Human Infection Rates Research Articles

Decreases in human immunodeficiency virus infection rates in Kombolcha, Ethiopia: a 10-year data review.

IntroductionAcquired immunodeficiency syndrome is one of the most serious public health and development challenges in sub-Saharan Africa, including Ethiopia. A particular challenge for prevention strategies has been the emergence of hotspot areas. Therefore, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome programs should not be based on national level statistics, but need to be more focused geographically. Kombolcha is one of the high spot areas with different projects and development corridors. Hence, the aim of this study is to assess the trend of HIV infection rates among patients who visited Africa Service Committee clinic from 2005 to 2014.MethodsAn institutional-based cross-sectional study was conducted from January 1 to January 30, 2016. All records of new patients enrolled from February 8, 2005 to December 31, 2014 were reviewed. Data on sociodemographic information, risky sexual behavior, and HIV test result were collected from each study participant using data collection format. Data were analyzed using SPSS version 20.0. A multivariate logistic regression model was used to identify risk factors of HIV infection.ResultsThe overall HIV infection was 10.8% (2,233/20,674). The rate of infection varied from 13.3% in 2005 to 4.5% in 2014, and its trend had significantly declined from 2008 to 2014. Urban residence (adjusted odds ratio [AOR]: 2.53; 95% confidence interval [CI]: 1.22–5.25), patients who ever had intercourse with penetration (AOR: 5.62; 95% CI: 1.11–28.57), and those who had marriage experience (AOR: 11.65; 95% CI: 4.2–32.3) were more infected with HIV.ConclusionThe trend of HIV infection significantly reduced in the last 10 years in Kombolcha area. However, the HIV infection still remains high (4.5%) that needs intervention of those who had marriage experience, risky sexual behavior, and urban dwellers.

Regional Comparison of Mosquito Bloodmeals in South Australia: Implications for Ross River Virus Ecology.

Ross River virus (RRV) is responsible for the most notifications of human arboviral infection in Australia. Seroprevalence and experimental infection studies have implicated macropods (e.g., kangaroos) as the major reservoir hosts. However, transmission ecology varies spatially, and infections in urban areas have prompted the question of what animals serve as reservoirs in regions where macropods are scarce. In South Australia (SA), human infection rates for RRV vary greatly by region as do vector and reservoir abundance. We hypothesized that mosquito abundance and feeding patterns would vary among ecoregions of SA and could help explain divergent human case rates. To test our hypothesis, we amplified and sequenced a 457 base pair region of the cytochrome B segment of mitochondrial DNA from blood fed mosquitoes collected in three main ecoregions of SA and identified sequences using a BLAST search in NCBI. Domestic livestock made up the vast majority of bloodmeals from the region with the highest human infection rate. Livestock are generally not considered to be important reservoir hosts for RRV, but our results suggest they may have a role in transmission ecology in some places. Surprisingly, none of the 199 bloodmeal samples were identified as macropod in origin. In the context of these findings, we consider the possible RRV vectors and reservoir hosts in these regions and propose that diverse spatial and temporal transmission ecologies occur in SA, depending on vector and reservoir availability.

Identification of Immunoreactive Leishmania infantum Protein Antigens to Asymptomatic Dog Sera through Combined Immunoproteomics and Bioinformatics Analysis.

Leishmania infantum is the etiologic agent of zoonotic visceral leishmaniasis (VL) in countries in the Mediterranean basin, where dogs are the domestic reservoirs and represent important elements in the transmission of the disease. Since the major focal areas of human VL exhibit a high prevalence of seropositive dogs, the control of canine VL could reduce the infection rate in humans. Efforts toward this have focused on the improvement of diagnostic tools, as well as on vaccine development. The identification of parasite antigens including suitable major histocompatibility complex (MHC) class I- and/or II-restricted epitopes is very important since disease protection is characterized by strong and long-lasting CD8+ T and CD4+ Th1 cell-dominated immunity. In the present study, total protein extract from late-log phase L. infantum promastigotes was analyzed by two-dimensional western blots and probed with sera from asymptomatic and symptomatic dogs. A total of 42 protein spots were found to differentially react with IgG from asymptomatic dogs, while 17 of these identified by Coommasie stain were extracted and analyzed. Of these, 21 proteins were identified by mass spectrometry; they were mainly involved in metabolism and stress responses. An in silico analysis predicted that the chaperonin HSP60, dihydrolipoamide dehydrogenase, enolase, cyclophilin 2, cyclophilin 40, and one hypothetical protein contain promiscuous MHCI and/or MHCII epitopes. Our results suggest that the combination of immunoproteomics and bioinformatics analyses is a promising method for the identification of novel candidate antigens for vaccine development or with potential use in the development of sensitive diagnostic tests.

Understanding the transmission dynamics of Leishmania donovani to provide robust evidence for interventions to eliminate visceral leishmaniasis in Bihar, India.

Visceral Leishmaniasis (VL) is a neglected vector-borne disease. In India, it is transmitted to humans by Leishmania donovani-infected Phlebotomus argentipes sand flies. In 2005, VL was targeted for elimination by the governments of India, Nepal and Bangladesh by 2015. The elimination strategy consists of rapid case detection, treatment of VL cases and vector control using indoor residual spraying (IRS). However, to achieve sustained elimination of VL, an appropriate post elimination surveillance programme should be designed, and crucial knowledge gaps in vector bionomics, human infection and transmission need to be addressed. This review examines the outstanding knowledge gaps, specifically in the context of Bihar State, India.The knowledge gaps in vector bionomics that will be of immediate benefit to current control operations include better estimates of human biting rates and natural infection rates of P. argentipes, with L. donovani, and how these vary spatially, temporally and in response to IRS. The relative importance of indoor and outdoor transmission, and how P. argentipes disperse, are also unknown. With respect to human transmission it is important to use a range of diagnostic tools to distinguish individuals in endemic communities into those who: 1) are to going to progress to clinical VL, 2) are immune/refractory to infection and 3) have had past exposure to sand flies.It is crucial to keep in mind that close to elimination, and post-elimination, VL cases will become infrequent, so it is vital to define what the surveillance programme should target and how it should be designed to prevent resurgence. Therefore, a better understanding of the transmission dynamics of VL, in particular of how rates of infection in humans and sand flies vary as functions of each other, is required to guide VL elimination efforts and ensure sustained elimination in the Indian subcontinent. By collecting contemporary entomological and human data in the same geographical locations, more precise epidemiological models can be produced. The suite of data collected can also be used to inform the national programme if supplementary vector control tools, in addition to IRS, are required to address the issues of people sleeping outside.

HIV testing patterns for United States Air Force personnel, 2008–2012

ObjectiveThis study evaluated 3rd generation human immunodeficiency virus (HIV) test patterns and HIV infection rates in the United States Air Force (USAF). Study designRetrospective database study. MethodsHIV enzyme-linked immunoassay (ELISA) and Western blot tests were analysed for all USAF personnel from 2008 to 2012. For new HIV cases, unadjusted and adjusted annual rates were calculated per 100,000 persons. ResultsIn total, 1,608,665 tests were performed in 626,298 individuals, with a reactive ELISA observed in 809 (0.001%) persons. Western blot (n = 1949) results included 378 (19.4%) positive, 1283 (65.8%) negative, and 288 (15.0%) indeterminate (WBi). Unadjusted annual HIV rates were between 16.7 and 20.6 per 100,000 persons during the study period. The overall age-adjusted rate was 14.8 cases per 100,000 persons tested. Blacks/African Americans had the highest risk of HIV (risk ratio 7.9 [95% confidence interval 5.78, 9.95] compared to Whites). ConclusionsWBi results, which can cause delays in determining HIV status, were relatively common with the 3rd generation assay. However, this will be mitigated by a planned transition to a 4th generation assay. Although the overall rate of HIV in the USAF is lower than US civilian adults, HIV prevention efforts targeting young Blacks/African Americans may help to reduce HIV incidence in the USAF.

A Meta-Analysis of the Prevalence of Influenza A H5N1 and H7N9 Infection in Birds.

Despite a much higher rate of human influenza A (H7N9) infection compared to influenza A (H5N1), and the assumption that birds are the source of human infection, detection rates of H7N9 in birds are lower than those of H5N1. This raises a question about the role of birds in the spread and transmission of H7N9 to humans. We conducted a meta-analysis of overall prevalence of H5N1 and H7N9 in different bird populations (domestic poultry, wild birds) and different environments (live bird markets, commercial poultry farms, wild habitats). The electronic database, Scopus, was searched for published papers, and Google was searched for country surveillance reports. A random effect meta-analysis model was used to produce pooled estimates of the prevalence of H5N1 and H7N9 for various subcategories. A random effects logistic regression model was used to compare prevalence rates between H5N1 and H7N9. Both viruses have low prevalence across all bird populations. Significant differences in prevalence rates were observed in domestic birds, farm settings, for pathogen and antibody testing, and during routine surveillance. Random effects logistic regression analyses show that among domestic birds, the prevalence of H5N1 is 47.48 (95% CI: 17.15-133.13, P<0.001) times higher than H7N9. In routine surveillance (where surveillance was not conducted in response to human infections or bird outbreaks), the prevalence of H5N1 is still higher than H7N9 with an OR of 43.02 (95% CI: 16.60-111.53, P<0.001). H7N9 in humans has occurred at a rate approximately four times higher than H5N1, and for both infections, birds are postulated to be the source. Much lower rates of H7N9 in birds compared to H5N1 raise doubts about birds as the sole source of high rates of human H7N9 infection. Other sources of transmission of H7N9 need to be considered and explored.

Is There an Association between Bacterial Vaginosis Infection and HIV-1 Infection Acquisition among Women Aged 18 - 35 Years in Soweto?

Background: Studies suggest that there is association between Bacterial Vaginosis and Human Immunodeficiency Virus infection but its temporal effect has not been sufficiently investigated. Methods: It is a secondary data analysis following a cohort study. It was carried out to describe Bacterial Vaginosis infection association to Human Immunodeficiency Virus acquisition. The primary cohort study registered 750 study participants. A gram stain slide prepared from a vaginal swab was used to measure Bacterial Vaginosis as the primary exposure. A score of 7 or above was considered positive for Bacterial Vaginosis. The determination of the dependent variable Human Immunodeficiency Virus infection was achieved through dual rapid tests which were confirmed by using a third generation ELISA. Incident Human Immunodeficiency Virus infection rate was calculated. To test significance, Kaplan Meier survival time analysis and log rank test were carried out. The association of Bacterial Vaginosis with Human Immunodeficiency Virus infection was investigated using Cox regression. Results: The baseline prevalence of Bacterial Vaginosis was 52%, 95% CI; 45 - 59. There were 21 Human Immunodeficiency Virus seroconversions in total of which 7 had no Bacterial Vaginosis results and were left out in the analysis. The analysis only involved 14 seroconversions and these were followed for a mean time of 0.40 of a year and total time at risk of 286 person years. This shows incident rate of Human Immunodeficiency Virus infection of 4.9 per 100 person years of follow up, 95 % CI: 2.9 - 8.27. Kaplan Meier curves revealed a higher risk of incident infection among women who were Bacterial Vaginosis positive than the women who were Bacterial Vaginosis negative. A log rank test showed that the probability of incident infection differed among the women depending on Bacterial Vaginosis status, X2 value 3.8, p value 0.05. Adjusting for the other variables, incident Human Immunodeficiency Virus infection was high among Bacterial Vaginosis positive women, adjusted hazard ratio 3.21; 95% CI; 0.85 - 12.12, p value 0.08, though significance was not attained. Conclusion: The study showed an association between Bacterial Vaginosis and Human Immunodeficiency Virus seroconversion risk though statistical significance was not achieved. Education on vaginal cleansing, screening and treating women with Bacterial Vaginosis could maintain normal vaginal flora and reduce their vulnerability to Human Immunodeficiency Virus.

Low rate of oropharyngeal human papillomavirus infection among women with cervical lesion. Preliminary results from the South-Eastern Hungarian population

Although the natural history of cervical and oral human papillomavirus infection has been intensively investigated in the past years, the ability of this virus to infect oral and genital mucosae in the same individual and its potential to co-infect both cervical and oral mucosa are still unclear. The aim of the authors was to assess the presence of oropharyngeal human papillomavirus infection in women with cervical lesions in the South-Eastern Hungarian population. The total of 103 women have been included in the study between March 1, 2013 and January 1, 2015. Brushing was used to collect cells from the oropharyngeal mucosa. Human papillomavirus DNA was detected using polymerase chain reaction, and Amplicor line blot test was used for genotyping. Oropharyngeal human papillomavirus infection was detected in 2 cases (3%). The detected genotypes were 31, 40/61 and 73 in the oropharyngeal region. The results indicate that in women with cervical lesions oropharyngeal human papillomavirus infection rarely occurs.

Evaluation of end-term effectiveness of medium-and-long-term programme for schistosomiasis control in Fanchang County, Anhui Province

To evaluate the end-term effectiveness of the medium-and-long-term programme for prevention and control of schistosomiasis in Fanchang County, Anhui Province. The epidemiological data of schistosomiasis were collected and analyzed in Fanchang County from 2004 to 2014. The end-term effectiveness of the programme was observed and evaluated. From 2004 to 2014, 1 938 schistosomiasis patients and 64 256 persons with the history of infested water contact were treated. Totally 12 cattle-times of schistosome infected cattle and 2 745 cattle-times of cattle with the history of infested water contact were treated. The area with snails controlled by molluscicides was 7 758.1 hm2, and the area with snails controlled by environmental modification was 36.0 hm2. The integrated control measures were carried out in all of the endemic villages with human infection rate being higher than 1%. Up to 2014, the infection rates of human and cattle, and the incidence rate of acute schistosomiasis were reduced to 0.27%, 0 and 0, respectively; the area with snails reduced to 103.20 hm2; the densities of both living snails and infected snails showed a declining trend in general. The effect of the integrated strategies of schistosomiasis control is remarkable, and the whole county reached the criteria of transmission-controlled of schistosomiasis.

Structure/Function Studies Involving the V3 Region of the HIV-1 Envelope Delineate Multiple Factors That Affect Neutralization Sensitivity.

ABSTRACTAntibodies (Abs) specific for the V3 loop of the HIV-1 gp120 envelope neutralize most tier 1 and many tier 2 viruses and are present in essentially all HIV-infected individuals as well as immunized humans and animals. Vaccine-induced V3 Abs are associated with reduced HIV infection rates in humans and affect the nature of transmitted viruses in infected vaccinees, despite the fact that V3 is often occluded in the envelope trimer. Here, we link structural and experimental data showing how conformational alterations of the envelope trimer render viruses exceptionally sensitive to V3 Abs. The experiments interrogated the neutralization sensitivity of pseudoviruses with single amino acid mutations in various regions of gp120 that were predicted to alter packing of the V3 loop in the Env trimer. The results indicate that the V3 loop is metastable in the envelope trimer on the virion surface, flickering between states in which V3 is either occluded or available for binding to chemokine receptors (leading to infection) and to V3 Abs (leading to virus neutralization). The spring-loaded V3 in the envelope trimer is easily released by disruption of the stability of the V3 pocket in the unliganded trimer or disruption of favorable V3/pocket interactions. Formation of the V3 pocket requires appropriate positioning of the V1V2 domain, which is, in turn, dependent on the conformation of the bridging sheet and on the stability of the V1V2 B-C strand-connecting loop.IMPORTANCE The levels of antibodies to the third variable region (V3) of the HIV envelope protein correlate with reduced HIV infection rates. Previous studies showed that V3 is often occluded, as it sits in a pocket of the envelope trimer on the surface of virions; however, the trimer is flexible, allowing occluded portions of the envelope (like V3) to flicker into an exposed position that binds antibodies. Here we provide a systematic interrogation of mechanisms by which single amino acid changes in various regions of gp120 (i) render viruses sensitive to neutralization by V3 antibodies, (ii) result in altered packing of the V3 loop, and (iii) activate an open conformation that exposes V3 to the effects of V3 Abs. Taken together, these and previous studies explain how V3 antibodies can protect against HIV-1 infection and why they should be one of the targets of vaccine-induced antibodies.

An avian influenza A (H7N9) virus vaccine candidate based on the fusion protein of hemagglutinin globular head and Salmonella typhimurium flagellin.

BackgroundA novel influenza virus, subtype H7N9, circulated through China in 2013–2014. Its higher rates of human infection in a wide range of locations within China and the associated increased likelihood of human-to-human transmission have caused global concern. Recombinant subunit vaccines provide safe and targeted protection against viral infections. However, the protective efficacy of recombinant subunit vaccines tends to be less potent than vaccines made from whole viruses. Studies have shown that bacterial flagellin has strong adjuvant activity and induces protective immune responses.ResultsIn this study, we used overlap-PCR to generate an H7N9 influenza recombinant subunit vaccine that fused the globular head domain (HA1-2, aa 62–284) of the protective hemagglutinin (HA) antigen with the potent TLR5 ligand, Salmonella typhimurium flagellin (fliC). The resulting fusion protein, HA1-2-fliC, was efficiently expressed in an Escherichia coli prokaryotic expression system, and Western blotting and TLR5-stimulating activity analysis confirmed that the HA1-2-fliC moiety could be faithfully refolded to take on the native HA and fliC conformations. In a C3H/HeJ mouse model of intraperitoneal vaccination, the fusion protein elicited significant and robust HA1-2-specific serum IgG titers, maintaining high levels for at least 3 months in the vaccinated animals, and induced similar levels of HA1-2-specific IgG1 and IgG2a that were detectable 12 days after the third immunization. HA1-2-fliC was also found to be capable of triggering the production of neutralizing antibodies, as assessed by measuring hemagglutination inhibition titers.ConclusionsWe conclude that immunization with HA1-2-fliC induces potent HA1-2-specific responses, offering significant promise for the development of a successful recombinant subunit vaccine for avian influenza A (H7N9).

Great cities look small.

Great cities connect people; failed cities isolate people. Despite the fundamental importance of physical, face-to-face social ties in the functioning of cities, these connectivity networks are not explicitly observed in their entirety. Attempts at estimating them often rely on unrealistic over-simplifications such as the assumption of spatial homogeneity. Here we propose a mathematical model of human interactions in terms of a local strategy of maximizing the number of beneficial connections attainable under the constraint of limited individual travelling-time budgets. By incorporating census and openly available online multi-modal transport data, we are able to characterize the connectivity of geometrically and topologically complex cities. Beyond providing a candidate measure of greatness, this model allows one to quantify and assess the impact of transport developments, population growth, and other infrastructure and demographic changes on a city. Supported by validations of gross domestic product and human immunodeficiency virus infection rates across US metropolitan areas, we illustrate the effect of changes in local and city-wide connectivities by considering the economic impact of two contemporary inter- and intra-city transport developments in the UK: High Speed 2 and London Crossrail. This derivation of the model suggests that the scaling of different urban indicators with population size has an explicitly mechanistic origin.

Prevalence of oral and oropharyngeal human papillomavirus infection in Brazilian population studies: a systematic review

IntroductionHuman papillomavirus has been associated with head and neck squamous cell carcinoma. However, there is no conclusive evidence on the prevalence of oral or pharyngeal infection by human papillomavirus in the Brazilian population. ObjectiveTo determine the rate of human papillomavirus infection in the Brazilian population. MethodsSystematic review of published articles. Medline, The Cochrane Library, Embase, Lilacs (Latin American and Caribbean Health Sciences) and Scielo electronic databases were searched. The search included published articles up to December 2014 in Portuguese, Spanish and English. A wide search strategy was employed in order to avoid publication biases and to assess studies dealing only with oral and/or oropharyngeal human papillomavirus infections in the Brazilian population. ResultsThe 42 selected articles enrolled 4066 patients. It was observed that oral or oropharyngeal human papillomavirus infections were identified in 738 patients (18.2%; IC 95 17.6–18.8), varying between 0.0% and 91.9%. The prevalences of oral or oropharyngeal human papillomavirus infections were respectively 6.2%, 44.6%, 44.4%, 27.4%, 38.5% and 11.9% for healthy people, those with benign oral lesions, pre-malignant lesions, oral or oropharyngeal squamous cell carcinoma, risk groups (patients with genital human papillomavirus lesions or infected partners) and immunocompromised patients. The risk of human papillomavirus infection was estimated for each subgroup and it was evident that, when compared to the healthy population, the risk of human papillomavirus infection was approximately 1.5–9.0 times higher, especially in patients with an immunodeficiency, oral lesions and squamous cell carcinoma. The rates of the most well-known oncogenic types (human papillomavirus 16 and/or 18) also show this increased risk. ConclusionsGlobally, the Brazilian healthy population has a very low oral human papillomavirus infection rate. Other groups, such as at-risk patients or their partners, immunocompromised patients, people with oral lesions and patients with oral cavity or oropharyngeal squamous cell carcinoma have a high risk of human papillomavirus infection.

Human embryonic lung fibroblasts treated with artesunate exhibit reduced rates of proliferation and human cytomegalovirus infection in vitro.

Cytomegalovirus (CMV) pneumonia is a major cause of death in immunosuppressed patients. Despite the effective treatment with ganciclovir (GCV) and other antiviral agents, the mortality rate remains between 30% to 50%. Recently, the anti-malarial drug artesunate (ART) wasfound to exhibit significant anti-viral activity. Here, we examined the effects of ART on human cytomegalovirus (HCMV) infection and human embryonic lung fibroblast (HELF) proliferation in vitro. HELFs infected with the GFP-expressing Towne-BAC strain of HCMV were divided into three treatment groups: Group I, cells treated with ART for 1.5 h before HCMV inoculation; Group II, cells infected with HCMV that was pre-treated with ART for 1.5 h before HCMV inoculation; Group III, cells that were treated with ART at 1.5 h post-HCMV inoculation. GFP expression was observed daily by fluorescence microscopy, and the number of GFP-positive cells in each experimental group was recorded at 4-5 days post-infection. At 10 days post-infection, the viability of cells in each group was recorded. GCV treatment was used as a control. While no significant effects on cytotoxicity, cell viability, viral infection rates, or antiviral activity were observed upon treatment of Group I or II cells with GCV or low levels of ART, the ART-treated Group III population exhibited significantly reduced rates of infection at drug concentrations higher than 12.5 µM. Similarly, we observed a GCV concentration-dependent reduction in the viral infection rate in Group III cells. Notably, ART-treated, but not GCV-treated, cells also exhibited decreased proliferation. The 50% cytostatic concentrations (CC50) and the half maximal inhibitory concentrations (IC50) of ART and GCV were 54.382 µM and 12.679 µM, and 3.76 M and 14.479 µM, respectively. In addition to its robust antiviral activity, ART inhibits proliferation of HCMV-infected lung fibroblasts, making it a potential next-generation drug for CMV pneumonia treatment and for reducing fibroproliferation and fibrosis in these patients.

Outbreak of Tuberculosis in a Colony of Rhesus Monkeys (Macaca mulatta) after Possible Indirect Contact with a Human TB Patient

Simian tuberculosis is one of the most important bacterial diseases of non-human primates. Outbreaks of tuberculosis have been reported in primate colonies almost as long as these animals have been used experimentally or kept in zoological gardens. Significant progress has been made in reducing the incidence of tuberculosis in captive non-human primates, but despite reasonable precautions, outbreaks continue to occur. The most relevant reason is the high incidence of tuberculosis (TB) amongst the human population, in which tuberculosis is regarded as an important re-emerging disease. Furthermore, many non-human primate species originate from countries with a high burden of human TB. Therefore, Mycobacterium tuberculosis remains a significant threat in animals imported from countries with high rates of human infection. We report an outbreak of tuberculosis among a group of rhesus monkeys (Macaca mulatta) living in a closed, long-term colony. The outbreak coincided with reactivation of a TB infection in a co-worker who never had direct access to the animal house or laboratories. Eleven of 26 rhesus monkeys developed classical chronic active tuberculosis with typical caseous granulomata of varying size within different organs. The main organ system involved was the lung, suggesting an aerosol route of infection. Such an outbreak has significant economic consequences due to animal loss, disruption of research and costs related to disease control. Precautionary measures must be improved in order to avoid TB in non-human primate colonies.

Genetic diversity of Brucella abortus and Brucella melitensis in Kazakhstan using MLVA-16

Brucellosis is an endemic disease in Central Asia characterized by high infection rates in humans and animals. Currently, little is known about the genetic diversity of Brucella spp. circulating in the region, despite the high prevalence of brucellosis. This study aimed to analyze the genetic diversity of Brucella melitensis and Brucella abortus strains circulating in the Republic of Kazakhstan. We genotyped 128 B. melitensis and 124 B. abortus strains collected in regions with the highest prevalence of brucellosis. Genotyping was performed using multi-locus variable-number tandem-repeat analysis (MLVA). Analysis of a subset of 8 loci (MLVA-8) of 128 B. melitensis strains identified genotypes 42 (n=108), 43 (n=2), and 63 (n=19) related to the ‘East Mediterranean’ group. An MLVA-16 assay sorted 128 B. melitensis strains into 25 different genotypes. Excluding one variable locus, MLVA-15 of B. melitensis was distinct from strains originating in the Mediterranean region; however, 77% of them were identical to strains isolated in China. A minimum spanning tree for B. melitensis using MLVA-15 analysis clustered the local strains together with strains previously collected in China. MLVA-8 analysis of 124 B. abortus strains identified them as genotype 36, suggesting Eurasian distribution of this lineage. Complete MLVA-16 assay analysis clustered the strains into five genotypes, revealing little diversity of B. abortus when compared on the global scale. A minimum spanning tree for B. abortus obtained using MLVA-15 analysis clustered the 2 most prevalent genotypes (n=117) together with strains previously collected in China. Thus, MLVA analysis was used to characterize 252 strains of Brucella collected in Kazakhstan. The analysis revealed genetic homogeneity among the strains. Interestingly, identical MLVA-15 profiles were found in seemingly unrelated outbreaks in China, Turkey, and Kazakhstan. Further analysis is needed for better understanding of the epidemiology of brucellosis in Asia.

Distribution of Fasciola hepatica and F. gigantica in the endemic area of Guilan, Iran: Relationships between zonal overlap and phenotypic traits

Fascioliasis is a zoonotic disease emerging in numerous parts of the world. In any endemic area, the characterisation of scenarios and patterns of infection must always be considered the starting point before implementing any control measure. Fascioliasis is a parasitic disease of different epidemiological, pathological and control characteristics depending on the endemic area and the causal agent, Fasciola hepatica and Fasciolagigantica. Classically it has been accepted that F. hepatica is present worldwide, while the distribution of the two species overlaps in many areas of Africa and Asia. Fascioliasis caused by F. hepatica, F. gigantica and intermediate forms is present in Guilan province, a complicated epidemiological situation where the highest human infection rates have been described in Iran. Morphometric tools were used to analyse the possible relationship between liver-fluke metric traits and geographical and altitudinal distribution. This is the first study in which a detailed distribution of both Fasciola species is analysed in a human fascioliasis endemic area with a zonal overlap transmission pattern. An accurate analysis was conducted to phenotypically discriminate between fasciolids from naturally infected livestock (cattle, buffaloes, sheep and goats). The distribution of the % F. hepatica-like (F.h.) and F. gigantica-like (F.g.) flukes detected in each liver versus altitude (m) in each group was analysed. The presence of F.g. specimens mainly in locations below sea level (average: 11.23% F.h., 88.77% F.g.), the presence of both species with similar intensity at 1–99m (average: 56.95% F.h., 43.05% F.g.) and the presence of F.h. specimens mainly from 100 to 999m (average: 71.69% F.h., 28.31% F.g.) as well as in locations with an altitude above 1000m (average: 97.48% F.h., 2.52% F.g.) are noteworthy. A significant positive correlation was obtained between altitude and % F.h., and a significant negative correlation was obtained between altitude and % F.g. The results show that F.g. populations in cattle, buffaloes and sheep share larger size values, but smaller specimens are present mainly in lowland populations located below sea level, independently of the host species (cattle, buffalo). F.g. from lowland cattle presented larger worm size variability. Four different fascioliasis transmission areas may be distinguished in Guilan: (a) lowland coastal areas neighbouring the Caspian Sea shore, below sea level, where basically F. gigantica-like specimens are found; (b) a coastal plain with an altitude between 1 and 100m where both species co-exist; (c) areas with altitude values of 100–999m where mainly F. hepatica-like specimens are found; (d) highland mountainous areas, where basically F. hepatica-like specimens are found. The study of the influence of the host species on the liver fluke was also carried out by a size-out analysis. This is the first report concerning the decisive influence exercised by the host species on the metric traits of F. gigantica adults.

Low rate of oropharyngeal human papillomavirus infection of women with cervical lesions and their partners: new data from Brazilian population

Although the natural history of cervical and oral infection by human papillomavirus (HPV) has been intensely investigated, the ability of this virus to infect oral and genital mucosae in the same individual and its potential of communicability are still unclear. This study aimed at assessing the presence of oropharyngeal HPV infection in women with cervical lesions and in their current sexual partners in a Brazilian population. It included a total of 65 patients, 43 women and 22 male partners. Medical history and the sociobehavioral profile were assessed through interviews that included the association of oropharyngeal HPV and the sexual behavior of patients, and also extra and intra-oral examinations were performed. Brushing was used to collect cells from the oropharyngeal mucosa. HPV DNA was checked through nested PCR with primers PGMY09/11 and GP5+/6+, and Pappilocheck to genotyping. Oropharyngeal HPV infection was detected in four of 65 (6.15%) cases, with one of 43 (2.3%) women, and three of 22 (13.6%) male partners. Clinically no patient showed HPV-related oral lesions. Pappilocheck assay showed the absence of HPV genotype commonly found in cervical mucosa. Moreover, there was no correlation between the presence of oropharyngeal HPV and sexual behavior risk factors. The results suggest that the presence of cervical lesions does not lead to HPV oropharyngeal infection. It also highlights the low rate of HPV infection in the oropharyngeal mucosa of women with cervical lesions and their partners in a researched sample.

Fasciola gigantica transmission in the zoonotic fascioliasis endemic lowlands of Guilan, Iran: Experimental assessment

The lowland flatlands around the city of Bandar-Anzali, at the Caspian Sea shore, Guilan province, are an endemic area where Fasciola gigantica appears to be the fasciolid species involved and past outbreaks affecting around 15,000 people and the highest human infection rates in Iran have been reported. Fascioliasis transmission in that area has been experimentally analysed for the first time, by means of assays of monomiracidial (Group A: 120 snails) and pentamiracidial (Group B: 96 snails) infections of local Radix lymnaeid snails with a local cattle F. gigantica isolate. Ribosomal DNA ITS-2 sequencing proved that Lymnaea (Radix) gedrosiana should henceforth be considered a synonym of Radix auricularia, the haplotype found in Bandar-Anzali being identical to that found in many European countries. Survival rates at day 30 postinfection and metacercarial productivity (both higher in Group A) and longevity of the shedding snails (higher in Group B), were affected by the miracidial dose, whereas prepatent period, patent period, infection rate, and the percentages of shedding and infected non-shedding snails did not. The higher percentage of shedding snails in Group A (51.0% versus 37.7%) counteracts the higher number of metacercariae produced in Group B (243.9±259.2 versus 157.2±153.2). High numbers of shedding snails in both experimental groups passed less than 100 cercariae, and 16% in Group A and 35% in Group B produced more than 300 metacercariae, while only four snails (8%) in Group A and two snails (10%) in Group B shed more than 500 metacercariae. Most metacercariae (94.7% in Group A and 85.1% in Group B) were recorded during the first 15 days of patent period. The comparison with results from other fasciolid/lymnaeid systems indicates that the F. gigantica/R. auricularia system of Guilan is highly susceptible and compatible. Results obtained suggest that increased lymnaeid vector populations and not polymiracidial snail infections most probably underlay the human outbreaks in the past. The climatic analyses suggest a long fascioliasis transmission period in the Bandar-Anzali area covering from May to the end of November regarding permanent water bodies, a transmission season window widening in rice fields and irrigation canals, and a shortening of the transmission period from only end of August to beginning of November in temporary water bodies.

Trends in childhood drug-resistant tuberculosis in South Africa: a window into the wider epidemic?

Childhood tuberculosis (TB) is a marker of TB transmission within a community. We present the fourth consecutive survey of children with culture-confirmed TB at a hospital in Cape Town, South Africa, from 2009 to 2011. In comparison to the previous survey, the rate of multidrug-resistant TB (MDR-TB) has stabilised and the human immunodeficiency virus infection rate has declined. We also report on the first systematic surveillance of resistance to second-line drugs. Two concerns following from this are the high rate (22%) of ofloxacin resistance in MDR-TB isolates, and the discordance between isolates with an inhA promoter region mutation, usually implying ethionamide (ETH) resistance, and phenotypic ETH results in these isolates showing ETH susceptibility.