Center For Infectious Diseases Research Articles

Hepatitis C virus infection in HIV-infected men in Singapore, 2006-2018: incidence and associated factors.

A retrospective cohort study was conducted using a clinical database maintained by the Clinical HIV Program at the National Centre for Infectious Diseases, Singapore. Factors associated with incident HCV infections were identified using Cox proportional hazards regression analyses. Among 1348 HIV-infected male patients who were HCV seronegative at baseline, 64 (4.7%) subsequently tested positive for HCV, giving an incidence of 0.88 per 100 person-years of follow-up (PYFU) (95% confidence interval (CI) 0.69-1.13). The incidence rate of HCV seroconversion increased from 0.33 (95% CI 0.12-0.71) per 100 PYFU in 2010-2012 to 1.93 (95% CI 1.36-2.67) in 2016-2018. Independent factors associated with incident HCV infection were younger age groups at HIV diagnosis versus ≥45 years, HIV acquisition via MSM or via both sexual contact and intravenous drug use versus heterosexual transmission, HIV diagnosis in later periods versus 2006-2009, and recent syphilis acquisition. An increasing trend of incident HCV infection was seen in HIV-infected men, particularly for MSM. Preventive and behavioural interventions should be targeted at HIV-infected individuals engaged in high-risk sexual behaviour.

Clinical and epidemiological features of lyme borreliosis

Lyme borreliosis (LB) is the most common transmissible disease of tick-borne origin. This disease is a significant medical challenge due to the damage to many organs and systems and the tendency to chronicity and long-term disability in the future. Currently, there is an upward trend in the incidence of Lyme disease in Sumy Oblast. Thus, in Ukraine in 2015 the incidence was 7.96 per 100,000 population, and in 2019 it increased to 10.62. The average level of indicators was exceeded in Kyiv Oblast (29.0), Cherkasy Oblast (25.4), Vinnytsia Oblast (23.09), Sumy (25.89) Oblast, and Kyiv (2.54). The peak of tick activity in Ukraine is registered in May and has increased by 4.23 times. The maximum number of patients falls within the working population and causes significant state financial damage. The increase in the number of cases indicates a spread of Lyme disease in Sumy Oblast. In order to prevent the spread, it is necessary to study all possible causes of this disease and find ways to eliminate them. This was the ground for the creation of a unified anonymous questionnaire, which covers the main issues regarding this disease from the standpoint of different population groups. A unified anonymous "Questionnaire for Lyme disease patients" contains 16 multiple choice questions and an option for comments. The first group of questions concerned gender, age, and social data of respondents (the largest part of patients fell within the working population – 42.86%). The next group of questions clarified the epidemiological features of this pathology (circumstances, date, time, location, body part bitten). Most often tick bites occurred during walks in the urban forests (42.86% of cases). Most respondents reported that tick bites had happened in June and July (39.29%). Other questions were designed to determine patients' awareness about Lyme borreliosis prevention. The next group of questions was aimed at clarifying the clinical features of the disease (lower extremities were the most frequent site of a tick bite) (46.43%), with erythema dominating among the clinical manifestations of Lyme borreliosis (91.07%). According to the anonymous questionnaire, we analyzed and evaluated awareness of diagnosis, clinical signs, and measures of Lyme disease prevention in the patients who were receiving treatment at Municipal Non-Commercial Enterprise of Sumy Regional Council "Medical Clinical Center of Infectious Diseases and Dermatology Named After Z. Krasovytskyi" and SSU University Clinic.

Показатели количественной электроэнцефалографии у детей с острым гнойным менингитом

Our aim was the assessment of the bioelectrical activity of the brain in children with bacterial meningitis in its acute period. 31 children were enrolled: 16 children with acute bacterial meningitis (8.9 ± 2.4 years) in 1–6 days from the onset of the disease, hospitalized to The Pediatric Research and Clinical Center for Infectious Diseases with a laboratory-confirmed diagnosis of bacterial meningitis (Neisseria meningitidis (n = 11), Streptococcus pneumoniae (n = 2), unspecified etiology (n = 3)) and 15 healthy controls. The electroencephalogram (EEG) was recorded in all children using a 16-channel electroencephalograph “Neuron-Spectrum 4/VP”. The clinical evaluation of the EEG included an analysis of the background rhythm, zonal differences, and the identification of pathological types of activity. The quantitative assessment consisted of the parameters of the average power (μV2) and amplitude (μV) of the alpha, theta and delta rhythms, as well as the ratio of the average spectral power – alpha/theta, alpha/delta. The visual analysis of EEG revealed a diffuse slowing with the registration of delta and theta waves in 100% of children in the acute period of bacterial meningitis. Focal changes were recorded in 18,8% of cases (3 patients). Periodic activity wasn’t recordedin any case. There was a significant decrease in the ratio of alpha/delta (p = 0.001) and alpha/theta (p = 0.048) spectra. Using ROC analysis, it was determined that an alpha/theta value less than 0.18 and an alpha/delta value less than 0.02 (a sensitivity 100%, a specificity 80%, AUROC 0.9) may indicate the likely development of cerebral edema. Thus, in pediatric patients with acutebacterial meningitis, a significant disorder of the normal ratio of the power of alpha/theta and alpha/delta rhythms on the EEG is recorded, which is presumably associated with inhibition of the functional activity of the thalamus and thalamo-cortical pathways, as well as the reticular formation of the brain.

Treatment outcomes and characteristics of HIV-2 patients compared to HIV-1 patients on an NNRTI-based first line art at the adult infectious diseases centre of the University Teaching Hospital (UTH) in Lusaka.

Introduction:the focus of antiretroviral therapy (ART) in Zambia has been on HIV-1. However, some patients are infected with HIV-2 or both. HIV-2 is resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs), drugs used for HIV-1. Therefore, this study sought to determine the seroprevalence of HIV-2 or dual infection in HIV infected individuals and compare the treatment outcomes associated with HIV subtype in patients taking NNRTI-based first line cART at the University Teaching Hospitals (UTH).Methods:this was a cross- sectional study, we collected data from the Virological Impact of Switching from Efavirenz and Nevirapine based first-line cART regimens to Dolutegravir (VISEND) study being conducted at UTH. Ninety six individuals were included in the study. Descriptive and inferential statistics were performed. Logistic regression was used to assess the relationship between treatment outcomes and HIV type.Results:the proportion of HIV 1 and 2 co-infected patients was 5.2% (95% CI 2%-12%). The mean age was 46 years ± 2 years with 60 (62.5%) being females. The median viral load was 1.3 log 10 copies/ml, IQR 0-1.7 log 10 copies/ml and the median absolute CD4+ T cell count increased from 231 to 463 cells/mm3 (p < 0.001) after being on cART for one year or more. The study did not report any associations between treatment outcomes and HIV type (p > 0.05).Conclusion:there is a small proportion of patients that are HIV 1 and 2 co-infected but are on an NNRTI-based cART regimen, drugs that are not active against HIV-2. This, however, does not seem to significantly affect the patient´s virological or immunological treatment outcome.

Long-Term, Infection-Acquired Immunity Against the SARS-CoV-2 Delta Variant in a Hamster Model

The emergence of the SARS-CoV-2 Delta variant (B.1.617.2) has raised concerns about reduced sensitivity of the virus to antibody neutralization and subsequent vaccine breakthrough infections. In a live virus neutralization assay with sera from Pfizer- and Moderna-vaccinated individuals, we observed a 3.9-and 2.7-fold reduction, respectively, in neutralizing antibody titers against the Delta variant compared with a control virus bearing only a D614G substitution in its spike. Similar reduced sensitivity was observed with sera from hamsters that were previously infected with an early isolate of SARS-CoV-2 (spike 614D). Despite this reduction in neutralizing antibody titers against the Delta variant, hamsters that were previously infected (up to 15 months earlier) with an early virus isolate (spike 614D) were protected from infection with the Delta variant, suggesting that the immune response to the first infection was sufficient to provide protection against subsequent infection with the Delta virus. Funding: National Institutes of Allergy and Infectious Diseases Center for Research on Influenza Pathogenesis (HHSN272201400008C) and the Collaborative Influenza Vaccine Innovation Center (75N93019C00051) and by a Research Program on Emerging and Re-emerging Infectious Diseases (JP19fk0108113 and JP20fk0108412), the Japan Initiative for Global Research Network on Infectious Diseases (J-GRID) (JP19fm0108006), the Japan Program for Infectious Diseases Research and Infrastructure (JP21wm0125002) from the Japan Agency for Medical Research and Development (AMED). Declaration of Interests: None to declare. Ethics Approval Statement: After informed consent was obtained, blood samples were collected from individuals who received the mRNA vaccine BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) as part of the Immunity Associated with SARS-CoV-2 (IASO) study under the IRB-approved protocol of the University of Michigan Medical School (protocol number HUM00184533). All experiments with hamsters were performed after approval from the Animal Care and Use Committee at the University of Wisconsin-Madison in accordance with the approved protocol (protocol number V6426).

Africa's COVID-19 Situation in Focus and Recent Happenings: A Mini Review.

Given that COVID-19 (SARS-CoV-2) has crept into Africa, a major public health crisis or threat continues to linger on the continent. Many local governments and various stakeholders have stepped up efforts for early detection and management of COVID-19. This mini review highlights the current trend in Africa, history and general epidemiological information on the virus. Current ongoing efforts (e.g., improving testing capacity) and some effective ways (e.g., intensified surveillance, quick detection, contact tracing, isolation measures [e.g., quarantine], and social distancing) of preventing and managing COVID-19 in Africa are described. The review concludes by emphasizing the need for public health infrastructure development (e.g., laboratories, infectious disease centers, regional hospitals) and human capacity building for combating COVID-19 and potential future outbreaks. Additionally, regular public health educational campaigns are urgently required. Future epidemiological studies to ascertain case fatality and mortality trends across the continent for policy directions are necessary.

Congenital Toxoplasmosis: Missed Opportunities for Diagnosis and Prevention.

Identify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016. Descriptive study including infants with CT, diagnosis established based on Brazil's Ministry of Health's criteria. All data regarding the infants and their mother's prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)-a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded. The obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth. Despite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.

Respiratory virus profile among paediatric patients with acute respiratory infections in Sg Buloh hospital Malaysia - An infectious disease centre

Respiratory virus profile among paediatric patients with acute respiratory infections in Sg Buloh hospital Malaysia - An infectious disease centre

Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19.

Background and Purpose: Cryptococcal meningitis (CM) is a serious fungal infection that especially affects patients with human immunodeficiency virus (HIV). In this regard, the present retrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted to two teaching referral centers in the north of Iran during 2011-19. Materials and Methods: This study was performed on all the hospitalized patients diagnosed with CM in two therapeutic centers of infectious diseases in the north of Iran. The required data, such as demographic characteristics and clinical and paraclinical features of patients, were extracted and entered in the information forms. Finally, the collected data were analyzed in SPSS software (version 16). Results: For the purpose of the study, records of 12 confirmed CM patients were evaluated in this research. Based on the results, 75% of the patients were male. Moreover, the average age of the subjects was 40.33± 8.93 years old and 66.6% of them (n=8) were HIV-positive. Other underlying diseases among HIV-positive patients included infection with hepatitis C virus (25%) and a history of tuberculosis (25%). In total, three HIV-negative patients suffered from Hodgkin lymphoma (25%), sarcoidosis (25%), and asthma (25%) and one patient (25%) had no underlying disease. Headache (75%), weakness, and fatigue (75%) were the most common symptoms among the participants. The cluster of differentiation 4 (CD4) count in all HIV-positive patients was less than 100 cells/μl. There was no significant difference between symptoms in HIV-positive and HIV-negative patients. Besides, no significant difference was observed between the groups of HIV-positive and HIV-negative patients regarding the period between the onset of symptoms and diagnosis of CM, the length of hospital stay, and the duration of antifungal medication consumption. In total, three patients (25%) expired, and six patients recovered. The CM recurred in two HIV-negative and one HIV-positive subjects; the two HIV-negative patients were treated, while the HIV-positive patient expired due to this recurrence. Conclusion: Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact that CM is not common in Iran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered for patients with signs and symptoms of infection in the central nervous system.

Adapting trauma workflows for severely injured trauma patients during the COVID-19 pandemic: experience in a regional trauma centre in Singapore.

Adapting trauma workflows for severely injured trauma patients during the COVID-19 pandemic: experience in a regional trauma centre in Singapore.

Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon.

The epidemic transmission of Zika virus (ZIKV) in Brazil has been identified as a cause of microcephaly and other neurological malformations in the babies of ZIKV-infected women. The frequency of adverse outcomes of Zika virus infection (ZIKVi) in pregnancy differs depending on the characteristics of exposure to infection, the time of recruitment of research participants, and the outcomes to be observed. This study provides a descriptive analysis—from the onset of symptoms to delivery—of a cohort registered as having maternal ZIKVi in pregnancy, from November 2015 to December 2016. Suspected cases were registered at a referral center for infectious and tropical diseases in Manaus, in the Amazonian region of Brazil. Of 834 women notified, 762 women with confirmed pregnancies were enrolled. Reverse-transcriptase polymerase chain reaction (RT-PCR) confirmed ZIKVi in 42.3% of the cohort. In 35.2% of the cohort, ZIKV was the sole infection identified. Severe adverse pregnancy outcomes (miscarriage, stillbirth, or microcephaly) were observed in both RT-PCR ZIKV-positive (5.0%) and ZIKV-negative (1.8%) cases (RR 3.1; 95% IC 1.4–7.3; p < 0.05), especially during the first trimester of pregnancy (RR 6.2, 95% IC 2.3–16.5; p < 0.001). Although other infectious rash diseases were observed in the pregnant women in the study, having confirmed maternal ZIKVi was the most important risk factor for serious adverse pregnancy events.

The Effectiveness of COVID-19 Infection Control Measures Evaluated by SARS-CoV-2 Antibody Screening of Staff Members at a Hospital Designated as a Treatment Center for Infectious Diseases ―Efforts to Eliminate Nosocomial Infections and Verification of Their Effectiveness―

新型コロナウイルス（severe acute respiratory syndrome coronavirus 2, SARS-CoV-2）は世界各国同様，日本においても社会的・医療的に大きな問題となり，様々な地域，介護施設，そして病院においてもクラスター発生が報告されている．医療従事者の新型コロナウイルス感染は患者への曝露による感染拡大はもちろん，医療機関として機能が停止することによる周囲の医療機関への負担の増加，ひいては地域医療の崩壊にもつながる．特に感染症指定医療機関においては新型コロナウイルス患者と接触する機会が市中や一般医療機関と比較し極めて多く，院内感染を防ぐために本感染症に対する感染予防策の有効性を評価することは大変重要である．感染症指定医療機関である福岡市民病院の職員のうち，同意を得られた375 名を対象とし，3種類の抗体検査試薬を用いてSARS-CoV-2 抗体を測定した．対象者をCoronavirus disease 2019（COVID-19）患者との接触頻度と業務内容によって規定したリスクで区分し，それぞれの抗体保有率を比較することで院内において患者医療従事者間での感染の有無を調査し，当院の感染予防策を評価した．結果，陽性が否定できなかった職員はCOVID-19 患者と接触機会のなかった1 例のみであり，患者医療従事者間の感染拡大はなく，当院の感染予防策は濃厚な医療行為においてもSARS-CoV-2 感染を予防できる可能性が示唆された．また今回実施された一部の医療資材の再利用に関しても，感染拡大に対する悪影響は明らかにならなかった．今後長期的な感染予防に向け，医療資源の利用可能状況や正確なSARS-CoV-2 の感染様式に応じて，適宜感染予防策を改善していく必要がある．

The epidemiology, clinical presentation, and predictors of severe Tick-borne encephalitis in Lithuania, a highly endemic country: A retrospective study of 1040 patients.

IntroductionIn recent decades, the incidence of Tick-borne encephalitis (TBE) has been increasing and posing a growing health problem because of the high costs to the healthcare system and society. The clinical manifestations are well studied but there is a lack of research analyzing the severity of the disease.ObjectiveThe aim of this study was to analyze the epidemiology and clinical presentation of severe TBE, to identify the predictors for a severe disease course, and also predictors for meningoencephalomyelitic and severe meningoencephalitic/encephalitic forms.MethodsA retrospective study was conducted in the Center of Infectious Diseases and the Center of Neurology at Vilnius University Hospital Santaros Klinikos in the years 2005–2017 to describe the clinical and epidemiological features of TBE in adults.Results1040 patients were included in the study. A total of 152/1040 (14.6%) patients had a severe course. The highest proportion of severe cases, reaching 41.2%, was reported in the 70–79 year-old age group. A total of 36/152 (23.7%) severe patients presented meningoencephalomyelitis. Myelitic patients were older, were frequently infected in their living areas, and usually reported a monophasic disease course compared with severe meningoencephalitic/encephalitic patients. Severe meningoencephalitic/encephalitic patients, compared with non-severe meningoencephalitic/encephalitic, were older, less often noticed the tick bite, and often had a monophasic course. The sequelae on discharge were observed in 810/1000 (81%) of patients.ConclusionsThe prognostic factors associated with a severe disease course and severe meningoencephalitic form are: older age, comorbidities, a monophasic course, a fever of 40˚C and above, CRP more than 30 mg/l, CSF protein more than 1 g/l, delayed immune response of TBEV IgG, pathological findings in CT. Age above 60 years, presence of CNS disease, bulbar syndrome, pleocytosis 500x106/l and above, and delayed immune response of TBEV IgG are predictors of the most severe myelitic form.

Olfactory taste disorder as a presenting symptom of COVID-19: a large single-center Singapore study.

PurposeTo investigate the prevalence and epidemiological risk factors of olfactory and/or taste disorder (OTD), in particular isolated OTD, in patients with laboratory-confirmed COVID-19 infection.MethodsWe conducted a retrospective and cross-sectional study. Patients with laboratory-confirmed COVID-19 infection were recruited from the National Centre for Infectious Diseases (NCID) Singapore between 24 March 2020 and 16 April 2020. The electronic health records of these patients were accessed, and demographic data and symptoms reported (respiratory, self-reported OTD and other symptoms such as headache, myalgia and lethargy) were collected.ResultsA total of 1065 patients with laboratory-confirmed COVID-19 were recruited. Overall, the prevalence of OTD was 12.6%. Twelve patients (1.1%) had isolated OTD. The top three symptoms associated with OTD were cough, fever and sore throat. The symptoms of runny nose and blocked nose were experienced by only 29.8 and 19.3% of patients, respectively. Multivariate analysis demonstrated that the female gender, presence of blocked nose and absence of fever were significantly associated with OTD (adjusted relative risks 1.77, 3.31, 0.42, respectively). All these factors were statistically significant.ConclusionPatients with COVID-19 infection can present with OTD, either in isolation or in combination with other general symptoms. Certain demographic profile, such as being female, and symptomatology such as the presence of blocked nose and absence of fever, were more likely to have OTD when infected by COVID-19. Further studies to elucidate the pathophysiology of OTD in these patients will be beneficial.

Mumps outbreaks across Canada, 2016 to 2018.

An increase in mumps incidence was observed in late 2016 (365 cases in 2016 compared to 59 cases in 2015). This unusual level of mumps activity prompted the Public Health Network Council and the National Advisory Committee on Immunization to request situation awareness updates from the Centre for Immunization and Respiratory Infectious Diseases (CIRID) at the Public Health Agency of Canada in 2017 and 2018. A mumps outbreak survey was developed and administered by epidemiologists within CIRID and sent electronically to provincial and territorial public health officials in charge of mumps surveillance. The survey collected information on mumps outbreaks pertaining to demographics, risk factors, laboratory data and public health interventions. The first survey collected data on outbreaks occurring between January 1, 2016 and February 28, 2017, while the second survey contained outbreak data from January 1, 2017 to July 31, 2018. Duplicate outbreaks entries were removed. The response rate for the first and second surveys was 61% and 69%, respectively. Twenty-four mumps outbreaks across nine provinces were reported between January 1, 2016 and July 31, 2018, for a cumulative total of 881 mumps cases. Adolescents and adults 15 to 39 years of age accounted for the majority of cases (80.6%). Specifically, adults 20 to 24 years of age represented the largest proportion of cases (24.6%). Community and social gatherings were the most common exposure setting (62.5%). Slightly more than one third of cases were known to have received at least two doses of mumps-containing vaccine (35.6%). Results from the surveys indicate that the increase in mumps activity was widespread throughout Canada, affecting multiple jurisdictions. Young adults accounted for the largest proportion of cases. These surveys provided evidence to support recommendations on the use of additional mumps vaccination in outbreak settings.

Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study

ObjectivesTo identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the...

Exposing the changes in work stress level among Mongolian nurses by salivary Alpha amylase test

When stress is part of the work environment, it is difficult to control stress, which can cause recurrent aggression, and which in turn affects an individual's health and ability to act. The relationship between workplace stressors, physical and mental health changes of the nurses have been found. A combination of high workplace demands, over-responsibility, and over-authority have been identified major sources of occupational stress among nursing staff.&#x0D; A total of 473 nurses from four tertiary referral hospitals of Mongolia were involved in the study. We employed a Work Stress Profile (WSP) questionnaire of Rice to figure out how nurses perceive and accept stress. The Likert scale was used in measuring the questions. Concerning physical stress factor we measured the level of α-amylase in the saliva of the nurses using the SALIVA AMYLASE MONITOR 2004, a Japanese device. Fabricated salivary amylase activity monitor consisted of three devices, the salivary transcription device, a testing-strip and an optical analyzer. Firstly, the test-strip was taken and put under the tongue for 30 seconds in the morning.&#x0D; Occasionally, our study was conducted during the COVID-19 pandemic quarantine period, and we could clearly see that the nurses at National Center for Infectious Diseases are working hard under the urged stressed condition.

Long-term comparative analysis of the main epidemiological indicators for tuberculosis in combination with HIV infection in the Udmurt Republic

The objective of the study: to assess changes of epidemiological indicators for TB/HIV co-infection in the Udmurt Republic (UR) and the Russian Federation (RF) from 2008 to 2017 and make the prognosis for the next 5 years.Subjects and methods. The main epidemiological indicators for TB/HIV infection were retrospectively analyzed, the data were taken from annual reports of Republican TB Dispensary, Regional Center for AIDS and Infectious Diseases and Federal Research Institute for Health Organization and Informatics by the Russian Ministry of Health.Results. From 2008 to 2017, the incidence of respiratory tuberculosis both in the Russian Federation and in the Udmurt Republic decreased by 43.0%. While the incidence of HIV infection among the population of the Udmurt Republic increased by 148.5%, in the Russian Federation by 79.7%. From 2011 to 2017, the TB/HIV incidence increased in the UR by 76.6%, in the RF by 48.2%. The mortality of tuberculosis patients died of HIV infection increased by 147.6% in the RF, and by 400% in the UR. Trends in forecasts for investigated indicators of TB/HIV co-infection in the Udmurt Republic and the Russian Federation demonstrate their further growth.

Exploring the health education model for chronic hepatitis C micro-elimination in Guizhou Province from a global perspectives

The micro-elimination strategy is an effective approach to rapidly reduce the incidence and mortality of specific populations infected with hepatitis C virus (HCV). This article combines the current status of hepatitis C prevention and treatment in Guizhou Province, and introduces the current domestic and foreign hepatitis C micro-elimination models. It is worth mentioning that the Guizhou Provincial Medical Quality Control Center for Infectious Diseases jointly formulated the "Guizhou Province Chronic Hepatitis C Health Education Standards" to improve the awareness of health care workers and patients about the disease, increase the screening rate, and increase the patients willingness to receive treatment and accomplish the World Health Organization's goal of eliminating hepatitis C threat by 2030.

Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

BackgroundThe morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial, and the etiology, clinical characteristics, treatment outcomes and predictors of poor prognosis must be assessed regularly. The aim of this study was to identify the distribution of etiological agents and their relationship with clinical characteristics, treatment and outcomes in this cohort of patients with CABM.MethodsOur retrospective chart review analyzed the causative microorganisms, clinical characteristics, laboratory findings, treatment and outcomes of 159 adults with CABM hospitalized in the Infectious Diseases Centre of Vilnius University Hospital from January 1, 2009 to December 31, 2016. A Glasgow Outcome Scale (GOS) score ≤ 3 was defined as unfavorable outcome. Predictors of an unfavorable outcome were identified through logistic regression analysis.ResultsThe median patient age was 36 (IQR 24–56), and 51.6% were male. Microbiologically confirmed causative agents were identified in 80 (50.3%) patients: N. meningitidis in 55 (34.6%) patients with serotype B accounting for 85% of cases, S. pneumoniae in 15 (9.4%), L. monocytogenes in 5 (3.1%) and other in 5 (3.1%). The clinical triad of fever, neck stiffness and a change in mental status was present in 59.1% of patients. Coexisting conditions and comorbidities were similar in all groups stratified by etiology. Initial antimicrobial treatment consisted of penicillin in 78 patients (49.1%) and ceftriaxone in 72 patients (45.3%). The median time in which antibiotic treatment was started was 40 min (IQR 30.0–90.0). The outcome was unfavorable in 15.7% of episodes and death occurred in 5.7% of cases and did not differ according to the causative agent. Risk factors for an unfavorable outcome were age > 65 years, coexisting pneumonia and a platelet count <150x10e9/l.ConclusionsThe most common causative agent of CABM was N. meningitidis, with serotype B clearly dominant. Causative agents did not influence the disease outcome. The strongest risk factors for an unfavorable outcome were older age, pneumonia and a low platelet count. Since the introduction of routine vaccination against meningococcus B for infants in Lithuania in 2018, the national vaccination policy may hopefully contribute to a decrease in the incidence of serogroup B meningococcal disease in the Lithuanian population.