Microbiological screenings for infection control in unaccompanied minor refugees： the German Armed Forces Medical Service＇s experience

Background:The German Military Medical Service contributed to the medical screening of unaccompanied minor refugees(UMRs)coming to Germany in 2014 and 2015.In this study,a broad range of diagnostic procedures was applied to identify microorganisms with clinical or public health significance.Previously,those tests had only been used to screen soldiers returning from tropical deployments.This instance is the first time the approach has been studied in a humanitarian context.Methods:The offered screenings included blood cell counts,hepatitis B serology and microscopy of the stool to look for protozoa and worm eggs as well as PCR from stool samples targeting pathogenic bacteria,protozoa and helminths.If individuals refused certain assessments,their decision to do so was accepted.A total of 219 apparently healthy male UMRs coming from Afghanistan,Egypt,Somalia,Eritrea,Syria,Ghana,Guinea,Iran,Algeria,Iraq,Benin,Gambia,Libya,Morocco,Pakistan,and Palestine were assessed.All UMRs who were examined at the study department were included in the assessment.Results:We detected decreasing frequencies of pathogens that included diarrhoea-associated bacteria[Campylobacter(C.)jejuni,enteropathogenic Escherichia(E.)coli(EPEC),enterotoxic E.coli(ETEC),enteroaggregative E.coli(EAEC),enteroinvasive E.coli(EIEC)/Shigella spp.),Giardia(G.)duodenalis,helminths(comprising Schistosoma spp.,Hymenolepis(H.)nana,Strongyloides(S.)stercoralis]as well as hepatitis B virus.Pathogenic microorganisms dominated the samples by far.While G.duodenalis was detected in 11.4%of the assessed UMRs,the incidence of newly identified cases in the German population was 4.5 cases per 100,000 inhabitants.Conclusion:We conclude that the applied in-house PCR screening systems,which have proven to be useful for screening military returnees from tropical deployments,can also be used for health assessment of immigrants from the respective sites.Apparently healthy UMRs may be enterically colonized with a broad variety of pathogenic and apathogenic microorganisms.Increased colonization rates,as shown for G.duodenalis,can pose a hygiene problem in centralized homes for asylum seekers.

Screening agars for MRSA:evaluation of a stepwise diagnostic approach with two different selective agars for the screening for methicillin-resistant Staphylococcus aureus(MRSA)

Background: Colonization with methicillin-resistant Staphylococcus aureus(MRSA) poses a hygiene risk that does not spare field hospitals or military medical field camps during military deployments. Diagnostic options for unambiguously identifying MRSA isolates are usually scarce in military environments. In this study, we assessed the stepwise application of two different selective agars for the specific identification of MRSA in screening analyses.Methods: Nasal swabs from 1,541 volunteers were subjected to thioglycollate broth enrichment and subsequently screened on CHROMagar MRSA selective agar for the identification of MRSA. The MRSA identity of suspiciouslooking colonies was confirmed afterwards or excluded by another selective agar, chrom ID MRSA. All isolates from the selective agars with MRSA-specific colony morphology were identified by biochemical methods and mass spectrometry.Results: The initial CHROMagar MRSA screening identified suspicious colonies in 36 out of 1541 samples. A total of 25 of these 36 isolates showed MRSA-like growth on chrom ID agar. Out of these 25 isolates, 24 were confirmed as MRSA, while one isolate was identified as Staphylococcus kloosii. From the 11 strains that did not show suspicious growth on chrom ID agar, 3 were methicillin-sensitive Staphylococcus aureus(MSSA, with one instance of cocolonization with Corynebacterium spp.), 2 were confirmed as MRSA(with 1 instance of co-colonization with MSSA), 2 were lost during passaging and could not be re-cultured, one could not be identified by the applied approaches, and the remaining 3 strains were identified as Staphylococcus saprophyticus, Staphylococcus hominis(co-colonized with Macrococcus caseolyticus) and Staphylococcus cohnii, respectively.Conclusion: The application of the selective agar CHROMagar MRSA alone proved to be too non-specific to allow for a reliable diagnosis of the presence of MRSA. The combined use of two selective agars in a stepwise approach reduced this non-specificity with an acceptably low loss of sensitivity. Accordingly, such a stepwise screening approach might be an option for resource-restricted military medical field camps.

Effectiveness and Safety of 9-Month Treatment Regimen for Multidrug-Resistant Tuberculosis in the Philippines

Background: The Philippines has a burden of drug-resistant tuberculosis (DR-TB). One of the key challenges in the programmatic management of DR-TB (PMDT) is the high rate of loss to follow-up (38% in the 2010 cohort). An urgent need for a shorter, more tolerable, less expensive treatment regimen exists. The aim of the operational study is to determine the efficacy and safety of the short treatment regimen among drug resistant TB. Methods: This is a prospective single-arm cohort study evaluating the effectiveness and safety of a shorter 9 - 11-month treatment regimen (9MTR) for rifampicin-resistant/multi-drug resistant TB (RR/MDR-TB) in 10 PMDT facilities. All eligible consenting adult patients with rifampicin-resistant TB were enrolled and received the standardized 9-month treatment regimen (9MTR), including injectables, with a follow-up after 12 months of treatment completion. Results: A total of 329 patients were enrolled from July 2015 to December 2016. At the 6th month post-enrollment, 256 (77.8%) of them had culture-negative test results. The end-of-treatment success rate was 74.1% (224 [68.0%] were cured and 20 [6.1%] completed the treatment). On the other hand, 10 (3.0%) died, 41 (12.5%) lost to follow-up, 33 (10.0%) withdrawn, 1 (0.3%) treatment failure. In the 12th month after 9MTR completion, among the 244 patients with successful treatment, 198 (81.1%) had culture-negative results, while there were 46 patients whose culture tests were not done. One patient developed TB relapse with fluoroquinolone resistance. The majority of the adverse events were mild that occurred mostly during the first 6 months of treatment. Conclusion: The 9-month treatment regimen had a high treatment success rate with a favorable safety profile. The loss to follow-up was reduced;however, it was still a challenge. The introduction of the 9MTR via operational research had a major impact on building national capacity and infrastructure for the programmatic adoption of a new regimen. Ten PMDT centers received training and experience, created diagnostic pathways, and active drug safety monitoring and management were built.

Isoforskolin from Native Plant Coleus forskohlii of Yunnan, China Plays Multiple Biological Roles

Isoforskolin (ISOF) was isolated from Coleus forskohlii native to Yunnan in China. It is identified as one analog of diterpene forskolin (FSK) which comes from the Indian plant Coleus forskohlii. Researches found that the Yunnan native plant Coleus forskohlii contained rich ISOF but not FSK. ISOF was reported to activate adenylyl cyclase (AC) isoforms. The ophthalmologic and cardiovascular effects of ISOF were firstly reported in the 1990s. The researchers in Kunming, China, found ISOF could lower blood pressure and intraocular pressure. Recent researches found the respiratory tract effects of ISOF, and showed that ISOF significantly elevated cyclic adenosine monophosphate (cAMP) levels in rat lung homogenate, and relaxed the histamine-induced contraction of isolated guinea pig trachea and lung smooth muscle, isoforskolin pretreatment attenuates acute lung injury induced by lipopolysaccharide (LPS) in several models, lowered LPS-induced secretion of the inflammatory cytokine in human monocytes.

Surveillance of arthropod-borne viruses in Benin,West Africa 2020–2021:detection of dengue virus 3 in Aedes aegypti(Diptera:Culicidae)

Dear Editor,Dengue virus(DENV,family Flaviviridae,genus Flavivirus)serotypes 1 to 4(DENV-1,-2,-3,and-4)are responsible for more than 100 million infections per year worldwide.Symptoms of DENV infection can be diverse,reaching from an acute febrile illness to the more severe,sometimes fatal dengue haemorrhagic fever/dengue shock syndrome.

An unfolding monkeypox outbreak in Europe and beyond

Dear Editor,Monkeypox is a zoonotic disease caused by the monkeypox virus(MPXV),a double-stranded DNA virus in the genus Orthopoxvirus,family Poxviridae.MPXV is known to be transmitted between animals such as rats and squirrels,but animal-to-human and human-to-human transmission has been known in Africa since 1970.Transmission is linked to direct contact with body fluids,skin lesions,and patient items as well as respiratory droplets in case of prolonged face-to-face contact[1].Until recently,only a few cases were associated with travel to endemic countries or contact with infected animals imported from endemic countries.

Efficacy and Safety of Antibiotics for the Treatment of Relapsing Fever:A Systematic Review and Network Meta-analysis

Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes,for which no optimal treatment has been developed.The purposes of this study were to compare the efficacy and safety of commonly used antibiotics for the treatment of relapsing fever using a network meta-analysis approach and to explore the advantages of each drug based on the current evidence.This study examined nine published studies involving 1416 patients with relapsing fever treated with penicillin,erythromycin,tetracycline,doxycycline,minocycline or chloramphenicol.The odds ratio(OR)and 95% confidence interval(CI)were used as influence indices for discontinuous data,and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking(SUCRA)curve.The primary outcomes of this study were mortality and cure rates,and the secondary outcomes were the rates of Jarisch-Herxheimer reaction and relapse.Erythromycin(SUCRA,84.5%)was the most effective antibiotic for reducing mortality,whereas tetracycline was the most effective antibiotic for improving the cure rate(SUCRA,69.3%)and reducing the relapse rate(SUCRA,79.7%),and minocycline(SUCRA,66.4%)was the most effective antibiotic for reducing Jarisch-Herxheimer reactions.In addition,our network meta-analysis showed that tetracycline is superior to penicillin for improving the cure rate(OR,5.91;95%CI,2.21-15.81)and reducing the relapse rate(OR,0.16;95%CI,0.04-0.67).

A deterministic model for homologous antibody dependant enhancement on influenza infection

Antibody dependant enhancement refers that viral infectivity was unexpectedly enhanced at low antibody concentration compared to when antibodies were absent,such as Dengue,Zika and influenza virus.To mathematically describe switch from enhancement to neutralisation with increase of antibody concentration,one hyperbolic tangent variant is used as switching function in existed models.However,switching function with hyperbolic tangent contains four parameters,and does not always increase with antibody concentration.To address this problem,we proposed a monotonically increasing Logistical function variant as switching function,which only contains position parameter and magnitude parameter.Analysing influenza viral titre estimated from 21 focus reduction assay(FRA)datasets from neutralisation group(viral titre lower than negative control on all serial dilutions)and 20 FRA dataset from enhancement group(viral titre higher than negative control on high serial dilution),switching function with Logistic function performs better than existed model independent of both groups and exhibited different behaviour/character;specifically,magnitude parameter estimated from enhancement group is lower,but position parameter estimated from enhancement group is higher.A lower magnitude parameter refers that enhancement group more rapidly switches from enhancement to neutralisation with increase of antibody concentration,and a higher position parameter indicates that enhancement group provides a larger antibody concentration interval corresponding to enhancement.Integrating estimated neutralisation kinetics with viral replication,we demonstrated that antibody-induced bistable influenza kinetics exist independent of both groups.However,comparing with neutralisation group,enhancement group provides higher threshold value of antibody concentration corresponding to influenza infectivity.This explains the observed phenomenon that antibody dependent enhancement enhances susceptibility,severity,and mortality to influenza infection.On population level,antibody dependant enhancement can promote H1N1 and H3N2 influenza virus cooperate to sustain long-term circulation on human populations according to antigenic seniority theory.

如何提高传染性肺结核病人的发现率?——埃塞俄比亚索马里地区的成功经验

1999年初,埃塞俄比亚索马里地区发现的肺结核(PTB)病例中48％者为痰涂片阳性。于是提出实验室水平上的质量强化措施,并对痰涂片阴性的肺结核诊断进行复核。临床医生虽然了解国家结核病规划关于肺结核诊断的基本原则,但并没有完全遵循这些原则,部分是因为考虑到病人的费用问题。 通过上述非威胁性方式对临床医生提出挑战,发挥其临床实践当中的积极主动性获得了巨大成功,涂阳肺结核比例增至65％。需要开展研究以评估这些广泛推行的涂阴肺结核诊断指南的可行性。

Estimates of Genetic Variability of <i>Mycobacterium tuberculosis</i>Complex and Its Association with Drug Resistance in Cameroon

The present study investigates the genetic diversity among Mycobacterium tuberculosis complex circulating in the Centre region of Cameroon and analyzes the relationship between genotypes and drug resistance patterns. Spoligotyping was performed by PCR-amplification followed by the reverse hybridization of 298 cultured specimens. Spoligotypes patterns were identified by comparison to reference strains in SPolDB4 database via the MIRU VNTR plus web application. About 97.65% of all tuberculosis (TB) cases were attributed to M. tuberculosis. A total of 65 different profiles were identified. Of these, 40 were represented as Shared Types (ST) while the others were orphans. LAM10_CAM and Haarlem families were the most prevalent genetic families with 51.01% and 14.09% respectively. ST 61, a member of the LAM10_ CAM family formed the largest cluster with 128 (42.95%) isolates. No association was found between genotypes with regard to drug resistance and HIV sero-status. However, there was a significant association between genotypes and age groups. Patients belonging to 15 - 24 and 35 - 44 age groups were more likely infected by LAM10_CAM strains compared to others. The population structure of Mycobacterium tuberculosis complex strains from the Centre region was found to be diverse and the spoligotype 61 of the LAM10_CAM family was highly predominant. Isolates of the LAM10_CAM seem to be not associated with drug resistance.

First Evidence of Hantavirus in Central Iran as an Emerging Viral Disease

Hantavirus is a zoonosis transmitted from rodents to humans. Asymptomatic infected rodents can secrete hantaviruses in the urine, feces, and saliva. The main route of infection transmission to human is aerosols contaminated with the virus. This study was designed to evaluate the serological and molecular prevalence of hantavirus as an emerging zoonoses disease among street sweepers in Isfahan province, central Iran. Serum samples from 200 street sweepers in healthy condition and those with recent renal failure were tested by ELISA (IgM and IgG). Molecular analysis was subsequently applied for IgM positive cases. From these samples, 9 (4.5%) were positive, of which 2 (22.22%) were positive for both IgM and RT-PCR, while 7 (77.77%) were positive for IgG. The mean age and work experience of the positive cases were 39.7 and 11.5 respectively. According to our observations, all positive cases reported prevalence of rodents in their work place. The logistic regression test showed that the age and work experience were not risk factors for being positive, but prevalence of rodents in work place was a risk factor for being positive, when compared with negative cases. This is the first comprehensive study on the prevalence of hantavirus with positive results coming from Iranian population, which can raise the public awareness for the hantavirus infections as a public health threat.

Serum Concentrations of Angiotensin, C-Reactive Protein, Interleukin-8, and Tumor Necrosis Factor-α in Train Driver Population

Train drivers are engaged in high-stress job. It may induce sleep, fatigue, and alertness loss at work, and endanger public safety. It’s unclear that cytokines of train driver would be influenced by their job. The research considers the hypothesis that stressful professions, such as train driver, influence the body’s immune system through the long-time and high-pressure working, and change production of neuro-immune factors. Using enzyme linked immunosorbent assay (ELISA), several neuro-immune factors were assayed among train drivers (N = 82) and health blood donors (N = 80) enrolled in the Yunnan Collaborative Innovation Center for Public Health and Disease Control. The concentrations of angiotensin, C-reactive protein (CRP), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) were determined. Kruskal-Wallis test and Dunn’s multiple comparisons test were performed for overall comparison between groups and for pairwise comparison, respectively. Statistical significance level was set at P < 0.05. The profession of train driving was not associated with significant increases or decreases in the systemic levels of inflammatory (CRP, IL-8, and TNF-α), but it was associated with the high expression of angiotensin in vivo. These findings suggest that the job of train driving may not be associated with significant alterations in systemic immune condition, but arouse the level of angiotensin.

Community perceptions of massdrug administration for soil-transmitted helminthiasis and schistosomiasis in selected schools in the Philippines

Background:Soil-transmitted helminthiasis(STH)and schistosomiasis are parasitic infections prevalent in tropical and subtropical countries,such as the Philippines.The prevalence of these infections remain high in certain Philippine provinces,despite established mass drug administration(MDA)programs in endemic communities.This study aimed to understand community knowledge and perceptions of these infections to determine their implications on the current control and elimination strategies,including possible barriers to MDA compliance.Methods:The study was conducted in Northern Samar and Sorsogon,two provinces with the highest STH and schistosomiasis prevalence in the country.Focus group discussions with separate parent and children groups were utilized to gather knowledge and perceptions on STH and schistosomiasis causes,symptoms,treatment,and prevention;and on the deworming drugs and overall program implementation.Data collection in Northern Samar were done in August 2017,while the sessions in Sorsogon took place in May 2018.A cultural construction of disease framework will show how several factors affect MDA participation.Results:Results showed that participants held mostly correct biomedical notions of the infections and expressed willingness to participate in MDA program.However,reservations remained due to a reported lack of information dissemination,lack of confidence in the drugs used,and widespread fear of adverse side effects.Conclusion:Addressing these concerns-improving the conduct of the deworming program,incorporating suggestions from the community,and managing potential adverse events-may help raise MDA participation and encourage better personal preventive practices,reducing STH and schistosomiasis prevalence.

Performance of the point-of-care circulating cathodic antigen test in the diagnosis of schistosomiasis japonica in a human cohort from Northern Samar, the Philippines

Background:Zoonotic schistosomiasis,caused by Schistosoma japonicum,remains a major public health problem in the Philippines.This study aimed to evaluate the commercially available rapid diagnostic point-of-care circulating cathodic antigen(POC-CCA)test in detecting individuals infected with S.japonicum in a human cohort from an endemic area for schistosomiasis japonica in the Philippines.Methods:Clinical samples were collectedin 18 barangays endemic for S.japonicum infection in Laoang and Palapag municipalities,Northern Samar,the Philippines,in 2015.The presence of CCA in flter-concentrated urine samples(n=412)was evaluated using the commercial kits and the results were converted to images,which were further analyzed by ImageJ software to calculate R values.The diagnostic performance of the immunochromatographic POCCCA test was compared using the Kato-Katz(KK)procedure,in-house enzyme-linked immunosorbent assays(ELISAs)and droplet digital(dd)PCR assays as reference.Results:The POC-CCA test was able to detect S.japonicum-infected individuals in the cohort with an eggs per gram of faeces(EPG)more than or equal to 10 with sensitivity/specifcity values of 63.3%/93.3%.However,the assay showed an inability to diagnose schistosomiasis japonica infections in all cohort KK-positive individuals,of which the majority had an extremely low egg burden(EPG:1–9).The prevalence of S.japonicum infection in the total cohort determined by the POC-CCA test was 12.4%,only half of that determined by the KK method(26.2%).When compared with the ELISAs and ddPCR assays as a reference,the POC-CCA assay was further shown to be a test with low sensitivity.Nevertheless,the assay exhibited signifcant positive correlations with egg burden determined by the KK technique and the target gene copy number index values determined by the ddPCR assays within the entire cohort.Conclusions:By using in silico image analysis,the POC-CCA cassette test could be converted to a quantitative assay to avoid reader-variability.Because of its low sensitivity,the commercially available POC-CCA assay had limited potential for determining the status of a S.japonicum infection in the target cohort.The assay should be applied with caution in populations where schistosome parasites(especially S.japonicum)are present at low infection intensity.

Prevalence of fever of unidentifed aetiology in East African adolescents and adults: a systematic review and meta-analysis

Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accu‑racy.In addition,there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa.The purpose of this study was to estimate the pooled prevalence of fever of unidentifed aetiology among adolescent and adult febrile patients seeking health care in East Africa.Methods We pursued a systematic review using readily available electronic databases(i.e.PubMed,Cumulative Index to Nursing&Allied Health Literature,Scopus,Cochrane Library and Web of Science)without language restric‑tion from inception date of the respective databases to October 31,2022.We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Identifed studies were screened for relevance.Further analyses based on pre-set eligibility criteria were carried out for fnal inclusion.Two reviewers independently screened and extracted data.Risk of study bias was assessed.Meta-analysis of the prevalence of fever of unidentifed aetiology was performed.Results We identifed 14,029 articles of which 25 were eligible for inclusion,reporting data from 8538 participants.The pooled prevalence of febrile cases with unidentifed aetiology was 64%[95%confdence interval(CI):51–77%,I 2=99.6%]among febrile adolescents and adults in East Africa.For the proportion of patients with identifed aetiol‑ogy,the studies documented bacterial pathogens(human bloodstream infections),bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa.Conclusions Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentifed potential life-threat‑ening fever aetiology.Hence,we call for a comprehensive fever syndromic surveillance to broaden a consequential diferential diagnosis of syndromic fever and to considerably improve the course of patients’disease and treatment outcomes.

Correlation of Whole Blood Zinc Levels,CD4 Cell Count,Disease Stage,and Dermatologic Manifestations Among HIV Patients:A Single Center Experience in Philippines

Objective:Zinc deficiency is the most common micronutrient abnormality seen in human immunodeficiency virus(HIV)infection.Depletion of CD4 cells is a hallmark of HIV infection.The study aims to determine the association between whole blood zinc levels and CD4 cell count and stage of HIV infection among patients in a tertiary hospital in the Philippines.Methods:Sixty-five newly diagnosed HIV-positive patients of the institution were recruited.Demographic profile,whole blood zinc levels,CD4 cell count level,HIV disease stage,and presence of any dermatologic manifestations were noted.Prevalence of zinc deficiency and correlation between whole blood zinc levels and CD4 cell count were determined.The data were analyzed by chi-square and pearson correlation analysis.Results:Among the 65 patients,overall zinc deficiency was noted at 33.8%.Low CD4 count and HIV disease stage IV participants had the highest percentage of zinc deficiency at 54.6%and 50%,respectively.A correlation coefficient atr=0.3364 was noted between whole blood zinc levels and CD4 cell count(P=0.006).Twenty-nine patients presented with dermatologic manifestations,with 10 patients being zinc deficient.Conclusion:A weak positive correlation was seen between zinc levels and CD4 count.There is an increasing frequency of zinc level deficiency with a higher HIV disease stage.Dermatologic manifestations of HIV may be present in both patients with normal and deficient zinc levels.

What are the pathways between poverty and malaria in sub-Saharan Africa?A systematic review of mediation studies

Background Malaria remains a major burden in sub-Saharan Africa(SSA).While an association between poverty and malaria has been demonstrated,a clearer understanding of explicit mechanisms through which socioeconomic position(SEP)influences malaria risk is needed to guide the design of more comprehensive interventions for malaria risk mitigation.This systematic review provides an overview of the current evidence on the mediators of socioeconomic disparities in malaria in SSA.Methods We searched PubMed and Web of Science for randomised controlled trials,cohort,case-control and cross-sectional studies published in English between January 1,2000 to May 31,2022.Further studies were identified following reviews of reference lists of the studies included.We included studies that either(1)conducted a formal mediation analysis of risk factors on the causal pathway between SEP and malaria infections or(2)adjusted for these potential mediators as confounders on the association between SEP and malaria using standard regression models.At least two independent reviewers appraised the studies,conducted data extraction,and assessed risk of bias.A systematic overview is presented for the included studies.Results We identified 41 articles from 20 countries in SSA for inclusion in the final review.Of these,30 studies used cross-sectional design,and 26 found socioeconomic inequalities in malaria risk.Three formal mediation analyses showed limited evidence of mediation of food security,housing quality,and previous antimalarial use.Housing,education,insecticide-treated nets,and nutrition were highlighted in the remaining studies as being protective against malaria independent of SEP,suggesting potential for mediation.However,methodological limitations included the use of cross-sectional data,insufficient confounder adjustment,heterogeneity in measuring both SEP and malaria,and generally low or moderate-quality studies.No studies considered exposure mediator interactions or considered identifiability assumptions.Conclusions Few studies have conducted formal mediation analyses to elucidate pathways between SEP and malaria.Findings indicate that food security and housing could be more feasible(structural)intervention targets.Further research using well-designed longitudinal studies and improved analysis would illuminate the current sparse evidence into the pathways between SEP and malaria and adduce evidence for more potential targets for effective intervention.

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.

Original article Schistosomiasis in China： acute infections during 2005-2008

Background Significant progress has taken place over the past 50 years in the control of schistosomiasis japonica in China. However, the available data suggested that schistosomiasis has re-emerged shortly after the World Bank Loan Project which was conducted from 1992 to 2001. The national control program with a revised strategy to control schistosomiasis by using integrated measures has been implemented since 2005. In this study, we aimed to evaluate the effect of the national program on schistosomiasis control from 2005 to 2008.Methods A retrospective study was carried out to analyze the epidemic patterns of acute infections with Schistosoma japonicum （S. japonicum）, based on the number of acute cases annually collected from the web-based national communicable diseases reporting system from 2005 to 2008.Results A total of 564, 207, 83 and 57 acute cases infected with S. japonicum were reported nationwide in 2005, 2006, 2007 and 2008, respectively, with an average annual reduction rate of 46.35% during last four years. Six outbreaks of acute infection with S. japonicurn were reported in 2005 but none in the period of 2006 to 2008. All acute cases that were reported mainly came from the lake regions and became infected during the higher risk periods from the 27th to 43rd weeks of the year. Most of these cases are students （44.87%）, farmers （31.51 %） and fishermen （7.79%） who got the infection by water contact mainly through swimming （41.49%） and production activities （40.25%）. With time, the proportion of imported cases among all acute cases increased due to more frequent movement of people that has occurred with a more mobile population.Conclusions The national control program on schistosomiasis aliened with the revised control strategy has been effectively brought into effect. However, there is still a significant risk of infection among students, farmers and fishermen living in the lake regions. Therefore, it is important to strengthen control measures among risk populations in the high risk areas of transmission, or the lake regions.

Association between helminth infections and diabetes mellitus in adults from the Lao People’s Democratic Republic:a crosssectional study

Background:As a result of epidemiological transition,the health systems of low-and middle-income countries are increasingly faced with a dual disease burden of infectious diseases and emerging non-communicable diseases.Little is known about the mutual influence of these two disease groups.The aim of this study was to investigate the cooccurrence of helminth infections and diabetes mellitus in adults in Lao People’s Democratic Republic(Lao PDR).Methods:We conducted a cross-sectional study among 1600 randomly selected adults aged 35 and older from four different socio-economical and ecological provinces.Information on socio-demographics,risk factors and health conditions was obtained from personal interviews.Clinical assessments including anthropometry(height,weight,waist and hip circumference)and blood pressure measurements were also conducted.Diabetes was classified based on selfreported diagnoses and a point-of-care glycated haemoglobin(HbA1c)test from finger prick blood samples.Stool samples for helminth diagnosis were examined with formalin-ether concentration technique for intestinal parasitic infections.The independent associations of helminth infections with diabetic status and HbA1c were assessed using multiple regression analyses.Results:The prevalence of pre-diabetes and diabetes was 37.3%and 22.8%,respectively.Fifty-six percent of diabetic cases were undiagnosed and 85%of diagnosed diabetic cases had poor glycemic control.Participants from rural areas and from southern parts of the country had higher infection rates,with Opisthorchis viverrini,being the most common helminth infection(30.5%).We found a positive association between Taenia spp.infections and HbA1c(β=0.117;95%CI:0.042-0.200)and diabetes mellitus risk(OR=2.98;95%CI:1.10-8.05).No other helminth species was associated with glycated hemoglobin.Conclusions:Hyperglycaemia and diabetic rates in Lao PDR are alarmingly high,but consistent with other high rates in the region.Given the high rates of under-diagnosis and poorly-controlled glycaemia in diabetes mellitus patients,routine diabetes screening and treatment is essential for the local healthcare system.Large longitudinal cohorts integrating biomarkers are warranted in the search of causal diabetes mellitus risk factors in the region.Common intestinal helminth infections,including O.viverrini,are unlikely to explain the high diabetes mellitus rates observed.