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Anti-SARS-CoV-2 vaccination has saved millions of lives in the past few years. To maintain a high level of protection, particularly in at-risk populations, booster doses are recommended to counter the waning of circulating antibody levels over time and the continuous emergence of immune escape variants of concern (VOCs). As anti-spike serology is now widely available, it may be considered a useful tool to identify individuals needing an additional vaccine dose, i.e., to screen certain populations to identify those whose plasma antibody levels are too low to provide protection. However, no recommendations are currently available on this topic. We reviewed the relevant supporting and opposing arguments, including areas of uncertainty, and concluded that in most populations, spike serology should not be used to decide about the administration of a booster dose. The main counterarguments are as follows: correlates of protection are imperfectly characterised, essentially owing to the emergence of VOCs; spike serology has an intrinsic inability to comprehensively reflect the whole immune memory; and booster vaccines are now VOC-adapted, while the commonly available commercial serological assays explore antibodies against the original virus., Competing Interests: Declaration of competing interest Anna L. Goodman reports grants from Novavax to run vaccine trials and non-commercial funding from the INSIGHT network (NIH-TICO trial) to her institution outside of the submitted work; moreover, ALG is named on a patent AstraZeneca vaccine issued to the University of Oxford and has received personal financial contributions for this. Manuel Krone received honoraria from Abbott, GSK and Pfizer outside this work. All other authors have not conflict of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Envenomation due to exposure to caterpillars is an emerging public health problem. A life-threatening bleeding diathesis has been described in South America after exposure to Lonomia obliqua or L. acheolus. Deforestation, forest degradation, and global warming might increase the frequency of human exposure to these insects. Prompt recognition and administration of antivenom are crucial to ensure a favorable outcome., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Cryptococcus neoformans, an opportunistic fungal pathogen, primarily infects immunodeficient patients frequently causing cryptococcal meningoencephalitis (CM). Increased intracranial pressure (ICP) is a serious complication responsible for increased morbidity and mortality in CM patients. Non-invasive pharmacological agents that mitigate ICP could be beneficial in treating CM patients. The objective of the study was to investigate the efficacy of acetazolamide (AZA), candesartan (CAN), and triciribine (TCBN), in combination with the antifungal fluconazole, on C. neoformans-induced endothelial, brain, and lung injury in an experimental mouse model of CM. Our study shows that C. neoformans increases the expression of brain endothelial cell (BEC) junction proteins Claudin-5 (Cldn5) and VE-Cadherin to induce pathological cell-barrier remodeling and gap formation associated with increased Akt and p38 MAPK activation. All three agents inhibited C. neoformans-induced endothelial gap formation, only CAN and TCBN significantly reduced C. neoformans-induced Cldn5 expression, and only TCBN was effective in inhibiting Akt and p38MAPK. Interestingly, although C. neoformans did not cause brain or lung edema in mice, it induced lung and brain injuries, which were significantly reversed by AZA, CAN, or TCBN. Our study provides novel insights into the direct effects of C. neoformans on BECs in vitro, and the potential benefits of using AZA, CAN, or TCBN in the management of CM patients., Competing Interests: Declaration of competing interest PRS is a scientific advisor of Ayma Therapeutics, NJ. All other authors declare that there are no financial or other conflicts of interest exist., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Despite the availability of a safe and effective vaccine, yellow fever remains a major vaccine-preventable disease in endemic regions. Additionally, travelers risk acquiring yellow fever when visiting areas of endemic transmission or locations with ongoing outbreaks. Yellow fever is a viral hemorrhagic fever that has inflicted stigma, illness, and death among human societies. From the 17 th to the 19 th centuries, yellow fever remained a mysterious illness that predominantly affected tropical regions in Africa, the Caribbean and the Americas. The disease was as feared as cholera or smallpox, and played a significant geopolitical role in shaping modern societies. Epidemics of yellow fever brought out the best and the worst of human nature: the disease spread to new regions during the Atlantic slave trade; while the identification of its causative viral agent and mode of transmission, as well as the development of a vaccine, were made possible by the sacrifice of selfless scientists. Confirmation of the vector transmission of YF paved the way for the development of an effective vaccine in the first half of the 20 th century. Encroachment of human settlements into locations with sylvatic transmission has blurred the distinction between the urban and sylvatic cycles. Introduction or expansion of routine immunization activities and reaching hard-to-reach populations consitute public health priorities toward ensuring vaccine equity in endemic areas. It is also critical to ensure the timely immunization of at-risk populations during outbreaks and to promote vaccination of international travelers. We conclude that the threat of YF will linger far into the 21 st century as a leading public health emergency of global concern under the International Health Regulations., (Copyright © 2022. Published by Elsevier Inc.)

Competing Interests: We declare no competing interests.

Rapid rise of population migration is a defining feature of the 21st century due to the impact of climate change, political instability, and socioeconomic downturn. Over the last decade, an increasing number of migrant peoples travel across the Americas to reach the United States seeking asylum or cross the border undocumented in search of economic opportunities. In this journey, migrant people experience violations of their human rights, hunger, illness, violence and have limited access to medical care. In the 'Divine Comedy', the Italian poet Dante Alighieri depicts his allegorical pilgrimage across Hell and Purgatory to reach Paradise. More than 700 years after its publication, Dante's poem speaks to the present time and the perilious journey of migrant peoples to reach safehavens. By exploring the depths and heights of the human condition, Dante's struggles resonate with the multiple barriers and the unfathomable experiences faced by migrant peoples in transit across South, Central, and North America to reach the United States. Ensuring the safety of migrant peoples across the Americas and elsewhere, and attending to their health needs during their migratory paths represent modern priorities to reduce social injustices and achieving health equity., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Jails and prisons are exceptionally susceptible to viral outbreaks, such as severe acute respiratory syndrome coronavirus 2. The USA has extremely high rates of incarceration and COVID-19 is causing an urgent health crisis in correctional facilities and detention centres. Epidemics happening in prisons are compounding the elevated risks that COVID-19 poses to people of colour, older people, and those with comorbidities. Intersectoral community re-entry efforts in the USA and other countries have shown that releasing people from correctional facilities as a pandemic-era public health intervention is safe and can support both public safety and community rebuilding. Therefore, substantial decarceration in the USA should be initiated. A point of focus for such efforts is that many people in prison are serving excessively long sentences and pose acceptable safety risks for release. Properly managed, correctional depopulation will prevent considerable COVID-19 morbidity and mortality and reduce prevailing socioeconomic and health inequities., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Over the past two decades, several countries in Latin American, particularly Brazil, Venezuela, and Colombia, have experienced multiple outbreaks of oral Chagas disease. Transmission occurs secondary to contamination of food or beverages by triatomine (kissing bug) feces containing infective Trypanosoma cruzi metacyclic trypomastigotes. Orally transmitted infections are acute and potentially fatal. Oral Chagas transmission carries important clinical implications from management to public health policies compared to vector-borne transmission. This review aims to discuss the contemporary situation of orally acquired Chagas disease, and its eco-epidemiology, pathogenesis, and clinical management. We also propose preventive public health interventions to reduce the burden of disease and provide important perspectives for travel medicine. Travel health advisors need to counsel intending travellers to South America on avoidance of "deadly feasts" - risky beverages such as fruit juices including guava juice, bacaba, babaçu and palm wine (vino de palma), açai pulp, sugar cane juice and foodstuffs such as wild animal meats that may be contaminated with T. cruzi., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

For centuries, yellow fever virus infection generated substantial fear among explorers, tourist travellers, workers, military personnel, and others entering areas of transmission. Currently, there is transmission only in some areas of tropical South America and sub-Saharan Africa. When symptomatic, yellow fever infection causes severe liver dysfunction and coagulopathy with elevated mortality rates. Since there is no effective treatment, vaccination against yellow fever, available since 1937, represents an important preventive intervention in endemic areas. Every year, an increasing number of individuals are travelling to yellow fever endemic areas, many of whom have complex medical conditions. Travel health practitioners should do individualised assessments of the risks and benefits of yellow fever vaccination to identify potential contraindications. The most relevant contraindications include a history of thymoma or thymus dysfunction, AIDS, and individuals receiving immunosuppressive drugs including biological therapies or chemotherapy. We briefly review strategies to prevent yellow fever infection in travellers with the use of yellow fever vaccination and the use of personal protection measures to avoid mosquito bites., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date., Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI)., Results: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 95%CI 40.8-74.4%) and dyspnea (45.6%, 95%CI 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock. Some 13.9% (95%CI 6.2-21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR)., Conclusion: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19., Competing Interests: Declaration of competing interest All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Brucellosis remains as a significant public health concern in many areas where the infection persists in domestic hosts (i.e. goats, cattle, and domestic swine) with subsequent risk of transmission to human populations. Brucellosis caused by B. suis remains an important threat to human populations in many countries exposed to domestic and feral swine. In the U.S., swine brucellosis has been under control for many years. Meanwhile, it is a widespread infection among feral swine, particularly in the Southeastern United States; and exposure to infected animals pose a growing threat to humans. We present the case of a 31-year male hunter who six weeks after a knife injury to his hand while field dressing a wild boar, developed a febrile illness associated with hematologic abnormalities and splenic abscesses caused by Brucella suis infection., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C gattii., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Aims: Streptococcus pneumoniae infection continues to be a major source of morbidity and mortality in children in Mexico. The aim of this study was to evaluate the immune response to six serotypes in children <5 years of age after immunization with a 23-valent pneumococcal polysaccharide vaccine., Methods: A prospective study was conducted among children aged from 18 months to 4 years. Pre- and postvaccination titers for the serotypes selected in this project demonstrate a substantial response among all age groups., Results: We identified mild adverse events in 62% of the participants in this study. No serious adverse events were reported during the study., Conclusions: Pneumococcal polysaccharide vaccine produced adequate immunogenicity in all age groups evaluated., (Copyright © 2012 IMSS. Published by Elsevier Inc. All rights reserved.)

Outbreaks of influenza A (H1N1) of avian- or swine-related origin have substantially impacted human populations. The most dramatic pandemic of influenza H1N1 occurred during 1918-1919 producing significant morbidity and mortality worldwide. In the 20th century, two other major pandemics took place but they were the H2N2 and H3N2 reassorted influenza strains. In 1976, a small outbreak of swine-related H1N1 in the U.S. led to a national scare but without any significant public health impact. More recently, in April 2009, in Mexico, and subsequently worldwide, an influenza (H1N1) triple reassortant strain produced >200,000 laboratory-confirmed cases and resulted in >2000 deaths. In August 2009, WHO declared this outbreak as the first influenza pandemic of the 21(st) century. It is critical to apply lessons learned during previous pandemics to mitigate the public health impact of the ongoing influenza pandemic in 2009. In particular, it is useful to compare the events in Mexico in 2009 to those during the Spanish influenza pandemic of 1918-1919.

We need to apply lessons learned from previous influenza pandemics to continuously update preparedness and response plans. It has become evident that strengthening networks of international referral laboratories coupled with scaling-up efforts to expand epidemiological surveillance networks is critical for responding and mitigating the impact of influenza pandemics. The current swine-related influenza A (H1N1) pandemic has also shown that international collaboration remains a critical component to effectively respond to influenza pandemics in the current globalized world.

Background: Screening of refugees resettled from areas with a high (>8%) or intermediate (2-7%) prevalence of hepatitis B virus infection (HBV) is critical to identify and to provide counseling to those with chronic HBV carriage; and to ensure entry into medical care of those with chronic hepatitis to prevent long-term sequelae., Methods: We performed a descriptive retrospective analysis of refugees resettled into the US seen at a US travel clinic over a 3-year period and in whom we have obtained HBV serologies and clinical evaluations to define various clinical stages of HBV infection., Results: During the study period, we evaluated a total of 80 patients categorized as refugees or asylum seekers resettled mostly from African countries. In our clinic, we performed HBV serologic analyses among 74/80 (90%) of them. Of those undergoing testing, 17/74 (23%) patients had evidence of HBsAg-positivity. Among these, one patient died secondary to HBV-associated hepatocellular carcinoma, three had chronic HBV infection, and thirteen were found to be chronic inactive HBV carriers. The average time of their resettlement to their time of HBV-related diagnosis was 3.5 years. All 17 patients with HBV surface antigenemia were counseled and enter into medical care for long-term clinical follow up., Conclusion: Earlier efforts are required to provide counseling for HBV chronic carriers, vaccinate the unexposed, and assure entry into medical care for those with chronic HBV infection among refugee communities resettled in the US.

We present a case of chagasic meningoencephalitis reactivation in an HIV-infected woman with advanced immunosuppression. Prolonged survival was attained with antiparasitic therapy and secondary prophylaxis, in conjunction with the use of highly-active antiretroviral therapy. The geographic expansion of the HIV epidemic around the world coupled with global migration and international travel have created a favourable situation for Trypanosoma cruzi and HIV coinfection. The clinical manifestations of Chagas disease in HIV-positive people usually represent reactivation and not acute infection with T cruzi (coinfection). Symptomatic reactivation of chronic latent T cruzi infection can be triggered by severe immunosuppression associated with HIV infection. In this setting, Chagas disease reactivation often presents as meningoencephalitis resembling toxoplasma encephalitis. We review, in this Grand Round, the clinical manifestations, diagnostic approach, pathogenesis, natural history, treatment, prognosis, and prevention of Chagas disease reactivation among HIV-infected people with an emphasis on CNS manifestations.

Background: Imported cases of malaria constitute an important public health problem in many countries, even in those with autochthonous cases, where disease could be acquired in these areas and then seen in non-endemic regions. Non-immune populations are susceptible to complications due to malaria infection, particularly in malaria caused by Plasmodium falciparum. However, Plasmodium vivax the predominant Plasmodium spp. in Venezuela can also lead to severe malaria., Methods: We reviewed retrospectively cases of malaria to identify the clinical features of those imported cases diagnosed at two institutions in Margarita Island (a non-endemic area), Venezuela, in an 8-year period. We conducted a retrospective observational study to identify the clinical and epidemiological features among hospitalized patients at Hospital Central and Hospital Agustin Hernández with malaria acquired at malaria-endemic locations., Results: We identified eighteen imported cases of malaria confirmed by thin and thick peripheral blood smears at these two institutions over an 8-year period. The mean age of diagnosis was 27 years. P. vivax was responsible for the majority of cases. All patients presented with fever, 89% with malaise, 78% with chills, and 67% with myalgia, among others symptoms. Mean haemoglobin levels on admission were 8.1g/dL (100% <12g/dL); platelets: 79,283cells/mm(3) (89% had platelets below 150,000); and a mean total leukocyte count: 3.4x10(3)cells/mm(3) (78% had leukopenia). Thirty nine percent of patients required blood transfusions. Two fatalities were identified (CFR=11%), one associated to severe malaria due to P. falciparum and the other due to a complicated case of P. vivax malaria., Discussion: Imported cases of malaria due to P. vivax and P. falciparum in the studied population are associated with significant hematological complications. These findings illustrate the importance of educating non-immune populations about the malaria risk and prevention strategies; and from a pubic health perspective, the need to develop further malaria prevention strategies at a national level.

Background: Imported leishmaniasis could be defined as any case acquired outside of a defined area in which the diagnosis of leishmaniasis is made. This definition has been used for the diagnosis of disease in a patient who arrives from an endemic area and displays symptoms or seeks medical attention in a nonendemic zone. However, this phenomenon can also occur between two endemic zones., Methods: We evaluated the epidemiologic features of imported cases of cutaneous leishmaniasis imported from Colombia into Northcentral Venezuela from 2001 to 2006. A total of 29 patients with the clinical diagnosis of cutaneous leishmaniasis arriving from Colombia were evaluated at our referral center. Different diagnostic methods were used to confirm the diagnosis (the Montenegro skin test; an indirect immunofluorescence test and smear of cutaneous lesion). Clinical and epidemiological features of cutaneous leishmaniasis among these patients were evaluated., Results: We identified that most identified patients were male with a mean age of 35 years (age range was 7-64); all cases were from northern departments of Colombia. These patients presented a mean clinical evolution of 3 months. Most patients presented with one cutaneous lesion (17%), which were located mostly in extremities (20%). Of the 29 patients, in 16 (55%) cutaneous leishmaniasis was confirmed by different diagnostic techniques. In 2 patients the diagnosis was made by smear. In the rest, 14 (100%) patients were positive by the Montenegro skin test and 11 (79%) were positive by the indirect immunofluorescence test (79% were positive simultaneously by both tests)., Discussion: The identification of imported cutaneous leishmaniasis in our setting becomes important, given the differences in the epidemiology of the disease and the clinical severity of leishmaniasis between both zones (ecological characteristics, circulating Leishmania spp., and population characteristics) and the risk of the mucocutaneous forms of the disease.

We present a case of a patient with chronic meningoencephalitis caused by Mycobacterium abscessus. We also summarise the clinical features and outcomes of cases of CNS infection caused by rapidly growing mycobacteria that have been described in the literature. Rapidly growing mycobacteria are notorious for causing skin and soft-tissue infections after trauma or surgery, pulmonary disease in patients with cystic fibrosis, and disseminated disease in immunocompromised patients. CNS infection with this organism is extremely rare. Patients usually present with subacute to chronic meningitis, neutrophilic pleocytosis, and have a history of trauma or neurosurgery. The smears are often negative for acid-fast organisms, but may show Gram-positive rods. Treatment requires a long course of two or more antibiotics that have the ability to penetrate the blood-brain barrier, and possibly of steroids as immunomodulatory agents, such as those used in tuberculous meningitis.

Human infection with Plasmodium spp leading to clinical episodes of malaria probably began very early in the history of humankind and has persistently inflicted disease among human populations. Malaria is currently considered the world's most important parasitic infection. The global impact of malaria is incalculable and appears to be worsening over the past decades. Although most of this burden of disease is carried by developing tropical countries, cases of imported malaria acquired by international travel are increasingly reported. These numbers are growing because of increased travel to malaria-endemic areas and also due to increased risk of transmission in these areas. Indeed, travel has contributed to the global spread of malaria during the history of humankind. Travellers visiting malaria risk areas should use both personal protective measures and chemoprophylaxis. Non-adherence to chemoprophylactic regimens is frequently secondary to drug side-effects. Therefore, a careful risk-benefit analysis on the use of antimalarial prophylaxis should be carried out in every individual travelling to malaria risk areas. Standby malaria self-treatment represents an alternative in some travellers. However, carefully selected and geographically specific antimalarial drug regimens should be recommended to non-immune people travelling to high-risk areas.

The suitability of olive mill wastewater (OMW) for composting was studied by the addition of this liquid waste to a mixture of cotton gin waste and sewage sludge, and its composting was compared with that of another pile of similar composition, but without olive mill wastewater. Both piles were composted by the Rutgers static pile system in a pilot plant. To study the effects of both composts on plant yield and soil properties, a plot experiment was carried out with Swiss chard (Beta vulgaris L. var. cicla). Five treatments were applied: mineral fertiliser and two doses (30 and 60 tons ha(-1)) of both composts. The olive mill wastewater addition produced a compost with lower organic matter and nitrate concentrations, higher electrical conductivity, and a stabilised and humified organic matter similar to that of the compost produced without olive mill wastewater. The olive mill wastewater compost application to soil did not injure plants, producing a similar plant yield to both compost without olive mill wastewater and inorganic fertiliser. Also, the accumulation of potentially toxic heavy metals in plants cultivated with organic or mineral fertilisers did not reveal significant differences. The olive mill wastewater compost application to soil also improved the chemical and physicochemical properties of the soil.

The immunosuppressive effects of intravenous lipid emulsions are a matter of great concern and debate. In a rat model of gram-negative bacteremia, we assessed whether the use of three intravenous lipid emulsions with different triacylglycerol compositions could influence mortality, bacterial clearance, and prostaglandin E(2) (PGE(2)) levels and compared these groups with groups of orally fed rats and rats that received a small amount of calories in form of glucose without enteral feeding (starvation). RATS WERE ASSIGNED TO ONE OF FIVE GROUPS: group 1 (control, n = 15) received rodent chow ad libitum and saline infusion; group 2 (starvation group, n = 12) had no access to chow and received an infusion of 5% glucose; group 3 (n = 17) received total parenteral nutrition (TPN) with long-chain triacylglycerols; group 4 (n = 12) received TPN with medium- and long-chain triacylglycerols; and group 5 (n = 15) received TPN with its emulsion based on olive oil. Animals received isonitrogenous and isocaloric TPN. After 2 d of TPN, a dose of 10(8) colony-forming units of Escherichia coli was introduced via the venous catheter; 2 d later the animals were killed. Blood, spleen, liver, and lungs were cultured. Circulating levels of PGE(2) were measured. Bacterial growth in the liver and lungs were significantly higher in groups 3 and 4 than in group 1, with no differences among the other groups. Rates of bacteremia were significantly higher in groups 3 and 4 than in group 1, with no differences among the other groups. Plasma levels of PGE(2) did not differ, and mortality was unaffected. Bacterial clearance clearly was preserved in orally fed, control rats when compared with rats on TPN with long-chain triacylglycerols or medium- plus long-chain triacylglycerols. However, the use of a lipid emulsion enriched intravenously with oleic acid was a valid way of reducing this disturbance, although plasma levels of PGE(2) and survival were not modified.