scholarly journals Characteristics of SARS‐CoV ‐2 positive individuals in California from two periods during notable decline in incident infection

2021 ◽  
Vol 4 (4) ◽  
Author(s):  
Lao‐Tzu Allan‐Blitz ◽  
Isaac Turner ◽  
Fred Hertlein ◽  
Jeffrey D. Klausner
Keyword(s):  
Incident Infection

Incident infection during the first year of treatment – A comparison of clozapine and paliperidone palmitate long-acting injection

2022 ◽  
pp. 026988112110589
Author(s):  
Shubhra Mace ◽  
Olubanke Dzahini ◽  
Victoria Cornelius ◽  
Hadar Langerman ◽  
Ebenezer Oloyede ◽  
...  
Keyword(s):  
Mental Health ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Paliperidone Palmitate ◽  
First Year ◽  
Risk Of Infection ◽  
Long Acting ◽  
First Time ◽  
Health Trust ◽  
Incident Infection

Background: To examine the risk of infection in patients prescribed clozapine compared with patients prescribed paliperidone palmitate long-acting injection (PPLAI). Method: A retrospective, 1-year, cohort study conducted on events occurring in eligible patients beginning treatment for the first time with clozapine or PPLAI between June 2017 and June 2019 in a UK mental health trust providing in-patient and out-patient services. Results: The study included 64 patients starting clozapine and 120 patients starting PPLAI. Incidence of infection was greater in clozapine starters than in PPLAI starters (28% vs 6%; p = 0.001; adjusted odds ratio 5.82 (95% confidence interval (CI) = 2.15–15.76, p = 0.001). Infectious episodes in clozapine patients were not related to changes in neutrophil counts. Incident infection in the clozapine group was highest in the first 3 months of treatment. The most commonly reported infection in the clozapine group was chest infection; however, the majority of infections were non-chest-related. Conclusion: Patients starting clozapine showed a substantially increased likelihood of infection compared with patients starting PPLAI.

scholarly journals Initial vancomycin versus metronidazole for the treatment of first-episode non-severe Clostridioides difficile infection

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Kevin Zhang ◽  
Patricia Beckett ◽  
Salaheddin Abouanaser ◽  
Marek Smieja
Keyword(s):  
Treatment Guidelines ◽  
Multivariable Analysis ◽  
Current Treatment ◽  
Multivariate Logistic Regression Model ◽  
First Episode ◽  
Study Cohort ◽  
Clostridioides Difficile ◽  
Nosocomial Diarrhea ◽  
Clostridioides Difficile Infection ◽  
Incident Infection

Abstract Objective: Clostridioides difficile infection (CDI) is the leading cause of infectious nosocomial diarrhea. Although initial fidaxomicin or vancomycin treatment is recommended by most major guidelines to treat severe CDI, there exists varied recommendations for first-episode non-severe CDI. Given the discrepancy in current treatment guidelines, we sought to evaluate the use of initial vancomycin versus metronidazole for first-episode non-severe CDI. Methods: We conducted a retrospective cohort study of all adult inpatients with first-episode CDI at our institution from January 2013 to May 2018. The initial vancomycin versus initial metronidazole cohorts were examined using a multivariate logistic regression model. Results: The study cohort of 737 patients had a median age of 72.3 years, and 357 of these patients (48.4%) had hospital-acquired infection. Among 326 patients with non-severe CDI, recurrence, new incident infection, and 30-day mortality rates were 16.2%, 10.9%, and 5.3%, respectively, when treated with initial metronidazole, compared to 20.0%, 1.4%, and 10.0%, respectively, when treated with initial vancomycin. In an adjusted multivariable analysis, the use of initial vancomycin for the treatment of non-severe CDI was associated with a reduction in new incident infection (adjusted odds ratio [ORadj], 0.11; 95% confidence interval [CI], 0.02–0.86; P = .035), compared to initial metronidazole. Conclusions: Initial vancomycin was associated with a reduced rate of new incident infection in the treatment of adult inpatients with first-episode non-severe CDI. These findings support the use of initial vancomycin for all inpatients with CDI, when fidaxomicin is unavailable.

Reduced Endometrial Ascension and Enhanced Reinfection Associated with IgG Antibodies to Specific Chlamydia trachomatis Proteins in Women at Risk for Chlamydia

2021 ◽  
Author(s):  
Chuwen Liu ◽  
Katrin Hufnagel ◽  
Catherine M O’Connell ◽  
Nilu Goonetilleke ◽  
Neha Mokashi ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Transcript Abundance ◽  
Stepwise Logistic Regression ◽  
Gene Transcript ◽  
Igg Antibody ◽  
Wilcoxon Rank Sum Test ◽  
Gene Transcripts ◽  
The Impact ◽  
Incident Infection

Abstract Background Previous research revealed antibodies targeting Chlamydia trachomatis (CT) elementary bodies was not associated with reduced endometrial or incident infection in CT-exposed women. However, data on the role of CT protein-specific antibodies in protection are limited. Methods A whole-proteome CT array screening serum pools from CT-exposed women identified 121 immunoprevalent proteins. Individual sera were probed using a focused array. IgG antibody frequencies and endometrial or incident infection relationships were examined using Wilcoxon Rank sum test. The impact of breadth and magnitude of protein-specific IgGs on ascension and incident infection were examined using multivariable stepwise logistic regression. Complementary RNA-sequencing quantified CT gene transcripts in cervical swabs from infected women. Results IgG to Pgp3 and CT005 were associated with reduced endometrial infection; anti-CT443, -CT486 and -CT123 were associated with increased incident infection. Increased breadth of protein recognition did not however predict protection from endometrial or incident infection. mRNAs for immunoprevalent CT proteins were highly abundant in the cervix. Conclusions Protein-specific CT antibodies are not sufficient to protect against ascending or incident infection but broad recognition of CT proteins by IgG correlates with cervical CT gene transcript abundance, suggesting CT protein abundance correlates with immunogenicity and signifies their potential as vaccine candidates.

scholarly journals HIV-1 Transmission linkages among persons with incident infection to inform public health surveillance

2021 ◽  
Vol 37 ◽  
pp. 100968
Author(s):  
Ann M. Dennis ◽  
Simon D.W. Frost ◽  
Kimberly Enders ◽  
Andrew E. Cressman ◽  
Erik Volz ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Surveillance ◽  
Health Surveillance ◽  
Hiv 1 ◽  
Incident Infection

scholarly journals HIV incidence and associated risk factors in female spouses of men who inject drugs in Pakistan

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jenny Iversen ◽  
Salman ul H Qureshi ◽  
Malika Zafar ◽  
Machteld Busz ◽  
Lisa Maher
Keyword(s):  
Hiv Transmission ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hiv Prevalence ◽  
Hiv Incidence ◽  
Hiv Education ◽  
Number Of Children ◽  
Cox Proportional Hazards Models ◽  
Incident Infection ◽  
Female Spouses

Abstract Introduction Female sexual partners of men who inject drugs (MWID) living with HIV are at risk of HIV transmission. HIV prevalence estimates among non-drug using female sex partners of MWID are scarce, with no studies documenting HIV incidence. We investigated HIV prevalence and incidence among female spouses of MWID registered at Nai Zindagi Trust (NZT), Pakistan, between 2012 and 2019. Methods NZT registration and service provision data for female spouses who participated in HIV testing and counselling calculated HIV prevalence and incidence using the person years (PY) method. Cox proportional hazards models identified factors associated with incident infection. Results Overall HIV prevalence among female spouses of MWID was 8.5%. Among 3478 HIV-negative female spouses, 109 incident infections were observed, yielding an incidence rate of 1.5/100PY (95% CI 1.2–1.8). Independent predictors of incident infection were registration in Punjab province (AHR 1.73 95% CI 1.13–2.68, p = 0.012) and 1–5 years of education (AHR 1.89 95% CI 1.22–2.93, p = 0.004). Knowledge of HIV at registration was protective against infection (AHR 0.51, 95% CI 0.26–0.99, p = 0.047), along with a MWID spouse who had initiated antiretroviral therapy (ART) (AHR 0.25, 95% CI 0.16–0.38, p < 0.001), while incident infection was inversely associated with number of children (≥ 5 children AHR 0.44 95% CI 0.22–0.88, p = 0.022). Conclusions Additional efforts are needed to reduce HIV transmission among female spouses of MWID, including targeted provision of HIV education and access to HIV screening. Interventions that target MWID are also required, including evidence-based drug treatment and access to ART, including support to maximize adherence. Finally, consideration should be given to making HIV pre-exposure prophylaxis available to female spouses at high risk of HIV transmission, particularly young women and those whose husbands are not receiving, or have difficulty adhering to, ART.

scholarly journals Characterising heterogeneity and sero-reversion in antibody responses to mild SARS⍰CoV-2 infection: a cohort study using time series analysis and mechanistic modelling

2020 ◽  
Author(s):  
C Manisty ◽  
TA Treibel ◽  
M Jensen ◽  
A Semper ◽  
G Joy ◽  
...  
Keyword(s):  
Production Rate ◽  
Humoral Immunity ◽  
Antibody Production ◽  
Nucleocapsid Protein ◽  
Care Workers ◽  
Antibody Production Rate ◽  
Antibody Titres ◽  
Antibody Levels ◽  
Incident Infection

AbstractBackgroundSARS-CoV-2 serology is used to identify prior infection at individual and at population level. Extended longitudinal studies with multi-timepoint sampling to evaluate dynamic changes in antibody levels are required to identify the time horizon in which these applications of serology are valid, and to explore the longevity of protective humoral immunity.MethodsHealth-care workers were recruited to a prospective cohort study from the first SARS-CoV-2 epidemic peak in London, undergoing weekly symptom screen, viral PCR and blood sampling over 16-21 weeks. Serological analysis (n=12,990) was performed using semi-quantitative Euroimmun IgG to viral spike S1 domain and Roche total antibody to viral nucleocapsid protein (NP) assays. Comparisons were made to previously reported pseudovirus neutralising antibody measurements.FindingsA total of 157/729 (21.5%) participants developed positive SARS-CoV-2 serology by one or other assay, of whom 31.0% were asymptomatic and there were no deaths. Peak Euroimmun anti-S1 and Roche anti-NP measurements correlated (r=0.57, p<0.0001) but only anti-S1 measurements correlated with near-contemporary pseudovirus neutralising antibody titres (measured at 16-18 weeks, r=0.57, p<0.0001). By 21 weeks’ follow-up, 31/143 (21.7%) anti-S1 and 6/150 (4.0%) anti-NP measurements reverted to negative. Mathematical modelling suggested faster clearance of anti-S1 compared to anti-NP (median half-life of 2.5 weeks versus 4.0 weeks), earlier transition to lower levels of antibody production (median of 8 versus 13 weeks), and greater reductions in relative antibody production rate after the transition (median of 35% versus 50%).InterpretationMild SARS-CoV-2 infection is associated with heterogenous serological responses in Euroimmun anti-S1 and Roche anti-NP assays. Anti-S1 responses showed faster rates of clearance, more rapid transition from high to low level production rate and greater reduction in production rate after this transition. The application of individual assays for diagnostic and epidemiological serology requires validation in time series analysis.FundingCharitable donations via Barts CharityResearch in contextEvidence before this studyWe searched PubMed, medRxiv, and bioRxiv for [“antibody” OR “serology”] AND [“SARS-CoV-2” OR “COVID-19”]. The available literature highlights widespread use of serology to detect recent SARS-CoV-2 infection in individual patients and in population epidemiological surveys. Antibody to virus spike protein S1 domain is widely reported to correlate with neutralising antibody titres. The existing assays have good sensitivity to detect seroconversion within 14 days of incident infection, but the available longitudinal studies have reported variable rates of decline in antibody levels and reversion to undetectable levels in some people over 3 months. High frequency multi-time point serology data for different antibody targets or assays in longitudinal cohorts from the time of incident infection to greater than 3 months follow up are lacking.Added value of this studyWe combine detailed longitudinal serology using the Euroimmun anti-S1 and Roche anti-nucleocapsid protein (NP) assays in 731 health care workers from the time of the first SARS-CoV-2 epidemic peak in London, UK. In 157 seroconverters (using either assay) we show substantial heterogeneity in semiquantitative antibody measurements over time between individuals and between assays. Mathematical modelling of individual participant antibody production and clearance rates in individuals with at least 8 data points over 21 weeks showed anti-S1 antibodies to have a faster clearance rate, earlier transition from the initial antibody production rate to lower rates, and greater reduction in antibody production rate after this transition, compared to anti-NP antibodies as measured by these assays. As a result, Euroimmun anti-S1 measurements peaked earlier and then reduced more rapidly than Roche anti-NP measurements. In this study, these differences led to 21% anti-S1 sero-reversion, compared to 4% anti-NP sero-reversion over 4-5 months.Implications of all of the available evidenceThe rapid decline in anti-S1 antibodies measured by the Euroimmun assay following infection limits its application for diagnostic and epidemiological screening. If generalisable, these data are consistent with the hypothesis that anti-S1 mediated humoral immunity may not be sustained in some people beyond the initial post-infective period. Further work is required to understand the mechanisms behind the heterogeneity in antibody kinetics between individuals to SARS-CoV-2. Our data point to differential mechanisms regulating humoral immunity against these two viral targets.

scholarly journals Exhaled Mycobacterium tuberculosis predicts incident infection in household contacts

2021 ◽  
Author(s):  
Caroline ML Williams ◽  
Abdul K Muhammad ◽  
Basil Sambou ◽  
Adama Bojang ◽  
Alhaji Jobe ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Face Mask ◽  
Public Health Importance ◽  
Outbreak Management ◽  
Non Invasive ◽  
Household Contacts ◽  
Screening Strategies ◽  
Highly Sensitive ◽  
Incident Infection ◽  
Logistical Regression Analysis

Background Halting transmission of Mycobacterium tuberculosis (Mtb) by identifying infectious individuals early is key to eradicating Tuberculosis (TB). Here we evaluate face mask sampling as a tool for stratifying infection risk in household contacts of pulmonary TB (pTB). Methods Forty-six sputum positive pTB patients in The Gambia (Aug 2016-Nov 2017) consented to mask sampling prior to commencing treatment. Incident Mtb infection was defined in their 181 household contacts as QuantiFERON (QFT) conversion or an increase in Interferon-ƴ release of ≥ 1IU/ml, 6 months after index diagnosis. Multilevel mixed-effects logistical regression analysis with cluster adjustment by household was used to identify predictors of incident infection. Findings Mtb was detected in 91% of pTB mask samples with high variation in IS6110 copies (5.3 x102 to 1.2 x107). A high mask Mtb level (≥20,000 IS6110 copies) was observed in 45% of cases and independently associated with increased likelihood of incident Mtb infection in contacts (AOR (95%CI) 3.20 (1.26 - 8.12), p=0.01), compared with cases having low/negative mask Mtb levels. Mask Mtb level was a better predictor of incident Mtb infection than sputum bacillary load, chest radiographic characteristics or sleeping proximity. Interpretation Mask sampling offers a highly sensitive and non-invasive tool to support both diagnosis of pTB and stratification of individuals who are most infectious. Our findings have the potential to revolutionise contact screening strategies and outbreak management in high TB burden settings and is of urgent public health importance.

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