Unveiling patterns of viral pathogen infection in free-ranging carnivores of northern Portugal using a complementary methodological approach.

Pathogen surveillance in free-ranging carnivores presents challenges due to their low densitie and secretive nature. We combined molecular and serological assays to investigate infections by viral pathogens (Canine parvovirus (CPV), Canine distemper virus (CDV) and Canine coronavirus (CCoV)) in Portuguese carnivores (Canis lupus, Vulpes vulpes, Lutra lutra, Martes foina, M. martes, Meles meles, and Genetta genetta) over a period of 16 years. Additionally we explored spatio-temporal patterns of virus occurrence in Canis lupus. Our study identified CPV DNA in all carnivore species with an overall prevalence of 91.9 %. CPV was detected in all sampled years and seasons in Canis lupus, supporting its enzootic nature. CDV RNA was mainly detected in the Canidae family, with viral nucleic acid recorded between 2005 and 2008 with a peak prevalence of 67 % among the wolf population, followed by a sharp decline, suggesting an epizootic behaviour of the virus. Antibodies show that mustelids and viverrids were often exposed to CDV. CCoV was first recorded by molecular methods in wolf samples in 2002, remaining in the wolf populations with marked fluctuations over time. The dual serological and molecular approach provided important epidemiological data on pathogens of wild carnivores in Portugal. These programmes should also include monitoring of other potential reservoir hosts such as domestic cats and dogs.

Linkage to HIV care and its determinants in the late HAART era: a systematic review and meta-analysis.

Poor engagement into HIV care limits the effectiveness of highly active antiretroviral therapies (HAART) to improve survival and reduce transmission. The design of effective interventions to enhance linkage to care is dependent on evidence about rates of entry into HIV care. This is a systematic review and meta-analysis on linkage measurement and its determinants in the late era of HAART (post-2003), in high-income countries. We searched the PubMed and Web of Science databases, restricting our sample to the late HAART era (post-2003) until February 2016, and to high-income countries. We retained only studies that produced quantified outcomes. We rejected the studies with a high risk of bias, and followed a standard meta-analytic approach. Because there was a high heterogeneity ( I 2 > 90%), the aggregated findings were based on a random-effects model. A total of 43 studies were identified, all of them following a cohort of patients newly diagnosed until referred to specialized care. For a one-month period, the meta-proportion was 71.1% (IC95%: 61.0%-81.2). For a three-month duration, the meta-proportion of linkage to care was 77.0% (IC95%: 75.0%-79.0). For a one-year period, the meta-proportion was 76.3% (IC95%: 54.2%-98.4%). The proportions were lower when lab tests were used as referral indicator, with a pooled meta-proportion of 76.7% (IC95%: 73.0%-80.4), in comparison to a value of 80.8% (IC95%: 68.7%-92.9) for consultations. Being black or male were the most commonly observed determinants of delayed entry into care. Young people, injecting drug users, people with low socioeconomic status, or at a less advanced stage of disease also experienced lower proportions of timely linkage. Timely engagement into care is below 80% and specific sub-groups are particularly at risk of late entry. These findings confirm earlier evidence that linkage to care remains low, and that efforts should focus on vulnerable populations.

Economic evaluation of HIV testing for men who have sex with men in community-based organizations - results from six European cities.

The non-decreasing incidence of HIV among men who have sex with men (MSM) has motivated the emergence of Community Based Voluntary Counselling and Testing (CBVCT) services specifically addressed to MSM. The CBVCT services are characterized by facilitated access and linkage to care, a staff largely constituted by voluntary peers, and private not-for-profit structures outside the formal health system institutions. Encouraging results have been measured about their effectiveness, but these favourable results may have been obtained at high costs, questioning the opportunity to expand the experience. We performed an economic evaluation of HIV testing for MSM at CBVCT services, and compared them across six European cities. We collected retrospective data for six CBVCT services from six cities (Copenhagen, Paris, Lyon, Athens, Lisbon, and Ljubljana), for the year 2014, on the number of HIV tests and HIV reactive tests, and on all expenditures to perform the testing activities. The total costs of CBVCTs varied from 54,390€ per year (Ljubljana) to 245,803€ per year (Athens). The cost per HIV test varied from to 41€ (Athens) to 113€ (Ljubljana). The cost per HIV reactive test varied from 1966€ (Athens) to 9065€ (Ljubljana). Our results show that the benefits of CBVCT services are obtained at an acceptable cost, in comparison with the literature (values, mostly from the USA, range from 1600$ to 16,985$ per HIV reactive test in clinical and non-clinical settings). This result was transversal to several European cities, highlighting that there is a common CBVCT model, the cost of which is comparable regardless of the epidemiological context and prices. The CBVCT services represent an effective and "worth it" experience, to be continued and expanded in future public health strategies towards HIV.

Variability in the recovery of a virus concentration procedure in water: Implications for QMRA.

Methods for analysing water for viruses are known to have variable and relatively poor recovery efficiencies. Quantitative method recovery data are needed to correct virus enumeration results so that estimates of virus concentrations in surface waters for QMRA are not too low. Obtaining quantitative data representing method recoveries for different pathogenic viruses is a significant challenge. In this study, we investigated the use of mengovirus process control data for quantifying recovery efficiency of human adenovirus (AdV) and noroviruses GI (NoVGI) and GII (NoVGII) from surface waters. Samples were collected from the inlet to a drinking water treatment plant on the Glomma River, Norway. Performance of the sample concentration procedure was quantified by comparing the virus concentrations found in concentrated and unconcentrated samples. The mean recovery of viruses (1.2%, 0.31%, 0.15% and 0.053% for mengovirus (n = 86), AdV (n = 20), NoVGI (n = 33) and NoVGII (n = 21) respectively) estimated in this study were lower than expected, and the between sample variability in estimated recovery was very high, spanning around 6 orders of magnitude for mengovirus. Within-sample correlation between the estimated recovery of mengovirus and human viruses was poor, and therefore sample specific mengovirus data could not be used to correct all human virus concentrations. Instead beta distributions were fitted to human virus-specific recovery estimates. The magnitude and variability of virus concentration when corrected for the variable recovery efficiency was orders of magnitude higher than the uncorrected concentration. Better estimates of virus concentration could be achieved if a sample-specific spiking control could be developed that mimicked closely the behaviour of human viruses in environmental samples.

Molecular detection of haemotropic Mycoplasma species in urban and rural cats from Portugal.

OBJECTIVES: The aim of the present study was to evaluate the prevalence of haemoplasma infection in cats in Portugal and to assess risk factors for infection. METHODS: Real-time polymerase chain reaction techniques were used to assess 236 urban and rural cats from central and southern Portugal. RESULTS: The overall prevalence of haemoplasma in the target population was 27.1% (64/236), with individual species' prevalences as follows: 17.8% (42/236) 'Candidatus Mycoplasma haemominutum' (CMhm), 14.4% (34/236) Mycoplasma haemofelis (Mhf) and only 5.9% (14/236) 'Candidatus Mycoplasma turicensis' (CMt). Multiple infections were detected in 8.1% (19/236) of the samples, with triple and double infections with Mhf and CMhm being most commonly detected (5.9% [14/236] of cats). Haemoplasma infection was significantly higher in shelter cats (P = 0.015) than in cats with other lifestyles (eg, free-roaming/house pet/blood donors). Haemoplasma prevalence was also higher in cats with feline immunodeficiency virus infection (FIV; P = 0.011). Although sex was not significantly associated with haemoplasma infection (P = 0.050), CMt was predominantly found in males (P = 0.032). Also, the presence of haemoplasma multiple infections was statistically associated with being in a shelter (P = 0.021), male (P = 0.057) and with FIV co-infection (P = 0.004). No evidence of an association between haemoplasma infection and geographical location, age or feline leukaemia virus co-infection was found. CONCLUSIONS AND RELEVANCE: The results obtained in our study are consistent with the documented worldwide prevalence of feline haemoplasma infections, suggesting that the three main feline haemoplasma species are common in Portugal.

A One Year Study on the Concentrations of Norovirus and Enteric Adenoviruses in Wastewater and A Surface Drinking Water Source in Norway.

Enteric viruses transmitted via the faecal-oral route occur in high concentrations in wastewater and may contaminate drinking water sources and cause disease. In order to quantify enteric adenovirus and norovirus genotypes I and II (GI and GII) impacting a drinking source in Norway, samples of surface water (52), wastewater inlet (64) and outlet (59) were collected between January 2011 and April 2012. Samples were concentrated in two steps, using an electropositive disc filter and polyethylene glycol precipitation, followed by nucleic acid extraction and analysis by quantitative polymerase chain reaction. Virus was detected in 47/52 (90.4%) of surface water, 59/64 (92%) of wastewater inlet and 55/59 (93%) of wastewater outlet samples. Norovirus GI occurred in the highest concentrations in surface water (2.51e + 04) and adenovirus in wastewater (2.15e + 07). While adenovirus was the most frequently detected in all matrices, norovirus GI was more frequently detected in surface water and norovirus GII in wastewater. This study is the first in Norway to monitor both sewage and a drinking water source in parallel, and confirms the year-round presence of norovirus and adenovirus in a Norwegian drinking water source.