Frontiers in epidemiology最新文献

Antiretroviral therapy (ART) has tremendously improved the quality of life of people living with HIV (PLWH). Through rigorous scientific research and development, newer, more effective, and less toxic antiretrovirals (ARVs) have been developed and are available to PLWH in high-income countries (HICs). Although Africa accounts for more than two-thirds of the global burden of HIV/AIDS, this large population does not readily have access to these newer and more effective ARVs. In some instances, new ARVs become available to PLWH in Africa over a decade after they have been approved for use by the Food and Drug Authorities (FDAs) in HICs. Since 2010, 35 new drug entities have been approved; of those, only 3 are in common use in Ghana and most of Sub-Saharan Africa. To achieve the 2030 goal of ending HIV/AIDS as a global health epidemic, it is critical to ensure equity in access to newer and effective ARVs across all regions, including Africa, where the majority of PLWH reside. We highlight here the urgent need to make newer ARVs available in Africa to ensure the realization of the Global End AIDS by 2030 goal.

Background: The probability of presenting with infectious mononucleosis (IM) upon primary Epstein-Barr virus infection increases dramatically at the start of puberty. Aiming to understand why that is, we assessed whether the number of infection-related health events during two specific time periods-ages 10-12 years (pre-teen window) and the three most recent years (recent window)-could predict the likelihood of individuals aged 13-19 years developing IM.

Methods: We used sibship-stratified Cox regression to mitigate socio-demographic confounding and bias. Consequently, we only followed members of IM-affected sibships aged 13-19 years between 1999 and 2021 for IM, based on information from complete nationwide Danish administrative and health registers. Estimates were further adjusted for sex, age, birth order (1, 2, 3+) and sibship constellation [number of siblings and their signed (older/younger) age difference to the index person]. Infection-related health events defining the exposures considered were either a category of antimicrobial prescription, or a hospital contact with an infectious disease diagnosis. We measured evidence/probability of the associations using asymptotic Bayes factors, rather than using p-value based testing.

Results: The adjusted hazard ratio (HR) for IM with 95% confidence limits for an additional antimicrobial prescription in the pre-teen exposure window was [1.01; 0.98-1.04], and the corresponding adjusted HR for an additional antimicrobial prescription in the recent exposure window was [1.02; 0.99-1.06].

Conclusions: IM was not preceded by unusual numbers of infections. Small effect sizes, together with small variation in exposure, did not render the assessed exposures useful for predicting IM for public health or the clinic.

Introduction: Substance use disorders impact a significant portion of the US population. Exposure to neighborhood environment early in life may contribute to disparities in policing, health outcomes and access to treatment for substance use disorders. Although many studies have examined the relationship between neighborhood context and substance use, few studies have accounted for the spatial distribution of substance use and social environment. The current study examined the association between birth address and substance addiction service utilization of individuals born in communities around the New Bedford Harbor Superfund site in southeast Massachusetts that face potential racial, socioeconomic, and environmental stressors.

Methods: The analysis utilized birth record data between January 1992 and December 1998 (N = 12,151) from the Registry of Vital Records and Statistics with follow-up for substance addiction service utilization through June 2022 by the Bureau of Substances Addiction Services within the Massachusetts Department of Public Health (MADPH). We used generalized additive models (GAM) with a smooth for location to estimate local odds ratios (ORs) and 95% confidence intervals (CI) of substance addiction service utilization while adjusting for sociodemographic risk factors to identify important contributors to geographic disparities.

Results: We found that birth addresses were significantly associated with substance addiction service utilization as a young adult (p = 0.037), with the highest statistically significant risk located closest to the harbor (OR = 1.42, 95% CI: 1.00, 2.02). Family education and prenatal care payer were significant predictors (p < 0.001) of substance addiction services use and strong spatial confounders.

Discussion: The current study showed that significant associations between birth addresses and substance addiction service utilization later in life are primarily driven by socioeconomic predictors including family education and prenatal care payer.

There is much focus in the field of HIV prevention research on understanding the impact of social determinants of health (e.g., housing, employment, incarceration) on HIV transmission and developing interventions to address underlying structural drivers of HIV risk. However, such interventions are resource-intensive and logistically challenging, and their evaluation is often limited by small sample sizes and short duration of follow-up. Because they allow for both detailed and large-scale simulations of counterfactual experiments, agent-based models (ABMs) can demonstrate the potential impact of combinations of interventions that may otherwise be infeasible to evaluate in empirical settings and help plan for efficient use of public health resources. There is a need for computational models that are sufficiently realistic to allow for evaluation of interventions that address socio-structural drivers of HIV transmission, though most HIV models to date have focused on more proximal influences on transmission dynamics. Modeling the complex social causes of infectious diseases is particularly challenging due to the complexity of the relationships and limitations in the measurement and quantification of causal relationships linking social determinants of health to HIV risk. Uncertainty exists in the magnitude and direction of associations among the variables used to parameterize the models, the representation of sexual transmission networks, and the model structure (i.e. the causal pathways representing the system of HIV transmission) itself. This paper will review the state of the literature on incorporating social determinants of health into epidemiological models of HIV transmission. Using examples from our ongoing work, we will discuss Uncertainty Quantification and Robust Decision Making methods to address some of the above-mentioned challenges and suggest directions for future methodological work in this area.

The Global Technical Strategy for Malaria 2016-2030 targets eliminating malaria from at least 35 countries and reducing case incidence by 90% globally. The importation of parasites due to human mobilization poses a significant obstacle to achieve malaria elimination as it can undermine the effectiveness of local interventions. Gaining a comprehensive understanding of parasite importation is essential to support control efforts and advance progress toward elimination. Parasite genetic data is widely used to investigate the spatial and temporal dynamics of imported infections. In this context, this systematic review aimed to aggregate evidence on the application of parasite genetic data for mapping imported malaria and the analytical methods used to analyze it. We discuss the advantages and limitations of the genetic approaches employed and propose a suitable type of genetic data along with an analytical framework to discriminate imported malaria infections from local infections. The findings offer potential actionable insights for national control programs, enabling them select the most effective methods for detecting imported cases. This also may aid in the evaluation and refinement of elimination programs by identifying high-risk areas and enabling the targeted allocation of resources to these regions.

Introduction: Dengue fever, traditionally a tropical disease, has shown a notable increase in incidence within the United States over recent decades. This paper focuses on the increase in dengue fever cases in Maryland during increasing temperature and humidity and the expanding geographical range of Aedes mosquitoes, the primary vectors for dengue virus transmission.

Methods: Electronic health data was used to identify patterns in dengue incidence from 2014 to 2024. Correlation analysis between temperature and dengue incidence and a review of humidity factors was conducted.

Results: Results indicate an increased incidence of dengue fever cases over the past decade. However, a reduction in dengue incidence was observed in 2019-2020, likely due to COVID-19-related travel restrictions.

Discussion: As global temperatures increase, the habitats suitable for Aedes mosquitoes have expanded, allowing for their proliferation in previously inhospitable regions. Additionally, higher temperatures can accelerate the life cycle and viral replication rates in these mosquitoes, further enhancing transmission potential. Humidity, another key environmental factor, influences the life expectancy of dengue mosquitoes. This research underscores the urgency of addressing climate change as a public health issue, emphasizing the need for integrated vector management strategies and public health preparedness to mitigate the growing threat of dengue in temperate regions. By understanding the interplay between global warming, humidity, and dengue transmission, we can better inform policy decisions and healthcare practices to curb the spread of this disease in Maryland and the United States.

Background: Human immunodeficiency virus (HIV) is a virus that attacks the immune system. Globally, more than 79.3 million people have been infected with it, and about 36.3 million people have died since the beginning of the epidemic. Ethiopia is one of the major affected countries in sub-Saharan Africa, with a huge number of people living with HIV. The identification of recent HIV-1 infections plays a crucial role in guiding prevention and control interventions. Moreover, data on the prevalence and factors associated with recent HIV-1 infection among cases tested by the Asante Rapid Recency Assay at health facilities in the Harari region has been inadequate. This study aimed to assess the prevalence and associated factors of recent HIV-1 infection among newly identified HIV-positive individuals tested with the Asante Rapid Recency Assay in Health Facilities of Harari Region, Eastern Ethiopia.

Methods: Retrospective cross-sectional study was employed using HIV-1 diagnoses data from April 15-20, 2024 with 580 study participants. The data were extracted based on the standardized HIV Case-Based Surveillance report form, as outlined by the Ethiopian Public Health Institute. Data extracted from Redcap were checked and cleared for completeness then entered and analysed using the Statistical Package for Social Science software version 27. Bivariate and multivariable regression analyses were carried out to examine the associations between dependent and independent variables. A P-value of <0.05 was considered statistically significant.

Results: The overall prevalence of recent HIV infection was 9.1% (95% CI: 7.0%, 11.8%). The highest proportion of recent HIV infections was in the year 2019 [9(22.5%)]. The study also found that no formal education (AOR = 18.424, 95% CI = 1.468-231.2), primary educational level (AOR = 22.1, 95% CI = 1.91-256.1, P = 0.013), no formal education (AOR = 18.424, 95% CI = 1.468-231.2, P = 0.028), having sex in the last 12 months (AOR = 5.508, 95% CI = 2.167-15.7, P = <.001), having sex with known/suspected HIV positive (AOR = 4.35, 95% CI = 1.455-13.04, P = 0.009) and Illicit drug use (AOR = 57.8, 95% CI = 16.19-207.5, P = <.001) had higher likelihood of having recent HIV infection.

Conclusion: This study found a 9.1% proportion of recent HIV infections, indicating significant ongoing HIV transmission within the community. The study also revealed multiple risk factors for recent HIV infection, including lower educational levels, recent sexual activity, sex with high-risk partners, and drug use. This study emphasizes the significance of improving targeted HIV preventive programs.

Introduction: Previous studies indicate that the prevalence of type 2 diabetes (T2D) will increase substantially over the coming decades. One projection from 2019 estimated an increase in prevalence in Germany by 54% to 77% (depending on future trends in incidence and mortality) between 2015 and 2040. We aim to update this projection by incorporating recently published trends in T2D incidence in Germany that include the changes during the SARS-CoV-2 pandemic.

Materials and methods: We used a partial differential equation that describes the illness-death model to project the age- and sex-specific T2D prevalence among adults between 2015 and 2040. This required input data for the age- and sex-specific incidence, mortality of the general population, mortality rate ratio of people with vs. without T2D and prevalence in the initial year of the projection. We considered five scenarios with different future trends in incidence and their impact on prevalence. Using the most recently available data on T2D incidence, we assumed that the incidence remains constant as observed in 2021 for the whole projection horizon (first scenario). In further scenarios, we assumed that the observed age- and sex-specific trends in incidence between 2015 and 2021 would continue until 2025 (second scenario), 2030 (third scenario), 2035 (fourth scenario) and 2040 (fifth scenario). One additional scenario assumed that the age-specific prevalence remains constant.

Results: Observed trends in incidence suggest a decrease between 2015 and 2017, and a slight upward trend thereafter until 2021 in most age groups. Depending on how long these observed increases in incidence continue, the number of people with T2D in Germany will increase from 6.8 million in 2015 to between 10.9 million and 14.2 million in 2040. These numbers correspond to increases in prevalence from 10.5% in 2015 to between 15.5% and 20.1% in 2040. In the constant prevalence scenario, the overall prevalence and number of people with T2D in 2040 was 11.4% and 8.1 million, respectively.

Conclusions: The future prevalence of T2D in Germany strongly depends on how long the recently observed increasing trend in T2D incidence will continue, which warrants close monitoring of these trends in post-pandemic years.

Background: Measles is a major public health concern that causes morbidity and mortality among children. In 2019, measles incidence reached its highest level in 23 years, with low measles containing vaccine dose one coverage playing a vital role. It can be prevented by two doses of the measles vaccine, either alone or in combination with measles-rubella (MR), which is a low-cost strategy for lowering morbidity and mortality among children.

Objectives: To conduct spatial analysis of measles cases and vaccination coverage in the Somali region, Eastern Ethiopia.

Methods: This retrospective study was done by using public health emergency directorate measles data from 2022 to 2023 and four years (July 2019-July 2023) of vaccination data from district health information system version 2.36. After the data completeness and consistency were ensured, it was cleaned and recoded. STATA version 17 and QGIS version 3.38 software were used for the data analysis.

Results: From 2022 to 2023, the disease affected more than 5,930 people. The majority of the participants, 5,260 (88.7%), were under the age of 59 months, with 3,184 (53.7%) being male. Furthermore, the majority of residents were from Nogob 2,238 (37.7%), Erer 1,027 (17.3%), and Jarar 954 (16.1%). According to clinical symptoms, 5,930 (100%) of the cases had fever, cough, and rash, and more than two-thirds, 4,901 (82.6%), had complications. A measles vaccination coverage of 59.4% and a measles incidence of 0.087 per 100 people were found in the region.

Conclusions: This study found a very low measles vaccination coverage. Furthermore, Nogob, Erer, and Jarar zones showed the highest measles incidence rate, respectively. It is recommended to strengthen routine immunization services according to the national vaccination agenda, categorize, and reach unvaccinated children through catch-up vaccination campaigns. A concerted effort should be made to improve MCV2 coverage in hard-to-reach areas of the region. Special focus should be given to vaccine cold chain management in the zone and its districts with high vaccination coverage but also a high measles incidence rate. An investigation should be done into the associated factors of the higher incidence despite its vaccination coverage.