Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain.

BACKGROUND: Monkeypox DNA has been detected in skin lesions, saliva, oropharynx, urine, semen, and stool of patients infected during the 2022 clade IIb outbreak; however, the viral dynamics within these compartments remain unknown. We aimed to characterise the viral load kinetics over time in various parts of the body. METHODS: This was an observational, prospective, multicentre study of outpatients diagnosed with monkeypox in two hospitals and two sexual health clinics in Spain between June 28, 2022, and Sept 22, 2022. Men and women aged over 18 years were eligible if they reported having symptom onset within the previous 10 days of presentation, and were ineligible if disease was severe enough to be admitted to hospital. Samples were collected from five body locations (skin lesions, oropharynx, rectum, semen or vagina, and a dried blood spot) at six time points up to 57 days after the screening visit. Samples were analysed by quantitative PCR and a subset by cell culture. The primary endpoint was time from symptom onset to viral DNA clearance. FINDINGS: Overall, 1663 samples were collected from 77 study participants. 75 (97%) participants were men, the median age was 35·0 years (IQR 29·0-46·0), and 39 (51%) participants were living with HIV. The median time from symptom onset to viral clearance was 25 days (95% CI 23-28) in the skin lesions, 16 days (13-19) in the oropharynx, 16 days (13-23) in the rectum, 13 days in semen (9-18), and 1 day in blood (0-5). The time from symptom onset to viral clearance for 90% of cases was 41 days (95% CI 34-47) in skin lesions and 39 days (27-56) in semen. The median viral load in skin lesions was 7·3 log10 copies per mL (IQR 6·5-8·2) at baseline, compared with 4·6 log10 copies per mL (2·9-5·8) in oropharyngeal samples, 5·0 log10 copies per mL (2·9-7·5) in rectal samples, 3·5 log10 copies per mL (2·9-4·7) in semen samples, and 4·0 log10 copies per mL (4·0-4·0) in blood specimens. Replication-competent viruses were isolated in samples with high DNA levels (>6·5 log10 copies per mL). INTERPRETATION: In immunocompetent patients with mild monkeypox disease, PCR data alone would suggest a contact isolation period of 3 to 6 weeks but, based on detection of replication-competent virus, this time could be reduced. Based on findings from this cohort of patients, semen testing and prolonged use of condoms after recovery from monkeypox might not be necessary. FUNDING: University Hospital Germans Trias i Pujol and the YoMeCorono. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Evaluating the Accuracy of Self-Collected Swabs for the Diagnosis of Mpox.

We evaluated the accuracy of patient-collected skin lesions, oropharyngeal, and rectal swabs among 50 individuals enrolled in a study of mpox viral dynamics. We found that the performance of self-collected samples was similar to that of physician-collected samples, suggesting that self-sampling is a reliable strategy for diagnosing mpox.

Correction: Characterization of intra- and inter-host norovirus P2 genetic variability in linked individuals by amplicon sequencing.

[This corrects the article DOI: 10.1371/journal.pone.0201850.].

Characterization of intra- and inter-host norovirus P2 genetic variability in linked individuals by amplicon sequencing.

Noroviruses are the main cause of epidemics of acute gastroenteritis at a global scale. Although chronically infected immunocompromised individuals are regarded as potential reservoirs for the emergence of new viral variants, viral quasispecies distribution and evolution patterns in acute symptomatic and asymptomatic infections has not been extensively studied. Amplicons of 450 nts from the P2 coding capsid domain were studied using next-generation sequencing (454/GS-Junior) platform. Inter-host diversity between symptomatic and asymptomatic acutely infected individuals linked to the same outbreak as well as their viral intra-host diversity over time were characterized. With an average of 2848 reads per sample and a cutoff frequency of 0.1%, minor variant haplotypes were detected in 5 out of 8 specimens. Transmitted variants could not be confirmed in all infected individuals in one outbreak. The observed initial intra-host viral diversity in asymptomatically infected subjects was higher than in symptomatic ones. Viral quasispecies evolution over time within individuals was host-specific, with an average of 2.8 nt changes per day (0.0062 changes per nucleotide per day) in a given symptomatic case. Nucleotide polymorphisms were detected in 28 out of 450 analyzed nucleotide positions, 32.14% of which were synonymous and 67.86% were non-synonymous. Most observed amino acid changes emerged at or near blockade epitopes A, B, D and E. Our results suggest that acutely infected individuals, even in the absence of symptoms, which go underreported and may enhance transmission, may contribute to norovirus genetic variability and evolution.

Assessment of clinical symptoms in household contacts of confirmed pertussis cases.

OBJECTIVES: We assessed the value of the clinical symptoms included in the case definition of pertussis in household contacts of laboratory-confirmed cases. METHODS: A prospective epidemiological study was made in two Spanish regions. Household contacts were identified for each confirmed case reported during 2012 and 2013. Two clinical samples were taken to determine the presence or absence of Bordetella pertussis by culture or real-time PCR. Clinical variables, age and vaccination status were recorded. Positive and negative likelihood ratios (PLR, NLR) were estimated for each symptom. RESULTS: 2852 household contacts of 688 confirmed cases were reported. 178 household contacts with clinical symptoms were analyzed: 150 were laboratory confirmed and 28 were not. The clinical symptom with the highest PLR in comparison with the NLR was paroxysmal cough(PLR 4.76; 95% CI 1.91-11.87 and NLR 0.37; 95% CI 0.28-0.49). The contrast between the PLR and NLR was especially important for persons aged <18 years (PLR 7.08; 95% CI 1.10-45.74 and NLR 0.32; 95% CI 0.21-0.49). CONCLUSIONS: The clinical symptoms of pertussis are poor predictors of pertussis disease, independently of the vaccination status. Differences were observed between persons aged <18 years and adults. To adopt the appropriate treatment and control measures, rapid laboratory confirmation by PCR of all household contacts of confirmed cases who present any clinical symptoms compatible with pertussis should be recommended.

Factors influencing the spread of pertussis in households: a prospective study, Catalonia and Navarre, Spain, 2012 to 2013.

We aimed to investigate transmission rates of pertussis in household contacts of cases and factors associated with transmission. A prospective epidemiological study was conducted in 2012 and 2013 to determine the incidence of pertussis among household contacts of reported cases in Catalonia and Navarre, Spain. An epidemiological survey was completed for each case and contact, who were followed for 28 days to determine the source of infection (primary case) and detect the occurrence of secondary cases. Odds ratios (ORs) were used to estimate the effectiveness of vaccination and chemoprophylaxis in preventing new cases, using the formula (1 - OR) × 100. For the 688 primary cases, a total of 2,852 contacts were recorded. The household transmission rate was 16.1% (459/2,852) and rose according to the age (> 18 years) and lack of immunisation of the primary cases, and also the age (0-18 years), family relationship (siblings and children), lack of vaccination and chemoprophylaxis of contacts. Pertussis vaccine effectiveness in preventing new cases was 65.0% (95% confidence interval (CI): 11.6 to 86.2) for full vaccination (≥ 4 doses) and 59.7% (95% CI: -6.8 to 84.8) for incomplete vaccination (< 4 doses). The effectiveness of chemoprophylaxis was 62.1% (95% CI: 40.3 to 75.9). To reduce household transmission, contacts should be investigated to detect further cases and to administer chemoprophylaxis. The current vaccination status of cases and contacts can reduce household transmission.

Aspectos epidemiológicos y carga asistencial de gastroenteritis agudas por Campylobacter y Salmonella / Campylobacter and Salmonella acute gastroenteritis: Epidemiology and health care utilization

Fundamento y objetivo: En Cataluña, los sistemas de notificación y vigilancia no permiten conocer la incidencia real ni la carga asistencial de las gastroenteritis agudas (GEA) bacterianas de origen alimentario por Campylobacter ySalmonella, objeto de este estudio. Pacientes y métodos: Estudio descriptivo de los casos de GEA por Campylobacter y Salmonella en los años 2002 y 2012 en una región de Cataluña, España, identificados a partir de cultivos microbiológicos. Resultados: La incidencia estimada de GEA por Salmonella se redujo un 50% en 2012, y la de Campylobacter, un 20%. Los niños entre 1-4 años fueron los más afectados en ambos períodos. Se observaron diferencias significativas según el microorganismo en la presentación clínica de algunos síntomas y en la duración de la enfermedad. Acudieron al Servicio de Urgencias el 63,7% de los casos, y un 15% requirieron hospitalización, siendo más frecuente entre los casos de salmonelosis. Conclusión: La incidencia de GEA por Campylobacter y Salmonella se ha reducido, pero continúa siendo importante, como lo es la carga asistencial para ambas infecciones. El control de estas dolencias requiere una mayor adecuación de los actuales sistemas de vigilancia epidemiológica (AU)

Background and objective: In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. Patients and methods: Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. Results: The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed betweenCampylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. Conclusion The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections (AU)

[Campylobacter and Salmonella acute gastroenteritis: epidemiology and health care utilization]. / Aspectos epidemiológicos y carga asistencial de gastroenteritis agudas por Campylobacter y Salmonella.

BACKGROUND AND OBJECTIVE: In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. PATIENTS AND METHODS: Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. RESULTS: The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed between Campylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. CONCLUSION: The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections.

Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine

INTRODUCTION: We describe the pertussis epidemic, based only on confirmed whooping cough cases. We have analyzed data on the diagnosis, epidemiology and vaccine history in order to understand the factors that might explain the trends of the disease. METHODS: A descriptive study of the confirmed pertussis cases reported during 2011 in the Vallès region (population 1,283,000). Laboratory criteria for confirmed pertussis cases include isolation of Bordetella pertussis from a clinical specimen or detection of B. pertussis by PCR in nasopharyngeal swabs. RESULTS: A total of 421 pertussis confirmed cases were reported, which was the highest incidence reported in the last decade (33 cases/100,000 people/year in 2011). The highest incidence rate was among infants less than 1 year old (448/100,000), followed by children 5-9 years old (154/100,000). Pertussis cases aged 2 months-1 year were 90% vaccinated following the current DTaP schedule for their age group in Catalonia, and cases of 5-9 years were 87% fully vaccinated with 5 doses of DTaP vaccine. There were no deaths, although 8% of cases were hospitalized. Pertussis was more severe in infants, 30% required hospitalization despite having received the vaccine doses corresponding to their age. Children of 5-9 years were most often identified as primary cases in households or school clusters. CONCLUSIÓN: Despite high levels of vaccination coverage, pertussis circulation cannot be controlled at all. The results question the efficacy of the present immunization programmes

INTRODUCCIÓN: Se describe la epidemia de tos ferina en el año 2011 solo en casos confirmados. Se analizan datos sobre diagnóstico, epidemiología y antecedentes vacunales que podrían explicar las tendencias de la enfermedad. MÉTODOS: Estudio descriptivo de los casos confirmados de tos ferina notificados durante 2011 en la región del Vallès (población 1.283.000 habitantes). Los criterios de laboratorio para confirmación de un caso incluyen el aislamiento de Bordetella pertussis mediante cultivo en una muestra clínica o detección deB. pertussis por PCR en muestras nasofaríngeas. RESULTADOS: Fueron declarados 421 casos confirmados, siendo la incidencia más alta de los últimos 10 años (33 casos por 100.000 personas/año en 2011). La mayor tasa de incidencia fue en niños < 1 año de edad (448/100.000), seguido de los de 5-9 años (154/100.000). Los casos entre 2 meses y 1 año de edad estaban el 90% vacunados con DTaP según el calendario vacunal vigente en Cataluña para esta edad, entre 5-9 años el 87% estaban completamente vacunados con 5 dosis de DTaP. No hubo defunciones, pero el 8% de los casos fueron hospitalizados. La enfermedad fue más grave en < 1 año, y el 30% fueron hospitalizados a pesar de estar bien vacunados para su edad. Los casos de 5-9 años fueron más frecuentemente identificados como casos primarios en los hogares o grupos escolares. CONCLUSIÓN: A pesar de los altos niveles de cobertura vacunal, la circulación de la tos ferina no se puede controlar del todo. Los resultados ponen en duda la eficacia de los programas de inmunización actuales

Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine.

INTRODUCTION: We describe the pertussis epidemic, based only on confirmed whooping cough cases. We have analyzed data on the diagnosis, epidemiology and vaccine history in order to understand the factors that might explain the trends of the disease. METHODS: A descriptive study of the confirmed pertussis cases reported during 2011 in the Vallès region (population 1,283,000). Laboratory criteria for confirmed pertussis cases include isolation of Bordetella pertussis from a clinical specimen or detection of B. pertussis by PCR in nasopharyngeal swabs. RESULTS: A total of 421 pertussis confirmed cases were reported, which was the highest incidence reported in the last decade (33 cases/100,000 people/year in 2011). The highest incidence rate was among infants less than 1 year old (448/100,000), followed by children 5-9 years old (154/100,000). Pertussis cases aged 2 months-1 year were 90% vaccinated following the current DTaP schedule for their age group in Catalonia, and cases of 5-9 years were 87% fully vaccinated with 5 doses of DTaP vaccine. There were no deaths, although 8% of cases were hospitalized. Pertussis was more severe in infants, 30% required hospitalization despite having received the vaccine doses corresponding to their age. Children of 5-9 years were most often identified as primary cases in households or school clusters. CONCLUSION: Despite high levels of vaccination coverage, pertussis circulation cannot be controlled at all. The results question the efficacy of the present immunization programmes.

Characteristics of pertussis outbreaks in Catalonia, Spain, 1997 to 2010.

In Catalonia, pertussis outbreaks must be reported to the Department of Health. This study analyzed pertussis outbreaks between 1997 and 2010 in general and according to the characteristics of the index cases. The outbreak rate, hospitalization rate and incidence of associated cases and their 95%CI were calculated. Index cases were classified in two groups according to age (<15 years and ≥15 years) and the vaccine type received: whole cell vaccine (DTwP) or acellular vaccine (DTaP). During the study period, 230 outbreaks were reported. The outbreak rate was 2.43 × 10(-6) persons-year, and outbreaks ranged from 2 to 32 cases, with a median duration of 18 days. There were 771 associated cases, with an incidence rate of 0.8 × 10(-5) persons-year.   After classifying outbreaks according to the age of the index case, 126 outbreaks (1.3 × 10(-6) persons-year) had an index case aged <15 y and 87 (0.87 × 10(-6) person-year) had an index case aged ≥15 y (RR = 1.44, 95%CI 1.10-1.90; P = 0.007). Between 2003 and 2010, after the introduction of the acellular vaccine, the index case was vaccinated with DTwP vaccine in 25 outbreaks (0.43 × 10(-6) persons-year) and with DTaP vaccine in 32 outbreaks (0.55 × 10(-6) person-year) (RR = 0.78, 95%CI 0.46-1.31; P = 0.35). Of cases, 37.2% were correctly vaccinated, suggesting waning immunity of pertussis vaccine protection and endogenous circulation of pertussis. A greater number of outbreaks had an index case aged <15 y. No changes in the disease incidence, associated cases and hospitalization rate were observed after the introduction of DTaP.

[Adherence and effectiveness of the treatment of latent tuberculosis infection with isoniazid for 9 months in a cohort of 755 patients]. / Cumplimiento y efectividad del tratamiento de la infección tuberculosa con isoniazida durante 9 meses en una cohorte de 755 pacientes.

BACKGROUND AND OBJECTIVE: The effectiveness of the treatment of latent tuberculosis infection depends on its efficacy, the adherence to treatment and patient's risk of tuberculosis. The objective of this study was to evaluate the adherence to treatment with daily isoniazid for 9 months, its effectiviness and equivalent adherence with daily isoniazid for 6 months so that treatment can be as effective as with daily isoniazid for 9 months. PATIENTS AND METHOD: Cohort of 755 contacts of patients with lung confirmed tuberculosis with latent tuberculosis infection treated from 1986 to 2004, classified according to risk of tuberculosis disease into converters (high risk), frequent and non-frequent contacts. Adherence's rate for daily isoniazid for 9 months is evaluated according to percentage of treatment completion and effectiveness achieved is the number necessary to treat for preventing one tuberculosis case. Efficacy (reduction of morbidity) with isoniazid for 9 months: 93%, and with isoniazid for 6 months: 69%. RESULTS: Adherence's rate: 53/59 (89.9%; 95% confidence interval [CI], 82.1-97.5%) in converters; 305/380 (80.3%; 95% CI, 76.3-84.3%) in frequent contacts; and 205/211 (64.9%; 95% CI, 59.6-70.2%) in non-frequent contacts. The number necessary to treat with isoniazid for 9 months was 9 for converters, 16 for frequent contacts, and 79 for non-frequent contacts. Equivalent adherence for daily isoniazid for 6 months was 121% for converters, 108% for frequent contacts and 87.5% for non-frequent contacts. CONCLUSIONS: For latent tuberculosis infection, a 9-month-isoniazid treatment has the highest effectiveness in the converters and frequent contacts. Such high effectiveness is impossible to achieve with a daily 6-month-isoniazid regimen.

Brote de gastroenteritis por virus Norwalk en una residencia geriátrica / Outbreak of gastroenteritis by Norwalk virus

No disponible

Cumplimiento y efectividad del tratamiento de la infección tuberculosa con isoniazida durante 9 meses en una cohorte de 755 pacientes / Adherence and effectiveness of the treatment of latent tuberculosis infection with isoniazid for 9 months in a cohort of 755 patients

Fundamento y objetivo: La efectividad del tratamiento de la infección tuberculosa depende de su eficacia, la adherencia al tratamiento y el riesgo de enfermar. El objetivo del estudio ha sido evaluar la adherencia al tratamiento con isoniazida durante 9 meses, su efectividad y la adherencia equivalente para conseguir idéntica efectividad a la pauta de isoniazida durante 6 meses. Pacientes y método: Se incluyó en el estudio a contactos de pacientes con tuberculosis pulmonar a quienes se había diagnosticado de infección tuberculosa, clasificados de mayor a menor riesgo de desarrollar la enfermedad (conversores, contactos frecuentes y no frecuentes), y que entre 1986 y 2004 recibieron tratamiento con isoniazida durante 9 meses. Se determinaron la tasa de adherencia, es decir, el porcentaje que completó el tratamiento, y la efectividad como el número de pacientes que es necesario tratar para prevenir que uno desarrolle la enfermedad. La eficacia del tratamiento con isoniazida durante 9 meses es del 93% de reducción de la morbilidad, y la del tratamiento durante 6 meses, del 69%. Resultados: Se estudió a 755 contactos: 59 conversores, 380 contactos frecuentes y 316 contactos no frecuentes. En los primeros la tasa de adherencia fue del 89,9% (intervalo de confianza [IC] del 95%, 82,1-95,7%); en los segundos, del 80,3% (IC del 95%, 76,3-84,3%), y en los terceros, del 64,9% (IC del 95%, 59,6-70,2%). Con isoniazida durante 9 meses, el número de pacientes que era preciso tratar para prevenir que uno desarrollara la enfermedad fue de 9 en conversores, de 16 en contactos frecuentes y de 79 en contactos no frecuentes. Para la misma efectividad, la tasa de adherencia equivalente con isoniazida durante 6 meses sería del 121% en conversores, del 108% en contactos frecuentes y del 87,5% en contactos no frecuentes. Conclusiones: La mayor efectividad del tratamiento de la infección tuberculosa en conversores y contactos frecuentes se ha conseguido con una pauta de isoniazida durante 9 meses, efectividad no alcanzable con la pauta de 6 meses

Background and objective: The effectiveness of the treatment of latent tuberculosis infection depends on its efficacy, the adherence to treatment and patient's risk of tuberculosis. The objective of this study was to evaluate the adherence to treatment with daily isoniazid for 9 months, its effectiviness and equivalent adherence with daily isoniazid for 6 months so that treatment can be as effective as with daily isoniazid for 9 months. Patients and method: Cohort of 755 contacts of patients with lung confirmed tuberculosis with latent tuberculosis infection treated from 1986 to 2004, classified according to risk of tuberculosis disease into converters (high risk), frequent and non-frequent contacts. Adherence's rate for daily isoniazid for 9 months is evaluated according to percentage of treatment completion and effectiveness achieved is the number necessary to treat for preventing one tuberculosis case. Efficacy (reduction of morbidity) with isoniazid for 9 months: 93%, and with isoniazid for 6 months: 69%. Results: Adherence's rate: 53/59 (89.9%; 95% confidence interval [CI], 82.1-97.5%) in converters; 305/380 (80.3%; 95% CI, 76.3-84.3%) in frequent contacts; and 205/211 (64.9%; 95% CI, 59.6-70.2%) in non-frequent contacts. The number necessary to treat with isoniazid for 9 months was 9 for converters, 16 for frequent contacts, and 79 for non-frequent contacts. Equivalent adherence for daily isoniazid for 6 months was 121% for converters, 108% for frequent contacts and 87.5% for non-frequent contacts. Conclusions: For latent tuberculosis infection, a 9-month-isoniazid treatment has the highest effectiveness in the converters and frequent contacts. Such high effectiveness is impossible to achieve with a daily 6-month-isoniazid regimen