Systematic review of global hepatitis E outbreaks to inform response and coordination initiatives.

INTRODUCTION: Hepatitis E virus (HEV) is the most common cause of acute hepatitis. While symptoms are generally mild and resolve within weeks, some populations (e.g., pregnant women, immunocompromised adults) are at high-risk of severe HEV-related morbidity and mortality. There has not been a recent comprehensive review of contemporary HEV outbreaks, which limits the validity of current disease burden estimates. Therefore, we aimed to characterize global HEV outbreaks and describe data gaps to inform HEV outbreak prevention and response initiatives. METHODS: We performed a systematic review of peer-reviewed (PubMed, Embase) and gray literature (ProMED) to identify reports of outbreaks published between 2011 and 2022. We included (1) reports with ≥ 5 cases of HEV, and/or (2) reports with 1.5 times the baseline incidence of HEV in a specific population, and (3) all reports with suspected (e.g., clinical case definition) or confirmed (e.g., ELISA or PCR test) cases if they met criterium 1 and/or 2. We describe key outbreak epidemiological, prevention and response characteristics and major data gaps. RESULTS: We identified 907 records from PubMed, 468 from Embase, and 247 from ProMED. We screened 1,362 potentially relevant records after deduplication. Seventy-one reports were synthesized, representing 44 HEV outbreaks in 19 countries. The populations at risk, case fatalities, and outbreak durations were not reported in 66% of outbreak reports. No reports described using HEV vaccines. Reported intervention efforts included improving sanitation and hygiene, contact tracing/case surveillance, chlorinating boreholes, and advising residents to boil water. Commonly missing data elements included specific case definitions used, testing strategy and methods, seroprevalence, impacts of interventions, and outbreak response costs. Approximately 20% of HEV outbreaks we found were not published in the peer-reviewed literature. CONCLUSION: HEV represents a significant public health problem. Unfortunately, extensive data shortages and a lack of standardized reporting make it difficult to estimate the HEV disease burden accurately and to implement effective prevention and response activities. Our study has identified major gaps to guide future studies and outbreak reporting systems. Our results support the development of standardized reporting procedures/platforms for HEV outbreaks to ensure accurate and timely data distribution, including active and passive coordinated surveillance systems, particularly among high-risk populations.

Consequences of Shigella infection in young children: a systematic review.

OBJECTIVES: We conducted a systematic review of the longitudinal consequences of Shigella infection in children to inform the value proposition for an effective vaccine. METHODS: We searched PubMed and Embase for studies published from January 01, 1980 to December 12, 2022 and conducted in low- and middle-income countries that included longitudinal follow-up after Shigella detection among children aged <5 years, irrespective of language. We collected data on all outcomes subsequent to Shigella detection, except mortality. RESULTS: Of 2627 papers identified, 52 met inclusion criteria. The median sample size of children aged <5 years was 66 (range 5-2172). Data were collected in 20 countries; 56% (n = 29) of the publications included Bangladesh. The most common outcomes related to diarrhea (n = 20), linear growth (n = 14), and the mean total cost of a Shigella episode (n = 4; range: $ 6.22-31.10). Among children with Shigella diarrhea, 2.9-61.1% developed persistent diarrhea (≥14 days); the persistence was significantly more likely among children who were malnourished, had bloody stool, or had multidrug-resistant Shigella. Cumulative Shigella infections over the first 2 years of life contributed to the greatest loss in length-for-age z-score. CONCLUSION: We identified evidence that Shigella is associated with persistent diarrhea, linear growth faltering, and economic impact to the family.

Provider Use of Time Alone With Adolescents: Differences by Health Concern.

PURPOSE: To examine associations between reports of sensitive health behaviors and the provision of time alone by a clinician during adolescent well visits. METHODS: Data were collected from 547 adolescents who completed a well visit at one of eight clinics. Adjusted mixed logistic regression was used to examine whether reports of sexual behavior, substance use, disordered eating, mental health concerns, and demographic characteristics were associated with time alone. RESULTS: Sexual behavior was found to be significantly associated with time alone, while substance use, disordered eating, a positive depression screen, and suicidal ideation were not. Older adolescents and males were more likely to report time alone, while race/ethnicity had no association with time alone. DISCUSSION: Clinicians may be prioritizing time alone for behavioral concerns differently than for other sensitive behaviors.

Adenomatoid odontogenic tumor: Case series of 14 with wide range of clinical presentation.

BACKGROUND: To present 14 cases of adenomatoid odontogenic tumor (AOT), highlighting their clinical, radiographic, and histologic characteristics. MATERIAL AND METHODS: Fourteen cases of AOT were retrieved from the archives of the Oral Pathology Biopsy Service (OPBS). Clinical, radiologic, and histologic findings are described. RESULTS: Fourteen AOT cases were reviewed, of which 12 were intraosseous and two were peripheral (gingiva). The cases came from eight females and six males with an age range of 11-30. Of the 12 intraosseous cases, nine were follicular (associated with impacted teeth), while three were extra-follicular (present between teeth). Six of the 12 cases were in the maxilla, and the other six were in the mandible. The two peripheral cases presented as nodules on the buccal gingiva of the anterior maxillary teeth. Radiographically, all 12 follicular and extra-follicular cases were unilocular radiolucencies; of those, only one had specks of radiopacity. Histologically, all specimens were similar in morphology, demonstrating a varied degree of duct-like structures, epithelial spheres, spindle-shaped epithelial cells, calcifications, and a thick capsule. The two peripheral cases had no capsule. CONCLUSIONS: AOT usually affects patients under 20 years of age, with a female to male ratio close to 2:1. Presentation in the anterior maxilla is almost twice as common as in the anterior mandible. Radiographically, AOT presents as a unilocular radiolucency more commonly associated with impacted teeth, simulating a dentigerous cyst. We present 14 new cases of AOT (nine follicular, three extra-follicular, and two peripheral) with discussions of their clinical, radiographic, and histological features. Key words:Adenomatoid, odontogenic, tumor.