Underreporting Of Cases Research Articles

Effectiveness of non-pharmaceutical interventions and vaccine for containing the spread of COVID-19: Three illustrations before and after vaccination periods

BackgroundThere are few studies demonstrating how the effectiveness of various extents of non-pharmaceutical interventions (NPIs) before and after vaccination periods. The study aimed to demonstrate such an effectiveness in the alteration of the epidemic curves from theory to practice.MethodsThe empirical data on the daily reported COVID-19 cases were extracted from open source. A computer simulation design in conjunction with the susceptible-exposed-infected-recovered (SEIR) type model was applied to evaluating confinement measures in Italy with adjustment for underreported cases; isolation and quarantine in Taiwan; and NPIs and vaccination in Israel.ResultsIn Italy scenario, the extents of confinement measures were 34% before the end of March and then scaled up to 70% after then. Both figures were reduced to 22–69% after adjusting for underreported cases. Approximately 44% of confinement measures were implemented in the second surge of pandemic in Italy.Fitting the observational data on Taiwan assuming the initial outbreak similar to Wuhan, China, 44% of isolation and quarantine were estimated before March 23rd, 2020. Isolation and quarantine were scaled up to 90% and at least 60% to contain community-acquired outbreaks from March 24th, 2020 onwards. Given 15% monthly vaccination rate from December 2020 in Israel, the effectiveness estimates of reducing the infected toll were 36%, 56%, and 85% for NPIs alone, vaccination alone, and both combined, respectively.ConclusionWe demonstrated how various NPIs stamp out and delay the epidemic curve of COVID-19. The optimal implementation of these NPIs has to be planned before wide vaccine uptake worldwide.

COVID-19 in the MENA Region: Facts and Findings.

Our study aims to assess the prevalence of COVID-19 in the Middle East and North Africa (MENA) region. It aims also to examine the various factors that have led to the unequal distribution of the confirmed cases among the different MENA countries. Data was retrieved from the World Health Organization situation reports issued between January 29 and June 5, 2020. It included the numbers of cumulative cases, new cases, and cumulative deaths reported by MENA countries. Similarly, we searched for relevant articles in PubMed and Medline. A total of 481,347 cases and 11,851 deaths occurred in the MENA region, accounting for 7.37% and 3.06% of the global cases and deaths respectively. Iran had the highest number of cases and deaths accounting for 34.1% and 68.1% of the MENA cases and deaths respectively. Together the Gulf Cooperation Council (GCC) countries accounted for 52.2% and 10.6% of MENA cases and deaths respectively. Egypt had the highest number of confirmed cases and deaths among the African countries of the region. Syria, Libya and Yemen (countries at war) had the lowest numbers of reported cases. The MENA region overall case fatality rate (CFR) was estimated at 2.46%. The highest CFR (22.75%) occurred in Yemen, and the lowest (0.07%) in Qatar. The unequal distribution of wealth among the MENA countries, the lack of sociopolitical stability, and the high number of undetected and underreported cases in some of them have resulted in varied incidences of COVID-19 related morbidity and mortality.

Why Do so Many African Leaders Die of COVID-19?

This paper provides evidence that the COVID-19-related mortality rate of national government ministers and heads of state has been substantially higher than that of people with a similar sex and age profile in the general population, a trend that is driven by African cases (17 out of 24 reported deaths worldwide, as of 15 February 2021). Ministers' work frequently puts them in close contact with diverse groups, and therefore at higher risk of contracting COVID-19, but this is not specific to Africa. This paper discusses four non-mutually exclusive hypotheses for the Africa-specific trend, involving co-morbidity, poorly-resourced healthcare and possible restrictions in accessing out-of-country health facilities, the underreporting of cases, and the disproportionate impact of the so-called ‘South African’ variant (501Y.V2). The paper then turns its attention to the public health and political implications of the trend. While governments have measures in place to cope with the sudden loss of top officials, the COVID-19-related deaths have been associated with substantial changes in public health policy in cases where the response to the pandemic had initially been contested or minimal. Ministerial deaths also result in a reconfiguration of political leadership, but we do not expect a wave of younger and more gender representative replacements. Rather, we speculate that a disconnect may emerge between the top leadership and the public, with junior ministers filling the void and in so doing putting themselves more at risk of infection. Opposition politicians may also be at significant risk of contracting COVID-19.

Under-reported COVID-19 cases in South Asian countries.

Background: The purpose of the study was to compare trends in the progression of COVID-19 among South Asian countries with more developed Western countries. Methods: COVID-19 data from South Asian countries were used for this observational study. Data were taken up to April 21, 2020 from the outbreak of the COVID-19. Four of the seven countries met the inclusion criteria and were included in the analysis. Results: An exponential increase in the average number of weekly cases was reported after the fifth week following the first case. The correlation between reported cases and tests was found to be strong and significant (r=0.90, p=0.037). However, on average, 315.25 tests per million population were performed, which was at least 12 times lower than the number of tests performed in countries with a large number of COVID-19 cases. Conclusions: At present, the number of confirmed cases from South Asia was found to be significantly lower than in Western countries. Hence, an increase in the strength of performing diagnostic tests is highly recommended. Strict measures are required to make the people of these countries follow the instructions of social distancing and comply with preventive measures.

Prevalence of the Enterotoxigenic Staphylococcus Aureus Strains Isolated from Raw Milk and Cheese Produced in North Macedonia

Abstract Staphylococcus aureus is an important foodborne pathogen due to toxin-related virulence, invasiveness and antibiotic resistance. The ability of S. aureus strains to produce one or more staphylococcal enterotoxins (SEs) in food has been associated with the occurrence of staphylococcal food poisoning (SFP), which is the most common foodborne intoxication worldwide. The study aimed to determine the count of S. aureus strains in samples of raw cow’s milk and various cheeses produced in R. North Macedonia and to detect their ability to produce enterotoxins by passive agglutination SET RPLA (OXOID, UK) and by enzyme-linked fluorescence assay (ELFA) VIDAS SET 2 (Biomerieux, France). A total of 130 S. aureus strains were analyzed. The ability to produce SEs was determined in 17 (13.1%) strains using the SET RPLA detection kit and in 20 (15.4%) strains using the VIDAS SET 2. The study detected enterotoxigenic strains in cheese samples, despite the low count of S. aureus which was below the detection limit according to the Book of rules for microbiological criteria (Off. G. of R.M no 100/2013). Based on these and similar findings, S. aureus must be considered as a possible cause of intoxication, despite the undetected and underreported cases of SFP in the scientific literature.

Under-reported COVID-19 cases in South Asian countries

Background: The purpose of the study was to compare trends in the progression of COVID-19 among South Asian countries with more developed Western countries. Methods: COVID-19 data from South Asian countries were used for this observational study. Data were taken up to April 21, 2020 from the outbreak of the COVID-19. Four of the seven countries met the inclusion criteria and were included in the analysis. Results: An exponential increase in the average number of weekly cases was reported after the fifth week following the first case. The correlation between reported cases and tests was found to be strong and significant (r=0.90, p=0.037). However, on average, 315.25 tests per million population were performed, which was at least 12 times lower than the number of tests performed in countries with a large number of COVID-19 cases. Conclusions: At present, the number of confirmed cases from South Asia was found to be significantly lower than in Western countries. Hence, an increase in the strength of performing diagnostic tests is highly recommended. Strict measures are required to make the people of these countries follow the instructions of social distancing and comply with preventive measures.

Under-reported COVID-19 cases in South Asian countries.

Background: The purpose of the study was to compare trends in the progression of COVID-19 among South Asian countries with more developed Western countries. Methods: COVID-19 data from South Asian countries were used for this observational study. Data were taken up to April 21, 2020 from the outbreak of the COVID-19. Four of the seven countries met the inclusion criteria and were included in the analysis. Results: An exponential increase in the average number of weekly cases was reported after the fifth week following the first case. The correlation between reported cases and tests was found to be strong and significant (r=0.90, p=0.037). However, on average, 315.25 tests per million population were performed, which was at least 12 times lower than the number of tests performed in countries with a large number of COVID-19 cases. Conclusions: At present, the number of confirmed cases from South Asia was found to be significantly lower than in Western countries. However, this could be due to the smaller number of tests performed. Hence, an increase in the strength of performing diagnostic tests is highly recommended. Strict measures are required to make the people of these countries follow the instructions of social distancing and comply with preventive measures.

Human brucellosis: Seroprevalence and associated exposure factors among the rural population in Nagpur, Maharashtra, India.

Introduction:Brucellosis is a recognised occupational threat among animal handler and raw animal product consumers. In India, there is a likelihood of missed diagnoses and under-reporting cases by physicians causing an extended debilitating illness. We steered research to conclude the seroprevalence and risk factors allied with Human Brucellosis (HB) among the rural population in Nagpur District, Maharashtra, India.Methods:Closed-ended questionnaires used for a cross-sectional study to collect data for demographics and risk exposure variables. 382 subjects' serum-samples were tested by using Rose-Bengal (RBPT) and ELISA technique. An odd ratio calculated for risk factors for HB reported positive or negative. Data were analysed by using SPSS.Results:The brucellosis seroprevalence in rural Nagpur was 1.83%. The mean age was 42.32 years, 78.5% were male, and 21.5% were female. Prevalence was higher among males [85.7%] than females [14.3%]. The risk for brucellosis among males (OR = 1.65, 95% CI = 0.19–13.92, P = 0.64) was more than females. Handling raw meat had more risk (OR = 3.14, 95% CI = 0.40 – 28.6, P = 0.23) than those not handling raw meat. Milking animal was protective (OR = 0.88, 95% CI = 0.80 – 0.96, P < 0.001) for brucellosis than those not milking animal. Subjects reported more likely to be a seropositive to human brucellosis those involved in assisted animal delivery (P = 0.001), drinking unpasteurised milk (P<0.001), consuming milk products made from raw milk (P<0.001) and eating raw meat (P = 0.001)Conclusion:Health education program is essential to generate awareness for brucellosis in the rural community to prevent animal to human disease transmission.

An epidemiological forecast model and software assessing interventions on the COVID-19 epidemic in China

We develop a health informatics toolbox that enables timely analysis and evaluation of the timecourse dynamics of a range of infectious disease epidemics. As a case study, we examine the novel coronavirus (COVID-19) epidemic using the publicly available data from the China CDC. This toolbox is built upon a hierarchical epidemiological model in which two observed time series of daily proportions of infected and removed cases are generated from the underlying infection dynamics governed by a Markov Susceptible-Infectious-Removed (SIR) infectious disease process. We extend the SIR model to incorporate various types of time-varying quarantine protocols, including government-level ‘macro’ isolation policies and community-level ‘micro’ social distancing (e.g. self-isolation and self-quarantine) measures. We develop a calibration procedure for underreported infected cases. This toolbox provides forecasts, in both online and offline forms, as well as simulating the overall dynamics of the epidemic. An R software package is made available for the public, and examples on the use of this software are illustrated. Some possible extensions of our novel epidemiological models are discussed.

The Epidemic of Covid-19 in Africa: Demographic Effect, Under-Reporting of Cases, Dynamical Complexity and Mitigation Strategies Impact

Background: The epidemic of Covid-19 has shown a different development in Africa in comparison with the other continents. The reasons for this remain unclear.Methods: Basic statistics are first applied to estimate the contributions of the elder people and the health systems capacities on the total numbers of cases and deaths. Differential equations are then reconstructed from the observational time series in order to analyse the dynamics of Covid-19 at the countries scale. The contact number is estimated as a function of time for a selection of seventeen African countries to investigate the effectiveness of the mitigation strategies.Findings: Taking into account the health systems capacity and the proportion of elder people enables to reduce considerably the differences of Covid-19 number of cases and death observed between Africa and Europe. The global modelling technique reveals the dynamical complexity of the epidemics: the dynamics is geographically very diversified, and in many contexts – strictly speaking – chaotic including situations of bistability. The time evolution of the contact number reveals a relatively poor comparison with the strength of control measures in place.Interpretation: The lower proportion of elder people in Africa enables to explain the lower total numbers of cases and deaths by 20.0 times on average (from 7.4 to 31) and corresponds to a real effect. Covid-19 numbers are however largely underestimated in Africa by a factor of 8.5 on average (from 1.6 to 55) due to the weakness of the health systems at country level. Although the dynamics of COVID-19 can be reasonably approximated by few variables, its dynamics is proven to be highly unpredictable on the long term. The analysis of the obtained models evidence very diversified dynamics. The efficiency of the mitigation strategy is confirmed only in a few countries.Funding Information: This work was supported by the French programs Fonds d’Urgence Muse (Montpellier Université d’Excellence), Les Enveloppes Fluides et l’Environnement (CNRS-INSU), Défi Infinity (CNRS) and Programme National de Télédétection Spatiale (CNRS-INSU).Declaration of Interests: None to declare.

Prediction of secondary testosterone deficiency using machine learning: A comparative analysis of ensemble and base classifiers, probability calibration, and sampling strategies in a slightly imbalanced dataset

Testosterone is the most important male sex hormone, and its deficiency brings many physical and mental harms. Efficiently identifying individuals with low testosterone is crucial prior to starting proper treatment. However, routine monitoring of testosterone levels can be costly in many regions, resulting in an underreporting of cases, especially in developing countries. Moreover, there are few studies that employ machine learning (ML) in prognosticating testosterone deficiency. This research, therefore, aims to offer a coherent comparative analysis of machine learning methods that can predict testosterone deficiency without having patients undergo costly medical tests. In doing so, we seek to provide to the urological community a publicly available dataset ( https://github.com/osmarluiz/Testosterone-Deficiency-Dataset ) to increase research in this yet untapped field. For this analysis, we used ten base classifiers (optimized with grid search stratified K-fold cross-validation); three ensemble methods; and eight sampling strategies to analyze a total of 3397 patients. The analysis was based on six features (age; abdominal circumference; triglycerides; high-density lipoprotein; diabetes; and hypertension), all of which were obtained by low-cost exams. We compared the sampling strategies and the classifiers' performance on an independent test set using ranking (PR-AUC), probabilistic (Brier score), and threshold metrics. We found that: (1) within the ranking metrics, sampling strategies did not enhance results in this slightly imbalanced (4:1 ratio) dataset; (2) the ensemble classifier using weighted average presented the best performance; (3) the best base classifier was XGBoost; (4) calibration showed significant improvement for the sampling strategies and slight improvements for the no sampling strategy; (5) the McNemar's test presented statistically similar results among all classifiers; and (6) abdominal circumference (AC) had by far the highest feature importance, followed by triglycerides (TG). Age showed very little significance in predicting testosterone deficiency.

Cross-sectional Survey on Parental Perception and Attitude on Measles Vaccine: Low Hospital Measles Case Presentation in Rural Area in Enugu, Nigeria

Introduction: The incidence of measles has spiked in recent times despite the efforts to its eradication using a highly effective measles vaccine. Vaccine coverage and underreporting of cases are the major challenges to this effort. Aim: This study was designed to assess the parental knowledge of measles, attitude to measles vaccine and practice of case notification in a rural area in Enugu Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out during a house to house campaign on measles in Ogwuagor (a rural area in Enugu, with frequent cases of measles like symptoms) between June to November 2019. A pre-tested self/interviewer’s administered questionnaire was used to assess the knowledge of measles while Parental Attitude on Childhood Vaccine (PACV) questions were adopted and used to assess the attitude of parents to the measles vaccine. The participants were parents of at least one child of above 12 months of age. The findings and scores were analysed using IBM SPSS Statistic software for windows (SPSS statistical software V.21 (IBM Corp. 2019). The age of the respondents was grouped, and the simple mean obtained. The associations of variables; number of children, level of education and last antenatal care with respect to knowledge and attitude were analysed using Chi-square and p&lt;0.05 was regarded as statistically significant. Results: Out of 652 households in the area, 213 were assessed. One hundred and ninety three (90.6%) expressed knowledge above average about measles and measles vaccine. The score was higher among mothers who had at least three children in their household (p=0.518), tertiary education (p=0.706) and their last antenatal care in a hospital (p=0.774). Majority of the participants had good knowledge about symptoms, transmission and prevention of measles. Only about half, 114 (53.5%) knew the complication of measles. All the respondents had a positive attitude to the measles vaccine. Forty seven (22.1%) of the respondents delayed having their child get a measles shot while 31 (14.6) had concern on the efficacy of the vaccine. Forty-eight 22.5% were concerned about the side-effects of the measles vaccine. The delays having their child get a measles shot, concern on the efficacy of the vaccine, and concern about the side-effects of the measles vaccine observed were significant (p=0.0001, 0.0001, 0.0001, respectively) among parents of more than two children. Conclusion: There was adequate knowledge on measles symptoms, transmission and prevention but poor knowledge of the complication. Their attitudes on the measles vaccine were generally good however, the expression of delays having their child get a measles shot, concern on the efficacy of the vaccine, and concern about the side-effects of the measles vaccine were significant among parents of more than two children. Also, few measles cases were treated in hospital. There is a need to educate parents on the complication of measles and the importance of early hospital presentation of suspected cases for confirmation and prompt management. This will help to prevent complications and community transmission.

Is COVID-19 Fatality Rate Associated with Malaria Endemicity?

COVID-19 (coronavirus disease 2019) is a disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). COVID-19 has yielded many reported complications and unusual observations. In this article, we have reviewed one such observation: an association between malaria endemicity and reduced reported COVID-19 fatality. Malaria-endemic regions have a significantly lower reported COVID-19 fatality rate as compared to regions where malaria is non-endemic. Statistical analyses show that there is a strong negative correlation between the reported SARS-CoV-2 fatality and endemicity of malaria. In this review, we have discussed the potential role of CD-147, and potential malaria-induced immunity and polymorphisms in COVID-19 patients. Noteworthy, the results may also be due to underreported cases or due to the economic, political, and environmental differences between the malaria endemic and non-endemic countries. The study of this potential relationship might be of great help in COVID-19 therapy and prevention.

Finding incident cancer cases through outpatient oncology clinic claims data and integration into a state cancer registry.

Cancer data from population-based cancer registries under-report cancer cases, especially for cancers primarily diagnosed and treated in outpatient clinical settings, away from hospital-based cancer registrars. Previously, we developed alternative methods of cancer case capture including a claims-based method, which identified a large proportion of cancer cases missed by traditional population-based cancer registries. In this study, we adapted aclaims-based method for statewide implementation of cancer surveillance in Florida. Between 2010 and 2017 the claims-based method identified 143,083 cancer abstracts, of which 42% were new and 58% were previously registered. The claims-based method led to the creation of 53,419 new cancer cases in the state cancer registry, which made up 9.3% of all cancer cases registered between 2010 and 2017. The types of cancers identified by the claims-based method were typical of the kinds primarily diagnosed and treated in outpatient oncology clinic settings, such as hematological malignancies, prostate cancer, melanoma, breast cancer, and bladder cancer. These cases were added to the Florida cancer registry and may produce an artefactual increase in cancer incidence, which is believed to be closer to the actual burden of cancer in the state.

Mathematical Modeling Based Study and Prediction of COVID-19 Epidemic Dissemination Under the Impact of Lockdown in India

COVID-19 (SARS-CoV-2) is rapidly spreading in south asian countries especially in India. India is the fourth most COVID-19 affected country at present i.e. until July 10, 2020. With limited medical facilities and high transmission rate, the study of COVID-19 progression and its subsequent trajectory need to be analyzed in India. Epidemiologic mathematical models have the potential to predict the epidemic peak of COVID-19 under different scenarios. Lockdown is one of the most effective mitigation policy adopted worldwide to control the transmission rate of COVID-19 cases. In this study, we use an improvised five compartment mathematical model, i.e. Susceptible (S) - Exposed (E) - Infected (I) - Recovered (R) - Death (D) (SEIRD) to investigate the progression of COVID-19 and predict the epidemic peak under the impact of lockdown in India. The aim of this study is to provide the more precise prediction of epidemic peak and to evaluate the impact of lockdown on epidemic peak shift in India. For this purpose, we examine most recent data (from January 30, 2020 to July 10, 2020 i.e. 160 days) to enhance the accuracy of outcomes obtained from the proposed model. The model predicts the total number of COVID-19 active cases would be around 5.8 105 on August 15, 2020 under current circumstances. In addition, our study indicates the existence of under-reported cases i.e. 105 during post-lockdown period in India. Consequently, this study suggests that nationwide public lockdown would lead to epidemic peak suppression in India. It is expected that the obtained results would be beneficial for determining further COVID-19 mitigation policies not only in India but globally as well.

Single Level Percutaneous Vertebroplasty for Vertebral Hemangiomata — A Review of Outcomes

Background Percutaneous vertebroplasty is a minimally invasive technique to treat patients with symptomatic vertebral hermangiomata. Objectives We present a single-operator series of cases to demonstrate the clinical outcomes and complication profiles for this technique. Study design This is a retrospective multi-center cohort study. Setting Procedures were performed across multiple hospitals in Italy by a single proceduralist. Methods All patients with symptomatic vertebral hermangiomata that had percutaneous vertebroplasty over a 14-year period (March 1999 to April 2013) by a single proceduralist were included in this study. Information collected included demographic data, vertebral level of intervention, cement volume used, and the Visual Analogue Score for pain that was assessed pre- and post-intervention. Patients were followed up for a minimum of one year. Results Percutaneous vertebroplasty was performed for 50 patients. All patients had an improvement in pain, with 39 patients (78%) reporting complete pain relief. A unipedicular approach was undertaken in 41 cases (82%), and bipedicular approach in 8 patients (16%), while a transoral approach was used in one patient. The mean cement volume per vertebral level was 6.8 mL (1 - 18 mL). Recurrent symptoms occurred in 2 patients (4%) requiring repeat vertebroplasty. There were no cases of symptomatic cement leak, and no cases of procedural morbidity or mortality. Limitations As a multicenter study conducted over a 14-year time period, there may be heterogeneity in procedural technique and rehabilitation protocols. There were no cases of cement leakage in our study, which could be an underreporting of cases. This is could be due to none of our patients receiving a post procedural computerized tomography scan, which is more sensitive in detecting cement leakage when compared to procedural fluoroscopy. Conclusion Percutaneous vertebroplasty is associated with good post-procedural outcomes in patients with vertebral hermangiomata. Complications such as neurological injury and cement leakages are rare.

Why the misinformation, shame and guilt associated with coronavirus?

Mass media information, scientific articles and reports on measures to prevent infection are confusing at the least and figures from China and Iran lack cohesion. Reports suggest that Chinese scientists knew about coronavirus in early December 2019, but were told to conceal evidence by government. It is alleged that as cover-up, government officials intentionally withheld information that hospital workers had been infected by patients, a sign of how highly contagious the virus is. Researchers were also instructed to keep quiet and even ordered to destroy samples. Similar reports are also suggesting that Iran is under-reporting cases. In Africa, employees from a hospital in Zambia have also reported having been ordered not to speak publicly. They reported witnessing people who recently returned from China with coughs not being put in quarantine. Similar denials and cover-up strategies were seen in the 90s during the AIDS crisis. The guilt and shame that was associated with HIV were thought to have been associated with the intimate nature of transmission (mostly sexual) even though others got it through other routes including mother to child transmission etc. SARS-CoV-2 has not yet been proven to be intimately transmitted though having been isolated from semen. Why then the misinformation, shame, and guilt? How can countries move from the cover-up, blame games to responsibility as the virus defies containment? Some questions remain; How can cover-ups be prevented? How can governments be held accountable for cover-ups, misinformation, etc?

The COVID-19 pandemic should not jeopardize dengue control.

Author summaryThe concurrent circulation of dengue and coronavirus disease 2019 (COVID-19) may produce many unfavourable outcomes—such as co-infections; delays in diagnosis, treatment, and mitigation measures; overwhelming of the healthcare system; underreporting of cases; deterioration in surveillance and control interventions; and exacerbation of social inequalities. Indeed, lockdown is greatly compromising the effectiveness of vector control, especially social mobilization campaigns and preventive insecticide spraying in private spaces (indoor and peridomestic spraying). Thus, failure to appropriately implement the full range of vector control interventions can lead to a reduction in their overall effectiveness and an increasing risk of vector-borne diseases circulating. Consequently, the health community and policy makers should develop proactive policies and allocate adequate resources to prevent and manage the resurgence of dengue and other vector-borne diseases in the new era of COVID-19.

Epidemic trends, public health response and health system capacity: the Chilean experience in four months of the COVID-19 pandemic.

ABSTRACTObjectives.To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system.Methods.We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2.Results.After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region).Conclusions.Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.

Epidemiology and associated microbiota changes in deployed military personnel at high risk of traveler's diarrhea.

Travelers' diarrhea (TD) is the most prevalent illness encountered by deployed military personnel and has a major impact on military operations, from reduced job performance to lost duty days. Frequently, the etiology of TD is unknown and, with underreporting of cases, it is difficult to accurately assess its impact. An increasing number of ailments include an altered or aberrant gut microbiome. To better understand the relationships between long-term deployments and TD, we studied military personnel during two nine-month deployment cycles in 2015-2016 to Honduras. To collect data on the prevalence of diarrhea and impact on duty, a total of 1173 personnel completed questionnaires at the end of their deployment. 56.7% reported reduced performance and 21.1% reported lost duty days. We conducted a passive surveillance study of all cases of diarrhea reporting to the medical unit with 152 total cases and a similar pattern of etiology. Enteroaggregative E. coli (EAEC, 52/152), enterotoxigenic E. coli (ETEC, 50/152), and enteropathogenic E. coli (EPEC, 35/152) were the most prevalent pathogens detected. An active longitudinal surveillance of 67 subjects also identified diarrheagenic E. coli as the primary etiology (7/16 EPEC, 7/16 EAEC, and 6/16 ETEC). Eleven subjects were recruited into a nested longitudinal substudy to examine gut microbiome changes associated with deployment. A 16S rRNA amplicon survey of fecal samples showed differentially abundant baseline taxa for subjects who contracted TD versus those who did not, as well as detection of taxa positively associated with self-reported gastrointestinal distress. Disrupted microbiota was also qualitatively observable for weeks preceding and following the incidents of TD. These findings illustrate the complex etiology of diarrhea amongst military personnel in deployed settings and its impacts on job performance. Potential factors of resistance or susceptibility can provide a foundation for future clinical trials to evaluate prevention and treatment strategies.