Redefining pandemic preparedness:Multidisciplinary insights from the CERP modelling workshop in infectious diseases,workshop report

In July 2023,the Center of Excellence in Respiratory Pathogens organized a two-day workshop on infectious diseases modelling and the lessons learnt from the Covid-19 pandemic.This report summarizes the rich discussions that occurred during the workshop.The workshop participants discussed multisource data integration and highlighted the benefits of combining traditional surveillance with more novel data sources like mobility data,social media,and wastewater monitoring.Significant advancements were noted in the development of predictive models,with examples from various countries showcasing the use of machine learning and artificial intelligence in detecting and monitoring disease trends.The role of open collaboration between various stakeholders in modelling was stressed,advocating for the continuation of such partnerships beyond the pandemic.A major gap identified was the absence of a common international framework for data sharing,which is crucial for global pandemic preparedness.Overall,the workshop underscored the need for robust,adaptable modelling frameworks and the integration of different data sources and collaboration across sectors,as key elements in enhancing future pandemic response and preparedness.

Burden of colorectal cancer in China, 1990-2017: Findings from the Global Burden of Disease Study 2017

Objective: Our goal is to analyze the trend of colorectal cancer(CRC) regarding the death, incidence and prevalence rates over time, and to provide epidemiological knowledge basis for health policy revision by comparing data about fatal outcomes of CRC in 2017 to those data in 1990, which was extracted from the Global Burden of Disease(GBD).Methods: The time trend and changes of CRC burden from 1990 to 2017 were measured by using the methods and results from the Institute for Health Metrics and Evaluation(IHME) GBD 2017, based on the rates of death,incidence and prevalence.Results: The death rate of CRC is 13.24/100,000, accounting for 1.79% of total deaths in China in 2017. In1990, CRC ranked 21 st in all causes of death in China compared to its 11 th ranking in 2017. The death, incidence and prevalence rate of CRC were standardized by the age scale of the global population in 2010, the change of standardized death rate of CRC was not significant, from 9.33/100,000 in 1990 to 10.10/100,000 in 2017. The standardized incidence rate of CRC significantly increased from 12.18/100,000 in 1990 to 22.42/100,000 in 2017.The standardized prevalence rate of CRC significantly increased from 44.55/100,000 in 1990 to 118.40/100,000 in2017. The trend of the prevalence rate in both genders grow higher in 2017 compared to the 1990, resulting in141.6%, 209.8% and 189.0% for the studied three age groups(15-49, 50-69 and 70+ years old), respectively. The death rate increased in the age groups of 50-69 and 70+ years in both genders(8.6% and 31.0% respectively), in contrast to a decrease of death rate in the age group of 15-49 years old(-10.8%).Conclusions: China experienced a stunning increase in terms of incidence and prevalence rate of CRC from1990 to 2017. To decrease the burden of CRC, prevention and management of known risk factors should be promoted through national polices.

Longwall mining,shale gas production,and underground miner safety and health

This paper presents the results of a unique study conducted by the National Institute for Occupational Safety and Health(NIOSH)from 2016 to 2019 to evaluate the effects of longwall-induced subsurface deformations on shale gas well casing integrity and underground miner safety and health.At both deep-cover and shallow-cover instrumentation sites,surface subsidence measurements,subsurface inplace inclinometer measurements,and underground pillar pressure measurements were conducted as longwall panels were mined.Comparisons of the deep-cover and shallow-cover test site results with those from a similar study under medium cover reveal an interesting longwall-induced response scenario.Under shallow and medium covers,measured horizontal displacements within the abutment pillar are one order of magnitude higher than those measured under deep cover.On the other hand,measured vertical compressions under deep cover are one order of magnitude higher than those under shallow and medium covers.However,FLAC3 Dsimulations of the casings indicate that,in all three cases,the P-110 production casings remain intact under longwall-induced deformations and compressions,which has serious implications for future mine design in areas where shale gas wells have been drilled ahead of mining.

Analyses on cancer incidence and mortality in Huai’an area,China,from 2009 to 2011

Objective： The aim of the study was to investigate the cancer incidence and mortality in Huai＇an area, China, from 2009 to 2011. Methods： The data about cancer incidence and mortality were provided by Huai＇an Cancer Registry, China. Incidence and mortality rates, and standardized rates were calculated by age, gender, areas （urban and rural areas of Huai＇an） and cancer sites. Results： The crude incidence rate for all cancer sites was 205.60/105 and the standardized incidence rate was 166.22/10. Both the crude and standardized rates were higher in urban area than in rural area for both sexes. The inci- dence rates increased in people aged 40 and over, and the peak ages of incidence were between 70-75 in both males and females. The crude mortality rate for all cancer sites was 153.88/105 and the standardized mortality rate was 122.14/105. Both the crude and standardized rates were similar in urban and rural areas for both men and women. The mortality rates were at low level under the age 50 in both sexes, but increased after the age 50, reaching the peak at the ages of 80-85 in both males and females. The top 10 most common cancer sites in rank were esophagus, stomach, lung, liver, colon-rectum, breast, pancreas, cervix uteri, brain and central nervous system, and leukemia, accounting for 87.56% of all cancers. The top 10 most leading causes of cancer death in order were cancers of esophagus, lung, liver, stomach, colon-rectum, pancreas, brain and central nervous system, leukemia, breast and lymphoma, accounting for 90.53% of all cancer deaths. Conclusion： Cancer is one kind of major diseases threatening people＇s health in Huai＇an area, China. Cancer prevention and control should be enhanced, especially for esophageal cancer.

Effect of longwall-induced subsurface deformations on shale gas well casing stability under deep covers

This paper presents the results of a 2017 study conducted by the National Institute for Occupational Safety and Health(NIOSH), Pittsburgh Mining Research Division(PMRD), to evaluate the effects of longwall-induced subsurface deformations within a longwall abutment pillar under deep cover. The 2017 study was conducted in a southwestern Pennsylvania coal mine, which extracts 457 m-wide longwall panels under 361 m of cover. One 198 m-deep, in-place inclinometer monitoring well was drilled and installed over a 45 m by 84 m center abutment pillar. In addition to the monitoring well, surface subsidence measurements and underground coal pillar pressure measurements were conducted as the 457 m-wide longwall panel on the south side of the abutment pillar was being mined. Prior to the first longwall excavation, a number of simulations using FLAC3D^(TM) were conducted to estimate surface subsidence, increases in underground coal pillar pressure, and subsurface horizontal displacements in the monitoring well. Comparisons of the pre-mining FLAC3D simulation results and the surface, subsurface,and underground instrumentation results show that the measured in-place inclinometer casing deformations are in reasonable agreement with those predicted by the 3D finite difference models. The measured surface subsidence and pillar pressure are in excellent agreement with those predicted by the 3D models.Results from this 2017 research clearly indicate that, under deep cover, the measured horizontal displacements within the abutment pillar are approximately one order of magnitude smaller than those measured in a 2014 study under medium cover.

Transmission of Carbapenem Resistance Between Human and Animal NDM-Positive Escherichia coli Strains

Although carbapenem use is prohibited in animals in China,carbapenem-resistant Escherichia coli(CREC),especially New Delhi metallo-β-lactamase(NDM)-producing strains,are widely prevalent in foodproducing animals.At present,the impact of livestock-associated CREC strains on human populations at the national level is unknown.Here,we conduct a retrospective cross-sectional study to investigate the prevalence of CREC from clinical settings across 22 Chinese provinces or municipalities and analyze anthropogenic factors associated with their presence.We also ascertain the blaNDMand blaKPCabundance among pig and chicken farms and present a detailed genomic framework for CREC of animal and human origin.Overall,631/29799(2.1%)clinical Escherichia coli(E.coli)isolates were identified as CREC.Multivariable analysis revealed that being male,an age below 1,an age between 13 and 18,provinces with greater chicken production,and provinces with higher pig production were associated with higher odds of CREC infection.In general,73.8%(n=45/61)of pig farms and 62.2%(n=28/45)of chicken farms had a blaNDMabundance of 1×10^(-5)to 1×10^(-3)and 1×10^(-3)to 1×10^(-2),respectively.Among all the Chinese NDM-positive E.coli(n=463)available at the National Center for Biotechnology Information(NCBI),the genomic analysis revealed that blaNDM-5and Inc X3 were the predominant carbapenemase gene-plasmid combination,while a highly homogeneous relationship between NDM-positive isolates from humans and animals was demonstrated at the plasmid and core genome levels.All the findings suggest frequent CREC transmission between humans and animals,indicating that further discussions on the use of antibiotics in animals and humans are needed,both in China and across the globe.

Outcome Evaluation of Early Implementation of Option B+ in Cameroon: A Prospective Cohort Observational Survey in the Northwest and Southwest Regions

Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. Option B+ was offered to participants and outcome indicators were measured. Results: Out of 680 women eligible for this assessment, 669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively. Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to 8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%) negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention, maternal and infant mortality and final MTCT rate after cessation of breastfeeding require further evaluation.

First imported Plasmodium ovale malaria in Central America: Case report of a Guatemalan soldier and a call to improve its accurate diagnosis

The Mesoamerican Ministers of Health have set 2020 as the target for malaria elimination to be achieved in the region. Imported malaria cases are a potential threat to countries attempting elimination or working to prevent resurgence. We report the first imported Plasmodium ovale infection with molecular confirmation in Central America, which occurred in a Guatemalan soldier that had been deployed in Africa. The obstacles for its diagnosis using the standard microscopy technique and the need to improve its detection are discussed.

Knowledge, Attitudes, and Experiences of HIV Pre-Exposure Prophylaxis (PrEP) Trial Participants in Botswana

Recent clinical trials have shown that a daily dose of oral TDF/FTC pre-exposure prophylaxis (PrEP) is effective in reducing human immunodeficiency (HIV) risk. Understanding trial participants’ perspectives about retention and PrEP adherence is critical to inform future PrEP trials and the scale-up and implementation of PrEP programs. We analyzed 53 in-depth interviews conducted in April 2010 with participants in the TDF2 study, a Phase 3, randomized, double-blind, place-bo-controlled clinical trial of daily oral TDF/FTC with heterosexual men and women in Francistown and Gaborone, Botswana. We examined participants’ knowledge, attitudes, and experiences of the trial, identified facilitators and barriers to enrollment and retention, and compared participant responses by study site, sex, and study drug adherence. Our findings point to several factors to consider for participant retention and adherence in PrEP trials and programs, including conducting pre-enrollment education and myth reduction counseling, providing accurate estimates of participant obligations and side effect symptoms, ensuring participant understanding of the effects of non-adherence, gauging personal commitment and interest in study outcomes, and developing a strong external social support network for participants.

四川西部藏区包虫病流行病学研究Ⅱ.牲畜及野生动物两型包虫病感染状况调查

目的 明确四川西部地区石渠县、甘孜县牲畜和野生动物两型包虫病 (Hydatidosis,HD)的感染状况 ,为进一步开展防治工作做好基线调查。方法 采取捕杀、剖检、作病理切片等。结果 检查牦牛 42 9头 ,其中 2 19头感染细粒棘球蚴 (Cysticechinococcus,Ce)感染率为 5 0 8% ,3头感染多房棘球蚴 (Alveolarechinococcus,Ae)感染率为 0 7%。在啮齿类动物中 ,黑唇鼠兔 (Ochotonacurzoniae)Ae感染率为 5 6 % (13/2 33) ,灰尾兔 (Lepusoiostolus)Ae感染率为 7 1% (1/14) ,松田鼠 (PitymysireneThomas)Ae感染率为 2 5 % (3/12 ) 检查小家鼠 (Musmusculus) 70只未发现感染。终末宿主调查中 ,犬体内发现两种棘球绦虫感染 ,其中细粒棘球绦虫 (Echinococcusgranulosus,Eg)感染率为 13 2 % (7/16 ) ;多房棘球绦虫(Echinococcusmultilocularis,Em)感染率 16 98% (9/16 ) ,未发现混合感染犬。藏狐 (Vulpesferrilata)的Em感染率为 44 4%(76 /171)。

四川西部藏区包虫病流行病学研究──Ⅰ.囊型包虫病与泡型包虫病人群感染特点与分布趋势

本文报告四川西部藏区两型包虫病（Hydatidosis，HD）人群感染特点与分布趋势。在石渠县与甘孜县的8个调查点，采用以B超与X光检查为主，辅以Dot－ELISA与Eml8blot血清学试验的方法对3999人的检查结果，人群平均感染率4．03％。其中细粒棘蚴病（CysticEchinococcosis，CE）2．13％，泡球蚴病（AlveolarEchinococcossi，AE）1．90％。女性感染率略高于男性，性别分布无明显差异。年龄分布显示中老年是高发人群。CE患者平均年龄38．8岁，AE为45．6岁。在不同经济类型地区，纯牧业乡的病情尤为严重，牧区＞城区＞农区的这种趋势极为明显。职业分布显示牧民是高危人群，HD感染率达7．01％—13．53％。AE患者亦以牧民最多，石渠县与甘孜县牧民AE感染率分别达6．06％、4．46％。此外，人群中文盲及受教育程度低者患者较多，随着文化水平提高人群感染率逐渐降低的趋势明显。

Floor dust erosion during early stages of coal dust explosion development

An ignition of methane and air can generate enough air flow to raise mixtures of combustible coal and rock dust.The expanding high temperature combustion products ignite the suspended dust mixture and will continue to propagate following the available combustible fuel supply.If the concentration of the dispersed rock dust is sufficient,the flame will stop propagating.Large-scale explosion tests were conducted within the National Institute for Occupational Safety and Health(NIOSH)Lake Lynn Experimental Mine(LLEM)to measure the dynamic pressure history and the post-explosion dust scour depth.The aim of this effort is to provide quantitative data on depth of dust removal during the early stages of explosion development and its relationship to the depth of floor dust collected for assessing the incombustible content most likely to participate in the combustion process.This experimental work on dust removal on is not only important for coal mine safety but also for industrial dust explosions.

乌干达在接受抗病毒治疗的艾滋病病人中筛查活动性结核病的一个简单工具

背景:在撒哈拉以南非洲地区,采用可靠的临床程序,对开始接受或已经接受抗病毒治疗的艾滋病病人进行活动性结核病筛查,可减少对诊断程序的需要。方法:我们对6个与结核病相关的症状和体征单独或组合在一起的效用进行了估计,并与乌干达卫生部对现患结核病(在评估抗病毒治疗资格时,作为基线)、抗病毒治疗早期(抗病毒治疗开始后的3个月内)结核病和新发结核病(抗病毒治疗3个月以后)的诊断指南进行了比较。结果:在1 995例接受抗病毒治疗资格筛查的HIV感染者中,71例(3.6%)被诊断患有结核病。对于预测活动性结核病而言,下列任一症状或体征:咳嗽≥3周,发热≥4周,淋巴结肿大或基线体质量指数≥18 kg/m^2,其灵敏度为99%(95%可信区间为96～100),特异度66%(95%可信区间为64～68),阴性预测值为100%(95%可信区间为99～100)。在抗病毒治疗随访期间,结核病发病率为2.4/100人年(95%可信区间为1.6～3.4)。出现咳嗽≥3周或全身乏力症状或体征的灵敏度为100%(95%可信区间为99～100),特异度为66%(95%可信区间为59～74),阴性预测值为100%(95%可信区间为99～100)。结论:在资源贫乏的非洲地区,应用简单的结核病筛查流程,可以准确地辨别出哪些HIV感染者需要接受进一步的结核诊断检查。

Persistent Zika Virus Infection Associated with Early Fetal Demise: A Case Report

Background: Infection with Zika virus (ZIKV) during pregnancy is known to cause birth defects and could also be linked to pregnancy loss. Case: A pregnant woman in Puerto Rico contracted ZIKV at 16 weeks gestation. ZIKV RNA persisted in serum from her initial test at 16 weeks through 24 weeks gestation, when fetal demise occurred, and was detected in placental tissue. Conclusion: Prolonged detection of ZIKV RNA in maternal serum was associated with ZIKV RNA detection in the placenta of a patient who experienced fetal demise. While detection of placenta ZIKV RNA does not establish that ZIKV conclusively caused the demise, these findings support emerging evidence that the placenta may serve as a reservoir for ZIKV, which may be associated with prolonged detection of ZIKV RNA in serum.

Association between Taenia solium infection and HIV/AIDS in northern Tanzania: a matched cross sectional-study

Background:The frequency of Taenia solium,a zoonotic helminth,is increasing in many countries of sub-Saharan Africa,where the prevalence of the human immunodeficiency virus(HIV)is also high.However,little is known about how these two infections interact.The aim of this study was to compare the proportion of HIV positive(+)and negative(−)individuals who are infected with Taenia solium(TSOL)and who present with clinical and neurological manifestations of cysticercosis(CC).Methods:In northern Tanzania,170 HIV+individuals and 170 HIV–controls matched for gender,age and village of origin were recruited.HIV staging and serological tests for TSOL antibodies(Ab)and antigen(Ag)were performed.Neurocysticercosis(NCC)was determined by computed tomography(CT)using standard diagnostic criteria.Neurological manifestations were confirmed by a standard neurological examination.In addition,demographic,clinical and neuroimaging data were collected.Further,CD4^(+)cell counts as well as information on highly active antiretroviral treatment(HAART)were noted.Results:No significant differences between HIV+and HIV–individuals regarding the sero-prevalence of taeniosis-Ab(0.6%vs 1.2%),CC-Ab(2.4%vs 2.4%)and CC-Ag(0.6%vs 0.0%)were detected.A total of six NCC cases(3 HIV+and 3 HIV–)were detected in the group of matched participants.Two individuals(1 HIV+and 1 HIV–)presented with headaches as the main symptom for NCC,and four with asymptomatic NCC.Among the HIV+group,TSOL was not associated with CD4+cell counts,HAART duration or HIV stage.Conclusions:This study found lower prevalence of taeniosis,CC and NCC than had been reported in the region to date.This low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or NCC.Larger sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself.

High-risk spatiotemporal patterns of cutaneous leishmaniasis:a nationwide study in Iran from 2011 to 2020

Background Cutaneous leishmaniasis(CL)is a wide-reaching infection of major public health concern.Iran is one of the six most endemic countries in the world.This study aims to provide a spatiotemporal visualization of CL cases in Iran at the county level from 2011 to 2020,detecting high-risk zones,while also noting the movement of high-risk clusters.Methods On the basis of clinical observations and parasitological tests,data of 154,378 diagnosed patients were obtained from the Iran Ministry of Health and Medical Education.Utilizing spatial scan statistics,we investigated the disease’s purely temporal,purely spatial,spatial variation in temporal trends and spatiotemporal patterns.At P=0.05 level,the null hypothesis was rejected in every instance.Results In general,the number of new CL cases decreased over the course of the 9-year research period.From 2011 to 2020,a regular seasonal pattern,with peaks in the fall and troughs in the spring,was found.The period of September–February of 2014–2015 was found to hold the highest risk in terms of CL incidence rate in the whole country[relative risk(RR)=2.24,P<0.001)].In terms of location,six signifcant high-risk CL clusters covering 40.6%of the total area of the country were observed,with the RR ranging from 1.87 to 9.69.In addition,spatial variation in the temporal trend analysis found 11 clusters as potential high-risk areas that highlighted certain regions with an increasing tendency.Finally,fve space-time clusters were found.The geographical displacement and spread of the disease followed a moving pattern over the 9-year study period afecting many regions of the country.Conclusions Our study has revealed signifcant regional,temporal,and spatiotemporal patterns of CL distribution in Iran.Over the years,there have been multiple shifts in spatiotemporal clusters,encompassing many diferent parts of the country from 2011 to 2020.The results reveal the formation of clusters across counties that cover certain parts of provinces,indicating the importance of conducting spatiotemporal analyses at the county level for studies that encompass entire countries.Such analyses,at a fner geographical scale,such as county level,might provide more precise results than analyses at the scale of the province.