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Background: Drug users are a high-risk group for HIV infection and are prominent HIV carriers. Given the emergence of new drugs, we explored current drug-using behaviors, HIV infections, and the correlation between drug-using behaviors and HIV infection risk among drug users from 2014 to 2021. Objective: We aimed to identify the prevalence of HIV infection risk among drug users and explore drug use behaviors based on the updated data, which could provide evidence for the precision of HIV prevention strategies among drug users. Methods: Data were collected from sentinel surveillance of drug users in rehabilitation centers and communities in Hangzhou (2014-2021), including sociodemographic characteristics, HIV awareness, drug use, risky sexual behaviors, and HIV infection status. Multivariate logistic regression was used to identify the factors influencing HIV infection and risky sexual behaviors among drug users. Results: In total, 5623 drug users (male: n=4734, 84.19%; age: mean 38.38, SD 9.94 years) were included. New drugs dominated among the participants (n=3674, 65.34%). The main mode of drug use was noninjection (n=4756, 84.58%). Overall, for 27.45% (n=1544) of injected drugs in the last month before the investigation, the average daily injection frequency was 3.10 (SD 8.24). Meanwhile, 3.43% of participants shared needles. The incidence of sexual behaviors after drug use was 33.13% (n=1863), with 35.75% (n=666) of them using a condom in the last time. Overall, 116 participants tested positive for HIV antibodies (infection rate=2.06%). New drug users exhibited more postuse sexual behaviors than traditional drug users (odds ratio [OR] 7.771, 95% CI 6.126-9.856; P<.001). HIV-aware drug users were more likely to engage in risky sexual behaviors (OR 1.624, 95% CI 1.152-2.291; P=.006). New-type drug users were more likely to engage in unprotected sexual behavior (OR 1.457, 95% CI 1.055-2.011; P=.02). Paradoxically, drug users with greater HIV awareness were more prone to engaging in unprotected sexual behavior (OR 5.820, 95% CI 4.650-7.284; P<.001). Women engaged less in unprotected sex than men (OR 0.356, 95% CI 0.190-0.665; P=.001). HIV rates were higher among injecting drug users (OR 2.692, 95% CI 0.995-7.287; P=.04) and lower among drug users who used condoms during recent sex than those who did not (OR 0.202, 95% CI 0.076-0.537; P=.001). Higher education levels were associated with higher HIV infection rates. However, there was no significant correlation between HIV cognition level and HIV infection. Conclusions: New drug types and noninjection were the main patterns in last 7 years. Using new types of drugs, rather than traditional drugs, was associated with an increased risk of HIV infection. Injection drug use was a risk factor for HIV infection. HIV awareness among drug users was high, but the incidence of risky sexual behaviors remained high. Therefore, it is important to promote the behavioral transformation of high-risk populations from cognition to attitude, and then to taking protective measures.
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Consumidores de Drogas , Infecciones por VIH , Asunción de Riesgos , Trastornos Relacionados con Sustancias , Humanos , Masculino , China/epidemiología , Infecciones por VIH/epidemiología , Estudios Transversales , Femenino , Adulto , Consumidores de Drogas/estadística & datos numéricos , Consumidores de Drogas/psicología , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Prevalencia , Factores de Riesgo , Conducta Sexual/estadística & datos numéricos , Adulto Joven , Vigilancia de Guardia , AdolescenteRESUMEN
BACKGROUND: Surveillance of HIV-1 pre-treatment drug resistance (PDR) is essential for ensuring the success of first-line antiretroviral therapy (ART). Beside population-based surveys, sentinel surveillance of PDR and circulating HIV-1 clades in specific populations such as blood donors could efficiently inform decision-making on ART program. We therefore sought to ascertain HIV-1 residual infection, the threshold of PDR and viral diversity among recently-diagnosed blood donors in Gabon. METHODS: A sentinel surveillance was conducted among 381 consenting blood donors at the National Blood Transfusion Center (NBTC) in Gabon from August 3,2020 to August, 31, 2021. In order to determine the residual risk of HIV transmission, viral load and HIV-1 Sanger-sequencing were performed at the Chantal BIYA International Reference Center (CIRCB)-Cameroon on HIV samples previously tested seronegative with ELISA in Gabon. Phylogeny was performed using MEGA X, PDR threshold>10% was considered high and data were analysed using p≤0.05 for statistical significance. RESULTS: Five HIV-negative blood donors had a detectable viral load indicating a high residual risk of HIV transmission. Among the samples successfully sequenced, four participants had major drug resistance mutations (DRMs), giving a threshold of PDR of 25% (4/16). By drug class, major DRMs targeting NNRTI (K103N, E138G), NRTIs (L210W) and PI/r (M46L). The most representative viral clades were CRF02_AG and subtype A1. The genetic diversity of HIV-1 had no significant effect on the residual risk in blood transfusion (CRF02_AG, P = 0.3 and Recombinants, P = 0.5). CONCLUSION: This sentinel surveillance indicates a high residual risk of HIV-1 transfusion in Gabon, thereby underscoring the need for optimal screening strategy for blood safety. Moreover, HIV-1 transmission goes with high-risk of PDR, suggesting suboptimal efficacy of ART. Nonetheless, the genetic diversity has limited (if any effect) on the residual risk of infection and PDR in blood donors.
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Donantes de Sangre , Farmacorresistencia Viral , Infecciones por VIH , VIH-1 , Vigilancia de Guardia , Humanos , Donantes de Sangre/estadística & datos numéricos , VIH-1/genética , VIH-1/efectos de los fármacos , Gabón/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Masculino , Farmacorresistencia Viral/genética , Femenino , Adulto , Persona de Mediana Edad , Carga Viral , Filogenia , Adulto Joven , Adolescente , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/farmacologíaRESUMEN
Eight peaks of coronavirus disease 2019 (COVID-19) outbreak occurred in Japan, each associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern. The National Epidemiological Surveillance of Infectious Diseases (NESID) analyzed viral genome sequences from symptomatic patients and submitted the results to GISAID. Meanwhile, commercial testing services occasionally sequence samples from asymptomatic individuals. We compared a total of 1248 SARS-CoV-2 full-genome sequences obtained from the SB Coronavirus Inspection Center Corp. (SBCVIC) during Japan's seventh wave, which was dominated by Omicron variants, with 1764 sequences obtained in Japan from GISAID during the same period using chronological phylogenies and molecular transmission networks. The number of SBCVIC sequences was consistent with the number of cases reported by NESID. The SBCVIC detected a shift in the PANGO lineage from BA.2 to BA.5 earlier than that of GISAID. BA.2 lineages from the SBCVIC were distributed at different locations in the transmission network dominated by GISAID entries, whereas BA.5 lineages from SBCVIC and GISAID often formed distinct subclusters. Test-based sentinel surveillance of asymptomatic individuals may be a more manageable approach compared to notifiable disease surveillance; however, it may not necessarily capture all infection populations throughout Japan.
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COVID-19 , Genoma Viral , Filogenia , SARS-CoV-2 , Vigilancia de Guardia , Humanos , Japón/epidemiología , COVID-19/epidemiología , COVID-19/virología , COVID-19/transmisión , COVID-19/diagnóstico , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Epidemiología Molecular , Infecciones Asintomáticas/epidemiologíaRESUMEN
IntroductionRespiratory sentinel surveillance systems leveraging computerised medical records (CMR) use phenotyping algorithms to identify cases of interest, such as acute respiratory infection (ARI). The Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC) is the English primary care-based sentinel surveillance network.AimThis study describes and validates the RSC's new ARI phenotyping algorithm.MethodsWe developed the phenotyping algorithm using a framework aligned with international interoperability standards. We validated our algorithm by comparing ARI events identified during the 2022/23 influenza season in England through use of both old and new algorithms. We compared clinical codes commonly used for recording ARI.ResultsThe new algorithm identified an additional 860,039 cases and excluded 52,258, resulting in a net increase of 807,781 cases (33.84%) of ARI compared to the old algorithm, with totals of 3,194,224 cases versus 2,386,443 cases. Of the 860,039 newly identified cases, the majority (63.7%) were due to identification of symptom codes suggestive of an ARI diagnosis not detected by the old algorithm. The 52,258 cases incorrectly identified by the old algorithm were due to inadvertent identification of chronic, recurrent, non-infectious and other non-ARI disease.ConclusionWe developed a new ARI phenotyping algorithm that more accurately identifies cases of ARI from the CMR. This will benefit public health by providing more accurate surveillance reports to public health authorities. This new algorithm can serve as a blueprint for other CMR-based surveillance systems wishing to develop similar phenotyping algorithms.
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Algoritmos , Fenotipo , Infecciones del Sistema Respiratorio , Vigilancia de Guardia , Humanos , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Inglaterra/epidemiología , Enfermedad Aguda , Sistemas de Registros Médicos Computarizados , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Masculino , Femenino , Atención Primaria de Salud , Registros Electrónicos de SaludRESUMEN
This perspective summarises and explains the long-term surveillance framework 2021-2027 for infectious diseases in the European Union/European Economic Area (EU/EEA) published in April 2023. It shows how shortcomings in the areas of public health focus, vigilance and resilience will be addressed through specific strategies in the coming years and how these strategies will lead to stronger surveillance systems for early detection and monitoring of public health threats as well as informing their effective prevention and control. A sharper public health focus is expected from a more targeted list of notifiable diseases, strictly public-health-objective-driven surveillance standards, and consequently, leaner surveillance systems. Vigilance should improve through mandatory event reporting, more automated epidemic intelligence processing and increased use of genomic surveillance. Finally, EU/EEA surveillance systems should become more resilient by modernising the underlying information technology infrastructure, expanding the influenza sentinel surveillance system to other respiratory viruses for better pandemic preparedness, and increasingly exploiting potentially more robust alternative data sources, such as electronic health records and wastewater surveillance. Continued close collaboration across EU/EEA countries will be key to ensuring the full implementation of this surveillance framework and more effective disease prevention and control.
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Enfermedades Transmisibles , Unión Europea , Salud Pública , Humanos , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/diagnóstico , Vigilancia de la Población , Europa (Continente)/epidemiología , Brotes de Enfermedades/prevención & control , Vigilancia de Guardia , Control de Enfermedades Transmisibles/métodos , Vigilancia en Salud Pública/métodosRESUMEN
BACKGROUND: Influenza sentinel surveillance in Lao PDR is used to inform seasonal vaccination programs. This analysis reviews epidemiologic and virologic characteristics of influenza virus infection over 8 years, before and after emergence of SARS-CoV-2. METHODS: Data collected for ILI and SARI surveillance during January 2016 through December 2023 were analyzed from nine hospitals. Respiratory specimens from ILI and SARI cases were tested by reverse transcriptase polymerase chain reaction to determine influenza positivity and subtype and lineage. Aggregate counts of outpatient visits and hospitalizations were collected from hospital logbooks. Epidemiologic trends of influenza activity were described, and the proportional contribution of influenza-associated ILI and SARI to outpatient and inpatient loads was estimated. RESULTS: Influenza was detected year-round with positivity peaking during September through January and occurring in most years approximately 1 month earlier in the south than the north. After decreasing in 2 years following the emergence of SARS-CoV-2, influenza positivity increased in 2022 and resumed its typical temporal trend. Influenza-associated ILI contribution to outpatient visits was highest among children ages 5-14 years (3.0% of all outpatient visits in 2023), and influenza-associated SARI contribution to inpatient hospitalizations was highest among children ages 2-4 years (2.2% of all hospitalizations in 2023). CONCLUSIONS: Influenza surveillance in Lao PDR provides clinicians and public health authorities with information on geographic and temporal patterns of influenza transmission. Influenza surveillance data support current vaccination timing and recommendations to vaccinate certain populations, especially young children.
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Hospitalización , Gripe Humana , Vigilancia de Guardia , Humanos , Laos/epidemiología , Gripe Humana/epidemiología , Gripe Humana/virología , Gripe Humana/prevención & control , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Lactante , Femenino , Masculino , Anciano , Hospitalización/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/virología , COVID-19/prevención & control , Estaciones del Año , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Recién Nacido , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Lack of data on the burden and scope of congenital disorders (CDs) in South Africa undermines resource allocation and limits the ability to detect signals from potentially teratogenic pregnancy exposures. METHODS: We used routine electronic data in the Western Cape Pregnancy Exposure Registry (PER) to determine the overall and individual prevalence of CD identified on neonatal surface examination at birth in the Western Cape, South Africa, 2016-2022. CD was confirmed by record review. The contribution of late (≤24 months) and antenatal diagnoses was assessed. We compared demographic and obstetric characteristics between women with/without pregnancies affected by CD. RESULTS: Women with a viable pregnancy (>22 weeks gestation; birth weight ≥ 500 g) (n = 32,494) were included. Of 1106 potential CD identified, 56.1% were confirmed on folder review. When internal and minor CD were excluded the prevalence of major CD identified on surface examination at birth was 7.2/1000 births. When missed/late diagnoses on examination (16.8%) and ultrasound (6.8%) were included, the prevalence was 9.2/1000 births: 8.9/1000 livebirths and 21.5/1000 stillbirths. The PER did not detect 21.5% of major CD visible at birth. Older maternal age and diabetes mellitus were associated with an increased prevalence of CD. Women living with/without HIV (or the timing of antiretroviral therapy, before/after conception), hypertension or obesity did not significantly affect prevalence of CD. CONCLUSIONS: A surveillance system based on routine data successfully determined the prevalence of major CD identified on surface examination at birth at rates slightly higher than in equivalent studies. Overall rates, modeled at ~2%, are likely underestimated. Strengthening routine neonatal examination and clinical record-keeping could improve CD ascertainment.
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Anomalías Congénitas , Humanos , Sudáfrica/epidemiología , Femenino , Embarazo , Prevalencia , Adulto , Recién Nacido , Anomalías Congénitas/epidemiología , Vigilancia de Guardia , Sistema de Registros , Masculino , Diagnóstico Prenatal/métodosRESUMEN
BackgroundA new respiratory virus surveillance platform, based on nationwide hospital laboratory data, was established in Israel during the COVID-19 pandemic.AimWe aimed to evaluate the performance of this platform with respect to the detection of influenza and respiratory syncytial virus (RSV) from week 36 in 2020 to week 15 in 2023, and how it fits with the World Health Organization (WHO) mosaic surveillance framework.MethodsData of respiratory samples from hospitalised patients sent for laboratory confirmation of influenza virus or RSV from 25 general hospital laboratories nationwide were collected. We analysed the weekly number and percentage of samples positive for influenza virus or RSV vis-à-vis SARS-CoV-2 activity and compared data from the new surveillance platform with existing surveillance platforms. Using data in the new surveillance platform, we analysed early stages of a 2021 out-of-season RSV outbreak and evaluated the capabilities of the new surveillance system with respect to objectives and domains of the WHO mosaic framework.ResultsThe new hospital-laboratory surveillance platform captured the activity of influenza virus and RSV, provided crucial data when outpatient sentinel surveillance was not operational and supported an out-of-season RSV outbreak investigation. The new surveillance platform fulfilled important objectives in all three domains of the mosaic framework and could serve for gathering additional information to fulfil more domain objectives.ConclusionThe new hospital laboratory surveillance platform provided essential data during the COVID-19 pandemic and beyond, fulfilled important domain objectives of the mosaic framework and could be adapted for the surveillance of other viruses.
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COVID-19 , Gripe Humana , Pandemias , Infecciones por Virus Sincitial Respiratorio , SARS-CoV-2 , Organización Mundial de la Salud , Humanos , COVID-19/epidemiología , Israel/epidemiología , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Gripe Humana/epidemiología , Gripe Humana/diagnóstico , Vigilancia de Guardia , Laboratorios de Hospital/estadística & datos numéricos , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Vigilancia de la Población/métodosRESUMEN
BACKGROUND: Guided by the data from the surveillance system, public health efforts have contributed to reducing the burden of influenza in many countries. During the COVID-19 pandemic, many surveillance resources were directed at tracking the severe acute respiratory syndrome-Coronavirus 2. However, most countries have not reported surveillance evaluations during the COVID-19 pandemic. METHODS: Using the U.S. CDC surveillance evaluation method, we evaluated the influenza-like illness (ILI) sentinel surveillance performance in South Korea between January 2017 and September 2023. For the timeliness, we measured the mean time lag between the reports from the sentinel sites to the Korea Disease Control and Prevention Agency (KDCA) and surveillance result dissemination from KDCA. For the completeness, we measured the submission rate of complete reports per overall number of reports from each sentinel site to the KDCA. For the sensitivity, we calculated the correlation coefficient between the monthly number of ILI reports and the patients with ILI from the Korea national reimbursement data by either Pearson's or Spearman's test. For the representativeness, we compared the age-specific distribution of ILI between the surveillance data and the national reimbursement data using a chi-squared test. RESULTS: We found that the surveillance performance of timeliness (less than 2 weeks) and completeness (97 %-98 %) was stable during the study period. However, we found a reduced surveillance sensitivity (correlation coefficient: 0.73 in 2020, and 0.84 in 2021) compared to that of 2017-2019 (0.96-0.99), and it recovered in 2022-2023 (0.93-0.97). We found no statistical difference across the proportion of age groups between the surveillance and reimbursement data during the study period (all P-values > 0.05). CONCLUSIONS: Ongoing surveillance performance monitoring is necessary to maintain efficient policy decision-making for the control of the influenza epidemic. Additional research is needed to assess the overall influenza surveillance system including laboratory and hospital-based surveillance in the country.
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COVID-19 , Gripe Humana , Vigilancia de Guardia , Humanos , República de Corea/epidemiología , Gripe Humana/epidemiología , COVID-19/epidemiología , Niño , Preescolar , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Lactante , Adulto Joven , Masculino , Femenino , Recién Nacido , SARS-CoV-2 , Anciano de 80 o más AñosAsunto(s)
Enfermedades de los Animales , Enfermedades de las Aves , Enfermedades de los Bovinos , Brotes de Enfermedades , Enfermedades de las Aves de Corral , Vigilancia de Guardia , Enfermedades de las Ovejas , Enfermedades de los Porcinos , Gales/epidemiología , Inglaterra/epidemiología , Animales , Enfermedades de los Porcinos/epidemiología , Vigilancia de Guardia/veterinaria , Ovinos , Enfermedades de las Ovejas/epidemiología , Enfermedades de los Animales/epidemiología , Bovinos , Enfermedades de las Aves de Corral/epidemiología , Enfermedades de los Bovinos/epidemiología , Porcinos , Brotes de Enfermedades/veterinaria , Enfermedades de las Aves/epidemiología , Femenino , Animales Salvajes , Aves , Masculino , InternacionalidadRESUMEN
BackgroundShigella is a leading cause of moderate-to-severe diarrhoea worldwide and diarrhoeal deaths in children in low- and-middle-income countries.AimWe investigated trends and characteristics of shigellosis and antimicrobial resistance of Shigella sonnei in Israel.MethodsWe analysed data generated by the Sentinel Laboratory-Based Surveillance Network for Enteric Pathogens that systematically collects data on detection of Shigella at sentinel laboratories, along with the characterisation of the isolates at the Shigella National Reference Laboratory. Trends in the shigellosis incidence were assessed using Joinpoint regression and interrupted time-series analyses.ResultsThe average incidence of culture-confirmed shigellosis in Israel declined from 114 per 100,000 population (95% confidence interval (CI): 112-115) 1998-2004 to 80 per 100,000 population (95% CI: 79-82) 2005-2011. This rate remained stable 2012-2019, being 18-32 times higher than that reported from the United States or European high-income countries. After decreasing to its lowest values during the COVID-19 pandemic years (19/100,000 in 2020 and 5/100,000 in 2021), the incidence of culture-confirmed shigellosis increased to 39 per 100,000 population in 2022. Shigella sonnei is the most common serogroup, responsible for a cyclic occurrence of propagated epidemics, and the proportion of Shigella flexneri has decreased. Simultaneous resistance of S. sonnei to ceftriaxone, ampicillin and sulphamethoxazole-trimethoprim increased from 8.5% (34/402) in 2020 to 92.0% (801/876) in 2022.ConclusionsThese findings reinforce the need for continuous laboratory-based surveillance and inform the primary and secondary prevention strategies for shigellosis in Israel and other endemic high-income countries or communities.
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Antibacterianos , Disentería Bacilar , Vigilancia de Guardia , Shigella sonnei , Humanos , Disentería Bacilar/epidemiología , Disentería Bacilar/microbiología , Disentería Bacilar/diagnóstico , Israel/epidemiología , Niño , Preescolar , Incidencia , Adolescente , Lactante , Masculino , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Femenino , Shigella sonnei/aislamiento & purificación , Shigella sonnei/efectos de los fármacos , Adulto , Persona de Mediana Edad , Adulto Joven , COVID-19/epidemiología , SARS-CoV-2 , Pruebas de Sensibilidad Microbiana , Anciano , Diarrea/epidemiología , Diarrea/microbiología , Recién Nacido , Farmacorresistencia BacterianaRESUMEN
Objective: To analyze the epidemiological characteristics of human respiratory syncytial virus (HRSV) in patients with acute respiratory infection (ARIs) in sentinel hospitals of the Hubei influenza surveillance network from 2016 to 2023. Methods: ARIs samples [including influenza-like cases (ILI) and severe acute respiratory infection (SARI)] were collected from influenza surveillance sentinel hospitals in Hubei Province from 2016 to 2023, and case information was collected. HRSV virus nucleic acid typing was performed by fluorescence quantitative PCR method, and the data were collated, plotted and analyzed. Results: From 2016 to 2023, 12 779 cases of ILI and 9 166 cases of SARI were collected. The positive rate of HRSV was the highest in<5 years of age group [15.77% (168/1 065)], among which the positive rate was the highest in 2 to 5 years of age group of ILI cases [13.60% (31/228)], and the positive rate was the highest in 0 to 2 years of age group of SARI cases [25.97% (60/231)] (all P values<0.001). The positive rate of HRSV in SARI cases was 2.31%-25.97%, higher than that in ILI cases (0-13.60%) (P=0.016). HRSV was prevalent in autumn and winter from 2016 to 2020 and in spring in 2023. Alternating epidemics of HRSV virus type A and B in Hubei Province from 2016 to 2023 (dominant epidemics of type B in 2016 and 2020; dominant epidemics of type A in 2017-2019 and 2023). Conclusion: SARI and ILI patients under five years old are the main infection groups of HRSV. The seasonal prevalence characteristics of HRSV in Hubei Province from 2016 to 2023 shift from autumn and winter to spring.
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Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Infecciones del Sistema Respiratorio , Humanos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Preescolar , Lactante , China/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Niño , Adolescente , Estaciones del Año , Gripe Humana/epidemiología , Femenino , Masculino , Vigilancia de Guardia , Adulto , Persona de Mediana Edad , Recién NacidoRESUMEN
BACKGROUND: Afghanistan introduced monovalent rotavirus vaccine (Rotarix) into its national immunisation schedule in January, 2018. While post-licensure studies have shown substantial declines in rotavirus gastroenteritis cases and deaths globally, there is little evidence of rotavirus vaccine effectiveness and impact from low-income countries in Asia. We aimed to evaluate the effectiveness of the Rotarix vaccine and the impact of Rotarix vaccine on rotavirus gastroenteritis hospitalisations (ie, hospital admissions) among children younger than 5 years in Afghanistan. METHODS: We used a test-negative case-control design embedded in an active sentinel surveillance platform to evaluate vaccine effectiveness. Children born on or after Jan 1, 2018, who had documentation of their rotavirus vaccination status and who were admitted for acute gastroenteritis at one of four sentinel hospitals from May, 2018 to December, 2021 were eligible to be included. We used an unconditional logistic regression model to estimate vaccine effectiveness and 95% CIs for a complete series of doses compared with no rotavirus vaccine doses among patients admitted with acute gastroenteritis. Vaccine effectiveness against hospitalisation was calculated as (1â-â[odds of being vaccinated in cases]â/â[odds of being vaccinated in controls])â×â100%. We compared pre-vaccine (2013-15) and post-vaccine (2019-21) surveillance data from two sites to calculate vaccine impact. FINDINGS: The vaccine effectiveness analysis included 1172 cases and 2173 controls. Approximately 2108 (63·0%) of 3345 cases and controls were male, 1237 (37·0%) were female, and 2171 (65·0%) were aged 6-11 months. Two doses of Rotarix were 45% (95% CI 22-62) effective against rotavirus hospitalisation in children aged 6-59 months, adjusting for age, severity, admission year, and rotavirus season. Rotavirus positivity decreased from 51% pre-vaccine to 39% post-vaccine, resulting in a 39% adjusted reduction in rotavirus positivity among children younger than 5 years admitted with acute gastroenteritis. INTERPRETATION: Rotarix showed moderate effectiveness in preventing rotavirus gastroenteritis hospitalisations, consistent with findings in other low-income countries. These findings support the continued administration of the rotavirus vaccine in Afghanistan. FUNDING: Gavi, the Vaccine Alliance. TRANSLATION: For the Dari translation of the abstract see Supplementary Materials section.
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Gastroenteritis , Infecciones por Rotavirus , Vacunas contra Rotavirus , Eficacia de las Vacunas , Humanos , Vacunas contra Rotavirus/administración & dosificación , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/epidemiología , Afganistán/epidemiología , Estudios de Casos y Controles , Lactante , Masculino , Femenino , Preescolar , Gastroenteritis/prevención & control , Gastroenteritis/virología , Gastroenteritis/epidemiología , Eficacia de las Vacunas/estadística & datos numéricos , Vacunas Atenuadas/administración & dosificación , Hospitalización/estadística & datos numéricos , Vigilancia de Guardia , Vacunación/estadística & datos numéricosAsunto(s)
Brotes de Enfermedades , Enfermedades de los Caballos , Enfermedades Parasitarias en Animales , Vigilancia de Guardia , Caballos , Animales , Enfermedades de los Caballos/epidemiología , Vigilancia de Guardia/veterinaria , Reino Unido/epidemiología , Brotes de Enfermedades/veterinaria , Enfermedades Parasitarias en Animales/epidemiología , Femenino , Virosis/veterinaria , Virosis/epidemiología , Masculino , Infecciones Bacterianas/veterinaria , Infecciones Bacterianas/epidemiología , EmbarazoAsunto(s)
Enfermedades de las Ovejas , Escocia/epidemiología , Animales , Ovinos , Enfermedades de las Ovejas/epidemiología , Enfermedades de las Ovejas/mortalidad , Bovinos , Vigilancia de Guardia/veterinaria , Enfermedades por Picaduras de Garrapatas/veterinaria , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/mortalidad , Enfermedades de los Bovinos/mortalidad , Enfermedades de los Bovinos/epidemiología , Porcinos , Femenino , Enfermedades de los Animales/epidemiología , Enfermedades de los Animales/mortalidad , Enfermedades de los Porcinos/epidemiología , Enfermedades de los Porcinos/mortalidadRESUMEN
BACKGROUND: Influenza, an acute infectious respiratory disease, presents a significant global health challenge. Accurate prediction of influenza activity is crucial for reducing its impact. Therefore, this study seeks to develop a hybrid Convolution Neural Network-Long Short Term Memory neural network (CNN-LSTM) model to forecast the percentage of influenza-like-illness (ILI) rate in Hebei Province, China. The aim is to provide more precise guidance for influenza prevention and control measures. METHODS: Using ILI% data from 28 national sentinel hospitals in the Hebei Province, spanning from 2010 to 2022, we employed the Python deep learning framework PyTorch to develop the CNN-LSTM model. Additionally, we utilized R and Python to develop four other models commonly used for predicting infectious diseases. After constructing the models, we employed these models to make retrospective predictions, and compared each model's prediction performance using mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), and other evaluation metrics. RESULTS: Based on historical ILI% data from 28 national sentinel hospitals in Hebei Province, the Seasonal Auto-Regressive Indagate Moving Average (SARIMA), Extreme Gradient Boosting (XGBoost), Convolution Neural Network (CNN), Long Short Term Memory neural network (LSTM) models were constructed. On the testing set, all models effectively predicted the ILI% trends. Subsequently, these models were used to forecast over different time spans. Across various forecasting periods, the CNN-LSTM model demonstrated the best predictive performance, followed by the XGBoost model, LSTM model, CNN model, and SARIMA model, which exhibited the least favorable performance. CONCLUSION: The hybrid CNN-LSTM model had better prediction performances than the SARIMA model, CNN model, LSTM model, and XGBoost model. This hybrid model could provide more accurate influenza activity projections in the Hebei Province.
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Predicción , Gripe Humana , Redes Neurales de la Computación , Humanos , China/epidemiología , Gripe Humana/epidemiología , Aprendizaje Profundo , Estudios Retrospectivos , Vigilancia de GuardiaRESUMEN
BACKGROUND: In countries where malaria is endemic, the use of rapid diagnostic tests(RDTs) has become routine, especially in rural settings. Such regions are characterised by often having other co-endemic infectious diseases, at high levels of prevalence. AIM: To illustrate the potential added-value of "sentinel" screening for patients presenting for a routine diagnostic test for malaria, at healthcare facilities in Uganda. METHODS: We developed an economic model by combining two decision trees, one for malaria and a second for the co-endemic disease schistosomiasis. The integrated model was designed to inform policy strategies for the co-endemic disease in addition to malaria (i.e., whether to test opportunistically for schistosomiasis or use mass drug administration(MDA) as per usual practice).We performed the analysis on three comparators varying testing accuracy and costs. RESULTS: Sentinel screening can provide added value to the testing of patients compared with the status quo: when schistosomiasis prevalence is high then MDA is preferential; if low prevalence, treating no one is preferred. If the disease has average levels of prevalence, then a strategy involving testing is preferred. Prevalence thresholds driving the dominant strategy are dependent upon the model parameters, which are highly context specific. At average levels of prevalence for schistosomiasis and malaria for Uganda, adding a sentinel screening was cost-effective when the accuracy of test was higher than current diagnostics and when economies of scope were generated(Expected value clinical Information = 0.65$ per DALY averted, 137.91$ per correct diagnoses).Protocols using diagnostics with current accuracy levels were preferred only for levels of MDA coverage below 75%. CONCLUSION: The importance of the epidemiological setting is crucial in determining the best cost-effective strategy for detecting endemic disease. Economies of scope can make sentinel screenings cost-effective strategies in specific contexts. Blanket thresholds recommended for MDA may not always be the preferred option for endemic diseases.
Asunto(s)
Análisis Costo-Beneficio , Enfermedades Endémicas , Malaria , Esquistosomiasis , Humanos , Esquistosomiasis/diagnóstico , Esquistosomiasis/epidemiología , Esquistosomiasis/economía , Malaria/diagnóstico , Malaria/epidemiología , Uganda/epidemiología , Femenino , Masculino , Adulto , Niño , Adolescente , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/métodos , Persona de Mediana Edad , Preescolar , Adulto Joven , Prevalencia , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Vigilancia de Guardia , Modelos Económicos , AncianoRESUMEN
The influenza-like illness (ILI) sentinel surveillance operates in Brazil to identify respiratory viruses of public health relevance circulating in the country and was first implemented in 2000. Recently, the COVID-19 pandemic reinforced the importance of early detection of the circulation of new viruses in Brazil. Therefore, an analysis of the design of the ILI sentinel surveillance is timely. To this end, we simulated a sentinel surveillance network, identifying the municipalities that would be part of the network according to the criteria defined in the design of the ILI sentinel surveillance and, based on data from tested cases of severe acute respiratory illness (SARI) from 2014 to 2019, we drew samples for each sentinel municipality per epidemiological week. The draw was performed 1,000 times, obtaining the median and 95% quantile interval (95%QI) of virus positivity by Federative Unit and epidemiological week. According to the ILI sentinel surveillance design criteria, sentinel units would be in 64 municipalities, distributed mainly in capitals and their metropolitan areas, recommending 690 weekly samples. The design showed good sensitivity (91.65% considering the 95%QI) for qualitatively detecting respiratory viruses, even those with low circulation. However, there was important uncertainty in the quantitative estimate of positivity, reaching at least 20% in 11.34% of estimates. The results presented here aim to assist in evaluating and updating the ILI sentinel surveillance design. Strategies to reduce uncertainty in positivity estimates need to be evaluated, as does the need for greater spatial coverage.