Lifetime Risk Of Infection Research Articles

Estimating the population health burden of Lyme disease in Ontario, Canada: a microsimulation modelling approach.

Background:If untreated, Lyme disease can lead to long-term sequelae and post-treatment Lyme disease syndrome (PTLDS), resulting in reduced health-related quality of life. The objective of this study was to develop a microsimulation model to estimate the population-level health burden of Lyme disease in Ontario, Canada.Methods:We developed a Lyme disease history model using microsimulation, simulating 100 000 people (mean age 37.6 yr, 51% female) from 2017 in Ontario over a lifetime risk of infection and time horizon. We extracted the sensitivity and specificity of the 2-tier testing recommended by the Canadian Public Health Laboratory Network, probabilities and health state utility values from the published literature and health administrative data. Our reported outcomes from our stochastic analysis include diagnosed cases of Lyme disease (stratified by stage), undiagnosed infections, sequelae, individuals with PTLDS and quality-adjusted life-years (QALYs) lost.Results:Our model estimated 333 (95% confidence interval [CI] 329–337) infections over the lifetime of 100 000 simulated people (mean age 37.6 yr, 51% female), with 92% (95% CI 91%–93%) of infections diagnosed. Of those 308 people with Lyme Disease diagnoses, 67 (95% CI 65–69) developed sequelae (e.g., arthritic, cardiac, neurologic sequelae), and 34 (95% CI 33–35) developed PTLDS. Lyme disease resulted in a loss of 84.5 QALYs (95% CI 82.9–86.2) over the lifetime of the simulated cohort. Sensitivity and scenario analysis showed that increasing incidence rates of Lyme disease, potential underreporting, duration of PTLDS and quality of life (health state utility) associated with PTLDS had the greatest impact on health burden.Interpretation:Lyme disease contributes considerable health burden in terms of QALYs lost. Our analysis provides evidence to understand the disease burden and lays the foundation to assess the cost-effectiveness of pharmaceutical and nonpharmaceutical interventions.

Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies

SummaryBackgroundAs the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in mean age at infection, age distribution of new infections, and birth cohort cumulative incidence.MethodsWe used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals' HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe, in a collaborative analysis of the ALPHA network. We modelled HIV incidence rates by age, time, and sex using smoothing splines functions. We estimated incidence trends separately by sex and study. We used estimated incidence and prevalence results for 2000–17, standardised to study population distribution, to estimate mean age at infection and proportion of new infections by age. We also estimated cumulative incidence (lifetime risk of infection) by birth cohort.FindingsAge-specific incidence declined at all ages, although the timing and pattern of decline varied by study. The mean age at infection was higher in men (cohort mean 27·8–34·6 years) than in women (24·8–29·6 years). Between 2000 and 2017, the mean age at infection per cohort increased slightly: 0·5 to 2·8 years among men and −0·2 to 2·5 years among women. Across studies, between 38% and 63% (cohort medians) of the infections in women were among those aged 15–24 years and between 30% and 63% of infections in men were in those aged 20–29 years. Lifetime risk of HIV declined for successive birth cohorts.InterpretationHIV incidence declined in all age groups and shifted slightly to older ages. Disproportionate new HIV infections occur among women aged 15–24 years and men aged 20–29 years, supporting focused prevention in these groups. However, 40–60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages.FundingBill & Melinda Gates Foundation.

Infections in Ocular Prosthesis

There has been an exponential expansion of the types and application of ocular prostheses in the last 10 years. Patients with ocular prostheses in all forms are at increased risk for microbial infections. The true incidence and/or prevalence of ocular prosthesis-associated infections are unknown. Millions of people worldwide are candidates in need of ocular prostheses for cosmesis, vision rehabilitation, and restoration. The presence of an ocular prosthesis carries a lifetime risk of infection and leads to ocular surface and microbiome dysbiosis. Ophthalmologists should be aware of the inherent risk and diversity of microbial colonization and infections associated with the placement of the expanding list of ocular prostheses. Additional adverse events include ocular surface and ocular microbiome disruption, vision loss, and ocular surface dysfunction.

Partial spleen resection with a radiofrequency needle device—a pilot study

Total splenectomy leads to an immunocompromised state, with an increased lifetime risk of infection. The lifetime risk of developing overwhelming postsplenectomy infection is 5 %, with a mortality rate of approximately 50 %. In addition to vaccination and antibiotic prophylaxis, partial splenectomy is believed to improve patient safety. We performed partial splenectomy in seven patients using a radiofrequency (RF) technique with Habib® needles. In seven patients, an open access partial splenectomy was performed. In three patients, a partial splenectomy was performed simultaneously with intraabdominal tumour resection. In two patients, the upper pole of the spleen was removed due to tumours of the spleen. In one patient, a large symptomatic splenic cyst was resected and in another patient, a partial splenectomy was performed due to trauma. RF was applied using Habib® needles (AngioDynamics, Manchester, GA, 31816, USA). The partial splenectomy procedures were easy and safe in all seven patients. The RF application with the Habib® needles led to primary haemostasis. The blood loss was less than 50 ml in all cases. After a minimum follow-up of 1 year, there were no cases of infections or other adverse events related to the previous partial splenectomy. In our experience, partial splenectomy with Habib® needles is easy to perform and safe for the patient. Thus, radiofrequency resection is a good alternative to total splenectomy in many patients and reduces the risk of postsplenectomy infections.

Genital warts and genital papillomavirus disease

Abstract Genital infection with human papillomavirus (HPV) is a common STI. Reliable estimates indicate a lifetime risk of infection of more than 50% for the population. Genital HPV infection can be divided into infection with genotypes less likely to be associated with neoplasia (low oncogenic risk) and genotypes with a stronger association with neoplasia (high oncogenic risk). A family of high-risk HPVs has been described, including HPV types 16, 18, 31, 33, 35, 39 and 45. Most high-risk HPV infections are asymptomatic and resolve spontaneously within 1 year. Persistent infection with high-risk HPV causes epithelial dysplasia. This can progress to invasion, and high-risk HPV has been shown to be a necessary cause of cervical cancer; HPV 16 alone causes more than 50% of cases. High-risk HPV is also causative in 90% of anal and vaginal squamous carcinomas, and 40% of vulval and penile cancers. Low-risk HPV infection usually manifests as anogenital warts, caused by HPV types 6 and 11. This is the most common clinically recognized viral STI. Treatments for genital warts can be divided into self-treatments such as podophyllotoxin and imiquimod, and clinic-based treatments such as cryotherapy, trichloroacetic acid and electrosurgery. Recurrence of genital warts after apparent cure is common. Prophylactic HPV vaccines using virus-like particles are under development; phase II trials have shown 90–100% efficacy against persistent infection and disease, and the results of ongoing phase III trials are awaited.