Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA

<p>Abstract</p> <p>Background</p> <p>West Nile virus (WNV) emerged as a threat to public and veterinary health in the Midwest United States in 2001 and continues to cause significant morbidity and mortality annually. To investigate biotic and abiotic factors associated with disease incidence, cases of reported human disease caused by West Nile virus (WNV) in the state of Iowa were aggregated by census block groups in Iowa for the years 2002–2006. Spatially explicit data on landscape, demographic, and climatic conditions were collated and analyzed by census block groups. Statistical tests of differences between means and distributions of landscape, demographic, and climatic variables for census block groups with and without WNV disease incidence were carried out. Entomological data from Iowa were considered at the state level to add context to the potential ecological events taking place.</p> <p>Results</p> <p>Numerous statistically significant differences were shown in the means and distributions of various landscape and demographic variables for census block groups with and without WNV disease incidence. Census block groups with WNV disease incidence had significantly lower population densities than those without. Landscape variables showing differences included stream density, road density, land cover compositions, presence of irrigation, and presence of animal feeding operations. Statistically significant differences in the annual means of precipitations, dew point, and minimum temperature for both the year of WNV disease incidence and the prior year, were detected in at least one year of the analysis for each parameter. However, the differences were not consistent between years.</p> <p>Conclusion</p> <p>The analysis of human WNV disease incidence by census block groups in Iowa demonstrated unique landscape, demographic, and climatic associations. Our results indicate that multiple ecological WNV transmission dynamics are most likely taking place in Iowa. In 2003 and 2006, drier conditions were associated with WNV disease incidence. In a significant novel finding, rural agricultural settings were shown to be strongly associated with human WNV disease incidence in Iowa.</p

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA-1

E while the WNV disease incidence rates were derived by dividing the number of cases in a county by the population and multiplying by one million to get the rate per million people.<p><b>Copyright information:</b></p><p>Taken from "Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA"</p><p>http://www.ij-healthgeographics.com/content/7/1/19</p><p>International Journal of Health Geographics 2008;7():19-19.</p><p>Published online 1 May 2008</p><p>PMCID:PMC2396613.</p><p></p

Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA-2

Alysis distance. The values above 2.0 represent statistically significant hot-spots while below -2.0 are statistically significant cold-spots. The majority of census block groups fall in the statistically insignificant middle categories.<p><b>Copyright information:</b></p><p>Taken from "Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA"</p><p>http://www.ij-healthgeographics.com/content/7/1/19</p><p>International Journal of Health Geographics 2008;7():19-19.</p><p>Published online 1 May 2008</p><p>PMCID:PMC2396613.</p><p></p

Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA-0

Alysis distance. The values above 2.0 represent statistically significant hot-spots while below -2.0 are statistically significant cold-spots. The majority of census block groups fall in the statistically insignificant middle categories.<p><b>Copyright information:</b></p><p>Taken from "Landscape, demographic, entomological, and climatic associations with human disease incidence of West Nile virus in the state of Iowa, USA"</p><p>http://www.ij-healthgeographics.com/content/7/1/19</p><p>International Journal of Health Geographics 2008;7():19-19.</p><p>Published online 1 May 2008</p><p>PMCID:PMC2396613.</p><p></p

Subtype Analysis of Cryptosporidium Specimens from Sporadic Cases in Colorado, Idaho, New Mexico, and Iowa in 2007: Widespread Occurrence of One Cryptosporidium hominis Subtype and Case History of an Infection with the Cryptosporidium Horse Genotype▿

Subtyping was conducted in late 2007 on 57 Cryptosporidium specimens from sporadic cases in Colorado, Idaho, New Mexico, and Iowa. One previously rare Cryptosporidium hominis subtype was indentified in 40 cases (70%) from all four states, and the Cryptosporidium horse genotype was identified in a pet shop employee with severe clinical symptoms