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Disinfection methods for preventing COVID-19 infections in healthcare settings: A rapid review
Get PDFBackground: Disinfectant sprays and wipes reduce the risk of infection from contaminated surfaces and materials in healthcare facilities. To support guideline updates, evidence on surface disinfection against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are needed.Aim: This study aims to compare the effect of disinfection by spraying or wiping on the risk of human infections in healthcare facilities providing coronavirus disease 2019 (COVID-19) services.Setting: Healthcare settings providing care for patients with COVID-19 or where exposure risk to COVID-19 is high.Method:We searched the Central Register of Controlled Trials (CENTRAL) and Cochrane Database of systematic review; PubMed, EMBASE and EPOC databases from 01 January 2020 to 31 August 2022. Results were screened for eligibility, the risk of bias in included studies assessed, and the certainty of evidence defined using GRADE®.Results: Three observational studies were included. Two studies reporting proportion of surfaces with residual contamination, showed contrasting results with spraying more effective (0%, [n= 0/39] vs. 25.6% [n= 23/90]) in one study but less effective (25.0% [n= 12/48] vs. 48.2% [n= 13/27]) in the other. The third study reported higher reductions from wiping (88.0%) compared to spraying (15.1%). The risk of bias ranged from moderate to serious and the certainty of the evidence was very low. No study reported a direct effect on the risk of infection in humans.Conclusion: Both spraying and wiping methods may protect against SARS-CoV-2 infections indirectly by reducing residual surface contamination</p
Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal study.
Get PDFBackgroundBronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time.MethodsThe multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003 and December 26, 2016. Follow-up measurements were collected between January 29, 2019 and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers.FindingsWe analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20).InterpretationBronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.</p
The tear production of tecovirimat in a single hospitalized mpox patient: a pharmacokinetic analysis
Get PDFMpox is an orthopox DNA virus.1,2 Ophthalmic manifestations include preseptal cellulitis, conjunctivitis and keratitis, either as a primary or secondary viral infection or a secondary bacterial infection.2 Tecovirimat (Tpoxx) is an oral orthopox-specific drug that inhibits the orthopoxvirus VP37 envelope-wrapping protein and prevents the formation of egress-competent virions.3 There are limited pharmacokinetic/pharmacodynamic (PK/PD) data available. We present a case report of a critically unwell mpox patient, who had tecovirimat PK sampling of plasma and tears.</p
Entomological surveillance of onchocerciasis in Burkina Faso: Progress towards interrupting transmission in blackflies in the main river basins of the country
Get PDFCurrent guidelines for onchocerciasis elimination rely heavily upon assessment of the presence of Onchocerca volvulus in the vector Simulium damnosum (sensu lato). This entomological study was conducted over four years in several regions of Burkina Faso to determine the progress made towards interrupting onchocerciasis transmission. Larvae and adult blackflies were collected in eight river basins (Comoé, Léraba, Dienkoa, Mouhoun, Bougouriba, Bambassou, Nakambé, Nazinon and Sissili). Larvae were analysed by cytotaxonomy, and the adult blackflies analysed for the presence of infective larvae of O. volvulus by PCR. Blackfly infectivity rates were first determined by year for each basin, then compared to the thresholds established by the WHO. The results indicate that the blackflies collected belong to the savannah group Simulium damnosum (sensu stricto) and Simulium sirbanum. Hybrids of the two species were also identified. Overall, the prevalence of flies carrying infective larvae was below the threshold of 0.05% established by the WHO indicating important progress towards the interruption of onchocerciasis transmission in Burkina Faso, though hotspots with infectivity rates well above the WHO’s thresholds remain. Onchocerca volvulus continues to be transmitted in six of the nine basins evaluated, all of which border neighbouring countries. These data indicate that it will be necessary to maintain entomological surveillance in these hotspot areas until transmission is interrupted throughout the region.</p
Prophylactic antibiotics for uterine evacuation procedures to manage miscarriage
No full textBackgroundProcedural management of early pregnancy loss (EPL) involves removing any residual pregnancy tissue from the uterus. Clinical evidence and guidance are clear that antibiotic treatment is needed for women experiencing EPL, with signs and symptoms of infection. However, it is less clear whether prophylactic antibiotics are routinely required during procedural management in those without features of infection.ObjectivesTo evaluate the effectiveness of routine antibiotic prophylaxis for women undergoing uterine evacuation procedures to manage early pregnancy loss.Search methodsWe searched the Cochrane Fertility Regulation Review Group trials register, CENTRAL, MEDLINE, Embase, Global Health (Ovid), Scopus (conference abstracts only), and grey literature in October 2023. We checked references and contacted study authors and experts in the field to identify additional studies.Selection criteriaWe included randomised controlled trials comparing prophylactic antibiotics with placebo or no treatment. Trials with a cluster‐randomised design and trials published only in abstract form were also eligible for inclusion. We included all types of EPL managed with surgical uterine evacuation. There was no gestational age limit. We excluded women with signs and symptoms of infection.Data collection and analysisTwo review authors independently assessed trials for inclusion and risk of bias, extracted and checked data for accuracy, and assessed the certainty of evidence using the GRADE approach. We contacted the authors of the ongoing trial for additional information.</p
Collaborative engagement with vector control stakeholders is key to enhance the utility of vector-borne disease models.
Get PDFBackgroundDespite the growing complexity, computational power, and mapping capacity incorporated into vector-borne disease models, they still do not fully elucidate the role of environmental, demographic, socioeconomic, or other drivers, and rarely directly inform vector control efforts. To understand how we can improve the utility of vector-borne disease models for vector control activities, we interviewed vector control agents from the United States (USA) and the European Union.MethodsBetween July and December 2023, in-depth interviews were held using a geographically targeted convenience sample with 26 individuals from organizations involved in vector control operations: 12 in the USA and 14 in the EU. We used both deductive and inductive coding of transcribed interviews to identify themes with the goal of understanding barriers to model use and uptake.ResultsDespite the recognition that models could be useful, few interviewees reported that models informed surveillance and control activities, citing a mismatch in spatial and temporal scale between model outputs and operational decisions or a general lack of accessibility. Interviewees reported relying on experienced field experts and legacy protocols. Despite these critiques, there is belief that models can support operational decision-making.ConclusionsThe disconnect between models and users can be improved by allowing time and resources to build collaborative relationships, by acknowledging the knowledge all members bring, and by ensuring clear communication and mutual respect. Modelers must shift their focus by aligning vector-borne disease models with operational needs.</p
How macrophage heterogeneity affects tuberculosis disease and therapy
Get PDFMacrophages are the primary host cell type for infection by Mycobacterium tuberculosis in vivo. Macrophages are also key immune effector cells that mediate the control of bacterial growth. However, the specific macrophage phenotypes that are required for optimal immune control of M. tuberculosis infection in vivo remain poorly defined. There are two distinct macrophage lineages in the lung, comprising embryonically derived, tissue-resident alveolar macrophages and recruited, blood monocyte-derived interstitial macrophages. Recent studies have shown that these lineages respond divergently to similar immune environments within the tuberculosis granuloma. Here, we discuss how the differing responses of macrophage lineages might affect the control or progression of tuberculosis disease. We suggest that the ability to reprogramme macrophage responses appropriately, through immunological or chemotherapeutic routes, could help to optimize vaccines and drug regimens for tuberculosis
The Economic Burden of Healthcare Utilization: Findings from a Health and Well-Being Survey in Informal Settlements of Freetown, Sierra Leone
Get PDFThe fragile health system in Sierra Leone undermines healthcare, leading to substantial patient costs. We aimed to estimate the economic burden and inequalities in healthcare in urban informal settlements in Freetown, Sierra Leone. A cross-sectional survey was conducted in three informal settlements in Freetown in April and May 2023 to collect data on healthcare usage within and outside the boundaries of the informal settlements. Catastrophic expenditures were estimated using the payer’s household budget. Logistic regression explored socioeconomic characteristics associated with catastrophic expenditures. Inequalities in healthcare expenditures were assessed through concentration curves and indices. A total of 2575 participants reported healthcare utilization. Dwarzark (US7.1) had higher costs than Cockle Bay (US14 vs US$ 7). Over half of the households across the settlements incurred catastrophic expenditures when seeking care outside the communities (57%), with the poorest wealth quintile (poorest, 89%; wealthier, 12%) incurring in higher incidence. Attending informal healthcare had a protective effect against catastrophic expenditure for healthcare within the communities. Age + 35, residence in Dwarzark and Moyiba, and length of residence + 4 years were associated with catastrophic expenditures. Healthcare expenditure was progressive in Dwarzark and equally distributed across wealth quintiles in the other communities. Our findings indicate the need to provide accessible, affordable, and good-quality healthcare within communities to alleviate the catastrophic costs of healthcare utilization. The regulation of informal health providers and their integration into the formal health system should be considered
Mosquitoes Reared in Nearby Insectaries at the Same Institution Have Significantly Divergent Microbiomes
Get PDFThe microbiome influences critical aspects of mosquito biology and variations in microbial composition can impact the outcomes of laboratory studies. To investigate how biotic and abiotic conditions in an insectary affect the composition of the mosquito microbiome, a single cohort of Aedes aegypti eggs was divided into three batches and transferred to three different climate-controlled insectaries within the Liverpool School of Tropical Medicine. The bacterial microbiome composition was compared as mosquitoes developed, the microbiome of the mosquitoes' food sources was characterised, environmental conditions over time in each insectary were measured, and mosquito development and survival were recorded. While developmental success was similar across all three insectaries, differences in microbiome composition were observed between mosquitoes from each insectary. Environmental conditions and bacterial input via food sources varied between insectaries, potentially contributing to the observed differences in microbiome composition. At both adult and larval stages, specific members of the mosquito microbiome were associated with particular insectaries; the insectary with less stable and cooler conditions resulted in a slower pupation rate and higher diversity of the larval microbiome. These findings underscore that even minor inconsistencies in rearing conditions can affect the composition of the mosquito microbiome, which may influence experimental outcomes.</p
Preventing HIV in women in Africa
Get PDFHIV incidence is declining globally, but around half of all new infections are in sub-Saharan Africa—where adolescent girls and young women bear a disproportionate burden of new infections. Those who sell sex are at particularly high risk. Despite declining incidence rates and availability of effective biomedical prevention tools, we are not on track, globally or in Africa, to achieve UNAIDS 2025 prevention targets. For those at risk, interventions that strengthen their motivation, capabilities and access to all available HIV prevention technologies are critical—for adolescent girls and women in particular, but also for epidemic control more broadly. Exciting possibilities for scaling up new and highly effective prevention technologies are close, but delivery, implementation and financing models need to be developed and urgently evaluated, in partnership with communities, or these opportunities may be lost. Here, we discuss the evolving landscape of biomedical prevention technologies for women in Africa, their implementation and financing, as well as priorities for HIV prevention research in this setting.</p