Advocating for Coccidioidomycosis to Be a Reportable Disease Nationwide in the United States and Encouraging Disease Surveillance across North and South America.

Coccidioidomycosis (Valley fever) has been a known health threat in the United States (US) since the 1930s, though not all states are currently required to report disease cases. Texas, one of the non-reporting states, is an example of where both historical and contemporary scientific evidence define the region as endemic, but we don't know disease incidence in the state. Mandating coccidioidomycosis as a reportable disease across more US states would increase disease awareness, improve clinical outcomes, and help antifungal drug and vaccine development. It would also increase our understanding of where the disease is endemic and the relationships between environmental conditions and disease cases. This is true for other nations in North and South America that are also likely endemic for coccidioidomycosis, especially Mexico. This commentary advocates for US state and territory epidemiologists to define coccidioidomycosis as a reportable disease and encourages disease surveillance in other endemic regions across North and South America in order to protect human health and reduce disease burden.

Coccidioidomycosis Cases at a Regional Referral Center, West Texas, USA, 2013-2019.

We describe 73 patients with coccidioidomycosis diagnosed or treated at a regional referral center in West Texas, USA. Patients most at risk worked in oil production or agriculture; the most-associated health factors were smoking and diabetes. Patient demographics suggest that access to care may affect coccidioidomycosis diagnosis in this region.

Acceptability of COVID-19 vaccination among health care workers: a cross-sectional survey in Morocco.

INTRODUCTION: This study aimed to evaluate the acceptability of COVID-19 vaccination among health care workers prior to the start of the COVID-19 vaccination campaign in Morocco. METHODS: This cross-sectional study was conducted in the Cheikh Khalifa University Hospital of Casablanca-Morocco. Utilizing a web-based platform surveys were distributed over a 3-week period via professional mailing list and social media. Odds ratios and 95% confidence intervals were estimated by using logistic regression models. RESULTS: A total of 303 health care workers participated in this study. The results showed a relatively high rate of vaccination acceptability (62.0%) among health care workers included in this study. Participants were more likely to accept the COVID-19 vaccine if they were physician, nurse, or technician (OR 1.79; 95% CI: 1.09-2.95), had high score of confidence in the information circulating about COVID-19 (OR 1.91; 95% CI: 1.36-2.69), or had high score of perceived severity of COVID-19 (OR 1.55; 95% CI: 1.11-2.15). Reasons of hesitation/or refusal of COVID-19 vaccine were fear of the likely side effects of the vaccine for 74.8% of participants, and concern about the effectiveness of the vaccine for 47.8%. CONCLUSION: This study showed a relatively high rate of the COVID-19 vaccination acceptance among health care workers in Morocco. Willingness to be vaccinated was significantly associated with job category, confidence in the information circulating about COVID-19, and perceived severity of COVID-19. These results could be useful in the development of educational interventions to increase the acceptance of COVID-19 vaccine among health care workers in Morocco and similar settings.

Consideration of Vector-Borne and Zoonotic Diseases during Differential Diagnosis.

OBJECTIVE: Recognition and reporting of vector-borne and zoonotic disease (VBZD) cases is largely dependent upon the consideration of such diseases by healthcare practitioners during the initial diagnosis and ordering of specific confirmative diagnostic tests. This study was conducted to assess the general knowledge and understanding of VBZD transmission and clinical presentation. METHODS: Healthcare practitioners were surveyed to determine the extent of training and educational experiences they received relative to VBZDs, and their likelihood to consider such diseases during differential diagnoses. In addition, an assessment of their knowledge of arthropod species that may transmit VBZD pathogens was conducted. RESULTS: Having postprofessional school training relevant to VBZDs significantly influenced diagnostic accuracy for such disease cases based on the presented clinical signs and symptoms. CONCLUSIONS: The prevalence of VBZDs in the United States likely is significantly underestimated. The authors suggest the enhancement of VBZD-focused education as an important initiative that would significantly improve timely diagnosis, treatment, and, ultimately, prevention of these diseases.

Nosocomial transmission of invasive group a streptococcus from patient to health care worker.

BACKGROUND: Nosocomial transmission of group A streptococcus (GAS) has been well described. Instances resulting in fulminant disease among health care workers have not been described. Contact and droplet precautions have been advised to minimize the risk of nosocomial transmission. We aimed to determine whether a case of invasive GAS pneumonia and streptococcal toxic shock syndrome in a respiratory therapist was acquired as a result of caring for a patient with GAS necrotizing fasciitis. Contacts of these patients were screened to determine if they were the reservoir of the GAS. Genetic testing to confirm clonal transmission was conducted. METHODS: Contacts of the patients with GAS infection were screened using questionnaires and testing of pharyngeal specimens. Specimens from patients and carriers of GAS who were identified during screening were subjected to pulsed-field gel electrophoresis and emm gene typing. RESULTS: We identified 705 contacts of the 2 patients; all contacts had oropharyngeal specimens collected for culture. Only the index patient and the respiratory therapist yielded identical pulse-field gel electrophoresis GAS isolates, with clonality indicated by emm typing. CONCLUSIONS: Nosocomial transmission of GAS from a patient to a health care worker who developed streptococcal toxic shock syndrome may have occurred after the index patient had received 48 h of antibiotic therapy and despite placement in contact isolation. Isolation guidelines for patients with severe GAS infection may need to be reviewed.

The obscuration by dust of most of the growth of supermassive black holes.

Supermassive black holes underwent periods of exponential growth during which we see them as quasars in the distant Universe. The summed emission from these quasars generates the cosmic X-ray background, the spectrum of which has been used to argue that most black-hole growth is obscured. There are clear examples of obscured black-hole growth in the form of 'type-2' quasars, but their numbers are fewer than expected from modelling of the X-ray background. Here we report the direct detection of a population of distant type-2 quasars, which is at least comparable in size to the well-known unobscured type-1 population. We selected objects that have mid-infrared and radio emissions characteristic of quasars, but which are faint at near-infrared and optical wavelengths. We conclude that this population is responsible for most of the black-hole growth in the young Universe and that, throughout cosmic history, black-hole growth occurs in the dusty, gas-rich centres of active galaxies.

Atovaquone/proguanil therapy for Plasmodium falciparum and Plasmodium vivax malaria in Indonesians who lack clinical immunity.

Thirty-eight of 295 subjects participating in a randomized, double-blind, placebo-controlled trial of the efficacy of daily administration of atovaquone/proguanil for malaria prevention developed malaria at some time during the 20-week prophylaxis period. These subjects (3 atovaquone/proguanil recipients and 35 placebo recipients) were treated with 4 tablets of atovaquone/proguanil per day for 3 days. Atovaquone/proguanil provided safe, well-tolerated, and effective therapy for uncomplicated malaria in nonimmune Indonesians.

Randomized, placebo-controlled trial of atovaquone/proguanil for the prevention of Plasmodium falciparum or Plasmodium vivax malaria among migrants to Papua, Indonesia.

The increasing prevalence of resistance to antimalarial drugs reduces options for malaria prophylaxis. Atovaquone/proguanil (Malarone; GlaxoSmithKline) has been >95% effective in preventing Plasmodium falciparum malaria in lifelong residents of areas of holoendemicity, but data from persons without clinical immunity or who are at risk for Plasmodium vivax malaria have not been described. We conducted a randomized, double-blinded study involving 297 people from areas of nonendemicity in Indonesia who migrated to Papua (where malaria is endemic) < or =26 months before the study period. Subjects received prophylaxis with 1 Malarone tablet (250 mg of atovaquone and 100 mg of proguanil hydrochloride; n=148) or placebo (n=149) per day for 20 weeks. Hematologic and clinical chemistry values did not change significantly. The protective efficacy of atovaquone/proguanil was 84% (95% confidence interval [CI], 44%-95%) for P. vivax malaria, 96% (95% CI, 72%-99%) for P. falciparum malaria, and 93% (95% CI, 77%-98%) overall. Atovaquone/proguanil was well tolerated, safe, and effective for the prevention of drug-resistant P. vivax and P. falciparum malaria in individuals without prior malaria exposure who migrated to Papua, Indonesia.