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Modelling the temperature dependent extrinsic incubation period of West Nile Virus using Bayesian time delay models 利用贝叶斯时间延迟模型模拟西尼罗河病毒随温度变化的外在潜伏期。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-27 DOI: 10.1016/j.jinf.2024.106296
Maisie Vollans , Julie Day , Susie Cant , Jordan Hood , A. Marm Kilpatrick , Laura D. Kramer , Alexander Vaux , Jolyon Medlock , Thomas Ward , Robert S. Paton
West Nile Virus (WNV) is a mosquito-borne pathogen that primarily infects birds. Infections can spillover to humans and cause a spectrum of clinical symptoms, including WNV neuroinvasive disease. The extrinsic incubation period (EIP) is the time taken for a mosquito to become infectious following the ingestion of an infected blood meal. Characterising how the EIP varies with temperature is an essential part of predicting the impact and transmission dynamics of WNV. We re-analyse existing experimental data using Bayesian time delay models, allowing us to account for variation in how quickly individual mosquitoes developed disseminated WNV infections. In these experiments, cohorts of Culex pipiens mosquitoes were infected with WNV and kept under different temperature conditions, being checked for disseminated infection at defined timepoints. We find that EIPs are best described with a Weibull distribution and become shorter log-linearly with temperature. Under 18°C, less than 1% of infected Cx. pipiens had a disseminated infection after 5 days, compared to 9.73% (95% CrI: 7.97 to 11.54) at 25°C and 42.20% (95% CrI: 38.32 to 46.60) at 30°C. In the hottest experimental temperature treatment (32°C), the EIP50 was estimated at 3.78 days (CrI: 3.42 to 4.15) compared to over 100 days in the coolest treatment (15°C). The variance of EIPs was found to be much larger at lower temperatures than higher temperatures, highlighting the importance of characterising the time delay distribution associated with the EIP. We additionally demonstrate a competitive advantage of WNV strain WN02 over NY99, where the former infects mosquitoes more quickly at colder temperatures than the latter. This research contributes crucial parameters to the WNV literature, providing essential insights for modellers and those planning interventions.
西尼罗河病毒(WNV)是一种由蚊子传播的病原体,主要感染鸟类。感染可波及人类,并引起一系列临床症状,包括西尼罗河病毒神经侵袭性疾病。体外潜伏期(EIP)是指蚊子在摄入受感染的血餐后产生传染性的时间。描述 EIP 如何随温度变化是预测 WNV 影响和传播动态的重要部分。我们利用贝叶斯时间延迟模型对现有实验数据进行了重新分析,使我们能够考虑到单个蚊子感染 WNV 的速度变化。在这些实验中,成群的库蚊感染了 WNV 病毒,并在不同的温度条件下饲养,在规定的时间点检查是否有传播感染。我们发现,EIPs 最适合用 Weibull 分布来描述,并随温度的升高而呈对数线性缩短。在 18ºC 温度条件下,受感染的蝰蛇在 5 天后扩散感染的比例不到 1%,而在 25ºC 温度条件下为 9.73%(95% 置信区间:7.97 至 11.54),在 30ºC 温度条件下为 42.20%(95% 置信区间:38.32 至 46.60)。在最热的实验温度处理(32ºC)中,EIP50 估计为 3.78 天(CrI:3.42 至 4.15),而在最冷的处理(15ºC)中,EIP50 超过 100 天。研究发现,低温条件下的 EIP 方差比高温条件下的 EIP 方差大得多,这突出表明了确定与 EIP 相关的时间延迟分布特征的重要性。我们还证明了 WNV 株系 WN02 相对于 NY99 的竞争优势,前者在低温下感染蚊子的速度比后者更快。这项研究为 WNV 文献提供了重要参数,为建模者和计划干预者提供了重要见解。
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引用次数: 0
Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves 对 MANTICO2 和 MONET 随机对照试验的汇总分析,比较了在 Omicron 波期间早期治疗 COVID-19 的药物疗效。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-27 DOI: 10.1016/j.jinf.2024.106294
Valentina Mazzotta , Fulvia Mazzaferri , Simone Lanini , Massimo Mirandola , Alessandro Cozzi Lepri , Alessandra Vergori , Alessia Savoldi , Andrea Santoro , Gaia Maccarrone , Ilaria Mastrorosa , Omar Simonetti , Federico De Zottis , Emanuele Nicastri , Giulia Rosini , Laura Rovigo , Lorenzo Tavernaro , Loredana Sarmati , Carlo Tascini , Enrico Girardi , Anna Maria Cattelan , Evelina Tacconelli
<div><h3>Background</h3><div>The clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves.</div></div><div><h3>Methods</h3><div>The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500 mg of intravenous sotrovimab (SOT) or 600 mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100 mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI. Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixed effects logistic model. These trials are registered with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021–004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2).</div></div><div><h3>Findings</h3><div>Between March 2022 and February 2023, 991 patients (SOT = 332, TGM/CGM = 327, NMV/r = 332) were enrolled in 15 Italian centers. The overall mean age was 66 years; 482 participants (48.80%) were male, and 856 were vaccinated with at least a primary course (86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35–1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p = 0.015) and 2.42 (95% CI 0.19 to infinity; p = 0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032–1.83; p = 0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the
背景:在 Omicron 时代,抗病毒药物和单克隆抗体 (mAbs) 的早期治疗轻度至中度 COVID-19 的临床效果尚未通过批准后的比较试验进行最终评估。我们对 Omicron 时代进行的两项随机临床试验进行了汇总分析。方法 MANTICO2/MONET 试验是对两项多中心、独立、第四阶段、三臂、优越性、随机、开放标签试验的汇总分析。患有早期轻度至中度 COVID-19(症状出现后 5 天内)且至少有一个疾病进展风险因素的非住院患者按 1:1:1 随机分配,接受 500 毫克静脉注射索托维单抗 (SOT) 或 600 毫克肌肉注射替沙吉单抗/西格维单抗 (TGM/CGM) 或 5 天口服尼尔马特韦/利托那韦 (NMV/r) 300/100 毫克 BID 疗程。主要结果为随机分组后 29 天内与 COVID-19 相关的住院或死亡。对汇总数据进行了费舍尔精确检验,并报告了总体和各臂的失败发生率及各自的 95% CI。采用未经调整的精确逻辑回归对各臂进行配对比较。此外,还利用增强反概率加权(AIPW)的双重稳健边际模型进行了分析,以估算每个治疗组的潜在结果(Pom),并通过平均治疗效果(ATE)估算其差异。随机分组后 30 天内症状持续情况的分析采用 2 级分层混合效应 logistic 模型进行,并在患者水平设置随机截距。点估计值和 95% 置信区间根据年龄和性别进行了调整,并采用类似于混合效应逻辑模型的方差分析方法进行计算。这些试验在欧洲临床试验数据库EudraCT2021-002612-31(MANTICO2)和EudraCT2021-004188-28(MONET)以及ClinicalTrials.总平均年龄为 66 岁;482 名参与者(48.80%)为男性,856 人至少接种了一个初级疗程(86%)。在观察到的 8/991 例住院病例中,有一人死亡。总体估计失败率为 0.81%(95%CI;0.35-1.58%)。NMV/r治疗组与TGM/CGM治疗组和SOT治疗组相比,主要结果的几率比(OR)分别为8.41(95% CI 1.21至无穷大;p=0.015)和2.42(95% CI 0.19至无穷大;p=0.499)。在 SOT 和 TGM/CGM 之间未观察到明显差异(OR 0.32;95% CI 0.032-1.83;p=0.174)。当我们采用边际加权模型来考虑潜在的残余混杂偏差时,结果与之相似。没有证据表明治疗组之间的症状发生率存在差异,但咳嗽除外,在 21 天的随访中,SOT 组的咳嗽发生率高于其他两组(P=0.039),在 7 天的随访中,NMV/r 组的恶心发生率高于 mAbs 组(P=0.036)。解释 NMV/r 在减少临床易感的 SARS-CoV-2 感染者在症状出现 5 天内入院治疗或死亡方面优于 TGM/CGM。各组患者的症状发生率在一段时间内没有明显差异:这些试验于2021年由意大利药物管理局(AIFA)资助。
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引用次数: 0
Revealing patterns of SARS-CoV-2 variant emergence and evolution using RBD amplicon sequencing of wastewater 利用废水中的 RBD 扩增片段测序揭示 SARS-CoV-2 变异出现和进化的模式。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1016/j.jinf.2024.106284
Xingwen Chen , John Balliew , Cici X. Bauer , Jennifer Deegan , Anna Gitter , Blake M. Hanson , Anthony W. Maresso , Michael J. Tisza , Catherine L. Troisi , Janelle Rios , Kristina D. Mena , Eric Boerwinkle , Fuqing Wu

Objectives

Rapid evolution of SARS-CoV-2 has resulted in the emergence of numerous variants, posing significant challenges to public health surveillance. Clinical genome sequencing, while valuable, has limitations in capturing the full epidemiological dynamics of circulating variants in the general population. This study aimed to monitor the SARS-CoV-2 variant community dynamics and evolution using receptor-binding domain (RBD) amplicon sequencing of wastewater samples.

Methods

We sequenced wastewater from El Paso, Texas, over 17 months, compared the sequencing data with clinical genome data, and performed biodiversity analysis to reveal SARS-CoV-2 variant dynamics and evolution.

Results

We identified 91 variants and observed waves of dominant variants transitioning from BA.2 to BA.2.12.1, BA.4&5, BQ.1, and XBB.1.5. Comparison with clinical genome sequencing data revealed earlier detection of variants and identification of unreported outbreaks. Our results also showed strong consistency with clinical data for dominant variants at the local, state, and national levels. Alpha diversity analyses revealed significant seasonal variations, with the highest diversity observed in winter. By segmenting the outbreak into lag, growth, stationary, and decline phases, we found higher variant diversity during the lag phase, likely due to lower inter-variant competition preceding outbreak growth.

Conclusions

Our findings underscore the importance of low transmission periods in facilitating rapid mutation and variant evolution. Our approach, integrating RBD amplicon sequencing with wastewater surveillance, demonstrates effectiveness in tracking viral evolution and understanding variant emergence, thus enhancing public health preparedness.
目的:SARS-CoV-2 的快速演变导致出现了许多变种,给公共卫生监测工作带来了巨大挑战。临床基因组测序虽然很有价值,但在捕捉普通人群中循环变异体的全部流行病学动态方面存在局限性。本研究旨在通过对废水样本进行受体结合域(RBD)扩增子测序,监测SARS-CoV-2变异体群落的动态和演变:我们对得克萨斯州埃尔帕索的废水进行了长达17个月的测序,将测序数据与临床基因组数据进行了比较,并进行了生物多样性分析,以揭示SARS-CoV-2变体的动态和演化:我们发现了 91 个变体,并观察到从 BA.2 到 BA.2.12.1、BA.4&5、BQ.1 和 XBB.1.5 的显性变体波。与临床基因组测序数据进行比较后发现,变异的检测时间更早,并发现了未报告的爆发。我们的结果还显示,在地方、州和国家层面,显性变异与临床数据非常一致。阿尔法多样性分析显示了显著的季节性变化,冬季的多样性最高。通过将疫情分为滞后期、增长期、静止期和衰退期,我们发现滞后期的变异体多样性较高,这可能是由于疫情增长前变异体之间的竞争较低:我们的发现强调了低传播期在促进快速突变和变异进化方面的重要性。我们的方法将 RBD 扩增片段测序与废水监测相结合,在跟踪病毒进化和了解变异体出现方面显示出了有效性,从而提高了公共卫生防备能力。
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引用次数: 0
Clinical and epidemiological investigation of human infection with zoonotic parasite Trypanosoma dionisii in China 中国人畜共患病寄生虫锥虫感染的临床和流行病学调查。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1016/j.jinf.2024.106290
Nannan Xu , Xiaoai Zhang , Hui Liu , Yintao Xu , Huixia Lu , Lianhui Zhao , Yishan He , Meiqi Zhang , Jingtao Zhang , Guangqian Si , Ziyi Wang , Muxin Chen , Yuchun Cai , Yi Zhang , Qiang Wang , Yuwan Hao , Yuanyuan Li , Zhengbin Zhou , Yunhai Guo , Caiyun Chang , Wei Liu

Background

Trypanosomiasis continues to pose a global threat to human health, with human infection mainly caused by Trypanosoma brucei and Trypanosoma cruzi.

Methods

We present a 30-year-old pregnant woman with persistent high fever from Shandong Province, China. High-throughput sequencing revealed the presence of Trypanosoma dionisii in blood. We conducted an analysis of the patient’s clinical, epidemiological, and virological data.

Results

The patients exhibited fever, shortness of breath, chest tightness, accompanied by change in liver function and inflammatory response. She made a full recovery without any long-term effects. T. dionisii was detected in blood collected 23 days after onset of illness. The 18S rRNA gene sequence showed close similarity to T. dionisii found in bats from Japan, while the gGAPDH gene was closely related to T. dionisii from bats in Mengyin County, Shandong Province. Phylogenetic analysis demonstrated the current T. dionisii belongs to clade B within its species group. Positive anti-Trypanosoma IgG antibody was detected from the patient on Day 23, 66 and 122 after disease onset, as well as the cord blood and serum from the newborn. Retrospective screening of wild small mammals captured from Shandong Province revealed a prevalence rate of 0.54% (7/1304) for T. dionisii; specifically among 0.81% (5/620) of Apodemus agrarius, and 0.46% (2/438) of Mus musculus.

Conclusions

The confirmation of human infection with T. dionisii underscores its potential as a zoonotic pathogen, while the widespread presence of this parasite in rodent and bat species emphasizes the emerging threat it poses to human health.
背景:锥虫病继续对全球人类健康构成威胁:锥虫病继续对全球人类健康构成威胁,人类感染主要由布氏锥虫和克鲁斯锥虫引起:方法:我们研究了一名来自中国山东省、患有持续高烧的 30 岁孕妇。高通量测序发现血液中存在狄奥尼斯锥虫。我们对患者的临床、流行病学和病毒学数据进行了分析:患者表现出发热、气短、胸闷,并伴有肝功能和炎症反应的改变。她完全康复,没有受到任何长期影响。在发病 23 天后采集的血液中检测到了狄奥尼氏菌。18S rRNA基因序列显示与日本蝙蝠中的T. dionisii近似,而gGAPDH基因与山东省蒙阴县蝙蝠中的T. dionisii关系密切。系统进化分析表明,目前的T. dionisii属于其种群中的B支系。在患者发病后第23天、第66天和第122天,以及新生儿的脐带血和血清中均检测到阳性的抗锥虫IgG抗体。对山东省捕获的野生小型哺乳动物进行的回顾性筛查显示,T. dionisii的感染率为0.54%(7/1304),特别是在Apodemus agrarius和Mus musculus中的感染率分别为0.81%(5/620)和0.46%(2/438):人类感染 T. dionisii 的确认突显了其作为人畜共患病病原体的潜力,而这种寄生虫在啮齿动物和蝙蝠物种中的广泛存在则强调了它对人类健康构成的新威胁。
{"title":"Clinical and epidemiological investigation of human infection with zoonotic parasite Trypanosoma dionisii in China","authors":"Nannan Xu ,&nbsp;Xiaoai Zhang ,&nbsp;Hui Liu ,&nbsp;Yintao Xu ,&nbsp;Huixia Lu ,&nbsp;Lianhui Zhao ,&nbsp;Yishan He ,&nbsp;Meiqi Zhang ,&nbsp;Jingtao Zhang ,&nbsp;Guangqian Si ,&nbsp;Ziyi Wang ,&nbsp;Muxin Chen ,&nbsp;Yuchun Cai ,&nbsp;Yi Zhang ,&nbsp;Qiang Wang ,&nbsp;Yuwan Hao ,&nbsp;Yuanyuan Li ,&nbsp;Zhengbin Zhou ,&nbsp;Yunhai Guo ,&nbsp;Caiyun Chang ,&nbsp;Wei Liu","doi":"10.1016/j.jinf.2024.106290","DOIUrl":"10.1016/j.jinf.2024.106290","url":null,"abstract":"<div><h3>Background</h3><div>Trypanosomiasis continues to pose a global threat to human health, with human infection mainly caused by <em>Trypanosoma brucei</em> and <em>Trypanosoma cruzi.</em></div></div><div><h3>Methods</h3><div>We present a 30-year-old pregnant woman with persistent high fever from Shandong Province, China. High-throughput sequencing revealed the presence of <em>Trypanosoma dionisii</em> in blood. We conducted an analysis of the patient’s clinical, epidemiological, and virological data.</div></div><div><h3>Results</h3><div>The patients exhibited fever, shortness of breath, chest tightness, accompanied by change in liver function and inflammatory response. She made a full recovery without any long-term effects. <em>T. dionisii</em> was detected in blood collected 23 days after onset of illness. The 18S rRNA gene sequence showed close similarity to <em>T. dionisii</em> found in bats from Japan, while the <em>gGAPDH</em> gene was closely related to <em>T. dionisii</em> from bats in Mengyin County, Shandong Province. Phylogenetic analysis demonstrated the current <em>T. dionisii</em> belongs to clade B within its species group. Positive anti-<em>Trypanosoma</em> IgG antibody was detected from the patient on Day 23, 66 and 122 after disease onset, as well as the cord blood and serum from the newborn. Retrospective screening of wild small mammals captured from Shandong Province revealed a prevalence rate of 0.54% (7/1304) for <em>T. dionisii</em>; specifically among 0.81% (5/620) of <em>Apodemus agrarius</em>, and 0.46% (2/438) of <em>Mus musculus</em>.</div></div><div><h3>Conclusions</h3><div>The confirmation of human infection with <em>T. dionisii</em> underscores its potential as a zoonotic pathogen, while the widespread presence of this parasite in rodent and bat species emphasizes the emerging threat it poses to human health.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106290"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331428","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
Severity of respiratory syncytial virus compared with SARS-CoV-2 and influenza among hospitalised adults ≥65 years 在≥65 岁的住院成年人中,呼吸道合胞病毒与 SARS-CoV-2 和流感的严重程度进行比较。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1016/j.jinf.2024.106292
Lorena Vega-Piris , Silvia Galindo Carretero , José Luis Mayordomo , Mercedes Belén Rumayor Zarzuelo , Virginia Álvarez Río , Virtudes Gallardo García , Miriam García Vázquez , María del Carmen García Rodríguez , Luca Basile , Nieves López González-Coviella , Maria Isabel Barranco Boada , Olaia Pérez-Martínez , Ana Lameiras Azevedo , Carmen Quiñones Rubio , Jaume Giménez Duran , Ana Fernández Ibáñez , María Victoria García Rivera , Violeta Ramos Marín , Daniel Castrillejo , Luis Javier Viloria Raymundo , Susana Monge

Introduction

Our aim was to estimate the risk of pneumonia, admission to intensive care unit (ICU) or death in individuals ≥65 years old admitted to hospital with RSV, compared to influenza or COVID-19.

Methods

We included hospitalised patients from Severe Acute Respiratory Infection Surveillance in Spain between 2021–2024, aged ≥65 years, laboratory confirmed for RSV, influenza or SARS-CoV-2. Using a binomial regression with logarithmic link, we estimated the relative risk (RR) of pneumonia, ICU admission and in-hospital mortality, in patients with RSV compared to influenza or SARS-CoV-2, adjusting for age, sex, season and comorbidities. We stratified the estimates by vaccination status for influenza or SARS-CoV2.

Results

Among patients unvaccinated for influenza or SARS-CoV-2, those with RSV had similar or lower risk of pneumonia [vs. influenza: RR= 0.91 (95% Confidence Interval: 0.72–1.16); vs. SARS-CoV-2: 0.81 (0.67–0.98)], ICU admission [vs. influenza: 0.93 (0.41–2.08); vs. SARS-CoV-2: 1.10 (0.61–1.99)] and mortality [vs. influenza: 0.64 (0.32–1.28); vs. SARS-CoV-2: 0.56 (0.30–1.04)]. Among the vaccinated, results were largely similar except for a higher risk of ICU admission with RSV [vs. influenza: 2.13(1.16–3.89); vs. SARS-CoV-2: 1.83 (1.02–3.28)]

Conclusions

RSV presented similar or lower intrinsic severity than influenza or SARS-CoV2. Among vaccinated patients, RSV was associated to higher ICU-admission, suggesting the potential for preventive RSV vaccination.
导言我们的目的是估算与流感或 COVID-19 相比,≥65 岁的 RSV 住院患者患肺炎、入住重症监护室 (ICU) 或死亡的风险:我们纳入了 2021-2024 年间西班牙严重急性呼吸道感染监测中年龄≥65 岁、实验室确诊为 RSV、流感或 SARS-CoV-2 的住院患者。通过二项回归与对数链接,我们估算了与流感或 SARS-CoV-2 相比,RSV 患者患肺炎、入住重症监护室和院内死亡的相对风险 (RR),并对年龄、性别、季节和合并症进行了调整。我们根据流感或 SARS-CoV2 疫苗接种情况对估计值进行了分层:结果:在未接种流感疫苗或 SARS-CoV-2 疫苗的患者中,RSV 感染者患肺炎的风险相似或更低[与流感相比,RR=0.91(95%)]:RR=0.91(95% 置信区间:0.72-1.16);vs. SARS-CoV-2:0.81(0.67-0.98)]、入住重症监护室的风险[vs. 流感:0.93(0.41-2.08);vs. SARS-CoV-2:1.10(0.61-1.99)]和死亡率[vs. 流感:0.64(0.32-1.28);vs. SARS-CoV-2:0.56(0.30-1.04)]。在接种疫苗的人群中,除了 RSV 的 ICU 入院风险较高之外,其他结果基本相似[与流感相比:2.13(1.16-3.89);与 SARS-CoV-2 相比:1.83(1.02-3.28)] 结论:RSV 与流感的内在风险相似或更低:RSV 的内在严重性与流感或 SARS-CoV2 相似或更低。在接种过疫苗的患者中,RSV 与较高的 ICU 入院率相关,这表明预防性 RSV 疫苗接种具有潜力。
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引用次数: 0
N-protein vaccine is effective against COVID-19: Phase 3, randomized, double-blind, placebo-controlled clinical trial N蛋白疫苗对COVID-19有效:3期随机、双盲、安慰剂对照临床试验。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1016/j.jinf.2024.106288
Sevastyan O. Rabdano , Ellina A. Ruzanova , Anastasiya E. Vertyachikh , Valeriya A. Teplykh , Alla B. Emelyanova , German O. Rudakov , Sergei A. Arakelov , Iuliia V. Pletyukhina , Nikita S. Saveliev , Anna A. Lukovenko , Liliya N. Fakhretdinova , Ariana S. Safi , Ekaterina N. Zhirenkina , Irina N. Polyakova , Natalia S. Belozerova , Vladislav V. Klykov , Arina P. Savelieva , Aleksey A. Ekimov , Konstantin V. Pokachalov , Vadim A. Merkulov , Veronika I. Skvortsova

Background

Despite the success of first-generation COVID-19 vaccines targeting the spike (S) protein, emerging SARS-CoV-2 variants have led to immune escape, reducing the efficacy of these vaccines. Additionally, some individuals are unable to mount an effective immune response to S protein-based vaccines. This has created a need for alternative vaccine strategies that are less susceptible to mutations and capable of providing broad and durable protection. This study aimed to evaluate the efficacy and safety of a novel COVID-19 vaccine based on the full-length recombinant nucleocapsid (N) protein of SARS-CoV-2.

Methods

We conducted a prospective, multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial (NCT05726084) in Russia. Participants (n = 5229) were adults aged 18 years and older, with a BMI of 18.5–30 kg/m², and without significant clinical abnormalities. They were randomized in a 2:1 ratio to receive a single intramuscular dose of either the N protein-based vaccine (50 µg) or placebo. Randomization was done through block randomization, and masking was ensured by providing visually identical formulations of vaccine and placebo. The primary outcome was the incidence of symptomatic COVID-19 confirmed by PCR more than 15 days after vaccination within a 180-day observation period, analyzed on an intention-to-treat basis.

Findings

Between May 18, 2023, and August 9, 2023, 5229 participants were randomized, with 3486 receiving the vaccine and 1743 receiving the placebo. Eight cases of PCR-confirmed symptomatic COVID-19 occurred in the vaccine group (0.23%) compared to 27 cases in the placebo group (1.55%), yielding a vaccine efficacy of 85.2% (95% CI: 67.4–93.3; p < 0.0001). Adverse events were mostly mild and included local injection site reactions. There were no vaccine-related serious adverse events.

Interpretation

The N protein-based COVID-19 vaccine demonstrated significant efficacy and a favorable safety profile, suggesting it could be a valuable addition to the global vaccination effort, particularly in addressing immune escape variants and offering an alternative for those unable to respond to S protein-based vaccines. These results support the continued development and potential deployment of N protein-based vaccines in the ongoing fight against COVID-19.
背景:尽管针对尖峰(S)蛋白的第一代 COVID-19 疫苗取得了成功,但新出现的 SARS-CoV-2 变种导致了免疫逃逸,降低了这些疫苗的效力。此外,有些人无法对基于 S 蛋白的疫苗产生有效的免疫反应。因此,我们需要不易受变异影响、能提供广泛持久保护的替代疫苗策略。本研究旨在评估基于 SARS-CoV-2 全长重组核壳(N)蛋白的新型 COVID-19 疫苗的有效性和安全性:我们在俄罗斯进行了一项前瞻性、多中心、随机、双盲、安慰剂对照的 3 期临床试验(NCT05726084)。参与者(5229 人)均为 18 岁及以上的成年人,体重指数在 18.5-30kg/m² 之间,无明显临床异常。他们按 2:1 的比例被随机分配接受单剂量肌肉注射 N 蛋白疫苗(50 微克)或安慰剂。随机分配采用区组随机法,并通过提供视觉上完全相同的疫苗和安慰剂配方来确保掩蔽。主要结果是在180天的观察期内,接种疫苗后15天以上经PCR确诊的无症状COVID-19的发生率:2023年5月18日至2023年8月9日期间,5229名参与者被随机分组,其中3486人接种疫苗,1743人接种安慰剂。疫苗组出现了8例经PCR确诊的无症状COVID-19(0.23%),而安慰剂组出现了27例(1.55%),疫苗有效率为85.2%(95% CI:67.4-93.3;p解释:基于N蛋白的COVID-19疫苗表现出显著的有效性和良好的安全性,这表明它可以成为全球疫苗接种工作的重要补充,特别是在应对免疫逃逸变异和为那些无法对基于S蛋白的疫苗产生反应的人提供替代疫苗方面。这些结果支持继续开发和潜在使用基于 N 蛋白的疫苗来对抗 COVID-19。
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引用次数: 0
The Platform Trial In COVID-19 Priming and BOOsting (PICOBOO): The immunogenicity, reactogenicity, and safety of different COVID-19 vaccinations administered as a second booster (fourth dose) in AZD1222 primed individuals aged 50-<70 years old COVID-19 接种前和接种后的平台试验(PICOBOO):对 50-<70 岁年龄段的 AZD1222 接种者接种不同 COVID-19 疫苗作为第二针加强剂(第四针)的免疫原性、反应原性和安全性。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1016/j.jinf.2024.106286
C. McLeod , M. Dymock , K.L. Flanagan , M. Plebanski , H. Marshall , M.J. Estcourt , M.C. Tjiam , C.C. Blyth , K. Subbarao , F.L. Mordant , S. Nicholson , S.N. Faust , U. Wadia , R.B. Thornton , Z. Ellis , A. Mckenzie , J.A. Marsh , T.L. Snelling , P. Richmond

Objectives

PICOBOO is a randomised, adaptive trial evaluating the immunogenicity, reactogenicity, and safety of COVID-19 booster strategies. We report data for second boosters among individuals 50-<70 years old primed with AZD1222 (50-<70y-AZD1222) until Day 84.

Methods

Immunocompetent adults who received any first booster ≥three months prior were eligible. Participants were randomly allocated to BNT162b2, mRNA-1273 or NVX-CoV2373 1:1:1. The concentrations of ancestral anti-spike immunoglobulin were summarised as the geometric mean concentrations (GMC). Reactogenicity and safety outcomes were captured. Additional analyses including neutralising antibodies were performed on a subset. ACTRN12622000238774.

Results

Between Mar 2022 and Aug 2023, 743 participants were recruited and had D28 samples; 155 belonged to the 50-<70y-AZD1222 stratum. The mean adjusted GMCs (95% credible intervals) were 20,690 (17 555−23 883), 23,867 (20 144−27 604) and 8654 (7267−9962) U/mL at D28 following boosting with BNT162b2, mRNA-1273 and NVX-CoV2372, respectively, and 10,976 (8826−13 196), 15,779 (12 512−19 070) and 6559 (5220−7937) U/mL by D84. IgG against Omicron BA.5 was 2.7–2.9 times lower than the ancestral strain. Limited neutralisation against Omicron subvariants was found following all vaccines. Severe reactogenicity events were <4%.

Conclusions

All vaccines were immunogenic with more rapid waning after mRNA vaccines. These data support boosting with vaccines with greater specificity for circulating Omicron subvariants.
试验目的PICOBOO 是一项随机适应性试验,旨在评估 COVID-19 强化策略的免疫原性、反应原性和安全性。我们报告了在 50 人中进行第二次强化的数据:免疫功能正常的成年人在接受任何首次强化治疗 > 三个月之前均符合条件。参与者以 1:1:1 的比例随机分配到 BNT162b2、mRNA-1273 或 NVX-CoV2373。祖先抗尖峰免疫球蛋白的浓度汇总为几何平均浓度(GMC)。反应生成性和安全性结果均有记录。对一个子集进行了包括中和抗体在内的额外分析。ACTRN12622000238774.Results:2022年3月至2023年8月期间,共招募了743名参与者并采集了D28样本;其中155人属于50-结论组:所有疫苗都具有免疫原性,mRNA 疫苗的免疫原性减弱更快。这些数据支持使用对循环中的 Omicron 亚变体具有更强特异性的疫苗来增强免疫力。
{"title":"The Platform Trial In COVID-19 Priming and BOOsting (PICOBOO): The immunogenicity, reactogenicity, and safety of different COVID-19 vaccinations administered as a second booster (fourth dose) in AZD1222 primed individuals aged 50-<70 years old","authors":"C. McLeod ,&nbsp;M. Dymock ,&nbsp;K.L. Flanagan ,&nbsp;M. Plebanski ,&nbsp;H. Marshall ,&nbsp;M.J. Estcourt ,&nbsp;M.C. Tjiam ,&nbsp;C.C. Blyth ,&nbsp;K. Subbarao ,&nbsp;F.L. Mordant ,&nbsp;S. Nicholson ,&nbsp;S.N. Faust ,&nbsp;U. Wadia ,&nbsp;R.B. Thornton ,&nbsp;Z. Ellis ,&nbsp;A. Mckenzie ,&nbsp;J.A. Marsh ,&nbsp;T.L. Snelling ,&nbsp;P. Richmond","doi":"10.1016/j.jinf.2024.106286","DOIUrl":"10.1016/j.jinf.2024.106286","url":null,"abstract":"<div><h3>Objectives</h3><div>PICOBOO is a randomised, adaptive trial evaluating the immunogenicity, reactogenicity, and safety of COVID-19 booster strategies. We report data for second boosters among individuals 50-&lt;70 years old primed with AZD1222 (50-&lt;70y-AZD1222) until Day 84.</div></div><div><h3>Methods</h3><div>Immunocompetent adults who received any first booster ≥three months prior were eligible. Participants were randomly allocated to BNT162b2, mRNA-1273 or NVX-CoV2373 1:1:1. The concentrations of ancestral anti-spike immunoglobulin were summarised as the geometric mean concentrations (GMC). Reactogenicity and safety outcomes were captured. Additional analyses including neutralising antibodies were performed on a subset. ACTRN12622000238774.</div></div><div><h3>Results</h3><div>Between Mar 2022 and Aug 2023, 743 participants were recruited and had D28 samples; 155 belonged to the 50-&lt;70y-AZD1222 stratum. The mean adjusted GMCs (95% credible intervals) were 20,690 (17 555−23 883), 23,867 (20 144−27 604) and 8654 (7267−9962) U/mL at D28 following boosting with BNT162b2, mRNA-1273 and NVX-CoV2372, respectively, and 10,976 (8826−13 196), 15,779 (12 512−19 070) and 6559 (5220−7937) U/mL by D84. IgG against Omicron BA.5 was 2.7–2.9 times lower than the ancestral strain. Limited neutralisation against Omicron subvariants was found following all vaccines. Severe reactogenicity events were &lt;4%.</div></div><div><h3>Conclusions</h3><div>All vaccines were immunogenic with more rapid waning after mRNA vaccines. These data support boosting with vaccines with greater specificity for circulating Omicron subvariants.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 6","pages":"Article 106286"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331471","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
Trends in hospitalisations for lower respiratory infections after the COVID-19 pandemic in France 法国 COVID-19 大流行后因下呼吸道感染住院的趋势。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1016/j.jinf.2024.106287
Alexandre Sabaté-Elabbadi , Lucie Brolon , Christian Brun-Buisson , Didier Guillemot , Muriel Fartoukh , Laurence Watier

Objectives

We aimed to evaluate the impact of the pandemic and post-pandemic periods on hospital admissions for LRTI, with a focus on patients with chronic respiratory disease (CRD).

Methods

From July 2013 to June 2023, monthly numbers of adult hospitalisations for LRTI (excluding SARS-CoV-2) were extracted from the French National Hospital Discharge Database. They were modelled by regressions with autocorrelated errors. Three periods were defined: (1) early pandemic and successive lockdowns; (2) gradual lifting of restrictions and widespread SARS-CoV-2 vaccination; (3) withdrawal of restriction measures.

Results

Pre-pandemic incidence was 96 (90.5 to 101.5) per 100,000 population. Compared with the pre-pandemic period, no more seasonality and significant reductions were estimated in the first two periods: −43.64% (−50.11 to −37.17) and −32.97% (−39.88 to −26.05), respectively. A rebound with a positive trend and a seasonal pattern was observed in period 3. Similar results were observed for CRD patients with no significant difference with pre-pandemic levels in the last period (−9.21%; −20.9% to 1.67%), albeit with differential changes according to the type of CRD.

Conclusions

COVID-19 pandemic containment measures contributed to changes in LRTI incidence, with a rapid increase and return to a seasonal pattern after their lifting, particularly in patients with CRD.
目的我们的目的是评估大流行期间和大流行后对 LRTI 住院人数的影响,重点是慢性呼吸道疾病(CRD)患者:从 2013 年 7 月到 2023 年 6 月,每月因 LRTI(不包括 SARS-CoV-2)住院的成人人数均来自法国国家医院出院数据库。通过自相关误差回归法建立模型。研究界定了三个时期:(1) 大流行初期和连续封锁期;(2) 逐步取消限制和广泛接种 SARS-CoV-2 疫苗期;(3) 取消限制措施期:大流行前的发病率为每 10 万人 96 例(90.5 至 101.5 例)。与疫情流行前相比,前两个时期的发病率不再具有季节性,且有明显下降:分别为-43.64%(-50.11 至-37.17)和-32.97%(-39.88 至-26.05)。在第 3 个阶段,观察到呈正趋势的反弹和季节性模式。CRD患者也出现了类似的结果,在最后一个时期与大流行前的水平没有明显差异(-9.21%;-20.9%至1.67%),尽管根据CRD类型的不同而出现不同的变化:COVID-19大流行遏制措施促进了LRTI发病率的变化,在这些措施解除后,LRTI发病率迅速上升并恢复到季节性模式,尤其是在CRD患者中。
{"title":"Trends in hospitalisations for lower respiratory infections after the COVID-19 pandemic in France","authors":"Alexandre Sabaté-Elabbadi ,&nbsp;Lucie Brolon ,&nbsp;Christian Brun-Buisson ,&nbsp;Didier Guillemot ,&nbsp;Muriel Fartoukh ,&nbsp;Laurence Watier","doi":"10.1016/j.jinf.2024.106287","DOIUrl":"10.1016/j.jinf.2024.106287","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the impact of the pandemic and post-pandemic periods on hospital admissions for LRTI, with a focus on patients with chronic respiratory disease (CRD).</div></div><div><h3>Methods</h3><div>From July 2013 to June 2023, monthly numbers of adult hospitalisations for LRTI (excluding SARS-CoV-2) were extracted from the French National Hospital Discharge Database. They were modelled by regressions with autocorrelated errors. Three periods were defined: (1) early pandemic and successive lockdowns; (2) gradual lifting of restrictions and widespread SARS-CoV-2 vaccination; (3) withdrawal of restriction measures.</div></div><div><h3>Results</h3><div>Pre-pandemic incidence was 96 (90.5 to 101.5) per 100,000 population. Compared with the pre-pandemic period, no more seasonality and significant reductions were estimated in the first two periods: −43.64% (−50.11 to −37.17) and −32.97% (−39.88 to −26.05), respectively. A rebound with a positive trend and a seasonal pattern was observed in period 3. Similar results were observed for CRD patients with no significant difference with pre-pandemic levels in the last period (−9.21%; −20.9% to 1.67%), albeit with differential changes according to the type of CRD.</div></div><div><h3>Conclusions</h3><div>COVID-19 pandemic containment measures contributed to changes in LRTI incidence, with a rapid increase and return to a seasonal pattern after their lifting, particularly in patients with CRD.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"89 5","pages":"Article 106287"},"PeriodicalIF":14.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331473","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
Long-term morbidity and mortality of patients who survived past 30 days from bloodstream infection: A population-based retrospective cohort study 因血流感染而存活超过 30 天的患者的长期发病率和死亡率:基于人群的回顾性队列研究
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-25 DOI: 10.1016/j.jinf.2024.106283
Anthony D. Bai , Nick Daneman , Kevin A. Brown , J. Gordon Boyd , Sudeep S. Gill

Background

For bloodstream infections (BSI), treatment and research have focused on short term mortality. The objective of this study was to describe the 1-year mortality and morbidity in survivors of bloodstream infection when compared to patients with negative blood cultures.

Methods

We conducted a population-based retrospective cohort study using Ontario administrative databases. Patients were included if they had a blood culture taken from January 1, 2014, to December 31, 2021, and survived past 30 days from blood culture collection. They were followed for the subsequent year. Outcomes were compared among patients with BSI and those without BSI, including all-cause mortality, stroke, myocardial infarction (MI), congestive heart failure (CHF) exacerbation, new start dialysis and admission to a long-term care (LTC) facility. Prognostic factors were balanced using overlap weighting of propensity scores, and a survival or competing risk model was used to describe time-to-event.

Results

Of 981,341 patients undergoing blood culture testing, 99,080 (10.1%) patients had a BSI and 882,261 (89.9%) patients did not. Outcomes were all more common among those with BSI as compared to those without BSI, including all-cause mortality (16,764 [16.9%] vs. 84,480 [9.6%]), stroke (1016 [1.0%] vs. 4680 [0.5%]), MI (1043 [1.1%] vs. 4547 [0.5%]), CHF exacerbation (2643 [2.7%] vs. 13,200 [1.5%]), new start dialysis (1703 [1.7%] vs. 2749 [0.3%]), and LTC admission (4231 [4.3%] vs. 13,016 [1.5%]). BSI had an adjusted hazard ratio of 1.10 (95% CI 1.08–1.12, P < 0.0001) for mortality, subdistribution hazard ratio (sHR) of 1.27 (95% CI 1.19–1.37, P < 0.0001) for stroke, sHR of 1.18 (95% CI 1.10–1.26, P < 0.0001) for MI, sHR of 1.05 (95% CI 1.01–1.10, P = 0.0176) for CHF exacerbation, sHR of 3.42 (95% CI 3.21–3.64, P < 0.0001) for new start dialysis and sHR of 1.87 (95% CI 1.80–1.94, P < 0.0001) for LTC admission.

Conclusion

BSI survivors have substantial long-term mortality and morbidity including stroke, MI, new start dialysis and functional decline leading to LTC admission.
背景对于血流感染(BSI),治疗和研究的重点是短期死亡率。本研究旨在描述血流感染幸存者与血培养阴性患者相比的 1 年死亡率和发病率。在 2014 年 1 月 1 日至 2021 年 12 月 31 日期间进行过血培养并在血培养采集后 30 天内存活的患者均被纳入研究范围。随后一年对他们进行了随访。比较了有 BSI 和无 BSI 患者的结局,包括全因死亡率、中风、心肌梗死 (MI)、充血性心力衰竭 (CHF) 恶化、新开始透析和入住长期护理 (LTC) 机构。结果 在接受血液培养检测的 981,341 名患者中,99,080 名(10.1%)患者发生了 BSI,882,261 名(89.9%)患者没有发生 BSI。5%])、心肌梗死(1043 [1.1%] vs. 4547 [0.5%])、慢性阻塞性肺病恶化(2643 [2.7%] vs. 13,200 [1.5%])、新开始透析(1703 [1.7%] vs. 2749 [0.3%])和入住长期护理中心(4231 [4.3%] vs. 13,016 [1.5%])。BSI的调整后死亡率危险比为1.10(95% CI 1.08-1.12,P <0.0001),亚分布危险比(sHR)为1.27(95% CI 1.19-1.37,P <0.0001)。37, P < 0.0001),心肌梗死危险比(sHR)为 1.18 (95% CI 1.10-1.26, P < 0.0001),慢性阻塞性肺疾病恶化危险比(sHR)为 1.05 (95% CI 1.01-1.10, P = 0.0176),心肌梗死危险比(sHR)为 3.42 (95% CI 3.21-3.64, P < 0.0001);入住 LTC 的 sHR 为 1.87 (95% CI 1.80-1.94, P < 0.0001)。
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引用次数: 0
Corrigendum to “Patients with transplantation have reduced mortality in bacteraemia: Analysis of data from a randomised trial” [J Infect 85 (2022) 17–23] 对 "移植患者的菌血症死亡率降低:一项随机试验的数据分析" [J Infect 85 (2022) 17-23] 的更正
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-25 DOI: 10.1016/j.jinf.2024.106281
Fergus Hamilton , Rebecca Evans , Peter Ghazal , Alasdair MacGowan
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引用次数: 0
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Journal of Infection
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