Prevention of infection and disruption of the pathogen transfer chain in elective surgery

The COVID-19 pandemic has caused us all to stop our normal activities and consider how we can safely return to caring for our patients. There are many common practices (such as an increased use of personal protective equipment) which we are all familiar with that can be easily incorporated into our daily routines. Other actions, such as cleaning more surfaces with solutions such as dilute povidone iodine or changing the air filtration systems used within operating room theaters, may require more extensive efforts on our behalf. In this article, we have attempted to highlight some of the changes that arthroplasty surgeons may need to instigate when we are able to resume elective joint arthroplasty procedures in an effort to disrupt the chain of pathogen transfer

Ready or Not? Protecting the Public's Health From Diseases, Disasters, and Bioterrorism, 2008

Examines ten indicators to assess progress in state readiness to respond to bioterrorism and other public health emergencies. Evaluates the federal government's and hospitals' preparedness. Makes suggestions for funding, restructuring, and other reforms

The Microbiome and Hematopoietic Cell Transplantation: Past, Present, and Future

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Pathogens and host immunity in the ancient human oral cavity.

Calcified dental plaque (dental calculus) preserves for millennia and entraps biomolecules from all domains of life and viruses. We report the first, to our knowledge, high-resolution taxonomic and protein functional characterization of the ancient oral microbiome and demonstrate that the oral cavity has long served as a reservoir for bacteria implicated in both local and systemic disease. We characterize (i) the ancient oral microbiome in a diseased state, (ii) 40 opportunistic pathogens, (iii) ancient human-associated putative antibiotic resistance genes, (iv) a genome reconstruction of the periodontal pathogen Tannerella forsythia, (v) 239 bacterial and 43 human proteins, allowing confirmation of a long-term association between host immune factors, 'red complex' pathogens and periodontal disease, and (vi) DNA sequences matching dietary sources. Directly datable and nearly ubiquitous, dental calculus permits the simultaneous investigation of pathogen activity, host immunity and diet, thereby extending direct investigation of common diseases into the human evolutionary past

2020-04-30 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM residential facility deaths. NM case update. NM TriCore testing antibodies. Navajo nation cases. May 10 Navajo peak. Udall funding push. El Paso shopping discouraged. NM budget shortfall. Santa Fe furlough. Ethanol sanitizer safety. LA free testing for all. Michigan protest. NM Batelle N95 decontamination. Hospital revenue decline. Wastewater early detection. German herd immunity. 60-day viral shedding possible. Temporary infected “ark”. Prison release preparedness. Low quality research. Phased long-term care. Suicide prevention. Corticosteroid tradeoffs. Cloth mask guidelines. SARS-CoV-2 assays compared. IgG and viral loads. Better testing reporting. Dubious testing vendors. Promising oral drug. Hydroxychloroquine prophylaxis dosing. Umifenovir ineffective. Multi-drug nanoparticles. Drug discovery new targets. 38 new COVID-19 trials. Cancer research review. Attenuated SARS-CoV-2

Prospects for the development of a subunit vaccine against Mycobacterium ulcerans disease (Buruli ulcer)

Buruli ulcer (BU) is a slow progressing disease of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. It presents in different clinical forms ranging from small non-ulcerative nodules to large ulcers and sometimes multiple ulcerations. The highest prevalence of the focally occurring disease is found in rural areas of West African countries. Both the mode of transmission as well as the potential environmental reservoir of M. ulcerans remain unidentified to date. In Cameroon, the remote Mapé dam region has recently been identified as a new BU endemic area. To assess the age-adjusted prevalence and local geographic distribution of BU, a house-by-house survey in the Bankim health district was conducted. Results showed that children between the age of five to 15 and elderly people were over proportionally affected by BU. To confirm the clinical diagnosis of BU during and after the health survey in Bankim, fine needle aspirates and swabs from undermined ulcer edges were transported to the Swiss Tropical and Public Health Institute for laboratory confirmation by quantitative real time PCR. In parallel we developed a protocol for primary culture initiation of M. ulcerans from patient lesions after a long time span between sampling and processing in a BSL3 culture laboratory. The established two sets of Cameroonian patient isolates from the Mapé and the Nyong river valleys were used for a comparative genome sequencing study revealing the presence of two distinct phylogenetic clonal complexes in Cameroon. Despite the fact that BU can be treated with antibiotics, the socioeconomic impact of the disease on affected populations remains devastating. As long as it is not clearly known how the disease is contracted, interruption of transmission is not an option. A vaccine against M. ulcerans on the other hand could be used both as preventive measure and therapeutically. While sero-epidemiological studies imply the presence of protective immunity in some individuals, no vaccine is available to date. Within the framework of the EU funded collaborative project BuruliVac we investigated the potential for developing a protein subunit vaccine against M. ulcerans by delivering vaccine candidate antigens with three different systems: i. as recombinant proteins with an adjuvant, ii. as vesicular stomatitis virus replicon and iii. incorporated into a genetically modified mouse malaria parasite (Plasmodium berghei) in an infection - treatment - approach. All three formulations were assessed for their immunogenicity and their protective potential in a mouse model of BU. Although all three vaccination approaches elicited strong humoral immune responses, no full protection was observed for any of the formulations. However a slight partial protection was seen for a replicon - prime / recombinant protein boost regimen with a vesicular stomatitis virus replicon incorporating an expression cassette for the M. ulcerans protein MUL2232. Additionally, a transient delay of foot pad swelling was observed in mice receiving infection - treatment - vaccination with P. berghei expressing MUL4987. Despite the mainly extracellular nature of M. ulcerans in infected tissue, antibody production against the protein vaccine candidates thus does not seem to be sufficient for protection. Considering marked differences between the mouse footpad model of BU and the disease in humans, we aimed at developing an animal model that better reflects local pathogenesis and host-pathogen interactions in the human BU lesions. Hence, we developed the pig as novel animal model for BU and showed that the observed histopathological changes in the infected pig skin closely represent those of human BU. Therefore the pig model has great potential for the validation of new therapeutic and prophylactic interventions

Pulmonary infections complicating ARDS.

Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients. Diagnosing pulmonary infection in ARDS patients is challenging, and requires a combination of clinical, biological and microbiological criteria. The role of modern tools (e.g., molecular methods, metagenomic sequencing, etc.) remains to be evaluated in this setting. One of the challenges of antimicrobial treatment is antibiotics diffusion into the lungs. Although targeted delivery of antibiotics using nebulization may be interesting, their place in ARDS patients remains to be explored. The use of extracorporeal membrane oxygenation in the most severe patients is associated with a high rate of infection and raises several challenges, diagnostic issues and pharmacokinetics/pharmacodynamics changes being at the top. Prevention of pulmonary infection is a key issue in ARDS patients, but there is no specific measure for these high-risk patients. Reinforcing preventive measures using bundles seems to be the best option

Comparison of sputum collection methods for tuberculosis diagnosis: a systematic review and pairwise and network meta-analysis

Background The performance of laboratory tests to diagnose pulmonary tuberculosis is dependent on the quality of the sputum sample tested. The relative merits of sputum collection methods to improve tuberculosis diagnosis are poorly characterised. We therefore aimed to investigate the effects of sputum collection methods on tuberculosis diagnosis. Methods We did a systematic review and meta-analysis to investigate whether non-invasive sputum collection methods in people aged at least 12 years improve the diagnostic performance of laboratory testing for pulmonary tuberculosis. We searched PubMed, Google Scholar, ProQuest, Web of Science, CINAHL, and Embase up to April 14, 2017, to identify relevant experimental, case-control, or cohort studies. We analysed data by pairwise meta-analyses with a random-effects model and by network meta-analysis. All diagnostic performance data were calculated at the sputum-sample level, except where authors only reported data at the individual patient-level. Heterogeneity was assessed, with potential causes identified by logistic meta-regression. Findings We identified 23 eligible studies published between 1959 and 2017, involving 8967 participants who provided 19 252 sputum samples. Brief, on-demand spot sputum collection was the main reference standard. Pooled sputum collection increased tuberculosis diagnosis by microscopy (odds ratio [OR] 1·6, 95% CI 1·3–1·9, p<0·0001) or culture (1·7, 1·2–2·4, p=0·01). Providing instructions to the patient before sputum collection, during observed collection, or together with physiotherapy assistance increased diagnostic performance by microscopy (OR 1·6, 95% CI 1·3–2·0, p<0·0001). Collecting early morning sputum did not significantly increase diagnostic performance of microscopy (OR 1·5, 95% CI 0·9–2·6, p=0·2) or culture (1·4, 0·9–2·4, p=0·2). Network meta-analysis confirmed these findings, and revealed that both pooled and instructed spot sputum collections were similarly effective techniques for increasing the diagnostic performance of microscopy. Interpretation Tuberculosis diagnoses were substantially increased by either pooled collection or by providing instruction on how to produce a sputum sample taken at any time of the day. Both interventions had a similar effect to that reported for the introduction of new, expensive laboratory tests, and therefore warrant further exploration in the drive to end the global tuberculosis epidemic

CDC activities and initiatives supporting the COVID-19 response and the President\u2019s plan for opening America up again : May 2020

This document briefly summarizes CDC\u2019s initiatives, activities, and tools in support of the Whole-of-Government response to COVID-19.The principal objectives of COVID-19 surveillance are to monitor the spread and intensity of the pandemic, to enable contact tracing to slow transmission, and to identify disease clusters requiring special intervention. Secondary objectives include understanding the severity and spectrum of disease, identifying risk factors for and methods of preventing infection, and producing data essential for forecasting. In addition to tracking the disease itself, monitoring of healthcare capacity and essential supplies through the National Healthcare Safety Network (NHSN) is critical to ensure adequacy of care.Because no single system can capture all parameters of the pandemic, CDC has implemented multiple, complementary surveillance systems (Appendix A). Key systems are case-based reporting through the National Notifiable Diseases Surveillance System (NNDSS), laboratory-based surveillance, syndromic-surveillance data reported through the National Syndromic Surveillance Program (NSSP), and data on healthcare system capacity reported through the NHSN (Appendix B). Additional systems, such as COVID-Net, provide rich, publicly available information for meeting secondary objectives. CDC continues to explore emerging and experimental surveillance platforms with a critical eye toward proven utility.Control of the epidemic requires action at the individual, community, and population levels. CDC has provided state, tribal, local, and territorial health departments with extensive detailed guidance on contact tracing, infection control, and a wide range of other prevention and control topics. Recent models suggest that asymptomatic and pre-symptomatic transmission and delays in case recognition can greatly reduce the effectiveness of contact tracing. To enhance the speed and thus effectiveness of contact tracing, CDC is exploring technologic methods for instantaneous voluntary notification of contacts of confirmed cases.At the community level, recent events have shown the devastating effects that outbreaks can have among vulnerable populations, especially those in congregate settings such as nursing homes, prisons, and homeless shelters. Similarly, outbreaks in food production plants and other critical industries are crippling communities financially and threatening national food security. Rapid identification and response to these events is a CDC priority that can mitigate the immediate impact and provide critical insights needed to prevent future outbreaks in similar settings. CDC has developed extensive tools to assist states, counties, facilities, and industries in responding to and preventing these events (Appendix C).Widespread community mitigation combined with ongoing containment activities represents both an effective intervention for limiting the spread of COVID-19 and a serious threat to the economic well-being of the country and the world.Publication date from document properties.CDC-Activities-Initiatives-for-COVID-19-Response.pdfCDC Activities and Initiatives Supporting the COVID-19 Response and the President\u2019s Plan for Opening America Up Again -- Appendix A: Surveillance for COVID-19 -- Appendix B: Healthcare System Surveillance -- Appendix C: Guidance on Infection Control and Contact Tracing -- Appendix D: Guidance on Test Usage (Asymptomatic Populations and Serology).20207703Supersede