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The purpose of this paper is to investigate how to interpret the outcome of a test‐negative design study. We does so by systematically reviewing the properties of the design in relation to its potential applications. We first argue that the application of the design does not depend on certain assumptions (as is sometimes articulated in the literature), which may open new opportunities for using the design. Then, we relate a number of limitations of the design. The design cannot be used for studying the mortality effects of vaccines and is problematic for studies into the effect on hospitalization. The vaccine's effectiveness on the transmission of viruses is also potentially problematic, depending very much on the characteristics of the tests. The implication of our findings is that the test‐negative designs can, at best, be seen as an indication of effectiveness in highly idealized situations that are often far away from reality. [ABSTRACT FROM AUTHOR]

Background and Objectives: A cross-sectional survey including 38 questions about demography, clinical condition, changes in health habits, and medical treatments for cardiometabolic patients in outpatient follow-up was conducted. From June 15 to July 15, 2020, a total of 13 Latin-American countries participated in enrolling patients. Methods: These countries were divided into 3 geographic regions: Region 1 including North, Central, and Caribbean Regions (NCCR), Region 2 including the Andean Region (AR), and Region 3 including the Southern Cone Region (SCR). 4.216 patients were analyzed, resulting in a coefficient of 33.82%, 32.23%, and 33.94% for NCCR, AR, and SCR, respectively. Results: Significant differences were found between the AR, SCR, and NCCR regions. The analysis of habitual medication usage showed that discontinued use of medication was more present in AR, reaching almost 30% (p < 0.001). The main finding of this study was the negative impact that restrictive measures have on adherence to medications and physical activity: Rs = 0.84 (p = 0.0003) and Rs = 0.61 (p = 0.0032), respectively. AR was the most vulnerable region. Conclusion: Restrictive quarantine measures imposed by the different countries showed a positive correlation with medication discontinuation and a negative correlation with physical activity levels in patients analyzed. These findings characterize the impact of the consequences left by this pandemic. Undoubtedly, restrictive measures have been and will continue to have reverberating negative effects in most Latin-American countries. [ABSTRACT FROM AUTHOR]

Sheep and goat pox (SGP) disease is a highly contagious and dangerous viral infection, characterized by fever, formation of papular-pustular lesions in the epithelium of the skin and respiratory tract of small ruminants. This disease causes enormous damage to sheep breeding due to the death of animals, forced slaughter, loss of productivity, costs for veterinary and sanitary and quarantine measures. The causative agents are two closely related viruses: sheep pox virus and goat pox virus, belonging to the family Poxviridae, the genus Capripoxvirus. SGP is considered an endemic in Kazakhstan and SGP outbreaks have been registered in a number of regions both in our country and bordering states. The uncontrolled spread of this infection can be associated with colossal economic losses and significant damage of the image of our country as an exporter of lamb. Thus, it is important to monitore the epizootological situation of SGP in the country, control outbreaks of infection, and develop veterinary and sanitary measurements to adequately anticipate of the disease spread. Therefore, the purpose of this study is to perform risk analyses of SGP transmission in Kazakhstan. As a result of the research, the SGP risk factors, epizootological characteristics of this infection in Kazakhstan in the last 10 years, and the districts with high risks regarding the possible occurrence of large outbreaks of SGP were identified and the epizootic visualization map was created. This work provides valuable information on the importance of SGP control and prevention programs in Kazakhstan. [ABSTRACT FROM AUTHOR]

Dentists are on the frontline of infection, especially regarding respiratory viruses like the new coronavirus. The production of aerosols and droplets accompanies many dental procedures. The emergence of severe acute air-droplet disease, respiratory syndrome, or SARS, warrants a revision of the infection control procedures for aerosols. The aim. In this article, we aim to raise awareness of the potential risks of COVID-19 transmission in dental practice and discuss and suggest some preventive measures. Methods. This study reviewed the published research articles and the guidelines of international healthcare institutions on dentistry and COVID-19. We searched Pubmed, Web of Science, and SCOPUS electronic databases using MESH terms. Results. The main way of transmission of the SARS CoV is air-droplet. Thus, healthcare professionals that perform aerosol-generating procedures, i.e. dentists, need to be updated about the origin of the disease. The patient and the dentist often share close contact while ongoing dental treatment; thus, knowledge about the disease and necessary preventive measures is required. In addition to the standard precautions, some special preventive measures that should be implemented during an outbreak of disease have been raised in this review. Conclusions. Following the protective protocols in the COVID-19 crisis is of utmost importance in a dental setting. [ABSTRACT FROM AUTHOR]

Established theories of the policy process recognize the challenges governments face in processing information. We examine how the ways in which public problems develop over time condition subsequent policy actions. We contend that policymakers will become routinized to and consequently under-respond to the accumulating signals of slowly-developing problems (i.e., those featuring long runs of relatively small changes). Event history analyses leverage variation across the United States in the development of the COVID-19 pandemic and the subsequent implementation of social distancing policies. Looking across the 50 states and Washington DC, we find that regions that saw protracted deterioration in their health situation were slower to respond with social distancing than those that saw an abrupt deterioration to the same point. These results highlight the risks associated with problems that worsen only gradually over time. [ABSTRACT FROM AUTHOR]

In the context of COVID-19 government-ordered lockdowns, more individualistic people might be less willing to leave their homes to protect their own health, or they might be more willing to go out to relieve their boredom. Using an Australian sample, a pilot study found that people's lay theories were consistent with the latter possibility, that individualism would be associated with a greater willingness to violate lockdown orders. Using a longitudinal data set containing location records of about 18 million smartphones across the United States, Study 1 found that people in more individualistic states were less likely to comply with social distancing rules following lockdown orders. Additional analyses replicated this finding with reference to counties' residential mobility, which is associated with increased individualism. In a longitudinal data set containing mobility data across 79 countries and regions, Study 2 found that people in more individualistic countries and regions were also less likely to follow social distancing rules. Preregistered Study 3 replicated these findings at the individual level: People scoring higher on an individualism scale indicated that they had violated social distancing rules more often during the COVID-19 pandemic. Study 4 found that the effect of individualism on violating social distancing rules was mediated by people's selfishness and boredom. Overall, our findings document a cultural antecedent of individuals' socially responsible behavior during a pandemic and suggest an additional explanation for why the COVID-19 pandemic has been much harder to contain in some parts of the world than in others. [ABSTRACT FROM AUTHOR]

Introduction: The SIR epidemic model is useful for measuring the rate of spread of COVID-19 strains (B.1.617.2/P.1/C.37/B.1.621), in terms of epidemiological threshold R0 over time. Objective: To evaluate a mathematical model of differential type, typical of the behavior of COVID-19 for the Peruvian collective. Methods: A differential mathematical model of the behavior of the pandemic was developed for the Peruvian collective, based on the experience in the control of Kermack--McKendrick infections. The number of susceptible S, infected and spreading infection I and recovered R was estimated, using official datasets from the World Health Organization, based on the history between March 7 and September 12, 2020 and; projected for 52 weeks until September 11, 2021. Results: The lowest rate of infections will occur from April 3, 2021. Evidencing a prognosis of lower transmissibility for May 29, 2021 with an infected rate (β=0.08) and threshold (R0=0.000), the accuracy of the model was also quantified at 97.795%, with 2.205% of average percentage error, with the temporary average value being R0 <1, so each person who contracts the disease will infect less than one person before dying or recovering, so the outbreak will disappear. Conclusion: The curve of infections in Peru will depend directly on mitigation measures to curb the spread of infection and predict sustained transmission through vaccination against covid-19 type strains; with the observance of people of preventive measures. [ABSTRACT FROM AUTHOR]

Background: Undisclosed sexual infection risks are the main reasons for transfusion transmissible infections in German blood donors that have qualified for donation by donor health interviews and questionnaires. Until now, data about compliance with deferral criteria were only available from post-donation interviews with infected donors, and information about the proportion of donors which did not disclose (sexual) risks at the donor health questionnaire was not available. Methods: A prospective nationwide anonymous online survey was conducted to investigate compliance of whole blood donors with deferral criteria for sexual infection risks. Twenty-one blood establishments which represent 80% of the regular whole blood-donor population invited all donors which donated blood during an 8-week period between January and March 2020. Results: 14,882 participants completed the questionnaire. A relevant proportion of non-compliance was shown (3.0%, 95% CI: 2.7–3.3%) – with male donors being non-compliant significantly more frequently than females (3.5% vs. 2.2%, p < 0.001). A quarter of the non-compliant men were MSM (0.9%, 95% CI: 0.7–1.1%). Non-compliance was strongly associated with the perception that questions about sexual risk exposures are too private. This is in line with the finding that a large proportion of donors (21%) refused to answer at least one question about sexual infection risks. Conclusion: The presented data, collected for the first time, is suitable for assessing the impact of changes in the donor selection process. Donor's limited willingness to provide detailed information about sexual risk behaviour has to be kept in mind when further strategies for fair appraisal of individual sexual infection risks will be discussed. [ABSTRACT FROM AUTHOR]

Background: Beta-thalassemia represents a major public health problem in Egypt. The carrier rate varies between 5.5% to = 9%.Unfortunately, most patients suffer from complications of blood transfusions, mainly transfusion transmitted viral infections and iron overload. Prevention by carrier detection and prenatal diagnosis is needed in populations with high incidence of the disease, such as Egypt. This study aimed at identifying thalassemia carriers among secondary school children in Faquos city, EL-Sharkia Governorate to be taken in consideration of prevention program of ß-thalassemia and to update carrier rate data in EL-Sharkia Governorate. Methods: This was a prospective cross-sectional study conducted on 350 se condary school students in Faquos, Sharkia Governorate. All subjects were subjected to the following: Complete blood count, Serum ferritin level, Serum iron level, total iron binding capacity(TIBC). Subjects with microcytic anemia were subjected to specific laboratory tests: High Performance Liquid Chromatography(HPLC) which include hemoglobin A2(HbA2). Results: Headache and pallor were the most common findings in all studied subjects. Investigations of all studied subjects (350) revealed that 200 (57.14%) subjects were non anemic, 150 (42.86 %) subjects were anemic. Among anemic group, 45 (12.85%) subjects had normocytic anemia and 105 (30%) subjects had microcytic anemia. Beta-thalassemia carrier rate was 10% among all the studied group. Beta-thalassemia carrier rate was 33.3% among microcytic anemia group. There was significant decrease in the mean value of red blood cells count, hemoglobin, hematocrite, mean corpuscular volume and mean cell hemoglobin in B-thalassaemia carriers compared to non-carriers among microcytic anemia group. There was a significant increase in hemoglobin A2 level in ß-thalassemia carrier group compared to noncarrier group among microcytic anemia group. Conclusion: Carrier rate among secondary school students in Faquos, Sharkia Governorate was 10%.Hemoglobin A2 is the gold standard for B-thalassemia carrier screening. [ABSTRACT FROM AUTHOR]

Warts are common benign skin tumors caused by human papilloma viruses. Recalcitrant facial warts tend to be cosmetically embarrassing to patients and difficult to treat for doctors. Recently, intralesional immunotherapy by antigens like Bacille Calmette--Guerin vaccine, candida antigen, and measles, mumps, and rubella (MMR) vaccine has shown promising efficacy. Here, we report two cases of Omani men who presented with recalcitrant facial warts that resolved completely with a single intralesional injection of the MMR vaccine. [ABSTRACT FROM AUTHOR]

Sexual violence, comprising all non-consensual sexual acts, is an important driver of HIV infection in sub-Saharan Africa. Definitions of sexual violence rely on understandings of sexual consent, understood as a feeling of willingness that is communicated via shared indicators of consent. In this paper, through analysis of young authors' narrative-based social representations, we sought to provide insight into young Africans' sense-making around sexual consent in order to develop a conceptual framework that can guide future methodological and conceptual work. We analyzed representations of sexual consent in a sample of 291 creative narratives about HIV written for a scriptwriting competition by young Nigerians, Kenyans and Swazis in 2005, 2008, and 2014. We combined thematic data analysis and narrative-based approaches. Narratives represented consent as a feeling of wanting or being willing to have sex, or an intention to have sex, communicated via character actions, conversations, or circumstances. Some narratives depicted characters not wanting but consenting to sex to avoid negative repercussions. Representations of sexual consent were fairly consistent across contexts and over time, although certain representations were more prominent in some country/year samples than others. Results are translated into a conceptual framework that can guide future prevention efforts to reframe sexual consent. [ABSTRACT FROM AUTHOR]

The article discusses the human-to-human spread of monkeypox (MPX) in nonendemic countries as a consequence of neglecting to control the disease in endemic areas. It describes the history of MPX to determine whether it can help control measures. It also explains the factors to consider in developing a sustainable and equitable global plan to control MPX in endemic countries and prevent it from becoming endemic in other parts of the world.

Background: Masking, which is known to decrease the transmission of respiratory viruses, was not widely practiced in the United States until the coronavirus disease 2019 (COVID-19) pandemic. This provides a natural experiment to determine whether the percentage of community masking was associated with decreases in emergency department (ED) visits due to non-COVID viral illnesses (NCVIs) and related respiratory conditions.Methods: In this observational study of ED encounters in a 11-hospital system in Maryland during 2019-2020, year-on-year ratios for all complaints were calculated to account for "lockdowns" and the global drop in ED visits due to the pandemic. Encounters for specific complaints were identified using the International Classification of Diseases, version 10. Encounters with a positive COVID test were excluded. Linear regression was used to determine the association of publicly available masking data with ED visits for NCVI and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), after adjusting for patient age, sex, and medical history.Results: There were 285,967 and 252,598 ED visits across the hospital system in 2019 and 2020, respectively. There was a trend toward an association between the year-on-year ratio for all ED visits and the Maryland stay-at-home order (parameter estimate = -0.0804, P = .10). A 10% percent increase in the prevalence of community masking was associated with a 17.0%, 8.8%, and 9.4% decrease in ED visits for NCVI and exacerbations of asthma exacerbations and chronic obstructive pulmonary disease, respectively (P < .001 for all).Conclusions: Increasing the prevalence of masking is associated with a decrease in ED visits for viral illnesses and exacerbations of asthma and COPD. These findings may be valuable for future public health responses, particularly in future pandemics with respiratory transmission or in severe influenza seasons. [ABSTRACT FROM AUTHOR]

Background: This research estimates the effects of vulnerability on the spread of COVID-19 cases across U.S. counties. Vulnerability factors (Socioeconomic Status, Minority Status & Language, Housing type, Transportation, Household Composition & Disability, Epidemiological Factors, Healthcare system Factors, High-risk Environments, and Population density) do not only influence an individual's likelihood of getting infected but also influence the likelihood of his/her neighbors getting infected. Thus, spatial interactions occurring among individuals are likely to lead to spillover effects which may cause further virus transmission.Methods: This research uses the COVID-19 community index (CCVI), which defines communities likely vulnerable to the impact of the pandemic and captures the multi-dimensionality of vulnerability. The spatial Durbin model was used to estimate the spillover effects of vulnerability to COVID-19 in U.S. counties, from May 1 to December 15, 2020.Results: The findings confirm the existence of spatial spillover effects; with indirect effects (from neighboring counties) dominating the direct effects (from county-own vulnerability level). This not only validates social distancing as a strategy to contain the spread of the pandemic but also calls for comprehensive and coordinated approach to fight its effects. By keeping vulnerability factors constant but varying the number of reported infected cases every 2 weeks, we found that marginal effects of vulnerability vary significantly across counties. This might be the reflection of both the changing intensity of the pandemic itself but also the lack of consistency in the measures implemented to combat it.Conclusion: Overall, the results indicate that high vulnerability in Minority, Epidemiological factors, Healthcare System Factors, and High-Risk Environments in each county and adjacent counties leads to an increase in COVID-19 confirmed cases. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited.Case Presentation: We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient.Conclusions: The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Background: Smoking impairs lung immune function and damages upper airways, increasing risks of contracting and severity of infectious diseases. This paper quantifies the association between smoking and COVID-19 disease progression.Methods: We searched PubMed and Embase for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used random effects meta-analysis, meta-regression and locally weighted regression and smoothing to examine relationships in the data.Results: We identified 46 peer-reviewed papers with a total of 22,939 COVID-19 patients, 5421 (23.6%) experienced disease progression and 2914 (12.7%) with a history of smoking (current and former smokers). Among those with a history of smoking, 33.5% experienced disease progression, compared with 21.9% of non-smokers. The meta-analysis confirmed an association between ever smoking and COVID-19 progression (OR 1.59, 95% CI 1.33-1.89, p = 0.001). Ever smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.02-1.39, p = 0.003). We found no significant difference (p = 0.864) between the effects of ever smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression higher among younger adults (p = 0.001), with the effect most pronounced among younger adults under about 45 years old.Conclusions: Smoking is an independent risk for having progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Early in the COVID-19 pandemic, outpatient clinics throughout the US shifted toward virtual care to limit viral transmission in the office. However, as health care facilities have reopened, evidence about the risk of acquiring respiratory viral infections in medical office settings remains limited. To inform policy for reopening outpatient care settings, we analyzed rates of potential airborne disease transmission in medical office settings, focusing on influenza-like illness. We quantified whether exposed patients (that is, those seen in a medical office after a patient with influenza-like illness) were more likely to return with a similar illness in the next two weeks compared with nonexposed patients seen earlier in the day. Patients exposed to influenza-like illness in the medical office setting were more likely than nonexposed patients to revisit with a similar illness within two weeks (adjusted absolute difference: 0.7 per 1,000 patients). Similar patterns were not observed for exposure to urinary tract infection and back pain as noncontagious control conditions. These results highlight the potential threat of reopening outpatient clinics during the pandemic and the value of virtual visits for patients with suspected respiratory infections. [ABSTRACT FROM AUTHOR]

The Malaysian government has committed to 'Fast Tracking the HIV Response' to achieve UNAIDS 2030 targets to end AIDS. The epidemic is concentrated among key populations and has shifted from people who inject drugs to HIV infection through sexual transmission among men who have sex with men, sex workers and transgender people. The aim of this scoping review was to examine social and behavioural research published since 2005 that can inform understanding of each stage of the 90:90:90 treatment cascade (as proposed by UNAIDS), including HIV risk behaviours and testing practices that precede entry. We found a concentration of studies related to predictors or correlates of HIV infections (mostly among men who have sex with men) and a shortfall in literature pertaining to sex workers or transgender people. While several studies examined factors associated with HIV testing, only one examined uptake of antiretroviral therapy and two explored issues of treatment adherence. No study examined broader care and support of people living with HIV. To scale-up effective programmes and apprise investment to achieve the ambitious targets set-out in the Malaysian National HIV/AIDS Strategic Plan, a combination of comprehensive strategic information and evidence generated through primary research is critical. [ABSTRACT FROM AUTHOR]

Masks are a vital tool for limiting SARS-CoV-2 spread in the population. Here we utilize a mathematical model to assess the impact of masking on transmission within individual transmission pairs and at the population level. Our model quantitatively links mask efficacy to reductions in viral load and subsequent transmission risk. Our results reinforce that the use of masks by both a potential transmitter and exposed person substantially reduces the probability of successful transmission, even if masks only lower exposure viral load by ~ 50%. Slight increases in mask adherence and/or efficacy above current levels would reduce the effective reproductive number (Re) substantially below 1, particularly if implemented comprehensively in potential super-spreader environments. Our model predicts that moderately efficacious masks will also lower exposure viral load tenfold among people who get infected despite masking, potentially limiting infection severity. Because peak viral load tends to occur pre-symptomatically, we also identify that antiviral therapy targeting symptomatic individuals is unlikely to impact transmission risk. Instead, antiviral therapy would only lower Re if dosed as post-exposure prophylaxis and if given to ~ 50% of newly infected people within 3 days of an exposure. These results highlight the primacy of masking relative to other biomedical interventions under consideration for limiting the extent of the COVID-19 pandemic prior to widespread implementation of a vaccine. To confirm this prediction, we used a regression model of King County, Washington data and simulated the counterfactual scenario without mask wearing to estimate that in the absence of additional interventions, mask wearing decreased Re from 1.3–1.5 to ~ 1.0 between June and September 2020. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak is asynchronous in US counties. Mitigating the COVID-19 transmission requires not only the state and federal level order of protective measures such as social distancing and testing, but also public awareness of time-dependent risk and reactions at county and community levels. We propose a robust approach to estimate the heterogeneous progression of SARS-CoV-2 at all US counties having no less than 2 COVID-19 associated deaths, and we use the daily probability of contracting (PoC) SARS-CoV-2 for a susceptible individual to quantify the risk of SARS-CoV-2 transmission in a community. We found that shortening by 5 % of the infectious period of SARS-CoV-2 can reduce around 39 % (or 78 K, 95 % CI: [66 K , 89 K ]) of the COVID-19 associated deaths in the US as of 20 September 2020. Our findings also indicate that reducing infection and deaths by a shortened infectious period is more pronounced for areas with the effective reproduction number close to 1, suggesting that testing should be used along with other mitigation measures, such as social distancing and facial mask-wearing, to reduce the transmission rate. Our deliverable includes a dynamic county-level map for local officials to determine optimal policy responses and for the public to better understand the risk of contracting SARS-CoV-2 on each day. [ABSTRACT FROM AUTHOR]

Background: Transmission of viral diseases (e.g., influenza A H1N1) via respiratory droplets takes place mainly in confined spaces, including in aircraft during commercial air travel. The adoption of hygiene measures may help to prevent disease spread aboard aircraft. This review summarizes the evidence on hand hygiene and the use of facemasks as viral disease prevention measures in aircraft.Methods: A literature search was performed in the PubMed, Scopus, and Web of Science databases up to 10 June 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A population, intervention, comparison, outcomes, and study design (PICOS) approach was used to define the review question.Results: We included four studies published between 2007 and 2020, all targeting influenza virus disease, in the qualitative synthesis. Three studies used mathematical models to simulate single- or multiple-direction flights, and two of them showed that facemask (e.g., N95 respirator) use considerably reduced infection probability. In the third study, hand cleaning by 20 to 60% of people at any time in all airports (including on aircraft) reduced the measure of airports' power to spread the disease across the globe by ~ 24 to 69%. The fourth study was a case-control study designed to trace an influenza outbreak in two flights during the 2009 influenza A H1N1 pandemic. The study showed that none (0%) of nine infected passengers compared to 15 (47%) of 32 healthy control passengers in the aircraft cabin during one of these flights wore a facemask (odds ratio, 0.0; 95% confidence interval, 0.0-0.7). In contrast, both case and control passengers appeared to be equally compliant in self-assessed hand hygiene.Conclusions: Facemask use combined with hand hygiene may minimize the chance of droplet-transmitted virus spread by air travelers. Thus, it is necessary that hygiene measures become an integral part of standard procedures in commercial air travel. [ABSTRACT FROM AUTHOR]

Background: The Zika virus outbreak has triggered a set of local and global actions for a rapid, effective, and timely public health response. A World Health Organization (WHO) initiative, supported by the Department of Chronic Condition Diseases and Sexually Transmitted Infections (DCCI) of the Health Surveillance Secretariat (SVS), Brazil Ministry of Health (MoH) and other public health funders, resulted in the start of the "Study on the persistence of Zika virus in body fluids of patients with ZIKV infection in Brazil - ZIKABRA study". The ZIKABRA study was designed to increase understanding of how long ZIKV persists in bodily fluids and informing best measures to prevent its transmission. Data collection began in July 2017 and the last follow up visit occurred in 06/26/2020.Methods: A framework for the ZIKABRA Cooperation initiative is provided through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international governance and technical cooperation in health for scientific exchange in the context of a public health emergency. Among the methodological strategies, we included a review of the legal documents that supported the ZIKABRA Cooperation; weekly documents produced in the meetings and working sessions; technical reports; memorandum of understanding and the research protocol.Conclusion: We highlight the importance of working in cooperation between different institutional actors to achieve more significant results than that obtained by each group working in isolation. In addition, we point out the advantages of training activities, ongoing supervision, the construction of local installed research capacity, training academic and non-academic human resources, improvement of laboratory equipment, knowledge transfer and the availability of the ZIKABRA study protocol for development of similar studies, favoring the collective construction of knowledge to provide public health emergency responses. Strategy harmonization; human resources and health services; timing and recruiting particularities and processing institutional clearance in the different sites can be mentioned as challenges in this type of initiative. [ABSTRACT FROM AUTHOR]

Background: To reduce the transmission of the severe acute respiratory syndrome coronavirus 2 in its first wave, European governments have implemented successive measures to encourage social distancing. However, it remained unclear how effectively measures reduced the spread of the virus. We examined how the effective-contact rate (ECR), the mean number of daily contacts for an infectious individual to transmit the virus, among European citizens evolved during this wave over the period with implemented measures, disregarding a priori information on governmental measures.Methods: We developed a data-oriented approach that is based on an extended Susceptible-Exposed-Infectious-Removed (SEIR) model. Using the available data on the confirmed numbers of infections and hospitalizations, we first estimated the daily total number of infectious-, exposed- and susceptible individuals and subsequently estimated the ECR with an iterative Poisson regression model. We then compared change points in the daily ECRs to the moments of the governmental measures.Results: The change points in the daily ECRs were found to align with the implementation of governmental interventions. At the end of the considered time-window, we found similar ECRs for Italy (0.29), Spain (0.24), and Germany (0.27), while the ECR in the Netherlands (0.34), Belgium (0.35) and the UK (0.37) were somewhat higher. The highest ECR was found for Sweden (0.45).Conclusions: There seemed to be an immediate effect of banning events and closing schools, typically among the first measures taken by the governments. The effect of additionally closing bars and restaurants seemed limited. For most countries a somewhat delayed effect of the full lockdown was observed, and the ECR after a full lockdown was not necessarily lower than an ECR after (only) a gathering ban. [ABSTRACT FROM AUTHOR]

Background: Zika virus (ZIKV) is a mosquito-borne virus that is also transmitted sexually; however, the epidemiological relevance of ZIKV sexual transmission in endemic regions is unclear.Methods: We performed a household-based serosurvey in Northeast Brazil to evaluate the differential exposure to ZIKV and chikungunya virus (CHIKV) among households. Individuals who participated in our previous arboviral disease cohort (indexes) were recontacted and enrolled, and their household members were newly enrolled.Results: The relative risk of sexual partners being ZIKV-seropositive when living with a ZIKV-seropositive index participant was significantly higher, whereas this was not observed among nonsexual partners of the index. For CHIKV, both sexual and nonsexual partner household members living with a CHIKV-seropositive index had a significantly higher risk of being seropositive. In the nonindex-based dyadic and generalized linear mixed model analyses, the odds of sexual dyads having a concordant ZIKV plaque reduction neutralization test result was significantly higher. We have also analyzed retrospective clinical data according to the participants' exposure to ZIKV and CHIKV.Conclusions: Our data suggest that ZIKV sexual transmission may be a key factor for the high ZIKV seroprevalence among households in endemic areas and raises important questions about differential disease from the 2 modes of transmission. [ABSTRACT FROM AUTHOR]

Background: As COVID-19 continues to spread around the world, understanding how patterns of human mobility and connectivity affect outbreak dynamics, especially before outbreaks establish locally, is critical for informing response efforts. In Taiwan, most cases to date were imported or linked to imported cases.Methods: In collaboration with Facebook Data for Good, we characterized changes in movement patterns in Taiwan since February 2020, and built metapopulation models that incorporate human movement data to identify the high risk areas of disease spread and assess the potential effects of local travel restrictions in Taiwan.Results: We found that mobility changed with the number of local cases in Taiwan in the past few months. For each city, we identified the most highly connected areas that may serve as sources of importation during an outbreak. We showed that the risk of an outbreak in Taiwan is enhanced if initial infections occur around holidays. Intracity travel reductions have a higher impact on the risk of an outbreak than intercity travel reductions, while intercity travel reductions can narrow the scope of the outbreak and help target resources. The timing, duration, and level of travel reduction together determine the impact of travel reductions on the number of infections, and multiple combinations of these can result in similar impact.Conclusions: To prepare for the potential spread within Taiwan, we utilized Facebook's aggregated and anonymized movement and colocation data to identify cities with higher risk of infection and regional importation. We developed an interactive application that allows users to vary inputs and assumptions and shows the spatial spread of the disease and the impact of intercity and intracity travel reduction under different initial conditions. Our results can be used readily if local transmission occurs in Taiwan after relaxation of border control, providing important insights into future disease surveillance and policies for travel restrictions. [ABSTRACT FROM AUTHOR]

Background: The relationship between socioeconomic status and the risk of contracting coronavirus disease (COVID-19) remains controversial. We aimed to investigate whether socioeconomic status affected the risk of contracting COVID-19 in the South Korean population.Methods: The NHIS-COVID-19 database cohort was used in this population-based study. We collected the data of COVID-19 patients who were diagnosed between January 1, 2020 and June 4, 2020 and those of the control population. The income levels of all individuals as of February 2020 were extracted, and study participants were classified into four groups based on quartiles: Q1 (the lowest) to Q4 (the highest). Data were statistically analyzed using multivariable logistic regression modeling.Results: In total, 122,040 individuals-7669 and 114,371 individuals in the COVID-19 and control groups, respectively-were included in the final analysis. The multivariable logistic regression model showed that the Q1 group had a 1.19-fold higher risk of contracting COVID-19 than the Q4 group, whereas the Q2 and Q3 groups showed no significant differences. In the 20-39 years age group, compared with the Q4 group, the Q3 and Q2 groups showed 11 and 22% lower risks of contracting COVID-19, respectively. In the ≥60 years age group, compared with the Q4 group, the Q1, Q2, and Q3 groups showed a 1.39-, 1.29-, and 1.14-fold higher risks of COVID-19, respectively.Conclusions: Lower socioeconomic status was associated with a higher risk of contracting COVID-19 in South Korea. This association was more evident in the older population (age ≥ 60 years), whereas both lower and higher socioeconomic statuses were associated with higher risks of contracting COVID-19 in the young adult population (in the 20-39 year age group). Strategies for the prevention of COVID-19 should focus on individuals of lower socioeconomic status and on young adults of higher and lower socioeconomic status. [ABSTRACT FROM AUTHOR]

There have been growing concerns of a potential re-establishment of measles transmission in the United States (US) in the years to come. This study aims to explore potential factors underlying the resurgence of measles in the US by objectively assessing the associations between annual incidence rates (AIR), case importation, vaccination status and disease outbreaks. Data on measles transmission between January 1st, 2001 and December 31st, 2019 were obtained from the national centres for disease control and prevention (CDC) surveillance databases and other published reports. Changes in incidence rates over time were assessed by binomial regression models. Of the 3874 cases of measles in the US over the study period, 3506 (90.5%, 95% CI: 89.5–91.4) occurred in US residents. The AIR per million population in US residents over this period was 0.60 (95% CI: 0.59–0.61), with an overall significant increase over time (p = 0.011). The median percentage of imported and vaccinated cases were 36% [17.9–46.6] and 15% [12.1–23.2] respectively. There was a significant decrease in the percentage of imported cases (p < 0.001) but not of vaccinated cases (p = 0.159) over time. There was a moderate and weak negative correlation between the AIR and the percentage of imported and vaccinated cases respectively (r = –0.59 and r = –0.27 respectively). On multiple linear regression there was a significant linear association between the AIR and the number of outbreaks (p = 0.003) but not with the percentage of imported cases (p = 0.436) and vaccinated cases (p = 0.692), R2 = 0.73. Strong negative and positive correlations were seen between the number of outbreaks and the percentage of imported cases (r = –0.61) and the of number states affected (r = 0.88) respectively. Despite the overall reduction in the percentage of imported cases of measles over the past two decades, pockets of internal transmission of the disease following importation via increasing number of outbreaks in unvaccinated subpopulations, reinforced by vaccine hesitancy, account for the sustained increase in measles incidence rates in the US. Controlling indigenous transmission through efficient vaccination coverage in at-risk subpopulations and among international US travellers, improved disease surveillance and rapid outbreak containment are essential in curbing the measles resurgence. [ABSTRACT FROM AUTHOR]

High quality, representative data from HIV surveillance systems that have country ownership and commitment are critical for guiding national HIV responses, especially among key and priority populations given their disproportionate role in the transmission of the virus. Between 2011 to 2013, the Mozambique Ministry of Health has conducted five Biobehavioral Surveillance Surveys among key populations (female sex workers, men who has sex with men and people who inject drugs) and priority populations (long distance truck drives and miners) as part of the national HIV surveillance system. We describe the experience of strengthening the HIV surveillance system among those populations through the implementation of these surveys in Mozambique. We document the lessons learned through the impact on coordination and collaboration; workforce development and institutional capacity building; data use and dissemination; advocacy and policy impact; financial sustainability and community impact. Key lessons learned include the importance of multisectoral collaboration, vital role of data to support key populations visibility and advocacy efforts, and institutional capacity building of government agencies and key populations organizations. Given that traditional surveillance methodologies from routine data often do not capture these hidden populations, it will be important to ensure that Biobehavioral Surveillance Surveys are an integral part of ongoing HIV surveillance activities in Mozambique. [ABSTRACT FROM AUTHOR]

Physical performance measures, including cardiopulmonary exercise testing (CPXT), are widely used in geriatric practice and aging research. Theoretically, research participants and study personnel could get infected in the closed environment of the exercise laboratory by contact with respiratory droplets from an infected person, by breathing virus‐laden aerosols, or by touching fomites. Older adults are at increased risk of developing more severe disease and of dying from SARS‐CoV‐2 infection. This special article offers guidance—informed by a synthesis of scientific data and recommendations of the CDC and WHO—on procedures that can be implemented in exercise laboratories to minimize risk of SARS‐CoV‐2 and other respiratory infections. Most tests of physical function (e.g., gait speed, Short Physical Performance Battery) are not aerosol‐generating and are associated with only a small increase in minute ventilation; in contrast, CPXT markedly increases minute ventilation and is potentially aerosol‐generating. Researchers should evaluate the benefit‐to‐risk ratio of information gained from the laboratory assessment versus the risk of SARS‐CoV2 infection. Risk mitigation strategies described here fall into four categories: personal hygiene and the use of personal protective equipment; standardized screening; reconfiguration of laboratory space; and optimization of laboratory ventilation. The proposed safety measures are not intended to replace institutional policy, state, or federal guidelines; they may not apply to all settings and are expected to evolve as more definitive information becomes available. These practical measures to maximize protection against SARS‐CoV2 infection can help maximize participant and staff safety, reduce anxiety, and facilitate protocol adherence, and study integrity. See related Letter by Tamara Konetzka et al. and Special article Cohen et al. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on social changes that prevailed in order to prevent the transmission of COVID-19. Topics mentioned include the impact of the disruptions of circadian rhythm on mood disorders, the need to create a digital self-management intervention to improve circadian system, major life events that are linked with mood disorder, and the role of social zeitgeber hypothesis and social rhythm therapies on the management of mood disorders.

Sexually transmitted infections are of major concern to reproductive specialists. Heading the list are human immunodeficiency virus types 1 and 2 and hepatitis B and C viruses. These pathogens, which may cause incurable chronic infections, can be transmitted through assisted reproductive technologies and from infected mothers to the fetus or newborn. This document replaces the document of the same name last published in 2013 (Fertil Steril 2013;99:340-6). [ABSTRACT FROM AUTHOR]

Introduction: Recently the world's news is all about the Coronavirus pandemic. The novel coronavirus was discovered in Wuhan, China. It is a dangerous virus which has spread all over the world causing a pandemic. The lockdown has affected the world in almost all the aspects, mentally, socially, economically. People are made aware of the symptoms and self practice instructions to be taken to avoid the spread of novel corona outbreak. The aim of the survey was to evaluate the awareness of the self care practices taken by the urban population of Chennai to prevent COVID 19 infection. Material and Method: An online survey was conducted among urban adult population of Chennai to evaluate the knowledge, awareness of the self care practices to be taken to avoid COVID 19 infection .The study population was the adult urban population of Chennai, with a sample size of 225. The questionnaire consisted of 12 questions and was shared to the participants using online survey platform. The study was conducted in the month of may, 2020. The statistics done using SPSS software, chi square test was done to check the association and a p value of 0.05 was said to be statistically significant. Result:72.44% of the respondents were aware of self care practises to be taken to avoid COVID 19 infection. Majority of the participants were aware of symptoms and precautions to be taken if affected by COVID-19 and also found that both male and female participants were equally aware of the self care practices(p-value>0.05). Conclusion: From the survey, it was evident that urban adult population of Chennai are well aware of the self care practices to be taken to avoid COVID-19 infection and it was also found that both male and female participants were equally aware of the self care practices. [ABSTRACT FROM AUTHOR]

The most unexpected pandemic outbreak is Coronavirus (COVID-19) and it is the most serious challenge the world has faced. It can spread among animals and has been reported to be transmitted from animal to human. COVID-19 cases have been increasing day by day and its economic impact on poor people has brought them down. The main aim of the study is to study the knowledge and awareness of the general public about the impact of COVID-19 on the global economy. An online survey was conducted with a self-structured questionnaire comprising 15 questions that were distributed through the google forms among 100 subjects. The data were collected and the results were statistically analyzed. 65% of the participants were aware of COVID-19 and the economic impact caused due to this pandemic. The COVID-19 pandemic is spreading all over the world and the number of cases is increasing rapidly. Analyzing all the challenges, it was understood that participants were aware of the impact of COVID-19 on the global economy [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and resultant coronavirus disease 2019 (COVID-19) have evolved into a pandemic. The novel coronavirus disease that emerged in 2019 started to threaten many people's lives and highly infectious risk of severe respiratory illness.COVID-19 is spread by human-to-human transmission through the droplet, faeco-oral route, and direct contact. Older adults and those with underlying health conditions are at greatest risk for severe infection and death due to COVID-19. Several researchers are showing that adults 60 and older, especially those with preexisting medical conditions, especially heart disease, lung disease, diabetes or cancer are more likely to have severe even deadly coronavirus infection than other age groups. A time-sensitive study was done among higher-risk, older adults living with pre-existing respiratory diseases to determine their current awareness of COVID-19, their perception of the seriousness of its threat. The study aims to determine the perception, attitude, and knowledge of COVID-19 infections among elders with respiratory diseases. An online questionnaire-based survey was conducted among 200 older people with preexisting respiratory infections. All the data from the survey was collected and it was analyzed statistically with the help of SPSS. Results showed that the majority of people were aware of coronavirus and its symptoms and mode of transmission. The current threatening pandemic caused by coronavirus has significant impacts on the daily routine life of our study population. Majority 57.71% have reported that the COVID-19 affected their regular hospital visits and treatments. Many of our participants are not feeling safe to go to the hospital during the current global threat. Preference over e- consulting was started by a few of our study population. This survey reveals the presence of sufficient knowledge over COVID-19 among elderly peoples. Fewer misconceptions about the current pandemic have been noted which has to be solved. [ABSTRACT FROM AUTHOR]

African swine fever (ASF) entered Georgia in 2007 and the EU in 2014. In the EU, the virus primarily spread in wild boar (Sus scrofa) in the period from 2014–2018. However, from the summer 2018, numerous domestic pig farms in Romania were affected by ASF. In contrast to the existing knowledge on ASF transmission routes, the understanding of risk factors and the importance of different transmission routes is still limited. In the period from May to September 2019, 655 Romanian pig farms were included in a matched case-control study investigating possible risk factors for ASF incursion in commercial and backyard pig farms. The results showed that close proximity to outbreaks in domestic farms was a risk factor in commercial as well as backyard farms. Furthermore, in backyard farms, herd size, wild boar abundance around the farm, number of domestic outbreaks within 2 km around farms, short distance to wild boar cases and visits of professionals working on farms were statistically significant risk factors. Additionally, growing crops around the farm, which could potentially attract wild boar, and feeding forage from ASF affected areas to the pigs were risk factors for ASF incursion in backyard farms. [ABSTRACT FROM AUTHOR]

We investigated the effect of annual winter visitor restrictions on hospital respiratory virus transmission. The healthcare-associated (HA) viral respiratory infection (VRI) transmission index (number of HA VRIs per 100 inpatient community-associated VRIs) was 59% lower during the months in which visitor restrictions were implemented. These data prompt consideration for instituting year-round visitor restrictions. [ABSTRACT FROM AUTHOR]

We aimed to assess the occurrence of bovine viruses (bovine leukemia virus–BLV and bovine adenovirus–BAdV) at workplaces in traditional dairies and to evaluate the potential role of airborne and surface contamination in spreading of these viruses derived from raw milk. The total amount of 122 samples—including 37 air (bioaerosol), 40 surface, and 45 milk samples—were checked for the presence of BLV and BAdV genomes using RT-qPCR/qPCR method. The study showed that the viruses were present in 7 air (among them 71.4% were BLV-positive and 28.6% were BAdV-positive), 14 surface (among them 85.7% were BLV-positive and 14.3% were BAdV-positive), and 34 milk (all were BLV-positive only) samples. Statistical analysis revealed that both the air and surfaces in studied occupational environment were more frequently contaminated with BLV than with BAdV (Chi-square test: p = 0.002, Fisher's Exact test: p = 0.002). Kruskal-Wallis tests showed significant differences in BLV genome concentrations in the air (p = 0.045) as well as in BLV and BAdV genome concentrations on surfaces (p = 0.005 and p = 0.040, respectively) between studied processing areas. In units of genome copies (gc) per area, the highest concentrations of BLV and BAdV genomes in the air (9.8 × 101 ± 1.14 × 102 gc/m3 and 5.4 × 101 ± 9.1 × 101 gc/m3, respectively) and on surfaces (9.83 × 102 ± 7.41 × 102 gc/100cm2 and 2.30 × 102 ± 3.8 × 102 gc/100cm2, respectively) were observed in milk reception area. The air and surfaces of pre-production zones were also significantly more contaminated with BAdV genomes compared to production areas (Mann-Whitney test: p = 0.039 and p = 0.029, respectively). This study showed that dairy workers may be exposed to bovine viruses through the inhalation of bioaerosols and contact with contaminated surfaces. To reduce the probability of virus transmission from the raw milk to humans, efficient surface cleaning procedures degrading viral particles should be introduced and the use of personal protection equipment, especially within pre-production zones, should be required. As the raw milk may be a source of bovine viruses, the development of strategies for both the control and eradication of BLV and BAdV among cattle seems to be also urgently needed. [ABSTRACT FROM AUTHOR]

The coronaviruses are a large family of viruses infecting animals or humans and causing diseases, including Middle East Respiratory Syndrome(MERS, MERS-CoV) and Severe Acute Respiratory Syndrome(SARS, SARSCoV). The novel coronavirus SARS-CoV-2 emerged in December 2019 at the city of Wuhan, affecting the respiratory system leading to pneumonia, pulmonary edema, Acute Respiratory Distress Syndrome, multiorgan failure, and death. Treatment studies are still ongoing, but hydroxychloroquine, azithromycin, oseltamivir, favipiravir with some other anti-virals, and convalescent plasma therapy are prominent. The mortality rate of disease is 3.8% in the world, infesting many countries. Legal regulations have been made for the public to reduce transmission. Family health centers are providing healthcare services to every individual, for example, children, pregnant, patients with chronic diseases, patients with any complaint, and individuals who applied for health papers. In such a pandemic family, physicians also have to restrain the transmission of viruses between those people who applied. Therefore triage is needed to determine the high-risk patients as soon as possible. Both of them and other patients are protected in that way. After the filiation is done, suspected cases or COVID-19 contacted cases are kept in touch by family physicians to follow up their clinical status and check for isolation conditions. For all these reasons, we aimed to examine the family health centers coping with COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: On 31 December 2019, the China Country Office of the World Health Organization (WHO) reported on cases of pneumonia with unknown etiology in the Wuhan city of the province of Hubei. On 7 January 2020, the factor was defined as a new Coronavirus (2019-nCoV) that had not been detected in humans before. The aim of this study is to analyze the pandemic in 8 different countries. Materials and Methods: In the study, we included the countries with the highest numbers of cases by the date 04.05.2020 (USA, China, Italy, Germany, Iran, France, Turkey), as well as South Korea. We comparatively analyzed the countries' total case and mortality numbers, mortality rates, over-65 years old population rates and dates of precautions that were taken. Results: The number of COVID cases in the entire world exceeded 3.6 million, and approximately 75.2% of these cases were seen in 7 countries (USA, Italy, China, Germany, France, Iran, Turkey), whereas the number of related deaths worldwide exceeded 250 thousand by the same date (04.05.2020). Conclusion: We are facing the greatest pandemic of the last century, or even the history of humanity, which has affected the society in all aspects from the field of medicine to economics. The greatest weapon for the history of humanity in the fight against the pandemic would be countries' transfer of their knowledge to each other. [ABSTRACT FROM AUTHOR]

Viral infections are an occupational health concern for office workers and employers. The objectives of this study were to estimate rotavirus, rhinovirus, and influenza A virus infection risks in an office setting and quantify infection risk reductions for two hygiene interventions. In the first intervention, research staff used an ethanol-based spray disinfectant to clean high-touch non-porous surfaces in a shared office space. The second intervention included surface disinfection and also provided workers with alcohol-based hand sanitizer gel and hand sanitizing wipes to promote hand hygiene. Expected changes in surface concentrations due to these interventions were calculated. Human exposure and dose were simulated using a validated, steady-state model incorporated into a Monte Carlo framework. Stochastic inputs representing human behavior, pathogen transfer efficiency, and pathogen fate were utilized, in addition to a mixed distribution that accounted for surface concentrations above and below a limit of detection. Dose-response curves were then used to estimate infection risk. Estimates of percent risk reduction using mean values from baseline and surface disinfection simulations for rotavirus, rhinovirus, and influenza A infection risk were 14.5%, 16.1%, and 32.9%, respectively. For interventions with both surface disinfection and the promotion of personal hand hygiene, reductions based on mean values of infection risk were 58.9%, 60.8%, and 87.8%, respectively. This study demonstrated that surface disinfection and the use of personal hand hygiene products can help decrease virus infection risk in communal offices. Additionally, a variance-based sensitivity analysis revealed a greater relative importance of surface concentrations, assumptions of relevant exposure routes, and inputs representing human behavior in estimating risk reductions. [ABSTRACT FROM AUTHOR]

In this paper, a new model describing the human immunodeficiency virus (HIV)-acquired immuno deficiency syndrome (AIDS) epidemic spread is proposed. The improvement with respect to the known models has been driven by recent results obtained from historical data collection and the suggestions given by the World Health Organization: the characteristics of the virus diffusion, mainly by body fluids, imply the trivial fact that wise behaviors of healthy subjects and fast timely recognition of a new positive diagnosis should reduce the spread quite fast. Therefore, the set of susceptible subjects is divided into two categories: the wise people that, suitably informed, avoid dangerous behaviors, and the ones that, with irresponsible acts, could get the infection. The set of infected subjects is constituted by people who are still not aware of being infected (and therefore are responsible of the HIV spread), along with the subjects aware of being infected by HIV or AIDS. Inspired by the international guidelines suggestions, three controls are introduced, aiming both at the prevention and at the cure: an informative campaign, a test campaign, and an HIV/AIDS therapy action. Among them, the core of the control effort is a fast HIV diagnosis. The equilibrium points, their stability, and the influences of the introduced inputs to the system behavior are studied, yielding to preliminary statements for prospective works on suitable control design approaches. [ABSTRACT FROM AUTHOR]

This Medical News article discusses ongoing HIV outbreaks in West Virginia and restrictive new laws that jeopardize syringe services programs aimed at halting HIV transmission. [ABSTRACT FROM AUTHOR]