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Drug Use Disorders and Violence: Associations With Individual Drug Categories. 药物使用障碍和暴力:与个别药物类别的关联。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa006
Shaoling Zhong, Rongqin Yu, Seena Fazel

We conducted a systematic review that examined the link between individual drug categories and violent outcomes. We searched for primary case-control and cohort investigations that reported risk of violence against others among individuals diagnosed with drug use disorders using validated clinical criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 18 studies published during 1990-2019, reporting data from 591,411 individuals with drug use disorders. We reported odds ratios of the violence risk in different categories of drug use disorders compared with those without. We found odds ratios ranging from 0.8 to 25.0 for most individual drug categories, with generally higher odds ratios among individuals with polydrug use disorders. In addition, we explored sources of between-study heterogeneity by subgroup and meta-regression analyses. Cohort investigations reported a lower risk of violence than case-control reports (odds ratio =  2.7 (95% confidence interval (CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)), and associations were stronger when the outcome was any violence rather than intimate partner violence (odds ratio = 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)), which was consistent with results from the meta-regression. Overall, these findings highlight the potential impact of preventing and treating drug use disorders on reducing violence risk and associated morbidities.

我们进行了一项系统回顾,检查了个别药物类别与暴力结果之间的联系。我们根据系统评价和荟萃分析指南的首选报告项目,搜索了主要病例对照和队列调查,这些调查使用经过验证的临床标准报告了被诊断为药物使用障碍的个体中对他人的暴力风险。我们确定了1990-2019年期间发表的18项研究,报告了来自591,411名药物使用障碍患者的数据。我们报告了不同类别药物使用障碍中暴力风险的比值比与非药物使用障碍的比值比。我们发现,大多数药物类别的比值比在0.8到25.0之间,多种药物使用障碍患者的比值比通常更高。此外,我们通过亚组和元回归分析探讨了研究间异质性的来源。队列调查报告的暴力风险低于病例对照报告(优势比= 2.7(95%置信区间(CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)),当结果是任何暴力而不是亲密伴侣暴力时,关联更强(优势比= 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)),这与meta回归的结果一致。总的来说,这些发现突出了预防和治疗药物使用障碍对减少暴力风险和相关发病率的潜在影响。
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引用次数: 21
Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use. 向注射吸毒过渡过程中提供和接受援助的流行程度及其相关性。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa008
Rachel E Gicquelais, Dan Werb, Charles Marks, Carolyn Ziegler, Shruti H Mehta, Becky L Genberg, Ayden I Scheim

Preventing the transition to injection drug use is an important public health goal, as people who inject drugs (PWID) are at high risk for overdose and acquisition of infectious disease. Initiation into drug injection is primarily a social process, often involving PWID assistance. A better understanding of the epidemiology of this phenomenon would inform interventions to prevent injection initiation and to enhance safety when assistance is provided. We conducted a systematic review of the literature to 1) characterize the prevalence of receiving (among injection-naive persons) and providing (among PWID) help or guidance with the first drug injection and 2) identify correlates associated with these behaviors. Correlates were organized as substance use behaviors, health outcomes (e.g., human immunodeficiency virus infection), or factors describing an individual's social, economic, policy, or physical environment, defined by means of Rhodes' risk environments framework. After screening of 1,164 abstracts, 57 studies were included. The prevalence of receiving assistance with injection initiation (help or guidance at the first injection) ranged 74% to 100% (n = 13 estimates). The prevalence of ever providing assistance with injection initiation varied widely (range, 13%-69%; n = 13 estimates). Injecting norms, sex/gender, and other correlates classified within Rhodes' social risk environment were commonly associated with providing and receiving assistance. Nearly all PWID receive guidance about injecting for the first time, whereas fewer PWID report providing assistance. Substantial clinical and statistical heterogeneity between studies precluded meta-analysis, and thus local-level estimates may be necessary to guide the implementation of future psychosocial and sociostructural interventions. Further, estimates of providing assistance may be downwardly biased because of social desirability factors.

防止过渡到注射吸毒是一项重要的公共卫生目标,因为注射吸毒者(PWID)有过量吸毒和感染传染病的高风险。开始注射药物主要是一个社会过程,通常涉及PWID援助。更好地了解这一现象的流行病学将为干预措施提供信息,以防止开始注射并在提供援助时加强安全性。我们对文献进行了系统回顾,以1)描述首次注射药物时接受(未注射者)和提供(PWID患者)帮助或指导的流行程度,2)确定这些行为的相关性。相关因素被组织为物质使用行为、健康结果(如人类免疫缺陷病毒感染)或描述个人社会、经济、政策或物理环境的因素,这些因素由Rhodes风险环境框架定义。在筛选了1164篇摘要后,纳入了57篇研究。开始注射时接受帮助(第一次注射时的帮助或指导)的流行率为74%至100% (n = 13个估计值)。曾经协助开始注射的流行率差异很大(范围,13%-69%;N = 13个估计)。注射规范、性/性别和其他被归类为罗兹社会风险环境的相关因素通常与提供和接受援助有关。几乎所有的未成年人都是第一次接受注射指导,而很少有未成年人报告提供帮助。研究之间的大量临床和统计异质性排除了荟萃分析,因此可能需要地方水平的估计来指导未来社会心理和社会结构干预措施的实施。此外,由于社会期望因素,对提供援助的估计可能会向下偏误。
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引用次数: 11
Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications. 处方阿片类药物在育龄人群中的使用:对生育能力、妊娠丢失和妊娠并发症的影响。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa007
Kerry S Flannagan, Lindsey A Sjaarda, Sunni L Mumford, Enrique F Schisterman

Prescription opioid use is common among men and women of reproductive age, including during assisted-reproduction procedures. Opioid use disorder and chronic use are associated with harms to fertility and pregnancy outcomes, but it is unclear whether these associations extend to common short-term patterns of prescription opioid use. We conducted a literature review using PubMed, Embase, Web of Science, and Scopus to identify studies of nonchronic, nondependent opioid use and reproductive endpoints including fertility, pregnancy loss, and pregnancy complications (i.e., preterm birth, birth weight, gestational diabetes, and hypertensive disorders of pregnancy). Seventeen studies were included. Although results of the studies suggest possible harms of short-term opioid use on fertility and pregnancy loss, methodologic limitations and the small number of studies make the literature inconclusive. This review highlights important data gaps that must be addressed to make conclusions about potential reproductive effects of short-term opioid use. These include the need for additional data on opioid use before clinically recognized pregnancy; accurate measurement of opioid exposure by multiple means with detailed information on the types and quantity of opioids used; assessment of important confounders, including opioid use indication, comorbidities, and use of other medications and substances; and studies of paternal opioid use, fertility, and pregnancy outcomes. A primary limitation of this review targeting studies of nonchronic opioid exposure is the possibility that selected studies included populations with unspecified chronic or dependent opioid use. Efforts to understand the impact of the prescription opioid epidemic should address potential reproductive harms of these medications among people of reproductive age.

处方阿片类药物的使用在育龄男性和女性中很常见,包括在辅助生殖过程中。阿片类药物使用障碍和慢性使用与生育和妊娠结局的危害有关,但尚不清楚这些关联是否延伸到处方阿片类药物使用的常见短期模式。我们使用PubMed、Embase、Web of Science和Scopus进行了文献综述,以确定非慢性、非依赖性阿片类药物使用和生殖终点的研究,包括生育力、妊娠丢失和妊娠并发症(即早产、出生体重、妊娠糖尿病和妊娠高血压疾病)。纳入了17项研究。虽然研究结果表明短期使用阿片类药物可能对生育和妊娠损失造成危害,但方法学的局限性和研究数量少使得文献不具有结论性。本综述强调了必须解决的重要数据缺口,以得出关于短期阿片类药物使用的潜在生殖影响的结论。其中包括需要在临床确认怀孕前获得阿片类药物使用的额外数据;通过多种手段准确测量阿片类药物暴露情况,并提供使用阿片类药物类型和数量的详细信息;评估重要混杂因素,包括阿片类药物使用指征、合并症和其他药物和物质的使用;以及父亲使用阿片类药物、生育能力和妊娠结局的研究。本综述针对非慢性阿片类药物暴露研究的主要局限性是所选研究可能包括未指明的慢性或依赖性阿片类药物使用人群。努力了解处方类阿片流行病的影响,应解决这些药物对育龄人群生殖的潜在危害。
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引用次数: 3
Adherence to and Retention in Medications for Opioid Use Disorder Among Adolescents and Young Adults. 青少年和年轻成年人对阿片类药物使用障碍药物的依从性和保留率。
IF 5.2 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa001
Adam Viera, Daniel J Bromberg, Shannon Whittaker, Bryan M Refsland, Milena Stanojlović, Kate Nyhan, Frederick L Altice

The volatile opioid epidemic is associated with higher levels of opioid use disorder (OUD) and negative health outcomes in adolescents and young adults. Medications for opioid use disorder (MOUD) demonstrate the best evidence for treating OUD. Adherence to and retention in MOUD, defined as continuous engagement in treatment, among adolescents and young adults, however, is incompletely understood. We examined the state of the literature regarding the association of age with adherence to and retention in MOUD using methadone, buprenorphine, or naltrexone among persons aged 10-24 years, along with related facilitators and barriers. All studies of MOUD were searched for that examined adherence, retention, or related concepts as an outcome variable and included adolescents or young adults. Search criteria generated 10,229 records; after removing duplicates and screening titles and abstracts, 587 studies were identified for full-text review. Ultimately, 52 articles met inclusion criteria for abstraction and 17 were selected for qualitative coding and analysis. Younger age was consistently associated with shorter retention, although the overall quality of included studies was low. Several factors at the individual, interpersonal, and institutional levels, such as concurrent substance use, MOUD adherence, family conflict, and MOUD dosage and flexibility, appeared to have roles in MOUD retention among adolescents and young adults. Ways MOUD providers can tailor treatment to increase retention of adolescents and young adults are highlighted, as is the need for more research explaining MOUD adherence and retention disparities in this age group.

阿片类药物的不稳定流行与青少年阿片类药物使用障碍(OUD)的高发和不良健康后果有关。治疗阿片类药物使用障碍(MOUD)的药物是治疗 OUD 的最佳证据。然而,人们对青少年和年轻成年人坚持和继续服用阿片类药物治疗(即持续接受治疗)的情况了解甚少。我们研究了有关年龄与 10-24 岁人群使用美沙酮、丁丙诺啡或纳曲酮进行 MOUD 治疗的依从性和持续性的关系,以及相关的促进因素和障碍的文献现状。我们搜索了所有将依从性、保持率或相关概念作为结果变量进行研究的 MOUD 研究,研究对象包括青少年或年轻成年人。搜索标准产生了 10,229 条记录;在删除重复内容并筛选标题和摘要后,确定了 587 篇研究报告供全文审阅。最终,有 52 篇文章符合摘要纳入标准,其中 17 篇被选中进行定性编码和分析。虽然纳入研究的总体质量不高,但年龄越小,保留时间越短。个人、人际和机构层面的一些因素,如同时使用药物、坚持MOUD、家庭冲突以及MOUD的剂量和灵活性,似乎对青少年和年轻成年人的MOUD保留率有影响。我们强调了MOUD提供者如何调整治疗方法以提高青少年和年轻人的保留率,同时也强调了需要更多的研究来解释这个年龄组的MOUD坚持率和保留率差异。
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引用次数: 0
The Worldwide Opioid Pandemic: Epidemiologic Perspectives. 全球阿片类药物大流行:流行病学观点。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2020-01-31 DOI: 10.1093/epirev/mxaa012
David Celentano
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引用次数: 2
CEPI: Driving Progress Toward Epidemic Preparedness and Response CEPI:推动流行病防范和应对取得进展
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2019-01-31 DOI: 10.1093/epirev/mxz012
D. Gouglas, Marios Christodoulou, S. Plotkin, R. Hatchett
Abstract The Coalition for Epidemic Preparedness Innovations (CEPI) was formed in the aftermath of the 2014–2015 Ebola outbreak in west Africa to support the development of vaccines that could improve the world’s preparedness against outbreaks of epidemic infectious diseases. Since its launch in 2017, CEPI has mobilized more than US$750 million to support its mission to develop vaccines against agents such as Lassa virus, Middle East respiratory syndrome coronavirus, and Nipah virus, as well as several rapid-response vaccine platforms to accelerate response times to unexpected epidemic threats. CEPI has also played a leading role in fostering institutional partnerships between public- and private-sector organizations to optimize allocation of resources for vaccine development against its priority pathogens. CEPI’s priorities include diversification of its current vaccine research and development investment portfolio to include additional pathogens, such as Rift Valley fever and chikungunya; establishment of technical and regulatory pathways for vaccine development across CEPI’s portfolio; development of sustainable manufacturing solutions for vaccine candidates nearing completion of safety and immunogenicity testing in humans; and creation of investigational stockpiles of its vaccine candidates for use in emergency situations. This commentary provides an overview of the global health challenges CEPI was established to address and its achievements to date, and indicates priorities for funding and coordination in the coming years.
摘要流行病防范创新联盟(CEPI)成立于2014-2015年西非埃博拉疫情爆发后,旨在支持疫苗的开发,以提高世界对流行病爆发的防范能力。自2017年启动以来,CEPI已筹集了超过7.5亿美元,用于支持其开发针对拉沙病毒、中东呼吸综合征冠状病毒和尼帕病毒等病原体的疫苗的任务,以及几个快速反应疫苗平台,以加快对意外流行病威胁的反应时间。CEPI还在促进公共和私营部门组织之间的机构伙伴关系方面发挥了主导作用,以优化针对其优先病原体的疫苗开发资源分配。CEPI的优先事项包括使其目前的疫苗研发投资组合多样化,以包括其他病原体,如裂谷热和基孔肯雅病;在CEPI的投资组合中建立疫苗开发的技术和监管途径;为即将完成人体安全性和免疫原性测试的候选疫苗开发可持续生产解决方案;以及建立用于紧急情况的候选疫苗的研究库存。本评论概述了CEPI旨在应对的全球卫生挑战及其迄今取得的成就,并指出了未来几年的资金和协调优先事项。
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引用次数: 59
Forecasting the 2014 West African Ebola Outbreak. 预测2014年西非埃博拉疫情。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2019-01-31 DOI: 10.1093/epirev/mxz013
C. Carias, J. O'Hagan, M. Gambhir, E. Kahn, D. Swerdlow, M. Meltzer
In 2014/15 an Ebola outbreak of unprecedented dimensions afflicted the West African countries of Liberia, Guinea, and Sierra Leone. We performed a systematic review of manuscripts that forecasted the outbreak while it was occurring, and derive implications on the ways results could be interpreted by policy-makers. We reviewed 26 manuscripts, published between 2014 and April 2015, that presented forecasts of the West African Ebola outbreak. Forecasted case counts varied widely. An important determinant of forecast accuracy for case counts was how far into the future predictions were made. Generally, those that made forecasts less than 2 months into the future tended to be more accurate than those that made forecasts more than 10 weeks into the future. The exceptions were parsimonious statistical models in which the decay of the rate of spread of the pathogen among susceptible individuals was dealt with explicitly. Regarding future outbreaks, the most important lessons for policy makers when using similar modeling results are: i) uncertainty of forecasts will be higher in the beginning of the outbreak, ii) when data are limited, forecasts produced by models designed to inform specific decisions should be used in complimentary fashion for robust decision making - for this outbreak, two statistical models produced the most reliable case counts forecasts, but did not allow to understand the impact of interventions, while several compartmental models could estimate the impact of interventions but required data that was not available; iii) timely collection of essential data is necessary for optimal model use.
2014/15年,西非国家利比里亚、几内亚和塞拉利昂爆发了规模空前的埃博拉疫情。我们对在疫情发生时预测疫情的手稿进行了系统回顾,并对决策者解释结果的方式得出了启示。我们回顾了2014年至2015年4月间发表的26篇预测西非埃博拉疫情的论文。预测的病例数差异很大。对病例数的预测准确性的一个重要决定因素是对未来的预测有多远。一般来说,那些预测未来少于2个月的人往往比那些预测未来超过10周的人更准确。例外的是简洁的统计模型,其中明确地处理了病原体在易感个体中传播率的衰减。关于未来的疫情,决策者在使用类似的建模结果时最重要的经验教训是:(1)在疫情开始时,预测的不确定性会更高;(2)当数据有限时,旨在为具体决策提供信息的模型所产生的预测应以互补的方式用于强有力的决策——对于本次疫情,两个统计模型产生了最可靠的病例数预测,但无法了解干预措施的影响;虽然有几个分区模型可以估计干预措施的影响,但需要的数据无法获得;Iii)及时收集必要数据是优化模型使用的必要条件。
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引用次数: 9
Dietary Inflammatory Potential and the Risk of Neurodegenerative Diseases in Adults. 膳食炎症潜能与成人神经退行性疾病的风险
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2019-01-31 DOI: 10.1093/epirev/mxz005
S. Kheirouri, M. Alizadeh
Nutrition and diet have been suggested to induce or inhibit the risk of several neurodegenerative diseases and cognitive performance. This systematic review was developed to derive the relationship between inflammatory capacity of a diet and the risk of incidence of neurodegenerative diseases. Databases including PubMed, Google Scholar, ScienceDirect, and Scopus, as well as Google site were searched for any year until June 2018. Original, full text, and English language articles with human participants which investigated the link between dietary inflammatory potential and the risk of development of neurodegenerative diseases were included. Duplicated and irrelevant studies were removed and data were drawn out by critical analyzing of the articles. Initially, 457 articles were collected by the searching method, of which 196 studies remained after removing of duplicates. Fourteen articles were screened and known relevant to scope of the study. After critical analyzing, 10 articles were included in the final review. All the studies, except one reported that higher dietary inflammatory index (DII) was related to higher risk of developing neurodegenerative diseases symptoms including memory and cognition decline and Multiple Sclerosis. Of three studies, two indicated that DII positively correlated with circulating inflammatory markers. Low literacy, unhealthy life style, individuals' nutritional status were the factors that involved in intake of a diet with inflammatory potential. The findings enhance confidence that DII is an appropriate tool measure of dietary inflammatory potential and validate the role of diets with inflammatory potential in the pathophysiology of neurodegenerative diseases. DII may possibly be correlated with circulating inflammatory markers.
营养和饮食被认为可以诱导或抑制几种神经退行性疾病的风险和认知能力。这篇系统综述旨在推导饮食的炎症能力与神经退行性疾病发病风险之间的关系。包括PubMed、Google Scholar、ScienceDirect和Scopus在内的数据库以及谷歌网站在2018年6月之前的任何一年都会被搜索。包括人类参与者的原创、全文和英文文章,这些文章调查了饮食炎症潜能与神经退行性疾病发展风险之间的联系。删除重复和不相关的研究,并通过对文章的批判性分析得出数据。最初,通过搜索方法收集了457篇文章,其中196篇研究在去除重复后仍然存在。对14篇文章进行了筛选,已知其与研究范围相关。经过批判性分析,10篇文章被纳入最终综述。除一项研究外,所有研究都报告了较高的饮食炎症指数(DII)与更高的神经退行性疾病症状风险有关,包括记忆力和认知能力下降以及多发性硬化症。在三项研究中,有两项表明DII与循环炎症标志物呈正相关。低识字率、不健康的生活方式、个人的营养状况是导致摄入具有炎症潜能的饮食的因素。这些发现增强了人们的信心,即DII是衡量饮食炎症潜能的适当工具,并验证了具有炎症潜能的饮食在神经退行性疾病病理生理学中的作用。DII可能与循环炎症标志物相关。
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引用次数: 16
Global Geographical and Temporal Patterns of Seasonal Influenza and Associated Climatic Factors. 季节性流感的全球地理和时间模式及相关气候因素。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2019-01-31 DOI: 10.1093/epirev/mxz008
Kunjal Dave, Patricia C Lee
Understanding geographical and temporal patterns of seasonal influenza can help strengthen influenza surveillance to early detect epidemics and inform influenza prevention and control programs. This study examines variations in spatiotemporal patterns of seasonal influenza in different global regions and explores climatic factors that influence differences in influenza seasonality through a systematic review of peer-reviewed publications. The literature search was conducted to identify original studies published between January 2005 and November 2016. Studies were selected using predetermined inclusion and exclusion criteria. The primary outcome was influenza cases and additional outcomes included seasonal or temporal patterns of influenza seasonality, study regions (temperate or tropical) and associated climatic factors. Of the 2160 records identified in the selection process, 36 eligible studies were included. Results showed significant differences in influenza seasonality in terms of the time of onset, duration, number of peaks and amplitude of epidemics between temperate and tropical/subtropical regions. Different viral types, co-circulation of influenza viruses and climatic factors especially temperature and absolute humidity were found to contribute to the variations in spatiotemporal patterns of seasonal influenza. The findings of this review could inform global surveillance of seasonal influenza and influenza prevention and control measures such as vaccination recommendations for different regions.
了解季节性流感的地理和时间模式有助于加强流感监测,尽早发现流行病,并为流感预防和控制计划提供信息。这项研究考察了全球不同地区季节性流感时空模式的变化,并通过对同行评审出版物的系统综述,探讨了影响流感季节性差异的气候因素。进行文献检索是为了确定2005年1月至2016年11月期间发表的原始研究。使用预先确定的纳入和排除标准选择研究。主要结果是流感病例,其他结果包括流感季节性的季节或时间模式、研究区域(温带或热带)和相关气候因素。在筛选过程中确定的2160份记录中,包括36项符合条件的研究。结果显示,温带和热带/亚热带地区的流感季节性在发病时间、持续时间、高峰数量和流行幅度方面存在显著差异。不同的病毒类型、流感病毒的共同循环以及气候因素,特别是温度和绝对湿度,都有助于季节性流感时空模式的变化。这项审查的结果可以为全球季节性流感监测和流感预防和控制措施提供信息,如不同地区的疫苗接种建议。
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引用次数: 20
A Review of Asymptomatic and Subclinical Middle East Respiratory Syndrome Coronavirus Infections 中东无症状和亚临床呼吸综合征冠状病毒感染综述
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2019-01-31 DOI: 10.1093/epirev/mxz009
Rebecca Grant, M. Malik, A. Elkholy, M. V. Van Kerkhove
Abstract The epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) since 2012 has been largely characterized by recurrent zoonotic spillover from dromedary camels followed by limited human-to-human transmission, predominantly in health-care settings. The full extent of infection of MERS-CoV is not clear, nor is the extent and/or role of asymptomatic infections in transmission. We conducted a review of molecular and serological investigations through PubMed and EMBASE from September 2012 to November 15, 2018, to measure subclinical or asymptomatic MERS-CoV infection within and outside of health-care settings. We performed retrospective analysis of laboratory-confirmed MERS-CoV infections reported to the World Health Organization to November 27, 2018, to summarize what is known about asymptomatic infections identified through national surveillance systems. We identified 23 studies reporting evidence of MERS-CoV infection outside of health-care settings, mainly of camel workers, with seroprevalence ranges of 0%–67% depending on the study location. We identified 20 studies in health-care settings of health-care worker (HCW) and family contacts, of which 11 documented molecular evidence of MERS-CoV infection among asymptomatic contacts. Since 2012, 298 laboratory-confirmed cases were reported as asymptomatic to the World Health Organization, 164 of whom were HCWs. The potential to transmit MERS-CoV to others has been demonstrated in viral-shedding studies of asymptomatic MERS infections. Our results highlight the possibility for onward transmission of MERS-CoV from asymptomatic individuals. Screening of HCW contacts of patients with confirmed MERS-CoV is currently recommended, but systematic screening of non-HCW contacts outside of health-care facilities should be encouraged.
摘要自2012年以来,中东呼吸综合征冠状病毒(MERS-CoV)的流行病学在很大程度上以单峰骆驼反复出现的人畜共患疾病为特征,随后是有限的人传人,主要是在医疗环境中。MERS-CoV的全部感染程度尚不清楚,无症状感染者在传播中的程度和/或作用也不清楚。2012年9月至2018年11月15日,我们通过PubMed和EMBASE对分子和血清学调查进行了综述,以测量医疗环境内外的亚临床或无症状MERS-CoV感染。我们对截至2018年11月27日向世界卫生组织报告的实验室确诊的MERS-CoV感染进行了回顾性分析,以总结通过国家监测系统确定的无症状感染者的已知情况。我们确定了23项研究,报告了医疗机构以外的MERS-CoV感染证据,主要是骆驼工人,血清流行率范围为0%-67%,具体取决于研究地点。我们在医护人员(HCW)和家庭接触者的医疗环境中确定了20项研究,其中11项记录了无症状接触者中MERS-CoV感染的分子证据。自2012年以来,世界卫生组织报告了298例实验室确诊病例为无症状,其中164例为HCW。在对无症状MERS感染者的病毒脱落研究中,已经证明了将MERS-CoV传播给他人的潜力。我们的研究结果强调了无症状个体传播MERS-CoV的可能性。目前建议对确诊MERS-CoV患者的HCW接触者进行筛查,但应鼓励对医疗机构外的非HCW接触人员进行系统筛查。
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引用次数: 32
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Epidemiologic Reviews
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