High Public Health Importance Research Articles

The prevalence of anaemia in rural adolescent girls - A cross-sectional study to understand the sociodemographic and dietary determinants in Dharwad District, India.

Anaemia is one leading cause of morbidity among adolescent girls. Prevention, early detection, and treatment can break the intergeneration cycle of malnutrition. The aim of the study was to estimate the prevalence of anaemia and assess its sociodemographic determinants and understand its association with the dietary pattern of rural adolescent girls. A cross-sectional study was conducted among 350 adolescent girls studying in the school of Kalgatigi Taluk, Dharwad district. The school girls were interviewed using a predesigned structured questionnaire by interview method. A food frequency questionnaire was used to assess the dietary pattern. Haemoglobin levels were estimated using Sahli's method. Data were entered in Microsoft Excel and analysed using SPSS version 19 and the Chi-square test was applied to study the significance. Rural adolescent school girls between the age group of 13-16 years were included. The prevalence of anaemia among them was found to be 47.4% and was significantly associated with the educational status of the mother, their socioeconomic status (SES), and type of diet. Vegetarian girls had a higher prevalence of anaemia. The frequency of meat and egg consumption was significantly associated with anaemia. The prevalence of anaemia was higher in thin and severely thin girls based on WHO-BMI. Anaemia in rural adolescent girls is of high burden and public health importance with a prevalence of 47.4% and significant association with dietary habits, SES, and BMI.

Is dirofilariosis an emerging conservation threat in wild carnivores across the Palearctic?

AbstractDirofilaria species are mosquito‐borne filarial nematodes, with a high veterinary and public health importance, but growing evidence also indicates their frequent occurrence in wildlife. Wild animals may play an important role in the maintenance, transmission and spread of dirofilariosis, but we have little understanding of the ecological and environmental processes that drive infection dynamics in these hosts. Here, we summarise the current knowledge about the distribution of Dirofilaria spp. across carnivore host species and geographic localities in the Palearctic region. This summary highlights that some of these sylvatic species may be important reservoirs of the pathogen, and identifies research trends and biases in the surveillance and monitoring of this host–parasite system in the wild. Furthermore, we provide directions for future research for a better understanding of the threat these parasites may pose to wild mammals.

Sex selection drug and congenital malformations in North India

Background: An increasing incidence of congenital malformations (CMF) has been reported in North India in cases use of traditional drug by Mothers to have male child. Aim was to ascertain the association of Sex selection drug (SSD) and congenital malformations. Methods: This hospital-based age-sex matched pair case control study was done at Advanced Pediatric Centre, Obstretics and Gynaecology department (ANC clinic, Maternity ward, labor room etc.) and Special Clinics, PGIMER, Chandigarh, India in 2019. The mothers were interviewed to collect information about risk factors. Results: Two hundred three CMF (under five children and gestational CMF) cases and same number of controls were studied. Significant association of CMF was observed with the use of sex selection drugs by mothers (OR= 4.35). Conclusions: The use of sex selection drugs is an avoidable risk factor of CMF and is of high public health importance. People need to be educated about this.

Tackling a global epidemic threat: Nipah surveillance in Bangladesh, 2006-2021.

Human Nipah virus (NiV) infection is an epidemic-prone disease and since the first recognized outbreak in Bangladesh in 2001, human infections have been detected almost every year. Due to its high case fatality rate and public health importance, a hospital-based Nipah sentinel surveillance was established in Bangladesh to promptly detect Nipah cases and respond to outbreaks at the earliest. The surveillance has been ongoing till present. The hospital-based sentinel surveillance was conducted at ten strategically chosen tertiary care hospitals distributed throughout Bangladesh. The surveillance staff ensured that routine screening, enrollment, data, and specimen collection from suspected Nipah cases were conducted daily. The specimens were then processed and transported to the reference laboratory of Institute of Epidemiology, Disease Control and Research (IEDCR) and icddr,b for confirmation of diagnosis through serology and molecular detection. From 2006 to 2021, through this hospital-based surveillance platform, 7,150 individuals were enrolled and tested for Nipah virus. Since 2001, 322 Nipah infections were identified in Bangladesh, 75% of whom were laboratory confirmed cases. Half of the reported cases were primary cases (162/322) having an established history of consuming raw date palm sap (DPS) or tari (fermented date palm sap) and 29% were infected through person-to-person transmission. Since the initiation of surveillance, 68% (218/322) of Nipah cases from Bangladesh have been identified from various parts of the country. Fever, vomiting, headache, fatigue, and increased salivation were the most common symptoms among enrolled Nipah patients. Till 2021, the overall case fatality rate of NiV infection in Bangladesh was 71%. This article emphasizes that the overall epidemiology of Nipah virus infection in Bangladesh has remained consistent throughout the years. This is the only systematic surveillance to detect human NiV infection globally. The findings from this surveillance have contributed to early detection of NiV cases in hospital settings, understanding of Nipah disease epidemiology, and have enabled timely public health interventions for prevention and containment of NiV infection. Although we still have much to learn regarding the transmission dynamics and risk factors of human NiV infection, surveillance has played a significant role in advancing our knowledge in this regard.

MTOR signaling inhibition decreases lysosome migration and impairs the success of Trypanosoma cruzi infection and replication in cardiomyocytes

Chagas disease is caused by the parasite Trypanosoma cruzi (T. cruzi) and, among all the chronic manifestations of the disease, Chronic Chagas Cardiomyopathy (CCC) is the most severe outcome. Despite high burden and public health importance in Latin America, there is a gap in understanding the molecular mechanisms that results in CCC development. Previous studies showed that T. cruzi uses the host machinery for infection and replication, including the repurposing of the responses to intracellular infection such as mitochondrial activity, vacuolar membrane, and lysosomal activation in benefit of parasite infection and replication. One common signaling upstream to many responses to parasite infection is mTOR pathway, previous associated to several downstream cellular mechanisms including autophagy, mitophagy and lysosomal activation. Here, using human iPSC derived cardiomyocytes (hiPSCCM), we show the mTOR pathway is activated in hiPSCCM after T. cruzi infection, and the inhibition of mTOR with rapamycin reduced number of T. cruzi 48 h post infection (hpi). Rapamycin treatment also reduced lysosome migration from nuclei region to cell periphery resulting in less T. cruzi inside the parasitophorous vacuole (PV) in the first hour of infection. In addition, the number of parasites leaving the PV to the cytoplasm to replicate in later times of infection was also lower after rapamycin treatment. Altogether, our data suggest that host's mTOR activation concomitant with parasite infection modulates lysosome migration and that T. cruzi uses this mechanism to achieve infection and replication. Modulating this mechanism with rapamycin impaired the success of T. cruzi life cycle independent of mitophagy.

Prevalence and factors associated with brucellosis and tuberculosis in cattle from extensive husbandry systems in Sahel and Hauts-Bassins regions, Burkina Faso

Brucellosis and tuberculosis are important zoonotic diseases with high economic and public health importance mainly in low income countries. In Burkina Faso, studies have been implemented to assess prevalence of these diseases but data remain scare about the prevalence in extensive husbandry systems. This study aimed to determine the prevalence and factors associated with brucellosis and tuberculosis in cattle from extensive husbandry systems in two regions of Burkina Faso. Serums samples were collected on 2195 cattle from 206 herds in Hauts-Bassins and Sahel region. Intradermal skin test and Rose Bengal Plate test have been carried out for the diagnosis of tuberculosis and brucellosis respectively. The overall herd prevalence was 18.93% and 25.73% respectively for brucellosis and tuberculosis while the herd prevalence of co-infections was 6.31%. The individual prevalence was 3.64% (95% CI: 2.85% - 4.42%) and 3.51% (95% CI: 2.74% - 4.28%) for brucellosis and tuberculosis respectively. A prevalence of 0.32% (95% CI: 0.08% - 0.55%) was noted for co-infections. Brucellosis infection was associated with herd size, animal sex and age (p ˂ 0.05). The highest prevalence was found in herds of more than 60 animals (8.2%; 95% CI: 5.7%-10.6%) and in animal aged between 5 and 8 years old (5.3%; 95 CI: 3.4%–7.1%). The prevalence was significantly higher in females (3.9%; 95%CI: 3.0%–4.7%) compared with males (1.0%; 0.04% - 2%). Tuberculosis prevalence was significantly higher in Hauts-Bassins region (6.2%; 95% CI: 4.4%-8.0%) than in Sahel region (2.3%; 95% CI: 1.5%–3.0%). The highest prevalence of tuberculosis was found in herds with at most 30 animals (9.9%; 95% CI: 4.0% - 15.7%) and in animal less than 4 years old (5.4%; 95% CI: 3.4%–7.4%). Results suggest that brucellosis and tuberculosis are prevalent in cattle herds, therefore management practices are needed for better control of the zoonotic diseases.

Neomycin resistance in clinical Escherichia coli from Danish weaner pigs is associated with recent neomycin use and presence of F4 or F18 fimbriaes

Neomycin is a first-choice antibiotic for treatment of porcine enteritis caused by enterotoxigenic Escherichia coli (ETEC), but little is known about factors influencing resistance to this drug. The aims of this study were to assess antimicrobial resistance and virulence in 325 E. coli isolates obtained in 2020 from various infections in pigs, and to identify factors associated with neomycin resistance development. Susceptibility to 16 antimicrobial agents was determined by broth microdilution, and occurrence of ETEC-associated virulence factors was screened by PCR and hemolysis on blood agar. Univariate and multivariate logistic regression analyses were performed to determine if age group, virulence factors, or antibiotic use (neomycin and other antibiotics) were associated with neomycin resistance. STa, STb, LT, F4, and F18 were detected in 14%, 37%, 26%, 21% and 23% of the isolates, respectively. Resistance was low for antimicrobials of high public health importance (1.5% for cefotaxime, 1% for colistin and no fluoroquinolone resistance) but high for drugs used for treatment of ETEC enteritis (e.g. 20% for neomycin). Isolates with the ETEC pathotype were significantly associated with the weaner age group and intestinal/fecal origin. Multivariate analysis showed that recent neomycin use and presence of F4 or F18 were significantly associated with neomycin resistance amongst isolates from weaners. These results prove an association between neomycin resistance and use at the farm level. Further research is warranted to determine why neomycin resistance was associated with F4 and F18, and whether neomycin use may co-select for virulent strains.

Characteristics and Outcomes of Traumatic Brain Injury among Older Adults with and without Pre‐injury Dementia: an Israel National Trauma Registry Study

AbstractBackgroundOlder adults have the highest and fastest rising incidence of traumatic brain injury (TBI) compared to all other age groups. Few studies have examined the prevalence of pre‐injury dementia among older adults presenting with TBI. None have examined injury characteristics and outcomes specifically among those with pre‐injury dementia. Our aim was to describe prevalence of pre‐injury dementia among older adults hospitalized with TBI in Israel and to examine features of those with versus without pre‐injury dementia.MethodWe identified all TBIs recorded in the Israel National Trauma Registry from 2015‐2020 among adults age 65 years and older who were admitted to one of 15 trauma centers. We determined the prevalence of a diagnosis of pre‐injury dementia recorded in the registry and compared baseline demographics, injury features, and hospital outcomes among those with versus without pre‐injury dementia.ResultAmong N = 7,788 identified cases of geriatric TBI, 9.8% (N = 762) had pre‐injury dementia. Compared to those without pre‐injury dementia, those with pre‐injury dementia were significantly older (90% vs. 70% age >75 years), more female (58% vs. 47%), had higher rates of injury location of residential institution (24% vs. 7%) or home (63% vs. 58%), and higher rates of injury mechanism of fall (95% vs. 84%; all p<0.01). No differences were identified in Injury Severity Score (ISS) across groups (p = 0.19). However, those with pre‐injury dementia had lower rates of severe TBI (4% vs. 7% Glasgow Coma Scale <9), lower rates of polytrauma (10% vs. 13%), and lower rates of surgical intervention (9% vs. 13%), yet had higher rates of in‐hospital mortality (10% vs. 8%) and new institutionalization post‐discharge (11% vs. 4%; all p<0.02).ConclusionApproximately 10% of older adults admitted to hospitals in Israel with TBI have dementia compared to only 7% of older adults in the general population (per 2019 national health service data), suggesting that dementia is likely a risk factor for TBI in the elderly. Additionally, admission for a TBI resulted in 10% in‐hospital mortality and 11% new institutionalization post‐discharge among those with pre‐injury dementia. Geriatric TBI prevention, primarily through fall‐prevention, is of high public health importance in Israel.

High prevalence of urinary schistosomiasis in a desert population: results from an exploratory study around the Ounianga lakes in Chad

BackgroundResearching a water-borne disease in the middle of the Sahara desert might not seem the most relevant concern. However, nomadic Sahelian pastoralists health concerns regarding their livestock and anecdotal reports about trematode infections of Fasciola spp. and Schistosoma spp. in desert-raised animals justified an exploratory study focusing on the lakes of Ounianga in Northern Chad. The aim was to test whether trematode parasites such as Schistosoma spp. occur in human populations living around the Sahara desert lakes of Ounianga Kebir and Ounianga Serir in northern Chad.MethodsThe study was carried out in January 2019 and comprised of three components. First, a cross sectional survey based on a random sample drawn from the population to detect infections with S. haematobium and S. mansoni; second, focus group discussions exploring disease priorities, access to health and health seeking behaviour; and third, surveying water contact sites for intermediate host snails. Samples of trematode parasites and snails were confirmed on species level by molecular genetic methods. For parasitological and malacological surveys descriptive statistics were performed. Qualitative data analysis included the full review of all transcripts, followed by a descriptive and explorative thematic analysis.ResultsAmong 258 participants, the overall S. haematobium prevalence using urine filtration was 39.2% [95% confidence interval (CI): 33.5–45.1%], with 51.5% of the infected suffering from heavy infection. The intermediate host snail of S. haematobium (Bulinus truncatus) occurred at water contact sites near both study villages, revealing the potential for local transmission. Although a positive S. mansoni point-of-care circulating cathodic antigen (POC-CCA) test result was obtained from 8.6% (95% CI 5.7–12.8%) of the samples, no intermediate host snails of S. mansoni were found, and the relevance of S. mansoni remains uncertain. Qualitative findings underline the importance of morbidity caused by urinary schistosomiasis, and the lack of access to diagnostics and treatment as a major health concern.ConclusionsThis research revealed a high prevalence of urinary schistosomiasis in the population living around the lakes of Ounianga in the Sahara, a United Nations Educational, Scientific and Cultural Organization (UNESCO) world heritage site in Chad. Despite the high public health importance of the associated morbidity expressed by the population, there is no access to diagnostics and treatment. Further work is needed to develop and test a context-adapted intervention.Graphical

Seroprevalence and risk factors for brucellosis in small ruminant flocks in Karnataka in the Southern Province of India.

Background and Aim:Brucellosis is a zoonotic disease of high economic and public health importance in large and small ruminant populations worldwide. A cross-sectional study was conducted to determine the seroprevalence and risk factors of brucellosis in small ruminants in organized farms in the southern region of India.Materials and Methods:Farms exclusively rearing sheep and goats were selected based on the number of animals (small, medium, or large) and the location of the farm (urban, periurban, or rural). A total of 1499 serum samples; 1001 from sheeps and 498 from goats were sourced from six sheep and four goat farms and tested using Rose Bengal Plate and indirect Enzyme-Linked Immunosorbent Assay tests.Results:The apparent prevalence of brucellosis was higher in sheep (8.29%, 95% CI 6.7-10.1) than goats (5.82%, 95% CI 4.0-8.2). The true adjusted population level seroprevalence was also higher in sheep, at 7.7% (95% CI 6.0-9.6) than in goats, at 5.1% (95% CI 3.2-7.6). According to bivariate categorical analysis, six highly significant (p<0.001) animal- and farm-level risk factors for sheep were age, breed, number of lambings, history of abortion, rural farms, and presence of dogs on the farm. In goats, five significant risk factors were found: History of abortion, separate sheds, dogs on the farm, weekly veterinary consultation, and lack of brucellosis awareness. In a logistic regression model, abortion (OR adjusted 10.8, 95% CI 1.2-96.12), rural farms (OR adjusted 8.5, 95% CI 3.6-20.0), and absence of separate sheds on the farms (OR 1.9, 95% CI 1.1-3.5) were found to be significant risk factors for ovine brucellosis.Conclusion:The use of complementary measures to tackle the multiple animal- and farm-level risk factors may help to reduce the disease burden in the absence of a vaccination policy for small ruminants in India.

Dog ownership, demographics, owners’ knowledge of rabies, and factors associated with canine rabies vaccination in urban and rural areas of Dedougou, Burkina Faso

Rabies is a prioritized zoonotic disease in Burkina Faso and is known as a major zoonotic disease with high public health importance. This investigation was conducted to assess community knowledge, dog ecology and demographics, and factors associated with dog vaccination against rabies in the urban and rural areas of Dedougou. Three hundred and sixteen (316) dog-owning households were surveyed in the rural and urban areas of Dedougou using a semi-structured questionnaire. Among participants, 55.7% lived in rural area, and 59.8% were farmers. Only 34.5% of participants had satisfactory knowledge of rabies. About 22% were aware of the required age of dogs’ primo vaccination against rabies while 55.7% knew the frequency of booster vaccination. Participants living in households with less than five persons were significantly more likely to be aware of rabies than those living in households with the higher number of persons (P<0.05). Participants who were aware of rabies were more likely to vaccinate their dogs compared to those who were not aware of rabies (P<0.05). In total, 2930 persons were recorded in visited households with 60.6% from rural area, and an average household size of 9.27 persons. Three hundred and thirty seven dogs were found in surveyed households’ and 54.9% were from rural area. In overall, a dog per human ratio of 1:8.7 was determinated. Regarding dog ownership practices, the majority of respondents reported that they provided their dogs with water (84.5%) and food (84.8%). This research reported supplementary data on dog ecology and rabies, which could be useful for rabies control planning in Burkina Faso.

Different diagnostic groups and labour market marginalization among refugee youths

Abstract Background Refugees are at increased risk of labor market marginalization (LMM), which is of high Public Health importance. However, little is known whether specific multimorbidity patterns increase the risk of LMM in this group. We sought to examine whether different diagnostic groups associate with subsequent unemployment and disability pension in refugee youth as compared to their counterparts born in Sweden. Methodology We analyzed 249,245 individuals between the age of 16 and 26 at 31.12.2011 from a combined Swedish registry. Refugees were matched to five second-generation-native-born Swedes. LMM was defined as disability pension or &amp;gt; 180 days of unemployment, 2012-2015. Relative risks (RR) were calculated for 114 diagnostic groups (2009-11) with regard to the two outcome measures. Results The mean age was 23±1.7 years, 2,841 (1.1%) received disability pension and 16,323 (6.5%) individuals experienced unemployment. The majority of diagnostic groups was associated with a higher risk for unemployment and a lower risk for disability pension in refugees. Hypertensive diseases and external causes of morbidity showed higher risk ratios of unemployment for refugees compared to Swedish-born: RRs (95% Confidence Interval) 6.8 (3.16, 14.6) and 6.31 (4.45, 8.94), respectively. Diabetes and mental disorders were associated with higher risk estimates for disability pension in refugees: RRs (95% CI) 2.4 (1.02, 5.6) and 1.8 (0.80, 3.9), respectively. Conclusions Diagnoses are differentially associated with LMM in refugee youth as compared to Swedish-born individuals. In order to prevent LMM in refugees, early intervention for the identified diseases is important. Key message The importance of diagnostic groups for subsequent LMM differs for young refugees and Swedish-born individuals. Findings are also divergent regarding the measure of LMM.

Epidemiology of tuberculosis in Sabah, Malaysia, 2012\u20132018

BackgroundTuberculosis (TB) is of high public health importance in Malaysia. Sabah State, located on the island of Borneo, has previously reported a particularly high burden of disease and faces unique contextual challenges compared with peninsular Malaysia. The aim of this study is to describe the epidemiology of TB in Sabah to identify risk groups and hotspots of TB transmission.MethodsWe conducted a retrospective review of TB cases notified in Sabah, Malaysia, between 2012 and 2018. Using data from the state’s ‘myTB’ notification database, we calculated the case notification rate and described trends in the epidemiology, diagnostic practices and treatment outcomes of TB in Sabah within this period. The Chi-squared test was used for determining the difference between two proportions.ResultsBetween 2012 and 2018 there were 33 193 cases of TB reported in Sabah (128 cases per 100 000 population). We identified several geographic hotspots, including districts with > 200 cases per 100 000 population per year. TB rates increased with age and were highest in older males. Children < 15 years accounted for only 4.6% of cases. Moderate or advanced disease on chest X-ray and sputum smear positivity was high (58 and 81% of cases respectively), suggesting frequent late diagnosis. Multi-drug resistant (MDR) TB prevalence was low (0.3% of TB cases), however, rapid diagnostic test coverage was low (1.2%) and only 18% of all cases had a positive culture result. Treatment success was 83% (range: 81–85%) in those with drug-sensitive TB and 36% (range: 25–45%) in cases of MDR-TB.ConclusionBetween 2012 and 2018, TB notifications in Sabah State equated to 20% of Malaysia’s total TB notifications, despite Sabah representing only 10% of Malaysia’s population. We found hotspots of TB in urbanised population hubs and points of migration, as well as evidence of late presentation and diagnosis. Ensuring universal health coverage and expansion of GeneXpert® coverage is recommended to reduce barriers to care and early diagnosis and treatment for TB.

Muscle Quality Predicts Improvements In Transfer Task Performance After Weight Loss In Older Women

PURPOSE: The contributions of weight loss and exercise to improvements in physical function in older adults remains debated and of high public health importance. Physical function tasks vary, but an inability to complete those most simple in life can be highly distressful for older individuals. The Transfer Task (TT), simple to administer, assesses an individual’s ability to stand up from the floor, but whether weight or fat loss (i.e., the load to be moved) or improved muscle quality (i.e., ability to move the load) is more important to successfully complete this task is unclear. This study aimed to examine the relative contributions of changes in muscle capacity and body composition to improvements in Transfer Task performance following a weight loss and exercise program in inactive obese older women. METHODS: Inactive older women (n = 34; BMI = 30.0 ± 4.5 kg/m2; 69.4 ± 4. yo) completed a 6-month weight loss and supervised exercise intervention. Maximal leg strength (STR) was measured via isokinetic dynamometry and leg power (POW) via leg extension power rig. Fat mass and mineral free lean mass (Leg-MFLM) were assessed via DXA. Muscle quality (MQ) was calculated as a ratio between maximal STR and POW and Leg-MFLM (MQ-STR; MQ-POW). The Transfer Task (TT) required sitting down on the floor and returning to a standing position as quickly as possible. RESULTS: Body weight (-9.6 ± 3.5%), fat mass (-6.8 ± 2.4 kg), and Leg-MFLM (-0.3 ± 0.5 kg) decreased (all p < 0.01). MQ-STR and MQ-POW improved (8.2 and 10.1%, respectively, both p < 0.001). TT time improved (-39.0 ± 19.8%, p < 0.01). Stepwise linear regression indicated that changes in MQ-POW predicted improvement in TT [unstandardized β = -0.50, R2 = 0.18, p = 0.017]; MQ-STR was excluded from the model. A second stepwise model determined that neither change in weight (β = 0.24, p = 0.15) nor fat mass (β = 0.21, p = 0.21) influenced the predictive relationship between changes in MQ-POW and TT. CONCLUSION: Changes in muscle quality based on power independently predicts improvements in transfer task performance. Thus, the ability to move the load appears to be more important than the load to be moved regarding the ability to sit on the floor and return to standing after a weight loss and exercise program for older women.

Genetically 'pure' Fasciola gigantica discovered in Algeria: DNA multimarker characterization, trans-Saharan introduction from a Sahel origin and spreading risk into north-western Maghreb countries.

Fascioliasis is a freshwater snail-borne zoonotic helminth disease caused by two species of trematodes: Fasciola hepatica of almost worldwide distribution and the more pathogenic F. gigantica restricted to parts of Asia and most of Africa. Of high pathological impact in ruminants, it underlies large livestock husbandry losses. Fascioliasis is moreover of high public health importance and accordingly included within the main neglected tropical diseases by WHO. Additionally, this is an emerging disease due to influences of climate and global changes. In Africa, F. gigantica is distributed throughout almost the whole continent except in the north-western Maghreb countries of Morocco, Algeria and Tunisia where only F. hepatica is present. The present study concerns the DNA multimarker characterization of the first finding of F. gigantica in sheep in Algeria by the complete sequences of rDNA ITS-1 and ITS-2 and mtDNA cox1 and nad1 genes. Sequence comparisons and network analyses show sequence identities and similarities suggesting a south-north trans-Saharan geographical origin, with introduction from Ghana, through the Sahel countries of Burkina Faso and Mali into Algeria. This way perfectly fits with nomadic pastoralism according to interconnecting intranational and transborder herd transhumance routes traditionally followed in this western part of Africa from very long ago. The risk for further spread throughout the three north-western Maghreb countries is multidisciplinarily analysed, mainly considering the present extensive motorization of the intranational transhumance system in Algeria, the lymnaeid snail vector species present throughout the north-western Maghreb, the increasing demand for animal products in the growing cities of northern Algeria and the continued human infection reports. Control measures should assure making anti-fasciolid drugs available and affordable for herders from the beginning and along their transhumant routes and include diffusion and rules within the regional regulatory framework about the need for herd treatments.

Geometric morphometrics of Aedes aegypti populations and study of transmission of arboviral diseases in Barreiras, Brazil

Abstract Aedes (Stegomyia) aegypti (A. aegypti) transmits arboviral diseases of high public health importance, including those caused by Zika virus (ZIKV), Dengue virus (DENV), Chikungunya virus (CHIKV) and Yellow fever virus (YFV). Barreiras is a city with 157,638 inhabitants in the West of the State of Bahia, Northeast of Brazil. The climate is dry, with well-determined and concentrated seasons of rains. The city is crossed by a Federal Highway and by the Rio Grande river. In this study, we aimed to understand the dynamics of mosquito vectors and arboviral diseases in Barreiras. We used correlation statistics to investigate a possible relationship among rains, mosquito abundance and transmission of diseases. In addition, as a preliminary population genetics estimate, we used geometric morphometrics to compare mosquitoes from areas limited by a highway and a river. We found that i) infestation occurs in rain-dependent cycles and that ii) both, the river and the highway segregate populations of A. aegypti in different areas of the studied city. Our results indicate that it is necessary to treat anthropic containers with mosquito breading capacity during both, the dry and rain seasons in urban areas similar to Barreiras.

Positive association between Brucella spp. seroprevalences in livestock and humans from a cross-sectional study in Garissa and Tana River Counties, Kenya.

BackgroundBrucella spp. is a zoonotic bacterial agent of high public health and socio-economic importance. It infects many species of animals including wildlife, and people may get exposed through direct contact with an infected animal or consumption of raw or undercooked animal products. A linked livestock-human cross-sectional study to determine seroprevalences and risk factors of brucellosis in livestock and humans was designed. Estimates were made for intra-cluster correlation coefficients (ICCs) for these observations at the household and village levels.MethodologyThe study was implemented in Garissa (specifically Ijara and Sangailu areas) and Tana River (Bura and Hola) counties. A household was the unit of analysis and the sample size was derived using the standard procedures. Serum samples were obtained from selected livestock and people from randomly selected households. Humans were sampled in both counties, while livestock could be sampled only in Tana River County. Samples obtained were screened for anti-Brucella IgG antibodies using ELISA kits. Data were analyzed using generalized linear mixed effects logistic regression models with the household (herd) and village being used as random effects.ResultsThe overall Brucella spp. seroprevalences were 3.47% (95% confidence interval [CI]: 2.72–4.36%) and 35.81% (95% CI: 32.87–38.84) in livestock and humans, respectively. In livestock, older animals and those sampled in Hola had significantly higher seroprevalences than younger ones or those sampled in Bura. Herd and village random effects were significant and ICC estimates associated with these variables were 0.40 (95% CI: 0.22–0.60) and 0.24 (95% CI: 0.08–0.52), respectively. In humans, Brucella spp. seroprevalence was significantly higher in older people, males, and people who lived in pastoral areas than younger ones, females or those who lived in irrigated or riverine areas. People from households that had at least one seropositive animal were 3.35 (95% CI: 1.51–7.41) times more likely to be seropositive compared to those that did not. Human exposures significantly clustered at the household level; the ICC estimate obtained was 0.21 (95% CI: 0.06–0.52).ConclusionThe presence of a Brucella spp.-seropositive animal in a household significantly increased the odds of Brucella spp. seropositivity in humans in that household. Exposure to Brucella spp. of both livestock and humans clustered significantly at the household level. This suggests that risk-based surveillance measures, guided by locations of primary cases reported, either in humans or livestock, can be used to detect Brucella spp. infections in livestock or humans, respectively.

A64 Viral sequence classification using deep learning algorithms

Sewage samples have a high potential benefit for surveillance of circulating pathogens because they are easy to obtain and reflect population-wide circulation of pathogens. These type of samples typically contain a great diversity of viruses. Therefore, one of the main challenges of metagenomic sequencing of sewage for surveillance is sequence annotation and interpretation. Especially for high-threat viruses, false positive signals can trigger unnecessary alerts, but true positives should not be missed. Annotation thus requires high sensitivity and specificity. To better interpret annotated reads for high-threat viruses, we attempt to determine how classifiable they are in a background of reads of closely related low-threat viruses. As an example, we attempted to distinguish poliovirus reads, a virus of high public health importance, from other enterovirus reads. A sequence-based deep learning algorithm was used to classify reads as either polio or non-polio enterovirus. Short reads were generated from 500 polio and 2,000 non-polio enterovirus genomes as a training set. By training the algorithm on this dataset we try to determine, on a single read level, which short reads can reliably be labeled as poliovirus and which cannot. After training the deep learning algorithm on the generated reads we were able to calculate the probability with which a read can be assigned to a poliovirus genome or a non-poliovirus genome. We show that the algorithm succeeds in classifying the reads with high accuracy. The probability of assigning the read to the correct class was related to the location in the genome to which the read mapped, which conformed with our expectations since some regions of the genome are more conserved than others. Classifying short reads of high-threat viral pathogens seems to be a promising application of sequence-based deep learning algorithms. Also, recent developments in software and hardware have facilitated the development and training of deep learning algorithms. Further plans of this work are to characterize the hard-to-classify regions of the poliovirus genome, build larger training databases, and expand on the current approach to other viruses.

Outcomes after paediatric anaesthesia: which ones should have the priority?

To review the developments within paediatric anaesthesia and describe the various factors that have contributed to the improvements in anaesthesia-related outcomes in children. During the years substantial improvements in paediatric anaesthesia-related outcomes has derived from safety advances in equipment, drugs, human factor analysis, professional standardization and organization, subspecialty care and regionalization. However, universally agreed outcome measures are lacking. Despite a steadily and significant improvement in paediatric anaesthesia-related outcomes over the years further and future improvements are still necessary in areas such as adverse-event reporting and long-term neurocognitive outcomes with much more focus on patient/family-centred outcomes. Clinical experts and stakeholders should meet and agree on a consensus to identify indicators that could act as outcome measures in future large-scale prospective observational studies and clinical trials. Such an approach will foster benchmarking and continuous quality assessment and improvement at individual, institutional, interinstitutional, regional, national and international levels and facilitate larger scale clinical research. Furthermore, it will attain a high public health importance and will facilitate comparisons between healthcare provision models leading to optimization of perioperative care delivery.

New Bacteriophages against Emerging Lineages ST23 and ST258 of Klebsiella pneumoniae and Efficacy Assessment in Galleria mellonella Larvae.

Klebsiella pneumoniae is a bacterial pathogen of high public health importance. Its polysaccharide capsule is highly variable but only a few capsular types are associated with emerging pathogenic sublineages. The aim of this work is to isolate and characterize new lytic bacteriophages and assess their potential to control infections by the ST23 and ST258 K. pneumoniae sublineages using a Galleria mellonella larvae model. Three selected bacteriophages, targeting lineages ST258 (bacteriophages vB_KpnP_KL106-ULIP47 and vB_KpnP_KL106-ULIP54) and ST23 (bacteriophage vB_KpnP_K1-ULIP33), display specificity for capsular types KL106 and K1, respectively. These podoviruses belong to the Autographivirinae subfamily and their genomes are devoid of lysogeny or toxin-associated genes. In a G. mellonella larvae model, a mortality rate of 70% was observed upon infection by K. pneumoniae ST258 and ST23. This number was reduced to 20% upon treatment with bacteriophages at a multiplicity of infection of 10. This work increases the number of characterized bacteriophages infecting K. pneumoniae and provides information regarding genome sequence and efficacy during preclinical phage therapy against two prominent sublineages of this bacterial species.