, Ravo Razafindrakoto, Philipp Klein, Anna Jaeger, Rivo Solotiana Rakotomalala, Zoly Rakotomalala, Bodo Sahondra Randrianasolo, Sandrine McKay-Chopin, Jürgen May, Rapahel Rakotozandrindrainy, Dewi Ismajani Puradiredja, Elisa Sicuri, Monika Hampl, Eva Lorenz, Tarik Gheit, Rivo Andry Rakotoarivelo, Daniela Fusco

Background: Women's health in resource-limited settings can benefit from the integrated management of high-burden diseases, such as female genital schistosomiasis (FGS) and human papilloma virus (HPV)-related cervical cancer. In schistosomiasis-endemic countries such as Madagascar, data on FGS and HPV prevalence are lacking as well as preventive measures for both conditions. This study aims to estimate the prevalence of FGS and HPV in rural Madagascar, and to examine associated risk factors to identify opportunities for improving women's health.

Methods: After initial community outreach activities, interested women aged 18-49 years were recruited consecutively in 2021 at three primary health care centers in the district of Marovoay. FGS was detected by colposcopy. Colposcopy images were double-blind reviewed by two independent specialists. A Luminex bead-based assay was performed on cervical vaginal lavage specimens for HPV typing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated using univariable and multivariable binary Poisson regression with 95% confidence intervals (CIs).

Results: Among 500 women enrolled, 302 had complete information on FGS and HPV diagnosis, and were thus eligible for analysis. Within the sample, 189 (62.6%, 95% CI: 56.9-68.1) cases of FGS were detected. A total of 129 women (42.7%, 95% CI: 37.1-48.5) tested positive for HPV. In total, 80 women (26.5%, 95% CI: 21.6-31.8]) tested positive for both conditions. No association was observed between FGS and HPV positivity, while previous pregnancy (APR = 0.65, 95% CI: 0.43-0.78) and older age (APR = 0.59, 95% CI: 0.42-0.81) are showing a negative association with HPV infection compared to no previous pregnancy and younger age groups.

Conclusions: The results of the study show that FGS and HPV are highly prevalent in rural Madagascar. The concurrent prevalence of these two conditions requires urgent adaptations of public health strategies to improve women's health, such as integrated services at primary level of care.

背景:在资源有限的环境中,妇女的健康可以受益于高负担疾病的综合管理,如女性生殖器血吸虫病(FGS)和人乳头瘤病毒(HPV)相关的宫颈癌症。在马达加斯加等血吸虫病流行国家,缺乏FGS和HPV流行率的数据,也缺乏针对这两种情况的预防措施。本研究旨在评估马达加斯加农村女性生殖器切割和人乳头状瘤病毒的患病率,并检查相关的风险因素,以确定改善妇女健康的机会。方法:在最初的社区外展活动之后,2021年,在Marovoy区的三个初级卫生保健中心连续招募了18-49岁的感兴趣的女性。阴道镜检查发现FGS。两位独立专家对阴道镜图像进行了双盲审查。对宫颈阴道灌洗标本进行基于Luminex珠的HPV分型测定。采用95%置信区间(CI)的单变量和多变量二元泊松回归估计了所选因素与FGS和HPV阳性之间关系的粗患病率(CPR)和调整患病率(APR)。在样本中,检测到189例(62.6%,95%置信区间:56.9-68.1)FGS病例。共有129名女性(42.7%,95%置信区间:37.1-48.5)的HPV检测呈阳性。总共有80名女性(26.5%,95%CI:21.6-31.8])在这两种情况下检测呈阳性。未观察到FGS与HPV阳性之间的相关性,而既往妊娠(APR = 0.65,95%可信区间:0.43-0.78)和年龄较大(APR = 0.59,95%CI:0.42-0.81)显示出与HPV感染的负相关。结论:研究结果表明,FGS和HPV在马达加斯加农村高度流行。这两种疾病同时流行,需要紧急调整公共卫生战略,以改善妇女的健康,例如初级保健的综合服务。
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引用次数: 0
Assessing food security performance from the One Health concept: an evaluation tool based on the Global One Health Index. 从“一个健康”概念评估粮食安全绩效:基于全球一个健康指数的评估工具。
IF 8.1 1区 医学 Pub Date : 2023-09-22 DOI: 10.1186/s40249-023-01135-7
Si-Yu Gu, Fu-Min Chen, Chen-Sheng Zhang, Yi-Bin Zhou, Tian-Yun Li, Ne Qiang, Xiao-Xi Zhang, Jing-Shu Liu, Shu-Xun Wang, Xue-Chen Yang, Xiao-Kui Guo, Qin-Qin Hu, Xiao-Bei Deng, Le-Fei Han

Background: Food systems instantiate the complex interdependencies across humans, physical environments, and other organisms. Applying One Health approaches for agri-food system transformation, which adopts integrated and unifying approaches to optimize the overall health of humans, animals, plants, and environments, is crucial to enhance the sustainability of food systems. This study develops a potential assessment tool, named the global One Health index-Food Security (GOHI-FS), aiming to evaluate food security performance across countries/territories from One Health perspective and identify relevant gaps that need to be improved for sustainable food systems.

Methods: We comprehensively reviewed existing frameworks and elements of food security. The indicator framework of GOHI-FS was conceptualized following the structure-process-outcome model and confirmed by expert advisory. Publicly available data in 2020 was collected for each indicator. The weighting strategy was determined by the Fuzzy Analytical Hierarchy Process. The data for each indicator was normalized and aggregated by weighted arithmetic mean. Linear regressions were performed to evaluate the associations of GOHI-FS with health and social-economic indicators.

Results: The GOHI-FS includes 5 first-level indicators, 19 second-level indicators and 45 third-level indicators. There were 146 countries/territories enrolled for evaluation. The highest average score of first-level indicators was Nutrition (69.8) and the lowest was Government Support and Response (31.3). There was regional heterogeneity of GOHI-FS scores. Higher median scores with interquartile range (IQR) were shown in North America (median: 76.1, IQR: 75.5-76.7), followed by Europe and Central Asia (median: 66.9, IQR: 60.1-74.3), East Asia and the Pacific (median: 60.6, IQR: 55.5-68.7), Latin America and the Caribbean (median: 60.2, IQR: 57.8-65.0), Middle East and North Africa (median: 56.6, IQR: 52.0-62.8), South Asia (median: 51.1, IQR: 46.7-53.8), and sub-Saharan Africa (median: 41.4, IQR: 37.2-46.5). We also found significant associations between GOHI-FS and GDP per capita, socio-demographic index, health expenditure and life expectancy.

Conclusions: GOHI-FS is a potential assessment tool to understand the gaps in food security across countries/territories under the One Health concept. The pilot findings suggest notable gaps for sub-Saharan Africa in numerous aspects. Broad actions are needed globally to promote government support and response for food security.

背景:食物系统体现了人类、物理环境和其他生物之间复杂的相互依存关系。将“一个健康”方法应用于农业食品系统转型,该方法采用综合统一的方法来优化人类、动物、植物和环境的整体健康,对于提高食品系统的可持续性至关重要。这项研究开发了一种潜在的评估工具,名为全球单一健康指数粮食安全(GOHI-FS),旨在从单一健康的角度评估各国/地区的粮食安全绩效,并确定可持续粮食系统需要改进的相关差距。方法:我们全面审查了粮食安全的现有框架和要素。GOHI-FS的指标框架是根据结构-过程-结果模型概念化的,并得到了专家咨询的确认。收集了2020年每个指标的公开数据。加权策略由模糊层次分析法确定。对每个指标的数据进行归一化,并通过加权算术平均数进行汇总。进行线性回归来评估GOHI-FS与健康和社会经济指标的相关性。结果:GOHI-FS包括5个一级指标、19个二级指标和45个三级指标。共有146个国家/地区参加了评估。一级指标平均得分最高的是营养(69.8),最低的是政府支持和反应(31.3)。GOHI-FS得分存在区域异质性。北美(中位数:76.1,IQR:75.5-76.7)、欧洲和中亚(中位数:66.9,IQR:60.1-74.3)、东亚和太平洋(中位数:60.6,IQR:55.5-68.7)、拉丁美洲和加勒比(中位数:60.0,IQR:57.8-65.0)、中东和北非(中位数:56.6,IQR:52.0-62.8),南亚(中位数:51.1,IQR:46.7-53.8)和撒哈拉以南非洲(中位数:41.4,IQR:37.2-46.5)。我们还发现GOHI-FS与人均GDP、社会人口指数、医疗支出和预期寿命之间存在显著关联。结论:GOHI-FS是一个潜在的评估工具,可以了解“一个健康”概念下各国/地区的粮食安全差距。试点结果表明,撒哈拉以南非洲在许多方面存在显著差距。需要在全球范围内采取广泛行动,促进政府对粮食安全的支持和应对。
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引用次数: 0
Hepatitis B reactivation in cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis. 接受免疫检查点抑制剂治疗的癌症患者的乙型肝炎再激活:系统综述和荟萃分析。
IF 8.1 1区 医学 Pub Date : 2023-09-22 DOI: 10.1186/s40249-023-01128-6
Zhengzheng Xia, Jianyu Zhang, Wenjun Chen, Haiyan Zhou, Di Du, Kongcai Zhu, Hui Chen, Jun Meng, Jun Yang

Background: Immunotherapy shows promise as a treatment option for various cancers. However, there is growing concern over potential complications from hepatitis B virus (HBV) reactivation after checkpoint blockade immunotherapy. Although most of the previous clinical trials on immune checkpoint inhibitors (ICIs) excluded patients with HBV, a few case reports and retrospective studies of HBV reactivation have been published. The aim of this study is to assess the risk of hepatitis B virus reactivation (HBVr) in patients receiving ICIs for advanced cancer.

Methods: English and Chinese language literature published prior to April 30, 2023, was searched in PubMed, EMBASE, Web of Science, Cochrane, SinoMed, CNKI and Wanfang Data for studies reporting HBVr rates in cancer patients treated with ICIs. A pooled risk estimate was calculated for HBVr rates with 95% confidence intervals (CI).

Results: Data from 34 studies including 7126 patients were retrieved and analyzed. The pooled HBVr rate in cancer patients treated with ICIs was 1.3% (I2 = 90.44%, 95% CI: 0.2-2.9%, P < 0.001). Subgroup analysis revealed that patients diagnosed with hepatocellular carcinoma (HCC), HBV carriers, and patients from Asian regions or in developing countries have a higher rate of HBVr.

Conclusions: Our meta-analysis demonstrated a low risk of HBVr in patients treated with ICIs for advanced cancer. ICI treatment may be safely used in patients with existing HBV infection or chronic hepatitis B, accompanied by regular monitoring and appropriate antiviral prophylaxis if necessary.

背景:免疫疗法有望成为各种癌症的治疗选择。然而,人们越来越担心检查点阻断免疫疗法后乙型肝炎病毒(HBV)再激活的潜在并发症。尽管以前大多数关于免疫检查点抑制剂(ICIs)的临床试验都排除了HBV患者,但已经发表了一些HBV再激活的病例报告和回顾性研究。本研究的目的是评估接受ICI治疗晚期癌症患者的乙型肝炎病毒再激活(HBVr)风险。方法:在PubMed、EMBASE、Web of Science、Cochrane、SinoMed、CNKI和Wanfang Data中检索2023年4月30日之前发表的中英文文献,以了解报道ICIs治疗的癌症患者HBVr率的研究。以95%置信区间(CI)计算HBVr发病率的合并风险估计值。结果:检索并分析了34项研究的数据,包括7126名患者。接受ICIs治疗的癌症患者的合并HBVr率为1.3%(I2 = 90.44%,95%置信区间:0.2-2.9%,P 结论:我们的荟萃分析表明,接受ICIs治疗的晚期癌症患者的HBVr风险较低。ICI治疗可以安全地用于已有HBV感染或慢性乙型肝炎的患者,并在必要时进行定期监测和适当的抗病毒预防。
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引用次数: 1
Tackling barriers to scale up human papillomavirus vaccination in China: progress and the way forward. 解决中国扩大人乳头瘤病毒疫苗接种的障碍:进展和前进方向。
IF 8.1 1区 医学 Pub Date : 2023-09-21 DOI: 10.1186/s40249-023-01136-6
Xue-Lian Zhao, Shang-Ying Hu, Jia-Wei Hu, Hong-Hao Wang, Tian-Meng Wen, Yu-Shu Feng, You-Lin Qiao, Fang-Hui Zhao, Yong Zhang

The human papillomavirus (HPV) vaccine is the first vaccine developed specifically targeting the prevention of cervical cancer. For more than 15 years, China has expedited a series of efforts on research and development of the domestically manufactured HPV vaccines, producing local population-based evidence, promoting free HPV vaccination from pilots, and launching action plans to tackle barriers in the scale-up of HPV vaccination. To further roll out the HPV vaccination program in China, several challenges should be addressed to support the steps forward. The availability of more locally manufactured HPV vaccines, pricing negotiation and local evidence supporting the efficacy of one-dose schedule would greatly alleviate the continued supply and financial constraints in China. Meanwhile, more attention should be paid to girls living in low-resource areas and males to ensure equal access to the HPV vaccination. Furthermore, linkage to secondary prevention and further real-world monitoring and evaluation are warranted to inform effective cervical cancer prevention strategies in the post-vaccine era.

人乳头瘤病毒(HPV)疫苗是第一种专门针对预防癌症而开发的疫苗。15年多来,中国加快了一系列国产HPV疫苗的研发工作,提供了基于当地人群的证据,推广了试点免费HPV疫苗接种,并启动了解决扩大HPV疫苗接种障碍的行动计划。为了在中国进一步推广HPV疫苗接种计划,应解决几个挑战,以支持向前迈出的步伐。更多本地生产的HPV疫苗的可用性、价格谈判和支持一剂计划有效性的本地证据将大大缓解中国持续的供应和财政限制。同时,应更多地关注生活在低资源地区的女孩和男性,以确保平等获得HPV疫苗接种。此外,有必要将二级预防与进一步的现实世界监测和评估联系起来,为后疫苗时代有效的癌症预防策略提供信息。
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引用次数: 0
National prevalence and risk factors for tungiasis in Kenya. 肯尼亚tungiasis的全国流行率和危险因素。
IF 8.1 1区 医学 Pub Date : 2023-09-18 DOI: 10.1186/s40249-023-01131-x
Lynne Elson, Christopher Kamau, Sammy Koech, Christopher Muthama, George Gachomba, Erastus Sinoti, Elwyn Chondo, Eliud Mburu, Miriam Wakio, Jimmy Lore, Marta Maia, Ifedayo Adetifa, Benedict Orindi, Phillip Bejon, Ulrike Fillinger

Background: Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans, the female of which burrows into the skin, causing pain and itching. The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens. The tungiasis research community is keen to develop survey methods to fill this gap. Here we used a school-based, thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya.

Methods: We conducted the first nationally representative survey of tungiasis, including nine counties covering the major ecological zones of Kenya. A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school. Pupils were examined thoroughly for tungiasis. Two surveys were conducted, the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors. Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect.

Results: The overall prevalence of tungiasis in the first survey was 1.35% [95% confidence interval (CI): 1.15-1.59%], and 0.89% in the second survey. The prevalence ranged from 0.08% (95% CI: 0.01-0.59%) in Taita Taveta county to 3.24% (95% CI: 2.35-4.44%) in Kajiado county. Tungiasis infection was associated with county of residence, male sex [adjusted odds ratio (aOR) = 2.01, 95% CI: 1.52-2.67], and lower age (aOR = 0.81, 95% CI: 0.75-0.88). For the first time we demonstrate an association with attending public schools rather than private schools (aOR = 5.62, 95% CI: 1.20-26.22) and lower socioeconomic status (aOR = 0.10, 95% CI: 0.03-0.33). Using a rapid screening method of the top of feet only, would have missed 62.9% of all cases, 78.9% of mild cases and 20.0% of severe cases.

Conclusions: Tungiasis is widely but heterogeneously distributed across Kenya. School-based surveys offer an efficient strategy for mapping tungiasis distribution.

背景:Tungiasis是一种被高度忽视的热带皮肤病,由沙跳蚤Tunga penetrans引起,其雌性会钻入皮肤,引起疼痛和瘙痒。这种疾病发生在整个南美洲和撒哈拉以南非洲,但很少有关于国家疾病负担的系统数据。tungiasis研究界热衷于开发调查方法来填补这一空白。在这里,我们使用了一种基于学校的、彻底的检查方法来确定肯尼亚线虫病的流行率和风险因素。方法:我们进行了第一次具有全国代表性的线虫病调查,包括肯尼亚主要生态区的九个县。采用分层多阶段随机抽样的方法,从九个县中的每一个县选出22所小学,并在每所学校选出多达114名8至14岁的学生。对小学生进行了彻底的甲状腺肿检查。进行了两次调查,第一次是在2021年5月至7月,第二次是在2020年10月至2023年4月,学生们也接受了风险因素的采访。使用混合效应逻辑回归模型,以学校为随机效应,检验自变量与tungiasis的相关性。结果:第一次调查中的甲状腺肿总患病率为1.35%[95%置信区间(CI):1.15-1.59%],第二次调查中为0.89%。患病率从Taita Taveta县的0.08%(95%CI:0.01-0.59%)到Kajiado县的3.24%(95%CI:2.35-4.44%)不等。Tungiasis感染与居住县、男性相关[调整比值比(aOR)] = 2.01,95%CI:1.52-2.67],年龄较低(aOR = 0.81,95%可信区间:0.75-0.88)。我们首次证明了与上公立学校而非私立学校的关系(aOR = 5.62,95%CI:1.20-26.22)和较低的社会经济地位(aOR = 0.10,95%CI:0.03-0.33)。仅使用脚尖快速筛查方法,将遗漏62.9%的所有病例、78.9%的轻度病例和20.0%的重度病例。结论:Tungiasis在肯尼亚分布广泛但不均匀。基于学校的调查提供了一种绘制隧道分布图的有效策略。
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引用次数: 0
Prevalence and factors associated with pentavalent vaccination: a cross-sectional study in Southern China. 华南地区五价疫苗的流行及相关因素:一项横断面研究。
IF 8.1 1区 医学 Pub Date : 2023-09-15 DOI: 10.1186/s40249-023-01134-8
Jianing Xu, Yujie Cui, Chuican Huang, Yuanyuan Dong, Yunting Zhang, Lichun Fan, Guohong Li, Fan Jiang

Background: Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives. A complex immunization schedule, however, may be burdensome to parents and lead to reduced vaccine compliance and completion. Thus, it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule. This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B conjugate (DTaP-IPV/Hib) vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations.

Methods: A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023. The study employed a stratified multistage cluster random sampling method. Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire. Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations.

Results: Of the 4818 valid responses, 95.3% of children were aged 3-4 years, and 2856 (59.3%) held rural hukou. Coverage rates of the DTaP-IPV/Hib vaccine, from 1 to 4 doses, were 24.4%, 20.7%, 18.5%, and 16.0%, respectively. Caregivers who are concerned about vaccine efficacy [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI): 1.30-1.79], the manufacturer (aOR = 2.05, 95% CI: 1.69-2.49), and a simple immunization schedule (aOR = 1.26, 95% CI: 1.04-1.54) are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib. In addition, caregivers in urban areas showed more concern about the vaccine price (P = 0.010) and immunization schedule (P = 0.022) in regard to vaccinating children.

Conclusions: The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low. Factors such as lower socioeconomic status, cultural beliefs, concerns about vaccine safety, and cost may hinder caregivers from vaccinating their children. Further measures, such as health education campaigns to raise knowledge and awareness, and encouragement of domestic vaccine innovation, which would reduce out-of-pocket costs, could be implemented to improve the coverage of DTap-IPV/Hib vaccination.

背景:免疫接种是促进健康和拯救生命的最具深远意义和成本效益的战略之一。然而,复杂的免疫计划可能会给家长带来负担,并导致疫苗接种的依从性和完成率降低。因此,开发联合疫苗以减少注射次数和简化免疫计划是至关重要的。本研究旨在调查中国南方地区白喉-破伤风-无细胞百日咳灭活脊髓灰质炎和B型流感嗜血杆菌(DTaP-IPV/Hib)五价疫苗接种的现状,探讨普通人群中与接种相关的因素以及城乡人群之间的差异。方法:对海南省2022年12月至2023年1月新入园的幼儿园学生进行横断面研究。本研究采用分层多阶段整群随机抽样方法。通过在线问卷从儿童照顾者那里收集了有关人口特征和影响决策因素的信息。采用多因素logistic回归来确定与DTap-IPV/Hib疫苗接种状况相关的因素。结果:4818份有效问卷中,3 ~ 4岁儿童占95.3%,其中农村户口儿童2856名,占59.3%。1至4剂DTaP-IPV/Hib疫苗的接种率分别为24.4%、20.7%、18.5%和16.0%。关心疫苗效力的护理人员[调整优势比(aOR) = 1.53, 95%可信区间(CI): 1.30-1.79]、制造商(aOR = 2.05, 95% CI: 1.69-2.49)和简单的免疫计划(aOR = 1.26, 95% CI: 1.04-1.54)是提高儿童接种ddap - ipv /Hib疫苗可能性的相关因素。此外,城市照料者对儿童接种疫苗更关注疫苗价格(P = 0.010)和免疫计划(P = 0.022)。结论:海南省DTaP-IPV/Hib疫苗接种率仍然较低。诸如较低的社会经济地位、文化信仰、对疫苗安全性的担忧和成本等因素可能阻碍照顾者为其儿童接种疫苗。可以采取进一步的措施,例如开展卫生教育运动以提高知识和认识,并鼓励国内疫苗创新,从而减少自付费用,以提高百白破- ipv /Hib疫苗接种的覆盖率。
{"title":"Prevalence and factors associated with pentavalent vaccination: a cross-sectional study in Southern China.","authors":"Jianing Xu, Yujie Cui, Chuican Huang, Yuanyuan Dong, Yunting Zhang, Lichun Fan, Guohong Li, Fan Jiang","doi":"10.1186/s40249-023-01134-8","DOIUrl":"10.1186/s40249-023-01134-8","url":null,"abstract":"<p><strong>Background: </strong>Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives. A complex immunization schedule, however, may be burdensome to parents and lead to reduced vaccine compliance and completion. Thus, it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule. This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis and Haemophilus influenzae type B conjugate (DTaP-IPV/Hib) vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023. The study employed a stratified multistage cluster random sampling method. Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire. Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations.</p><p><strong>Results: </strong>Of the 4818 valid responses, 95.3% of children were aged 3-4 years, and 2856 (59.3%) held rural hukou. Coverage rates of the DTaP-IPV/Hib vaccine, from 1 to 4 doses, were 24.4%, 20.7%, 18.5%, and 16.0%, respectively. Caregivers who are concerned about vaccine efficacy [adjusted odds ratio (aOR) = 1.53, 95% confidence interval (CI): 1.30-1.79], the manufacturer (aOR = 2.05, 95% CI: 1.69-2.49), and a simple immunization schedule (aOR = 1.26, 95% CI: 1.04-1.54) are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib. In addition, caregivers in urban areas showed more concern about the vaccine price (P = 0.010) and immunization schedule (P = 0.022) in regard to vaccinating children.</p><p><strong>Conclusions: </strong>The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low. Factors such as lower socioeconomic status, cultural beliefs, concerns about vaccine safety, and cost may hinder caregivers from vaccinating their children. Further measures, such as health education campaigns to raise knowledge and awareness, and encouragement of domestic vaccine innovation, which would reduce out-of-pocket costs, could be implemented to improve the coverage of DTap-IPV/Hib vaccination.</p>","PeriodicalId":48820,"journal":{"name":"Infectious Diseases of Poverty","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10502987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10285401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevalence of Strongyloides in Southeast Asia: a systematic review and meta-analysis with implications for public health and sustainable control strategies. 东南亚类圆线虫流行:对公共卫生和可持续控制策略影响的系统回顾和荟萃分析
IF 8.1 1区 医学 Pub Date : 2023-09-13 DOI: 10.1186/s40249-023-01138-4
Abigail Hui En Chan, Teera Kusolsuk, Dorn Watthanakulpanich, Wallop Pakdee, Pham Ngoc Doanh, Azlin Mohd Yasin, Paron Dekumyoy, Urusa Thaenkham

Background: Strongyloidiasis, caused by the nematodes Strongyloides stercoralis and Strongyloides fuelleborni, is estimated to affect over 600 million individuals worldwide. The disease is endemic in Southeast Asia, where a warm-humid climate and socio-economic conditions maintain the parasite's life cycle and transmission. However, the current diagnostic methods may not be sufficiently sensitive, suggesting that the true prevalence of strongyloidiasis could be seriously underestimated in this. This study aims to determine the prevalence of strongyloidiasis in Southeast Asia through a systematic review and meta-analysis and to discuss the implications of the estimated prevalence on diagnostic approaches and control strategies.

Methods: Following PRISMA guidelines, we conducted a systematic literature search in PubMed and Google Scholar databases to identify studies reporting Strongyloides prevalence data in the 11 Southeast Asian countries up to December 2022. A random effects model was employed to estimate the pooled prevalence of S. stercoralis at both regional and country levels.

Results: Out of 3722 articles identified, 224 met our inclusion criteria. For S. stercoralis specifically, we found 187 articles, of which 52.4% were from Thailand. All Southeast Asian countries, except Brunei, had at least one study on Strongyloides prevalence. The estimated pooled prevalence of S. stercoralis regionally was 12.7% (95% CI 10.70-14.80%), ranging from 0.4 to 24.9% at the country level. Cambodia had the highest pooled prevalence (24.9%, 95% CI 15.65-35.38%), followed by Lao PDR (16.5%, 95% CI 9.50-24.95%). Moreover, we obtained a pooled prevalence of 10% (95% CI 7.06-13.52%) in a group comprising immigrants, workers, and veterans from Southeast Asian countries. S. stercoralis infects various host types, including nonhuman primates, domestic dogs and cats, rodents, and transport carriers such as cockroaches and vegetables.

Conclusions: A high prevalence of strongyloidiasis in Southeast Asia was revealed, highlighting the importance of the region's ongoing research, surveillance, and control efforts. Factors contributing to the strongyloidiasis transmission include the role of animal hosts, the impact of global connectivity, and the significance of the co-endemicity of other Strongyloides species. Based on these findings, a multi-pronged One-Health approach is essential for sustainable intervention and control.

背景:由粪类圆线虫和燃料类圆线虫引起的类圆线虫病,估计影响全世界超过6亿人。该病在东南亚流行,那里温暖潮湿的气候和社会经济条件维持了寄生虫的生命周期和传播。然而,目前的诊断方法可能不够敏感,这表明在这方面可能严重低估了圆线虫病的真实患病率。本研究旨在通过系统回顾和荟萃分析来确定圆线虫病在东南亚的患病率,并讨论估计患病率对诊断方法和控制策略的影响。方法:根据PRISMA指南,我们在PubMed和谷歌Scholar数据库中进行了系统的文献检索,以确定截至2022年12月11个东南亚国家中报告类圆线虫流行数据的研究。采用随机效应模型估计区域和国家水平的粪球菌总流行率。结果:在纳入的3722篇文章中,224篇符合纳入标准。针对粪球菌,共发现187篇,其中52.4%来自泰国。除文莱外,所有东南亚国家都至少有一项关于类圆线虫流行率的研究。估计粪虫的区域总流行率为12.7% (95% CI 10.70-14.80%),在国家一级的范围为0.4%至24.9%。柬埔寨的总患病率最高(24.9%,95% CI 15.65-35.38%),其次是老挝人民民主共和国(16.5%,95% CI 9.50-24.95%)。此外,我们在东南亚国家的移民、工人和退伍军人中获得了10%的总患病率(95% CI 7.06-13.52%)。粪球菌感染各种宿主类型,包括非人灵长类动物、家养狗和猫、啮齿动物和运输载体,如蟑螂和蔬菜。结论:东南亚的类圆线虫病流行率很高,强调了该地区正在进行的研究、监测和控制工作的重要性。导致类圆线虫病传播的因素包括动物宿主的作用、全球连通性的影响以及其他类圆线虫物种共同流行的重要性。基于这些发现,多管齐下的“一个健康”方法对于可持续的干预和控制至关重要。
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引用次数: 0
Impact factors of Blastocystis hominis infection in persons living with human immunodeficiency virus: a large-scale, multi-center observational study from China. 人类免疫缺陷病毒感染者人胚囊虫感染的影响因素:一项来自中国的大规模、多中心观察性研究
IF 8.1 1区 医学 Pub Date : 2023-09-11 DOI: 10.1186/s40249-023-01137-5
Shun-Xian Zhang, Ji-Chun Wang, Zhong-Wei Li, Jin-Xin Zheng, Wen-Ting Zhou, Guo-Bing Yang, Ying-Fang Yu, Xiu-Ping Wu, Shan Lv, Qin Liu, Mu-Xin Chen, Yan Lu, Zhi-Hui Dou, Da-Wei Zhang, Wen-Wen Lv, Lei Wang, Zhen-Hui Lu, Ming Yang, Pei-Yong Zheng, Yue-Lai Chen, Li-Guang Tian, Xiao-Nong Zhou

Background: Blastocystis hominis (Bh) is zoonotic parasitic pathogen with a high prevalent globally, causing opportunistic infections and diarrhea disease. Human immunodeficiency virus (HIV) infection disrupts the immune system by depleting CD4+ T lymphocyte (CD4+ T) cell counts, thereby increasing Bh infection risk among persons living with HIV (PLWH). However, the precise association between Bh infection risk and HIV-related biological markers and treatment processes remains poorly understood. Hence, the purpose of the study was to explore the association between Bh infection risk and CD4+ T cell counts, HIV viral load (VL), and duration of interruption in antiviral therapy among PLWH.

Methods: A large-scale multi-center cross-sectional study was conducted in China from June 2020 to December 2022. The genetic presence of Bh in fecal samples was detected by real-time fluorescence quantitative polymerase chain reaction, the CD4+ T cell counts in venous blood was measured using flowcytometry, and the HIV VL in serum was quantified using fluorescence-based instruments. Restricted cubic spline (RCS) was applied to assess the non-linear association between Bh infection risk and CD4+ T cell counts, HIV VL, and duration of interruption in highly active antiretroviral therapy (HARRT).

Results: A total of 1245 PLWH were enrolled in the study, the average age of PLWH was 43 years [interquartile range (IQR): 33, 52], with 452 (36.3%) being female, 50.4% (n = 628) had no immunosuppression (CD4+ T cell counts > 500 cells/μl), and 78.1% (n = 972) achieved full virological suppression (HIV VL < 50 copies/ml). Approximately 10.5% (n = 131) of PLWH had interruption. The prevalence of Bh was found to be 4.9% [95% confidence interval (CI): 3.8-6.4%] among PLWH. Significant nonlinear associations were observed between the Bh infection risk and CD4+ T cell counts (Pfor nonlinearity < 0.001, L-shaped), HIV VL (Pfor nonlinearity < 0.001, inverted U-shaped), and duration of interruption in HARRT (Pfor nonlinearity < 0.001, inverted U-shaped).

Conclusions: The study revealed that VL was a better predictor of Bh infection than CD4+ T cell counts. It is crucial to consider the simultaneous surveillance of HIV VL and CD4+ T cell counts in PLWH in the regions with high level of socioeconomic development. The integrated approach can offer more comprehensive and accurate understanding in the aspects of Bh infection and other opportunistic infections, the efficacy of therapeutic drugs, and the assessment of preventive and control strategies.

背景:人芽囊虫(Blastocystis hominis, Bh)是一种全球高发的人畜共患寄生虫病原体,可引起机会性感染和腹泻病。人类免疫缺陷病毒(HIV)感染通过消耗CD4+ T淋巴细胞(CD4+ T)计数破坏免疫系统,从而增加HIV感染者(PLWH)感染Bh的风险。然而,hiv感染风险与hiv相关生物标志物和治疗过程之间的确切关联仍然知之甚少。因此,本研究的目的是探讨HIV感染风险与PLWH中CD4+ T细胞计数、HIV病毒载量(VL)和抗病毒治疗中断时间之间的关系。方法:于2020年6月至2022年12月在中国进行大规模多中心横断面研究。采用实时荧光定量聚合酶链反应检测粪便样品中Bh的遗传存在,采用流式细胞术检测静脉血中CD4+ T细胞计数,采用荧光仪器定量血清中HIV VL。应用限制性三次样条(RCS)来评估Bh感染风险与CD4+ T细胞计数、HIV VL和高活性抗逆转录病毒治疗(HARRT)中断时间之间的非线性关系。结果:共有1245个PLWH登记在这项研究中,PLWH的平均年龄是43年(四分位范围(差):33岁,52),452(36.3%)是女性,50.4% (n = 628)没有免疫抑制CD4 + T细胞计数(> 500细胞/μl),和78.1% (n = 972)取得了圆满病毒学抑制(艾滋病毒六世+ T细胞计数(Pfor非线性对非线性非线性结论:这项研究表明,重要的是一个更好的预测黑洞感染的CD4 + T细胞计数。在社会经济发展水平较高的地区,考虑同时监测PLWH中的HIV VL和CD4+ T细胞计数是至关重要的。综合方法可以在Bh感染及其他机会性感染、治疗药物疗效、防控策略评价等方面提供更全面、准确的认识。
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引用次数: 1
High efficacy of chlorfenapyr-based net Interceptor® G2 against pyrethroid-resistant malaria vectors from Cameroon. 基于氯虫腈的净拦截器®G2对喀麦隆拟除虫菊酯耐药疟疾媒介的高效防治
IF 8.1 1区 医学 Pub Date : 2023-08-29 DOI: 10.1186/s40249-023-01132-w
Magellan Tchouakui, Riccado F Thiomela, Elysee Nchoutpouen, Benjamin D Menze, Cyrille Ndo, Dorothy Achu, Raymond N Tabue, Flobert Njiokou, Ateba Joel, Charles S Wondji
<p><strong>Background: </strong>The increasing reports of resistance to pyrethroid insecticides associated with reduced efficacy of pyrethroid-only interventions highlight the urgency of introducing new non-pyrethroid-only control tools. Here, we investigated the performance of piperonyl-butoxide (PBO)-pyrethroid [Permanet 3.0 (P3.0)] and dual active ingredients (AI) nets [Interceptor G2 (IG2): containing pyrethroids and chlorfenapyr and Royal Guard (RG): containing pyrethroids and pyriproxyfen] compared to pyrethroid-only net Royal Sentry (RS) against pyrethroid-resistant malaria vectors in Cameroon.</p><p><strong>Methods: </strong>The efficacy of these tools was firstly evaluated on Anopheles gambiae s.l. and Anopheles funestus s.l. from Gounougou, Mibellon, Mangoum, Nkolondom, and Elende using cone/tunnel assays. In addition, experimental hut trials (EHT) were performed to evaluate the performance of unwashed and 20 times washed nets in semi-field conditions. Furthermore, pyrethroid-resistant markers were genotyped in dead vs alive, blood-fed vs unfed mosquitoes after exposure to the nets to evaluate the impact of these markers on net performance. The XLSTAT software was used to calculate the various entomological outcomes and the Chi-square test was used to compare the efficacy of various nets. The odds ratio and Fisher exact test were then used to establish the statistical significance of any association between insecticide resistance markers and bed net efficacy.</p><p><strong>Results: </strong>Interceptor G2 was the most effective net against wild pyrethroid-resistant An. funestus followed by Permanet 3.0. In EHT, this net induced up to 87.8% mortality [95% confidence interval (CI): 83.5-92.1%) and 55.6% (95% CI: 48.5-62.7%) after 20 washes whilst unwashed pyrethroid-only net (Royal Sentry) killed just 18.2% (95% CI: 13.4-22.9%) of host-seeking An. funestus. The unwashed Permanet 3.0 killed up to 53.8% (95% CI: 44.3-63.4%) of field-resistant mosquitoes and 47.2% (95% CI: 37.7-56.7%) when washed 20 times, and the Royal Guard 13.2% (95% CI: 9.0-17.3%) for unwashed net and 8.5% (95% CI: 5.7-11.4%) for the 20 washed net. Interceptor G2, Permanet 3.0, and Royal Guard provided better personal protection (blood-feeding inhibition 66.2%, 77.8%, and 92.8%, respectively) compared to pyrethroid-only net Royal Sentry (8.4%). Interestingly, a negative association was found between kdrw and the chlorfenapyr-based net Interceptor G2 (χ<sup>2</sup> = 138; P < 0.0001) with homozygote-resistant mosquitoes predominantly found in the dead ones.</p><p><strong>Conclusions: </strong>The high mortality recorded with Interceptor G2 against pyrethroid-resistant malaria vectors in this study provides first semi-field evidence of high efficacy against these major malaria vectors in Cameroon encouraging the implementation of this novel net for malaria control in the country. However, the performance of this net should be established in other locations and on other maj
背景:越来越多的报告显示,对拟除虫菊酯类杀虫剂的抗药性与仅限拟除虫菊酯干预措施的效果下降有关,这突出了引入新的非仅限拟除虫菊酯控制工具的紧迫性。本研究比较了胡椒酰丁醇(PBO)-拟除虫菊酯类杀虫剂[Permanet 3.0 (P3.0)]和双活性成分(AI)蚊帐[Interceptor G2 (IG2):含拟除虫菊酯类杀虫剂和氯虫腈;Royal Guard (RG):含拟除虫菊酯类杀虫剂和吡虫腈]与纯拟除虫菊酯类杀虫剂Royal Sentry (RS)蚊帐在喀麦隆对拟除虫菊酯类杀虫剂耐药疟疾媒介的效果。方法:采用锥形/隧道法,首先评价这些工具对来自Gounougou、Mibellon、Mangoum、Nkolondom和Elende的冈比亚按蚊和funestus按蚊的杀灭效果。此外,还进行了实验小屋试验(EHT),以评估未洗网和20次洗网在半田条件下的性能。此外,对接触蚊帐后的死蚊与活蚊、吸血蚊与未吸血蚊进行基因分型,以评估这些标记对蚊帐性能的影响。采用XLSTAT软件计算各项昆虫学结果,采用卡方检验比较各种蚊帐的功效。然后使用优势比和Fisher精确检验来确定杀虫剂抗性标记与蚊帐功效之间的任何关联的统计学意义。结果:拦截剂G2对野生拟除虫菊酯类杀虫剂抗药性的效果最好。funestus其次是Permanet 3.0。在EHT中,清洗20次后,该蚊帐的死亡率高达87.8%[95%置信区间(CI): 83.5-92.1%)和55.6% (95% CI: 48.5-62.7%),而未清洗的纯拟除虫菊酯蚊帐(Royal Sentry)仅杀死18.2% (95% CI: 13.4-22.9%)的寻找宿主的安。funestus。未洗净的Permanet 3.0对田间抗性蚊子的杀灭率为53.8% (95% CI: 44.3-63.4%),水洗20次杀灭率为47.2% (95% CI: 37.7-56.7%),皇家卫士未洗净的蚊帐杀灭率为13.2% (95% CI: 9.0-17.3%),水洗20次的蚊帐杀灭率为8.5% (95% CI: 5.7-11.4%)。Interceptor G2、Permanet 3.0和Royal Guard提供了更好的个人保护(分别为66.2%、77.8%和92.8%),而纯拟除虫菊酯的净Royal Sentry(8.4%)。有趣的是,kdrw与基于氯虫腈的净拦截剂G2呈负相关(χ2 = 138;结论:在本研究中,拦截器G2对拟除虫菊酯抗性疟疾媒介的高死亡率记录为喀麦隆对这些主要疟疾媒介的高效防治提供了第一个半现场证据,鼓励在该国实施这种新型疟疾控制网。但是,在大规模实施之前,应在其他地点和其他主要疟疾病媒确定这一蚊帐的效果。
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Infectious Diseases of Poverty
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