Risk Of New Infections Research Articles

Risk of dengue virus infection according to serostatus in individuals from dengue endemic areas of Mexico

The variability in the host immune response directed against dengue virus (DENV) has demonstrated the need to understand the immune response associated with protection in incident infection. The objective was to estimate the association between serostatus and the risk of incident DENV infection. We used a prospective study from 2014 to 2016 in the localities of Axochiapan and Tepalcingo, Morelos, Mexico. We recruited 966 participants, of which, according to their infection history registered were categorized in four groups. To accomplish the objectives of this study, we selected to 400 participants older than 5 years of age were followed for 2.5 years. Blood samples were taken every 6 months to measure serological status and infection by ELISA. In individuals with at least two previous infections the risk of new infection was lower compared to a seronegative group (hazard ratio adjusted 0.49, 95% CI 0.24–0.98), adjusted for age and locality. Therefore, individuals who have been exposed two times or more to a DENV infection have a lower risk of re-infection, thus showing the role of cross-immunity and its association with protection.

Covid-19, Educación y Derechos de la Infancia en España

Las medidas adoptadas en el Real Decreto por el que se declara el estado de alarma para luchar contra la epidemia producida por el Covid-19 en España impactan de manera directa sobre niños, niñas y adolescentes. El objetivo de este artículo es analizar, en su primera parte, la compleja relación que existe entre el derecho a la protección de la salud, el derecho a la educación y los derechos de la infancia. La suspensión de la actividad docente presencial ha supuesto no solamente la posibilidad de que muchos niños y niñas vean ralentizados sus aprendizajes escolares, especialmente aquellos que proceden de entornos más vulnerables, sino también que dejen de estar protegidos y que pierdan la posibilidad de alcanzar unas mejores condiciones de vida, por el efecto positivo que la escuela tiene como herramienta de compensación de las desigualdades sociales. Parece, entonces, necesario que se aborde, en la segunda parte del artículo, una seria reflexión acerca de las condiciones y el momento en el que se debe volver a las aulas. Así como, sobre las medidas que se han de adoptar para garantizar la calidad y la equidad del sistema educativo teniendo en cuenta que la enfermedad seguirá estando presente en nuestras vidas y, por tanto, el riesgo de que se produzcan nuevos contagios. Disponer de un Plan Nacional de Digitalización; revisar el curriculum, y proporcionar programas de refuerzo son retos que enfrenta nuestro sistema educativo, pero que pueden convertirse en oportunidades para mejorar su calidad y equidad.

Importance of Lifetime Sexual History on the Prevalence of Genital Human Papillomavirus (HPV) Among Unvaccinated Adults in the National Health and Nutrition Examination Surveys: Implications for Adult HPV Vaccination.

Although the United States Food and Drug Administration recently approved the human papillomavirus (HPV) vaccine for individuals aged 27-45 years, the Centers for Disease Control and Prevention did not change its guidelines for routine HPV vaccination. Since recommendations for adult vaccination emphasize shared clinical decision-making based on risk of new infections, we examined the relationship between HPV prevalence and sexual behavior. This study was conducted among 5093 HPV-unvaccinated, sexually experienced adults aged 18-59 years in the National Health and Nutrition Examination Surveys (2013-2016). For each sex and age group, adjusted prevalences of 9-valent vaccine-specific, high-risk, and any HPV infection were estimated by number of lifetime sexual partners (LTSPs) using logistic regression. An analysis restricted to persons who did not have a new sexual partner in the past year (ie, removing those at highest risk of newly acquired HPV) was also conducted. In each age group, genital HPV prevalence was higher among persons with >5 LTSPs compared with 1-5 LTSPs in both males and females. There were only slight reductions in HPV prevalence after removing participants who reported a new sexual partner in the past year. For example, among females aged 27-45 years with >5 LTSPs, the adjusted prevalence of 9-valent vaccine-type HPV infection was 13.4% (95% confidence interval [CI], 9.9%-17.0%) in the full population compared to 12.1% (95% CI, 8.8%-15.4%) among those with no new sexual partners. Prevalent HPV infection was primarily reflective of cumulative exposures over time (higher LTSPs). New exposures had limited impact, emphasizing the need to consider sexual history in the decision-making process for adult HPV vaccination.

COVID-19 and hypertension-evidence and practical management: Guidance from the HOPE Asia Network.

There are several risk factors for worse outcomes in patients with coronavirus 2019 disease (COVID‐19). Patients with hypertension appear to have a poor prognosis, but there is no direct evidence that hypertension increases the risk of new infection or adverse outcomes independent of age and other risk factors. There is also concern about use of renin‐angiotensin system (RAS) inhibitors due to a key role of angiotensin‐converting enzyme 2 receptors in the entry of the SARS‐CoV‐2 virus into cells. However, there is little evidence that use of RAS inhibitors increases the risk of SARS‐CoV‐2 virus infection or worsens the course of COVID‐19. Therefore, antihypertensive therapy with these agents should be continued. In addition to acute respiratory distress syndrome, patients with severe COVID‐19 can develop myocardial injury and cytokine storm, resulting in heart failure, arteriovenous thrombosis, and kidney injury. Troponin, N‐terminal pro‐B‐type natriuretic peptide, D‐dimer, and serum creatinine are biomarkers for these complications and can be used to monitor patients with COVID‐19 and for risk stratification. Other factors that need to be incorporated into patient management strategies during the pandemic include regular exercise to maintain good health status and monitoring of psychological well‐being. For the ongoing management of patients with hypertension, telemedicine‐based home blood pressure monitoring strategies can facilitate maintenance of good blood pressure control while social distancing is maintained. Overall, multidisciplinary management of COVID‐19 based on a rapidly growing body of evidence will help ensure the best possible outcomes for patients, including those with risk factors such as hypertension.

Investigation of Ixodid ticks as vectors of Babesia caballi and Theileria equi (Protozoa: Apicomplexa) in central Italy

Babesia caballi and Theileria equi are widely recognized as causative agents of equine pirolasmosis (EP), an acute, sub-acute, and chronic disease of equines, with relevant economic impact on horse trade worldwide. Although several studies on EP prevalence from central Italy have been published, data on ticks responsible for its transmission are still lacking. In this study, we identified a potential competent vector, investigating main features of its ecology together with EP infection rates. A two-year sampling of questing ticks was carried out for the first time in Italy in an area known for high EP prevalence in horse sera, detecting the association between Rhipicephalus bursa and causative agents of EP. Most of the positive pools harbored a single infection (91.1%); mixed infections were also detected (8.9%). The infection rate for T. equi slightly decreased among years; B. caballi showed a lower, but increasing, infection rate. Tick phenology, climate variables, and peaks of EP prevalence indicated late May and second half of June as periods with the highest risk of new infections, especially during warm and dry days.

Abstract IA16: Prevention of hepatocellular carcinoma through preventative hepatitis C vaccination

Abstract In the United States, the incidence of hepatocellular carcinoma (HCC) has tripled and mortality rates have doubled since 1980. Between 2006 and 2015, HCC diagnoses increased by approximately 3% annually. Liver cancer is the fifth most common cause of cancer death in men and the seventh among women. Hepatitis C virus (HCV) infection is the primary risk factor for about one-third of cases of HCC in the US population. Hepatitis C virus (HCV) infection is a bloodborne disease with global distribution that affects almost 3% of the world’s population. Less than 20% of acute HCV infections cause acute viral hepatitis symptoms severe enough for the patient to seek medical care, and approximately 75% of all infections become persistent. Individuals with chronic HCV infection usually remain asymptomatic and undiagnosed for decades before chronic hepatitis leads to complications that can include severe fibrosis and cirrhosis, hepatic failure, or HCC. In studies of people with HCV, the risk for HCC increased as much as 3% per year after diagnosis of cirrhosis. Despite effective therapy, HCV remains the leading cause of liver failure requiring transplantation and HCC in many countries. Continuing advances in therapeutic regimens are promising for effecting cures of HCV and may reduce transmission. However, there remain challenges in HCV control. Identifying those with HCV infection is difficult because of its relative silence until end-stage disease develops. It is estimated that fewer than 5% of HCV-infected persons are diagnosed worldwide, and the proportion of patients who access and complete treatment remains low. Even when current HCV therapy is administered successfully, it does not provide immunity against subsequent infection. Intravenous drug users and other high-risk groups, such as health care providers, those living in endemic regions, and HIV-infected men who have sex with men, are at risk for new infections and will continue to be at increased risk of infection despite better regimens for HCV treatment. HCV transmission is likely to persist in areas with limited access to antiviral drugs and poor needle injection and blood product hygiene. These challenges, as well as the cost of therapy, make HCV therapy alone unlikely to block the spread of infection within the total human population and to eradicate HCV. In contrast, in Taiwan immunization of infants against hepatitis B virus (HBV) has substantially reduced HBV transmission and subsequently the risk of developing HCC as children and young adults. Therefore, development of a vaccine to prevent chronic HCV infection, if not to prevent infection altogether, remains a critical aspect of an HCV disease control platform. This talk will discuss the need for a vaccine, the evidence that a vaccine to prevent chronic infection is possible, and the vaccine strategies tested to date. Citation Format: Andrea L. Cox. Prevention of hepatocellular carcinoma through preventative hepatitis C vaccination [abstract]. In: Proceedings of the AACR Special Conference on the Microbiome, Viruses, and Cancer; 2020 Feb 21-24; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2020;80(8 Suppl):Abstract nr IA16.

Q fever seroprevalence in parturient women: the EQRUN cross-sectional study on Reunion Island

BackgroundQ fever (Coxiella burnetii infection) has been associated with adverse perinatal outcomes. After investigating the obstetrical importance of Q fever on Reunion island and demonstrating an association between incident Q fever and miscarriage, we conducted a cross-sectional serosurvey to assess the prevalence of Coxiella burnetii infection among parturient women.MethodsBetween January 9 and July 24, 2014, within the level-4 maternity of Saint Pierre hospital and the level-1 maternity of Le Tampon, we proposed to screen all parturient women for Coxiella burnetii serology. Seropositivity was defined using indirect immunofluorescence for a dilution of phase 2 IgG titre ≥1:64. Further dilutions were chosen to discriminate recent or active infections from past or prevalent infections (< 1:128) and classify these as either possible (1:128), or probable (≥1:256). Recurrent miscarriage, stillbirth, preterm birth, small-for-gestational as well as a composite outcome of these adverse pregnancy outcomes were compared according to seropositivity using bivariate analysis or propensity score matching of seropositive and seronegative women on confounding factors.ResultsAmong 1112 parturient women screened for Q fever over this 7-month period, 203 (18.3%) were seropositive. Overall weighted seroprevalence was of 20.1% (95%CI, 17.7–22.5%). Weighted seroprevalence of probable infections was 4.7% (95%CI 3.4–5.9%), while > 90% of positive serologies corresponded to past infections or false positives. Seropositivity was associated with none of the abovementioned adverse perinatal outcomes, whether in unpaired or matched analyses on propensity score.ConclusionThe magnitude and the pattern of seroprevalence suggest that Q fever is endemic on Reunion island. In this context, we found no significant contribution of prevalent Coxiella burnetii infection to adverse pregnancy outcomes. Although reassuring, these data put in our endemic context, with a previously demonstrated increased risk of incident Q fever associated miscarriage, encourage us to protect pregnant women against the risk of new infection, periconceptional or early in pregnancy.

Hepatitis B Virus (HBV) Subviral Particles as Protective Vaccines and Vaccine Platforms

Hepatitis B remains one of the major global health problems more than 40 years after the identification of human hepatitis B virus (HBV) as the causative agent. A critical turning point in combating this virus was the development of a preventative vaccine composed of the HBV surface (envelope) protein (HBsAg) to reduce the risk of new infections. The isolation of HBsAg sub-viral particles (SVPs) from the blood of asymptomatic HBV carriers as antigens for the first-generation vaccines, followed by the development of recombinant HBsAg SVPs produced in yeast as the antigenic components of the second-generation vaccines, represent landmark advancements in biotechnology and medicine. The ability of the HBsAg SVPs to accept and present foreign antigenic sequences provides the basis of a chimeric particulate delivery platform, and resulted in the development of a vaccine against malaria (RTS,S/AS01, MosquirixTM), and various preclinical vaccine candidates to overcome infectious diseases for which there are no effective vaccines. Biomedical modifications of the HBsAg subunits allowed the identification of strategies to enhance the HBsAg SVP immunogenicity to build potent vaccines for preventative and possibly therapeutic applications. The review provides an overview of the formation and assembly of the HBsAg SVPs and highlights the utilization of the particles in key effective vaccines.

Rotavirus infection in immunocompetent adult patient in a city of state of São Paulo, Brazil – case report

This article aims to describe a case report of an immunocompetent adult patient with rotavirus infection, highlighting the points to be reviewed and the conducts performed, in order to include in the routine of health professionals more appropriate actions in cases of diarrhea. acute. The research was conducted qualitatively, with the direct collection of patient data, describing the events chronologically, aiming at a better understanding of the clinical picture and medical actions. The patient presented with diarrhea and colic, with worsening in 24 hours, being seen at the emergency room and later with specialist in infectology. Routine examinations, water and food support were performed during hospitalization, as well as symptomatic therapy and antibiotic therapy. Complementary examinations showed fecal rotavirus positivity, anti-HIV 1 - 2 negatives, co-culture and negative Clostridium difficile screening, and presence of liquid cecum-ascending dilation on computed tomography. During the evaluation period, a deficit in conduct points and decision-making concerns was visualized in patients with acute diarrheal diseases in a hospital environment. Thus, it is concluded that some protocols performed in ADD patients, such as the use of antibiotic therapy, should be closely monitored, as well as the need for greater attention to biosecurity and, consequently, the risk of new infections in the environment. in addition to the need for data to accompany the occurrence of rotavirus in adult patients, which target not only public units, which may serve to leverage preventive methodologies.

Epidemiological Characteristics of Newly Diagnosed Cases of HIV through Injection Drug Use - China, 2012-2019.

What is already known about this topic? The annual rates of newly diagnosed cases of human immunodeficiency virus (HIV) are increasing in China, yet the annual number of newly diagnosed cases of HIV infected through injection drug use (IDU) is decreasing. What is added by this report? Newly diagnosed cases of HIV infected through IDU in China from 2012 to 2019 show decreases year over year, but the risk of new infections through injecting drugs still exists. What are the implications for public health practice? This study highlighted that new HIV infections through IDU continue to be at a low level. However, individuals that are newly diagnosed as HIV-positive through IDU need to have their baseline CD4 T+ lymphocytes (CD4) cell counts monitored and have their sources of infections traced.

Trypanosomatid infections in captive wild mammals and potential vectors at the Brasilia Zoo, Federal District, Brazil.

BackgroundConservation projects in zoos may involve translocation of captive animals, which may lead to pathogen spread. Neotropical mammals are important hosts of Trypanosoma cruzi and Leishmania spp. the etiological agents of Chagas disease and Leishmaniasis respectively. Studies of trypanosomatid‐infected mammals and vectors (triatomines and sandflies) in zoos are important for the establishment of surveillance and control measures.ObjectivesWe investigated trypanosomatid infections in captive wild mammals, triatomines and sandflies at the Brasília Zoo.MethodsWe collected triatomines during active bimonthly surveys, sampled sandflies using light‐traps and obtained blood samples from 74 mammals between 2016 and 2017. We used quantitative PCR to detect trypanosomatids in vectors and mammals.ResultsWe found a colony of 19 Panstrongylus megistus in the porcupine unit and detected T. cruzi infections in five bugs. We captured 17 sandflies of four species including Nyssomyia whitmani and Lutzomyia longipalpis, but no Leishmania infection was detected. qPCR detected 50 T. cruzi‐infected mammals belonging to 24 species and five groups of mammals (Carnivora, Cetartiodactyla, Perissodactyla, Pilosa and Primates); Leishmania DNA was detected in 23 mammals from 15 species, mainly carnivores. We detected trypanosomatid infections in 11 mammals born at the Brasília Zoo.ConclusionsOur results suggest vector‐borne transmission of T. cruzi among maned wolves; measures to reduce the risk of new infections should therefore be taken. We also report sandfly presence and Leishmania‐infected mammals at the Brasília Zoo. Translocation of wild mammals in and out of the Brasília Zoo should consider the risk of T. cruzi and Leishmania spread.

Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis.

While previous trials have indicated that the use of corticosteroids for patients with acute respiratory distress syndrome (ARDS) is effective, the dosage and time-course for the use of corticosteroids remain a subject of controversy. The present study aimed to address and resolve these problems. PubMed, Embase and the Cochrane Library databases were searched from inception to March 2017 for randomized controlled trials (RCTs), which included patients with ARDS using corticosteroids. Related data were extracted independently by two investigators. The Mantel-Haenszel method was used with random-effects modeling to calculate the pooled odds ratio (OR) and 95% confidence interval (CI) for the mortality of patients with ARDS, and the risk of new infection arising from the use of glucocorticoids. The inverse variance method was used to calculate the mean difference (MD) and 95% CI for the duration of mechanical-free ventilation and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FIO2 ratio). The use of low-dose corticosteroids significantly reduced the mortality rate of patients with ARDS (OR: 0.43; 95% CI: 0.24–0.79; P=0.006) while the use of high-dose corticosteroids provided no significant benefit to reducing the mortality rate (OR: 1.33; 95% CI: 0.86–2.04; P=0.20). The present study identified that glucocorticoids reduced the mortality rate of patients during the early stages of ARDS (OR: 0.61; 95% CI: 0.43–0.86; P=0.005). Glucocorticoids significantly reduced the duration of mechanical ventilation (MD: 3.08; 95% CI: 1.49–4.68; P<0.05) and significantly improved the PaO2/FiO2 ratio (MD: 66.39; 95% CI: 57.79–74.98; P<0.05). The use of corticosteroids did not significantly increase the rate of infectious complications (OR: 0.60; 95% CI: 0.32–1.12; P>0.05). The use of low-dose corticosteroids may significantly reduce the mortality rate, particularly in the early stages of ARD, shorten the duration of mechanical ventilation and improve the PaO2/FiO2 ratio without increasing the risk of a new infection.

Urban Air Pollution Particulates Suppress Human T-Cell Responses to Mycobacterium Tuberculosis.

Tuberculosis (TB) and air pollution both contribute significantly to the global burden of disease. Epidemiological studies show that exposure to household and urban air pollution increase the risk of new infections with Mycobacterium tuberculosis (M.tb) and the development of TB in persons infected with M.tb and alter treatment outcomes. There is increasing evidence that particulate matter (PM) exposure weakens protective antimycobacterial host immunity. Mechanisms by which exposure to urban PM may adversely affect M.tb-specific human T cell functions have not been studied. We, therefore, explored the effects of urban air pollution PM2.5 (aerodynamic diameters ≤2.5µm) on M.tb-specific T cell functions in human peripheral blood mononuclear cells (PBMC). PM2.5 exposure decreased the capacity of PBMC to control the growth of M.tb and the M.tb-induced expression of CD69, an early surface activation marker expressed on CD3+ T cells. PM2.5 exposure also decreased the production of IFN-γ in CD3+, TNF-α in CD3+ and CD14+ M.tb-infected PBMC, and the M.tb-induced expression of T-box transcription factor TBX21 (T-bet). In contrast, PM2.5 exposure increased the expression of anti-inflammatory cytokine IL-10 in CD3+ and CD14+ PBMC. Taken together, PM2.5 exposure of PBMC prior to infection with M.tb impairs critical antimycobacterial T cell immune functions.

Controlling bovine leukemia virus in dairy herds by identifying and removing cows with the highest proviral load and lymphocyte counts

The objective of this field trial was to reduce bovine leukemia virus (BLV) transmission and prevalence in commercial dairy herds using proviral load (PVL) and lymphocyte count (LC) measurements as indicators of the most infectious animals for culling or segregation. Bovine leukemia virus causes lymphoma in <5% of infected cattle, and increased lymphocyte counts (lymphocytosis) in about one-third. Recent research has shown that dairy cows infected with BLV have altered immune function associated with decreases in milk production and lifespan. Recent findings show that a minority of infected cattle have PVL concentrations in blood and other body fluids of over 1,000 times that of other infected cattle. In combination with a high LC, these animals are thought to be responsible for most transmission of BLV in a herd. Milk or blood samples from adult cows in our 3 Midwestern dairy farm field trials were tested semiannually with ELISA for BLV antibodies, and ELISA-positive cattle were then retested using a blood LC and a quantitative PCR test for PVL to identify the animals presumed to be most infectious. Herd managers were encouraged to consider PVL and LC status when making cull decisions, and to segregate cows with the highest PVL and LC from their BLV ELISA-negative herd mates where possible. After 2 to 2.5 yr of this intervention, the incidence risk of new infections decreased in all 3 herds combined, from 13.8 to 2.2, and the overall herd prevalence decreased in all 3 herds combined from 62.0 to 20.7%, suggesting that this approach can efficiently reduce BLV transmission as well as prevalence. This is encouraging, because a very low prevalence of BLV infection would make it economically feasible to cull the remaining ELISA-positive cattle, as was achieved in national eradication programs in other countries decades ago.

The GH Axis in Relation to Accepting an Early Macronutrient Deficit and Outcome of Critically Ill Patients.

Changes in the GH axis during critical illness resemble fasting in healthy adults and contribute to hypercatabolism, which potentially affects outcome. Accepting macronutrient deficits by withholding parenteral nutrition (PN) during the first week in the intensive care unit (ICU; late PN) reduced complications and accelerated recovery as compared with early use of PN (early PN). To investigate how late PN affects the GH axis in relation to its clinical outcome benefits. Preplanned subanalysis of the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients randomized controlled trial. A total of 1128 patients for time-course study, 20 patients investigated for nocturnal GH pulsatility, and 600 patients investigated for muscle weakness, with early PN and late PN patients having comparable baseline characteristics. Withholding PN during the first ICU week (late PN) vs early PN. Changes in serum GH, IGF-I, IGF-binding protein (IGFBP) 3, and IGFBP1 concentrations from ICU admission to day 4 or last ICU day for patients with a shorter ICU stay (d4/LD) and association in multivariable analyses with likelihood of earlier live ICU discharge, risk of new infection, and muscle weakness. Late PN attenuated a rise in serum GH and IGF-I (P < 0.0001), did not affect IGFBP3, and attenuated a decrease in IGFBP1 concentrations from admission to d4/LD (P < 0.0001) as compared with early PN. Late PN decreased nonpulsatile (P = 0.005), but not pulsatile, GH secretion. Adjusting the multivariable models for the observed GH axis alterations increased the independent benefit of late PN for all outcomes. GH axis alterations induced by late PN were independently associated with adverse outcomes (P ≤ 0.03). Accepting macronutrient deficits early during critical illness further suppressed the GH axis, which statistically attenuated its clinical outcome benefits.

Effect of late versus early initiation of parenteral nutrition on weight deterioration during PICU stay: Secondary analysis of the PEPaNIC randomised controlled trial

Critically ill children are at increased risk of weight deterioration in the paediatric intensive care unit (PICU). Whether early initiation of parenteral nutrition (PN) prevents weight deterioration is unknown. The aims of this study were to assess the effect of withholding supplemental PN during the first week on weight Z-score change in PICU and to evaluate the association between weight Z-score change in the PICU and clinical outcomes. This is a secondary analysis of the Paediatric Early versus Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC) randomised controlled trial (N=1440), which focused on the subgroup of patients with longitudinal weight Z-scores available on admission and on the last day in PICU. Patients were randomly allocated to initiation of supplemental PN after one week (Late-PN) or within 24h (Early-PN) when enteral nutrition was insufficient. The effect of Late-PN versus Early-PN on the change in weight Z-score was investigated, adjusted for risk factors. Moreover, the association between weight Z-score change and clinical outcomes was explored, adjusted for risk factors. Longitudinal weight Z-scores were available for 470 patients. Enteral nutrition intake was equal in the Early-PN and Late-PN group. Less weight Z-score deterioration during PICU stay was associated with a lower risk of new infections (adjusted OR per Z-score increase 0.72 [0.55-0.96], p=0.02), and with a higher likelihood of an earlier discharge from PICU alive (adjusted HR per Z-score increase 1.22 [1.10-1.37], p<0.001). During PICU-stay, the change in weight Z-score did not differ among both groups (Late-PN median 0.00 [-0.34-0.12] vs Early-PN median-0.03 [-0.48-0.01], adjusted β=0.10 [-0.05-0.25], p=0.18). Weight deterioration during the PICU stay was associated with worse clinical outcomes. Withholding supplemental PN during the first week did not aggravate weight Z-score deterioration during PICU stay. clinicaltrials.gov NCT01536275.

Reports of Sexually Acquired Hepatitis C Infection Among MSM on PrEP

Adherence to preexposure HIV prophylaxis (PrEP) significantly decreases the risk for new HIV infection among men who have sex with men (MSM). In many

Moderate endemicity of the human T-lymphotropic virus infection in the metropolitan region of Belém, Pará, Brazil.

The spread of the HTLV infection in families living in the metropolitan area of Belém, Pará, Brazil, and the lack of studies in the general population requires studies to better understand its prevalence in the region. An anti-HTLV-1/HTLV-2 antibodies test was carried out on random adults in public places in Belém between November 2014 and November 2015. A proviral DNA test detected if the person was infected, and then a clinical evaluation and an intrafamilial investigation were carried out. Of the 1059 individuals being investigated, 21 (2.0%) had seroreagent samples, 15 (1.4%) had HTLV-1, 5 (0.5%) had HTLV-2, and proviral DNA was undetectable in one case. The mean age of the infected people (57.2) was higher than that of those that were uninfected (46.2) (p = 0.0010). The prevalence of infection increased with age, especially in individuals with a family income equal to or less than a minimum wage. Intrafamilial transmission seems to have occurred in all of the families being studied. Among the patients with HTLV-1, 30% (3/10) already had some symptom related to the infection. The increase in prevalence rates according to age may be due to late seroconversion of a previously acquired infection, or the cumulative risk of new infections, especially in women. There was a moderate prevalence of the HTLV infection among adult individuals from the metropolitan area of Belém, with a predominance of HTLV-1. This infection was associated with low income and increasingly older women. It also presented intrafamily spread and negligence in the diagnosis of associated diseases.

Outcomes of Delaying Parenteral Nutrition for 1 Week vs Initiation Within 24 Hours Among Undernourished Children in Pediatric Intensive Care

Undernourishment has been associated with poor outcomes of critical illness in children. The effects of withholding parenteral nutrition (PN) for 1 week in undernourished critically ill children are unknown. To assess the outcome effects of withholding PN for 1 week in undernourished critically ill children. This is a subanalysis of the randomized clinical trial Pediatric Early vs Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC; N = 1440), which focused on the subgroup of pediatric intensive care unit (PICU) patients identified as undernourished on admission. Children included in the PEPaNIC trial were enrolled between June 18, 2012, and July 27, 2015. Undernourishment was defined as weight-for-age z score less than -2 in children younger than 1 year, and body mass index-for-age z score less than -2 in children 1 year or older. Data analysis was conducted from August 3, 2017, to July 6, 2018. Patients were randomized to initiation of supplemental PN within 24 hours (early PN) or after 1 week (late PN) when enteral nutrition was insufficient. Primary end points were risk of new infections acquired in the PICU and time to live PICU discharge, assessed via multivariable logistic regression and Cox proportional hazard analyses, adjusted for risk factors. A total of 289 of 1440 children (20.1%), term newborn to age 17 years, were identified as undernourished, of whom 150 of 717 patients (20.9%) were in the late PN group and 139 of 723 patients (19.2%) were in the early PN group. On admission, characteristics were similar among the treatment groups. Mean (SD) weight z scores were -3.33 (1.18) in the late PN group and -3.21 (1.09) in the early PN group. Compared with well-nourished PICU patients, undernourishment on admission was associated with lower likelihood of an earlier live PICU discharge (adjusted hazard ratio, 0.86; 95% CI, 0.75-0.99; P = .03). Among undernourished PICU patients, late PN reduced the risk of new infections by 11.0% (adjusted odds ratio, 0.39; 95% CI, 0.19-0.78; P = .01), and shortened the duration of PICU stay by a median of 2 days (earlier live PICU discharge: adjusted hazard ratio, 1.37; 95% CI, 1.06-1.75; P = .01). The safety outcomes mortality, incidence of hypoglycemia during the first week, and incidence of weight deterioration during PICU stay were similar between the treatment groups. In undernourished critically ill children, withholding PN for 1 week was clinically superior to early PN. ClinicalTrials.gov Identifier: NCT01536275.

Correlates of Correct HIV Knowledge and Myth Rejection in South Africa: The 2012 National HIV Prevalence, Incidence and Behavior Survey

Introduction: Correct knowledge of HIV transmission and prevention and myth rejection is a prerequisite to practicing safer behavior and important for reducing the risk of new infections. This study investigates the association between correct knowledge of HIV transmission, prevention and myth rejection with socio-demographic factors and HIV-related behavioral risk practices in South Africa. Methods: The study used the 2012 South African national HIV prevalence, incidence and behavior survey data based on a multistage cross-sectional design. Univariate and multivariate logistic regression models were used to examine correlates of correct HIV knowledge and myth rejection. Results: Of 26,544 sub-sample of youth and adults data (15 years and older) who responded to the HIV knowledge question, only 26.8% reported correct knowing of HIV transmission, prevention and rejection of all myths about HIV. In the final model significant negative predictors of correct HIV knowledge, prevention and myth rejection included residing in rural informal areas (OR=0.68 (95% CI: 0.48- 0.95), p=0.027), and being a harmful alcohol drinker (OR= 0.18 (95% CI: 0.06- 1.29), p=0.001) while sexual debut at 15 years and older (OR=1.8 (95 CI: 1.12- 2.91), p= 0.015) was a significant positive predictor of correct HIV knowledge and myth rejection. Conclusion: The findings confirms that levels of HIV knowledge can either prevent individuals from making informed choices and take appropriate actions aimed at preventing the infection or make people to take precautions to protect themselves. Efforts to promote HIV knowledge, prevention and myth rejection in the general population should be strengthened given the declining HIV knowledge levels in the country.