Transmission Of Pathogens Research Articles

Spread of infectious diseases by microorganisms present in fomites

Fomites, inanimate objects that can carry infectious agents, play a critical role in the spread of infectious diseases. Despite advances in sanitation and hygiene practices, fomites remain a significant vector for the transmission of various pathogens, particularly in healthcare settings and densely populated environments. This paper reviews the mechanisms by which microorganisms are transmitted through fomites, the types of diseases commonly spread in this way and the factors that influence fomite-based transmission. Strategies for mitigating the risk of fomite-based disease spread are also discussed, highlighting the importance of targeted hygiene interventions, material design and environmental decontamination.

Malaria mosquitoes, Plasmodium parasites and skin microbiota, towards control of malaria: A review

Vector-borne pathogens are transmitted by bites of infected arthropod species. The pathogens require two different host species to complete their lifecycle, usually a vertebrate and an invertebrate host, of which the latter transmits the pathogen between vertebrate hosts. Blood-feeding mosquitoes are important vectors of several human pathogens, including arboviruses namely: chikungunya, dengue fever, Rift Valley fever, yellow fever and Zika transmitted by Aedes mosquitoes amongst others. Culex mosquitoes on the other hand transmit Saint Louis and Japanese encephalitis, lymphatic filariasis, West Nile fever and Rift Valley Fever virus while Anopheles mosquitoes transmit malaria. The contact rate between vectors and their vertebrate hosts affects the intensity of pathogen transmission, and hence disease epidemiology. The ability of vectors to locate their blood hosts therefore is crucial in disease maintenance and perseverance. Host odour is known to play an important role in mosquito host-seeking behaviour and hence influences the contact rate between vectors and hosts. This literature review focuses on interactions between malaria parasites, humans, mosquitoes and how skin bacterial volatiles mediate host-seeking behaviour of mosquitoes.

Temporal Analysis of Sanitation and Water Development Indicators in Tunisia: 2012-2023

Abstract Background Access to sanitation and water resources is a cornerstone of the ‘One Health’ approach, which encompasses the holistic integration of human, animal and environmental health considerations. We aimed to elucidate the temporal trajectory of sanitation and water resource development in Tunisia across successive years. Methods Data from the Multiple Indicator Cluster Survey in Tunisia, a UNICEF-conducted repeated cross-sectional survey, was used to compare trends in access to improved water sources, utilization of improved sanitation facilities, and handwashing practices across 2012, 2018, and 2023. Results In 2023, we observed that 20.9% of households did not have access to drinking water on site, compared with 12.7% in 2018 (p = 0.15). The availability of drinking water in sufficient quantity was 69.8% in 2023 and 80.6% in 2018 (p = 0.37). In 2023, 78.1% of the population had access to an improved water source, compared with 86.3% in 2018 and 95.7% in 2012 (p = 0.4), 80% in urban areas and 73% in rural areas (p = 0.57). In 2023, 12.5% of the population consumed water from sources contaminated with Escherichia coli, compared with 20.5% in 2018 (p = 0.16). Disparities in Escherichia coli detection were observed between rural (21%) and urban (8.3%) areas (p = 0.01). In 2023, 92.1% of households had access to handwashing facilities equipped with soap and water, compared with 89.9% in 2018 and 91.5% in 2012 (p = 0.98). The breakdown between urban and rural areas was 95.1% and 86.4% respectively (p = 0.51). Conclusions Access to improved water sources, sanitation, and handwashing practices remains high over time, but regional disparities persist. Improved water quality directly reduces the transmission of waterborne pathogens, emphasizing the need to address regional disparities and socio-economic inequalities to promote public health nationwide. Key messages • Challenges persist in tunisia regarding sanitation and access to water. • Regional disparities threaten public health.

How have respiratory tract infections changed in the post-covid era for children under 5 years?

Abstract Background Social distancing measures introduced in response to the covid-19 pandemic reduced transmission of all respiratory pathogens. Exposure to respiratory pathogens in early life affects future lung health. We aimed to describe changes in the incidence of respiratory tract infections (RTIs) in children <5 years in England in the post-pandemic era. Methods Population-based retrospective cohort study using electronic health records. We included all children aged <5 years registered with a primary care practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs in the two post-pandemic years (April 2021 - March 2022 and April 2022 - March 2023) with corresponding months during pre-pandemic years (April 2016 - February 2020). Results There were 3 045 701 respiratory tract infections among 2 894 539 children <5 years registered with a GP practice during the study period. Pre-pandemic, monthly RTI rates varied from lows of 29.1 per 100 child-years in August to highs of 108.8 per 100 child-years in November. In 2021/22, monthly RTI rates were bimodal peaking in June and October, although the winter peak was lower than pre-pandemic years and mean monthly RTI rates were ∼15% lower overall. In 2022/23 mean monthly RTI rates remained ∼15% lower than pre-pandemic years, but there was a single peak in December 2022 of 117.6 RTIs per 100 child-years, exceeding the pre-pandemic winter peaks by 8.1%. Conclusions Overall, monthly RTIs in post-pandemic years were 15% lower than pre-pandemic years. However, there was a concerning peak in December 2022 that exceeded the winter peaks from previous years. Comparisons with national surveillance data suggest this peak reflects changes in RTI incidence, particularly among group A streptococcal infections, but this peak may also reflect changes in access to care or healthcare seeking behaviour. Continued monitoring of post-pandemic seasonal patterns will assist in planning for health service use. Key messages • Respiratory tract infections in children <5 years in post-pandemic years were 15% lower than pre-pandemic years, but winter peaks in incidence may be of greater magnitude in the post pandemic era. • Ongoing monitoring of patterns of respiratory tract infections in young children is important for future health service planning and delivery.

Are prison settings included in national preparedness plans?

Abstract With the aim to explore the extent to which places of detention are considered in national preparedness planning in the WHO European Region, a desktop review was conducted and combined with responses to the Health in Prisons European Database (HIPED) survey from Member States referring to 2020. In both searches, the aim was to identify the existence of: 1) national pandemic preparedness plans written prior to the COVID-19 pandemic; and 2) national pandemic preparedness and response plans specific to the COVID-19 pandemic. Where prisons were included, all aspects of pandemic preparedness relating to prisons were extracted and collated as per the main domains of the WHO checklist for influenza pandemic preparedness plans. The desktop review found that 30 Member States had pandemic plans accessible online, but only seven included any mention of prisons. Responses to the HIPED survey suggested wide dissemination of a COVID-19 preparedness and/or response plan, but only six out of 36 Member States referred to prisons or the vulnerabilities of people living in places of detention. The combined findings suggest that prisons are rarely considered in national planning and that lessons from previous pandemics have not led to a change in recognizing that prisons are high-risk environments for pathogen transmission and that failing to consider them in national planning may lead to impacts that affect the wider community.

Bat-associated ticks as a potential link for vector-borne pathogen transmission between bats and other animals.

Potentially zoonotic pathogens have been previously detected in bat-associated ticks, but their role in disease transmission and their frequency of feeding on non-bat hosts is poorly known. We used molecular blood meal analysis to reveal feeding patterns of the bat-associated tick species Ixodes ariadnae, I. simplex, and I. vespertilionis collected from cave and mine walls in Central and Southeastern Europe. Vertebrate DNA, predominantly from bats, was detected in 43.5% of the samples (70 of 161 ticks) but in these ticks we also detected the DNA of non-chiropteran hosts, such as dog, Canis lupus familiaris, wild boar, Sus scrofa, and horse, Equus caballus, suggesting that bat-associated ticks may exhibit a much broader host range than previously thought, including domestic and wild mammals. Furthermore, we detected the zoonotic bacteria Neoehrlichia mikurensis in bat ticks for the first time, and other bacteria, such as Bartonella and Wolbachia. In the light of these findings, the role of bat ticks as disease vectors should be urgently re-evaluated in more diverse host systems, as they may contribute to pathogen transmission between bats and non-chiropteran hosts.

Práticas higiênico-sanitárias em feiras de arte e gastronomia de Niterói/RJ, Brasil

Introduction: Street food is an important market segment with an impact on the generation of jobs, income, and appreciation of food culture. However, it poses a challenge for public health because it increases the risk of transmission of pathogens from foodborne disease. Objective: Evaluate the hygienic-sanitary practices of food handlers at fairs and the physical-functional conditions of gastronomy and arts fairs in the city of Niterói/RJ. Method: The descriptive methodology was applied, using a qualitative and quantitative approach. For data collection, two scripts were developed and applied to evaluate the functional conditions of the fairs and the hygienic-sanitary practices of the handlers during sales, and a questionnaire was administered to outline the socioeconomic profile of the workers. Results: 68.1% were women; average income of 3 minimum wages; 51.1% had completed higher education; 46.8% had never taken a Good Food Handling Practices course; 70.5% did not use hair protection; and 86.8% used adornments. In 40% of the fairs visited, there was the presence of animals/vectors, as well as the absence of toilet facilities for handlers. Conclusions: Thus, despite its socioeconomic importance, the street food trade represents a potential health risk. Therefore, it is necessary to expand the hygienic-sanitary training of handlers and improve the environmental conditions of fairs.

One-Second Touchscreen Disinfection with Internal UVC-LEDs

The transmission of pathogens via touchscreens is a concern both in medical environments regarding nosocomial infections and in public spaces. This study presents the development of a self-disinfecting touchscreen system and its implementation into an existing medical device. The disinfection was achieved by irradiating UVC light laterally into the quartz front glass of the touchscreen. The system also included a two-stage safety shutdown feature to protect users from UVC exposure. To detect the presence of the user’s hand, a proximity sensor behind the front glass of the touch screen was installed in combination with touch input registration. A rapid disinfection of staphylococci was achieved without compromising usability and user safety. The prototype demonstrated a bacterial reduction of 99.96% or 3.4 (±0.36) log levels in less than 1 s. The results suggest that the technology has the potential to make a significant contribution to reducing the transmission of infections in healthcare settings and beyond.

Increased pathogen exposure of a marine apex predator over three decades.

Environmental changes associated with global warming create new opportunities for pathogen and parasite transmission in Arctic wildlife. As an apex predator ranging over large, remote areas, changes in pathogens and parasites in polar bears are a useful indicator of changing transmission dynamics in Arctic ecosystems. We examined prevalence and risk factors associated with exposure to parasites and viral and bacterial pathogens in Chukchi Sea polar bears. Serum antibodies to six pathogens were detected and prevalence increased between 1987-1994 and 2008-2017 for five: Toxoplasma gondii, Neospora caninum, Francisella tularensis, Brucella abortus/suis, and canine distemper virus. Although bears have increased summer land use, this behavior was not associated with increased exposure. Higher prevalence of F. tularensis, Coxiella burnetii, and B. abortus/suis antibodies in females compared to males, however, could be associated with terrestrial denning. Exposure was related to diet for several pathogens indicating increased exposure in the food web. Elevated white blood cell counts suggest a possible immune response to some pathogens. Given that polar bears face multiple stressors in association with climate change and are a subsistence food, further work is warranted to screen for signs of disease.

A survey of healthcare workers on the acceptance and value of personal protective equipment for patient care.

Assess healthcare workers' (HCW) attitudes toward universal masking, and gowns and gloves used as part of transmission-based precautions. Cross-sectional survey. Academic, tertiary care medical center in Baltimore, Maryland. HCW who work in patient care areas and have contact with patients. In May 2023, a 15-question web-based survey was distributed by the hospital's communications team via email. The survey contained questions to assess HCW perceptions of universal masking policies prior to the availability of COVID-19 vaccines and at the time of the survey, and the use of gowns and gloves for transmission-based precautions. Descriptive statistics were used to summarize data. Differences in agreement with universal masking over time, level of agreement with gown and glove policies, and with all PPE types across respondent characteristics were assessed. 257 eligible respondents completed the survey. Nurses and patient care technicians (43%) and providers (17%) were the most commonly reported roles. Agreement with universal mask use decreased from 84% early in the pandemic to 55% at the time of the survey. 70% and 72% of HCW agreed masks protect themselves and others, respectively. 63% expressed any level of annoyance with mask wearing, the most often due to communication challenges or physical discomfort. 75% agreed with gown use for antibiotic-resistant bacteria compared with 90% for glove use. The majority of HCW agree with the use of PPE to prevent pathogen transmission in the healthcare setting. Agreement with universal mask use for patient care shifted during the COVID-19 pandemic.

Gene Sequencing Study of Mitochondrial Cytochrome Oxidase Subunit I (COI) in Aedes aegypti Mosquito

Aedes aegypti is an important vector from the public health point of view. It transmits pathogens of Dengue and various other diseases. Controlling vector populations is key to reducing disease transmission and it is possible by understanding the taxonomic characteristics of the vectors and their genetic analysis helps in the identification of the genetic variations in species of different geographical areas. The main aim of the present study is the screening of the Aedes mosquito genome of local species as genetic studies give some insights into the vaccine for the treatment of the diseases caused by mosquito species. In the present study, the adult Ae. aegypti collected from Suryapet town where Dengue fever is endemic, used for the mitochondrial Cytochrome Oxidase subunit I (COI) gene sequencing using the techniques of polymerase chain reaction, Electrophoretic separation, spectrophotometric analysis, and BLAST. The mitochondrial COI sequence of 583 bps is published in the National Centre for Biotechnology Information (NCBI) with accession number ON413769. The sequence data was matched with the database available in the NCBI to identify variation in the gene as this gene keeps changing in the organisms and may contribute to the species establishing itself in a particular region due to congenial environmental conditions. One match with the protein called haem copper oxidase subunit I. The transmission of different pathogens in different areas can be ascertained by comparing similar sequence studies documented. Genomic studies involving genetic markers are of immense help in developing the vaccine. The mitochondrial COI gene is the marker often used for evolutionary research. The single nucleotide polymorphisms (SNP) or Restricted fragment length polymorphisms (RFLPs) that occur in DNA also contribute to the vector's adaptability to the different geographical areas and also the survival benefit which are the basis for understanding the vectors thoroughly and their role in disease transmission.

Impact of non-pharmaceutical interventions during the COVID-19 pandemic on pathogens transmitted via food in the Netherlands.

The COVID-19 pandemic impacted the transmission of many pathogens. The aim was to determine the effect of non-pharmaceutical interventions on the incidence of diseases transmitted via food. Weekly incidence rates for nine foodborne pathogens were collected from national surveillance registries. Weekly pathogen incidence during lockdown weeks of 2020 and 2021 were compared with corresponding weeks in 2015-2019. The same analyses were performed to determine the effect of self-defined expected impact levels of measures (low, intermediate and high). Eight out of 9 diseases showed a significant decrease in case number in 2020, except for listeriosis, which remained unchanged. The largest decrease was observed for rotavirus gastronteritis A (-81%), norovirus gastroenteritis (-78%), hepatitis A (-75%) and shigellosis (-72). In 2021, lower case numbers were observed for 6 out of 9 diseases compared with 2015-2019, with the largest decrease for shigellosis (-5/%) and hepatitis E (-47%). No significant change was observed for listeriosis, STEC infection and rotavirus gastroenteritis. Overall, measures with increased expected impact level did not result in a larger decrease in number of cases, except for Campylobacter, and norovirus and rotavirus gastroenteritis. Disease transmitted via food significantly decreased during the COVID-19 pandemic, with a more pronounced effect during 2020 than 2021.

Little disease but lots of bites: social, urbanistic, and entomological risk factors of human exposure to Aedes aegypti in South Texas, U.S.

Aedes aegypti presence, human-vector contact rates, and Aedes-borne virus transmission are highly variable through time and space. The Lower Rio Grande Valley (LRGV), Texas, is one of the few regions in the U.S. where local transmission of Aedes-borne viruses occurs, presenting an opportunity to evaluate social, urbanistic, entomological, and mobility-based factors that modulate human exposure to Ae. aegypti. Mosquitoes were collected using BG-Sentinel 2 traps during November 2021 as part of an intervention trial, with knowledge, attitudes, and practices (KAP) and housing quality surveys to gather environmental and demographic data. Human blood samples were taken from individuals and a Bitemark Assay (ELISA) was conducted to quantify human antibodies to the Ae. aegypti Nterm-34kDa salivary peptide as a measure of human exposure to bites. In total, 64 houses were surveyed with 142 blood samples collected. More than 80% of participants had knowledge of mosquito-borne diseases and believed mosquitoes to be a health risk in their community. Our best fit generalized linear mixed effects model found four fixed effects contributed significantly to explaining the variation in exposure to Ae. aegypti bites: higher annual household income, younger age, larger lot area, and higher female Ae. aegypti abundance per trap night averaged over 5 weeks prior to human blood sampling. Most surveyed residents recognized mosquitoes and the threat they pose to individual and public health. Urbanistic (i.e., lot size), social (i.e., income within a low-income community and age), and entomological (i.e., adult female Ae. aegypti abundance) factors modulate the risk of human exposure to Ae. aegypti bites. The use of serological biomarker assays, such as the Bitemark Assay, are valuable tools for surveillance and risk assessment of mosquito-borne disease, especially in areas like the LRGV where the transmission of target pathogens is low or intermittent.

Synthesis of a Quaternary Ammonium-Halamine and Preparation on the Modified Nanofibrous Filter with Superior Sterilization, Air Filtration, and Biodegradability.

The outbreak of the 2019 coronavirus pandemic has raised worldwide attention about self-protection from airborne diseases. Air filtration and wearing mask have been proven to be effective measures in reducing the pathogenic aerosol's transmission. Those lead to an increasing demand of high-efficient filters. However, the nonbiodegradable polymeric materials used in filters can accumulate in landfills or ecosystems, potentially causing pollution after improper disposals. Sustainable and biodegradable alternatives to current filter materials are urgently needed. Yet, very few commercial filters meet these needs. In this paper, a novel quaternary ammonium-halamine compound containing Schiff base and a sandwich-structured preparation strategy were developed. The obtained multifunctional filter consists of a PLA fleece as a support layer, an antimicrobial coating for bactericidal function, and a nanofibrous membrane for the particle removal. The filter demonstrates strong bactericidal properties, killing 97% of Escherichia coli and Staphylococcus aureus at a biocide concentration of only 1 mg/mL. It can rapidly kill bacteria within 5 min contact without leaching antimicrobial substances. Furthermore, it boasts a filtration performance with a success rate over 99.99% and a pressure drop of 45 Pa, which surpasses that of commercial N95 filters for PM0.3. Even under humid conditions, it maintains excellent filtration performance. Our reusability testing result of the developed filters shows that a simple halogenation treatment can renew the halamines and restore the filter's antimicrobial activity. The filters can degrade in natural soil. The successful development of this sustainable and biodegradable filter material offers a new alternative for high-performance air quality control that protect public health.

Application of the MENTOR model to advance One Health by promoting bat conservation and reducing zoonotic spillover risk

For few taxonomic groups do conservation efforts have such a disproportionate impact on biodiversity and human well-being as they do with bats. Bats face significant conservation challenges that affect their long-term viability, inhibit their ecosystem functions and services, and increase zoonotic spillover risks. Protecting bat populations and their habitats ultimately reduces these conservation threats, helps prevent pandemics, and supports essential ecosystem services. MENTOR-Bat is a fellowship program focused on strengthening technical research, and leadership capacity in the Global South to promote healthy environments where bats and humans can coexist with reduced risks of pathogen transmission. Co-designed by the United States Fish and Wildlife Service (USFWS) and Bat Conservation International (BCI), MENTOR-Bat mirrors the One Health framework by featuring a transdisciplinary team of three mentors and nine fellows from Cameroon, Colombia, and Indonesia. Fellows and mentors receive academic and field-based training on bat ecology and conservation, One Health, human dimensions of conservation, behavior change, strategic communications, international policy, adaptive management, project planning, conservation leadership, and public health. Fellows will then design and implement team pilot projects to advance One Health and bat conservation in their respective countries. Program evaluation of MENTOR-Bat is based on Kirkpatrick’s Hierarchy and focuses on measuring the development of established One Health core competences. By incorporating One Health and conservation within its activities, MENTOR-Bat can become a valuable programmatic template for transdisciplinary programming advancing evidence-based strategies for improving the well-being of bats, humans, and the environment.

Chemical inactivation of two non-enveloped viruses results in distinct thermal unfolding patterns and morphological alterations

BackgroundNon-enveloped viruses, which lack a lipid envelope, display higher resistance to disinfectants, soaps and sanitizers compared to enveloped viruses. The capsids of these viruses are highly stable and symmetric protein shells that resist inactivation by commonly employed virucidal agents. This group of viruses include highly transmissible human pathogens such as Rotavirus, Poliovirus, Foot and Mouth Disease Virus, Norovirus and Adenovirus; thus, devising appropriate strategies for chemical disinfection is essential.ResultsIn this study, we tested a mild, hypoallergenic combination of a denaturant, alcohol, and organic acid (3.2% citric acid, 1% urea and 70% ethanol, pH4) on two representative non-enveloped viruses – Human Adenovirus 5 (HAdV5) and Feline Calicivirus (FCV)– and evaluated the pathways of capsid neutralization using biophysical methods. The conformational shifts in the capsid upon chemical treatment were studied using Differential Scanning Calorimetry (DSC), while the morphological alterations were visualized concurrently using Transmission Electron Microscopy (TEM). We found that while treatment of purified HAdV5 particles with a formulation resulted in thermal instability and, large scale aggregation; similar treatment of FCV particles resulted in complete collapse of the capsids. Further, while individual components of the formulation caused significant damage to the capsids, a synergistic action of the whole formulation was evident against both non-enveloped viruses tested.ConclusionsThe distinct effects of the chemical treatment on the morphology of HAdV5 and FCV suggests that non-enveloped viruses with icosahedral geometry can follow different morphological pathways to inactivation. Synergistic effect of whole formulation is more effective compared to individual components. Molecular level understanding of inactivation pathways may result in the design and development of effective mass-market formulations for rapid neutralization of non-enveloped viruses.

Serological analysis in humans in Malaysian Borneo suggests prior exposure to H5 avian influenza near migratory shorebird habitats

Cases of H5 highly pathogenic avian influenzas (HPAI) are on the rise. Although mammalian spillover events are rare, H5N1 viruses have an estimated mortality rate in humans of 60%. No human cases of H5 infection have been reported in Malaysian Borneo, but HPAI has circulated in poultry and migratory avian species transiting through the region. Recent deforestation in coastal habitats in Malaysian Borneo may increase the proximity between humans and migratory birds. We hypothesise that higher rates of human-animal contact, caused by this habitat destruction, will increase the likelihood of potential zoonotic spillover events. In 2015, an environmentally stratified cross-sectional survey was conducted collecting geolocated questionnaire data in 10,100 individuals. A serological survey of these individuals reveals evidence of H5 neutralisation that persisted following depletion of seasonal H1/H3 HA binding antibodies from the plasma. The presence of these antibodies suggests that some individuals living near migratory sites may have been exposed to H5 HA. There is a spatial and environmental overlap between individuals displaying high H5 HA binding and the distribution of migratory birds. We have developed a novel surveillance approach including both spatial and serological data to detect potential spillover events, highlighting the urgent need to study cross-species pathogen transmission in migratory zones.

Zoonotic Pathogens Isolated from an Introduced Population of Red Swamp Crayfish (Procambarus clarkii) in Tenerife (Canary Islands, Spain)

The red swamp crayfish (Procambarus clarkii) is a widely distributed invasive species that is listed in the Delivering Alien Invasive Species Inventory for Europe. Native to North America, it has been introduced to numerous regions, such as the Canary Islands, Spain. Previous studies have confirmed the role of this crayfish in the maintenance of several foodborne pathogenic bacteria. Therefore, the aim of this study was to analyze the main zoonotic bacterial and parasitic pathogens present in a P. clarkii population introduced to the island of Tenerife, Canary Islands, and to assess the potential risk to public health and native fauna. A total of 22 crayfish from Tenerife were analyzed using Biofire FilmArray Gastrointestinal Panels and culture–PCR methods. The results show the presence of Plesiomonas shigelloides, Shigella/enteroinvasive Escherichia coli, enteropathogenic Escherichia coli, Salmonella ser. Enteritidis, Salmonella ser. Typhimurium, and Salmonella ser. Typhi. These results demonstrate the presence of a variety of pathogenic bacteria in the red swamp crayfish in Tenerife that represent a significant concern in terms of public health and conservation. Implementing educational campaigns to inform the community about the risks associated with handling and consuming contaminated crayfish, as well as initiatives for the restoration of the contaminated ecosystem, are necessary to prevent the transmission of the foodborne pathogens.

To see, or not to see… pathogens in virtual reality hand hygiene training.

ViRTUE, a virtual reality (VR) hand hygiene trainer, offers users the option of visualizing pathogen transfers during virtual patient care either in "real-time" or at the end of a level as a "summary" visualization. In this study, we aimed to evaluate the effect of different timings of pathogen visualization ("real-time" vs "summary") on in-trainer performance and user's immersion. The study included first-year medical students undergoing hand hygiene training with ViRTUE, randomized to one of three visualization set-ups: set-up 1 ("on-off-off", with "real-time" visualization at the first level only, and "summary" visualization at level 2 and 3), set-up 2 ("off-on-off"), and set-up 3 ("off-off-off"). In-trainer performance was defined by number of pathogen transmission events (=contaminations) in level 3. The virtual experience of user's (among others: immersion) was assessed with a questionnaire. 173 medical students participated in the study, with 58, 54, and 61 assigned to set-up 1, set-up 2, and set-up 3, respectively. Users assigned to set-up 3 with "summary" visualization at all levels, performed best with 1.02 (standard deviation (SD) +/- 1.86) contaminations, compared to 2.34 (SD +/- 3.09) and 2.07 (SD +/- 2.52) contaminations of users assigned to the other set-ups. "Summary" visualization at all levels also resulted in higher immersion of users. "Real-time" visualization of pathogen transmission during VR hand hygiene training with ViRTUE may negatively affect in-trainer performance and user immersion. This emphasizes the importance of pilot testing the effect of VR-based trainings in order to understand their impact on users.

Systematic review on infectious agents inducing cancer in animals: What do we know?

Neoplastic diseases are the leading cause of death in animals and humans worldwide. Furthermore, neoplasms in patients with infectious diseases account for 15% of non-hereditary neoplasms. Chronic infections are considered a major cause of neoplasm development, with numerous mechanisms mediated by these factors reportedly involved in oncogenesis. This review aimed to identify publications involving diagnosis and prognosis to improve understanding of concomitant interrelated scenarios involving interactions between microorganisms and neoplasms. A systematic literature review was conducted to identify publications regarding effects of infectious agents on neoplasms, including diagnostic challenges, and impacts on patient prognosis. Coexistence of neoplasms and infectious diseases has been frequently reported. Microorganisms can promote or suppress neoplastic development, with studies conducted to elucidate interactions between microorganisms and oncogenesis. Understanding the role of pathogens in oncogenesis could help prevent or control pathogen transmission and, consequently, the incidence of certain cancers, with much relevance for public health.