Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106328
Clare Thakker , Clare Warrell , Jessica Barrett , Helen L. Booth , Peter L. Chiodini , Sylviane Defres , Jane Falconer , Nathan Jacobs , Jayne Jones , Jonathan Lambert , Clare Leong , Angela McBride , Elinor Moore , Tara Moshiri , Laura E. Nabarro , Geraldine O’Hara , Neil Stone , Clare van Halsema , Anna M. Checkley , On behalf of the British Infection Association
Eosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting, it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.1 Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised.
Changes made to the guidelines include updates in the sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis and taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included.
{"title":"UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants","authors":"Clare Thakker , Clare Warrell , Jessica Barrett , Helen L. Booth , Peter L. Chiodini , Sylviane Defres , Jane Falconer , Nathan Jacobs , Jayne Jones , Jonathan Lambert , Clare Leong , Angela McBride , Elinor Moore , Tara Moshiri , Laura E. Nabarro , Geraldine O’Hara , Neil Stone , Clare van Halsema , Anna M. Checkley , On behalf of the British Infection Association","doi":"10.1016/j.jinf.2024.106328","DOIUrl":"10.1016/j.jinf.2024.106328","url":null,"abstract":"<div><div>Eosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting, it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.<span><span><sup>1</sup></span></span> Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised.</div><div>Changes made to the guidelines include updates in the sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis and taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106328"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631769","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106393
Edward J.M. Monk , Sarah Foulkes , Katie Munro , Ana Atti , Jasmin Islam , Susan Hopkins , Jacqui S. Reilly , Colin S. Brown , Victoria J. Hall , SIREN Study Group
Background
Healthcare workers were at a high risk of infection early in the SARS-CoV-2 pandemic. It is uncertain to what extent occupational, household and community factors contributed, and how this changed over time. We aimed to characterise the risk factors for infection over four successive waves of the pandemic in a large, UK healthcare worker cohort (SIREN).
Methods
Participants underwent fortnightly SARS-CoV-2 PCR testing and symptom/exposure questionnaire. Attack rates and adjusted OR of infection were calculated according to participant characteristics and exposures for each wave between 1st October 2020 and 30th August 2022.
Findings
19,427 participants were included in the second wave, 20,260 in the third, 11,937 in the fourth, and 6503 in the fifth. The attack rates of infection were 9.1% (alpha), 6.6% (delta), 36.6% (omicron BA.1/2) and 15.9% (omicron BA.4/5), respectively.
Occupational risk factors were only apparent in the second wave, during which significant social distancing measures were in place. These were identified as working as a healthcare assistant, nurse or bedside therapist, and working on an inpatient ward. Occupational exposure requiring personal protective equipment was also a risk.
In subsequent waves, without social restrictions, occupational characteristics were not risk factors. Instead, living with others compared to living alone was a risk, particularly children. During the third wave (winter 2021–2022), having a colleague with COVID-19 was identified as a risk for the first time.
Interpretation
Our findings highlight clinical areas and occupational groups in which there may be scope to prevent healthcare-associated infections, particularly during winter pressures. Prospective studies targeting these are essential to establish which interventions are most effective. This study also underscores the importance of community circulation and exposures when considering healthcare workforce protection.
{"title":"Characterisation of the SARS-CoV-2 pandemic in healthcare workers within the United Kingdom: Risk factors for infection during four successive waves","authors":"Edward J.M. Monk , Sarah Foulkes , Katie Munro , Ana Atti , Jasmin Islam , Susan Hopkins , Jacqui S. Reilly , Colin S. Brown , Victoria J. Hall , SIREN Study Group","doi":"10.1016/j.jinf.2024.106393","DOIUrl":"10.1016/j.jinf.2024.106393","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare workers were at a high risk of infection early in the SARS-CoV-2 pandemic. It is uncertain to what extent occupational, household and community factors contributed, and how this changed over time. We aimed to characterise the risk factors for infection over four successive waves of the pandemic in a large, UK healthcare worker cohort (SIREN).</div></div><div><h3>Methods</h3><div>Participants underwent fortnightly SARS-CoV-2 PCR testing and symptom/exposure questionnaire. Attack rates and adjusted OR of infection were calculated according to participant characteristics and exposures for each wave between 1st October 2020 and 30th August 2022.</div></div><div><h3>Findings</h3><div>19,427 participants were included in the second wave, 20,260 in the third, 11,937 in the fourth, and 6503 in the fifth. The attack rates of infection were 9.1% (alpha), 6.6% (delta), 36.6% (omicron BA.1/2) and 15.9% (omicron BA.4/5), respectively.</div><div>Occupational risk factors were only apparent in the second wave, during which significant social distancing measures were in place. These were identified as working as a healthcare assistant, nurse or bedside therapist, and working on an inpatient ward. Occupational exposure requiring personal protective equipment was also a risk.</div><div>In subsequent waves, without social restrictions, occupational characteristics were not risk factors. Instead, living with others compared to living alone was a risk, particularly children. During the third wave (winter 2021–2022), having a colleague with COVID-19 was identified as a risk for the first time.</div></div><div><h3>Interpretation</h3><div>Our findings highlight clinical areas and occupational groups in which there may be scope to prevent healthcare-associated infections, particularly during winter pressures. Prospective studies targeting these are essential to establish which interventions are most effective. This study also underscores the importance of community circulation and exposures when considering healthcare workforce protection.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106393"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903864","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106414
Tangwei Mou , Kai-Cheng Gao , Xiyao Chen , Qingyang Qian , Jing Lin , Ran Zhang , Jing Yang , Peipei Qu , Guozhong Zhou , Yi-Qun Kuang
Background
Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLWH), but poor CD4+ T-cell recovery remains a challenge. This study aimed to evaluate the relationship between poor CD4+ T-cell recovery and the morbidity of clinical events (CEs) in PLWH after ART initiation.
Methods
We conducted a comprehensive search of the EMBASE, PubMed, Web of Science, and Cochrane Library databases up to February 19, 2024, and included studies that reported the number of CEs along with the CD4 count at the time of the CEs or the most recent CD4 count prior to the CEs. A random-effects model was employed for meta-analysis to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for CEs at different CD4 count thresholds.
Findings
We included 15 studies with 54,766 PLWH and reported a significant inverse correlation between CD4+ T-cell counts and the morbidity of both AIDS-defining events (ADEs) and non-AIDS-defining infections (NADIs). However, CD4+ T-cell counts were not significantly associated with non-AIDS-defining noninfections (NADNIs). Compared with individuals with normal CD4 counts (>500 cells/μL), those with CD4 counts <200 cells/μL and 200–350 cells/μL exhibited higher ADEs morbidity, with ORs of 7·04 (95% CI: 1·77−28·03) and 1·63 (95% CI: 1·36−1·97), respectively. Similarly, individuals with CD4 counts <200 cells/μL showed a higher morbidity of NADIs (OR = 2·82, 95% CI: 1·50−5·31). However, no significant difference in NADNI morbidity was observed between groups with poor CD4+ T-cell recovery and those with normal CD4 counts.
Interpretation
This meta-analysis revealed an inverse relationship between CD4+ T-cell counts and morbidity associated with ADEs and NADIs in PLWH after ART initiation, with key thresholds of 350 cells/μL and 200 cells/μL. No significant associations were found between CD4 counts and NADNIs. These results highlight the need for comprehensive patient care that goes beyond monitoring only CD4 counts.
{"title":"Clinical events associated with poor CD4+ T-cell recovery in people living with HIV following ART: A systematic review and meta-analysis","authors":"Tangwei Mou , Kai-Cheng Gao , Xiyao Chen , Qingyang Qian , Jing Lin , Ran Zhang , Jing Yang , Peipei Qu , Guozhong Zhou , Yi-Qun Kuang","doi":"10.1016/j.jinf.2025.106414","DOIUrl":"10.1016/j.jinf.2025.106414","url":null,"abstract":"<div><h3>Background</h3><div>Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLWH), but poor CD4<sup>+</sup> T-cell recovery remains a challenge. This study aimed to evaluate the relationship between poor CD4<sup>+</sup> T-cell recovery and the morbidity of clinical events (CEs) in PLWH after ART initiation.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of the EMBASE, PubMed, Web of Science, and Cochrane Library databases up to February 19, 2024, and included studies that reported the number of CEs along with the CD4 count at the time of the CEs or the most recent CD4 count prior to the CEs. A random-effects model was employed for meta-analysis to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for CEs at different CD4 count thresholds.</div></div><div><h3>Findings</h3><div>We included 15 studies with 54,766 PLWH and reported a significant inverse correlation between CD4<sup>+</sup> T-cell counts and the morbidity of both AIDS-defining events (ADEs) and non-AIDS-defining infections (NADIs). However, CD4<sup>+</sup> T-cell counts were not significantly associated with non-AIDS-defining noninfections (NADNIs). Compared with individuals with normal CD4 counts (>500 cells/μL), those with CD4 counts <200 cells/μL and 200–350 cells/μL exhibited higher ADEs morbidity, with ORs of 7·04 (95% CI: 1·77−28·03) and 1·63 (95% CI: 1·36−1·97), respectively. Similarly, individuals with CD4 counts <200 cells/μL showed a higher morbidity of NADIs (OR = 2·82, 95% CI: 1·50−5·31). However, no significant difference in NADNI morbidity was observed between groups with poor CD4<sup>+</sup> T-cell recovery and those with normal CD4 counts.</div></div><div><h3>Interpretation</h3><div>This meta-analysis revealed an inverse relationship between CD4<sup>+</sup> T-cell counts and morbidity associated with ADEs and NADIs in PLWH after ART initiation, with key thresholds of 350 cells/μL and 200 cells/μL. No significant associations were found between CD4 counts and NADNIs. These results highlight the need for comprehensive patient care that goes beyond monitoring only CD4 counts.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106414"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015009","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106423
Shuo Feng , Sagida Bibi , Parvinder K. Aley , Federica Cappuccini , Elizabeth A. Clutterbuck , Kerry Conlin , Narges Ebrahimi , Agnes Eordogh , Saul N. Faust , Sally Felle , Justin Green , Hardeep Gill , Yama Mujadidi , Iyiola Oladunjoye , Nelly Owino , Emma Plested , Hannah Robinson , Arabella Stuart , Merryn Voysey , Andrew J. Pollard , Teresa Lambe
Objectives
Evaluation of the safety and humoral immunogenicity of ChAdOx1 nCoV-19 as a fourth dose booster in individuals who have had two initial doses of the vaccine and a third dose of BNT162b2.
Methods
COV009 is a safety follow-up study of volunteers enroled in the pivotal pre-licensure ChAdOx1 nCoV-19. In this sub-study, 149 eligible participants were given a fourth dose of ChAdOx1 nCoV-19. Primary outcomes were reactogenicity, safety, and humoral immunogenicity. Anti-spike IgG and pseudo-neutralising antibody against multiple variants were measured from pre-first dose to 28 days post-second and post-fourth dose (third dose samples were unavailable).
Results
A fourth dose of ChAdOx1 nCoV-19 had an acceptable safety profile with no vaccine-related serious adverse events. Humoral responses against various SARS CoV-2 variants post-fourth dose were significantly increased compared with the responses after the second dose (7- to 9-fold increase for anti-spike IgG responses across variants, all p<0.05). Those with lower antibody levels prior to the 4th dose had stronger responses to a 4th dose booster. Seropositivity by anti-nucleocapsid, or higher antibody responses pre-fourth dose correlated with lower infection risks six months thereafter (OR: 0.16, 95% CI: 0.05, 0.50).
Conclusions
The ChAdOx1 nCoV-19 fourth dose is well tolerated and boosts humoral immunity; this was evident as an increased humoral response across multiple variants of concern. These data support its use as a booster dose against SARS-CoV-2 infection.
{"title":"Safety and humoral immunogenicity of the ChAdOx1 nCoV-19 vaccine administered as a fourth dose booster following two doses of ChAdOx1 nCoV-19 and a third dose of BNT162b2 (COV009): A prospective cohort study","authors":"Shuo Feng , Sagida Bibi , Parvinder K. Aley , Federica Cappuccini , Elizabeth A. Clutterbuck , Kerry Conlin , Narges Ebrahimi , Agnes Eordogh , Saul N. Faust , Sally Felle , Justin Green , Hardeep Gill , Yama Mujadidi , Iyiola Oladunjoye , Nelly Owino , Emma Plested , Hannah Robinson , Arabella Stuart , Merryn Voysey , Andrew J. Pollard , Teresa Lambe","doi":"10.1016/j.jinf.2025.106423","DOIUrl":"10.1016/j.jinf.2025.106423","url":null,"abstract":"<div><h3>Objectives</h3><div>Evaluation of the safety and humoral immunogenicity of ChAdOx1 nCoV-19 as a fourth dose booster in individuals who have had two initial doses of the vaccine and a third dose of BNT162b2.</div></div><div><h3>Methods</h3><div>COV009 is a safety follow-up study of volunteers enroled in the pivotal pre-licensure ChAdOx1 nCoV-19. In this sub-study, 149 eligible participants were given a fourth dose of ChAdOx1 nCoV-19. Primary outcomes were reactogenicity, safety, and humoral immunogenicity. Anti-spike IgG and pseudo-neutralising antibody against multiple variants were measured from pre-first dose to 28 days post-second and post-fourth dose (third dose samples were unavailable).</div></div><div><h3>Results</h3><div>A fourth dose of ChAdOx1 nCoV-19 had an acceptable safety profile with no vaccine-related serious adverse events. Humoral responses against various SARS CoV-2 variants post-fourth dose were significantly increased compared with the responses after the second dose (7- to 9-fold increase for anti-spike IgG responses across variants, all p<0.05). Those with lower antibody levels prior to the 4th dose had stronger responses to a 4th dose booster. Seropositivity by anti-nucleocapsid, or higher antibody responses pre-fourth dose correlated with lower infection risks six months thereafter (OR: 0.16, 95% CI: 0.05, 0.50).</div></div><div><h3>Conclusions</h3><div>The ChAdOx1 nCoV-19 fourth dose is well tolerated and boosts humoral immunity; this was evident as an increased humoral response across multiple variants of concern. These data support its use as a booster dose against SARS-CoV-2 infection.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106423"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015296","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106420
Chun-Yan Zhao , Chang Song , Fei-Yi Du , Chang-Yue Jiang, Hang-Biao Qiang, Chao-Yan Xu, Zhou-Hua Xie, Qing-Dong Zhu
{"title":"Third-generation nanopore sequencing for rapid diagnosis of Pneumocystis jirovecii pneumonia and co-pathogens","authors":"Chun-Yan Zhao , Chang Song , Fei-Yi Du , Chang-Yue Jiang, Hang-Biao Qiang, Chao-Yan Xu, Zhou-Hua Xie, Qing-Dong Zhu","doi":"10.1016/j.jinf.2025.106420","DOIUrl":"10.1016/j.jinf.2025.106420","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106420"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015309","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106427
Paul Ogbuigwe , Patrick J. Biggs, Juan Carlos Garcia-Ramirez, Matthew A. Knox, Anthony Pita, Niluka Velathanthiri, Nigel P. French, David T.S. Hayman
Cryptosporidiosis is a disease caused by the parasite Cryptosporidium. Globally, it is a leading cause of diarrhoea and a notifiable disease in New Zealand. Molecular analyses of Cryptosporidium isolated from notified cases do not always provide support for epidemiological links between individuals. We hypothesised this could be due to undetected diversity and the use of consensus Sanger sequence analyses. Here, we analysed 105 Cryptosporidium samples from outbreaks and sporadic cases occurring between 2010 and 2018 in New Zealand using both Next-Generation Sequencing (NGS) and Sanger sequencing of the glycoprotein 60 (gp60) locus. NGS metabarcoding at the gp60 locus uncovered significant intra- and inter-sample genotypic diversity in outbreaks and identified subtypes shared by epidemiologically linked cases, along with rare subtypes, suggesting it may be a useful tool for epidemiological investigations.
{"title":"Metabarcoding captures genetic diversity and links cases in outbreaks of cryptosporidiosis in New Zealand","authors":"Paul Ogbuigwe , Patrick J. Biggs, Juan Carlos Garcia-Ramirez, Matthew A. Knox, Anthony Pita, Niluka Velathanthiri, Nigel P. French, David T.S. Hayman","doi":"10.1016/j.jinf.2025.106427","DOIUrl":"10.1016/j.jinf.2025.106427","url":null,"abstract":"<div><div>Cryptosporidiosis is a disease caused by the parasite <em>Cryptosporidium</em>. Globally, it is a leading cause of diarrhoea and a notifiable disease in New Zealand. Molecular analyses of <em>Cryptosporidium</em> isolated from notified cases do not always provide support for epidemiological links between individuals. We hypothesised this could be due to undetected diversity and the use of consensus Sanger sequence analyses. Here, we analysed 105 <em>Cryptosporidium</em> samples from outbreaks and sporadic cases occurring between 2010 and 2018 in New Zealand using both Next-Generation Sequencing (NGS) and Sanger sequencing of the glycoprotein 60 (<em>gp60</em>) locus. NGS metabarcoding at the <em>gp60</em> locus uncovered significant intra- and inter-sample genotypic diversity in outbreaks and identified subtypes shared by epidemiologically linked cases, along with rare subtypes, suggesting it may be a useful tool for epidemiological investigations.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106427"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076258","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}
Ureaplasma parvum (U. parvum) is generally regarded as innocuous, and studies focusing on variations in pathogenicity among U. parvum serovars are inadequate. We elucidated the variations in the pathogenicity of U. parvum serovars in promoting human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN).
Methods
This cross-sectional study used baseline data from a Chinese multicenter prospective cohort of women of childbearing age undergoing routine cervical cancer screening. We employed multivariate logistic regression analysis to estimate the pathogenic effects of specific U. parvum serovars on HPV infection and CIN. Causal mediation analysis was performed to ascertain the direct effects of specific U. parvum serovars on CIN and their indirect implications via HPV infection.
Findings
The final data analysis encompassed 7058 participants. Upon adjusting for confounding factors, a positive association was observed between U. parvum serovars 1, 3, and 6 and HPV infection (OR 1.53, 95%CI 1.15−2.03; OR 1.31, 95%CI 1.06−1.64; OR 2.34, 95%CI 1.90−2.87); however, only participants with U. parvum serovar 6 showed an increased risk of CIN (OR 1.90, 95%CI 1.19−3.02). No substantial correlation was observed between U. parvum serovar 14 and HPV or CIN incidence. HPV infection potentially mediates the influence of U. parvum serovar 6 on CIN, with a mediation proportion of 76.66%.
Interpretations
Our findings suggest that different U. parvum serovars vary in pathogenicity regarding HPV and CIN. Early detection of specific U. parvum serovars, such as U. parvum serovar 6, in HPV-infected individuals may enable early intervention therapies and reduce the risk of CIN development.
{"title":"Ureaplasma parvum serovar 6 may be a novel element in the progression of HPV infection to CIN: A cross-sectional study of 7058 women","authors":"Yingxuan Zhang , Rongdan Chen , Zuyi Zhou , Wei Qing, Cancan Qi, Jinxia Ou, Hongwei Zhou, Muxuan Chen, CALM 2004 Study Group","doi":"10.1016/j.jinf.2024.106397","DOIUrl":"10.1016/j.jinf.2024.106397","url":null,"abstract":"<div><h3>Background</h3><div><em>Ureaplasma parvum</em> (<em>U. parvum</em>) is generally regarded as innocuous, and studies focusing on variations in pathogenicity among <em>U. parvum</em> serovars are inadequate. We elucidated the variations in the pathogenicity of <em>U. parvum</em> serovars in promoting human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN).</div></div><div><h3>Methods</h3><div>This cross-sectional study used baseline data from a Chinese multicenter prospective cohort of women of childbearing age undergoing routine cervical cancer screening. We employed multivariate logistic regression analysis to estimate the pathogenic effects of specific <em>U. parvum</em> serovars on HPV infection and CIN. Causal mediation analysis was performed to ascertain the direct effects of specific <em>U. parvum</em> serovars on CIN and their indirect implications via HPV infection.</div></div><div><h3>Findings</h3><div>The final data analysis encompassed 7058 participants. Upon adjusting for confounding factors, a positive association was observed between <em>U. parvum</em> serovars 1, 3, and 6 and HPV infection (OR 1.53, 95%CI 1.15−2.03; OR 1.31, 95%CI 1.06−1.64; OR 2.34, 95%CI 1.90−2.87); however, only participants with <em>U. parvum</em> serovar 6 showed an increased risk of CIN (OR 1.90, 95%CI 1.19−3.02). No substantial correlation was observed between <em>U. parvum</em> serovar 14 and HPV or CIN incidence. HPV infection potentially mediates the influence of <em>U. parvum</em> serovar 6 on CIN, with a mediation proportion of 76.66%.</div></div><div><h3>Interpretations</h3><div>Our findings suggest that different <em>U. parvum</em> serovars vary in pathogenicity regarding HPV and CIN. Early detection of specific <em>U. parvum</em> serovars, such as <em>U. parvum</em> serovar 6, in HPV-infected individuals may enable early intervention therapies and reduce the risk of CIN development.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106397"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899822","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106398
Hui Ming Ong , Puteri Ainaa S. Ibrahim , Chee Ning Chong , Chong Tin Tan , Jie Ping Schee , Michael Selorm Avumegah , Raúl Gómez Román , Neil George Cherian , Won Fen Wong , Li-Yen Chang
Objective
To evaluate the long-term humoral immune response to Nipah virus (NiV) in a cohort of 25 survivors after 25 years of post-infection.
Methods
A total of 25 survivors of NiV infection from the 1998 outbreak were recruited for sample collection. The serum IgG antibody response to NiV antigens, specifically nucleocapsid (N), fusion glycoprotein (F) and attachment glycoprotein (G) was evaluated using ELISA. Additionally, the samples were tested for neutralizing antibodies and memory B cell responses.
Results
Detection rates of anti-NiV-F and anti-NiV-G were 56% and 60%, respectively, among the survivors at a 1:100 dilution, whereas only 20% were specifically reactive to rNiV-N. Notably, all samples that tested positive for NiV-F and NiV-G at this dilution also exhibited neutralizing antibodies, highlighting the specificity of these assays. Live virus neutralization assay showed that 72% of survivors had detectable neutralizing antibodies, with varying titers, indicating long-lasting immune memory. Furthermore, memory B cell responses specific to NiV-F and NiV-G were observed in six randomly selected survivors, suggesting the presence of enduring immunological memory.
Conclusions
These findings highlight the potential of NiV-F and NiV-G as reliable markers for NiV exposure and underscore the need for continuous surveillance and research. Such efforts are crucial for advancing vaccine development and improving preparedness for future NiV outbreaks.
{"title":"Malaysia outbreak survivors retain detectable Nipah antibodies and memory B cells after 25 years","authors":"Hui Ming Ong , Puteri Ainaa S. Ibrahim , Chee Ning Chong , Chong Tin Tan , Jie Ping Schee , Michael Selorm Avumegah , Raúl Gómez Román , Neil George Cherian , Won Fen Wong , Li-Yen Chang","doi":"10.1016/j.jinf.2024.106398","DOIUrl":"10.1016/j.jinf.2024.106398","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the long-term humoral immune response to Nipah virus (NiV) in a cohort of 25 survivors after 25 years of post-infection.</div></div><div><h3>Methods</h3><div>A total of 25 survivors of NiV infection from the 1998 outbreak were recruited for sample collection. The serum IgG antibody response to NiV antigens, specifically nucleocapsid (N), fusion glycoprotein (F) and attachment glycoprotein (G) was evaluated using ELISA. Additionally, the samples were tested for neutralizing antibodies and memory B cell responses.</div></div><div><h3>Results</h3><div>Detection rates of anti-NiV-F and anti-NiV-G were 56% and 60%, respectively, among the survivors at a 1:100 dilution, whereas only 20% were specifically reactive to rNiV-N. Notably, all samples that tested positive for NiV-F and NiV-G at this dilution also exhibited neutralizing antibodies, highlighting the specificity of these assays. Live virus neutralization assay showed that 72% of survivors had detectable neutralizing antibodies, with varying titers, indicating long-lasting immune memory. Furthermore, memory B cell responses specific to NiV-F and NiV-G were observed in six randomly selected survivors, suggesting the presence of enduring immunological memory.</div></div><div><h3>Conclusions</h3><div>These findings highlight the potential of NiV-F and NiV-G as reliable markers for NiV exposure and underscore the need for continuous surveillance and research. Such efforts are crucial for advancing vaccine development and improving preparedness for future NiV outbreaks.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106398"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928508","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106365
Lise Gehrt , Sören Möller , Hélène Englund , Ida Laake , Heta Nieminen , Berit Feiring , Mika Lahdenkari , Arto A. Palmu , Lill Trogstad , Christine Stabell Benn , Signe Sørup
Objectives
To investigate if receipt of measles-mumps-rubella (MMR) vaccine following the third dose of diphtheria-tetanus-acellular pertussis (DTaP3) is associated with reduced rates of non-targeted infectious disease hospitalisations.
Methods
Register based cohort study following 1,397,027 children born in Denmark, Finland, Norway, and Sweden until 2 years of age. Rates of infectious disease hospitalisations with minimum one overnight stay according to time-varying vaccination status were compared using Cox proportional hazards regression analysis with age as the underlying timescale and including multiple covariates. Summary estimates were calculated using random-effects meta-analysis.
Results
Compared with DTaP3 and no MMR vaccine, MMR after DTaP3 was associated with reduced rates of infectious disease hospitalisations: aHR was 0.86 (0.83–0.89) in Denmark, 0.70 (0.64–0.75) in Finland, 0.71 (0.68–0.74) in Norway, and 0.71 (0.65–0.77) in Sweden: summary estimate was 0.75 (0.65 to 0.84). A beneficial association was also seen in a negative control exposure analysis (3 vs. 2 DTaP doses): summary estimate aHR was 0.81 (0.75–0.87).
Conclusions
Having MMR as the most recent vaccine was consistently associated with reduced rates of infectious disease hospitalisation. However, bias may account for at least some of the observed association. Randomised controlled trials are warranted to inform the optimal timing of MMR for both its specific and potential non-specific effects.
{"title":"Vaccination against measles-mumps-rubella and rates of non-targeted infectious disease hospitalisations: Nationwide register-based cohort studies in Denmark, Finland, Norway, and Sweden","authors":"Lise Gehrt , Sören Möller , Hélène Englund , Ida Laake , Heta Nieminen , Berit Feiring , Mika Lahdenkari , Arto A. Palmu , Lill Trogstad , Christine Stabell Benn , Signe Sørup","doi":"10.1016/j.jinf.2024.106365","DOIUrl":"10.1016/j.jinf.2024.106365","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate if receipt of measles-mumps-rubella (MMR) vaccine following the third dose of diphtheria-tetanus-acellular pertussis (DTaP3) is associated with reduced rates of non-targeted infectious disease hospitalisations.</div></div><div><h3>Methods</h3><div>Register based cohort study following 1,397,027 children born in Denmark, Finland, Norway, and Sweden until 2 years of age. Rates of infectious disease hospitalisations with minimum one overnight stay according to time-varying vaccination status were compared using Cox proportional hazards regression analysis with age as the underlying timescale and including multiple covariates. Summary estimates were calculated using random-effects meta-analysis.</div></div><div><h3>Results</h3><div>Compared with DTaP3 and no MMR vaccine, MMR after DTaP3 was associated with reduced rates of infectious disease hospitalisations: aHR was 0.86 (0.83–0.89) in Denmark, 0.70 (0.64–0.75) in Finland, 0.71 (0.68–0.74) in Norway, and 0.71 (0.65–0.77) in Sweden: summary estimate was 0.75 (0.65 to 0.84). A beneficial association was also seen in a negative control exposure analysis (3 vs. 2 DTaP doses): summary estimate aHR was 0.81 (0.75–0.87).</div></div><div><h3>Conclusions</h3><div>Having MMR as the most recent vaccine was consistently associated with reduced rates of infectious disease hospitalisation. However, bias may account for at least some of the observed association. Randomised controlled trials are warranted to inform the optimal timing of MMR for both its specific and potential non-specific effects.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106365"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958194","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106388
Kevin Yuan , Augustine Luk , Jia Wei , A. Sarah Walker , Tingting Zhu , David W. Eyre
Background
Patients with Gram-negative bloodstream infections are at risk of serious adverse outcomes without active treatment, but identifying who has antimicrobial resistance (AMR) to target empirical treatment is challenging.
Methods
We used XGBoost machine learning models to predict antimicrobial resistance to seven antibiotics in patients with Enterobacterales bloodstream infection. Models were trained using hospital and community data from Oxfordshire, UK, for patients with positive blood cultures between 01-January-2017 and 31-December-2021. Model performance was evaluated by comparing predictions to final microbiology results in test datasets from 01-January-2022 to 31-December-2023 and to clinicians’ prescribing.
Findings
4709 infection episodes were used for model training and evaluation; antibiotic resistance rates ranged from 7–67%. In held-out test data, resistance prediction performance was similar for the seven antibiotics (AUCs 0.680 [95%CI 0.641–0.720] to 0.737 [0.674–0.797]). Performance improved for most antibiotics when species identifications (available ∼24 h later) were included as model inputs (AUCs 0.723 [0.652–0.791] to 0.827 [0.797–0.857]). In patients treated with a beta-lactam, clinician prescribing led to 70% receiving an active beta-lactam: 44% were over-treated (broader spectrum treatment than needed), 26% optimally-treated (narrowest spectrum active agent), and 30% under-treated (inactive beta-lactam). Model predictions without species data could have led to 79% of patients receiving an active beta-lactam: 45% over-treated, 34% optimally-treated, and 21% under-treated.
Conclusions
Predicting AMR in bloodstream infections is challenging for both clinicians and models. Despite modest performance, machine learning models could still increase the proportion of patients receiving active empirical treatment by up to 9% over current clinical practice in an environment prioritising antimicrobial stewardship.
{"title":"Machine learning and clinician predictions of antibiotic resistance in Enterobacterales bloodstream infections","authors":"Kevin Yuan , Augustine Luk , Jia Wei , A. Sarah Walker , Tingting Zhu , David W. Eyre","doi":"10.1016/j.jinf.2024.106388","DOIUrl":"10.1016/j.jinf.2024.106388","url":null,"abstract":"<div><h3>Background</h3><div>Patients with Gram-negative bloodstream infections are at risk of serious adverse outcomes without active treatment, but identifying who has antimicrobial resistance (AMR) to target empirical treatment is challenging.</div></div><div><h3>Methods</h3><div>We used XGBoost machine learning models to predict antimicrobial resistance to seven antibiotics in patients with Enterobacterales bloodstream infection. Models were trained using hospital and community data from Oxfordshire, UK, for patients with positive blood cultures between 01-January-2017 and 31-December-2021. Model performance was evaluated by comparing predictions to final microbiology results in test datasets from 01-January-2022 to 31-December-2023 and to clinicians’ prescribing.</div></div><div><h3>Findings</h3><div>4709 infection episodes were used for model training and evaluation; antibiotic resistance rates ranged from 7–67%. In held-out test data, resistance prediction performance was similar for the seven antibiotics (AUCs 0.680 [95%CI 0.641–0.720] to 0.737 [0.674–0.797]). Performance improved for most antibiotics when species identifications (available ∼24 h later) were included as model inputs (AUCs 0.723 [0.652–0.791] to 0.827 [0.797–0.857]). In patients treated with a beta-lactam, clinician prescribing led to 70% receiving an active beta-lactam: 44% were over-treated (broader spectrum treatment than needed), 26% optimally-treated (narrowest spectrum active agent), and 30% under-treated (inactive beta-lactam). Model predictions without species data could have led to 79% of patients receiving an active beta-lactam: 45% over-treated, 34% optimally-treated, and 21% under-treated.</div></div><div><h3>Conclusions</h3><div>Predicting AMR in bloodstream infections is challenging for both clinicians and models. Despite modest performance, machine learning models could still increase the proportion of patients receiving active empirical treatment by up to 9% over current clinical practice in an environment prioritising antimicrobial stewardship.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106388"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916263","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}
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