scholarly journals Vaccination against antibiotic resistant gonorrhoea for men who have sex with men in England: a modelling study

2019 ◽  
Author(s):  
Lilith K Whittles ◽  
Peter J. White ◽  
Xavier Didelot
Keyword(s):  
Antibiotic Resistance ◽  
Case Scenario ◽  
Symptomatic Infection ◽  
Worst Case ◽  
Antibiotic Resistant ◽  
Worst Case Scenario ◽  
Health Clinics ◽  
Sex With Men ◽  
Sexual Health Clinics ◽  
The Impact

SUMMARYBackgroundGonorrhoea incidence is increasing rapidly: diagnoses in men who have sex with men (MSM) in England increased eight-fold 2008-2017. Concurrently, antibiotic resistance is making treatment more difficult, leading to renewed interest in a gonococcal vaccine. The MeNZB meningococcal B vaccine is partially protective, and several other candidates are in development. We modelled realistic vaccination strategies under various scenarios of antibiotic resistance and vaccine protection level and duration, to assess the impact of vaccination and examine the feasibility of the WHO’s target of reducing gonorrhoea incidence by 90% between 2016 and 2030.MethodsWe fitted a stochastic transmission-dynamic model, incorporating asymptomatic and symptomatic infection and heterogeneous sexual behaviour, to gonorrhoea incidence in MSM in England, 2008-17, using particle Markov Chain Monte Carlo methods. Bayesian forecasting was used to examine future scenarios, including emergence of extensively antibiotic-resistant (ABR) gonorrhoea.FindingsEven in the worst-case scenario of untreatable infection emerging, the WHO target could be met by vaccinating all MSM attending sexual health clinics with a 53%-protective vaccine lasting for >6 years, or a 70%-protective vaccine lasting >3 years. A vaccine like MeNZB, conferring 30% protection for 2-4 years, could reduce incidence in 2030 by 45% in the worst-case scenario, and by 75% if >70% of ABR gonorrhoea is treatable.InterpretationOur statistically-rigorous assessment shows that even a partially-protective vaccine, delivered through a practical targeting strategy, could have substantial benefit in reducing gonorrhoea incidence in the context of an epidemic with rising antibiotic resistance.

scholarly journals Assessment of the Potential of Vaccination to Combat Antibiotic Resistance in Gonorrhea: A Modeling Analysis to Determine Preferred Product Characteristics

2020 ◽  
Vol 71 (8) ◽  
pp. 1912-1919
Author(s):  
Lilith K Whittles ◽  
Peter J White ◽  
Xavier Didelot
Keyword(s):  
Antibiotic Resistance ◽  
World Health ◽  
Case Scenario ◽  
Symptomatic Infection ◽  
Worst Case ◽  
Worst Case Scenario ◽  
Health Clinics ◽  
Sex With Men ◽  
Sexual Health Clinics ◽  
Duration Of Protection

Abstract Background Gonorrhea incidence is increasing rapidly in many countries, while antibiotic resistance is making treatment more difficult. Combined with evidence that two meningococcal vaccines are likely partially protective against gonorrhea, this has renewed interest in a gonococcal vaccine, and several candidates are in development. Key questions are how protective and long-lasting a vaccine needs to be, and how to target it. We assessed vaccination’s potential impact and the feasibility of achieving the World Health Organization’s (WHO) target of reducing gonorrhea incidence by 90% during 2018–2030, by comparing realistic vaccination strategies under a range of scenarios of vaccine efficacy and duration of protection, and emergence of extensively-resistant gonorrhea. Methods We developed a stochastic transmission-dynamic model, incorporating asymptomatic and symptomatic infection and heterogeneous sexual behavior in men who have sex with men (MSM). We used data from England, which has a comprehensive, consistent nationwide surveillance system. Using particle Markov chain Monte Carlo methods, we fitted to gonorrhea incidence in 2008–2017, then used Bayesian forecasting to examine an extensive range of scenarios. Results Even in the worst-case scenario of untreatable infection emerging, the WHO target is achievable if all MSM attending sexual health clinics receive a vaccine offering ≥ 52% protection for ≥ 6 years. A vaccine conferring 31% protection (as estimated for MeNZB) for 2–4 years could reduce incidence in 2030 by 45% in the worst-case scenario, and by 75% if > 70% of resistant gonorrhea remains treatable. Conclusions Even a partially-protective vaccine, delivered through a realistic targeting strategy, could substantially reduce gonorrhea incidence, despite antibiotic resistance.

scholarly journals Validation of a Worst-Case Scenario Method Adapted to the Healthcare Environment for Testing the Antibacterial Effect of Brass Surfaces and Implementation on Hospital Antibiotic-Resistant Strains

Antibiotics ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 245
Author(s):  
Emilie Dauvergne ◽  
Corinne Lacquemant ◽  
Crespin Adjidé ◽  
Catherine Mullié
Keyword(s):  
Exposure Time ◽  
Antibacterial Effect ◽  
Real Life ◽  
Health Care Facilities ◽  
Case Scenario ◽  
Worst Case ◽  
Antibiotic Resistant ◽  
Worst Case Scenario ◽  
Resistant Strains ◽  
The Impact

The evaluation of antibacterial activity of metal surfaces can be carried out using various published guidelines which do not always agree with each other on technical conditions and result interpretation. Moreover, these technical conditions are sometimes remote from real-life ones, especially those found in health-care facilities, and do not include a variety of antibiotic-resistant strains. A worst-case scenario protocol adapted from published guidelines was validated on two reference strains (Staphylococcus aureus ATCC 6538 and Enterobacter aerogenes ATCC 13048). This protocol was designed to be as close as possible to a healthcare facility environment, including a much shorter exposure-time than the one recommended in guidelines, and evaluated the impact of parameters such as the method used to prepare inocula, seed on the surface, and recover bacteria following exposure. It was applied to a panel of 12 antibiotic-resistant strains (methicillin resistant, vancomycin-resistant, beta-lactamase, and carbapenemase producing strains as well as efflux pump-overexpressing ones) chosen as representative of the main bacteria causing hospital acquired infections. Within a 5-min exposure time, the tested brass surface displayed an antibacterial effect meeting a reduction cut-off of 99% compared to stainless steel, whatever the resistance mechanism harbored by the bacteria.

scholarly journals Antibiotic resistance detection is essential for gonorrhoea point-of-care testing: A mathematical modelling study

2017 ◽  
Author(s):  
Stephanie M. Fingerhuth ◽  
Nicola Low ◽  
Sebastian Bonhoeffer ◽  
Christian L. Althaus
Keyword(s):  
Antibiotic Resistance ◽  
Clinical Pathways ◽  
Point Of Care ◽  
High Sensitivity ◽  
Nucleic Acid Amplification ◽  
Transmission Model ◽  
Antibiotic Resistant ◽  
Sex With Men ◽  
The Impact ◽  
Resistance Detection

AbstractAntibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC + R) and without (POC − R) resistance detection, culture, and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections, cases averted after 5 years, and compared how fast resistant infections spread in the populations. The proportion of resistant infections after 30 years is lowest for POC + R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HWM: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC − R (MSM: 100%, HMW: 99.73%). NAAT leads to 36 366 (median MSM) and 1 228 (median HMW) observed cases after 5 years. When compared with NAAT, POC + R results in most cases averted after 5 years (median MSM: 3 353, HMW: 118 per 100 000 persons). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than using culture. POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.

scholarly journals A preliminary scenario analysis of the impacts of teleworking on energy consumption and greenhouse gas (GHG) emissions

2021 ◽  
Vol 2069 (1) ◽  
pp. 012077
Author(s):  
Farzam Kharvari ◽  
Sara Azimi ◽  
William O’Brien
Keyword(s):  
Energy Consumption ◽  
Scenario Analysis ◽  
Energy Use ◽  
Residential Buildings ◽  
Ghg Emissions ◽  
Level Energy ◽  
Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario ◽  
The Impact

Abstract This paper uses scenario analysis to investigate the broader impact of teleworking in four scenarios including the COVID-19 pandemic, worst-, moderate-, and best-case scenarios on building-level energy use, energy consumption in transportation, and information and communication technology (ICT) usage by using the databases of the Government of Canada. The COVID-19 scenario relies on the available data for the pandemic period. The worst-case scenario is when telework has an adverse effect on energy use while the moderate-and best-case scenarios are when the minimum and maximum savings are achieved by telework. The data includes commuting distances, electricity and natural gas consumption for offices and residential buildings, and ICT usage. Then, the associated GHG emissions are calculated for transportation, residential and office buildings, and ICT and the analysis are carried out by applying a potential fraction of saving to the associated GHG emissions of each domain and scenario. This paper demonstrates the potential energy savings of teleworking significantly depends on teleworker behavior to a degree that in the worst-case scenario no potential saving is observed while the savings are significant in the best-case scenario. Therefore, the impact of telework is highly uncertain and complicated and current statistics are insufficient for accurate estimates.

Reducing Probabilistic Weather Forecasts to the Worst Case Scenario: Anchoring Effects

2008 ◽  
Author(s):  
Sonia Savelli ◽  
Susan Joslyn ◽  
Limor Nadav-Greenberg ◽  
Queena Chen
Keyword(s):  
Case Scenario ◽  
Worst Case ◽  
Weather Forecasts ◽  
Worst Case Scenario ◽  
Anchoring Effects

scholarly journals A Comparison of Match Demands Using Ball-in-Play versus Whole Match Data in Professional Soccer Players of the English Championship

Sports ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 76
Author(s):  
Dylan Mernagh ◽  
Anthony Weldon ◽  
Josh Wass ◽  
John Phillips ◽  
Nimai Parmar ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Soccer Players ◽  
Training Methods ◽  
Case Scenario ◽  
Worst Case ◽  
Repeated Measures Design ◽  
Worst Case Scenario ◽  
Professional Soccer ◽  
Peak Match ◽  
Playing Time

This is the first study to report the whole match, ball-in-play (BiP), ball-out-of-play (BoP), and Max BiP (worst case scenario phases of play) demands of professional soccer players competing in the English Championship. Effective playing time per soccer game is typically <60 min. When the ball is out of play, players spend time repositioning themselves, which is likely less physically demanding. Consequently, reporting whole match demands may under-report the physical requirements of soccer players. Twenty professional soccer players, categorized by position (defenders, midfielders, and forwards), participated in this study. A repeated measures design was used to collect Global Positioning System (GPS) data over eight professional soccer matches in the English Championship. Data were divided into whole match and BiP data, and BiP data were further sub-divided into different time points (30–60 s, 60–90 s, and >90 s), providing peak match demands. Whole match demands recorded were compared to BiP and Max BiP, with BiP data excluding all match stoppages, providing a more precise analysis of match demands. Whole match metrics were significantly lower than BiP metrics (p < 0.05), and Max BiP for 30–60 s was significantly higher than periods between 60–90 s and >90 s. No significant differences were found between positions. BiP analysis allows for a more accurate representation of the game and physical demands imposed on professional soccer players. Through having a clearer understanding of maximum game demands in professional soccer, practitioners can design more specific training methods to better prepare players for worst case scenario passages of play.

scholarly journals Is it time to move to nucleic acid amplification tests screening for pharyngeal and rectal gonorrhoea in men who have sex with men to improve gonorrhoea control?

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 9 ◽  
Author(s):  
Christopher K. Fairley ◽  
Marcus Y. Chen ◽  
Catriona S. Bradshaw ◽  
Sepehr N. Tabrizi
Keyword(s):  
Nucleic Acid ◽  
Antimicrobial Resistance ◽  
Sexual Health ◽  
Nucleic Acid Amplification ◽  
Nucleic Acid Amplification Tests ◽  
Health Clinics ◽  
Sex With Men ◽  
Sexual Health Clinics

The use of nucleic acid amplification tests (NAAT), as well as or in preference to culture for non-genital sites is now recommended both in Australia and overseas because of their greater sensitivity and improved specificity. A survey of 22 Australian sexual health clinics who each year test over 14 500 men who have sex with men (MSM) show that culture remains the predominate method for detecting gonorrhoea at pharyngeal (64%) and rectal (73%) sites. This editorial discusses the potential disadvantages of using culture over NAAT in relation to optimal gonorrhoea control among MSM and advocates that significantly improved control would be achieved by moving to NAAT with the proviso that culture samples are taken wherever possible on NAAT-positive samples and from clients with urethritis to ensure continued surveillance for antimicrobial resistance.

Legal adaptability in Elbonia

2006 ◽  
Vol 2 (4) ◽  
pp. 393-408 ◽  
Author(s):  
Mathias M. Siems
Keyword(s):  
Empirical Data ◽  
Baltic States ◽  
Case Scenario ◽  
Worst Case ◽  
Worst Case Scenario ◽  
The Law

Law has to be able to respond to new or changing circumstances. This ‘legal adaptability’ may be more important than details in the ‘law as such’. However, its meaning and its significance have not yet been analysed in detail. Thus, legal adaptability will be examined in this article. It looks at the worst case scenario by discussing a fictional country (Elbonia) where legal adaptability is poor, and identifies the main adaptability criteria. By using empirical data from the three Baltic States (Lithuania, Latvia, Estonia), it also provides an example of how to ascertain the degree of legal adaptability of particular countries.

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