Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysis

To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreatic carcinoma registered within the Surveillance, Epidemiology and End Results (SEER) database.METHODSSEER database (2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases (liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved.RESULTSA total of 13233 patients with stage IV pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases (for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001) (for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSIONPancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.

Nomogram for overall survival in ampullary adenocarcinoma using the surveillance,epidemiology,and end results database and external validation

BACKGROUND Ampullary adenocarcinoma is a rare malignant tumor of the gastrointestinal tract.Currently,only a few cases have been reported,resulting in limited information on survival.AIM To develop a dynamic nomogram using internal and external validation to predict survival in patients with ampullary adenocarcinoma.METHODS Data were sourced from the surveillance,epidemiology,and end results stat database.The patients in the database were randomized in a 7:3 ratio into training and validation groups.Using Cox regression univariate and multivariate analyses in the training group,we identified independent risk factors for overall survival and cancer-specific survival to develop the nomogram.The nomogram was validated with a cohort of patients from the First Affiliated Hospital of the Army Medical University.RESULTS For overall and cancer-specific survival,12(sex,age,race,lymph node ratio,tumor size,chemotherapy,surgical modality,T stage,tumor differentiation,brain metastasis,lung metastasis,and extension)and 6(age;surveillance,epidemiology,and end results stage;lymph node ratio;chemotherapy;surgical modality;and tumor differentiation)independent risk factors,respectively,were incorporated into the nomogram.The area under the curve values at 1,3,and 5 years,respectively,were 0.807,0.842,and 0.826 for overall survival and 0.816,0.835,and 0.841 for cancer-specific survival.The internal and external validation cohorts indicated good consistency of the nomogram.CONCLUSION The dynamic nomogram offers robust predictive efficacy for the overall and cancer-specific survival of ampullary adenocarcinoma.

Treatment trends of muscle invasive bladder cancer: Evidence from the Surveillance, Epidemiology, and End Results database, 1988 to 2013

Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patterns of MIBC have been defined using the National Cancer Database,data using the Surveillance,Epidemiology,and End Results(SEER)program have been poorly described.Methods:Using the SEER database,we collected data of MIBC according to the American Joint Commission on Cancer.We considered differences in patient demographics and tumor charac-teristics based on three treatment groups:chemotherapy(both adjuvant and neoadjuvant)with radical cystectomy,radical cystectomy,and chemoradiotherapy.Multinomial logistic regression was performed to compare likelihood ratios.Temporal trends were included for each treatment group.Kaplan-Meier curves were performed to compare cause-specific sur-vival.A Cox proportional-hazards model was utilized to describe predictors of survival.Results:Of 16728 patients,10468 patients received radical cystectomy alone,3236 received chemotherapy with radical cystectomy,and 3024 received chemoradiotherapy.Patients who received chemoradiotherapy over radical cystectomy were older and more likely to be African American;stage III patients tended to be divorced.Patients who received chemotherapy with radical cystectomy tended to be males;stage II patients were less likely to be Asian than Caucasian.Stage III patients were less likely to receive chemoradiotherapy as a treatment op-tion than stage II.Chemotherapy with radical cystectomy and chemoradiotherapy are both un-derutilized treatment options,though increasingly utilized.Kaplan-Meier survival curves showed significant differences between stage II and III tumors at each interval.A Cox proportional-hazards model showed differences in gender,tumor stage,treatment modality,age,andmarital status.Conclusion:Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends.Significant disparities exist in those who receive radical cystectomy over chemoradiotherapy for treatment.

Prognostic impact of tumor deposits on overall survival in colorectal cancer:Based on Surveillance, Epidemiology, and End Results database

BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival(OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.RESULTS Overall, 103755 patients were enrolled with 14131(13.6%) TD-positive and 89624(86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3%(95%CI, 46.5%-48.1%) and 77.5%(95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS(hazard ratio, 1.35;95%CI, 1.31-1.38;P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965(4.4%) N1 patients were restaged as p N2, with worse outcomes than patients restaged as p N1(3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively;P < 0.0001).CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.

Strengthening District Health Teams Capacity in Surveillance Systems and Response to Public Health Threats in Western Uganda through Field Epidemiology Training Program (FETP)

Aim: To strengthen the District Capacity in surveillance for effective detection, Reporting and Response to Public Health threats. Background: The overall aim of a good surveillance system is to strengthen the capacity of a Health system through training of health personnel who can conduct effective surveillance activities. A good surveillance system is achieved through improved use of complete and timely health information to detect changes in time to institute a rapid response to the suspected outbreak of Public Health events. This assessment followed a 3-month Field Epidemiology Training program undertaken by the investigator who applied the acquired knowledge and skills in completion of the assessment. Study Design: It was a descriptive cross-sectional, institutional based epidemiological investigation conducted at district level and Health Centre 1V in Kabarole from 15th December 2019-March 2020. eReports were retrieved from DHIS-2 for epidemiological weeks 44 in 2019 to week 3 in 2020. Data analysis: Micro soft word excel program was used to determine the reporting rates, epidemic disease trends and construction of malaria channel. SWOT analysis was done to identify poor HMIS reporting as the lead surveillance quality challenge and route cause analysis done to determine underlying causes. Results: Weekly reports analyzed were from a total of 53 Health facilities and one Health Centre four for malaria channel construction. Of the 53 functional Health facilities assessed in the district, the average reporting Timeliness was 32% and Completeness at 63% from week 44 in 2019 to week 3 in 2020. This finding shows that the district was not achieving the 80% Timeliness and 80% Completeness national target. The poor reporting situation implies that the district may not detect an emerging Public Health Event and respond in time. Poor reporting rate was linked to knowledge gap among reporting staff in completion of the newly revised HMIS tools and lack of support supervision. The analyzed data revealed that the district had increased dysentery, measles and typhoid fever cases. The dysentery and typhoid fever cases had reached and surpassed the Alert and Action thresh hold levels however there was no reported death from these diseases. Further inquiry revealed that Typhoid fever was being diagnosed using WIDAL test as opposed to WHO recommendation of stool or blood culture. The noted typhoid fever outbreak in the district was therefore being based on wrong laboratory tests hence regarded by the researcher as speculative. Findings on malaria channel revealed a normal and expected trend of malaria in Kabarole district in 2020. Conclusion: knowledge and skills from FETP-training enabled the investigator to establish the fact that the district’s surveillance system was less sensitive in detecting Public Health events for a quick response. Intensified targeted support supervision and mentorships of all health workers on reporting could help improve the districts surveillance system.

How to use the Surveillance,Epidemiology,and End Results(SEER)data:research design and methodology

In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data.This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field.Currently,the SEER program covers approximately half of the total cancer patients in the US.A growing number of clinical studies have applied the SEER database in various aspects.However,the intrinsic features of the SEER database,such as the huge data volume and complexity of data types,have hindered its application.In this review,we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database.Therefore,the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.

Epidemiology of Mpox Outbreaks and Implications for Surveillance in Imo State, Nigeria

Mpox disease is caused by a double-stranded DNA virus, genus Orthopoxvirus of the family Poxviridae. The incubation period is usually 6 to 13 days but can range from 5 to 21 days while symptoms and signs may persist for 2 to 5 weeks. Although, the clinical features are usually less severe when compared to the deadly smallpox, the disease can be fatal with case fatality rate between 1% and 10%. In Imo State, Nigeria, there has been a changing epidemiology of the disease in the last 6 years and the frequency and geographic distribution of cases have progressively increased. This study aims to conduct a review of the disease epidemiology between 2017 and 2023 and implications for surveillance in Imo State. Surveillance data from the Surveillance Outbreak Response and Management System (SORMAS) was extracted between January 2017 and December 2023 across the 27 Local Government Areas (LGAs) of Imo State. A line list of 231 suspected cases was downloaded into an excel template and analyzed using SPSS® version 20 software. Analysis was done using descriptive statistics and associations were tested using Fischer’s exact at 0.05 level of significance. Of the 231 suspected cases, 57.1% (132) were males, 42.9% (99) were females and the modal age group was between the ages of 0 - 4 (32.5%). Eight (8) LGAs (districts) accounted for 71% (n = 164) of all the suspected cases. 21.2% (49) were confirmed positive, 27 males (55.1%) and 22 females (44.9%) (p > 0.05). Modal age group was 20 - 24 (22.4%, n = 11), 18% (9) were children under 14 years, p > 0.05. Case fatality rate was 8% (n = 4). There was no significant association between mortality and age group. Five (5) LGAs accounted for about 60% (29) of all confirmed cases. These LGAs contribute only 20% to the total population in the State. Only 5.6% and 4% of suspected and confirmed cases, respectively, had knowledge of contact with an infectious source. The study described the epidemiology of Mpox outbreaks between 2017 and 2023 and the findings have significant implications on detection and outbreak response activities.

Lymphatic filariasis in the foothill areas around Susunia of West Bengal in India

Objective:To investigate the filarial epidemiology in 16 foothill villages around Susunia hill,Bankura district, West Bengal,India.Indices studied were microfilaria rate,mean microfilarial density,filarial disease rate and endemicity rate.Other indices related to transmission were incrimination of vector species,man-hour density of the vector,vector infection and infectivity rates,human blood index of the vector etc.Methods:Examination of 20μL night blood samples by finger prick and clinical examination for filarial diseases of 3 737 people(2 241 male and 1 496 female) was done randomly covering nearly 22%population of the study area.Aspects related to vectors were dealt by regular collection and dissection of mosquitoes.Results:Overall microfilaria rate,mean microfilarial density,disease rate and endemicity rate were 6.10%,10.86%,20.20%and 25.58%,respectively. Causative parasite was identified as Wuchereria bancrofii and Culex quinquefasciatus was incriminated as the vector therein.Vector infection rate,infectivity rate and human blood index were assessed to be 6. 31%,1.38%and 77.33%,respectively.Conclusion:Present study is highly endemic for bancroftian filariasis. More than one fourth of the population under study were filarial victims indicating an overall alarming situation and immediate measure should be taken to rectify the situation.

Application of geographical information system technology to epidemiological surveillance and prevention and cure decision-making for SARS

Objective:To expound geographical information system (GIS) technology is a very important tool when it was employed to assist to present the distribution by time and place and the model of transmission of infectious disease. Methods: We illustrated the assistant decision-making support function of GIS with an example of the spatial decision support system for SARS controlling in Shaanxi province of China which was developed by us. Results: The spatial decision support system established by applying GIS technology fulfilled the needs of real-time collection and management and dissemination SARS information and of surveillance and analysis the epidemic situation of SARS. Conclusion: Occurrence and epidemic of diseases, implement prevention and intervention measures and collocation hygienic resources are all with the characteristic of the variation of time and space, therefore, GIS technology has become a powerful tool for identifying risk factors of diseases, providing clues of causation of diseases , evaluating the effects of intervention measures and drawing a health management plan.

Five years of post-validation surveillance of lymphatic filariasis in Thailand

Background The World Health Organization (WHO) validated Thailand in 2017 as having eliminated lymphatic filariasis (LF) as a public health problem with recommendations for continued surveillance. This article describes measures and progress made in Thailand with post-validation surveillance (PVS) of LF from 2018 until 2022.Methods The implementation unit (IU) is a sub-village in 11 former LF endemic provinces. Human blood surveys are targeted in 10% of IUs each year. InWuchereria bancrofti areas, filaria antigen test strips (FTS) are used, and inBrugia malayi areas, antibody test kits (Filaria DIAG RAPID) are used. Positive cases are confirmed by thick blood film (TBF) and polymerase chain reaction (PCR). Vector surveys for mosquito species identification and dissection for microfilaria (Mf)/filarial larvae are done in 1% of IUs where human blood surveys are conducted. Human blood surveys using FTS are conducted among migrants in five provinces. Surveillance of cats is done in areas that previously recorded > 1.0% Mf rate among cats. Morbidity management and disability prevention (MMDP) are done every 2 years in LF-endemic areas where chronic disease patients reside.Results From 2018 to 2022, in a total of 357 IUs in 11 provinces, human blood surveys were conducted in 145 IUs (41%) with an average population coverage of 81%. A total of 22,468 FTS and 27,741 FilariaDIAG RAPID were performed. 27 cases were detected: 3 cases ofW. bancrofti in Kanchanaburi province and 24 cases ofB. malayi in Narathiwat province. 4 cases ofW. bancrofti were detected in two provinces through routine public health surveillance. Vector surveys in 47 IUs detectedB. malayi Mf filarial larvae only in Narathiwat province. Chronic LF patients reduced from 114 in 2017 to 76 in 2022. Surveys among 7633 unregistered migrants yielded 12 cases ofW. bancrofti. Mf rate among cats in Narathiwat province declined from 1.9% in 2018 to 0.7% in 2022. MMDP assessments revealed gaps in healthcare provider’s management of chronic cases due to staff turnover.Conclusions In 2022, after 5 years of PVS, Thailand re-surveyed 41% of its previously endemic IUs and demonstrated ongoing transmission in only one province of Narathiwat, where Mf prevalence is below the WHO provisional transmission threshold of 1%. This study highlights the importance of continued disease surveillance measures and vigilance among health care providers in LF receptive areas.

Case-by-Case Surveillance for Bacterial Meningitis in Benin: Data Analysis, 2016 to 2018

Background: Bacterial meningitis is an inflammation of the meninges caused mainly by three bacterial species Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae that are transmitted by nasopharyngeal secretions emitted by carriers. Meningitis is a public health problem in Benin, like all countries in the African meningitis belt. This study aims to analyze the epidemiological surveillance data of meningitis in Benin from 2016 to 2018. Methods: Each suspect case of meningitis was recorded and Cerebrospinal Fluid (CSF) samples were collected. CSF collection was accompanied by the Integrated Disease Surveillance and Response form. This sheet provides information on the patient’s social-demographic and epidemiological data. CSF specimens were sent to the laboratory for analysis and identification (Gram stain, biochemical parameters, and latex agglutination test) of pathogens according to the WHO standards. Results: Of the 2992 patients with suspected meningitis, 2893 were hospitalized with a death rate of 9.4% (281/2992). The sex ratio of registered patients was 1.29 in favor of men. The median age was 4 years (min: 0;max: 90). Patients younger than five years were the most represented (44.8%). During the study period, there was a decrease in the incidence of meningitis per 100,000 inhabitants (6.3 to 3.2 from 2016 to 2018). Of 2928 CSF samples collected we were able to identify 899 pathogenic bacterial species. The most represented species are S. pneumoniae (63.4%), N. meningitidis (24.4%) and H. influenzae (12.2%). Conclusion: The burden of disease is disproportionate in the northern departments as in others. The frequency of bacterial meningitis in the northern region increased during the study period. However, deaths have been recorded in the departments of the South (“Atlantic”, “Plateau”). This suggests an improvement in epidemiological surveillance and case management throughout the national territory.

Risk stratification for malignant progression in Barrett's esophagus: Gender, age, duration and year of surveillance

AIM To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender.METHODS Patients registered with the United Kingdom Barrett's Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were(1) development of all grades of dysplasia;(2) development of high-grade of dysplasia or adenocarcinoma; and(3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender.RESULTS One thousand and one hundred thirty six patients were included(total 6474 patient-years). Fifty-four patients developed adenocarcinoma(0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma(1.1% per annum) and 190 developed any grade of dysplasia(3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma.CONCLUSION The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.

Which Are the Factors Associated to Child Mistreatment? Use of a Routinely Collected Specific Dataset for Surveillance in a Belgian Pediatric Unit

Introduction: Child abuse is a serious health problem with compelling evidence that the phenomenon is common throughout the world. The Center “SOS enfants ULB” is a specialized team, established in a pediatric ward, which had mission to prevent and to treat the situations of children victims of physical, sexual, psychological abuse or of neglect. Our objectives were to describe the characteristics of 439 children hospitalized for (suspicion of) maltreatment and to investigate different factors potentially associated with the children at risk of neglect or maltreatment, the children victims of neglect and the physically maltreated children. Methods: Chi square test and multinomial logistic regression models with clustered robust standard error were applied to assess the relationship between the three types of mistreatment and the potential associated factors. Results: Maltreatment was observed for almost one in two children (48.7%) and approximately four on ten (41.5%) were considered at risk. Physical abuse was the most prevalent (57.9%) among the maltreated children and neglect was the second most prevalent (37.4%) form of maltreatment. Regarding the criteria leading to hospitalisation, at least one protective criterion was observed for a little more than eight children on ten. The parental criteria have shown that social problems and conjugal conflicts were the most prevalent for this category of hospitalisation criteria. Conclusion: These data, concerning the hospitalized children for which there is (suspicion of) mistreatment, collected by this team make important contribution to describing child maltreatment and its associated factors. Despite the fact that these hospitalized cases may be probably more serious than those who were not reported, every event, however small it may be, should be known for better organizing each level of prevention.

Surveillance, epidemiology, and pathogen spectrum of hand, foot, and mouth disease in mainland of China from 2008 to 2017

Hand,foot and mouth disease(HFMD)was reported in May 2,2008 to be the 38th legally notifiable disease in China's National Notifiable Disease Reporting and Surveillance System.In order to solve the infection,an extensive three-level HFMD surveillance laboratory network was established.In this study,the framework of that network is assessed and the incidence of HFMD in China from 2008 to 2017 is reported using a descriptive epidemiologic method.During these 10 years,a series of techniques have been widely applied in all the network laboratories.Using information and material obtained from the network,a virus bank and database containing 18,238 viruses were established.Nationally,18,184,834 HFMD cases,including 152,436 severe cases and 3633 fatal cases,were reported in mainland of China.The average annual incidence in the population was 133.99/100,000 people,with a maximum incidence of 205.06/100,000 people in 2014.The incidence and mortality rates of HFMD were the highest in children aged 1–2 years.The numbers of reported cases fluctuated,with a high incidence observed every 2 years.An overall increase in the number of reported cases was also observed throughout the study period.Despite this,the incidence of severe cases and the mortality rate have been decreasing.High-risk regions are located in southern,eastern,and central China.Two peaks of HFMD infection cases were observed annually except for Northeast China.Different proportions of enterovirus serotypes were observed during the studied years.The predominant enterovirus varies from year to year,but the disease severity is always closely related to the specific serotype.EV-A71 is the dominant serotype associated with severe and fatal cases,with constituent ratios of 70.03%and 92.23%,respectively.The studied highly sensitive and efficient surveillance network provides information that is critical for prevention and control of the disease.It is extremely necessary and important to continuously conduct extensive virological surveillance for HFMD.

A unified global genotyping framework of dengue virus serotype-1 for a stratified coordinated surveillance strategy of dengue epidemics

Background: Dengue is the fastest spreading arboviral disease, posing great challenges on global public health. A reproduceable and comparable global genotyping framework for contextualizing spatiotemporal epidemiological data of dengue virus (DENV) is essential for research studies and collaborative surveillance.Methods: Targeting DENV-1 spreading prominently in recent decades, by reconciling all qualified complete E gene sequences of 5003 DENV-1 strains with epidemiological information from 78 epidemic countries/areas ranging from 1944 to 2018, we established and characterized a unified global high-resolution genotyping framework using phylogenetics, population genetics, phylogeography, and phylodynamics.Results: The defined framework was discriminated with three hierarchical layers of genotype, subgenotype and clade with respective mean pairwise distances 2-6%, 0.8-2%, and ≤ 0.8%. The global epidemic patterns of DENV-1 showed strong geographic constraints representing stratified spatial-genetic epidemic pairs of Continent-Genotype, Region-Subgenotype and Nation-Clade, thereby identifying 12 epidemic regions which prospectively facilitates the region-based coordination. The increasing cross-transmission trends were also demonstrated. The traditional endemic countries such as Thailand, Vietnam and Indonesia displayed as persisting dominant source centers, while the emerging epidemic countries such as China, Australia, and the USA, where dengue outbreaks were frequently triggered by importation, showed a growing trend of DENV-1 diffusion. The probably hidden epidemics were found especially in Africa and India. Then, our framework can be utilized in an accurate stratified coordinated surveillance based on the defined viral population compositions. Thereby it is prospectively valuable for further hampering the ongoing transition process of epidemic to endemic, addressing the issue of inadequate monitoring, and warning us to be concerned about the cross-national, cross-regional, and cross-continental diffusions of dengue, which can potentially trigger large epidemics.Conclusions: The framework and its utilization in quantitatively assessing DENV-1 epidemics has laid a foundation and re-unveiled the urgency for establishing a stratified coordinated surveillance platform for blocking global spreading of dengue. This framework is also expected to bridge classical DENV-1 genotyping with genomic epidemiology and risk modeling. We will promote it to the public and update it periodically.

Environment surveillance of filamentous fungi in two tertiary care hospitals in China

Background Invasive fungal infections have constituted an increasingly important cause of morbidity and mortality in immunocompromised patients. In this study, a surveillance project was conducted in three different intensive care units of two large tertiary hospitals in China. Methods A one-year surveillance project was conducted in two tertiary hospitals which located in northern China and southwest China respectively. Air, surfaces and tap water were sampled twice a month in a central intensive care unit, a bone marrow transplant unit, a neurosurgery intensive care unit and a live transplant department. Environmental conditions such as humidity, temperature and events taking place, for example the present of the visitors, healthcare staff and cleaning crew were also recorded at the time of sampling. Results The air fungal load was 91.94 cfu/m3 and 71.02 cfu/m3 in the southwest China hospital and the northern China hospital respectively. The five most prevalent fungi collected from air and surfaces were Penicillium spp., Cladospcrium spp., Altemaria spp., Aspergillus spp. and Saccharomyces spp. in the southwest China hospital, meanwhile Penicillium spp., Fusarium spp., Aspergillus spp., Alternaria spp. and Cladospcrium spp. in the northern China hospital. The least contaminated department was intensive care units, and the heaviest contaminated department was neurosurgery intensive care unit. Seventy-three percent of all surfaces examined in the northern China hospital and eighty-six percent in the southwest China hospital yielded fungi. Fifty-four percent of water samples from the northern China hospital and forty-nine percent from the southwest China hospital yielded fungi. Conclusions These findings suggested that the fungus exist in the environment of the hospital including air, surface and water. Air and surface fungal load fluctuated over the year. Air fungal load was lower in winter and higher in summer and autumn, but seldom exceeded acceptable level. The higher values were created during May to August in the northern China hospital and May to June and September to October in the southwest China hospital. A correlation between air fungal load and humidity, as well as personnel was observed.

Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar

Background:Lymphatic filariasis(LF)is endemic in Myanmar and targeted for elimination.To highlight the National Programme to Eliminate Lymphatic Filariasis(NPELF)progress between 2000 and 2014,this paper describes the geographical distribution of LF,the scale-up and impact of mass drug administration(MDA)implementation,and the first evidence of the decline in transmission in five districts.Methods:The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF.Data on the MDA implementation,reported coverage rates and sentinel site surveillance were summarized.A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement.Transmission assessment survey(TAS)methods,measuring antigenemia(Ag)prevalence in children,were used to determine whether prevalence was below a level where recrudescence is unlikely to occur.Results:The highest baseline LF prevalence was found in the Central Valley region.The MDA implementation activities scaled up to cover 45 districts,representing the majority of the endemic population,with drug coverage rates ranging from 60.0%to 98.5%.Challenges related to drug supply and local conflict were reported,and interrupted MDA in some districts.Overall,significant reductions in LF prevalence were found,especially after the first 2 to 3 rounds of MDA,which was supported by the corresponding model.The TAS activities in five districts found only two Ag positive children,resulting in all districts passing the critical threshold.Conclusion:Overall,the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges,however,it needs to maintain momentum,drawing on international stakeholder support,to aim towards the national and global goals of elimination.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Lymphatic filariasis elimination endgame in an urban Indian setting: the roles of surveillanee and residual microfilaremia after mass drug administration

Background:To secure the gains of lymphatic filariasis(LF)elimination programs,attention is needed to the Yesidual microfilaremia phase;in which high-risk populations may be crucial.The present study documents the impact of mass drug administration(MDA)in the urban Indian setting of Surat City,with high rates of in-migration.

Surveillance of Hand,Foot,and Mouth Disease in China's Mainland (2008-2009)

Objective Since HFMD was designated as a class C communicable disease in May 2008,18 months surveillance data have been accumulated to December 2009.This article was to describe the distribution of HFMD for age,sex,area,and time between 2008 and 2009,to reveal the characteristics of the epidemic.Methods We analyzed weekly reported cases of HFMD from May 2008 to December 2009,and presented data on the distribution of age,sex,area and time.A discrete Poisson model was used to detect spatial-temporal clusters of HFMD.Results More than 1 065 000 cases of HFMD were reported in China's Mainland from May 2008 to December 2009 （total incidence：12.47 per 10 000）.Male incidence was higher than female for all ages and 91.9% of patients were 5 years old.The incidence was highest in Beijing,Shanghai,Zhejiang and Hainan.The highest peak of HFMD cases was in April and the number of cases remained high from April to August.The spatial-temporal distribution detected four clusters.Conclusion Children 5 years old were susceptible to HFMD and we should be aware of their vulnerability.The incidence was higher in urban than rural areas,and an annual pandemic usually starts in April.