The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal.

OBJECTIVES: To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal. DESIGN: HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM]. METHODS: Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012-2021 averted by condom use and antiretroviral therapy (ART) uptake among key populations and non-key populations, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012-2021 due to prevention gaps, and the distribution of undiagnosed people with HIV (PWH) by risk group in January 2022 and their tPAF over 2022-2031. RESULTS: Condom use and ART may have averted 81-88% of new HIV infections over 2012-2021 across countries, mostly due to condom use by key population. The tPAF of all key populations combined over 2012-2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key populations (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key populations = 15%), 46% in Mali (male key populations = 23%), and 69% in Senegal (male key populations = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key populations living with HIV in Côte d'Ivoire over 2022-2031, 53% in Mali, and 65% in Senegal. CONCLUSION: Substantial HIV diagnosis gaps remain in Western Africa, especially among male key populations. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.

Developing respiratory pathogen pandemic preparedness plans

Planning for public health emergencies should ensure that capabilities developed during previous emergencies are maintained, incorporated, and put into practice when a new event of public health concern arises. Investments in pandemic preparedness lead to more rapid detection and a stronger response to public health threats, thereby shielding communities from the debilitating social and economic effects of epidemics and pandemics. The Pan American Health Organization (PAHO) recognizes the efforts of countries in the Region of the Americas to develop and/or strengthen their respiratory pathogen pandemic plans. PAHO supports planning activities with tools and expertise, aligning these efforts with the Preparedness and Resilience for Emerging Threats (PRET) initiative. The PRET initiative is an innovative approach to improving disease pandemic preparedness. It recognizes that the same systems, capacities, knowledge, and tools can be leveraged and applied for groups of pathogens based on their mode of transmission (respiratory, vector-borne, foodborne etc.). The PRET initiative incorporates the latest tools and approaches for shared learning and collective action established during the COVID-19 pandemic and other recent public health emergencies. It places the principles of equity, inclusivity, and coherence at the forefront. This document outlines four steps for respiratory pathogen pandemic planning (PRET Module1). Step 1: Prepare, analyze the situation and engage stakeholders, Step 2: Draft the plan, Step 3: Evaluate, finalize and disseminate the plan and Step 4: Implement, monitor and continuously evaluate the plan. The scope of this document is guide the process of updating and developing preparedness and response plans for pandemics caused by respiratory pathogens, in order to strengthen their basic capacities and encourage the countries of the Region of the Americas to have operational, proven plans, and with a regular monitoring and updating plan to address epidemics and pandemics in the face of this type of threat.

Tackling transmission of infectious diseases: A probiotic-based system as a remedy for the spread of pathogenic and resistant microbes.

Built environments (BEs) currently represent the areas in which human beings spend most of their life. Consistently, microbes populating BEs mostly derive from human occupants and can be easily transferred from BE to occupants. The hospital microbiome is a paradigmatic example, representing a reservoir for harmful pathogens that can be transmitted to susceptible patients, causing the healthcare-associated infections (HAIs). Environmental cleaning is a crucial pillar in controlling BE pathogens and preventing related infections, and chemical disinfectants have been largely used so far towards this aim. However, despite their immediate effect, chemical-based disinfection is unable to prevent recontamination, has a high environmental impact, and can select/increase antimicrobial resistance (AMR) in treated microbes. To overcome these limitations, probiotic-based sanitation (PBS) strategies were recently proposed, built on the use of detergents added with selected probiotics able to displace surrounding pathogens by competitive exclusion. PBS was reported as an effective and low-impact alternative to chemical disinfection, providing stable rebalance of the BE microbiome and significantly reducing pathogens and HAIs compared to disinfectants, without exacerbating AMR and pollution concerns. This minireview summarizes the most significant results obtained by applying PBS in sanitary and non-sanitary settings, which overall suggest that PBS may effectively tackle the infectious risk meanwhile preventing the further spread of pathogenic and resistant microbes.

Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial.

OBJECTIVE: To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya. DESIGN: Cluster randomized trial and mystery shopper evaluation. METHODS: Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or "mystery shoppers" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP. RESULTS: Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P  < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P  < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P  < 0.001). CONCLUSIONS: SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.

Risk assessment of the mechanical spread of bacterial pathogens due to Lasius neglectus ants infesting a tertiary hospital.

INTRODUCTION: Mechanical spread of microbial pathogens has been investigated in cockroaches, but less well in ants. Considerably less information is available for ants. An investigation into ant-borne mechanical pathogen transmission was triggered by an infestation of a tertiary care hospital with Lasius neglectus ants. METHODS: The L. neglectus infestation of the orthopaedic surgery department, the ear-nose-throat clinic and the eye clinic as well as of outdoor areas was monitored and correlated with seasonal and weather influences. Microbial colonization on the ants' exoskeleton as well as in homogenates of complete insects and decolonization dynamics of artificial Staphylococcus aureus colonization on the exoskeleton was assessed. RESULTS: In a low-level infestation setting, L. neglectus activity showed seasonal variations and was positively correlated with temperature (r = 0.7515; P=0.0368) but not with precipitation (r = 0.4699, P=0.2431). Colonization with environmental commensals dominated, while exoskeleton colonization with bacteria with potential aetiological relevance for nosocomial infections was higher for ants from the inpatient setting (6%) than from outdoor areas (0%). Artificial colonization of the exoskeleton with S. aureus vanished to values statistically indistinguishable from baseline within 72 h. CONCLUSIONS: Low colonization rates with aetiologically relevant bacteria and rapid spontaneous decolonization in the case of contamination make ant-borne transmissions to patients unlikely.

Retrospective genome-oriented analysis reveals low transmission rate of multidrug-resistant Pseudomonas aeruginosa from contaminated toilets at a bone marrow transplant unit.

BACKGROUND: Prevention of toilet-to-patient transmission of multidrug-resistant Pseudomonas aeruginosa (MDR PA) poses management-related challenges at many bone marrow transplant units (BMTUs). AIM: To conduct a longitudinal retrospective analysis of the toilet-to-patient transmission rate for MDR PA under existing infection control (IC) measures at a BMTU with persistent MDR PA toilet colonization. METHODS: The local IC bundle comprised: (1) patient education regarding IC; (2) routine patient screening; (3) toilet flushing volume of 9 L; (4) bromination of toilet water tanks, and (5) toilet decontamination using hydrogen peroxide. Toilet water was sampled periodically between 2016 and 2021 (minimum every three months: 26 intervals). Upon MDR PA detection, disinfection and re-sampling were repeated until ≤3 cfu/100 mL was reached. Whole-genome sequencing (WGS) was performed retrospectively on all available MDR PA isolates (90 out of 117 positive environmental samples, 10 out of 14 patients, including nine nosocomial). FINDINGS: WGS of patient isolates identified six sequence types (STs), with ST235/CT1352/FIM-1 and ST309/CT3049/no-carbapenemase being predominant (three isolates each). Environmental sampling consistently identified MDR PA ST235 (65.5% ST235/CT1352/FIM-1), showing low genetic diversity (difference of ≤29 alleles by core-genome multi-locus sequence typing (cgMLST)). This indicates that direct toilet-to-patient transmission was infrequent although MDR PA was widespread (detection on 79 occasions, detection in every toilet). Only three MDR PA patient isolates can be attributed to the ST235/CT1352/FIM-1 toilet MRD PA population over six years. CONCLUSION: Stringent targeted toilet disinfection can reduce the potential risk for MDR PA acquisition by patients.

Including transgender populations in mathematical models for HIV treatment and prevention: current barriers and policy implications.

INTRODUCTION: Mathematical models of HIV have been uniquely important in directing and evaluating HIV policy. Transgender and nonbinary people are disproportionately impacted by HIV; however, few mathematical models of HIV transmission have been published that are inclusive of transgender and nonbinary populations. This commentary discusses current structural challenges to developing robust and accurate trans-inclusive models and identifies opportunities for future research and policy, with a focus on examples from the United States. DISCUSSION: As of April 2024, only seven published mathematical models of HIV transmission include transgender people. Existing models have several notable limitations and biases that limit their utility for informing public health intervention. Notably, no models include transgender men or nonbinary individuals, despite these populations being disproportionately impacted by HIV relative to cisgender populations. In addition, existing mathematical models of HIV transmission do not accurately represent the sexual network of transgender people. Data availability and quality remain a significant barrier to the development of accurate trans-inclusive mathematical models of HIV. Using a community-engaged approach, we developed a modelling framework that addresses the limitations of existing model and to highlight how data availability and quality limit the utility of mathematical models for transgender populations. CONCLUSIONS: Modelling is an important tool for HIV prevention planning and a key step towards informing public health interventions, programming and policies for transgender populations. Our modelling framework underscores the importance of accurate trans-inclusive data collection methodologies, since the relevance of these analyses for informing public health decision-making is strongly dependent on the validity of the model parameterization and calibration targets. Adopting gender-inclusive and gender-specific approaches starting from the development and data collection stages of research can provide insights into how interventions, programming and policies can distinguish unique health needs across all gender groups. Moreover, in light of the data structure limitations, designing longitudinal surveillance data systems and probability samples will be critical to fill key research gaps, highlight progress and provide additional rigour to the current evidence. Investments and initiatives like Ending the HIV Epidemic in the United States can be further expanded and are highly needed to prioritize and value transgender populations across funding structures, goals and outcome measures.

Orientações sobre o uso de vacinas contra a varíola símia. Edição corrigida

A erradicação da varíola humana (mpox em inglês) foi certificada em 1980. A varíola símia (mpox em inglês) é endêmica nos países da África Central e Ocidental desde a sua primeira detecção, em 1958. Trata-se de uma zoonose cujos casos geralmente ocorrem perto de florestas tropicais, onde diversos animais são portadores do ortopoxvírus causador da doença. A maioria das infecções em seres humanos pelo vírus da varíola símia em países onde a doença é endêmica é resultado de transmissão primária de animais para humanos. A transmissão de pessoa a pessoa pode ocorrer por meio de contato próximo com secreções respiratórias ou lesões cutâneas de uma pessoa infectada ou com objetos recém-contaminados. A transmissão também pode ocorrer através da placenta da mãe para o feto ou por contato direto durante ou após o parto. Até 21 de maio de 2022, 12 países onde não há varíola símia endêmica, em 2 regiões da Organização Mundial da Saúde (OMS), haviam notificado 92 casos confirmados da doença. Até 26 de agosto de 2022, 96 países sem endemicidade, de todas as 6 regiões da OMS, haviam notificado 45.198 casos confirmados de varíola símia, incluindo 6 óbitos. No mesmo período, os países onde a doença é endêmica notificaram 350 casos confirmados e 6 óbitos. Na Região das Américas, 29 países e territórios notificaram 23.479 (48%) casos confirmados e 3 óbitos. Diversos estudos observacionais sobre as vacinas de primeira geração demonstraram que a eficácia da vacinação contra a varíola humana na prevenção da varíola símia é de aproximadamente 85%. Atualmente, as vacinas originais (de primeira geração) contra a varíola humana não estão mais disponíveis.

Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa.

OBJECTIVE: We developed the Healthy Families-PrEP intervention to support HIV-prevention during periconception and pregnancy. We evaluated preexposure prophylaxis (PrEP) use with three objective measures. DESIGN: This single-arm intervention study enrolled women in KwaZulu-Natal, South Africa, who were HIV-uninfected, not pregnant, in a relationship with a partner with HIV or unknown-serostatus, and with pregnancy plans. PrEP was offered as part of a comprehensive HIV prevention intervention. Participants were followed for 12 months. METHODS: We evaluated periconception PrEP uptake and adherence using quarterly plasma tenofovir concentrations. We modeled factors associated with PrEP uptake and high plasma tenofovir (past day dosing). Patterns of use were analyzed using electronic pillcap data. Dried blood spots to measure intracellular tenofovir product (past 2 months dosing) were analyzed for a subset of women. RESULTS: Three hundred thirty women with median age 24 (IQR: 22-27) years enrolled. Partner HIV-serostatus was unknown by 96% ( N  = 316); 60% (195) initiated PrEP. High plasma tenofovir concentrations were seen in 35, 25, 22, and 20% of samples at 3, 6, 9, and 12 months, respectively. Similar adherence was measured by pillcap and dried blood spots. In adjusted models, lower income, alcohol use, and higher HIV stigma were associated with high plasma tenofovir. Eleven HIV-seroconversions were observed (incidence rate: 4.04/100 person-years [95% confidence interval: 2.24-7.30]). None had detectable plasma tenofovir. CONCLUSION: The Healthy Families-PrEP intervention supported women in PrEP use. We observed high interest in periconception PrEP and over one-third adhered to PrEP in the first quarter; one-fifth were adherent over a year. High HIV incidence highlights the importance of strategies to reduce HIV incidence among periconception women. CLINICAL TRIAL NUMBER: NCT03194308.

The relationship between anti-LGBTQ+ legislation and HIV prevention among sexual and gender minoritized youth.

OBJECTIVE: The aim of this study was to estimate the longitudinal associations of state-level anti-LGBTQ+ policies and county-level politics with individual HIV prevention outcomes among sexual and gender minoritized (SGM) youth. DESIGN: Keeping it LITE-1 prospectively enrolled 3330 SGM youth and young adults (ages 13-34) at increased risk of HIV throughout the United States from 2017 to 2022. METHODS: Semiannual surveys collected self-reported HIV prevention measures [current preexposure prophylaxis (PrEP) use, weekly PrEP adherence, HIV/STI testing in the past 6 months]. Geolocation was linked with state-level LGBTQ+ policy data and county-level election data. Generalized linear models with GEE estimated the single and joint longitudinal associations for two exposures [state-level policy climate (more discriminatory vs. less discriminatory) and county-level political majority (Democratic/swing vs. Republican)] with each outcome. RESULTS: Among participants living in a state with more discriminatory laws, those in a Democratic/swing county had a 6-percentage point increase in PrEP use (95% confidence interval: 0.02, 0.09) compared to those in a Republican county. Those living in a Republican county but a state with less discriminatory laws saw a similar increase (0.05; -0.02,0.11). Residing in both a Democratic/swing county and a state with less discriminatory laws, relative to a Republican county and a state with more discriminatory laws, was associated with a 10-percentage point increase in PrEP use (0.10; 0.06,0.14) and a 5-percentage point increase in HIV/STI testing (0.05; 0.00,0.09). CONCLUSION: More progressive state and local policies were each associated with increased PrEP use, and together, doubled the magnitude of this association. PrEP is underutilized among SGM youth, and anti-LGBTQ+ policies may exacerbate this gap in coverage.

Epidemiological profile of individuals with HIV/Aids in a municipality in Maranhão State, Brazil, from 2017 to 2020 / Perfil epidemiológico de individuos con VIH/SIDA en municipio en Maranhão, Brasil, de 2017 a 2020 / Perfil epidemiológico de indivíduos com HIV/Aids em município no Maranhão, Brasil, de 2017 a 2020

Background and Objective: To understand the main forms of transmission of HIV in order to foster the containment of the transmission chain, early diagnosis and the epidemiological profile of patients. In this sense, it will enable the analysis of the epidemiological profile and the transmissibility variables of patients with HIV/Aids from the municipality of Imperatriz-MA.. Method: This is an observational cross-sectional study. Data collection was performed from the analysis of patients' records registered in the Center for Testing and Counseling (CTA) from 2017 to 2020. For data collection, a questionnaire with transmission variables and epidemiological characteristics of patients was used. Results: From January 2017 to December 2020, 211 medical records were filed. Of these, 71.6% were male, 55.5% of the participants were between 21 and 40 years, and 66.4% from Imperatriz-MA. The most prevalent type of exposure was sexual intercourse without a condom. Among the participants, 83.9% (n=177) were positive only for HIV. About 140 people with HIV had an undetectable viral load (VL) (< 50 copies/ml) after 6 months of using antiretroviral therapy, making it low transmissibility. Conclusion: The study was able to characterize the epidemiological profile of patients from the Specialized Assistance Service (SAE) in Imperatriz between 2017 and 2020. Despite the increase in the number of cases among women, the most affected public remains young men, from 21 to 40 years of age, with 8 to 11 years of education, single and brown. Sexual intercourse without a condom is the main type of exposure.(AU)

Justificación y Objetivo: Buscando proporcionar a la contención de la cadena de transmisión del VIH, el diagnóstico precoz y el perfil epidemiológico de los pacientes para conocer las principales formas de transmisión del VIH. En este sentido, el estudio tiene como objetivo analizar el perfil epidemiológico y las variables de transmisibilidad de los usuarios con VIH/sida del municipio de Imperatriz-MA. Método: Se trata de un estudio observacional de carácter transversal, la recolección de datos fue realizada a partir del análisis de registros de usuarios registrados en el CTA en el período de 2017 a 2020. Para la recolección de datos, se utilizó un cuestionario con variables de transmisión y características epidemiológicas de los pacientes. Resultados: Se registraron 211 registros y enero de 2017 a diciembre de 2020. De estos, 71,6% del sexo masculino, 55,5% de los participantes tenían entre 21 y 40 años y 66,4% de Imperatriz - MA. El tipo de exposición más prevalente fue la relación sexual sin condón. Entre los participantes, 83,9% (n=177) fueron positivos solo para el VIH. Cerca de 140 personas con VIH tenían carga viral indetectable (< 50 copias/ml) después de 6 meses usando terapia antirretroviral, haciéndola de baja transmisibilidad. Conclusión: El público más afectado sigue siendo hombres jóvenes, de 21 a 40 años, con 8 a 11 años de educación, solteros y de piel morena. Las relaciones sexuales sin preservativo son el principal tipo de exposición.(AU)

Justificativa e Objetivo: Conhecer as principais formas de transmissão do HIV para proporcionar a contenção da cadeia de transmissão do HIV, o diagnóstico precoce e o perfil epidemiológico dos pacientes. Nesse sentido, será possível analisar o perfil epidemiológico e as variáveis de transmissibilidade dos usuários com HIV/Aids do município de Imperatriz-MA. Métodos: Trata-se de um estudo observacional de caráter transversal. A coleta de dados foi realizada a partir da análise de registros de usuários cadastrados no CTA no período de 2017 a 2020. Para a coleta de dados, utilizou-se um questionário com variáveis de transmissão e características epidemiológicas dos pacientes. Resultados: Foram registrados 211 prontuários de janeiro de 2017 a dezembro de 2020. Destes, 71,6% do sexo masculino, 55,5% dos participantes tinham entre 21 e 40 anos e 66,4% de Imperatriz-MA. O tipo de exposição mais prevalente foi a relação sexual sem preservativo. Entre os participantes, 83,9% (n=177) foram positivos apenas para HIV. Cerca de 140 pessoas com HIV tinham carga viral indetectável (< 50 cópias/ml) após 6 meses usando terapia antirretroviral, tornando-a de baixa transmissibilidade. Conclusões: O estudo conseguiu caracterizar o perfil epidemiológico dos usuários de SAE em Imperatriz entre 2017 e 2020. Apesar do aumento no número de casos em mulheres, o público mais afetado continua sendo homens jovens, de 21 a 40 anos, com 8 a 11 anos de educação, solteiros e pardos. A relação sexual sem preservativo é o principal tipo de exposição.(AU)

Quantifying the contribution of smear-negative, culture-positive pulmonary tuberculosis to nosocomial transmission.

BACKGROUND: Despite current guidelines for tuberculosis (TB) control in health care settings, which focused on smear-positive cases, prevention of nosocomial TB transmission continues to be a challenge. Here, we report the results of the first hospital-wide prospective study applying interferon-gamma release assay to investigate the role of smear-negative, culture-positive index cases in nosocomial TB transmission. METHODS: We prospectively identified cases of culture-confirmed smear-negative pulmonary TB receiving aerosol-generating procedures (AGPs) and cases of culture-confirmed smear-positive pulmonary TB admitted at a medical center. Nosocomial transmission was evaluated by screening their close contacts for latent TB infection (LTBI) using an interferon-gamma release assay. RESULTS: A total of 93 smear-negative index receiving AGP and 122 smear-positive index were enrolled. Among them, 13 (14.0%) and 43 (35.2%) index cases, respectively, had secondary cases of LTBI (P < .001). Sputum smear negativity (adjusted odds ratio: 0.20 [0.08-0.48]) and AGP (sputum suction; adjusted odds ratio: 3.48 [1.34-9.05]) are independent factors of transmission. A similar proportion in the close contacts of the 2 index groups had LTBI (17 [15.3%] and 63 [16.0%], respectively), and the former index group contributed to 21.3% of the nosocomial transmission. CONCLUSIONS: Smear-negative, culture-positive index cases receiving AGPs could be as infectious as smear-positive index cases. Hospital TB control policy should also focus on the former group.

Inference of Infectious Disease Transmission through a Relaxed Bottleneck Using Multiple Genomes Per Host.

In recent times, pathogen genome sequencing has become increasingly used to investigate infectious disease outbreaks. When genomic data is sampled densely enough amongst infected individuals, it can help resolve who infected whom. However, transmission analysis cannot rely solely on a phylogeny of the genomes but must account for the within-host evolution of the pathogen, which blurs the relationship between phylogenetic and transmission trees. When only a single genome is sampled for each host, the uncertainty about who infected whom can be quite high. Consequently, transmission analysis based on multiple genomes of the same pathogen per host has a clear potential for delivering more precise results, even though it is more laborious to achieve. Here, we present a new methodology that can use any number of genomes sampled from a set of individuals to reconstruct their transmission network. Furthermore, we remove the need for the assumption of a complete transmission bottleneck. We use simulated data to show that our method becomes more accurate as more genomes per host are provided, and that it can infer key infectious disease parameters such as the size of the transmission bottleneck, within-host growth rate, basic reproduction number, and sampling fraction. We demonstrate the usefulness of our method in applications to real datasets from an outbreak of Pseudomonas aeruginosa amongst cystic fibrosis patients and a nosocomial outbreak of Klebsiella pneumoniae.

Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study.

BACKGROUND: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. OBJECTIVE: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. METHODS: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. RESULTS: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74). CONCLUSIONS: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.

Principais motivos de descarte de córneas para transplante na Paraíba: por que o anti-HBc merece atenção?* / Main reasons for discarding corneas for transplant in Paraíba: why does anti-HBc deserve attention?*

RESUMO Objetivo: Identificar o perfil dos doadores de tecidos oculares humanos na área de atuação do Banco de Olhos da Paraíba, destacando o impacto da sorologia positiva para hepatite B no descarte dos tecidos para transplante. Métodos: O estudo é transversal e utilizou dados do Banco de Olhos da Paraíba entre janeiro de 2013 e dezembro de 2022. Dados sobre procedência, idade, sexo, causa do óbito, tempo entre óbito e enucleação, resultados sorológicos e motivo de descarte das córneas dos doadores foram coletados. Resultados: O maior motivo de descarte foi por sorologia positiva (56,5%), sendo positivadas as sorologias positivas para hepatite B e HBsAg em 11,1% e 4,75% dos pacientes, respectivamente. Conclusão: A sorologia positiva para hepatite B como um critério de descarte absoluto é responsável por grande parcela de descartes, apesar da pouca informação sobre suas repercussões e representação de infectividade nos receptores do transplante.

ABSTRACT Objective: To identify the profile of human ocular tissue donors in the area covered by the Eye Bank of Paraíba (PB), highlighting the impact of positive serology for hepatitis B (anti-HBc) in the disposal of tissues for transplantation. Methods: This is a cross-sectional that uses data from the Eye Bank of Paraíba (PB) between January 2013 and December 2022. Data on origin, age, sex, cause of death, time between death and enucleation, serological results, and reason for discarded donor corneas were collected. Results: The main reason for discarding was due to positive serology (56.5%), with positive anti-HBc and HBsAg serology in 11.1% and 4.75% of patients, respectively. Conclusion: Anti-HBc positive serology as an absolute disposal criterion is responsible for great part of disposals, despite little information about its repercussions and representation of infectivity in transplant recipients.

CREAS e covid-19: desafios e perspectivas da psicologia no Norte de Minas / CREAS and covid-19: challenges and perspectives for Northern Minas Gerais psychology / CREAS y covid-19: desafíos y perspectivas de la psicología en el Norte de Minas

Este artigo analisa os desafios e estratégias de atuação de psicólogas(os) nos Centros de Referência Especializados de Assistência Social (CREAS) do norte de Minas Gerais durante a pandemia de covid-19. Trata-se de um estudo descritivo, quanti-qualitativo, de corte transversal e com análise de conteúdo e estatística para a interpretação de dados primários e meio de questionário eletrônico, emergiram os seguintes eixos temáticos: (a) Perfil sociodemográfico das(os) trabalhadoras(es); (b) Medidas de prevenção à contaminação para quem? Impactos da pandemia na práxis da psicologia no CREAS; (c) Chegada das demandas no CREAS; e (d) Tenuidade entre as potencialidades e vicissitudes do uso das tecnologias digitais. Observou-se que a inserção das(os) trabalhadoras(es) nos CREAS é marcada por contratos temporários, altas jornadas de trabalho e baixa remuneração. Além disso, com a pandemia de covid-19, têm enfrentado obstáculos como a falta de equipamentos de proteção individual (EPI) e de prevenção ao vírus. A chegada de demandas aos CREAS também foi afetada pela pandemia, como apontam as análises estatísticas dos registros mensais de atendimento dos municípios. As tecnologias digitais se configuraram como a principal estratégia adotada no ambiente de trabalho dos CREAS. Conclui-se que, se por um lado, a pandemia engendrou e acentuou obstáculos para a práxis da psicologia; por outro, a imprevisibilidade desse cenário e a potência da psicologia norte-mineira possibilitaram diversas estratégias para assistir os usuários.(AU)

This article analyses the challenges and strategies over the psychologists activity at the Specialized Reference Centers for Social Assistance (CREAS), from the north of the state of Minas Gerais during the COVID-19 pandemic. It is a descriptive, quantitative-qualitative study on content and statistics analysis for interpretation of primary and secondary data, with 19 psychologists participating. From interviews made with electronic questionnaires, the following theatrical axes emerged: (a) Social demographic profile of workers; (b) Prevention measures over contamination directed to which public? The impacts of the pandemic over the practice of psychology at CREAS; (c) Demand reception at CREAS; and (d) Tenuity between potentialities and vicissitudes of the use of digital technologies. The workers insertion at CREAS is notably marked by transitory working contracts, long labor journeys, and low wages. Furthermore, the COVID-19 pandemic is causing hindrances such as the lack of personal protection equipment (PPE) and virus prevention. The demands received by CREAS were also affected by the pandemic, as shown in the statistics analysis from monthly county treatment records. The digital technologies were the main strategy enforced by the working environment at CREAS. In conclusion, if on the one hand, the pandemic produced and increased obstacles for the practice of Psychology, on the other hand, the unpredictability of this scenery and the capacity of the psychology of the north of Minas Gerais enabled diverse strategies to attend the users.(AU)

Este artículo analiza los desafíos y las estrategias en la actuación de psicólogas(os) en los Centros de Referencia Especializados de Asistencia Social (CREAS) del norte de Minas Gerais (Brasil) durante la pandemia de la COVID-19. Se trata de un estudio descriptivo, cualicuantitativo, de cohorte transversal, con análisis de contenido y estadísticas para la interpretación de datos primarios y secundarios, en el cual participaron 19 psicólogas(os). De las entrevistas en un cuestionario electrónico surgieron los siguientes ejes temáticos: (a) perfil sociodemográfico de los(as) trabajadores(as); (b) medidas de prevención de la contaminación ¿para quién? Impactos de la pandemia en la praxis de la psicología en CREAS; (c) la llegada de demandas a CREAS y; (d) la tenuidad entre las potencialidades y vicisitudes del uso de tecnologías digitales. Se observó que la inserción de las(os) trabajadoras(es) en el CREAS está marcada por contratos laborales temporales, largas jornadas y baja remuneración. Además, con la pandemia de la COVID-19, se han enfrentado a obstáculos como la falta de equipo de protección personal (EPP) y prevención del virus. La llegada de demandas al CREAS también se vio afectada por la pandemia, como lo demuestran los análisis estadísticos de los registros mensuales de atención de los municipios. Las tecnologías digitales se han convertido en la principal estrategia adoptada en el entorno laboral de los CREAS. Se concluye que si, por un lado, la pandemia engendró y acentuó obstáculos a la praxis de la Psicología, por otro, la imprevisibilidad de este escenario y el poder de la Psicología en el norte de Minas Gerais posibilitaron varias estrategias para asistir a los usuarios.(AU)

Guidance on the use of mpox vaccines. Revised edition

On 23 July 2022, the WHO Director-General declared the mpox outbreak a public health emergency of international concern (PHEIC). A coordinated response was launched, aimed at interrupting transmission and protecting vulnerable groups, and a number of recommendations were made, including vaccination. These temporary recommendations apply to different groups of countries, based on their epidemiological situation, patterns of transmission, and capacities. These recommendations include different aspects such as: the implementation of a coordinated response, community engagement and protection, surveillance and public health measures, clinical management, and infection control, among others. WHO recommends use of the vaccine for countries that have imported cases of mpox in the population and/or human-to-human transmission of monkeypox virus, including in key population groups and communities at high risk of exposure. The overall goal of the global response to mpox as a PHEIC, is to stop human-to-human transmission and minimize zoonotic transmission of the monkeypox virus wherever it occurs. The use of vaccines can contribute to this response. However, vaccination should be considered a measure to complement primary public health interventions that include surveillance, early case detection, diagnosis and care, isolation and contact tracing and follow-up, and self-monitoring to reduce contacts. This document aims to provide useful accessible, and understandable information about mpox vaccines in order to facilitate deployment of vaccination strategies in the context of the current epidemiological scenario and based on the recommendations of the VIII Ad Hoc Meeting of the PAHO Technical Advisory Group (TAG) on Vaccine-Preventable Diseases.

Emergence and control of an outbreak of PVL-positive MRSA in a UK-based maternity setting.

This paper aims to describe the investigation and control of an outbreak of USA300 ST8 Panton-Valentine leucocidin (PVL)-positive meticillin-resistant Staphylococcus aureus (MRSA), confirmed by whole genome sequencing (WGS), within a maternity and neonatal setting in the UK. The identification of two linked PVL-MRSA cases led to an outbreak investigation. A lookback exercise conducted using the infection control surveillance database, typing of saved MRSA isolates, enhanced patient screening, and staff screening were used to identify further cases. Environmental screening was also performed. Genetic relatedness between isolates was assessed by WGS. During the outbreak, 18 cases were identified between 11th July 2021 and 22nd December 2022: 10 cases were infections and eight cases were colonizations. A healthcare worker (HCW) tested positive for colonization with the same strain, and environmental swabbing identified contaminated information technology equipment in the hospital. The outbreak was brought to an end by exclusion of the colonized HCW from work, and infection prevention and control measures. Since the end of the outbreak, cases of PVL-MRSA with similar molecular profiles have been found in the community. It is likely that the HCW played a role in the transmission of PVL-MRSA. Their exclusion from work and decolonization were key to preventing further cases. WGS was valuable in identifying and linking cases. The identification of community cases of PVL-MRSA with similar molecular profiles confirms transmission of the organism outside of healthcare settings.