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2.
Biosci Trends ; 14(2): 134-138, 2020 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-32188819

RESUMEN

To assess the effectiveness of response strategies of avoiding large gatherings or crowded areas and to predict the spread of COVID-19 infections in Japan, we developed a stochastic transmission model by extending the Susceptible-Infected-Removed (SIR) epidemiological model with an additional modeling of the individual action on whether to stay away from the crowded areas. The population were divided into three compartments: Susceptible, Infected, Removed. Susceptible transitions to Infected every hour with a probability determined by the ratio of Infected and the congestion of area. The total area consists of three zones crowded zone, mid zone and uncrowded zone, with different infection probabilities characterized by the number of people gathered there. The time for each people to spend in the crowded zone is curtailed by 0, 2, 4, 6, 7, and 8 hours, and the time spent in mid zone is extended accordingly. This simulation showed that the number of Infected and Removed will increase rapidly if there is no reduction of the time spent in crowded zone. On the other hand, the stagnant growth of Infected can be observed when the time spent in the crowded zone is reduced to 4 hours, and the growth number of Infected will decrease and the spread of the infection will subside gradually if the time spent in the crowded zone is further cut to 2 hours. In conclusions The infection spread in Japan will be gradually contained by reducing the time spent in the crowded zone to less than 4 hours.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Modelos Estadísticos , Neumonía Viral/epidemiología , Betacoronavirus/aislamiento & purificación , Simulación por Computador , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Métodos Epidemiológicos , Humanos , Japón/epidemiología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Aislamiento Social , Procesos Estocásticos
4.
N Engl J Med ; 382(13): 1199-1207, 2020 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-31995857

RESUMEN

BACKGROUND: The initial cases of novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. METHODS: We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. RESULTS: Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). CONCLUSIONS: On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.).


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Epidemias , Periodo de Incubación de Enfermedades Infecciosas , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Adolescente , Adulto , Anciano , Betacoronavirus/genética , China/epidemiología , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/virología , Transmisión de Enfermedad Infecciosa/prevención & control , Epidemias/prevención & control , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Reacción en Cadena de la Polimerasa , Adulto Joven
5.
BMC Public Health ; 20(1): 17, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910842

RESUMEN

BACKGROUND: A recent study found that the gut microbiota, Lactobacillus and Bifidobacterium, have the ability to modulate the severity of malaria. The modulation of the severity of malaria is not however, the typical focal point of most widespread interventions. Thus, an essential element of information required before serious consideration of any intervention that targets reducing severe malaria incidence is a prediction of the health benefits and costs required to be cost-effective. METHODS: Here, we developed a mathematical model of malaria transmission to evaluate an intervention that targets reducing severe malaria incidence. We consider intervention scenarios of a 2-, 7-, and 14-fold reduction in severe malaria incidence, based on the potential reduction in severe malaria incidence caused by gut microbiota, under entomological inoculation rates occurring in 41 countries in sub-Saharan Africa. For each intervention scenario, disability-adjusted life years averted and incremental cost-effectiveness ratios were estimated using country specific data, including the reported proportions of severe malaria incidence in healthcare settings. RESULTS: Our results show that an intervention that targets reducing severe malaria incidence with annual costs between $23.65 to $30.26 USD per person and causes a 14-fold reduction in severe malaria incidence would be cost-effective in 15-19 countries and very cost-effective in 9-14 countries respectively. Furthermore, if model predictions are based on the distribution of gut microbiota through a freeze-dried yogurt that cost $0.20 per serving, a 2- to 14-fold reduction in severe malaria incidence would be cost-effective in 29 countries and very cost-effective in 25 countries. CONCLUSION: Our findings indicate interventions that target severe malaria can be cost-effective, in conjunction with standard interventions, for reducing the health burden and costs attributed to malaria. While our results illustrate a stronger cost-effectiveness for greater reductions, they consistently show that even a limited reduction in severe malaria provides substantial health benefits, and could be economically viable. Therefore, we suggest that interventions that target severe malaria are worthy of consideration, and merit further empirical and clinical investigation.


Asunto(s)
Antimaláricos/economía , Antimaláricos/uso terapéutico , Transmisión de Enfermedad Infecciosa/economía , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Malaria/economía , Malaria/terapia , Malaria/transmisión , África del Sur del Sahara/epidemiología , Análisis Costo-Beneficio , Humanos , Incidencia , Malaria/epidemiología , Modelos Teóricos
6.
Br J Sports Med ; 54(4): 200-207, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30890535

RESUMEN

This American Medical Society for Sports Medicine position statement update is directed towards healthcare providers of patients involved in sport and exercise. There have been significant advances in clinical and scientific research in the understanding of blood-borne pathogens (BBPs), and this update incorporates these advancements. This document is intended as a general guide to clinical practice based on the current state of the evidence, while acknowledging the need for modification as new knowledge becomes available. Confirmed transmission of BBPs during sport is exceedingly rare. There are no well-documented reports of HIV, HCV or HDV transmission during sport. There is also no evidence for universal testing for BBPs as a specific requirement for participation in sports. Competitive athletes and non-athletes should follow appropriate general public health agency recommendations for screening for BBPs, considering their individual risk factors and exposures. Standard (universal) precautions must be followed by those providing care to athletes. Exercise and athletic participation can help promote a healthy lifestyle for persons living with BBPs. Those with acute symptomatic BBP infection should limit exercise intensity based on their current health status. Education is the key tool for preventing BBP transmission. Research gaps include evaluation of the prevalence of BBP infections in competitive athletes, the effects of long-term, intense training on infected athletes and the effects of BBP treatment therapies on performance.


Asunto(s)
Patógenos Transmitidos por la Sangre , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Deportes , Ejercicio Físico , Estilo de Vida Saludable , Humanos , Educación del Paciente como Asunto , Prevalencia , Factores de Riesgo
7.
PLoS Negl Trop Dis ; 13(8): e0007688, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31425512

RESUMEN

BACKGROUND: Changes in climate and environmental conditions could be the driving factors for the transmission of hantavirus. Thus, a thorough collection and analysis of data related to the epidemic status of hemorrhagic fever with renal syndrome (HFRS) and the association between HFRS incidence and meteorological factors, such as air temperature, is necessary for the disease control and prevention. METHODS: Journal articles and theses in both English and Chinese from Jan 2014 to Feb 2019 were identified from PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang Data and VIP Info. All identified studies were subject to the six criteria established to ensure the consistency with research objectives, (i) they provided the data of the incidence of HFRS in mainland China; (ii) they provided the type of air temperature indexes; (iii) they indicated the underlying geographical scale information, temporal data aggregation unit, and the data sources; (iv) they provided the statistical analysis method that had been used; (v) from peer-reviewed journals or dissertation; (vi) the time range for the inclusion of data exceeded two consecutive calendar years. RESULTS: A total of 27 publications were included in the systematic review, among them, the correlation between HFRS activity and air temperature was explored in 12 provinces and autonomous regions and also at national level. The study period ranged from 3 years to 54 years with a median of 10 years, 70.4% of the studies were based on the monthly HFRS incidence data, 21 studies considered the lagged effect of air temperature factors on the HFRS activity and the longest lag period considered in the included studies was 34 weeks. The correlation between HFRS activity and air temperature varied widely, and the effect of temperature on the HFRS epidemic was seasonal. CONCLUSIONS: The present systematic review described the heterogeneity of geographical scale, data aggregation unit and study period chosen in the ecological studies that seeking the correlation between air temperature indexes and the incidence of HFRS in mainland China during the period from January 2014 to February 2019. The appropriate adoption of geographical scale, data aggregation unit, the length of lag period and the length of incidence collection period should be considered when exploring the relationship between HFRS incidence and meteorological factors such as air temperature. Further investigation is warranted to detect the thresholds of meteorological factors for the HFRS early warning purposes, to measure the duration of lagged effects and determine the timing of maximum effects for reducing the effects of meteorological factors on HFRS via continuous interventions and to identify the vulnerable populations for target protection.


Asunto(s)
Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Fiebre Hemorrágica con Síndrome Renal/epidemiología , Fiebre Hemorrágica con Síndrome Renal/transmisión , Temperatura , Adulto , China/epidemiología , Agregación de Datos , Femenino , Humanos , Incidencia , Masculino , Conceptos Meteorológicos , Persona de Mediana Edad , Medición de Riesgo , Análisis Espacio-Temporal
9.
Hosp Top ; 97(3): 80-86, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31124745

RESUMEN

The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.


Asunto(s)
Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Microbiología Ambiental , Visitas a Pacientes/estadística & datos numéricos , Carga Bacteriana/métodos , Transmisión de Enfermedad Infecciosa/prevención & control , Hospitales Universitarios/organización & administración , Hospitales Universitarios/estadística & datos numéricos , Humanos , Sicilia
10.
Rev Saude Publica ; 53: 49, 2019 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-31116238

RESUMEN

OBJECTIVE: To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS: The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS: The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19-3.56), 1.73 (95%CI 1.19-2.51) and 1.10 (95%CI 1.03-1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS: As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.


Asunto(s)
Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Bosques , Malaria/epidemiología , Malaria/transmisión , Brasil/epidemiología , Ciudades/epidemiología , Humanos , Incidencia , Modelos Logísticos , Factores de Riesgo , Estaciones del Año , Factores Socioeconómicos , Análisis Espacio-Temporal , Factores de Tiempo
11.
Infect Immun ; 87(7)2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30833332

RESUMEN

Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen worldwide, and there is a need to control this epidemic. So far there is no established animal model in which both the horizontal and the vertical transmission of Chlamydia can be studied. To implement a horizontal sexual transmission model, male mice were inoculated in the meatus urethra with Chlamydia muridarum and they were caged with naive female mice. Urine and vaginal swab specimens were collected for culture. To study vertical transmission, newborns were euthanized and specimens were cultured. As controls, females were mated with sham-infected male mice. All C. muridarum-inoculated male mice had positive urine cultures. As determined by serology, all females caged with C. muridarum-inoculated males became infected, and 93% of them had positive vaginal swab specimen cultures. More females mated with C. muridarum-infected male mice (35%) than females mated with sham-infected male mice (0%) were infertile (P < 0.05). Also, C. muridarum-infected females delivered significantly fewer pups (3.8 ± 3.2/mouse) than control females (6.3 ± 1.6/mouse) (P < 0.05). Of the newborn mice, 32% were C. muridarum positive either in the lungs or in the intestines. Female mice housed with sham-infected males had no positive vaginal swab specimen cultures or C. muridarum-positive pups. This new mouse model of horizontal and vertical sexual transmission of Chlamydia closely parallels C. trachomatis sexual transmission in humans and may be a good model system to better understand the pathogenesis of these infections.


Asunto(s)
Infecciones por Chlamydia/microbiología , Chlamydia muridarum/patogenicidad , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Animales , Anticuerpos Antibacterianos/inmunología , Infecciones por Chlamydia/inmunología , Chlamydia muridarum/inmunología , Modelos Animales de Enfermedad , Femenino , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Masculino , Ratones , Infecciones Urinarias/microbiología , Vagina/microbiología
12.
Nat Commun ; 10(1): 898, 2019 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-30796206

RESUMEN

Infectious disease outbreaks recapitulate biology: they emerge from the multi-level interaction of hosts, pathogens, and environment. Therefore, outbreak forecasting requires an integrative approach to modeling. While specific components of outbreaks are predictable, it remains unclear whether fundamental limits to outbreak prediction exist. Here, adopting permutation entropy as a model independent measure of predictability, we study the predictability of a diverse collection of outbreaks and identify a fundamental entropy barrier for disease time series forecasting. However, this barrier is often beyond the time scale of single outbreaks, implying prediction is likely to succeed. We show that forecast horizons vary by disease and that both shifting model structures and social network heterogeneity are likely mechanisms for differences in predictability. Our results highlight the importance of embracing dynamic modeling approaches, suggest challenges for performing model selection across long time series, and may relate more broadly to the predictability of complex adaptive systems.


Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Predicción/métodos , Modelos Estadísticos , Humanos , Modelos Biológicos
13.
PLoS Comput Biol ; 15(2): e1006761, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30807578

RESUMEN

The relationship between the underlying contact network over which a pathogen spreads and the pathogen phylogenetic trees that are obtained presents an opportunity to use sequence data to learn about contact networks that are difficult to study empirically. However, this relationship is not explicitly known and is usually studied in simulations, often with the simplifying assumption that the contact network is static in time, though human contact networks are dynamic. We simulate pathogen phylogenetic trees on dynamic Erdos-Renyi random networks and on two dynamic networks with skewed degree distribution, of which one is additionally clustered. We use tree shape features to explore how adding dynamics changes the relationships between the overall network structure and phylogenies. Our tree features include the number of small substructures (cherries, pitchforks) in the trees, measures of tree imbalance (Sackin index, Colless index), features derived from network science (diameter, closeness), as well as features using the internal branch lengths from the tip to the root. Using principal component analysis we find that the network dynamics influence the shapes of phylogenies, as does the network type. We also compare dynamic and time-integrated static networks. We find, in particular, that static network models like the widely used Barabasi-Albert model can be poor approximations for dynamic networks. We explore the effects of mis-specifying the network on the performance of classifiers trained identify the transmission rate (using supervised learning methods). We find that both mis-specification of the underlying network and its parameters (mean degree, turnover rate) have a strong adverse effect on the ability to estimate the transmission parameter. We illustrate these results by classifying HIV trees with a classifier that we trained on simulated trees from different networks, infection rates and turnover rates. Our results point to the importance of correctly estimating and modelling contact networks with dynamics when using phylodynamic tools to estimate epidemiological parameters.


Asunto(s)
Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Filogenia , Algoritmos , Biología Computacional/métodos , Simulación por Computador , Brotes de Enfermedades/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/genética , Humanos , Modelos Biológicos , Análisis de Componente Principal , Aprendizaje Automático Supervisado
14.
Cad Saude Publica ; 35(2): e00105318, 2019 02 18.
Artículo en Portugués | MEDLINE | ID: mdl-30785488

RESUMEN

The study sought to analyze the magnitude of occurrence and the sociodemographic, economic and clinical profiles of leprosy associated with household social networks (HSN), with disease overlap in cities from the states of Bahia, Piauí and Rondônia, Brazil, from 2001 to 2014. This is a cross-sectional study using primary and secondary data regarding new cases of leprosy notified to the Brazilian Information System for Notifiable Diseases (SINAN, in Portuguese) residing in the cities. We applied a standardized instrument to the new cases and reviewed data from charts and from SINAN. Of a total of 1,032 (29.6%) assessed cases, 538 (52.1%) had more than one case in their HSN. There were larger frequencies of female sex (292; 54.3%), age between 41 and 60 years (240; 44.6%), primary education (272; 50.6%), income lower than the minimum wage (265; 49.3%) and living with 5 or more people (265; 49.3%). The overlap of cases in the HSN was associated in the multivariate analysis with residing in cities in the state of Rondônia (PR = 1.23; 95%CI: 1.07-1.43; p = 0.003), as well as living with 3 to 4 people in the same household (PR = 1.66; 95%CI: 1.11-2.49; p = 0.014) and having leprosy reaction (PR = 1.31; 95%CI: 0.99-1.70; p = 0.050). Case repetition within the same HSN is a frequent event in the situations we studied. Its occurrence must be considered as a sentinel indicator of greater epidemiological severity in primary health care surveillance. We highlight the vulnerability of affected families.


Asunto(s)
Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Composición Familiar , Lepra/transmisión , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , Enfermedades Endémicas/estadística & datos numéricos , Monitoreo Epidemiológico , Femenino , Humanos , Lactante , Recién Nacido , Sistemas de Información , Lepra/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Características de la Residencia , Factores Sexuales , Determinantes Sociales de la Salud , Red Social , Factores Socioeconómicos , Adulto Joven
17.
Am J Epidemiol ; 188(3): 545-554, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30608525

RESUMEN

Population-level effects of control strategies on the dynamics of Chlamydia trachomatis transmission are difficult to quantify. In this study, we calibrated a novel sex- and age-stratified pair-formation transmission model of chlamydial infection to epidemiologic data in the United States for 2000-2015. We used sex- and age-specific prevalence estimates from the National Health and Nutrition Examination Surveys, case report data from national chlamydia surveillance, and survey data from the Youth Risk Behavior Survey on the proportion of the sexually active population aged 15-18 years. We were able to reconcile national prevalence estimates and case report data by allowing for changes over time in screening coverage and reporting completeness. In retrospective analysis, chlamydia prevalence was estimated to be almost twice the current levels in the absence of screening and partner notification. Although chlamydia screening and partner notification were both found to reduce chlamydia burden, the relative magnitude of their estimated impacts varied in our sensitivity analyses. The variation in the model predictions highlights the need for further data collection and research to improve our understanding of the natural history of chlamydia and the pathways through which prevention strategies affect transmission dynamics.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Trazado de Contacto/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Adolescente , Adulto , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Masculino , Encuestas Nutricionales , Prevalencia , Estudios Retrospectivos , Parejas Sexuales , Estados Unidos/epidemiología , Adulto Joven
18.
Vox Sang ; 114(1): 17-27, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30523642

RESUMEN

BACKGROUND AND OBJECTIVES: Globally, blood safety interventions have been successful in mitigating risk of the major transfusion-transmitted (TT) viruses. However, strategies that address risk from parasites are comparatively limited. TT parasites are often regional in nature, posing unique challenges; we sought to understand their impact on blood safety. MATERIALS AND METHODS: An electronic questionnaire was distributed to transfusion medicine leaders in 100 countries. The survey focused on specific questions pertaining to four parasitic diseases: babesiosis, Chagas, leishmaniasis and malaria. Respondents provided data on historical TT cases, local epidemiology, policies to mitigate risk and an assessment of public health perceptions for each aetiologic agent. RESULTS: Twenty-eight (28%) surveys were returned from countries in Europe (n = 13), the Americas (n = 6), Africa (n = 4), Asia (n = 3) and Oceana (n = 2). Historically, no cases of TT leishmaniasis were reported, TT babesiosis was exclusive to Canada and the USA, TT Chagas was limited to the Americas and Spain, while TT malaria was cosmopolitan. Mitigation efforts varied widely; malaria was the most frequently tested parasitic disease. The public's perception of risk for parasitic agents was low, while that of health authorities in endemic countries was higher. CONCLUSION: The global impact of parasitic infections on blood safety and related mitigation efforts varied widely by parasite epidemiology, test availability, public health priorities and socioeconomic constraints. While parasites continue to pose a risk to blood safety, the successful mitigation of viral risk has elevated the prominence of TT parasites in many locations, thereby requiring consideration of mitigation efforts.


Asunto(s)
Seguridad de la Sangre/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Infecciones por Protozoos/epidemiología , Reacción a la Transfusión/epidemiología , Animales , Seguridad de la Sangre/normas , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Infecciones por Protozoos/prevención & control , Infecciones por Protozoos/transmisión , Encuestas y Cuestionarios , Reacción a la Transfusión/prevención & control
19.
Ophthalmology ; 126(1): 137-143, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30180976

RESUMEN

PURPOSE: Outbreaks of adenovirus in neonatal intensive care units (NICUs) can lead to widespread transmission and serious adverse outcomes. We describe the investigation, response, and successful containment of an adenovirus outbreak in a NICU associated with contaminated handheld ophthalmologic equipment used during retinopathy of prematurity (ROP) screening. DESIGN: Epidemiologic outbreak investigation. PARTICIPANTS: A total of 23 hospitalized neonates, as well as NICU staff and parents of affected infants. MAIN OUTCOME MEASURES: Routine surveillance identified an adenovirus outbreak in a level IV NICU in August 2016. Epidemiologic investigation followed, including chart review, staff interviews, and observations. Cases were defined as hospital-acquired adenovirus identified from any clinical specimen (NICU patient or employee) or compatible illness in a family member. Real-time polymerase chain reaction (PCR) and partial- and whole-genome sequencing assays were used for testing of clinical and environmental specimens. RESULTS: We identified 23 primary neonatal cases and 9 secondary cases (6 employees and 3 parents). All neonatal case-patients had respiratory symptoms. Of these, 5 developed pneumonia and 12 required increased respiratory support. Less than half (48%) had ocular symptoms. All neonatal case-patients (100%) had undergone a recent ophthalmologic examination, and 54% of neonates undergoing examinations developed adenovirus infection. All affected employees and parents had direct contact with infected neonates. Observations revealed inconsistent disinfection of bedside ophthalmologic equipment and limited glove use. Sampling of 2 handheld lenses and 2 indirect ophthalmoscopes revealed adenovirus serotype 3 DNA on each device. Sequence analysis of 16 neonatal cases, 2 employees, and 2 lenses showed that cases and equipment shared 100% identity across the entire adenovirus genome. Infection control interventions included strict hand hygiene, including glove use; isolation precautions; enhanced cleaning of lenses and ophthalmoscopes between all examinations; and staff furlough. We identified no cases of secondary transmission among neonates. CONCLUSIONS: Adenovirus outbreaks can result from use of contaminated ophthalmologic equipment. Even equipment that does not directly contact patients can facilitate indirect transmission. Patient-to-patient transmission can be prevented with strict infection control measures and equipment cleaning. Ophthalmologists performing inpatient examinations should take measures to avoid adenoviral spread from contaminated handheld equipment.


Asunto(s)
Infecciones por Adenovirus Humanos/epidemiología , Brotes de Enfermedades , Contaminación de Equipos , Infecciones Virales del Ojo/epidemiología , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Oftalmología/instrumentación , Infecciones del Sistema Respiratorio/epidemiología , Infecciones por Adenovirus Humanos/tratamiento farmacológico , Infecciones por Adenovirus Humanos/transmisión , Infecciones por Adenovirus Humanos/virología , Adenovirus Humanos/genética , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Infección Hospitalaria/virología , ADN Viral/genética , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Infecciones Virales del Ojo/tratamiento farmacológico , Infecciones Virales del Ojo/transmisión , Infecciones Virales del Ojo/virología , Femenino , Edad Gestacional , Humanos , Lactante , Control de Infecciones , Pacientes Internos , Masculino , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/transmisión , Infecciones del Sistema Respiratorio/virología , Retinopatía de la Prematuridad/diagnóstico , Secuenciación Completa del Genoma
20.
Bull Math Biol ; 81(3): 869-877, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30535846

RESUMEN

In an epidemic of a serious disease, there is likely to be behavioral response that decreases the epidemic size considerably, and taking this into account may lead to estimates of the final epidemic size that are much smaller and more realistic than estimates that do not take this into account.


Asunto(s)
Epidemias/estadística & datos numéricos , Modelos Biológicos , Número Básico de Reproducción/estadística & datos numéricos , Simulación por Computador , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Guinea/epidemiología , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/transmisión , Humanos , Liberia/epidemiología , Conceptos Matemáticos , Sierra Leona/epidemiología
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