Hospital outbreak of Carbapenem-resistant acinetobacter baumannii in the context of local facility transmission.

Carbapenem-resistant Acinetobacter baumannii are of increasing concern in the health care setting. We describe a cluster of 9 cases in hospitalized patients over a 3-month period that reflected ongoing community transmission from high-risk facilities. Robust surveillance and knowledge of local epidemiology are critical to mitigating onward transmission in the health care setting.

Retrospective evaluation of real-time estimates of global COVID-19 transmission trends and mortality forecasts.

Since 8th March 2020 up to the time of writing, we have been producing near real-time weekly estimates of SARS-CoV-2 transmissibility and forecasts of deaths due to COVID-19 for all countries with evidence of sustained transmission, shared online. We also developed a novel heuristic to combine weekly estimates of transmissibility to produce forecasts over a 4-week horizon. Here we present a retrospective evaluation of the forecasts produced between 8th March to 29th November 2020 for 81 countries. We evaluated the robustness of the forecasts produced in real-time using relative error, coverage probability, and comparisons with null models. During the 39-week period covered by this study, both the short- and medium-term forecasts captured well the epidemic trajectory across different waves of COVID-19 infections with small relative errors over the forecast horizon. The model was well calibrated with 56.3% and 45.6% of the observations lying in the 50% Credible Interval in 1-week and 4-week ahead forecasts respectively. The retrospective evaluation of our models shows that simple transmission models calibrated using routine disease surveillance data can reliably capture the epidemic trajectory in multiple countries. The medium-term forecasts can be used in conjunction with the short-term forecasts of COVID-19 mortality as a useful planning tool as countries continue to relax public health measures.

An Epidemic Model for Multi-Intervention Outbreaks.

Modeling is an important tool to utilize at the beginning of an infectious disease outbreak, as it allows estimation of parameters - such as the basic reproduction number, R0-that can be used to postulate how the outbreak may continue to spread. However, there exist many challenges that need to be accounted for, such as an unknown first case date, retrospective reporting of 'probable' cases, changing dynamics between case count and death count trends, and the implementation of multiple control efforts and their delayed or diminished effects. Using the near-daily data provided from the recent outbreak of Sudan ebolavirus in Uganda as a case study, we create a model and present a framework aimed at overcoming these aforementioned challenges. The impact of each challenge is examined by comparing model estimates and fits throughout our framework. Indeed, we found that allowing for multiple fatality rates over the course of an outbreak generally resulted in better fitting models. On the other hand, not knowing the start date of an outbreak appeared to have large and non-uniform effects on parameter estimates, particularly at the beginning stages of an outbreak. While models that did not account for the decaying effect of interventions on transmission underestimated R0, all decay models run on the full dataset yielded precise R0 estimates, demonstrating the robustness of R0 as a measure of disease spread when examining data from the entire outbreak.

Otolaryngologic manifestations among MPOX patients: A systematic review and meta-analysis.

PURPOSE: MPOX has numerous otolaryngologic presentations that have been recognized as clinically important, especially with the onset of the 2022 outbreak. However, how these features vary across region and outbreak have yet to be elucidated or supported by meta-analysis. The objective of this study is to identify the otolaryngologic manifestations of MPOX across previous and current outbreaks and among endemic and non-endemic regions. BASIC PROCEDURES: Data sources of MEDLINE (PubMed), the Cochrane Library, Scopus, Embase, Web of Science, Google Scholar, and OpenGrey were searched through August 2022. All observational studies reporting data on laboratory-confirmed MPOX patients with otolaryngologic symptoms were included. Two authors independently performed the screening process while a third resolved disagreements. Data were extracted into a structured form by two authors independently. We performed a meta-analysis of the prevalence of otorhinolaryngologic symptoms using MetaXL software (version 5.3) under a random-effects model. MAIN FINDINGS: 38 studies with 5952 patients were included. The four most prevalent manifestations were headache at 31 % (95 % CI [0.16-0.49], I 2  = 99 %), sore throat at 22 % (95 % CI [0.09-0.37], I 2  = 99 %), cough at 16 % (95 % CI [0.05-0.30], I 2  = 99 %), and cervical lymphadenopathy at 10 % (95 % CI [0.01-0.26], I 2  = 100 %). Otolaryngologic features were more prevalent in previous outbreaks as compared to the 2022 outbreak including 37 % prevalence of headache (95 % CI [0.11-0.66], I 2  = 100 %), 33 % prevalence of cough (95 % CI [0.21-0.47], I 2  = 98 %), 27 % prevalence of sore throat (95 % CI [0.07-0.53], I 2  = 99 %), 15 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.428], I 2  = 100 %), 13 % prevalence of oral ulcers (95 % CI [0.02-0.30], I 2  = 99 %), 6 % prevalence of oral exanthem (95 % CI [0.00-0.17], I 2  = 99 %), 5 % prevalence of dysphagia (95 % CI [0.00-0.18], I 2  = 99 %), and 5 % prevalence of tonsillar signs (95 % CI [0.00-0.13], I 2  = 99 %). Features that were more prevalent in endemic areas versus non-endemic areas include 27 % prevalence of cough (95 % CI [0.14-0.41], I 2  = 99 %), 15 % prevalence of oral ulcers (95 % CI [0.02-0.36], I 2  = 99 %), 6 % prevalence of tonsillar signs (95 % CI [0.00-0.18], I 2  = 99 %), and 19 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.48], I 2  = 100 %), while the only feature more prevalent in non-endemic areas was headache with a prevalence of 36 % (95 % CI [0.24-0.47], I 2  = 96 %). PRINCIPAL CONCLUSIONS: In this systematic review and meta-analysis, four symptoms - headache, sore throat, cough, and cervical lymphadenopathy - were found to be the most prevalent otolaryngologic features of MPOX. Otolaryngologic manifestations of MPOX were more pronounced in prior outbreaks and in endemic areas as compared to the 2022 outbreak and non-endemic areas. These findings may aid MPOX recognition in an otolaryngology setting.

JYNNEOS Vaccine for Mpox.

This JAMA Patient Page describes the eligibility, safety and effectiveness, and administration procedure for the JYNNEOS vaccine for mpox infection.

Mpox Infection in Children-Infection Control Implications for Household Contacts.

Mpox has recently re-emerged as a global entity of concern. We report one of the first pediatric cases in the United States and provide updated recommendations relevant to infection control and prevention measures of those in close contact with mpox.

Evolving Face Mask Guidance During a Pandemic and Potential Harm to Public Perception: Infodemiology Study of Sentiment and Emotion on Twitter.

BACKGROUND: Throughout the COVID-19 pandemic, US Centers for Disease Control and Prevention policies on face mask use fluctuated. Understanding how public health communications evolve around key policy decisions may inform future decisions on preventative measures by aiding the design of communication strategies (eg, wording, timing, and channel) that ensure rapid dissemination and maximize both widespread adoption and sustained adherence. OBJECTIVE: We aimed to assess how sentiment on masks evolved surrounding 2 changes to mask guidelines: (1) the recommendation for mask use on April 3, 2020, and (2) the relaxation of mask use on May 13, 2021. METHODS: We applied an interrupted time series method to US Twitter data surrounding each guideline change. Outcomes were changes in the (1) proportion of positive, negative, and neutral tweets and (2) number of words within a tweet tagged with a given emotion (eg, trust). Results were compared to COVID-19 Twitter data without mask keywords for the same period. RESULTS: There were fewer neutral mask-related tweets in 2020 (ß=-3.94 percentage points, 95% CI -4.68 to -3.21; P<.001) and 2021 (ß=-8.74, 95% CI -9.31 to -8.17; P<.001). Following the April 3 recommendation (ß=.51, 95% CI .43-.59; P<.001) and May 13 relaxation (ß=3.43, 95% CI 1.61-5.26; P<.001), the percent of negative mask-related tweets increased. The quantity of trust-related terms decreased following the policy change on April 3 (ß=-.004, 95% CI -.004 to -.003; P<.001) and May 13 (ß=-.001, 95% CI -.002 to 0; P=.008). CONCLUSIONS: The US Twitter population responded negatively and with less trust following guideline shifts related to masking, regardless of whether the guidelines recommended or relaxed mask usage. Federal agencies should ensure that changes in public health recommendations are communicated concisely and rapidly.

Compassionate Use of Tecovirimat for the Treatment of Monkeypox Infection.

This case series describes the clinical resolution of systemic symptoms and lesions, along with any adverse events, in patients with monkeypox infection who were treated with tecovirimat on a compassionate use basis.

Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021.

OBJECTIVE: Northern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aimed to investigate the trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016 and 2021 and the potential impact of SARS-CoV-2. METHODS: We extracted weekly EWARN data on ILI/ SARI and aggregated cases and consultations into 4-week intervals to calculate case positivity. We conducted a seasonal-trend decomposition to assess case trends in the presence of seasonal fluctuations. RESULTS: It was observed that 4-week aggregates of ILI cases (n = 5,942,012), SARI cases (n = 114,939), ILI case positivity, and SARI case positivity exhibited seasonal fluctuations with peaks in the winter months. ILI and SARI cases in individuals aged ≥5 years surpassed those in individuals aged <5 years in late 2019. ILI cases clustered primarily in Aleppo and Idlib, whereas SARI cases clustered in Aleppo, Idlib, Deir Ezzor, and Hassakeh. SARI cases increased sharply in 2021, corresponding with a severe SARS-CoV-2 wave, compared with the steady increase in ILI cases over time. CONCLUSION: Respiratory infections cause widespread morbidity and mortality throughout northern Syria, particularly with the emergence of SARS-CoV-2. Strengthened surveillance and access to testing and treatment are critical to manage outbreaks among conflict-affected populations.

Misinformation and Disinformation: The Potential Disadvantages of Social Media in Infectious Disease and How to Combat Them.

Although the use of social media to spread misinformation and disinformation is not a new concept, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has further highlighted the dangers that misinformation can pose to public health. More than two-thirds of Americans receive their news from at least 1 social media outlet, most of which do not undergo the same review process as academic journals and some professional news organizations. Unfortunately, this can lead to inaccurate health information being conveyed as truth. The purpose of this article is to inform the infectious diseases community of the history and dangers of health misinformation and disinformation in social media, present tools for identifying and responding to misinformation, and propose other ethical considerations for social media.

Viral Hepatitis E Outbreaks in Refugees and Internally Displaced Populations, sub-Saharan Africa, 2010-2020.

Hepatitis E virus is a common cause of acute viral hepatitis. We analyzed reports of hepatitis E outbreaks among forcibly displaced populations in sub-Saharan Africa during 2010-2020. Twelve independent outbreaks occurred, and >30,000 cases were reported. Transmission was attributed to poor sanitation and overcrowding.

Antimicrobial Resistance and Human Mobility.

Antimicrobial resistance (AMR) is of increasing global concern. Human mobility is one factor that has recently been associated with AMR, though the extent of its impact has not yet been well established due to the limited availability of rigorous data. This review examines the existing literature regarding various types of human mobility including short-term travelers, forcibly displaced persons, migrant populations, and their association with global rates of AMR.

Evaluating criminal justice reform during COVID-19: The need for a novel sentiment analysis package.

The health and safety of incarcerated persons and correctional personnel have been prominent in the U.S. news media discourse during the COVID-19 pandemic. Examining changing attitudes toward the health of the incarcerated population is imperative to better assess the extent to which the general public favors criminal justice reform. However, existing natural language processing lexicons that underlie current sentiment analysis (SA) algorithms may not perform adequately on news articles related to criminal justice due to contextual complexities. News discourse during the pandemic has highlighted the need for a novel SA lexicon and algorithm (i.e., an SA package) tailored for examining public health policy in the context of the criminal justice system. We analyzed the performance of existing SA packages on a corpus of news articles at the intersection of COVID-19 and criminal justice collected from state-level outlets between January and May 2020. Our results demonstrated that sentence sentiment scores provided by three popular SA packages can differ considerably from manually-curated ratings. This dissimilarity was especially pronounced when the text was more polarized, whether negatively or positively. A randomly selected set of 1,000 manually scored sentences, and the corresponding binary document term matrices, were used to train two new sentiment prediction algorithms (i.e., linear regression and random forest regression) to verify the performance of the manually-curated ratings. By better accounting for the unique context in which incarceration-related terminologies are used in news media, both of our proposed models outperformed all existing SA packages considered for comparison. Our findings suggest that there is a need to develop a novel lexicon, and potentially an accompanying algorithm, for analysis of text related to public health within the criminal justice system, as well as criminal justice more broadly.

Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave.

The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.