The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia

OBJECTIVE

Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality.

METHODS

The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders.

RESULTS

A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795).

CONCLUSION

Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.

Long-term immunity after HBV vaccine: shall we consider a change? A 20-year-follow-up study

Introduction

Although vaccines against HBV have been available since the 1980s, the long-term immunity is still debated. When assessing immune persistence, a number of clearly defined variables must be taken into account. Often the expression ‘infant vaccination’ means the administration within the first year of life at any age, but a difference of a few months may imply a different antibody persistence over the years. This study assessed the anti-HBs titre 20 years after the primary vaccination course and estimated the effect of age at 1st dose and time interval between doses on long-term protection.

Methods

Data on age, sex and date of administration were collected. Inclusion criteria: born to negative mother, 3-dose schedule, no previous HBV infection, age at enrolment 18-24 years; age at 1st dose 2-12 months. Titres ≥10IU/l were considered protective. A logistic regression was performed, adjusting for sex, follow-up time and date of 1st dose and analysis.

Results

We included 5,485 participants (64% female). The mean anti-HBsAg increased from 46, 52, 85 to 193IU/l when the 1st dose was administered in the I, II, III or IV trimester of life, respectively. Similarly, the proportion of individuals with titre &lt;10IU/l decreased from 51 to 18% between the two extreme quarters. The risk of a titre &lt;10IU/l decreased with age at the 1st dose (AOR: 0.84; 95%CI: 0.78-0.91 per one-month increase) and time between the 2nd and 3rd doses (AOR: 0.89; 95%CI:0.85-0.94).

Conclusions

The mere presence of a titre &lt;10IU/l does not equate lack of protection. However, antibody levels are very different depending on the actual age of vaccination. One-month delay within the first year is associated with a -18% chance of a titre &lt;10IU/l 20 years later. Although this information needs to be combined with local epidemiology and surveillance to obtain an informed risk-benefit balance, the implications from a public health and economic perspective may be diverse and worth considering.

Key messages

• Still within the first year of life, a delay in the administration of the 1st dose of HBV vaccine and a longer time between the 2nd and 3rd dose imply a higher antibody persistence even 20 years later.

• Considering the local circulation of HBV and surveillance, this result could be taken into account to obtain an informed risk-benefit balance.

Aetiology of influenza-like illnesses in the pre-COVID-19 season 2019-2020: role of coronaviruses

Background

Only a proportion of seasonal influenza-like illnesses (ILIs) can de facto be attributed to influenza viruses. This study investigated the aetiology of ILIs to estimate the prevalence of human coronaviruses (CoVs) and to analyse their clinical-epidemiological traits.

Methods

A sample of 613 outpatients (253 adults, 360 children) with ILI in Veneto Region, Italy, was included. ILI was defined according with the EU Decision 2018/945. Sigma-Virocult nasopharyngeal swab were used. Nucleic acids were extracted with the QiaAmp Viral RNA Mini Kit (Qiagen). Molecular detection of respiratory viruses was performed with commercial One-step RT qPCR reagents (Allplex® Respiratory Panels, Seegene). Information on age, sex, symptoms, co-infections and comorbidities was collected.

Results

CoVs were the 3rd most frequent pathogen in adults (7.5%, after influenza and rhinovirus) and the 4th in children (4.7%, after influenza, rhino- and adenovirus). Subtype distribution was similar, with OC43 the most frequent. Probability of CoV involvement was twice in males (AOR=2.16; 95%CI: 1.05-4.39), whereas no association with age was noted. Co-infection with other viruses was frequent in children (65% of cases). CoV symptoms were not peculiar, although respiratory tract involvement was less likely than influenza (AOR=0.13; 95%CI: 0.04-0.41). Among CoV outpatients, 36% had one or more chronic diseases, compared with 5.6% among influenza (p = 0.001).

Conclusions

Even before the COVID-19 pandemic, CoVs had a substantial role in ILI aetiology: 1 case of CoV every 3 influenza infections in adults. The higher prevalence of comorbidities among CoV positives compared to influenza indirectly shows the benefits of flu vaccines in individuals at higher risk. Careful surveillance of the viruses responsible for ILI continues to be desirable, including, but not limited to, detecting a possible change in the aetiology of ILI after the administration of SARS-CoV-2 vaccines in the population.

Key messages

• Pre-pandemic virological surveillance of influenza-like illnesses (ILIs) reveals how seasonal coronaviruses were the third most frequent respiratory pathogen in adults.

• Prevalence of comorbidities was significantly higher in patients with a coronavirus-related ILI compared to influenza, supporting the benefits of flu vaccination for high risk groups.

Evaluating the presence of SARS-CoV-2 RNA in the particulate matters during the peak of COVID-19 in Padua, northern Italy

The airborne transmission of SARS-CoV-2, the etiologic agent of the current COVID-19 pandemic, has been hypothesized as one of the primary routes of transmission. Current data suggest a low probability of airborne transmission of the virus in open environments and a higher probability in closed ones, particularly in hospitals or quarantine facilities. However, the potential diffusion of the virus in open environments, especially using particulate matter (PM) as a transport carrier, generated concern in the exposed populations. Several authors found a correlation between the exceeding of the PM10 concentration limits in some Italian cities and the prevalence of Covid-19 cases detected in those areas. This study investigated the potential presence of SARS-COV-2 RNA on a representative series of PM samples collected in the province of Padua in Northeastern Italy during the first wave of COVID pandemic. Forty-four samples of PM2.5 and PM10 were collected between February 24 and March 9, 2020 and analyzed with RT-qPCR for SARS-CoV-2 RNA. The experimental results did not indicate the presence of SARS-CoV-2 RNA in the outdoor PMs, thus confirming the low probability of virus airborne transmission through PM.

Holistic model-based monitoring of the human health status in an urban environment system: pilot study in Verona city, Italy

INTRODUCTION

In recent decades the global health paradigm gained an increasing systemic characterization. The ecosystem health theory states that a healthy ecosystem, whether natural or artificial, significantly contributes to the good health status of the human population.

METHODS

The present study describes an interdisciplinary monitoring model that retrospectively analyzes the intersection between the urban environment and citizens. The model analyzes both the biophysical and the anthropic subsystems through the application of landscape ecology and environmental quality indexes along with human health indicators. Particularly, ecological quality of landscape pattern, atmospheric pollution, outdoor noise levels and local health indicators were assessed. Verona municipality was chosen as study area to test the preliminary efficiency of the model. Territory was split into two superimposed layers of land units, which were further geo-referentiated with Geographical Information System (GIS) technology. Interdependence of any of the analyzed traits was further investigated with Fisher exact test.

RESULTS

Landscape composition was assessed and an Average Ecological Quality (AEQ) score assigned to each land unit. A direct proportionality emerged for concentrations of considered air pollutants and traffic levels: a spatial model for the atmospheric pollution was drawn. A map depicting the distribution of traffic-related noise levels was also drawn. From chosen indicators, a quality class score was assigned to every minor and major land unit. Age-standardised rates about hospitalizations for the municipal population and specific rates for the over-65s/1000 inhabitants were calculated. Quality class assignement for each health indicator was graphically rendered. After direct standardisation of rates for the population sample, data were compared with two reference populations, the Regional population and the Local Socio-sanitary Unit (ULSS20) population. Standardised hospitalization rates for the whole municipal population always resulted lower than the ULSS20 rates, except for auditory pathologies. It was notable that rates of hospitalizations for cancerous diseases for Verona municipal population were four times and two times lower than the ULSS20 and the Regional population ones, respectively. Contingency table were made for the health main indicator (specific rates for the over-65s/1000 inhabitants) and the environmental quality key factors of landscape ecological quality, outdoor noise level and air pollution. H0 of independence was rejected for respiratory pathologies and air pollution and for the triad cardiocirculatory pathologies, air pollution and landscape ecological quality at (a = 0.05). Fisher exact test confirmed the non-independence of cardiocirculatory diseases and biophysical environment and the analogous association for respiratory pathologies when comparison was made with global environmental quality index.

DISCUSSION

The first testing of the model suggests some possible elements of implementation and integration which could further enhance it. Among them, the subjective investigation of the health status assumes a primary role. On the whole the monitoring model seems to effectively represent the real complexity of the urban environment systems and should be regarded as an important contribution to the new way of health research.