What did we learn after the 2020 pandemic? Seroprevalence of SARS-CoV-2 infection in a North region of Portugal during 3rd lockdown

Background: Serological studies of antibody prevalence in response to infection with the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are useful to monitor the epidemic progression of the disease and to evaluate infection rates. In this study, we estimated the prevalence of anti-SARS-CoV-2 antibodies (IgM and IgG) in a Portuguese sub-district, during National lockdown - January-March 2021.Methods: In the seroepidemiological survey participants were tested for SARS-CoV-2 antibodies (IgM and IgG), in blood samples. The estimated seroprevalence and results were stratified by age, gender, education, occupational exposure, symptoms and previous SARS-CoV-2 infection.Results: Seroprevalence was 41.3%, (15.7% IgG positive, 11.6% IgM positive and 14% positive for both). The majority (74%) of the participants were working presentially and did the serological assay because they had either symptoms / positive contact (90%) or had a previous positive antigen test (36%). From all the seropositive cases only 44% were symptomatic. Our results show that seroprevalence of SARS -CoV-2 is high in the North, in parallel with the National Surveillance System. Seroprevalence was higher in woman than man and in adults older than 21. Almost all the people with symptoms or a positive contact had a positive test and were working at their regular places of work reflecting the danger of occupational exposure. Conclusions: These results suggest that, between January and March 2021, the restriction conditions were effective but unable to stop SARS-CoV-2 epidemic. It is essential to assess SARS-CoV-2 seroprevalence to monitor population immunity and if it lasts, specially from new COVID 19 variants.

Farm Suicides in Wisconsin, 2017–2018: Preliminary Findings and a Call for Future Research

Studies across the last few decades have consistently found farmers and farmworkers at an elevated risk of death by suicide compared to other occupational groups in the United States. Still, there is currently no comprehensive national surveillance system for agricultural-related injuries or suicides. For this study, we analyzed Wisconsin death certificate data from 2017 and 2018 to identify the burden of suicide among farmers and farmworkers. In 2017 and 2018, 44 farm-related suicides were identified, or 14.3 per 100,000 farmers and farmworkers. The median age of victims was 51.5 ± 20, and six (13.6%) were female. As these suicide cases were cross-checked, we found that none were identifiable solely from previously published news media or obituaries, indicating: (1) a clear need for a multi-sourced suicide data approach and inter-agency collaborations for future research, and (2) the need for a deeper investigation into the reporting of farm-related suicides. These data are necessary for informing state and local level policy, resource prioritization, and the evaluation of intervention efforts.

Clustering of non-leukemia childhood cancer in Colombia: a nationwide study

Background: Childhood cancer is considered one the most important causes of death in children and adolescents, despite having a low incidence in this population. Spatial analysis has been previously used for the study of childhood cancer to study the geographical distribution of leukemias. This study aimed to identify the presence of space-time clusters of childhood of cancer excluding leukemia in Colombia between 2014 and 2017. Methods: All incident cancer cases (excluding leukemia) in children under the age of 15 years that had been confirmed by the National Surveillance System of Childhood Cancer between 2014 and 2017 were included. Kulldorf’s circular scan test was used to identify clusters using the municipality of residence as the spatial unit of analysis and the year of diagnosis as the temporal unit of analysis. A sensitivity analysis was conducted with different upper limit parameters for the at-risk population in the clusters. Results: A total of 2006 cases of non-leukemia childhood cancer were analyzed, distributed in 432 out of 1,122 municipalities with a mean annual incidence rate of 44 cases per million children under the age of 15. Central nervous system (CNS) tumors were the most frequent type. Two space-time clusters were identified in the central and southwest regions of the country. In the analysis for CNS tumors, a spatial cluster was identified in the central region of the country. Conclusions: The distribution of non-leukemia childhood cancer seems to have a clustered distribution in some Colombian regions that may suggest infectious or environmental factors associated with its incidence although heterogeneity in access to diagnosis cannot be discarded.

A decade of plague in Madagascar: a description of two hotspot districts

Background Human plague cases, mainly in the bubonic form, occur annually in endemic regions of the central highlands of Madagascar. The aim of this study was to compare the dynamics of the epidemiological features of the human plague in two districts of the central highlands region. Methods In Madagascar, all clinically suspected plague cases that meet clinical and epidemiological criteria specified in the World Health Organization (WHO) standard case definition are reported to the national surveillance system. Data on plague cases reported between 2006 and 2015 in the districts of Ambositra and Tsiroanomandidy were analysed. Statistical comparisons between the epidemiological characteristics of the two districts were conducted. Results A total of 840 cases of plague were reported over the studied period, including 563 (67%) probable and confirmed cases (P + C). Out of these P + C cases, nearly 86% (488/563) were cases of bubonic plague. Reported clinical forms of plague were significantly different between the districts from 2006 to 2015 (p = 0.001). Plague cases occurred annually in a period of 10 years in the Tsiroanomandidy district. During the same period, the Ambositra district was characterized by a one-year absence of cases. Conclusion The differences in the epidemiological situation with respect to the plague from 2006 to 2015 in the two central highlands districts may suggest that several factors other than biogeographical factors determine the representation of the plague and its dynamics in this region. Considering the epidemiological situations according to the specific contexts of the districts could improve the results in the fight against the plague in Madagascar.

POS1246 COVID-19 IN ITALIAN PATIENTS WITH RHEUMATIC AUTOIMMUNE SYSTEMIC DISEASES: RESULTS OF A NATIONWIDE SURVEY STUDY

Background:SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement.Objectives:To evaluate the impact of Covid-19 pandemic in a large series of Italian patients with ASD.Methods:Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, Covid-19 was classified as definite Covid-19 (signs or symptoms of Covid-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected Covid-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis.Results:The main findings of the survey study revealed a significantly increased prevalence of Covid-19 in:a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%; p=0.0007;definite Covid-19 plus highly suspected Covid-19: 74/2,994, 2.47%; p<0.0001) when compared to Italian general population of Covid-19 infected individuals (349/100000 = 0.34%; data from Italian Superior Institute of Health;https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-national-surveillance-system).b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%; p=0.036; definite Covid-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%; p<0.0001)c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%; p=0.0015; definite Covid-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%; p<0.0001).Of interest, the prevalence of Covid-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs; while patients treated with conventional DMARDs showed a significantly lower prevalence of Covid-19 compared to those without. Covid-19 was more frequently observed in the patients’ populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate; 4/9 individuals requiring hospital admission died for severe pneumonia.Conclusion:The prevalence of Covid-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population; moreover, the actual prevalence of Covid-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as ‘frail patients’ during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection.The statistically significant association of Covid-19 with connective tissue diseases/systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients’ vulnerability to SARS-CoV-2 infection.Disclosure of Interests:None declared

Characterization of Klebsiella pneumoniae isolated from patients suspected of pulmonary or bubonic plague during the Madagascar epidemic in 2017

Klebsiella pneumoniae can lead to a wide range of diseases including pneumonia, bloodstream, and urinary tract infections. During a short period of a plague epidemic in October 2017 in Madagascar, 12 K. pneumoniae isolates were identified in ten sputum and two buboes aspirate samples. These isolates were from 12 patients suspected of plague, without epidemiological relationships, but were negative for Yersinia pestis in culture. Data were collected from the plague national surveillance system. The isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing. Real-time PCR was performed to confirm the presence of K. pneumoniae DNA in buboes. All isolates were identified as K. pneumoniae sensu stricto. Five isolates were extended-spectrum β-lactamases producers; eight different sequence types were identified. Five isolates belonged to known hypervirulent sequence types. Our results demonstrate community-acquired pneumonia caused by K. pneumoniae isolates in patients suspected of plague, showing that plague epidemics can hide other etiologies.

Malaria in Cambodia: A Retrospective Analysis of a Changing Epidemiology 2006–2019

Background: In Cambodia, malaria persists with changing epidemiology and resistance to antimalarials. This study aimed to describe how malaria has evolved spatially from 2006 to 2019 in Cambodia. Methods: We undertook a secondary analysis of existing malaria data from all government healthcare facilities in Cambodia. The epidemiology of malaria was described by sex, age, seasonality, and species. Spatial clusters at the district level were identified with a Poisson model. Results: Overall, incidence decreased from 7.4 cases/1000 population in 2006 to 1.9 in 2019. The decrease has been drastic for females, from 6.7 to 0.6/1000. Adults aged 15–49 years had the highest malaria incidence among all age groups. The proportion of Plasmodium (P.) falciparum + Mixed among confirmed cases declined from 87.9% (n = 67,489) in 2006 to 16.6% (n = 5290) in 2019. Clusters of P. falciparum + Mixed and P. vivax + Mixed were detected in forested provinces along all national borders. Conclusions: There has been a noted decrease in P. falciparum cases in 2019, suggesting that an intensification plan should be maintained. A decline in P. vivax cases was also noted, although less pronounced. Interventions aimed at preventing new infections of P. vivax and relapses should be prioritized. All detected malaria cases should be captured by the national surveillance system to avoid misleading trends.