Cases of Meningococcal Disease Associated with Travel to Saudi Arabia for Umrah Pilgrimage - United States, United Kingdom, and France, 2024.

Invasive meningococcal disease (IMD), caused by infection with the bacterium Neisseria meningitidis, usually manifests as meningitis or septicemia and can be severe and life-threatening (1). Six serogroups (A, B, C, W, X, and Y) account for most cases (2). N. meningitidis is transmitted person-to-person via respiratory droplets and oropharyngeal secretions. Asymptomatic persons can carry N. meningitidis and transmit the bacteria to others, potentially causing illness among susceptible persons. Outbreaks can occur in conjunction with large gatherings (3,4). Vaccines are available to prevent meningococcal disease. Antibiotic prophylaxis for close contacts of infected persons is critical to preventing secondary cases (2).

Pathogen prioritisation for wastewater surveillance ahead of the Paris 2024 Olympic and Paralympic Games, France.

BackgroundWastewater surveillance is an effective approach to monitor population health, as exemplified by its role throughout the COVID-19 pandemic.AimThis study explores the possibility of extending wastewater surveillance to the Paris 2024 Olympic and Paralympic Games, focusing on identifying priority pathogen targets that are relevant and feasible to monitor in wastewater for these events.MethodsA list of 60 pathogens of interest for general public health surveillance for the Games was compiled. Each pathogen was evaluated against three inclusion criteria: (A) analytical feasibility; (B) relevance, i.e. with regards to the specificities of the event and the characteristics of the pathogen; and (C) added value to inform public health decision-making. Analytical feasibility was assessed through evidence from peer-reviewed publications demonstrating the detectability of pathogens in sewage, refining the initial list to 25 pathogens. Criteria B and C were evaluated via expert opinion using the Delphi method. The panel consisting of some 30 experts proposed five additional pathogens meeting criterion A, totalling 30 pathogens assessed throughout the three-round iterative questionnaire. Pathogens failing to reach 70% group consensus threshold underwent further deliberation by a subgroup of experts.ResultsSix priority targets suitable for wastewater surveillance during the Games were successfully identified: poliovirus, influenza A virus, influenza B virus, mpox virus, SARS-CoV-2 and measles virus.ConclusionThis study introduced a model framework for identifying context-specific wastewater surveillance targets for a mass gathering. Successful implementation of a wastewater surveillance plan for Paris 2024 could incentivise similar monitoring efforts for other mass gatherings globally.

Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022.

BackgroundIn 2022, a global monkeypox virus (MPXV) clade II epidemic occurred mainly among men who have sex with men. Until early 1980s, European smallpox vaccination programmes were part of worldwide smallpox eradication efforts. Having received smallpox vaccine > 20 years ago may provide some cross-protection against MPXV.AimTo assess the effectiveness of historical smallpox vaccination against laboratory-confirmed mpox in 2022 in Europe.MethodsEuropean countries with sufficient data on case vaccination status and historical smallpox vaccination coverage were included. We selected mpox cases born in these countries during the height of the national smallpox vaccination campaigns (latest 1971), male, with date of onset before 1 August 2022. We estimated vaccine effectiveness (VE) and corresponding 95% CI for each country using logistic regression as per the Farrington screening method. We calculated a pooled estimate using a random effects model.ResultsIn Denmark, France, the Netherlands and Spain, historical smallpox vaccination coverage was high (80-90%) until the end of the 1960s. VE estimates varied widely (40-80%, I2 = 82%), possibly reflecting different booster strategies. The pooled VE estimate was 70% (95% CI: 23-89%).ConclusionOur findings suggest residual cross-protection by historical smallpox vaccination against mpox caused by MPXV clade II in men with high uncertainty and heterogeneity. Individuals at high-risk of exposure should be offered mpox vaccination, following national recommendations, regardless of prior smallpox vaccine history, until further evidence becomes available. There is an urgent need to conduct similar studies in sub-Saharan countries currently affected by the MPXV clade I outbreak.

Providing parents with HPV vaccine information from a male perspective may render them more inclined to have their daughters vaccinated.

OBJECTIVES: Several high-income countries have implemented a gender-neutral vaccination program against human papillomavirus (HPV) infections. The impact of a gender-neutral program (GNP) on parental intention to vaccinate their daughters has not been studied, especially in countries with low HPV vaccine coverage among girls. PATIENTS AND METHODS: In July 2019, before a GNP was implemented in France (2021), the French National Cancer Institute (INCa) conducted a survey on HPV vaccine acceptance among parents of children aged 11-19 years living in France. In the sample of girls' parents (n = 1424 parents, 1726 girls), we investigated whether parents who declared no initial intention to have their daughter(s) vaccinated changed their minds after reading information including a male perspective on HPV consisting in description of HPV-related disease among men and in ascertainment of the fact that in some countries, the HPV vaccine is recommended for boys, after which they were once again asked about their intentions "if the vaccine were recommended to boys and girls alike". RESULTS: As regards 295 (25.7 %) of the 1147 unvaccinated girls, their parents declared no intention to have them vaccinated, while 509 (44.4 %) were not sure. Among the parents of the 804 girls whose parents had not intended to have them vaccinated, 134 (16.7 %) changed their minds after reading about HPV among men. Fathers were more likely than mothers to change their minds, and finally intend to have their daughters vaccinated (adjusted relative risk, 1.74 [95 % confidence interval, 1.20,2.54]). CONCLUSIONS: These results suggest that parents, and fathers in particular, could be more motivated to have their daughters vaccinated against HPV if the information with which they were provided included a male perspective and a recommendation of vaccination for boys as well as girls.

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.

Tratamento medicamentoso e não medicamentoso de usuários de um Centro de Atenção Psicossocial / Pharmacological and non-pharmacological treatment of a Psychosocial Care Center users

OBJETIVOS: Verificar o perfil de tratamento medicamentoso e não medicamentoso de usuários assistidos em um Centro de Atenção Psicossocial. MÉTODOS: Estudo epidemiológico com delineamento transversal, realizado em um Centro de Atenção Psicossocial de um município do Noroeste do Estado do Rio Grande do Sul. Foram incluídos todos os usuários assistidos no Centro, com idade superior a 18 anos, de ambos os gêneros. Foram excluídos aqueles com falta de informações sobre o tratamento. A coleta de dados foi realizada pelo acesso direto aos prontuários quanto às características sociodemográficas, informações relacionadas ao diagnóstico, internações hospitalares anteriores, tratamento medicamentoso e não medicamentoso. A análise dos dados foi realizada por meio do teste Qui-quadrado de Pearson e o nível de significância considerado foi p<0,05. RESULTADOS: Foram incluídos 448 pacientes, cuja média de idade foi 48,25±12,44 anos, sendo que 293 (65,4%) eram do gênero feminino, 266 (59,2%) viviam sem companheiro e 206 (46,0%) tinham ensino fundamental incompleto. Todos os usuários realizavam tratamento não medicamentoso e 445 (99,3%) faziam também uso de medicamentos. Entre as classes de medicamentos utilizados houve predomínio de antipsicóticos (78,3%) e dos antidepressivos (71,2%). O uso de quatro ou mais medicamentos foi associado à internação hospital anterior e ao uso de antipsicóticos, antidepressivos, antiepiléticos e ansiolíticos. CONCLUSÕES: Constatou-se um perfil sociodemográfico semelhante ao de usuários de Centros de Atenção Psicossocial em diferentes regiões brasileiras. A totalidade dos pacientes recebia tratamento não medicamentoso e quase a totalidade utilizava também medicamentos. Diante do elevado número de medicamentos e internações hospitalares anteriores identificadas emerge a necessidade de ampliação do escopo de terapêuticas não medicamentosas no tratamento de transtornos mentais, a fim de promover a integralidade e a resolubilidade do cuidado em saúde mental.

AIMS: To verify the profile of pharmacological and non-pharmacological treatment of patients assisted in a Psychosocial Care Center. METHODS: An epidemiological study with a cross-sectional design was carried out in a Psychosocial Care Center of a municipality in the Northwest of the State of Rio Grande do Sul. All patients assisted in the Center, aged over 18 years, of both genders, were included. Those for whom information about treatment was missing were excluded. Data collection was performed by direct access to medical records regarding sociodemographic characteristics, information on diagnosis, previous hospital admissions, pharmacological and non-pharmacological treatment. Data analysis was performed using the Pearson Chi-square test and the significance level was set at p<0.05. RESULTS: A total of 448 patients were included, whose mean age was 48.25±12.44 years, 293 (65.4%) were female, 266 (59.2%) lived without a partner and 206 (46.0%) had incomplete elementary education. All patients were receiving non-pharmacological treatment and 445 (99.3%) were also taking medications. Among the classes of drugs used, antipsychotics (78.3%) and antidepressants (71.2%) predominated. Using of four or more drugs was associated with previous hospitalization and with taking antipsychotics, antidepressants, antiepileptics and anxiolytics. CONCLUSIONS: A sociodemographic profile similar to that of users of Psychosocial Care Centers in different Brazilian regions was found. All patients received non-pharmacological treatment and almost all also used drugs. In view of the high number of medications and hospital admissions identified, there is a need to expand the scope of non-pharmacological therapies in the treatment of mental disorders, in order to promote the comprehensiveness and the resolubility of mental health care.