Public Health Threat Research Articles

Impact of COVID-19 and Mpox on Sexual Practices and Disease Mitigation Strategies Over Time Among Men Who Have Sex With Men Affiliated With Collective Sex Venues.

The COVID-19 pandemic and subsequent multinational mpox outbreak significantly disrupted sexual health care delivery, particularly impacting men who have sex with men (MSM). This study investigated these public health emergencies in relation to perceptions, attitudes, and sexual practices among MSM affiliated with a collective sex venue (CSV). Electronic surveys were sent to clientele of a high-volume CSV between June 2021 and November 2022 across 3 time periods defined as pre-Omicron, post-Omicron, and mpox. Data collection encompassed sociodemographics, health care access, sexually transmitted infection/HIV status, COVID-19 testing, and sexual behaviors. Multivariable regression analyses identified factors associated with self-reported COVID-19 testing and positivity, and mpox exposure. Among 1135 responses, demographics were largely cisgender MSM and predominantly White. Increased self-reported COVID-19 positivity was associated with having more sex partners and frequenting bathhouses for meeting sex partners. Confidence in COVID-19 mitigation strategies decreased post-Omicron. Factors linked to mpox exposure included younger age, increased sex partners, sexually transmitted infection positivity, and lower confidence in mitigation strategies. These findings underscore the intersectionality between sexual behaviors and public health responses to COVID-19 and mpox among MSM communities affiliated with a CSV. Decreased confidence in mitigation strategies and changes in sexual behaviors during public health emergencies underscore the need for targeted interventions and messaging. Collaboration between health departments and CSVs can facilitate responses to current and future public health threats and interventions.

The application value of bacteriophage in patients with severe drug-resistant bacterial infections

The emergence of antimicrobial resistance (AMR) represents one of the most significant global public health threats, imposing substantial economic burdens. To address this critical issue of resistance, one of the most promising alternative strategies for treating antimicrobial resistant bacterial infections is bacteriophage therapy. Bacteriophages exhibit high specificity towards bacteria, capable of lysing and killing specific bacterial strains. Phage cocktails can broaden the spectrum of activity, contribute to target multiple types of bacteria. Personalized bacteriophage therapy, tailored to individual patients, enhances precise targeting of pathogens. Increasing evidence supports the feasibility of phage-antibiotic combinations in treating multidrug-resistant bacteria. Furthermore, genetic engineering, including technologies like clustered regularly interspaced short palindromic repeats (CRISPR)-Cas, has advanced the development of engineering phages, providing novel ways to kill bacterial hosts. This review discusses the research progress of bacteriophage for refractory infections caused by multidrug-resistant bacteria, the advantages and limitations of phage therapy, and highlights clinical studies and case reports of various phage treatment modalities.

Elimination of hepatitis B as a public health threat: Addressing the challenge and taking action

Despite the significant efforts made in recent years, the latest data from the World Health Organization indicates that there are substantial challenges in achieving the elimination of hepatitis B virus (HBV) infection by 2030. The article in the World Journal of Hepatology by Ismael et al highlighted the limited accessibility to screening and antiviral treatment for HBV infection in eastern Ethiopia. Therefore, the editorial comments on this article will focus on the current challenges and recent efforts in the prevention and treatment of chronic hepatitis B, particularly emphasizing the expansion of screening and antiviral therapy, as well as feasible strategies to improve accessibility for HBV testing, antiviral therapy, and adherence enhancement.

Phenotypic and genomic characterization of ST11-K1 CR-hvKP with highly homologous bla KPC-2 -bearing plasmids in China

ABSTRACT Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) strains present a significant global public health threat due to their high mortality rates. This study investigated the genomic characteristics of seven ST11-K1 CR-hvKP isolates harboring highly homologous KPC-2-encoding multidrug-resistance plasmids. The strains were isolated from a Chinese tertiary hospital between 2017 and 2020. Whole-genome sequencing and bioinformatic analysis revealed various antibiotic resistance genes (ARGs) and virulence determinants. The bla KPC-2 -bearing plasmids that contain multiple antibiotic-resistance genes were also identified in these strains. ISfinder and Orifinder were applied to identify insertion sequences (IS) and conjugation-related factors among these bla KPC-2 -bearing plasmids. The bla KPC-2 was highly consistent in seven bla KPC-2 -bearing plasmids (IS Kpn6-bla KPC-2 -IS Kpn27 -IS Yps3 -IS 26 ). In addition, we found a region composed of IS IR , Tn 5393 , and IS 26 . It was located upstream of the bla CTX-M-15 gene and presented in six bla KPC-2 -bearing plasmids, with pCR-hvKP221-KPC-P3 as an exception. Conjugation experiments demonstrated the horizontal transfer of resistance plasmids pCR-hvKP128-KPC-P1 and pCR-hvKP132-KPC-P1 across species. Notably, pLVPK-like virulence plasmids carrying virulence gene clusters pCR-hvKP173-Vir-P1, and pCR-hvKP221-Vir-P1 were also detected. A fusional plasmid pCR-hvKP221-Vir-P2, which carries virulence gene clusters and ARGs, was also identified. Five CR-hvKP strains displayed enhanced biofilm formation and high virulence in vivo infection models. Phylogenetic and single nucleotide polymorphism (SNP) analyses indicated a close genetic relationship among the isolates, suggesting a subclade. These findings highlight the complex genetic profiles and potential transmission mechanisms of CR-hvKP strains. IMPORTANCE We reported seven CR-hvKP strains all carried a highly homologous bla KPC-2 integrated IncFⅡ-resistant plasmid, and two strains harbored virulence plasmids. Conjugation experiments confirmed the transferability of these plasmids, indicating a potential for resistance spread. Phylogenetic analysis clarified the relationship among the CR-hvKP isolates. This study provides insights into the phenotypic and genomic characteristics of seven ST11-K1 CR-hvKP strains. The high prevalence and potential for local outbreaks emphasize the need for effective control measures.

Global trends in antibiotic consumption during 2016–2023 and future projections through 2030

Antibiotic resistance is a global public health threat. Many factors contribute to this issue, with human antibiotic consumption being significant among them. Analyzing trends and patterns in consumption can aid in developing policies to mitigate the burden of antimicrobial resistance and global disparities in access to antibiotics. Using pharmaceutical sales data licensed from IQVIA, we estimate national-level trends in antibiotic consumption in 67 countries during 2016–2023 and analyze the effects of economic growth and the COVID-19 pandemic. Finally, we estimate global human consumption and project growth through 2030 assuming current trends. We find that estimated antibiotic consumption in reported countries increased 16.3% from 29.5 to 34.3 billion defined daily doses (DDDs) from 2016 to 2023, reflecting a 10.6% increase in the consumption rate from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. Increases were most pronounced in upper-middle- and lower-middle-income countries. While the COVID-19 pandemic significantly reduced consumption globally, this was most pronounced in high-income countries, and in these countries, reductions in antibiotic use in 2020 were sharper, and lasted longer, than in other countries. By 2030, we project that, without reductions in rapidly developing nations, such as investments to improve infrastructure, particularly water and sanitation, along with improved access to vaccination, global antibiotic consumption will increase by 52.3% from an estimated 49.3 billion in 2023 to 75.1 billion DDDs.

Confronting the Crystal Meth Epidemic: Urgent Insights and Solutions

Crystal methamphetamine, or "ice," poses a significant public health threat, particularly in urban areas like Peshawar, where it has gained popularity among youth as a socially accepted "party drug." This editorial examines the factors driving its use, including peer influence and social normalization, which lead to compulsive consumption and severe health consequences. The drug's spread resembles a "contagious social virus," especially among educated and affluent young people. To address this epidemic, coordinated efforts are needed, including stricter legislation, public awareness campaigns, school-based education programs, and community support initiatives. Ongoing research is crucial for tracking trends and developing effective interventions to safeguard youth and community well-being.

Antibiogram, Phenotypic and Genotypic Detection of Extended-Spectrum β-lactamase Producing and Fluoroquinolone Resistant Escherichia coli Isolated from Pigs

Antimicrobial resistance in food animals is a global issue. Particularly, the dissemination of Extended Spectrum Beta-Lactamase and fluoroquinolone resistant Escherichia coli in food-producing animals posed a public health threat to the efficacy of various antibiotics. Therefore, this study aimed to detect the presence of multidrug-resistant Escherichia coli from fecal samples of pigs in Puducherry. In total, 16 faecal samples from apparently healthy pigs of different age groups were chosen for this study and subjected to detection of ESBL production and FQ resistance. E. coli was isolated from all the faecal samples (100%) and confirmed by biochemical tests and Polymerase Chain Reaction. All the E. coli isolates were found to be positive for ESBL production and fluoroquinolone resistance by phenotypic method. Out of 16 E. coli isolates, 11 (68.75%) isolates were positive for the presence of ESBL-producing genes, in which, 2 harbored bla TEM and 9 harboured bla SHV genes. In total 13/16 (81.2%) E. coli isolates harbored PMQR genes, in which 11 isolates harbored the qnrS gene and 11 isolates harbored the qnrB gene. The results showed that 9 isolates harbored both qnrS and qnrB genes in combination. Antimicrobial susceptibility test showed that the majority of the isolates exhibited a high level of resistance against Amoxycillin/clavulanic acid (100%), Cefpodoxime (100%), Cefotaxime (80%), Aztreonam (70%), Ceftazidime (70%), Enrofloxacin (70%) and Ceftriaxone (40%). The present study showed the presence of ESBL-producing and FQ-resistant E. coli in swine in the Puducherry region and their antibiogram pattern.

A humanized neutralizing antibody protects against human adenovirus type 7 infection in humanized desmoglein-2 and CD46 double-receptor transgenic mice.

Human adenovirus type 7 (HAdV7) has become a major public health threat due to its widespread transmission, severe associated pneumonia, and a lack of effective anti-HAdV7 drugs. The aim of the current study is to design a humanized monoclonal antibody (mAb) demonstrating efficacy against HAdV-7 infections in vitro and in vivo. The humanized neutralizing antibody, 3G5-hu, was derived from the murine mAb 3G5. Antibody activity was evaluated using a flow cytometry-based neutralization (FCN) assay to identify humanized mAbs retaining potent neutralizing activity. Additionally, a humanized hDSG2/hCD46 dual-receptor transgenic mouse model was developed to simulate HAdV-7 infection. Using recombinant HAdV-7 expressing enhanced green fluorescent protein and clinically isolated wild-type HAdV-7, the half-maximal effective concentration of 3G5-hu against HAdV-7 was determined to be < 30 ng/mL. Notably, 3G5-hu exhibits high specificity for the hexon protein of the HAdV-7 capsid (affinity: KD = 9.02 × 10- 11 M). Microneutralization studies with wild-type HAdV-7 and rAd7EGFP confirmed that humanized mAb 3G5-hu neutralizes 10-30 ng/mL HAdV-7 (approximately 67-200 pM). Furthermore, hDSG2/hCD46 double-receptor transgenic mice are more susceptible to HAdV-7 infection than single-receptor transgenic mice. Meanwhile, the humanized mAb 3G5-hu provides good protection against HAdV-7 infection in hDSG2/hCD46 knock-in transgenic mice. The newly designed humanized mAb 3G5-hu specifically neutralizes HAdV-7 in vitro and in vivo. 3G5-hu elicits protection against HAdV-7 infection in hDSG2/hCD46 knock-in transgenic mice. The findings of this study provide insights to guide the future development of preventative and therapeutic treatments for HAdV-7 infection.

Dietary zinc deficiency promotes Acinetobacter baumannii lung infection via IL-13 in mice.

Dietary zinc deficiency is a major risk factor for pneumonia. Acinetobacter baumannii is a leading cause of ventilator-associated pneumonia and a critical public health threat due to increasing rates of multidrug resistance. Patient populations at increased risk for A. baumannii pneumonia are also at increased risk of zinc deficiency. Here we established a mouse model of dietary zinc deficiency and acute A. baumannii pneumonia to test the hypothesis that host zinc deficiency contributes to A. baumannii pathogenesis. We showed that zinc-deficient mice have significantly increased A. baumannii burdens in the lungs, dissemination to the spleen and higher mortality. During infection, zinc-deficient mice produce more pro-inflammatory cytokines, including IL-13. Administration of IL-13 promotes A. baumannii dissemination in zinc-sufficient mice, while antibody neutralization of IL-13 protects zinc-deficient mice from A. baumannii dissemination and mortality during infection. These data highlight the therapeutic potential of anti-IL-13 antibody treatments, which are well tolerated in humans, for the treatment of pneumonia.

The human plasma lipidome response to exertional heat tolerance testing.

The year of 2023 displayed the highest average global temperatures since it has been recorded-the duration and severity of extreme heat are projected to increase. Rising global temperatures represent a major public health threat, especially to occupations exposed to hot environments, such as construction and agricultural workers, and first responders. Despite efforts of the scientific community, there is still a need to characterize the pathophysiological processes leading to heat related illness and develop biomarkers that can predict its onset. Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based lipidomics analysis was performed on plasma from male and female subjects who underwent exertional heat tolerance testing (HTT), consisting of a 2-h treadmill walk at 5km/h with 2.0% incline at a controlled temperature of 40ºC. From HTT, heat tolerance was calculated using the physiological strain index (PSI). Nearly half of all 995 detected lipids from 27 classes were responsive to HTT. Lipid classes related to substrate utilization were predominantly affected by HTT, with a downregulation of triacylglycerols and upregulation of free fatty acids and acyl-carnitines (CARs). Even chain CAR 4:0, 14:0 and 16:1, suggested by-products of incomplete beta oxidation, and diacylglycerols displayed the highest correlation to PSI. PSI did not correlate with plasma lactate levels, suggesting that correlations between even chain CARs and PSI are related to metabolic efficiency versus physical exertion. Overall, HTT displays a strong impact on the human plasma lipidome and lipid metabolic inefficiencies may underlie reduced heat tolerance.

Treatment uptake among notified cases of hepatitis C virus infection in Norway, 1990 to 2022: a registry-based study to monitor progress towards elimination.

BackgroundHepatitis C virus (HCV) infection is targeted for elimination as a public health threat by 2030. The World Health Organization goal for treatment uptake is ≥ 80% among cases diagnosed with an active HCV infection (RNA- or core antigen-positive), maintained for 2 years.AimTo calculate treatment uptake, time from diagnosis to treatment start and complete treatment dispensation among notified cases of HCV infection in Norway.MethodWe linked national data on notified cases diagnosed from 1990-2022 to dispensed prescriptions for HCV treatment from January 2004-February 2023 and data on residence status at the end of 2022. We described treatment uptake by demographic and epidemiological characteristics. We calculated the median number of months from diagnosis to treatment start by year. For direct-acting antiviral treatment periods, complete dispensation was based on the treatment and number of defined daily doses.ResultsAmong 12,178 notified cases that had an active infection at diagnosis and were still resident, 10,091 (83%) had received treatment. Uptake among resident cases was > 80% in 2021 and 2022. The median number of months from diagnosis to treatment decreased over time to 3 (interquartile range: 1-5) among cases diagnosed in 2021 and 2022. From 2015-22, 89-93% of direct-acting antiviral treatment periods annually had complete treatment dispensed.ConclusionNorway has achieved the elimination goal for treatment uptake among notified cases diagnosed with an active HCV infection. This highlights the benefit of a strategy that includes unrestricted, simplified and integrated treatment options.

Measuring hospital antibiotic consumption in EU/EEA countries: comparison of different metrics, 2017 to 2021.

BackgroundAntibiotic resistance poses a considerable public health threat, with data-driven stewardship a main prevention measure. While quantifying antibiotic consumption is a key component of antibiotic stewardship programmes, the choice of denominator for calculating this metric can impact comparative analyses and trend evaluations substantially, influencing targeted stewardship interventions.AimWe aim to evaluate how using hospital sector-specific antibiotic consumption rate denominators at country level impacts country rankings and trends, addressing the limitations of the commonly used 'defined daily doses (DDD) per 1,000 inhabitants per day' metric.MethodsHospital antibiotic consumption data from ESAC-Net and denominator data from Eurostat ('inhabitants,' 'bed-days' and 'discharges') for 2017-2021 were used to calculate hospital antibiotic consumption rates for 24 reporting European Union/ European Economic Area (EU/EEA) countries. Countries were ranked by their consumption rates and trends were analysed to assess the effects of using different denominators.ResultsCountry rankings and 5-year trend analyses varied depending on the denominator used. Antibiotic consumption rates were more similar when using hospital activity-based denominators 'bed-days' and 'discharges' compared with the population-based 'inhabitants' denominator. Differences in country rankings and trends were also seen among rates derived using 'bed-days' and 'discharges'.ConclusionThe study underscores the importance of using hospital activity-based denominators such as 'bed-days' and 'discharges' when evaluating hospital antibiotic consumption. ESAC-Net's historical reliance on only 'DDD per 1,000 inhabitants per day' is challenged, advocating for the use of multiple hospital activity-based denominators. Corresponding hospital activity denominators for ESAC-Net data will more effectively inform national hospital antibiotic stewardship interventions.

Genomic characteristics of Salmonella enterica serovar Blockley.

Non-typhoidal Salmonella (NTS) is a significant cause of foodborne illness worldwide, with increasing antimicrobial resistance posing a public health concern. Salmonella enterica serovar Blockley (S. Blockley) is relatively uncommon, and its antimicrobial resistance profile and population structure have been understudied. This study presents a comprehensive genomic analysis of 264 S. Blockley isolates from diverse geographical regions to elucidate antimicrobial resistance patterns and population structure. Bayesian analysis classified these genomes into 10 distinct groups (BAPS A to BAPS J), further categorized into two lineages, R and S. Lineage R comprised six BAPS clusters (BAPSs A-F), predominantly found in Asia and Africa, all of which harbored the azithromycin resistance gene mph(A) and other resistance determinants. In contrast, lineage S, lacking mph(A), comprised the remaining four BAPS clusters, which were primarily found in Europe and the Americas. Several types of mutations in gyrA were found in lineage R, which were specific to BAPS clusters. These BAPS clusters exhibited distinct geographic distributions, with BAPS B, BAPS D, and BAPS E unique to China, Taiwan, and Japan, respectively, while BAPS H and BAPS I were predominantly found in the United States. Temporal phylogenetic analysis suggested that lineage R diverged in the 1980s, with notable microevolutionary changes. The presence of a genomic island with mph(A), aph(3')-Ia, aph(3")-Ib, aph(6)-Id, and tet(A) in lineage R underscores the public health threat, highlighting a need for continuous surveillance.IMPORTANCEAntimicrobial resistance in Salmonella is a global public health concern. In this study, we focused on serovar Blockley, and a whole-genome analysis revealed its global population structure. The results revealed the existence of azithromycin-resistant strains, which were characterized both phylogenetically and geographically. The resistance genes were transmitted via genomic islands, and their micro-scale evolution was also revealed. Our findings are the first to reveal the dissemination of antimicrobial resistance genes, including azithromycin, in serovar Blockley, and provide valuable insights into understanding the spread of antimicrobial resistance.

The Influence of COVID-19 on Antimicrobial-Resistance in Gram-Positive Bacteria at a Private Saudi Hospital: A Five-Year Evaluation

Due to the emergence of antimicrobial-resistance (AR) as a public health threat, the Saudi National Action Plan (SNAP) was implemented in 2017, incorporating various strategies to combat AR. To evaluate the effectiveness of SNAP and the impact of COVID-19, the study analyzed pre- and post-pandemic rates of AR, methicillin-resistant Staphylococcus aureus (MRSA), and multidrug resistance (MDR) among Gram-positive bacteria at a private medical center in Saudi Arabia. This study reviewed the cases of all patients who had been diagnosed with Gram-positive bacterial infection between January 2017 and December 2021. Bacterial strain identification was conducted using VITEK-2 ID-GP cards, while AR, MRSA, and MDR were defined using AST-GP 67 and AST-ST02 cards, all adhering to the manufacturer’s recommended protocols. The five-year study from 2017 to 2021 yielded 6,271 Gram-positive bacteria isolates from patients in a Saudi private hospital. Though the rate of AR initially declined between 2017 and 2019, it spiked significantly from 2020 to 2021. Similarly, the MRSA rate exhibited a substantial decrease (p &lt; 0.05) from 2017 to 2019, followed by a significant rise (p &lt; 0.05) between 2020 and 2021. Out of the isolated pathogens, 1,031 (16.44%) exhibited MDR, with all isolates showing a marked increase (p &lt; 0.05) in MDR from 2020 to 2021. The study highlights the aggravating impact of the COVID-19 pandemic on AR, underscoring the need for the SNAP to intensify its efforts in combating AR.

Wound Characteristics Among Patients Exposed to Xylazine.

The alpha-2 agonist xylazine is increasingly detected as an adulterant in illicitly manufactured fentanyl. There is concern that xylazine may be responsible for an emerging pattern of necrotizing wounds among people who use drugs, but the clinical features of wounds associated with xylazine remain poorly characterized. To systematically characterize the location, wound bed surface, and chronicity of wounds among persons with confirmed xylazine exposure. This case series at 3 academic medical hospitals in Philadelphia, Pennsylvania, included patients with emergency department or inpatient encounters from April 2022 to February 2023 who had a wound-related chief complaint and xylazine detected with urine gas chromatography-mass spectroscopy. Xylazine. The location, size, wound bed, and chronicity of wounds associated with xylazine using electronic medical record abstraction and Fisher exact tests. Of 59 wounds from 29 unique patients with confirmed xylazine exposure (mean [SD] age, 39.4 [8.8] years; 15 [52%] male; all using fentanyl, and 23 [79%] routinely injecting opioids), 53 wounds (90%) were located on extremities, and 41 (69%) involved extensor surfaces. Five wounds (9%) involved exposed deep structures such as bone or tendon. Of 57 wounds with photographs, 34 (60%) had wound beds of predominantly devitalized tissue (eschar or slough). Based on patient report, 28 wounds (48%) were acute (<1 month old), 12 (20%) were subacute (present for 1-3 months), and 17 (29%) were chronic (developed ≥3 months prior). Subacute and chronic wounds were more often medium or large in size (odds ratio, 48.5; 95% CI, 8.2-1274.8; P < .001) and more frequently had devitalized wound beds (odds ratio, 9.5; 95% CI, 2.9-37.0; P < .001). In this case series of hospitalized patients with confirmed xylazine exposure, wounds were commonly located on extensor surfaces of the extremities, frequently had devitalized tissue or exposed deep structures, and were more likely to have larger and necrotic wound beds the longer they had persisted. This systematic characterization of xylazine-associated wounds may inform identification, management, and research to address this emerging public health threat.

Prevalence, transmission and genomic epidemiology of mcr-1-positive colistin-resistant Escherichia coli strains isolated from international airplane waste, local resident fecal and wastewater treatment plants.

The emergence and dissemination of mcr-1-positive Escherichia coli (MCRPEC) represent a critical public health threat. Here, we conducted a prospective analysis of MCRPEC isolates from wastewater treatment plants (WWTPs), local residents' fecal (LRF), and international airplane waste (IAW) to investigate their genetic characteristics and transmission patterns circulating in human-environment domains. The MCRPEC prevalence was 2.43 % in WWTPs, 1.37 % in IAW and 0.69 % in LRF. MCRPEC showed substantial genetic diversity, encompassing 61 sequence types (primarily ST1011, ST101, and ST2705), 7 plasmid types (primarily IncI2), 8 phylogroups (primarily A and B1), 9 mcr-1-flanked lineages (primarily L5), 6 clusters (primarily C2 and C4), diverse serotypes, and 61.95 % transposon-containing strains. The mcr-1 gene co-existed with 46 antibiotic resistance genes (ARGs) and 19 virulence factor genes (VFGs). Notably, 6 IncI2 plasmids carried the blaCTX-M, IS1380, and mcr-1 genes. MCRPEC from WWTPs harbored a greater number of ARGs (56.95 ± 5.99) but fewer VFGs (15.03 ± 6.40) compared to those from human-associated sources (LRF and IAW). ST1011, ST2705, IncHI2, and L7 were prevalent in WWTP-derived MCRPEC, whereas IncX4 and L3 were more common in human-derived MCRPEC. Genetic features such as ST101, ST48, IncI2, L4, L5, C2, and C4 were simultaneously present in strains from LRF, IAW, and WWTPs. Core genetic analyses also showed genetically similar MCRPEC strains across various geographic locations. The findings underscore the extensive dissemination, strong environmental adaptation, and clonal transmission of MCRPEC across diverse reservoirs, reinforcing the urgent need for coordinated multisectoral surveillance of human and environment interfaces to effectively mitigate further transmission.

Lassa fever in Nigeria: epidemiology and risk perception.

Annual outbreaks of Lassa fever have resulted in a public health threat in Nigeria and other endemic countries in Sub-Saharan Africa. While the Lassa Virus (LASV) is endemic in rodent populations, zoonotic spillover to humans causes annual outbreaks. This study reviewed the burden of Lassa fever (LF) in Nigeria between 2020 and 2023 and conducted a cross-sectional survey of Nigerians to evaluate their risk perceptions of LF. During the period under review, 28,780 suspected and 4,036 confirmed cases of LF were reported from 34 of the 37 states of Nigeria. These cases resulted in 762 deaths (a CFR of 18.9%). The overall case positivity rate was 14% (4,036/28,780), with more positive cases in 2020 (17.5%, n = 1,189/6,791). A total of 2,150 study participants were enrolled in the prospective cross-sectional study, with most of them (87.5%, n = 1,881/2,150) having previously heard of Lassa fever (LF). The numerical scoring system revealed that 35.43% (n = 762/1,881) of those aware of LF have poor knowledge of its preventive measures, route of transmission, and control measures. Approximately 6.84% (n = 147/2,150) of them were at a high risk of contracting LF, with 27.6% (n = 584/2,150) of study participants feeling concerned about contracting LF because of the presence of rodents in their immediate vicinity, occupational exposure to healthcare workers, and the probability of contamination of food by infected rodents without necessary food safety measures. Multivariable logistic regression analysis revealed that tertiary education was associated with an increased likelihood of better LF knowledge (OR: 17.32; 95% CI: 10.62, 28.26; p < 0.01) and a lower risk of contracting LF when compared to respondents with no formal education. In addition, study participants who reside in low-burden states have lower LF perception than those residents in high-LF-burden states (OR: 0.59; 95% CI: 0.38-0.91; p = 0.049). On the other hand, study participants with poor risk perception (knowledge) of LF had a higher likelihood (RR: 0.33; 95% CI: 0.20, 0.53; p < 0.01) of contracting LF when compared to those with good knowledge of LF. Similarly, those residents in low LF burden states were less likely (OR: 0.09; 95% CI: 0.05,0.17; p < 0.01) to contract LF when compared to those residents in high burden states. There is a need to improve LF diagnostics capacity, infection prevention and control measures, and implementation of the One Health approach to controlling LASV from animal reservoirs. In addition, public enlightenment campaigns to address fundamental knowledge gaps are crucial to mitigating the ongoing and future impact of LF in Nigeria.

Abstract 4133460: VCAM1 contributes to pathogenesis during influenza-induced exacerbation of atherosclerosis.

Background and hypothesis: Influenza is a significant public health and economic threat around the world. Although pneumonia is the most common complication associated with influenza, there are several clinical reports demonstrating increased risk for cardiovascular disease. Influenza infection induces interferons, proinflammatory cytokines and chemokines, and recruits’ macrophages and neutrophils to control the virus. However, an excessive influx of innate immune cells and dysregulated production of inflammatory mediators results in pathological responses during influenza infection. Studies have shown that influenza infection correlates with increased incidence of myocardial infarction. Atherosclerosis is the most known cause of ischemic heart diseases and stroke. Vascular cell adhesion molecule-1 (VCAM1) has been shown to promote adhesion of monocytes and promotes atherosclerosis. In this study, we hypothesize that VCAM1 plays a role in exacerbation of atherosclerosis during influenza infection. Methods: High-Fat diet (HFD)-fed Apoe -/- mice were infected with influenza A/PR/8/34 (H1N1) and weight loss, survival rate, and gene expression of vascular endothelial adhesion molecules, inflammatory cytokines and chemokines were measured. HFD-fed Apoe -/- mice were infected with influenza, and treated with anti-VCAM1 antibody, and weight loss and cellular responses were measured. Results and conclusions: Increased weight loss and decreased survival of mice were observed in response to influenza infection in HFD-induced atherosclerosis in Apoe -/- mice. Further, the expression of VCAM1, and the levels of IL-6, CCL2, CCL3, CCL5 were significantly increased in aorta in Apoe -/- mice when compared to PBS-treated controls. Increased survival, decreased weight loss, decreased lesion area, decreased frequency of CD11b + F4/80 + Ly6C + , CD4 + RORgt + cells and increased frequency of CD4 + FoxP3 + Treg cells were observed in aorta in response to antibody mediated VCAM1 neutralization. These results suggest that VCAM1 plays a pathological role in influenza-induced exacerbation of atherosclerosis.

Understanding the future of dengue in Malaysia: Assessing knowledge, attitude, and homeowner practices in mitigating climate-driven risks

Introduction Dengue fever poses a significant public health threat, particularly in tropical regions like Malaysia. The rising incidence of dengue outbreaks challenges healthcare systems and highlights the urgent need for effective preventive measures. Climate change, with rising temperatures and shifting rainfall patterns, is expected to worsen the dengue situation in the coming years. Methods . This is a cross-sectional study conducted among adult residents of low-cost housing apartments in an urban poor community in Kuala Lumpur, Malaysia involving approximately 16,000 residents. A representative sample of 1,636 residents was calculated using the Krejcie and Morgan formula, and stratified random sampling was used to ensure proportional representation across the various floors of each PPR community apartment block. Data were collected using a structured questionnaire adapted from a validated Malay version. The questionnaire assessed respondents’ knowledge, attitudes, and practices (KAP) related to dengue prevention, categorising KAP scores as “Good” (≥80%) or “Poor” (&lt;80%). Descriptive statistics summarized population characteristics and KAP scores, while logistic regression identified predictors of KAP levels, with significance set at p ≤ 0.05. Results In this community, 76.7% of participants exhibited poor knowledge and 83.1% had a negative attitude towards dengue, despite 66.7% demonstrating good preventive practices. The PPR location significantly predicts dengue knowledge, attitudes, and preventive practices, with p-values of less than 0.001 for all domains. Marital status also predicts dengue knowledge (p = 0.007) and preventive practices (p = 0.023), while prior infection with dengue is a predictor of preventive practices (p = 0.047). Conclusion Despite the community’s good dengue prevention practices, likely influenced by environmental expectations, there remains a critical need for education to sustain and strengthen these efforts, as climate change continues to worsen in the coming years. It is crucial to help residents grasp the relevance of these practices, so they can apply them more effectively as climate-driven risks intensify. Targeted interventions should de designed differently for each of the four PPR communities as their levels of knowledge, attitude and practices vary significantly, taking into account independent factors like marital status and prior dengue infection, which shape preventive behaviors.

Prevalence of blaOXA-48 and other carbapenemase encoding genes among carbapenem-resistant Pseudomonas aeruginosa clinical isolates in Egypt.

Resistance to carbapenem, the last line of treatment for gram-negative bacterial infections has been increasing globally and becoming a public health threat. Since integrons may aid in the transmission of resistance genes, the purpose of this study was to detect the frequency of class 1, 2, and 3 integrons as well as carbapenem-resistant genes in clinical isolates of P. aeruginosa that are resistant to carbapenem. This study was carried out on 97 clinical isolates of P. aeruginosa isolated from wound and urine samples. The antimicrobial susceptibility for all isolates was tested by the disc diffusion method. The presence of integrons and carbapenem-resistant genes among carbapenem-resistant P. aeruginosa isolates was evaluated by conventional PCR. The antimicrobial resistance rate among P. aeruginosa clinical isolates was high, with imipenem resistance in 58.8% of the studied isolates. In this study, 86% of the carbapenem-resistant P. aeruginosa isolates carry carbapenemase genes, with blaVIM being the most common gene followed by the blaOXA-48 gene. Class 1 and class 2 integrons were reported in 37 (64.9%) and 10 (17.5%) of the tested carbapenem-resistant P. aeruginosa isolates, respectively. Our data reported a high prevalence of class 1 integrons in carbapenem-resistant P. aeruginosa clinical isolates, suggesting the important role of integrons in carbapenem-resistant gene transfer among such isolates.