The association between common mental disorders and tuberculosis: a case-control study from Guinea-Bissau

OBJECTIVE

The aim of the study was to explore the association between tuberculosis (TB) and common mental disorders (CMD), in an area with high prevalence of TB.

METHODS

We performed a case-control study of TB patients and unmatched healthy controls, from a demographic surveillance site in Guinea-Bissau. Screening for CMD was performed once for controls and at inclusion and follow-up for TB patients. Kessler 10 (K-10) and a brief version of Hopkins Symptom Checklist 25 (SCL-8d) were used as screening instruments.

RESULTS

571 controls were interviewed and 416 interviews were performed for 215 TB cases. Estimated CMD prevalence at the time of diagnosis of TB was 33.6 % (SCL-8d) and 46.2 % (K-10), compared with 6.8 % (SCL-8d) and 6.7 % (K-10) among controls; adjusted OR 7.18 (95 % CI 4.07 to 12.67) and 14.52 (95 % CI 8.15 to 25.84), respectively. No significant difference in CMD prevalence rates was observed between TB patients, after 6 months of treatment, and controls.

CONCLUSION

Psychological distress and common mental disorders were more prevalent among TB patients at the time of diagnosis compared with the background population, but after completion of TB treatment no increased prevalence of psychological distress was found.

Engagement of private health sector in communicable disease and immunization programmes in Pakistan

Background

In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision.

Aim

To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage.

Methods

We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes.

Results

Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government.

Conclusion

We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases.

Retrospective Cohort Study of Syphilis-Related Stillbirths in Winnipeg, Manitoba From 2017-2020

OBJECTIVE

Syphilis-related stillbirths (SRSBs) disproportionately affect marginalized women with 11% of all local stillbirths having maternal syphilis as a contributory factor in 2020. This study describes the incidence and perinatal factors associated with SRSB.

METHODS

This was a retrospective cohort study of all stillbirths occurring from 1 January 2017 to 31 December 2020, at a single tertiary-level referral hospital in Winnipeg, Manitoba. Cases that met criteria for SRSB were identified from hospital records and included in the final analysis. Maternal demographics, comorbidities, prenatal care attendance, sexually transmitted infection testing, treatment, and diagnostic investigations at time of stillbirth were collected from hospital charts using a standardized data collection form. Descriptive statistics were performed to present the results.

RESULTS

The proportion of SRSB increased over the period of study from 0%-11%. Eleven cases were identified as SRSB, with diagnosis occurring intrapartum in 7 cases and antenatally in 4 cases. Of the 4 antenatal cases, only 2 had identifiable treatment responses indicated by microbiological and pathology workup. Commonly identified risk factors for SRSB were homelessness, mental illness, substance use, sexually transmitted co-infections, and lack of prenatal care.

CONCLUSIONS

Cases of SRSB are rising in Winnipeg with 11% of all stillbirths having maternal syphilis as a contributory factor by 2020. SRSBs disproportionately affect marginalized women. The dramatic and rapid changes in the epidemiology of syphilis in Winnipeg are likely shared by other Canadian regions and warrant increased prevention strategies to improve outcomes.

Monkeypox and the eye

KEYWORDS monkey pox, Orthopoxviruses, transmission, communicable disease, conjunctivitides, blepharitides, scleritides, keratitides, uveitides, acquired blindness, pandemic, COVID 19

Monkeypox (Mpox) Vaccine Hesitancy Among Mpox Cases: A Qualitative Study

Human mpox has been an increasing concern in the United States and California since late 2022. While the Jynneos vaccine offers a degree of cross-protection against the disease, vaccine hesitancy is common among those recommended for vaccination. The purpose of this study was to assess vaccine knowledge, facilitators, and barriers to vaccine uptake among individuals previously diagnosed with mpox, or mpox cases, in Santa Clara County, California. In-depth interviews were conducted by public health department staff among mpox cases diagnosed in Santa Clara County between July and September 2022. Responses were analyzed using a grounded theory data analysis approach. Among the 47 participants, 36 (77%) had heard of mpox before diagnosis, and of these, 20 (56%) did not think they were at risk of developing mpox, and 28 (78%) were aware that a vaccine was available. Those who did not receive the vaccine stated vaccine access and availability were the main barriers. Among the six participants not interested in the vaccine, the main hesitancies were lack of perceived risk, stigma of being branded by scarring and labeled gay, and vaccine safety. Overall, the following themes were attributed to reasons for vaccine hesitancy: (a) lack of awareness of the disease and vaccine, including perceived risks; (b) lack of vaccine availability and accessibility; and (c) stigma associated with receiving the vaccine, including being publicly labeled as "gay" and the scarring on forearm potentially seen as branding. We recommend tailoring outreach and educational campaigns to address reasons for mpox vaccine hesitancy.

Hepatitis C Knowledge and Self-Reported Testing Behavior in the General Population in China: Online Cross-Sectional Survey

BACKGROUND

The World Health Organization has proposed a worldwide target of eliminating hepatitis C virus (HCV) by 2030. A better understanding of HCV, testing behaviors, and associated factors in the general population is essential.

OBJECTIVE

This study aimed to assess HCV knowledge, self-reported HCV testing behavior, and willingness to undergo HCV screening in the general Chinese population.

METHODS

A cross-sectional online survey of the general Chinese population aged ≥15 years was conducted from November 2021 to May 2023. Participant characteristics were assessed based on their knowledge level and uptake of HCV testing. Participants ever having heard of HCV were recognized as being aware of HCV and asked additional HCV knowledge questions using a brief, validated 9-item scale. Participants with 0-3 points and who were unaware of HCV were categorized as having poor knowledge, and those with 4-6 points and 7 points were categorized as having fair and good knowledge, respectively. Participant uptake of HCV testing, testing results, reasons for undergoing or not undergoing HCV testing, and willingness to undergo HCV screening were collected through self-reports. Ordinal and binary logistic regression analyses were used to assess factors associated with the HCV knowledge level and the uptake of HCV testing, respectively.

RESULTS

A total of 1491 valid participants' questionnaires were included. Of these, 714 (47.6%) participants were aware of HCV. The proportion of participants with poor, fair, and good HCV knowledge was 63.4% (945/1491), 9.3% (139/1491), and 27.3% (407/1491), respectively. A total of 465 (31.2%) participants reported ever undergoing HCV testing, and 4 (0.9%) were anti-HCV antibody positive. Most participants were tested for HCV following blood donation (353/465, 75.9%). The most common reasons for not undergoing HCV screening were a lack of HCV awareness (665/1026, 64.8%), followed by a low self-perceived risk of infection (176/1026, 17.2%). Of 1026 participants who had never undergone HCV testing, 937 (91.3%) were willing to undergo HCV screening if universal screening was provided at no cost. The HCV knowledge level was positively associated with the HCV testing rate. Participants who were less educated, lived in rural areas, resided in West China, and were currently alcohol drinkers had lower HCV knowledge and reduced odds of having undergone HCV testing. In contrast, participants with a blood donation history and a family history of hepatitis B virus or HCV infection had higher HCV knowledge and increased odds of prior testing. Participants aged ≥60 years had lower knowledge, and women had reduced odds of having undergone previous HCV testing.

CONCLUSIONS

The general population of China has low HCV knowledge and testing rate. There is an urgent need for enhanced HCV awareness and scaled-up HCV screening and treatment. Individuals who are less well educated, reside in less-developed areas, currently drink alcohol, and are female should be prioritized for health education and interventions.

Detecting Disease Transmission: Comparing SARS-CoV-2 Cases in a County Jail and the Surrounding Community

Early detection of infectious disease transmission is an important public health tool. We sought to evaluate how positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, identified within 14 days of admission to a jail setting, are linked to local county incidence. Data were extracted from the electronic health record and publicly accessible websites. We compared positive cases of SARS-CoV-2 identified in the Santa Clara County (SCC) jail within 14 days of admission (250 cases) with positive cases reported in SCC (141,841 cases) between March 15, 2020, and October 2, 2021. There was a strong, positive correlation between cases of SARS-CoV-2 identified within 14 days of jail admission and SCC cases the following week (r = .785). Our findings show that admission SARS-CoV-2 testing data from jails may be useful for detecting disease transmission in the surrounding community.

One Health approach and zoonotic diseases in Indonesia: Urgency of implementation and challenges

The urgency of implementing the One Health approach to overcome zoonotic diseases cannot be overstated. By recognizing the interconnectedness of human health, animal health, and the environment, we can effectively prevent and respond to emerging infectious disease threats. This review article provides information on the importance of generating research on zoonotic diseases, especially in Indonesia, where research is still relatively scarce. The Indonesian government has taken steps to implement the One Health by establishing the One Health Coordinating Unit and the National Zoonosis Committee; however, implementation has not been optimal. The urgency and challenges are focused on critical implementation aspects in the community. The urgency of implementing One Health includes that Indonesia has experienced several outbreaks of zoonotic diseases; high environmental degradation; and the antimicrobial resistance issue in Indonesia has increased. The challenges faced in implementing One Health are overcoming fragmentation due to incohesive communication between important sectors, securing funding and resource investment, aligning policies to eliminate regulation barriers, capacity building to increase awareness and professionals, and addressing critical socioeconomic factors. By prioritizing implementing the One Health approach and addressing existing challenges, Indonesia can build a more resilient and integrated system to protect the well-being of all species, protect ecosystems, and prevent the devastating effects of zoonotic diseases on global health. In this review, we present the urgency of One Health implementation and its challenges comprehensively.

Evaluation and comparison of risk-based and universal prenatal HCV screening programs in Alberta, Canada

BACKGROUND & AIMS

Canadian clinical practice guidelines currently recommend risk-based screening for HCV in pregnant individuals. However, no provinces or territories have ever compared the effectiveness of risk-based vs. universal screening for the prenatal diagnosis of HCV. We aimed to evaluate and compare HCV screening programs after implementing a universal population-level pilot program among prenatal patients in Alberta, Canada.

METHODS

The Alberta Prenatal Screening Program for Select Communicable Diseases was amended to include universal HCV antibody screening. Cohorts of pregnant individuals screened for HCV through risk-based or universal programs were generated over 1-year periods. HCV screening rates and prevalence were analyzed and compared between cohorts to evaluate the effectiveness of screening methods. Social and demographic risk factors for HCV-positive individuals were compared between screening cohorts to identify which populations may be overlooked with risk-based guidelines.

RESULTS

HCV antibody screening rates were 11.9% and 99.9% among pregnant individuals in the risk-based and universal cohorts, respectively. HCV prevalence among the cohorts was 0.07% and 0.11% (difference = 0.04%, p = 0.032), with an average of 21 additional HCV-positive pregnant individuals identified annually with universal screening. HCV-positive pregnant patients diagnosed through universal screening were more likely to engage in high-risk sexual behaviours/sex work compared to those diagnosed through risk-based screening (47.6% vs. 12.5%, respectively p = 0.035), suggesting that these high-risk cases are being missed by risk-based screening.

CONCLUSIONS

Universal HCV screening diagnoses significantly higher numbers of pregnant individuals infected with HCV compared to risk-based screening. Universal HCV screening or amending risk-based guidelines to incorporate more proxy variables for risk factors should be considered to improve prenatal HCV screening guidelines in Canada and help achieve HCV elimination in the next decade.

IMPACT AND IMPLICATIONS

HCV is a bloodborne pathogen that can cause severe liver disease and be vertically transmitted from a mother to her baby during pregnancy. Pregnant individuals in Alberta are currently only tested for HCV if they disclose engaging in activities that put them at risk of acquiring the infection (risk-based screening). Using a population-wide universal prenatal HCV screening program, our work shows that testing based on patient disclosed risk alone leads to the significant underdiagnosis of HCV in pregnant individuals and suggests individuals engaging in sex work or risky sexual behaviours are being overlooked by the current risk-based program. Our outcomes represent the first province-wide study to evaluate and compare prenatal HCV risk-based and universal screening programs in Canada and provide evidence to support the update of prenatal HCV screening policies across the country and in similar jurisdictions.

Erratum to Commun Dis Intell (2018) 2023;47. (https://doi.org/10.33321/cdi.2023.47.46)

The text within this report, as originally published, incorrectly stated that the two included cases of dengue had not recently travelled to a dengue-endemic country. A reexamination of the case data has shown that both cases had recently travelled to a country where dengue is endemic. The paragraph below provides the corrected text for the dengue case descriptions, and replaces the paragraph at the foot of the right-hand column of text on page 10 of the published report. In 2022, two cases of dengue were notified to the APSU, one confirmed and one probable (Table 1), and the incidence estimate for the surveillance period (1 February - 31 December 2022) is shown in Table 2. Neither child had a prior history of dengue; however, both had recently travelled to an endemic country. One had DENV2 serotype and the serotype was not recorded for the second child. Both children were hospitalised and symptoms included fever, rash, cough, severe abdominal pain, diarrhoea, fatigue, retro-orbital pain and myalgia/arthralagia joint pains. One child had respiratory co-infection with human metapneumovirus. Both children received supportive therapies (intravenous fluids, pain relief) and one child received ceftriaxone. On discharge, one child had ongoing problems including arthralgia, fatigue, thrombocytopaenia and hepatitis.

An Ayurvedic Medication (Chyawanprash) as a Prophylaxis for Non-Communicable Disease and Communicable Disease: A Protocol for Systematic Review and Meta-Analysis

Globally, non-communicable diseases (NCDs) and communicable diseases (CDs) are on the rise, posing a significant public health threat. A holistic ayurvedic preparation called chyawanprash (CP) has shown positive outcomes in NCDs and CDs. Hence, we aimed to report the outcomes in a systematic manner. To determine the safety, efficacy, healthcare utilization, and quality of life of CP as an optional therapy for NCD and CD management. This systematic review will adhere to PRISMA-P and Cochrane guidelines for methodological considerations. It will evaluate CP efficacy in diverse populations, considering Ayurvedic and non-Ayurvedic comparators. The study design will encompass randomized controlled trials (RCTs) published from 2010 to 2023 in healthcare settings, controlled environments, and communities. We will also analyze primary outcomes related to immunity biomarkers, vital signs, and secondary outcomes such as quality of life. Data sources and search strategy will involve systematic searches in databases such as Cochrane, PubMed, Google Scholar, Web of Science, and Scopus using MeSH terms and Boolean operators. Screening and data extraction will follow a standardized form with four independent reviewers. Quality assessment will use the Cochrane risk of bias tool. The systematic review will provide an exhaustive summary of the effectiveness and safety of CP to address the growing burden of NCDs and CDs. Registration: CRD42023418994.

The pregnant traveller: An overview of common preventable infections

Pregnant travellers are often unaware of the various infections that can be acquired during travel and that pregnant people may be at increased risk of severe disease compared to their non-pregnant counterparts. Pregnant people often seek pre-travel counselling from their obstetrician or primary care physicians, who may not be well versed in travel medicine. This paper aims to provide information for maternity care providers regarding important travel-related food, water and mosquito-borne illnesses, including their prevention and treatment methods, equipping maternity care providers to confidently counsel prospective travellers during pregnancy.

Testing for Hepatitis C During Pregnancy Among Persons With Medicaid and Commercial Insurance: Cohort Study

BACKGROUND

The reported incidence of acute hepatitis C virus (HCV) infection is increasing among persons of childbearing age in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. In 2020, the United States Preventive Services Task Force and Centers for Disease Control and Prevention recommended that all pregnant persons be screened during each pregnancy for hepatitis C. However, there are limited data on trends in hepatitis C testing during pregnancy.

OBJECTIVE

We estimated hepatitis C testing rates in a large cohort of patients with Medicaid and commercial insurance who gave birth during 2015-2019 and described demographic and risk-based factors associated with testing.

METHODS

Medicaid and commercial insurance claims for patients aged 15-44 years and who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. We also compared the timing of testing relative to delivery among patients with commercial or Medicaid insurance. Multivariable logistic regression was used to identify factors associated with testing.

RESULTS

Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 175,223 (15.3%) and 221,436 (18.3%) were tested for hepatitis C during pregnancy, respectively. Testing rates were 89,730 (21.8%) and 187,819 (21.9%) among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 20,758/108,332, 19.2% to 13,971/52,330, 26.8%) and commercially insured patients (from 38,308/211,555, 18.1% to 39,152/139,972, 28%), respectively. Among Medicaid patients, non-Hispanic Black (odds ratio 0.73, 95% CI 0.71-0.74) and Hispanic (odds ratio 0.53, 95% CI 0.51-0.56) race or ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients.

CONCLUSIONS

Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurance, although tremendous opportunity for improvement remains. Interventions to increase testing among pregnant persons are needed.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2022

For 30 years the Australian Paediatric Surveillance Unit (APSU) has conducted national surveillance of rare communicable diseases and rare complications of communicable diseases. In this report, we describe the results of thirteen such studies surveyed by the APSU in 2022, including reported case numbers and incidence estimates, demographics, clinical features, management and short-term outcomes. Conditions described are: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV); neonatal and infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection; severe complications of influenza; juvenile-onset recurrent respiratory papillomatosis (JoRRP); congenital rubella infection/syndrome; congenital varicella syndrome (CVS) and neonatal varicella infection (NVI); and the new conditions dengue; Q fever; and severe acute hepatitis. In 2022, cases of severe complications of influenza were reported to the APSU for the first time since 2019. This likely reflects the easing of government-mandated restrictions imposed in 2020-2021 to curb the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the re-emergence of a range of infectious diseases. As previously, AFP surveillance by the APSU contributed to Australia achieving a minimum target incidence of one AFP case per 105 children aged less than 15 years. Cases of JoRRP and NVI were reported in 2022. This indicates potential gaps in human papillomavirus (HPV) and varicella vaccination coverage respectively, especially in high-risk groups such as young migrant and refugee women of childbearing age from countries without universal vaccination programs. Paediatric HIV case numbers resulting from mother-to-child-transmission (MTCT) of HIV remain low in Australia due to use of effective intervention strategies. However, there has been an increase in the number of imported cases of HIV in children (mainly perinatally-acquired) from countries with a high HIV prevalence. Without effective vaccines, there has been no decline in the incidence of congenital CMV and neonatal HSV, indicating the importance of early identification and management to reduce morbidity and mortality. The first cases of dengue, Q fever and severe acute hepatitis were received by APSU in 2022, including two cases of acute hepatitis in which aetiology has not been confirmed to date. The APSU has an important ongoing role in monitoring rare childhood infections.

Non-Tuberculous Mycobacterial Cervicofacial Lymphadenitis in Children-10-Year Experience in a Tertiary Pediatric Center

BACKGROUND

Lymphadenitis is the most common manifestation of non-tuberculous mycobacteria (NTM) infection in children. We describe the epidemiology and clinical characteristics of NTM lymphadenitis, determine diagnostic yield from tissue sampling, and review management and outcomes.

METHODS

This was a 10-year retrospective review of children aged 0-16 years diagnosed with NTM cervicofacial lymphadenitis who were seen in a pediatric infectious disease clinic in a tertiary public hospital. Data relating to patient demographics, clinical features, surgical and antimicrobial treatment, complications, and outcomes were retrieved from patients' electronic medical records and analyzed.

RESULTS

There were 48 episodes of NTM cervicofacial lymphadenitis in 45 children (17 males and 28 females). Of these episodes, 43.7% manifested as a unilateral single node, mostly parotid (39.6%) and submandibular (29.2%). All patients underwent diagnostic fine-needle aspiration or surgery. Surgical excision more frequently yielded positive histological findings (P = .016). NTM was identified in 22/48 episodes (45.8%) via culture or molecular sequencing. Mycobacterium abscessus was most commonly found (47.8%). Thirty-eight children (79.2%) received antibiotics. Outcomes in 43 episodes revealed full resolution in 69.8%, while 25.6% had de novo disease and 4.6% experienced recurrence at the same site. Overlying skin changes and multiple or bilateral nodal diseases were significantly associated with de novo disease or recurrence (P = .034 and .084, respectively). Complications occurred in 11/70 (15.7%) procedures. Antibiotic-associated adverse effects occurred in 14/38 (36.8%) episodes.

CONCLUSIONS

NTM lymphadenitis remains a challenging condition. More aggressive management with surgical excision and antibiotics is recommended for those with overlying skin changes and extensive nodal disease.

Civil servants' physical activity status and its associated factors in Northeast Ethiopia: applying Health Belief Model

Background

Identifying the associated factors of the physical activity of civil servants is necessary to increase the practice of physical activity. However, limited studies addressed associated factors of civil servants' physical activity status in Ethiopia. Hence, this study assessed civil servants' physical activity status and associated factors in Northeast Ethiopia.

Methods

An institution-based cross-sectional study design was conducted from 28 February to 13 March 2020 and measured physical activity using WHO physical activity definition. Four hundred and eight civil servants were interviewed using a systematic random sampling technique. A descriptive statistics and multivariable logistic regression model were used.

Result

The percentage of physical activity for the civil servants of the study was only 2.38, with the prevalence of physical activity status of 64.0% (95% CI 60.4% to 67.61%). Perceived self-efficacy (adjusted OR (AOR)=1.98, 95% CI 1.15 to 4.12), cues to action (AOR=2.12, 95% CI 1.04 to 3.22) and being a health professional (AOR=2.19, 95% CI 1.13, 4.23) were main associated factors of physical activity. However, physical activity was not affected by respondents' sex (AOR=1.01, 95% CI 0.67 to 1.83), educational status (AOR=0.23, 95% CI 0.03 to 1.91), perceived barrier (AOR=0.97, 95% CI 0.91 to 1.04) or perceived benefit (AOR=1.02, 95% CI 0.95 to 1.09).

Conclusion

The health profession, self-efficacy and cues to action were the main associated factors of physical activity. Hence, the Sports Bureau and Health Bureau should pay attention to providing information by focusing on improving self-confidence and creating a positive attitude toward physical activity.

Anti-Peri-implantitis Bacteria's Ability of Robusta Green Coffee Bean (Coffea Canephora) Ethanol Extract: An In Silico and In Vitro Study

OBJECTIVE

 This study was aimed to investigate RGCBE extract as antioxidant and anti-peri-implantitis bacteria through in vitro study and its potential as antioxidant, antibacterial, anti-inflammatory, antibone resorption, and proosteogenic through in silico study.

MATERIALS

AND METHODS:  Absorption, distribution, metabolism, excretion and toxicity prediction, molecular docking simulation, and visualization of chlorogenic acid (CGA) and coumaric acid (CA) as anti-inflammatory, antioxidant, and antibacterial were investigated in silico. Inhibition zone by diffusion method, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) of RGCBE extract against Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) were done.

STATISTICAL ANALYSIS

the analysis of variance (ANOVA) difference test, and the post-hoc Tukey's Honest Significant Different (HSD) with a different significance value of p<0.05 RESULTS:  GCA and CA compounds are good drug molecules and it has low toxicity. Chlorogenic acid have higher binding activity than coumaric acid to tumor necrosis factor (TNF)-α, nuclear factor (NF)-κB, receptor activation NF-κB (RANK) and its ligand (RANKL), interleukin (IL)-6, IL-10, runt related transcription factor (RUNX2), receptor activator nuclear Kappa beta Ligand-osteoprotegrin osteocalcin (RANKL-OPG), osteocalcin, nuclear factor associated T-cell 1 (NFATc1), tartate resistant acid phosphatase (TRAP), peptidoglycan, flagellin, dectin, Hsp70, and Hsp10 protein. RGCB ethanol extract has high antioxidant ability and it has MIC, MBC, and inhibit the growth of Aa, Pg, Fn, and Pi at 50% concentration with significantly different (p=0.0001 and<0.05).

CONCLUSION

 RGCB ethanol extract has high antioxidant ability and 50% RGCB ethanol extract may act as strong anti-peri-implantitis bacteria in vitro. In addition, CGA in RGCB potential as antioxidant, antibacterial, anti-inflammatory, antibone resorption, and proosteogenic in silico.

Predicting Norovirus in England Using Existing and Emerging Syndromic Data: Infodemiology Study

BACKGROUND

Norovirus is associated with approximately 18% of the global burden of gastroenteritis and affects all age groups. There is currently no licensed vaccine or available antiviral treatment. However, well-designed early warning systems and forecasting can guide nonpharmaceutical approaches to norovirus infection prevention and control.

OBJECTIVE

This study evaluates the predictive power of existing syndromic surveillance data and emerging data sources, such as internet searches and Wikipedia page views, to predict norovirus activity across a range of age groups across England.

METHODS

We used existing syndromic surveillance and emerging syndromic data to predict laboratory data indicating norovirus activity. Two methods are used to evaluate the predictive potential of syndromic variables. First, the Granger causality framework was used to assess whether individual variables precede changes in norovirus laboratory reports in a given region or an age group. Then, we used random forest modeling to estimate the importance of each variable in the context of others with two methods: (1) change in the mean square error and (2) node purity. Finally, these results were combined into a visualization indicating the most influential predictors for norovirus laboratory reports in a specific age group and region.

RESULTS

Our results suggest that syndromic surveillance data include valuable predictors for norovirus laboratory reports in England. However, Wikipedia page views are less likely to provide prediction improvements on top of Google Trends and Existing Syndromic Data. Predictors displayed varying relevance across age groups and regions. For example, the random forest modeling based on selected existing and emerging syndromic variables explained 60% variance in the ≥65 years age group, 42% in the East of England, but only 13% in the South West region. Emerging data sets highlighted relative search volumes, including "flu symptoms," "norovirus in pregnancy," and norovirus activity in specific years, such as "norovirus 2016." Symptoms of vomiting and gastroenteritis in multiple age groups were identified as important predictors within existing data sources.

CONCLUSIONS

Existing and emerging data sources can help predict norovirus activity in England in some age groups and geographic regions, particularly, predictors concerning vomiting, gastroenteritis, and norovirus in the vulnerable populations and historical terms such as stomach flu. However, syndromic predictors were less relevant in some age groups and regions likely due to contrasting public health practices between regions and health information-seeking behavior between age groups. Additionally, predictors relevant to one norovirus season may not contribute to other seasons. Data biases, such as low spatial granularity in Google Trends and especially in Wikipedia data, also play a role in the results. Moreover, internet searches can provide insight into mental models, that is, an individual's conceptual understanding of norovirus infection and transmission, which could be used in public health communication strategies.

Prevalence of and factors associated with diabetes mellitus among people living with HIV in Vietnam

Studies have shown that people living with HIV (PLWH) have a higher risk of having non-communicable diseases (NCDs) than do people without HIV. In Vietnam, HIV remains a major public health concern, and with recent rapid economic growth, NCDs such as diabetes mellitus (DM) have become a significant disease burden. This cross-sectional study was conducted to examine the prevalence of DM and the factors associated with DM among PLWH on antiretroviral therapy (ART). In total, 1,212 PLWH were included in the study. The age-standardized prevalence of DM and pre-diabetes were 9.29% and 10.32%, respectively. In the multivariate logistic regression analysis, male sex, age above 50 years, and body mass index ≥ 25 kg/m² were associated with DM, and borderline p-value was found for associations with current smoking and years on ART. The results suggest higher DM prevalence among PLWH and that longer time on ART could be an important risk factor for DM among PLWH. These findings also suggest that interventions such as weight control and smoking cessation support could be provided at outpatient clinics. Integration of HIV/AIDS and NCDs services is essential to address health needs comprehensively and enhance health-related quality of life for PLWH.

A new approach to digital health? Virtual COVID-19 care: A scoping review

Aims

The use of virtual care enabled by digital technologies has increased, prompted by public health restrictions in response to COVID-19. Non-hospitalized persons in the acute phase of COVID-19 illness may have unique health needs while self-isolating in the community. This scoping review aimed to explore the nature of care, the use of digital technologies, and patient outcomes arising from virtual care among community-based self-isolating COVID-19 patients.

Methods

Literature searches for peer-reviewed articles were conducted in four bibliographic databases: CINAHL, Medline, Embase and Cochrane Database of Systematic Reviews between January and February 2022, followed by hand-searching reference lists of included articles. Two levels of screening using defined eligibility criteria among two independent reviewers were completed.

Results

Of the 773 articles retrieved, 19 were included. Results indicate that virtual care can be safe while enabling timely detection of clinical deterioration to improve the illness trajectory. COVID-19 virtual care was delivered by single health professionals or by multidisciplinary teams using a range of low-technology methods such as telephone to higher technology methods like wearable technology that transmitted physiological data to the care teams for real-time or asynchronous monitoring.

Conclusion

The review described the varied nature of virtual care including its design, implementation, and evaluation. Further research is needed for continued exploration on how to leverage digital health assets for the delivery of appropriate and safe virtual COVID-19 community care, which can support patient recovery, control transmission, and prevent intensifying the burden on the health care system, especially during surges.

Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System: Retrospective Analysis of Implications for Active Case Finding Interventions

BACKGROUND

Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non-hot spots.

OBJECTIVE

We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria.

METHODS

KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients' residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non-hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non-hot spot wards were analyzed retrospectively for this study.

RESULTS

During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non-hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non-hot spot areas was 146 and 193 per 10,000 people, respectively.

CONCLUSIONS

Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non-hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.

The perinatal health challenges of emerging and re-emerging infectious diseases: A narrative review

The world has seen numerous infectious disease outbreaks in the past decade. In many cases these outbreaks have had considerable perinatal health consequences including increased risk of preterm delivery (e.g., influenza, measles, and COVID-19), and the delivery of low birth weight or small for gestational age babies (e.g., influenza, COVID-19). Furthermore, severe perinatal outcomes including perinatal and infant death are a known consequence of multiple infectious diseases (e.g., Ebola virus disease, Zika virus disease, pertussis, and measles). In addition to vaccination during pregnancy (where possible), pregnant women, are provided some level of protection from the adverse effects of infection through community-level application of evidence-based transmission-control methods. This review demonstrates that it takes almost 2 years for the perinatal impacts of an infectious disease outbreak to be reported. However, many infectious disease outbreaks between 2010 and 2020 have no associated pregnancy data reported in the scientific literature, or pregnancy data is reported in the form of case-studies only. This lack of systematic data collection and reporting has a negative impact on our understanding of these diseases and the implications they may have for pregnant women and their unborn infants. Monitoring perinatal health is an essential aspect of national and global healthcare strategies as perinatal life has a critical impact on early life mortality as well as possible effects on later life health. The unpredictable nature of emerging infections and the potential for adverse perinatal outcomes necessitate that we thoroughly assess pregnancy and perinatal health implications of disease outbreaks and their public health interventions in tandem with outbreak response efforts. Disease surveillance programs should incorporate perinatal health monitoring and health systems around the world should endeavor to continuously collect perinatal health data in order to quickly update pregnancy care protocols as needed.

A framework to guide research and practice response to emerging infectious diseases: Genomic-to-global considerations

Newly emerging infectious diseases (EIDs), like the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, are becoming increasingly common. Due to geographic, political, social, behavioral, and genomic differences, some populations are more vulnerable to infectious disease spread than others. The purpose of this article is to present a framework for research and practice response to emergent infectious diseases that addresses multiple transdisciplinary actions to limit exposure or mitigate adverse outcomes for individuals and communities. Recent experience with new strains of emergent infectious diseases reinforces the importance of intervening at multiple levels, from genomics to political messaging to create multipronged, transdisciplinary interventions to contain the threat. In particular, incorporation of genomics into public health nursing practice of infectious diseases management can enhance existing regional-, community-, and individual-level health promotion and protection efforts, thus impacting long-term health outcomes.

Similarity Analysis in Understanding Online News in Response to Public Health Crisis

BACKGROUND

The "Syphilis No!" campaign the Brazilian Ministry of Health (MoH) launched between November 2018 and March 2019, brought forward the concept "Test, Treat and Cure" to remind the population of the importance of syphilis prevention. In this context, this study aims to analyze the similarity of syphilis online news to comprehend how public health communication interventions influence media coverage of the syphilis issue.

METHODS

This paper presented a computational approach to assess the effectiveness of communication actions on a public health problem. Data were collected between January 2015 and December 2019 and processed using the Hermes ecosystem, which utilizes text mining and machine learning algorithms to cluster similar content.

RESULTS

Hermes identified 1049 google-indexed web pages containing the term 'syphilis' in Brazil. Of these, 619 were categorized as news stories. In total, 157 were grouped into clusters of at least two similar news items and a single cluster with 462 news classified as "single" for not featuring similar news items. From these, 19 clusters were identified in the pre-campaign period, 23 during the campaign, and 115 in the post-campaign.

CONCLUSIONS

The findings presented in this study show that the volume of syphilis-related news reports has increased in recent years and gained popularity after the SNP started, having been boosted during the campaign and escalating even after its completion.

Physicians' Knowledge, Practices, and Perceptions of Reporting Communicable Diseases at Primary Health Care Centers in Jeddah, Saudi Arabia: A Cross-Sectional Study

Background Jeddah has the highest international traffic and is among the most diverse cities in Saudi Arabia. The chance of importing an emerging communicable disease is significant, particularly during the religious seasons. Therefore, timely and accurate reporting of communicable diseases at primary health care centers (PHCCs) is crucial. Objectives The main objective of this study was to assess physicians' knowledge, practices, and perceptions of reporting communicable diseases at PHCCs in Jeddah, Saudi Arabia. Methods The study was a cross-sectional study comprising 143 physicians from all PHCCs in Jeddah from October 2017 to February 2018. An electronic questionnaire was used to collect data to assess the physicians' knowledge, practices, and perceptions related to reporting communicable diseases at PHCCs. Results A total of 106 physicians participated in the study. Although only 21.7% of the physicians had received training on reporting communicable diseases, the average knowledge score for the six commonly reported diseases was 72%. More than half (58.5%) of the physicians indicated that they had reported at least one disease. However, there was no agreement on who should be responsible for reporting communicable diseases at PHCCs. Furthermore, some obstacles were perceived that could prevent disease reporting, including physicians not knowing which diseases to report (66%), not knowing how or whom to report to (54.7%), and a limited diagnostic or laboratory capacity (52.8%). Conclusions Reporting communicable diseases at PHCCs was of adequate quality. However, some obstacles must be addressed, and regular applied training must be provided. More extensive assessments are needed to improve the reporting of communicable diseases locally and nationally.

Prevention and Treatment of Monkeypox: A Systematic Review of Preclinical Studies

The outbreak of monkeypox, coupled with the onslaught of the COVID-19 pandemic is a critical communicable disease. This study aimed to systematically identify and review research done on preclinical studies focusing on the potential monkeypox treatment and immunization. The presented juxtaposition of efficacy of potential treatments and vaccination that had been tested in preclinical trials could serve as a useful primer of monkeypox virus. The literature identified using key terms such as monkeypox virus or management or vaccine stringed using Boolean operators was systematically reviewed. Pubmed, SCOPUS, Cochrane, and preprint databases were used, and screening was performed in accordance with PRISMA guidelines. A total of 467 results from registered databases and 116 from grey literature databases were screened. Of these results, 72 studies from registered databases and three grey literature studies underwent full-text screening for eligibility. In this systematic review, a total of 27 articles were eligible according to the inclusion criteria and were used. Tecovirimat, known as TPOXX or ST-246, is an antiviral drug indicated for smallpox infection whereas brincidofovir inhibits the viral DNA polymerase after incorporation into viral DNA. The ability of tecovirimat in providing protection to poxvirus-challenged animals from death had been demonstrated in a number of animal studies. Non-inferior with regard to immunogenicity was reported for the live smallpox/monkeypox vaccine compared with a single dose of a licensed live smallpox vaccine. The trial involving the live vaccine showed a geometric mean titre of vaccinia-neutralizing antibodies post two weeks of the second dose of the live smallpox/monkeypox vaccine. Of note, up to the third generation of smallpox vaccines-particularly JYNNEOS and Lc16m8-have been developed as preventive measures for MPXV infection and these vaccines had been demonstrated to have improved safety compared to the earlier generations.

Automatic Detection of Tuberculosis Using VGG19 with Seagull-Algorithm

Due to various reasons, the incidence rate of communicable diseases in humans is steadily rising, and timely detection and handling will reduce the disease distribution speed. Tuberculosis (TB) is a severe communicable illness caused by the bacterium Mycobacterium-Tuberculosis (M. tuberculosis), which predominantly affects the lungs and causes severe respiratory problems. Due to its significance, several clinical level detections of TB are suggested, including lung diagnosis with chest X-ray images. The proposed work aims to develop an automatic TB detection system to assist the pulmonologist in confirming the severity of the disease, decision-making, and treatment execution. The proposed system employs a pre-trained VGG19 with the following phases: (i) image pre-processing, (ii) mining of deep features, (iii) enhancing the X-ray images with chosen procedures and mining of the handcrafted features, (iv) feature optimization using Seagull-Algorithm and serial concatenation, and (v) binary classification and validation. The classification is executed with 10-fold cross-validation in this work, and the proposed work is investigated using MATLAB^® software. The proposed research work was executed using the concatenated deep and handcrafted features, which provided a classification accuracy of 98.6190% with the SVM-Medium Gaussian (SVM-MG) classifier.

Application of non-pharmaceutical interventions in camps following the onset of COVID-19

BACKGROUND

As the COVID-19 pandemic emerged in the United States in the spring and summer of 2020, many organizations serving children and youth immediately faced significant operational and healthcare challenges. Centers for Disease Control and Prevention guidance for the safe operation of youth programmes emphasized the importance of non-pharmaceutical interventions (NPIs), yet few studies have examined NPI usage in summer programmes such as camps.

METHOD

This sequential explanatory mixed-methods study explored the utilization of NPIs among camp healthcare providers who completed an online questionnaire followed by one-on-one interviews.

RESULTS

The study findings indicated that camps consistently used a core set of NPIs to maintain and protect the health of camp participants, including screening, cohorting, hand hygiene, sanitizing practices, ventilation and physical distancing. The study findings further identified specific practices of camp healthcare providers that made NPI utilization possible, as exemplified in the emergent themes of wellness promotion; health awareness and modelling; and camp health service mobilization.

CONCLUSION

NPI usage benchmarks from this study, as well as effective practices for NPI utilization, can inform the application of NPIs and other health-promoting practices across diverse formal and informal youth settings.

The role of primary eye health care in controlling the surge of monkeypox

Letter to the editor

Effectiveness of a vaccination education module for college freshmen

Objective: To evaluate the effectiveness of a vaccination education module to improve vaccine expectations and behaviors among college freshmen. Participants: The participants were 177 college freshmen at one private Utah university. Participants were eligible for this study if admitted as new freshmen during the 2019-2020 school year. Methods: The study was a cross-sectional pre- and post-education evaluation assessing vaccine expectations and behaviors using Likert-type and open-ended questions. Results: After completing the vaccination education module, participants' vaccine expectations and behavioral intentions improved. Participants reported they were more likely to be up-to-date on personal vaccines and more likely to expect other students to be up-to-date on their vaccinations. Participants were more likely to ask other students to vaccinate and were also more likely to ask their family members to be vaccinated. Conclusions: This online vaccination education module effectively improved participants' vaccine expectations and behavioral intentions.

Exploring the experiences of frontline nurses caring for COVID-19 patients

AIM

This study seeks to gain a comprehensive understanding of the experiences of frontline nurses who provided direct care for COVID-19 patients.

BACKGROUND

Due to the COVID-19 pandemic, the demands on healthcare systems have been higher than before. Although previous studies have explored the experiences of frontline nurses, these experiences could vary depending on each country's social, cultural, and historical contexts.

INTRODUCTION

In the midst of the global pandemic, sharing the experiences of COVID-19 frontline nurses could have implications for both nursing and nursing policies that could be applied to future pandemics.

METHODS

This descriptive qualitative study comprised 14 South Korean nurses with a minimum of one month of experience working within a COVID-19 department. Individual interviews were conducted on a virtual platform, and a thematic analysis was employed. The consolidated criteria for reporting qualitative studies were used to ensure a detailed reporting of the study.

RESULTS

Four themes and 12 subthemes were developed. The themes included: (1) feeling forced into a world of uncertainty; (2) providing unique care for COVID-19 patients; (3) perceiving barriers to providing quality care; and (4) seeking meaning in caring for COVID-19 patients.

DISCUSSION

Nurses recognized their unique roles in caring for COVID-19 patients and sought new meanings within their profession. However, the poor work environment exacerbated the physical and emotional burden among the nurses and compromised the provision of quality care.

CONCLUSION

This study highlighted the nursing policy issues that need to be improved to ensure better quality care and a stronger healthcare system.

IMPLICATIONS FOR NURSING POLICY

Governmental action is essential to ensure that nurses can maintain the quality of care they have provided during COVID-19 and any future pandemics.

Body Mass Index as a Predictor of Symptom Duration in COVID-19 Outpatients

BACKGROUND

Obesity is a risk factor for various diseases and can affect the disease course. Studies have shown detrimental effects of obesity on patients affected with SARS-CoV-2 including increased hospitalization and more severe disease. This study aims to investigate the effects of obesity on symptom duration in patients with COVID-19, and also explore the possibility of using BMI as a predictor of symptom duration in outpatient settings.

METHODS

Patients diagnosed with COVID-19 between June and October 2020, who had no other comorbidities, and were planned to receive treatment in the outpatient setting were enrolled in the study. Duration of the symptoms was determined based on participants' self-report of their symptoms. Linear regression was used to create predictive models based on participants' BMI, age, sex, disease presentation, and their self-reported symptom duration.

RESULTS

A total of 210 patients were included in the final analysis. Patients with higher BMI had significantly longer symptom duration. Linear regression models showed highest correlation between BMI and symptom duration compared to other covariates.

CONCLUSION

Low error in predictions and high coverage of data variability showed BMI can be used as a predictive factor for symptom duration in COVID-19 patients treated in outpatient settings.

Accountability mechanisms of inquiries and investigations into Australian governments' responses to the COVID-19 pandemic

OBJECTIVE

Australian federal, state and territory government responses to the COVID-19 pandemic have been subject to public oversight by various domestic inquiries and investigations, despite little analysis about what accountability these processes deliver in the context of public health emergencies (PHEs) involving communicable disease. This article identifies and describes recent inquiries and investigations. It examines their ability to promote accountability through mechanisms of answerability (information and justification) and enforceability (sanctions).

METHODS

A systematic scoping review was used to identify inquiries and investigations initiated by May 2021 and to examine the answerability and enforceability mechanisms present. Three diverse case studies were chosen for further description and examination.

RESULTS

Seven parliamentary inquiries, two commissions/boards of inquiry and one Ombudsman investigation were identified. All had numerous mechanisms of answerability. All but two embedded enforceability mechanisms; these were limited, however, to basic reporting.

CONCLUSION

While inquiries and investigations can promote accountability through various mechanisms of answerability, external enforceability mechanisms may be beneficial to strengthen accountability and ensure learning.

IMPLICATIONS FOR PUBLIC HEALTH

Consideration of the kind of accountability that public inquiries and investigations should provide in the context of communicable disease PHEs, and how accountability mechanisms can be strengthened, may improve future public health responses.

Analyzing households' food insecurity during the COVID-19 pandemic and the role of public policies to mitigate it: evidence from Ceará, Brazil

OBJECTIVE

To evaluate the association of conditional cash transfer policies to mitigate the food insecurity (FI) among families living in poverty during the COVID-19 pandemic in Ceará, Brazil.

METHODS

An analytical cross-sectional study was carried out through telephone contact during the period of May-July 2021, during the second wave of the COVID-19 pandemic in Ceará. Families in a situation of high social and economic vulnerability participated in this study (monthly per capita income of less than US$16.50). FI was assessed using the EBIA, a Brazilian validated questionnaire. The participation of families in government programs and public policies was also investigated. Logistic regression models were used to assess the association of the several factors assessed with food insecurity.

RESULTS

The prevalence of any food insecurity in this sample was 89.1% (95% Confidence interval (95% CI: 86.2 - 92.1) and of severe food insecurity, 30.3% (95% CI: 26.0 - 34.6). The Mais Infância card program, adopted as a cash transfer supplement in the state of Ceará, was significantly associated with food insecurity (OR 4.2 (95% CI: 1.7 - 10.2), with a p-value of 0.002. In addition, families affected by job losses due to the COVID-19 pandemic presented higher odds of FI.

CONCLUSIONS

In this study, 89% of evaluated families presented food insecurity. Conditional cash transfer programs were associated with FI. We highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on food insecurity. Such policies can adopt appropriate criteria for defining the participants, as well as connect the participants to an appropriate set of broader social protection measures.

Using Automation, Prioritization, and Collaboration to Manage a COVID-19 Case Surge in Maricopa County, Arizona, 2020

During summer 2020, the Maricopa County Department of Public Health (MCDPH) responded to a surge in COVID-19 cases. We used internet-based platforms to automate case notifications, prioritized investigation of cases more likely to have onward transmission or severe COVID-19 based on available preinvestigation information, and partnered with Arizona State University (ASU) to scale investigation capacity. We assessed the speed of automated case notifications and accuracy of our investigation prioritization criteria. Timeliness of case notification-the median time between receipt of a case report at MCDPH and first case contact-improved from 11 days to <1 day after implementation of automated case notification. We calculated the sensitivity and positive predictive value (PPV) of the investigation prioritization system by applying our high-risk prioritization criteria separately to data available pre- and postinvestigation to determine whether a case met these criteria preinvestigation, postinvestigation, or both. We calculated the sensitivity as the percentage of cases classified postinvestigation as high risk that had also been classified as high risk preinvestigation. We calculated PPV as the percentage of all cases deemed high risk preinvestigation that remained so postinvestigation. During June 30 to July 31, 2020, a total of 55 056 COVID-19 cases with an associated telephone number (94% of 58 570 total cases) were reported. Preinvestigation, 8799 (16%) cases met high-risk criteria. Postinvestigation, 17 037 (31%) cases met high-risk criteria. Sensitivity was 52% and PPV was 98%. Automating case notifications, prioritizing investigations, and collaborating with ASU improved the timeliness of case contact, focused public health resources toward high-priority cases, and increased investigation capacity. Establishing partnerships between health departments and academia might be a helpful strategy for future surge capacity planning.

Systematic Review on Information Technology Approaches to Evaluate the Impact of Public Health Campaigns: Real Cases and Possible Directions

Evaluating the success of a public health campaign is critical. It helps policy makers to improve prevention strategies and close existing gaps. For instance, Brazil's “Syphilis No!” campaign reached many people, but how do we analyze its real impact on population awareness? Are epidemiologic variables sufficient? This study examined literature on using of information technology approaches to analyze the impact of public health campaigns. We began the systematic review with 276 papers and narrowed it down to 17, which analyzed campaigns. In addition to epidemiological variables, other types of variables of interest included: level of (i) access to the campaign website, (ii) subject knowledge and awareness, based on questionnaires, (iii) target population's interest, measured from both online search engine and engagement with Social Network Service, and (iv) campaign exposure through advertising, using data from television commercials. Furthermore, we evaluated the impact by considering several dimensions such as: communication, epidemiology, and policy enforcement. Our findings provide researchers with an overview of various dimensions, and variables-of-interest, for measuring public campaign impact, and examples of how and which campaigns have used them.

Associations of Stay-at-Home Order Enforcement With COVID-19 Population Outcomes: An Interstate Statistical Analysis

In the United States, state governors initially enacted coronavirus diseases 2019 (COVID-19)-mitigation policies with limited epidemiologic data. One prevailing legislative approach, from March to May 2020, was the implementation of "stay-at-home" (SAH) executive orders. Although social distancing was encouraged, SAH orders varied between states, and the associations between potential legal prosecution and COVID-19 outcomes are currently unknown. Here, we provide empirical evidence on how executive enforcement of movement restrictions may influence population health during an infectious disease outbreak. A generalized linear model with negative binomial regression family compared COVID-19 outcomes in states with law-enforceable stay-at-home (eSAH) orders versus those with unenforceable or no SAH orders (uSAH), controlling for demographic factors, socioeconomic influences, health comorbidities, and social distancing. COVID-19 incidence was less by 1.22 cases per day per capita in eSAH states compared with uSAH states (coefficient = -1.22, 95% confidence interval (CI): -1.83, -0.61; P < 0.001), and each subsequent day without an eSAH order was associated with a 0.03 incidence increase (coefficient = 0.03, 95% CI: 0.03, 0.04; P < 0.001). Daily mortality was 1.96 less for eSAH states per capita (coefficient = -1.96, 95% CI: -3.25, -0.68; P = 0.004). Our findings suggest allowing the enforcement of public health violations, compared with community education alone, is predictive of improved COVID-19 outcomes.

Influence of anti-coronavirus disease 2019 policies on 10 pediatric infectious diseases

BACKGROUND

To combat the coronavirus disease 2019 pandemic, many countries, including Japan, implemented policies limiting social activities and encouraging preventive behaviors. This study examines the influence of such policies on the trends of 10 infectious pediatric diseases: pharyngoconjunctival fever; group A streptococcal pharyngitis; infectious gastroenteritis; chickenpox; erythema infectiosum; hand, foot, and mouth disease; herpangina; respiratory syncytial virus; exanthem subitum; and mumps.

METHODS

The research adopted a retrospective cohort study design. We collected data from Japan's National Epidemiological Surveillance Program detailing the incidences of the 10 diseases per pediatric sentinel site for a period beginning at 9 weeks before government-ordered school closures and ending at 9 weeks after the end of the state of emergency. We obtained corresponding data for the equivalent weeks in 2015-2019. We estimated the influence of the policies using a difference-in-differences regression model.

RESULTS

For seven diseases (pharyngoconjunctival fever; group A streptococcal pharyngitis; infectious gastroenteritis; chickenpox; erythema infectiosum; hand, foot, and mouth disease; and herpangina), the incidence in 2020 decreased significantly during and after the school closures. Sensitivity analysis, in which the focus area was limited to the policy-implementation period or existing trend patterns, replicated these significant decreases for one of the above mentioned seven diseases - infectious gastroenteritis.

CONCLUSIONS

Policies such as school closures and encouragement of preventive behaviors were associated with significant decreases in the incidences of most of the 10 diseases, which sensitivity analysis replicated in infectious gastroenteritis. To determine the long-term effects of these policies, prospective cohort studies are needed.

Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.

Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study

Background

In a prior study at the start of the pandemic, we reported reduced numbers of Google searches for the term “conjunctivitis” in the United States in March and April 2020 compared with prior years. As one explanation, we conjectured that reduced information-seeking may have resulted from social distancing reducing contagious conjunctivitis cases. Here, after 1 year of continued implementation of social distancing, we asked if there have been persistent reductions in searches for “conjunctivitis,” and similarly for other communicable disease terms, compared to control terms.

Objective

The aim of this study was to determine if reduction in searches in the United States for terms related to conjunctivitis and other common communicable diseases occurred in the spring-winter season of the COVID-19 pandemic, and to compare this outcome to searches for terms representing noncommunicable conditions, COVID-19, and to seasonality.

Methods

Weekly relative search frequency volume data from Google Trends for 68 search terms in English for the United States were obtained for the weeks of March 2011 through February 2021. Terms were classified a priori as 16 terms related to COVID-19, 29 terms representing communicable conditions, and 23 terms representing control noncommunicable conditions. To reduce bias, all analyses were performed while masked to term names, classifications, and locations. To test for the significance of changes during the pandemic, we detrended and compared postpandemic values to those expected based on prepandemic trends, per season, computing one- and two-sided P values. We then compared these P values between term groups using Wilcoxon rank-sum and Fisher exact tests to assess if non-COVID-19 terms representing communicable diseases were more likely to show significant reductions in searches in 2020-2021 than terms not representing such diseases. We also assessed any relationship between a term’s seasonality and a reduced search trend for the term in 2020-2021 seasons. P values were subjected to false discovery rate correction prior to reporting. Data were then unmasked.

Results

Terms representing conjunctivitis and other communicable conditions showed a sustained reduced search trend in the first 4 seasons of the 2020-2021 COVID-19 pandemic compared to prior years. In comparison, the search for noncommunicable condition terms was significantly less reduced (Wilcoxon and Fisher exact tests, P<.001; summer, autumn, winter). A significant correlation was also found between reduced search for a term in 2020-2021 and seasonality of that term (Theil-Sen, P<.001; summer, autumn, winter). Searches for COVID-19–related conditions were significantly elevated compared to those in prior years, and searches for influenza-related terms were significantly lower than those for prior years in winter 2020-2021 (P<.001).

Conclusions

We demonstrate the low-cost and unbiased use of online search data to study how a wide range of conditions may be affected by large-scale interventions or events such as social distancing during the COVID-19 pandemic. Our findings support emerging clinical evidence implicating social distancing and the COVID-19 pandemic in the reduction of communicable disease and on ocular conditions.

Learning From Each Other in the Management of Natural Disaster and COVID-19 Pandemic: A Case Study in Taiwan

In response to the COVID-19 pandemic, Taiwan has been one of the best performers in the world with extremely low infections and deaths. This success can be attributed to the long experiences dealing with natural disasters and communicable diseases. However, with different disastrous characteristics, the disaster management systems for communicable diseases and natural disasters are very different in terms of laws, plans, frameworks, and emergency operations. Taking the response to COVID-19 pandemic as a study subject, we found that disaster management for communicable diseases can be improved through a comparison with natural disasters, and vice versa. First, having wider and longer impacts than natural disasters, the plans and framework for communicable diseases in Taiwan focus more on national and regional scales. Local governments would need more capacity support including budgets and training to conduct investigations and quarantine during the COVID-19 pandemic. Second, for quick response, the emergency operation for communicable diseases was designed to be more flexible than that for natural disasters by giving the commander more authority to adjust to the circumstances. The commanding system requires a more objective consultation group to prevent arbitrary decisions against the COVID-19 pandemic. Finally, risk governance is important for communicable diseases as well as for natural disasters. Additional efforts should be made to enhance vulnerability assessment, disaster reduction, and risk communication for shaping responses and policies in an efficient and coordinating way.

Decreased Incidence of Pediatric Intussusception during COVID-19

Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.

Characterization of Clinical Escherichia coli Strains Producing a Novel Shiga Toxin 2 Subtype in Sweden and Denmark

Shiga toxin (Stx) is the key virulence factor in the Shiga Toxin-Producing Escherichia coli (STEC), which can cause diarrhea and hemorrhagic colitis with potential life-threatening complications. There are two major types of Stx: Stx1 and Stx2. Several Stx1/Stx2 subtypes have been identified in E. coli, varying in sequences, toxicity and host specificity. Here, we report a novel Stx2 subtype (designated Stx2m) from three clinical E. coli strains isolated from diarrheal patients and asymptomatic carriers in Sweden and Denmark. The Stx2m toxin was functional and exhibited cytotoxicity in vitro. The two Swedish Stx2m-producing strains belonged to the same serotype O148:H39 and Multilocus Sequencing Typing (MLST) Sequence Type (ST) 5825, while the Danish strain belonged to the O96:H19 serotype and ST99 type. Whole-genome sequencing (WGS) data analysis revealed that the three Stx2m-producing strains harbored additional virulence genes and the macrolide resistance gene mdf (A). Our findings expand the pool of Stx2 subtypes and highlight the clinical significance of emerging STEC variants. Given the clinical relevance of the Stx2m-producing strains, we propose to include Stx2m in epidemiological surveillance of STEC infections and clinical diagnosis.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2020

Abstract

For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.

Social distancing during COVID-19: threat and efficacy among university students in seven nations

COVID-19 has been spreading fast worldwide, and until effective and safe vaccines have been widely adopted, preventive measures such as social distancing are crucial to keep the pandemic under control. The study's research questions asked which psychosocial factors predict social distancing behavior and whether there are country-level differences in social distancing? Using the Extended Parallel Process Model (EPPM) as a theoretical lens, we examined the predictive effects of threat and efficacy and demographic variables on adherence to the COVID-19 preventive behavior of social distancing using a survey among an international sample of university students. Using path modeling and analysis of covariance, we confirmed the predictive effects of the EPPM on social distancing behavior. Our final model showed that perceived susceptibility to COVID-19 was both directly and indirectly (through response efficacy) associated with social distancing behavior; that perceived severity of COVID-19 yielded a significant indirect effect on social distancing behavior through both self-efficacy and response efficacy; that perceived susceptibility is indirectly and positively associated with social distancing behavior through response efficacy; and that self-efficacy and response efficacy were directly associated with social distancing behavior. Additionally, there were country-level differences in social distancing. Possible explanations for and implications of these findings are discussed.

A Review of Using Mathematical Modeling to Improve Our Understanding of Bacteriophage, Bacteria, and Eukaryotic Interactions

Phage therapy, the therapeutic usage of viruses to treat bacterial infections, has many theoretical benefits in the ‘post antibiotic era.’ Nevertheless, there are currently no approved mainstream phage therapies. One reason for this is a lack of understanding of the complex interactions between bacteriophage, bacteria and eukaryotic hosts. These three-component interactions are complex, with non-linear or synergistic relationships, anatomical barriers and genetic or phenotypic heterogeneity all leading to disparity between performance and efficacy in in vivo versus in vitro environments. Realistic computer or mathematical models of these complex environments are a potential route to improve the predictive power of in vitro studies for the in vivo environment, and to streamline lab work. Here, we introduce and review the current status of mathematical modeling and highlight that data on genetic heterogeneity and mutational stochasticity, time delays and population densities could be critical in the development of realistic phage therapy models in the future. With this in mind, we aim to inform and encourage the collaboration and sharing of knowledge and expertise between microbiologists and theoretical modelers, synergising skills and smoothing the road to regulatory approval and widespread use of phage therapy.

Measles outbreak, Montenegro January-July 2018: Lessons learned

In 2017, the Regional Verification Commission for Measles and Rubella Elimination (RVC) of the World Health Organization confirmed that measles elimination was sustained in Montenegro, and the previous endemic transmission remained interrupted. However, the RVC was extremely concerned over the continuing low vaccination coverage reported for this country. In this study, we describe the most recent measles epidemic in Montenegro using the epidemiological data collected from January 1 to July 31, 2018. The outbreak is largely attributable to a dangerous accumulation of susceptible subjects across the country and represents a high‐risk factor for re‐establishing endemic transmission in the Balkan area. This study showed how a vaccine‐preventable communicable disease outbreak can have a dramatic impact and severe consequences on regional public health system performance in terms of the sanitary spending point of view. A detailed update is provided on the epidemiological situation in this Central European area, not available until now.

On 2017, the Regional Verification Commission for Measles and Rubella Elimination (RVC) of World Health Organization confirmed that measles elimination was sustained in Montenegro, and the previous endemic transmission remained interrupted.

The reduction in vaccination coverage was one of the main causes of the measles outbreak in Montenegro in 2018: this report provides information on the impact of the epidemic on the national health service and complements the gap in epidemiological data on measles trends available for this country of the WHO European Region.

Fueling the Covid-19 pandemic: summer school holidays and incidence rates in German districts

BACKGROUND

The Robert-Koch-Institute reports that during the summer holiday period a foreign country is stated as the most likely place of infection for an average of 27 and a maximum of 49% of new SARS-CoV-2 infections in Germany.

METHODS

Cross-sectional study on observational data. In Germany, summer school holidays are coordinated between states and spread out over 13 weeks. Employing a dynamic model with district fixed effects, we analyze the association between these holidays and weekly incidence rates across 401 German districts.

RESULTS

We find effects of the holiday period of around 45% of the average district incidence rates in Germany during their respective final week of holidays and the 2 weeks after holidays end. Western states tend to experience stronger effects than Eastern states. We also find statistically significant interaction effects of school holidays with per capita taxable income and the share of foreign residents in a district's population.

CONCLUSIONS

Our results suggest that changed behavior during the holiday season accelerated the pandemic and made it considerably more difficult for public health authorities to contain the spread of the virus by means of contact tracing. Germany's public health authorities did not prepare adequately for this acceleration.

Early perception, behavior, knowledge, and preventive practices related to COVID-19 among Palestinians

It is necessary to understand early perception, behavior, and knowledge of coronavirus disease 2019 (COVID-19) and preventive practices in relation to suggested policies and information accessible to the Palestinian population during the early stages of the pandemic. The aim of this research is to contribute to this understanding for the purpose of affecting future practical preventive policies that can be implemented and adapted in Palestine in order to shape a new reflective practices model to face any future epidemic crisis of any type. A cross-sectional design was used to conduct the study over 3 weeks in April 2020 and an online survey was disseminated in all areas of Palestine. A total of 1040 responses were collected from persons who were over 18 years of age. A high level of knowledge related to COVID-19 was found, including symptoms and characteristics of the virus, prevention practices, and at-risk groups. Respondents believe that they are more susceptible to influenza than COVID-19 and more likely to be infected by the influenza virus than the COVID-19 virus but expect that infection of influenza would be less severe than infection of COVID-19. Respondents were more inclined to find COVID-19 worrying and stressful than they were to find it fear-inducing. Around two-thirds of respondents believe that different types of COVID-19-related conspiracy theories are true to some degree. Going forward, it is crucial and essential to provide basic awareness among large populations around diseases, which can contribute to positively influencing people's knowledge and attitudes and their perception toward such diseases and combat conspiracy theories.