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Arnold L, Bimczok S, Schütt H, Lisak-Wahl S, Buchberger B, Stratil JM. How to protect long-term care facilities from pandemic-like events? - A systematic review on the effectiveness of non-pharmacological measures to prevent viral respiratory infections. BMC Infect Dis 2024; 24:589. [PMID: 38880893 PMCID: PMC11181531 DOI: 10.1186/s12879-024-09271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long-term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non-pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear. METHODS We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE. RESULTS We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems. CONCLUSIONS Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics. TRIAL REGISTRATION CRD42022344149.
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Affiliation(s)
- Laura Arnold
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Simon Bimczok
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Hannah Schütt
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Stefanie Lisak-Wahl
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Barbara Buchberger
- Robert Koch Institute, Berlin, Germany
- University of Duisburg-Essen, Institute for Health Care Management and Research, Essen, Germany
| | - Jan M Stratil
- Robert Koch Institute, Berlin, Germany.
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.
- Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), ECDC Fellowship Programme, Stockholm, Sweden.
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Goldberg Z, Linder AG, Miller LN, Sorrell EM. Wastewater Collection and Sequencing as a Proactive Approach to Utilizing Threat Agnostic Biological Defense. Health Secur 2024; 22:11-15. [PMID: 37856169 DOI: 10.1089/hs.2023.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Affiliation(s)
- Zev Goldberg
- Zev Goldberg, MSc, was a 2022-2023 Griffin Fellow; Elizabeth R. Griffin Program, Center for Global Health Science and Security, Georgetown University, Washington, DC
| | - Alexander G Linder
- Alexander G. Linder, MSc, is Junior Scientists; Elizabeth R. Griffin Program, Center for Global Health Science and Security, Georgetown University, Washington, DC
| | - Lauren N Miller
- Lauren N. Miller, MSc, is Junior Scientists; Elizabeth R. Griffin Program, Center for Global Health Science and Security, Georgetown University, Washington, DC
| | - Erin M Sorrell
- Erin M. Sorrell, PhD, MSc, is a Senior Scholar, Johns Hopkins Center for Health Security, and an Associate Professor, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Shivgunde P, Thakare S, Sen S, Kanitkar M, Agrawal M, Vidyasagar M. COVID-19 Pandemic in Malegaon: SUTRA over the Three Waves. Indian J Microbiol 2023; 63:344-351. [PMID: 37781020 PMCID: PMC10533435 DOI: 10.1007/s12088-023-01096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/13/2023] [Indexed: 10/03/2023] Open
Abstract
Over the past two years, the COVID-19 pandemic has seen multiple waves with high morbidity and mortality. Lockdowns and other prompt responses helped India's situation become less severe. Although Malegaon in the Indian state of Maharashtra has a high population density, poor hygienic standards, and oppositional local community views toward national pandemic addressing measures, it is nevertheless reasonably safe. To understand the possible reasons serosurvey was conducted to estimate the anti-SARS-CoV-2 neutralizing antibody levels in the Malegaon population. Also, we did SUTRA mathematical modeling to the Malegaon daily data on COVID-19 attributable events and compared it with the National and state level. The case fatality rate (CFR) in Malegaon city for the first, second, and third waves was 3.25%, 2.25%, and 0.39%, respectively. The crude death rate (CDR) for Maharashtra ranked first for the initial two waves and India for the third wave. Malegaon, meanwhile, finished second in the first two waves but fared best in the third. The Vaccination coverage for the first dose before the second wave was only 0.34% but had risen to 64.46% by 12 Oct 2022. By then, the second and booster dose coverage was 27.55% and 2.38%, respectively. Serosurvey did between 12 and 18 Jan 2022 showed a 93.93% anti-SARS-CoV-2 neutralizing antibody presence. SUTRA modeling elucidated the high levels of antibodies due to the pandemic-reach over 102% by the third wave. The serosurvey and the model explain why the pandemic severity in terms of duration and CFR during the subsequent waves, especially third wave, was milder compared to the first wave in spite of low vaccination rates. Supplementary Information The online version contains supplementary material available at 10.1007/s12088-023-01096-3.
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Affiliation(s)
- Prashant Shivgunde
- Department of Pharmaceutical Medicine, Maharashtra University of Health Sciences, Nashik, MH 422004 India
| | - Sapana Thakare
- Malegaon Municipal Corporation, Malegaon, MH 423105 India
| | - Sourav Sen
- University Research Department, Maharashtra University of Health Sciences, Nashik, MH 422004 India
| | - Madhuri Kanitkar
- Maharashtra University of Health Sciences, Nashik, MH 422004 India
| | | | - Mathukumalli Vidyasagar
- Department of Artificial Intelligence, Indian Institute of Technology Hyderabad, Kandi, TS 502284 India
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Smyk JM, Szydłowska N, Szulc W, Majewska A. Evolution of Influenza Viruses-Drug Resistance, Treatment Options, and Prospects. Int J Mol Sci 2022; 23:12244. [PMID: 36293099 PMCID: PMC9602850 DOI: 10.3390/ijms232012244] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Viral evolution refers to the genetic changes that a virus accumulates during its lifetime which can arise from adaptations in response to environmental changes or the immune response of the host. Influenza A virus is one of the most rapidly evolving microorganisms. Its genetic instability may lead to large changes in its biological properties, including changes in virulence, adaptation to new hosts, and even the emergence of infectious diseases with a previously unknown clinical course. Genetic variability makes it difficult to implement effective prophylactic programs, such as vaccinations, and may be responsible for resistance to antiviral drugs. The aim of the review was to describe the consequences of the variability of influenza viruses, mutations, and recombination, which allow viruses to overcome species barriers, causing epidemics and pandemics. Another consequence of influenza virus evolution is the risk of the resistance to antiviral drugs. Thus far, one class of drugs, M2 protein inhibitors, has been excluded from use because of mutations in strains isolated in many regions of the world from humans and animals. Therefore, the effectiveness of anti-influenza drugs should be continuously monitored in reference centers representing particular regions of the world as a part of epidemiological surveillance.
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Affiliation(s)
| | | | | | - Anna Majewska
- Department of Medical Microbiology, Medical University of Warsaw, Chalubinskiego 5 Str., 02-004 Warsaw, Poland
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5
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Widiawaty MA, Lam KC, Dede M, Asnawi NH. Spatial differentiation and determinants of COVID-19 in Indonesia. BMC Public Health 2022; 22:1030. [PMID: 35606710 PMCID: PMC9125018 DOI: 10.1186/s12889-022-13316-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The spread of the coronavirus disease 2019 (COVID-19) has increasingly agonized daily lives worldwide. As an archipelagic country, Indonesia has various physical and social environments, which implies that each region has a different response to the pandemic. This study aims to analyze the spatial differentiation of COVID-19 in Indonesia and its interactions with socioenvironmental factors. METHODS The socioenvironmental factors include seven variables, namely, the internet development index, literacy index, average temperature, urban index, poverty rate, population density (PD) and commuter worker (CW) rate. The multiple linear regression (MLR) and geographically weighted regression (GWR) models are used to analyze the impact of the socioenvironmental factors on COVID-19 cases. COVID-19 data is obtained from the Indonesian Ministry of Health until November 30th 2020. RESULTS Results show that the COVID-19 cases in Indonesia are concentrated in Java, which is a densely populated area with high urbanization and industrialization. The other provinces with numerous confirmed COVID-19 cases include South Sulawesi, Bali, and North Sumatra. This study shows that the socioenvironmental factors, simultaneously, influence the increasing of confirmed COVID-19 cases in the 34 provinces of Indonesia. Spatial interactions between the variables in the GWR model are relatively better than those between the variables in the MLR model. The highest spatial tendency is observed outside Java, such as in East Nusa Tenggara, West Nusa Tenggara, and Bali. CONCLUSION Priority for mitigation and outbreak management should be high in areas with high PD, urbanized spaces, and CW.
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Affiliation(s)
- Millary Agung Widiawaty
- Faculty of Social Sciences Education (FPIPS), Universitas Pendidikan Indonesia, Jln. Dr. Setiabudho no. 299, Bandung City, West Java, 40154, Indonesia
- National Research and Innovation Agency of Indonesia (BRIN), Jln. Kuningan Barat, Mampang Prapatan, Jakarta, 12710, Indonesia
| | - Kuok Choy Lam
- Geography Program, Centre for Research in Development, Social and Environment, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, 43600, Selangor, Malaysia.
| | - Moh Dede
- National Research and Innovation Agency of Indonesia (BRIN), Jln. Kuningan Barat, Mampang Prapatan, Jakarta, 12710, Indonesia
- Center for Environment and Sustainability Science, Universitas Padjadjaran, Bandung City, West Java, 40132, Indonesia
| | - Nur Hakimah Asnawi
- Geography Program, Centre for Research in Development, Social and Environment, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, 43600, Selangor, Malaysia
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Kember M, Grandy S, Raudonis R, Cheng Z. Non-Canonical Host Intracellular Niche Links to New Antimicrobial Resistance Mechanism. Pathogens 2022; 11:pathogens11020220. [PMID: 35215166 PMCID: PMC8876822 DOI: 10.3390/pathogens11020220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022] Open
Abstract
Globally, infectious diseases are one of the leading causes of death among people of all ages. The development of antimicrobials to treat infectious diseases has been one of the most significant advances in medical history. Alarmingly, antimicrobial resistance is a widespread phenomenon that will, without intervention, make currently treatable infections once again deadly. In an era of widespread antimicrobial resistance, there is a constant and pressing need to develop new antibacterial drugs. Unraveling the underlying resistance mechanisms is critical to fight this crisis. In this review, we summarize some emerging evidence of the non-canonical intracellular life cycle of two priority antimicrobial-resistant bacterial pathogens: Pseudomonas aeruginosa and Staphylococcus aureus. The bacterial factors that modulate this unique intracellular niche and its implications in contributing to resistance are discussed. We then briefly discuss some recent research that focused on the promises of boosting host immunity as a combination therapy with antimicrobials to eradicate these two particular pathogens. Finally, we summarize the importance of various strategies, including surveillance and vaccines, in mitigating the impacts of antimicrobial resistance in general.
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7
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Bath PM, Coleman CM, Gordon AL, Lim WS, Webb AJ. Nitric oxide for the prevention and treatment of viral, bacterial, protozoal and fungal infections. F1000Res 2021; 10:536. [PMID: 35685687 PMCID: PMC9171293 DOI: 10.12688/f1000research.51270.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
Although the antimicrobial potential of nitric oxide (NO) is widely published, it is little used clinically. NO is a key signalling molecule modulating vascular, neuronal, inflammatory and immune responses. Endogenous antimicrobial activity is largely mediated by high local NO concentrations produced by cellular inducible nitric oxide synthase, and by derivative reactive nitrogen oxide species including peroxynitrite and S-nitrosothiols. NO may be taken as dietary substrate (inorganic nitrate, L-arginine), and therapeutically as gaseous NO, and transdermal, sublingual, oral, intranasal and intravenous nitrite or nitrate. Numerous preclinical studies have demonstrated that NO has generic static and cidal activities against viruses (including β-coronaviruses such as SARS-CoV-2), bacteria, protozoa and fungi/yeasts in vitro. Therapeutic effects have been seen in animal models in vivo, and phase II trials have demonstrated that NO donors can reduce microbial infection. Nevertheless, excess NO, as occurs in septic shock, is associated with increased morbidity and mortality. In view of the dose-dependent positive and negative effects of NO, safety and efficacy trials of NO and its donors are needed for assessing their role in the prevention and treatment of infections. Trials should test dietary inorganic nitrate for pre- or post-exposure prophylaxis and gaseous NO or oral, topical or intravenous nitrite and nitrate for treatment of mild-to-severe infections, including due to SARS-CoV-2 (COVID-19). This review summarises the evidence base from in vitro, in vivo and early phase clinical studies of NO activity in viral, bacterial, protozoal and fungal infections.
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Affiliation(s)
- Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Notts, NG7 2UH, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, Notts, NG7 2UH, UK
| | - Christopher M Coleman
- Division of Infection, Immunity and Microbes, School of Life Sciences, University of Nottingham, Nottingham, Notts, NG7 2UH, UK
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham, Derby, Derbyshire, DE22 3NE, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, Notts, UK
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Andrew J Webb
- Clinical Pharmacology, School of Cardiovascular Medicine & Sciences, Kings College London British Heart Foundation Centre of Research Excellence, St Thomas' Hospital, London, SE1 7EH, UK
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8
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Bath PM, Coleman CM, Gordon AL, Lim WS, Webb AJ. Nitric oxide for the prevention and treatment of viral, bacterial, protozoal and fungal infections. F1000Res 2021; 10:536. [PMID: 35685687 PMCID: PMC9171293 DOI: 10.12688/f1000research.51270.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/18/2023] Open
Abstract
Although the antimicrobial potential of nitric oxide (NO) is widely published, it is little used clinically. NO is a key signalling molecule modulating vascular, neuronal, inflammatory and immune responses. Endogenous antimicrobial activity is largely mediated by high local NO concentrations produced by cellular inducible nitric oxide synthase, and by derivative reactive nitrogen oxide species including peroxynitrite and S-nitrosothiols. NO may be taken as dietary substrate (inorganic nitrate, L-arginine), and therapeutically as gaseous NO, and transdermal, sublingual, oral, intranasal and intravenous nitrite or nitrate. Numerous preclinical studies have demonstrated that NO has generic static and cidal activities against viruses (including β-coronaviruses such as SARS-CoV-2), bacteria, protozoa and fungi/yeasts in vitro. Therapeutic effects have been seen in animal models in vivo, and phase II trials have demonstrated that NO donors can reduce microbial infection. Nevertheless, excess NO, as occurs in septic shock, is associated with increased morbidity and mortality. In view of the dose-dependent positive and negative effects of NO, safety and efficacy trials of NO and its donors are needed for assessing their role in the prevention and treatment of infections. Trials should test dietary inorganic nitrate for pre- or post-exposure prophylaxis and gaseous NO or oral, topical or intravenous nitrite and nitrate for treatment of mild-to-severe infections, including due to SARS-CoV-2 (COVID-19). This review summarises the evidence base from in vitro, in vivo and early phase clinical studies of NO activity in viral, bacterial, protozoal and fungal infections.
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Affiliation(s)
- Philip M. Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, Notts, NG7 2UH, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, Notts, NG7 2UH, UK
| | - Christopher M. Coleman
- Division of Infection, Immunity and Microbes, School of Life Sciences, University of Nottingham, Nottingham, Notts, NG7 2UH, UK
| | - Adam L. Gordon
- Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham, Derby, Derbyshire, DE22 3NE, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, Notts, UK
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Andrew J. Webb
- Clinical Pharmacology, School of Cardiovascular Medicine & Sciences, Kings College London British Heart Foundation Centre of Research Excellence, St Thomas' Hospital, London, SE1 7EH, UK
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Oh DY, Buda S, Biere B, Reiche J, Schlosser F, Duwe S, Wedde M, von Kleist M, Mielke M, Wolff T, Dürrwald R. Trends in respiratory virus circulation following COVID-19-targeted nonpharmaceutical interventions in Germany, January - September 2020: Analysis of national surveillance data. THE LANCET REGIONAL HEALTH. EUROPE 2021; 6:100112. [PMID: 34124707 PMCID: PMC8183189 DOI: 10.1016/j.lanepe.2021.100112] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND During the initial COVID-19 response, Germany's Federal Government implemented several nonpharmaceutical interventions (NPIs) that were instrumental in suppressing early exponential spread of SARS-CoV-2. NPI effect on the transmission of other respiratory viruses has not been examined at the national level thus far. METHODS Upper respiratory tract specimens from 3580 patients with acute respiratory infection (ARI), collected within the nationwide German ARI Sentinel, underwent RT-PCR diagnostics for multiple respiratory viruses. The observation period (weeks 1-38 of 2020) included the time before, during and after a far-reaching contact ban. Detection rates for different viruses were compared to 2017-2019 sentinel data (15350 samples; week 1-38, 11823 samples). FINDINGS The March 2020 contact ban, which was followed by a mask mandate, was associated with an unprecedented and sustained decline of multiple respiratory viruses. Among these, rhinovirus was the single agent that resurged to levels equalling those of previous years. Rhinovirus rebound was first observed in children, after schools and daycares had reopened. By contrast, other nonenveloped viruses (i.e. gastroenteritis viruses reported at the national level) suppressed after the shutdown did not rebound. INTERPRETATION Contact restrictions with a subsequent mask mandate in spring may substantially reduce respiratory virus circulation. This reduction appears sustained for most viruses, indicating that the activity of influenza and other respiratory viruses during the subsequent winter season might be low,whereas rhinovirus resurgence, potentially driven by transmission in educational institutions in a setting of waning population immunity, might signal predominance of rhinovirus-related ARIs. FUNDING Robert Koch-Institute and German Ministry of Health.
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Affiliation(s)
- Djin-Ye Oh
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
- The Rockefeller University, New York, NY, United States
| | - Silke Buda
- Department of Infectious Diseases Epidemiology, Robert-Koch Institute, Germany
| | - Barbara Biere
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
| | - Janine Reiche
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
| | - Frank Schlosser
- Computational Epidemiology (P4), Robert Koch-Institute, Germany
- Institute for Theoretical Biology, Humboldt University of Berlin, D-10115 Berlin, Germany
| | - Susanne Duwe
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
| | - Marianne Wedde
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
| | - Max von Kleist
- Systems Medicine of Infectious Disease (P5), Robert Koch-Institute, Germany
| | - Martin Mielke
- Department of Infectious Diseases, Robert Koch-Institute, Germany
| | - Thorsten Wolff
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
| | - Ralf Dürrwald
- Unit 17: Influenza and Other Respiratory Viruses | German National Influenza Center, Department of Infectious Diseases, Robert Koch-Institute, D-13353 Berlin, Germany
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Davda J, Reynolds K, Davis JD, Smith PF. Blueprint for pandemic response: Focus on translational medicine, clinical pharmacology and pharmacometrics. Br J Clin Pharmacol 2021; 87:3398-3407. [PMID: 33855747 DOI: 10.1111/bcp.14859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/19/2021] [Accepted: 04/04/2021] [Indexed: 12/14/2022] Open
Abstract
Perhaps the most important lesson learned from the COVID-19 pandemic is that of preparedness. Enhanced surveillance systems for early threat detection will be crucial to maximizing response time for implementation of public health measures and mobilization of resources in containing an emerging pandemic. Recent outbreaks have been dominated by viral pathogens, with RNA respiratory viruses being the most likely to have pandemic potential. These should therefore be a preparedness priority. Tools in the areas of virology, drug discovery, clinical pharmacology, translational medicine and pharmacometrics should be considered key components in the rapid identification and development of existing and novel interventions for a pandemic response. Prioritization of therapeutics should be based on in vitro activity, likelihood of achieving effective drug concentrations at the site of action, and safety profile at the doses that will be required for clinical efficacy. Deployment strategies must be tailored to the epidemiology of the disease, and the adequacy of the response should be re-evaluated in view of evolving epidemiological factors. An interdisciplinary framework integrating drug pharmacology, viral kinetics, epidemiology and health economics could help optimize the deployment strategy by improving decision-making around who to treat, when to treat, and with what type of intervention for optimal outcomes. Lastly, while an effective vaccine will ultimately end a pandemic, antiviral drug intervention guided by clinical pharmacology principles will continue to play a critical role in any pandemic response.
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Affiliation(s)
| | - Kellie Reynolds
- Division of Infectious Disease Pharmacology (DIDP), Office of Clinical Pharmacology (OCP), Office of Translational Sciences (OTS), Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - John D Davis
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Conserved Structural Motifs of Two Distant IAV Subtypes in Genomic Segment 5 RNA. Viruses 2021; 13:v13030525. [PMID: 33810157 PMCID: PMC8004953 DOI: 10.3390/v13030525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
The functionality of RNA is fully dependent on its structure. For the influenza A virus (IAV), there are confirmed structural motifs mediating processes which are important for the viral replication cycle, including genome assembly and viral packaging. Although the RNA of strains originating from distant IAV subtypes might fold differently, some structural motifs are conserved, and thus, are functionally important. Nowadays, NGS-based structure modeling is a source of new in vivo data helping to understand RNA biology. However, for accurate modeling of in vivo RNA structures, these high-throughput methods should be supported with other analyses facilitating data interpretation. In vitro RNA structural models complement such approaches and offer RNA structures based on experimental data obtained in a simplified environment, which are needed for proper optimization and analysis. Herein, we present the secondary structure of the influenza A virus segment 5 vRNA of A/California/04/2009 (H1N1) strain, based on experimental data from DMS chemical mapping and SHAPE using NMIA, supported by base-pairing probability calculations and bioinformatic analyses. A comparison of the available vRNA5 structures among distant IAV strains revealed that a number of motifs present in the A/California/04/2009 (H1N1) vRNA5 model are highly conserved despite sequence differences, located within previously identified packaging signals, and the formation of which in in virio conditions has been confirmed. These results support functional roles of the RNA secondary structure motifs, which may serve as candidates for universal RNA-targeting inhibitory methods.
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12
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Singer BJ, Thompson RN, Bonsall MB. The effect of the definition of 'pandemic' on quantitative assessments of infectious disease outbreak risk. Sci Rep 2021; 11:2547. [PMID: 33510197 PMCID: PMC7844018 DOI: 10.1038/s41598-021-81814-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023] Open
Abstract
In the early stages of an outbreak, the term 'pandemic' can be used to communicate about infectious disease risk, particularly by those who wish to encourage a large-scale public health response. However, the term lacks a widely accepted quantitative definition. We show that, under alternate quantitative definitions of 'pandemic', an epidemiological metapopulation model produces different estimates of the probability of a pandemic. Critically, we show that using different definitions alters the projected effects of key parameters-such as inter-regional travel rates, degree of pre-existing immunity, and heterogeneity in transmission rates between regions-on the risk of a pandemic. Our analysis provides a foundation for understanding the scientific importance of precise language when discussing pandemic risk, illustrating how alternative definitions affect the conclusions of modelling studies. This serves to highlight that those working on pandemic preparedness must remain alert to the variability in the use of the term 'pandemic', and provide specific quantitative definitions when undertaking one of the types of analysis that we show to be sensitive to the pandemic definition.
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Affiliation(s)
| | - Robin N Thompson
- Christ Church, University of Oxford, Oxford, UK
- Mathematical Institute, University of Oxford, Oxford, UK
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Biosurfactants’ Potential Role in Combating COVID-19 and Similar Future Microbial Threats. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app11010334] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During 2020, the world has experienced extreme vulnerability in the face of a disease outbreak. The coronavirus disease 2019 (COVID-19) pandemic discovered in China and rapidly spread across the globe, infecting millions, causing hundreds of thousands of deaths, and severe downturns in the economies of countries worldwide. Biosurfactants can play a significant role in the prevention, control and treatment of diseases caused by these pathogenic agents through various therapeutic, pharmaceutical, environmental and hygiene approaches. Biosurfactants have the potential to inhibit microbial species with virulent intrinsic characteristics capable of developing diseases with high morbidity and mortality, as well as interrupting their spread through environmental and hygiene interventions. This is possible due to their antimicrobial activity, ability to interact with cells forming micelles and to interact with the immune system, and compatibility with relevant processes such as nanoparticle synthesis. They, therefore, can be applied in developing innovative and more effective pharmaceutical, therapeutics, sustainable and friendly environmental management approaches, less toxic formulations, and more efficient cleaning agents. These approaches can be easily integrated into relevant product development pipelines and implemented as measures for combating and managing pandemics. This review examines the potential approaches of biosurfactants as useful molecules in fighting microbial pathogens both known and previously unknown, such as COVID-19.
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Host-Pathogen Responses to Pandemic Influenza H1N1pdm09 in a Human Respiratory Airway Model. Viruses 2020; 12:v12060679. [PMID: 32599823 PMCID: PMC7354428 DOI: 10.3390/v12060679] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
The respiratory Influenza A Viruses (IAVs) and emerging zoonotic viruses such as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pose a significant threat to human health. To accelerate our understanding of the host–pathogen response to respiratory viruses, the use of more complex in vitro systems such as normal human bronchial epithelial (NHBE) cell culture models has gained prominence as an alternative to animal models. NHBE cells were differentiated under air-liquid interface (ALI) conditions to form an in vitro pseudostratified epithelium. The responses of well-differentiated (wd) NHBE cells were examined following infection with the 2009 pandemic Influenza A/H1N1pdm09 strain or following challenge with the dsRNA mimic, poly(I:C). At 30 h postinfection with H1N1pdm09, the integrity of the airway epithelium was severely impaired and apical junction complex damage was exhibited by the disassembly of zona occludens-1 (ZO-1) from the cell cytoskeleton. wdNHBE cells produced an innate immune response to IAV-infection with increased transcription of pro- and anti-inflammatory cytokines and chemokines and the antiviral viperin but reduced expression of the mucin-encoding MUC5B, which may impair mucociliary clearance. Poly(I:C) produced similar responses to IAV, with the exception of MUC5B expression which was more than 3-fold higher than for control cells. This study demonstrates that wdNHBE cells are an appropriate ex-vivo model system to investigate the pathogenesis of respiratory viruses.
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Peters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. J Hosp Infect 2020; 104:440-448. [PMID: 32145323 PMCID: PMC7124368 DOI: 10.1016/j.jhin.2020.02.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Affiliation(s)
- A Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Vetter
- Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C Guitart
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - N Lotfinejad
- Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - D Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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