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69 result(s)
Journal Article > ReviewFull Text

Possible scenarios for the spread of mpox outside the endemic focus in Africa

Int J Infect Dis. 1 April 2025; Volume 153; 107373.; DOI:10.1016/j.ijid.2024.107373
Petersen E, Hvid U, Tomori O, Pedersen AG, Wallinga J,  et al.
Int J Infect Dis. 1 April 2025; Volume 153; 107373.; DOI:10.1016/j.ijid.2024.107373

The recent expansion of mpox in Africa is characterized by a dramatic increase in zoonotic transmission (clade Ia) and the emergence of a new clade Ib that is transmitted from human to human by close contact. Clade Ia does not pose a threat in areas without zoonotic reservoirs. But clade Ib may spread widely, as did clade IIb which has spread globally since 2022 among men who have sex with men. It is not clear whether controlling clade Ib will be more difficult than clade IIb. The population at risk potentially counts 100 million but only a million vaccine doses are expected in the next year. Surveillance is needed with exhaustive case detection, polymerase chain reaction confirmation, clade determination, and about severe illness. Such data is needed to identify routes of transmission and core transmitters, such as sex workers. Health care workers are vaccinated to ensure their protection, but this will not curb mpox transmission. With the recent inequitable distribution of COVID-19 vaccines in mind, it is a global responsibility to ensure that low-income nations in the mpox epicenter have meaningful access to vaccines. Vaccination serves not only to reduce mortality in children but limit the risk of future mpox variants emerging that may spread in human populations globally.

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Journal Article > ResearchFull Text

Risk stratification of childhood infection using host markers of immune and endothelial activation: A multi-country prospective cohort study in Asia (Spot Sepsis)

medRxiv. 5 February 2025; DOI:10.1101/2025.02.03.25321543
Chandna A, Koshiaris C, Mahajan R, Ahmad RA, Anh DTV,  et al.
medRxiv. 5 February 2025; DOI:10.1101/2025.02.03.25321543

BACKGROUND

Circulating markers of immune and endothelial activation risk stratify infection syndromes agnostic to disease aetiology. However, their utility in children presenting from the community remains unclear.


METHODS

This study recruited children aged 1-59 months presenting with community-acquired acute febrile illnesses to seven hospitals in Bangladesh, Cambodia, Indonesia, Laos, and Viet Nam. Clinical parameters and biomarker concentrations were measured at presentation. The outcome measure was death or receipt of vital organ support within two days of enrolment. Prognostic performance of endothelial (Ang-1, Ang-2, sFlt-1) and immune (CHI3L1, CRP, IP-10, IL-1ra, IL-6, IL-8, IL-10, PCT, sTNFR-1, sTREM-1, suPAR) activation markers, WHO Danger Signs, and two validated severity scores (LqSOFA, SIRS) was compared.


RESULTS

3,423 participants were recruited. 133 met the outcome (weighted prevalence: 0.34%; 95% CI 0.28-0.41). sTREM-1 exhibited highest prognostic accuracy (AUC 0.86; 95% CI 0.82-0.90), outperforming WHO Danger Signs (AUC 0.75; 95% CI 0.70-0.80; p < 0.001), LqSOFA (AUC 0.74; 95% CI 0.70-0.78; p < 0.001), and SIRS (AUC 0.63; 95% CI 0.58-0.68; p < 0.001). Discrimination of immune and endothelial activation markers was particularly strong for children who deteriorated later in the course of their illness. Compared to WHO Danger Signs, an sTREM-1-based triage strategy improved recognition of children at risk of progression to life-threatening infection (sensitivity: 0.80 vs. 0.72), while maintaining comparable specificity (0.81 vs. 0.79).


CONCLUSIONS

Measuring circulating markers of immune and endothelial activation may help earlier recognition of febrile children at risk of poor outcomes in resource-constrained community settings.

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Journal Article > ResearchFull Text

Differential symptomology of possible and confirmed Ebola virus disease infection in the Democratic Republic of the Congo: a retrospective cohort study

Lancet Infect Dis. 1 January 2023; Volume 23 (Issue 1); 91-102.; DOI:10.1016/S1473-3099(22)00584-9
Nsio JM, Ardiet DL, Coulborn RM, Grellety E, Albela M,  et al.
Lancet Infect Dis. 1 January 2023; Volume 23 (Issue 1); 91-102.; DOI:10.1016/S1473-3099(22)00584-9
BACKGROUND
In its earliest phases, Ebola virus disease's rapid-onset, high fever, and gastrointestinal symptoms are largely indistinguishable from other infectious illnesses. We aimed to characterise the clinical indicators associated with Ebola virus disease to improve outbreak response.

METHODS
In this retrospective analysis, we assessed routinely collected data from individuals with possible Ebola virus disease attending 30 Ebola health facilities in two provinces of the Democratic Republic of the Congo between Aug 1, 2018, and Aug 28, 2019. We used logistic regression analysis to model the probability of Ebola infection across 34 clinical variables and four types of possible Ebola virus disease exposures: contact with an individual known to have Ebola virus disease, attendance at any funeral, health facility consultation, or consultation with an informal health practitioner.

FINDINGS
Data for 24 666 individuals were included. If a patient presented to care in the early symptomatic phase (ie, days 0–2), Ebola virus disease positivity was most associated with previous exposure to an individual with Ebola virus disease (odds ratio [OR] 11·9, 95% CI 9·1–15·8), funeral attendance (2·1, 1·6–2·7), or health facility consultations (2·1, 1·6–2·8), rather than clinical parameters. If presentation occurred on day 3 or later (after symptom onset), bleeding at an injection site (OR 33·9, 95% CI 12·7–101·3), bleeding gums (7·5, 3·7–15·4), conjunctivitis (2·4, 1·7–3·4), asthenia (1·9, 1·5–2·3), sore throat (1·8, 1·3–2·4), dysphagia (1·8, 1·4–2·3), and diarrhoea (1·6, 1·3–1·9) were additional strong predictors of Ebola virus disease. Some Ebola virus disease-specific signs were less prevalent among vaccinated individuals who were positive for Ebola virus disease when compared with the unvaccinated, such as dysphagia (–47%, p=0·0024), haematemesis (–90%, p=0·0131), and bleeding gums (–100%, p=0·0035).

INTERPRETATION
Establishing the exact time an individual first had symptoms is essential to assessing their infection risk. An individual's exposure history remains of paramount importance, especially in the early phase. Ebola virus disease vaccination reduces symptom severity and should also be considered when assessing the likelihood of infection. These findings about symptomatology should be translated into practice during triage and should inform testing and quarantine procedures.
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Journal Article > Short ReportFull Text

Notes from the field: Hepatitis E Outbreak Among Refugees from South Sudan - Gambella, Ethiopia, April 2014- January 2015

Morbidity and Mortality Weekly Report. 22 May 2015
Browne L, Menkir Z, Kahi V, Maina G, Asnakew S,  et al.
Morbidity and Mortality Weekly Report. 22 May 2015
In early April 2014, two South Sudanese refugees in the Gambella region of western Ethiopia experienced acute onset of jaundice, accompanied by fever. One patient was a pregnant woman aged 24 years evaluated at a routine prenatal clinic visit in Leitchour refugee camp. The second patient was a malnourished boy aged 1 year who resided in Tierkidi refugee camp. The boy died despite hospitalization. During the last 2 weeks of May, four more cases of acute jaundice syndrome (AJS), defined as yellow discoloration of the eyes, were detected in Leitchuor. By mid-June, an additional 50 AJS cases were reported across three large camps in the region, Kule, Leitchuor, and Tierkidi, with 45 (90%) of these cases reported in Leitchuor. Sera collected from a convenience sample of 21 AJS cases were sent to Addis Ababa and Nairobi for real-time polymerase chain reaction testing; 12 (57%) were positive for hepatitis E virus (HEV) RNA. By January 2015, a total of 1,117 suspected cases of hepatitis E meeting the case definition of AJS were reported among refugees in camps across Gambella.More
Journal Article > ReviewFull Text

Diagnosis of viral hepatitis

Curr Opin HIV AIDS. 1 May 2017; Volume 12 (Issue 3); DOI:10.1097/COH.0000000000000370
Easterbrook PJ, Roberts TR, Sands A, Peeling RW
Curr Opin HIV AIDS. 1 May 2017; Volume 12 (Issue 3); DOI:10.1097/COH.0000000000000370
Journal Article > CommentaryAbstract

Ten priorities for expanding access to HCV treatment for people who inject drugs in low- and middle-income countries

Int J Drug Policy. 18 May 2015; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Ford NP, Wiktor SZ, Kaplan K, Andrieux-Meyer I, Hill AM,  et al.
Int J Drug Policy. 18 May 2015; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Journal Article > ResearchFull Text

Hepatitis C seroprevalence and HIV co-infection in sub-Saharan Africa: a systematic review and meta-analysis

Lancet Infect Dis. 5 May 2015; Volume 15 (Issue 7); DOI:10.1016/S1473-3099(15)00006-7
Rao VB, Johari N, du Cros PAK, Messina J, Ford NP,  et al.
Lancet Infect Dis. 5 May 2015; Volume 15 (Issue 7); DOI:10.1016/S1473-3099(15)00006-7
An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa.More
Journal Article > ResearchFull Text

CMV retinitis in China and SE Asia: the way forward

BMC Infect Dis. 24 November 2011; Volume 11 (Issue 1); DOI:10.1186/1471-2334-11-327
Heiden D, Saranchuk P
BMC Infect Dis. 24 November 2011; Volume 11 (Issue 1); DOI:10.1186/1471-2334-11-327
AIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extraocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia.More
Journal Article > ResearchFull Text

Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes

Trop Med Int Health. 7 January 2015; Volume 20 (Issue 4); DOI:10.1111/tmi.12454
Dallatomasinas S, Crestani R, Squire JS, Declerck H, Caleo GNC,  et al.
Trop Med Int Health. 7 January 2015; Volume 20 (Issue 4); DOI:10.1111/tmi.12454
To describe Ebola cases in the district Ebola Management Centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalization characteristics, treatment outcomes and time from symptom onset to admission.More
Journal Article > CommentaryFull Text

Expanding access to treatment for hepatitis C in resource-limited settings: Lessons from HIV/AIDS

Clin Infect Dis. 19 March 2012; Volume 54 (Issue 10); DOI:10.1093/cid/cis227
Ford NP, Singh K, Cooke GS, Mills EJ, von Schoen-Angerer T,  et al.
Clin Infect Dis. 19 March 2012; Volume 54 (Issue 10); DOI:10.1093/cid/cis227