Infectious diseases (London, England)最新文献

Background: Respiratory syncytial virus (RSV) significantly impacts not only children but also adults. However, knowledge of the severity and outcomes among adult RSV inpatients is still limited.

Objectives: To clarify the short- and long-term health threats associated with adult RSV infections.

Methods: This retrospective observational study included 56,980 adult inpatients aged 18 years and older due to RSV or influenza infection between April 2010 and March 2022. After inverse probability weighting adjustment, we used Poisson's regression to estimate the risk of outcomes.

Results: The RSV group had a higher risk of requiring mechanical ventilation during hospitalization compared to the influenza group (9.7% vs. 7.0%; risk ratio (RR), 1.35; 95% confidence interval (CI), 1.08-1.67). In-hospital mortality was comparable between RSV and influenza groups (7.5% vs. 6.6%; RR, 1.05; 95% CI, 0.82-1.34). RSV group was associated with increased risk of readmission within 1 year after surviving discharge (34.0% vs. 28.9%; RR, 1.19; 95% CI, 1.07-1.32) and all-cause mortality within 1 year of admission (12.9% vs. 10.3%; RR, 1.17; 95% CI, 1.02-1.36). In the age-stratified analysis, the RSV group aged 60 years and older had a higher risk than the influenza group for in-hospital death, readmission and all-cause mortality within one year.

Conclusions: RSV infections demonstrated comparable or greater health threats than influenza infections not only during hospitalization but also in long-term outcomes. The findings underscore the threat of RSV in adults, the impact on healthcare systems and the need for continued development of public health counter measures against RSV.

Background: Data on the outcomes of COVID-19 in people living with HIV (PLHIV), specifically in relation to vaccination status, are lacking during the Omicron era.

Methods: This nationwide registry-based study included all resident in Sweden ≥18 years with a positive SARS-CoV-2 PCR test during January 2021-February 2023. We estimated adjusted odds ratios (adjOR) for COVID-19 hospitalisation and severe COVID-19 (ICU admission and 90-day mortality), categorised by SARS-CoV-2 vaccination status (0-1, 2, and ≥3 doses), and HIV-status. Analyses were then categorised by time periods of pre-Omicron, Omicron during public testing, and Omicron after public testing.

Results: 1348 PLHIV and 1 669 389 people without HIV (PWoH) were included. PLHIV were older, more migrant (65 vs. 22%) and male (59 vs. 46%). Of PLHIV, 96% were on antiretroviral treatment and 94% virally suppressed. AdjORs of COVID-19 hospitalisation were similar irrespective of HIV-status, controlled for demographics, calendar month of infection, comorbidities, and income. PLHIV were more likely to be hospitalised than PWoH during Omicron and public testing (adjOR 2.3, 95% CI 1.1-4.2), but not after public testing. The odds of severe COVID-19 were three times higher in PLHIV compared to PWoH vaccinated with 2 doses (adjOR 3.2, 95% CI 1.3-6.9), but not when vaccinated with ≥3 doses (adjOR 0.7, 95% CI 0.2-1.6). Migrant and low nadir CD4⁺ T-cells were associated with higher odds of hospitalisation in unvaccinated PLHIV.

Conclusions: This nationwide study, including mostly well-treated PLHIV, highlights the importance of vaccination with booster dose/s for effective protection against severe COVID-19 in PLHIV.KEY POINTPeople living with HIV compared to people without HIV did not have higher odds of COVID-19 hospitalisation irrespective of SARS-CoV-2 vaccination status (0-1 dose, 2 doses, ≥3 doses) when adjusting for known risk factors including comorbidities and socioeconomic status.

Background: The effectiveness of remdesivir in patients with coronavirus disease 2019 (COVID-19) and severe renal insufficiency remains underexplored.

Objectives: To evaluate whether remdesivir reduces the risk of mortality or invasive mechanical ventilation/extracorporeal membrane oxygenation (IMV/ECMO) in this population.

Methods: This retrospective observational study utilising the COVID-19 Registry Japan (COVIREGI-JP) included noncritical patients with COVID-19 and severe renal insufficiency (defined as serum creatinine levels ≥3 mg/dL, on maintenance dialysis, or kidney transplant recipients) admitted to Japanese hospitals within 7 days of symptom onset between January 1, 2020 and May 8, 2023. Patients were classified into the remdesivir group if remdesivir was initiated within the first 2 days of admission. We estimated the multivariable-adjusted hazard ratio (HR) for mortality and initiation of IMV/ECMO using landmark analysis to address immortal time bias.

Results: Among the 1,449 patients included in the landmark analysis (median age, 74 years [interquartile range 62-84 years]; 992 [68.5%] were male), 272 initiated remdesivir within the first 2 days of admission. During the 28 days from the landmark timepoint, 19 (7.0%) and 136 (11.6%) patients in the remdesivir and control groups, respectively, had an outcome. The remdesivir group had a lower risk of mortality or IMV/ECMO initiation than the control group (adjusted HR, 0.44; 95% confidence interval, 0.23-0.83).

Conclusions: In noncritical patients with COVID-19 and severe renal insufficiency at admission, initiating remdesivir early after disease onset, within the first 2 days of admission, led to a lower risk of mortality or IMV/ECMO initiation, compared with non-initiation of remdesivir.

Hepatitis delta virus (HDV) infection has an aggressive disease course and is the most difficult to treat of the human hepatitis viruses. In Denmark, as in many countries, the national prevalence of HDV has not been established. Based on diagnoses and laboratory test results in national healthcare registries, we estimated that the prevalence of current HDV infection amongst patients with chronic hepatitis B was 3.1% and the general population prevalence approximately 4 in 100,000.

Background: BNT162b2 and mRNA-1273 COVID-19 vaccines have been used for mass vaccinations in Curaçao, the Caribbean but information on adverse events (AEs)in this population is unavailable. This study describes the characteristics of vaccinees that incurred AEs, explores the associations between AEs by vaccine and doses, and estimates the rate of AEs.

Methods: Vaccination and AEs data for all persons of age 5 years (range 5-105 years) and older who received two doses of COVID-19 vaccine at 71 centres in Curaçao between February 24, 2021, and April 5, 2023, were included in this retrospective observational study.

Results: The vaccines differed significantly in the frequency distribution of vaccinees by age, age groups, sex, AEs, and prior COVID-19 infection. Occurrence of AEs was strongly associated with mRNA vaccine brand, sex, number of doses, but not with age, age group, and prior COVID-19 infection. Of 209,720 doses, 84 persons (0.04%) incurred AEs following two doses of mRNA vaccines (overall rate of 40.1 per 100,000 persons (95% CI 32.4-49.6). AEs were also significantly higher in females compared to males.AE rates associated with BNT162b2, and mRNA-1273 vaccines were low, but BNT162b2 vaccinees incurred substantially significantly higher AE rates (58.3 per 100,000 persons, 95% CI 45.4-74.9) than mRNA-1273 vaccinees (21.9 per 100,000 persons, 95% CI 14.6-32.8). mRNA-1273 vaccine was associated with a significantly lower risk of AEs.

Conclusions: AE reporting varied by age, sex, and vaccine used as well as the number of doses. Future studies with follow-up and longer-term reporting of AEs should be conducted.

Background: Climate change significantly influences the distribution and severity of tropical diseases. Rising temperatures, changing precipitation patterns, and extreme weather events are transforming the habitats of vectors like mosquitoes and ticks, promoting their proliferation and geographic spread. These changes have facilitated the resurgence of diseases such as malaria, dengue, and chikungunya fever in previously unaffected areas, including parts of Europe and Italy.

Objective and methods: This review aims to explore the relationship between climate change and the spread of vector-borne and tropical parasitic diseases across Europe, with a particular focus on Italy. Recent studies are analyzed to identify emerging trends in disease transmission influenced by shifting climates. Genome-based monitoring and predictive models incorporating climatic and ecological data are highlighted as methods to enhance disease surveillance and preparedness.

Results: The analysis reveals a clear link between climate change and altered disease patterns. The proliferation of vectors into new territories is associated with increased incidence of diseases. Genome-based tools demonstrate their utility in tracking the evolution of pathogens, particularly regarding changes in virulence, drug resistance, and adaptability to new climates. Predictive models have proven effective in anticipating outbreaks and supporting timely public health interventions.

Conclusions: To mitigate the risks posed by climate-induced changes in disease dynamics, continuous monitoring and international collaboration are essential. Strengthening health systems' resilience through mitigation and adaptation strategies is crucial for preventing future epidemics. These insights contribute to the development of sustainable long-term policies for managing tropical diseases in the context of climate change, ensuring timely responses to public health emergencies.

Background: Because patients infected with respiratory syncytial virus (RSV) have been reported to be older than patients infected with influenza virus, the more frequent incidence of complications in RSV-infected patients may be age-related. This study compared clinical characteristics and outcomes in hospitalized adults infected with RSV with findings in age- and sex-matched adults infected with influenza virus.

Methods: The medical records of hospitalized adult patients infected with RSV or influenza virus at two university hospitals from 2013 to 2022 were retrospectively analyzed. Virus infection was confirmed by real-time polymerase chain reaction. Each RSV-infected patient was matched by age and sex with two influenza virus-infected patients, and their clinical symptoms, laboratory parameters and hospital courses were compared.

Results: The study cohort consisted of 552 patients, 184 infected with RSV and 368 infected with influenza virus. Fever (71.2% vs. 79.9%, p = .022) and cough (70.1% vs. 80.4%, p = .007) were significantly less frequent in the RSV than in the influenza group, whereas white blood cell counts (9132/mm³ vs. 7616/mm³, p < .001) and C-reactive protein concentrations (10.25 vs. 8.88 mg/dL, p = .029) were significantly higher in the RSV group. The frequency of oxygen therapy was higher (60.3% vs. 48.6%, p = .010) and hospital stay was longer (8 vs. 6 days, p = .003) in RSV than in influenza virus-infected patients.

Conclusions: Clinical symptoms were less frequent, but disease was more severe, in hospitalized adult patients infected with RSV than in age- and sex-matched patients infected with influenza. Greater attention should be paid to diagnosing and preventing RSV infection in adults.

The pertussis epidemic in Korea is ongoing, with a record-high incidence rate. Although pertussis incidence is high worldwide in 2024, the scale of the increase observed in Korea is unprecedented and incomparable to that in other countries. The high proportion of cases among children aged 5 to 14 years is the distinctive characteristics of the 2024 pertussis epidemic in Korea. To accurately interpret the epidemiological trend in pertussis incidence in Korea, validating the surveillance system and evaluating vaccine efficacy and effectiveness are essential.

Background: Multidrug-resistant bacteria (MDR) represent a significant global health concern and vary in specific settings. Spain reported several annual deaths attributed to MDR bacteria, mainly carbapenemase-producing Enterobacterales.

Objectives: We aimed to characterise the incidence and temporal trends of MDR bacterial infections or colonisations reported within the province of Granada (data from five hospitals), and to investigate factors linked to clinical vulnerability.

Methods: We conducted an observational retrospective study (2014-2022) using the Andalusian Epidemiological Surveillance System. We employed descriptive, bivariate analyses and geographical mapping. Multivariable logistic regression models were adjusted to identify factors associated with (1) carbapenemase-production and (2) in-hospital mortality.

Results: We included 1482 patients. The main microorganisms identified were Klebsiella spp., Escherichia spp. and Acinetobacter baumannii. Carbapenemases were detected in 23% of cases, and were associated with higher in-hospital mortality rates (OR: 1.92; 95% confidence interval (95% CI): 1.31-2.81) and male sex (OR: 1.50; 95% CI: 1.01-2.23). The overall in-hospital mortality rate was estimated at 18.1%. Infections caused by A. baumannii (OR: 2.11; 95% CI: 1.41-3.13) or carbapenemase-producing Klebsiella pneumoniae (OR: 2.11; 95% CI: 1.28-3.45) were associated with increased mortality.

Conclusions: These findings contribute to our understanding of the characteristics associated with carbapenemase-producing and early mortality resulting from MDR bacteria. This study offers insights into the factors associated with clinical vulnerability, which may improve future preventive measures.