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1.
BMC Infect Dis ; 24(1): 174, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326781

RESUMO

BACKGROUND: It is not yet fully understood to what extent in-flight transmission contributed to the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This study aimed to determine the occurrence and extent of SARS-CoV-2 transmission in-flight and assess factors associated with transmission risk to inform future control strategies. METHODS: Retrospective cohort study using data obtained from contact tracing of international flights arriving in England between 02/08/2021-15/10/2021. Transmission risk was estimated by calculating the secondary attack rate (SAR). Univariable and multivariable analyses of the SAR by specific risk factors was undertaken, including: number of in-flight index cases; number of symptomatic index cases; contact vaccination status; flight duration; proximity to the index case(s); contact age. RESULTS: 11,307 index cases linked to 667,849 contacts with 5,289 secondary cases reported. In-flight SAR was 0.79% (95% CI: 0.77-0.81). Increasing numbers of symptomatic cases (when > 4 index cases compared to one index case aOR 1.85; 95% CI: 1.40-2.44) and seating proximity to an index case (seated within compared to outside of two rows OR 1.82; 95% CI: 1.50-2.22) were associated with increased risk of secondary cases. Full vaccination history was protective (aOR 0.52; 95% CI: 0.47-0.57). CONCLUSIONS: This study confirms that in-flight transmission of SARS-CoV-2 occurred. There are factors associated with increased risk of infection. Contact tracing identified exposed persons who subsequently developed infection. A targeted approach to contact tracing passengers with the highest exposure risk could be an effective use of limited public health resources.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , Estudos Retrospectivos , Busca de Comunicante , Inglaterra/epidemiologia
2.
AIDS Patient Care STDS ; 38(2): 82-92, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38381947

RESUMO

In Massachusetts (MA), partner notification is routinely offered for new HIV and infectious syphilis cases, but there are no formal partner notification services for gonorrhea and chlamydia. Electronic partner notification (ePN), which allows patients to anonymously notify their partners of sexually transmitted infection exposure, could fill this gap. We evaluated the acceptability of and ideal characteristics for a statewide ePN service in MA. We performed semistructured interviews with patients at a Boston area sexual health clinic and conducted focus groups with clinicians and Massachusetts Department of Public Health Field Epidemiologists (FEs). We developed a codebook and thematically analyzed interview and focus group data; 25% of interviews were double coded. We identified six main themes from our data: (1) partner notification is a relational process and (2) partner notification is situation dependent. There are three pairs of challenges and core values for an effective ePN system: (3) stigmatization versus inclusivity, (4) trust versus mistrust, and (5) privacy versus helpful information sharing. Therefore, (6) a statewide ePN platform must be customizable at each possible step. Although ePN was acceptable across all three groups, the likelihood of individual use was grounded in a patient's sociocultural context, interpersonal relationships, trust in the platform and health authorities, desire to avoid stigmatization, and privacy needs. These factors are best accommodated by a platform that adapts to users' preferences and needs. ePN presents an opportunity to link partners at risk for gonorrhea or chlamydia to clinical care that is complementary to the more labor-intensive FE role.


Assuntos
Infecções por Chlamydia , Gonorreia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Humanos , Gonorreia/epidemiologia , Busca de Comunicante , Epidemiologistas , Infecções por HIV/epidemiologia , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções por Chlamydia/epidemiologia
3.
BMC Public Health ; 24(1): 521, 2024 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-38373972

RESUMO

BACKGROUND: Voluntary assisted partner notification (VAPN) in HIV contact tracing is a globally recommended strategy to identify persons who have been exposed to HIV and link them to HIV testing and follow-up. However, there is little understanding about how VAPN is experienced by stakeholders in sub-Saharan African (SSA) contexts. We conducted a multi-level and multi-national qualitative analysis evaluating stakeholder perspectives surrounding VAPN implementation to inform the development of future VAPN policies. METHOD: We conducted in-depth interviews (IDIs) with VAPN stakeholders at global (n = 5), national (n = 6), and community level (n = 4) across a total of seven SSA countries. Eligible participants were ≥ 18 years old and had experience developing, implementing, or overseeing VAPN policies in SSA. We sought to understand stakeholder's perspectives on policy development, implementation, and perceived outcomes (barriers and facilitators). Interviews were audio recorded, transcribed, and analyzed thematically using a combination of inductive and deductive approaches. RESULTS: Between December 2019 and October 2020 we conducted 15 IDIs. While participants agreed that VAPN resulted in a high yield of people newly diagnosed with HIV; they noted numerous barriers surrounding VAPN implementation across global, national, and community levels, the majority of which were identified at community level. Barriers at global and national level included high target setting, contradictory laws, and limited independent research disenfranchising the experiences of implementing partners. The barriers identified at community level included client-level challenges (e.g., access to healthcare facilities and fear of adverse events); healthcare worker challenges (e.g., high workloads); limited data infrastructure; and cultural/gender norms that hindered women from engaging in HIV testing and VAPN services. In response to these barriers, participants shared implementation facilitators to sustain ethical implementation of VAPN services (e.g., contact tracing methods) and increase its yield (e.g., HIV self-testing integrated with VAPN services). CONCLUSION: Overall, stakeholders perceived VAPN implementation to encounter barriers across all implementation levels (global to community). Future VAPN policies should be designed around the barriers and facilitators identified by SSA stakeholders to maximize the implementation of (ethical) HIV VAPN services and increase its impact in sub-Saharan African settings.


Assuntos
Infecções por HIV , Humanos , Feminino , Adolescente , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Busca de Comunicante/métodos , África Subsaariana , Teste de HIV , Programas de Rastreamento/métodos
4.
BMC Public Health ; 24(1): 414, 2024 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-38331772

RESUMO

IMPORTANCE: Contact tracing is the process of identifying people who have recently been in contact with someone diagnosed with an infectious disease. During an outbreak, data collected from contact tracing can inform interventions to reduce the spread of infectious diseases. Understanding factors associated with completion rates of contact tracing surveys can help design improved interview protocols for ongoing and future programs. OBJECTIVE: To identify factors associated with completion rates of COVID-19 contact tracing surveys in New York City (NYC) and evaluate the utility of a predictive model to improve completion rates, we analyze laboratory-confirmed and probable COVID-19 cases and their self-reported contacts in NYC from October 1st 2020 to May 10th 2021. METHODS: We analyzed 742,807 case investigation calls made during the study period. Using a log-binomial regression model, we examined the impact of age, time of day of phone call, and zip code-level demographic and socioeconomic factors on interview completion rates. We further developed a random forest model to predict the best phone call time and performed a counterfactual analysis to evaluate the change of completion rates if the predicative model were used. RESULTS: The percentage of contact tracing surveys that were completed was 79.4%, with substantial variations across ZIP code areas. Using a log-binomial regression model, we found that the age of index case (an individual who has tested positive through PCR or antigen testing and is thus subjected to a case investigation) had a significant effect on the completion of case investigation - compared with young adults (the reference group,24 years old < age < = 65 years old), the completion rate for seniors (age > 65 years old) were lower by 12.1% (95%CI: 11.1% - 13.3%), and the completion rate for youth group (age < = 24 years old) were lower by 1.6% (95%CI: 0.6% -2.6%). In addition, phone calls made from 6 to 9 pm had a 4.1% (95% CI: 1.8% - 6.3%) higher completion rate compared with the reference group of phone calls attempted from 12 and 3 pm. We further used a random forest algorithm to assess its potential utility for selecting the time of day of phone call. In counterfactual simulations, the overall completion rate in NYC was marginally improved by 1.2%; however, certain ZIP code areas had improvements up to 7.8%. CONCLUSION: These findings suggest that age and time of day of phone call were associated with completion rates of case investigations. It is possible to develop predictive models to estimate better phone call time for improving completion rates in certain communities.


Assuntos
COVID-19 , Adolescente , Adulto Jovem , Humanos , Adulto , Idoso , COVID-19/epidemiologia , Busca de Comunicante/métodos , Cidade de Nova Iorque/epidemiologia , Inquéritos e Questionários , Surtos de Doenças
5.
J Infect Dev Ctries ; 18(1): 53-59, 2024 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-38377082

RESUMO

INTRODUCTION: In 2021, there were 4 million tuberculosis (TB) cases that were not detected by health systems, globally. Many of those cases are among hard-to-reach populations or key population groups. An Optimized Case Finding (OCF) strategy was introduced in Ukraine to enhance case detection and identify those "missing" cases. OCF included screening of up to eight referred household and social network contacts of an index TB case. Following the OCF project implementation, TB detection and characteristics of index cases and contacts were assessed. METHODOLOGY: A cohort study using project data (July 2018 - April 2022) was conducted. RESULTS: In total 7,976 close contacts were engaged in the project from 1,028 index TB cases. Among the contacts, 507 were diagnosed with TB. The TB case detection was 6,356/100,000 and the number needed to investigate was 16. Multiple factors were identified as associated with TB detection including smoking, HIV, poverty, etc. About 90% of cases were identified at the initial screening of the contacts. OCF was proven to be 5.8 times more effective than the standard active case finding using household surveys and 106 times more effective than passive case finding in the general public. CONCLUSIONS: Our study demonstrated the effectiveness of OCF in detecting cases among key population groups and their social networks. We encourage adaptation and use of OCF by civil society organizations that already work with key vulnerable populations around the globe.


Assuntos
Grupos Populacionais , Tuberculose , Humanos , Seguimentos , Estudos de Coortes , Ucrânia/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Busca de Comunicante
6.
BMC Health Serv Res ; 24(1): 96, 2024 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-38233812

RESUMO

BACKGROUND: During the COVID-19 response in Norway, many municipalities used the Fiks contact tracing tool (FiksCT) to register positive individuals and follow-up contacts. This tool is based on DHIS2, an open source, web-based platform. In this study we examined if data completeness in FiksCT improved after integration with national registers between May 2020 and September 2021. METHODS: Data from municipalities using FiksCT was extracted from the Norwegian Emergency Preparedness Register for COVID-19 (Beredt C19). We linked FiksCT data to the Norwegian Surveillance System for Communicable Diseases (MSIS), the National Population Register (FREG), and the Norwegian Vaccine Registry (SYSVAK) using unique identification numbers (ID). Completeness for each variable linked with a national register was calculated before and after integration with these registers. RESULTS: Of the 125 municipalities using FiksCT, 87 (69.6%) agreed to share and upload their data to Beredt C19. Data completeness for positive individuals improved after integration with national registers. After integration with FREG, the proportion of missing values decreased from 12.5 to 1.6% for ID, from 4.5 to 0.9% for sex, and from 1.2 to 0.4% for date of birth. Missing values for vaccine type decreased from 63.0 to 15.2% and 39.3-36.7% for first and second dose, respectively. In addition, direct reporting from FiksCT to MSIS increased the proportion of complete records in MSIS (on the selected variables) from 68.6% before to 77.0% after integration. CONCLUSION: The completeness of local contact tracing data can be improved by enabling integration with established national registers. In addition, providing the option to submit local data to the national registers could ease workload and reduce the need to collect duplicate data.


Assuntos
COVID-19 , Vacinas , Humanos , Busca de Comunicante , COVID-19/epidemiologia , COVID-19/prevenção & controle , Sistema de Registros , Noruega/epidemiologia
7.
BMC Health Serv Res ; 24(1): 97, 2024 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-38233915

RESUMO

BACKGROUND: Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS: Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS: From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS: Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Busca de Comunicante , Agentes Comunitários de Saúde , México/epidemiologia , Pobreza
8.
Artigo em Inglês | MEDLINE | ID: mdl-38248558

RESUMO

The digitisation of healthcare has allowed a significant rethinking of the previous clinical protocols, improving their interoperability through substantial standardisation. These technological advances have ensured that data are comparable, as they are obtained from 'reliable' and certified processes; however, there are billions of data that are neither structured nor quality-controlled. They are collectively referred to as 'Real World Data' (RWD). Blockchain (BC) is a procedure with specific characteristics and algorithms that ensure that the stored data cannot be tampered with. Nowadays, there is an increasing need to rethink blockchain in a one-health vision, making it more than just a 'repository' of data and information, but rather an active player in the process of data sharing. In this landscape, several scholars have analysed the potential benefits of BC in healthcare, focusing on the sharing and safety of clinical data and its contact tracing applications. There is limited research on this matter; moreover, there is a strategic interest in managing RWD in a reliable and comparable way, despite the lack of knowledge on this topic. Our work aims to analyse systematically the most impacting literature, highlighting the main aspects of BC within the context of the new digital healthcare, and speculating on the unexpressed potential of RWD.


Assuntos
Blockchain , Saúde Pública , Algoritmos , Certificação , Busca de Comunicante
9.
Epidemiol Infect ; 152: e26, 2024 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-38229514

RESUMO

The yield of contact investigation on relapsed tuberculosis (TB) cases can guide strategies and resource allocation in the TB control programme. We conducted a retrospective cohort study to review the yield of contact investigation in relapsed TB cases and identify factors associated with TB infection (TBI) among close contacts of relapsed TB cases notified between 2018 and 2022 in Singapore. TB infection positivity was higher among contacts of relapsed cases which were culture-positive for Mycobacterium tuberculosis complex compared to those who were only polymerase chain reaction (PCR)-positive (14.8% vs. 12.3%). On multivariate analysis, after adjusting for age and gender of the index, gender, and existing comorbidities of contacts, factors independently associated with TBI were culture and smear positivity of the index (AOR 1.41, 95%CI 1.02-1.94), higher odds with every 10 years of increase in age compared to contacts below aged 30, contacts who were not Singapore residents (AOR 2.09, 95%CI 1.46-2.97), and household contacts (AOR 2.19, 95%CI 1.44-3.34). Although the yield of screening was higher for those who were culture-positive compared to only PCR-positive relapsed cases, contact tracing for only PCR-positive cases may still be important in a country with moderate TB incidence, should resources allow.


Assuntos
Tuberculose Latente , Mycobacterium tuberculosis , Tuberculose , Humanos , Busca de Comunicante , Estudos Retrospectivos , Singapura/epidemiologia , Tuberculose/epidemiologia , Tuberculose/diagnóstico , Tuberculose Latente/epidemiologia
10.
J Med Virol ; 96(1): e29355, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38179882

RESUMO

It is widely acknowledged that infectious diseases have wrought immense havoc on human society, being regarded as adversaries from which humanity cannot elude. In recent years, the advancement of Artificial Intelligence (AI) technology has ushered in a revolutionary era in the realm of infectious disease prevention and control. This evolution encompasses early warning of outbreaks, contact tracing, infection diagnosis, drug discovery, and the facilitation of drug design, alongside other facets of epidemic management. This article presents an overview of the utilization of AI systems in the field of infectious diseases, with a specific focus on their role during the COVID-19 pandemic. The article also highlights the contemporary challenges that AI confronts within this domain and posits strategies for their mitigation. There exists an imperative to further harness the potential applications of AI across multiple domains to augment its capacity in effectively addressing future disease outbreaks.


Assuntos
COVID-19 , Doenças Transmissíveis , Humanos , Inteligência Artificial , Pandemias , Busca de Comunicante , Doenças Transmissíveis/diagnóstico
11.
J Med Virol ; 96(1): e29352, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38180437

RESUMO

To control human-to-human mpox transmission during the 2022 outbreak, European Union (EU)/European Economic Area (EEA) countries conducted case investigation and contact tracing (CT). We aimed to provide an overview of CT activities, describe CT data collection practices, and identify related facilitators, barriers, and potential opportunities for improvement. Between April 03, 2023 and May 12, 2023, a survey was distributed to CT stakeholders in 30 EU/EEA countries, asking about mpox CT activities and data collection and requesting to rank enablers, barriers, and improvements for CT on a five-point Likert scale. The 139 respondents from 27 countries indicated having performed case investigations (96%, n = 133), backward CT (88%, n = 122), forward CT (87%, n = 121), and follow-up on contacts' outcomes (77%, n = 107). Sixty percent (n = 80/134) used standardized data collection forms and 73% (n = 91/124) used databases. The highest-rated enablers were clear guidelines (mean = 3.9), quick access to laboratory results (3.6), and sufficient expertise (3.6). Highly rated barriers were inability to contact contacts (3.0) or cases (2.5) and lack of staff (2.4). The most needed improvements were availability of staff (3.5), expertise on affected populations (3.4) and data reporting tools and systems (3.3). To improve CT of mpox and diseases with similar transmission patterns, EU/EEA countries should increase workforce capacity in public and sexual health, offer training on CT operations and communication with affected communities, and use common CT data collection tools and systems.


Assuntos
Busca de Comunicante , Humanos , União Europeia , Coleta de Dados , Surtos de Doenças/prevenção & controle
14.
J Infect ; 88(2): 173-179, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38242366

RESUMO

OBJECTIVES: Calculations of SARS-CoV-2 transmission networks at a population level have been limited. Networks that estimate infections between individuals and whether this results in a mutation, can be a way to evaluate fitness of a mutational clone by how much it expands in number as well as determining the likelihood a transmission results in a new variant. METHODS: Australian Delta and Omicron SARS-CoV-2 sequences were downloaded from GISAID. Transmission networks of infection between individuals were estimated using a novel mathematical method. RESULTS: Many of the sequences were identical, with clone sizes following power law distributions driven by negative binomial probability distributions for both the number of infections per individual and the number of mutations per transmission (median 0.74 nucleotide changes for Delta and 0.71 for Omicron). Using these distributions, an agent-based model was able to replicate the observed clonal network structure, providing a basis for more detailed COVID-19 modelling. Possible recombination events, tracked by insertion/deletion (indel) patterns, were identified for each variant in these outbreaks. CONCLUSIONS: This modelling approach reveals key transmission characteristics of SARS-CoV-2 and may complement traditional contact tracing. This methodology can also be applied to other diseases as genetic sequencing of viruses becomes more commonplace.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , SARS-CoV-2/genética , COVID-19/epidemiologia , Busca de Comunicante , Austrália/epidemiologia , Surtos de Doenças
15.
Emerg Infect Dis ; 30(2): 333-336, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38181801

RESUMO

Because of constrained personnel time, the Philadelphia Department of Public Health (Philadelphia, PA, USA) adjusted its COVID-19 contact tracing protocol in summer 2021 by prioritizing recent cases and limiting staff time per case. This action reduced required staff hours to prevent each case from 21-30 to 8-11 hours, while maintaining program effectiveness.


Assuntos
COVID-19 , Humanos , COVID-19/prevenção & controle , Busca de Comunicante/métodos , SARS-CoV-2 , Philadelphia/epidemiologia , Saúde Pública
16.
Am J Public Health ; 114(S1): S96-S102, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38207263

RESUMO

Objectives. To describe the implementation of a novel disease surveillance model in Puerto Rico, the Municipal Case Investigation and Contact Tracing System for COVID-19, established during the pandemic as the primary response. Methods. We analyzed data from July 2020 to June 2021, including all COVID-19 cases reported by public and private laboratories in Puerto Rico to describe the accomplishments and limitations of the surveillance. Results. During the first year, the system was successfully implemented in all Puerto Rican municipalities, collecting data on more than 132 000 confirmed COVID-19 cases. It improved case investigation coverage, reduced laboratory reporting times, and facilitated community engagement for ongoing response enhancements. Conclusions. Surveillance systems of this scale were new to Puerto Rico's Health System, and there was a steep learning and improvement curve. This approach enabled tailored health education, equitable distribution of testing and treatments, and surveillance by educational institutions. Public Health Implications. Near-real-time epidemiological data publication promoted trust, education, and evidence-based policymaking. (Am J Public Health. 2024;114(S1):S96-S102. https://doi.org/10.2105/AJPH.2023.307493).


Assuntos
COVID-19 , Busca de Comunicante , Humanos , Porto Rico/epidemiologia , COVID-19/epidemiologia , Vigilância da População , Saúde Pública
17.
Euro Surveill ; 29(3)2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38240059

RESUMO

BackgroundContact tracing was one of the central non-pharmaceutical interventions implemented worldwide to control the spread of SARS-CoV-2, but its effectiveness depends on its ability to detect contacts.AimEvaluate the proportion of secondary infections captured by the contact tracing system in Geneva.MethodsWe analysed 166,892 concomitant infections occurring at the same given address from June 2020 until February 2022 using an extensive operational database of SARS-CoV-2 tests in Geneva. We used permutation to compare the total number of secondary infections occurring at the same address with that reported through manual contact tracing.ResultsContact tracing captured on average 41% of secondary infections, varying from 23% during epidemic peaks to 60% during low epidemic activity. People living in wealthy neighbourhoods were less likely to report contacts (odds ratio (OR): 1.6). People living in apartment buildings were also less likely to report contacts than those living in a house (OR: 1.1-3.1) depending on the SARS-CoV-2 variant, the building size and the presence of shops. This under-reporting of contacts in apartment buildings decreased during periods of mandatory wearing of face masks and restrictions on private gatherings.ConclusionContact tracing alone did not detect sufficient secondary infections to reduce the spread of SARS-CoV-2. Campaigns targeting specific populations, such as those in wealthy areas or apartment buildings, could enhance coverage. Additionally, measures like wearing face masks, improving ventilation and implementing restrictions on gatherings should also be considered to reduce infections resulting from interactions that may not be perceived as high risk.


Assuntos
COVID-19 , Coinfecção , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2 , Busca de Comunicante/métodos , Suíça/epidemiologia
19.
Nature ; 626(7997): 145-150, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38122820

RESUMO

How likely is it to become infected by SARS-CoV-2 after being exposed? Almost everyone wondered about this question during the COVID-19 pandemic. Contact-tracing apps1,2 recorded measurements of proximity3 and duration between nearby smartphones. Contacts-individuals exposed to confirmed cases-were notified according to public health policies such as the 2 m, 15 min guideline4,5, despite limited evidence supporting this threshold. Here we analysed 7 million contacts notified by the National Health Service COVID-19 app6,7 in England and Wales to infer how app measurements translated to actual transmissions. Empirical metrics and statistical modelling showed a strong relation between app-computed risk scores and actual transmission probability. Longer exposures at greater distances had risk similar to that of shorter exposures at closer distances. The probability of transmission confirmed by a reported positive test increased initially linearly with duration of exposure (1.1% per hour) and continued increasing over several days. Whereas most exposures were short (median 0.7 h, interquartile range 0.4-1.6), transmissions typically resulted from exposures lasting between 1 h and several days (median 6 h, interquartile range 1.4-28). Households accounted for about 6% of contacts but 40% of transmissions. With sufficient preparation, privacy-preserving yet precise analyses of risk that would inform public health measures, based on digital contact tracing, could be performed within weeks of the emergence of a new pathogen.


Assuntos
COVID-19 , Busca de Comunicante , Aplicativos Móveis , Saúde Pública , Medição de Risco , Humanos , Busca de Comunicante/métodos , Busca de Comunicante/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Pandemias , SARS-CoV-2 , Medicina Estatal , Fatores de Tempo , Inglaterra/epidemiologia , País de Gales/epidemiologia , Modelos Estatísticos , Características da Família , Saúde Pública/métodos , Saúde Pública/tendências
20.
Infect Dis Poverty ; 12(1): 111, 2023 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-38053215

RESUMO

BACKGROUND: Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment. METHODS: Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated. RESULTS: New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81). CONCLUSIONS: The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.


Assuntos
Hanseníase , Criança , Humanos , Masculino , Feminino , Nepal/epidemiologia , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Busca de Comunicante , Fatores de Risco , Diagnóstico Precoce
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