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What is the economic benefit of annual COVID-19 vaccination from the adult individual perspective? 从成人个人角度来看,每年接种 COVID-19 疫苗的经济效益如何?
Pub Date : 2024-04-06 DOI: 10.1093/infdis/jiae179
Sarah M Bartsch, Kelly J O’Shea, Colleen Weatherwax, Ulrich Strych, Kavya Velmurugan, Danielle C John, Maria Elena Bottazzi, Mustafa Hussein, Marie F Martinez, Kevin L Chin, Allan Ciciriello, Jessie Heneghan, Alexis Dibbs, Sheryl A Scannell, Peter J Hotez, Bruce Y Lee
Background With COVID-19 vaccination no longer mandated by many businesses/organizations, it is now up to individuals to decide whether to get any new boosters/updated vaccines going forward. Methods We developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine. Results For an 18-49-year-old, getting vaccinated at its current price ($60) can save the individual on average $30-$603 if the individual is uninsured and $4-$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is ≥50% and the weekly risk of getting infected is ≥0.2%, corresponding to an individual interacting with 9 other people in a day under Winter 2023-2024 Omicron SARS-CoV-2 variant conditions with an average infection prevalence of 10%. For a 50-64-year-old, these cost-savings increase to $111-$1,278 and $119-$1,706, for someone without and with insurance, respectively. The risk threshold increases to ≥0.4% (interacting with 19 people/day), when the individual has 13.4% pre-existing protection against infection (e.g., vaccinated 9 months earlier). Conclusion There is both clinical and economic incentive for the individual to continue to get vaccinated against COVID-19 each year.
背景 随着许多企业/组织不再强制要求接种 COVID-19 疫苗,现在应由个人决定是否接种任何新的加强剂/更新疫苗。方法 我们建立了一个马尔可夫模型,从个人角度说明在美国每年接种与不接种 COVID-19 疫苗可能产生的临床/经济结果。结果 对于一个 18-49 岁的人来说,只要预防严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染的起始疫苗效力≥50%,且每周感染风险≥0.2%,那么以目前的价格(60 美元)接种疫苗,如果没有保险,平均可为个人节省 30-603 美元,如果有私人保险,可节省 4-437 美元。2%,相当于在 2023-2024 年冬季 Omicron SARS-CoV-2 变体条件下,一个人一天内与 9 个其他人互动,平均感染率为 10%。对于 50-64 岁的人来说,无保险和有保险分别可节省 111-1 278 美元和 119-1 706 美元。当个人已有 13.4% 的预防感染保护(如 9 个月前接种过疫苗)时,风险阈值会增加到≥0.4%(每天与 19 人互动)。结论 个人每年继续接种 COVID-19 疫苗具有临床和经济激励作用。
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引用次数: 0
Membrane Lipids Augment Cell Envelope Stress Signaling via the MadRS System to Defend Against Antimicrobial Peptides and Antibiotics in Enterococcus faecalis 膜脂通过 MadRS 系统增强细胞包膜压力信号,以抵御粪肠球菌中的抗菌肽和抗生素
Pub Date : 2024-04-05 DOI: 10.1093/infdis/jiae173
William R Miller, April Nguyen, Kavindra V Singh, Samie Rizvi, Ayesha Khan, Sam G Erickson, Stephanie L Egge, Melissa Cruz, An Q Dinh, Lorena Diaz, Philip C Thornton, Rutan Zhang, Libin Xu, Danielle A Garsin, Yousif Shamoo, Cesar A Arias
Enterococci have evolved resistance mechanisms to protect their cell envelopes against bacteriocins and host cationic antimicrobial peptides (CAMPs) produced in the gastrointestinal environment. Activation of the membrane stress response has also been tied to resistance to the lipopeptide antibiotic daptomycin. However, the actual effectors mediating resistance have not been elucidated. Here, we show that the MadRS (formerly YxdJK) membrane antimicrobial peptide defense system controls a network of genes, including a previously uncharacterized three gene operon (madEFG) that protects the E. faecalis cell envelope from antimicrobial peptides. Constitutive activation of the system confers protection against CAMPs and daptomycin in the absence of a functional LiaFSR system and leads to persistence of cardiac microlesions in vivo. Moreover, changes in the lipid cell membrane environment alter CAMP susceptibility and expression of the MadRS system. Thus, we provide a framework supporting a multilayered envelope defense mechanism for resistance and survival coupled to virulence.
肠球菌已进化出抗性机制,以保护其细胞膜免受胃肠道环境中产生的细菌素和宿主阳离子抗菌肽(CAMPs)的侵害。膜应激反应的激活也与对脂肽抗生素达托霉素的耐药性有关。然而,介导耐药性的实际效应因子尚未阐明。在这里,我们发现 MadRS(前身为 YxdJK)膜抗菌肽防御系统控制着一个基因网络,其中包括一个以前未表征的三基因操作子(madEFG),它能保护粪肠球菌细胞膜免受抗菌肽的侵害。在缺乏功能性 LiaFSR 系统的情况下,该系统的持续激活可提供对 CAMPs 和达托霉素的保护,并导致体内心脏微裂孔的持续存在。此外,脂质细胞膜环境的变化会改变对 CAMP 的敏感性和 MadRS 系统的表达。因此,我们提供了一个支持多层包膜防御机制的框架,该机制具有抗性和存活以及毒力。
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引用次数: 0
AMPing up the Pressure: Cell envelope signaling protects Enterococcus faecalis from antimicrobial peptides. AMPing up the Pressure:细胞包膜信号保护粪肠球菌免受抗菌肽的侵害。
Pub Date : 2024-04-05 DOI: 10.1093/infdis/jiae175
Adeline Supandy, D. Van Tyne
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引用次数: 0
Prevotella timonensis bacteria associated with vaginal dysbiosis enhance HIV-1 susceptibility of vaginal CD4+ T cells 与阴道菌群失调有关的蒂莫纳氏前驱菌提高了阴道 CD4+ T 细胞对 HIV-1 的易感性
Pub Date : 2024-04-04 DOI: 10.1093/infdis/jiae166
Nienke H van Teijlingen, Marleen Y van Smoorenburg, Ramin Sarrami-Forooshani, Esther M Zijlstra-Willems, John L van Hamme, Hanneke Borgdorff, Janneke HHM van de Wijgert, Elisabeth van Leeuwen, Joris A M van der Post, Karin Strijbis, Carla M S Ribeiro, Teunis B H Geijtenbeek
Dysbiosis of the vaginal microbiome poses a serious risk for sexual HIV-1 transmission. Prevotella spp. are abundant during vaginal dysbiosis and associated with enhanced HIV-1 susceptibility; however, underlying mechanisms remain unclear. Here, we investigated the direct effect of vaginal bacteria on HIV-1 susceptibility of vaginal CD4+ T cells. Notably, pre-exposure to Prevotella timonensis enhanced HIV-1 uptake by vaginal T cells, leading to increased viral fusion and enhanced virus production. Pre-exposure to antiretroviral inhibitors abolished Prevotella timonensis-enhanced infection. Hence, our study shows that the vaginal microbiome directly affects mucosal CD4+ T cell susceptibility, emphasising importance of vaginal dysbiosis diagnosis and treatment.
阴道微生物群失调对 HIV-1 的性传播构成严重威胁。在阴道菌群失调期间,普雷沃特氏菌大量存在,并与 HIV-1 易感性增强有关;然而,其潜在机制仍不清楚。在此,我们研究了阴道细菌对阴道 CD4+ T 细胞的 HIV-1 易感性的直接影响。值得注意的是,预先暴露于Prevotella timonensis会增强阴道T细胞对HIV-1的摄取,导致病毒融合增加和病毒生成增强。而预先暴露于抗逆转录病毒抑制剂则可消除由普雷沃氏菌增强的感染。因此,我们的研究表明,阴道微生物群直接影响粘膜 CD4+ T 细胞的易感性,强调了阴道菌群失调诊断和治疗的重要性。
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引用次数: 0
Analysis of a large SARS-CoV-2 (Alpha) outbreak in a Catalan prison using conventional and genomic epidemiology. 利用传统流行病学和基因组流行病学分析加泰罗尼亚一所监狱爆发的大规模 SARS-CoV-2 (阿尔法)疫情。
Pub Date : 2024-04-04 DOI: 10.1093/infdis/jiae161
A. Bordoy, Xavier Vallès, J. Fernández-Náger, Montserrat Sánchez-Roig, Juan Fernandez-Recio, V. Saludes, M. Noguera-Julián, Ignacio Blanco, E. Martró
Enforcing strict protocols that prevent transmission of airborne infections in prisons is challenging. We examine a large SARS-CoV-2 outbreak in a Catalan penitentiary center from February-March 2021, prior to vaccination deployment. The aim was to describe the evolution of the outbreak using classical and genomic epidemiology and the containment strategy applied. The outbreak was initially detected in one module but spread to four, infecting 7 staff members and 140 incarcerated individuals, 6 of whom were hospitalized (4.4%). Genomic analysis confirmed a single origin (B.1.1.7). Contact tracing identified transmission vectors between modules and prevented further viral spread. In future similar scenarios, the control strategy described here may help limiting transmission of airborne infections in correctional settings.
在监狱中执行防止空气传播感染的严格规程具有挑战性。我们研究了 2021 年 2 月至 3 月疫苗接种前加泰罗尼亚监狱中心爆发的大规模 SARS-CoV-2 疫情。我们的目的是利用经典和基因组流行病学以及所采用的遏制策略来描述疫情的演变过程。疫情最初在一个监区发现,后来蔓延到四个监区,感染了 7 名工作人员和 140 名囚犯,其中 6 人住院治疗(4.4%)。基因组分析确认了单一来源(B.1.1.7)。接触追踪确定了模块之间的传播媒介,防止了病毒的进一步传播。在未来类似的情况下,本文所述的控制策略可能有助于限制空气传播感染在惩教场所的传播。
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引用次数: 0
Respiratory syncytial virus vs. Influenza virus infection: mortality and morbidity comparison over 7 epidemic seasons in an elderly population 呼吸道合胞病毒感染与流感病毒感染:老年人群 7 个流行季节的死亡率和发病率比较
Pub Date : 2024-04-04 DOI: 10.1093/infdis/jiae171
C Recto, S Fourati, M Khellaf, J-M Pawlotsky, N De Prost, H Diakonoff, C Donadio, L Pouga, C de Tymowski, C Kassasseya
Background Respiratory syncytial virus (RSV) infection is gaining interest due to the recent development of vaccines, but it is still misdiagnosed in the elderly. The primary objective was to compare all-cause mortality at day 30. Secondary objectives were to compare clinical presentation, and rates of consolidative pneumonia, hospitalization, and intensive care unit (ICU) admission. Methods Single-centre retrospective study conducted in a French university hospital during 7 epidemic seasons. All patients aged ≥75 years were included. Results 558 patients were included: 125 with RSV and 433 with Influenza. Median age was 84.8 years. RSV patients had more respiratory symptoms (wheezing, dyspnea), whereas Influenza patients had more general symptoms (fever, asthenia, myalgia). Consolidative pneumonia (28.8% vs. 17.2%; p = 0.004), hospitalization rates (83.2% vs. 70%; p = 0.003), ICU admissions (7.2% vs. 3.0%; p = 0.034) and length of stay (9 days [2-16] vs. 5 days [0-12]; p = 0.002), were higher in the RSV group. Mortality rates at day 30 were comparable (RSV 9.6%, Influenza 9.7%; p = 0.973). Conclusions This study included the largest cohort of RSV-infected patients aged over 75, documented in-depth thus far. RSV shares a comparable mortality rate with Influenza but is associated with higher rates of consolidative pneumonia, hospitalization, ICU admissions, and extended hospital stays.
背景 由于最近疫苗的开发,呼吸道合胞病毒(RSV)感染越来越受到关注,但在老年人中仍存在误诊。研究的首要目标是比较第 30 天的全因死亡率。次要目标是比较临床表现、合并肺炎发生率、住院率和入住重症监护室(ICU)率。方法 在法国一所大学医院进行的单中心回顾性研究,共经历了 7 个流行季节。纳入所有年龄≥75 岁的患者。结果 共纳入 558 名患者:125名 RSV 患者和 433 名流感患者。中位年龄为 84.8 岁。RSV 患者多有呼吸道症状(喘息、呼吸困难),而流感患者多有全身症状(发热、气喘、肌痛)。合并肺炎(28.8% 对 17.2%;p = 0.004)、住院率(83.2% 对 70%;p = 0.003)、入住重症监护室(7.2% 对 3.0%;p = 0.034)和住院时间(9 天 [2-16] 对 5 天 [0-12];p = 0.002)在 RSV 组更高。第 30 天的死亡率相当(RSV 为 9.6%,流感为 9.7%;P = 0.973)。结论 该研究包括了迄今为止有深度记录的最大一批 75 岁以上 RSV 感染者。RSV 的死亡率与流感相当,但合并肺炎、住院、入住重症监护室和延长住院时间的比例更高。
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引用次数: 0
Estimating the Potential Public Health Value of BCG Revaccination 估算卡介苗再接种的潜在公共卫生价值
Pub Date : 2024-04-03 DOI: 10.1093/infdis/jiae089
Rebecca A Clark, Tom Sumner, Chathika K Weerasuriya, Roel Bakker, Thomas J Scriba, Richard G White
An upcoming trial may provide further evidence that adolescent/adult-targeted BCG revaccination prevents sustained Mycobacterium tuberculosis infection, but its public health value depends on its impact on overall tuberculosis morbidity and mortality, which will remain unknown. Using previously calibrated models for India and South Africa, we simulated BCG revaccination assuming 45% prevention-of-infection efficacy, and we evaluated scenarios varying additional prevention-of-disease efficacy between +50% (reducing risk) and −50% (increasing risk). Given the assumed prevention-of-infection efficacy and range in prevention-of-disease efficacy, BCG revaccination may have a positive health impact and be cost-effective. This may be useful when considering future evaluations and implementation of adolescent/adult BCG revaccination.
即将进行的一项试验可能会进一步证明,针对青少年/成人的卡介苗再接种可预防结核分枝杆菌的持续感染,但其公共卫生价值取决于其对结核病总体发病率和死亡率的影响,而这一点仍是未知数。利用之前为印度和南非校准的模型,我们对卡介苗再接种进行了模拟,假设感染预防效果为 45%,我们评估了额外疾病预防效果在 +50%(降低风险)和 -50%(增加风险)之间变化的情况。考虑到假定的感染预防效果和疾病预防效果范围,卡介苗再接种可能会对健康产生积极影响,并且具有成本效益。这在考虑未来对青少年/成人卡介苗再接种进行评估和实施时可能会有所帮助。
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引用次数: 0
High Frequency of Prior SARS-CoV-2 Infection by Sensitive Nucleocapsid Assays 通过灵敏的核头壳检测发现 SARS-CoV-2 之前的高感染率
Pub Date : 2024-04-03 DOI: 10.1093/infdis/jiae174
Joseph P Nkolola, Jinyan Liu, Ai-ris Y Collier, Catherine Jacob-Dolan, Yasmeen Senussi, Ella Borberg, Zoe Swank, David R Walt, Dan H Barouch
Prior infection with SARS-CoV-2 is typically measured by nucleocapsid serology assays. In this study, we show that the Simoa serology assays and T cell intracellular cytokine staining assays are more sensitive than the clinical Elecsys assay for detection of nucleocapsid-specific immune responses. These data suggest that the prevalence of prior SARS-CoV-2 infection in the population may be higher than currently appreciated.
SARS-CoV-2 之前的感染情况通常是通过核壳血清学检测法来衡量的。在本研究中,我们发现在检测核壳特异性免疫反应方面,Simoa 血清学检测和 T 细胞胞内细胞因子染色检测比临床 Elecsys 检测更灵敏。这些数据表明,人群中 SARS-CoV-2 既往感染率可能高于目前的认识。
{"title":"High Frequency of Prior SARS-CoV-2 Infection by Sensitive Nucleocapsid Assays","authors":"Joseph P Nkolola, Jinyan Liu, Ai-ris Y Collier, Catherine Jacob-Dolan, Yasmeen Senussi, Ella Borberg, Zoe Swank, David R Walt, Dan H Barouch","doi":"10.1093/infdis/jiae174","DOIUrl":"https://doi.org/10.1093/infdis/jiae174","url":null,"abstract":"Prior infection with SARS-CoV-2 is typically measured by nucleocapsid serology assays. In this study, we show that the Simoa serology assays and T cell intracellular cytokine staining assays are more sensitive than the clinical Elecsys assay for detection of nucleocapsid-specific immune responses. These data suggest that the prevalence of prior SARS-CoV-2 infection in the population may be higher than currently appreciated.","PeriodicalId":501010,"journal":{"name":"The Journal of Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140349100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cytotoxic lymphocyte-monocyte complex reflects the dynamics of COVID-19 systemic immune response 细胞毒性淋巴细胞-单核细胞复合体反映了 COVID-19 全身免疫反应的动态变化
Pub Date : 2024-02-01 DOI: 10.1093/infdis/jiae048
Jiajia Lin, Shiyu Bai, Liheng He, Ye Yang, Xiyue Li, Liulin Luo, Ying Wang, Ying-ying Chen, Jinhong Qin, Yi Zhong
SARS-CoV-2 infection causes a variety of clinical manifestations, many of which originate from altered immune responses, either locally or systemically. Immune cell crosstalk occurs mainly in lymphoid organs. However, systemic cell interaction specific to COVID-19 has not been well characterized. Here, by employing single cell RNA sequencing and imaging flow cytometry analysis, we unraveled, in peripheral blood, a heterogeneous group of cell complexes formed by the adherence of CD14+ monocytes to different cytotoxic lymphocytes, including SARS-CoV-2-specific CD8+ T cells, γδT and NKT cells. These lymphocytes attached to CD14+ monocytes that showing enhanced inflammasome activation and pyroptosis-induced cell death in progression stage, whereas in convalescent phase, CD14+ monocytes with elevated antigen presentation potential were targeted by cytotoxic lymphocytes, thereby restricting the excessive immune activation. Collectively, our study reports previously unrecognized cell-cell interplay in SARS-CoV-2 specific immune response, providing new insight into the intricacy of dynamic immune cell interaction representing anti-viral defense.
SARS-CoV-2 感染会导致多种临床表现,其中许多都源于局部或全身免疫反应的改变。免疫细胞间的相互作用主要发生在淋巴器官。然而,特异于 COVID-19 的全身细胞相互作用尚未得到很好的描述。在这里,我们通过单细胞 RNA 测序和成像流式细胞仪分析,揭示了外周血中由 CD14+ 单核细胞与不同的细胞毒性淋巴细胞(包括 SARS-CoV-2 特异性 CD8+ T 细胞、γδT 和 NKT 细胞)粘附形成的一组异质性细胞复合体。这些淋巴细胞附着在 CD14+ 单核细胞上,在进展期,CD14+ 单核细胞显示出更强的炎症小体活化能力,并由热蛋白诱导细胞死亡;而在恢复期,细胞毒性淋巴细胞靶向具有更高抗原呈递潜能的 CD14+ 单核细胞,从而限制了过度的免疫活化。总之,我们的研究报告了在 SARS-CoV-2 特异性免疫反应中以前未被认识到的细胞间相互作用,为了解代表抗病毒防御的动态免疫细胞相互作用的复杂性提供了新的视角。
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引用次数: 0
How Global Collaboration Can Improve the Medical Countermeasure Life Cycle for Infectious Disease Outbreaks: A BARDA Perspective 全球合作如何改善传染病爆发的医疗对策生命周期:BARDA 的视角
Pub Date : 2024-01-20 DOI: 10.1093/infdis/jiae017
Jessica Swenson, Gary Disbrow, Robert A Johnson
Infectious disease outbreaks have become increasingly common and require global partnership for adequate preparedness and response. During outbreaks, medical countermeasures (MCMs)—vaccines, therapeutics, and diagnostics—need to reach patients quickly. BARDA utilizes public-private partnerships to support advanced development of MCMs through U.S. FDA approval against a variety of threats within its mission space. MCM preparedness and response must be approached as an integrated life cycle, not as independent steps. Recent filovirus outbreaks in Africa exemplify that collaborative relationships are critical for emergency response, and products with regulatory approval can expand access and reach patients quicker than investigational products. Unfortunately, insufficient funding globally and differences in funders’ prioritization puts gains and future efforts at risk. Of primary concern is a) lack of a feasible regulatory path and clinical capability to achieve regulatory approval for new MCMs for many diseases; and b) the need for partners with the mandate, funding, and capabilities to support the life cycle activities following development—long-term sustainment of manufacturing capability and stockpiling of licensed products to support international outbreaks. Finding partners that complement BARDA’s mission and support the MCM life cycle will be a key component in deciding which MCM development efforts can be supported. Without collaboration, the global community runs the risk of losing the capabilities built through years of investment and being underprepared to combat future threats. Synergies between funders that have different roles and responsibilities within the MCM life cycle are critical to MCM availability and create long-term sustainment of products to ensure access.
传染病爆发越来越常见,需要全球合作以做好充分准备和应对。在疫情爆发期间,医疗对策 (MCM) - 疫苗、疗法和诊断 - 需要迅速送达患者手中。BARDA 利用公私合作伙伴关系,通过美国食品及药物管理局的批准,支持先进的 MCMs 开发,以应对其任务范围内的各种威胁。MCM 的准备和响应必须作为一个综合生命周期来处理,而不是作为独立的步骤。最近在非洲爆发的丝状病毒疫情表明,合作关系对于应急响应至关重要,与研究产品相比,获得监管部门批准的产品能够更快地扩大使用范围并惠及患者。遗憾的是,全球范围内的资金不足以及资助者在优先顺序上的差异,使已经取得的成果和未来的努力面临风险。最令人担忧的问题是:a) 缺乏可行的监管途径和临床能力,无法获得针对许多疾病的新型 MCM 的监管批准;b) 需要拥有授权、资金和能力的合作伙伴,以支持开发后的生命周期活动--长期维持制造能力和许可产品储备,以支持国际疫情爆发。寻找与 BARDA 的任务相辅相成并支持 MCM 生命周期的合作伙伴,将是决定支持哪些 MCM 开发工作的关键因素。如果不进行合作,全球社会将面临失去多年投资所建立的能力的风险,并且在应对未来威胁时准备不足。在装甲运兵车生命周期内发挥不同作用和承担不同责任的资助者之间的协同增效对于装甲运兵车的可用性和产品的长期可持续性至关重要,以确保产品的可获取性。
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引用次数: 0
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The Journal of Infectious Diseases
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