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Effectiveness of test-and-treat model with direct-acting antiviral for hepatitis C virus infection in migrants: a prospective interventional study in Italy. 针对移民丙型肝炎病毒感染的直接作用抗病毒药物试验-治疗模式的有效性:意大利前瞻性干预研究。
IF 8.1 1区 医学 Pub Date : 2024-05-28 DOI: 10.1186/s40249-024-01200-9
Nicola Coppola, Loredana Alessio, Stefania De Pascalis, Margherita Macera, Giovanni Di Caprio, Vincenzo Messina, Lorenzo Onorato, Carmine Minichini, Maria Stanzione, Gianfranca Stornaiuolo, Mario Starace, Caterina Monari, Federica Calò, Caterina Sagnelli, Mariantonietta Pisaturo

Background: Migrants, mainly undocumented and low-income refugees, are at high risk of hepatitis C virus (HCV) infection, but are a difficult-to-reach and to-treat population. The aim of the study was to evaluate the effectiveness of a test and treat model with direct-acting antiviral for HCV infection in these migrants coming from low-income and living in southern Italy.

Methods: A prospective, multicenter, collaborative study based on a four-phase-program (educational counseling, screening, linkage-to-care and treatment) was designed in southern Italy; the study started in June 2018, was stopped in February 2020 because of the outbreak of SARS-CoV2 infection in Italy and was resumed in February 2021 until November 2021. After educational counseling on infectious diseases that are transmitted through blood or sexually pseudonymized HCV screening was offered to all undocumented migrants and low-income refugees observed at one of the 1st level clinical centers. The HCV-RNA-positive subjects were referred to one of the 3rd level units of Infectious Diseases (ID) and treated with a 12-week course of sofosbuvir-velpatasvir and observed for 12 weeks after the end of direct antiviral agents (DAA) treatment.

Statistical analysis: For the descriptive analysis, the categorical variables were reported as absolute numbers and relative frequencies. Continuous variables were summarized as mean and standard deviation (SD) if normally distributed, or as a median and interquartile range (IQR) if not normally distributed. We used Pearson chi-square or Fisher's exact test for categorical variables and Student's t test or Mann-Whitney test for continuous variables. A P value < 0.05 was considered to be statistically significant. Analyses were performed with SPSS 21.0.

Results: Of the 3501migrants observed in the study period, 3417 (97.6%) agreed to be screened; 185 (4.7%) were anti-HCV-positive and, of these, 53 (28.6%) were HCV-RNA-positive. Of these 53 subjects, 48 (90.5%) were referred to an ID unit and started DAA treatment. The HCV-RNA-positive-subjects were older [median 36 years (IQR: 32-21) vs 27.19 (IQR: 30.5-19.25); P = 0.001], and less frequently males [35 (66.03 %) vs 119 (90.1%), P < 0 .0001] than seronegative participants. They more frequently came from Eastern Europe (70.8%) stayed longer in Italy [months of stay in Italy, mean ± SD: 51.02 ± 52.84 vs 25.7 ± 42.65, P = 0.001], and had more years of schooling [years of schooling, mean ± SD: 9.61±2.81 vs 7.10 ± 4, P = 0.0001]. HCV-RNA-positive-subjects less frequently reported piercing, tattoos and tribal scars as risk factors (23.6%). Of these 48 HCV RNA positive subjects who started DAA, 47 (97.9%) showed a sustained virological response and one dropped-out in follow-up after DAA treatment. No subject had any adverse event.

Conclusions: This model of HCV screening and linkage to care seems e

背景:移民(主要是无证移民和低收入难民)是丙型肝炎病毒(HCV)感染的高危人群,但却是难以接触和治疗的人群。该研究旨在评估直接作用抗病毒药物检测和治疗模式对这些来自意大利南部低收入地区的移民感染丙型肝炎病毒的有效性:在意大利南部设计了一项基于四阶段计划(教育咨询、筛查、链接到护理和治疗)的前瞻性多中心合作研究;该研究于2018年6月启动,因意大利爆发SARS-CoV2感染而于2020年2月停止,并于2021年2月恢复至2021年11月。在对通过血液或性行为传播的传染病进行教育咨询后,在一家一级临床中心观察到的所有无证移民和低收入难民都接受了化名 HCV 筛查。HCV-RNA阳性受试者被转诊到传染病(ID)三级单位之一,接受为期12周的索非布韦-韦帕他韦治疗,并在直接抗病毒药物(DAA)治疗结束后观察12周:在描述性分析中,分类变量以绝对数和相对频率表示。连续变量如果呈正态分布,则以平均值和标准差(SD)表示;如果不呈正态分布,则以中位数和四分位数间距(IQR)表示。对于分类变量,我们采用皮尔逊卡方检验或费雪精确检验;对于连续变量,我们采用学生 t 检验或曼-惠尼检验。A P 值 结果:在研究期间观察到的 3501 名移民中,有 3417 人(97.6%)同意接受筛查;185 人(4.7%)为抗-HCV 阳性,其中 53 人(28.6%)为 HCV-RNA 阳性。在这 53 名受试者中,48 人(90.5%)被转诊至 ID 部门并开始接受 DAA 治疗。与血清阴性受试者相比,HCV-RNA 阳性受试者年龄更大[中位数为 36 岁(IQR:32-21) vs 27.19 岁(IQR:30.5-19.25);P = 0.001],男性更少[35 人(66.03%) vs 119 人(90.1%),P < 0.0001]。他们更多来自东欧(70.8%),在意大利逗留的时间更长[在意大利逗留的月数,平均±标准差:51.02±52.84 vs 25.7±42.65,P = 0.001],受教育年限更长[受教育年限,平均±标准差:9.61±2.81 vs 7.10±4,P = 0.0001]。HCV-RNA阳性受试者较少报告穿孔、纹身和部落疤痕是风险因素(23.6%)。在开始接受DAA治疗的48名HCV RNA阳性受试者中,47人(97.9%)出现了持续的病毒学应答,1人在DAA治疗后的随访中退出。没有受试者出现任何不良反应:结论:这种 HCV 筛查和联系治疗模式似乎能有效消除难以接触和治疗人群(如无证移民和低收入难民)的 HCV 感染。文化调解人参与这项研究,使移民与医生之间有了更好的互动,这一点从大量受试者的登记中可以看出。从公共卫生和医疗保健的角度来看,消除移民中的丙型肝炎病毒将产生长期的积极影响,因为这将减少可能患上丙型肝炎病毒相关并发症(如肝硬化和肝细胞癌)的人数,并减少丙型肝炎病毒在移民所在地区的传播,而这些地区(如意大利)往往是丙型肝炎病毒感染的低流行区。
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引用次数: 0
Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review. 气候变化对西尼罗河病毒全球循环的影响及适应对策:范围审查。
IF 8.1 1区 医学 Pub Date : 2024-05-24 DOI: 10.1186/s40249-024-01207-2
Hao-Ran Wang, Tao Liu, Xiang Gao, Hong-Bin Wang, Jian-Hua Xiao

Background: West Nile virus (WNV), the most widely distributed flavivirus causing encephalitis globally, is a vector-borne pathogen of global importance. The changing climate is poised to reshape the landscape of various infectious diseases, particularly vector-borne ones like WNV. Understanding the anticipated geographical and range shifts in disease transmission due to climate change, alongside effective adaptation strategies, is critical for mitigating future public health impacts. This scoping review aims to consolidate evidence on the impact of climate change on WNV and to identify a spectrum of applicable adaptation strategies.

Main body: We systematically analyzed research articles from PubMed, Web of Science, Scopus, and EBSCOhost. Our criteria included English-language research articles published between 2007 and 2023, focusing on the impacts of climate change on WNV and related adaptation strategies. We extracted data concerning study objectives, populations, geographical focus, and specific findings. Literature was categorized into two primary themes: 1) climate-WNV associations, and 2) climate change impacts on WNV transmission, providing a clear understanding. Out of 2168 articles reviewed, 120 met our criteria. Most evidence originated from North America (59.2%) and Europe (28.3%), with a primary focus on human cases (31.7%). Studies on climate-WNV correlations (n = 83) highlighted temperature (67.5%) as a pivotal climate factor. In the analysis of climate change impacts on WNV (n = 37), most evidence suggested that climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Although few studies directly addressed the implementation of adaptation strategies for climate-induced disease transmission, the proposed strategies (n = 49) fell into six categories: 1) surveillance and monitoring (38.8%), 2) predictive modeling (18.4%), 3) cross-disciplinary collaboration (16.3%), 4) environmental management (12.2%), 5) public education (8.2%), and 6) health system readiness (6.1%). Additionally, we developed an accessible online platform to summarize the evidence on climate change impacts on WNV transmission ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

Conclusions: This review reveals that climate change may affect the transmission and distribution of WNV, but the literature reflects only a small share of the global WNV dynamics. There is an urgent need for adaptive responses to anticipate and respond to the climate-driven spread of WNV. Nevertheless, studies focusing on these adaptation responses are sparse compared to those examining the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, along with more comprehensive evidence synthesis, is needed to inform effective policy responses tailored to local cont

背景:西尼罗河病毒(WNV)是全球分布最广的黄病毒,可引起脑炎,是一种具有全球重要性的病媒传播病原体。不断变化的气候将重塑各种传染病的格局,尤其是像西尼罗河病毒这样的病媒传播疾病。了解气候变化导致疾病传播的预期地理和范围变化以及有效的适应战略,对于减轻未来的公共卫生影响至关重要。本范围综述旨在整合有关气候变化对 WNV 影响的证据,并确定一系列适用的适应策略:我们系统分析了来自 PubMed、Web of Science、Scopus 和 EBSCOhost 的研究文章。我们的标准包括 2007 年至 2023 年间发表的英文研究文章,重点关注气候变化对 WNV 的影响以及相关的适应策略。我们提取了有关研究目标、研究人群、地域重点和具体发现的数据。文献主要分为两个主题:1)气候与 WNV 的关联;2)气候变化对 WNV 传播的影响。在2168篇被审查的文章中,有120篇符合我们的标准。大多数证据来自北美(59.2%)和欧洲(28.3%),主要关注人类病例(31.7%)。关于气候与 WNV 相关性的研究(n = 83)强调温度(67.5%)是关键的气候因素。在分析气候变化对 WNV 的影响时(n = 37),大多数证据表明,气候变化可能会影响 WNV 的传播和分布,影响程度取决于当地和区域条件。尽管很少有研究直接涉及针对气候引起的疾病传播实施适应策略,但提出的策略(n = 49)可分为六类:1)监视和监测(38.8%);2)预测建模(18.4%);3)跨学科合作(16.3%);4)环境管理(12.2%);5)公众教育(8.2%);6)卫生系统准备(6.1%)。此外,我们还开发了一个可访问的在线平台,以总结气候变化对 WNV 传播影响的证据 ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ )。结论:本综述显示,气候变化可能会影响 WNV 的传播和分布,但文献仅反映了全球 WNV 动态的一小部分。目前迫切需要采取适应性应对措施,以预测和应对由气候驱动的 WNV 传播。然而,与研究气候变化影响的研究相比,关注这些适应性应对措施的研究还很少。需要进一步研究气候变化的影响和病媒传播疾病的适应策略,并进行更全面的证据综合,以便为因地制宜的有效对策提供信息。
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引用次数: 0
Geography and health: role of human translocation and access to care. 地理与健康:人类迁移和获得医疗服务的作用。
IF 8.1 1区 医学 Pub Date : 2024-05-23 DOI: 10.1186/s40249-024-01205-4
Norbert Brattig, Robert Bergquist, Danielle Vienneau, Xiao-Nong Zhou

Natural, geographical barriers have historically limited the spread of communicable diseases. This is no longer the case in today's interconnected world, paired with its unprecedented environmental and climate change, emphasising the intersection of evolutionary biology, epidemiology and geography (i.e. biogeography). A total of 14 articles of the special issue entitled "Geography and health: role of human translocation and access to care" document enhanced disease transmission of diseases, such as malaria, leishmaniasis, schistosomiasis, COVID-19 (Severe acute respiratory syndrome corona 2) and Oropouche fever in spite of spatiotemporal surveillance. High-resolution satellite images can be used to understand spatial distributions of transmission risks and disease spread and to highlight the major avenue increasing the incidence and geographic range of zoonoses represented by spill-over transmission of coronaviruses from bats to pigs or civets. Climate change and globalization have increased the spread and establishment of invasive mosquitoes in non-tropical areas leading to emerging outbreaks of infections warranting improved physical, chemical and biological vector control strategies. The translocation of pathogens and their vectors is closely connected with human mobility, migration and the global transport of goods. Other contributing factors are deforestation with urbanization encroaching into wildlife zones. The destruction of natural ecosystems, coupled with low income and socioeconomic status, increase transmission probability of neglected tropical and zoonotic diseases. The articles in this special issue document emerging or re-emerging diseases and surveillance of fever symptoms. Health equity is intricately connected to accessibility to health care and the targeting of healthcare resources, necessitating a spatial approach. Public health comprises successful disease management integrating spatial surveillance systems, including access to sanitation facilities. Antimicrobial resistance caused, e.g. by increased use of antibiotics in health, agriculture and aquaculture, or acquisition of resistance genes, can be spread by horizontal gene transfer. This editorial reviews the key findings of this 14-article special issue, identifies important gaps relevant to our interconnected world and makes a number of specific recommendations to mitigate the transmission risks of infectious diseases in the post-COVID-19 pandemic era.

历史上,自然和地理障碍限制了传染病的传播。在当今这个相互联系的世界中,这种情况已不复存在,再加上前所未有的环境和气候变化,强调了进化生物学、流行病学和地理学(即生物地理学)之间的交叉。在题为 "地理与健康:人类迁移的作用和获得护理的机会 "的特刊中,共有 14 篇文章记录了疟疾、利什曼病、血吸虫病、COVID-19(严重急性呼吸系统综合征冠状病毒 2)和奥罗普切热等疾病的传播,尽管有时空监测。高分辨率卫星图像可用于了解传播风险和疾病传播的空间分布情况,并强调冠状病毒从蝙蝠向猪或果子狸的溢出传播是增加人畜共患病发病率和地理范围的主要途径。气候变化和全球化加剧了入侵蚊虫在非热带地区的传播和定居,导致新出现的传染病爆发,需要改进物理、化学和生物病媒控制策略。病原体及其病媒的转移与人类的流动、迁移和全球货物运输密切相关。其他促成因素包括森林砍伐和城市化侵蚀野生动物区。自然生态系统遭到破坏,再加上低收入和社会经济地位低下,增加了被忽视的热带病和人畜共患病的传播几率。本特刊中的文章记录了新出现或再次出现的疾病以及对发热症状的监测。健康公平与医疗保健的可及性和医疗保健资源的针对性密切相关,因此有必要采用空间方法。公共卫生包括整合空间监测系统的成功疾病管理,包括卫生设施的使用。抗生素耐药性是由卫生、农业和水产养殖业中抗生素使用量的增加或耐药性基因的获得等因素造成的,可通过水平基因转移进行传播。这篇社论回顾了本特刊 14 篇文章的主要研究成果,指出了与我们这个相互联系的世界相关的重要差距,并提出了一些具体建议,以降低后 COVID-19 大流行时代的传染病传播风险。
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引用次数: 0
Malaria epidemiology, surveillance and response for elimination in Lao PDR. 老挝人民民主共和国的疟疾流行病学、监测和消除对策。
IF 8.1 1区 医学 Pub Date : 2024-05-23 DOI: 10.1186/s40249-024-01202-7
Chawarat Rotejanaprasert, Vilayvone Malaphone, Mayfong Mayxay, Keobouphaphone Chindavongsa, Virasack Banouvong, Boualam Khamlome, Phoutnalong Vilay, Viengxay Vanisavaeth, Richard J Maude

Background: Lao PDR has made significant progress in malaria control. The National Strategic Plans outline ambitious targets, aiming for the elimination of Plasmodium falciparum and P. vivax malaria from all northern provinces by 2025 and national elimination by 2030. This article presents an overview of malaria epidemiology, surveillance, and response systems in Lao PDR, emphasizing experiences and achievements in transmission reduction.

Methods: Data on surveillance, monitoring and evaluation systems, human resources, infrastructure, and community malaria knowledge during 2010-2020 were systematically gathered from the national program and relevant documents. The collected information was synthesized, and discussions on challenges and future prospects were provided.

Results: Malaria control and elimination activities in Lao PDR were implemented at various levels, with a focus on health facility catchment areas. There has been significant progress in reducing malaria transmission throughout the country. Targeted interventions, such as case management, vector control, and community engagement, using stratification of control interventions by catchment areas have contributed to the decline in malaria cases. In elimination areas, active surveillance strategies, including case and foci investigation, are implemented to identify and stop transmission. The surveillance system has facilitated timely detection and response to malaria cases, enabling these targeted interventions in higher-risk areas.

Conclusions: The malaria surveillance and response system in Lao PDR has played a crucial role in reducing transmission and advancing the country towards elimination. Challenges such as importation, drug resistance, and sustaining support require ongoing efforts. Further strengthening surveillance, improving access to services, and addressing transmission determinants are key areas of focus to achieve malaria elimination and enhance population health in Lao PDR.

背景:老挝人民民主共和国在疟疾控制方面取得了重大进展。国家战略计划列出了雄心勃勃的目标,旨在到 2025 年在北部所有省份消灭恶性疟原虫和间日疟原虫疟疾,到 2030 年在全国消灭疟疾。本文概述了老挝人民民主共和国的疟疾流行病学、监测和应对系统,强调了在减少传播方面的经验和成就:方法:从国家计划和相关文件中系统地收集了2010-2020年期间有关监测、监控和评估系统、人力资源、基础设施和社区疟疾知识的数据。方法:从国家计划和相关文件中系统地收集了 2010-2020 年期间有关监测、监控和评估系统、人力资源、基础设施和社区疟疾知识的数据,并对收集到的信息进行了综合,讨论了挑战和未来前景:老挝人民民主共和国在各级开展了疟疾控制和消除活动,重点是卫生设施集水区。在减少全国疟疾传播方面取得了重大进展。有针对性的干预措施,如病例管理、病媒控制和社区参与,利用按集水区分层的控制干预措施,促进了疟疾病例的减少。在消除疟疾地区,实施了积极的监测战略,包括病例和病灶调查,以确定和阻止传播。监测系统有助于及时发现和应对疟疾病例,从而能够在高风险地区采取有针对性的干预措施:老挝人民民主共和国的疟疾监测和应对系统在减少传播和推动该国实现消灭疟疾目标方面发挥了至关重要的作用。进口、抗药性和持续支持等挑战需要不断努力。进一步加强监测、改善服务获取途径以及解决传播决定因素是老挝人民民主共和国实现消除疟疾和提高人口健康水平的关键重点领域。
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引用次数: 0
Need for operational simplicity and timely disbursal of benefits-a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India. 简化操作和及时发放福利的必要性--对印度肺结核患者直接福利转移计划实施情况的定性探讨。
IF 8.1 1区 医学 Pub Date : 2024-05-23 DOI: 10.1186/s40249-024-01206-3
Malu Mohan, Jeromie W V Thangaraj, Sumit Pandey, G Sri Lakshmi Priya, Sivavallinathan Arunachalam, Rahul Sharma, Hemant Deepak Shewade, B Aishwarya, K Afeeq, Afsana Khatoon, B Gokulvijay, Gude Sireesha, Kavita Chandra, S Nandhakumar, Prince Samuel, C Nanditha Viswanathan, Devika Shanmugasundaram, Raghuram Rao, Manoj V Murhekar, Kathiresan Jeyashree

Background: Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme.

Methods: We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation.

Results: Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization.

Conclusion: The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably.

背景:Ni-kshay Poshan Yojana(NPY)是印度政府于 2018 年推出的一项直接福利转移计划,旨在支持肺结核患者(PwTB)的额外营养需求。我们最近利用随机抽取的印度九个邦的肺结核患者的计划数据,对 NPY 的实施和利用情况进行了全国范围的评估,结果表明,该计划的覆盖率为 70%,福利信贷的中位延迟率较高。我们在 2023 年 1 月至 7 月期间开展了一项定性研究,以了解 NPY 的详细实施过程,并探讨有效实施和利用 NPY 计划的促进因素和障碍:我们采用了基础理论方法,通过多种来源的数据,归纳出对社会现象的理论解释。我们对国家消除结核病计划(NTEP)的国家级、地区级和实地级工作人员以及来自印度 9 个邦 30 个地区的 NPY 受益者进行了 36 次深入访谈,这些访谈是通过理论抽样选出的。通过对一组六次访谈进行归纳编码,形成了一个分析框架,为后续访谈的编码提供了指导。通过不断比较产生了类别和主题,数据收集工作一直持续到理论饱和为止:利益相关者认为 NPY 是一项有益的举措。州政府强有力的政治承诺、NTEP 工作与地区公共医疗保健服务系统的主流化、良好的地理和互联网连接以及各州特有的申诉处理机制和创新被认为是实施的推动因素。然而,复杂、多层次的福利审批程序、获得银行服务方面的困难、福利不足的看法以及国家医疗保险计划人力资源的过度劳累被认为是实施和利用的障碍:结论:强有力的政治承诺使国家养老金计划得到了最佳利用,但其漫长的实施过程和延迟发放福利的做法则使其面临挑战。我们建议在实施 NPY 的过程中简化操作,将 NTEP 活动与公共卫生系统结合起来,以减轻计划工作人员的负担,并更加公平地修订福利金额。
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引用次数: 0
Epidemiological characteristics of tuberculosis incidence and its macro-influence factors in Chinese mainland during 2014-2021. 2014-2021 年中国大陆结核病发病的流行病学特征及其宏观影响因素。
IF 8.1 1区 医学 Pub Date : 2024-05-21 DOI: 10.1186/s40249-024-01203-6
Le-le Deng, Fei Zhao, Zhuo-Wei Li, Wei-Wei Zhang, Guang-Xue He, Xiang Ren
<p><strong>Background: </strong>Tuberculosis (TB) remains a pressing public health issue, posing a significant threat to individuals' well-being and lives. This study delves into the TB incidence in Chinese mainland during 2014-2021, aiming to gain deeper insights into their epidemiological characteristics and explore macro-level factors to enhance control and prevention.</p><p><strong>Methods: </strong>TB incidence data in Chinese mainland from 2014 to 2021 were sourced from the National Notifiable Disease Reporting System (NNDRS). A two-stage distributed lag nonlinear model (DLNM) was constructed to evaluate the lag and non-linearity of daily average temperature (℃, Atemp), average relative humidity (%, ARH), average wind speed (m/s, AWS), sunshine duration (h, SD) and precipitation (mm, PRE) on the TB incidence. A spatial panel data model was used to assess the impact of demographic, medical and health resource, and economic factors on TB incidence.</p><p><strong>Results: </strong>A total of 6,587,439 TB cases were reported in Chinese mainland during 2014-2021, with an average annual incidence rate of 59.17/100,000. The TB incidence decreased from 67.05/100,000 in 2014 to 46.40/100,000 in 2021, notably declining from 2018 to 2021 (APC = -8.87%, 95% CI: -11.97, -6.85%). TB incidence rates were higher among males, farmers, and individuals aged 65 years and older. Spatiotemporal analysis revealed a significant cluster in Xinjiang, Qinghai, and Xizang from March 2017 to June 2019 (RR = 3.94, P < 0.001). From 2014 to 2021, the proportion of etiologically confirmed cases increased from 31.31% to 56.98%, and the time interval from TB onset to diagnosis shortened from 26 days (IQR: 10-56 days) to 19 days (IQR: 7-44 days). Specific meteorological conditions, including low temperature (< 16.69℃), high relative humidity (> 71.73%), low sunshine duration (< 6.18 h) increased the risk of TB incidence, while extreme low wind speed (< 2.79 m/s) decreased the risk. The spatial Durbin model showed positive associations between TB incidence rates and sex ratio (β = 1.98), number of beds in medical and health institutions per 10,000 population (β = 0.90), and total health expenses (β = 0.55). There were negative associations between TB incidence rates and population (β = -1.14), population density (β = -0.19), urbanization rate (β = -0.62), number of medical and health institutions (β = -0.23), and number of health technicians per 10,000 population (β = -0.70).</p><p><strong>Conclusions: </strong>Significant progress has been made in TB control and prevention in China, but challenges persist among some populations and areas. Varied relationships were observed between TB incidence and factors from meteorological, demographic, medical and health resource, and economic aspects. These findings underscore the importance of ongoing efforts to strengthen TB control and implement digital/intelligent surveillance for early risk detection and comprehensive interventions.<
背景:结核病(TB)仍然是一个紧迫的公共卫生问题,对个人的福祉和生命构成重大威胁。本研究对 2014-2021 年中国大陆结核病发病情况进行了深入研究,旨在深入了解其流行病学特征,并探索宏观因素,以加强防控工作:方法:2014 年至 2021 年中国大陆结核病发病率数据来源于国家疫情报告系统(NNDRS)。建立两阶段分布式滞后非线性模型(DLNM),评估日平均气温(℃,Atemp)、平均相对湿度(%,ARH)、平均风速(m/s,AWS)、日照时数(h,SD)和降水量(mm,PRE)对结核病发病率的滞后性和非线性。采用空间面板数据模型评估人口、医疗卫生资源和经济因素对结核病发病率的影响:结果:2014-2021年间,中国大陆共报告肺结核病例6,587,439例,年平均发病率为59.17/100,000。结核病发病率从 2014 年的 67.05/100,000 降至 2021 年的 46.40/100,000,2018 年至 2021 年的发病率明显下降(APC = -8.87%,95% CI:-11.97, -6.85%)。男性、农民和 65 岁及以上人群的结核病发病率较高。时空分析显示,2017 年 3 月至 2019 年 6 月期间,新疆、青海和西藏出现了一个显著的群集(RR = 3.94,P 71.73%),日照时间短(结论:新疆、青海和西藏的结核病发病率较高:中国在结核病防控方面取得了重大进展,但部分人群和地区仍面临挑战。肺结核发病率与气象、人口、医疗卫生资源和经济等因素之间存在不同的关系。这些发现凸显了当前加强结核病控制、实施数字化/智能化监测以实现早期风险检测和综合干预的重要性。
{"title":"Epidemiological characteristics of tuberculosis incidence and its macro-influence factors in Chinese mainland during 2014-2021.","authors":"Le-le Deng, Fei Zhao, Zhuo-Wei Li, Wei-Wei Zhang, Guang-Xue He, Xiang Ren","doi":"10.1186/s40249-024-01203-6","DOIUrl":"10.1186/s40249-024-01203-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tuberculosis (TB) remains a pressing public health issue, posing a significant threat to individuals' well-being and lives. This study delves into the TB incidence in Chinese mainland during 2014-2021, aiming to gain deeper insights into their epidemiological characteristics and explore macro-level factors to enhance control and prevention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;TB incidence data in Chinese mainland from 2014 to 2021 were sourced from the National Notifiable Disease Reporting System (NNDRS). A two-stage distributed lag nonlinear model (DLNM) was constructed to evaluate the lag and non-linearity of daily average temperature (℃, Atemp), average relative humidity (%, ARH), average wind speed (m/s, AWS), sunshine duration (h, SD) and precipitation (mm, PRE) on the TB incidence. A spatial panel data model was used to assess the impact of demographic, medical and health resource, and economic factors on TB incidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 6,587,439 TB cases were reported in Chinese mainland during 2014-2021, with an average annual incidence rate of 59.17/100,000. The TB incidence decreased from 67.05/100,000 in 2014 to 46.40/100,000 in 2021, notably declining from 2018 to 2021 (APC = -8.87%, 95% CI: -11.97, -6.85%). TB incidence rates were higher among males, farmers, and individuals aged 65 years and older. Spatiotemporal analysis revealed a significant cluster in Xinjiang, Qinghai, and Xizang from March 2017 to June 2019 (RR = 3.94, P &lt; 0.001). From 2014 to 2021, the proportion of etiologically confirmed cases increased from 31.31% to 56.98%, and the time interval from TB onset to diagnosis shortened from 26 days (IQR: 10-56 days) to 19 days (IQR: 7-44 days). Specific meteorological conditions, including low temperature (&lt; 16.69℃), high relative humidity (&gt; 71.73%), low sunshine duration (&lt; 6.18 h) increased the risk of TB incidence, while extreme low wind speed (&lt; 2.79 m/s) decreased the risk. The spatial Durbin model showed positive associations between TB incidence rates and sex ratio (β = 1.98), number of beds in medical and health institutions per 10,000 population (β = 0.90), and total health expenses (β = 0.55). There were negative associations between TB incidence rates and population (β = -1.14), population density (β = -0.19), urbanization rate (β = -0.62), number of medical and health institutions (β = -0.23), and number of health technicians per 10,000 population (β = -0.70).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Significant progress has been made in TB control and prevention in China, but challenges persist among some populations and areas. Varied relationships were observed between TB incidence and factors from meteorological, demographic, medical and health resource, and economic aspects. These findings underscore the importance of ongoing efforts to strengthen TB control and implement digital/intelligent surveillance for early risk detection and comprehensive interventions.&lt;","PeriodicalId":48820,"journal":{"name":"Infectious Diseases of Poverty","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11107005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076935","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 estimates of Opisthorchis viverrini and Clonorchis sinensis infection in the Greater Mekong subregion: a systematic review and meta-analysis. 大湄公河次区域疟原虫(Opisthorchis viverrini)和中华疟原虫(Clonorchis sinensis)感染的流行率估计:系统回顾和荟萃分析。
IF 8.1 1区 医学 Pub Date : 2024-05-08 DOI: 10.1186/s40249-024-01201-8
Pornphutthachat Sota, Morsid Andityas, Manas Kotepui, Banchob Sripa

Background: Opisthorchiasis and clonorchiasis, caused by Opisthorchis viverrini and Clonorchis sinensis, respectively, are significant yet neglected foodborne trematodiases in the Great Mekong Subregion (GMS). Despite the reporting of the prevalence of these human liver flukes in the region over the past decades, there has been a lack of a comprehensive and systematic consolidation of this data. Therefore, we aimed to conduct a thorough systematic review and meta-analysis to synthesize and analyze time-trend prevalence estimates of both O. viverrini and C. sinensis across the GMS for the past 30 years.

Methods: This study undertakes a systematic review using a comprehensive search for published articles in PubMed, EMBASE, Scopus, Cochrane and Thai Journal Online databases until early 2023. The pooled prevalence of O. viverrini and C. sinensis infection was analyzed through a random-effects meta-analysis, with meta-regression analysis used to quantify associations with study characteristics. Sub-group analysis was conducted, whenever comparison data were available, to assess the risk of O. viverrini and C. sinensis infection in each GMS country. Heterogeneity among studies was assessed using the Q statistic and quantified by using the I 2 Index.

Results: From a total of 2997 articles, 155 articles comprising 218 datasets and 751,108 participants were included for review. The GMS prevalence of O. viverrini was 21.11% [45,083/260,237; 95% confidence interval (CI): 17.74-24.47%]. Pooled prevalence estimates were highly observed in Laos (34.06%, 95% CI: 26.85-41.26%), followed by Thailand (18.19%, 95% CI: 13.86-22.51%), and Cambodia (10.48%, 95% CI: 5.52-15.45%). Myanmar and Vietnam had limited data sources for calculation. Clonorchis sinensis infection in GMS was 25.33% (95% CI: 18.32-32.34%), with Guangxi, China, exhibiting the highest prevalence rates at 26.89% (95% CI: 18.34-35.43%), while Vietnam had a prevalence rate of 20.30% (95% CI: 9.13-31.47%). O. viverrini prevalence decreased significantly over time, whereas C. sinensis infection appeared to be stable consistently over time in both China and Vietnam.

Conclusions: This comprehensive study, drawing from the largest datasets to date, offers an in-depth systematic prevalence review of human liver flukes in the Greater Mekong Subregion. It underscores the imperative for systematic surveillance, data collection, and the implementation of intervention and control measures for these infectious diseases of poverty.

背景:由Opisthorchis viverrini和Clonorchis sinensis分别引起的Opisthorchis病和Clonorchis病是大湄公河次区域(GMS)重要的食源性吸虫病,但却被忽视了。尽管在过去几十年中,该地区一直有关于这些人类肝吸虫流行情况的报道,但一直缺乏对这些数据进行全面系统的整合。因此,我们旨在进行一次全面的系统综述和荟萃分析,以综合分析过去30年里大湄公河次区域内O. viverrini和C. sinensis的时间趋势流行率估计值:本研究通过全面检索 PubMed、EMBASE、Scopus、Cochrane 和泰国期刊在线数据库中截至 2023 年初已发表的文章,进行了系统性回顾。通过随机效应荟萃分析法分析了O. viverrini和C. sinensis感染的总体流行率,并利用荟萃回归分析法量化了与研究特征的关联。只要有比较数据,就会进行分组分析,以评估每个大湄公河次区域国家的O. viverrini和C. sinensis感染风险。使用 Q 统计量评估研究之间的异质性,并使用 I 2 指数进行量化:结果:在总共 2997 篇文章中,有 155 篇文章、218 个数据集和 751 108 名参与者被纳入审查范围。O.viverrini的GMS流行率为21.11%[45,083/260,237;95%置信区间(CI):17.74-24.47%]。老挝的综合流行率估计值较高(34.06%,95% CI:26.85-41.26%),其次是泰国(18.19%,95% CI:13.86-22.51%)和柬埔寨(10.48%,95% CI:5.52-15.45%)。缅甸和越南的计算数据来源有限。大湄公河次区域的中华铃虫感染率为 25.33%(95% CI:18.32-32.34%),其中中国广西的感染率最高,为 26.89%(95% CI:18.34-35.43%),而越南的感染率为 20.30%(95% CI:9.13-31.47%)。随着时间的推移,O. viverrini 的感染率明显下降,而在中国和越南,C. sinensis 的感染率似乎一直保持稳定:这项综合研究利用了迄今为止最大的数据集,对大湄公河次区域人类肝吸虫的流行情况进行了深入系统的审查。它强调了对这些贫困传染病进行系统监测、数据收集以及实施干预和控制措施的必要性。
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引用次数: 0
Accelerating snail vector genomics. 加速蜗牛载体基因组学研究。
IF 8.1 1区 医学 Pub Date : 2024-05-06 DOI: 10.1186/s40249-024-01199-z
Tom Pennance, David Rollinson

The three most important genera of snails for the transmission of schistosomes are Bulinus, Biomphalaria and Oncomelania. Each of these genera, found in two distantly related families, includes species that act as the intermediate host for one of the three most widespread schistosome species infecting humans, Schistosoma haematobium, S. mansoni and S. japonicum, respectively. An important step in the fight against schistosomiasis in Asia has been taken with the publication of the article "Chromosome-level genome assembly of Oncomelania hupensis: the intermediate snail host of Schistosoma japonicum", which means that genomes for all three major genera, including species across three continents, are now available in the public domain. This includes the first genomes of African snail vectors, namely Biomphalaria sudanica, Bi. pfeifferi and Bulinus truncatus, as well as high-quality chromosome level assemblies for South American Bi. glabrata. Most importantly, the wealth of new genomic and transcriptomic data is helping to establish the specific molecular mechanisms that underly compatibility between snails and their schistosomes, which although diverse and complex, may help to identify potential targets dictating host parasite interactions that can be utilised in future transmission control strategies. This new work on Oncomelania hupensis and indeed studies on other snail vectors, which provide deep insights into the genome, will stimulate research that may well lead to new and much needed control interventions.

传播血吸虫最重要的三个螺属是Bulinus、Biomphalaria和Oncomelania。这三个螺属分别属于两个远缘科,其中的每一个螺属都是感染人类最广泛的三种血吸虫(血吸虫、曼氏血吸虫和日本血吸虫)之一的中间宿主。随着 "Oncomelania hupensis 的染色体级基因组组装:日本血吸虫的中间宿主 "一文的发表,亚洲在抗击血吸虫病方面迈出了重要的一步,这意味着包括三大洲物种在内的所有三个主要属的基因组现在都可以在公共领域获得。这包括非洲蜗牛载体(Biomphalaria sudanica、Bi. pfeifferi和Bulinus truncatus)的首个基因组,以及南美洲Bi. glabrata的高质量染色体组。最重要的是,大量新的基因组和转录组数据有助于确定蜗牛与其血吸虫之间相容的特定分子机制,尽管这些机制多种多样且错综复杂,但可能有助于确定宿主寄生虫相互作用的潜在目标,从而可用于未来的传播控制策略。这项关于胡蜂蜗牛的新工作以及对其他蜗牛载体的研究,提供了对基因组的深入了解,将促进研究工作,很可能会产生新的、急需的控制干预措施。
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引用次数: 0
Assessing intersectional gender analysis in Nepal’s health management information system: a case study on tuberculosis for inclusive health systems 评估尼泊尔卫生管理信息系统中的跨部门性别分析:结核病案例研究,促进包容性卫生系统的发展
IF 8.1 1区 医学 Pub Date : 2024-04-25 DOI: 10.1186/s40249-024-01194-4
Ayuska Parajuli, S. Kakchapati, A. Arjyal, Deepak Joshi, C. Kharel, Mariam Otmani del Barrio, Sushil C Baral
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引用次数: 0
Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study. 方便真的是王道吗?越南公立和私立医疗机构结核病灾难性成本的比较评估:一项纵向患者成本研究。
IF 8.1 1区 医学 Pub Date : 2024-03-25 DOI: 10.1186/s40249-024-01196-2
Hoa Binh Nguyen, Luan Nguyen Quang Vo, Rachel Jeanette Forse, Anja Maria Christine Wiemers, Huy Ba Huynh, Thuy Thi Thu Dong, Yen Thi Hoang Phan, Jacob Creswell, Thi Minh Ha Dang, Lan Huu Nguyen, Jad Shedrawy, Knut Lönnroth, Tuan Dinh Nguyen, Luong Van Dinh, Kristi Sidney Annerstedt, Andrew James Codlin

Background: In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector.

Methods: Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.

Results: The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021).

Conclusions: Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.

背景:在越南,肺结核(TB)是一种破坏性的生命事件,其代价高昂,部分原因是在公共医疗机构接受每日直接观察治疗所造成的收入损失。因此,肺结核患者可能会寻求私立医疗机构的治疗,因为私立医疗机构具有灵活性、便利性和私密性。我们的研究旨在衡量受结核病影响的家庭在公共部门和私营部门的收入变化、费用和灾难性费用发生情况:2020 年 10 月至 2022 年 3 月期间,我们在越南河内、海防和胡志明市对 50 名接受私人治疗的肺结核患者和 60 名接受国家肺结核计划(NTP)治疗的肺结核患者进行了 110 次纵向患者费用访谈。采用世界卫生组织结核病患者成本调查工具的本地化改编版,在强化治疗阶段、继续治疗阶段和治疗后对参与者进行了访谈。我们使用 Wilcoxon 秩和检验和卡方检验比较了两个组群的收入水平、直接和间接治疗费用、灾难性费用,并使用多变量回归比较了相关风险因素:私营部门队列的治疗前家庭月收入中位数明显高于 NTP 队列(868 美元对 578 美元;P = 0.010)。然而,私营部门的治疗费用也明显更高(2075 美元对 1313 美元;P = 0.005),直接医疗费用是国家结核病防治计划参与者报告费用的 4.6 倍(754 美元对 164 美元;P 结论:在越南,结核病患者面临着巨大的经济压力:越南的肺结核患者无论是在公立医院还是私立医院接受治疗,都面临着同样高的灾难性费用风险。可以通过扩大保险报销范围来减少患者的费用,从而最大限度地降低私营部门的直接医疗费用,在公共部门使用远程监测和多周/多月给药策略来避免经济成本,并在总体上提供更多的社会保障机制。
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Infectious Diseases of Poverty
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