Who infects whom?-Reconstructing infection chains of Mycobacterium avium ssp. paratuberculosis in an endemically infected dairy herd by use of genomic data.

Recent evidence of circulation of multiple strains within herds and mixed infections of cows marks the beginning of a rethink of our knowledge on Mycobacterium avium ssp. paratuberculosis (MAP) epidemiology. Strain typing opens new ways to investigate MAP transmission. This work presents a method for reconstructing infection chains in a setting of endemic Johne's disease on a well-managed dairy farm. By linking genomic data with demographic field data, strain-specific differences in spreading patterns could be quantified for a densely sampled dairy herd. Mixed infections of dairy cows with MAP are common, and some strains spread more successfully. Infected cows remain susceptible for co-infections with other MAP genotypes. The model suggested that cows acquired infection from 1-4 other cows and spread infection to 0-17 individuals. Reconstructed infection chains supported the hypothesis that high shedding animals that started to shed at an early age and showed a progressive infection pattern represented a greater risk for spreading MAP. Transmission of more than one genotype between animals was recorded. In this farm with a good MAP control management program, adult-to-adult contact was proposed as the most important transmission route to explain the reconstructed networks. For each isolate, at least one more likely ancestor could be inferred. Our study results help to capture underlying transmission processes and to understand the challenges of tracing MAP spread within a herd. Only the combination of precise longitudinal field data and bacterial strain type information made it possible to trace infection in such detail.

Lethal zoonotic coronavirus infections of humans - comparative phylogenetics, epidemiology, transmission, and clinical features of coronavirus disease 2019, The Middle East respiratory syndrome and severe acute respiratory syndrome.

PURPOSE OF REVIEW: Severe acute respiratory syndrome-coronaviruses-2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), emerged as a new zoonotic pathogen of humans at the end of 2019 and rapidly developed into a global pandemic. Over 106 million COVID-19 cases including 2.3 million deaths have been reported to the WHO as of February 9, 2021. This review examines the epidemiology, transmission, clinical features, and phylogenetics of three lethal zoonotic coronavirus infections of humans: SARS-CoV-1, SARS-CoV-2, and The Middle East respiratory syndrome coronavirus (MERS-COV). RECENT FINDINGS: Bats appear to be the common natural source of SARS-like CoV including SARS-CoV-1 but their role in SARS-CoV-2 and MERS-CoV remains unclear. Civet cats and dromedary camels are the intermediary animal sources for SARS-CoV-1 and MERS-CoV infection, respectively whereas that of SARS-CoV-2 remains unclear. SARS-CoV-2 viral loads peak early on days 2-4 of symptom onset and thus high transmission occurs in the community, and asymptomatic and presymptomatic transmission occurs commonly. Nosocomial outbreaks are hallmarks of SARS-CoV-1 and MERS-CoV infections whereas these are less common in COVID-19. Several COVID-19 vaccines are now available. SUMMARY: Of the three lethal zoonotic coronavirus infections of humans, SARS-CoV-2 has caused a devastating global pandemic with over a million deaths. The emergence of genetic variants, such as D614G, N501Y (variants 1 and 2), has led to an increase in transmissibility and raises concern about the possibility of re-infection and impaired vaccine response. Continued global surveillance is essential for both SARS-CoV-2 and MERS-CoV, to monitor changing epidemiology due to viral variants.

Higiene das mãos na segurança da criança hospitalizada / Hands hygiene in the safety of the hospitalized child

A segurança nos cuidados de saúde impõe-se a nível mundial. Os cuidados à criança hospitalizada devem garantir parâmetros de qualidade e de segurança, nomeadamente no âmbito da prevenção e controlo das Infeções Associadas aos Cuidados de Saúde. A higiene das mãos, é uma intervenção simples e de eficácia comprovada na quebra da cadeia de transmissão da infeção, sendo importante garantir a higiene das mãos no contexto de cuidados hospitalares pediátricos. É neste âmbito que se justifica o desenvolvimento de um estudo com o objetivo de explorar a perceção dos enfermeiros acerca da higiene das mãos realizada pelos próprios enfermeiros, pelas crianças e seus acompanhantes. É finalidade do estudo contribuir para a melhoria da higiene das mãos no contexto de cuidados hospitalares pediátricos, de forma a promover a segurança nos cuidados à criança. É um estudo descritivo, enquadrado no paradigma qualitativo. Participaram no estudo 15 enfermeiros que exercem funções num serviço de pediatria de um hospital central da região norte de Portugal que constituem a amostra. Os participantes, de ambos os sexos, apresentavam uma idade média de 37,5 anos. O instrumento de recolha de dados foi um guião de entrevista semiestruturada e a análise dos dados obedece ao método de análise de conteúdo de Bardin. Da análise do discurso dos participantes surgiram especificidades relativas aos enfermeiros, aos acompanhantes e às crianças. Na perceção dos enfermeiros, em relação à higiene das mãos pela equipa de enfermagem, emergiram três categorias: fatores condicionantes da higiene das mãos, momentos de adesão à higiene das mãos e estratégias para melhorar a adesão à higiene das mãos. Relativamente à perceção dos enfermeiros em relação à adesão das crianças e dos seus acompanhantes emergiram três categorias: fatores condicionantes da adesão à higiene das mãos das crianças, fatores condicionantes da adesão à higiene das mãos dos acompanhantes e estratégias para melhorar a adesão à higiene das mãos das crianças e acompanhantes. Consciencializar e capacitar as equipes e os utilizadores das unidades de saúde para este problema e como o minimizar é determinante. O conhecimento produzido neste estudo pode constituir um contributo para o planeamento de intervenções multimodais promotoras da higiene das mãos no contexto da pediatria.

Safety in health care is required worldwide. Care for hospitalized children must guarantee quality and safety parameters, namely in the context of the prevention and control of Infections Associated with Health Care. Hand hygiene is a simple and proven intervention in breaking the chain of infection transmission, and there for, is important to guarantee hand hygiene in the context of paediatric hospital care. It is in this context that the development of a study is justified in order to explore the nurses' perception of hand hygiene performed by the nurses themselves, by the children and their companions. The purpose of the study is to contribute to the improvement of hand hygiene in the context of paediatric hospital care, in order to promote safety in childcare. It is a descriptive study, framed in the qualitative paradigm. In the study participated 15 nurses who work in a paediatric service of a central hospital in the northern region of Portugal that constitute the study sample. The participants, of both sexes, had an average age of 37.5 years. The data collection instrument was a semi-structured interview guide and the data analysis follows the Bardin content analysis method. From the analysis of the participants' information, specificities related to nurses, children's and companions emerged. Three categories emerged about the perception of nurses in relation to hand hygiene by the nursing team: hand hygiene conditioning factors, moments of adherence to hand hygiene and strategies to improve adherence to hand hygiene. Regarding the nurses' perception of the adherence of children and their companions, also three categories emerged: factors conditioning adherence to children's hand hygiene, conditioning factors of adherence to the hand hygiene of the companions and strategies to improve adherence to the hand hygiene of children and companions. It is crucial to raise awareness and to train the teams and users of health units for this problem and how to minimize it. The knowledge produced in this study can be a contribution to the planning of multimodal interventions that promote hand hygiene in the context of paediatrics.

Establishment and lineage dynamics of the SARS-CoV-2 epidemic in the UK.

The United Kingdom's COVID-19 epidemic during early 2020 was one of world's largest and was unusually well represented by virus genomic sampling. We determined the fine-scale genetic lineage structure of this epidemic through analysis of 50,887 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes, including 26,181 from the UK sampled throughout the country's first wave of infection. Using large-scale phylogenetic analyses combined with epidemiological and travel data, we quantified the size, spatiotemporal origins, and persistence of genetically distinct UK transmission lineages. Rapid fluctuations in virus importation rates resulted in >1000 lineages; those introduced prior to national lockdown tended to be larger and more dispersed. Lineage importation and regional lineage diversity declined after lockdown, whereas lineage elimination was size-dependent. We discuss the implications of our genetic perspective on transmission dynamics for COVID-19 epidemiology and control.

The Zika virus: Lurking behind the COVID-19 pandemic?

WHAT IS KNOWN AND OBJECTIVE: The sudden and extensive outbreak of coronavirus (SARS-CoV-2) has overshadowed another developing viral threat: the Zika flavivirus. Of particular concern is that pregnant women can pass Zika virus to the foetus, and there is a strong implication of an association between Zika virus infection and foetal microcephaly. Currently, there is no vaccine, and there is no cure. METHODS: Published literature and Internet sources were searched for information related to Zika virus, its transmission, its clinical presentation and sequalae, prevention and implications (practice and regulatory) for healthcare providers. The identified English sources were reviewed, assessed and synthesized. Emphasis was placed on providing an overview of the problem, and identification of unmet needs and future directions. RESULTS AND DISCUSSION: Zika virus poses a major challenge for healthcare providers, particularly in areas unaccustomed to it, since it is transmitted to humans by the vector Aedes aegypti mosquito. The outbreak impacts every healthcare provider, because every provider is required to report cases of Zika infection to their state or local health agencies--whether the infection is confirmed or merely suspected. Since the virus has become a worldwide crisis, healthcare providers will need to work across national boundaries and medical disciplines in order to educate patients about Zika symptoms and the mosquito vector. Until further information is known, infected patients (male and female) are being advised to avoid conceiving a child. WHAT IS NEW AND CONCLUSION: Until a vaccine is developed or effective treatment for Zika virus is discovered, healthcare providers must be AVP (aware, vigilant and proactive) in order to lessen the spread and impact of the implicated devastating birth defects (microcephaly) and other neurological disorders (eg Guillain-Barré Syndrome) of this infection. Unfortunately, many knowledge gaps exist. There is an urgent need for a reliable, inexpensive diagnostic test, an effective treatment and an approved and readily available vaccine.

Transmission heterogeneities, kinetics, and controllability of SARS-CoV-2.

A long-standing question in infectious disease dynamics concerns the role of transmission heterogeneities, which are driven by demography, behavior, and interventions. On the basis of detailed patient and contact-tracing data in Hunan, China, we find that 80% of secondary infections traced back to 15% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primary infections, which indicates substantial transmission heterogeneities. Transmission risk scales positively with the duration of exposure and the closeness of social interactions and is modulated by demographic and clinical factors. The lockdown period increases transmission risk in the family and households, whereas isolation and quarantine reduce risks across all types of contacts. The reconstructed infectiousness profile of a typical SARS-CoV-2 patient peaks just before symptom presentation. Modeling indicates that SARS-CoV-2 control requires the synergistic efforts of case isolation, contact quarantine, and population-level interventions because of the specific transmission kinetics of this virus.

Tinea capitis et barbae caused by Trichophyton tonsurans: A retrospective cohort study of an infection chain after shavings in barber shops.

BACKGROUND: Tinea capitis is a highly contagious infectious disease caused by dermatophytes. In Central Europe, it is mainly caused by zoophilic dermatophytes, as, for example Microsporum (M) canis or Trichophyton (T) mentagrophytes and increasingly by anthropophilic fungi. T tonsurans was commonly related to the Tinea gladiatorum, where transmission occurred between infected persons or via contaminated floors. OBJECTIVE: Reporting the transmission of this highly contagious dermatophyte for the first time via beard shaving and hairdressing in barber shops in Germany. PATIENTS AND METHODS: 18 young male patients developed tinea capitis and/or barbae shortly after shavings of the beard and/or hair in a barber shop. Native, cultural and molecular diagnostics as well as tissue biopsies and resistance tests were performed of skin and hair samples. RESULTS: In all samples, T tonsurans could be identified. The medical history and the clinical picture suggest a transmission through contaminated hairdressing tools. The patients were treated with terbinafine or itraconazole in combination with or exclusively with topical antimycotics. CONCLUSION: The transmission and a resulting increase in the incidence of infections with T tonsurans may be due to shavings with direct skin contact of insufficiently disinfected hairdressing tools. This path of infection has already been observed in Africa and is now being described for the first time in Germany. Knowledge of the pathogen and its transmission ways are essential to interrupt the chain of infection.

COVID-19 in the Indigenous Population of Brazil.

Brazil has 896,917 Indigenous individuals distributed among 505 Indigenous lands. There are 274 different Indigenous languages within 305 Indigenous ethnic groups. The Indigenous population is susceptible to pandemics, especially to the current pandemic of COVID-19, which has spread rapidly. In Brazil, after the first COVID-19-confirmed Indigenous case on 05th June 2020, more 420 suspected cases, 1727 confirmed cases being 934 active cases, 715 cases with clinical cure, and 70 cases of death were accounted through the first week of June. The number of cases is underestimated, according to the Special Secretariat for Indigenous Health (SESAI) database, since the deaths are due to respiratory failure, possibly caused by COVID-19, but not confirmed. The first COVID-19-caused death was a 15-year-old Indigenous Yanomami teenage from Roraima State without known previous diseases history and/or comorbidities. In the present study, the importance of social isolation, especially for Indigenous people who are more vulnerable to the COVID-19, was highlighted by the identification of the infection community. An Indigenous of the Kokama ethnicity was infected after coming in contact with a Medical Doctor who was infected with the disease. Later, it was noticed that both, Indigenous and doctor, were responsible for COVID-19's transmission to 43 other Indigenous individuals (30 in Alto Rio Solimões and 13 in Parintis), causing possibly other confirmed deaths. The impact of COVID-19 for Indigenous population might be an unprecedented tragedy, and the government in Brazil must take emergency measures as the social isolation.