Australian Hajj pilgrims' knowledge about MERS-CoV and other respiratory infections

Dear Editor,With the intense crowding in mass gatherings such as Hajj,there is a high risk of acquisition of airborne in-fections with the potential for its transmission in the pilgrims’country of origin(Memish Z A,et al.,2014).The risk of importing serious infections from Hajj has escalated since the emergence of the Middle East respiratory syndrome coronavirus(MERS-CoV)in Saudi Arabia and other neighbouring countries from September2012.Active surveillance of Hajj pilgrims in 2012 and

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019(COVID-19)for surgeons is not quantified which may be affected by their risk of exposure and individual factors.The objective of this review is to quantify the risk of COVID-19 among surgeons,and explore whether facemask can minimise the risk of COVID-19 among surgeons.A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers(HCWs)especially those work in surgical specialities including surgical nurses and intensivists.Additionally,systematic reviews that assessed the effectiveness of facemask against viral respiratory infections,including COVID-19,among HCWs were identified.Data from identified articles were abstracted,synthesised and summarised.Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask(and other personal protective equipment)were summarised.Although the risk of COVID-19 could not be quantified precisely among surgeons,about 14%of HCWs including surgeons had COVID-19,there could be variations depending on settings.Facemask was found to be somewhat protective against COVID-19,but the HCWs’compliance was highly variable ranging from zero to 100%.Echoing surgical societies’guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.

Surveillance of Australian Hajj pilgrims for carriage of potentially pathogenic bacteria:Data from two pilot studies

AIM To estimate the pharyngeal carriage rate of Neisseria meningitidis(N. meningitidis), Streptococcus pneumoniae(S. pneumoniae) and Staphylococcus aureus(S. aureus) among Australian Hajj pilgrims.METHODS In 2014, surveillance was conducted in two phases among Australian Hajj pilgrims: The first phase during Hajj in Mina, and the second phase soon after returning home to Australia. Nasopharyngeal or oropharyngeal swabs were taken from participants then tested, firstly by nucleic acid testing, and also by standard culture.RESULTS Of 183 participants recruited in the first phase, 26(14.2%) tested positive for S. pneumoniae; 4 had received pneumococcal conjugate vaccine(PCV13). Only one tested positive for N. meningitidis(W). Of 93 2^(nd) phase samples cultured, 17(18.3%) grew S. aureus, all methicillin sensitive, 2(2.2%) grew N. meningitidis(on subculture; one serotype B, one negative), and 1(1%), from an unvaccinated pilgrim, grew S. pneumoniae.CONCLUSION Relatively high carriage of S. pneumoniae and little meningococcal carriage was found. This indicates the importance of a larger study for improved infection surveillance and possible vaccine evaluation.

Mandatory meningococcal vaccine, and other recommended immunisations: Uptake, barriers, and facilitators among health care workers and trainees at Hajj

AIM To evaluate the uptake of a mandatory meningococcal, a highly recommended influenza, and an optional pneumococcal vaccine, and to explore the key factors affecting vaccination rate among health care workers(HCWs) during the Hajj.METHODS An anonymous cross-sectional online survey was distributed among HCWs and trainees who worked or volunteered at the Hajj 2015-2017 through their line managers, or by visiting their hospitals and healthcare centres in Makkah and Mina. Overseas HCWs who accompanied the pilgrims or those who work in foreign Hajj medical missions were excluded. Pearson's χ2 test was used to compare categorical variables and odds ratio(OR) was calculated by "risk estimate" statistics along with 95% confidence interval(95%CI).RESULTS A total of 138 respondents aged 20 to 59(median 25.6) years with a male to female ratio of 2.5:1 participated in the survey. Only 11.6%(16/138) participants reported receiving all three vaccines, 15.2%(21/138) did not receive any vaccine, 76.1%(105/138) received meningococcal, 68.1%(94/138) influenza and 13.8%(19/138) pneumococcal vaccine. Females were more likely to receive a vaccine than males(OR 3.6, 95%CI: 1.0-12.7, P < 0.05). Willingness to follow health authority's recommendation was the main reason for receipt of vaccine(78.8%) while believing that they were up-to-date with vaccination(39.8%) was the prime reason for non-receipt. CONCLUSION Some HCWs at Hajj miss out the compulsory and highly recommended vaccines; lack of awareness is a key barrier and authority's advice is an important motivator. Health education followed by stringent measures may be required to improve their vaccination rate.

Risk factors for severity and mortality in patients with MERS-CoV:Analysis of publicly available data from Saudi Arabia

Dear Editor,Middle East respiratory syndrome coronavirus(MERS-CoV)has affected over 1600 people across four continents;it has a fatality rate of about 36%(WHO,2015).Approximately 75%of MERS-CoV patients have a preexisting medical condition(Zumla et al.,2015).MERS-CoV is especially severe in patients with comorbidities.

Viral respiratory infections among Hajj pilgrims in 2013

Middle East respiratory syndrome coronavirus(MERS-Co V) has emerged in the Arabian Gulf region, with its epicentre in Saudi Arabia, the host of the ‘Hajj' which is the world's the largest mass gathering. Transmission of MERS-Co V at such an event could lead to its rapid worldwide dissemination. Therefore, we studied the frequency of viruses causing influenza-like illnesses(ILI) among participants in a randomised controlled trial at the Hajj 2013. We recruited 1038 pilgrims from Saudi Arabia, Australia and Qatar during the first day of Hajj and followed them closely for four days. A nasal swab was collected from each pilgrim who developed ILI. Respiratory viruses were detected using multiplex RT-PCR. ILI occurred in 112/1038(11%) pilgrims. Their mean age was 35 years, 49(44%) were male and 35(31%) had received the influenza vaccine pre-Hajj. Forty two(38%) pilgrims had laboratory-confirmed viral infections; 28(25%) rhinovirus, 5(4%) influenza A, 2(2%) adenovirus, 2(2%) human coronavirus OC43/229 E, 2(2%) parainfluenza virus 3, 1(1%) parainfluenza virus 1, and 2(2%) dual infections. No MERS-Co V was detected in any sample. Rhinovirus was the commonest cause of ILI among Hajj pilgrims in 2013. Infection control and appropriate vaccination are necessary to prevent transmission of respiratory viruses at Hajj and other mass gatherings.

Identifying the Risk of SARS-CoV-2 Infection and Environmental Monitoring in Airborne Infectious Isolation Rooms(AIIRs)

Healthcare workers(HCWs)are at high risk of occupational exposure to the new pandemic human coronavirus,SARSCoV-2,and are a source of nosocomial transmission in airborne infectious isolation rooms(AIIRs).Here,we performed comprehensive environmental contamination surveillance to evaluate the risk of viral transmission in AIIRs with 115 rooms in three buildings at the Shanghai Public Health Clinical Center,Shanghai,during the treatment of 334 patients infected with SARS-CoV-2.The results showed that the risk of airborne transmission of SARS-CoV-2 in AIIRs was low(1.62%,25/1544)due to the directional airflow and strong environmental hygiene procedures.However,we detected viral RNA on the surface of foot-operated openers and bathroom sinks in AIIRs(viral load:55.00–3154.50 copies/mL).This might be a source of contamination to connecting corridors and object surfaces through the footwear and gloves used by HCWs.The risk of infection was eliminated by the use of disposable footwear covers and the application of more effective environmental and personal hygiene measures.With the help of effective infection control procedures,none of 290 HCWs was infected when working in the AIIRs at this hospital.This study has provided information pertinent for infection control in AIIRs during the treatment of COVID-19 patients.

Proposed nomenclature for Pseudallescheria,Scedosporium and related genera

As a result of fundamental changes in the International Code of Nomenclature on the use of separate names for sexual and asexual stages of fungi,generic names of many groups should be reconsidered.Members of the ECMM/ISHAM working group on Pseudallescheria/Scedosporium infections herein advocate a novel nomenclature for genera and species in Pseudallescheria,Scedosporium and allied taxa.The generic names Parascedosporium,Lomentospora,Petriella,Petriellopsis,and Scedosporium are proposed for a lineage within Microascaceae with mostly Scedosporium anamorphs producing slimy,annellidic conidia.Considering that Scedosporium has priority over Pseudallescheria and that Scedosporium prolificans is phylogenetically distinct from the other Scedosporium species,some name changes are proposed.Pseudallescheria minutispora and Petriellidium desertorum are renamed as Scedosporium minutisporum and S.desertorum,respectively.Scedosporium prolificans is renamed as Lomentospora prolificans.

Potential carrier priming effect in Australian infants after 7-valent pneumococcal conjugate vaccine introduction

AIM:To investigate evidence of clinical protection in infants after one dose of 7-valent pneumococcal conjugate vaccine(7vPCV) owing to carrier priming.METHODS:Using Australian National Notifiable Diseases Surveillance System data,we conducted a descriptive analysis of cases of vaccine type invasive pneumococcal disease(VT-IPD) during "catch-up" years,when 7vPCV was carrier primed by prior administration of DTPa vaccine.We compared the number of VT-IPD cases occurring 2-9 wk after a single dose of 7vPCV(carrier primed),with those < 2 wk post vaccination,when no protection from 7vPCV was expected yet.Further comparison was conducted to compare the occurrence of VT-IPD cases vs non-VT-IPD cases after a single carrier-primed dose of 7vPCV.RESULTS:We found four VT-IPD cases occurring <2 wk after one carrier primed dose of 7vPCV while only one case occurred 2-9 wk later.Upon further comparison with the non-VT-IPD cases that occurred after one carrier primed dose of 7vPCV,two cases were detected within 2 wk,whereas seven occurred within2-9 wk later;suggesting a substantial level of protection from VT-IPD occurring from 2 wk after carrier-primed dose of 7vPCV.CONCLUSION:This data suggest that infants may benefit from just one dose of 7vPCV,likely through enhanced immunity from carrier priming effect.If this is proven,an adjusted 2-dose schedule(where the first dose of PCV is not given until after DTPa) may be sufficient and more cost-effective.

小胶质细胞比星形胶质细胞对干扰素α的反应更广泛而多样性

Ⅰ型干扰素(IFN-Ⅰ)对于中枢神经系统(CNS)产生有效的抗菌防御是至关重要的,但IFN-Ⅰ也会引起严重的神经疾病(即脑干扰素病),例如Aicardi-Goutières综合征。在CNS中,小胶质细胞和星形胶质细胞在宿主对感染和损伤的反应中具有重要作用,这2种细胞都对IFN-Ⅰ有反应。虽然IFN-Ⅰ信号传导途径在星形胶质细胞和小胶质细胞中是相同的,但这2种细胞对IFN-Ⅰ的应答差异是否存在、程度如何,仍然是未知的。在本研究中,我们探索了星形胶质细胞和小胶质细胞对IFN-Ⅰ,IFN-α的全局转录反应。我们发现在基础条件下,每种细胞类型都有一种独特的基因表达模式,反映了其发育起源和生物学功能。在IFN-α刺激后,星形胶质细胞和小胶质细胞也显示出共同的核心反应,其特征是检测和消除病原体所需的基因表达增加。与星形胶质细胞相比,小胶质细胞对IFN-α具有更广泛和多样的反应,同时有更多的基因表达上调(282 vs.141)和下调(81 vs.3)。在脑干扰素病小鼠模型中也记录了特定IFN-Ⅰ调控基因的进一步验证。本研究结果不仅发现星形胶质细胞和小胶质细胞对IFN-I的反应机制存在相同之处,也存在明显的不同。这些细胞在宿主防御和脑干扰素病发展中都起着独特的作用。

Molecular Epidemiology and Vaccine Compatibility Analysis of Seasonal Influenza Viruses in Wuhan, 2016–2019

Influenza viruses(FLUV)cause high morbidity and mortality annually in the world and pose a serious threat to the public health.Wuhan,as an important transportation hub in China,has a dense population and suitable climate,which also lays a major hidden danger for the outbreak of influenza.To survey and characterize the seasonal FLUV in Wuhan during 2016–2019,we collected 44,738 throat swabs,among which 15.5%were influenza A(FLUAV)positive,6.1%influenza B(FLUBV)and 0.3%co-infection.By monitoring FLUV in each month from June 2016 to May 2019,different with the previously seasonality pattern,only a single influenza peak was appeared in winter of 2017–2018 and 2018–2019,respectively.These data indicated that the complex circulation pattern of seasonal influenza in Wuhan.In addition,we found the age group was skewed towards 5–14 years group whose activity were mostly school based,which suggested school may be an important place for influenza outbreaks.Meanwhile,phylogenic analysis revealed that two subtypes(subclade 3C.2 a2 and 3C.2 a1b)of A(H3N2)were circulating in Wuhan and there was an obvious transition in 2018 because the two subclades were detected simultaneously.Furthermore,by estimating the vaccine effectiveness,we found that the vaccine strain of FLUAV didn’t seem to match very well the current epidemic strain,especially A(H3N2).Hence,more accurate prediction of seasonal outbreak is essential for vaccine design.Taken together,our results provided the current information about seasonal FLUV in Wuhan which form the basis for vaccine updating.

针对老年人群的疫苗

全球65岁以上的人口比重正在迅速增加。该年龄段人群发生的感染,比如最近的新型冠状病毒(SARS-CoV-2)感染,可导致大量并发症和死亡。通过添加新型佐剂(如新型重组带状疱疹疫苗和佐剂流感疫苗)或增加抗原浓度(如流感疫苗),老年人疫苗的开发已取得了重大进展。本文综述了3种最重要的可通过疫苗预防的老年疾病的免疫预防进展。重组带状疱疹疫苗的有效性为90%,很少受疫苗接种者年龄的影响,并且免疫效能可以持续4年以上。增加抗原剂量或加入佐剂已经改善了老年人流感疫苗的免疫原性,不过增强型流感疫苗的相对有效性和免疫反应持久性仍是正在进行的临床试验的焦点。在老年人中,肺炎球菌结合疫苗和多糖疫苗对于疫苗血清型引起的侵袭性肺炎球菌性疾病和肺炎球菌肺炎具有相似的功效。它们的相对价值受疫苗血清型的流行情况影响,主要与儿童结合疫苗的接种覆盖率有关。改善疫苗的效能可以增强公众对疫苗的信心并提高接种率。对老年人而言,联合接种这些疫苗切实可行并且至关重要。SARS-CoV-2的出现推动了新疫苗平台的开发,未来有望开发出针对其他病原体的新疫苗。