Perceptions of rodent-associated problems: an experience in urban and rural areas of Yucatan, Mexico

Rodents are a threat to agriculture and homes, and are a public health risk. Local perceptions about rodents and the damage they cause are vital, as a first step, to the design and implementation of rodent control or educational programs. A total of 111 interviews were conducted in two urban neighborhoods and two rural villages in Yucatan, Mexico. More than 90% of the interviewed inhabitants perceived rodents as a problem. The fear of rodents (57%), damage to food and stocks (56%), and damage to clothes (34%), were the most cited problems. In the urban neighborhoods, the use of rodent control methods was more frequent (57%) than in the villages (33%) in this study. In addition, the percentage of damage to domestic appliances was lower in villages (10%) than in neighborhoods (33%). Our preliminary results suggest that rodent pests represent a threat to human health and to human food security in the studied sites.Facultad de Ciencias Naturales y MuseoCentro de Estudios Parasitológicos y de Vectore

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Immunization of Mice with Recombinant Mosquito Salivary Protein D7 Enhances Mortality from Subsequent West Nile Virus Infection via Mosquito Bite

<div><h3>Background</h3><p>Mosquito salivary proteins (MSPs) modulate the host immune response, leading to enhancement of arboviral infections. Identification of proteins in saliva responsible for immunomodulation and counteracting their effects on host immune response is a potential strategy to protect against arboviral disease. We selected a member of the D7 protein family, which are among the most abundant and immunogenic in mosquito saliva, as a vaccine candidate with the aim of neutralizing effects on the mammalian immune response normally elicited by mosquito saliva components during arbovirus transmission.</p> <h3>Methodology/Principal Findings</h3><p>We identified D7 salivary proteins of <em>Culex tarsalis</em>, a West Nile virus (WNV) vector in North America, and expressed 36 kDa recombinant D7 (rD7) protein for use as a vaccine. Vaccinated mice exhibited enhanced interferon-γ and decreased interleukin-10 expression after uninfected mosquito bite; however, we found unexpectedly that rD7 vaccination resulted in enhanced pathogenesis from mosquito-transmitted WNV infection. Passive transfer of vaccinated mice sera to naïve mice also resulted in increased mortality rates from subsequent mosquito-transmitted WNV infection, implicating the humoral immune response to the vaccine in enhancement of viral pathogenesis. Vaccinated mice showed decreases in interferon-γ and increases in splenocytes producing the regulatory cytokine IL-10 after WNV infection by mosquito bite.</p> <h3>Conclusions/Significance</h3><p>Vector saliva vaccines have successfully protected against other blood-feeding arthropod-transmitted diseases. Nevertheless, the rD7 salivary protein vaccine was not a good candidate for protection against WNV disease since immunized mice infected <em>via</em> an infected mosquito bite exhibited enhanced mortality. Selection of salivary protein vaccines on the bases of abundance and immunogenicity does not predict efficacy.</p> </div

Outcomes of WNV infection by mosquito bite of rD7-vaccinated mice.

<p>A. Survival curves comparing WNV-infected rD7-vaccinated mice (solid line, n = 13) with mock-vaccinated mice (dotted line, n = 12). <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001935#s3" target="_blank">Results</a> are combined from four experiments (p = 0.0347). B. Survival curves after passive serum transfer and infection with WNV. Mice were injected IP with pooled sera from rD7-vaccinated mice (solid line, n = 4), non-vaccinated mice (dotted line, n = 5), or mice repeatedly bitten by <i>Cx. tarsalis</i> (dashed line, n = 5) and 30 h later infected with WNV <i>via</i> bites of infected <i>Cx. tarsalis.</i> Mice passively immunized with rD7-vaccinee serum exhibited significantly higher mortality rates than either control group (p = 0.002). Mortality rates of mice passively immunized with mosquito-exposed mouse serum were not different from those that received untreated mouse serum. C. Proportion of total splenocytes from rD7- and mock-vaccinated mice that were CD4+ T-lymphocytes staining positive for intracellular IL-10 two days post-WNV infection; rD7-vaccinated animals (filled bar) had significantly higher IL-10 levels than mock-vaccinated animals (p<0.05, n = 3 per group). D. CBA assay of medium from WNV peptide-stimulated splenocytes that were collected at 2 days post-WNV infection; all cytokine levels from rD7-immunized mice (filled bars) were significantly lower than those from mock-immunized mice (open bars) (p<0.05, n = 3 per group).</p

Survey of intestinal helminths collected from pet rodents in México

In this survey, intestinal helminths from pet rodents in Mérida, México, were analyzed. A total of 46 mice Mus musculus, 28 hamsters Mesocricetus auratus, 23 rats Rattus norvegicus, and 1 gerbil Meriones unguiculatus were purchased from six pet shops and one black market for wildlife in the city of Mérida. The overall prevalence of helminths in rodents was 61.2% (60/98). Six species of helminths were identified: the zoonotic cestode Rodentolepis nana, and the nematodes Aspiculuris tetraptera, Dentostomella translucida, Syphacia obvelata, Syphacia mesocriceti, and Syphacia muris. Of the 60 infected rodents, 25 (41.7%) harbored 2 or 3 species of helminths. Rodentolepis nana was found in 4.3% of mice and 17.9% of hamsters. This is the first report of infection with S. muris in pet rats. Considering the close physical contact between pet rodents and humans, the presence of R. nana in pets represents a potential risk of transmission, especially to children and immunocompromised individuals.Fil: Panti May, Jesús Alonso. Universidad Autonóma de Yucatán; MéxicoFil: Caraveo Centeno, Luis. Universidad Autonóma de Yucatán; MéxicoFil: Hernández Betancourt, Silvia F.. Universidad Autonóma de Yucatán; MéxicoFil: Robles, Maria del Rosario. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Estudios Parasitológicos y de Vectores. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Centro de Estudios Parasitológicos y de Vectores; ArgentinaFil: Machain Williams, Carlos. Universidad Autonóma de Yucatán; Méxic