Infection Risk Assessment Research Articles

Infection-Related Mortality in Adults and Children Undergoing Allogeneic Hematopoietic Cell Transplantation: An Australian Registry Report

Infection-related mortality (IRM) is the most common non-relapse-related cause of death reported after allogeneic hematopoietic cell transplantation (HCT). Information on the incidence and timing of specific infective organisms and the risk factors for IRM is essential to developing prevention strategies. This report provides the first account of IRM in adults and children undergoing HCT in Australia. Between 2013 and 2018, 2705 adult and 689 pediatric first HCTs were identified from the Australasian Bone Marrow Transplant Recipient Registry database, associated with 1075 (39.7%) total overall deaths in adults and 134 (19.4%) in children. Demographics and causes of death, including infectious etiology and causative organisms, were extracted from the database for adults and children for analysis. At day +100 and 1 year post-HCT, IRM was the leading cause of early post-HCT mortality in adults, accounting for 6.2% and 9.8%, respectively; in children, IRM was the leading cause of post-HCT mortality at day +100 at 2.5% and the second highest cause of post-HCT mortality at 1 year post-HCT at 4.9%, following relapse at 5.8%. In adults, older age, transplantation not in a first complete remission (non-CR1), the use of antithymocyte globulin (ATG) or alemtuzumab, donor-positive/recipient-negative cytomegalovirus (CMV) serostatus, and acute graft-versus-host disease were significant risk factors for IRM. However, in children, age >5 years, acute lymphocytic leukemia as the primary disease, and mismatched unrelated or haploidentical donor source were predictive of IRM. Of the deaths in which an infectious etiology was reported in adults (52.4%), 49.3% were attributed to bacteria, 25.3% to fungus, 21.7% to viruses, and 3.6% to post-transplantation lymphoproliferative disorder (PTLD). The most common organisms were Pseudomonas spp, Enterococcus spp, Candida spp, Aspergillus spp, and CMV. In children where an infectious etiology was reported (64%), 13% were attributed to bacteria, 26% to fungus, 45% to viruses, and 16% to PTLD. This report highlights that IRM was the leading cause of death early post-HCT in Australia. Strategies to reduce IRM, such as individualized pre-transplantation infection risk assessment, rapid diagnostics, and prevention management strategies should be explored to determine whether these outcomes can be improved. In addition, improving the completeness and accuracy of reported data, particularly for infectious pathogens, could assist in directing management strategies to reduce IRM in HCT.

SARS-CoV-2 infection among primary healthcare workers: a cross-sectional study

Healthcare workers (HCWs) are critical to the healthcare system and are at an increased risk of SARS-CoV-2 infection.1 They may acquire infections from the community and their work settings. To date, the majority of the studies reporting on the epidemiology of SARS-CoV-2 infections in HCWs, including serology testing, are from hospital settings.2 Primary care provides a platform and plays a critical role in prevention, testing, triaging and treating patients, but a smaller number of studies focus on primary care settings.3 In a recent systematic review, primary care physicians were at increased risk of worse outcomes and were the highest risk specialty for deaths among doctors.2 This short report provides an objective assessment of infection risk among frontline primary care HCWs utilizing RT-PCR results and serology testing. The study aims to establish the point and the period prevalence of SARS-CoV-2 infection among HCWs and their characteristics, exposure risks and infection control practices for SARS-CoV-2 in primary care settings. Overview A cross-sectional study design was employed for the study. The study settings were Primary Health Care Corporation (PHCC) – the largest primary health care provider in Qatar. It has 27 health centers across the country with approximately 1.4 million registered individuals. The study was conducted in July 2020 during the first SARS-CoV-2 pandemic wave with approximately 163 new cases daily per million population. Five health centers were randomly selected for the study – Rawdat Al Khail, Gharrafat Al Rayyan, Al Wajbah, Qatar University and Al Wakrah. Suspected or confirmed SARS-CoV-2 individuals presented in all health centers at the time. All frontline physicians and nurses working in the five selected health centers were invited to participate in the study. Overall, 291 of the 720 invited participants consented to participate. HCWs were booked an appointment where they completed a self-administered questionnaire on sociodemographic, RT-PCR test results, SARS-CoV-2 exposure risk and provided a blood sample to test for antibodies (IgM and IgG) against SARS-CoV-2.

Potential infection risk assessment of improper bioaerosol experiment operation in one BSL-3 laboratory based on the improved Wells-Riley method

Laboratory-acquired infection caused by improper operation in the course of experimental process is frequently reported, so the exposure risk study of biosafety laboratory has become a top priority. In this study, the infection risk of bioaerosols under three typical improper operations was investigated by means of Computational Fluid Dynamics (CFD) method coupled with Wells-Riley equation based on one typical BSL-3 laboratory bioaerosol releasing experiment. Filed measurement of concentrations of two bioaerosols (Serratia marcescens and phage ΦX174) were used to verify the accuracy of the CFD model. Combined with air-age isosurface map, the potential infection risk and time disinfection law were explored in detail. The results showed that the air recirculation zone of the laboratory is mainly located near the experimental equipments, and the bioaerosol removal efficiency in regions above 1.5 m is low. The risk of infection in different regions varied by more than 20 times. In addition, the potential exposure per minute was higher at the beginning of the leak, and the risk value was maintained at about 1%/min after 4 min. These findings provide some guidance suggestions for disinfection procedures that the first is to avoid the initial exposure of leakage, and the second is to grasp high-risk targeted disinfection location.

Herpes zoster in chronic lymphocytic leukemia: Effect of vaccination and treatment.

7527 Background: Patients with Chronic Lymphocytic Leukemia (CLL) are susceptible to infections due to impaired humoral immunity as a complication of the disease, treatments received and age at diagnosis. Herpes zoster (HZ) is a painful, vesicular rash from reactivation of varicella-zoster virus that is common in immunocompromised patients. While HZ vaccines can reduce both varicella-zoster reactivation and post-herpetic neuralgia, vaccination rates are low. The aim of this study is to determine the effect of vaccination on rates of HZ infection in patients with CLL. Methods: We identified patients diagnosed with CLL between September 1999 and October 2015 using Veterans Administration Central Cancer Registry (VACCR). Pharmacy records were used to identify patients who received treatment for CLL and HZ. HZ events were defined as patients with International Classification of Diseases 9th Revision (ICD-9) codes for HZ infection (053) or prescriptions of acyclovir or valacyclovir at a dose of 1500 mg/day or higher or famciclovir at a dose of 1000 mg/day or higher without a diagnosis of Herpes simplex or Bell’s palsy, or an ICD-9 code and prescription above. Cox proportional hazards regression model was used to assess the association between vaccination as a time-varying exposure and developing HZ while controlling age at CLL diagnosis, co-morbidity score, and receipt of first and second line chemotherapy. The study was approved by the St. Louis VA Medical Center institutional review board. Results: A cohort of 7155 patients with CLL was identified using VACCR. 2640 patients (36.9%) and 1161 patients (16.2%) received first and second line chemotherapy respectively. Mean age at first chemotherapy was 69.5 years. We detected 1115 cases of HZ (15.6%) using ICD-9 codes, prescriptions or both. 615 patients (8.6%) received HZ vaccinations. Patients with HZ were younger (mean 68.0 vs. 69.8 years, p < 0.001), had similar co-morbidities, and were more likely to get treatment for CLL (58.1% vs. 33.0%, p < 0.001). Using a time-varying analysis, there was a trend for HZ vaccine to decrease the risk of developing HZ (HR 0.71, 95% CI 0.49-1.04, p = 0.082). When adjusting for age and co-morbidity, patients with CLL treated with first line chemotherapy had a higher risk of HZ (HR 2.34, 95% CI 2.02-2.71, p < 0.001) compared to those never receiving therapy. Second line chemotherapy increased risk of HZ (HR 1.32, 95% CI 1.13-1.55, p < 0.001) beyond first line treatment. Conclusions: HZ is prevalent in patients with CLL and affects younger patients who require chemotherapy. The risk of developing HZ increases in recipients of first and second line chemotherapy. In the time-varying analysis, there was a trend towards decreased infection in patients who received HZ vaccination. Further studies in a more modern cohort that assess infection risk using a larger vaccinated group with the newer and more effective HZ vaccine are warranted.

Potential Infection Risks of the Wheat Stripe Rust and Stem Rust Pathogens on Barberry in Asia and Southeastern Europe.

Barberry (Berberis spp.) is an alternate host for both the stripe rust pathogen, Puccinia striiformis f. sp. tritici (Pst), and the stem rust pathogen, P. graminis f. sp. tritici (Pgt), infecting wheat. Infection risk was assessed to determine whether barberry could be infected by either of the pathogens in Asia and Southeastern Europe, known for recurring epidemics on wheat and the presence of barberry habitats. For assessing infection risk, mechanistic infection models were used to calculate infection indices for both pathogens on barberry following a modeling framework. In East Asia, Bhutan, China, and Nepal were found to have low risks of barberry infection by Pst but high risks by Pgt. In Central Asia, Azerbaijan, Iran, Kazakhstan, southern Russia, and Uzbekistan were identified to have low to high risks of barberry infection for both Pst and Pgt. In Northwest Asia, risk levels of both pathogens in Turkey and the Republic of Georgia were determined to be high to very high. In Southwest Asia, no or low risk was found. In Southeastern Europe, similar high or very high risks for both pathogens were noted for all countries. The potential risks of barberry infection by Pst and/or Pgt should provide guidelines for monitoring barberry infections and could be valuable for developing rust management programs in these regions. The framework used in this study may be useful to predict rust infection risk in other regions.

Gastrointestinal endoscopic practice during COVID-19 pandemic: a multi-institutional survey.

Introduction. An on-going coronavirus disease 2019 (COVID-19) has become a challenge all over the world. Since an endoscopy unit and its staff are at potentially high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we conducted a survey for the management of the gastrointestinal endoscopic practice, personal protective equipment (PPE), and risk assessment for COVID-19 during the pandemic at multiple facilities.Methods. The 11-item survey questionnaire was sent to representative respondent of Department of Gastroenterology, Osaka City University Hospital, and its 19 related facilities.Results. A total of 18 facilities submitted valid responses and a total of 373 health care professionals (HCPs) participated. All facilities (18/18: 100%) were screening patients at risk for SARS-CoV-2 infection before endoscopy. During the pandemic, we found that the total volume of endoscopic procedures decreased by 44%. Eleven facilities (11/18: 61%) followed recommendations of the Japan Gastroenterological Endoscopy Society (JGES); consequently, about 35%-50% of esophagogastroduodenoscopy and colonoscopy were canceled. Mask (surgical mask or N95 mask), face shield/goggle, gloves (one or two sets), and gown (with long or short sleeves) were being used by endoscopists, nurses, endoscopy technicians, and endoscope cleaning staff in all the facilities (18/18: 100%). SARS-CoV-2 infection risk assessment of HCPs was conducted daily in all the facilities (18/18: 100%), resulting in no subsequent SARS-CoV-2 infection in HCPs.Conclusion. COVID-19 has had a dramatic impact on the gastrointestinal endoscopic practice. The recommendations of the JGES were appropriate as preventive measures for the SARSCoV-2 infection in the endoscopy unit and its staff.

Postoperative Infection Risk in Total Joint Arthroplasty After Perioperative IV Corticosteroid Administration: A Systematic Review and Meta-Analysis of Comparative Studies

BackgroundPerioperative corticosteroid administration is associated with reduced postoperative nausea, pain, and enhanced recovery after surgery. However, potential complications including wound and periprosthetic joint infections remain a concern for surgeons after total joint arthroplasty (TJA). MethodsA systematic review of the search databases PubMed, Google Scholar, and EMBASE was made in January 2021 to identify comparative studies evaluating infection risk after perioperative corticosteroid administration in TJA. PRISMA guidelines were used for this review. Meta-analysis was used to assess infection risk in accordance with joint and corticosteroid dosing regimen used. Results201 studies were returned after initial search strategy, with 29 included for review after application of inclusion and exclusion criteria. Studies were categorized as using low- or high-dose corticosteroid with single or repeat dosing regimens. Single low-dose corticosteroid administration was not associated with an increased risk of infection (P = .4; CI = 0.00-0.00). Single high-dose corticosteroid was not associated with an increased infection risk (P = .3; CI = 0.00-0.01) nor did repeat low-dose regimens result in increased risk of infection (P = .8; CI = −0.02-0.02). Studies assessing repeat high-dosing regimens reported no increased infection, with small numbers of participants included. No significant risk difference in infection risk was noted in hip (P = .59; CI = −0.03-0.02) or knee (P = .2; CI = 0.00-0.01) arthroplasty. Heterogeneity in patient profiles included in studies to date was noted. ConclusionUse of perioperative corticosteroid in TJA does not appear to be associated with increased risk of postoperative infection in patients with limited comorbidities. Further research is warranted to evaluate postoperative complications after TJA in these at-risk patient populations.

Analysis on prediction power of HIV infection risk assessment tool in men who have sex with men in Guizhou province

Objective: To evaluate the prediction power of HIV infection risk assessment tool and the applicability in MSM in Guizhou province. Methods: MSM were recruited through snowball sampling method. Questionnaire surveys were conducted among the MSM using HIV infection risk assessment tool, and combined with HIV serologic test results, the risk prediction power of HIV infection risk assessment tool was evaluated. Results: A total of 3 379 MSM were recruited from January 2018 to December 2019 in Guizhou. The HIV infection rate was 3.3%(111/3 379). The mean risk scores of HIV positive and HIV negative MSM were (12.15±3.08) and (12.07±3.07), respectively. The difference in risk score was significant between MSM with different HIV status (t=8.69, P<0.001). According to the principle of decision tree, individual risk scores were divided into following three categories: ≤11.96, 11.97-14.80 and >14.80, the HIV infection rate was 0.8%, 4.3% and 8.6% respectively, suggesting that the higher the individual risk score was, the higher the HIV infection rate was (trend χ2=88.18, P<0.001). Multivariate logistic regression analysis showed that the higher the individual risk score was, the higher the risk of HIV infection was. Compared to the total score ≤11.96, the aOR values at total scores of 11.97-14.80 and >14.80 were 6.34 (95%CI: 3.38-11.88) and 14.07(95%CI: 7.44-26.61), respectively. The risk of HIV infection in Miao ethnic group was higher than that in Han ethnic group (aOR=1.83, 95%CI:1.04-3.21), and the risk of HIV infection in those with education level of primary school and below was higher than that in undergraduates or those with education level of junior college and above (aOR=2.50, 95%CI:1.06-5.88), and the risk of HIV infection was higher in those who had bisexual behaviors than in those who had homosexual behaviors (aOR=1.95, 95%CI:1.19-3.19). The risk of HIV infection was higher in those who had never received HIV testing (aOR=1.53, 95%CI:1.01-2.33). The area under the receiver operating characteristic (ROC) curve and area under ROC (AUC) for HIV infection prediction was 0.751 (95%CI:0.710-0.792, P<0.001). The maximum Youden's index was individual risk score of 12.56, and the sensitivity of the risk assessment tool was 0.838, and its specificity was 0.412. Conclusions: The results of HIV infection risk assessment tool in Guizhou indicated that in MSM the higher the individual risk score, the higher the risk of HIV infection is. The tool can be used to evaluate the risk of HIV infection in MSM, but the specificity should be improved.

Assessment of Infection Risk of Covid-19 among Health Care Workers in a Tertiary Health Care Facility

Introduction: Health care providers are working round the clock in their fight against COVID-19. Appropriate measures are taken by the hospital administration and also healthcare providers for the protection of patients as well as for them. This study is taken up to assess infection risk of COVID-19 among healthcare providers about infection, prevention, and practices in a tertiary healthcare facility.

Risk Assessment of COVID-19 Airborne Infection During Hybrid Learning

Converging lines of evidence seem to indicate that SARS-CoV-2, the novel coronavirus responsible for the COVID-19 pandemic, can be transmitted from person-to-person via aerosols that waft through the air and accumulate over time. The airborne nature of the virus could be a threat in indoor spaces in general and in particular for in-class education. We provide an assessment of the risk of SARS-CoV-2 infection during a 7-hour school day in elementary schools. We show that existing data are insufficient to establish a low (below 1%) probability of infection with high accuracy. The use of facemasks and social distancing could significantly decrease this risk.

Simulation-based study of COVID-19 outbreak associated with air-conditioning in a restaurant.

COVID-19 has shown a high potential of transmission via virus-carrying aerosols as supported by growing evidence. However, detailed investigations that draw direct links between aerosol transport and virus infection are still lacking. To fill in the gap, we conducted a systematic computational fluid dynamics (CFD)-based investigation of indoor airflow and the associated aerosol transport in a restaurant setting, where likely cases of airflow-induced infection of COVID-19 caused by asymptomatic individuals were widely reported by the media. We employed an advanced in-house large eddy simulation solver and other cutting-edge numerical methods to resolve complex indoor processes simultaneously, including turbulence, flow–aerosol interplay, thermal effect, and the filtration effect by air conditioners. Using the aerosol exposure index derived from the simulation, we are able to provide a spatial map of the airborne infection risk under different settings. Our results have shown a remarkable direct linkage between regions of high aerosol exposure index and the reported infection patterns in the restaurant, providing strong support to the airborne transmission occurring in this widely reported incident. Using flow structure analysis and reverse-time tracing of aerosol trajectories, we are able to further pinpoint the influence of environmental parameters on the infection risks and highlight the need for more effective preventive measures, e.g., placement of shielding according to the local flow patterns. Our research, thus, has demonstrated the capability and value of high-fidelity CFD tools for airborne infection risk assessment and the development of effective preventive measures.

Population Immunity to Varicella Zoster Virus in the Republic of Belarus

Relevance. Chickenpox occupies a leading position in the structure of infectious pathology in the Republic of Belarus; 50,000-80,000 cases are registered annually in the country, including 2500-4500 cases among people over 15. Aims - to study the prevalence of IgG antibodies to Varicella Zoster virus among the population of the Republic of Belarus and assess the relative risk of infection for people of different ages. Materials and methods. The blood sera of 1190 people aged 2-75 from all 7 regions of the Republic of Belarus were investigated. IgG antibodies were detected using Serion ELISA classic Varicella Zoster Virus IgG, Virion\Serion, Germany. Sera with a n antibody concentration more than 100 mIU/ml were regarded as positive. The dynamics of the proportion of immune individuals by age was determined by regression analysis and estimated by the average rate of increase. To assess the risk of infection in different age groups, an indicator of the relative risk of being infected (IRR) was used. Results. It has been established that the prevalence of IgG antibodies to Varicella Zoster virus among the population of the Republic of Belarus is 85.5%, ranging from 82.0% to 89.7% in various regions of the country. The level of seropositive increases with age (from 16.0% among children aged 2 years to 86.6% by 15-17 years), it is 95.4% at the age of 18-25 years, 97.1% at the age of 26-35 years and remains at the level of 97.1-100% among older people. In the most active childbearing age of 18-35 years, 3-5% of women are susceptible to this infection. Varicella Zoster virus infection risk assessment data for people of different ages indicate that the probability of getting this infection is highest among children 3-5 years old (IRR = 98.4). In adults, it decreases many times, but in the age group of 26-35 years, it still remains two times higher (IRR = 2.0) than in people reached 46 years of age. Conclusions. The obtained data on seroprevalence are consistent with the data on morbidity and suggest that, without social management of the epidemic process (vaccination), the infection potential remains sufficient to maintain the high-intensity epidemic process among children, and medium intensity among young adults.

Drinking Water Consumption Patterns among Private Well Users in Ontario: Implications for Exposure Assessment of Waterborne Infection.

Understanding the water consumption patterns within a specific population informs development of increasingly accurate, spatially specific exposure and/or risk assessment of waterborne infection. The current study examined the consumption patterns of private well users in Ontario while considering potentially influential underlying sociodemographics, household characteristics, and experiential factors. A province-wide online survey was circulated between May and August 2018 (n = 1,162). Overall, 81.5% of respondents reported daily well water consumption (i.e., tap water). Results indicate a mean daily well water consumption rate of 1,132 mL/day (SD = 649 mL/day) among well water consumers. Gender was significantly associated with well water consumption, with higher consumption rates found among female respondents. The experience of acute gastrointestinal illness (AGI) symptoms or diagnosis in the past 12 months did not impact the volume of water consumed, suggesting that experiencing previous AGI does not decrease consumption volumes, and therefore exposure over time. Significantly higher rates of well water consumption were found among respondents who reported previous testing or ongoing water treatment. Approximately 45.5% of survey respondents who stated that they do not consume well water selected bottled water as their primary household drinking water supply. Bottled water consumption was also not associated with previous AGI experiences. Findings will inform future quantitative microbial risk assessments associated with private well water use by providing spatially and demographically specific estimates of well water consumption.

An intelligent healthcare system for predicting and preventing dengue virus infection

Dengue is a mosquito-borne pandemic viral infection, which transmits to humans from Female Aedes albopictis or Aedes agypti mosquitoes. It progressively deteriorates the health of infected individuals and poses a high threat of human morbidity and mortality. This paper proposes an intelligent healthcare system which identifies, monitors, and alerts dengue virus (DeV) infected individuals and other stakeholders in real-time and control the DeV infection outbreak using cloud computing, internet of things and fog computing paradigms. The proposed system uses Naive Bayesian Network (NBN) for diagnosing the possibly DeV infected individuals and generating real-time alerts for suggesting and alerting the concerned stakeholders for taking on-time necessary actions at the fog subsystem. The proposed system also uses Social Network Analysis at the cloud subsystem, to provide Global Positioning Systems (GPS)-based global risk assessment of the DeV infection on Google Maps (Google-based web map service) and control DeV infection outbreak. The analysis of the experimental results acknowledges the efficiency of the NBN-based DeV infection diagnosis, alert generation, and GPS-based risk assessment functionality, of the proposed system, via various statistical measures and experimental approaches.

Under the Right Conditions, Center-Based Child Care is an Unlikely COVID-19 Threat to Staff

* Abbreviation: COVID-19 — : coronavirus disease 2019 Research on coronavirus transmission from young children to adults in child care settings is largely based on case reports with limited generalizability,1,2 impeding evidence-based assessment of infection risk to child care providers. Gilliam et al3 address these limitations in their multistate study of 57 335 child care providers reporting on exposures, risk mitigation strategies in the workplace, and coronavirus disease 2019 (COVID-19) infection from March through May 2020. The team solicited child care providers through contact lists provided by national child care organizations and state child care workforce registries, conducted 3 rounds of surveys, and collected data on key variables including exposure to child care (provided child care during the pandemic compared to program closure) and COVID-19 infection based on a positive test result or hospitalization for COVID-19. Respondents who had exposure to child care services from March through May also reported numerous infection prevention strategies, such as class size reduction, masking, and disinfection practices. This exposure was not associated with odds of COVID-19 infection in both unmatched and propensity score matched analyses that accounted for community … Address correspondence to Heather L. Tubbs-Cooley, PhD, RN, FAAN, College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210. E-mail: tubbscooley.1{at}osu.edu

Successful identification of predictive profiles for infection utilising systems-level immune analysis: a pilot study in patients with relapsed and refractory multiple myeloma.

ObjectivesPatients with multiple myeloma (MM) are at increased risk for infection. Clinical assessment of infection risk is increasingly challenging in the era of immune‐based therapy. A pilot systems‐level immune analysis study to identify predictive markers for infection was conducted.MethodsPatients with relapsed and/or refractory MM (RRMM) who participated in a treatment trial of lenalidomide and dexamethasone were evaluated. Data on patient demographics, disease and episodes of infection were extracted from clinical records. Peripheral blood mononuclear cells (PBMCs) collected at defined intervals were analysed, with or without mitogen re‐stimulation, using RNA sequencing and mass cytometry (CyTOF). CyTOF‐derived cell subsets and RNAseq gene expression profiles were compared between patients that did and did not develop infection to identify immune signatures that predict infection over a 3‐month period.ResultsTwenty‐three patients participated in the original treatment trial, and we were able to access samples from 17 RRMM patients for further evaluation in our study. Nearly half the patients developed an infection (8/17) within 3 months of sample collection. Infections were mostly clinically diagnosed (62.5%), and the majority involved the respiratory tract (87.5%). We did not detect phenotypic or numerical differences in immune cell populations between patients that did and did not develop infections. Transcriptional profiling of stimulated PBMCs revealed distinct Th2 immune pathway signatures in patients that developed infection.ConclusionImmune cell counts were not useful predictors of infection risk. Functional assessment of stimulated PBMCs has identified potential immune profiles that may predict future infection risk in patients with RRMM.

Navigating the Covid-19 Pandemic by Caring for Our Health Care Workforce as They Care for Our Patients

Summary Leaders at Stanford Medicine, located in one of the first U.S. communities to be affected by Covid-19, quickly realized that they were not prepared to meet the escalating needs of their clinical and operational workforce. The pandemic would require existing care-delivery structures across the academic medical system to be expanded and aligned to prioritize workforce protection. Leaders identified an approach driven by connection, collaboration, and caring. They created specialized teams to develop a systemwide Occupational Health service with practices and procedures to assess health care workers and begin robust Covid-19 polymerase chain reaction testing; to centralize operations to maximize utilization of essential clinical and nonclinical staffing resources; to make visible and address psychological safety concerns and basic needs for faculty and staff; to aggressively address personal protective equipment supply chain issues and effectively assess infection risk; and to plan for a safe return of elective procedures and visits.

Modelling the interplay of future changes and wastewater management measures on the microbiological river water quality considering safe drinking water production

Rivers are important for drinking water supply worldwide. However, they are often impacted by pathogen discharges via wastewater treatment plants (WWTP) and combined sewer overflows (CSO). To date, accurate predictions of the effects of future changes and pollution control measures on the microbiological water quality of rivers considering safe drinking water production are hindered due to the uncertainty of the pathogen source and transport variables. The aim of this study was to test an integrative approach for an improved understanding of these effects, i.e. climate change and population growth as well as enhanced treatment at WWTPs and/or prevention of CSOs. We applied a significantly extended version of QMRAcatch (v1.0 Python), a probabilistic-deterministic model that combines fate and transport modelling with quantitative microbial infection risk assessment. The impact of climatic changes until the period 2035–2049 was investigated by a conceptual semi-distributed hydrological model, based on regional climate model outputs. QMRAcatch was calibrated and validated using site- and source-specific data (human-associated genetic microbial source tracking marker and enterovirus). The study showed that the degree to which future changes affect drinking water safety strongly depends on the type and magnitude of faecal pollution sources and are thus highly site- and scenario-specific. For example, if the load of pathogens from WWTPs is reduced through enhanced treatment, climate-change driven increases in CSOs had a considerable impact. Preventing CSOs and installing enhanced treatment at the WWTPs together had the most significant positive effect. The simultaneous consideration of source apportionment and concentrations of reference pathogens, focusing on human-specific viruses (enterovirus, norovirus) and cross-comparison with bacterial and protozoan pathogens (Campylobacter, Cryptosporidium), was found crucial to quantify these effects. While demonstrated here for a large, wastewater-impacted river, the approach is applicable at other catchments and pollution sources. It allows assessing future changes and selecting suitable pollution control measures for long-term water safety planning.

Comparison of HIV infection risk between 15 to 24 year-old student men who have sex with men and non-student men who have sex with men: a cross-sectional study

Objective: To compare the difference of HIV infection risk among student Men who have sex with men (sMSM) attending secondary vocational colleges or high school, sMSM attending universities or above, and non-student men who have sex with men (MSM). Methods: A cross-sectional study was conducted between July and October, 2019. Inclusion criteria of participants include: 15-24 years old, male at birth, had homosexual oral or anal intercourse before survey, self-reported HIV negative or unclear. Demographic information, HIV testing history and social media usage were collected by a self-reporting questionnaire, the HIV risk assessment tool was used for HIV infection risk assessment. We used Logistic regression to analyze the difference of HIV infection risk among student sMSM attending secondary vocational colleges or high school, sMSM attending universities or above, and non-student MSM. Results: Of the 1 707 participants, 45% (771 projects) reported homosexual debut before the age of 19, the proportion of HIV self-testing was 49% (833 projects), and 34% (587 projects) received facility-based testing. Comparing with sMSM attending universities or above, non-student MSM and sMSM attending secondary vocational colleges or high school had higher probability of medium and high HIV infection risk [OR(95%CI): 1.53(1.10-2.12), 1.80(1.06-3.07), respectively], while the probability of medium and high HIV infection risk between sMSM attending secondary vocational colleges and non-student MSM was not statistically different. Conclusion: Non-student MSM and sMSM attending secondary vocational college or high school have higher risk of HIV infection, health staff should allocate more education resources to Non-student MSM and sMSM attending secondary vocational college or high school, in order to alleviate HIV threat to them.

Sexually Transmitted Infection Risk Assessments in Retail Health Clinics

Sexually transmitted infections (STIs) remain a costly, yet preventable public health problem in the United States. A complete sexual history and risk assessment should be included in each clinical encounter, when appropriate. This research aimed to increase the providers’ confidence level with sexual history taking and assessing for high-risk sexual behaviors using an STI risk assessment tool. Risk assessment tool training increased nurse practitioners’ confidence in screening patients at risk for STIs. Nurse practitioners in retail health clinics have the opportunity to address this preventable public health crisis by focusing on STI risk factors.