Laboratory-confirmed Cases Research Articles

SARS-CoV-2 rapid antigen testing positive rate in community testing stations as an indicator for COVID-19 epidemic trend, Taipei, Taiwan, May to August 2021

BackgroundReal-time surveillance of COVID-19 in large-scale community outbreaks presents challenges. Simple counts of the daily confirmed cases can be misleading due to constraints from bottlenecks in access to care or laboratory testing. This study aimed to investigate the role of the SARS-CoV-2 antigen rapid diagnostic test (Ag-RDT) in addressing these challenges for real-time COVID-19 surveillance. MethodsThis study included the results of 86,933 SARS-CoV-2 Ag-RDT and real-time reverse transcription polymerase chain reaction (RT-PCR) tests. These were conducted at four community testing stations within the Taipei metropolitan area during a community COVID-19 outbreak spanning from May 17, 2021, to August 9, 2021. We examined the correlation between the positive rates of Ag-RDT tests and the epidemic curve of laboratory-confirmed COVID-19 cases by onset date to examine its role in real-time surveillance. ResultsDuring the 85-day study period, the trend of Ag-RDT test positive rates paralleled that of the epidemic curve. The correlation between the Ag-RDT positive rate and the number of cases (Pearson correlation coefficient: 0.968) is comparable to that of the RT-PCR positive rate (Pearson correlation coefficient: 0.964). The Ag-RDT positive rate exhibited a more advanced leading trend, with Ag-RDT leading by 3 days in comparison to the 2-day lead for RT-PCR. ConclusionThe positive rate of SARS-CoV-2 Ag-RDT tests at community testing stations serves as a good surrogate for assessing virus activity within the community and a useful tool for real-time COVID-19 surveillance. It is a robust indicator of the outbreak trend and near-term numbers of cases. This finding may facilitate the management of subsequent outbreaks of emerging infectious diseases.

Nasal spray of an IgM-like ACE2 fusion protein HH-120 prevents SARS-CoV-2 infection: Two investigator-initiated postexposure prophylaxis trials.

HH-120, an IgM-like angiotensin converting enzyme 2 (ACE2) fusion protein, has been developed as a nasal spray against Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) and is currently undergoing human trials.HH-120 nasal spray was assessed for postexposure prophylaxis (PEP) in two investigator-initiated (NS01 and NS02) trials with different risk levels of SARS-CoV-2 exposure. NS01 enrolled family caregiver participants who had continuous contacts with laboratory-confirmed index cases; NS02 enrolled participants who had general contacts (Part 1) or close contacts (Part 2) with index cases. The primary endpoints were safety and laboratory-confirmed and/or symptomatic SARS-CoV-2 infection.In NS01 trial (14 participants), the SARS-CoV-2 infection rates were 25% in the HH-120 group and 83.3% in the external control group (relative risk reduction [RRR]:70.0%). In NS02-Part 1 (193 participants), the infection rates were 4% (HH-120) versus 11.3% (placebo), symptomatic infection rates were 0.8% versus 3.5%, hence with a RRR of 64.6% and 77.1%, respectively. In Part 2 (76 participants), the infection rates were 17.1% (HH-120) versus 30.4% (placebo), symptomatic infection rates were 7.5% versus 27.3%, with a RRR of 43.8% and 72.5%, respectively. No HH-120-related serious adverse effects were observed.The HH-120 nasal spray used as PEP was safe and effective in preventing laboratory-confirmed and symptomatic SARS-CoV-2 infection.

Time series analysis and forecasting of the number of canine rabies confirmed cases in Thailand based on national-level surveillance data

IntroductionRabies, a deadly zoonotic viral disease, accounts for over 50,000 fatalities globally each year. This disease predominantly plagues developing nations, with Thailand being no exception. In the current global landscape, concerted efforts are being mobilized to curb human mortalities attributed to animal-transmitted rabies. For strategic allocation and optimization of resources, sophisticated and accurate forecasting of rabies incidents is imperative. This research aims to determine temporal patterns, and seasonal fluctuations, and project the incidence of canine rabies throughout Thailand, using various time series techniques.MethodsMonthly total laboratory-confirmed rabies cases data from January 2013 to December 2022 (full dataset) were split into the training dataset (January 2013 to December 2021) and the test dataset (January to December 2022). Time series models including Seasonal Autoregressive Integrated Moving Average (SARIMA), Neural Network Autoregression (NNAR), Error Trend Seasonality (ETS), the Trigonometric Exponential Smoothing State-Space Model with Box-Cox transformation, ARMA errors, Trend and Seasonal components (TBATS), and Seasonal and Trend Decomposition using Loess (STL) were used to analyze the training dataset and the full dataset. The forecast values obtained from the time series models applied to the training dataset were compared with the actual values from the test dataset to determine their predictive performance. Furthermore, the forecast projections from January 2023 to December 2025 were generated from models applied to the full dataset.ResultsThe findings revealed a total of 4,678 confirmed canine rabies cases during the study duration, with apparent seasonality in the data. Among the models tested with the test dataset, TBATS exhibited superior predictive accuracy, closely trailed by the SARIMA model. Based on the full dataset, TBATS projections suggest an annual average of approximately 285 canine rabies cases for the years 2023 to 2025, translating to a monthly average of 23 cases (range: 18–30). In contrast, SARIMA projections averaged 277 cases annually (range: 208–214).DiscussionThis research offers a new perspective on disease forecasting through advanced time series methodologies. The results should be taken into consideration when planning and conducting rabies surveillance, prevention, and control activities.

1742. Predictors of Antiviral Receipt for Influenza in Hospitalized U.S. Children, New Vaccine Surveillance Network (NVSN), 2016–2020

Abstract Background Children hospitalized with suspected or confirmed influenza should promptly receive influenza antivirals, as recommended by the Infectious Diseases Society of America, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention (CDC). However, despite these recommendations, antiviral receipt remains suboptimal. We assessed predictors of antiviral receipt for influenza in hospitalized children. Methods We conducted active, population-based surveillance of children presenting with fever or respiratory symptoms from December 1, 2016, to March 31, 2020, at seven children’s hospitals in the CDC NVSN. The cohort consisted of children hospitalized with influenza confirmed by research molecular testing. We assessed predictors of antiviral receipt, selected a priori, using logistic regression, and included all in the final model. Results We enrolled and tested 16,853 hospitalized children for influenza, identifying 1,120 laboratory-confirmed cases (6.6%). Of these laboratory-confirmed cases, clinicians ordered influenza testing for 693/1,120 (61.9%), and among those tested, 599/693 (86.4%) tested positive by clinical assays. Overall, 545/1,120 children (48.7%) received influenza antivirals. Of those with a positive clinical test, 405/599 (67.6%) received antivirals. Factors associated with higher odds of antiviral receipt included an underlying oncologic or immunocompromising disorder, symptom onset ≤ 2 days, intensive care unit (ICU) admission at presentation, use of influenza antivirals for this illness prior to hospitalization, and a positive clinical test (Table). Additionally, we found that a negative clinical test was associated with lower odds of antiviral receipt, and receipt varied significantly by study site. Table Logistic regression model of influenza-specific antiviral receipt among hospitalized children testing positive for influenza by research testing, December 1, 2016, and March 31, 2020 (N=1,120). Conclusion More than half of children hospitalized with influenza in our surveillance population did not receive antivirals, despite treatment recommendations. Efforts to improve antiviral receipt are important for optimizing care in all children hospitalized with influenza, and clinician education should continue to highlight the use of antivirals across the full spectrum of children hospitalized with influenza, including children not admitted to the ICU and those without underlying conditions. Disclosures Marian G. Michaels, MD, MPH, Merck: Grant/Research Support|Viracor: Grant/Research Support John V. Williams, MD, Merck: Grant/Research Support|Quidel: Board Member Janet A. Englund, MD, Ark Biopharma: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Geoffrey A. Weinberg, MD, Merck & Co: Honoraria Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Honoraria|Altona Diagnostics: Grant/Research Support|Baebies Inc: Advisor/Consultant|BioMerieux: Advisor/Consultant|BioMerieux: Grant/Research Support|Bio-Rad: Grant/Research Support|Cepheid: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Lab Simply: Advisor/Consultant|Luminex: Grant/Research Support Flor M. Munoz, MD, MSc, CDC respiratory virus surveillance: Grant/Research Support|Gilead: Grant/Research Support|Moderna, sanofi, aztra zeneca, Merck, GSK: Advisor/Consultant|NIH: DSMB|NIH COVID-19 vaccines in pregnancy: Grant/Research Support|Pfizer Pediatric COVID-19 vaccines: Grant/Research Support|Pfizer, Dynavax, Monderna, Meissa, NIH: DSMB Mary A. Staat, MD, MPH, CDC: Grant/Research Support|Cepheid: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support|Quidell: Grant/Research Support|Quidell: donation of kits|Sanofi: Grant/Research Support|Sanofi: vaccine support

Temporal, spatial and space-time distribution of infections caused by five major enteric pathogens, Ontario, Canada, 2010-2017.

In Canada, enteric diseases pose substantial health and economic burdens. The distribution of these diseases is uneven across both geography and time and understanding these patterns is therefore important for the prevention of future outbreaks. We evaluated temporal, spatial and space-time clustering of laboratory-confirmed cases of Campylobacter spp. (n = 28,728), non-typhoidal Salmonella spp. (n = 22,640), Shiga toxin-producing Escherichia coli (STEC; n = 1340), Yersinia spp. (n = 1674) and Listeria monocytogenes (n = 471) infections, reported between 2010 and 2017 inclusive in Ontario, the most populous province in Canada (population ~ 13,500,000 in 2016). For each enteric pathogen, we calculated the mean incidence rates (IRs) for Ontario's 35 public health unit (PHU) areas and visualized them using choropleth maps. We identified temporal, spatial and space-time high infection rate clusters using retrospective Poisson scan statistics. Campylobacter and Salmonella infections had the highest IRs, while Listeria infections had the lowest. Campylobacter, Salmonella, STEC and Listeria mostly clustered temporally in the spring/summer and sometimes extended into fall, while Yersinia showed a less clear seasonal pattern. The IR visualizations and spatial and space-time scan statistics showed geographic heterogeneity of infection rates with high infection rate clusters detected mainly in PHUs across the southwestern and central-western regions of Ontario for Campylobacter, Salmonella and STEC infections, and mainly in PHUs located in the central-eastern regions for Yersinia and Listeria. A high proportion of cases in some of the significant Salmonella, STEC and Listeria infection clusters were linked to disease outbreaks. Results from this study will inform heightened public health surveillance, and prevention and control programmes, in populations and regions of high infection rates. Further research is needed to determine the pathogen-specific socioeconomic, environmental and agricultural risk factors that may be related to the temporal and spatial disease patterns we observed in our study.

Interactive effect of air pollutant and meteorological factors on seasonal influenza transmission, Shanghai, China

BackgroundPrevious studies have provided evidence of seasonal influenza transmission linked to various meteorological and environmental factors. However, the joint effect from both air pollutant exposure and meteorological factors that modify the seasonal influenza incidence is not well discussed. MethodsData on weekly laboratory-confirmed influenza positive case numbers were obtained from Pudong New Area, Shanghai, China between January 1, 2011 and December 31, 2019. Weekly average weather data (absolute humidity (AH), minimum temperature (Min Temp) and particulate matter <2.5 μm (PM2.5) concentration levels) at the same period were collected from Copernicus Atmosphere Monitoring Services (CAMS).A General additive model (GAM) and distributed lag nonlinear model (DLNM) with Quasi-Poisson likelihood were used to evaluate the independent and interaction effect of weather factors and PM2.5 on seasonal influenza transmission along with lag effects. ResultsOur research showed that both AH and Min Temp had U-shape interactive relationships with PM2.5 at high PM2.5 concentration level. Interaction between PM2.5 and AH had positive relative risk (RR) effect at lag of 5 weeks when AH = 5 g/m3and 15 g/m3, as well as the same lag period when Min Temp = 5 °C and 20 °C. ConclusionOur study found that an interactive effect between air pollutant and weather factors exists and significantly affects influenza transmission. For future studies, lag interactive effects among air pollutant and temperature or humidity should be considered in the evaluation of the environment-influenza association, as such interactions might change the disease response to short-term effects.

Meningococcal Surveillance Australia - Reporting period 1 January to 31 March 2023.

The reference laboratories of the National Neisseria Network, Australia report data on invasive meningococcal disease (IMD) cases confirmed by culture and/or molecular techniques for the Australian Meningococcal Surveillance Programme (AMSP). Culture-positive cases and molecular-based diagnoses are defined as IMD by the Communicable Diseases Network Australia National Guidelines for Public Health Units.1 Data contained in the quarterly reports are restricted to a description of the number of cases by jurisdiction and serogroup, when known. Some minor corrections to data in Table 1 may be made in subsequent reports if additional data are received. IMD notifications in Australia in the first quarter of 2023 were greater than in the corresponding period in 2022 but still below the 36 IMD cases reported in quarter one of 2019 (prior to the SARS-CoV-2 pandemic).2 Notably, the predominance of N. meningitidis serogroup B (MenB) IMD continued in the first quarter of 2023 (21/23, 91.3% of notifications), showing an increase from 84% in the fourth quarter of 2022.3 In contrast, between 2019 and 2021, 50–62% of IMD was attributable to MenB.4 A full analysis of laboratory-confirmed cases of IMD in each calendar year is contained in the AMSP annual report published in Communicable Diseases Intelligence.

Epidemiological characteristics of seven notifiable respiratory infectious diseases in the mainland of China: an analysis of national surveillance data from 2017 to 2021

BackgroundRespiratory infectious diseases (RIDs) remain a pressing public health concern, posing a significant threat to the well-being and lives of individuals. This study delves into the incidence of seven primary RIDs during the period 2017–2021, aiming to gain deeper insights into their epidemiological characteristics for the purpose of enhancing control and prevention strategies.MethodsData pertaining to seven notifiable RIDs, namely, seasonal influenza, pulmonary tuberculosis (PTB), mumps, scarlet fever, pertussis, rubella and measles, in the mainland of China between 2017 and 2021 were obtained from the National Notifiable Disease Reporting System (NNDRS). Joinpoint regression software was utilized to analyze temporal trends, while SaTScan software with a Poisson probability model was used to assess seasonal and spatial patterns.ResultsA total of 11,963,886 cases of the seven RIDs were reported during 2017–2021, and yielding a five-year average incidence rate of 170.73 per 100,000 individuals. Among these RIDs, seasonal influenza exhibited the highest average incidence rate (94.14 per 100,000), followed by PTB (55.52 per 100,000), mumps (15.16 per 100,000), scarlet fever (4.02 per 100,000), pertussis (1.10 per 100,000), rubella (0.59 per 100,000), and measles (0.21 per 100,000). Males experienced higher incidence rates across all seven RIDs. PTB incidence was notably elevated among farmers and individuals aged over 65, whereas the other RIDs primarily affected children and students under 15 years of age. The incidences of PTB and measles exhibited a declining trend from 2017 to 2021 (APC = −7.53%, P = 0.009; APC = −40.87%, P = 0.02), while the other five RIDs peaked in 2019. Concerning seasonal and spatial distribution, the seven RIDs displayed distinct characteristics, with variations observed for the same RIDs across different regions. The proportion of laboratory-confirmed cases fluctuated among the seven RIDs from 2017 to 2021, with measles and rubella exhibiting higher proportions and mumps and scarlet fever showing lower proportions.ConclusionsThe incidence of PTB and measles demonstrated a decrease in the mainland of China between 2017 and 2021, while the remaining five RIDs reached a peak in 2019. Overall, RIDs continue to pose a significant public health challenge. Urgent action is required to bolster capacity-building efforts and enhance control and prevention strategies for RIDs, taking into account regional disparities and epidemiological nuances. With the rapid advancement of high-tech solutions, the development and effective implementation of a digital/intelligent RIDs control and prevention system are imperative to facilitate precise surveillance, early warnings, and swift responses.Graphical

A case of hand-foot-and-mouth disease in a systemic lupus erythematosus patient presenting as late complication onychomadesis

Hand, foot and mouth disease (HFMD) is a common childhood viral disease, characterized frequently by flu-like illness with fever, myalgia and typical vesicular lesions on the palms, soles, buttocks and oral cavity. Although HFMD primarily occurs in children, it can also be seen in immunocompromised adults. This report describes a laboratory-confirmed clinical case of Echovirus-7 hand, foot and mouth disease, presented with typical clinical features and late complication onychomadesis in an immunocompromised patient with systemic lupus erythematosus in Greece.

Transmissibility and severity of COVID-19 in a humanitarian setting: First few X investigation of cases and contacts in Juba, South Sudan, 2020.

The first few 'X' (FFX) studies provide evidence to guide public health decision-making and resource allocation. The adapted WHO Unity FFX protocol for COVID-19 was implemented to gain an understanding of the clinical, epidemiological, virological and household transmission dynamics of the first cases of COVID-19 infection detected in Juba, South Sudan. Laboratory-confirmed COVID-19 cases were identified through the national surveillance system, and an initial visit was conducted with eligible cases to identify all close contacts. Consenting cases and close contacts were enrolled between June 2020 and December 2020. Demographic, clinical information and biological samples were taken at enrollment and 14-21 days post-enrollment for all participants. Twenty-nine primary cases and 82 contacts were included in the analyses. Most primary cases (n= 23/29, 79.3%) and contacts (n= 61/82, 74.4%) were male. Many primary cases (n= 18/29, 62.1%) and contacts (n= 51/82, 62.2%) were seropositive for SARS-CoV-2 at baseline. The secondary attack rate among susceptible contacts was 12.9% (4/31; 95% CI: 4.9%-29.7%). All secondary cases and most (72%) primary cases were asymptomatic. Reported symptoms included coughing (n= 6/29, 20.7%), fever or history of fever (n= 4/29, 13.8%), headache (n= 3/29, 10.3%) and shortness of breath (n= 3/29, 10.3%). Of 38 cases, two were hospitalised (5.3%) and one died (2.6%). These findings were used to develop the South Sudanese Ministry of Health surveillance and contract tracing protocols, informing local COVID-19 case definitions, follow-up protocols and data management systems. This investigation demonstrates that rapid FFX implementation is critical in understanding the emerging disease and informing response priorities.

Assessing Influenza Vaccine Adherence Among Pregnant Women: A Health Center-Based Study in Qatar

The World Health Organization (WHO) issues recommendations regarding influenza vaccine utilization, with a focus on safeguarding the most vulnerable and high-risk segments of the population against severe disease [1]. WHO's policy report on influenza vaccine, published in 2022, specifically designates pregnant women as a priority group for nations expanding their influenza vaccination initiatives, underlining the vaccine's capacity to confer protection to both mothers and their newborns for up to six months postpartum, shielding them from influenza infections [2]. Extensive evidence attests to the safety of administering influenza vaccines to pregnant women, with studies revealing a substantial reduction in laboratory-confirmed influenza cases, ranging from 35% to 70% for mothers and 28% to 61% for infants under six months of age [3,5]. The Ministry of Public Health (MOPH) in Qatar recommends that pregnant women receive a single dose of the influenza vaccine during any trimester of pregnancy, and this guidance is implemented across Antenatal clinics, including the Rawadat al Khail Health Center. Adherence to both local and WHO guidelines in clinical practice is of paramount importance. Thus, this study endeavors to ascertain the degree of adherence exhibited by healthcare professionals and pregnant women to the recommendations pertaining to influenza vaccination during pregnancy.

Sentinel Surveillance of Severe Acute Respiratory Infections in Serbia in 2022-2023 Season

Abstract Introduction Sentinel surveillance of severe acute respiratory infections (SARI) was implemented in Serbia in November 2009. Nine sentinel hospitals in 3 cities participated in the integrated SARI surveillance system. Four of them are children's hospitals. The aim of this study is to provide a review of integrated sentinel surveillance of SARI in Serbia in 2022-2023 influenza season, from October 2022 to April 2023. Methods Integrated Sentinel Surveillance of SARI has been done in accordance with professional guidance for epidemiological surveillance of influenza. Both epidemiological and virological data were collected on a weekly basis. All specimens were tested for influenza, SARS-CoV-2 and Respiratory syncytial virus (RSV). Intensive care units (ICUs), pediatric and respiratory disease wards were all represented. For laboratory confirmation, Real time polymerase chain reaction (RT-PCR) was used. Results Start of influenza season was registered in week 44/2022. A total of 3027 SARI cases were reported with 100% recorded age. Of these, 14% were 0-4 years old, 9% were 5-14, 7% were 15-29, 38% were 30-64 and 32% were ≥65. Among these cases, 607(20%) respiratory specimens were collected during the surveillance period. The number of positive samples for influenza was 208(34%), for SARS-CoV-2 was 37(6%) and for RSV 12(2%). The highest proportion of laboratory-confirmed influenza cases was 58% in week 51/2022. then, above 50% in week 7/2023 and 8/2023. All three influenza viruses were confirmed: A(H1)pdm09, A(H3) and type B. B viruses predominated, accounting for 38% of all sentinel SARI detections. There no were death associated to influenza, SARS-CoV-2 and RSV. Conclusions Integration epidemiological with laboratory surveillance as well as integrated sentinel SARI surveillance for influenza, SARS -CoV-2 and RSV highlights the importance of maintaining and improving national influenza surveillance capacity especially in the frame of International Health Regulations. Key messages • Quality, representativeness and sustainability are the guiding principles for integrated, SARS-CoV-2, RSV and influenza sentinel SARI surveillance. • The threat of influenza remains, and it is essential for countries to be vigilant for the emergence of non seasonal influenza viruses of pandemic potential and prepare for the next influenza season.

Heterologous booster vaccines reduce severity and mortality in COVID-19 during BA.2 and BA.4/BA.5 omicron predominance in Thailand

BackgroundThe COVID-19 pandemic has evolved quickly, with variants of concern resulting in the need to offer booster vaccinations. Unfortunately, the booster uptake has been slow and vaccine response has shown to wane over time. Therefore, it's critical to evaluate the role of vaccinations on outcomes with newer sub-lineages of omicron. MethodsUtilising a Hospital Information System established in Chiang Mai, Thailand, we conducted a cohort study by linking patient-level data of laboratory-confirmed COVID-19 cases to the national immunization records, during BA.2 and BA.4/BA.5 predominance. ResultsIn adjusted cox-proportional hazard models, BA.4/BA.5 was not associated with more severe COVID-19 outcomes or deaths as compared to BA.2. Risk of severe outcomes and deaths were significantly reduced with third (87% and 95%) and fourth (88% and 95%) dose vaccination, while events were not observed with a fifth dose. Across the regimens, vaccination within 14–90 days prior showed the highest level of protection. All the vaccine types used for boosting in Thailand offered similar protection against severe COVID-19. ConclusionsBoosters provide high level of protection against severe COVID-19 outcomes and deaths with newer omicron sub-lineages. Booster campaigns should focus on improving coverage utilising all available vaccines to ensure optimal protection.

Measuring the impact of an integrated bite case management program on the detection of canine rabies cases in Vietnam.

Dog-mediated rabies is enzootic in Vietnam, resulting in at least 70 reported human deaths and 500,000 human rabies exposures annually. In 2016, an integrated bite cases management (IBCM) based surveillance program was developed to improve knowledge of the dog-mediated rabies burden in Phu Tho Province of Vietnam. The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation. Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures. A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.

COVID-19 Seyrinde NLR, LMR, PLR, d-NLR, LeCR, LCR, NMR Biyoparametrelerinin Etkinliğinin Değerlendirilmesi

Background/Objective: Severe inflammatory response of the immune system has a serious role in the progression of Coronavirus disease 2019 (COVID-19). The clinical benefits of early diagnosis of immune activation of COVID-19 have been emphasized repeatedly in the trials to this date. In this study, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), derived neutrophil-to-lymphocyte ratio (d-NLR), lymphocyte-to-C reactive protein ratio (LCR), leukocyte-to-C reactive protein ratio (LeCR), neutrophil-to-monocyte ratio (NMR) biomarkers were evaluated for predicting clinical course of COVID-19. &#x0D; Methods: In this retrospective cohort study, 383 laboratory-confirmed COVID-19 cases, who had been hospitalized in a tertiary care hospital between April and November 2020, were included. Patients, including 279 mild and 104 severe cases, were sequentially selected. Blood tests, conducted at the time of admission, were examined. Data was analyzed and ROC analysis was performed by using SPSS 22.0 program. &#x0D; Results: 44.3% of the patients included in the study were female, 99.2% of the patients had viral pneumonia, 27.2% met clinical criteria for severe disease and median age was 58 years. Age, duration of hospitalization, white blood cell count, neutrophil count, ferritin, CRP, procalcitonin, D-dimer, troponin levels were higher and lymphocyte, monocyte counts were lower in the group with clinically severe disease. The diagnostic sensitivities of LCR, CRP, d-NLR, NLR, LeCR were found to be high (AUC&gt; 0.8) for the prediction of clinical severity with cut-off values of 15, 74.65, 2.55, 4, 133 respectively. &#x0D; Conclusion: High CRP, d-NLR, NLR and low LCR, LeCR are early predictors of the clinical severity, these patients should be under hospital follow-up for close monitoring and early intervention.

Household transmission investigation for Corona Virus Disease 2019 (COVID-19) in a rural and urban population of north India.

Transmissibility within closed settings, such as households, can provide a strategic way to characterize the virus transmission patterns because the denominator can be well defined. We aimed to characterize the household transmission of Severe Acute Respiratory Syndrome Coronavirus (SARS CoV-2) and its associated risk factors. This prospective case-ascertained study was conducted among the household contacts of laboratory-confirmed SARS CoV-2 cases residing in Ballabgarh, Haryana. We enrolled 148 index cases and their 645 household contacts between December 16, 2020 and June 24, 2021. We defined household contact as any person who had resided in the same household as a confirmed COVID-19 case. Baseline data collection and sample collection for real time- reverse transcriptase polymerase chain reaction (RT-PCR) and IgM/IgG against SARS CoV-2 were done on day 1 visit, and followed for a period of 28 days. RT-PCR was repeated on day 14 or whenever the contact is symptomatic and blood sample for serology was repeated on day 28. We estimated household secondary infection rate (SIR) and other epidemiological indicators-median incubation period and serial interval. We employed binomial logistic regression to quantify risk factors associated with infection. The household SIR was 30.5% (95% CI: 27.1-34.1%). The secondary clinical attack rate was 9.3% (95% CI: 7.2-11.8). The risk factors that showed higher susceptibility to infection were household contacts who were the primary care giver of the case, whose index cases were symptomatic, those with underlying medical conditions, those living in overcrowded households, who were sharing toilet with the index cases and also who were not wearing a mask when coming in contact with the case. The median (IQR) incubation period was 4 days (4, 5), mean (SD) serial interval 6.4 (±2.2) days, and median (IQR) serial interval 5 days (5, 7). Households favour secondary transmission of SARS CoV- 2, hence, index cases are recommended to self-isolate and wear masks; and household contacts to follow strict COVID infection control measures within households when a family member is infected.

Distribution of West Nile virus cases in horses reveals different spatiotemporal patterns in eastern and western Canada.

West Nile virus (WNV) became notifiable in horses in 2003 in Canada and has been reported every year since. The objective of this study was to describe the spatiotemporal distribution of WNV in horses between 2003 and 2020 in Canada. The 848 symptomatic and laboratory-confirmed WNV cases in horses reported to the Canadian Food Inspection Agency between 2003 and 2020. Canada was divided into eastern and western regions for analysis. For each case, location and date of notification were captured. Triennial maps were made to describe the spatiotemporal distribution and expansion of reported cases. The association between year and latitude of cases was investigated with simple linear regressions, and space-time clusters were detected with a permutation scan test. Most of the western region showed an extended distribution of WNV cases from 2003 to 2005 and a high recurrence of cases at the census division level. In the eastern region, the expansion of cases was gradual, with new infected census divisions mostly contiguous to previous ones. There was no association between year and latitude of cases. Six spatiotemporal clusters were detected. This study confirmed the endemicity of WNV in parts of both regions with local peaks in risk varying in time. Prevention and control efforts should focus on previously infected areas based on the spatiotemporal regional distribution patterns. Incursions of WNV to new areas should also be anticipated. These findings could also contribute to enhancing monitoring and prevention of WNV infections in an integrated surveillance system.

Risk estimation of chronic kidney disease in a leptospirosis endemic area: A case-control study from south Andaman Islands of India

Objective: To estimate the risk of chronic kidney disease in patients with leptospirosis. Methods: All reported (41 890) and later confirmed leptospirosis (1 990) cases from 2010-2020 were traced by universal sampling. 386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age, gender, area, and occupation matched healthy persons were included as controls. Variables including socio-demographic characteristics, medical history, and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate (eGFR) was analyzed with multiple linear regression. Results: The median of eGFR was 49.0 (27.0, 75.0) mL/min/1.73 m2 in the cases and 96.0 (72.0, 121.0) mL/min/1.73 m2 in the controls, showing significant differences (P &lt;0.001). Bivariate analysis showed that leptospirosis seropositivitiy, repeat leptospirosis infection, diabetes, male gender, working in field (sun exposure), COVID-19 infection and smoking had statistically significant association with reduced eGFR. Leptospirosis seropositivity had negative effects on eGFR. Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR (unstandardised p coefficients= −30.86, 95% CI −49.7 to −11.9, P &lt;0.001). Conclusions: Chronic kidney disease is a complex disease with multiple risk factors involved. Exposure to leptospirosis is one of the essential factors in accelerating its progression.

Epidemiological and molecular characterization of Coxsackievirus A6 causing hand, foot, and mouth disease in the Philippines, 2012-2017.

Coxsackievirus A6 (CVA6) is emerging as the dominant serotype among enteroviruses (EVs) responsible for hand, foot, and mouth disease (HFMD) outbreaks in multiple countries. However, details regarding this serotype in the Philippines are limited. In this study, we investigated the epidemiological and molecular characteristics of laboratory-confirmed CVA6 HFMD cases in the Philippines between 2012 and 2017. Data collected from case report forms submitted to the National Reference Laboratory for Poliovirus and other Enteroviruses were used to determine the distribution and clinical findings of laboratory-confirmed CVA6 HFMD. Phylogenetic analyses of the complete viral protein 1 (VP1) and partial 3D polymerase (3Dpol) gene sequences were performed to determine the genotype and recombinant (RF) form of the selected samples. An increase in the detection rate of CVA6 among enterovirus-positive HFMD cases was observed from 61.9% (140/226) in 2012 to 88.1% (482/587) in 2017, with most cases coming from the Luzon island group. Among the detected cases, the majority were children, with a median age of 2 years old (interquartile range: 1.17-3.40). Respiratory-related morbidities were the commonly reported complications (7.9%; 72/907). Based on the VP1 and 3Dpol gene sequence analysis, the CVA6 strains in this study were classified as genotype D3b and RF-A group, respectively. This study elucidated that CVA6 was the most prevalent enterovirus serotype causing HFMD in the Philippines in 2012-2017, with genotype D3b/RF-A circulating within this period. This study highlights the importance of viral surveillance and molecular epidemiological analysis to broaden our understanding of HFMD in the Philippines.

Methicillin-resistant Staphylococcus aureus (MRSA) clusters in neonatal intensive care units (NICUs) and other neonatal units in New York State (NYS), 2001 to 2017

New York State (NYS) mandates reporting of all hospital-associated communicable disease outbreaks. We describe trends in NYS surveillance for neonatal unit methicillin-resistant Staphylococcus aureus (MRSA) outbreaks, the evolution of national MRSA infection prevention and control (IPC) recommendations, and IPC measures taken by NYS neonatal units. We evaluated trends of reported neonatal unit MRSA outbreaks by etiology from 2001 to 2017. We reviewed all reports and the use of IPC recommendations over time. From 2001 to 2017, 124 MRSA outbreaks were reported in 47 hospital neonatal units, with a total of 1,055 laboratory-confirmed infant cases, 18 infant deaths, and 52 laboratory-confirmed staff cases. The number of outbreaks increased with the level of care. During the study period, a higher proportion of hospitals reported implementing IPC measures, including reinforcing hand hygiene compliance (increased from 79.2% to 95.1%) and enhancing environmental cleaning and disinfection (increased from 4.2% to 78.0%) as well as performing active surveillance testing (AST) on exposed neonates (increased from 4.2% to 51.2%) and molecular testing on MRSA-positive isolates (increased from 5.3% to 18.9%). From 2001 to 2017, IPC measures in neonatal units increased in parallel with expanded national IPC recommendations. However, MRSA outbreaks in neonatal units continued to be frequent occurrences in NYS.