Risk factors associated with the presence of Mycobacterium bovis in macroscopic lesions suspected as being caused by bovine tuberculosis detected in slaughterhouses

Mycobacterium bovis is a bacterium belonging to the Mycobacterium tuberculosis complex that causes tuberculosis in cattle and in other domestic and wild animals, as well as in humans. Disease control measures are carried out by slaughtering animals tested positive in the intradermal tuberculinization test and sanitation of their original living spaces, in addition to epidemiological surveillance carried out through the sanitary inspection of bovine carcasses in slaughterhouses. In the latter, official inspection services collect samples from macroscopic lesions suspected of bovine tuberculosis, which are then sent for laboratory analysis. Knowledge concerning the variables associated with the occurrence of M. bovis can aid in decision-making regarding control and disease eradication efforts. In this context, the aim of this study was to identify the risk factors for a positive M. bovis diagnosis in suspected bovine tuberculosis lesions obtained during epidemiological surveillance activities in the state of Mato Grosso, Brazil. A total of 105 suspicious lesions were analyzed using the Nested Polymerase Chain Reaction (nested q-PCR) method, of which 14 (13.33%) tested positive for M. bovis. Univariate and bivariate statistical analyses indicated that the variable “animal slaughter” was the only risk factor presenting statistical significance associated with the diagnosis of M. bovis (p < 0.05), demonstrating that macroscopic lesions suspected as being caused by bovine tuberculosis from animals with an in vivo diagnosis were 2.82 - fold more likely to result in a positive M. bovis diagnosis by molecular tests.

Incidence of common infectious diseases in Japan during the COVID-19 pandemic

Recent reports indicate that respiratory infectious diseases were suppressed during the novel coronavirus disease-2019 (COVID-19) pandemic. COVID-19 led to behavioral changes aimed to control droplet transmission or contact transmission. In this study, we examined the incidence of common infectious diseases in Japan during the COVID-19 pandemic. COVID-19 data were extracted from the national data based on the National Epidemiological Surveillance of Infectious Diseases (NESID). Common infectious diseases were selected from notifiable infectious diseases under the NESID. The epidemic activity of the diseases during 2015–2020 was evaluated based on the Infectious Disease Weekly Reports published by the National Institute of Infectious Diseases. Each disease was then categorized according to the route of transmission. Many Japanese people had adopted hygienic activities, such as wearing masks and hand washing, even before the COVID-19 pandemic. We examined the correlation between the time-series of disease counts of common infectious diseases and COVID-19 over time using cross-correlation analysis. The weekly number of cases of measles, rotavirus, and several infections transmitted by droplet spread, was negatively correlated with the weekly number of cases of COVID-19 for up to 20 weeks in the past. According to the difference-in-differences analysis, the activity of influenza and rubella was significantly lower starting from the second week in 2020 than that in 2015–2019. Only legionellosis was more frequent throughout the year than in 2015–2019. Lower activity was also observed in some contact transmitted, airborne-transmitted, and fecal-oral transmitted diseases. However, carbapenem-resistant Enterobacteriaceae, exanthema subitum, showed the same trend as that over the previous 5 years. In conclusion, our study shows that public health interventions for the COVID-19 pandemic may have effectively prevented the transmission of most droplet-transmitted diseases and those transmitted through other routes.

Estimated Costs Associated with Surgical Site Infections in Patients Undergoing Cholecystectomy

Among healthcare-associated infections, surgical site infections (SSIs) are the most frequent in Spain. The aim of this work was to estimate the costs of SSIs in patients who underwent a cholecystectomy at the Hospital General Universitario de Alicante (Spain) between 2012–2017. This was a prospective observational cohort study. The Active Epidemiological Surveillance Program at our hospital recorded all the cholecystectomies performed. Risk factors associated with the development of SSIs were determined by multivariate analysis and two homogeneous comparison groups were obtained by using the propensity score. The number of extra days of hospital stay were recorded for patients with an SSI and with the cost per hospitalised day data, the additional cost attributed to SSIs was calculated. A total of 2200 cholecystectomies were considered; 110 patients (5.0%) developed an SSI. The average length of hospital stay was 5.6 days longer among patients with an SSI. The cost per SSI was EUR 1890.60 per patient, with the total cost for this period being EUR 207,961.60. SSIs after cholecystectomy lead to a prolongation of hospital stay and an increase in economic costs. It is essential to implement infection surveillance and control programs to reduce SSIs, improve patient safety, and reduce economic burden.

The Rise in Norovirus-Related Acute Gastroenteritis During the Fight Against the COVID-19 Pandemic in Southern China

Background: There has been a significant decline in the morbidity of almost all infectious diseases during the COVID-19 pandemic. However, while the incidence of norovirus-related acute gastroenteritis declined in Guangzhou, China during the initial period of the pandemic, incidence increased significantly once the new school year began in September 2020.Methods: Norovirus-related acute gastroenteritis clusters and outbreaks were assessed in Guangzhou from 2015 to 2020. Medians and interquartile ranges were compared between groups using the Mann–Whitney U-test, and attack rates were calculated.Results: While 78,579 cases of infectious diarrhea were reported from 2015 to 2019, with an average of 15,716 cases per year, only 12,065 cases of infectious diarrhea were reported in 2020. The numbers of sporadic cases and outbreaks reported from January to August 2020 were lower than the average numbers reported during the same time period each year from 2015 to 2019 but began to increase in September 2020. The number of cases in each reported cluster ranged from 10 to 70 in 2020, with a total of 1,280 cases and an average attack rate of 5.85%. The median number of reported cases, the cumulative number of cases, and the attack rate were higher than the average number reported each year from 2015 to 2019. The intervention time in 2020 was also higher than the average intervention time reported during 2015–2019. The main norovirus genotypes circulating in Guangzhou during 2015–2020 included genogroup 2 type 2 (GII.2) (n = 79, 26.69%), GII.17 (n = 36, 12.16%), GII.3 (n = 27, 9.12%), GII.6 (n = 8, 2.7%), GII.4 Sydney_2012 (n = 7, 2.36%), and GII.4 (n = 6, 2.03%).Conclusions: Our findings illustrate the importance of maintaining epidemiological surveillance for viral gastroenteritis during the COVID-19 pandemic. Local disease prevention and control institutions need to devote sufficient human resources to control norovirus clusters.

Optimising Malaria Control Interventions in Mali Based on Epidemiological Surveillance and Rainfall Data

Background In malaria endemic countries, control interventions are performed during the high malaria transmission season using epidemiological surveillance data. One such intervention, seasonal chemoprevention (SMC), consists of the monthly administration of antimalarial drugs to children under 5 years. This study proposes an anticipating approach for adapting the timing of SMC interventions in Mali and the number of rounds. Our primary objective was to select the best approach for anticipating the onset of the high transmission season in the different health districts of Mali based on epidemiological surveillance and rainfall data. Our secondary objective was to evaluate the number of malaria cases, hospitalisations, and deaths in children under 5 years that could be prevented in Mali using the selected approach and the additional cost associated.Method Confirmed malaria cases and weekly rainfall data were collected for the 75 health districts of Mali for the 2014-2019 period. The onset of the rainy season, the onset of the high transmission season, the lag between these two events and the duration of the high transmission season were determined for each health district. Two approaches for anticipating the onset of the high transmission season in 2019 were evaluated. Results In 2014-2019, the onset of the rainy season ranged from W17 April to W34 August and that of the high transmission season from W25 June to W40 September. The lag between these two events ranged from 5 to 12 weeks. The duration of the high transmission season ranged from 3 to 6 months. The best approach anticipated the onset of the high transmission season 2019 in June in 2 districts, July in 46 districts, August in 21 districts and September in 6 districts. Using this approach over the 2014-2019 period would have led to changing the timing of SMC interventions in 36 health districts and would have prevented 43,819 cases, 1,943 hospitalisations and 70 deaths in children under 5 years. The additional cost of using our proposed approach is less than 5% of the current approach. Conclusion Adapting the timing of SMC interventions using our proposed approach would improve the prevention of malaria cases, hospitalisations, and deaths for a reasonable additional cost.

COVID-19 patient cohort identification during the SARS-CoV-2 outbreak through a tertiary hospital Electronic Health Record alert system (Preprint)

BACKGROUND On 11th March 2020, the World Health Organization declared a pandemic caused by the coronavirus with 118.629 identified cases and 4.292 confirmed deaths. Up to date, 252 million cases and 5 million deaths have been identified as caused by COVID-19. An epidemic situation is characterized by an overload of patients suffering a particular clinical condition and needing acute medical attention in a short period. Usually, the pathogen n causing the epidemic is either new or emergent, and the knowledge a priori is limited. Information is crucial for public health authorities to establish policies to prevent transmission. Thus, the cycle of knowledge acquisition must be efficient and as short as possible. An interdisciplinary team adapted the electronic health record alert systems for real-time data tool collection for clinical characterization and epidemiological surveillance. This system has been working from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first outbreak up to date OBJECTIVE To share the experience of handling COVID-19 and non-COVID-19 patients' circuits through an Electronic Health Record (EHR) alert system during the pandemic. This system allowed the creation of a COVID-19 hospitalized patient cohort, with implications in the hospital circuit management, patients risk stratification and secondary use for research projects in a period of high uncertainty. Additionally, its integration as an epidemiological surveillance tool favored the submission of updated information to public health authorities. METHODS Almost 30,000 alerts related to COVID-19 were activated in the EHR. Overall, the most frequent were “COVID-19 ruled out” (N = 12,438) followed by “COVID-19 Confirmed Case” (N = 8,999). Up to 13,106 patients (65.7%) were labeled with just one alert during their in-patient stay, while 6,857 (34.3%) received two or more labels. For the alert sequences, 96% were considered logical sequences, 3,1% as low-quality logic sequences, and less than 1% aberrant sequences. Although some temporal variations, all periods had a high rate of logical sequences achieving more than 95%. Preventive medicine professionals activated most COVID-19 alerts and acted as auditors for data quality. When possible, automatic alerts were in place, which became the most frequent. RESULTS Almost 30,000 alerts related to COVID-19 were activated in the EHR. Overall, the most frequent were “COVID-19 ruled out” (N = 12,438) followed by “COVID-19 Confirmed Case” (N = 8,999). Up to 13,106 patients (65.7%) were labeled with just one alert during their in-patient stay, while 6,857 (34.3%) received two or more labels. For the alert sequences, 96% were considered logical sequences, 3,1% as low-quality logic sequences, and less than 1% aberrant sequences. Although some temporal variations, all periods had a high rate of logical sequences achieving more than 95%. Preventive medicine professionals activated most COVID-19 alerts and acted as auditors for data quality. When possible, automatic alerts were in place, which became the most frequent. CONCLUSIONS The EHR integrated system favored in-hospital management of patients during the COVID-19 pandemic. It was helpful for both the institution and the health system, representing an example of interlevel integration. The performance was adequate and robust, with insights at different levels: infection control, patient safety, research, and pandemic response. Preventive Medicine teams should maximize EHR solutions for epidemiological surveillance. CLINICALTRIAL Not required.

Incidence of Arterial Hypertension in People With Periodontitis and Characterization of the Oral and Subgingival Microbiome: A Study Protocol

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. High blood pressure in particular, continues to increase throughout the global population at an increasingly fast pace. The relationship between arterial hypertension and periodontitis has been recently discussed in the context of its origins and implications. Particularly relevant is the role of the periodontal microbiome linked to persistent local and systemic inflammation, along with other risk factors and social determinants of health. The present protocol will investigate/assess the association between periodontal disease and its microbiome on the onset of hypertension, within a cohort from Mexico City. One thousand two hundred twelve participants will be studied during a 60-month period. Studies will include analysis of periodontal conditions, sampling and sequencing of the salivary and subgingival microbiome, interviews on nutritional and lifestyle habits, social determinants of health, blood pressure and anthropometric measurements. Statistical associations and several classic epidemiology and machine learning approaches will be performed to analyze the data. Implications for the generation of public policy—by early public health interventions or epidemiological surveillance approaches—and for the population empowerment—via the establishment of primary prevention recommendations, highlighting the relationship between oral and cardiovascular health—will be considered. This latter set of interventions will be supported by a carefully planned science communication and health promotion strategy. This study has been registered and approved by the Research and Ethics Committee of the School of Dentistry, Universidad Nacional Autónoma de México (CIE/0308/05/2019) and the National Institute of Genomic Medicine (CEI/2020/12). The umbrella cohort was approved by the Institutional Bioethics Committee of the National Institute of Cardiology-Ignacio Chavez (INC-ICh) under code 13-802.

Sociodemographic profile and distribution of Spotted Fever cases per brazilian region between the years 2008 and 2017

This study aims to identify the clinical and sociodemographic characteristics of Spotted Fever in Brazil between 2008 and 2017. A descriptive, retrospective, cross-sectional study with a quantitative approach that used as a source of data the Sistema de Informação de Agravos de Notificação (SINAN) available in the public database of the Departamento de Informática do Sistema Único de Saúde (DATASUS), adopting the following variables within the pre-established period: Region of Notification, Sex, Age Group, Evolution, Infection Zone, Schooling, Environment of Infection, and Confirmation Criteria. Spotted fever was prevalent in the Southeast region of the country, although underreporting is a reality in other regions. The most affected population was male, economically active, living in rural areas, and with incomplete primary education. Thus, epidemiological surveillance is fundamental, especially in endemic and "silent" regions for the notification of the disease.

Co-Circulation of Chikungunya and Multiple DENV Serotypes and Genotypes, Western Indonesia 2015–2016

Dengue is a mosquito-borne disease of public health concern affecting tropical and subtropical countries, including Indonesia. Although studies on dengue epidemiology have been undertaken in Indonesia, data are lacking in many areas of the country. The aim of this study was to determine dengue virus (DENV) and chikungunya virus (CHIKV) molecular epidemiology in western regions of the Indonesian archipelago. A one-year prospective study was conducted in Aceh and Jambi in 2015 and 2016, respectively, where patients with dengue-like illness were enrolled. Of 205 patients recruited, 29 and 27 were confirmed with dengue in Aceh and Jambi, respectively, and three from Jambi were confirmed with chikungunya. DENV-1 was the predominant serotype identified in Aceh while DENV-2 was predominant in Jambi. All DENV-1 and DENV-2 from both regions were classified as Genotype I and Cosmopolitan genotype, respectively, and all DENV-3 viruses from Jambi were Genotype I. Some viruses, in particular DENV-1, displayed a distinct lineage distribution, where two DENV-1 lineages from Aceh were more closely related to viruses from China instead of Jambi highlighting the role of travel and flight patterns on DENV transmission in the region. DENV-2 from both Aceh and Jambi and DENV-3 from Jambi were all closely related to Indonesian local strains. All three CHIKV belonged to Asian genotype and clustered closely with Indonesian CHIKV strains including those previously circulating in Jambi in 2015, confirming continuous and sustainable transmission of CHIKV in the region. The study results emphasize the importance of continuous epidemiological surveillance of arboviruses in Indonesia and simultaneous testing for CHIKV among dengue-suspected patients.

Characteristics of persons who died by suicide in prison in France: 2017–2018

Background In northern countries, suicide rates among prisoners are at least three times higher for men and nine times higher for women than in the general population. The objective of this study is to describe the sociodemographic, penal, health characteristics and circumstances of suicide of French prisoners who died by suicide. Methods This study is an intermediate analysis of the French epidemiological surveillance program of suicides in prison. All suicides in prison in 2017–2018 in France were included in the study. Archival sociodemographic and penal data and specific data on the circumstances of the suicidal act were provided by the National Prison Service. Health data was provided by physicians working in prison using a standardized questionnaire. Results In 2017–2018, 235 prisoners died by suicide. The suicide rate was 16.8/10 000 person-years. Among suicide cases, 94.9% were male, 27.2% were under 30, 25.1% were aged 30 to 39, 27.7% were aged 40 to 49 and 20.0% were 50 or older. At the time of suicide, 48.5% were on custodial remand. Incarceration is associated with a threefold increase in the frequency of anxio-depressive disorders (24.6% in prison versus 8.2% before prison). The week before the suicidal act, 60% of prisoners visited the health unit and a significant event was detected for 61% of all cases. Suicide was less than 1 week after prison entry for 11.9% of prisoners, corresponding to a suicide rate 6.4 (CI95% [4.3 – 9.5]) times higher than for the remaining time in prison, and was more than 1 year after entry for 33.7% of them. Conclusions The high frequency of events the week before suicide in our study suggests that events in prison could play a role in the occurrence of suicides. Comparative studies are needed to further explore the time association between events and suicide in prison. As most of prisoners who died by suicide visited the health unit the week before suicide, the identification of triggering factors could help psychiatrists and other health professionals to assess the short-term risk of suicide and to implement preventive measures.