French national survey of dog and cat owners on the deworming behaviour and lifestyle of pets associated with the risk of endoparasites

Abstract Background Endoparasites in dogs and cats are a concern related to pet health and zoonotic risks. Several determinants may affect the endoparasite transmission and infection of dogs and cats such as pet’s lifestyle or regional parasite distribution. Although different zoonotic endoparasites, such as Toxocara spp. and Echinococcus spp., have been identified in France, little information exists about the deworming behaviors of owners or the frequency of occurrence of risk factors associated with endoparasite infection or transmission. Deworming guidelines, such as those created by the European Scientific Counsel Companion Animal Parasites (ESCCAP), recommend a deworming frequency according to the risk of infection of every pet and the potential risk for zoonotic transmission. The objectives of this study were to explore how lifestyles of dogs and cats from France were related to a particular risk of endoparasites and assess whether deworming frequencies complied with ESCCAP recommendations. Methods French data were extracted from a database created during a recent European pet owner survey regarding endoparasitic infection risk. Dogs and cats were grouped into risk categories based upon the ESCCAP guidelines. The compliance between the actual and recommended deworming frequencies were explored among the regions surveyed. Results The majority of dogs and cats were older than 6 months, had outdoor access, had contact with children or elderly people, and lived in rural and town areas. Most of the dogs were in contact with other dogs, snails or prey (83%), and ate slugs, snails, grass or dug in the garden (68%). Likewise, most of the cats hunted outside (57%) and caught prey animals (52%). Consequently, most of the dogs (89%) and cats (53%) were considered to be in the highest-risk category (D). However, independent of the region, the average deworming compliance for dogs was poor (6%). While deworming compliance for cats in category A (low-risk) was excellent (94%), for cats in category D it was poor (6%). Conclusions Deworming compliance is needed to enhance pet health and reduce zoonotic risks. Future studies are warranted to thoroughly investigate the compliance and effectiveness of deworming protocols, and the risk factors associated with endoparasites in France.

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1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1281 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S576-S577

Author(s):

Thomas Holowka ◽

Harry Cheung ◽

Maricar F Malinis ◽

Sarah Perreault ◽

Iris Isufi ◽

...

Keyword(s):

Risk Factors ◽

Fungal Infections ◽

Antimicrobial Prophylaxis ◽

Hematologic Malignancy ◽

Invasive Fungal Infections ◽

Risk Of Infection ◽

Factors Associated ◽

Serious Infection ◽

Increased Risk ◽

Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p < 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p < 0.001), neutropenia (OR 3.6, p < 0.01), lymphopenia (OR 2.4, p < 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p < 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

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Development of an Emergency Revisit Score for Patients With Drug-Related Problems

Journal of Pharmacy Technology ◽

10.1177/87551225211011731 ◽

2021 ◽

pp. 875512252110117

Author(s):

Jesus Ruiz Ramos ◽

Laura Gras-Martin ◽

Ana María Juanes Borrego ◽

Marta Blazquez-Andion ◽

Mireia Puig Campmany ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Receiver Operating Curve ◽

Drug Related Problems ◽

Derivation Cohort ◽

Factors Associated ◽

Final Score ◽

Anticholinergic Burden ◽

Risk Categories ◽

Frequent Reason

Background: Drug-related problems (DRPs) are a frequent reason for emergency departments (EDs) visits. However, data about the risk factors associated with EDs revisits are limited. Objective: To develop and validate a predictive model indicating the risk factors associated with EDs revisit within 30 days of the first visit. Methods: A retrospective cohort study was conducted involving patients who attended an ED for DRPs related to cardiovascular drugs. A 30-day prediction model was created in a derivation cohort by logistic regression. An integer score proportional to the regression coefficient was assigned to the variables with P < .100 in the multivariate analysis. Results: 581 patients (mean age: 80.0 [12.6] years) were included, 133 (22.9%) revisited the ED within 30 days from discharge. Six factors (chronic kidney disease, chronic heart failure, visit to an ED in the preceding 3 months, high anticholinergic burden, DRPs associated with heparin, and safety-related DRPs) were identified as risk factors and combined into a final score, termed the DREAMER score. The model reached an area under the receiver operating curve values of 0.72 (95% confidence interval [CI] = 0.67-0.77) in the referral cohort and 0.71 (95% CI = 0.65-0.74) in the validation cohort ( P = .273). Three risk categories were generated, with the following scores and estimated risks: low risk (0-8 points): 11.6%; intermediate risk (9-14 points): 21.3%; and high risk (>14 points): 41.2%. Conclusion and Relevance: The DREAMER score identifies patients at high risk for ED revisit within 30 days from the first visit for a DRPs, being a useful tool to prioritize interventions on discharge.

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Seroprevalence and risk factors associated with infection by Neospora caninum of dairy cattle in the state of Alagoas, Brazil

Pesquisa Veterinária Brasileira ◽

10.1590/s0100-736x2012001000011 ◽

2012 ◽

Vol 32 (10) ◽

pp. 1009-1013 ◽

Cited By ~ 9

Author(s):

Maria E. Sousa ◽

J.N. Porto Wagnner ◽

Pedro P.F. Albuquerque ◽

Orestes L. Souza Neto ◽

Eduardo B. Faria ◽

...

Keyword(s):

Risk Factors ◽

Dairy Cattle ◽

Indirect Immunofluorescence ◽

Neospora Caninum ◽

Infection Risk ◽

Control Measures ◽

Risk Indicators ◽

Blood Samples ◽

Factors Associated ◽

Serological Investigation

The objective of this study was to investigate the prevalence of anti-Neospora caninum antibodies in cattle from milk producing farms of the microregion of Batalha, state of Alagoas, Brazil, as well as to identify the risk factors associated with the infection. Blood samples were collected from 1,004 cattle of 17 farms for the serological investigation regarding the presence of anti-N. caninum antibodies by the Indirect Immunofluorescence Reaction Technique (IMRT). From the total amount of samples analyzed, 77/1,004 (7.67%) were positive and 927/1,004 (92.33%) were negative. The logistical regression identified that cattle from farms without consortium breeding have an infection risk 6.33 (p<0.001; C.I. 2.89-13.10) times higher than cattle from farms with that type of breeding. Cattle from farms where the aborted fetuses are not adequately buried have an infection risk 3.04 (p<0.001; C.I. 1.64-5.63) times higher than cattle from farms with adequate destination of these fetuses. Infection by N. caninum occurs in cattle of the investigated region. The factors identified in our study can be used as risk indicators, so that control measures could be implemented to avoid infection by N. caninum in the herds of this region.

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China’s Youth in NEET (Not in Education, Employment, or Training): Evidence from a National Survey

The Annals of the American Academy of Political and Social Science ◽

10.1177/0002716220909807 ◽

2020 ◽

Vol 688 (1) ◽

pp. 171-189

Author(s):

Yi Yang

Keyword(s):

Risk Factors ◽

Public Policy ◽

Married Women ◽

Multilevel Logistic Regression ◽

Protective Effects ◽

Men And Women ◽

Future Studies ◽

Factors Associated ◽

Force Dynamics ◽

Female Migrants

This study aims to understand the prevalence and characteristics of individuals aged 16 to 35 who are not in education, employment, or training (NEET) and the risk factors associated with being in NEET in China. The analysis uses the 2012 China Labor-Force Dynamics Survey to show that the NEET rate was 8 percent during the study period. Multilevel logistic regression indicates that women were more likely to be in NEET. Married women and female migrants had significantly higher risks of being in NEET, with migration having opposite effects for men and women. Education had protective effects against being in NEET, especially for women. Age had a nonlinear effect, with individuals aged 22 to 25 at the highest risk of being in NEET. I discuss implications for public policy and directions for future studies on NEET in China.

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Duodenoscope-Acquired Infections: Risk Factors to Consider

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1739562 ◽

2021 ◽

Vol 12 (03) ◽

pp. 151-159

Author(s):

Grace Thornhill ◽

Brian Dunkin

Keyword(s):

Risk Factors ◽

At Risk ◽

Antibiotic Sensitivity ◽

Infectious Agent ◽

Multidrug Resistant ◽

Infection Risk ◽

Control Measures ◽

Risk Of Infection ◽

New Device ◽

Mesh Terms

AbstractIn the wake of highly publicized duodenoscope-associated outbreaks caused by multidrug-resistant organisms (MDRO), a herculean effort was made to understand the conditions that led to these transmission events. Although there is now a clearer picture on how these outbreaks happened, there are still significant data gaps when it comes to understanding the rate of duodenoscope-acquired infections (DAIs), especially in nonoutbreak situations. Recent publications indicate that DAIs are still occurring and suggest that infection rates are higher than currently believed. Given this data gap, it is important to identify those patient populations that are most at risk of postprocedure infection, so that appropriate infection control measures may be implemented. Although those patients receiving antibiotic prophylaxis are most at risk for infection, there are additional risk factors that should be considered. For the purposes of this review, risk factors for infection were divided into three broad categories as follows: (1) those that increase patient susceptibility to infection, (2) those related to the endoscopic procedure, and (3) those factors that put reusable duodenoscope inventories at risk of contamination. Infection risk is a complex interaction between the immune status of the patient, the characteristics of the infectious agent (antibiotic sensitivity, virulence factors, and epidemiology), and the environment of care. Because of this complexity, any assessment of the risk of infection should be performed on a case-by-case basis. There is a dearth of information on infection risk for those patients undergoing endoscopic retrograde cholangiopancreatograpy (ERCP), especially in the context of the development and implementation of new device technology, and new endoscopic procedures that are increasing in complexity. This narrative review was developed using the Medical Subject Heading (MeSH) terms to perform an electronic search in PubMed with the goal of generating a summary of the patient, procedural, and duodenoscope-associated factors that increase the risk of infection in patients undergoing ERCP. This review provides practical information regarding the segmentation of ERCP patients by infection risk, so that endoscopists can make informed decisions about the risk benefits of using enhanced duodenoscope technologies in the care of their patients.

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Prevalence and risk factors for human leptospirosis in a rural district of Pelotas, a city in southernmost Brazil

Research Society and Development ◽

10.33448/rsd-v9i10.8903 ◽

2020 ◽

Vol 9 (10) ◽

pp. e6429108903

Author(s):

Gilmar Batista Machado ◽

Amilton Clair Pinto Seixas Neto ◽

Tanise Pacheco Fortes ◽

Caroline Dewes ◽

Sibele Borsuk ◽

...

Keyword(s):

Risk Factors ◽

Rural Community ◽

Domestic Animals ◽

Rural District ◽

Future Studies ◽

Factors Associated ◽

Human Leptospirosis ◽

The World ◽

Synanthropic Rodents

Leptospirosis is one of the most widespread zoonosis in the world. In humans, the disease is responsible for more than a million cases annually. The purpose of this study was to assess human seroprevalence to leptospirosis in a rural community of southernmost Brazil. Furthermore, we assess possible epidemiological cues associated with seroprevalence. A total of 216 individuals were enrolled in the study. With an overall seroprevalence of 21.3% (n=46), to at least one of the 12 antigens tested. Seroreactivity was associated with 13 of the investigated cues, including those associated with the individuals, their behavior, environment, domestic animals, and synanthropic rodents. While seroprevalence was not particularly high when compared to other studies in similar populations, some of the risk factors associated with the disease are easy to circumvent, and indications for policymakers and future studies are made within.

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Prevalence of cryptosporidian infection in cats in Turin and analysis of risk factors

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2007.03.005 ◽

2007 ◽

Vol 9 (5) ◽

pp. 392-396 ◽

Cited By ~ 14

Author(s):

Luisa Rambozzi ◽

Arianna Menzano ◽

Alessandro Mannelli ◽

Simona Romano ◽

Maria Cristina Isaia

Keyword(s):

Risk Factors ◽

Small Animal ◽

Cryptosporidium Species ◽

Risk Of Infection ◽

Domestic Cats ◽

North West ◽

Factors Associated ◽

Increased Risk ◽

Faecal Samples ◽

Enteric Parasites

An epidemiological study was carried out to identify factors associated with the risk of cryptosporidian infection in cats. Faecal samples from 200 domestic cats were collected in the small animal clinic at the Faculty of Veterinary Medicine in Turin (north-west Italy). The faecal samples were analysed for the presence of Cryptosporidium species oocysts using a centrifugation concentration floatation method. For each cat, age, sex, breed, indoor/outdoor status, diet, diarrhoea and presence of other enteric parasites were analysed for association with Cryptosporidium species infection. Cryptosporidia oocysts were identified in 49 cats (24.5%) aged from 2 months to 18 years. Statistical analysis revealed that four variables are significantly associated with an increased risk of infection: less than 1 year of age ( χ2=6.5, P=0.01), feeding home-cooked diet ( χ2=6.92, P<0.01), presence of diarrhoea ( χ2=4.34, P<0.037), and presence of other enteric parasites ( χ2=10.31, P<0.01). No statistical differences were found for sex ( χ2=1.56, P=0.21), breed ( χ2=0.78, P=0.38) and outdoor/indoor status ( χ2=1.49, P=0.22). Cryptosporidium species was the parasite most frequently detected in the cats surveyed.

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Risk and other factors associated with toxoplasmosis and toxocariasis in pregnant women from southern Brazil

Journal of Helminthology ◽

10.1017/s0022149x16000481 ◽

2016 ◽

Vol 91 (5) ◽

pp. 534-538 ◽

Cited By ~ 1

Author(s):

P.C. Santos ◽

P.L. Telmo ◽

L.M. Lehmann ◽

G.T. Mattos ◽

G.B. Klafke ◽

...

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Total Population ◽

University Hospital ◽

Risk Of Infection ◽

Southern Brazil ◽

Factors Associated ◽

Modes Of Transmission ◽

Increased Risk ◽

Serology Test

AbstractToxoplasmosis causes complications during pregnancy that have serious effects on fetal development. Thus far, toxocariasis has been reported to spread only via vertical transmission. Nonetheless, the population of pregnant women is also exposed to this infection. Co-infection with both Toxoplasma gondii and Toxocara spp. has been reported in children, but there are no reports of co-infection in the population of pregnant women. The aim of this study was to determine the prevalence of co-infection with T. gondii and Toxocara spp. in pregnant women at a university hospital in southern Brazil, and to identify the risk factors associated with infection by both parasites. Two hundred pregnant women were tested for the presence of anti-T. gondii and anti-Toxocara spp. antibodies and were asked to complete an epidemiological questionnaire. In this study, the co-infection rate observed in the total population of pregnant women was 8%. In addition, women with a positive result for a serology test for Toxocara spp. were at increased risk of infection by T. gondii (P = 0.019). Co-infection with both parasites in pregnant women was associated with low birth weights in neonates. The similar modes of transmission of both parasites could explain the co-infection. Only a few previous studies have investigated this phenomenon. The findings of the present study emphasize the importance of serological diagnosis during prenatal care and further research in this area to identify risk factors associated with this co-infection, and the possible implications of this co-infection during pregnancy and on the health of newborns.

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Human toxocariasis: a seroepidemiological survey in the Amazonian city of Yurimaguas, Peru

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652010000100006 ◽

2010 ◽

Vol 52 (1) ◽

pp. 37-42 ◽

Cited By ~ 22

Author(s):

William H. Roldán ◽

Yuri A. Cavero ◽

Yrma A. Espinoza ◽

Susana Jiménez ◽

César A. Gutiérrez

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

General Population ◽

Respiratory Compromise ◽

Public Places ◽

Future Studies ◽

Factors Associated ◽

Ocular Manifestations ◽

Intestinal Pathogen ◽

Almost All

The aim of this study was to determine the seroprevalence of the infection by Toxocara in the general population of the Amazonian city of Yurimaguas, Peru. From March to August 2008, a total of 300 subjects were sampled and tested by means of a Toxocara ELISA-IgG test. A clinical and epidemiological questionnaire was used to assess the symptomatology and risk factors associated with human toxocariasis. The overall rate of seropositivity was 35.66%, with a significant high proportion in children (p < 0.001). The clinical evaluation revealed that 95.33% of the seropositive group had some type of symptomatology: headache (66.36%), respiratory compromise (63.55%), abdominal pain (54.21%), cutaneous signs (40.19%) and ocular manifestations (36.45%), and almost all of them were statistically significant (p < 0.001). Furthermore, 56.07% of the seropositive subjects presented at least one intestinal pathogen parasite with predominance of helminthes, but without significant association (p = 0.334). The analysis of risk factors showed only that the use of public places and geophagia exhibited a significant association with the seropositivity (p < 0.001). Clinical, serological and epidemiological findings associated to infection with Toxocara were observed in the present study and future studies should be done to assess this serious health problem.

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P203 Incidence, characteristics and determinants of severe infections in patients with anti-neutrophil cytoplasm antibody-associated vasculitis receiving rituximab therapy: a single centre study

Rheumatology ◽

10.1093/rheumatology/keab247.198 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Francesco Dernie ◽

Nadia Ahmad ◽

Raashid Luqmani ◽

Joel David

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Regression Analysis ◽

Severe Infection ◽

Infection Risk ◽

P Value ◽

Risk Of Infection ◽

Electronic Patient Records ◽

Increased Risk ◽

Severe Infections

Abstract Background/Aims The efficacy of rituximab in managing anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is well-established; however its associated complications, including risk of developing serious infections, are less well characterised. Identifying infection risk factors may help to improve care of patients with AAV receiving rituximab. We characterised severe infections in a cohort of patients over a three-year period and identified factors affecting their risk of developing severe infections. Methods Electronic patient records were interrogated over a retrospective period (August 2016-August 2019) to compile baseline data and episodes of severe infection. Differences between groups were determined using appropriate parametric or non-parametric methods. Risk factors for severe infections were identified through multivariate binomial logistic regression analysis. Variables with an event count of ≥ 5 and a p-value ≤0.1 at univariate level were entered into the final multivariate analysis, where p ≤ 0.05 was taken as significant. Results Fifty patients were included. 24 (48%) were male, and 26 (52%) female. Average age was 60 years (range 25-90). 36 (72%) had GPA, 2 (4%) MPA, 1 (2%) EGPA, and 11 (22%) had overlap or undefined AAV. 14 (28%) patients developed at least one severe infection (≥grade 3, CTCAE criteria), giving an incidence of 15.4 severe infections per 100 person-years. The 18 severe infection events included 10 (56%) respiratory tract, 5 (28%) sepsis/neutropenic sepsis, 1 (6%) cellulitis, 1 (6%) complicated UTI and 1 (6%) recurrent wound infection. Patients who developed severe infections had lower immunoglobulin levels (IgG<6g/L, 36% vs 6%, p = 0.009), concomitant COPD (21% vs 3%, p = 0.029), and lower rates of concomitant co-trimoxazole use (7% vs 44%, p = 0.012) compared to patients not developing severe infections. Regression analysis of demographic, baseline blood markers and concomitant therapy data was performed to identify risk factors for developing severe infections (Table.1). Hypogammaglobulinaemia increased risk of infection (OR = 8.782, 95%CI=1.194-64.605, p = 0.033), while co-trimoxazole decreased risk of infection (OR = 0.096, 95%CI=0.009-0.996, p = 0.050). P203 Table 1:Univariate analysisMultivariate analysisVariablesOR95% CIP valueOR95% CIP valueAge (years)1.0320.994-1.0720.105Sex (male)0.3200.084-1.2130.0940.2860.057-1.4350.128Creatinine1.0050.987-1.0240.577eGFR0.9750.945-1.0060.109CRP1.0010.989-1.0120.899ESR1.0030.960-1.0460.908Neutrophils0.9730.789-1.2010.802WBC0.9590.780-1.1800.694Lymphocytes0.8700.420-1.8050.709CD190.4780.000-2000.9670.862CD19%0.9870.906-1.0750.767CD30.3140.055-1.7750.190CD3%0.9960.941-1.0550.902CD40.3920.034-4.4870.451CD4%1.0110.959-1.0660.675CD80.0530.001-4.7440.200CD8%0.9850.914-1.0610.689IgG0.8900.749-1.0570.185Hypogammaglobulinemic?8.6111.423-52.0910.0198.7821.194-64.6050.033IgM0.8360.350-1.9970.686IgA1.0890.787-1.5070.607BMI0.9460.858-1.0430.262COPD*9.5450.899-101.3380.061DM0.8330.147-4.7230.837Hypertension0.4330.082-2.2910.325CV disease0.000-0.999AKI0.4580.088-2.3780.353Latent TB0.3710.022-6.3830.495DI2.6920.157-46.2640.495Hypothyroidism0.000-1.000RA5.8330.484-70.2440.165OP2.6920.157-46.2640.495OA0.000-1.000SLE0.000-1.000AIH0.000-1.000CKD0.000-1.000Co-trimoxazole use0.0960.011-0.8150.0320.0960.009-0.9960.050Cumulative dose of RTX0.6690.392-1.1410.140Did patient have prior RTX before Aug 2016?0.6940.194-2.4870.575Yearly influenza vaccine between 2016-2019 (patients for whom vaccine records exist on EPR)1.3850.188-16.2770.796Average length of follow-up (days)1.0010.999-1.0030.360Prednisolone cumulative dose1.0001.000-1.0000.843Prednisolone average dose0.9920.991-1.0800.852MTX cumulative dose1.0000.999-1.0010.701MTX average dose1.0200.696-1.4960.918HCQ cumulative dose1.0001.000-1.0000.331HCQ average dose0.9850.964-1.0060.162LFN cumulative dose1.0001.000-1.0000.855LFN average dose0.8510.605-1.1990.357MMF cumulative dose1.0010.999-1.0020.263MMF average dose3.9960.402-39.7260.237AZT cumulative dose1.0001.000-1.0000.372AZT average dose0.9440.878-1.0140.116*too few events for progression to multivariate analysis. Conclusion The incidence of severe infections in patients with AAV receiving rituximab is significant. Our results support the monitoring of IgG levels to identify patients who may be more susceptible to infection, as well as the prescription of prophylactic co-trimoxazole to reduce overall severe infection risk. Disclosure F. Dernie: None. N. Ahmad: None. R. Luqmani: None. J. David: None.

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