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1.
Yale J Biol Med ; 93(4): 579-585, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33005122

RESUMO

Not only do epidemics such as HIV/AIDS, Ebola Virus Disease (EVD), and the current Coronavirus Disease (COVID-19) cause the loss of millions of lives, but they also cost the global economy billions of dollars. Consequently, there is an urgent need to formulate interventions that will help control their spread and impact when they emerge. The education of young girls and women is one such historical approach. They are usually the vulnerable targets of disease outbreaks - they are most likely to be vehicles for the spread of epidemics due to their assigned traditional roles in resource-limited countries. Based on our work and the work of others on educational interventions, we propose six critical components of a cost-effective and sustainable response to promote girl-child education in resource-limited settings.


Assuntos
Doenças Transmissíveis Emergentes , Infecções por Coronavirus , Identidade de Gênero , Saúde Global , Educação em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Criança , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Feminino , Saúde Global/economia , Saúde Global/educação , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
2.
Discov Med ; 29(158): 201-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007195

RESUMO

Sepsis is an important disorder in intensive care medicine, and the emphasis is not on infections but the imbalance in body reactions and life-threatening organ dysfunction. The infection, the imbalance in the body's reaction, and the deadly organ dysfunction are three aspects of sepsis. Currently, there is still a debate on suitable criteria for the diagnosis of patients with sepsis with continuing changes in the guidelines on sepsis management. Here we summarize recent advances on the definitions, diagnosis, and treatment in the clinical practice of sepsis management in the emergency department. We also highlight future research directions on sepsis. In particular, given the global outbreak of coronavirus disease 2019 (COVID-19), we briefly describe the relationship between COVID-19 and sepsis. How to manage sepsis caused by emerging pathogens such as COVID-19 is a new challenge for care professionals in the emergency department.


Assuntos
Betacoronavirus/patogenicidade , Doenças Transmissíveis Emergentes/terapia , Infecções por Coronavirus/terapia , Tratamento de Emergência/métodos , Pneumonia Viral/terapia , Sepse/terapia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Doenças Transmissíveis Emergentes/complicações , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sepse/diagnóstico , Sepse/virologia , Índice de Gravidade de Doença
3.
Infect Dis Poverty ; 9(1): 140, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028426

RESUMO

Most human pathogens originate from non-human hosts and certain pathogens persist in animal reservoirs. The transmission of such pathogens to humans may lead to self-sustaining chains of transmission. These pathogens represent the highest risk for future pandemics. For their prevention, the transmission over the species barrier - although rare - should, by all means, be avoided. In the current COVID-19 pandemic, surprisingly though, most of the current research concentrates on the control by drugs and vaccines, while comparatively little scientific inquiry focuses on future prevention. Already in 2012, the World Bank recommended to engage in a systemic One Health approach for zoonoses control, considering integrated surveillance-response and control of human and animal diseases for primarily economic reasons. First examples, like integrated West Nile virus surveillance in mosquitos, wild birds, horses and humans in Italy show evidence of financial savings from a closer cooperation of human and animal health sectors. Provided a zoonotic origin can be ascertained for the COVID-19 pandemic, integrated wildlife, domestic animal and humans disease surveillance-response may contribute to prevent future outbreaks. In conclusion, the earlier a zoonotic pathogen can be detected in the environment, in wildlife or in domestic animals; and the better human, animal and environmental surveillance communicate with each other to prevent an outbreak, the lower are the cumulative costs.


Assuntos
Doenças Transmissíveis Emergentes/prevenção & controle , Pandemias/prevenção & controle , Zoonoses/prevenção & controle , Doenças dos Animais/epidemiologia , Doenças dos Animais/prevenção & controle , Doenças dos Animais/transmissão , Animais , Betacoronavirus , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/transmissão , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Reservatórios de Doenças/veterinária , Reservatórios de Doenças/virologia , Monitoramento Epidemiológico/veterinária , Humanos , Itália/epidemiologia , Saúde Única , Pandemias/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Zoonoses/epidemiologia , Zoonoses/transmissão
4.
Rev Esp Salud Publica ; 942020 Sep 30.
Artigo em Espanhol | MEDLINE | ID: mdl-32994390

RESUMO

In the midst of the SARS-CoV-2 public-health pandemic emergency, it is important to understand its zoonotic origin and how an animal virus finally infects humans. Identifying the circumstances in which a virus jumps species boundaries to infect humans so productively is objective of this work and will help us to determine the epidemiology and pathogenisis of this agent. Nowadays, it is known that bats serve as reservoir hosts for virus progenitor, but determine the possibility of a potential intermediate host of SARS-CoV-2 is still a challenge. Scientific investigations stablish the natural selection theory as the most probable (natural selection in an animal host before zoonotic transfer or acquired mutations in humans following crossing species barrier). It is necessary to find out how SARS-CoV-2 emerged, its rapidly spreads within a community and the optimal context in which this virus binds to human receptor. One Health is a multisectoral, collaborative and transdisciplinary approach which allows a cooperative working between animal and human health that will help us to introduce some possible control measures that might reduce the spread of the virus; improving sanitary management, identifying new outbreaks and preventing future zoonotic and pandemic events.


Assuntos
Betacoronavirus , Quirópteros/virologia , Doenças Transmissíveis Emergentes/transmissão , Infecções por Coronavirus/transmissão , Reservatórios de Doenças/virologia , Pandemias , Pneumonia Viral/transmissão , Zoonoses/transmissão , Animais , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Saúde Global , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Seleção Genética , Zoonoses/epidemiologia , Zoonoses/virologia
7.
Int J Health Geogr ; 19(1): 32, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32791994

RESUMO

BACKGROUND: As of 13 July 2020, 12.9 million COVID-19 cases have been reported worldwide. Prior studies have demonstrated that local socioeconomic and built environment characteristics may significantly contribute to viral transmission and incidence rates, thereby accounting for some of the spatial variation observed. Due to uncertainties, non-linearities, and multiple interaction effects observed in the associations between COVID-19 incidence and socioeconomic, infrastructural, and built environment characteristics, we present a structured multimethod approach for analysing cross-sectional incidence data within in an Exploratory Spatial Data Analysis (ESDA) framework at the NUTS3 (county) scale. METHODS: By sequentially conducting a geospatial analysis, an heuristic geographical interpretation, a Bayesian machine learning analysis, and parameterising a Generalised Additive Model (GAM), we assessed associations between incidence rates and 368 independent variables describing geographical patterns, socioeconomic risk factors, infrastructure, and features of the build environment. A spatial trend analysis and Local Indicators of Spatial Autocorrelation were used to characterise the geography of age-adjusted COVID-19 incidence rates across Germany, followed by iterative modelling using Bayesian Additive Regression Trees (BART) to identify and measure candidate explanatory variables. Partial dependence plots were derived to quantify and contextualise BART model results, followed by the parameterisation of a GAM to assess correlations. RESULTS: A strong south-to-north gradient of COVID-19 incidence was identified, facilitating an empirical classification of the study area into two epidemic subregions. All preliminary and final models indicated that location, densities of the built environment, and socioeconomic variables were important predictors of incidence rates in Germany. The top ten predictor variables' partial dependence exhibited multiple non-linearities in the relationships between key predictor variables and COVID-19 incidence rates. The BART, partial dependence, and GAM results indicate that the strongest predictors of COVID-19 incidence at the county scale were related to community interconnectedness, geographical location, transportation infrastructure, and labour market structure. CONCLUSIONS: The multimethod ESDA approach provided unique insights into spatial and aspatial non-stationarities of COVID-19 incidence in Germany. BART and GAM modelling indicated that geographical configuration, built environment densities, socioeconomic characteristics, and infrastructure all exhibit associations with COVID-19 incidence in Germany when assessed at the county scale. The results suggest that measures to implement social distancing and reduce unnecessary travel may be important methods for reducing contagion, and the authors call for further research to investigate the observed associations to inform prevention and control policy.


Assuntos
Ambiente Construído , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Meio Ambiente , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos , Análise Espacial , Teorema de Bayes , Betacoronavirus , Estudos Transversais , Mapeamento Geográfico , Alemanha/epidemiologia , Humanos , Incidência , Aprendizado de Máquina , Pandemias , Fatores de Risco
8.
Arq Bras Cardiol ; 115(1): 111-126, 2020 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32813825

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Ecocardiografia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
9.
Infect Dis Poverty ; 9(1): 115, 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32814591

RESUMO

BACKGROUND: The emerging infectious disease, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a serious threat in China and worldwide. Challenged by this serious situation, China has taken many measures to contain its transmission. This study aims to systematically review and record these special and effective practices, in hope of benefiting for fighting against the ongoing worldwide pandemic. METHODS: The measures taken by the governments was tracked and sorted on a daily basis from the websites of governmental authorities (e.g. National Health Commission of the People's Republic of China). And the measures were reviewed and summarized by categorizations, figures and tables, showing an ever-changing process of combating with an emerging infectious disease. The population shift levels, daily local new diagnosed cases, daily mortality and daily local new cured cases were used for measuring the effect of the measures. RESULTS: The practices could be categorized into active case surveillance, rapid case diagnosis and management, strict follow-up and quarantine of persons with close contacts, and issuance of guidance to help the public understand and adhere to control measures, plus prompt and effective high-level policy decision, complete activation of the public health system, and full involvement of the society. Along with the measures, the population shift levels, daily local new diagnosed cases, and mortality were decreased, and the daily local new cured cases were increased in China. CONCLUSIONS: China's practices are effective in controlling transmission of SARS-CoV-2. Considering newly occurred situations (e.g. imported cases, work resumption), the control measures may be adjusted.


Assuntos
Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vigilância da População , China/epidemiologia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Política de Saúde , Humanos , Máscaras , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Fatores de Tempo , Viagem
10.
Curr Opin Ophthalmol ; 31(5): 416-422, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740063

RESUMO

PURPOSE OF REVIEW: To highlight the lessons learned from the Ebola outbreak that may inform our approach to the COVID-19 pandemic, particularly related to the widespread disruption of healthcare, ophthalmic disease manifestations, and vision health systems strengthening for future outbreaks. RECENT FINDINGS: Coronavirus disease 2019 (COVID-19), first detected in China in December 2019, has become a worldwide health emergency, with significant disruption of all aspects of society, including travel, business, and medical care. Although this pandemic has had unprecedented effects on healthcare delivery in the United States, experiences from recent Ebola virus disease (EVD) outbreaks in Africa provide insight and inform our approach to COVID-19 and outbreak preparedness. Like COVID-19, the rapid emergence of Ebola required new clinical and surgical approaches to understand its associated spectrum of ophthalmic complications and the potential for Ebola viral persistence within the eye and in tear film. Recent reports of ophthalmic findings associated with COVID-19 include conjunctivitis, retinopathy, and molecular evidence of virus within the tear film in a minority of cases. Yet, more rigorous approaches to understand ophthalmic disease and transmission risk associated with COVID-19 are needed. Gaps also remain in our understanding of eye disease associated with other high priority emerging infectious diseases including Nipah, Lassa fever, Marburg virus, and others. SUMMARY: Thoroughly understanding the ophthalmic findings and transmission risk associated with COVID-19 is paramount during this pandemic, providing additional measures of safety while resuming ophthalmic care for all patients. Vision health systems preparedness measures developed during recent EVD outbreaks and the current pandemic provide models for ophthalmic clinical practice, research, and education, as we continue to address COVID-19 and future emerging infectious disease threats.


Assuntos
Betacoronavirus , Defesa Civil/organização & administração , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/transmissão , Assistência à Saúde , Saúde Global , Humanos , Pandemias , Pneumonia Viral/transmissão
11.
J Prev Med Hyg ; 61(2): E130-E136, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32802995

RESUMO

SARS-CoV-2 is a new form of ß-coronavirus that has been recently discovered and is responsible for COVID 19 pandemic. The earliest infection can be traced back to Wuhan, China. From there it has spread all over the world. Keeping in view the above perspective, an attempt is made in order to find out the epidemiological pattern of COVID 19 pandemic, if any, in different geo-climatological regions of the world in terms of case incidence and mortality. This study is also an endeavor to review and analyze the gradual changes of the genetic makeup of SARS-CoV from evolutionary and epidemiological perspectives. The raw data of COVID-19 cases and death incidences were collected from the World Health Organization (WHO) website from the time period: 1st April to 6th April, 2020. The data that are utilized here for general and Case fatality rate (CFR) based analysis. Western pacific region, European region and Americas have the greatest number of infected cases (P < 0.001); whereas deaths have been found to be significantly higher in Europe (P < 0.001). Total number of confirmed cases and deaths in south-east Asia are comparatively lower (P < 0.001). Case fatality rate (CFR) has also found significant for European region. SARS-CoV-2 is considered to be a strain of SARS-CoV that has a high rate of pathogenicity and transmissibility. Result indicated that the European region has been affected mostly for both cases and death incidences. The novel mutations in SARS-CoV-2 possibly increase the virus infectivity. Genetic heterogeneity of this virus within the human population might originate as the representatives of naturally selected virus quasispecies. In this context, the presence of the asymptomatic individuals could be a significant concern for SARS-CoV-2 epidemiology. Further studies are required to understand its genetic evolution and epidemiological significance.


Assuntos
Betacoronavirus , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Monitoramento Epidemiológico , Europa (Continente)/epidemiologia , Saúde Global/estatística & dados numéricos , Humanos , Pandemias , Organização Mundial da Saúde
12.
Spat Spatiotemporal Epidemiol ; 34: 100354, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32807396

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered in late 2019 in Wuhan City, China. The virus may cause novel coronavirus disease 2019 (COVID-19) in symptomatic individuals. Since December of 2019, there have been over 7,000,000 confirmed cases and over 400,000 confirmed deaths worldwide. In the United States (U.S.), there have been over 2,000,000 confirmed cases and over 110,000 confirmed deaths. COVID-19 case data in the United States has been updated daily at the county level since the first case was reported in January of 2020. There currently lacks a study that showcases the novelty of daily COVID-19 surveillance using space-time cluster detection techniques. In this paper, we utilize a prospective Poisson space-time scan statistic to detect daily clusters of COVID-19 at the county level in the contiguous 48 U.S. and Washington D.C. As the pandemic progresses, we generally find an increase of smaller clusters of remarkably steady relative risk. Daily tracking of significant space-time clusters can facilitate decision-making and public health resource allocation by evaluating and visualizing the size, relative risk, and locations that are identified as COVID-19 hotspots.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Infecções por Coronavirus/diagnóstico , Bases de Dados Factuais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Modelos Estatísticos , Método de Monte Carlo , Pneumonia Viral/diagnóstico , Distribuição de Poisson , Prevalência , Estudos Prospectivos , Saúde Pública , Síndrome Respiratória Aguda Grave/diagnóstico , Conglomerados Espaço-Temporais , Estados Unidos/epidemiologia
13.
Spat Spatiotemporal Epidemiol ; 34: 100355, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32807400

RESUMO

Identifying areas with low access to testing and high case burden is necessary to understand risk and allocate resources in the COVID-19 pandemic. Using zip code level data for New York City, we analyzed testing rates, positivity rates, and proportion positive. A spatial scan statistic identified clusters of high and low testing rates, high positivity rates, and high proportion positive. Boxplots and Pearson correlations determined associations between outcomes, clusters, and contextual factors. Clusters with less testing and low proportion positive tests had higher income, education, and white population, whereas clusters with high testing rates and high proportion positive tests were disproportionately black and without health insurance. Correlations showed inverse associations of white race, education, and income with proportion positive tests, and positive associations with black race, Hispanic ethnicity, and poverty. We recommend testing and health care resources be directed to eastern Brooklyn, which has low testing and high proportion positives.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde da População Urbana/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico/estatística & dados numéricos , Análise por Conglomerados , Infecções por Coronavirus/diagnóstico , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/diagnóstico , Medição de Risco , Análise Espacial , Saúde da População Urbana/economia , População Urbana
14.
BMC Infect Dis ; 20(1): 575, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758175

RESUMO

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with the high case-fatality rate, and lack of vaccines. We aimed to systematically analysed the epidemiological characteristics, clinical signs, routine laboratory diagnosis, risk factors, and outcomes. METHODS: Documents on SFTS were collected by searching the Chinese National Knowledge Infrastructure, Wan Fang Data, PubMed, Embase, and Web of Science databases from 2011 to 2018. Meta-analysis was performed by using Review Manager and Stata software. RESULTS: Twenty-five articles involving 4143 cases were included. Diarrhea (odds ratio (OR) =1.60, 95% confidence interval (CI): 1.06 to 2.42, P = 0.02), and vomiting (OR = 1.56, 95% CI: 1.01 to 2.39, P = 0.04) on admission were associated with the fatal outcomes of SFTS. Compared to patients with mild symptoms, patients with severe symptoms had significantly elevated levels of lactic acid dehydrogenase (standard mean difference (SMD) =1.27, 95% CI: 0.59 to 1.94), alanine aminotransferase (SMD = 0.55, 95% CI: 0.24 to 0.85), aspirate aminotransferase (SMD = 1.01, 95% CI: 0.69 to 1.32), and creatine kinase (SMD = 1.04, 95% CI: 0.74 to 1.33) but had reduced platelet counts (SMD = -0.87, 95% CI: - 1.16 to - 0.58) and albumin levels (SMD = -1.00, 95% CI: - 1.32 to - 0.68). The risk factors for poor prognosis included age (mean difference (MD) =6.88, 95% CI: 5.41 to 8.35) and farming (OR = 2.01, 95% CI: 1.06 to 3.80). For the risk factors of contracting SFTS, the incidence of SFTS related to tick bites was 24% [95% CI: 0.18 to 0.31]. The pooled case-fatality rate of SFTS patients was 18% [95% CI: 0.16 to 0.21]. CONCLUSIONS: China is the country with the highest incidence of SFTS. May to July was the peak of the epidemic, and farmers were a high-risk group. The risk factor for SFTS included age (poor prognosis) and tick bites (contracting SFTS). Patients with severe diarrhea and vomiting symptoms on admission should be noted. Clinicians could use routine laboratory parameters and clinical symptoms as references for clinically suspected cases, classification of SFTS, and timely treatment, especially in basic hospitals.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Epidemias , Febre por Flebótomos/complicações , Febre por Flebótomos/epidemiologia , Phlebovirus/imunologia , Trombocitopenia/complicações , Trombocitopenia/epidemiologia , Idoso , Anticorpos Antivirais/sangue , China/epidemiologia , Doenças Transmissíveis Emergentes/sangue , Doenças Transmissíveis Emergentes/virologia , Fazendeiros , Feminino , Febre/complicações , Humanos , Incidência , Leucopenia/complicações , Masculino , Pessoa de Meia-Idade , Febre por Flebótomos/sangue , Febre por Flebótomos/virologia , Phlebovirus/isolamento & purificação , RNA Viral/sangue , Fatores de Risco , Síndrome , Trombocitopenia/virologia
15.
Proc Natl Acad Sci U S A ; 117(36): 22597-22602, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32826332

RESUMO

By March 2020, COVID-19 led to thousands of deaths and disrupted economic activity worldwide. As a result of narrow case definitions and limited capacity for testing, the number of unobserved severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during its initial invasion of the United States remains unknown. We developed an approach for estimating the number of unobserved infections based on data that are commonly available shortly after the emergence of a new infectious disease. The logic of our approach is, in essence, that there are bounds on the amount of exponential growth of new infections that can occur during the first few weeks after imported cases start appearing. Applying that logic to data on imported cases and local deaths in the United States through 12 March, we estimated that 108,689 (95% posterior predictive interval [95% PPI]: 1,023 to 14,182,310) infections occurred in the United States by this date. By comparing the model's predictions of symptomatic infections with local cases reported over time, we obtained daily estimates of the proportion of symptomatic infections detected by surveillance. This revealed that detection of symptomatic infections decreased throughout February as exponential growth of infections outpaced increases in testing. Between 24 February and 12 March, we estimated an increase in detection of symptomatic infections, which was strongly correlated (median: 0.98; 95% PPI: 0.66 to 0.98) with increases in testing. These results suggest that testing was a major limiting factor in assessing the extent of SARS-CoV-2 transmission during its initial invasion of the United States.


Assuntos
Doenças Transmissíveis Emergentes/transmissão , Infecções por Coronavirus/transmissão , Modelos Teóricos , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Infecções Comunitárias Adquiridas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública , Estados Unidos/epidemiologia
16.
Scand J Gastroenterol ; 55(9): 1049-1056, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32749177

RESUMO

BACKGROUND AND AIMS: Diarrhea was not uncommon in patients with coronavirus disease 2019 (COVID-19), but the significance remains undetermined. METHODS: This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who were admitted to Wuhan Union Hospital from January 20 to February 29, 2020. Clinical characteristics, the course and the outcome of patients with diarrhea were analyzed. The correlation between diarrhea and fecal presence of coronavirus was also determined. RESULTS: The overall morbidity of diarrhea was 27.8% (157/564) in COVID-19 patients. Among them, 38 cases presented only with diarrhea, and 119 cases in both diarrhea and respiratory symptoms. Patients with diarrhea and respiratory symptoms had higher levels of inflammatory activity, longer hospital stay (27.5 vs. 23.0 vs. 22.0 days, p = .029) and higher odds ratio of mortality (3.2 times and 2.2 times, respectively) than those with diarrhea only or respiratory symptoms only. However, patients with diarrhea had longer time from onset to admission (14.5 days vs. 11.0 days, p = .04), higher positive viral RNA in stool (80.0% vs. 52.4%, p = .016) than those with both diarrhea and respiratory symptoms. CONCLUSIONS: Diarrhea caused by high enteric viral burden may lead to long course and poor outcome in COVID-19 patients. The patients with diarrhea and respiratory symptoms were prone to serious condition, and had worse outcomes. However, the patients with diarrhea alone showed mild illness but delayed health-seeking.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Pneumonia Viral/epidemiologia , Adulto , Idoso , China/epidemiologia , Estudos de Coortes , Comorbidade , Diarreia/fisiopatologia , Diarreia/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida
17.
Cell ; 182(5): 1077-1092, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32846157

RESUMO

Infectious diseases prevalent in humans and animals are caused by pathogens that once emerged from other animal hosts. In addition to these established infections, new infectious diseases periodically emerge. In extreme cases they may cause pandemics such as COVID-19; in other cases, dead-end infections or smaller epidemics result. Established diseases may also re-emerge, for example by extending geographically or by becoming more transmissible or more pathogenic. Disease emergence reflects dynamic balances and imbalances, within complex globally distributed ecosystems comprising humans, animals, pathogens, and the environment. Understanding these variables is a necessary step in controlling future devastating disease emergences.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Doenças Transmissíveis Emergentes/transmissão , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Demografia , Meio Ambiente , Interações Hospedeiro-Patógeno , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
18.
PLoS One ; 15(8): e0237780, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845922

RESUMO

Modeling the behavior of zoonotic pandemic threats is a key component of their control. Many emerging zoonoses, such as SARS, Nipah, and Hendra, mutated from their wild type while circulating in an intermediate host population, usually a domestic species, to become more transmissible among humans, and this transmission route will only become more likely as agriculture and trade intensifies around the world. Passage through an intermediate host enables many otherwise rare diseases to become better adapted to humans, and so understanding this process with accurate mathematical models is necessary to prevent epidemics of emerging zoonoses, guide policy interventions in public health, and predict the behavior of an epidemic. In this paper, we account for a zoonotic disease mutating in an intermediate host by introducing a new mathematical model for disease transmission among three species. We present a model of these disease dynamics, including the equilibria of the system and the basic reproductive number of the pathogen, finding that in the presence of biologically realistic interspecies transmission parameters, a zoonotic disease with the capacity to mutate in an intermediate host population can establish itself in humans even if its R0 in humans is less than 1. This result and model can be used to predict the behavior of any zoonosis with an intermediate host and assist efforts to protect public health.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis Emergentes/epidemiologia , Reservatórios de Doenças/microbiologia , Modelos Biológicos , Zoonoses/epidemiologia , Animais , Animais Domésticos/microbiologia , Animais Selvagens/microbiologia , Bactérias/genética , Bactérias/patogenicidade , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Doenças Transmissíveis Emergentes/transmissão , Surtos de Doenças/prevenção & controle , Vetores de Doenças , Especificidade de Hospedeiro/genética , Humanos , Taxa de Mutação , Vírus/genética , Vírus/patogenicidade , Zoonoses/microbiologia , Zoonoses/prevenção & controle , Zoonoses/transmissão
19.
PLoS Negl Trop Dis ; 14(8): e0008338, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32790670

RESUMO

Pathogens originating from wildlife (zoonoses) pose a significant public health burden, comprising the majority of emerging infectious diseases. Efforts to control and prevent zoonotic disease have traditionally focused on animal-to-human transmission, or "spillover." However, in the modern era, increasing international mobility and commerce facilitate the spread of infected humans, nonhuman animals (hereafter animals), and their products worldwide, thereby increasing the risk that zoonoses will be introduced to new geographic areas. Imported zoonoses can potentially "spill back" to infect local wildlife-a danger magnified by urbanization and other anthropogenic pressures that increase contacts between human and wildlife populations. In this way, humans can function as vectors, dispersing zoonoses from their ancestral enzootic systems to establish reservoirs elsewhere in novel animal host populations. Once established, these enzootic cycles are largely unassailable by standard control measures and have the potential to feed human epidemics. Understanding when and why translocated zoonoses establish novel enzootic cycles requires disentangling ecologically complex and stochastic interactions between the zoonosis, the human population, and the natural ecosystem. In this Review, we address this challenge by delineating potential ecological mechanisms affecting each stage of enzootic establishment-wildlife exposure, enzootic infection, and persistence-applying existing ecological concepts from epidemiology, invasion biology, and population ecology. We ground our discussion in the neotropics, where four arthropod-borne viruses (arboviruses) of zoonotic origin-yellow fever, dengue, chikungunya, and Zika viruses-have separately been introduced into the human population. This paper is a step towards developing a framework for predicting and preventing novel enzootic cycles in the face of zoonotic translocations.


Assuntos
Infecções por Arbovirus/epidemiologia , Arbovirus , Zoonoses/epidemiologia , América , Animais , Animais Selvagens/virologia , Infecções por Arbovirus/transmissão , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/transmissão , Doenças Transmissíveis Emergentes/virologia , Ecossistema , Humanos , Mosquitos Vetores , Clima Tropical , Zoonoses/transmissão , Zoonoses/virologia
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