Revisión del sistema de vigilancia de lesiones y enfermedades durante juegos multideportivos (Review of the injury and illnesses surveillance system during multi-sport games)

El objetivo de este estudio fuer presentar al Sistema de Vigilancia de Lesiones y Enfermedades (SVLE) del Comité Olímpico Internacional (COI) diseñado para eventos multideportivos como un insumo para la planificación de los recursos necesarios para competencias deportivas. Desarrollamos una revisión sistemática siguiendo la guía PRISMA considerando como criterio de inclusión los eventos multideportivos con implementación de la SVLE del COI. La búsqueda fue realizada en los principales buscadores científicos (PubMed, Scopus, Scielo, ScientDirect, LILACS, y Latindex), en servidores públicos de pre-publicaciones (bioRxiv, SocArXiv, medRxiv y Preprints) y en metabuscadores (Google Scholar y Yahoo!). En la selección inicial se obtuvieron 367 estudios, incluyéndose 19 estudios para su análisis, donde solo 4 fueron deportes unitarios como fútbol, atletismo y balonmano. El SVLE del COI se ha usado inicialmente a gran escala en los Juegos Olímpicos de Beijing 2008 en 7 idiomas, al día de hoy más de 56,063 atletas en 19 eventos deportivos. En Sudamérica este sistema fue empleado en el I Juegos Deportivos Nacionales de Chile, los Juegos Olímpicos de Verano y los Juegos Olímpicos Rio 2016, y en los Juegos Panamericanos Lima 2019. Esta revisión muestra la experiencia documentada del SVLE del COI a lo largo de más de una década de uso de este instrumento, demostrando que el SVLE representa una herramienta útil, sencilla y ágil para el monitoreo de incidencias sanitarias. Abstract. The objective of this study was to present the Injury and Illness Surveillance System (SVLE) of the International Olympic Committee (IOC) designed for multi-sport events as an input for planning the necessary resources for sports competitions. We developed a systematic review following the PRISMA guide, considering multi-sport events with implementation of the IOC SVLE as inclusion criteria. The search was carried out in the main scientific search engines (PubMed, Scopus, Scielo, ScientDirect, LILACS, and Latindex), in public pre-publication servers (bioRxiv, SocArXiv, medRxiv, and Preprints), and metasearch engines (Google Scholar and Yahoo!). In the initial selection, 367 studies were obtained, including 19 studies for analysis, where only 4 were unitary sports such as soccer, athletics, and handball. The IOC SVLE has initially been used on a large scale at the 2008 Beijing Olympic Games in 7 languages, monitoring today more than 56,063 athletes in 19 sporting events. In South America, this system was used in the I National Sports Games of Chile, the Summer Olympic Games and the Rio 2016 Olympic Games, and the Lima 2019 Pan American Games. This review shows the documented experience of the IOC SVLE throughout more of a decade of use of this instrument, demonstrating that the SVLE represents a useful, simple, and agile tool for monitoring health incidents.

Cancer exosomes and natural killer cells dysfunction: biological roles, clinical significance and implications for immunotherapy

Tumor-derived exosomes (TDEs) play pivotal roles in several aspects of cancer biology. It is now evident that TDEs also favor tumor growth by negatively affecting anti-tumor immunity. As important sentinels of immune surveillance system, natural killer (NK) cells can recognize malignant cells very early and counteract the tumor development and metastasis without a need for additional activation. Based on this rationale, adoptive transfer of ex vivo expanded NK cells/NK cell lines, such as NK-92 cells, has attracted great attention and is widely studied as a promising immunotherapy for cancer treatment. However, by exploiting various strategies, including secretion of exosomes, cancer cells are able to subvert NK cell responses. This paper reviews the roles of TDEs in cancer-induced NK cells impairments with mechanistic insights. The clinical significance and potential approaches to nullify the effects of TDEs on NK cells in cancer immunotherapy are also discussed.

Surveillance of Hemodialysis Related Infections: A Prospective Multicenter Study

There is neither a surveillance system nor a study to reveal the HD related infection rates in Turkey. We aimed to investigate the infection rate among HD outpatients and implement CDC’s surveillance system. A multicenter prospective surveillance study is performed to investigate the infection rate among HD patients. CDC National Healthcare Safety Network dialysis event (DE) protocol is adopted for definitions and reporting. During April 2016–April 2018, 9 centers reported data. A total of 199 DEs reported in 10035 patient-months, and the overall DE rate was 1.98 per 100 patient-months. Risk of blood culture positivity is found to be 17.6 times higher when hemodialysis was through a tunneled catheter than through an arteriovenous fistula. DE rate was significantly lower in patients educated about the care of their vascular access site. Staphylococcus aureus was the most causative microorganism among mortal patients. Outcomes of DEs were hospitalization (73%), loss of vascular access (18.2%), and death (7.7%). This first surveillance study revealed the baseline status of HD related infections in Turkey and showed that NHSN DE surveillance system can be easily implemented even in a high workload dialysis unit and be adopted as a nationwide DE surveillance program.

Mechanisms and Contextual Factors Affecting the Implementation of Animal Health Surveillance in Tanzania: A Process Evaluation

A strong animal health surveillance system is an essential determinant of the health of animal and human population. To ensure its functionality and performance, it needs to be evaluated regularly. Therefore, a process evaluation was conducted in this study to assess animal health surveillance processes, mechanisms and the contextual factors which facilitate or hinder uptake, implementation and sustainability of the system in Tanzania. A mixed-method study design was used to evaluate the national animal health surveillance system guided by a framework for process evaluation of complex interventions developed by Moore and others. The system was assessed against standard guidelines and procedures using the following attributes: fidelity, adherence, exposure, satisfaction, participation rate, recruitment and context. Quantitative and qualitative data were collected using a cross-sectional survey, key informant interviews, document review, site visits and non-participant observation. Data from questionnaires were downloaded, cleaned and analyzed in Microsoft™ Excel. Qualitative data were analyzed following deductive thematic and content analysis methods. Fidelity attribute showed that case identification is mainly based on clinical signs due to limited laboratory services for confirmation. Data collection was not well-coordinated and there were multiple disparate reporting channels. Adherence in terms of the proportion of reports submitted per month was only 61% of the target. District-level animal health officials spent an average of 60% of their weekly time on surveillance-related activities, but only 12% of them were satisfied with the surveillance system. Their dissatisfaction was caused by large area coverage with little to no facilitation, poor communication, and lack of a supporting system. The cost of surveillance data was found to be 1.4 times higher than the annual surveillance budget. The timeliness of the system ranged between 0 and 153 days from the observation date (median = 2 days, mean = 6 days). The study pointed out some deviations in animal health surveillance processes from the standard guidelines and their implication on the system's performance. The system could be improved by developing a user-friendly unified reporting system, the active involvement of subnational level animal health officials, optimization of data sources and an increase in the horizon of the financing mechanism.

A multi-source global-local model for epidemic management

The Effective Reproduction Number Rt provides essential information for the management of an epidemic/pandemic. Projecting Rt into the future could further assist in the management process. This article proposes a methodology based on exposure scenarios to perform such a procedure. The method utilizes a compartmental model and its adequate parametrization; a way to determine suitable parameters for this model in México’s case is detailed. In conjunction with the compartmental model, the projection of Rt permits estimating unobserved variables, such as the size of the asymptomatic population, and projecting into the future other relevant variables, like the active hospitalizations, using scenarios. The uses of the proposed methodologies are exemplified by analyzing the pandemic in a Mexican state; the main quantities derived from the compartmental model, such as the active and total cases, are included in the analysis. This article also presents a national summary based on the methodologies to illustrate how these procedures could be further exploited. The supporting information includes an application of the proposed methods to a metropolitan area to show that it also works well at other demographic disaggregation levels. The procedures developed in this article shed light on how to develop an effective surveillance system when information is incomplete and can be applied in cases other than México’s.

Canadian Dairy Network for Antimicrobial Stewardship and Resistance (CaDNetASR): An On-Farm Surveillance System

Canada has implemented on-farm antimicrobial resistance (AMR) surveillance systems for food-producing animals under the Canadian Integrated Program for Antimicrobial Resistance (CIPARS); however, dairy cattle have not been included in that program yet. The objective of this manuscript was to describe the development and implementation of the Canadian Dairy Network for Antimicrobial Stewardship and Resistance (CaDNetASR). An Expert Panel (EP) of researchers was created to lead the development of the dairy surveillance system. The EP initiated a draft document outlining the essential elements of the surveillance framework. This document was then circulated to a Steering Committee (SC), which provided recommendations used by the EP to finalize the framework. CaDNetASR has the following components: (1) a herd-level antimicrobial use quantification system; (2) annually administered risk factor questionnaires; and (3) methods for herd-level detection of AMR in three sentinel enteric pathogens (generic Escherichia coli, Campylobacter spp., and Salmonella spp.) recovered from pooled fecal samples collected from calves, heifers, cows, and the manure pit. A total of 144 dairy farms were recruited in five Canadian provinces (British-Columbia, Alberta, Ontario, Québec, and Nova-Scotia), with the help of local herd veterinarians and regional field workers, and in September 2019, the surveillance system was launched. 97.1 and 94.4% of samples were positive for E. coli, 63.8, and 49.1% of samples were positive for Campylobacter spp., and 5.0 and 7.7% of samples were positive for Salmonella spp., in 2019 and 2020, respectively. E. coli was equally distributed among all sample types. However, it was more likely that Campylobacter spp. were recovered from heifer and cow samples. On the other hand, it was more common to isolate Salmonella spp. from the manure pit compared to samples from calves, heifers, or cows. CaDNetASR will continue sampling until 2022 after which time this system will be integrated into CIPARS. CaDNetASR will provide online access to farmers and veterinarians interested in visualizing benchmarking metrics regarding AMU practices and their relationship to AMR and animal health in dairy herds. This will provide an opportunity to enhance antimicrobial stewardship practices on dairy farms in Canada.

Identification of the First C1 Subgenotype of Enterovirus 71 in Mainland of China in a Retrospective Study

The C4 sub-genotype of Enterovirus 71(EV71) is identified as the most dominant sub-genotype circulating in Chinese mainland since 1998, while the circulation situation of EV71 before 1998 is not well established due to insufficient experimental data. The C1 sub-genotype of EV71 has not been reported in Chinese mainland by now. Based on AFP surveillance system of the mainland of China, this study performed a retrospective study of AFP cases for 1985-1999༚A strain of EV-A71 C1 sub-genotype was found. To our knowledge, this strain (SD92-41) is the first C1 sub-genotype reported in Chinese mainland. This study proves that the C1 gene subtype also appeared in Chinese mainland, but it is not clear whether it is an imported or a local epidemic strain. With sufficient information from retrospective studies, the source of the SD92-41 strain will be identified, and the prevalence of EV-A71 in Chinese mainland before 1998 will be clearer.

Participatory surveillance for COVID-19 trends detection in Brazil

The ongoing COVID-19 pandemic has emphasized the necessity of a well-functioning surveillance system to detect and mitigate disease outbreaks. Traditional surveillance (TS) usually relies on healthcare providers and generally suffers from reporting lags that prevent immediate response plans. Participatory surveillance (PS), an innovative digital approach whereby individuals voluntarily monitor and report on their own health status via Web-based surveys, has emerged in the past decade to complement traditional data collections approaches. This study compares novel PS data on COVID-19 infection rates across nine Brazilian cities with official TS data to examine the opportunities and challenges of using the former, and the potential advantages of combining the two approaches. We find that high participation rates are key for PS data to adequately mirror TS infection rates. Where participation was high, we document a significant trend correlation between lagged PS data and TS infection rates, suggesting that the former could be used for early detection. In our data, forecasting models integrating both approaches increased accuracy up to 3% relative to a 14-day forecast horizon model based exclusively on TS data. Furthermore, we show that the PS data captures a population that significantly differs from the traditional observation. These results corroborate previous studies when it comes to the benefits of an integrated and comprehensive surveillance system, but also shed lights on its limitations, and on the need for additional research to improve future implementations of PS platforms.