Burden Of Infection Research Articles

Low-cost, real-time detection of bacterial growth via diffraction-based sensing.

The emergence of antibacterial resistance impacts healthcare networks globally, with mortality rates and linked burdens of infection disproportionately affecting the developing world. Rapid alternatives to antibiotic susceptibility testing (AST) allow for swifter, more effective treatment, though they are limited in use in low-resource settings due to significant cost barriers. Herein we demonstrate a simple, cost-effective diffraction sensing-based approach for rapidly detecting bacterial growth (a precursor to AST). Diffraction gratings (1D, lined) directly comprised of our test bacteria (Escherichia coli DH5α) were produced using soft agar-based gel templates designed to direct bacterial attachment and produce a near-zero background signal. The diffraction spot intensities from the live bacterial gratings were monitored in growth and no growth (ampicillin) conditions at room temperature, using a simple fixed laser and photodetector setup. Growth-induced differences in signal were observed within 10-20 minutes, highlighting the sensitivity of this approach and its potential to be adapted as a rapid and accessible AST alternative.

The economic burden of nosocomial infections for hospitals: evidence from Germany.

Nosocomial infections (NI) significantly worsen patient outcomes, resulting in higher mortality rates and reduced health-related quality of life. Furthermore, they pose substantial economic strain on healthcare systems and hospitals. For instance, patients with nosocomial infections (NIs) experience prolonged hospital stays compared to those without NIs. These extended stays result in occupied bed-days, leading to opportunity costs for hospitals. This study aimed to estimate the opportunity costs for a German hospital based on hospital stays, daily revenue, and occupancy rates (OCR). We analysed cost data obtained from routine records maintained by the accounting department of a German hospital's surgical and orthopedic units from 2018 to 2019 for the "HygArzt" research project. To ensure balance, we employed genetic matching. We estimated the differences in length of stay (LOS) and daily revenue between patients with and without nosocomial infections (NI) using linear regression. Finally, we calculated the opportunity cost borne by the hospital by treating NI patients instead of non-NI patients. All costs are reported in 2018 Euros. The final sample included 81 patients with NI matched with 207 patients without NI. The majority of the NI patients (77.0%) had surgical site infection (SSI). Compared to non-NI patients, we observed that NI patients had a longer LOS (10 days, p < 0.001) and lower daily revenue (€400, p < 0.001). We also found that comorbidities and the frequency of operations had significant impact on the LOS. Using a baseline 30 to 50% preventable NIs, successful prevention of a single NI could potentially reduce the length of hospital stay by 3 to 5 days and increase hospital revenue by approximately €120 to €200 per day per prevented NI. Consequently, the hospital saves 3 to 5 more bed-days to backfill and generate more revenue, and/or make more efficient resource allocation by changing bed-capacity and staffing. The resulting opportunity costs can potentially exceed €1,000 per preventable case. NIs pose a substantial economic burden for hospitals. From a health economics' perspective, there are strong economic incentives for hospitals to implement infection control interventions, such as the involvement of a prevention link physician/nurse.

Factors associated with HIV self-testing and PrEP use among Nigerian youth: Baseline outcomes of a pragmatic, stepped-wedge, cluster-randomized controlled trial.

Adolescents and young adults (AYA, 14-24 years) bear a disproportionate burden of new HIV infections in Nigeria and are more likely to have worse HIV outcomes compared to other age groups. However, little is known about their access to recommended sexual health care services, including HIV self-testing (HIVST), sexually transmitted infections (STI) testing, sexual behavior patterns, awareness and or access to pre-exposure prophylaxis (PrEP), and overall risk for HIV. We present a baseline analysis of the 4 Youth by Youth randomized controlled trial aimed to evaluate the uptake and sustainability of crowdsourced HIVST strategies led by and for young people across 14 states in Nigeria. None of the participants had received intervention at the time of completing this self-reported behavioral survey. We conducted a descriptive analysis to summarize participants' characteristics, sexual behavior, HIV testing, STI testing, and knowledge of PrEP and use across the study sample of the AYAs. We conducted a chi-square test, and the level of significance was set at ≤0.05. A total of 1551 participants completed the baseline survey comprising males (777, 50.1 %) and females (774, 49.9 %). The majority (77 %) of the participants were students at enrollment. Very few of the participants had ever tested for syphilis, 47 (3.1 %), gonorrhea, 49 (3.2 %), chlamydia, 31 (2.0 %), and hepatitis B, 106 (6.9 %). 678 (43.8 %) of the participants reported to be sexually active at the time of enrolment into the study, of which about 38 % of them engaged in condomless sex. Paying for sex, alcohol use, and drug use are all significant sexual behaviors (p < 0.01). Only 14 (1 %) have ever used PrEP. 481 (31.4 %) have ever tested for HIV, and 104 (6.8 %) have ever used an HIV self-testing kit at baseline. 457 (38.6 %) were eligible for PrEP. HIVST and STI uptake were low at baseline among the AYA in this study. Most AYAs also do not receive recommended sexual health care services, including STI testing services. This underlines the need for interventions to increase the uptake of HIV/STI prevention services among Nigerian AYA.

Survey of clinical microbiology and infectious disease testing capabilities among institutions in Africa.

Inadequate laboratory infrastructure and testing capabilities are a major impediment to addressing the infectious disease burden in Africa. Therefore, the aims of this study were to characterize the clinical microbiology/infectious disease laboratory capabilities among countries in Africa. A survey to assess the microbiological testing capabilities at hospitals, government laboratories, and free-standing public and private laboratories in African countries was developed by subject matter experts. Questions included institutional demographics and microbiology services in the broad categories of bacteriology, virology, mycology, parasitology, and rapid diagnostics/point-of-care testing. The survey was distributed using the American Society of Clinical Pathology email listserv between June and August 2022. In total, 131 unique institutions in 28 countries endorsed at least 1 type of microbiology service, with parasitology (80.9%, 106/131) and bacteriology (77.9%, 102/131) being most common, while mycology (45.0%, 59/131) and virology (45.8%, 60/131) laboratories were less prevalent. The most frequently performed bacteriology test was bacterial identification (90.2%, 92/102), followed by aerobic bacterial cultures and antimicrobial susceptibility testing (both 89.2%, 91/102). Among all clinical microbiology/infectious disease laboratories, the most commonly tested agents were HIV (90.8%, 119/131), Treponema pallidum (78.6%, 103/131), Plasmodium falciparum (76.3%, 100/131), Mycobacterium tuberculosis (76.3%, 100/131), and hepatitis C virus (74.8%, 98/131). These findings provide contemporary data regarding the availability of critical infectious disease testing capabilities among institutions in Africa. These results and future additional studies will be crucial for understanding where strategic investment in the laboratory and public health infrastructure is warranted.

Factors associated with outcome in a national cohort of rhinovirus hospitalized patients in Brazil in 2022

The common cold is the primary cause of illness in the community, with over 200 viral strains identified, and rhinovirus infections being the most prevalent. Coronavirus Disease 19 (COVID-19) is also a significant cause of severe illness. The burden of acute respiratory infections has a significant impact on the economy, resulting in absenteeism from work and school. Rhinovirus infections can exacerbate asthma and other chronic diseases, leading to hospitalization. The objective of this study is to investigate the factors associated with death and survival in patients hospitalized for rhinovirus in Brazil in 2022. This is a retrospective cohort study using data from the national surveillance of Severe Acute Respiratory Syndrome (SARS) in 2022 in Brazil, with all the norrifications. We analysed and compared clinical and epidemiological factors and outcomes between survivors and deaths in patients hospitalised for rhinovirus. The absolute and relative frequencies were calculated according to the states. Bivariate analysis was performed using chi-squared test and Fisher’s exact test, while multivariate analysis was performed using COX regression. Out of 8,130 cases of SARS caused by rhinovirus, 291 (3.58%) resulted in death while 7839 (96.47%) patients survived. The factors associated with death were invasive ventilation (p- < 0.001 HR 4.888 CI 95% 3.816–6.262), bocavirus (p- < 0.001 HR 4.204 CI 95% 2.595–6.812), immunodepression/Immunosuppression (p- < 0.001 HR 2.417 CI 95% 1. 544–3, 786), COVID-19 (p- < 0.001 HR 2.167 CI 95% 1.495–3.142), chronic neurological diseases (p-0.007 HR 1.610 CI 95% 1.137–2.280), abdominal pain (p-0.005 HR 1.734 CI 95% 1.186–2.537), age (p- < 0.001 HR 1.038 CI 95% 1.034–1.042). The survival factors identified in this study were dyspnea (p = 0.005; HR 0.683; CI 95% 0.524–0.889), cough (p < 0.001; HR 0.603; CI 95% 0.472–0.769), and asthma (p = 0.052; HR 0.583; CI 95% 0.339–1.004). Additionally, the study found that receiving a COVID-19 booster dose was also a significant survival factor (p = 0.001; HR 0.570; CI 95% 0.415–0.784). The factors associated with death were similar to those in the literature, and the factors associated with survival were also similar, except for the booster dose of the COVID-19 vaccine, which we didn’t find in any studies. Our study is the first to associate the full course of the COVID-19 vaccine with survival in those hospitalized for rhinovirus, regardless of COVID-19 and rhinovirus co-detection.

Burden of Respiratory Syncytial Virus Infection in Children and Older Patients Hospitalized with Asthma: A Seven-Year Longitudinal Population-Based Study in Spain

(1) Background: To describe hospitalizations due to respiratory syncytial virus (RSV) infection among children and elderly patients with asthma. (2) Methods: We used a nationwide discharge database to select patients with asthma aged 0 to 15 years and ≥65 years admitted to Spanish hospitals from 2016 to 2022. (3) Results: We identified 49,086 children and 471,947 elderly patients hospitalized with asthma (3.52% and 0.51%, respectively, with RSV). The proportion of RSV increased over time in children with asthma (from 1.44% to 7.4%, p &lt; 0.001) and in elderly individuals (from 0.17% to 1.01%, p &lt; 0.001). Among children with RSV infection, the presence of influenza (OR 3.65; 95% CI 1.46–9.1) and pneumonia (OR 1.85; 95% CI 1.02–3.55) increased the risk of poor outcome. The presence of RSV was associated with severity in these patients, defined by use of mechanical ventilation and/or admission to the intensive care unit (OR 1.44; 95% CI 1.11–1.86). In elderly patients with RSV infection, older age, congestive heart failure, COVID-19, and pneumonia increased the risk of in-hospital mortality (IHM). However, RSV infection was not associated with IHM (OR 0.88; 95% CI 0.68–1.15) in these patients. (4) Conclusion: Our results highlight the impact of RSV infection in children and elderly patients hospitalized with asthma. Strategies to improve surveillance, prophylaxis, and management of RSV infection should be evaluated.

Evaluating the Impact of Moderate and Severe Varicella Infections on Danish Children Under 18 Years Old: A Comprehensive Analysis From 2015 to 2023

Background: Varicella (chickenpox) caused by varicella-zoster virus (VZV) is a highly contagious pediatric disease. While it typically manifests as a mild disease, complications leading to hospitalization are not uncommon. Knowing the current disease burden, seasonality and risk groups is pivotal for evidence-based decisions on the introduction of a varicella vaccine. Methods: Using the Danish National Patient Register and medical helpline records from the Capital Region, we estimated the burden of VZV infections among children younger than 18 years in Denmark from 2015 to June 2023. Results: We identified 14,443 cases with annual incidence rates of 325/100,000 children for mild-to-moderate varicella cases (helpline calls), 35/100,000 for moderate-to-severe cases (outpatients) and 10/100,000 for severe cases (hospitalized). Mild cases were most prevalent in children aged 1–4 years, while moderate-to-severe cases were most prevalent among infants &lt;1 year old. Among hospitalized cases, 23.2% had underlying diseases and 47.3% experienced complications. In April 2022, rapid surge in all types of VZV cases occurred, where admissions surpassed the prepandemic level. Conclusion: This study documents that varicella is highly prevalent among Danish young children. Mild-to-moderately severe cases strain healthcare, causing increased helpline calls and posing a persistent hospitalization risk, especially for infants and children with underlying conditions.

Availability and readiness of public health facilities to provide differentiated service delivery models for HIV treatment in Zambia: implications for better treatment outcomes

BackgroundThere is persistent pressure on countries with a high burden of HIV infection to reach desired targets for HIV treatment outcomes. This has led to moving from the “one-size-fits-all” model to differentiated service delivery (DSD) models, which are meant to be more patient-centered and efficient but without compromising on the quality of patient care. However, for DSD models to be efficient, facilities should have indicators of HIV services available and ready to provide the DSD models. We aimed to assess the availability of HIV service indicators and the readiness of facilities to provide DSD models for HIV treatment in selected public health facilities in Zambia.MethodsWe conducted a nationwide cross-sectional survey among public health facilities in Zambia that provide antiretroviral therapy (ART) services. We used an interviewer-administered questionnaire based on a World Health Organization (WHO) Service Availability Readiness Assessment (SARA) tool to assess the availability of HIV service indicators and the readiness of facilities to implement DSD models for HIV treatment. Availability and readiness were considered latent constructs, and therefore, we used structural equation modeling (SEM) to determine the correlations between them and their respective indicators.ResultsOf 60 public health ART facilities, the overall availability of HIV service indicators was 80.0% (48/60), and readiness to provide the DSD models was 81.7% (48/60). However, only 48 and 39% of the facilities had all indicators of availability and readiness, respectively. Retention in care for HIV multidisciplinary teams was more likely to occur in urban areas than in rural areas. SEM showed that the standardized estimate between availability and readiness was significantly and positively correlated (r = 0.73, p &amp;lt; 0.0001). In addition, both availability and readiness were significantly and positively correlated with most of their respective indicators.ConclusionAlthough most facilities had available HIV service indicators and were ready to provide DSD models, most facilities did not have all indicators of availability and readiness. In addition, there were differences between rural and urban facilities in some indicators. There is a need for persistent and heightened efforts meant to implement DSD in HIV treatment, especially in rural areas to accelerate reaching the desired HIV treatment outcomes.

Landscape of respiratory syncytial virus.

Respiratory syncytial virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus of the Orthopneumovirusgenus of the Pneumoviridae family in the order Mononegavirales. RSV can cause acute upper and lower respiratory tract infections, sometimes with extrapulmonary complications. The disease burden of RSV infection is enormous, mainly affecting infants and older adults aged 75 years or above. Currently, treatment options for RSV are largely supportive. Prevention strategies remain a critical focus, with efforts centered on vaccine development and the use of prophylactic monoclonal antibodies. To date, three RSV vaccines have been approved for active immunization among individuals aged 60 and above. For children who are not eligible for these vaccines, passive immunization is recommended. A newly approved prophylactic monoclonal antibody, Nirsevimab, which offers enhanced neutralizing activity and an extended half-life, provides exceptional protection for high-risk infants and young children. This review provides a comprehensive and detailed exploration of RSV's virology, immunology, pathogenesis, epidemiology, clinical manifestations, treatment options, and prevention strategies.

Assessing humoral immunity in daily practice: A retrospective study in a pediatric tertiary center

The evaluation of humoral immunity is usually performed through the assessment of serum immunoglobulin levels, vaccine titer responses, and B-cell enumeration and phenotyping. We performed a retrospective study assessing humoral immunity in 469 pediatric patients referred at the Sainte-Justine University Hospital Center. Almost half of the patients had at least one abnormal humoral immunological parameter at their evaluation, with low vaccine response titer to protein antigen being the most frequent. Fifteen patients (3.2 %) had a proven monogenic IEI, and 21 patients (4.5 %) required Ig replacement. Besides the infectious burden, hypoIgG remains the only parameter associated with Ig replacement therapy after the age of 6 years. Low antibody titers against conjugate vaccines had low sensitivity and positive predictive values for starting Ig replacement. Our study highlights the challenge of evaluating the humoral function in the pediatric population with suspected IEI with significant age and sex-dependent variability between parameters.

Real-World Assessment of Economic and Clinical Outcomes in Thai Patients With Respiratory Syncytial Virus Infection Across Age Groups: A Retrospective Cohort Analysis.

Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory infections worldwide, including Thailand. This study aimed to assess clinical and economic burdens of RSV infections across different age groups in Thailand. A retrospective cohort study was conducted using data from a tertiary care hospital from 2014 to 2021. Patients who tested at least one positive RSV were included and stratified into five age groups (< 2, 2-5, 5-18, 18-65, and > 65 years). Healthcare resource utilization, direct medical costs, and clinical outcomes were analyzed with descriptive statistics. Generalized linear models with gamma distributions and log link were used to model cost outcomes. Costs were reported in 2021 US dollars (USD), with 1 USD = 31.98 Thai Baht. A total of 2122 RSV-positive patients were identified, half of which (1097) were hospitalized. The median (interquartile range [IQR]) total hospitalization costs ranged from USD780 (IQR: USD488-USD1185) in those < 2 years to USD2231 (IQR: USD1250-USD4989) in those aged 65+ years. Case fatality rates among hospitalized patients also varied from 2.5% to 28.4% depending on age. Increased age, presence of comorbidities, and need for critical care were associated with higher hospitalization costs. Among RSV-positive patients, younger children experienced the greatest burden, but poorer outcomes were observed in older adults. Higher costs were associated with older age, comorbidities and critical care needs. Understanding RSV economic burdens is crucial for assessing the cost-effectiveness and public health value of vaccination programs that prioritize at-risk groups to mitigate the public health impact.

Respiratory Disease Surveillance in the Middle East and Latin America during the COVID-19 Pandemic, 2020-2022.

Characterizing the epidemiology of circulating respiratory pathogens during the COVID-19 pandemic could clarify the burden of acute respiratory infections and monitor outbreaks of public health and military relevance. The US Department of Defense supported 2 regions for influenza-like illness and severe acute respiratory infections surveillance, one in the Middle East through US Naval Medical Research Unit EURAFCENT, and another in Latin America through US Naval Medical Research Unit SOUTH. During 2020‒2022, coinciding with the COVID-19 pandemic, we collected a total of 16,146 nasopharyngeal and oropharyngeal swab samples from sentinel sites in Jordan (n = 11,305) and Latin America (n = 4,841). Samples were tested for SARS-CoV-2, influenza, and other respiratory pathogens. SARS-CoV-2 was the most frequently detected pathogen during 2020; other respiratory pathogens had distinct temporal and frequency distributions according to geographic location. Our findings support the need for continued sentinel surveillance as a vital tool for assessing the burden of respiratory diseases globally.

An Overview on Disease Burden and Management of Respiratory Syncytial Virus Infections in Older Adults in the Asia-Pacific Region.

Respiratory syncytial virus (RSV) represents a significant burden on older adults (aged ≥ 50years) globally and can lead to acute respiratory tract infections with substantial morbidity and mortality. However, there is a significant gap in knowledge regarding RSV infection in older adults, particularly in the Asia-Pacific region. This knowledge gap underscores the need for targeted and comprehensive studies to fully understand the nuanced epidemiology of RSV in ageing populations. This review synthesises data from various countries, emphasising the impact of RSV on older populations in the Asia-Pacific region. The overall proportions of RSV-related ARIs among older patients ranged from 0.2% to 5.6%. Among older adult patients with CAP, RSV accounted for 1.1%-10.3% of cases. However, it is crucial to note that the diversity in reported percentages highlights the influence of factors such as geographic location, health care settings and diagnostic practices. The most common symptoms observed in older adults with RSV infection were cough, sputum production and fever, followed by dyspnoea, sore throat and rhinorrhoea. Most of the old adults with RSV infection had underlying diseases, and RSV can cause significant morbidity and mortality in old adults. Treatment of RSV infections predominantly involve supportive care, with aerosolised ribavirin reserved for severe cases, especially immunocompromised patients. Emerging antiviral agents, including fusion and nucleoprotein inhibitors, offer promising avenues for future therapeutics. The recent approval of the bivalent RSV prefusion F protein-based vaccine for individuals aged 60 and older represents a milestone in preventive strategies. In conclusion, RSV infection remains a significant threat to older adults in the Asia-Pacific region, necessitating ongoing research and surveillance efforts. The recent vaccine approval marks a positive milestone, but further studies are crucial for refining prevention and treatment approaches.

‘Quality assessment of infection control measures in delivery points in a tribal district of Maharashtra’ - An observational study

ABSTRACT Background: Maternal and neonatal mortality rates remain alarmingly high in low-resource settings, with infections acquired during childbirth contributing significantly to this burden. Effective infection control measures at delivery points are crucial for mitigating these risks. This observational study aimed to assess the quality of infection control practices in delivery points in a tribal district of Maharashtra, India. Methods: A community-based study was conducted at delivery points across eight talukas in Palghar district. A total of 15 delivery points were selected using convenient sampling, representing three levels of facilities (L1, L2 and L3) which are healthcare facilities divided on the basis of the provision of services by Maternal and Newborn Health Toolkit. Data was collected using the validated LaQshya programme’s checklist through direct observation from June 1st to June 18th, 2021. Compliance with infection control protocols was scored based on predefined criteria. Results: The majority of L1 delivery points showed non-compliance in criteria such as surface microbiological surveillance and monitoring of infection control practices, 20–40% of Delivery points also showed non-compliance in the availability of personal protective equipment and waste management practices. Conclusion: This study highlights the need for targeted interventions to improve infection control practices in delivery points, particularly in lower-level facilities. Strengthening adherence to established protocols, enhancing staff training, ensuring availability of essential supplies and implementing robust monitoring systems are imperative for reducing the burden of maternal and neonatal infections and improving healthcare outcomes in resource-constrained settings.

Preventive measures against HIV among Uganda's youth: Strategies, implementation, and effectiveness.

Preventing HIV among Uganda's youth is a critical public health priority due to the high prevalence of HIV/AIDS and the disproportionate burden of new infections among young people. This paper examines the preventive measures implemented to combat HIV/AIDS among Uganda's youth, focusing on strategies, implementation efforts, and the effectiveness of interventions. Comprehensive sexuality education programs have been implemented in schools and communities to provide young people with accurate information on HIV transmission, prevention methods, and reproductive health. Condom distribution and promotion campaigns target sexually active youth, while HIV testing and counseling services aim to reach youth in various settings, including health facilities and community outreaches. The implementation of HIV prevention strategies involves collaboration among government agencies, NGOs, healthcare providers, educators, and community leaders. Efforts are made to ensure that prevention programs are culturally appropriate, evidence-based, and responsive to the needs of young people. Despite progress in HIV prevention, challenges persist, including knowledge gaps, stigma, gender inequalities, and socio-economic factors. Continuous monitoring and evaluation are essential to assess the impact of interventions and identify areas for improvement. Recommendations include increasing funding for HIV prevention programs, strengthening policy frameworks, enhancing access to youth-friendly health services, integrating comprehensive sexuality education into school curricula, and fostering community engagement. By addressing these recommendations, Uganda can strengthen its HIV prevention efforts and reduce the incidence of HIV/AIDS among its youth population, ultimately contributing to improved health outcomes and well-being.

Genotypic analysis of Shiga toxin-producing Escherichia coli clonal complex 17 in England and Wales, 2014-2022.

Introduction. Shiga toxin-producing Escherichia coli (STEC) are zoonotic, gastrointestinal pathogens characterized by the presence of the Shiga toxin (stx) gene. Historically, STEC O157:H7 clonal complex (CC) 11 has been the most clinically significant serotype; however, recently there has been an increase in non-O157 STEC serotypes, including STEC O103:H2 belonging to CC17.Gap statement. STEC O103:H2 is an STEC serotype frequently isolated in England, although little is known about the epidemiology, clinical significance, associated public health burden or evolutionary context of this strain.Aim. Surveillance data and whole-genome sequencing data were analysed to determine the microbiological characteristics and public health burden of CC17, including the clinically significant serotype O103:H2, in England and Wales.Methodology. Isolates of E. coli belonging to CC17 (n=425) submitted to the Gastrointestinal Bacteria Reference Unit from 2014 to 2022 were whole genome sequenced, integrated with enhanced surveillance questionnaire data and analysed retrospectively.Results. Overall, diagnoses of CC17 infection increased every year since 2014. Most cases were female (58.5%), with the highest proportion of cases belonging to the 0-4 age group (n=83/424, 19.6%). Clinical presentation data identified diarrhoea (92.1%), abdominal pain (72.4%) and blood in stool (55.3%) as the most frequent symptoms, while 20.4% cases were admitted to hospital and 1.3% developed haemolytic uraemic syndrome. The five most common established serotypes were O103:H2 (64.5%), O123:H2 (11.1%), O151:H2 (6.6%), O71:H2 (3.3%) and O4:H2 (2.6%). The majority of CC17 isolates (78.6%) had the stx1a/eae virulence gene combination. Nine outbreak clusters of STEC infections that were mainly geographically dispersed and temporally related were identified and associated with foodborne transmission.Conclusions. Nationwide implementation of PCR to detect non-O157 STEC and improvements to algorithms for the follow-up of PCR-positive faecal specimens is recommended. Enhanced surveillance is necessary to assess the incidence of CC17 infection and overall burden of this CC within the UK population.

A tool for the assessment of the risk drivers and public perception of WASH in South Africa.

Therefore, the study findings could be used to optimise the design and targeting of public awareness campaigns on WASH during the coronavirus pandemic or similar infectious disease burdens and related disaster risks.

Fungal disease incidence and prevalence in Iraq – Preliminary estimates

BackgroundThe surveillance of serious and superficial skin fungal infections in Iraq has not been conducted. Limited information exists on their incidence and prevalence. ObjectivesThis study aimed to analyze, compute and estimate the prevalence and burden of fungal infections, as no previous data is available and no studies has been attempted in Iraq. MethodsIn the present study the data were collected and reviewed from published data on epidemiology of fungal infections nationally, internationally, from unpublished postgraduate master and PhD theses, hospital records and private clinic records. External sources of data from other countries were used for diseases which lacked sufficient local data. ResultsWe estimated 985,628 annual serious infections comprising of 2.26 % of the total population. When including superficial fungal infections group of the skin, this rises to 2,075,113 infections at 4.76 % of the total population. The most common serious and skin infections were recurrent Candida vaginitis, fungal rhinosinusitis and tinea capitis comprising 61.5 %, 21.8 %, and 22.4 % of all infections although the total incidence of superficial fungal infections was also high at 1,071,485. Respiratory fungal disease is also common comprising 14.0 % of infections. We predicted the following annual burden per 100,000; oral candidiasis at 247.9, esophageal candidiasis at 6.04, candidemia at 5.0, Candida peritonitis at 0.75, recurrent Candida vaginitis at 5461, allergic bronchopulmonary aspergillosis at 35, severe asthma with fungal sensitisation at 46, invasive aspergillosis at 7.9, chronic pulmonary aspergillosis at 11.7, chronic fungal rhinosinusitis at 496, mucormycosis at 0.99, fungal keratitis at 14.0, and total dermatophytosis at 1631, the most severe being tinea capitis at 366. Many of these estimates were made with data sourced from other nations, so additional data from Iraq is required to validate or modify these estimates. ConclusionRecurrent Candida vaginitis, fungal rhinosinusitis, and tinea capitis are considered to be the most frequent fungal diseases present in Iraq.

Respiratory Carriage of Methicillin-Resistant Staphylococcus aureus-Encoding Gene in Hajj Pilgrims.

To assess the carriage of methicillin-resistant Staphylococcus aureus-encoding genes (MRSA) among French Hajj pilgrim cohorts. A prospective cohort study was conducted on pilgrims from Marseille during the 2014 to 2018 Hajj. Respiratory samples were collected before and after the pilgrimage. S. aureus and then MRSA-encoding genes were identified using real-time PCR. A total of 606 pilgrims were included with a sex ratio of 1:1.3 with a median age of 61 years (interquartile = 56-66 years, range = 21-88 years). A total of 511/606 (84.3%) pilgrims presented at least one respiratory symptom during their pilgrimage. Cough was the most frequent symptom occurring in 76.2% of pilgrims, followed by sore throat (57.6%), rhinitis (54.6%), and voice failure (36.3%). 87 (14.4%) were positive with S. aureus before travelling. On return, 130/606 (21.4%) participants were positive. The acquisition rate of S. aureus was 13.0% (79/606). The prevalence of MRSA pre- and post-travel and acquisition rate was 4.1% (25/606), 10.6% (62/606), and 8.2% (50/606), respectively. All MRSA were positive with mecA gene. No case was positive with mecC. Our study highlights the importance of surveillance and infection control measures during mass gatherings such as the Hajj to mitigate the spread of infectious pathogens, including antimicrobial-resistant bacteria like MRSA. Further research is warranted to elucidate the specific factors contributing to S. aureus and MRSA transmission during the pilgrimage and to inform targeted interventions aimed at reducing the burden of MRSA infection among pilgrims.

Uncovering the health system burden of pneumococcal infections in adult and elderly populations

Abstract Background Health system resources dedicated to vaccination and infectious disease prevention are often directed towards infants and children, through extensive childhood vaccination schedules. This focus has led to the near eradication of several preventable childhood diseases and had positive impacts on population health, but despite this track record of success, the ability of our health systems to make vaccinations accessible throughout the full life course has been less consistent. This project aims to address this issue by providing new data about the burden that pneumococcal infections, which are vaccine-preventable, have on adult and elderly populations. Methods This research aims to uncover the health system burden of invasive pneumococcal disease and pneumococcal pneumonia at all levels of the health system in 5 EU countries (Austria, Belgium, France, Italy &amp; Portugal). This involves a survey of managers and care providers working in hospitals, long-term care facilities, and primary care centres who may be affected by the health system impacts of pneumococcal infections. The survey covers several dimensions of health service delivery to collect a broad range of data on existing disruptions. The survey was translated into the study country languages and its formulation was further validated through interviews with experts in each study country to ensure that it can capture context-specific health system insights. The data collected through this survey will be further enhanced through a series of in-depth interviews before being synthesised, analysed and eventually published in a detailed report. Results Data collection begins as of 15 May 2024, and full results are expected to be published and available for the EPH Conference in November 2024. The results of this research will offer valuable evidence to public health professionals, health managers and policy-makers across Europe who are working to improve life-course access to pneumococcal vaccination. Key messages • Effective vaccination programmes for adult and elderly populations require expanding focus beyond childhood. • Data about the health system burden of pneumococcal infections in adult and elderly populations improves evidence-based decision-making and public health services.