WHO Goal Research Articles

Outcomes of HIV-Exposed Infants enrolled in the Prevention of Mother to Child Transmission of HIV (PMTCT) Program in Philippine General Hospital: An 8-year Retrospective Study

Background: Our country has the fastest growing number of HIV cases in the Asia-Pacific region with a 203% increase from 2010 to 2018. MTCT represents 6% of infections in children and interventions such as the PMTCT program are essential to help reduce new infant infections. Objective: To determine the outcomes of HIV-exposed infants born in PGH from 2010 to 2018 enrolled in the PMTCT program. To analyze the association of maternal and neonatal clinicodemographic factors to MTCT of HIV. Methods: A retrospective cohort study using data collected from medical records of HIV exposed infants enrolled in the program. Results: Out of 117 mother-infant pairs, only 70 met the eligibility criteria. Maternal factors showed that majority have: timely antenatal visit (56/70), maternal HIV diagnosis (70/70) and ART initiation (67/70) prior to delivery, triple lifelong maternal ART (69/70), CD4 >200 prior to delivery (52/70) and cesarean delivery (67/70). Amongst the infant factors-early infant prophylaxis (60/62), >4weeks prophylaxis duration (62/70) and replacement feeding (62/70) were noted in the majority. 2/70 infants were HIV positive. Mortality rate was 1.4% and 50% for HIV infected infants. Overall LTFU rate was 33.3%. Logistic regression showed that maternal co-infection with Hepatitis B(p=0.0275) was a possible determinant of MTCT. Infant HIV prophylaxis duration of >4 weeks had higher survival proportion(p=.0001). Conclusion: The HIV MTCT rate was 2.86% upon implementation of our PMTCT program, meeting the <5% goal of WHO, suggesting that the program was an effective health intervention strategy. The high LTFU rate though should be considered in the evaluation of the program effectiveness.

Comparative evaluation of various strategies medical care for chronic hepatitis С in the Republic of Sakha (Yakutia)

Hepatitis C is a major public health problem and measures against it require the development of a national strategy and concept of a prognostic model. This is relevant for Yakutia, as a tremendous region with extremely specific and severe climatic and social conditions that cause a high incidence of hepatitis C.Objective: to evaluate the effectiveness of various scenarios for the development of the epidemiological situation of hepatitis C in RS (Y) depending on the strategy for providing medical care to people with chronic hepatitis C.Material and Methods. The work uses the materials of official statistics of the Federal State Institution of Rospotrebnadzor for RS (Y) and information from the register «Chronic viral hepatitis in RS (Y). To assess the burden of disease, the main scenarios were analyzed using the dynamic Excel model.Results and discussion. RS (Y) is a disadvantaged territory of the Russian Federation for parenteral viral hepatitis, including hepatitis C. According to the register «Chronic viral hepatitis in RS (Y)», 14643 people are registered, of which with chronic hepatitis C — 7395, which amounted to 50,5%. The proportion of HCV infection in the group of people with cirrhosis is 44.1%, with hepatocellular carcinoma 59,3%, and 76% in the total structure of the dead. Implementation of the WHO scenario for hepatitis C will reduce mortality by 65%, the number of people with hepatocellular carcinoma by 66%, decompensated cirrhosis by 66% and reduce the overall incidence by 34% by 2030.Conclusion. Achieving the WHO goals by 2030 seems realistic when creating a regional strategy to eliminate HCV in RS (Y), which includes increasing access to therapy with modern drugs with direct antiviral effects, an interdisciplinary approach to the diagnosis and management of patients with chronic hepatitis C, specialties about the problem of chronic hepatitis C and the possibility of curing it.

Analysis of an age-structured tuberculosis model with treatment and relapse.

A new tuberculosis model consisting of ordinary differential equations and partial differential equations is established in this paper. The model includes latent age (i.e., the time elapsed since the individual became infected but not infectious) and relapse age (i.e., the time between cure and reappearance of symptoms of tuberculosis). We identify the basic reproduction number mathcal {R}_{0} for this model, and show that the mathcal {R}_{0} determines the global dynamics of the model. If mathcal {R}_{0}<1, the disease-free equilibrium is globally asymptotically stable, which means that tuberculosis will disappear, and if mathcal {R}_{0}>1, there exists a unique endemic equilibrium that attracts all solutions that can cause the spread of tuberculosis. Based on the tuberculosis data in China from 2007 to 2018, we use Grey Wolf Optimizer algorithm to find the optimal parameter values and initial values of the model. Furthermore, we perform uncertainty and sensitivity analysis to identify the parameters that have significant impact on the basic reproduction number. Finally, we give an effective measure to reach the goal of WHO of reducing the incidence of tuberculosis by 80% by 2030 compared to 2015.

Physical disabilities caused by leprosy in 100 million cohort in Brazil

BackgroundLeprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population.MethodsA large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001–2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals.ResultsAmong the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67).ConclusionsThe findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.

Biosimilars – status in July 2020 in 16 countries

The World Health Organization has provided specific guidance for biosimilar products to assist regulators, manufacturers and other professionals involved in the development and evaluation of these products. The development and approval of biosimilars are important for health care, as they allow the marketing of safe, efficacious and affordable biological products. Since the first biosimilars were approved in the EU in 2006, a series of biosimilars have been approved in many countries/geographical regions. This manuscript provides the figures on the status of approved biosimilars in 16 countries based on the information from regulatory experts and from publicly available data. It is clear that increasing numbers of biosimilars are now available in many countries and provide more options for treatments. It is expected that adoption of biosimilars will allow affordable health care and greater patient access to important medicinal products. It will also contribute to the overall WHO goal recognized by the World Health Assembly in 2014 by adopting a resolution on access to biotherapeutic products including biosimilars and on ensuring their quality, safety and efficacy.

From treatable to curable to eliminated ---- a decade of research progress in the diagnosis and treatment of hepatitis C

Hepatitis C is the first chronic viral infection that can be cured, and it has taken only 30 years from the discovery of the hepatitis C virus genome to the ability to eliminate the public health threat posed by hepatitis C virus. In the past ten years, the etiological detection of hepatitis C has experienced the development from sensitive and quantitative to rapid, convenient, automatic and point of care testing. With the continuous introduction of direct antiviral drugs, all types of hepatitis C patients, including special populations, can be safely and effectively cured by short courses of all-oral drugs. Progress in the diagnosis and treatment of hepatitis C is an important basis for eliminating the public health threat of hepatitis C. China has published the Planning of prevent and treatment for viral hepatitis in China (2017-2020). We look forward to achieving WHO's goal of eliminating viral hepatitis as a public health threat at an early date through effective screening, diagnosis and treatment.

Analysis of an age-structured model for HIV-TB co-infection

&lt;p style='text-indent:20px;'&gt;According to the report of the WHO, there is a strong relationship between AIDS and tuberculosis (TB). Therefore, it is very important to study how to control TB in the context of the global AIDS epidemic. In this paper, we establish an age structured mathematical model of HIV-TB co-infection to study the transmission dynamics of this co-infection, and consider awareness in the modeling. We give the basic reproduction numbers for each of the two diseases and find four equilibria, namely, disease-free equilibrium, TB-free equilibrium, HIV-free equilibrium and endemic disease equilibrium. Then we discuss the local stability of the equilibria according to the range of values of the two basic reproduction numbers, and find the endemic equilibrium is unstable. We also discuss the global stability of the disease-free equilibrium and the TB-free equilibrium. Based on the new HIV-positive cases and TB cases data in China, the best-fit parameter values and initial values of the model are identified by the MCMC algorithm. Then we perform uncertainty and sensitivity analysis to identify the parameters that have significant impact on the basic reproduction number &lt;inline-formula&gt;&lt;tex-math id="M1"&gt;\begin{document}$ \mathcal{R}_{T} $\end{document}&lt;/tex-math&gt;&lt;/inline-formula&gt;. Finally, combined with the established model, we give some measures that may help China achieve the goal of WHO of reducing the incidence of TB by 80% by 2030 compared to 2015.&lt;/p&gt;

Improving Oral Health Care Delivery

Around 40 years prior during the 1950s (not long after WHO started its exercises), oral wellbeing was the subject of overseers' consideration along with other medical services programs. In those years, regardless of the presence of serious issues in transferable illnesses, ecological risks and wholesome insufficiencies which were WHO's primary goals, the Oral Health Program was set up to save, and to advance a worthy level of, oral wellbeing in populaces. It was when numerous wellbeing overseers understood that therapeutic dentistry was not a drawn out arrangement and a developing interest for preventive measures got clear. Endeavors were made to perceive the earnest issues and to foster an overall arrangement for avoidance and control of oral infections on an overall premise, instead of keep supporting an endless interest for traditionalist dental treatment.

957. Efficacy of Using Disease Intervention Specialists (DIS) to Re-engage Out of Care HIV/HCV Co-Infected Persons into HCV Treatment

BackgroundPublished treatment cascades for HIV/HCV co-infection show WHO goals for HCV micro-elimination are not being met. Barriers include entry to care, access to DAA, treatment adherence, and out of care (OOC) patients. A Data to Care approach used to define persons with HIV (PWH) who are OOC, together with DPH-employed DIS to promote re-engagement has been successful for re-engaging OOC PWH. We modified this approach to re-engage OOC HIV/HCV coinfected persons.MethodsSurveillance databases used: CTEDSS (CT Electronic Disease Surveillance System used for HCV) and eHARS (electronic HIV/AIDS Reporting System). Two OOC cohorts studied: HIV OOC for 12 months (no HIV lab 10/2018-10/2019) and 18 months (no HIV lab 12/2017-6/2019). Lists generated for the 2 cohorts matched to CTEDSS to determine the coinfected OOC. DIS supervisor performed pre-work/case conferencing on lists to assess DIS intervention eligibility. DIS success was defined as those who reengaged (made/kept appointment) out of those successfully contacted. Analysis: tests of homogeneity performed between those OOC and not OOC; evaluation of cases at each level of the intervention; measures of dispersion/central tendency performed illustrating reengagement workload.Project Flow Chart Results 12-month OOC: Non-baby boomers (p-value 0.05) and those with detectable HIV VLs (0.04) were more likely to be OOC; 53.7% were DIS-eligible; DIS initiation to client contact, 7 days average (range 4-11); 75 calls and 31 field visits for those successfully contacted; reengagement success rate, 39%. 18-month OOC: Non-baby boomers (0.017), Hispanic and Black race/ethnicity (0.043), and those with detectable HIV viral loads (0.002) were more likely to be OOC; 44% were DIS-eligible; DIS initiation to client contact, 12 days average (range 8-18); 74 calls and 36 field visits for those successfully contacted; reengagement success rate, 43%.Results for the Two Cohorts Out of Care and Workload Results ConclusionA data-to-care approach successfully identified, characterized, connected OOC HIV/HCV coinfected patients. DIS provided patient education, facilitating reengagement to care. DIS Success rates are encouraging but small; efforts were labor intensive. Additional strategies focused on preventing non-baby boomers, persons of color, and those with detectable HIV VLs from becoming OOC should be studied.Disclosures All Authors: No reported disclosures

The state of laboratory diagnosis, surveillance, and response to outbreaks of bacterial Meningitis, Brong Ahafo Region, Ghana, 2019

Background: One goal of WHO and Global Health Security Agenda (GHSA), is to prevent, rapidly detect, diagnose, notify and respond to infectious diseases, in order to contain them at source, and prevent spread. We assessed cerebrospinal fluid (CSF) sample management, referral, laboratory diagnostics, notification, response, and surveillance capacity in relation to bacterial meningitis in Brong Ahafo Region(BAR), Ghana. Methods and materials: We conducted a cross-sectional study in BAR in September 2019. We reviewed Meningitis case-based forms, laboratory registers, from January to August 2019, and interviewed laboratory personnel. We collected data on sample quality, type of sample container, time of collection, receipt, and outcome of culture and PCR results at the Brong Ahafo Regional Hospital Laboratory (BARHL), and the PCR Zonal Public Health Reference Laboratory (ZPHRL), in the Northern Region, respectively Results: A total of 87 CSF samples were received at BARHL, between January–August 2019, from peripheral districts in BAR. The median time for samples receipt was; 1 day;(range; 1–4). Eight, (9.2%) tested culture-positive; Streptococcus pneumoniae. Sixty-nine (79.3%) samples met the criteria for adequacy and PCR analysis at the ZPHRL. It took 21 days to receive PCR results feedback. In all, 21 (30.4%) of the 69 samples were positive by PCR; (Streptococcus pneumoniae-20, Neisseria meningitidis-1). More than half; 13(62%) of the 21 positives by PCR, had been previously declared; ‘Culture Negative’ at BARHL. Across districts, there was lack of Gram stain and rapid latex agglutination test kits. Standard sample collection tubes such as dry cryo-tubes and trans-isolate bottles (meant to sustain the viability of CSF pathogens whilst in transit) was inadequate, and often yielded contaminated results due to inappropriate handling techniques. Conclusion: Poor specimen management and weak laboratory capacity possibly accounted for the low yield of culture results at BARHL. Observation suggests a high potential of failure to rapidly diagnose, notify, respond, and contain infectious outbreaks at source. Strengthening laboratory capacity at local and district levels in Brong Ahafo Region is crucial.

Hepatitis C in Poland in 2018.

Analysis of data on hepatitis C, collected as part of epidemiological surveillance in 2018, compared to previous years. Analysis of: 1) individual data from surveillance in 2018 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2012-2018 and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Central Statistical Office. In 2018, there was a decrease in the number of reported hepatitis C cases (3,442 cases) and the diagnosis rate (8.96 per 100,000; taking into account the territorial distribution: from 3.29 per 100,000 in the Podkarpackie voivodeship to 13.69 per 100,00 in the Lubuskie voivodeship). The disproportion of the rates between the sexes returned (in men 9.34 per 100,000 vs. women: 8.61 per 100,000). The disproportion of the diagnosis rate depending on the place of residence was still evident (urban: 10.84 per 100,000 vs. rural: 6.12 per 100,000). There are differences in the values of the diagnosis rates, analyzed in terms of gender, age groups and the place of residence. Based on the EU definition, 14 acute hepatitis C were reported, while according to the PL definition, 88 cases (0.4% and 2.6% of all reported cases, respectively). HCV infections due to medical procedures are still the main route of transmission, also in cases of acute hepatitis C - which indicates the current route of transmission. According to the Demographic Surveys and Labour Market Department of the Central Statistical Office, 119 deaths related to hepatitis C were reported. For years, the general picture of hepatitis C in Poland, observed through epidemiological surveillance, is determined by the availability of testing for HCV infections. The analysis identified subpopulations in which primary prevention activities (e.g. safer medical procedures, intensifying activities in the area of harm reduction for people who inject drugs) as well as secondary prevention (access to testing and quick inclusion in treatment) should be particularly strengthened. According to the micro-elimination strategy, the improvement of testing in particularly affected groups, including marginalized populations, is necessary to achieve the WHO goal of eliminating HCV by 2030.

The oral health status of children aged 12 years in Seychelles in the years 1994 and 2000

The results of two national oral health surveys in 1993/4 led the Seychelles School Dental Service (SDS) to implement an oral health improvement strategy through the adoption of a targeted population approach. The aim was to attain the World Health Organization's (WHO) goal for 12-year-olds, of a DMFT (decayed, missing, filled permanent teeth) of less than 3.0, by the year 2000. Primary 5 (P5) children from all state schools were selected as the target population. Although all the children (1538) were exposed to the targeted service interventions, 500 were sampled out for study, through random sampling of school class lists. Data was collected at the beginning of 1998 and end of 2000, through clinical examination and self-administered questionnaires. All examinations and interventions were carried out by dental therapists (DTs), in their respective clinics. For the purpose of this paper comparisons made between 12-year-olds of 1994 and those of 2000 are based only on the dental examination data. Interventions were spread over three years from 1998 to 2000. These included an initial dental examination followed by any dental treatment required, an annual recall visit, dental health education at class and individual level, and weekly school-based fluoride mouth rinses. Parameters investigated were 1) community periodontal index of treatment needs (CPITN), 2) dental health status (DMFT), 3) enamel defect, and 4) clinic attendance. All parameters improved significantly between the cohort of 1994 and that of 2000. The proportion of children and of sextants with healthy gingivae increased from 3.4% to 51.8% and from 25.9% to 70.9% respectively. Children with no enamel defects increased from 51.1% to. 92.6%, while children with newly decayed teeth decreased from 61% to 33%. The mean number of newly decayed teeth fell from 2.0 to 0.8. The proportion of children attending their clinic at least once a year for check up increased from 51% in 1994 through 73% in 1998 to almost 100% in 2000. The WHO goal for children aged 12 years to have a DMFT of less than 3 was met, with a change from 3.2 in 1994 to 1.9 in 2000.

Temporal analysis of leprosy in the metropolitan region of Aracaju, Sergipe, Brazil: 2001-2013

The study carried out a temporal analysis and description of the epidemiological profile of leprosy in the metropolitan region of Aracaju, Sergipe, Brazil, from 2001 to 2013. It was a temporal study based on secondary data from the Notifiable Diseases Information System (SINAN). In this study, the variables were analyzed: municipality of residence; number of cases diagnosed per year from 2001 to 2013; age; schooling; race / skin color; operational classification (paucibacillary or multibacillary); clinical form (indeterminate, tuberculoid, dimorphic, virchowian); and degree of disability, assessed at the time of notification and upon medical discharge: Degrees 0, I and II. The data were plotted in a spreadsheet (Microsoft Excel ©) and subsequently analyzed according to the descriptive statistical measure of association and the adhesion test was measured by the Bioestat 5.0 software. For the time trend analysis, it adopted the simple polynomial regression model, the variable time centralization to avoid autocorrelation between the terms of the equations. It was detected a total of 3,519 cases in Aracaju region. The predominant form paucibacillar. Clinical tuberculoid form of leprosy was the most frequent. The temporal analysis showed a declining trend to statistical significance (p &lt;0.05). The multibacillary predominated in the municipalities of Barra dos Coqueiros and Our Lady of Socorro. The results showed that the population did not have access to adequate health program and the Ministry of Health's strategies did not meet the goal of WHO for the elimination of leprosy.

199 False Positive or Acute Seroconversion? Examination of Patterns of Equivocal HIV Screening in the ED.

We consider the clinical presentation of patients with equivocal HIV test results in the ED (HIV Ab/Ag +, HIV Ab -) found through routine ED-based HIV screening and further describe those patients who presented to the ED during acute seroconversion (acute +) compared to the clinical characteristics of patients who were ultimately found to have false + initial screening results. We analyzed 4 years of HIV testing data (2016-2020) and determined the number of patients who had a Ab/Ag + screen. Patients with Ab/Ag + but a non-equivocal HIV+ lab signature (Ab/Ag +, Ab +, viral load > 0) were removed. Then we determined the remaining number with an equivocal laboratory signature (Ab/Ag +, Ab -). We separated those patients into 2 groups: false + (Ab/Ag +, Ab -, viral load 0) and acute + (Ab/Ag +, Ab -, viral load > 0). We conducted chart review on all patients with an equivocal laboratory signature and the clinical presentation was considered to detail patterns in false + compared to acute + patients presenting to the ED. We screened approximately 55,224 patients for HIV (16% volume) in 4 years. 787 patients had a Ab/Ag + result (1.4%) and, of those, 688 had non-equivocal positive HIV results (87.4% of Ab/Ag +, 1.2% of tested). 99 (12.5% of Ab/Ag +, 0.13% tested) were Ab/Ag +, Ab -. Of those 99, 73 had no detectable HIV RNA (false +, 9.3% of Ab/Ag +, 0.13% tested). 26 of the 99 with equivocal results had viral load > 0 (acute +, 3.3% of Ab/Ag +, 0.05% tested). Qualitative review of equivocal patient charts during the Ab/Ag reactive screening encounter showed statistically significance for acute positive results in younger male patients who have sex with men. 787 patients had a reactive screening test but 99 had an equivocal laboratory signature (12.5% of Ab/Ag+), making the information difficult to interpret during an ED encounter in high prevalence populations and challenging the ability to scale up ED based HIV screening, especially given the long turn around time for HIV RNA testing via PCR. ED based screening is an important strategy to help reach the WHO goal of eliminating HIV as a public health threat by 2030. However, the current algorithm and existing testing technology may not be best designed for acute clinical encounters and false + encounters are higher than previously reported. The results of this study detail characteristics of patients with equivocal test results that may improve clinical decision making in patients with false + compared to acute + laboratory signatures and suggest that young men who have sex with men and have a reactive HIV screening test in the ED should be considered HIV positive.

Enhancing Influenza Vaccination of Hospital Workers from 30% to 80% Through Application of Behavior Change Theories

Background: Historically, influenza vaccination coverage among Norwegian healthcare workers has been low. In 2014–2015 and 2015–2016 the national averages were 9% and 12%, respectively, Although the Fig.s for Oslo University Hospital were higher (30% in 2015–2016), we were still far from the goal of 75% set by the WHO. The same year, &lt;10% of employees at Vestre Viken Hospital Trust were vaccinated. Before the 2016–2017 influenza season, we therefore launched a campaign using methods based on behavior change theories and social marketing to enhance vaccination coverage. Methods: In May–June 2016 a questionnaire was sent by e-mail to all employees at Oslo University Hospital (n = ~25,000) and Vestre Viken Hospital Trust (n = 9,000). The questionnaire was structured according to the theory of planned behavior, asking questions related to attitude, subjective norms, and perceived control. The respondents were asked to grade each answer from 1 to 5, and we could then calculate a score for each question based on the proportion (%) of respondents across the 5 grades. Thus a score between 0 and 500 was possible. We then selected the questions with the highest and lowest scores for intervention, and applied stages of change principles and social marketing for implementation. In May–June 2017, the same questionnaire was sent to all employees and the procedure was repeated before the 2017–2018 influenza season. Finally, for the third time, the procedure was repeated before the 2019–2020 season. This time some additional questions were added, about which sources the employees were using for information on influenza vaccination. Results: In 2017–2018 vaccination coverage increased from 30% to 54%. The year after we reached 73%, and at the time of abstract submission (November 12, 2019) we have passed 80% for the 2019–2020 season, still with more vaccines to be given. Among Norwegian healthcare workers, attitudes and perceived control seemed to have a stronger impact on behavior (vaccination) than subjective norms. Conclusions: We were able to significantly increase voluntary influenza vaccination, reaching the WHO goal of at least 75%, by the application of behavior change theories and social marketing.Funding: NoneDisclosure: Egil Lingaas, Salary - 3M Healthcare

The use of geospatial tools to study the evolution of TB incidence in North Portugal between 2008-18

Abstract Background Tuberculosis continues to be a significant global health problem. Portugal isn't an exception to this health problem, being considered by the ECDC a high incidence country. According to the SDG target 3.3, the world must end the epidemics of tuberculosis by 2030. However, several parishes in Portugal continue to observe extremely high values of TB, taking into account the WHO goal for pre-elimination of 10 TB cases per million people. Methods A cross-sectional study was conducted with data from the Surveillance System of the National Program against Tuberculosis. Descriptive and regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. The geospatial analysis was carried out with ArcMap 10.7.1 using a five-year average of TB incidence. Animations and videos were made with Microsoft Office365 PowerPoint v2002. Results In the period 2008-2012, 55,7% of parishes had registered cases of tuberculosis. That value decreased to 50,6% parishes in the period 2014-2018. For the period of 2014-18, 30,3% of parishes had a five-year average incidence above 20/100.000 people (value defined as high-incidence by the ECDC) and 45,0% parishes an incidence above 10/100.000 people. With ArcMap HotSpot analysis was possible to observe the existence of a significant cluster of TB in the southwest of North Portugal. With animation analysis, it was also possible to see the global spatial reduction of TB cases between 2008 and 2018, and the ongoing problem of a high incidence of TB in specific regions of North Portugal. Conclusions TB continues to be a significant health problem in North Portugal. The spatial analysis pointed to a specific area of North Portugal that needs priority action. Videos produced by the Department of Public Health may guide health professionals and policymakers for future strategies to be implemented to reach SDG3. Key messages The importance of desegregated spatial data for TB elimination. The elimination efforts must be scaled up in specific areas to achieve SDG3.

Prevention of perinatal hepatitis B virus transmission: are we missing something?

Abstract Background The prevention of perinatal Hepatitis B virus (HBV) is crucial to reach the WHO's challenge to eliminate viral hepatitis as public health threat by 2030. After diagnosing 2 infants infected by vertical transmission, a retrospective analysis of policies and practices to prevent HBV congenital infection was conducted to assess any potential risk. Methods Paired maternal-infant medical records between 2017 and 2019 were reviewed at A.O.U Città della Salute e Scienza di Torino, the italian hospital with the highest number of deliveries. Data included maternal HBSAg and coinfection (HIV, HCV) status and the administration of prophylaxis in newborns at risk. Other serologic markers of HBV maternal infection were not available. Results 132 (0,6%) newborns from HBsAg positive mothers were identified between 2017-2019 among 21143 newborns. In this group pre-natal HBSAg status was known in 127 (96,2%), the remaining were tested during the hospitalization. Regarding maternal coinfection 130 (98%) were tested for HIV (1 positive), only 60 (45.1%) for HCV (all negative). All newborns received immunoprophylaxis consisting in the administration of vaccination and immunoglobulin: 119 (89%) within 24 hours (63% within 12 hours), 12 (9%) between 24-36 hours and 2 (1,6%) after 36 hours. The 2 cases of vertical transmission, even if correctly vaccinated, show a vaccination failure of 1,5%. Conclusions Although most of the mothers were tested for HBSAg status and all newborns were given immunoprophylaxis, vaccination failure seems to explain the 2 cases of vertical transmission. Since the lack in early maternal serologic screening and the late vaccination time could increase the risk of HBV infection, to achieve WHO goal we suggest to implement a multidisciplinary pathway to identify HBV positive mothers, to treat in case of high viral load, to provide a timely immunoprophylaxis considering a early vaccination and to set up a structured postnatal serologic check for newborns at risk. Key messages Vaccination failure must be considered in the service organization, a structured postnatal serologic check for all newborns at risk should be implemented to detect potential vaccination failure. A multidisciplinary pathway to identify HBV positive mothers, with a full serological markers set, should be implemented to give a correct maternal therapy and newborn prophylaxis.

A molecular dynamic simulation approach: development of dengue virus vaccine by affinity improvement techniques

This study is about proposing a vaccine for all four strains of dengue virus (DENV) that could be an important approach for reaching the WHO goal of reducing dengue morbidity and mortality. The significance of the DENV envelope proteins III lies in the fact that it elicits an immune response and hence can be a potential vaccine design candidate. This domain appears to play a key role in the host cell receptor binding for viral entry and in inducing long lasting protective immunity against the infection. We used long molecular dynamic simulation and mutagenesis scanning methods to provide the dynamic environment and propose the potential mutation that may result in enhancing the binding specificity and affinity of the antigen–antibody (Ag–Ab) complex. The binding free energetics were also estimated using free energy perturbation method. One charged mutation that is theorinine 93L to arginine interacting with epitopic glutamic acid 368 strongly contributing in increasing the binding affinity as well as specificity, predicted as −9.6 kcal/mol gain in 2H12-Fab with dengue envelope domain III binding free energy relative to the wild-type. In conclusion, the one charged residue that showed theoretically enhances the binding affinity of Ag–Ab complex by making couple of interactions i.e. by substituting theorinine to arginine in the antibody chains and can be considered as potential dengue vaccine candidate. Communicated by Ramaswamy H. Sarma

Twelve weeks of ledipasvir/sofosbuvir all-oral regimen for patients with chronic hepatitis C genotype 2 infection: Integrated analysis of three clinical trials.

The combination of ledipasvir and sofosbuvir (LDV/SOF) has been approved for the treatment of various hepatitis C virus (HCV) genotypes across many countries. This article presents an integrated analysis of three prospective phase II/III trials in the Asia-Pacific region to evaluate the efficacy and safety of 12weeks of LDV/SOF in HCV genotype 2 patients without cirrhosis or with compensated cirrhosis. A total of 200 patients were included in the integrated analysis. The primary end-point was the rate of sustained virologic response for 12weeks after the end of therapy (SVR12), analyzed by fibrosis stage, treatment history, HCV genotype subtype, and presence of baseline resistance-associated substitutions (RAS). Safety was evaluated by adverse events and laboratory abnormalities. Twelve weeks of treatment with LDV/SOF was associated with high SVR12 rates (overall 98%) in patients with genotype 2 HCV, irrespective of fibrosis stage, treatment history, genotype 2 subtype, and presence of baseline non-structural protein 5A resistance-associated substitution (NS5A RAS), and LDV/SOF was well tolerated. Twelve weeks of treatment with LDV/SOF provides a highly effective and safe treatment for patients with genotype 2 HCV, including those with advanced fibrosis. As a ribavirin-free and protease inhibitor-free regimen with minimal on-treatment monitoring requirements, LDV/SOF can potentially play a crucial role in achieving the WHO's goal of HCV elimination.

Saving lives through voluntary blood donation: learning from medical students in ruvuma, southern Tanzania

Background: Medical students present a high merit and potential source of blood in hospitals due to their medical knowledge, physiological potential by age however their use has been rarely described in southern Tanzania. Objectives: The main objective of the study was to assess the knowledge, attitude, willingness for the future blood donation among medical students of southern, Tanzania. Methods: A cross-sectional study to assess awareness, knowledge, attitudes, willingness and factors associated blood donation among medical students in Ruvuma, Southern Tanzania was conducted from March to June 2018. A self- administered questionnaire was used and data was analyzed by IBM Corp, SPSS Version 24.0. Results: A total of 176 students were assessed at an average age of 25.8 ± 3.6 years. Eighty medical students (45.5%) ever donated blood while among them 66 (82.5%) of those being out of volunteering. About 46 (57.5%) students had a repeated experience for blood donation. Majority of students had positive attitude toward blood donation 159 (90.3%), often 135 (77%) identified voluntary blood donation to be useful and 133 (75.6%) were willing to donate in the future. Factors that were significantly associated with blood donation were age above 30 (OR=0.18, p&lt;0.001), male sex (OR=3.69, p=0.001), past HIV screening (OR=2.59, p=0.029), knowledge of one’s own blood group (OR=4.86, p&lt;0.001,) and knowledge of the safe duration to donate a unit of blood (OR=2.42, p=0.024). Conclusion: Medical students present a high awareness, positive attitude, and high intention to donate blood to achieve the WHO goal for non-remunerated blood donation.