Monkeypox (hMPXV Infection): A Practical Review.

Monkeypox, a neglected disease previously confined to Africa, is causing a worldwide outbreak affecting predominantly males who have sex with males, especially those who are infected with HIV. The clinical presentation during the current outbreak differs from endemic cases. Treatment with tecovirimat and other antivirals is available. Immunization may be used as preexposure and postexposure prophylaxis.

COVID-19 infection in the developing world: the Peruvian perspective.

COVID-19 infections have spread widely in Peru, causing severe societal and health impact. We describe the evolution of the epidemics, the reasons for high transmission and the way the disease is diagnosed and managed in the Andean country.

Chikungunya: bending over the Americas and the rest of the world

Abstract Chikungunya is an arthropod-borne virus transmitted by Aedes mosquito bites. A viral mutation has allowed Aedes albopictus to become the preferred vector extending the geographic spread of the condition. The virus causes an acute febrile illness occasionally followed by a chronic rheumatic condition causing severe impairment. The diagnosis is usually confirmed with serology. No specific treatment is currently available. This article reviews the condition with emphasis on his dissemination in the Americas.

Chikungunya: bending over the Americas and the rest of the world.

Chikungunya is an arthropod-borne virus transmitted by Aedes mosquito bites. A viral mutation has allowed Aedes albopictus to become the preferred vector extending the geographic spread of the condition. The virus causes an acute febrile illness occasionally followed by a chronic rheumatic condition causing severe impairment. The diagnosis is usually confirmed with serology. No specific treatment is currently available. This article reviews the condition with emphasis on his dissemination in the Americas.

Ebola Virus Disease: A Perspective for the United States.

Ebola virus caused an epidemic of unprecedented extension in West Africa. There was concern that the outbreak would not be controlled for a prolonged period of time. Two cases of infected returning travelers have been reported in the US. One of the cases has been associated with secondary transmission and other infected subjects have been repatriated for treatment. This article reviews the etiology, pathogenesis, transmission, clinical manifestations, diagnosis, treatment, and prevention of the disease with emphasis on the identification and management in the US.

Immunogenicity and safety of AS03A-adjuvanted H5N1 influenza vaccine prepared from bulk antigen after stockpiling for 4 years.

BACKGROUND: Stockpiling vaccine for deployment in the event of an influenza pandemic is an important mitigation strategy. A necessary aspect of stockpiling is to determine the shelf-life of the stored vaccine. METHODS: In this Phase II, open-label study we assessed the immunogenicity and safety of H5N1 A/Indonesia/5/2005 vaccine adjuvanted with AS03A. The AS03A-H5N1 vaccine was prepared from bulk antigen that had been stored for 4 years, and adjuvant that had been stored for 2.5 years. Both the antigen and adjuvant were filled in separate multi-dose vials within 4 months of use, and on the day of vaccination, the contents of antigen and adjuvant vials were mixed. Seventy-eight adults aged 18-64 years were scheduled to receive two doses of hemagglutinin-antigen (3.75µg) given 21 days apart. Antibody responses were assessed by hemagglutination-inhibition (HI) assay according to age (18-30 years, 31-40 years, 41-50 years, and 51-64 years). Reactogenicity was assessed for 7 days after each vaccination, and safety was assessed for 385 days post-vaccination (NCT01416571). RESULTS: The vaccine was immunogenic. Twenty-one days after the second dose of vaccine in the overall population, the HI seroconversion rate and seroprotection rate (SPR; titer ≥1:40) was 96.0% and 98.7%, respectively. At Day 182 after vaccination, the SPR was 76.7% in the overall population. Injection site pain was the most frequent solicited adverse event (91.0%), and no safety concerns were raised. CONCLUSION: The immunogenicity and safety observed with AS03A-H5N1 vaccine formulated with bulk antigen which had been stockpiled before vialing and administration was consistent with that previously observed with newly manufactured AS03A-H5N1 vaccine. This suggests that stockpiling bulk antigen for 4 years does not compromise the immunogenicity or reactogenicity of the vaccine.

AS03B-adjuvanted H5N1 influenza vaccine in children 6 months through 17 years of age: a phase 2/3 randomized, placebo-controlled, observer-blinded trial.

BACKGROUND: This phase 2/3, randomized, placebo-controlled, observer-blinded study assessed the immunogenicity, reactogenicity, and safety of an inactivated, split-virion H5N1 influenza vaccine (A/Indonesia/5/2005) in children aged 6 months through 17 years. METHODS: Children received 2 influenza vaccine doses 21 days apart, each containing 1.9 µg of hemagglutinin and AS03B adjuvant (5.93 mg of α-tocopherol). The randomization ratio was 8:3 for vaccine to placebo, with equal allocation between 3 age strata (6-35 months, 3-8 years, and 9-17 years). Immunogenicity against the vaccine strain was assessed 21 days after the first and second vaccine doses for all vaccinees, at day 182 for half, and at day 385 for the remaining half. Reactogenicity after each dose and safety up to 1 year after vaccination were evaluated. RESULTS: Within each age stratum, the lower limit of the 98.3% confidence interval for the day 42 seroprotection rate was ≥70%, thus fulfilling the US and European licensure criteria. The immune responses elicited by vaccine persisted well above baseline levels for 1 year. The vaccine was more reactogenic than placebo, but no major safety concerns were identified. CONCLUSIONS: AS03B-adjuvanted H5N1 influenza vaccine was immunogenic and showed an acceptable safety profile in all age groups studied. Clinical Trials Registration: NCT01310413.

Long-term immunogenicity of an AS03-adjuvanted influenza A(H1N1)pdm09 vaccine in young and elderly adults: an observer-blind, randomized trial.

BACKGROUND: This study (NCT00979602) evaluated the immunogenicity and relative protective efficacy of one dose of influenza A(H1N1)pdm09 vaccine with or without AS03 (an α-tocopherol oil-in-water emulsion based Adjuvant System). METHODS: Four thousands and forty-eight healthy adults aged ≥ 18 years were randomized (1:1) to receive one dose of either the adjuvanted split virion (3.75 µg hemagglutinin antigen [HA]/AS03) or non-adjuvanted (15 µg HA) vaccine. Hemagglutination inhibition [HI] antibody response was evaluated before vaccination and at Days 21, 42 and 182 (Month 6). Safety of the study vaccines was evaluated during the entire study duration. RESULTS: At Day 21, both study vaccines induced HI immune responses meeting the US regulatory criteria in subjects 18-64 years (seroprotection rate [SPR]: 98.0% [97.1-98.6]; seroconversion rate [SCR]: 89.7% [88.0-91.2] in the AS03-adjuvanted group; SPR: 91.4% [89.9-92.8]; SCR: 74.6% [72.3-76.9] in the non-adjuvanted group) and >64 years of age (SPR: 86.0% [82.5-89.0]; SCR: 75.3% [71.1-79.2] in the AS03-adjuvanted group; SPR: 69.1% [64.6-73.3]; SCR: 56.7% [52.0-61.3] in the non-adjuvanted group). The AS03-adjuvanted vaccine induced higher HI geometric mean titers than the non-adjuvanted vaccine at all time points. At Month 6, only subjects 18-64 years of age from both vaccine groups still met the US regulatory criteria (SPR: 82.1% [80.0-84.1]; SCR: 62.3% [59.6-64.8] in the AS03-adjuvanted group; SPR: 75.3% [72.9-77.5]; SCR: 53.7% [51.0-56.4] in the non-adjuvanted group). Protective efficacy was not evaluated due to low number of RT-qPCR-confirmed A(H1N1)pdm09 influenza cases. Through Month 12, 216 serious adverse events (in 157 subjects: 84 in the AS03-adjuvanted and 73 in the non-adjuvanted group) and 12 potentially immune mediated diseases (5 in the AS03-adjuvanted and 7 in the non-adjuvanted group) were reported. CONCLUSION: A single dose of either adjuvanted or non-adjuvanted influenza A(H1N1)pdm09 vaccine induced protective HI antibody levels against the A/California/7/2009 strain that persisted through Month 6 in the 18-64 years population.

Safety and long-term humoral immune response in adults after vaccination with an H1N1 2009 pandemic influenza vaccine with or without AS03 adjuvant.

BACKGROUND: In this study (NCT00985088) we evaluated different formulations of an H1N1 2009 pandemic influenza vaccine that deliver various viral hemagglutinin (HA) doses with or without AS03 (a tocopherol-based oil-in-water adjuvant system). METHODS: A total of 1340 healthy subjects aged ≥18 years were randomized to receive 1 or 2 doses of an adjuvanted (3.75-µg HA/AS03(A) or 1.9-µg HA/AS03(B)) or nonadjuvanted vaccine formulation. Safety and immunogenicity (by hemagglutination-inhibition [HI] assay) after each dose and 6 months after dose 1 are reported here. RESULTS: A single dose of AS03(A)-adjuvanted 3.75-µg HA H1N1 2009 induced the strongest immune responses in subjects aged 18-64 years (seroprotection rate [SPR], 97.2%; seroconversion rate [SCR], 90.1%) as well as in subjects aged >64 years (SPR, 91.1%; SCR, 78.2%) 21 days after vaccination. Six months after dose 1, subjects who received 2 doses of either the adjuvanted formulation or 1 dose of the adjuvanted 3.75-µg HA formulation continued to meet all Center for Biologics Evaluation and Research and Committee for Medicinal Products for Human Use criteria. All formulations had clinically acceptable safety profiles. CONCLUSION: A single dose of the 3.75-µg HA AS03(A)-adjuvanted H1N1 2009 influenza vaccine was highly immunogenic in both age strata (18-64 and >64 years), inducing long-term persistence of the immune response until at least 6 months after dose 1.

The pathophysiology of the acute phase of human bartonellosis resembles AIDS.

Human bartonellosis is a South American anthroponosis caused by Bartonella bacilliformis. The disease has an acute phase characterized by invasion of red blood cells by parasites, and consequent severe anemia; and a chronic phase presenting with benign vascular tumors. During the acute phase, affected individuals are prone to developing opportunistic infections with a variety of organisms similar to the ones seen in AIDS. After antibiotic treatment is instituted, a subgroup of patients may develop atypical symptoms which potentially represent clinical manifestations of the restoration of macrophage function. We speculate that the pathophysiology of the acute phase of human bartonellosis resembles AIDS, with a period of immunosuppression following the infection and later, clinical manifestations of immune reconstitution subsequent to treatment.

Impact of race/ethnicity on survival among HIV-infected patients in care.

OBJECTIVE: To determine the prognostic influence of race/ethnicity on survival among patients infected with HIV infection. BACKGROUND: In the U.S., HIV infection occurs disproportionately in minority communities. Additionally, worse outcomes (including higher mortality) have been reported, particularly among African Americans. METHODS: This was a retrospective cohort study among 870 HIV-infected patients attending a Midwestern academic medical center. The study determined individual characteristics that were predictive of survival by using log rank tests and multivariate analysis models, after adjusting for known predictors of outcome. RESULTS: Low CD4 cell count (<100 cells/mm3), high viral load (>250,000 copies/mL), age older than 30, and Black race were independently predictive of poorer outcomes among patients infected with HIV. CONCLUSION: We found a large disparity in survival, with African Americans with advanced disease more likely to die than whites. This finding was not explained by socioeconomic status or other confounders. Future prospective studies are warranted.

Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review

Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.

Extensively drug-resistant tuberculosis.

Extensively drug-resistant tuberculosis (XDR-TB) is defined as Mycobacterium tuberculosis infection that is resistant to isoniazid, rifampin, any fluoroquinolone, and any injectable drug (amynoglicosides or polypetides). Although initially described in South Africa, it has emerged as a global threat, and cases have been reported from several countries, including the United States. XDR-TB has emerged mainly as a consequence of previous inadequate or poorly administered treatment, from failure of the public health infrastructure. As the diagnosis of this condition requires antibiotic susceptibility confirmation, a broad network of reference laboratories and the development of faster and more accurate tests for the identification of active cases of tuberculosis are urgently required. The treatment of XDR-TB is challenging and requires the use of multiple second-line drugs and, potentially, surgery. Infection control measures do not differ from those used for susceptible cases but may require more stringent application.

Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review.

Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.

Clinical utility of interferon gamma assay in the diagnosis of tuberculosis.

Newly developed assays that measure the production of cellular interferon gamma are useful diagnostic tools for the diagnosis of tuberculosis and may potentially replace or complement the tuberculin skin test in some circumstances. Importantly, interferon gamma release assays are more specific than tuberculin skin tests. Unfortunately the tests do not differentiate between active or latent infection. In addition, immunocompromised patients are more likely to have indeterminate results. The current interferon gamma release assays test approved in the United States is costly and requires drawing blood and processing within 12 hours of collection. This study discusses the potential benefits and drawbacks in patients, including those who are immunocompromised.