IDSky

www.thelancet.com

Evaluating the technical feasibility of serological testing and treatment for Plasmodium vivax in mobile at-risk of malaria Cambodian populations

The participation rates and overall technical feasibility of PvSeroTAT in highly mobile individuals living within communities in malaria endemic areas of Cambodia were very promising. PvSeroTAT with a...

www.cidrap.umn.edu

Top virologists urge world leaders to act on rising avian flu threat

Global Virus Network scientists highlight the need for robust surveillance, enhanced biosecurity, and readiness for potential human-to-human viral transmission.

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Scientific Integrity Under Threat: The Role of the IDSA, PIDS, and SHEA Journals in an Evolving Political Landscape

The landscape of scientific publishing, education, and healthcare research is facing unprecedented challenges as political decisions increasingly encroach on academic freedom, data accessibility, and global health priorities. Recent policy changes in the United States, including the removal of key educational materials from government websites, funding freezes on global health initiatives such as PEPFAR, and restrictions on language use in scientific communications, present a significant threat to the integrity of scientific discourse. The implications of these policies extend beyond research institutions—they have real and lasting consequences for healthcare equity, evidence-based policy making, and the ability to address infectious diseases worldwide.

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Clinical Outcomes and Perspectives of People With Human Immunodeficiency Virus Type 1 Twelve Months After Initiation of Long-acting Cabotegravir and Rilpivirine in an Observational Real-world US Study (BEYOND)

Long-acting cabotegravir plus rilpivirine (CAB + RPV LA) administered monthly or every 2 months is recommended by treatment guidelines for maintenance of virologic suppression in people with human immunodeficiency virus type 1 (HIV-1). In clinical trials, CAB + RPV LA demonstrated noninferiority versus United States (US) Food and Drug Administration–approved daily oral therapy, and outcomes in real-world settings can supplement these results. We present month 12 results of BEYOND.MethodsBEYOND is an ongoing, 2-year, multicenter, prospective, observational real-world study of adults initiating CAB + RPV LA in the US. Key outcomes included reasons for initiating, virologic outcomes, adherence, and patient-reported outcomes related to treatment satisfaction and treatment challenges at baseline and month 12.ResultsIn total, 308 participants (median age, 45 years; 83% identified as male; 39% identified as Black) initiated CAB + RPV LA most commonly because of treatment fatigue, adherence anxiety with daily oral therapy, and/or convenience. Of participants with baseline viral load data, 97% (194/200) had a viral load <50 copies/mL for their most recent test reported at month 12. Mean treatment satisfaction scores increased significantly from baseline to month 12 and 97% (223/229) of participants preferred LA versus oral treatment at month 12. Proportions of participants reporting “always” or “often” experiencing challenges related to HIV-1 treatment (fear of disclosure, adherence anxiety, reminder of HIV-1 status, and feeling stigmatized) decreased from baseline to month 12.ConclusionsMonth 12 results from the real-world BEYOND study support the effectiveness of CAB + RPV LA for maintenance of virologic suppression and as a preferred treatment option for people with HIV-1.

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Proportions of US Blood Donors With Serological Evidence of Severe Acute Respiratory Syndrome Coronavirus 2 Infections Who Reported Survey-Based Diagnosed Infections During July 2020–December 2022

AbstractThe proportion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections diagnosed by coronavirus disease 2019 (COVID-19) tests, including home antigen tests, is unknown. We detected infections among blood donors in the United States (US) by testing for nucleocapsid antibody (anti-N) seroconversion and administered a questionnaire to determine the proportion of those infections that were associated with a self-reported positive COVID-19 test. Among US blood donors with serologic evidence of SARS-CoV-2 infection who completed a survey, 47.7% reported an associated self-reported positive COVID-19 test. This proportion changed from July–December 2020 (44.9%) to July–December 2022 (54.8%). This study suggests many SARS-CoV-2 infections in adults are not diagnosed with a test.

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Toward Personalized Medicine: The Effect of Treatment of Chronic Enterovirus Diarrhea in an Immunocompromised Patient and the Correlation With In Vitro Models

AbstractEnteroviruses (EV) usually cause acute, mild, self-limiting disease. Chronic infections with EVs are rare, and typically occur in patients with immunodeficiency, posing a high risk of severe outcomes. We report a rare case of chronic diarrhea caused by coxsackievirus A1 (CVA1) (from EV-C species) infection in a patient with a common variable immunodeficiency, who was on treatment with pooled intravenous immunoglobulin (IVIG) from the Netherlands. To explore treatment options, we assessed the presence of neutralizing antibodies (nAbs) against CVA1 in pooled IVIG from South Africa, where EV-Cs are prevalent, and tested the antiviral efficacy of US Food and Drug Administration–approved drugs like fluoxetine, itraconazole, ribavirin, and remdesivir (RDV) against CVA1 in vitro. Both Dutch and South African IVIG showed low nAb titers against CVA1. The patient, treated with Dutch IVIG, also received a combination of amantadine and fluoxetine, which were discontinued due to side effects. Among the drugs tested, only RDV significantly inhibited CVA1 replication in rhabdomyosarcoma (RD) cells. This in vitro efficacy was not reflected by a favorable clinical response after treatment of the patient with RDV. In concordance with unfavorable antiviral response in the patient, preliminary tests on a co-culture model containing isogenic human intestinal cells and intestinal fibroblasts showed no significant reduction in CVA1 RNA copies after RDV administration. In conclusion, our results showed that repurposing of drugs that have shown in vitro efficacy does not translate well to the patients, and this is also reflected in a more physiologically relevant model of the human intestine.

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Impact of a Collaboration-Focused Intervention to Prevent Healthcare-Associated Infections Before and During the Coronavirus Disease 2019 Pandemic

Nursing home (NH) residents are susceptible to healthcare-associated infections (HAIs). Alignment among NHs, hospitals, and health departments is critical for effective implementation of infection prevention efforts. We tested a collaborative model that engaged hospitals and NHs to reduce infections among NH residents.MethodsWe recruited 92 NHs and 15 hospitals over four 12-month cohorts (2018–2022). The intervention focused on HAI prevention; practices to reduce infection transmission; and effective communication among hospitals, NHs, and state health departments. NHs submitted data on urinary tract infection, catheter-associated urinary tract infection, Clostridioides difficile infection, methicillin-resistant Staphylococcus aureus infection, catheter use, and urine cultures. Changes in outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic were assessed using multilevel negative binomial regression.ResultsA total of 63 NHs (68%) partnered with 18 hospitals and submitted 2 or more months of outcome data. Forty NHs participated before COVID-19 (contributing to 1 364 492 resident-days, 56 258 device-days), and 23 NHs participated during COVID-19 (566 142 resident-days, 29 568 device-days). While reductions in the incidence of urine cultures (incidence rate ratio [IRR], 0.37; P < .001) and total composite infections (IRR, 0.68; P = .03) were observed before COVID-19, these reductions were not sustained during the pandemic.ConclusionsPrior to COVID-19 pandemic, collaboration between NHs and referring regional hospitals with engagement from state health departments led to reductions in NH urine cultures and total infections. Although the pandemic significantly impacted our study, we demonstrate the importance of regional networks in promoting infection prevention in NHs.

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Clinical Characteristics and Factors Associated With Severe Outcomes of 1891 Pediatric Patients Admitted to the Referral Cholera Treatment Centers in Lusaka, Zambia, December 2023–March 2024

Zambia declared a cholera outbreak on 18 October 2023 and, as of 31 June 2024, had recorded 23 381 cases and 740 deaths. Of the patients seen at the 2 main cholera treatment centers in the capital Lusaka, a third of them were children aged 0 to 15 years. Despite the significant pediatric cholera burden, risk factors for mortality and prolonged hospitalization remain unknown.MethodsA retrospective data review was conducted by examining the clinical characteristics of patients aged 0 to 15 years hospitalized at the 2 cholera treatment centers between 15 October 2023 and 31 March 2024. Descriptive analysis was conducted for patient characteristics, and penalized logistic regression (PLR) was used to analyze risk factors for the outcomes.ResultsA total of 1891 patients were identified, among which 1.4% (18/1253) had fatal outcomes and 47.9% (399/833) had hospitalization >2 days. By the PLR, the following factors were independently correlated with hospitalization >2 days: HIV infection (odds ratio [OR], 6.89; 95% CI, 1.32–71.9), severe acute malnutrition (SAM; OR, 10.8; 95% CI, 2.91–61.1), and dehydration treatment plans B (OR, 3.93; 95% CI, 1.80–9.27) and C (OR, 7.54; 95% CI, 2.71–22.9). For the fatal outcome, none of them independently showed any significant correlations by the PLR, although younger age and SAM were positively associated by bivariate analysis.ConclusionsComorbidities such as SAM and HIV, being on plan B or C, and deteriorating and requiring more intense treatment are associated with longer hospitalization. Risk factors for mortality need to be further investigated.

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Machine Learning–Based Diagnosis of Cryptococcal Meningitis and Tuberculous Meningitis: A Single-Center Retrospective Clinical Study

Differentiating cryptococcal meningitis from tuberculous meningitis is critical for initiating appropriate treatment and improving patient outcomes. However, overlapping pathogenic mechanisms, clinical presentations, laboratory findings, and imaging features complicate accurate diagnosis.MethodsWe performed a retrospective single-center study at the First Hospital of Changsha, analyzing medical records from January 2021 to November 2024. A total of 271 patients were included: 125 diagnosed with cryptococcal meningitis and 146 with tuberculous meningitis. Using LASSO regression (least absolute shrinkage and selection operator), we identified 11 potential predictors, which were subsequently refined to 6 key variables: extracranial fungi, cerebrospinal fluid pressure, age, erythrocyte sedimentation rate, albumin levels, and India ink staining. A diagnostic nomogram was constructed through multivariate logistic regression and validated by receiver operating characteristic analysis, calibration plots, decision curve analysis, and SHAP tools (Shapley additive explanations) for model interpretability.ResultsThe optimized model incorporated 6 variables: extracranial fungal presence, cerebrospinal fluid pressure, patient age, erythrocyte sedimentation rate, albumin levels, and India ink staining. According to SHAP analysis, the significance of these factors in prediction was underscored. The model achieved an area under the curve of 0.919 for the training cohort and 0.921 for the validation cohort, demonstrating robust sensitivity and specificity across both data sets. Additionally, calibration plots and decision curve analysis validated the model's precision and its applicability in clinical settings.ConclusionsThe developed nomogram accurately distinguishes cryptococcal meningitis from tuberculous meningitis with superior discriminative ability and clinical relevance, providing a valuable diagnostic tool for clinicians.

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Abnormal Trabecular and Cortical Bone Microarchitecture in Chronic Hepatitis C Infection and Associations With Select Inflammatory Cytokines

Hepatitis C virus (HCV) infection is associated with reduced bone mineral density (BMD) and increased fracture risk. The structural underpinnings for skeletal fragility with HCV and contributions of inflammatory cytokines remain unknown. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to compare skeletal parameters by chronic HCV.MethodsWe conducted a cross-sectional study among 58 participants with chronic HCV and 58 participants without HCV. Volumetric BMD and cortical dimensions of the radius and tibia were determined by HR-pQCT; visceral fat area and appendicular lean mass were assessed by whole body dual-energy x-ray absorptiometry; serum levels of tumor necrosis factor α (TNF-α), interleukin 6, and interleukin 18 were measured. Multivariable linear regression was used to estimate group differences in bone measurements and cytokines.ResultsParticipants with chronic HCV had lower radius trabecular volumetric BMD (−24.2 mg hydroxyapatite [HA]/cm3) and lower tibia trabecular volumetric BMD (−20.5 mg HA/cm3), cortical area (−20.9 mm2), and cortical thickness (−0.47 mm) than participants without HCV (all P < .05), independent of age, sex, visceral fat area, appendicular lean mass, and smoking. Mean log TNF-α was higher with chronic HCV (+0.1-log pg/mL; P < .001), but no differences in mean log interleukin 6 or interleukin 18 were observed. Higher log TNF-α was associated with lower radius trabecular volumetric BMD (−99.7 mg HA/cm3), lower tibia cortical volumetric BMD (−91.6 mg HA/cm3), and higher tibia cortical porosity (+1.39%) by HR-pQCT (all P < .05).ConclusionsPatients with chronic HCV had decreased trabecular volumetric BMD and cortical dimensions and higher TNF-α than individuals without infection, suggesting that HCV-associated inflammation might contribute to bone deficits.

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Serosurveillance to Support HPV Vaccination in England

In 2020, the World Health Organization (WHO) declared a global strategy to accelerate the elimination of cervical cancer as a public health problem, for which high vaccination coverage rates are a key component. Since its inception in 2008, the UK national adolescent human papillomavirus (HPV) vaccination program has changed the vaccines being offered, the dosing regimen, and has become gender neutral.MethodsWe conducted serosurveillance to evaluate the magnitude and durability of vaccine-induced humoral immunity across various schedule changes, including changing from the bivalent to the quadrivalent vaccine, changes from a 3-dose to 2-dose schedule and inclusion of boys. It does not yet cover more recent schedule changes that include the nonavalent vaccine. Serostatus and antibody levels (in IU/mL) are reported for all nonavalent vaccine types.ResultsOur findings are consistent with data from clinical trials supporting durability of high vaccine-induced antibody levels through to adulthood (into the peak ages of exposure to sexually transmitted infections) and comparability between males and females.ConclusionsThese data support the utility of serosurveillance to monitor population level immunity to inform and evaluate national HPV vaccination programs. This ongoing serosurveillance aims to identify any reductions in vaccine-induced immunity that could foretell of a potential weakening in HPV control.

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Community-Embedded Low-Barrier Care: A Model for Engaging People With Complex Needs in HIV Treatment and Prevention

AbstractPeople living homeless and people with substance use disorders are at increased risk for HIV but experience multiple intersecting barriers to accessing medical care. Low-barrier care has emerged as a strategy to engage persons with complex needs in care, particularly in the fields of HIV and substance use treatment. We describe our experience implementing low-barrier whole person care for HIV treatment and prevention at 3 community-embedded sites in King County, Washington, and outline key operational and clinic characteristics that helped facilitate success.

www.statnews.com

Gilead will pay $202 million to settle charges of paying kickbacks to docs for boosting HIV drug sales

The company paid to settle allegations of paying kickbacks to doctors in exchange for prescribing several of its HIV medicines.

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Measles Population Immunity in Hunan, China: A Serological Assessment

Assessing the measles immunity profile is critical for developing effective nationwide or regionwide supplementary immunization activities (SIAs). This study aims to assess measles population immunity levels in China and investigate factors contributing to age-specific heterogeneities.MethodsWe conducted a cross-sectional population-based serological study in southern China between June and October 2021. We determined the population mean antibody concentration and seroprevalence by age and over time, along with their associated determinants. Moreover, we estimated the contact-adjusted immunity levels by considering both age-specific immunity levels and population contact rates.ResultsAmong the 1015 study participants (aged 0–95 years), the overall seroprevalence was estimated at 80.9% (95% confidence interval [CI], 78.3–83.3). When adjusting for the age-specific contact rates, the contact-adjusted immunity was estimated at 66.8% (95% CI, 56.6–75.1). Individuals younger than age 30 years showed significantly lower antibody concentration and seroprevalence (mean log concentration: 5.9, seroprevalence: 73.6% [95% CI, 69.9–77.3]) compared to those older than age 50 years (mean log concentration: 6.8, seroprevalence: 96.8% [95% CI, 94.7–98.9]). In particular, individuals born after the last SIA (2010) showed a significantly faster waning of immunity.ConclusionsOur findings highlight that immunity levels in the general population remain below the 95% threshold, underscoring the need for continued monitoring of immunity dynamics, especially for individuals born in a near-elimination setting and without subsequent SIAs.

doi.org

The Relationship Between Frailty and Respiratory Syncytial Virus Infection in Hospitalized Older Adults

This study aimed to evaluate the impact of frailty on the clinical outcomes and disease severity of respiratory syncytial virus(RSV) infection in older adults using data from the Canadian Immunization Research Network(CIRN) Serious Outcomes Surveillance(SOS) Network.