[Emergent infectious diseases: importance for public health, epidemiology, promoting factors, and prevention]

Epidemiological geography at work: An exploratory review about the overall findings of spatial analysis applied to the study of CoViD-19 propagation along the first pandemic year

The present work aims to give an overview on the international scientific papers related to the territorial spreading of SARS-CoV-2, with a specific focus upon applied quantitative geography and territorial analysis, to define a general structure for epidemiological geography research. The target publications were based on GIS spatial analysis, both in the sense of topological analysis and descriptive statistics or lato sensu geographical approaches. The first basic purpose was to organize and enhance the vast knowledge developments generated hitherto by the first pandemic that was studied "on-the-fly" all over the world. The consequent target was to investigate to what extent researchers in geography were able to draw scientifically consistent conclusions about the pandemic evolution, as well as whether wider generalizations could be reasonably claimed. This implied an analysis and a comparison of their findings. Finally, we tested what geographic approaches can say about the pandemic and whether a reliable spatial analysis routine for mapping infectious diseases could be extrapolated. We selected papers proposed for publication during 2020 and 209 articles complied with our parameters of query. The articles were divided in seven categories to enhance existing commonalities. In some cases, converging conclusions were extracted, and generalizations were derived. In other cases, contrasting or inconsistent findings were found, and possible explanations were provided. From the results of our survey, we extrapolated a routine for the production of epidemiological geography analyses, we highlighted the different steps of investigation that were attained, and we underlined the most critical nodes of the methodology. Our findings may help to point out what are the most critical conceptual challenges of epidemiological mapping, and where it might improve to engender informed conclusions and aware outcomes.

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INTRODUCTION

In sub-Saharan Africa, particularly in Burundi, uptake of HIV testing, which is fundamental to initiating treatment is relatively low. The present study aims to identify the individual and contextual determinants related to the uptake of HIV testing among women of childbearing age in this country.

MATERIALS AND METHODS

This was an analysis of secondary data from Burundi's 2016-2017 demographic and health surveys. Our target population was women aged 15 to 49. Data were analyzed with the software stata 15.1. In bivariate analysis, the chi-square test and simple logistic regression allowed us to identify the candidate variables for modeling at the 20% threshold. Multilevel binary logistic regression made it possible to identify the individual and contextual determinants of the uptake of HIV / AIDS testing in these women.

RESULTS

Out of a total of 8,537 women included in this study, 17.63% were between 15 and 24 years old, 46.44% between 25 and 34 and 35.93% between 35 and 49. The individual determinants of uptaking HIV testing were age, level of education, parity, marital status, decision-making power, and frequency of radio listening. Note that 1.36% of the use of the HIV testing was attributable to the region and the place of residence was an important variable of the context.

CONCLUSION

This analysis of population data from DHS surveys in Burundi made it possible to identify the individual and contextual determinants influencing the uptake of HIV testing in Burundi. Further qualitative research should also address the contextual barriers that influence the uptake of screening.

Evaluation of in vitro activity of ceftolozane-tazobactam in combination with other classes of antibacterial agents against Enterobacterales and Pseudomonas aeruginosa-the EM200 study

Ceftolozane-tazobactam is a cephalosporin/β-lactamase inhibitor combination developed for use against some β-lactam- and multidrug-resistant Gram-negative organisms. This study aimed to evaluate the in vitro activity of ceftolozane-tazobactam against clinical bacterial isolates at the University Hospital of Marrakech. This is a descriptive and analytical prospective study. A total of 143 Enterobacterales and 48 Pseudomonas aeruginosa isolates were collected from January 2018 to December 2018 from patients with respiratory, urinary and intra-abdominal infections. The identification was made by Phoenix automated system (BioMérieux). MIC50/90 were tested by broth microdilution for ceftolozane-tazobactam, and other drugs using dried panels. Antimicrobial susceptibility results were interpreted according to CLSI guidelines. Ceftolozane-tazobactam inhibited 98% of Escherichia coli (MIC_50/90; 0.25/0.5 μg/mL). The susceptibility rate of Klebsiella pneumoniae to ceftolozane-tazobactam was 68.8% (MIC_50/90, 0.5/>32 μg/mL); other Enterobacterales have shown susceptibility rates of 80.4% (MIC_50/90; 0.5/8 μg/mL). In carbapenemase-producing K. pneumoniae, the bla _OXA-48 mutation was found in two isolates. Susceptibility of P. aeruginosa to ceftolozane-tazobactam was 91.7% (MIC_50/90, 0.5/>32 μg/mL). In non-carbapenemase-producing P. aeruginosa, AmpC mutations were found in all isolates. Ceftolozane-tazobactam was satisfactorily active against a wide range of tested isolates and offers clinicians a potential therapeutic option even against resistant strains in patients with intra-abdominal infections, urinary tract infections and nosocomial pneumonia.

[What are the determinants of viral outbreaks and is it possible to predict their emergence?]

L’émergence d’une maladie virale résulte le plus souvent d’un déséquilibre dans l’interaction entre l’agent infectieux, l’hôte et l’environnement. Après une phase d’introduction de la maladie virale dans un territoire ou une population donnée et une fois que les premières chaînes de transmission sont en place, on peut assister à la diffusion de la maladie, voire sa pérennisation si les mesures de contrôle ne sont pas mises en œuvre ou ne sont pas suffisamment efficaces. S’il est difficile d’anticiper la survenue et l’introduction d’une maladie virale émergente, les trois axes suivants de lutte doivent être développés pour en limiter l’impact : (1) anticipation et préparation ; (2) recherche et (3) veille et surveillance. Pour garantir enfin que les mesures prises soient pertinentes au regard des données disponibles et acceptables par la population, il convient de s’appuyer de manière systématique sur une approche multidisciplinaire qui devra être réévaluée de manière dynamique.

Emerging and re-emerging infectious diseases in Iran

Despite development of preventive and controlling strategies regarding infectious diseases, they are still considered as one of the most significant leading causes of morbidity and mortality, worldwide. Changes in humans' demographics and behaviors, microbial and ecological alterations, agricultural development, international travels and susceptibility to infectious diseases have resulted in increased reports of emerging infectious diseases (EIDs) and reemerging infectious diseases (RIDs) in various geographical areas. Because of the various types of geographic properties in Iran, substantial climatic variability, as well as unstable political situations and poor public health conditions in some of neighboring countries, EIDs and RIDs are serious public health problems; among them, zoonotic and drug resistant diseases are the most significant. Hence, this review provides an overview of the significant bacterial, viral and fungal EIDs and RIDs in Iran regarding their epidemiological aspects.

[Travelling epidemics]

OBJECTIVES

We have to become aware of the current development of international travels which has contributed to amplify circulation of all sorts of infectious agents. We will describe the current situation.

OBSERVATIONS

Infectious agents are carried by means of travellers, immigrants, as well as by animals, goods and merchandise. The distribution of infections potentially responsible for epidemics tends to become worldwide and some of them are emergent diseases.

SOLUTIONS

Such a situation imposes enhancement of international surveillance and development of resources for control and response to alerts. Developed countries possess most advanced equipments and interventional structures: they are those which may intervene predominantly in the fight against epidemics. The necessary contribution of these industrialized countries is increasing in developing countries in which infectious epidemics are spreading and such intervention must be sustained. The content of the article is a review of major threatening infectious epidemic diseases with the contribution of personal experiences.

[Principles of an outbreak investigation in public health practice]

An outbreak (or epidemic) is a higher number of cases of a given disease in a given population and time interval. A timely investigation has for aim to identify the source and vehicle of the outbreak and provides unique opportunities to better understand its occurrence and the role of contributing risk factors to implement the most appropriate measures to control it and prevent further recurrences. The investigation of an outbreak is based on a multidisciplinary approach (clinical, epidemiological, environmental, and microbiological) with a descriptive and analytical (hypothesis testing) phase. In this article, we describe the methodological approach of a field outbreak investigation illustrated by examples taken from our experience. The investigation includes the following steps: establishing the existence of the outbreak; defining the disease; finding cases; describing cases by time, place, and person characteristics; establishing a hypothesis related to the mode of occurrence; testing the hypotheses; conducting an environmental investigation; conducting a microbiological investigation; controlling the outbreak, preventing further occurrences, and writing an investigation report to share experience with the public health and scientific community. The investigation of an outbreak is an evolving process: information gathered or conclusions made at a given stage must be fully used for following steps. The social, institutional, and political background associated with outbreaks usually makes their investigation complex and should be taken into account. The earlier the outbreak is detected and investigated in close relation with public health authorities, the greater will be the potential preventive impact of control measures.