Decrease Disease Transmission Research Articles

Optimal control strategies for infectious diseases with consideration of behavioral dynamics

We present a simple SVIR (susceptible, vaccinated, infected, recovered) model to analyze the spread of COVID‐19, incorporating the influence of the population's caution on the transmission rate, which is considered nonlinear in current number of infected. Demonstrating a positive bound solution confirms the model's biological relevance. Through a formula for the basic reproduction number, we explore the local asymptotic stability of the disease‐free equilibrium (DFE) and endemic equilibrium (EE), showing that the existence of the EE relies on the basic reproduction number. Furthermore, we establish the global stability of the DFE by constructing a Lyapunov function. We present an optimal control problem for vaccination, demonstrating the existence and uniqueness of the optimal strategy. Our simulations indicate that optimal vaccination is effective in reducing infections and costs. We also investigate the effect of integrating education into the model to underscore its importance in decreasing disease transmission rates and reducing the necessity for vaccine uptake.

Contacts, altruism and competing externalities

This paper considers voluntary transmissive contacts between partially altruistic individuals in the presence of asymptomatic infection. Two different types of externalities from contacts are considered, infection externalities and socioeconomic externalities. When contacts are incidental, then externalities work through disease propagation. When contacts are essential, both infection and socioeconomic externalities are present. It is shown that for incidental contacts, equilibrium involves suboptimally high exposure whereas for essential contacts, equilibrium exposure is suboptimally low. An increase in altruism may thus increase or decrease disease transmission, depending on the type of contact under consideration. The analysis implies that policy to manage an epidemic should differentiate between different types of transmissive activities.

Impact of Imperfect Vaccine, Vaccine Trade-Off and Population Turnover on Infectious Disease Dynamics

Vaccination is an essential tool for the management of infectious diseases. However, many vaccines are imperfect, having only a partial protective effect in decreasing disease transmission and/or favouring recovery of infected individuals and possibly exhibiting a trade-off between these two properties. Furthermore, the success of vaccination also depends on the population turnover, and the rate of entry to and exit from the population. We here investigate by means of a mathematical model the interplay between these factors to predict optimal vaccination strategies. We first compute the basic reproduction number and study the global stability of the equilibria. We then assess the most influential parameters determining the total number of infected over time using a sensitivity analysis. We derive conditions for the vaccination coverage and efficiency to achieve disease eradication, assuming different intensities of population turnover (weak and strong), vaccine properties (transmission and/or recovery) and the trade-off between the latter. We show that the minimum vaccination coverage increases with lower population turnover decreases with higher vaccine efficiency (transmission or recovery) and is increased/decreased by up to 15% depending on the vaccine trade-off. We conclude that the coverage target for vaccination campaigns should be evaluated based on the interplay between these factors.

Exposure to diverse sarbecoviruses indicates frequent zoonotic spillover in human communities interacting with wildlife

BackgroundSarbecoviruses are a subgenus of Coronaviridae that mostly infect bats with known potential to infect humans (SARS-CoV and SARS-CoV-2). Populations in Southeast Asia, where these viruses are most likely to emerge, have been undersurveyed to date. MethodsWe surveyed communities engaged in extractive industries and bat guano harvesting from rural areas in Myanmar. Participants were screened for exposure to sarbecoviruses, and their interactions with wildlife were evaluated to determine the factors associated with exposure to sarbecoviruses. ResultsOf 693 people screened between July 2017 and February 2020, 12.1% were seropositive for sarbecoviruses. Individuals were significantly more likely to have been exposed to sarbecoviruses if their main livelihood involved working in extractive industries (logging, hunting, or harvesting of forest products; odds ratio [OR] = 2.71, P = 0.019) or had been hunting/slaughtering bats (OR = 6.09, P = 0.020). Exposure to a range of bat and pangolin sarbecoviruses was identified. ConclusionExposure to diverse sarbecoviruses among high-risk human communities provides epidemiologic and immunologic evidence that zoonotic spillover is occurring. These findings inform risk mitigation efforts needed to decrease disease transmission at the bat-human interface, as well as future surveillance efforts warranted to monitor isolated populations for viruses with pandemic potential.

Changes in air pollution due to COVID-19 lockdowns in 2020: Limited effect on NO2, PM2.5, and PM10 annual means compared to the new WHO Air Quality Guidelines.

Lockdowns have been fundamental to decreasing disease transmission during the COVID-19 pandemic even after vaccines were available. We aimed to evaluate and compare changes in air quality during the first year of the pandemic in different cities around the world, investigate how these changes correlate with changes in mobility, and analyse how lockdowns affected air pollutants' annual means. We compared the concentrations of NO2, PM2.5, and PM10 in 42 cities around the world in the first months of the pandemic in 2020 to data from 2016-2019 and correlated them with changes in mobility using Human Development Indexes (HDIs). Cities with the highest decreases in air pollutants during this period were evaluated for the whole year 2020. We calculated the annual means for these cities and compared them to the new World Health Organization (WHO) Air Quality Guidelines. A Student's t-test (95% confidence interval) was used to evaluate significant changes. Highest decreases in NO2, PM2.5, and PM10 were between -50 and -70%. Cities evaluated for the whole year 2020 generally showed a recovery in air pollution levels after the initial months of the pandemic, except for London. These changes positively correlated with year-long mobility indexes for NO2 and PM2.5 for some cities. The highest reductions in air pollutants' annual means were from -20 to -35%. In general, decreases were higher for NO2, compared to PM2.5 and PM10. All analysed cities showed annual means incompliant with the new WHO Air Quality Guidelines for NO2 of 10 μg/m3, with values 1.7 and 4.3 times higher. For PM2.5, all cities showed values 1.3 to 7.6 times higher than the WHO Guidelines of 5 μg/m3, except for New Delhi, with a value 18 times higher. For PM10, only New York complied with the new guidelines of 15 μg/m3 and all the other cities were 1.1 to 4.2 times higher, except for New Delhi, which was 11 times higher. These data show that even during a pandemic that highly affected mobility and economic activities and decreased air pollution around the world, complying with the new WHO Guidelines will demand a global strategical effort in the way we generate energy, move in and around the cities, and manufacture products.

Co-dynamics of cassava virus disease with farming awareness and control measures: A case of lake zone in Tanzania

The cassava virus diseases co-dynamics model is formulated and analysed using ordinary differential equations theories. The modelling involves cassava plant and whitefly vector population, with aspects of Farmer's awareness level. The evaluation of farmers' awareness inverted numerically and found that increasing awareness levels among farmers decrease disease transmission and spread. The data from ten district councils in the Tanzania lake zone fit and estimate the model parameters. In addition, time-dependent controls were incorporated to reduce the burden on cassava farmers. The findings revealed that with limited resources, uprooting and burning the infected cassava plants and awareness campaign programs significantly reduce the transmission. Therefore, to overcome the burden caused by cassava virus diseases, the farmers are recommended to uproot and burn the infected cassava plants from the farm. Also, it should be updated on controlling disease through educational campaign programs to enhance farmers' awareness.

Blockchain‐Based Contact Tracing and Information Sharing Model for COVID‐19 Pandemic

COVID‐19 is the worst contagious disaster in the history of humankind, triggering a worldwide sickness pandemic. In lacking specialized treatments or immunizations, finding and eliminating the infection source is the best option to decrease disease transmission and lower sickness and degree of fatality among the general public. Generally, few significant barriers are present in the existing system of monitoring the contamination. One of the obstacles is regarding health‐related data storage. The user’s e‐health data is kept in a traditional method that might have been compromised if shared with third parties. Secondly, the current disease tracking technologies fail to monitor diseases numerous ways. The tracing system is either personal or location‐based. Apart from these, gathering individual consent and sharing their health data with unknown associations is a real‐time problem. We propose a blockchain‐based data system that maintains confidentiality with transparency. Users can acquire unlimited and nontampered vital routes as the suggested blockchain solution leverages to link the user/patient and approved solvers. Also, automatically executed smart contracts are constructed to desensitize the user ID and reallocation. The anonymous feature delivered by private blockchain with wireless technologies defends the customer’s identity secrecy. We develop a matching approach using machine learning technology. Users may take safeguards in advance by employing our suggested analytical technique for predicting the risk due to infectious source presence.

Disease Risk and Conservation Implications of Orangutan Translocations.

Critically Endangered orangutans are translocated in several situations: reintroduced into historic range where no wild populations exist, released to reinforce existing wild populations, and wild-to-wild translocated to remove individuals from potentially risky situations. Translocated orangutans exposed to human diseases, including Coronavirus Disease 2019 (COVID-19), pose risks to wild and previously released conspecifics. Wildlife disease risk experts recommended halting great ape translocations during the COVID-19 pandemic to minimize risk of disease transmission to wild populations. We collected data on orangutan releases and associated disease risk management in Indonesia during the COVID-19 pandemic, and developed a problem description for orangutan disease and conservation risks. We identified that at least 15 rehabilitated ex-captive and 27 wild captured orangutans were released during the study period. Identified disease risks included several wild-to-wild translocated orangutans in direct contact or proximity to humans without protective equipment, and formerly captive rehabilitated orangutans that have had long periods of contact and potential exposure to human diseases. While translocation practitioners typically employ mitigation measures to decrease disease transmission likelihood, these measures cannot eliminate all risk, and are not consistently applied. COVID-19 and other diseases of human origin can be transmitted to orangutans, which could have catastrophic impacts on wild orangutans, other susceptible fauna, and humans should disease transmission occur. We recommend stakeholders conduct a Disease Risk Analysis for orangutan translocation, and improve pathogen surveillance and mitigation measures to decrease the likelihood of potential outbreaks. We also suggest refocusing conservation efforts on alternatives to wild-to-wild translocation including mitigating human-orangutan interactions, enforcing laws and protecting orangutan habitats to conserve orangutans in situ.

Teaching Dermatology Using a Cognitive Learning Theory Approach: An Educational Technique

Context Athletic trainers must develop the knowledge and skills to recognize signs and symptoms of dermatologic conditions in the physically active population. Objective To present an overview of an educational technique aimed at promoting the development of skills related to dermatological care that meets clinical practice needs and accreditation requirements for athletic training programs at all levels. Background Curricular content standards in athletic training education require learners to obtain the skills necessary to perform an evaluation, formulate a diagnosis, and establish a plan of care relevant to the integumentary system, including dermatological conditions. Cognitive Learning Theory uses specific sequencing of content and learning sessions to promote student engagement in the learning process. Description Within an evaluation course for nonorthopaedic conditions, a 3–class session learning module was developed to target instruction, application, and assessment of dermatological conditions. This article describes the development, overview of content, delivery methods, outcomes to date, and connection to the instructional standards in athletic training. Clinical Advantage(s) Integrating evaluation of dermatological conditions into athletic training curricula enhances clinical decision-making skills and direct application of these skills to clinical practice. Conclusion(s) Athletic trainers should be able to effectively identify, manage, and potentially refer patients with dermatological conditions. Educating future athletic trainers to be able to prevent the spread of infection, decrease disease transmission, and enhance their ability to recognize and manage dermatological conditions is vital to their development toward independent clinical practice.

Telemedicine use in orthopaedics: Experience during the COVID-19 pandemic

Introduction With a recent resurgence of the 2019 coronavirus disease (COVID-19) cases globally, an increasing number of healthcare systems are adopting telemedicine as an alternative method of healthcare delivery in a bid to decrease disease transmission. Continued care of orthopaedic patients in the outpatient setting during the coronavirus disease of 2019 era can prove challenging without a systematic workflow, adequate logistics, and careful patient selection for teleconsultation. The aim of this paper is to describe our single-centre experience with the application of telemedicine in our orthopaedic practice, and its effectiveness in maintaining outpatient follow-up of orthopaedic patients. Methodology We describe our centre's telemedicine model of care for orthopaedic patients on the outpatient follow-up – which includes workforce assembly, population health and target patients, logistics and communications, and overall workflow – with roles and responsibilities of involved people portrayed in detail. Results Feedback from both patients and orthopaedic surgeons reflected high satisfaction rates with care provided, noting minimal communication and clinical barriers compared to face-to-face consultations. Whilst not without limitations, our protocol allowed for rapid adoption of telemedicine in line with a national-wide initiative to digitize healthcare. Discussion The implementation of teleconsultation services at our orthopaedic centre has provided an effective method of healthcare delivery while enforcing social distancing measures – which proves vital in combating the spread of COVID-19 and ushering in a new normal.

Academic activism on behalf of children during the COVID-19 pandemic in Israel; beyond public health advocacy

Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC’s activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society’s vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.

A COVID-19 Epidemic Model Predicting the Effectiveness of Vaccination in the US.

A model of a COVID-19 epidemic is used to predict the effectiveness of vaccination in the US. The model incorporates key features of COVID-19 epidemics: asymptomatic and symptomatic infectiousness, reported and unreported cases data, and social measures implemented to decrease infection transmission. The model analyzes the effectiveness of vaccination in terms of vaccination efficiency, vaccination scheduling, and relaxation of social measures that decrease disease transmission. The model demonstrates that the subsiding of the epidemic as vaccination is implemented depends critically on the scale of relaxation of social measures that reduce disease transmission.

Determining the prevalence and density of asymptomatic Plasmodium falciparum infections in low and high transmission settings in Western Kenya

Background/Objective: Malaria remains a global health burden as 2018 saw 228 million cases worldwide. Pre-elimination efforts aim to decrease disease transmission, which depends on development of asexual parasites to sexual gametocytes within the human host. To better determine the relationship between asexual parasites and gametocytes, we aim to quantify both stages within the same blood sample by developing a multiplex RT-qPCR assay. We hypothesize that gametocytemia decreases linearly with asexual parasitemia at higher parasitemias but increases at lower parasitemia to improve transmission probability. 
 
 Methods: We conducted a cross-sectional survey of healthy participants aged 0 to 92 years at four sites in Western Kenya (Ajigo, Webuye, Kipsamoite, Kapsisywa) with varying levels of transmission to determine prevalence of asymptomatic P. falciparum blood-stage infections. Parasite density was quantified by light microscopy and by quantitative PCR of genomic DNA isolated from dried blood spots using varATS primers. For varATS-positive samples, we isolated RNA from whole-blood and performed stage-specific quantification by multiplex Taqman RT-qPCR targeting PfPIESP2 (asexual), Pfs25 (female), and Pfs230p (male). 
 
 Results: Among all participants, 127 of 1355 (9.37%) were positive for asymptomatic P. falciparum infection by varATS-qPCR. Using varATS positivity as the standard, multiplex RT-qPCR targeting PfPIESP2 yielded a sensitivity of 78%. Across sites, overall parasite prevalence and gametocyte prevalence were highest in Ajigo (42.1%; 36%) followed by Webuye (10.5%; 9%) and Kipsamoite/Kapsisywa (0.873%; 0.1%). Pfs25-quantified gametocytemia decreased with decreasing varATS-quantified asexual parasitemia; however, the data poorly fit a linear model (R2 = 0.088). 
 
 Conclusions: PfPIESP2 detected 78% of varATS-positive samples, suggesting it may be poorly sensitive at detecting low-density blood-stage infections. Assay design may improve with a more sensitive gene target and further optimization. Based on quantification results, the relationship between gametocytemia and asexual parasitemia appears direct but non-linear. Further work is necessary to better model the relationship between stage-specific parasitemia levels.

Awareness and Attitudes Regarding COVID-19 Among Clinical Dental Technicians in Albayda, Libya

Despite the availability of prevention guidelines and recommendations on infection management, several dental practices lack the basic awareness of requirements for infection control. This study aimed to assess the amount of awareness, perception, and perspective relating to the coronavirus disease (COVID-19) and infection control among clinical dental technicians. The study population consisted of clinical dental technicians who worked in private clinics, hospitals, and health centers in Albayda, Libya. A questionnaire was sent to a sample of clinical dental technicians in August 2020. The questionnaire comprised of a series of questions about clinical dental technicians including the following: their demographic characteristics, their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19, and infection management measures for preventing COVID-19, and their perspective toward treating patients with COVID-19. This study enclosed a total of 35 clinical dental technicians aged 22–50 years (mean = 29.5 years, SD = 9.8 years). A total of 10 (28.5%) clinical dental technicians had completed a residency program in dentistry, 15 (42.8%) had received training in infection control in dentistry, and 10 (28.5%) had attended training or lectures regarding COVID-19. A total of 5 (14.2%) clinical dental technicians reported that the period of time is 1–14 days. The bulk of clinical dental technicians were aware of COVID-19 symptoms and ways patients are at risk of getting COVID-19, were able to correctly report best-known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 30 (85.7%) believed that it was necessary to wear masks when within the waiting room and to wash hands before going in the dental chair in order to decrease disease transmission. Clinical denturists were aware of COVID-19 symptoms, modes of transmission, and infection controls and measures in dental clinics. However, clinical dental technicians had restricted comprehension of the additional precautional measures that protect the dental staff and other patients from COVID-19.

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers : A Randomized Controlled Trial.

Observational evidence suggests that mask wearing mitigates transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is uncertain if this observed association arises through protection of uninfected wearers (protective effect), via reduced transmission from infected mask wearers (source control), or both. To assess whether recommending surgical mask use outside the home reduces wearers' risk for SARS-CoV-2 infection in a setting where masks were uncommon and not among recommended public health measures. Randomized controlled trial (DANMASK-19 [Danish Study to Assess Face Masks for the Protection Against COVID-19 Infection]). (ClinicalTrials.gov: NCT04337541). Denmark, April and May 2020. Adults spending more than 3 hours per day outside the home without occupational mask use. Encouragement to follow social distancing measures for coronavirus disease 2019, plus either no mask recommendation or a recommendation to wear a mask when outside the home among other persons together with a supply of 50 surgical masks and instructions for proper use. The primary outcome was SARS-CoV-2 infection in the mask wearer at 1 month by antibody testing, polymerase chain reaction (PCR), or hospital diagnosis. The secondary outcome was PCR positivity for other respiratory viruses. A total of 3030 participants were randomly assigned to the recommendation to wear masks, and 2994 were assigned to control; 4862 completed the study. Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8%) and 53 control participants (2.1%). The between-group difference was -0.3 percentage point (95% CI, -1.2 to 0.4 percentage point; P = 0.38) (odds ratio, 0.82 [CI, 0.54 to 1.23]; P = 0.33). Multiple imputation accounting for loss to follow-up yielded similar results. Although the difference observed was not statistically significant, the 95% CIs are compatible with a 46% reduction to a 23% increase in infection. Inconclusive results, missing data, variable adherence, patient-reported findings on home tests, no blinding, and no assessment of whether masks could decrease disease transmission from mask wearers to others. The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use. The data were compatible with lesser degrees of self-protection. The Salling Foundations.

Mental health and well-being during the COVID-19 pandemic in higher education: Evidence from G20 countries.

Background: The spread of coronavirus (COVID-19) has resulted in a drastic alteration to billions of individuals’ emotional, physical, mental, social, and financial status. As of July 21st, 2020, there had been 14.35 million confirmed cases of COVID-19, including 0.60 million deaths in 216 countries.Design and Methods: The study explores health and wellbeing in universities within the G20 countries (19 member countries and the European Union) during the COVID-19 pandemic. The sample selection of these countries was considered since it serves around 80% of the world’s economic output, two-thirds of the global population (including more than half of the world’s poor), and 75% of international trade. Specifically, due to this public health concern, schools’ nationwide closures are impacting over 60% of the world’s student population to promote their quality of life and well-being.Results: This study investigates the G20 policies and procedures within higher education regarding health and well-being measures during the COVID-19 epidemic. The findings reveal that the lockdown, social distancing, and self-isolation requirements are stressful and detrimental for many individuals and have caused students’ health and well-being concerns.Conclusions: Several countries within the G20 have taken significant steps to support health and well-being issues for university students; however, numerous countries are far behind in addressing this issue. Hence, government leaders of G20 countries, policymakers, and health providers should promptly take the necessary measures to regulate the outbreak, improve safety measures to decrease disease transmission, and administer those who demand medical attention.Significance for public healthMental health and well-being during the covid-19 pandemic in higher education is critical to be investigated as it influences hundreds of millions of instructors’ and students. The study reveals that government leaders of G20 countries, policymakers, and health providers should promptly take the necessary measures to regulate the outbreak, improve safety measures to decrease disease transmission, and manage those who demand medical attention.

Dentists' Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists.

BackgroundDespite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control.ObjectiveThis study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists.MethodsThe study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists’ demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19.ResultsThis study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission.ConclusionsJordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches.

Procedurally Robust Risk Assessment Framework for Novel Genetically Engineered Organisms and Gene Drives

AbstractIn this article, a new framework for improving risk assessments of novel genetically engineered organisms (GEOs) is developed and applied. The Procedurally Robust Risk Assessment Framework (PRRAF) provides a set of principles and criteria for assessing and enhancing risk assessment protocols for GEOs under conditions of high uncertainty. The application of PRRAF is demonstrated using the case of a genetically engineered mosquito designed to kill its wild population and therefore decrease disease transmission. Assessments for regulatory approval of this genetically engineered insect fall short of several PPRAF criteria under the principles of humility, procedural validity, inclusion, anticipation, and reflexivity. With the emergence of GEOs designed to spread in ecosystems, such as those with gene drives, it will become increasingly important for regulatory agencies and technology developers to bolster their risk analysis methods and processes prior to field testing. PRRAF can be used as a flexible guide for doing so within a variety of institutional, regulatory, and governance contexts.

"That Can't Be!": Perceptions of HIV and Hepatitis C Screening during Admission to an Acute Care Surgery Service.

Background:A large number of patients live with undiagnosed HIV and/or hepatitis C despite broadened national screening guidelines. European studies, however, suggest many patients falsely believe they have been screened during a prior hospitalization. This study aims to define current perceptions among trauma and emergency general surgery (EGS) patients regarding HIV and hepatitis C screening practices.Methods:Prospective survey administered to adult (>18 years old) acute care surgery service (trauma and EGS) patients at a Level 1 academic trauma center. The survey consisted of 13 multiple choice questions: demographics, whether admission tests included HIV and hepatitis C at index and prior hospital visits and whether receiving no result indicated a negative result, prior primary care screening. Response percentages calculated in standard fashion.Results:One hundred and twenty-five patients were surveyed: 80 trauma and 45 EGS patients. Overall, 32% and 29.6% of patients believed they were screened for HIV and hepatitis C at admission. There was no significant difference in beliefs between trauma and EGS. Sixty-eight percent of patients had a hospital visit within 10 years of these, 49.3% and 44.1% believe they had been screened for HIV and hepatitis C. More EGS patients believed they had a prior screen for both conditions. Among patients who believed they had a prior screen and did not receive any results, 75.9% (HIV) and 80.8% (hepatitis C) believed a lack of results meant they were negative. Only 28.9% and 23.6% of patients had ever been offered outpatient HIV and hepatitis C screening.Conclusions:A large portion of patients believe they received admission or prior hospitalization HIV and/or hepatitis C screening and the majority interpreted a lack of results as a negative diagnosis. Due to these factors, routine screening of trauma/EGS patients should be considered to conform to patient expectations and national guidelines, increase diagnosis and referral for medical management, and decrease disease transmission.

Using Gene Drive Technologies to Control Vector-Borne Infectious Diseases

After years of success in reducing the global malaria burden, the World Health Organization (WHO) recently reported that progress has stalled. Over 90% of malaria deaths world-wide occurred in the WHO African Region. New tools are needed to regain momentum and further decrease the burden of malaria. Gene drive, an emerging technology that can enhance the inheritance of beneficial genes, offers potentially transformative solutions for overcoming these challenges. Gene drives may decrease disease transmission by interfering with the growth of the malaria parasite in the mosquito vector or reducing mosquito reproductive capacity. Like other emerging technologies, development of gene drive products faces technical and non-technical challenges and uncertainties. In 2018, to begin addressing such challenges, a multidisciplinary group of international experts published comprehensive recommendations for responsible testing and implementation of gene drive-modified mosquitoes to combat malaria in Sub-Saharan Africa. Considering requirements for containment, efficacy and safety testing, monitoring, stakeholder engagement and authorization, as well as policy and regulatory issues, the group concluded that gene drive products for malaria can be tested safely and ethically, but that this will require substantial coordination, planning, and capacity development. The group emphasized the importance of co-development and co-ownership of products by in-country scientists.