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Hands are frequently contaminated with fecal bacteria and enteric pathogens globally: a systematic review and meta-analysis
No full textEnteric pathogen infections are a leading cause of morbidity and mortality globally, with the highest disease burden in low-income countries. Hands act as intermediaries in enteric pathogen transmission, transferring enteric pathogens between people and the environment through contact with fomites, food, water, and soil. In this study, we conducted a systematic review of prevalence and concentrations of fecal indicator microorganisms (i.e., E. coli, fecal coliform) and enteric pathogens on hands. We identified 84 studies, reporting 35,440 observations of hand contamination of people in community or household settings. The studies investigated 44 unique microorganisms, of which the most commonly reported indicators were E. coli and fecal coliforms. Hand contamination with 12 unique enteric pathogens was reported, with adenovirus and norovirus as the most frequent. Mean E. coli prevalence on hands was 62% [95% CI 40%-82%] and mean fecal coliform prevalence was 66% [95% CI 22%-100%]. Hands were more likely to be contaminated with E. coli in low/lower-middle-income countries (prevalence: 69% [95% CI 48%-88%]) than in upper-middle/high-income countries (6% [95% CI 2%-12%]). The Review also highlights the importance of standardizing hand sampling methods, as hand rinsing was associated with greater fecal contamination compared to other sampling methods. © 2023 The Authors. Published by American Chemical Society
Emodepside for Trichuris trichiura and hookworm infection
No full textBACKGROUND: Current treatments for soil-transmitted helminth infections in humans have low efficacy against Trichuris trichiura. Emodepside - a drug in veterinary use and under development for the treatment of onchocerciasis in humans - is a leading therapeutic candidate for soil-transmitted helminth infection. METHODS: We conducted two phase 2a, dose-ranging, randomized, controlled trials to evaluate the efficacy and safety of emodepside against T. trichiura and hookworm infections. We randomly assigned, in equal numbers, adults 18 to 45 years of age in whom T. trichiura or hookworm eggs had been detected in stool samples to receive emodepside, at a single oral dose of 5, 10, 15, 20, 25, or 30 mg; albendazole, at a single oral dose of 400 mg; or placebo. The primary outcome was the percentage of participants who were cured of T. trichiura or hookworm infection (the cure rate) with emodepside 14 to 21 days after treatment, determined with the use of the Kato-Katz thick-smear technique. Safety was assessed 3, 24, and 48 hours after the receipt of treatment or placebo. RESULTS: A total of 266 persons were enrolled in the T. trichiura trial and 176 in the hookworm trial. The predicted cure rate against T. trichiura in the 5-mg emodepside group (85% [95% confidence interval CI, 69 to 93]; 25 of 30 participants) was higher than the predicted cure rate in the placebo group (10% [95% CI, 3 to 26]; 3 of 31 participants) and the observed cure rate in the albendazole group (17% [95% CI, 6 to 35]; 5 of 30 participants). A dose-dependent relationship was shown in participants with hookworm: the observed cure rate was 32% (95% CI, 13 to 57; 6 of 19 participants) in the 5-mg emodepside group and 95% (95% CI, 74 to 99.9; 18 of 19 participants) in the 30-mg emodepside group; the observed cure rates were 14% (95% CI, 3 to 36; 3 of 21 participants) in the placebo group and 70% (95% CI, 46 to 88; 14 of 20 participants) in the albendazole group. In the emodepside groups, headache, blurred vision, and dizziness were the most commonly reported adverse events 3 and 24 hours after treatment; the incidence of events generally increased in a dose-dependent fashion. Most adverse events were mild in severity and were self-limited; there were few moderate and no serious adverse events. CONCLUSIONS: Emodepside showed activity against T. trichiura and hookworm infections. (Funded by the European Research Council; ClinicalTrials.gov number, NCT05017194.)
Advancing detection and response capacities for emerging and re-emerging pathogens in Africa
No full textRecurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa
Using a Madurella mycetomatis specific PCR on grains obtained via non-invasive fine needle aspirated material is more accurate than cytology
No full textBACKGROUND: Eumycetoma is a chronic subcutaneous inflammatory fungal infection most often caused by Madurella mycetomatis. Using a species-specific PCR on DNA directly isolated from grains is currently the most reliable method for species identification. However, so far, PCR has been performed on grains obtained through deep-seated surgical biopsies, which are invasive procedures. Grains can also be obtained via ultrasound-guided fine needle aspiration (US-FNA). Here we determined the diagnostic performance of species-specific PCRs performed on samples obtained through US-FNA. METHODS: From 63 patients, US-FNA was performed to obtain eumycetoma grains; 34 patients also underwent a deep-seated biopsy. From the grains, DNA was isolated, and one pan-fungal and two M. mycetomatis-specific PCRs were performed. The sensitivity and specificity were determined. RESULTS: Of the 63 patients who underwent US-FNA, 78% (49/63) had evidence of eumycetoma based on cytology and 93.7% (59/63) based on species-specific PCRs. In the 34 patients for whom surgical biopsies were performed as well, 31 patients had a positive PCR for M. mycetomatis when DNA was isolated from the deep-seated biopsy, and 30 had a positive PCR when DNA was obtained from US-FNA material. This resulted in a 96.8% sensitivity, and 100% specificity with 97.1% diagnostic accuracy for PCR performed on US-FNA. CONCLUSION: PCR performed on US-FNA material has a similar sensitivity and specificity as PCR performed on deep-seated biopsies. Therefore when using PCR, a deep-seated biopsy may not be necessary to obtain grains
The highly diverse plasmid population found in Escherichia coli colonizing travellers to Laos and its role in antimicrobial resistance gene carriage
Get PDFIncreased colonization by antimicrobial-resistant organisms is closely associated with international travel. This study investigated the diversity of mobile genetic elements involved with antimicrobial resistance (AMR) gene carriage in extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli that colonized travellers to Laos. Long-read sequencing was used to reconstruct complete plasmid sequences from 48 isolates obtained from the daily stool samples of 23 travellers over a 3 week period. This method revealed a collection of 105 distinct plasmids, 38.1 % (n=40) of which carried AMR genes. The plasmids in this population were diverse, mostly unreported and included 38 replicon types, with F-type plasmids (n=23) the most prevalent amongst those carrying AMR genes. Fine-scale analysis of all plasmids identified numerous AMR gene contexts and emphasized the importance of IS elements, specifically members of the IS6/IS26 family, in the evolution of complex multidrug resistance regions. We found a concerning convergence of ESBL and colistin resistance determinants, with three plasmids from two different F-type lineages carrying bla (CTX-M) and mcr genes. The extensive diversity seen here highlights the worrying probability that stable new vehicles for AMR will evolve in E. coli populations that can disseminate internationally through travel networks
Application of human biomonitoring data to support policy development, raise awareness and environmental public health protection among countries within the HBM4EU project
No full textMost countries have acknowledged the importance of assessing and quantifying their population's internal exposure from chemicals in air, water, soil, food and other consumer products due to the potential health and economic impact. Human biomonitoring (HBM) is a valuable tool which can be used to quantify such exposures and effects. Results from HBM studies can also contribute to improving public health by providing evidence of individuals' internal chemical exposure as well as data to understand the burden of disease and associated costs thereby stimulating the development and implementation of evidence-based policy. To have a holistic view on HBM data utilisation, a multi-case research approach was used to explore the use of HBM data to support national chemical regulations, protect public health and raise awareness among countries participating in the HBM4EU project. The Human Biomonitoring for Europe (HBM4EU) Initiative (https://www.hbm4eu.eu/) is a collaborative effort involving 30 countries, the European Environment Agency (EEA) and the European Commission (contracting authority) to harmonise procedures across Europe and advance research into the understanding of the health impacts of environmental chemical exposure. One of the aims of the project was to use HBM data to support evidence based chemical policy and make this information timely and directly available for policy makers and all partners. The main data source for this article was the narratives collected from 27 countries within the HBM4EU project. The countries (self-selection) were grouped into 3 categories in terms of HBM data usage either for public awareness, policy support or for the establishment HBM programme. Narratives were analysed/summarised using guidelines and templates that focused on ministries involved in or advocating for HBM; steps required to engage policy makers; barriers, drivers and opportunities in developing a HBM programme. The narratives reported the use of HBM data either for raising awareness or addressing environmental/public health issues and policy development. The ministries of Health and Environment were reported to be the most prominent entities advocating for HBM, the involvement of several authorities/institutions in the national hubs was also cited to create an avenue to interact, discuss and gain the attention of policy makers. Participating in European projects and the general population interest in HBM studies were seen as drivers and opportunities in developing HBM programmes. A key barrier that was cited by countries for establishing and sustaining national HBM programmes was funding which is mainly due to the high costs associated with the collection and chemical analysis of human samples. Although challenges and barriers still exist, most countries within Europe were already conversant with the benefits and opportunities of HBM. This article offers important insights into factors associated with the utilisation of HBM data for policy support and public awareness
Malaria transmission and insecticide resistance in Anopheles gambiae in Ellibou, Côte d'Ivoire
Get PDFBackground
Malaria is a major public health problem in Côte d'Ivoire with a countrywide prevalence exceeding 60%. The main strategies to fight the disease include early diagnosis, prompt and effective treatment as well as individual and community effective preventive measures, such as the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). The deployment of any of these preventive measures must take into account the local conditions of malaria transmission, in particular the level of endemicity, the vectors involved in the transmission and the factors which influence the level of transmission. Unfortunately, resistance of malaria vectors to pyrethroids (PYRs), the main approved class of insecticides for treatment of bednets is widespread and constitutes a problem in disease control by the National Malaria Control Programme (NMCP). Ellibou is located in the southern part of Côte d'Ivoire and apart from the LLIN distribution campaign by the NMCP in 2014, no entomological study has been conducted in this locality. However, knowledge of the local malaria vectors and their resistance status to insecticides are essential to implement vector control strategies.
Aim and objectives
The aim of this PhD study was to determine key entomological parameters of malaria transmission and to assess the insecticide susceptibility of malaria vectors in Elibou, South Côte d'Ivoire. Specifically, we (i) determined the species composition of mosquitoes in Elibou, the sporozoite rate and the seasonal variation of malaria vector density over an entire year; (ii) assessed the insecticide susceptibility of the main malaria vector to the four conventional classes of insecticides used in public health and characterise the mechanisms involved in resistance to these insecticides; and (iii) investigated the knowledge, attitudes, practices and believes (KAPB) of the population in relation to the use of insecticides and insecticide resistance in malaria vectors.
Methods
We carried out an entomological survey, including larvae and adult mosquito collections in Elibou village over a 1-year period. To catch adult mosquitoes we performed pyrethroid spray catches (PSCs) and deployed CDC light traps (LTs). Adults mosquitoes were identified morphologically and diagnosted by PCR to genus and, where possible, to species level.
The susceptibilty of female Anopheles moquitoes emerged from larvae to insecticides was assessed by World Health Organization (WHO) insecticide susceptibility assays, while we characterised the mechanisms involved in insecticide resistance by real-time reverse-transcription polymerase chain reaction (RT-PCR). Finally, a KAPB survey, using questionaires, focus group discussions (FGDs) and interviews, was carried out.
Results
We caught 2,383 adult mosquitoes, 884 specimens by CDC light traps and 1,499 by PSCs. We morphologically identified 10 different taxa, including three Anopheles taxa. Anopheles gambiae s.l. represented the predominant malaria vector. The other two Anopheles taxa were Anopheles funestus and Anopheles pharoensis representing less than 1% each. The molecular identification showed that An. gambiae s.s. (38.3%), Anopheles coluzzii (39.0%) and Anopheles arabiensis (19.5%) as the main malaria vectors in Elibou. To our knowledge, this is the first report of An. arababiensis in Côte d'Ivoire. We also found An. gambiae/coluzzii hybrids (4.7%). The other mosquito species included Aedes sp., Culex sp. and Mansonia sp. and represented 57.8% of the total of mosquitoes collected. The sporozoite rates were 5.3%. The numbers of adult An. gambiae s.l. mosquitoes increased considerably during the rainy seasons mainly between June and July. The main malaria vector was resistant to deltamethrin, dichloro-diphenyl-trichloroethane (DDT) and bendiocarb while susceptible to malathion. In the An. gambiae s.l. specimens we found the insecticide target site mutations kdr L1014F, L1014S and N1575Y, and the Ace-1 G119S at both the homozygous and heterozygous stage. While the L1014S was only found in An. arabiensis, nine individuals harboured simultaniousely the L1014F and L1014S alleles. The detoxification genes CYP6P3, CYP6M2, CYP6Z1, CYP6P4, CYP6P1, CYP9K1, CYP4G16 and GSTE2 were found to be overexpressed in all Anopheles tested from Ellibou. CYP6P4 and CYP6M2 were the most upregulated genes. The KAPB survey revealed that people have poor knowledge about insecticide resistance, while they felt that preventing measures were ineffective. The main reason given was that insecticides were diluted by the manufacturers as a marketing strategy to sell larger quantities of their products. More than a third of the farmers used agricultural pesticides for domestic purposes to kill weeds or mosquitoes.
Conclusion
The results of this study contribute to a better understanding of the main local malaria vectors and their resistance status to insecticides used in public health and agriculture as well as factors that lead to insecticide resistance and persistence of malaria affecting the NMCP activities in the fight against malaria. Here, we report for the first time the presence An. arabiensis among malaria vectors in Côte d’Ivoire. This finding is an early warning sign because An. arabiensis shows a different behaviour and ecology than An. coluzzii and An. gambiae s.s. Thus, different methods for vector control are required.
Resistance to insecticides as observed in Ellibou is a great concern. Our results show that several resistance mechanisms are involved in insecticide resistance. In addition, the KAPB results show that the pesticides used for agriculture are also used in households for domestic purposes and might be a cause of insecticide resistance development in mosquitoes in Elibou. Given the misunderstanding of resistance by the local population, it is important to inform them about the current situation for awareness and sensitise them for a change in behaviour on the best use of insecticides and the environmental sanitation.
For future studies, we recommend to investigate on the history of the onset of An. arabiensis in Côte d’Ivoire, its distribution, its resistance status and its implication in malaria transmission. For An. gambiae s.l., the use of an alternative insecticide such as pyrimiphos-methyl, an organophosphate for IRS, is recommended. However, An. arabiensis is primarily an outdoor biting mosquito, and hence IRS and LLINs may be less effective against this malaria vector. To this end, we recommend to implement an effective control using a transdisciplinary approach while involving the local population because it plays an important role in the spread of resistance. The conclusions of our study will guide decision makers to design and implement an effective vector control strategy in the Ellibou region and other localities with the same characteristics.
Key words : Anopheles arabiensis, Anopheles gambiae, Ellibou, Côte d’Ivoire, insecticide resistance, metabolic resistance, transmission, malaria
Administrative burden in Swiss nursing homes and its association with care workers' outcomes-a multicenter cross-sectional study
Get PDFCare workers in nursing homes often perform tasks that are rather related to organizational or management activities than 'direct patient care'. 'Indirect care activities', such as documentation or other administrative tasks are often considered by care workers as a burden, as they increase overall workload and keep them away from caring for residents. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers' outcomes.; The objective of this study was to describe care workers' administrative burden in Swiss nursing homes and to explore the association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession).; This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2'207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland's German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.; Overall, 73.9% (n = 1'561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n = 787) reporting to spend 2 h or more during a "normal" day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n = 884; ordering supplies and managing stocks) to 75.3% (n = 1'621; filling out the resident's health record). One out of four care workers (25.5%, n = 561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR = 1.24; 95%CI: 1.02-1.50) were more likely to intend to leave the profession.; This study provides first insights on care workers' administrative burden in nursing homes. By limiting care workers' burdensome administrative tasks and/or shifting such tasks from higher to lower educated care workers or administrative personnel when appropriate, nursing home managers could reduce care workers' workload and improve their job satisfaction and retention in the profession
Hepatic mTORC2 compensates for loss of adipose mTORC2 in mediating energy storage and glucose homeostasis
No full textMammalian target of rapamycin complex 2 (mTORC2) is a protein kinase complex that plays an important role in energy homeostasis. Loss of adipose mTORC2 reduces lipogenic enzyme expression and de novo lipogenesis in adipose tissue. Adipose-specific mTORC2 knockout mice also display triglyceride accumulation in the liver. However, the mechanism and physiological role of hepatic triglyceride accumulation upon loss of adipose mTORC2 are unknown. Here, we show that loss of adipose mTORC2 increases the expression of de novo lipogenic enzymes in the liver, thereby causing accumulation of hepatic triglyceride and hypertriglyceridemia. Simultaneous inhibition of lipogenic enzymes in adipose tissue and liver by ablating mTORC2 in both tissues prevented accumulation of hepatic triglycerides and hypertriglyceridemia. However, loss of adipose and hepatic mTORC2 caused severe insulin resistance and glucose intolerance. Thus our findings suggest that increased hepatic lipogenesis is a compensatory mechanism to cope with loss of lipogenesis in adipose tissue, and further suggest that mTORC2 in adipose tissue and liver plays a crucial role in maintaining whole body energy homeostasis.; NEW & NOTEWORTHY; Loss of adipose and hepatic mTORC2 causes diabetes
Characterising the IIIF and Linked Art communities: survey report
Get PDFThis report presents the findings and analysis of a survey conducted between 24 March and 7 May 2023, exploring the socio-technical characteristics of two prevalent community-driven initiatives in Digital Humanities, namely the International Image Interoperability Framework (IIIF) and Linked Art. With 79 participants, the survey investigates the practices and activities of individuals involved in these initiatives, which focus on developing and maintaining shared application programming interfaces (APIs) for enhanced interoperability and access to cultural heritage resources. It also seeks to situate these initiatives within a broader discourse of scholarly movements and principles. Additionally, it serves as a preliminary means of exploring the prospective impact of Linked Open Usable Data (LOUD) and its underlying design principles in the cultural heritage field