Epidemiological Context Research Articles

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States.

This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Tracking the Source of Human Q Fever from a Southern French Village: Sentinel Animals and Environmental Reservoir.

Coxiella burnetii, also known as the causal agent of Q fever, is a zoonotic pathogen infecting humans and several animal species. Here, we investigated the epidemiological context of C. burnetii from an area in the Hérault department in southern France, using the One Health paradigm. In total, 13 human cases of Q fever were diagnosed over the last three years in an area comprising four villages. Serological and molecular investigations conducted on the representative animal population, as well as wind data, indicated that some of the recent cases are likely to have originated from a sheepfold, which revealed bacterial contamination and a seroprevalence of 47.6%. However, the clear-cut origin of human cases cannot be ruled out in the absence of molecular data from the patients. Multi-spacer typing based on dual barcoding nanopore sequencing highlighted the occurrence of a new genotype of C. burnetii. In addition, the environmental contamination appeared to be widespread across a perimeter of 6 km due to local wind activity, according to the seroprevalence detected in dogs (12.6%) and horses (8.49%) in the surrounding populations. These findings were helpful in describing the extent of the exposed area and thus supporting the use of dogs and horses as valuable sentinel indicators for monitoring Q fever. The present data clearly highlighted that the epidemiological surveillance of Q fever should be reinforced and improved.

Nasal Tuberculosis: An Atypical Location

Tuberculosis is still endemic in developing countries. Nasal tuberculosis is a rare chronic infection, it remains a diagnostic challenge. We report the case of a 59-year-old female patient with multifocal tuberculosis (nasal, pulmonary, and lymph nodes). The revealing symptom of her illness was a progressive nasal obstruction with anosmia and intermittent pus discharge through the lacrimal duct. The diagnosis was retained in view of the epidemiological context, chronic crusted and purulent rhinitis that did not improve with antibiotics, presence of granulomatous lesions on nasal biopsy and detection of acid-alcohol resistant bacilli on direct examination of bronchial aspirates. The patient was treated with antituberculosis therapy for 9 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.

Decrease on malaria clinical cases from 2017 to 2019 in Franceville, Southeast Gabon, Central Africa.

In Gabon, malaria remains a major public health problem. All malaria cases with axillary temperature ≥ 37.5°C with a parasites density ≥ 1200/μL are serious cases and must be treated as a medical emergency. Thus, early diagnosis is essential for successful treatment. Because of the impact of malaria on the population, the surveillance of malaria infections in hospitals is urgently needed. The aim of this study was to to assess of clinical cases of malaria in a private health structure in Franceville between 2017 and 2019. For that, we conducted a retrospective study using data on malaria cases recorded in a private medical analysis laboratory in Franceville, southeast Gabon. Malaria was diagnosed in this laboratory using a Rapid Diagnostic Test and confirmed by microscopic analysis. Analysis of 2518 patient forms revealed an increase in malaria prevalence in Franceville between 2017-2019. The global clinical cases was 26.1% (658/2015). Children under 5 years (44.0%) and patients aged 5-14 years (40.1%) were more affected than patients aged ≥15 years (18.8%, P=0.0001). Malaria infection was also significantly dependent on season and gender. We observed at least three Plasmodium species and the predominant Plasmodium species was P. falciparum 80.0%, followed by P. ovale (19.5%) and P. malariae (17.8%). Our study showed that malaria remains a public health priority for the population of Franceville and that the prevalence of clinical cases of malaria at the laboratory decrease between 2017 and 2019. Our results highlight the need for strategies to control malaria in Franceville, adapted to epidemiological contexts and environmental constraint.

Qualitative longitudinal research on the experience of implementing Covid-19 prevention in English schools

Implementation studies rarely examine how health interventions are delivered in emergencies. Informed by May's general theory of implementation (GTI), we undertook qualitative longitudinal research to investigate how schools in England implemented Covid-19-prevention measures and how this evolved over the 2020–2021 school year in a rapidly changing epidemiological and policy context. We conducted 74 semi-structured interviews over two time-points with headteachers, teachers, parents and students across eight primary and secondary schools. School leaders rapidly made sense of government guidance despite many challenges. They developed and disseminated prevention plans to staff, parents and students. As defined by GTI, ‘cognitive participation’ and ‘collective action’ to enact handwashing, one-way systems within schools and enhanced cleaning were sustained over time. However, measures such as physical distancing and placing students in separated groups were perceived to conflict with schools' mission to promote student education and wellbeing. Commitment to implement these was initially high during the emergency phase but later fluctuated dependant on perceived risk and local disease epidemiology. They were not considered sustainable in the long term. Adherence to some measures, such as wearing face-coverings, initially considered unworkable, improved as they were routinised. Implementing home-based asymptomatic testing was considered feasible. Formal and informal processes of ‘reflexive monitoring’ by staff informed improvements in intervention workability and implementation. Leaders also developed skills and confidence, deciding on locally appropriate actions, some of which deviated from official guidance. However, over time, accumulating staff burnout and absence eroded school capacity to collectively enact implementation. Qualitative longitudinal research allowed us to understand how implementation in an emergency involved the above emergent processes. GTI was useful in understanding school implementation processes in a pandemic context but may need adaptation to take into account the changing and sometimes contradictory objectives, time-varying factors and feedback loops that can characterise implementation of health interventions in emergencies.

Extensive research into MERS-CoV to ascertain its current status, epidemiological context, and potential in the future.

Extensive research into MERS-CoV to ascertain its current status, epidemiological context, and potential in the future.

After action review of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, in 2020.

Surveillance is the backbone of any response to an infectious disease outbreak, and comprehensive evaluation of surveillance systems is crucial. However, structured evaluations of surveillance systems during the COVID-19 pandemic are scarce. We conducted a after action review (AAR) of the performance of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, during 2020 using the COVID-19-specific AAR methodology developed by the World Health Organization in combination with guidance from the US Centers for Disease Control and Prevention (CDC). We conducted a stakeholder survey, document reviews, and key informant interviews with staff from Quang Ninh CDC's COVID-19 surveillance system. The COVID-19 surveillance system was based on the pre-existing surveillance system in the province. The system's strengths were early preparation for emergency response, strong governance and central coordination, and multidisciplinary collaboration. Stakeholders agreed that the system proved useful and adaptive to the fast-evolving COVID-19 situation but was weakened by overly complex systems, redundant administrative processes, unclear communication channels, and lack of resources. Overall, the surveillance systems in Quang Ninh province proved effective in containing COVID-19 and adaptive in a fast-changing epidemiological context. Several recommendations were made based on identified areas of concern that are of relevance for COVID-19 surveillance systems in Vietnam and similar settings.

Three Years of African Swine Fever in South Korea (2019–2021): A Scoping Review of Epidemiological Understanding

African swine fever (ASF) is a highly contagious viral disease in domestic pigs and wild boar that causes tremendous socioeconomic damage in related industries. In 2019, the virus emerged in South Korea, which has since reported 21 outbreaks in domestic pig farms and over 2,600 cases in wild boar. In this review, we synthesize the epidemiological knowledge generated on ASF in South Korea during the first three years of the epidemic (2019–2021). We searched four international and one domestic Korean database to identify scientific articles published since 2019 and describing ASF epidemiology in South Korea. Fourteen articles met our selection criteria and were used to synthesize the origin of ASF in South Korea, the risk factors of disease occurrence, the effectiveness of the surveillance and intervention measures that were implemented, and the viral transmission dynamics. We found that timely intensive surveillance and interventions on domestic pig farms successfully blocked between-farm transmission. However, in wild boar, the ASF virus has spread massively towards the south primarily along the mountain ranges despite ongoing fence erection and intensive depopulation efforts, endangering domestic pig farms across the country. The current devastating epidemic is suspected to be the consequence of an ASF control strategy unaligned to the epidemiological context, the challenging implementation of control measures hindered by topological complexities, and inappropriate biosecurity by field workers. To improve our understanding of ASF epidemiology in South Korea and enhance disease management, future research studies should specify the ecological drivers of disease distribution and spread and devise effective control strategies, particularly in relation to Korean topography, and the latent spread of the virus in wild boar populations. Additionally, research studies should explore the psychosocial factors for ASF management, and develop tools to support evidence-based decision-making for managing ASFV in wild boar.

Proof-of-concept study for a long-acting formulation of ivermectin injected in cattle as a complementary malaria vector control tool

BackgroundDomesticated animals play a role in maintaining residual transmission of Plasmodium parasites of humans, by offering alternative blood meal sources for malaria vectors to survive on. However, the blood of animals treated with veterinary formulations of the anti-helminthic drug ivermectin can have an insecticidal effect on adult malaria vector mosquitoes. This study therefore assessed the effects of treating cattle with long-acting injectable formulations of ivermectin on the survival of an important malaria vector species, to determine whether it has potential as a complementary vector control measure.MethodsEight head of a local breed of cattle were randomly assigned to either one of two treatment arms (2 × 2 cattle injected with one of two long-acting formulations of ivermectin with the BEPO® technology at the therapeutic dose of 1.2 mg/kg), or one of two control arms (2 × 2 cattle injected with the vehicles of the formulations). The lethality of the formulations was evaluated on 3–5-day-old Anopheles coluzzii mosquitoes through direct skin-feeding assays, from 1 to 210 days after treatment. The efficacy of each formulation was evaluated and compared using Cox proportional hazards survival models, Kaplan–Meier survival estimates, and log-logistic regression on cumulative mortality.ResultsBoth formulations released mosquitocidal concentrations of ivermectin until 210 days post-treatment (hazard ratio > 1). The treatments significantly reduced mosquito survival, with average median survival time of 4–5 days post-feeding. The lethal concentrations to kill 50% of the Anopheles (LC50) before they became infectious (10 days after an infectious blood meal) were maintained for 210 days post-injection for both formulations.ConclusionsThis long-lasting formulation of ivermectin injected in cattle could complement insecticide-treated nets by suppressing field populations of zoophagic mosquitoes that are responsible, at least in part, for residual malaria transmission. The impact of this approach will of course depend on the field epidemiological context. Complementary studies will be necessary to characterize ivermectin withdrawal times and potential environmental toxicity.Graphical

How public health authorities can use pathogen genomics in health protection practice: a consensus-building Delphi study conducted in the United Kingdom.

Pathogen sequencing guided understanding of SARS-CoV-2 evolution during the COVID-19 pandemic. Many health systems developed pathogen genomics services to monitor SARS-CoV-2. There are no agreed guidelines about how pathogen genomic information should be used in public health practice. We undertook a modified Delphi study in three rounds to develop expert consensus statements about how genomic information should be used. Our aim was to inform health protection policy, planning and practice. Participants were from organisations that produced or used pathogen genomics information in the United Kingdom. The first round posed questions derived from a rapid literature review. Responses informed statements for the subsequent rounds. Consensus was accepted when 70 % or more of the responses were strongly agree/agree, or 70 % were disagree/strongly disagree on the five-point Likert scale. Consensus was achieved in 26 (96 %) of 27 statements. We grouped the statements into six categories: monitoring the emergence of new variants; understanding the epidemiological context of genomic data; using genomic data in outbreak risk assessment and risk management; prioritising the use of limited sequencing capacity; sequencing service performance; and sequencing service capability. The expert consensus statements will help guide public health authorities and policymakers to integrate pathogen genomics in health protection practice.

Barriers to conducting independent quantitative research in low-income countries: A cross-sectional study of public health graduate students in Liberia.

During recent disease outbreaks, quantitative research has been used to investigate intervention scenarios while accounting for local epidemiological, social, and clinical context. Despite the value of such work, few documented research efforts have been observed to originate from low-income countries. This study aimed to assess barriers that may be limiting the awareness and conduct of quantitative research among Liberian public health graduate students. A semi-structured questionnaire was administered September-November 2021 to Master's in Public Health (MPH) students in Liberia. Potential barriers around technology access, understanding of quantitative science, and availability of mentorship were interrogated. Associations between barriers and self-reported likelihood of conducting quantitative research within six months of the investigation period were evaluated using ordinal logistic regression. Among 120 participating MPH students, 86% reported owning a personal computer, but 18.4% and 39.4% had machines with malfunctioning hardware and/or with battery power lasting ≤2 hours, respectively. On average, students reported having poor internet network 3.4 days weekly. 47% reported never using any computer software for analysis, and 46% reported no specific knowledge on statistical analysis. Students indicated spending a median 30 minutes per week reading scientific articles. Moreover, 50% had no access to quantitative research mentors. Despite barriers, 59% indicated they were very likely to undertake quantitative research in the next 6 months; only 7% indicated they were not at all likely. Computer ownership was found to be statistically significantly associated with higher likelihood of conducting quantitative research in the multivariable analysis (aOR: 4.90,95% CI: 1.54-16.3). The high likelihood of conducting quantitative research among MPH students contrasts with limitations around computing capacity, awareness of research tools/methods, and access to mentorship. To promote rigorous analytical research in Liberia, there is a need for systematic measures to enhance capacity for diverse quantitative methods through efforts sensitive to the local research environment.

Optimizing Routine Malaria Surveillance Data in Urban Environments: A Case Study in Maputo City, Mozambique.

In urban settings in malaria-endemic countries, malaria incidence is not well characterized and assumed to be typically very low and consisting largely of imported infections. In such contexts, surveillance systems should adapt to ensure that data are of sufficient spatial and temporal resolution to inform appropriate programmatic interventions. The aim of this research was to 1) assess spatial and temporal trends in reported malaria cases in Maputo City, Mozambique, using an expanded case notification form and 2) to determine how malaria surveillance can be optimized to characterize the local epidemiological context, which can then be used to inform targeted entomological investigations and guide implementation of localized malaria responses. This study took place in all six health facilities of KaMavota District in Maputo City, Mozambique. A questionnaire was administered to all confirmed cases from November 2019 to August 2021. Households of cases were retrospectively geolocated using local landmarks as reference. Overall, 2,380 malaria cases were reported, with the majority being uncomplicated (97.7%) and a median age of 21 years; 70.8% of cases had reported traveling outside the city in the past month with nine reporting traveling internationally. Maps of the 1,314 malaria cases that were geolocated showed distinct spatial patterns. The expanded case notification form enables a more granular overview of the malaria epidemiology in Maputo City; the geolocation data clearly show the areas where endemic transmission is likely, thus informing where resources should be prioritized. As urbanization is rapidly increasing in malaria endemic areas, identifying systems and key variables to collect ensures an operational way to characterize urban malaria through optimization of routine data to inform decision-making.

Evaluation of Genomic Typing Methods in the Salmonella Reference Laboratory in Public Health, England, 2012–2020

We aim to provide an evidence-based evaluation of whole genome sequence (WGS) methods, employed at the Salmonella reference laboratory in England, in terms of its impact on public health and whether these methods remain a fit for purpose test under UKAS ISO 15189. The evaluation of the genomic methods were mapped against the value of detecting microbiological clusters to support the investigation of food-borne outbreaks of Salmonella in England between 2012-2020. The analysis of WGS with both SNP- and allelic-based methods provided an unprecedented level of strain discrimination and detection of additional clusters when comparing to all of the previous typing methods. The robustness of the routine genomic sequencing at the reference laboratory ensured confidence in the microbiological identifications, even in large outbreaks with complex international food distribution networks. There was evidence that the phylogeny derived from the WGS data can be used to inform the provenance of strains and support discrimination between domestic and non-domestic transmission events. Further insight on the evolutionary context of the emerging pathogenic strains was enabled with a deep dive of the phylogenetic data, including the detection of nested clusters. The public availability of the WGS data linked to the clinical, epidemiological and environmental context of the sequenced strains has improved the trace-back investigations during outbreaks. The global expansion in the use of WGS-based typing in reference laboratories has shown that the WGS methods are a fit for purpose test in public health as it has ensured the rapid implementation of interventions to protect public health, informed risk assessment and has facilitated the management of national and international food-borne outbreaks of Salmonella.

Genetic and Epigenetic Regulation of MEFV Gene and Their Impact on Clinical Outcome in Auto-Inflammatory Familial Mediterranean Fever Patients.

Epigenetic modifications play a pivotal role in autoimmune/inflammatory disorders and could establish a bridge between personalized medicine and disease epidemiological contexts. We sought to investigate the role of epigenetic modifications beside genetic alterations in the MEFV gene in familial Mediterranean fever (FMF). The study comprised 63 FMF patients diagnosed according to the Tel Hashomer criteria: 37 (58.7%) colchicine-responders, 26 (41.3%) non-responders, and 19 matched healthy controls. MEFV mutations were detected using a CE/IVD-labeled 4-230 FMF strip assay. DNA methylation of MEFV gene exon 2 was measured using bisulfite modification and related to pyrin level, phenotypic picture, MEFV mutations, disease severity, serum amyloid A (SAA), CRP, ESR, disease severity, and colchicine response. Our results showed that FMF patients exhibited significantly higher methylation percentage (p < 0.001) and lower pyrin levels (p < 0.001) compared to the control. The MEFV gene M694I mutation was the most commonly reported mutation (p < 0.004). High methylation percentage of the MEFV exon 2 and low pyrin concentration were correlated with disease severity, high SAA, ESR levels, H-pylori, and renal calculi. In conclusion, this study highlights the relation between high methylation percentage, reduced pyrin level, and different biomarkers in FMF, which underscores their role in the pathogenesis of FMF and could be considered as potential therapeutic targets.

Covid 19: Risk factors and development of pulmonary TB in household contacts, Lima, Peru

Objectiveis to determine the risk factors associated with developing tuberculosis in household contacts of patients with pulmonary tuberculosis in the epidemiological context of the Covid 19 pandemic. MethodsIt is descriptive, analytical and cross-sectional, the population of index cases with tuberculosis is 53, and a sample of 59 household contacts of a health center of the Ministry of Health, in Lima, in the months of September and October 2021, two pre-established surveys were applied, one applied in the index case, and another to household contacts; for the association of risk factors, the Mantel and Haenszel Chi-square test was used. Resultsin the sociodemographic risk, shared housing, with a significance of 0.000; family support, with a significance of 0.006, considered P values < 0.05. Clinical factor, 27.5 % (11) of the index cases have type 2 diabetes mellitus, and 7.5 % (3) have malnutrition, and 7.5 % have alcoholism, 5 % have HIV/AIDS, arterial hypertension, and lack of application of isoniazid preventive therapy (IPT) are associated with a significance level of 0.001, (P < 0.05). Environmental risk, home lighting, hygiene and ventilation are associated with a significance level of 0.017, 0.002 and 0.011 respectively, with P < 0.05. index cases, more than 28 % were infected, 69.8 % were vaccinated; in contacts more than 13 % were infected, and vaccinated more than 47 % Conclusionshared housing, family support, associated diseases, lack of implementation of isoniazid preventive therapy (PTZ), home lighting, hygiene and ventilation were the most relevant associated with the development of tuberculosis. Tuberculosis is a global health crisis, attention should focus on controlling tuberculosis in areas where it continues to develop. Given that migration factors are a prevalent condition in the Americas, the focus must address health risk factors to improve health outcomes and care for TB patients in Peru.

An improved framework for detecting discrete epidemiologically meaningful partitions in hierarchically clustered genetic data.

Hierarchical clustering of microbial genotypes has the limitation that hierarchical clusters are nested, where smaller groups of related isolates exist within larger groups that get progressively larger as relationships become increasingly distant. In an epidemiologic context, investigators must dissect hierarchical trees into discrete groupings that are epidemiologically meaningful. We recently described a statistical framework (Method A) for dissecting hierarchical trees that attempts to minimize investigator bias. Here, we apply a modified version of that framework (Method B) to a hierarchical tree constructed from 2111 genotypes of the foodborne parasite Cyclospora, including 639 genotypes linked to epidemiologically defined outbreaks. To evaluate Method B's performance, we examined the concordance between these epidemiologically defined groupings and the genetic partitions identified. We also used the same epidemiologic clusters to evaluate the performance of Method A, plus two tree-dissection methods (cutreeHybrid and cutreeDynamic) available within the Dynamic Tree Cut R package, in addition to the TreeCluster method and PARNAS. Compared to the other methods, Method B, TreeCluster, and PARNAS were the most accurate (99.4%) in identifying genetic groups that reflected the epidemiologic groupings, noting that TreeCluster and PARNAS performed identically on our dataset. CutreeHybrid identified groups reflecting patterns in the wider Cyclospora population structure but lacked finer, strain-level discrimination (Simpson's D: cutreeHybrid=0.785). CutreeDynamic displayed good strain discrimination (Simpson's D = 0.933), though lacked sensitivity (77%). At two different threshold/radius settings TreeCluster/PARNAS displayed similar utility to Method B. However, Method B computes a tree-dissection threshold automatically, and the threshold/radius settings used when executing TreeCluster/PARNAS here were computed using Method B. Using a TreeCluster threshold of 0.045 as recommended in the TreeCluster documentation, epidemiologic utility dropped markedly below that of Method B. Relevant code and data are publicly available. Source code (Method B) and instructions for its use are available here: https://github.com/Joel-Barratt/Hierarchical-tree-dissection-framework.

SMapper: visualizing spatial prevalence data of all types, including sparse and incomplete datasets

Abstract Motivation We introduce SMapper, a novel web and software tool for visualizing spatial prevalence data of all types including those suffering from incomplete geographic coverage and insufficient sample sizes. We demonstrate the benefits of our tool in overcoming interpretational issues with existing tools caused by such data limitations. We exemplify the use of SMapper by applications to human genotype and phenotype data relevant in an epidemiological, anthropological and forensic context. Availability and implementation A web implementation is available at https://rhodos.ccg.uni-koeln.de/smapper/. A stand-alone version, released under the GNU General Public License version 3 as published by the Free Software Foundation, is available from https://rhodos.ccg.uni-koeln.de/smapper/software-download.php as a Singularity container (https://docs.sylabs.io/guides/latest/user-guide/index.html) and a native Linux Python installation.

A Model-Based Cost-Effectiveness Analysis of Long-Acting Monoclonal Antibody (Tixagevimab and Cilgavimab: Evusheld) Preventive Treatment for High-Risk Populations Against SARS-CoV-2 in Korea.

Tixagevimab and cilgavimab (Evusheld) administration is a recommended strategy for unvaccinated patients with immunocompromised conditions and severe allergic reaction conditions to protect high-risk individuals and control the coronavirus disease 2019 (COVID-19) epidemic. We estimated the cost-effectiveness of Evusheld in key risk populations: 1) immunocompromised (vaccinated/unvaccinated), 2) severe allergic reaction, and 3) unvaccinated elderly high-risk groups. Based on the estimated target risk group population, we used a model of COVID-19 transmission to estimate the size of the risk group population for whom Evusheld treatment may help prevent symptomatic COVID-19 (and deaths) in 2022. We projected Evusheld intervention costs, quality-adjusted life year (QALY) lost, cost averted and QALY gained by reduced COVID-19 incidence, and incremental cost-effectiveness (cost per QALY gained) in each modeled population from the healthcare system perspective. Our study demonstrated that Evusheld treatment for COVID-19 infection in South Korea is highly cost-effective for unvaccinated risk groups ($18,959 per QALY gained for immunocompromised and $23,978 per QALY gained for high-risk elderly groups) and moderately cost-effective among individuals who are vaccinated immunocompromised ($46,494 per QALY gained), or have severe allergic reactions ($45,996 per QALY gained). Evusheld's cost-effectiveness may be subject to risk-group-specific COVID-19 disease progression and Evusheld efficacy and cost, which may change in future epidemic scenarios. As the COVID-19 variants and risk group-specific durable efficacy, toxicity (and/or resistance) and optimal dosing of Evusheld remain uncertain, better empirical estimates to inform these values in different epidemiological contexts are needed. These results may help decision-makers prioritize resources toward more equitable and effective COVID-19 control efforts.

Considerations for de-escalating universal masking in healthcare centers.

Three years after the beginning of the COVID-19 pandemic, better knowledge on the transmission of respiratory viral infections (RVI) including the contribution of asymptomatic infections encouraged most healthcare centers to implement universal masking. The evolution of the SARS-CoV-2 epidemiology and improved immunization of the population call for the infection and prevention control community to revisit the masking strategy in healthcare. In this narrative review, we consider factors for de-escalating universal masking in healthcare centers, addressing compliance with the mask policy, local epidemiology, the level of protection provided by medical face masks, the consequences of absenteeism and presenteeism, as well as logistics, costs, and ecological impact. Most current national and international guidelines for mask use are based on the level of community transmission of SARS-CoV-2. Actions are now required to refine future recommendations, such as establishing a list of the most relevant RVI to consider, implement reliable local RVI surveillance, and define thresholds for activating masking strategies. Considering the epidemiological context (measured via sentinel networks or wastewater analysis), and, if not available, considering a time period (winter season) may guide to three gradual levels of masking: (i) standard and transmission-based precautions and respiratory etiquette, (ii) systematic face mask wearing when in direct contact with patients, and (iii) universal masking. Cost-effectiveness analysis of the different strategies is warranted in the coming years. Masking is just one element to be considered along with other preventive measures such as staff and patient immunization, and efficient ventilation.

Psitacose e Saúde Ocupacional

Introduction/framework/objectives Psittacosis is a rare entity caused by Chlamydophila psittaci. This bacterium is transmitted through contact with contaminated birds, namely psittaciformes, which include parrots, macaws and parakeets, as pigeons and chickens. The objective of this work is to highlight the pathology and the role of Occupational Health in it. Methodology A bibliographic search was carried out on original articles published in Portuguese and English, in June 2022, in the PubMed and Cochrane Library databases, using the keywords “Psittacosis”, “Occupational exposure” and “Occupational health”. Three articles were also included, not covered by the research, relevant to the work, for reporting the Portuguese reality. Contents Outbreaks can occur in workers with occupations that involve contact with live birds or carcasses, such as veterinarians, breeders, or pet store workers. However, it is difficult to establish the precise incidence and prevalence of psittacosis, probably due to the lack of routine screening. Transmission occurs mainly by aerosols, inhalation of urine, feces or other contaminated particles; transmission between humans, although possible, is rare. The incubation period ranges from five to 14 days, but may extend to weeks in cases of subacute or latent infection. It has a clinical presentation like a flu-like syndrome and can cause disseminated and even potentially fatal disease. The most frequent findings on chest radiography are segmental or lobar consolidation, especially in the lower lobes. It can occasionally cause marked leukocytosis, c-reactive protein (CRP) is often elevated, and liver enzymes change in approximately half of hospitalized patients, with elevation of aspartate aminotransferase (AST) and low serum albumin levels. Tetracyclines are the drug of choice for treatment. Discussion and Conclusions Although the number of cases is apparently small, the impact of the disease is most likely underestimated. Thus, it is necessary to increase the awareness of this pathology both for Occupational Health professionals and for employers and workers themselves. On the other hand, an approach is needed that encompasses collaboration between human and animal health agencies, laboratories and medical and veterinary professionals, for timely surveillance, reporting and treatment. Thus, anamnesis and early recognition of the epidemiological context are extremely important, with a view to diagnosing and instituting appropriate therapy. In addition, occupational risk factors and exposure control among workers should be considered to prevent transmission in the workplace. KEYWORDS: psittacosis, occupational exposure, occupational health.