Annual Number Of Cases Research Articles

P-644. Clinical and Sociodemographic Changes in Reported Pertussis Cases, Los Angeles County, 2014-2023

Abstract Background In 2020, the pertussis national case definition was revised to classify any symptomatic PCR-positive case as confirmed, no longer requiring a cough illness of at least 14 days. The revision intended to improve case ascertainment, but the annual number of pertussis cases reported to Los Angeles County (LAC) Department of Public Health (DPH) has decreased since 2020 due to the pandemic. We sought to describe demographic and clinical differences among pertussis cases reported to LAC before 2020 versus 2020 onwards. Methods All confirmed, probable, and suspect pertussis cases reported to LAC DPH from 2014 through 2023 were analyzed. Cases were categorized as pre-2020 (reported 1/1/2014 to 12/31/2019) or post-2020 (reported 1/1/2020 to 12/31/2023). Pearson’s chi-square test was used to assess bivariate associations between report period and case demographics and reported symptoms (paroxysms of coughing, inspiratory whoop, post-tussive vomiting, apnea with or without cyanosis, and cough illness lasting ≥14 days). A logistic regression model was built with report period as the outcome and symptoms and demographics as model covariates. Event modeled is post-2020 with pre-2020 as reference group. Results Of 6,594 cases reported, 391 (5.9%) cases were reported post-2020. Post-2020, the average annual case count decreased 91% from 1,034 to 98. Between time periods, case populations differed with respect to age and ethnicity (p< .001); sex remained similar (p=0.39). Post-2020, median case age decreased from 11 (interquartile range (IQR): 4-16) to 5 (IQR: 2-13). The prevalence of all symptoms decreased post-2020 (p< .001) (Figure 1). In the multivariable model, the association remained significant for cough illness lasting ≥14 days) (odds ratio (OR): 0.47 95% confidence interval (CI): 0.36-0.61) (Figure 2). This finding suggests that among those reporting cough illness lasting ≥14 days, the odds of diagnosis post-2020 versus pre-2020 were lower, after adjustment for age, sex, ethnicity, and other symptoms. Conclusion The revised 2020 case definition may have increased case sensitivity in certain populations and among pertussis cases with less severe symptomology. Clinicians may consider PCR testing as soon as pertussis illness is suspected, which could enable sooner public health intervention and prevention of secondary transmission. Disclosures Chelsea Foo, MPH, Assertio Holdings: Stocks/Bonds (Public Company)|Bionano Genomics: Stocks/Bonds (Public Company)|eHealth, Inc.: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)

Analysis of the Seasonal Distribution Characteristics of Hand, Foot, and Mouth Disease in a Southern China

Hand, foot, and mouth disease (HFMD) is a common infectious disease affecting children, particularly prevalent in Asian countries. In a city in southern China, the annual number of HFMD cases exceeds 40,000, yet this data has not been thoroughly analyzed to date. The Chinese Center for Disease Control and Prevention collected data on HFMD cases in this southern city from 2014 to 2019, with cases recorded on a monthly basis. We aimed to analyze the seasonal distribution characteristics of HFMD in the city using two methods: the Concentration Method and the Seasonal Index Method. The study aims to fill the existing data gap and provide insights for developing effective prevention and control strategies. Over the six-year period from 2014 to 2019, a total of 187,887 cases of HFMD were reported in the province. The average annual incidence rate was 48.94 per 100,000 population. The concentration ratio (M) was calculated to be 0.335, with annual M values ranging from 0.151 to 0.554, indicating a significant degree of seasonality in the incidence of HFMD. The seasonal index (C) exceeded 100% from April to July, peaking in June at 228.418%, which suggests that the epidemic season for HFMD in this city is from April to July. Given the distinct seasonal characteristics of HFMD in the southern city, it is imperative that prevention and control measures are implemented in advance of the peak season. Concurrently, robust surveillance and early warning systems should be maintained to mitigate the spread of HFMD and prevent outbreaks.

Lifetime risk and projected burden of dementia.

Understanding the lifetime risk of dementia can inform public health planning and improve patient engagement in prevention. Using data from a community-based, prospective cohort study (n = 15,043; 26.9% Black race, 55.1% women and 30.8% with at least one apolipoprotein E4 (APOE ε4) allele), we estimated the lifetime risk of dementia (from age 55 years to 95 years), with mortality treated as a competing event. We applied lifetime risk estimates to US Census projections to evaluate the annual number of incident dementia cases from 2020 to 2060. The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41-43). Rates were substantially higher in women, Black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations. The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060. The relative growth in new dementia cases was especially pronounced for Black adults. These results highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.

Characterization of glucagon-like peptide-1 (GLP-1) agonist exposures reported to a single United States poison center.

Glucagon-like peptide-1 agonists have gained attention in recent years due to their efficacy in managing type II diabetes mellitus and their emerging role in weight management. The purpose of this study was to characterize glucagon-like peptide-1 agonist exposures reported to a single United States regional poison center over nine years, including causes of exposure, associated clinical effects, and potential areas for improving patient education and safety. This retrospective cohort study analyzed all poison center calls involving glucagon-like peptide-1 agonists submitted to a single United States regional poison center from 14 January 2014 to 1 May 2023. Data were abstracted from the electronic medical record of the poison center, including demographics, call volume, drug involved, type of exposure, frequency of hypoglycemia, and other side effects. Two hundred and thirty-seven cases involving glucagon-like peptide-1 agonists were reported to the poison center. The annual number of cases increased sharply over this period. Most patients (n=166, 70.0%) were females. Most calls (n=164, 69.2%) were due to unintentional therapeutic errors. Semaglutide was the most frequently involved medication (n=72, 36.0%). Hypoglycemia was identified in eight patients (3.4%). The lowest mean (±SD) blood glucose concentration in these hypoglycemic patients was 49.6±23.7 mg/dL (2.76±1.3 mmol/L). Unintentional therapeutic errors were involved in 164 (69.2%) cases. Despite the generally mild clinical effects observed in this study, the occurrence of hypoglycemia in a subset of patients, often requiring hospitalization, is of concern. With reports of the acquisition of these medications through online platforms and poorly regulated compounding sources, this trend may pose public health risks. This study demonstrates the increasing incidence of glucagon-like peptide-1 agonist exposures reported to a United States regional poison center, predominantly due to unintentional overdoses, which highlights the need for ongoing patient education.

Cancers attributed to modifiable factors in Norway 2016-2020.

Targeting modifiable factors offers significant potential for primary cancer prevention. For public health strategies, it is essential to quantify the contribution from each factor on a national level. We estimated the contribution of 12 modifiable factors on cancer incidence in the Norwegian population. Nationally representative data (1990-2015) on the prevalence of tobacco smoking, over-exposure to ultraviolet radiation (UVR), alcohol consumption, physical inactivity, overweight and obesity, intake of processed and red meat, fibre and calcium, menopausal hormone therapy (MHT), human papilloma virus (HPV) infection and insufficient breastfeeding were collected from health surveys. Using these prevalences, cancer risk estimates for for the exposures, and average annual cancer incidence rates for 2016-2020, we estimated annual population-attributable fractions (PAFs) and numbers of preventable cases. Of the average 24,608 annual cases of cancers related to our included modifiable factors, 12,12,250 (6240 in women and 6009 in men) (41 %) were attributed to these factors. Tobacco smoking caused the highest proportion of cancers cases, 20 % in men and 13 % in women. Sunburn and indoor tanning caused 13 % and 10 % of cancers in men and women, respectively, and overweight and obesity caused 4.5 % of the cases. Cancers of skin, lung, colon and female breast had the highest number of preventable cases. Over a third of the annual cancer cases in Norway were attributed to 12 modifiable factors. Based on this study, efforts to reduce tobacco smoking, UVR over-exposure, and overweight and obesity could be the most effective in primary prevention of cancer.

Analysis of chickenpox morbidity in the Republic of Moldova, years 2002–2023

The aim of the article is to analyze chickenpox morbidity in the Republic of Moldova during 2002-2023. Chickenpox morbidity in the period 2002–2019 was within the range of 169.5 (year 2006) -322.1 (year 2012) per 100 thousand population with a weak upward trend (change index equal to 1.1) and with a little evident cyclicity of 5-8 years. During COVID-19 pandemic, a significant and rapid reduction in chickenpox morbidity to 130.8 cases per 100 thousand people was observed linked to contact limitation and low addressability to health services. The age group most affected by chickenpox in most countries, with the exception of some Asian regions, is pre-school children aged 3-6 years, whose number in the age structure of the sick in the Republic of Moldova is increasing with the intensification of the epidemic process, being in the range of 45.2-49.1%. The calculated number of possible annual cases of herpes zoster in people aged 20+ is 3436-11,206 cases, being an additional source of infection, together with chickenpox patients. In order to reduce morbidity from chickenpox and herpes zoster it is necessary to implement the vaccination.

Progress Toward Poliomyelitis Eradication - Afghanistan, January 2023-September 2024.

Since the Global Polio Eradication Initiative began in 1988, wild poliovirus (WPV) types 2 and 3 have been eradicated, and annual polio case numbers have decreased by >99.9%. WPV type 1 (WPV1) transmission remains endemic in Afghanistan and Pakistan, two countries that share a 1,600-mile (2,600-km) border. This report describes immunization and surveillance activities and progress toward polio eradication in Afghanistan during January 2023-September 2024. As of November 1, Afghanistan reported 23 WPV1 cases in 2024, with onset during January-September 30, 2024. During the 3 previous years, 12 WPV1 cases were reported, including six during 2023. In August 2021, the Taliban took control nationwide and allowed increased geographic access for poliovirus vaccination campaigns. Multiple challenges have affected polio eradication activities in Afghanistan, including mandated repatriation of approximately 1 million Afghans by Pakistan beginning in late 2023, the ongoing humanitarian crisis that limits international agency effectiveness, polio program constraints imposed by authorities, and increased restrictions on female participation in vaccination activities. House-to-house vaccination coverage reached 90%-98% of children during June-July 2024. Beginning in 2021, authorities had progressively lifted restrictions on house-to-house campaigns, but abruptly reverted to national restrictions in September 2024. Both nationwide house-to-house activities and strengthening of the routine childhood immunization program would help ensure that every vulnerable child is vaccinated and provide a pathway to polio eradication in Afghanistan.

Time From Screening to Treatment at Accredited Breast Centers in the United States.

The National Accreditation Program for Breast Centers (NAPBC) launched the Patient-Reported Observations for Medical Procedure Timeliness quality collaborative to assess time intervals between screening and treatment for patients with breast cancer. Sites submitted monthly timeliness data in calendar days from 2019 to 2021 along with their perceptions of timeliness at their centers and facility characteristics. All patients were included in the interval from screening to diagnosis, whereas only patients with cancer were included in the biopsy to treatment intervals. Institutions were compared and assessed for differences and associations with center characteristics via the Kruskal-Wallis test. Three hundred seventy-three (64.5%) NAPBC-accredited breast centers enrolled, and 311 (83.3%) provided complete timeliness metrics. Two hundred nine (56%) sites did not have trainees, 154 (41.3%) sites were within 10 miles of a major city, and the median number of annual breast cancer cases was 280 (IQR, 189-366). From 2019 to 2021, the time between diagnosis and treatment was as follows: 11-12 days between screening mammogram (MGM) and diagnostic MGM, 8-9 days between diagnostic MGM and biopsy, 32-34 days between biopsy and neoadjuvant therapy, and 39-42 days between biopsy and surgery. The enrolled centers believe that these intervals should be 7, 7, 21, and 28 days, respectively. Higher annual case volume and a larger number of surgeons exclusively devoted to breast disease were significantly associated with longer time intervals. Time from biopsy to first treatment is longer than that centers expected compared with time from screening to diagnosis. There is significant variability across NAPBC in time from screening mammogram to treatment, and some institutions will face more challenges with timely quality measures than others. Further investigation into whether these differences confer outcome differences should be pursued.

Temporal pattern and effect of COVID-19 on the trend of TB, DRTB, paediatrics TB and TB with HIV Coinfection: A decadal trend analysis.

India shares 2/3 of global TB burden. MDR and HIV coinfections are the main obstacle in achieving the successful TB control because it decrease the therapy effect. To analyze the long-term trends of incidence of tuberculosis cases and identify any differences between actual and projected cases after the COVID-19 pandemic. A retrolective study was conducted in SMS medical college, Jaipur, and data were extracted from state TB cell and annual report published by central TB division. A multiplicative model was used for conducting time series analysis. The projected yearly number of cases were estimated using the line of best fit based on the least square method. An increasing trend in the incidence of TB was observed, rising from 1,517,363 in 2008 to 2,404,815 in 2019. Similarly, DRTB also showed an increasing trend from 10,267 (0.67% of total new cases) in 2011 to 66,255 (2.75%) in 2019. The new cases of DRTB in 2020 were significantly lower than the projected number. The trend of HIV coinfection in TB cases fluctuated over the past decade. The findings reveal a concerning upward trajectory in TB incidence and DRTB cases over the decade. The fluctuating trend in HIV coinfection in TB cases emphasizes the complexity of addressing these interconnected health challenges.

Defining a threshold for safe surgical management of vena cava thrombus in renal cell carcinoma patients: evidence from German total population data with 3,700 cases from 2006 to 2020

PurposeThe management of inferior vena cava (IVC) tumor thrombus in patients with renal cell carcinoma (RCC) is among the most challenging surgical procedures. We aimed to define a minimum annual caseload for sufficient expertise.MethodsWe identified all cases with RCC, nephrectomy, and IVC procedures in the Federal Statistical Office billing database (2006–2020). We defined annual hospital caseload categories as low (< 4 cases), medium (4–9 cases) and high (> 9 cases) volume. Logistic multivariate models identified mortality-related factors. In addition, we analyzed data on tumor stage distribution from German cancer registries.ResultsWe recorded 3,700 nephrectomies with IVC-tumor resection with stable annual case number of 247 mean. This correlated with a stable incidence of T3b/c RCC. Patient age was 66 ± 14 years. Of all cases, 56% occurred in low, 30% in medium, and 14% in high volume clinics without a significant trend towards centralization. The overall in-hospital mortality rate was 5.8% and the transfusion rate 72%. An annual caseload of 8 showed to be a significant cut-off for mortality with 6.2% at < 8 cases and 2.8% for > = 8 cases annually (p < 0.001). Multivariate analysis revealed patient age (OR 6.4 for octogenerians) ventilation time (OR 14.3 for > 24 h) and hospital caseload (OR 2.6) as the most important risk factors for in-hospital mortality.ConclusionOur results show a negative correlation of annual caseload and mortality for this procedure. A minimum number of 8 procedures per year seems reasonable for the successful management of IVC tumor thrombus with significantly lower mortality.

Impact of pharmacist-led aminoglycoside stewardship: a 10-year observational study

BackgroundAminoglycosides are crucial for treating multidrug-resistant gram-negative infections and endocarditis. However, aminoglycosides are associated with significant risks of nephrotoxicity, necessitating careful dose selection and therapeutic drug monitoring. Therapeutic drug monitoring is essential for minimizing risk; however, few institutions routinely perform it. This study aimed to assess the impact of a pharmacist-driven therapeutic drug monitoring intervention on aminoglycoside usage trends and clinical outcomes.MethodsThis retrospective cohort study included 263 patients treated with aminoglycosides between 2014 and 2023. A pharmacist-led therapeutic drug monitoring intervention began in 2017, focusing on monitoring renal function, documenting patient weight, and closely managing aminoglycoside concentrations. Trends in aminoglycoside use and renal outcomes were analyzed.ResultsOver the study period, appropriate use of aminoglycosides at the time of initial prescription increased from 49 to 82% (P < 0.01). Pharmacist dosing design at initial prescription increased significantly from 21% pre-intervention to 60% post-intervention (P < 0.01). The proportion of pharmacist intervention in initial dosing design increased over time. The proportion of patients with measured aminoglycoside blood concentrations significantly increased from 53% pre-intervention to 72% post-intervention (P < 0.01). The proportion of patients who were able to manage target blood concentrations from the initial aminoglycoside dose without dose adjustments increased from 31% pre-intervention to 42% post-intervention, although the results were not significantly different (P = 0.07). The incidence rate of renal impairment remained similar (11% vs. 12%; P = 0.85), although the annual average number of cases decreased from 4.3 before the intervention to 2.5 after. Similarly, there were no significant differences in clinical efficacy before and after the intervention (65% vs. 71%; P = 0.35). Furthermore, aminoglycoside stewardship led to a 56% cost saving.ConclusionsPharmacist-led aminoglycoside stewardship significantly improved the appropriate use of aminoglycosides and decreased the associated costs. Thus, pharmacist involvement is essential for the proper use of aminoglycosides. However, many patients required aminoglycoside dose reductions despite the pharmacist’s guideline-based dosing design. Therefore, further accumulation of information on the management of aminoglycoside blood concentration may be necessary for the revision of these guidelines.

An increase in paediatric arthroscopy in Europe: Experience of the EPOS Sport Study Group.

Paediatric musculoskeletal injuries in association with increased participation in sports activities continue to increase. Arthroscopy is recognized as a safe and effective procedure in children. This study aims to identify trends in European paediatric sports centres over 20 years. A survey was performed across the European Paediatric Orthopaedic Society (EPOS) Sports Study Group focusing on 3 years (2000, 2009 and 2019). Centres were divided into two groups: Group 1 (n = 5, with data for 2000, 2009 and 2019) and Group 2 (n = 8, with data for 2009 and 2019). Data were analysed as the total annual number of cases and separately by anatomical region and patient demographics. A descriptive analysis was performed to characterize the trends. Data from eight centres across Europe showed an increase in total annual arthroscopy cases (G1 from 53 to 202 and G2 from 393 to 615, p-value < 0.001) and as a percentage of paediatric orthopaedic surgeries (G1 from 1.6% to 5.2%; G2 from 5.1% to 6.8%) in seven out of eight centres. The knee remained the most commonly treated joint (G1 from 79.2% to 83.3%; G2 from 78.9% to 84.4%), despite the rise of others such as the elbow (p-value = 0.020) and decline of the shoulder (p-value = 0.014). Cases involving paediatric patients over 11 years increased while there was no gender distinction among paediatric patients. Paediatric arthroscopy procedures in Europe have increased in number over the past 3 decades. Technological advancements have allowed a surge in procedures and applications to new anatomical areas. IV - retrospective database review.

Microbiological trends, in-hospital outcomes, and mortality in infective endocarditis: a Swiss-nationwide cohort study.

The epidemiology of infective endocarditis (IE) is evolving, driven by an aging population and increased use of endovascular devices, and is associated with significant morbidity and mortality. This study aims to evaluate changes in microbiological trends and clinical outcomes in patients with IE over the past decade in Switzerland. This nationwide cohort study analyzed in-hospital claims data from patients hospitalized with IE in Switzerland between 2012 and 2021. We assessed incidence rates per 100,000 hospitalizations, categorizing them by common pathogens. The outcomes included in-hospital and 6-month mortality, admission to the intensive care unit (ICU), and length of hospital stay (LOS). Among 15,255 hospitalizations with IE, the annual number of cases increased from 1,361 in 2012 to 1,636 in 2021. The most frequently diagnosed pathogens were Staphylococcus aureus (increasing from 19.8% to 30.0%, ptrend <0.01) and Streptococcus species (from 17.6% to 24.4%, ptrend <0.01). Infective endocarditis caused by Staphylococcus aureus was associated with the highest in-hospital (19.9%) and 6-month mortality (30.3%), and ICU admission rates (44.2%), with no relevant changes over time. The longest LOS was observed in hospitalizations with IE caused by Enterococcus species (mean 23.9 days) and Staphylococcus aureus (23.8 days). This nationwide cohort study showed an increase in IE hospitalizations from 2012 to 2021, primarily due to Staphylococcus aureus and Streptococcus species. Predominantly, Staphylococcus aureus was associated with adverse outcomes that remained consistently high over time compared to other or unidentified pathogens.

Predicting the risk of malaria importation into Jiangsu Province, China: a modeling study

BackgroundThe World Health Organization certified China malaria-free in 2021. Consequently, preventing the risk of malaria re-introduction caused by imported malaria has now become a major challenge. This study aims to characterize the dynamics and predict the risk of malaria importation in Jiangsu Province, where the number of imported malaria cases ranks among the highest in China.MethodsThe annual number of cases with imported malaria in Jiangsu Province, the annual number of travelers from sub-Saharan Africa (SSA) to Jiangsu Province (both Chinese and international travelers), and the annual number of Chinese migrant workers from Jiangsu Province who stayed abroad between 2013 and 2020 were assessed. The spatio-temporal dynamics of malaria importation was characterized with ArcGIS 10.8. A negative binomial model was applied to model malaria importation to Jiangsu Province, China.ResultsA total of 2,221 of imported malaria cases were reported from January 1, 2013, until December 31, 2020. Imported malaria cases into China were mainly from SSA (98%) and P. falciparum (78%), the most common species. A seasonal pattern was observed, with the most cases occurring from December to February. The negative binomial model, which incorporates the number of Chinese migrant workers from Jiangsu Province who stayed abroad as an independent variable, demonstrated better performance (AIC: 96.495, BIC: 94.230) compared to the model based solely on travelers from SSA to Jiangsu Province. The model indicated an estimated 139% increase in imported cases for a 10% increase in Chinese migrant workers from Jiangsu Province who stayed abroad.ConclusionIn conclusion, our study underscores the importance of incorporating data on Chinese migrant workers who have stayed abroad when predicting malaria importation risks. By integrating both international travel patterns and migrant worker data, our findings offer a more robust framework for assessing and managing malaria risk in Jiangsu Province. This approach provides valuable insights for public health officials, enabling more effective resource allocation and targeted interventions to prevent the re-introduction of malaria and improve overall disease management.

Burden of gastrointestinal cancers among adolescent and young adults in Asia-Pacific region: trends from 1990 to 2019 and future predictions to 2044

Background Gastrointestinal cancer is a significant cause of cancer incidence and mortality. Nevertheless, the epidemiology of the burden among adolescents and young adults (AYAs, aged 15–39 years) remains limited in the Asia-Pacific region, despite the region’s significant population. This study aims to explore the gastrointestinal cancer burden among AYAs in the Asia-Pacific region for the year 2019, while also analysing trends from 1990 to 2019 and projecting future trends up to 2044. Methods Annual case numbers, age-standardized rates of incidence, death, and disability-adjusted life-years (DALYs) and their estimated annual percentage changes (EAPCs) for gastrointestinal cancers were derived from the Global Burden of Disease, Injuries, and Risk Factors Study 2019. Trends over the next 25 years have also been predicted. Results In 2019, there were 117,714 incident cases, 61,578 deaths and 3,483,053 DALYs due to gastrointestinal cancers in the Asia-Pacific region, accounting for 68.5%, 67.6% and 72.4%, respectively, of global gastrointestinal cancers in this population. The highest age­standardized rates occurred in countries with a middle Socio-demographic Index. From 1990 to 2019, there was a decline in the age-standardized rates of incidence, death and DALY attributed to gastrointestinal cancers, with EAPC of −1.10, −2.48 and −2.44, respectively. These rates are expected to stabilize over 25 years, with notable variations in individual gastrointestinal cancers. Conclusions Gastrointestinal cancers among AYAs in the Asia-Pacific region have posed a significant burden over the past 30 years and are expected to persist in the coming years.

Leprosy-related disability in children and adolescents under 15 years old in Brazil: evaluation of macro-regional disparities from 2001 to 2022

Objectives: to investigate macro-regional disparities in the incidence of leprosy in children and adolescents under 15 years old in Brazil from 2001 to 2022, with a focus on leprosy-related disabilities. Methods: an ecological study was carried out with data from the Brazilian Notifiable Diseases Information System (SINAN). The annual number of leprosy cases was normalized to every 100,000 residents in each macro-region (incidence), stratified by leprosy-related disability (grade 0, 1 and 2). The significance level was set at 5%, and Poisson regression adjusted for a robust dispersion was used to estimate the incidence ratio. Results: approximately 14% (7,694) of all leprosy cases in this age group were notified with grade 1 (78.9%) or 2 (21.1%) disability. Moreover, in grade 1 and 2, the incidence of leprosy was significantly higher in the North, Northeast and Central-West macro-regions when compared to the national estimate, as well as significantly lower in the Southeast and South (p-value &lt;0.05). Conclusion: macro-regional disparities were observed in the incidence of leprosy in children and adolescents under 15 years old with grade 1 or 2 disability in Brazil from 2001 to 2022.

Temporal and age-related trends in risk factors for development of atrial fibrillation in peripartum patients

Abstract Background Incidence of atrial fibrillation (AF) in pregnancy has steadily increased over the past two decades and may be related to changes in rates of AF risk factors. Objective To characterize trends in the prevalence of AF risk factors among patients with peripartum AF. Methods TrinetX, a large national healthcare database, was used to identify patients with peripartum AF from 2017-2022. Inclusion criteria were female patients aged &amp;gt;18 years old who received a diagnosis of AF within one month prior to and one year after a diagnosis of pregnancy. Annual prevalence of pre-existing AF risk factors, including diabetes, chronic kidney disease (CKD), obesity, and hypertension, were obtained, normalized to the annual number of peripartum AF cases, and followed. In a second analysis, student’s t-test and standardized mean difference were used to compare the rates of AF risk factors between patients with peripartum AF and pregnant patients with no history of AF within the same time frame. Comparisons were performed across age ranges. Results From 2017-2022, there were 6,465 patients with peripartum AF and 2,852,348 pregnant patients with no AF. There was an increase in the proportion of peripartum AF patients with pre-existing obesity (16.7% to 18.5%) and hypertension (28.9% to 33.7%). In comparing pregnant patients with no AF history with peripartum AF patients, the standardized mean difference for rates of all risk factors increased with age group. The peripartum AF group had significantly higher rates of all risk factors across all age groups (p &amp;lt; 0.0001 for all groups). Conclusion Rates of pre-existing obesity and hypertension increased among patients with peripartum AF, which could be a factor in increasing rates of peripartum AF. Differences in rates of AF risk factors between peripartum AF patients and pregnant patients with no AF were more pronounced at older age groups.

Yellow fever in Ghana: Predicting emergence and ecology from historical outbreaks.

Understanding the epidemiology and ecology of yellow fever in endemic regions is critical for preventing future outbreaks. Ghana is a high-risk country for yellow fever. In this study we estimate the disease burden, ecological cycles, and areas at risk for yellow fever in Ghana based on historical outbreaks. We identify 2387 cases and 888 deaths (case fatality rate 37.7%) from yellow fever reported in Ghana from 1910 to 2022. During the approximately 30-year periods before and after implementation of routine childhood vaccination in 1992, the reported mean annual number of cases decreased by 80%. The geographic distribution of yellow fever cases has also changed over the past century. While there have been multiple large historical outbreaks of yellow fever in regions throughout Ghana, recent outbreaks have originated in northern regions. Comparing the locations where yellow fever outbreaks have emerged, we find patterns with seasons and different ecological transmission cycles. Using an ecological niche modeling framework, we predict areas in Ghana that are similar to where prior yellow fever outbreaks have originated based on temperature, precipitation, vegetation, and human population density. We find that these predictions differ depending on the ecological cycles of outbreaks. Ultimately, these findings and methods could be used to inform further subnational risk assessments for yellow fever in Ghana and other high-risk countries.

An epidemiological and spatiotemporal analysis of visceral leishmaniasis in West Pokot, Kenya, between 2018 and 2022

BackgroundVisceral leishmaniasis (VL) remains a significant public health concern in West Pokot County, Kenya, where a large outbreak between 2020 and 2022 emphasised the need for improved VL control strategies. However, these measures are partially hampered by limited insight into the geographical distribution of cases and localised outbreaks of the disease. This study aimed to describe the epidemiology and spatiotemporal patterns of VL in West Pokot between 2018 and 2022, in order to map the spread of VL transmission and identify regions that should be prioritised for control interventions.MethodsVL patient demographics and village of residence were retrieved from admission records of Kacheliba Sub-County Hospital in West Pokot, Kenya. The temporal trend in VL admissions between 2018 and 2022 was analysed using seasonal decomposition analysis. To describe the spatial distribution of VL cases, geographic coordinates of villages of residence were collected from pre-established databases, and VL incidence was mapped at the sub-location level. Hotspot analysis was performed per study year to identify villages with high VL incidence, and scan statistics were applied to detect spatiotemporal clusters of VL cases during the study period.ResultsA total of 1948 VL patients were reported between 2018 and 2022. The annual number of cases increased from 245 in 2019 to 598 in 2022, and VL admissions were generally higher at the start of the wet seasons. 70% of the VL cases could be georeferenced, and mapping of VL incidence revealed high case rates in the east of West Pokot during the complete study period. The eastern villages Lotongot and Chepaywat were marked as VL hotspots at a 99% confidence level in all study years. In addition, five significant spatiotemporal clusters were detected in the east and north, suggestive of local VL outbreaks in these regions.ConclusionsThe increase in VL hospital admissions during the study period stresses the need for enhanced VL control and outbreak mitigation in West Pokot. These control measures should be focused on the hotspot regions in the east of the county.

Reappraising Cladophialophora bantiana phaeohyphomycosis in France: retrospective nation-based study

Cladophialophora bantiana is one of the most virulent phaeohyphomycetes, typically causes non-angiogenic single (or sometimes multiple) cystic brain lesions, and has resulted in a mortality rate of up to 70%.Most Cbantiana cases are described either in a series of isolated reports or in very small cohorts. The aim of this retrospective nation-based study was to share the data on Cbantiana phaeohyphomycosis cases reported in France and French overseas territories over the past two decades to improve understanding of this disease. Patients with Cbantiana infection were processed through the active surveillance programme of invasive fungal infections launched by the National Reference Center for Mycoses and Antifungals, Institut Pasteur (Paris, France), and the French Surveillance Network of Invasive Fungal Infections, which involved 29hospitals from mainland France and overseas French territories. Onlyproven and probable cases of infection, according to the revised and updated consensus definitions from the European Organization for Research and Treatment of Cancer and Mycoses Study Group, were included in the study. Patients were diagnosed or confirmed, or both, using a polyphasic approach at the Institut Pasteur between 2002and2022. Patients were separated into two groups: those with CNS involvement and those with no CNS involvement. Theprimary outcome was the survival rate. A total of 23patients with a Cbantiana invasive infection were included during the study period (Jan 1, 2002, to Dec 31, 2022). The median age was 56years in the CNS involvement group and 65years in the non-CNS involvement group. Until 2021, the annual number of cases varied between zero and two, with six cases observed in 2022, the warmest year recorded in France since 1900. CNS involvement was observed in 15 (65%) patients, including three disseminated cases; skin and soft tissue involvement in seven (30%) patients and an isolated lung infection in one case. Diabetes was observed in five patients, and any immunodepression factor was observed in 14 (61%) of 23patients. When considering only patients with CNS involvement, 9-month survival appeared higher in patients who underwent exeresis or large drainage (three [75%] of four patients vs three [27%] of 11patients; p=0·24) and significantly higher in those treated for 2or more weeks with triple antifungal therapy (liposomal amphotericin Bplus posaconazole and flucytosine; seven [78%] of nine patients vs one [17%] of six patients; p=0·040). Two patients were treated with excision surgery alone (one patient with success, and the other patient lost to follow-up). This study shows that the clinical presentations and underlying medical conditions of Cbantiana infections are more diverse than previously described. It also emphasises a significant difference in mortality rate between those with and without CNS involvement. The prognosis improved when surgery was performed and triple antifungal therapy was administered. Such rare and devastating invasive fungal infections should be managed by a multidisciplinary team. Santé Publique France.