Reinfection Rate Research Articles

Core-genome-mediated promising alternative drug and multi-epitope vaccine targets prioritization against infectious Clostridium difficile.

Prevention of Clostridium difficile infection is challenging worldwide owing to its high morbidity and mortality rates. C. difficile is currently being classified as an urgent threat by the CDC. Devising a new therapeutic strategy become indispensable against C. difficile infection due to its high rates of reinfection and increasing antimicrobial resistance. The current study is based on core proteome data of C. difficile to identify promising vaccine and drug candidates. Immunoinformatics and vaccinomics approaches were employed to construct multi-epitope-based chimeric vaccine constructs from top-ranked T- and B-cell epitopes. The efficacy of the designed vaccine was assessed by immunological analysis, immune receptor binding potential and immune simulation analyses. Additionally, subtractive proteomics and druggability analyses prioritized several promising and alternative drug targets against C. difficile. These include FMN-dependent nitroreductase which was prioritized for pharmacophore-based virtual screening of druggable molecule databases to predict potent inhibitors. A MolPort-001-785-965 druggable molecule was found to exhibit significant binding affinity with the conserved residues of FMN-dependent nitroreductase. The experimental validation of the therapeutic targets prioritized in the current study may worthy to identify new strategies to combat the drug-resistant C. difficile infection.

Evaluation of the healing potential of short-term ozone therapy for the treatment of diabetic foot ulcers.

The availability of research on short-term ozone therapy for diabetic foot ulcers (DFUs) is limited, and even when it is accessible, it mainly comprises of basic analysis conducted during long-term ozone therapy. This study was to evaluate the efficacy of short-term ozone therapy in promoting wound healing in DFUs. A retrospective analysis was conducted on 89 patients with type 2 diabetes complicated by DFUs. The patients were divided into two groups: ozone therapy group (n=41) and control group (n=48). Wound condition, change of bacterial types, changes in inflammatory indicators (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]), vascular endothelial growth factor (VEGF), cytokines [Interleukin 6 (IL-6) and tumor necrosis factor-α(TNF-α)], and oxidative stress levels (superoxide dismutase [SOD], malondialdehyde [MDA], and total antioxidant capacity [T-AOC]) were observed pre-treatment and after 1 week. After a 12-week of follow-up, wound healing rate, amputation rate, inpatient day, duration of antibiotics, reinfection rate, incidence of new ulcers, readmission rate, and reoperation rate, and cumulative wound healing rate using Kaplan-Meier curves were assessed. After 1 week of treatment, the ozone therapy group showed higher VEGF, SOD, and T-AOC levels compared to the control group (P<0.05), while CRP, PCT, ESR, IL-6, TNF-α, MDA levels and bacterial types were lower (P<0.05). The ozone therapy group had a higher wound healing rate after a 12-week follow-up (P<0.05). Kaplan-Meier curves indicated a higher cumulative wound healing rate in the ozone therapy group (P<0.05). Additionally, the ozone therapy group had lower inpatient day, duration of antibiotics, reinfection rate, and readmission rate compared to the control group (P<0.05). Short-term ozone therapy is effective in promoting wound healing in DFUs by reducing inflammation, increasing growth factor levels, improving oxidative stress status, shortening healing time, and improving long-term prognosis. These findings suggest the potential of short-term ozone therapy as a valuable treatment modality for DFUs.

Frequency and risk of SARS-CoV-2 reinfections in Norway: a nation-wide study, February 2020 to January 2022

BackgroundSARS-CoV-2 reinfection rates have been shown to vary depending on the circulating variant, vaccination status and background immunity, as well as the time interval used to identify reinfections. This study describes the frequency of SARS-CoV-2 reinfections in Norway using different time intervals and assesses potential factors that could impact the risk of reinfections during the different variant waves.MethodsWe used linked individual-level data from national registries to conduct a retrospective cohort study including all cases with a positive test for SARS-CoV-2 from February 2020 to January 2022. Time intervals of 30, 60, 90 or 180 days between positive tests were used to define potential reinfections. A multivariable Cox regression model was used to assess the risk of reinfection in terms of variants adjusting for vaccination status, demographic factors, and underlying comorbidities.ResultsThe reinfection rate varied between 0.2%, 0.6% and 5.9% during the Alpha, Delta and early Omicron waves, respectively. In the multivariable model, younger age groups were associated with a higher risk of reinfection compared to older age groups, whereas vaccination was associated with protection against reinfection. Moreover, the risk of reinfection followed a pattern similar to risk of first infection. Individuals infected early in the pandemic had higher risk of reinfection than individuals infected in more recent waves.ConclusionsReinfections increased markedly during the Omicron wave. Younger individuals, and primary infections during earlier waves were associated with an increased reinfection risk compared to primary infections during more recent waves, whereas vaccination was a protective factor. Our results highlight the importance of age and post infection waning immunity and are relevant when evaluating vaccination polices.

Trichomoniasis and retesting in Durham County, North Carolina, United States, 2021 - 2022.

The Centers for Disease Control and Prevention recommends universal retesting within 3months after treatment of Trichomonas vaginalis infection given high rates of persistent infection or reinfection, or if this is not possible, within 12months following treatment. Data is lacking on how often this is actually done. We analyzed the demographic and clinical characteristics, rate of return for the recommended retesting, concordance between wet prep and nucleic acid amplification testing, and percent positivity for T. vaginalis on repeat vaginal specimens at a local public health department in Durham, North Carolina, United States. Of 193 females treated for trichomoniasis between March 1, 2021 - May 31, 2022, 83% were Black or African American and 44% between the ages of 20 and 29years. Of these individuals, 32% had retesting performed within 3 months and 50% within 365days after treatment. Females between the ages of 20 and 29years were more likely to return for retesting than those between the ages of 30 and 39 years. Of those who returned for retesting, 10% were positive on repeat testing. In this study, 50% of females diagnosed with trichomoniasis completed retesting within 365days. Improved scheduling of clients at the time of trichomoniasis treatment and improved identification in our electronic health record of individuals diagnosed with trichomoniasis within the prior year would likely improve retesting rates. Given the high prevalence of trichomoniasis, expanded screening of asymptomatic females in settings where this is feasible may be warranted.

Two versus three doses of COVID-19 vaccine and post-vaccination COVID-19 infection in hemodialysis patients

Background and aimPatients with chronic kidney disease including those undergoing hemodialysis (HD) constitute a particularly challenging group regarding COVID-19 vaccination. The present study aimed to compare the rate of reinfection after two and three doses of Sinopharm COVID-19 vaccine in HD patients. Patients and methodsThe study included 80 HD patients who received three doses of Sinopharm COVID-19 vaccine. In addition, there were another 80 patients who received only two doses of the vaccine. Patients in the latter group were selected based on propensity matching score with 1:1 ratio. Patients were monitored for post-vaccination COVID-19 infection using PCR examination of nasopharyngeal swabs. Patients were also monitored for post-vaccination complications including general complaints (headache, fever, fatigue), injection site complaints (arm pain, swelling, itching, rash), musculoskeletal complaints (muscle spasm or pain, joint pain) and others. All patients were followed for six months. ResultsThe present study included 80 patients submitted to COVID-19 vaccination with two doses of Sinopharm vaccine (GI) and other 80 patients who received three doses of the same vaccine (GII). At the end of follow up, 11 patients (13.8 %) in GI caught COVID-19 infection. In contrast, no patient in GII had infection (p<0.001). Comparison between patients who had COVID-19 infection and those without infection revealed that the former subgroup had significantly lower BMI (23.3 ± 2.3 versus 27.5 ± 8.1 Kg/m2), higher frequency of associated Hepatitis C (HCV) infection (54.6 % versus 2.9 %, p<0.001) and higher serum ferritin levels [median (IQR): 1101.0 (836.0-1564.0) versus 675.0 (467.0-767.7) ng/mL, p=0.01]. Binary logistic regression analysis identified high serum ferritin levels [OR (95% CI): 0.014 (0.001-0.15), p<0.001] and associated HCV infection [OR (95% CI): 0.99 (0.98-1.01), p=0.02] as significant predictors of post-vaccination COVID-19 infection in multivariate analysis. ConclusionsA three dose regime of Sinopharm COVID-19 vaccine associated with significantly lower rate of reinfection COVID-19 infection in HD patients. Infected patients had significantly lower BMI, higher frequency of HCV and higher ferritin levels.

COVID-19 reinfection in Afghanistan: A descriptive analysis of data from DHIS2, 2022

Background: Despite millions of COVID-19 infections worldwide since the beginning of the pandemic, relatively few confirmed cases of COVID-19 reinfection have been reported. In Afghanistan, COVID-19 undetected cases are more than detected cases. This study aims to describe the burden of COVID-19 reinfection cases in Afghanistan, along with the epidemiological and demographical patterns. Methods: A descriptive study of national-wide secondary data on COVID-19 reinfection cases was carried out from January to June 2022. Data were extracted from the District Health Information Software 2 (DHIS2) and managed and analyzed using Microsoft Excel and Epi Info V.7.2.1. Results: In 2022, 79 reinfection cases of COVID-19 were reported, with males being more affected than females. The mean age of re-infected patients was 39, with most from Wardak province. Most cases occurred within six months after the primary infection. Cough was more prevalent among reinfected cases. Only 26 patients had taken two doses of the vaccine, while 44 (55.70%) had not received it. Out of all cases, 44 (55.70%) were recovered and 5 (6.85%) died. Conclusion: The COVID-19 reinfection rate is very low in Afghanistan, which was common in males since other cases might be unreported. Coughing was more common among reinfection patients. Relying on the results, vaccination and awareness-raising may play a protective role in reinfection; hence, enhancement of vaccination and taking preventive measures are recommended to prevent further reinfection.

Vaccine Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection by Type and Frequency of Vaccine: A Community-Based Case-Control Study.

Although guidelines recommend vaccination for individuals who have recovered from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to prevent reinfection, comprehensive evaluation studies are limited. We aimed to evaluate vaccine effectiveness against SARS-CoV-2 reinfection according to the primary vaccination status, booster vaccination status, and vaccination methods used. This population-based case-control study enrolled all SARS-CoV-2-infected patients in Seoul between January 2020 and February 2022. Individuals were categorized into case (reinfection) and control (no reinfection) groups. Data were analyzed using conditional logistic regression after adjusting for underlying comorbidities using multiple regression. The case group included 7,678 participants (average age: 32.26 years). In all vaccinated individuals, patients who received the first and second booster doses showed reduced reinfection rates compared with individuals who received basic vaccination (odds ratio [OR] = 0.605, P < 0.001 and OR = 0.002, P < 0.001). Patients who received BNT162b2 or mRNA-1273, NVX-CoV2373 and heterologous vaccination showed reduced reinfection rates compared with unvaccinated individuals (OR = 0.546, P < 0.001; OR = 0.356, P < 0.001; and OR = 0.472, P < 0.001). However, the ChAdOx1-S or Ad26.COV2.S vaccination group showed a higher reinfection rate than the BNT162b2 or mRNA-1273 vaccination group (OR = 4.419, P < 0.001). In SARS-CoV-2-infected individuals, completion of the basic vaccination series showed significant protection against reinfection compared with no vaccination. If the first or second booster vaccination was received, the protective effect against reinfection was higher than that of basic vaccination; when vaccinated with BNT162b2 or mRNA-1273 only or heterologous vaccination, the protective effect was higher than that of ChAdOx1-S or Ad26.COV2.S vaccination only.

Prediction of daily new COVID-19 cases - Difficulties and possible solutions.

Epidemiological compartmental models, such as SEIR (Susceptible, Exposed, Infectious, and Recovered) models, have been generally used in analyzing epidemiological data and forecasting the trajectory of transmission of infectious diseases such as COVID-19. Experience shows that accurately forecasting the trajectory of COVID-19 transmission curve is a big challenge for researchers in the field of epidemiological modeling because multiple unquantified factors can affect the trajectory of COVID-19 transmission. In the past years, we used a new compartmental model, l-i SEIR model, to analyze the COVID-19 transmission trend in the United States. Unlike the conventional SEIR model and the delayed SEIR model that use or partially use the approximation of temporal homogeneity, the l-i SEIR model takes into account chronological order of infected individuals in both latent (l) period and infectious (i) period, and thus improves the accuracy in forecasting the trajectory of transmission of infectious diseases, especially during periods of rapid rise or fall in the number of infections. This paper describes (1) how to use the new SEIR model (a mechanistic model) combined with fitting methods to simulate or predict trajectory of COVID-19 transmission, (2) how social interventions and new variants of COVID-19 significantly change COVID-19 transmission trends by changing transmission rate coefficient βn, the fraction of susceptible people (Sn/N), and the reinfection rate, (3) why accurately forecasting COVID-19 transmission trends is difficult, (4) what are the strategies that we have used to improve the forecast outcome and (5) what are some successful examples that we have obtained.

Rate, risk factors, and clinical outcomes of SARS-CoV-2 reinfection vs. primary infection in readmitted COVID-19 patients in Iran: a retrospective cohort study.

Corona Virus Disease 2019 (COVID-19) has severely impacted global health, resulting in high morbidity and mortality, and overwhelming healthcare systems, particularly in Iran. Understanding reinfection is crucial as it has significant implications for immunity, public health strategies, and vaccine development. This study aims to identify rate and the risk factors associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) reinfection and compare the clinical course of initial infection versus reinfection in readmitted COVID-19 patients in Iran. This retrospective cohort study was conducted from January 2020 to the end of 2022 in five hospitals in Iran. The study compared demographic and clinical data, vaccination status, and clinical outcomes between patients with reinfection (defined as a positive PCR test for SARS-CoV-2 at least 90 days after the primary admission) and a control group (patients who had an initial confirmed SARS-CoV-2 infection but were not readmitted with a positive PCR test for SARS-CoV-2 at least 90 days after their primary infection). Risk factors for reinfection were evaluated using a regression model. Propensity score matching (PSM) was used to compare post-clinical and laboratory outcomes between the matched case and control groups. Out of 31,245 patients, 153 (0.49%) experienced reinfections. The reinfection rate was significantly higher during B.1.617.2 and B.1.1.529 variant wave (p < 0.001). After multivariable regression analysis, incomplete vaccination status (OR: 1.68, 95% CI: 1.34-2.31, p = 0.021) and lack of booster vaccination (OR: 2.48, 95% CI: 1.96-3.65, p = 0.001) were the risk factors for reinfection. Furthermore, reinfection was associated with atypical COVID-19 symptoms, and shorter ICU and hospital stays (p < 0.001). The B.1.1.529 variant was significantly more common among reinfected patients (p < 0.001). SARS-CoV-2 reinfections are more frequently observed during waves of novel variants and are associated with a milder clinical course and shorter hospital stays. Full vaccination and booster doses can effectively reduce the risk of SARS-CoV-2 reinfections.

Clinical and prognostic implications of hyaluronic acid in patients with COVID-19 reinfection and first infection.

Previous research has shown that human identical sequences of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) promote coronavirus disease 2019 (COVID-19) progression by upregulating hyaluronic acid (HA). However, the association of HA with mortality and long COVID in SARS-CoV-2 reinfection and first infection is unclear. Patients with COVID-19 at Beijing Ditan Hospital from September 2023 to November 2023 were consecutively enrolled. SARS-CoV-2 reinfections were matched 1:2 with first infections using a nearest neighbor propensity score matching algorithm. We compared the hospital outcomes between patients with COVID-19 reinfection and first infection. The association between HA levels and mortality and long COVID in the matched cohort was analyzed. The reinfection rate among COVID-19 hospitalized patients was 25.4% (62 cases). After propensity score matching, we found that reinfection was associated with a better clinical course and prognosis, including lower levels of C-reactive protein and erythrocyte sedimentation rate, fewer cases of bilateral lung infiltration and respiratory failure, and shorter viral clearance time and duration of symptoms (p < 0.05). HA levels were significantly higher in patients with primary infection [128.0 (90.5, 185.0) vs. 94.5 (62.0, 167.3), p = 0.008], those with prolonged viral clearance time [90.5 (61.5, 130.8) vs. 130.0 (95.0, 188.0), p < 0.001], and deceased patients [105.5 (76.8, 164.5) vs. 188.0 (118.0, 208.0), p = 0.002]. Further analysis showed that HA was an independent predictor of death (AUC: 0.789), and the risk of death increased by 4.435 times (OR = 5.435, 95% CI = 1.205-24.510, p = 0.028) in patients with high HA levels. We found that patients with HA levels above 116 ng/mL had an increased risk of death. However, the incidence of long COVID was similar in the different HA level groups (p > 0.05). Serum HA may serve as a novel biomarker for predicting COVID-19 mortality in patients with SARS-CoV-2 reinfection and first infection. However, HA levels may not be associated with long COVID.

Rate and Risk Factors of Reinfection, Recurrence, and Hospital Readmission Among SARS-Cov-2 Hospitalized Patients; a National Cohort Study.

Reinfection and hospital readmission due to COVID-19 were significant and costly during the pandemic. This study aimed to assess the rate and risk factors of SARS-Cov-2 reinfection, recurrence, and hospital readmission, by analyzing the national data registry in Iran. This study was a retrospective cohort conducted from March 2020 to May 2021. A census method was used to consider all of the possible information in the national Medical Care Monitoring Center (MCMC) database obtained from the Ministry of Health and Medical Education; the data included information from all confirmed COVID-19 patients who were hospitalized and diagnosed using at least one positive Polymerase Chain Reaction (PCR) test by nasopharyngeal swab specimens. Univariate and multivariable Cox regression analyses were performed to assess the factors related to each studied outcome. After analyzing data from 1,445,441 patients who had been hospitalized due to COVID-19 in Iran, the rates of overall reinfection, reinfection occurring at least 90 days after the initial infection, recurrence, and hospital readmission among hospitalized patients were 67.79, 26.8, 41.61, and 30.53 per 1000 person-years, respectively. Among all cases of hospitalized reinfection (48292 cases), 38.61% occurred more than 90 days from the initial SARS-Cov-2 infection. Getting infected with COVID-19 in the fifth wave of the disease compared to getting infected in the first wave (P<0.001), having cancer (P<0.001), chronic kidney disease (P<0.001), and age over 80 years (P<0.001) were respectively the most important risk factors for overall reinfection. In contrast, age 19-44 years (P<0.001), intubation (P<0.001), fever (P<0.001), and cough (P<0.001) in the initial admission were the most important protective factors of overall reinfection, respectively. Reinfection and recurrence of COVID-19 after recovery and the rate of hospital readmission after discharge were remarkable. Advanced or young age, as well as having underlying conditions like cancer and chronic kidney disease, increase the risk of infection and readmission.

Omicron variant (B.1.1.529) challenge the integrity of blood brain barrier: Evidence from protein structural analysis

Studies on nonhuman primates, wild-type and transgenic mice have shown the presence of SARS-CoV-2 RNA components in the brains. Despite the Blood-Brain Barrier (BBB) provides protection there are less evidences on how the SARS-CoV-2 crosses the BBB. Given that there is an increase of Omicron reinfection rates, transmissibility rate and involvement to cause neurological dysfunctions, we hypothesized to investigate how the Omicron variant (B.1.1.529) binds structurally to key BBB-maintaining proteins and thus can possibly challenge the integrity and transportation to the brain. By using molecular dynamics simulation approaches we examined the interaction of Omicron variant (B.1.1.529) with different structural and transporter proteins located at the BBB. Our results show that in Zona Ocludin 1-RBD complex, we observe a distinct pattern. Omicron demonstrates a docking score of −88.9 ± 6.8 kcal/mol and six interactions, while the wild type (WT) presents a higher score of −94.0 ± 2.3 kcal/mol, forming eight interactions. Comparing affinities, the WT-RBD displays a stronger preference for Claudin-5, boasting a docking score of −110.2 ± 3.0 and nine interactions, versus Omicron-RBD's slightly reduced engagement, with a docking score of −105.6 ± 0.2 and seven interactions. Interestingly, the Omicron variant exhibits heightened stability in interactions with Glucose Transporter and ABC transporters, registering docking scores of −110.6 ± 1.9 and −112.0 ± 3.6 kcal/mol, respectively. This surpasses the WT's respective scores of −95.2 ± 2.2 and −104.0 ± 6.2 kcal/mol, reflecting a unique interaction profile. Rigorous molecular dynamics simulations validate our findings. Our study emphasizes the Omicron variant's increased affinity towards transporter proteins, illuminating potential implications for BBB integrity and brain transportation. While these insights offer a valuable framework, comprehensive experimental validation is indispensable for a comprehensive understanding.

Histopathological Findings in Adult Patients With Dyspepsia and Their Association With Helicobacter pylori Infection.

Helicobacter pylori infection is prevalent among Saudi adults and has been linked to gastric cancer and other tumor-like conditions. We aimed to explore the pathological characteristics of endoscopic gastric biopsies among symptomatic adult Saudi patients and their relation to H. pylori infection. Among 151 gastric biopsies, gastritis was detected in 97 (64.2%) cases, chronic active gastritis in 26 patients (17.2%), duodenitis in 20 (13.2%) patients, and total metaplasia in 14 (9.3%) patients. H. pylori was detected in 83 cases (55%), with a recurrence or reinfection rate of 9.8%. The patients with H. pylori infection were considerably young (median age: 34 (IQR: 15) vs. 35.5 (IQR: 11), p = 0.024) and had a low frequency of epigastric pain (78.3% vs. 91.2%, p = 0.031), reflux/regurgitation (7.2% vs. 20.6%, p = 0.016), and dysphagia (4.85% vs. 14.7%, p = 0.037). However, they exhibited a higher incidence of chronic active gastritis (96.2% vs. 3.8%, p < 0.001) and intestinal metaplasia (85.7% vs. 14.3%, p = 0.015). Young age (OR = 1.09, 95% CI = 1.02-1.16, p = 0.011) and H. pylori infection (OR = 30.85, 95% CI = 3.26-291.60, p = 0.003) were identified as a positive predictor of intestinal metaplasia while heartburn (OR = 0.08, 95% CI = 0.01-0.58, p = 0.012) was a negative predictor. H. pylori infection is prevalent among Saudi adults experiencing upper gastrointestinal symptoms and is associated with intestinal metaplasia. Infection rate and intestinal metaplasia were higher in patients with milder symptoms. Therefore, screening for H. pylori is highly recommended for Saudi individuals with upper gastrointestinal symptoms. Old age and H. pylori infection were identified as positive predictors of intestinal metaplasia, emphasizing the importance of early detection and management of H. pylori infection in the Saudi population.

Antibody response and risk of reinfection over 2 years among the patients with first wave of COVID-19

ObjectivesTo describe the dynamics and factors related to natural and hybrid humoral response against the SARS-CoV-2 and risk of reinfection among first-wave patients. MethodsA prospective longitudinal study with periodic serological follow-up after acute onset of all recovered patients with SARS-CoV-2 infection cared in Udine Hospital (March–May 2020). Nucleocapsid (N) protein and spike receptor-binding domain (S-RBD) antibody tests were used to distinguish natural and vaccine-induced response. ResultsOverall, 153 patients (66 men, mean age 56 years) were followed for a median of 27.3 (interquartile range 26.9–27.8) months. Seroreversion was 98.5% (95% CI: 96.8–99.4) for SARS-CoV-2-N IgM at 1 year and 57.4% (95% CI: 51.5–63.5) for SARS-CoV-2-N IgG at 2 years. Initial serological response (hazard ratio [HR]: 0.99, 95% CI: 0.99–0.99, p 0.002 for IgM and HR: 0.97, 95% CI: 0.97–0.98, p < 0.001 for IgG) and severity of acute infection (HR: 0.62, 95% CI: 0.39–0.96, p 0.033 for IgM and HR: 0.60, 95% CI: 0.37–0.99, p < 0.001 for IgG) were independently associated with persistent SARS-CoV-2-N IgM/IgG response. Older age and smoker status were associated with long-term SARS-CoV-2-N IgM and SARS-CoV-2-N IgG, respectively (HR: 0.75, 95% CI: 0.57–0.98, p 0.038; HR: 1.77, 95% CI: 1.19–2.61, p 0.004 respectively). All patients maintained SARS-CoV-2-S-RBD IgG response at 24-month follow-up. Reinfections occurred in 25 of 153 (16.3%) patients, mostly during the omicron circulation. Reinfection rates did not differ significantly between SARS-CoV-2-N IgG seronegative and seropositive patients (14/89, 15.7% vs. 10/62, 16.1%, p 0.947). Unvaccinated patients had higher risk of reinfection (4/7, 57.1% vs. vaccinated 21/146, 14.4%, p 0.014). DiscussionFirst-wave patients had durable natural humoral immunity in 40% and anti-S-RBD response in 100% up to 2 years after infection. Natural humoral response alone was not protective against reinfections with omicron SARS-CoV-2 variants, whereas vaccination was effective to reduce the risk of a new infection.

HepFREEPak: protocol for a multi-centre, prospective observational study examining efficacy and impact of current therapies for the treatment of hepatitis C in Pakistan and reporting resistance to antiviral drugs: study protocol

BackgroundPakistan has one of the highest burdens of Hepatitis C virus (HCV) infection globally. To achieve the World Health Organization’s goals for HCV elimination, there is a need for substantial scale-up in testing, treatment, and a reduction in new infections. Data on the population impact of scaling up treatment is not available in Pakistan, nor is there reliable data on the incidence of infection/reinfection. This project will fill this gap by providing important empirical data on the incidence of infection (primary and reinfection) in Pakistan. Then, by using this data in epidemic models, the study will determine whether response rates achieved with affordable therapies (sofosbuvir plus daclatasvir) will be sufficient to eliminate HCV in Pakistan.MethodsThis prospective multi-centre cohort study will screen 25,000 individuals for HCV antibody (Ab) and RNA (if Ab-positive) at various centers in Pakistan- Karachi (Sindh) and Punjab, providing estimates of the disease prevalence. HCV positive patients will be treated with sofosbuvir and daclatasvir for 12-weeks, (extended to 24-weeks in those with cirrhosis) and the proportion responding to this first-line treatment estimated. Patients who test HCV Ab negative will be recalled 12 months later to test for new HCV infections, providing estimates of the incidence rate. Patients diagnosed with HCV (~ 4,000) will be treated and tested for Sustained Virological Response (SVR). Questionnaires to assess risk factors, productivity, health care usage and quality of life will be completed at both the initial screening and at 12-month follow-up, allowing mathematical modelling and economic analysis to assess the current treatment strategies. Viral resistance will be analysed and patients who have successfully completed treatment will be retested 12 months later to estimate the rate of re-infection.ConclusionThe HepFREEPak study will provide evidence on the efficacy of available and widely used treatment options in Pakistan. It will also provide data on the incidence rate of primary infections and re-infections. Data on incidence risk factors will allow us to model and incorporate heterogeneity of risk and how that affects screening and treatment strategies. These data will identify any gaps in current test-and-treat programs to achieve HCV elimination in Pakistan.Study registrationThis study was registered on clinicaltrials.gov (NCT04943588) on June 29, 2021.

Respiratory Syncytial Virus Reinfections in Children in Western Australia.

Respiratory syncytial virus (RSV) reinfection in children is poorly understood. We examined the incidence, characteristics, and outcomes of hospital-attended RSV reinfections in children <16 years in Western Australia between 2012 and 2022. Individuals with repeat RSV detections ≥56 days apart were identified using laboratory data. The incidence of reinfection in the first five years of life was estimated using the total birth population from 2012 to 2017. Clinical data on a subset of reinfection episodes were obtained from two metropolitan pediatric centers. A total of 466 children with hospital-attended reinfections were identified. The median interval between RSV detections was 460 days (interquartile range: 324, 812), with a reinfection rate of 95 per 100,000 individuals (95% confidence interval: 82, 109). Reinfection was most common in children who experienced their first RSV detection <6 months of age. Predisposing factors were identified in 56% of children; children with predisposing factors were older at first and second detections, were more likely to be admitted, and had a longer length of stay. This study highlights the significant burden of hospital-attended RSV reinfections in children with and without predisposing factors. Expanded surveillance with in-depth clinical data is required to further characterize the impact of RSV reinfection.

The vital role of exercise and nutrition in COVID-19 rehabilitation: synergizing strength.

Since the outset of the COVID-19 pandemic, the global healthcare community has faced the challenge of understanding and addressing the ongoing and multi-faceted SARS-CoV-2 infection outcomes. As millions of individuals worldwide continue to navigate the complexities of post-hospitalization recovery, reinfection rates, and the increasing prevalence of Long-COVID symptoms, comprehensive COVID-19 rehabilitation strategies are greatly needed. Previous studies have highlighted the potential synergy between exercise and nutrition, suggesting that their integration into patient rehabilitation programs may yield improved clinical outcomes for survivors of COVID-19. Our group aimed to consolidate existing knowledge following the implementation of patient, intervention, comparison, and outcome (PICO) search strategies on the distinct and combined impacts of exercise and nutrition interventions in facilitating the recovery of COVID-19 patients following hospitalization, with a specific focus on their implications for both public health and clinical practice. The incorporation of targeted nutritional strategies alongside exercise-based programs may expedite patient recovery, ultimately promoting independence in performing activities of daily living (ADLs). Nonetheless, an imperative for expanded scientific inquiry remains, particularly in the realm of combined interventions. This mini-review underscores the compelling prospects offered by an amalgamated approach, advocating for the seamless integration of exercise and nutrition as integral components of post-hospitalization COVID-19 rehabilitation. The pursuit of a comprehensive understanding of the synergistic effects and effectiveness of exercise and nutrition stands as a crucial objective in advancing patient care and refining recovery strategies in the wake of this enduring global health crisis.

SARS-CoV-2 immune response and reinfection in vaccinated Maya and mestizo in Southeast of Mexico.

Immune response to pathogens, including coronaviruses, is influenced by HLA haplotypes. 1,2. Maya ethnic group is predominant in Yucatan peninsula, this Amerindian group present allele frequency HLA-G*01:01:02, HLA-G*01:01:01, HLA-G*01:04:01, HLA-A*68 not found in another Amerindians.3-5 Immune response to SARS-CoV-2 vaccination and reinfection particularly after Omicron variant appeared was explored in 118 vaccinated subjects with complete two shots immunization in Maya ascendant and mestizo no-Maya. 1172 epidemiological survey applied to university staff in Campeche, Mexico to evaluate reinfection, co-morbidities, variant virus, disease severity, aftermaths, clinical outcomes, age, sex, ethnicity, and vaccination shots. Multiple logistic regression, correspondence analysis, and association tests were used to analysis data. Sixteen percent of vaccinated subjects became seronegative after 11 months. We found that vaccinated Maya subjects respond with higher IgG immune response compared to no-Maya subjects, similarly women respond with higher IgG response than men (p<0.05). During an eleven-month period and after two vaccination shots, 7% of the vaccinated subjects reported a confirmed positive infection, and after the third vaccine shot a higher IgG immune response than two vaccination shots or natural infection was detected. However, we observed 23.7% reinfection in people after the third shot. This data represents almost three times the reinfection rate reported when compared to previous third vaccine shots. The increase of reinfection in vaccinated subjects was associated with circulation of Omicron variant by 71.5%. Others have reported reinfection of 40% and vaccine effectiveness of 60% during Omicron dominance.6 To understand COVID-19 severity after reinfection in vaccinated subjects and the associated variables, we carried out a multiple logistic regression, and found a strong association between less severe symptoms with Alfa and Omicron variants (B 5.3; Error 0.39; Wald 0.00; Significance 0.00; OR201). However, subjects with severe symptoms and or hospitalization correspondent to individuals with multiplex comorbidities and Gamma SARS-CoV-2 variants (B 5.06; Error 0.97; Wald 26.8; Significance 0.00; OR 158). A follow-up survey of COVID-19 recovered patients experienced diverse digestive, respiratory, cardiac, neurological, or joints involvement sequelae. We looked for SARS-CoV-2 variant and COVID-19 sequelae in a correspondence analysis. Our data suggest that Beta and Delta variants are associated with respiratory and digestive symptoms, whereas Omicron was more closely associated with joints and digestive symptoms, and finally the Gamma variant displayed wider and more diverse symptoms. Our results suggest that genetic background and gender influence IgG response to SARS-CoV-2 vaccine, and Maya ascendant has higher immune IgG response to vaccine than mestizos. Reinfection in our population studied fluctuate from 7% to 23.7% nevertheless is higher if Omicron variant is involved, but symptoms are less severe and more closely associated with joints and digestive symptoms.

Assessing the risk of COVID-19 reinfection and severe outcomes among individuals with substance use disorders: a retrospective study using real-world electronic health records

ObjectiveDespite advancement in vaccines and treatments for COVID-19 over the past 2 years, many concerns remain about reinfection and waning immunity against COVID-19 and its variants, especially among people with...

Single- and Multilevel Corpectomy and Vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases

BackgroundThe optimal operative approach for treating spinal infections remains a subject of debate. Corpectomy and Vertebral Body Replacement (VBR) have emerged as common modalities, yet data on their feasibility and complication profiles are limited. MethodsThis retrospective single-center study examined 100 consecutive cases (2015–2022) that underwent VBR for spinal infection treatment. A comparison between Single-level-VBR and Multi-level-VBR was performed, evaluating patient profiles, revision rates, and outcomes. ResultsAmong 360 cases treated for spinal infections, 100 underwent VBR, located in all spinal regions. Average clinical and radiologic follow-up spanned 1.5 years. Single-level-VBR was performed in 60 cases, Two-level-VBR in 37, Three-level-VBR in 2, and Four-level-VBR in one case.Mean overall sagittal correction reached 10° (range 0–54°), varying by region. Revision surgery was required in 31 cases. Aseptic mechanical complications (8% pedicle screw loosening, 3% cage subsidence, 6% aseptic adjacent disc disease) were prominent reasons for revision. Longer posterior constructs (>4 levels) had significantly higher revision rates (p < 0.01). General complications (wound healing, hematoma) followed, along with infection relapse and adjacent disc infection (9%) and neurologic impairment (1%).Multilevel-VBR (≥2 levels) displayed no elevated cage subsidence rate compared to Single-level-VBR. Three deaths occurred (43–86 days post-op), all in the Multi-level-VBR group. ConclusionThis study, reporting the largest number of VBR cases for spinal infection treatment, affirmed VBR's effectiveness in sagittal imbalance correction. The overall survival was high, while reinfection rates matched other surgical studies. Anterior procedures have minimal implant related risks, but extended dorsal instrumentation elevates revision surgery likelihood.