Epidemiology of co-infections in pregnant women living with human immunodeficiency virus 1 in rural Gabon:a cross-sectional study

Background There is no recent epidemiological data on HIV infection in Gabon,particularly in pregnant women.To close this gap,an HIV-prevalence survey was conducted among Gabonese pregnant women,followed by a cross-sectional case-control study in which the prevalence of various co-infections was compared between HIV-positive and HIV-negative pregnant women.Methods Between 2018 and 2019,data for the HIV-prevalence survey were collected retrospectively in 21 Gabonese antenatal care centres(ANCs).Subsequently,for the prospective co-infection study,all HIV-positive pregnant women were recruited who frequented the ANC in Lambarénéand a comparator sub-sample of HIV-negative pregnant women was recruited;these activities were performed from February 2019 to February 2020.The mean number of coinfections was ascertained and compared between HIV-positive and HIV-negative women.Additionally,the odds for being co-infected with at least one co-infection was evaluated and compared between HIV-positive and HIV-negative women.Results HIV-positivity was 3.9%(646/16,417)among pregnant women.183 pregnant women were recruited in the co-infection study.63%of HIV-positive and 75%of HIV-negative pregnant women had at least one co-infection.There was a trend indicating that HIV-negative women were more often co-infected with sexually transmitted infections(STIs)than HIV-positive women[mean(standard deviation,SD):2.59(1.04)vs 2.16(1.35),respectively;P=0.056];this was not the case for vector-borne infections[mean(SD):0.47(0.72)vs 0.43(0.63),respectively;P=0.59].Conclusions Counterintuitively,the crude odds for concomitant STIs was lower in HIV-positive than in HIV-negative women.The change of magnitude from the crude to adjustedOR is indicative for a differential sexual risk factor profile among HIV-positive and HIV-negative women in this population.This might potentially be explained by the availability of sexual health care counselling for HIV-positive women within the framework of the national HIV control programme,while no such similar overall service exists for HIV-negative women.This highlights the importance of easy access to sexual healthcare education programmes for all pregnant women irrespective of HIV status.

Outbreak of Crimean-Congo haemorrhagic fever with atypical clinical presentation in the Karak District of Khyber Pakhtunkhwa,Pakistan

Background:Crimean-Congo haemorrhagic fever(CCHF)is a potentially fatal disease endemic in Pakistan.The causative virus is transmitted by the bite of Hyalomma ticks or by contact with infected blood or tissue.First cases of the disease were reported in Pakistan in 1976 but regular outbreaks have been observed since the year 2000.A huge agricultural base with more than 175 million livestock,the concomitant presence of Hyalomma ticks and a lack of precautionary measures to prevent transmission lead to a considerable risk for exposed populations to contract CCHF in Pakistan.At the same time,secondary cases contracted by nosocomial transmission are reported from hospitals.Case presentation:Here we present an outbreak of CCHF with four of six patients succumbing to the disease before the suspicion for CCHF was raised.Importantly,the main clinical features of these cases were gastrointestinal symptoms without any clinical signs of bleeding.Only the last two patients in this outbreak presented with typical signs of bleeding disorder and were then confirmed being infected by CCHF.Confirmation of diagnosis was done at the National Institute of Health by real-time RT-PCR.Conclusions:This case series highlights the importance of early clinical suspicion for CCHF in exposed individuals and the need for improved precautionary measures against the spread of CCHF within the Pakistani population and hospitals.