Search

Background Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied, and data on their incidence by number of device-days is not available. Methods Prospective, surveillance study on PVCR-BSI conducted from September 1st, 2013 to 31st Mays, 2019 in 246 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 83 hospitals in 52 cities of 14 countries in the Middle East (Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates). We applied U.S. Results We followed 31,083 ICU patients for 189,834 bed-days and 202,375 short term peripheral venous catheter (PVC)-days. We identified 470 PVCR-BSIs, amounting to a rate of 2.32/1000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 10.38%, and 29.36% in patients with PVC and PVCR-BSI. The mean length of stay in patients with PVC but without PVCR-BSI was 5.94 days, and 16.84 days in patients with PVC and PVCR-BSI. The microorganism profile showed 55.2 % of gram-positive bacteria, with Coagulase-negative Staphylococci (31%) and Staphylococcus aureus (14%) being the predominant ones. Gram-negative bacteria accounted for 39% of cases, and included: Escherichia coli (7%), Klebsiella pneumoniae (8%), Pseudomonas aeruginosa (5%), Enterobacter spp. (3%), and others (29.9%), such as Serratia marcescens. Conclusions PVCR-BSI rates found in our ICUs were much higher than rates published from USA, Australia, and Italy. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.

In pandemic conditions, patients with febrile neutropenia are also at risk of COVID-19. Aim of this systematic review is to evaluate COVID-19 cases presented with febrile neutropenia and provide information regarding incidence, clinical course and prognosis.We systematically searched on COVID-19 and febrile neutropenia cases in PubMed, SCOPUS and Web of Science.A total of 19 febrile neutropenic patients were analyzed. A male predominance was noted. Eleven cases had hematological malignancies. Fourteen of the cases were previously received chemotherapy. Five patients had severe neutropenia: 3 had hematologic cancer and none died. 17 (89.5%) cases have pulmonary involvement and seven of them had severe disease with acute respiratory distress syndrome (ARDS). Three cases with ARDS were died. 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use. Overall mortality was 15.8%, while death was not observed in patients without malignancy and solid organ tumors, the mortality rate was 27% in cases with hematological malignancies.In ongoing pandemic, febrile neutropenic patients should be precisely evaluated for COVID-19 disease. It should be remembered that there may not be typical signs and symptoms and laboratory findings of COVID-19 disease because of the immunosuppression.

Objective: Occupational exposures, can lead to decreased employee productivity, increased cost of health expensesand temporary or permanent suspension from working life. The most common cause of illness and death due tooccupational exposures are blood-borne infections. In this study, it was aimed to evaluate the occupational exposuresamong residents in a tertiary hospital that provides health care in a region where the Crimean–Congo hemorrhagicfever disease is endemic.Methods: A questionnaire consisting of 18 questions distributed to the residents of internal, surgery and basic medicalsciences working at a tertiary hospital between February and March 2016. In the relevant departments, 330 residentswere reached and 210 of them answered the questionnaire.Results: In our study; 160(76.2%) of the residents reported occupational exposure in their working life and74(35.2%) of them had occupational exposure in the recent year. The incidence of occupational exposures in thecomparison of medical sciences was statistically higher in surgical sciences. Of the participants working in the surgicalsciences, 22(42.3%) residents stated that they received in-service training in the recent year on the prevention,treatment, and follow-up of occupational exposures. Among participants who had occupational exposure in recentyear, only 8(11.4%) residents declared that they have reported about their exposure.Conclusion: To prevent occupational exposures, it is required to make more effective interventions of protectionmeasures in the light of current information and assessment of post-exposure attitudes of residents. We hope that therisks that our study has identified may help to take necessary preventive measures. Giriş: Mesleki maruziyetler, sağlık çalışanlarını iş yaşamından geçici veya kalıcı olarak uzaklaştırmakta, iş verimliliğinidüşürmekte ve kurumların sağlık kaynaklı maliyet giderlerini arttırmaktadır. Sağlık çalışanları açısından meslekimaruziyet kaynaklı en sık hastalık ve ölüm nedeni enfeksiyonlardır. Çalışmamızda, Kırım-Kongo kanamalı ateşihastalığının endemik olduğu bir bölgede sağlık hizmeti veren üçüncü basamak bir hastanedeki uzmanlıköğrencilerinin mesleki maruziyetlerinin değerlendirilmesi amaçlanmıştır.Yöntemler: Üçüncü basamak bir hastanede çalışan iç hastalıkları, cerrahi ve temel tıp bilimleri uzmanlık öğrencilerineulaşılarak Şubat ve Mart 2016 tarihleri arasında dağıtılan 18 sorudan oluşan bir anketi yanıtlamaları istenmiştir. İlgilibölümlerden 330 uzmanlık öğrencisine ulaşılmış ve 210 kişi ankete katılmıştır.Bulgular: Uzmanlık öğrencilerinden 160(%76,2)’ı meslek yaşamları boyunca, 74 (%35,2)’si de son bir yıl içindemesleki maruziyet bildirdiler. Tıbbi bilimler arasında mesleki maruziyet sıklığı cerrahi bilimlerde istatistiki olarakfazla bulundu. Cerrahi bilimlerde çalışan katılımcıların 22(%42,3)’si mesleki maruziyetlerin önlenmesi, tedavisi vetakibi ile kurumunda son bir yıl içinde hizmet içi eğitim aldığını belirtti. Son bir yıl içinde mesleki maruziyeti olanuzmanlık öğrencisinden sadece 8(%11,4)’i maruziyet sonrası bildirimde bulunduklarını belirtmiştir.Sonuç: Mesleki maruziyetleri önlemek için, güncel bilgiler ışığında koruma tedbirlerine etkili müdahalelerininyapılması ve uzmanlık öğrencilerinin maruz kalma sonrası tutumlarının değerlendirilmesi gerekmektedir. Çalışmabulgularımızın, mesleki maruziyetlerin önlenmesi için bundan sonra alınacak olan tedbirlerin tespit edilmesindeyardımcı olacağını umuyoruz.

COVID-19 is a severe acute respiratory syndrome. Recent reports showed that autoimmune thyroiditis might occur following COVID-19 infection. We aimed to review the literature to assess the prevalence, clinical features and outcome of autoimmune thyroid disorders triggered by COVID-19. We reviewed case reports, case series, and observational studies of autoimmune thyroiditis including Graves' disease, Hashimoto thyroiditis, and silent thyroiditis developed in COVID-19 patients by searching PubMed, SCOPUS and Web of Science and included in the systematic review. Our search yielded no prevalence study. We noted 20 reported cases: Fourteen cases of Graves' disease, 5 cases of hypothyroidism due to Hashimoto's thyroiditis and one case of postpartum thyroiditis. The majority (16/20, 80%) were middle-aged (mean age: 40 years) female patients. Autoimmune thyroiditis was diagnosed either concomitantly or 7-90 days after the COVID-19 infection. Eight out of 14 cases with Graves' disease had a known thyroid disorder and they were stable in remission. One out of 5 cases with Hashimoto's thyroiditis had known prior hypothyroidism. The majority of the patients achieved remission within 3 months. One patient with thyroid storm due to Graves' disease and one patient with myxedema coma have died. Current data suggest that COVID-19 may cause autoimmune thyroid disease or exacerbate the underlying thyroid disease in remission. It is reasonable to routinely assess the thyroid functions both in the acute phase and during the convalescence so as not to overlook a thyroid disorder and not to delay treatment especially in patients with preexisting autoimmune thyroid diseases.

To the Editor—We read the paper of Mehmood et al1 with great interest. Their letter was based on a newspaper report of novel coronavirus (COVID-19) and Crimean–Congo hemorrhagic fever (CCHF) coinfection, and its scientific basis is questionable. 34462024

A novel coronavirus (SARS-CoV-2), causing an emerging coronavirus disease (COVID-19), first detected in Wuhan City, Hubei Province, China, which has taken a catastrophic turn with high toll rates in China and subsequently spreading across the globe. The rapid spread of this virus to more than 210 countries while affecting more than 25 million people and causing more than 843,000 human deaths, it has resulted in a pandemic situation in the world. The SARS-CoV-2 virus belongs to the genus Betacoronavirus, like MERS-CoV and SARS-CoV, all of which originated in bats. It is highly contagious, causing symptoms like fever, dyspnea, asthenia and pneumonia, thrombocytopenia, and the severely infected patients succumb to the disease. Coronaviruses (CoVs) among all known RNA viruses have the largest genomes ranging from 26 to 32 kb in length. Extensive research has been conducted to understand the molecular basis of the SARS-CoV-2 infection and evolution, develop effective therapeutics, antiviral drugs, and vaccines, and to design rapid and confirmatory viral diagnostics as well as adopt appropriate prevention and control strategies. To date, August 30, 2020, no effective, proven therapeutic antibodies or specific drugs, and vaccines have turned up. In this review article, we describe the underlying molecular organization and phylogenetic analysis of the coronaviruses, including the SARS-CoV-2, and recent advances in diagnosis and vaccine development in brief and focusing mainly on developing potential therapeutic options that can be explored to manage this pandemic virus infection, which would help in valid countering of COVID-19.

In this study, we performed a single‐centred study of 307 SARS‐CoV‐2 infected patients. It was found that co‐infection of SARS‐CoV‐2 and influenza virus was common during COVID‐19 outbreak. And patients co‐infected with SARS‐CoV‐2 and influenza B virus have a higher risk of developing poor outcomes so a detection of both viruses was recommended during COVID‐19 outbreak. This article is protected by copyright. All rights reserved.

KARABAY, OGUZ/0000-0003-1514-1685; Kaya, Sehnaz/0000-0003-0002-1517; Gan, Chin Seng/0000-0002-6758-4798; Valderrama, Sandra/0000-0003-1833-1599; Abouqal, Redouane/0000-0002-6117-4341; Unal, Necmettin/0000-0002-9440-7893; Yousef, Reham H. A./0000-0003-4004-3008; Horhat, Florin George/0000-0001-6133-0204 WOS: 000522628200013 PubMed: 31676155 Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. Conclusions: Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively. (C) 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. International Nosocomial Infection Control Consortium Surveillance Online System Funding for the design, development, maintenance, technical support, data validation, and report generation of the International Nosocomial Infection Control Consortium Surveillance Online System, and the activities carried out at the International Nosocomial Infection Control headquarters were provided by Victor D. Rosenthal, and the Foundation to Fight against Nosocomial Infections.

Background Increasing number of patients with COVID-19-associated mucormycosis have been reported, especially from India recently. We have described a patient with COVID-19-associated mucormycosis and, searched and analyzed current medical literature to delineate the characteristics of COVID-19-associated mucormycosis. Method We reported a patient developed mucormycosis during post-COVID period. We searched literature to describe the incidence, clinical features, and outcomes of COVID-19-associated mucormycosis. Demographic features, risk factors, clinical features, diagnostic methods, treatment and outcome were analyzed. Results We describe a 54-year-old male, hospitalized due to severe COVID-19 pneumonia. He was given long-term, high doses of systemic steroids. He developed maxillo-fascial mucormycosis and died of sepsis. Our literature search found 30 publications describing 100 patients including present case report. The majority (n = 68) were reported from India. 76% were male. The most commonly seen risk factors were corticosteroid use (90.5%), diabetes (79%), and hypertension (34%). Also, excessive use of broad-spectrum antibiotics were noted in cases. Most frequent involvements were rhino-orbital (50%), followed by rhino-sinusal (17%), and rhino-orbito-cerebral (15%). Death was reported as 33 out of 99 patients (33,3%). Conclusions Steroid use, diabetes, environmental conditions, excessive use of antibiotics, and hypoxia are main risk factors. Despite medical and surgical treatment, mortality rate is high. A multidisciplinary approach is essential to improve the conditions facilitating the emergence of COVID-19-associated mucormycosis.

Hasan, M. Shahnaz/0000-0002-7493-7416; Abouqal, Redouane/0000-0002-6117-4341; Altindis, Mustafa/0000-0003-0411-9669; Masjedi, Mansoor/0000-0001-6175-9289; Popescu, Roxana/0000-0002-9387-1141; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; Meco, Basak Ceyda/0000-0003-2951-9634; Kumar, Perikala Vijayananda/0000-0001-8315-7000; Zand, Farid/0000-0003-3489-3372; Maghsoudi, Behzad/0000-0002-1279-8799; KAMARUL ZAMAN, MAZUIN/0000-0002-7920-6399; Gan, Chin Seng/0000-0002-6758-4798; Horoz, Ozden Ozgur/0000-0001-7590-650X; Medeiros, Eduardo A/0000-0002-6205-259X; Sabetian, Golnar/0000-0001-8764-2150; UNAL, SERHAT/0000-0003-1184-4711; Gan, Chin Seng/0000-0002-6758-4798; Delia, Muntean/0000-0001-9100-4530; Yalcin, Ata Nevzat/0000-0002-7243-7354; Leblebicioglu, Hakan/0000-0002-6033-8543; Horhat, Florin George/0000-0001-6133-0204; Yousef, Reham H. A./0000-0003-4004-3008; Delgado Aguirre, Hector Alberto/0000-0001-5448-7975; El Kholy, Amani/0000-0002-0645-7664; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Sanaei Dashti, Anahita/0000-0002-2827-3575; KARABAY, OGUZ/0000-0003-1514-1685; Barahona G., Nayide/0000-0003-3559-6900; Stagnaro, Juan Pablo/0000-0003-3836-9957; Alexandru Florin, Rogobete/0000-0003-1286-4431; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Jayatilleke, Kushlani/0000-0002-3931-6630; Unal, Necmettin/0000-0002-9440-7893; Duszynska, Wieslawa/0000-0002-5880-4904; Ngo, Quy Chau/0000-0002-6787-2757; Elmanakhly, Arwa/0000-0001-8557-0536; yildizdas, dincer/0000-0003-0739-5108; Kanj, Souha/0000-0001-6413-3396; Gupta, Umesh/0000-0001-7717-1404 WOS: 000392626300014 PubMed: 27742143 Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DAHAI), we collected prospective data from861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central lineassociated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheterassociated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. VDR; Foundation to Fight against Nosocomial Infections The funding for design, development, maintenance, technical support, data validation, and report generation of the Surveillance Online System, and the activities carried out at International Nosocomial Infection Control Consortium headquarters, were provided by VDR and the Foundation to Fight against Nosocomial Infections.

Leblebicioglu, Hakan/0000-0002-6033-8543; Beeching, Nicholas/0000-0002-7019-8791; Fletcher, Tom/0000-0002-3712-415X WOS: 000476864600046 PubMed: 31262565 Background Data describing the coagulopathy of Crimean-Congo haemorrhagic fever are scarce. We did rotational thromboelastometry (ROTEM) and conventional coagulation testing in patients with Crimean-Congo haemorrhagic fever to increase our understanding of the coagulopathy of this infectious disease. Methods We did a prospective observational cohort study of adults aged 18 years and older and admitted to hospitals with PCR-confirmed Crimean-Congo haemorrhagic fever in Samsun and Tokat, Turkey. Demographic, clinical, and laboratory data were collected and blood samples for ROTEM analysis and coagulation testing were drawn at admission and during hospital admission and convalescence (up to 30 days after onset of illness). For the ROTEM analysis we recorded the following extrinsically activated ROTEM (EXTEM S) variables, with normal ranges indicated: clotting time (38-79 s), clot formation time (34-159 s), amplitude at 10 min after clotting time (43-65 mm), maximum clot firmness (50-72 mm), and maximum lysis (> 15% at 1 h). The following fibrin-specific ROTEM (FIBTEM S) variables were also recorded: amplitude at 10 min after clotting time (normal range 7-23 mm) and maximum clot firmness (9-25 mm). Disease severity was assessed by Swanepoel criteria, severity grading score (SGS), and the severity scoring index (SSI), with mild disease defined as meeting no Swanepoel criteria, graded mild by SSI, and graded low risk by SGS. Findings Between May 27, 2015, and Aug 2, 2015, 65 patients with confirmed Crimean-Congo haemorrhagic fever were recruited and had blood taken at 110 time points. Most were male (40 [62%] of 65) with mild disease (49 [75%] of 65). Haemorrhage occurred in 13 (20%; 95% CI 11.1-31.8) of 65 patients and 23 (35%) of 65 received blood products (15 received fresh frozen plasma and eight received red blood cell concentrates), and 21 patients received platelet transfusions. At admission, the following EXTEM S variables differed significantly between mild cases and moderate to severe cases: median clotting time 56 s (range 42-81; IQR 48-64) versus 69 s (range 48-164; IQR 54-75; p=0.01); mean amplitude at 10 min after clotting time 45.1 mm (SD 7.0) versus 33.9 mm (SD 8.6; p 15%). Interpretation Coagulopathy of Crimean-Congo haemorrhagic fever is related to defects in clot development and stabilisation that are more marked in severe disease than in mild disease. The combination of normal and slightly deranged coagulation screens and FIBTEM results with the absence of hyperfibrinolysis suggests that the coagulopathy of Crimean-Congo haemorrhagic fever relates to platelet dysfunction. Copyright (C) 2019. The Author(s). Published by Elsevier Ltd. Wellcome TrustWellcome Trust [104480/Z/14/Z]; UK Ministry of Defence TF is funded by the Wellcome Trust (104480/Z/14/Z) and the UK Ministry of Defence. RH and NJB are affiliated with the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool in partnership with Public Health England, in collaboration with the Liverpool School of Tropical Medicine. RH is based at Public Health England Porton and NJB is based at the Liverpool School of Tropical Medicine. The views expressed are those of the authors and not necessarily those of their respective institutions, the UK National Health Service (NHS), the National Institute for Health Research Health, the UK Department of Health, Public Health England, or the Ministry of Health, Turkey.

Hepatitis C virus (HCV) causes acute and chronic infection and is a global health problem. It leads to cirrhosis and hepatocellular carcinoma and causes several extrahepatic manifestations. Global prevalence of chronic HCV infection is estimated at around 1%. However the epidemiology of HCV infection changes according to the region. The estimated anti-HCV prevalence in Africa and Asia is higher than 2%, the central sub-Saharan Africa having the highest prevalence. Asia, having high prevalence and high population, has 60% of the cases worldwide. In Europe, Americas, and Australia, HCV prevalence is lower than 2%. Although pan-genotypic direct-acting antivirals have been developed, they are not available worldwide. Estimates of HCV genotypes are important for developing strategies for HCV elimination. The most prevalent HCV genotype is genotype 1 in the world (49%), followed by genotype 3 (18%), 4 (17%), and 2 (11%). Genotypes 5 and 6 account for the remaining 5%.

Highlights • Person-to-person transmission is the most important means of transmission. • Malaria remains by far the most important cause of death. • Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return) and clinical syndromes associated with a systematic search policy are usually mandatory to limit the risk of an outbreak. • Hospitalization in a single-bed room and isolation according to symptoms should be the rule while awaiting laboratory test results., Summary Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously. However, malaria remains by far the most important cause of death. The issues related to imported antibiotic resistance and protection from highly contagious diseases are reviewed here. Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return) and clinical syndromes, together with systematic search policies, are usually mandatory to limit the risk of an outbreak. Single-bed hospital rooms and isolation according to symptoms should be the rule while awaiting laboratory test results. Because person-to-person contact is the main route of transmission, healthcare workers should implement specific prevention strategies.

Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. Only 1%–30% of patients in need of treatment may get it. In recent years, the availability of direct-acting antiviral agents (DAA) has been an important advancement in treating HCV infection. However, due to cost, it is not possible to receive these drugs in many countries where infection is endemic. In these low- and middle-income countries, the main barriers to controlling HCV infection are lack of knowledge about the infection, constraints on diagnostic testing and treatment, and lack of experts. Both national and international support are essential to overcoming these barriers. In low- and middle-income countries, interferon and ribavirin-based therapies still are the first choices due to their availability and to government payment support. In addition, in developed countries, efforts to provide lower-cost DAA drugs continue. Pharmaceutical companies continue to research manufacture of bio-equivalent drugs to reduce treatment costs. Considering the fake drug market, all developments need to be monitored closely by the institutions involved. This review focuses on barriers to hepatitis C treatment and ways to overcome those barriers.

The conflict in Syria is a big humanitarian emergency. More than 200,000 Syrians have been killed, with more than half of the population either having been displaced or having immigrated. Healthcare has been interrupted due to the destruction of facilities, a lack of medical staff, and a critical shortage of life-saving medications. It produced suitable conditions leading to the re-emergence of tuberculosis, cutaneous leishmaniasis, polio, and measles. Lebanon and Jordan reported increased rates of tuberculosis among Syrian refugees. Cutaneous leishmaniasis outbreaks were noted not only in Syria but also in Turkey, Jordan, and Lebanon. After a polio-free 15 years, Syria reported a polio outbreak. Ongoing measles outbreaks in the region was accelerated by the conflict. Iraq declared a cholera outbreak among the Syrian refugees. The healthcare facilities of the countries hosting immigrants, mainly Turkey, Lebanon, Jordan, Iraq, and Egypt, are overburdened. The majority of the immigrants live in crowded and unsanitary conditions. Infectious diseases are big challenges for Syria and for the countries hosting immigrants. More structured support from international organizations is needed for the prevention, control, diagnosis, and treatment of infectious diseases.

Summary Background The recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large geographical area and with human-to-human transmission reported, especially in the healthcare setting. Objectives To systematically review the characteristics of travel associated Crimean-Congo haemorrhagic fever. Methods A systematic review of travel-associated cases of CCHF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) and ProMED databases were searched for reports published between January 1960 and January 2016. Three independent reviewers selected and reviewed studies and extracted data. Results 21 cases of travel associated CCHF were identified, of which 12 died (3 outcome unknown) and 4 secondary (nosocomial) infections were reported. Risk occupations or activities for CCHF infection were reported in 8/12 cases when data were available. Travel from Asia to Asia occurred in 9 cases, Africa to Africa occurred in 5 cases, Africa to Europe in 3 cases, Asia to Europe in 2 cases and Europe to Europe in 2 cases. Conclusion CCHF related to travel is rare, is generally associated with at risk activities/occupation and is frequently fatal. Key to early diagnosis and prevention of nosocomial transmission is an understanding of CCHF risk factors and the geographical distribution of CCHF. International travel to CCHF endemic areas is increasing and clinicians and laboratory personnel managing returning travellers should maintain a high index of suspicion.

Carratala, Jordi/0000-0003-3209-2563; Pierrotti, Ligia Camera/0000-0002-0216-3028; Carratala, Jordi/0000-0003-3209-2563; Segurado, Aluisio C/0000-0002-6311-8036; Abdala, Edson/0000-0003-0765-6654; Leblebicioglu, Hakan/0000-0002-6033-8543; Vilela, Eduardo Garcia/0000-0002-5443-7553; Kamar, Nassim/0000-0003-1930-8964; Kotton, Camille/0000-0001-7320-2234; Molina Romero, Israel/0000-0001-6642-7515; Colombo, Arnaldo Lopes/0000-0003-0793-8491; Beeching, Nicholas/0000-0002-7019-8791; Salvador, Fernando/0000-0002-0546-1354; Santoro Lopes, Guilherme/0000-0003-0867-4985; Len, Oscar/0000-0002-1819-3141 WOS: 000424093400021 PubMed: 29381647 The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both transplant ID and travel medicine specialists. The guidelines provide recommendations for risk evaluation and laboratory investigation, as well as management and prevention of infection of the most relevant endemic diseases of Latin America. This summary includes a brief description of the guideline recommendations but does not include the complete rationale and references for each recommendation, which is available in the online version of the article, published in this journal as a supplement. The supplement contains 10 reviews referring to endemic or travel diseases (eg, tuberculosis, Chagas disease [ChD], leishmaniasis, malaria, strongyloidiasis and schistosomiasis, travelers diarrhea, arboviruses, endemic fungal infections, viral hepatitis, and vaccines) and an illustrative section with maps (http://www.pmourao.com/map/). Contributors included experts from 13 countries (Brazil, Canada, Chile, Denmark, France, Italy, Peru, Spain, Switzerland, Turkey, United Kingdom, United States, and Uruguay) representing four continents (Asia, the Americas and Europe), along with scientific and medical societies.

In this chapter the global distribution and contemporary trends of the prevalence of hepatitis B in the different regions of the world were described. Analysis of the relationship between HBV prevalence and income, also vaccination campaign of infants and children under 5 years old, is presented. Specific attention was paid on the distribution of hepatitis B among risk groups (intravenous drug users, men who have sex with men, indigenous peoples and minorities, prisoners, migrants, blood donors, health-care workers, coinfection with HIV infection and hepatitis C). Gaps and problems in the study of hepatitis B epidemiology and prophylaxis and future trends and prognosis of the spread of HBV in the world are discussed.

Leblebicioglu, Hakan/0000-0002-6033-8543; cerik, idris bugra/0000-0003-1419-3950 WOS: 000452543100008 PubMed: 28590307 …

Mondelli, Mario U/0000-0003-1811-3153; Leblebicioglu, Hakan/0000-0002-6033-8543; Soriano, Vicente/0000-0002-4624-5199; Ruta, Simona/0000-0002-2492-6073; Lazarevic, Ivana/0000-0001-6795-1378; Harxhi, Arjan/0000-0001-8518-7377 WOS: 000364572800020 PubMed: 26166544 The prevalence and management of chronic hepatitis B virus (HBV) infection differ among European countries. The availability and reimbursement of diagnostics and drugs may also vary, determining distinct treatment outcomes. Herein, we analyse differences in medical facilities for the care of patients with chronic HBV infection across Europe. A survey was sent to the members of the ESCMID Study Group for Viral Hepatitis, all of whom are experts in chronic HBV infection management. The comprehensive survey asked questions regarding hepatitis B surface antigen (HBsAg) prevalence, the availability of diagnostics and drugs marketed, and distinct clinical practice behaviours in the management of chronic HBV infection. World Bank data were used to assess the economic status of the countries. With 16 expert physicians responding (69%), the HBsAg prevalence rates were 5%) in Albania and Iran. Regarding the availability and reimbursement of HBV diagnostics (HBV DNA and liver stiffness measurement), HBV drugs (interferon, lamivudine, tenofovir, and entecavir), HBV prophylaxis, and duration of HBeAg-positive and HBeAg-negative HBV infection, the majority of high-income and middle-income countries had no restrictions; Albania, Iran and Serbia had several restrictions in diagnostics and HBV drugs. The countries in the high-income group were also the ones with no restrictions in medical facilities, whereas the upper-middle-income countries had some restrictions. The prevalence of chronic HBV infection is much higher in southern and eastern than in western European countries. Despite the availability of European guidelines, policies for diagnostics and treatment vary significantly across European countries. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Crimean-Congo hemorrhagic fever (CCHF) is endemic in Eurasian countries such as, Turkey, Pakistan, Afghanistan and Iran. CCHF virus is spread by the Hyalomma tick, which is found mainly on cattle and sheep. Muslim countries, in which these animals are sacrificed during Eid-Al-Adha, are among the countries where CCHF is endemic, and it has been observed that CCHF is associated with practices surrounding the Eid-ad-Adha festival. The dates for Eid-Al-Adha drift 10 days earlier in each year according to Georgian calendar. In previous years Eid-al-Adha occurred in autumn-winter months however in the next 10-15 years it will be take place in the summer months when CCHF is more prevalent. This may lead to a rise in the number of cases due to increased dissemination of CCHF virus with uncontrolled animal movements in and between countries. This consensus report focuses on the variable practices regarding animal handling in different regions and possible preventative measures to reduce the incidence of CCHF. Environmental hygiene and personal protection are essential parts of prevention. There is a need for international collaborative preparedness and response plans for prevention and management of CCHF during Eid-Al-Adha in countries where the disease is prevalent.

Rello, Jordi/0000-0003-0676-6210; Leblebicioglu, Hakan/0000-0002-6033-8543 WOS: 000378046700029 PubMed: 27117201 …

Leblebicioglu, Hakan/0000-0002-6033-8543; yanik yalcin, tugba/0000-0001-5996-8639; atilla, aynur/0000-0001-8027-1991; Beeching, Nicholas/0000-0002-7019-8791; Fletcher, Tom/0000-0002-3712-415X; Kilic, Suleyman sirri/0000-0003-1255-9939 WOS: 000410001100007 PubMed: 28886039 Background Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers. Aim Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia. Methods A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016. Results Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23). Conclusions Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP& C practice at individual units in endemic areas, as part of national quality assurance programs. Wellcome TrustWellcome Trust [104480/Z/14/Z]; UK Ministry of Defence; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections; University of Liverpool, Liverpool School of Tropical Medicine and Public Health England (PHE) There was no specific funding for this study. TF is funded by Wellcome Trust (104480/Z/14/Z) and the UK Ministry of Defence. NJB is partially supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections, a partnership between the University of Liverpool, Liverpool School of Tropical Medicine and Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of their respective institutions or Ministries of Health.; There was no specific funding for this study. TF is funded by Wellcome Trust (104480/Z/14/Z) and the UK Ministry of Defence. NJB is partially supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections, a partnership between the University of Liverpool, Liverpool School of Tropical Medicine and Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of their respective institutions or Ministries of Health.

Amaç: Kronik hepatitli hastalar antiviral ilaç tedavisiyle beraber alternatif ürünleride kullanabilirler. Alternatif ürünler bazen klinik kötüleşmeye yol açabilir. Bu çalışmada kronik hepatit B (KHB) ve kronik hepatit C (KHC)'li hastaların alternatif ürün kullanımını ve sıklıklarını belirlemeyi amaçladık. Yöntemler: Bu prospektif kohort çalışmaya Ondokuz Mayıs Üniversitesi Enfeksiyon Hastalıkları Klinik Mikrobiyoloji polikliniğinde 1 Mart-30 Temmuz 2012 tarihleri arasında kronik hepatit B ve C tanısı ile izlenen 200 yetişkin hasta dahil edildi. Hastaların klinik bilgileri, demografik, laboratuvar değerleri ve alternatif ürün kullanma bilgileri kaydedildi. Bulgular: Hastalarımızın 150'inde KHB ve 50'inde KHB infeksiyonu olup % 54'ü erkekti. Alternatif ürün kullanım oranı % 26 idi. Bütün hastalarda antiviral tedavi kullanım oranı % 48,5'idi. En sık kullanılan alternatif ürünler enginar ve baldı. Hastaların % 67,3'ü sadece bal kullanırken, diğerleri iki veya daha fazla alternatif ürün kullanıyordu. Alternatif ürün kullanan hastaların sadece % 46,2'si ilk sorgulamada ürün kullanımı hakkında bilgiyi verirken diğerleri vermedi.Sonuç: Çalışmaya alınan hastaların çoğunluğunda alternatif ürün kullanımı belirlenirken hastaların yarısı alternatif ürün kullandıkları hakkında doktoruna bilgi vermedi. Sonuç olarak kronik hepatitli her hastada alternatif ürün kullanımı detaylı şekilde sorgulanmalıdır Objectives: Some of the patients with chronic hepatitis use both alternative product and/or antiviral treatment. These herbal products sometimes lead to clinical deterioration. In this study we aimed to determine the purpose of alternative product utilization and rate among the chronic hepatitis B (CHB) and C (CHC) patients. Methods: This prospective cohort study included 200 consecutive adult patients with chronic hepatitis B and C at the Department of Infectious Diseases, Ondokuz Mayis University, between 1 March 2012 and 30 July 2012. At enrollment, clinical information, demographics, laboratory variables and knowledge about alternative products were recorded. Results: Of the patients 150 had CHB, 50 had CHC. 54% of patients were male. Use of alternative products was 26%. Antiviral treatment rate was 48.5% for all patients. The most used alternative products were artichoke extract and honey. 67.3% of patients were using single alternative product whereas the others were using two or more alternative products. 46.2% of patients who use alternative product provided information about the alternative product usage, but the others did not. Conclusions: Majority of patients used alternative products. More than half of these patients did not give information to their physicians about their use of alternative medicine. Use of alternative product should be asked in all patients with chronic hepatitis. Herbal product usage was detected in majority of patients and also approximately half of these patients did not give information to their doctors about taking alternative medicine. In conclusion, it is necessary to take detailed information about herbal product usage in patients with chronic hepatitis. J Microbiol Infect Dis 2014; 4(3): 102-106

Leblebicioglu, Hakan/0000-0002-6033-8543; WOS: 000339864000010 PubMed: 25062428 We investigated migratory birds' role in spreading Crimean-Congo hemorrhagic fever virus (CCHFV) through attached ticks. We detected CCHFV RNA in ticks on migratory birds in Turkey. Two isolates showed similarity with CCHFV genotype 4, suggesting a role for ticks in CCHFV epidemics in Turkey and spread of CCHFV by birds. Ondokuz Mayis UniversityOndokuz Mayis University [PYO.TIP.1901.10.002] This work was supported by Ondokuz Mayis University (project no. PYO.TIP.1901.10.002).

Highlights • The paper provides a comprehensive overview of the status of Crimean-Congo hemorrhagic fever (CCHF) in countries across the World Health Organization Eastern Mediterranean Region (WHO EMR). • The increasing incidence of CCHF disease in the region and its spread to new geographical areas is highlighted. • Knowledge gaps concerning the burden and circulation of CCHF virus in the WHO EMR are identified. • A strategic framework is described, which details the research and development work necessary to curb the ongoing and new threats posed by CCHF virus., Summary Crimean-Congo haemorrhagic fever (CCHF) is the most widespread, tick-borne viral disease affecting humans. The disease is endemic in many regions, such as Africa, Asia, Eastern and Southern Europe, and Central Asia. Recently, the incidence of CCHF has increased rapidly in the countries of the World Health Organization Eastern Mediterranean Region (WHO EMR), with sporadic human cases and outbreaks of CCHF being reported from a number of countries in the region. Despite the rapidly growing incidence of the disease, there are currently no accurate data on the burden of the disease in the region due to the different surveillance systems used for CCHF in these countries. In an effort to increase our understanding of the epidemiology and risk factors for the transmission of the CCHF virus (CCHFV; a Nairovirus of the family Bunyaviridae) in the WHO EMR, and to identify the current knowledge gaps that are hindering effective control interventions, a sub-regional meeting was organized in Muscat, Oman, from December 7 to 9, 2015. This article summarizes the current knowledge of the disease in the region, identifies the knowledge gaps that present challenges for the prevention and control of CCHFV, and details a strategic framework for research and development activities that would be necessary to curb the ongoing and new threats posed by CCHFV.

Crimean-Congo hemorrhagic fever (CCHF) is a life-threatening tick-borne infection in Africa and Eurasia. Although knowledge of epidemiology is increasing, the global extent and risk of infection is not well described. A niche-modeling framework has been used to map the global distribution of risk for CCHF based on analysis of human CCHF reports. The new risk maps provide a valuable starting point for understanding the zoonotic niche of CCHF. Migratory birds travelling across continents may also introduce CCHF to new areas through attached ticks. There is an overlap between CCHF endemic areas and breeding and wintering grounds of migratory birds.