Score: 57.4, Published: 2024-02-11
DOI: 10.1101/2024.02.09.24302575
Climate change impacts on zoonotic/vector-borne diseases pose significant threats to humanity1 but these links are, in general, poorly understood2. Here, we project present and future geographical risk patterns for 141 infectious agents to understand likely climate change impacts, by integrating ecological models of infection hazard (climate-driven host/vector distributions and dispersal3,4) with exposure (human populations) and vulnerability (poverty prevalence). Projections until 2050, under a medium climate change (Representative Concentration Pathway (RCP) 4.5), show a 9.6% mean increase in endemic area size for zoonotic/vector-borne diseases globally (n=101), with expansions common across continents and priority pathogen groups. Range shifts of host and vector animal species appear to drive higher disease risk for many areas near the poles by 2050 and beyond. Projections using lower climate change scenarios (RCP 2.6 & 4.5) indicated similar or slightly worse future population exposure trends than higher scenarios (RCP 6.0 & 8.5), possibly due to host and vector species being unable to track faster climatic changes. Socioeconomic development trajectories, Shared Socioeconomic Pathways (SSPs), mediate future risk through a combination of climate and demographic change, which will disrupt current, regional patterns of disease burden. Overall, our study suggests that climate change will likely exacerbate global animal-borne disease risk, emphasising the need to consider climate change as a health threat. One Sentence SummaryClimate change and socio-economic development dictate future geographical areas at risk of zoonotic and vector-borne diseases.
Score: 12.0, Published: 2024-02-03
DOI: 10.1101/2024.02.02.24302216
IntroductionAmong adults who test positive for COVID-19, some develop long COVID (symptoms lasting [≥]3 months), and some do not. We compared 3 groups on selected measures to help determine strategies to reduce COVID impact. MethodsUsing Stata and data for 385,617 adults from the 2022 Behavioral Risk Factor Surveillance System, we compared adults reporting long COVID, those with just a positive test, and those who never tested positive, on several health status and risk factor measures plus vaccination rates (data for 178,949 adults in 29 states). ResultsPrevalence of just COVID was 26.5% (95% CI 26.2-26.8) and long COVID was 7.4% (7.3-7.6). Compared with adults with just COVID those with long COVID had worse rates for 13 of 17 measures of chronic disease, disability, and poor health status, while those with just COVID had the best results for 15 of the 17 measures among all 3 groups. The 5 risk factors (obesity, diabetes, asthma, cardiovascular disease, and COPD) previously associated with COVID deaths, increased long COVID but not just COVID rates, which were highest among younger and higher income adults. Adults with long COVID had the highest rate among the 3 groups for any COVID risk factors and data from 29 states showed they had the lowest rates for [≥]3 vaccine doses of 35.6%, vs. 42.7% and 50.3% for those with just a positive test, and neither, respectively. Vaccination with [≥]3 vaccines vs. <3 reduced long COVID rates by 38%, and just COVID rates by 16%. ConclusionsResults show the seriousness of long COVID vs. just a positive test and that increasing vaccine coverage by targeting adults with risk factors shows promise for reducing COVID impact.
Score: 1.5, Published: 2024-02-13
DOI: 10.1101/2024.02.12.24302698
Using longitudinal health records from 45.7 million adults in England followed for a year, our study compared the incidence of thrombotic and cardiovascular complications after first, second and booster doses of brands and combinations of COVID-19 vaccines used during the first two years of the UK vaccination program with the incidence before or without the corresponding vaccination. The incidence of common arterial thrombotic events (mainly acute myocardial infarction and ischaemic stroke) was generally lower after each vaccine dose, brand and combination. Similarly, the incidence of common venous thrombotic events, (mainly pulmonary embolism and lower limb deep venous thrombosis) was lower after vaccination. There was a higher incidence of previously reported rare harms after vaccination: vaccine-induced thrombotic thrombocytopenia after first ChAdOx1 vaccination, and myocarditis and pericarditis after first, second and transiently after booster mRNA vaccination (BNT-162b2 and mRNA- 1273) These findings support the wide uptake of future COVID-19 vaccination programs.
Score: 1.4, Published: 2024-02-14
DOI: 10.1101/2024.02.13.24302770
BackgroundPneumonia is the second leading cause of hospital admissions and deaths among children <5 years old in Uganda. In 2013, Uganda adopted various interventions to protect, prevent, and improve the treatment of pneumonia under the Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea (GAPPD), including the introduction of the pneumococcal conjugate vaccine (PCV) into routine immunization schedule. However, little is known about the impact of these interventions on pneumonia admissions and deaths. We described the trends and spatial distribution of pneumonia hospital admissions and mortality among children <5 years in Uganda, 2013-2021. MethodsWe analysed secondary data on pneumonia admissions and deaths from the District Health Information System version 2 during 2013-2021. Reporting rates were calculated as the percentage of expected complete monthly health facility reports submitted to the national surveillance database. The proportion of pneumonia cases admitted and case-fatality rates (CFRs) for children <5 years were calculated for children <5 years presenting at the outpatient department. At national, regional, and district levels, pneumonia mortality rates were calculated per 100,000 children <5 years. The Mann-Kendall Test was used to assess trend significance. ResultsThere were 753,978 pneumonia admissions and 13,632 (2%) deaths during 2013-2021. Reporting rates ranged from 78-92%. The overall proportion of pneumonia cases admitted among children <5 years was 23%. The overall CFR was 0.41%, and the overall pneumonia mortality rate among children <5 years was 21 deaths per 100,000. From 2013 to 2021, there were declines in the proportion of pneumonia cases admitted (33% to 15%; p=0.051), mortality rates (26/100,000 to 13 per 100,000; p=0.01), and CFR (0.61% to 0.24%; p=0.01), concomitant with increasing PCV coverage. Kotido District had a persistently high proportion of pneumonia cases that were admitted (>30%) every year while Kasese District had persistently high mortality rates (68-150 deaths per 100,000 children <5 years). ConclusionPneumonia admissions, mortality, and case fatality among children <5 years declined during 2013-2021 in Uganda after the introduction of PCV. However, with these trends it is unlikely that Uganda will meet the 2025 GAPPD targets. There is therefore a need to review implementation of existing interventions, identify gaps in order to highlight priority actions to further accelerate declines.
Score: 1.2, Published: 2024-02-12
DOI: 10.1101/2024.02.10.24302357
BackgroundThe paucity of data on the epidemiology of bloodstream infection (BSI) in Low-and middle-income countries (LMICs) countries hampers its effective prevention and management. This review sought to provide the current prevalence, bacteriological and antimicrobial resistance profiles of bacteria implicated in BSI in Cameroon. MethodsPubMed and Google Scholar databases were searched to identify relevant articles and screened according to the PRISMA guidelines. Data was analysed using comprehensive meta-analysis software. The I2 was used to evaluate heterogeneity between studies, funnel plot and Eggers test to evaluate publication bias and random-effects analysis models to calculate pooled prevalence. ResultsThe 10 eligible studies were carried out in only two of the 10 regions of Cameroon and investigated 4,223 participants, of whom 920 were children under two years old. The overall pooled prevalence of bacterial BSI was 26.36% (95%CI= 17.51%-37.64%). Klebsiella spp. (28.20%; 95%CI= 2.80%-63.60%), Escherichia coli (18.94%; 95%CI= 13.02%-26.72%) and Staphylococcus aureus (14.40%; 95%CI= 8.31%-23.81%) were the most incriminated bacteria species. E. coli and Klebsiella spp. displayed the highest resistance to amoxicillin (82.6%; 95%CI= 63.3%-92.9 vs 86.4%; 95%CI= 55.9%-97.0%), amoxicillin + clavulanic acid (71.7%; 95%CI= 0.44%-89.2% vs 73.1%; 95%CI= 38.7%-92.1%) and trimethoprim/sulfamethoxazole (76.2%; 95%CI= 51.3%-90.7% vs 69.5%; 95%CI= 52.3-82.6%) respectively. However, meropenem (26.7%; 95%CI= 20.8%-33.7%) and fosfomycin (14.9%; 95%CI= 9.1%-23.4%) were the least resistant in E. coli and Klebsiella spp. respectively. Staphylococcus aureus showed high resistance to penicillin (84.4%; 95%CI= 68.1%-93.2%), erythromycin (41.5%; 95%CI= 28.0%-56.5%) and oxacillin (37.4%; 95%CI= 8.8%-78.7%) and low resistance to rifampicin (2.9%; 95%CI= 0.6%-13.4%), fusidic acid (8.1%; 95%CI= 3.4%-18.0%) and vancomycin (13.6%; 95%CI= 2.2%-52.9%). ConclusionThis study reports a high prevalence of bacterial BSIs in Cameroon and the high resistance of these bacteria to common antibiotics. There is a pressing need to conduct BSI surveillance studies in all regions of Cameroon to generate data for evidence-based measures regarding BSI prevention and management.
Score: 1.0, Published: 2024-02-13
DOI: 10.1101/2024.02.12.24302727
Mold infestations in buildings pose significant challenges to human health, affecting both private residences and hospitals. While molds commonly trigger asthma and allergies in the immunocompetent, they can cause life-threatening diseases in the immunocompromised. Currently, there is an unmet need for new strategies to reduce or prevent mold infestations. Far-UVC technology can inactivate microorganisms while remaining safe for humans. This study investigates the inhibitory efficacy of far-UVC light at 222 nm on the growth of common mold-producing fungi, specifically Penicillium candidum, when delivered in low-dose on-off duty cycles, a configuration consistent with its use in real-world settings. The inhibitory effect of the low-dose duty cycles was assessed on growth induced by i) an adjacent spore-producing P. candidum donor and ii) P. candidum spores seeded directly onto agar plates. In both setups, the far-UVC light significantly inhibited both vertical and horizontal growth of P. candidum, even when the UV doses were below the Threshold Value Limit of 23 mJ/cm2. These results suggest that far-UVC light holds the potential to improve indoor air quality by reducing or preventing mold growth, also when people are present.
Score: 1.2, Published: 2024-02-08
DOI: 10.1101/2024.02.07.24302447
IntroductionDesigning policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a countrys epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. Materials and methodsThe OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. ResultsWe developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. ConclusionsThe OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.
Score: 28.4, Published: 2024-01-26
DOI: 10.1101/2024.01.24.24301676
Active monitoring of health outcomes after COVID-19 vaccination provides early detection of rare outcomes post-licensure. ObjectiveTo evaluate health outcomes following bivalent COVID-19 Pfizer-BioNTech (BNT162b2) and Moderna (mRNA-1273.222) vaccination among individuals 6 months and older in the United States. DesignMonthly monitoring of health outcomes from August 2022 to July 2023 in four administrative claims databases. Descriptive analyses monitored vaccine uptake, outcome counts and coadministration of bivalent COVID-19 and influenza vaccines. Sequential analyses tested for elevated risk of each outcome in a prespecified post-vaccination risk interval, or a period of hypothesized elevation based on clinical guidance, compared to a historical baseline. Participants and ExposuresPersons 6 months and older who received a bivalent COVID-19 BNT162b2 or mRNA-1273.222 vaccine during the study period, with continuous enrollment in a medical insurance plan from the start of an outcome-specific clean interval to the COVID-19 vaccination date. Vaccines were identified using product-specific codes from medical coding systems. Health OutcomesTwenty outcomes were monitored in BNT162b2 vaccine recipients 6 months-4 years, and mRNA-1273.222 vaccine recipients 6 months-5 years. Twenty-one outcomes were monitored in BNT162b2 vaccine recipients 5-17 years and mRNA-1273.222 vaccine recipients 6-17 years. Eighteen outcomes were monitored in persons 18 years and older for both mRNA vaccines. ResultsOverall, 13.9 million individuals 6 months and older received a single bivalent COVID-19 mRNA vaccine. The statistical threshold for a signal was met for two outcomes in one database: anaphylaxis following bivalent BNT162b2 and mRNA-1273.222 vaccines in persons 18-64 years and myocarditis/pericarditis following bivalent BNT162b2 vaccines in individuals 18-35 years. There were no signals identified in young children. ConclusionsResults were consistent with prior observations from published studies on COVID-19 vaccine safety. This study supports the safety profile of bivalent COVID-19 mRNA vaccines and the conclusion that the benefits of vaccination outweigh the risks.