Background Headlice are prevalent worldwide, with a higher burden in rural, lower-middle income settings. They can cause intense itchiness, discomfort, and secondary bacterial infections with potentially serious conse...Background Headlice are prevalent worldwide, with a higher burden in rural, lower-middle income settings. They can cause intense itchiness, discomfort, and secondary bacterial infections with potentially serious consequences. Ivermectin is efficacious against headlice, and is also being evaluated as a malaria vector control tool. In this study, we explored risk factors for headlice, and assessed the efficacy of ivermectin mass drug administration (MDA) designed for malaria against headlice.Methods We conducted an open-label, assessor-blind, cluster-randomized controlled trial in Mopeia, Mozambique. A single dose of ivermectin was given monthly to eligible humans or humans and livestock (humans: 400 μg/kg, livestock: 1% injectable 200 μg/kg) in 3 consecutive months during the rainy season. The control group received albendazole (humans only). Thirty-nine clusters (13 per arm) were randomly selected for the nested assessment of headlice prevalence. 1341 treated participants were followed up at least once, 1, 2 and 3 months and 382 untreated (ineligible) participants at 3 and 6 months after the first MDA round. Headlice diagnosis was determined by scalp examination. Logistic regression was used to identify risk factors for headlice at baseline, and to estimate the treatment effect at each time point.Results A total of 1309 participants were included in the main analysis assessing ivermectin MDA efficacy, and 1332 in the risk factor analysis. The baseline headlice prevalence was 11%. Risk factors included living with a household member with head itch [adjusted odds ratio (aOR)= 48.63, 95% confidence interval (CI): 28.7–82.3,P-value < 0.0001], being female (aOR= 2.25, 95%CI: 1.33–3.80,P-value < 0.01), and using surface water as the main water (aOR= 2.37, 95%CI: 1.12–5.33,P-value= 0.04). The treated population receiving ivermectin had significantly lower odds of having headlice at 3 months compared to those receiving albendazole (aOR= 0.19, 95%CI: 0.04–0.91,P-value = 0.04). There was no indirect effect on headlice among children ineligible for treatment.Conclusions In a highly endemic setting, mass drug administration with ivermectin significantly reduces headlice infestation prevalence among those who receive the drug for three sequential months. The lack of effect among untreated, ineligible children implies that additional interventions would be needed to interrupt local transmission.展开更多
Background Tegumentary leishmaniasis(TL)caused by Leishmania infantum is an overlooked yet re-emerging disease endemic in Mediterranean Europe.Currently,no standardized molecular surveillance of circulating Leishmania...Background Tegumentary leishmaniasis(TL)caused by Leishmania infantum is an overlooked yet re-emerging disease endemic in Mediterranean Europe.Currently,no standardized molecular surveillance of circulating Leishmania strains is performed in European endemic areas,despite the potential public health implications of parasite biodiversity.This study aims to characterize parasite population haplogroups causing TL in two active endemic areas in southern Europe,i.e.Bologna(northern Italy)and Fuenlabrada(central Spain).Methods In this retrospective study,we typed 87 L.infantum samples from TL cases in the areas of Bologna and Fuenlabrada;these areas hosted the main European foci of human TL occurring in the last 15 years.Two Leishmania genomic typing targets were used:the heat shock protein 70(Hsp70)and the cysteine peptidase b(Cpb).Simpson’s index was used to calculate the discriminatory power of the used typing methods.Results Typing results depicted the presence of a heterogeneous parasite population circulating in Bologna with two main haplogroups,i.e.Hsp70(A)_Cpb(F)(n=7,30.4%)and Hsp70(G)_Cpb(E/F)(n=7,30.4%),differing from the reference L.infantum strain JPCM5 haplogroup and partially overlapping with L.donovani lineages.Among the samples from Fuenlabrada,n=19 samples were typed by both targets,revealing a homogeneous population expressing Hsp70(A)and Cpb(E),matching the JPCM5 reference strain haplogroup.Overall,the Cpb typing method exhibited higher discrimination power as compared to the Hsp70 method(Simpson’s index of diversity,P-value<0.05).Conclusions Our findings show differences among L.infantum populations causing TL in two southern European epidemiological foci of human leishmaniasis and support the recent discovery of L.infantum/L.donovani hybrid strains circulating in northern Italy.These results underscore the critical need to identify the circulating Leishmania strains in endemic areas and assess their potential public health implications in active foci.展开更多
The coronavirus disease-19(COVID-19)outbreak,caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),was declared a global pandemic in March 2020.It has affected over 700 million people worldwide and...The coronavirus disease-19(COVID-19)outbreak,caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),was declared a global pandemic in March 2020.It has affected over 700 million people worldwide and resulted in almost 7 million deaths,equating to a 1%mortality rate.At present,the majority of COVID-19 cases are either asymptomatic or mild,typically resolving within two weeks.However,between 1%and 10%of COVID-19 survivors do not fully recover and experience a post-viral syndrome referred to as"long COVID","post-acute COVID-19 syndrome"(PASC),or"post-COVID condition"(PCC).This post-viral syndrome affects both adult and pediatric populations.However,most of the studies published to date evaluate the adult population,leaving a gap in our understanding of its impact on children and adolescents.展开更多
Background The current diagnostic strategy for hepatitis C virus(HCV)infection involves a two-step approach:antibody HCV screening followed by confirmatory nucleic acid testing.This study aimed to evaluate the diagnos...Background The current diagnostic strategy for hepatitis C virus(HCV)infection involves a two-step approach:antibody HCV screening followed by confirmatory nucleic acid testing.This study aimed to evaluate the diagnostic performance of the Abbott ARCHITECT HCV Ag assay in serum/plasma samples as a potential one-step alterna-tive for diagnosing active HCV infection in people living with hepatitis B virus(PLWHB)through a systematic review and meta-analysis.Methods A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines.This protocol was registered on PROSPERO(CRD42023402093).A comprehensive search of electronic databases identified studies published up to 1 November 2024,comparing the ARCHITECT HCV Ag assay to an HCV-RNA reference standard.Sen-sitivity,specificity,and likelihood ratios were pooled using a random-effects model within the MIDAS module of Stata software.Study quality was assessed using QUADAS-2.Heterogeneity was evaluated using the Q statistic,quantified using the I2,and further explored through meta-regression.Results Ten studies(n=494 participants)met inclusion criteria.The Abbott ARCHITECT HCV Ag assay demonstrated high sensitivity[91%,95%confidence interval(CI):76-97%]and specificity(99%,95%CI:99-100%).The positive likeli-hood ratio(PLR)was 81.20(95%CI:12.34-534.36),and the negative likelihood ratio(NLR)was 0.09(95%CI:0.03-0.27).The area under the summary receiver operating characteristic curve(AUC-SROC)was 99%(95%CI 98-100%).In regions with high HCV prevalence(≥10%),the test accurately confirmed active HCV infection in over 90%of cases.However,confirmatory testing remains necessary in low-prevalence settings(≤5%).The assay demonstrated an excel-lent ability to identify individuals without HCV infection,with a low false-negative rate(≤2%)regardless of HCV prevalence.Heterogeneity analysis revealed moderate to substantial variation in test performance(I2=72.09%for sensitivity,35.47%for PLR,and 78.33%for NLR).QUADAS-2 applicability concerns predicted heterogeneity,but dif-ferences were likely insignificant due to minimal variations and limited studies.Conclusions The Abbott ARCHITECT HCV Ag assay exhibited promising accuracy in detecting active HCV infection among PLWHB.This test might help diagnose active HCV infection in high-prevalence scenarios(≥10%)but needs further confirmation in low-prevalence settings(≤5%).展开更多
Background Onchocerciasis and lymphatic filariasis(LF)are endemic in Equatorial Guinea with notable variations in disease incidence between island and mainland regions.Historically,efforts to control and map these dis...Background Onchocerciasis and lymphatic filariasis(LF)are endemic in Equatorial Guinea with notable variations in disease incidence between island and mainland regions.Historically,efforts to control and map these diseases were concentrated in Bioko Island,where loiasis is absent,allowing for targeted onchocerciasis interruption strategies.With the cessation of onchocerciasis transmission on Bioko and no reported cases on Annobon island,assessing the trans-mission status in the previously unaddressed mainland region has become imperative.Mapping efforts in mainland Equatorial Guinea have proven low to moderate level of transmission for LF and onchocerciasis,although the results so far have not been very conclusive.The current study aims to update the prevalence estimates for onchocerciasis and LF in mainland Equatorial Guinea using various diagnostic techniques.Methods This is the first cross-sectional study carried out to estimate the prevalence of onchocerciasis and LF in the mainland area of Equatorial Guinea,from September to December 2019,based on the combination of skin snip biopsies,thick blood smears,laboratory serological tests(ELISA tests for the detection of lgG4 antibodies against Onchocerca volvulus recombinant antigen Ov16 and Wuchereria bancrofti recombinant antigen Wb123)and molecular laboratory tests.Frequencies and prevalence rates,along with 95%confidence intervals for interval estimation of a binomial proportion,were computed.Results The overall onchocerciasis seroprevalence calculated for the study was 0.3%(95%CI:0.1 to 0.5%).Micro-scopic examination of skin biopsies from the eight individuals seropositive for Ov16,out of the 3951 individuals initially tested,revealed no O.volvulus microfilariae.However,DNA extracted from one skin snip was successfully amplified,with subsequent sequencing confirming the presence of O.volvulus.Among the 3951 individuals,182 were found to have anti-Wb123 antibodies,suggesting exposure to W.bancrofti,with an estimated seroprevalence of 4.6%(95%CI:4.0 to 5.3%).Microscopy and Filaria-real time-PCR(F-RT-PCR)analysis for W.bancrofti were negative across all samples.Conclusions The findings indicate that onchocerciasis may no longer constitutes a public health problem in Equato-rial Guinea,positioning the country on the verge of achieving elimination.Additionally,the mapped prevalence of LF will facilitate the formulation of national strategies aimed at eradicating filariases countrywide.展开更多
基金This study was funded and supported by Unitaid under the BOHEMIA grant.The funder had no role in the decision to submit this manuscript for publicationISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the"Centro de Excelencia Severo Ochoa 2019-2023"Program(CEX2018-000806-S)support from the Generalitat de Catalunya through the CERCA program.
文摘Background Headlice are prevalent worldwide, with a higher burden in rural, lower-middle income settings. They can cause intense itchiness, discomfort, and secondary bacterial infections with potentially serious consequences. Ivermectin is efficacious against headlice, and is also being evaluated as a malaria vector control tool. In this study, we explored risk factors for headlice, and assessed the efficacy of ivermectin mass drug administration (MDA) designed for malaria against headlice.Methods We conducted an open-label, assessor-blind, cluster-randomized controlled trial in Mopeia, Mozambique. A single dose of ivermectin was given monthly to eligible humans or humans and livestock (humans: 400 μg/kg, livestock: 1% injectable 200 μg/kg) in 3 consecutive months during the rainy season. The control group received albendazole (humans only). Thirty-nine clusters (13 per arm) were randomly selected for the nested assessment of headlice prevalence. 1341 treated participants were followed up at least once, 1, 2 and 3 months and 382 untreated (ineligible) participants at 3 and 6 months after the first MDA round. Headlice diagnosis was determined by scalp examination. Logistic regression was used to identify risk factors for headlice at baseline, and to estimate the treatment effect at each time point.Results A total of 1309 participants were included in the main analysis assessing ivermectin MDA efficacy, and 1332 in the risk factor analysis. The baseline headlice prevalence was 11%. Risk factors included living with a household member with head itch [adjusted odds ratio (aOR)= 48.63, 95% confidence interval (CI): 28.7–82.3,P-value < 0.0001], being female (aOR= 2.25, 95%CI: 1.33–3.80,P-value < 0.01), and using surface water as the main water (aOR= 2.37, 95%CI: 1.12–5.33,P-value= 0.04). The treated population receiving ivermectin had significantly lower odds of having headlice at 3 months compared to those receiving albendazole (aOR= 0.19, 95%CI: 0.04–0.91,P-value = 0.04). There was no indirect effect on headlice among children ineligible for treatment.Conclusions In a highly endemic setting, mass drug administration with ivermectin significantly reduces headlice infestation prevalence among those who receive the drug for three sequential months. The lack of effect among untreated, ineligible children implies that additional interventions would be needed to interrupt local transmission.
基金supported by EU funding within the NextGeneration EUMUR PNRR Extended Partnership initiative on Emerging Infectious Diseases(Project no.PE00000007,INF-ACT)by the Ministry of Health,Italy(grant E54I19002870001—IZSLER PRC 2019016)+1 种基金by the Instituto de Salud Carlos Ⅲ through ISCⅢ-AES projects(PI24CⅢ/00023)CIBER of Infectious Diseases(CB21/13/00018).
文摘Background Tegumentary leishmaniasis(TL)caused by Leishmania infantum is an overlooked yet re-emerging disease endemic in Mediterranean Europe.Currently,no standardized molecular surveillance of circulating Leishmania strains is performed in European endemic areas,despite the potential public health implications of parasite biodiversity.This study aims to characterize parasite population haplogroups causing TL in two active endemic areas in southern Europe,i.e.Bologna(northern Italy)and Fuenlabrada(central Spain).Methods In this retrospective study,we typed 87 L.infantum samples from TL cases in the areas of Bologna and Fuenlabrada;these areas hosted the main European foci of human TL occurring in the last 15 years.Two Leishmania genomic typing targets were used:the heat shock protein 70(Hsp70)and the cysteine peptidase b(Cpb).Simpson’s index was used to calculate the discriminatory power of the used typing methods.Results Typing results depicted the presence of a heterogeneous parasite population circulating in Bologna with two main haplogroups,i.e.Hsp70(A)_Cpb(F)(n=7,30.4%)and Hsp70(G)_Cpb(E/F)(n=7,30.4%),differing from the reference L.infantum strain JPCM5 haplogroup and partially overlapping with L.donovani lineages.Among the samples from Fuenlabrada,n=19 samples were typed by both targets,revealing a homogeneous population expressing Hsp70(A)and Cpb(E),matching the JPCM5 reference strain haplogroup.Overall,the Cpb typing method exhibited higher discrimination power as compared to the Hsp70 method(Simpson’s index of diversity,P-value<0.05).Conclusions Our findings show differences among L.infantum populations causing TL in two southern European epidemiological foci of human leishmaniasis and support the recent discovery of L.infantum/L.donovani hybrid strains circulating in northern Italy.These results underscore the critical need to identify the circulating Leishmania strains in endemic areas and assess their potential public health implications in active foci.
基金supported by the Barcelona City Council and the Spanish Ministry of Science and Innovation(22S09391-001)by the University Hospital Germans Trias i Pujol(LC2313)+1 种基金a PhD Joan Oro fellowship(2023 FI-100207)from the Catalan Agency of Management of University and Research Grantsthe EU Gilead Research Scholars Program in HIV award 2021 and the grant 2020 BP 00046 from the Catalan Agency of Management of University and Research Grants.
文摘The coronavirus disease-19(COVID-19)outbreak,caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),was declared a global pandemic in March 2020.It has affected over 700 million people worldwide and resulted in almost 7 million deaths,equating to a 1%mortality rate.At present,the majority of COVID-19 cases are either asymptomatic or mild,typically resolving within two weeks.However,between 1%and 10%of COVID-19 survivors do not fully recover and experience a post-viral syndrome referred to as"long COVID","post-acute COVID-19 syndrome"(PASC),or"post-COVID condition"(PCC).This post-viral syndrome affects both adult and pediatric populations.However,most of the studies published to date evaluate the adult population,leaving a gap in our understanding of its impact on children and adolescents.
基金supported by grants from Instituto de Salud Carlos III(ISCII,grant#PI20CIII/00004 to SR,PI19CIII/00009 to IM,and PI23CIII/00018 to DSC and IM)and Gilead Science(grant#GLD20_0144 to SR)This research was also supported by CIBER‑Consorcio Centro de Investigación Biomédica en Red‑(CB 2021)+2 种基金Instituto de Salud Carlos III,Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU(CB21/13/00044)DSC is a‘Miguel Servet’researcher from ISCIII(grant#CP23CIII/00004)AT‑N is a Ph.D.student in the Biomedical Sciences and Public Health program at the UNED International Doctoral School.
文摘Background The current diagnostic strategy for hepatitis C virus(HCV)infection involves a two-step approach:antibody HCV screening followed by confirmatory nucleic acid testing.This study aimed to evaluate the diagnostic performance of the Abbott ARCHITECT HCV Ag assay in serum/plasma samples as a potential one-step alterna-tive for diagnosing active HCV infection in people living with hepatitis B virus(PLWHB)through a systematic review and meta-analysis.Methods A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines.This protocol was registered on PROSPERO(CRD42023402093).A comprehensive search of electronic databases identified studies published up to 1 November 2024,comparing the ARCHITECT HCV Ag assay to an HCV-RNA reference standard.Sen-sitivity,specificity,and likelihood ratios were pooled using a random-effects model within the MIDAS module of Stata software.Study quality was assessed using QUADAS-2.Heterogeneity was evaluated using the Q statistic,quantified using the I2,and further explored through meta-regression.Results Ten studies(n=494 participants)met inclusion criteria.The Abbott ARCHITECT HCV Ag assay demonstrated high sensitivity[91%,95%confidence interval(CI):76-97%]and specificity(99%,95%CI:99-100%).The positive likeli-hood ratio(PLR)was 81.20(95%CI:12.34-534.36),and the negative likelihood ratio(NLR)was 0.09(95%CI:0.03-0.27).The area under the summary receiver operating characteristic curve(AUC-SROC)was 99%(95%CI 98-100%).In regions with high HCV prevalence(≥10%),the test accurately confirmed active HCV infection in over 90%of cases.However,confirmatory testing remains necessary in low-prevalence settings(≤5%).The assay demonstrated an excel-lent ability to identify individuals without HCV infection,with a low false-negative rate(≤2%)regardless of HCV prevalence.Heterogeneity analysis revealed moderate to substantial variation in test performance(I2=72.09%for sensitivity,35.47%for PLR,and 78.33%for NLR).QUADAS-2 applicability concerns predicted heterogeneity,but dif-ferences were likely insignificant due to minimal variations and limited studies.Conclusions The Abbott ARCHITECT HCV Ag assay exhibited promising accuracy in detecting active HCV infection among PLWHB.This test might help diagnose active HCV infection in high-prevalence scenarios(≥10%)but needs further confirmation in low-prevalence settings(≤5%).
基金Funding WHO(GNQ/AFRO/19–194)Task Force for Global Health(NTDSC#093‑2016)Instituto de Salud Carlos III(AESI‑PI17CIII/00019&AESI‑PI20CIII/00034)and CIBERINFEC‑UE‑(CB21/13/00120).
文摘Background Onchocerciasis and lymphatic filariasis(LF)are endemic in Equatorial Guinea with notable variations in disease incidence between island and mainland regions.Historically,efforts to control and map these diseases were concentrated in Bioko Island,where loiasis is absent,allowing for targeted onchocerciasis interruption strategies.With the cessation of onchocerciasis transmission on Bioko and no reported cases on Annobon island,assessing the trans-mission status in the previously unaddressed mainland region has become imperative.Mapping efforts in mainland Equatorial Guinea have proven low to moderate level of transmission for LF and onchocerciasis,although the results so far have not been very conclusive.The current study aims to update the prevalence estimates for onchocerciasis and LF in mainland Equatorial Guinea using various diagnostic techniques.Methods This is the first cross-sectional study carried out to estimate the prevalence of onchocerciasis and LF in the mainland area of Equatorial Guinea,from September to December 2019,based on the combination of skin snip biopsies,thick blood smears,laboratory serological tests(ELISA tests for the detection of lgG4 antibodies against Onchocerca volvulus recombinant antigen Ov16 and Wuchereria bancrofti recombinant antigen Wb123)and molecular laboratory tests.Frequencies and prevalence rates,along with 95%confidence intervals for interval estimation of a binomial proportion,were computed.Results The overall onchocerciasis seroprevalence calculated for the study was 0.3%(95%CI:0.1 to 0.5%).Micro-scopic examination of skin biopsies from the eight individuals seropositive for Ov16,out of the 3951 individuals initially tested,revealed no O.volvulus microfilariae.However,DNA extracted from one skin snip was successfully amplified,with subsequent sequencing confirming the presence of O.volvulus.Among the 3951 individuals,182 were found to have anti-Wb123 antibodies,suggesting exposure to W.bancrofti,with an estimated seroprevalence of 4.6%(95%CI:4.0 to 5.3%).Microscopy and Filaria-real time-PCR(F-RT-PCR)analysis for W.bancrofti were negative across all samples.Conclusions The findings indicate that onchocerciasis may no longer constitutes a public health problem in Equato-rial Guinea,positioning the country on the verge of achieving elimination.Additionally,the mapped prevalence of LF will facilitate the formulation of national strategies aimed at eradicating filariases countrywide.
