Risk Of Fever Research Articles

Alleviated symptoms of SARS-CoV-2 Omicron variant infection in chronic hepatitis B patients with immune control.

The impact of hepatitis B virus (HBV) infection on the progression of coronavirus disease 2019(COVID-19) disease remains controversial. We aimed to investigate whether pre-existing chronic HBV (CHB) infection and therapy with anti-HBV nucleos(t)ide analogs (NAs) influence the clinical presentation of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Omicron variant infection. In this study, clinical information was collected via a questionnaire from patients with COVID-19, and their clinical symptoms were quantitatively assessed for comparative analyses. Additionally, hepatitis B-related laboratory data were collected for CHB patients. Propensity score matching (PSM) was used to minimize confounding biases. A total of 785 patients with COVID-19 were included in the cohort, of which 387 were identified as being infected with CHB infection and they were categorized as being in the immune control or clearance phase. After PSM, the CHB group (n = 222) had a shorter duration of fever and disease course, milder clinical symptoms, and lower incidence of pneumonia than the non-CHB group (n = 222) after Omicron variant infection (p < 0.05). After the adjustment of confounding factors, CHB patients showed a lower risk of prolonged fever, severe clinical symptoms, and pneumonia (p < 0.05). However, there were no statistically significant differences in the clinical symptoms and incidence of pneumonia between CHB patients who received and did not receive NAs, or CHB patients who received tenofovir disoproxil fumarate and entecavir (p > 0.05). In conclusion, our findings suggest that the crosstalk of anti-HBV immunity may contribute to the alleviated symptoms of SARS-CoV-2 Omicron variants infection in the CHB patients, independent of anti-HBV NA therapy.

Palatal microbiota associated with membranous substances in older Japanese individuals undergoing tube feeding in long-term care: A cross-sectional study

ObjectiveTube feeders are prone to membranous substance formation on the palate, and those with membranous substances have a risk of fever, with the probable involvement of their oral bacteria. However, the palatal microbiota of those with membranous substances has not been elucidated. Therefore, we evaluated the differences in palatal microbiota between tube-fed individuals with and without membranous substances to clarify the microbiota. Materials and methodsThis study included 19 participants aged 65 years who required tube feeding. The participants’ characteristics were collected from nursing records and oral examinations. If membranous materials were found on the palate, a specimen was collected. Membranous substances were defined as keratotic degeneration observed under a microscope. Additionally, we performed a comprehensive microbiome analysis by extracting DNA from the samples and performing 16 S rRNA gene sequencing. Finally, we compared the participant demographics and oral microbiota between patients with and without membranous substances. ResultsA total of 11 participants had membranous substances associated with “mouth dryness” (p < 0.001) and “constant mouth opening” (p = 0.020). Palatal microbiota differed between those with and without membranous substances. Among the bacteria with a relative abundance greater than 1.0%, the abundance of Streptococcus (p = 0.007), Fusobacterium (p = 0.041), Streptococcus agalactiae (p = 0.009), and Fusobacterium nucleatum subsp. vincentii (p = 0.026) was significantly higher in the membranous substance group than in the non-membranous substance group. ConclusionsThe palatal microbiota of individuals undergoing tube feeding differed depending on the presence or absence of membranous substances. Membrane substance formation associated with dry mouth purportedly alters the palatal microbiota. Streptococcus, Fusobacterium, S. agalactiae, and F. nucleatum subsp. vincentii were more abundant in the oral microbiota of patients with membranous substances. Thus, preventing this formation may help in controlling the growth of these microbes.

Assessment of vaccinations and breakthrough infections after adjustment of the dynamic zero-COVID-19 strategy in China: an online survey

ABSTRACT Coronavirus disease 2019 (COVID-19) cases in China has grown rapidly after adjustment of the dynamic zero-COVID-19 strategy. However, how different vaccination states affect symptoms, severity and post COVID conditions was unclear. Here, we used an online questionnaire to investigate the infection status of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among 11,897 participants, with 55.55% positive and 28.42% negative. The common COVID-19 symptoms were fatigue (73.31%), cough (70.02%), fever (65.25%) and overall soreness (58.64%); self-reported asymptomatic infection accounted for 0.7% of participants. The persistent symptoms at 1 month after infection included fatigue (48.7%), drowsiness (34.3%), cough (30.1%), decreased exercise ability (23.1%) and pharyngeal discomfort (19.4%), which was reduced by more than 200% at 2 months. Participants with complications such as chronic obstructive pulmonary disease, respiratory diseases, diabetes, hypertension, etc. have a higher proportion of hospitalization and longer recovery time (p < = 0.01). Multiple vaccination statuses reduced the infection (p < 0.001) and severity rates (p = 0.022) by varying degrees as well as reduced the risk of high fever (>39.1 °C), chills, diarrhea and ageusia/anosmia, respectively (p < 0.05). Vaccination may enhance some upper respiratory symptoms, including sore throat, nasal congestion and runny nose, respectively (p < 0.05). Participants who had been vaccinated within 3 months were better protected by helping reduce their risk of overall soreness, chills and ageusia/anosmia, respectively (p < 0.05). In conclusion, our work has updated the epidemic characteristics of the breakthrough infection (BTI) wave after the dynamic zero-COVID-19 strategy, providing data and insights on how different vaccination statuses affect COVID-19 symptoms and disease prognosis.

The lower Saint Lawrence River region of Quebec, a hot spot for sheepfold-associated Q fever in Canada: Review of 258 cases.

The lower Saint Lawrence river region (LSLRR), in Quebec, has a 10-fold higher incidence of Q fever compared to the provincial rate. This study aimed to review clinical cases and the Q fever risk exposure in this region. Data were retrieved from microbiology laboratory, medical records from Rimouski Regional Hospital and Public Health reports between 1991 and 2018. They were analyzed with Epi Info 7.2.2.6. Patients with confirmed acute, probable acute, and chronic Q fever were classified using standard case definitions and mapped according to the postal code, to assess the correlation between cases and sheep distribution. Out of 295 cases, 258 were included (241 confirmed acute, seven probable acute, 10 chronic). Median age was 49 years, 76% were male. For acute cases, the prominent symptoms were fever (99%), headache (83%), chills (80%), sweating (72%), myalgia (69%), and fatigue (67%). Clinical presentation was mostly febrile syndrome with mild hepatitis (84%). A seasonal peak was observed from May to July (56% of acute cases). Most cases (56%) occurred within the two counties where sheep production was highest. Exposure to sheep was prominent 93%, including 64% direct contact (15% shepherds, 49% sheepfold visitors), 14% indirect contact, and 15% sheepfold neighbors. To our knowledge, this is one of the largest retrospective studies of Q fever cases reported in Canada. Q fever in Quebec LSLRR is associated mainly with sheep exposure. Fever and hepatitis were the most common manifestations. Preventive measures should be considered in this region to protect sheepfold workers, visitors, and their neighbors.

Characteristics of preventive intervention acceptance for international travel among clients aged 60 years and older from a Japanese multicenter pretravel consultation registry

ObjectivesPretravel consultation (PTC) is important for older adults owing to health problems associated with overseas travel. Although older adults in Japan, their PTC characteristics are less known. This study aimed to investigate the epidemiology of clients aged ≥ 60 years based on data from the Japan Pre-travel Consultation Registry (J-PRECOR). MethodsClients aged ≥ 60 years who visited J-PRECOR cooperative hospitals from February 1, 2018, to May 31, 2022, were included. The primary endpoint was a comparison of prescriptions for vaccines for hepatitis A, tetanus toxoid, and malaria prophylaxis in travelers to high-risk malaria countries in yellow fever vaccination (YFV)-available facilities with and without YFV. ResultsIn total, 1000 clients (median age: 67 years) were included. Although 523 clients were immunized with YFV, only 38.6% of the 961 unimmunized clients were vaccinated with the tetanus toxoid-containing vaccine. Malaria chemoprophylaxis was prescribed to 25.7% of clients traveling for ≤55 days. At YFV-capable institutes, 557 clients traveling to yellow fever risk countries took PTC, 474 of whom received YFV and 83 were unvaccinated. Lower age (odds rate 0.85 per 1 year; 95% CI 0.80–0.90) and lower hepatitis A vaccination rate (0.29; 95% CI 0.14–0.63) were significantly associated with YFV. ConclusionsPreventive interventions other than YFV should be offered to older adults.

Molecular surveillance of arboviruses in Nigeria

Arboviral infections are fast becoming a global public health concern as a result of its high fatality rate and sporadic spread. From the outbreak of Zika virus in the Americas, the endemicity of Yellow fever in West Africa and South America, outbreaks of West Nile virus in South Africa to the year-round and national risk of Dengue fever in Mainland China and India. The war against emerging and re-emerging viral infection could probably lead to the next pandemic. To be above the pending possible arboviral pandemic, consistent surveillance of these pathogens is necessary in every society. This study was aimed at conducting a surveillance for Yellow fever virus, Zika virus, Chikungunya virus, Dengue virus and Rift Valley fever virus in four states in Nigeria using molecular techniques. A cross-sectional study involving 1600 blood samples collected from febrile patients in Lagos, Kwara, Ondo and Delta States between 2018 and 2021 was conducted using Real time polymerase chain reaction for detection of the pathogens. Extraction and purification of viral RNA were done using Qiagen Viral RNA Mini Kit. Samples were analyzed using One Step PrimeScript III RT-PCR mix (Takara Bio) alongside optimized primers and probes designed in-house. Positive samples were sequenced on MinION platform (Nanopore technologies). Bioinformatic and phylogenetic analysis were performed with DNASTAR Lasergene 17.3. All the RNA extracted from samples collected from the four states were negative for ZIKV RNA, RVFV RNA, CHIKV RNA and DENV RNA. However, twelve of the samples (2%) tested positive for YFV RNA. Three full genomes of sizes 10,751 bp, 10,500 bp and 10,715 bp were generated and deposited in GenBank with accession numbers: ON323052, ON323053 and ON323054 respectively. Phylogenetic analysis shows clustering within lineage 3 of West African genotype. This result shows an active spread of Yellow fever in Delta State, Nigeria. However, there is no emergence of a new genotype There is a need for an intense surveillance of Yellow fever virus in Nigeria to avert a major outbreak.

Drug Resistance, Characterization and Phylogenetic Discrepancy of Salmonella enterica Isolates from Distinct Sources.

Salmonella enterica is one of the foodborne pathogens that can infect humans, spreading from one person to another by contaminated food and water. To identify the pathogenicS. entericafrom the contaminated food product, culture-based and molecular identifications, drug resistance profiling, virulence and genetic traits of the strains have been used. Herein, different animal products was subjected to screen for S. enterica prevalence, pathogenic characterization and compared with clinical Salmonella isolates (human). A total of 173 isolates from animal products and 51 isolates from clinical samples were collected.S. Typhi, S. Agona andS. Ohio were predominant serovars in blood, stool and different animal products. Both, clinical [37% (n = 19/51)] and animal product-associated isolates [21% (n = 37/173)] expressed their highest resistance to nalidixic acid. Thirty-one percentage of (n = 16/51) clinical isolates and 12% (n = 21/173) animal food-associated isolates were resistant to multiple classes of antibiotics. Class 1 integrons encoded byS. Typhi,S. Infantis andS. Emek were screened for sequence analysis, the result revealed that the cassettes encoded-aminoglycoside acetyltransferase and dihydrofolate reductase enzymes. Salmonellapathogenicity island-1 encoded-hilAgene was detected most frequently in all the isolates. PFGE profile revealed the genetic traits of the isolates which were closely linked with antibiotic-resistant properties and virulent characteristics. OnlyS. Enteritidis, collected from different samples had clonal similarities. In summary, drug-resistant pathogenicSalmonellaprevalence was observed in the animal product that could be an important alarm to consumers with the risk of enteric fever and it causes the potential risk to public health.

Antimicrobial prophylaxis is not indicated for horses undergoing general anaesthesia for elective orthopaedic MRI.

Post-anaesthetic fever is a known complication of general anaesthesia, however, its incidence in horses undergoing elective magnetic resonance imaging (MRI) is unknown. To determine the incidence of post-anaesthetic fever in horses undergoing elective orthopaedic MRI and determine whether prophylactic antimicrobial therapy would be associated with a reduction in the incidence of post-anaesthetic fever. We hypothesised that prophylactic antimicrobials would be associated with a reduction in the incidence of post-anaesthetic fever. Retrospective cross-sectional study. This retrospective study included 791 elective orthopaedic MRIs in systemically healthy horses between June 2006 and March 2020 that recovered from general anaesthesia and did not undergo surgery or intensive medical therapy soon after recovery. Potential factors associated with post-anaesthetic fever were evaluated using multivariable logistic regression. Case signalment, travel time, preanaesthetic haematology and fibrinogen abnormalities, use of prophylactic antimicrobials, peri-anaesthetic nonsteroidal anti-inflammatories, anaesthesia time and recovery time were all evaluated for association with post-anaesthetic fever. Of 791 MRI cases, 44 (5.6%) developed a post-anaesthetic fever. Horses that received prophylactic antimicrobials were [odds ratio (OR) 3.8, 95% confidence interval (CI) 1.98-7.46; p ≤ 0.001] more likely to develop a post-anaesthetic fever than those that did not receive antimicrobials. Young horses (1-4 years of age) were (OR 2.8, 95% CI 1.26-6.17; p = 0.01) more likely to develop fever compared with adult horses (≥5 years of age). Limitations of this study pertain to retrospective analysis including nonrandomised case selection and incomplete data records. While fever may indicate infection, the majority of early post-anaesthetic fevers resolved before discharge from the hospital with no identified cause. The use of prophylactic antimicrobials to reduce the risk of post-anaesthetic fever for elective MRI is not supported by this study.

Detection of the Crimean-Congo Hemorrhagic Fever Virus Genome in Questing Ixodes spp. and Haemaphysalis spp. in the Periurban Forestry Areas of Istanbul: Has a New Biorisk Emerged?

Background: Istanbul is one of the world's most densely populated metropolitan cities, with various geographical areas that possess distinct characteristics. These areas have different climates, vegetation, and host populations that can support the survival of diverse tick species. Turkey is a region with a high risk of Crimean-Congo hemorrhagic fever (CCHF) disease, making it crucial to screen for this risk, especially in densely populated regions such as Istanbul and its surrounding areas. However, the presence of potential vectors for CCHF virus (CCHFV) in these areas has not been studied in the past 12 years. Materials and Methods: In this study, a total of 676 ticks were collected from 6 centers using the flagging and dragging method. Ticks were identified as Ixodes ricinus (7.85%), Ixodes spp. immature form (73.22%), Haemaphysalis parva (0.89%), Haemaphysalis inermis (0.15%), and Haemaphysalis spp. immature form (17.89%). Pooled samples were screened for the CCHFV genome (S segment) by RT-nested PCR. Results: A total of 14.28% of the samples were found as positive. Phylogenetic analysis revealed that all the CCHFV sequences obtained from the positive samples were clustered in clade V: Europe/Turkey genogroup. Conclusion: This study suggests that ixodes spp. and Haemaphysalis spp. may have the potential to pose a biorisk for Crimean-Congo hemorrhagic fever.

Seasonal Patterns and Genetic Variability of Aedes Mosquitoes in Some Selected Communities of Maiduguri Metropolitan Council, Borno State, Nigeria

Aedes aegypti and Aedes albopictus mosquitoes spread dengue and yellow fever in Africa and worldwide. Rural-urban drift creates Aedes mosquito breeding sites through uncontrolled urbanization, inadequate urban infrastructure, lack of basic public health delivery, indiscriminate waste disposal, varying socioeconomic activities, and climatic changes. The above have happened in Maiduguri Metropolis since Boko Haram insurgencies began. This study will examine Aedes aegypti's seasonal distribution, abundance, composition, and genetic variability in selected Maiduguri Metropolitan Council and Jere Local Government Council communities. From October 2016 to May 2017, CDC traps and vacuum aspirators collected adult mosquitoes from study sites and stored at – 80 C. These were identified morphologically with taxonomy keys and stereomicroscopes, then molecularly with markers. Aedes mosquito population structure and genetic variability were determined using statistical software and molecular methods on samples. Hot-dry season has the highest relative abundance of this mosquito species in these study sites, while cold-dry season has the lowest. The molecular identification found Aedes aegypti in nine of twelve study locations but not Aedes albopictus. Some mosquitoes from the study locations had mutations due to carrying dengue virus or host population genes, but those without mutations showed a good phylogenetic relationship with Aedes aegypti mosquitoes from other countries, suggesting no genetic variability. The relative abundance of Aedes mosquitoes in Maiduguri Metropolitan Council increases the risk of dengue, zika, yellow fever, and chikungunya virus infections, and this mosquito species' seasonal distributions vary within and across seasons, but no genetic variability was found in the mosquitoes from the different locations used in this study.

Emerging Resistance Trends in Viridans Group Streptococci Bloodstream Infections Among Immunocompromised Children Receiving Levofloxacin Prophylaxis.

Levofloxacin prophylaxis (LVXp) is often used for patients with underlying leukemia and severe neutropenia to reduce the risk of fever and bacteremia. This study evaluated trends in viridans group streptococci (VGS) antibiotic susceptibilities over time and clinical outcomes of children with VGS bloodstream infections (BSIs) during institutional adoption of LVXp. VGS blood culture isolates between 1/1/2010 and 12/31/2021 with susceptibility testing reported were included. Available isolates were re-identified to the species level and additional susceptibility testing was performed. Demographic and clinical data were abstracted from medical records. A total of 264 VGS BSI isolates were identified in immunocompromised (IC, n = 125) and non-immunocompromised subjects, (non-IC, n = 139). IC subjects had lower rates of VGS isolates susceptible (S) to LVX and higher minimum inhibitory concentration (MICs) to LVX (p = 0.004) and ciprofloxacin (p = 0.0005) compared with non-IC subjects. No other evaluated antibiotic had increased MICs in either group. Fifteen of 19 (74%) LVX not susceptible (NS) isolates occurred in IC subjects, 13 represented breakthrough infections. IC subjects had higher rates of VGS-related shock (p = 0.012), need for pressor support (p = 0.039), and longer duration of hospitalization than non-IC subjects (p < 0.001). Clinical outcomes were comparable between subjects with LVX S and NS VGS BSI isolates. VGS with reduced susceptibility to LVX emerged during institutional adoption of LVXp in high-risk children with immunocompromising conditions, but did not result in significant differences in clinical outcomes. Ongoing surveillance and susceptibility testing are critical in weighing the utility of LVXp against emerging antimicrobial resistance in this high-risk population.

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes.

This study aimed to explore the relationship between neuraxial labor analgesia and intrapartum fever and to demonstrate the influence of maternal fever on perinatal outcomes within 6 weeks after birth. This was a secondary analysis of a multicenter prospective cohort study that enrolled women with single- and full-term cephalic pregnancy in northern China. Intrapartum maternal fever was defined as the highest axillary temperature during labor ≥37.5°C. Data on baseline characteristics, maternal variables, and neonatal outcomes were all collected. The association between neuraxial labor analgesia and intrapartum maternal fever was analyzed with logistic regression models, and the cutoff point was identified by the receiver operating characteristic curve. Of 577 parturients, 74 (12.8%) developed intrapartum fever. Neuraxial analgesia was associated with an increased risk of maternal intrapartum fever with or without adjusting for confounding factors (adjusted OR = 2.68; 95% CI: 1.32-5.47; p = 0.007). Further analysis showed that neuraxial analgesia of <5 h did not increase the risk of intrapartum fever compared with no analgesia (OR = 1.52; 95% CI: 0.63-3.64; p = 0.35), and longer neuraxial labor analgesia time (over 5 h) significantly increased the risk of fever (OR = 3.38; 95% CI: 1.63-7.01; p = 0.001). Parturients with intrapartum fever suffered more maternal adverse outcomes compared with those without fever (p < 0.001). Neonates of women with intrapartum fever had slightly higher rates of composite adverse neonatal outcomes compared with those without fever; however, the difference was not statistically significant (p = 0.098). In women with low-risk pregnancies, a longer time of neuraxial labor analgesia was associated with an increased risk of intrapartum maternal fever. Intrapartum fever was related to adverse maternal outcomes but did not significantly affect neonatal outcomes within 6 weeks after delivery.

Unregulated Online Sales are High-Risk Sources of Domestic Swine (Sus scrofa) in Canada: Implications for Invasive Wild Pig and AfricanSwine Fever Risk Preparedness.

Free-ranging wild pig (Sus scrofa) populations may cause widespread environmental damage and transmit diseases at the wildlife-livestock interface. For example, African swine fever (ASF) is a highly contagious viral disease of pigs capable of causing catastrophic economic losses. Prevention and preparedness for ASF require understanding wild and domestic pig movements and distribution. We characterized a "grey" swine market and described the risks it poses, contributing to the threats associated with wild pig populations. We monitored www.kijiji.ca, a Canadian internet classified advertising service, for sales of domestic wild boar, pot-bellied pigs, other breeds, and their hybrids across Canada from 28 April to 30 June 2021. Data collected included seller-defined breed, age, sex, number for sale, sexual intactness, presence of identifying tags or tattoos, and the date and location of listings. Advertisement locations were mapped and compared with existing wild pig distributions, identifying areas new populations might be established, and existing populations supplemented or genetically diversified. We identified 151 advertisements on Kijiji: 34% (n=52/151) from Ontario, 29% (n=44/151) from Alberta, 41% (n=62/151) from existing wild pig populations, and 59% (n=89/151) from areas where wild pigs have not yet been identified. We propose requiring the use of individual animal identifiers (tags/tattoos), genetic analysis, and mandatory reporting for all pig sales in Canada to aid in ASF preparedness and to increase regulation and enforcement of the online swine market.

Outbreak Investigation of Typhoid Fever in the District of Gabes, South of Tunisia.

Typhoid fever is a significant public health concern in many parts of the world, particularly in developing countries with poor sanitation and hygiene conditions. In July 2016, an outbreak of typhoid fever occurred in Ghannouche, located in the south of Tunisia. This paper reports the results of a field investigation undertaken to identify possible transmission pathways and risk factors in order to propose control and preventive measures. A retrospective cohort study including a passive and active case finding, as well as an environmental and bacteriological investigation was conducted from July to September 2016. A case was defined as a person residing or having stayed in Ghannouche and having presented from the beginning of June clinical signs suggestive of typhoid fever, with, for a confirmed case, laboratory isolation of S.Tyhi, and for a probable case, an epidemiological link with a confirmed case. Attack rates were determined, and risk ratios were estimated with respect to exposures. Unadjusted and adjusted odds ratios were estimated using binary logistic regression. Among the 628 subjects investigated, 102 cases of typhoid fever were identified (74 confirmed and 28 probable) with an overall attack rate of 16.24%. Over 56% of cases were male and those under 10 years old were most affected (38.2%% of cases) with a median age of 12 years (interquartile range 5 to 25 years). The main clinical signs were fever (95%) and diarrhea (57%). Young age (adjusted OR = 0.95 and 95% CI = 0.93-0.97), low level of education (adjusted OR = 4.76 and 95% CI = 1.34-16.81), and the habitat type Arab or rudimentary house (adjusted OR = 4.93 and 95% CI = 2.61-8.27) were the socio-demographic factors independently associated with typhoid fever. Typhoid fever was found to be associated with drinking softened water (adjusted OR = 2.64 and 95% CI = 1.16-4.82), eating raw fruit and vegetables from family gardens (adjusted OR = 6.13 and 95% CI = 3.66-11.06), and using uncontrolled waste disposal (adjusted OR = 3.52 and 95% CI = 2.03-6.94). A total of 110 drinking water samples were analyzed; out of the 38 samples of softened water, 12 were non-compliant and 5 were positive for Salmonella. The screening activity identified two asymptomatic carriers, one of whom was a softened water seller. We concluded that drinking softened water from informal or unauthorized sale units, consuming fruit and vegetables from family gardens, uncontrolled dumping of household waste, and poor socio-economic conditions increase the risk of typhoid fever in this region. Many recommendations were implemented to stop this outbreak and to prevent further episodes.

Safety profile of inactivated COVID-19 vaccine in indonesian adults

BackgroundVaccines are urgently needed to handle the morbidity and mortality of the COVID-19 pandemic in Indonesia. The inactivated vaccine is widely used in Indonesia's national immunization program due to its eligibility of stock, easier to transport, and considered to be more established than newer platforms. In this study, we aimed to evaluate the safety profile of the inactivated vaccine and analyze the safety profile between adults and the elderly. MethodsA prospective analytical study was conducted to evaluate the safety profile of inactivated COVID-19 vaccine among healthy adults aged ≥ 18 years from September 2nd to December 28th, 2021, at ten primary health centers from 5 districts in Jakarta, Indonesia. The participants were instructed to record the symptoms after inactivated COVID-19 vaccine injection in the diary card for 28 days. Chi-square tests were carried out to analyze the relationship between the adverse event following immunization (AEFI) in adults and elderly groups. ResultsFour of 1113 participants were not included in this study due to the lack of follow-up. Out of 1109 participants, there were 1044 adults (18–59 years) and 65 elderly (>59 years). There were no serious AEFI cases reported. Most AEFI cases were mild to moderate and resolved after several days of injection. Local pain, myalgia and fatigue were the most frequent adverse events reported. We found that there was no correlation between the adults and elderly age group with the incidence of AEFI (p = 0.924) for local reactions (p = 0.181) and most of the systemic reactions (p = 0.629). However, there is an increased risk of fever in the elderly group compared to the adult group (OR 4.046, 95 % CI 1.794–9.124, p = 0.003) following immunization. ConclusionsOur study demonstrated that the inactivated COVID-19 vaccine is safe, considering that all symptoms experienced were mild to moderate and resolved entirely.

Oncologists’ receipt of pharmaceutical industry payments and use of non-recommended and low-value cancer care services.

6639 Background: Personal payments from the pharmaceutical industry to US physicians are common and influence physician practice. Prior studies have found that industry payments sway physicians’ selection among effective, medically appropriate treatments. However, whether industry payments may be associated with non-recommended and low-value care has not been assessed. The objective of this study was to estimate the association between oncologists’ receipt of industry payments and use of non-recommended and/or low-value (NR/LV) interventions. Methods: Population-based cohort study using fee-for-service Medicare claims and Open Payments records of industry payments. We identified four NR/LV cancer interventions: 1) denosumab for castrate-sensitive prostate cancer; 2) GCSF for patients at low risk for neutropenic fever; 3) nab-paclitaxel instead of paclitaxel for breast and lung cancer 4) branded drug instead of a generic or biosimilar. Study sample: Medicare beneficiaries with an incident cancer diagnosis (identified by new occurrence of a cancer diagnosis code in proximity to claims for cancer treatment) from 2014-2019. We applied additional requirements as appropriate to identify four sub-cohorts, corresponding to patients at risk for each of the NR/LV treatments, and identified the treating oncologist using claims. The primary exposure was receipt, by a patient’s oncologist, of any industry payments for the corresponding NR/LV treatment of interest, within 365 days before the patient’s index cancer date. The primary outcome was receipt of the corresponding NR/LV treatment. We fit general linear models controlling for patient characteristics and calendar year. To assess robustness, we also accounted for physician-level fixed effects in separate models. Results: Cohort sizes were: denosumab N = 9,799; GCSF N = 271,485; nab-paclitaxel N = 86,394; branded drug N = 13,386. Controlling for patient characteristics and calendar year, industry payment was associated with an increase in the absolute prevalence of denosumab (+17.5% [95%CI:15.3 to 19.7%]), GCSF (+5.8% [95%CI:5.4 to 6.1%]), and nab-paclitaxel (+7.6% [95%CI:7.1 to 8.1%]) use, but lower branded drug use (-4.6 [95%CI:-5.8 to -3.3]). In physician-level fixed effects models, industry payment was associated with increased denosumab (+7.4% [95%CI:2.5 to 12.2%]) and nab-paclitaxel (+1.7% [95%CI:0.9 to 2.5%]) use, but not with GCSF (+0.4% [95%CI:-0.3 to 1.1%]) or branded drugs (+1.2% [95%CI:-5.8 to 8.3%]). Conclusions: Recent receipt of industry payments by physicians was associated with increased use of several forms of NR/LV cancer treatment. These findings raise quality-of-care concerns regarding physician-industry financial relationships. Additional work is needed to further explore the causal relationship between payments and non-recommended treatments, and between payments and patient outcomes.

Spatial pattern assessment of dengue fever risk in subtropical urban environments: The case of Hong Kong

Dengue fever, a mosquito-borne fatal disease, brings a huge health burden in tropical regions. With global warming, rapid urbanization and the expansion of mosquitoes, dengue fever is expected to spread to many subtropical regions, leading to increased potential health risks on local populations. So far, limited studies assessed the dengue fever risk spatially for subtropical non-endemic regions hindering the development of related public health management. Therefore, we proposed a spatial hazard-exposure-vulnerability assessment framework for mapping the dengue fever risk in Hong Kong. Firstly, the spatial distribution of the habitat suitability for Aedes albopictus, the mosquito proxy for the dengue fever hazard, was predicted using a species distribution model (e.g., MaxEnt) relying on a list of variables related to local climate, urban morphology, and landscape metrics. Secondly, the spatial autocorrelation between high dengue hazard and high human population exposure in urban areas was measured. Finally, the dengue fever risk was assessed at community scale by integrating the results of vulnerability analysis basing on census data. This approach allowed the identification of 17 high-risk spots within Hong Kong. The landscape metrics about land utilities and vegetations, and urban morphological characteristics are the influential factors on the spatial distribution of dengue vector. In addition, the underlying factors behind each hot spot were investigated, and specific suggestions for dengue prevention were proposed accordingly. The findings provide a useful reference for developing local dengue fever risk prevention measures, with the proposed method easily exportable to other high-density cities within subtropical Asia and elsewhere.

Mapping the risk of Rift Valley fever in Uganda using national seroprevalence data from cattle, sheep and goats.

Uganda has had repeated outbreaks of Rift Valley fever (RVF) since March 2016 when human and livestock cases were reported in Kabale after a long interval. The disease has a complex and poorly described transmission patterns which involves several mosquito vectors and mammalian hosts (including humans). We conducted a national serosurvey in livestock to determine RVF virus (RVFV) seroprevalence, risk factors, and to develop a risk map that could be used to guide risk-based surveillance and control measures. A total of 3,253 animals from 175 herds were sampled. Serum samples collected were screened at the National Animal Disease Diagnostics and Epidemiology Centre (NADDEC) using a competition multispecies anti-RVF IgG ELISA kit. Data obtained were analyzed using a Bayesian model that utilizes integrated nested Laplace approximation (INLA) and stochastic partial differential equation (SPDE) approaches to estimate posterior distributions of model parameters, and account for spatial autocorrelation. Variables considered included animal level factors (age, sex, species) and multiple environmental data including meteorological factors, soil types, and altitude. A risk map was generated by projecting fitted (mean) values, from a final model that had environmental factors onto a spatial grid that covered the entire domain. The overall RVFV seroprevalence was 11.3% (95% confidence interval: 10.2-12.3%). Higher RVFV seroprevalences were observed in older animals compared to the young, and cattle compared to sheep and goats. RVFV seroprevalence was also higher in areas that had (i) lower precipitation seasonality, (ii) haplic planosols, and (iii) lower cattle density. The risk map generated demonstrated that RVF virus was endemic in several regions including those that have not reported clinical outbreaks in the northeastern part of the country. This work has improved our understanding on spatial distribution of RVFV risk in the country as well as the expected burden of the disease in livestock.

Areas within the United States at the Highest Risk for African Swine Fever, Classical Swine Fever, and Foot-and-Mouth Disease Introduction

Domestic livestock production is a major component of the agricultural sector, contributing to food security and human health and nutrition and serving as the economic livelihood for millions worldwide. The impact of disease on global systems and processes cannot be understated, as illustrated by the effects of the COVID-19 global pandemic through economic and social system shocks and food system disruptions. This study outlines a method to identify the most likely sites of introduction into the United States for three of the most concerning foreign animal diseases: African swine fever (ASF), classical swine fever (CSF), and foot-and-mouth disease (FMD). We first created an index measuring the amount of potentially contaminated meat products entering the regions of interest using the most recently available Agricultural Quarantine Inspection Monitoring (AQIM) air passenger inspection dataset, the AQIM USPS/foreign mail, and the targeted USPS/foreign mail interception datasets. The risk of introduction of a given virus was then estimated using this index, as well as the density of operations of the livestock species and the likelihood of infected material contaminating the local herds. Using the most recently available version of the datasets, the most likely places of introduction for ASF and CSF were identified to be in central Florida, while FMD was estimated to have been most likely introduced to swine in western California and to cattle in northeastern Texas. The method illustrated in this study is important as it may provide insights on risk and can be used to guide surveillance activities and optimize the use of limited resources to combat the establishment of these diseases in the U.S.

Seroepidemiology of Lassa virus in pregnant women in Southern Nigeria: A prospective hospital-based cohort study.

There is limited epidemiological evidence on Lassa fever in pregnant women with acute gaps on prevalence, infection incidence, and risk factors. Such evidence would facilitate the design of therapeutic and vaccine trials and the design of control programs. Our study sought to address some of these gaps by estimating the seroprevalence and seroconversion risk of Lassa fever in pregnant women. We conducted a prospective hospital-based cohort between February and December 2019 in Edo State, Southern Nigeria, enrolling pregnant women at antenatal clinic and following them up at delivery. Samples were evaluated for IgG antibodies against Lassa virus. The study demonstrates a seroprevalence of Lassa IgG antibodies of 49.6% and a seroconversion risk of 20.8%. Seropositivity was strongly correlated with rodent exposure around homes with an attributable risk proportion of 35%. Seroreversion was also seen with a seroreversion risk of 13.4%. Our study suggests that 50% of pregnant women were at risk of Lassa infection and that 35.0% of infections might be preventable by avoiding rodent exposure and conditions which facilitate infestation and the risk of human-rodent contact. While the evidence on rodent exposure is subjective and further studies are needed to provide a better understanding of the avenues of human-rodent interaction; public health measures to decrease the risk of rodent infestation and the risk of spill over events may be beneficial. With an estimated seroconversion risk of 20.8%, our study suggests an appreciable risk of contracting Lassa fever during pregnancy and while most of these seroconversions may not be new infections, given the high risk of adverse outcomes in pregnancy, it supports the need for preventative and therapeutic options against Lassa fever in pregnancy. The occurrence of seroreversion in our study suggests that the prevalence obtained in this, and other cohorts may be an underestimate of the actual proportion of women of childbearing age who present at pregnancy with prior LASV exposure. Additionally, the occurrence of both seroconversion and seroreversion in this cohort suggests that these parameters would need to be considered for the development of Lassa vaccine efficacy, effectiveness, and utility models.