History of smallpox vaccination and marked clinical expression of mpox among cases notified in France from May to July 2022.

OBJECTIVES: The aim was to estimate the effect of reported history of smallpox vaccination prior to 1980 on clinical expression of mpox. METHODS: We included all confirmed mpox cases identified by the national mpox surveillance system in France between May and July 2022. Cases tested positive for monkeypox virus or orthopoxviruses by PCR. Cases were interviewed by phone using a questionnaire documenting demographics, symptoms and exposures. To estimate the effect of smallpox vaccination on the presence of marked mpox symptoms (association of fever, lymphadenopathy and extensive mucocutaneous lesions), we estimated prevalence ratios (PRs) and 95% CIs using Poisson regression models with robust standard errors. RESULTS: There were 1888 confirmed mpox cases with date of symptom onset between 7 May and 31 July 2022. Overall, 7% (93/1394) presented marked mpox symptoms. Among patients who provided information about their vaccination status, 14% (207/1469) reported smallpox vaccination prior to 1980. The proportion of cases with marked symptoms was 2% (3/170) among those reporting smallpox vaccination prior to 1980 and 8% (76/974) among those who reported no vaccination. The proportion of marked symptoms was four times lower among cases reporting previous smallpox vaccination than in cases reporting no vaccination (PR, 0.24; 95% CI: 0.08-0.76). There was no evidence of an effect of smallpox vaccination on development of complications (PR, 0.65; 95% CI: 0.35-1.22) or hospitalization due to mpox (PR, 0.64; 95% CI: 0.23-1.80). DISCUSSION: Our results suggest that smallpox vaccination during childhood attenuated the clinical expression of monkeypox virus infection, but there was no evidence of an effect on complications or hospitalization.

Mpox outbreak in France: epidemiological characteristics and sexual behaviour of cases aged 15 years or older, 2022.

BackgroundLocally-acquired mpox cases were rarely reported outside Africa until May 2022, when locally-acquired-mpox cases occurred in various European countries.AimWe describe the mpox epidemic in France, including demographic and behavioural changes among a subset of cases, during its course.MethodsData were retrieved from the enhanced national surveillance system until 30 September 2022. Laboratory-confirmed cases tested positive for monkeypox virus or orthopoxviruses by PCR; non-laboratory-confirmed cases had clinical symptoms and an epidemiological link to a laboratory-confirmed case. A subset of ≥ 15-year-old male cases, notified until 1 August, was interviewed for epidemiological, clinical and sexual behaviour information. Association of symptom-onset month with quantitative outcomes was evaluated by t- or Wilcoxon tests, and with binary outcomes, by Pearson's chi-squared or Fisher exact tests.ResultsA total of 4,856 mpox cases were notified, mostly in Île-de-France region (62%; 3,025/4,855). Cases aged ≥ 15 years were predominantly male (97%; 4,668/4,812), with 37 years (range: 15-81) as mean age. Between May and July, among the subset interviewed, mpox cases increased in regions other than Île-de-France, and mean age rose from 35 (range: 21-64) to 38 years (range: 16-75; p = 0.007). Proportions of cases attending men-who-have-sex-with-men (MSM) meeting venues declined from 60% (55/91) to 46% (164/359; p = 0.012); median number of sexual partners decreased from four (interquartile range (IQR): 1-10) to two (IQR: 1-4; p < 0.001).ConclusionChanges in cases' characteristics during the epidemic, could reflect virus spread from people who were more to less behaviourally vulnerable to mpox between May and July, or MSM reducing numbers of sexual partners as recommended.

Effect and cost-effectiveness of human-centred design-based approaches to increase adolescent uptake of modern contraceptives in Nigeria, Ethiopia and Tanzania: Population-based, quasi-experimental studies.

Around half of adolescent pregnancies in low- and middle-income countries are unintended, contributing to millions of unsafe abortions per year. Adolescents 360 (A360), a girl-centred initiative, aimed to increase voluntary uptake of modern contraceptives among adolescents in Nigeria, Ethiopia and Tanzania. We evaluated the effectiveness and cost-effectiveness of A360 in increasing modern contraceptive use in selected geographies. We used before-and-after cross-sectional studies of adolescent girls in four settings. Two Nigerian settings had purposefully selected comparison areas. Baseline and endline household surveys were conducted. The primary study outcome was modern contraceptive prevalence rate (mCPR). Secondary outcomes mapped onto the A360 Theory of Change. Interpretation was aided by a process evaluation along with secular mCPR trends and self-reported A360 exposure data. Incremental design and implementation costs were calculated from implementer systems, site visits, surveys, and interviews. mCPR change was modelled into maternal disability-adjusted life years (DALY) averted to calculate incremental cost-effectiveness ratios. In Oromia, Ethiopia, mCPR increased by 5% points (95% CI 1-10; n = 1,697). In Nigeria, there was no evidence of an effect of A360 on mCPR in Nasarawa (risk ratio: 0·96, 95% CI: 0·76-1·21; n = 5,414) or in Ogun (risk ratio: 1·08, 95% CI: 0·92-1·26; n = 3,230). In Mwanza, Tanzania, mCPR decreased by 9% points (-17 to -0.3; n = 1,973). Incremental cost per DALY averted were $30,855 in Oromia, $111,416 in Nasarawa, $30,114 in Ogun, and $25,579 in Mwanza. Costs per DALY averted were 14-53 times gross domestic product per capita. A360 did not lead to increased adolescent use of modern contraceptives at a population level, except in Oromia, and was not cost-effective. This novel adolescent-centred design approach showed some promise in addressing the reproductive health needs of adolescents, but must be accompanied by efforts to address the contextual drivers of low modern contraceptive use.

Seroprevalence of Hantavirus in Forestry Workers, Northern France, 2019-2020.

We aimed to estimate the seroprevalence of Puumala orthohantavirus (PUUV) among forestry workers in northern France, and to explore sociodemographic risk factors. We conducted a random cross-sectional seroprevalence survey among 1777 forestry workers in 2019-2020. The presence of immunoglobulin G against PUUV antigens in serum was assessed using enzyme-linked immunosorbent assay and confirmed using immunofluorescence assay. Poisson regression models were used to explore factors associated with seropositivity. Weighted seroprevalence was 5% (3-6) in northeastern France, 4% (2-6) in north central France, and 1% in two regions located in the center of the country (Auvergne and Limousin). There were no seropositive workers detected in northwestern France. Seropositivity was associated with age, sex, and cumulative seniority in the forestry sector. Seroprevalence was highest in known endemic areas of the northeast and lowest in the northwest. Nevertheless, we found serological evidence of PUUV infection in two regions located in the center of the country, suggesting circulation of the virus in these regions, previously thought to be non-endemic.

Evaluation of Senegal supply chain intervention on contraceptive stockouts using routine stock data.

BACKGROUND: Until 2011, stockouts of family planning commodities were common in Senegalese public health facilities. Recognizing the importance of addressing this problem, the Government of Senegal implemented the Informed Push Model (IPM) supply system, which involves logisticians to collect facility-level stock turnover data once a month and provide contraceptive supplies accordingly. The aims of this paper were to evaluate the impact of IPM on contraceptive availability and on stockout duration. METHODS AND FINDINGS: To estimate the impact of the IPM on contraceptive availability, stock card data were obtained from health facilities selected through multistage sampling. A total number of 103 health facilities pertaining to 27 districts and nine regions across the country participated in this project. We compared the odds of contraceptive stockouts within the health facilities on the 23 months after the intervention with the 18 months before. The analysis was performed with a logistic model of the monthly time-series. The odds of stockout for any of the five contraceptive products decreased during the 23 months post-intervention compared to the 18 months pre-intervention (odds ratio, 95%CI: 0.34, 0.22-0.51). To evaluate the impact of the IPM on duration of stockouts, a mixed negative binomial zero-truncated regression analysis was performed. The IPM was not effective in reducing the duration of contraceptive stockouts (incidence rate ratio, 95%CI: 0.81, 0.24-2.7), except for the two long-acting contraceptives (intrauterine devices and implants). Our model predicted a decrease in stockout median duration from 23 pre- to 4 days post-intervention for intrauterine devices; and from 19 to 14 days for implants. CONCLUSIONS: We conclude that the IPM has resulted in greater efficiency in contraceptive stock management, increasing the availability of contraceptive methods in health facilities in Senegal. The IPM also resulted in decreased duration of stockouts for intrauterine devices and implants, but not for any of the short-acting contraception (pills and injectables).

Accuracy of leukocyte esterase test, endometrial cytology and vaginal discharge score for diagnosing postpartum reproductive tract health status in dairy cows at the moment of sampling, using a latent class model fit within a Bayesian framework.

The objectives of this retrospective study were: 1) to determine the sensitivity (Se) and specificity (Sp) of leukocyte esterase test (LE), endometrial cytology (CYTO) and vaginal discharge score (VDS) for diagnosis of reproductive tract diseases in dairy cows at the moment of sampling; 2) to assess the impact of different thresholds on test accuracy and misclassification costs; and 3) to quantify herd prevalence of reproductive tract diseases in dairy farms from Québec, Canada. Data from 2092 cows (39 herds) enrolled in two randomized control trials were included. Cows were examined at 35 (± 7) days in milk using LE, CYTO, and VDS to determine their reproductive tract health status. A latent class model assuming conditional dependence of CYTO and LE was fit within a Bayesian framework. Non-informative priors were used for the Se and Sp of LE, CYTO, and VDS, while prior information for disease prevalence was obtained from expert opinions (mode = 20%, 5th percentile = 10%). Posterior inferences (median and 95% Bayesian credible intervals; BCI) were obtained using the WinBUGS statistical freeware. An initial model was built using thresholds of ≥ 1 (small amount of leukocytes), of ≥ 6%, and of ≥ 3 (mucopurulent discharge) for the LE, CYTO, and VDS, respectively. Then, the impact on tests accuracy and misclassification costs of using different thresholds was explored. Optimal thresholds balancing the need for good antimicrobial stewardship and animal health considerations were proposed. The optimal thresholds obtained in the final model were: LE ≥ 2 (moderate amount of leukocytes), CYTO ≥ 6%, and VDS ≥ 2 (mucus with flecks of pus). In the final model, median (95% BCI) Se for LE, CYTO and VDS were 42.6% (38.8-47.0), 45.9% (41.9-50.7), and 64.2% (59.1-70.3), respectively. Median Sp was 90.9% (88.0-93.6) for LE, 92.2% (89.2-94.9) for CYTO and 96.6% (91.3-99.8) for VDS. Median within-herd prevalence of reproductive tract disease was estimated at 47.9% (39.0-56.7). At a threshold ≥ 2 (mucus with flecks of pus), VDS had the highest Se and Sp among the tests evaluated. The LE is an interesting diagnostic alternative for detecting reproductive tract disease in dairy cows. At a threshold ≥ 2 (moderate amount of leukocytes), LE Se and Sp were comparable to those of CYTO. This is the first study reporting the accuracy of LE, CYTO, and VDS for diagnosing reproductive tract diseases in dairy cows at the moment of sampling.

Algometer Precision for Quantifying Mechanical Nociceptive Threshold When Applied to the Udder of Lactating Dairy Cows.

Objectives of this study were to: (1) quantify the reliability of an algometer for measuring mechanical nociceptive thresholds when applied to the udder of dairy cows; and (2) evaluate whether covariates, such as cow characteristics or time of the day, would influence algometer measurements. This prospective study was performed in a university herd of 37 lactating cows during five consecutive days, involving two raters. Two types of measurement were obtained: one qualitative binary measure (i.e., reaction vs. no reaction) and one quantitative measure presented in kilograms (i.e., mechanical nociceptive threshold, MNT) for the cows that reacted. Kappa statistics were used to investigate test-retest and inter-rater reliability for the qualitative measure, while concordance correlation coefficient (CCC) and limits of agreement plot were used for the quantitative measure. Whether algometer measurements were influenced by several covariates (i.e., time of the day, level of milk production, days in milk, and parity) was then evaluated using logistic or linear regression models, depending on the outcome. The algometer was moderately reliable; there was moderate test-retest reliability (Kappa = 0.53; CCC = 0.58) and inter-rater reliability (Kappa = 0.42; CCC = 0.54). The MNT varied substantially as a function of time of the day and parity. This is the first study reporting reliability of a pressure algometer for quantifying MNT and investigating covariates possibly affecting this measurement when applied to the udder of dairy cows. It is concluded that the use of an algometer for quantifying MNT on the udder is only moderately repeatable and is influenced by extraneous covariates. Its usage in research setting to quantify changes in sensitivity at the udder level should, therefore, be considered very cautiously or it should be further developed.

Incomplete Milking in Early Lactation Does Not Affect Dairy Cows Resting Behaviors: Results from a Randomized Controlled Trial.

The objective of this study was to investigate the effect of incomplete milking during the first 5 days of lactation on the resting behavior of commercial dairy cows. The hypothesis was that the elevated intramammary pressure resulting from milk retained in the udder in incompletely milked cows could lead to a change in lying behavior. This study was a randomized controlled trial in which cows from two farms were randomly allocated into a treatment (n = 18) or a control group (n = 14). Cows in the treatment group were milked incompletely (10-14 L/days) during the first 5 days of lactation, while cows in the control group were milked as usually done on farm. Resting behaviors were recorded with a data logger. Linear mixed models were used to quantify the effects of treatment group on three dependent variables measured between 2 and 14 days in milk: daily duration of lying time (h/d), lying bout frequency (bouts/day), and mean duration of lying bouts (min/bout). There was no significant effect of treatment on lying time. However, the effect of treatment on frequency of lying bouts and on mean lying bout duration varied by parity level. Incompletely milked cows in second parity had a higher number of lying bouts (11.9 vs. 9.2 bouts/day) and shorter mean lying bout duration (57.8 min/bout vs. 66.7 min) than control cows. In third parity or more, the opposite happened. Therefore, our results suggest that an incomplete milking may be slightly problematic for second parity cows and, possibly, slightly beneficial for older cows. Whether the differences observed resulted from a biologic process (discomfort due to the incomplete milking) or from random error will have to be determined by future research.