Epidemic Settings Research Articles

ВЛИЯНИЕ КОРОНАВИРУСНОЙ ИНФЕКЦИИ И ВАКЦИНАЦИИ ПРОТИВ SARS-COV-2 НА ТЕЧЕНИЕ ХРОНИЧЕСКОЙ КРАПИВНИЦЫ

Abstract. Introduction. According to its definition, urticaria refers to a group of diseases characterized by the development of wheals, angioedema, or both. Most often, chronic urticaria is triggered by stress, hormonal drugs, consumption of products containing food colorants, preservatives, gastrointestinal diseases, autoimmune pathology, as well as by infections, including COVID-19. Due to the fact that the coronavirus epidemic set on relatively recently, the effect of this virus, as well as of SARS-CoV-2 vaccination, on the course of chronic urticaria has not been studied in sufficient detail. Aim. Evaluation of the impact of SARS-CoV-2 and COVID-19 vaccination on the course of chronic urticaria. Materials and Methods. The impact of SARS-CoV-2 and COVID-19 vaccination on the course of chronic urticaria was assessed in 100 patients from 2021 to 2023, using the questionnaire developed and the UCT questionnaire. Patients aged 39±15 years participated in the survey. Results and Discussion. The duration of chronic urticaria in most respondents (58%) was more than 2 years, and in only 7% less than a year. According to the UCT results, urticaria symptoms were controlled in 67% of patients before the SARS-CoV-2 epidemic. 64 people recovered from COVID-19; however, exacerbation of urticaria associated with SARS-CoV-2 was observed in 35.9% of patients, while the disease onset was found in 3.1% of them. It should be noted that exacerbation of urticaria developed during COVID-19 persisted in all patients for 3 months, and in a half of them for 6 months after the infection. 67 patients were vaccinated against COVID-19: 63 with Gam-COVID-Vac and 4 with CoviVac, while immunoprophylaxis was not recommended for 15 patients due to their uncontrolled urticaria. 23.8% patients vaccinated with Gam-COVID-Vac experienced fever and headache on the first day. Only 8% of patients experienced exacerbation of urticaria. Conclusions. Patients with chronic urticaria usually have a mild form of COVID-19. However, SARS-CoV-2 causes exacerbation or onset of urticaria in 35.9% of cases. Vaccination with Gam-COVID-Vac is well tolerated by patients with chronic urticaria, and only 8% of patients experience exacerbation of the disease.

Adaptation de la vaccinologie aux maladies infectieuses émergentes : innovations en recherche et coopération internationale

A remarkable acceleration in the development of vaccines was witnessed during the Covid-19 pandemic. However, progress along the vaccine research and development continuum must continue, particularly in the context of epidemic preparedness and response. In this review, we explore recent innovations that have advanced vaccinology, particularly in the development of antigens and vaccine platforms, as well as clinical evidence strategies that accelerate the evaluation of vaccine candidates, adapted to an epidemic setting. We discuss the challenges of international collaboration, notably in the European context, and accessibility to vaccines for low- and middle-income countries. This analysis leads us to the conclusion that technological innovation and global collaboration must be developed simultaneously and in synergy to improve our response to the next epidemic.

Rewiring cattle movements to limit infection spread

Cattle tracing databases have become major resources for representing demographic processes of livestock and assessing potential risk of infections spreading by trade. The herds registered in these databases are nodes of a network of commercial movements, which can be altered to lower the risk of disease transmission. In this study, we develop an algorithm aimed at reducing the number of infected animals and herds, by rewiring specific movements responsible for trade flows from high- to low-prevalence herds. The algorithm is coupled with a generic computational model based on the French cattle movement tracing database (BDNI), and used to describe different scenarios for the spread of infection within and between herds from a recent outbreak (epidemic) or a five-year-old outbreak (endemic). Results show that rewiring successfully contains infections to a limited number of herds, especially if the outbreak is recent and the estimation of disease prevalence frequent, while the respective impact of the parameters of the algorithm depend on the infection parameters. Allowing any animal movement from high to low-prevalence herds reduces the effectiveness of the algorithm in epidemic settings, while frequent and fine-grained prevalence assessments improve the impact of the algorithm in endemic settings. Our approach focusing on a few commercial movements is expected to lead to substantial improvements in the control of a targeted disease, although changes in the network structure should be monitored for potential vulnerabilities to other diseases. This general algorithm could be applied to any network of controlled individual movements liable to spread disease.

Impact of a multi-pronged cholera intervention in an endemic setting.

Cholera is a major global health concern that causes high morbidity. It is a bacterial water-borne disease that can be transmitted via the fecal-oral route or the ingestion of contaminated water. Hence, both population mobility and environmental exposure can promote cholera persistence. The primary tools to prevent cholera include vaccination and Water, Sanitation, and Hygiene (WASH) improvements. The effectiveness of these interventions is well understood in epidemic settings, but their impact in endemic settings is unclear. Achieving cholera elimination requires disentangling the contributors to transmission, specifically population mobility and aquatic reservoirs, and assessing the impact of interventions performed in endemic settings.This study focuses on Kalemie, a cholera endemic city in the Democratic Republic of Congo, on shore of a lake that serves as a potential environmental reservoir. It quantifies the short-term impact of an intervention that used targeted vaccination and WASH. The study shows that the impact of vaccination was dampened by very high background immunity due to constant environmental exposure. This suggests that WASH improvements should be the primary intervention in such settings despite the time- and resource-intensive nature of implementation.

Evaluation of Abbott ID-NOW Rapid Assay with Real-Time Reverse Transcription PCR Assay for Detection of SARS-CoV-2

Rapid nucleic acid assays have been approved by FDA for managing the COVID-19 pandemic, however its analytical efficiency has not been thoroughly validated. This study evaluates the detection and identification of COVID-19 virus using Abbott ID-Now to rapidly identify cases and intervention practices in comparison to nucleic acid detection. Nasopharyngeal Swabs collected from 611 participants were tested for Abbott ID-NOW and LabGun COVID-19 ExoFast RT-PCR Kit as per manufacturer’s protocol. The results from the ID NOW™ COVID-19 assay were evaluated by comparing results with the standard RT-PCR, which served as a standard reference. The infection burden of SARS-CoV-2 in the population of UAE was 11.62%. Compared to detection using real time-based platforms, the sensitivity, specificity, positive and negative predictive values of the ID-Now were 84.51%, 99.81%, 98.36% and 98.00% respectively for COVID-19. A stratified analysis was also carried out using cycle threshold (Ct) values categorizing as Ct>33 as with low viral loads while those with Ct<33 as high. This demonstrated statistically significant (P<0.0001) decrease in sensitivity in samples (97.87% in low Ct value samples versus 58.33% in high Ct value samples). Even though the sensitivity for Abbott ID NOW™ in this study was lower, the specificity, positive predictive values and negative predictive values were significant in low viral load samples. It is easy to use and interpret, giving early information to support clinical decision-making ID-NOW could be possibly used as a point-of-care test after evaluation in epidemic and endemic settings.

Can platform use patterns be an indicator of HIV-related risk and sub-group heterogeneity among men who have sex with men in Singapore: a latent class analysis.

Low-level HIV epidemic settings like Singapore face the challenge of reaching men at-risk who have less contact with programmes. We investigated patterns of meeting platform use by men seeking male sexual partners (MSM) as potential marker of risk to differentiate sub-groups for interventions. Latent Class Analysis (LCA) was applied to a survey sample of MSM recruited from bars/clubs, saunas and a smartphone application, using purposive sampling. The best-fit LCA model which identified homogeneous sub-groups with similar patterns of meeting platform was factored in multivariable regression to identify associations with risk behaviors on the pathway to HIV infection. Overall 1,141 MSM were recruited from bars/clubs (n = 426), saunas (n = 531), and online (n = 184). Five patterns emerged, reflecting salient platform use characteristics: Sauna-centric (SC; n = 413), App-centric (AC; n = 276), Multiple-platforms (MP; n = 123), Platform-inactive (PI; n = 257), and "Do not hook up" (DNH; n = 72) classes. Men in the SC and MP classes had high probabilities of using saunas to meet partners; SC were older and less likely to have disclosed their sexual orientation. The MP class had high probabilities of connecting across all platforms in addition to saunas and more likely to have disclosed their sexual orientation, than the PI class. Men in the SC and MP classes had twice the odds of reporting multiple sex partners (aORSC = 2.1; 95%CI: 1.33.2; aORMP = 2.2; 95%CI: 1.14.6). Single/non-partnered MSM and those using alcohol/drugs during sex had 1.7 (95%CI: 1.22.5) and 3.2 (95%CI: 2.05.1) the odds respectively, of reporting multiple sex partners. The SC and MP classes had higher odds of engaging in group sex while MSM using alcohol/drugs during sex had twice the odds of reporting group sex. Alcohol/drugs and group sex were independently associated with condomless sex (as was lower education). Group sex, alcohol/drugs during sex, disclosure of sexual orientation or being Singaporean/permanent resident were associated with recent testing for HIV. The five distinct risk profiles identified can help tailor differentiated HIV interventions-combined with field knowledge and other prevention-to expand HIV self-testing, Pre-Exposure Prophylaxis and other services (e.g., Mpox vaccination) to sub-groups at risk.

Quantifying the impact of hospital catchment area definitions on hospital admissions forecasts: COVID-19 in England, September 2020–April 2021

BackgroundDefining healthcare facility catchment areas is a key step in predicting future healthcare demand in epidemic settings. Forecasts of hospitalisations can be informed by leading indicators measured at the community level. However, this relies on the definition of so-called catchment areas or the geographies whose populations make up the patients admitted to a given hospital, which are often not well-defined. Little work has been done to quantify the impact of hospital catchment area definitions on healthcare demand forecasting.MethodsWe made forecasts of local-level hospital admissions using a scaled convolution of local cases (as defined by the hospital catchment area) and delay distribution. Hospital catchment area definitions were derived from either simple heuristics (in which people are admitted to their nearest hospital or any nearby hospital) or historical admissions data (all emergency or elective admissions in 2019, or COVID-19 admissions), plus a marginal baseline definition based on the distribution of all hospital admissions. We evaluated predictive performance using each hospital catchment area definition using the weighted interval score and considered how this changed by the length of the predictive horizon, the date on which the forecast was made, and by location. We also considered the change, if any, in the relative performance of each definition in retrospective vs. real-time settings, or at different spatial scales.ResultsThe choice of hospital catchment area definition affected the accuracy of hospital admission forecasts. The definition based on COVID-19 admissions data resulted in the most accurate forecasts at both a 7- and 14-day horizon and was one of the top two best-performing definitions across forecast dates and locations. The “nearby” heuristic also performed well, but less consistently than the COVID-19 data definition. The marginal distribution baseline, which did not include any spatial information, was the lowest-ranked definition. The relative performance of the definitions was larger when using case forecasts compared to future observed cases. All results were consistent across spatial scales of the catchment area definitions.ConclusionsUsing catchment area definitions derived from context-specific data can improve local-level hospital admission forecasts. Where context-specific data is not available, using catchment areas defined by carefully chosen heuristics is a sufficiently good substitute. There is clear value in understanding what drives local admissions patterns, and further research is needed to understand the impact of different catchment area definitions on forecast performance where case trends are more heterogeneous.

Estimation of the Population Size of Street- and Venue-Based Female Sex Workers and Sexually Exploited Minors in Rwanda in 2022: 3-Source Capture-Recapture.

HIV surveillance among key populations is a priority in all epidemic settings. Female sex workers (FSWs) globally as well as in Rwanda are disproportionately affected by the HIV epidemic; hence, the Rwanda HIV and AIDS National Strategic Plan (2018-2024) has adopted regular surveillance of population size estimation (PSE) of FSWs every 2-3 years. We aimed at estimating, for the fourth time, the population size of street- and venue-based FSWs and sexually exploited minors aged ≥15 years in Rwanda. In August 2022, the 3-source capture-recapture method was used to estimate the population size of FSWs and sexually exploited minors in Rwanda. The field work took 3 weeks to complete, with each capture occasion lasting for a week. The sample size for each capture was calculated using shinyrecap with inputs drawn from previously conducted estimation exercises. In each capture round, a stratified multistage sampling process was used, with administrative provinces as strata and FSW hotspots as the primary sampling unit. Different unique objects were distributed to FSWs in each capture round; acceptance of the unique object was marked as successful capture. Sampled FSWs for the subsequent capture occasions were asked if they had received the previously distributed unique object in order to determine recaptures. Statistical analysis was performed in R (version 4.0.5), and Bayesian Model Averaging was performed to produce the final PSE with a 95% credibility set (CS). We sampled 1766, 1848, and 1865 FSWs and sexually exploited minors in each capture round. There were 169 recaptures strictly between captures 1 and 2, 210 recaptures exclusively between captures 2 and 3, and 65 recaptures between captures 1 and 3 only. In all 3 captures, 61 FSWs were captured. The median PSE of street- and venue-based FSWs and sexually exploited minors in Rwanda was 37,647 (95% CS 31,873-43,354), corresponding to 1.1% (95% CI 0.9%-1.3%) of the total adult females in the general population. Relative to the adult females in the general population, the western and northern provinces ranked first and second with a higher concentration of FSWs, respectively. The cities of Kigali and eastern province ranked third and fourth, respectively. The southern province was identified as having a low concentration of FSWs. We provide, for the first time, both the national and provincial level population size estimate of street- and venue-based FSWs in Rwanda. Compared with the previous 2 rounds of FSW PSEs at the national level, we observed differences in the street- and venue-based FSW population size in Rwanda. Our study might not have considered FSWs who do not want anyone to know they are FSWs due to several reasons, leading to a possible underestimation of the true PSE.

A Journey of Uncertainty: Learned Lessons From the Lived Experiences of Nurses in Kuwait Taking Care of COVID-19 Patients in the Early Pandemic.

Purpose of the Study: This study explored the experiences of nurses in Kuwait who worked with COVID-19 patients during the first wave of the disease. Study Design: This was a qualitative descriptive study. Methods Used: In-depth interviews were conducted with seven (7) nurses who worked in intensive care units between September 2020 and March 2021. Findings: The experiences of Kuwait nurses in COVID-19 care showed an evolving journey of dealing with a strange and complex disease. With little known about the disease, the nurses approached COVID-19 care with uncertainty and ambivalence, unsure of where this journey would look like. Four themes emerged from the data and they included (1) from challenges to coping, (2) focusing on good health throughout the pandemic, (3) navigating through scarce resources and power dynamics, and (4) a multi-dimensional burden. Conclusions: Despite the difficulties encountered, supportive systems such as the availability of medical supplies, and support from superiors, colleagues, the community, and families, helped Kuwait nurses to cope with the stresses of an early COVID-19 pandemic while providing care. This approach takes a holistic stance to care for both patients and the nurses working in an epidemic setting.

Chikungunya seroprevalence, force of infection, and prevalence of chronic disability after infection in endemic and epidemic settings: a systematic review, meta-analysis, and modelling study

Chikungunya is an arboviral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes with a growing global burden linked to climate change and globalisation. We aimed to estimate chikungunya seroprevalence, force of infection (FOI), and prevalence of related chronic disability and hospital admissions in endemic and epidemic settings. In this systematic review, meta-analysis, and modelling study, we searched PubMed, Ovid, and Web of Science for articles published from database inception until Sept 26, 2022, for prospective and retrospective cross-sectional studies that addressed serological chikungunya virus infection in any geographical region, age group, and population subgroup and for longitudinal prospective and retrospective cohort studies with data on chronic chikungunya or hospital admissions in people with chikungunya. We did a systematic review of studies on chikungunya seroprevalence and fitted catalytic models to each survey to estimate location-specific FOI (ie, the rate at which susceptible individuals acquire chikungunya infection). We performed a meta-analysis to estimate the proportion of symptomatic patients with laboratory-confirmed chikungunya who had chronic chikungunya or were admitted to hospital following infection. We used a random-effects model to assess the relationship between chronic sequelae and follow-up length using linear regression. The systematic review protocol is registered online on PROSPERO, CRD42022363102. We identified 60 studies with data on seroprevalence and chronic chikungunya symptoms done across 76 locations in 38 countries, and classified 17 (22%) of 76 locations as endemic settings and 59 (78%) as epidemic settings. The global long-term median annual FOI was 0·007 (95% uncertainty interval [UI] 0·003-0·010) and varied from 0·0001 (0·00004-0·0002) to 0·113 (0·07-0·20). The highest estimated median seroprevalence at age 10 years was in south Asia (8·0% [95% UI 6·5-9·6]), followed by Latin America and the Caribbean (7·8% [4·9-14·6]), whereas median seroprevalence was lowest in the Middle East (1·0% [0·5-1·9]). We estimated that 51% (95% CI 45-58) of people with laboratory-confirmed symptomatic chikungunya had chronic disability after infection and 4% (3-5) were admitted to hospital following infection. We inferred subnational heterogeneity in long-term average annual FOI and transmission dynamics and identified both endemic and epidemic settings across different countries. Brazil, Ethiopia, Malaysia, and India included both endemic and epidemic settings. Long-term average annual FOI was higher in epidemic settings than endemic settings. However, long-term cumulative incidence of chikungunya can be similar between large outbreaks in epidemic settings with a high FOI and endemic settings with a relatively low FOI. International Vaccine Institute.

Comparison of rapid dengue NS1, qualitative ELISA, and quantitative ELISA result

Background: Non-structural glycoprotein-1 (NS1) is a useful biomarker for early diagnosis of dengue fever. NS-1 antigen ELISA can be used for the early diagnosis of dengue fever in the acute stage. Quantitative methods are better for epidemic settings due to high false negative rates in qualitative ELISA. Methods: The study was initiated after approval from the institutional ethics council (IEC/DISS/17118). Study examined 280 patients with dengue symptoms who presented to the hospital's OPDs and IPDs. Patients were tested using qualitative ELISA, and those with Leptospira antibody, malaria, or Chikungunya IgM antibody were excluded. Age, gender, symptoms, comorbidities, total leucocyte count, platelet count, and risk category were all patient-related parameters. Patient-related parameters were recorded, and data was collected using Microsoft excel and analysed statistically. Results: Most patients aged 2-40 with male predominance had fever, chills, and body aches, 243 (86.8%) tested positive for ELISA NS1. Quantitative ELISA test showed a statistically significant correlation with rapid antigen NS1 result (p=0.015). Its AUC was 0.883 (p=0.0001), and its cut-off was (>109.1) with 96.9% sensitivity and 13.64% specificity. The AUC of quantitative ELISA NS1 against qualitative ELISA NS1 was 0.853 which was statistically significant (p<0.0001). At the cut-off >74.34, the test's sensitivity was 92.59% and specificity was 75.68%. Conclusions: Qualitative ELISA NS1 test is better than rapid antigen test for screening due to its higher specificity and similar sensitivity.

Mobility paradoxes: disruptors, benefits, and agency among mobile female sex workers living with HIV in the Dominican Republic and Tanzania

Background Mobility is a key social determinant of health for female sex workers (FSWs). While extant research has focused on the adverse effects of mobility for FSWs, there are very few studies that have examined the multiple ways in which mobility may impact the lives of these mobile women from their perspective. This qualitative study aims to fill this gap by exploring how mobility impacts the lives, livelihoods, and HIV care and treatment from the perspectives of women living with HIV in two epidemic settings, the Dominican Republic and Tanzania.Methods We conducted two rounds of in-depth interviews with 12 Dominican women and 12 Tanzanian women who were 18 years plus, had an HIV-positive diagnosis, and reported having exchanged sex for money in the last month. We utilized thematic analysis with a focus on intra- and intercomparisons to observe patterns within and across the two contexts.ResultsWe identified a salient pattern of three thematic “mobility paradoxes,” which related to both disruptors and benefits of sex work mobility: (1) uncertainty versus autonomy: while sex work mobility often took place in contexts of vulnerability, which often led to women experiencing violence, it simultaneously benefitted women by allowing them to choose where they stayed and make plans on their terms; (2) financial insecurity versus profitability: although participants sometimes made less money than expected when they traveled for sex work, there was a powerful economic benefit for mobile women as it increased their likelihood of profitability; and (3) disorder and interruptions versus strategy and social support in HIV care and treatment: participants reported that they were sometimes inconsistent with their HIV appointments and medications when they traveled for sex work. On the other hand, mobility contributed to participants often becoming more strategic and creative in their HIV care and treatment and relying on one another for support.ConclusionsFindings indicate that sex work mobility is a nuanced, complex, and paradoxical phenomenon. Implications include the development of strengths-based and community empowerment mobile health initiatives tailored to mitigate disruptors of mobility while maximizing benefits for this population.

The AIDS Epidemic Model 2023 for Estimating HIV Trends and Transmission Dynamics in Asian Epidemic Settings.

Thirteen Asian countries use the AIDS Epidemic Model (AEM) as their HIV model of choice. This article describes AEM, its inputs, and its application to national modeling. AEM is an incidence tool used by Spectrum for the Joint United Nations Programme on HIV/AIDS global estimates process. AEM simulates transmission of HIV among key populations (KPs) using measured trends in risk behaviors. The inputs, structure and calculations, interface, and outputs of AEM are described. The AEM process includes (1) collating and synthesizing data on KP risk behaviors, epidemiology, and size to produce model input trends; (2) calibrating the model to observed HIV prevalence; (3) extracting outputs by KP to describe epidemic dynamics and assist in improving responses; and (4) importing AEM incidence into Spectrum for global estimates. Recent changes to better align AEM mortality with Spectrum and add preexposure prophylaxis are described. The application of AEM in Thailand is presented, describing the outputs and uses in-country. AEM replicated observed epidemiological trends when given observed behavioral inputs. The strengths and limitations of AEM are presented and used to inform thoughts on future directions for global models. AEM captures regional HIV epidemiology well and continues to evolve to meet country and global process needs. The addition of time-varying mortality and progression parameters has improved the alignment of the key population compartmental model of AEM with the age-sex-structured national model of Spectrum. Many of the features of AEM, including tracking the sources of infections over time, should be incorporated in future global efforts to build more generalizable models to guide policy and programs.

Influences of community engagement and health system strengthening for cholera control in cholera reporting countries

The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of...

Application of rapid qualitative methods in difficult conditions of an epidemic with emphasis on conceptual framework

Background: The world today is fraught with numerous perils, particularly due to frequent epidemics that inordinately impact people’s lives. Given such ongoing global crises, universities need to take into account the challenges that their research activities may encounter. Therefore, we aimed to conduct a thorough and rapid study of the causes and consequences of emergencies to overcome the methodological challenges that such crises impose. Methods: A literature review. Results: The effects of these social and epidemiological complications on academic and research practices have made scholars adapt their research approaches to the challenging and restrictive conditions of emerging societies in the postmodern epidemic and risk society. This has accentuated the importance of innovative approaches like team-based qualitative research. Conclusion: This research introduces a team-based, rapid qualitative approach to deliver timely, useful, and pertinent findings. It accentuates the feasibility of employing swift and urgent methods in challenging epidemic settings.

Reconstructing COVID-19 incidences from positive RT-PCR tests by deconvolution

BackgroundThe emergency of new COVID-19 variants over the past three years posed a serious challenge to the public health. Cities in China implemented mass daily RT-PCR tests by pooling strategies. However, a random delay exists between an infection and its first positive RT-PCR test. It is valuable for disease control to know the delay pattern and daily infection incidences reconstructed from RT-PCR test observations.MethodsWe formulated the convolution model between daily incidences and positive RT-PCR test counts as a linear inverse problem with positivity restrictions. Consequently, the Richard-Lucy deconvolution algorithm was used to reconstruct COVID-19 incidences from daily PCR tests. A real-time deconvolution was further developed based on the same mathematical principle. The method was applied to an Omicron epidemic data set of a bar outbreak in Beijing and another in Wuxi in June 2022. We estimated the delay function by maximizing likelihood via an E-M algorithm.ResultsThe delay function of the bar-outbreak in 2022 differs from that reported in 2020. Its mode was shortened to 4 days by one day. A 95% confidence interval of the mean delay is [4.43,5.55] as evaluated by bootstrap. In addition, the deconvolved infection incidences successfully detected two associated infection events after the bar was closed. The application of the real-time deconvolution to the Wuxi data identified all explosive incidence increases. The results revealed the progression of the two COVID-19 outbreaks and provided new insights for prevention and control strategies, especially for the role of mass daily RT-PCR testing.ConclusionsThe proposed deconvolution method is generally applicable to other infectious diseases if the delay model can be assumed to be approximately valid. To ensure a fair reconstruction of daily infection incidences, the delay function should be estimated in a similar context in terms of virus variant and test protocol. Both the delay estimate from the E-M algorithm and the incidences resulted from deconvolution are valuable for epidemic prevention and control. The real-time feedback is particularly useful during the epidemic’s acute phase because it can help the local disease control authorities modify the control measures more promptly and precisely.

Health Outcomes and Cost-effectiveness of Monoclonal SARS-CoV-2 Antibodies as Pre-exposure Prophylaxis

Pre-exposure prophylaxis with neutralizing SARS-CoV-2 monoclonal antibodies (mAbs PrEP) prevents infection and reduces hospitalizations and the duration thereof for COVID-19 and death among high-risk individuals. However, reduced effectiveness due to a changing SARS-CoV-2 viral landscape and high drug prices remain substantial implementation barriers. To assess the cost-effectiveness of mAbs PrEP as COVID-19 PrEP. For this economic evaluation, a decision analytic model was developed and parameterized with health care outcome and utilization data from individuals with high risk for COVID-19. The SARS-CoV-2 infection probability, mAbs PrEP effectiveness, and drug pricing were varied. All costs were collected from a third-party payer perspective. Data were analyzed from September 2021 to December 2022. Health care outcomes including new SARS-CoV-2 infections, hospitalization, and deaths. The cost per death averted and cost-effectiveness ratios using a threshold for prevention interventions of $22 000 or less per quality-adjusted life year (QALY) gained. The clinical cohort consisted of 636 individuals with COVID-19 (mean [SD] age 63 [18] years; 341 [54%] male). Most individuals were at high risk for severe COVID-19, including 137 (21%) with a body mass index of 30 or higher, 60 (9.4%) with hematological malignant neoplasm, 108 (17%) post-transplantation, and 152 (23.9%) who used immunosuppressive medication before COVID-19. Within the context of a high (18%) SARS-CoV-2 infection probability and low (25%) effectiveness the model calculated a short-term reduction of 42% ward admissions, 31% intensive care unit (ICU) admissions, and 34% deaths. Cost-saving scenarios were obtained with drug prices of $275 and 75% or higher effectiveness. With a 100% effectiveness mAbs PrEP can reduce ward admissions by 70%, ICU admissions by 97%, and deaths by 92%. Drug prices, however, need to reduce to $550 for cost-effectiveness ratios less than $22 000 per QALY gained per death averted and to $2200 for ratios between $22 000 and $88 000. In this study, use of mAbs PrEP for preventing SARS-CoV-2 infections was cost-saving at the beginning of an epidemic wave (high infection probability) with 75% or higher effectiveness and drug price of $275. These results are timely and relevant for decision-makers involved in mAbs PrEP implementation. When newer mAbs PrEP combinations become available, guidance on implementation should be formulated ensuring a fast rollout. Nevertheless, advocacy for mAbs PrEP use and critical discussion on drug prices are necessary to ensuring cost-effectiveness for different epidemic settings.

Magnetic Resonance Imaging Brain Findings in Chikungunya Virus (CHIKV) Infection with Neurological Complication during Epidemic Outbreak.

The Chikungunya virus is an alphavirus RNA of the family Togaviridae transmitted by the Aedes mosquito. We aim to report magnetic resonance imaging (MRI) brain findings for neurological complications at our institute during epidemic outbreak. A total of 43 seropositive cases of Chikungunya infection underwent MRI brain. Out of 43 patients, 27 (63%) had discrete and confluent supra-tentorial T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) hyper-intense white matter foci. A total of 14 patients (33%) showed multiple foci/areas of diffusion restriction, and four of these patients had infra-tentorial T2 & FLAIR hyper-intense foci with restricted diffusion. In three pediatric age group patients including two neonates, the pattern of involvement was diffuse white matter changes with restricted diffusion. In 30% cases, MRI was normal. Detection of focal or confluent white matter hyper-intense foci with restricted diffusion on MRI in patients presenting with fever and neurological symptoms has potential to conclude the diagnosis of Chikungunya encephalitis, especially in epidemic settings.

Anxiety and social media use: a moderator of stress in the COVID-19.

As concern for students' psychological well-being is shared by all segments of the culture, many scholars have conducted research on this issue in early years. The problem with these studies was that people's mental health was affected by their use of social media during a very bad epidemic. However, nowadays, the association between the use of social media and well-being needs to be further explained in the context of persistent disease outbreaks over time. This paper examines COVID-19-related anxiety and social media use. SMU, COVID-19 stressors, anxiety, and variables were obtained from Chinese college students using an online questionnaire (e.g., health history, online media use, etc.). According to regression analyses, participants who spent more time using social media were more anxious in COVID-19-related content, while participants with more related stressors experienced less anxiety. The purpose of this study was to determine whether COVID-19 stressors moderated the association between social media use and mental health conditions such as anxiety in an epidemic setting in China. Study findings revealed that students with more COVID-19 stressors experiencing less anxiety when using social media, but COVID-19 stressors were no longer a risk factor.

DIFFUSE LEPROMATOUS LEPROSY IN AN HIV-POSITIVE PATIENT

Leprosy is a disease known since ancient times. It is caused by Mycobacterium leprae. The skin, peripheral nerves, eyes, and mucous membranes of the upper respiratory tract are especially affected. Lepromatous leprosy is a clinical entity that has become rare worldwide today with the introduction of polydrug therapy, resulting in a dramatic decline in overall prevalence. In epidemic settings, atypical manifestations should be known because they are a source of disease transmission. Lepromatous leprosy rarely occurs as part of an immune deficiency. We report a case of diffuse leprosy in an HIV-positive patient.