Center For Infectious Diseases Research Articles

Ten-Year Trends of the Incidence of Cutaneous Leishmaniasis in the South of Fars Province, Iran, During 2007-2016

Background and aims: Leishmaniasis is one of the most overlooked diseases in tropical areas, which can lead to many deaths and illnesses. The present study was designed to determine the trend of cutaneous leishmaniasis in the south of Fars Province (south of Iran) during 2007-2016. Methods: The population of this cross-sectional study consisted of all people with cutaneous leishmaniasis referring to the Center for Infectious Diseases in Larestan, Gerash, Evaz, and Khonj in the south of Fars Province during 2007-2016. The incidence of cutaneous leishmaniasis was analyzed using the Cochrane-Armitage trend test, and the significance level was considered 5%. Results: In general, 4602 cases of cutaneous leishmaniasis were reported from 2007 to 2016. The highest and lowest incidence rates (659.1 versus 88. 3 per 100000 people) were observed in 2008 and 2012, respectively. In addition, the incidence of the disease significantly reduced (P Trend=0.003). Finally, the 0-4 age group had the highest incidence of the disease (69.64 per 100000 people), and the hands were the most common organ affected by cutaneous leishmaniasis (37%). Conclusion: According to the research findings, the incidence rate of cutaneous leishmaniasis is declining although leishmaniasis is still one of the endemic diseases in the region. Therefore, preventive and controlling interventional programs can be effective in reducing new cases of the disease, including the education of individuals, especially children, environmental cleanup, and extermination and control of stray dogs and rodents in the suburbs.

Clinical and laboratory differences in patients with local and generalized forms of Kaposi sarcoma

The objective: to evaluate clinical and laboratory parameters in local and generalized forms of Kaposi sarcoma (KS) in HIV infected patients to detect predictors of generalized forms of the disease.Subjects and methods. Case histories of 58 HIV infected patients with KS at the age from 28 to 80 years old were respectively analyzed; they all received treatment in National Medical Research Center of Phthisiopulmonology and Infectious Diseases of the Russian Ministry of Health in 2018-2020. Cases were divided into 2 groups depending on KS manifestations. LF group (local form of KS, n = 28) included the patients with skin lesions; GF group (generalized form of KS, n = 30) included patients with skin lesions and one or several lesions in the other sites: the mucous membrane of gastrointestinal tract, the mucous membrane of tracheobronchial tree, and lung parenchyma.Results. Patients with the generalized form of KS had a higher frequency of skin lesions on the body (pχ2 = 0.036), face (pχ2 = 0.033), and multiple sites (pχ2 = 0.018). Patients from both groups had low CD4+ count, but it was more severe in GF group (pχ2 = 0.027) with a significant increase of the viral load (pχ2 = 0.047). The predictors of the generalized form of KS are the following: the presence of specific lesions on the skin of body, face and multiple localizations, CD4 level below 125 cells/mcL, increase in the viral load above 5.3log10 copies/ml, reduction of erythrocytes level below 3.1 × 1012 cells/L. Among 24 patients with KS who had 4-6 predictors, 19 (79.2%) had the generalized form. Among KS patients with not a single predictor, there were no cases of generalized form, as well as there were no cases of local forms among patients who had 5 and 6 predictors.

Duration of fever in pediatric patients hospitalized with Community Acquired Pneumonia in a reference center for infectious diseases

Community acquired pneumonia (CAP) is an important cause of global morbidity and mortality, especially in developing countries, more frequently affecting children under 5 years of age. Few studies in the region have analyzed the total duration of fever days in relation to the presence of complications of the disease.

Current burden of cervical cancer in Bulgaria - epidemiological study

Abstract Background The risk factors of cervical cancer are well established and the disease is preventable through vaccination and early detection by screening. The disease ranks as leading cause of female cancer in Bulgaria. The objective of the research was to describe the current burden of cervical cancer in Bulgaria and medical decisions to improve women's health. Methods The information were summarized at the national level on the basis of official on-line database from the annual reports of the of the immunoprophylaxis activities of the National Center of Infectious and Parasitic Diseases (NCIPD), National Center for Public Health and Analyzes (NCPHA). Data for morbidity and mortality rate and vaccine coverage were analyzed and presented in tables and figures. Results Cancer registration has been compulsory in Bulgaria since 1952. National program for the primary prevention of cervical cancer was applied in 2012 (2012-2016, 2017-2020). From the same year was uses immunization against HPVs for 12 -year-old girls. Through these measures, the state guarantees the right of citizens to affordable primary prevention without imposing obligations. Despite the preventive strategy, the expected results are not observed. In 2018, the total number of registered malignancies of the cervix was 15759. The incidence of 100,000 population was 435.8. Of these, the number of newly diagnosed cases were 850, the incidence was 23.5 per 100,000 population. HPV vaccination coverage in girls by birth cohort was 15.1% - 1st dose and 14.3% - 2nd dose for 12-year-old girls and 7% - 1st dose for 13-year-old girls. Conclusions Bulgaria has a leading position in the incidence and mortality of cervical cancer among European countries, requiring mandatory screening and immunization against the Human Papilloma viruses. Key messages Cervical cancer, incidence rate, mortality rate. Vaccination coverage, HPVs, Bulgaria.

Building for the Known Unknown—Development of the National Centre for Infectious Diseases

Building for the Known Unknown—Development of the National Centre for Infectious Diseases

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Population-level emergence of bedaquiline and clofazimine resistance-associated variants among patients with drug-resistant tuberculosis in southern Africa: a phenotypic and phylogenetic analysis

SummaryBackgroundBedaquiline and clofazimine are important drugs in the treatment of drug-resistant tuberculosis and are commonly used across southern Africa, although drug susceptibility testing is not routinely performed. In this study, we did a genotypic and phenotypic analysis of drug-resistant Mycobacterium tuberculosis isolates from cohort studies in hospitals in KwaZulu-Natal, South Africa, to identify resistance-associated variants (RAVs) and assess the extent of clofazimine and bedaquiline cross-resistance. We also used a comprehensive dataset of whole-genome sequences to investigate the phylogenetic and geographical distribution of bedaquiline and clofazimine RAVs in southern Africa.MethodsIn this study, we included M tuberculosis isolates reported from the PRAXIS study of patients with drug-resistant tuberculosis treated with bedaquiline (King Dinuzulu Hospital, Durban) and three other cohort studies of drug-resistant tuberculosis in other KwaZulu-Natal hospitals, and sequential isolates from six persistently culture-positive patients with extensively drug-resistant tuberculosis at the KwaZulu-Natal provincial referral laboratory. Samples were collected between 2013 and 2019. Microbiological cultures were done as part of all parent studies. We sequenced whole genomes of included isolates and measured bedaquiline and clofazimine minimum inhibitory concentrations (MICs) for isolates identified as carrying any Rv0678 variant or previously published atpE, pepQ, and Rv1979c RAVs, which were the subject of the phenotypic study. We combined all whole-genome sequences of M tuberculosis obtained in this study with publicly available sequence data from other tuberculosis studies in southern Africa (defined as the countries of the Southern African Development Community), including isolates with Rv0678 variants identified by screening public genomic databases. We used this extended dataset to reconstruct phylogenetic relationships across lineage 2 and 4 M tuberculosis isolates.FindingsWe sequenced the whole genome of 648 isolates from 385 patients with drug-resistant tuberculosis recruited into cohort studies in KwaZulu-Natal, and 28 isolates from six patients from the KwaZulu-Natal referral laboratory. We identified 30 isolates with Rv0678 RAVs from 16 (4%) of 391 patients. We did not identify any atpE, pepQ, or Rv1979c RAVs. MICs were measured for 21 isolates with Rv0678 RAVs. MICs were above the critical concentration for bedaquiline resistance in nine (43%) of 21 isolates, in the intermediate category in nine (43%) isolates, and within the wild-type range in three (14%) isolates. Clofazimine MICs in genetically wild-type isolates ranged from 0·12–0·5 μg/mL, and in isolates with RAVs from 0·25–4·0 μg/mL. Phylogenetic analysis of the extended dataset including M tuberculosis isolates from southern Africa resolved multiple emergences of Rv0678 variants in lineages 2 and 4, documented two likely nosocomial transmission events, and identified the spread of a possibly bedaquiline and clofazimine cross-resistant clone in eSwatini. We also identified four patients with pepQ frameshift mutations that may confer resistance.InterpretationBedaquiline and clofazimine cross-resistance in southern Africa is emerging repeatedly, with evidence of onward transmission largely due to Rv0678 mutations in M tuberculosis. Roll-out of bedaquiline and clofazimine treatment in the setting of limited drug susceptibility testing could allow further spread of resistance. Designing strong regimens would help reduce the emergence of resistance. Drug susceptibility testing is required to identify where resistance does emerge.FundingWellcome Trust, National Institute of Allergy and Infectious Diseases and National Center for Advancing Translational Sciences of the National Institutes of Health.

Trauma and orthopaedics in the COVID-19 pandemic: breaking every wave.

The coronavirus disease 2019 (COVID-19) pandemic has placed the whole world and the medical profession in an unprecedented situation. Each medical specialty has had to develop protocols within the local context to cope with this crisis. We aimed to provide a commentary on the evolving situation in orthopaedic departments in Singapore and share insights and recommendations for the consideration of orthopaedic surgeons worldwide. The COVID-19 threat in Singapore can be classified into ‘waves’, which started with the confirmation of the first COVID-19-positive patient in Singapore on 23 January 2020. The first wave of cases was traced to travel or contact with travellers to and from the Chinese city of Wuhan, Hubei.(1) This progressed to more cases from North Asian cities in February 2020, with few cases from Europe or North America. As Singapore braced itself for community spread, the national disease threat level was stepped up from Disease Outbreak Response System Condition (DORSCON) Yellow to Orange on 7 February 2020.(2-4) By early March, the number of COVID-19-positive cases in Europe and North America had increased exponentially with a high number of fatalities, signalling a global pandemic. The second wave of cases in Singapore, many of whom were returning students and Singaporeans working abroad, was traced to previous travel to Europe, North America and other cities in Asia. Unlike many countries that imposed a lockdown to limit local community spread, Singapore maintained a strategy of testing and isolation of infected individuals, and quarantine of all close contacts of infected individuals. This aggressive public health strategy allowed most Singaporeans to continue work and school with limited restrictions in February and March 2020. The policy of ‘social distancing’ was additionally promoted to mitigate local transmission. The end of March 2020 saw multiple new local clusters and increased numbers of local unlinked COVID-19-positive cases. This heralded the start of the third wave of patients from significant local case transmission.(5) Over this period, the resources of the local medical community – community practice, government restructured hospitals and the National Centre for Infectious Diseases (NCID) – were strained and further put to the test. The significant rise of new local unlinked cases necessitated a national ‘circuit breaker’ period that commenced on 7 April 2020 for one month (i.e. two COVID-19 incubation cycles). During this time, only essential services were permitted to continue. A nationwide school and non-essential workplace closure took effect in order to create a period of enhanced social distancing and reduced human traffic in Singapore. Trauma and orthopaedics encompass both non-elective and elective work. Trauma involves the management of fractures that are categorised as urgent and semi-urgent. Elective orthopaedic surgery covers soft tissue repair and reconstruction, joint replacement in the shoulder, knee, ankle and hip joints, and spine surgery. Musculoskeletal oncology surgery and certain aspects of spine surgery such as spinal cord decompressions are generally considered urgent and semi-urgent. During this pandemic, orthopaedic departments in Singapore have to frequently calibrate and recalibrate their organisational structure and clinical operations as the crisis evolves.

Patterns of COVID-19 on computed tomography imaging.

As the designated tertiary referral centre for infectious diseases in Hong Kong, our hospital received the city's first group of patients diagnosed with coronavirus disease 2019 (COVID-19). Herein, we studied the earliest patients admitted to our centre in order to clarify the typical radiological findings, particularly computed tomography (CT) findings, associated with COVID-19. From 22 January 2020 to 29 February 2020, 19 patients with confirmed COVID-19 underwent high-resolution or conventional CT scans of the thorax in our centre. The CT imaging findings of these patients with confirmed COVID-19 in Hong Kong were reviewed in this study. Ground-glass opacities (GGO) with peripheral subpleural distribution were found in all patients (100%). No specific zonal predominance was observed. All lobes were involved in 16 (84.2%) patients, focal subsegmental consolidations were observed in 14 (73.7%) patients, and interlobular septal thickening was present in 12 (63.2%) patients. No mediastinal lymph node enlargement, centrilobular nodule, or pleural effusion was detected in any of the patients. Other imaging features present in several patients include bronchial dilatation, bronchial wall thickening, and crazy-paving patterns. Peripheral subpleural GGO without zonal predominance in the absence of centrilobular nodule, pleural effusion, and lymph node enlargement were consistent findings in patients with confirmed COVID-19. The observed radiological patterns on CT scans can help identify COVID-19 and assess affected patients in the context of the ongoing outbreak.

Stroke Care Services in Singapore During COVID-19 Pandemic-A National Perspective.

Stroke is a significant cause of admission to Singapore's acute care hospitals. Because of the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases. Otherwise, on arrival at the emergency room, all cases with fever or respiratory symptoms [COVID-19 suspect patients (CSPs)] are evaluated separately by staff wearing full personal protective equipment (PPE). Triage is not delayed. CSPs needing hyperacute therapies are sent to a specially prepared scanner; if not, imaging is deferred to the latter part of the day. CSPs are managed in isolation rooms, and sent to the acute stroke unit (ASU) if two consecutive COVID-19 swabs are negative. Investigation and rehabilitation are done within the room. ASU rounds are attended by essential members, communication by electronic means. Multidisciplinary team rounds have largely ceased, and discussions are via electronic platforms. Patient transfer and staff movement are minimized. All hospital staff wear face-masks, infection control is strictly enforced. Visitors are not allowed; staff make daily calls to update families. Mild stroke patients may be sent home with rehabilitation advice. Out-patient rehabilitation centers are closed. Patients return for out-patient visits only if needed; medications are sent to their home, and nurses make essential home visits. Stroke support and rehabilitation activities have started on-line. Continuing medical education activities are mainly by webinars. Stroke research has been severely hampered. Overall, evidence-based stroke care is delivered in a re-organized manner, with a clear eye on infection control.

Post-infectious irritable bowel syndrome after a laboratory-proven enteritis.

There are scarce data on risk factors for post-infectious irritable bowel syndrome (PI-IBS). The objective of this study was to determine the risk factors of developing PI-IBS following an acute infectious gastroenteritis (AGE) episode in which, by laboratory tests, the etiological agent was isolated. The study was conducted on patients admitted to a tertiary center of infectious diseases during three consecutive years. The patients were divided into two groups: a group consisting of patients admitted with AGE (with an isolated etiological agent) and a control group consisting of patients admitted for an acute upper respiratory tract infection (URTI). The subjects were recalled in our center 6 months after the admission and were evaluated with Rome III IBS diagnostic questionnaire and Bristol Stool Form Scale. The questionnaires were paper printed and directly filled in by the subjects. The response rate in the case group was 5% and in the control group 100%. The prevalence of PI-IBS was higher in patients with AGE, presenting a relative risk (RR) of 4.16 [95% confidence interval (CI), 1.89-9.17], statistically significant (P<0.001) vs. URTI. From 28 female patients, 22 patients (79%) developed PI-IBS and from 17 male patients, 3 patients (18%) had developed PI-IBS with a risk of 4.4 (95% CI, 1.56-12.65), P<0.001. Regarding the infectious etiology of the AGE, Campylobacter jejuni had the highest risk of developing PI-IBS, RR=1.2 (95% CI, 0.13-3.11), P=0.04 compared with the other agents with a lower risk. The risk to develop PI-IBS after AGE infection is 4.16 higher than after URTI. Female sex is a risk factor for PI-IBS, 79% of the female patients developed PI-IBS after AGE. The incidence of PI-IBS is highest in patients with Campylobacter jejuni AGE compared with the other agents.

SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States.

IntroductionSevere Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS‐CoV‐2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID‐19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS‐CoV‐2 coinfection from Rhode Island, US.MethodsWe describe outpatient and inpatient preparedness for the COVID‐19 pandemic, and present a case series of all known patients with HIV/SARS‐CoV‐2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US.Results and discussionThe Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS‐CoV‐2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS‐CoV‐2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty‐six of the 27 had common COVID‐19 symptoms for one to twenty‐eight days and most had other co‐morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS‐CoV‐2 coinfection, whereas the comparable state‐wide prevalence was 9%.ConclusionsWe highlight challenges of outpatient and inpatient HIV care in the setting of the COVID‐19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS‐CoV‐2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID‐19 appear consistent with those without HIV. Whether SARS‐CoV‐2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.

Etiological and epidemiological features of concomitant acute intestinal infections in children

Objective : to study the frequency, etiological, age, epidemiological features of combined acute intestinal infections in children. Materials and methods. In n the Department of intestinal infections of Pediatric Research and Clinical Center for Infectious Diseases within a year have observed 167 children with combined acute intestinal infections regardless of the severity of the disease. The etiology of the acute intestinal infections was verified by bacteriological, serological methods, PCR reagents “AmpliSens® AII screen-FL. Criteria for inclusion of patients in the study: no signs of nosocomial OKA. Statistical analysis of the results was performed using Excel 2007. Student’s criterion was used to estimate the difference of the studied data. Differences were considered significant at p&lt;0.05. Results. Combined acute intestinal infections were diagnosed in 5,6% of 2968 patients, among whom children under 1 year were 21,6%, from 1 to 3 years – 48,4%, from 4 to 7 years – 18%, from 8 to 14 years – 9%, from 14 to 18 years – 3%. The combination of bacterial pathogens was noted in 12% of patients; viral – in 37,1%; viral and bacterial – in 50,9%. Viral-bacterial AII had rises in the frequency of diagnosis in spring, summer, autumn; viral-viral acute intestinal infections – in spring and autumn, bacterial-bacterial acute intestinal infections – in autumn. Infants in the structure of patients with viral-viral acute intestinal infections were 23,3%, viral-bacterial acute intestinal infections – 29,6%, bacterial-bacterial acute intestinal infections – 5%; young age – 45%; 47,%; 40%; preschool age– 25%; 23,3%; 15,5%; school age – 30%; 8.3%; 7% respectively. Among of associates the bacterial-bacterial acute intestinal infections, diarrheal Escherichia (60%), Salmonella (50%) and Campylobacters (40%) dominated. Among of associates of the viral-viral acute intestinal infections noroviruses (74,2%) and rotaviruses (at 69,4%) dominated. Among of viral associates of viral-bacterial acute intestinal infections more prevalent were rotaviruses (52,9%) and noroviruses (27,1%); among bacterial associates were diarrheal Escherichia (at 51,8%). The results of the study allowed establish etiological, seasonal, age patterns of formation of the epidemiological process of intestinal infections of combined etiology in children.

Editorial introductions

Editorial introductions

Translation: Management of Coronavirus Disease 2019 (COVID-19): Experience in Zhejiang Province, China

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remains severe. As the National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital of the Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang Province. Based on the present expert consensus carried out by the National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on “Four-Anti and Two-Balance” for clinical practice. The “Four-Anti and Two-Balance” strategy includes antivirus, anti-shock, anti-hypoxemia, and anti-secondary infection, and maintaining of water, electrolyte and acid/base balance and microecological balance. Simultaneously, an integrated multidisciplinary personalized treatment is recommended to improve therapeutic effects. The importance of early viral detection, dynamic monitoring of inflammatory indexes, and chest radiographs has been emphasized in clinical decision-making. Sputum was observed with the highest positive rate by RT-PCR. Viral nucleic acids could be detected in 10% of the patients’ blood samples at the acute phase and 50% of patients had positive RT-PCR results in their feces. We also isolated live viral strains from feces, indicating potential infectiousness of feces. Dynamic cytokine detection was necessary to timely identify cytokine storms and for the application of the artificial liver blood purification system. The “Four-Anti and Two-Balance” strategy effectively increased cure rates and reduced mortality. Early antiviral treatment alleviated disease severity and prevented illness progression. We found that lopinavir/ritonavir combined with abidol showed antiviral effects against COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system was able to rapidly remove inflammatory mediators and block the cytokine storm. Moreover, it also contributed to the balance of fluids, electrolytes, and acids/bases and thus improved treatment efficacy during critical illness. For cases of severe illness, early and also short periods of moderate glucocorticoid administration was supported. Patients with an oxygenation index below 200 mm Hg were transferred to the intensive care unit. Conservative oxygen therapy was preferred and noninvasive ventilation (NIV) was not recommended. Patients with mechanical ventilation were strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was prescribed rationally and was not recommended, except for patients with a long course of disease, repeated fever, and elevated procalcitonin, similarly secondary fungal infections were of concern. Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased genus such as Lactobacillus and Bifidobacterium. Nutritional and gastrointestinal function should; therefore, be assessed for all patients. Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infections due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore, we established a dynamic assessment and warning for psychological crises. We also integrated Chinese medicine in the treatment to promote rehabilitation. We optimized nursing processes for severe patients to promote their rehabilitation. Since viral clearance patterns after severe acute respiratory syndrome coronavirus 2 infections remained unclear, 2 weeks quarantine for discharged patients was required, and a regular following-up was also needed. These Zhejiang experiences and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work is warranted to further improve strategies of prevention, diagnosis, and treatment for COVID-19.

Use of a Real-Time Locating System for Contact Tracing of Health Care Workers During the COVID-19 Pandemic at an Infectious Disease Center in Singapore: Validation Study.

BackgroundIn early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting.ObjectiveThis study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore.MethodsOver a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers.ResultsOf 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%).ConclusionsRTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary.

COVID-19 and the General Surgical Department - Measures to Reduce Spread of SARS-COV-2 Among Surgeons.

COVID-19 and the General Surgical Department - Measures to Reduce Spread of SARS-COV-2 Among Surgeons.

Incidence of syphilis among HIV-infected men in Singapore, 2006–2017: temporal trends and associated risk factors

ObjectiveThere have been recent reports globally on substantial increase in syphilis diagnoses particularly among high-risk men. The aim of this study was to assess temporal trends of incident syphilis and...

Parallel epidemics, or nearly so: Certainties and uncertainties about SARS-CoV-2 in Italy

Parallel epidemics, or nearly so: Certainties and uncertainties about SARS-CoV-2 in Italy

Responding to the COVID-19 Outbreak in Singapore: Staff Protection and Staff Temperature and Sickness Surveillance Systems.

BackgroundCoronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by novel coronavirus (SARS-CoV-2), and first reported in Wuhan, China, in December 2019. Since the severe acute respiratory syndrome (SARS) outbreak in 2003, Tan Tock Seng Hospital (TTSH) in Singapore has routinely fit-tested staff for high filtration N95 respirators, and established web-based staff surveillance systems. The routine systems were enhanced in response to Singapore’s first imported COVID-19 case on January 23,2020.MethodsWe conducted a cross-sectional study, from January 23,2020 to February 23,2020, among healthcare workers to evaluate the effectiveness of the staff protection and surveillance strategy in TTSH, a 1600-bed multidisciplinary acute-care hospital co-located with the 330-bed National Centre for Infectious Diseases (NCID). As of February 23,2020, TTSH/NCID has managed 76% of confirmed COVID-19 cases in Singapore. The hospital adopted a multi-pronged approach to protect and monitor staff with potential COVID-19 exposures:(1) Risk-based personal protective equipment, (2) Staff fever and sickness surveillance, and (3) Enhanced medical surveillance of unwell staff.ResultsA total of 10,583 staff were placed on hospital-wide fever and sickness surveillance, with 1,524 frontline staff working in COVID-19 areas under close surveillance. Among frontline staff, a median of eight staff illness episodes was seen per day, and almost 10% (n=29) resulted in hospitalization. None of the staff was found to be infected with COVID-19.ConclusionsA robust staff protection and health surveillance system that is routinely implemented during non-outbreak periods and enhanced during the COVID-19 outbreak is effective in protecting frontline staff from the infection.