Impact of a Gender-Neutral HPV Vaccination Program in Men Who Have Sex with Men (MSM)

[EN] A major challenge in human papillomavirus (HPV) vaccine programs is the universal gender-neutral recommendation, as well as estimation of its long-term effect. The objective of this study is to predict the added benefit of male vaccination, especially in men who have sex with men (MSM), and to analyze the impact of the program on society. We propose a mathematical model of the HPV infection based on a network paradigm. Data from Spain allowed constructing the sexual network. HPV force of infection was taken from literature. Different scenarios using variable vaccine coverage in both males and females were studied. Strong herd immunity is shown in the heterosexual population, with an important decrease of HPV 6/11 infections both in men and in unvaccinated women with an only-women vaccination at 14 years of age. No impact of this program occurred in the infection incidence in MSM. This group would only benefit from a vaccination program that includes males. However, the impact at short term would be lower than in heterosexual men. The protection of MSM can only be achieved by direct vaccination of males. This may have important consequences for public health.This paper has been supported by the Spanish Ministerio de Economía, Industria y Competitividad (MINECO), the Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (FEDER UE) grant MTM2017-89664-P. This paper has been supported by the European Union through the Operational Program of the [European Regional Development Fund (ERDF)/European Social Fund (ESF)] of the Valencian Community 2014¿2020. Files: GJIDI/2018/A/010 and GJIDI/2018/A/009Diez-Domingo, J.; Sánchez-Alonso, V.; Villanueva Micó, RJ.; Acedo, L.; Tuells, J. (2021). Impact of a Gender-Neutral HPV Vaccination Program in Men Who Have Sex with Men (MSM). International Journal of Environmental research and Public Health (Online). 18(3):1-11. https://doi.org/10.3390/ijerph18030963S11118

On the Elimination of Infections Related to Oncogenic Human Papillomavirus: an Approach using a Computational Network Model

[EN] Cervical cancer is the fourth most common malignancy in women worldwide, although it is preventable with prophylactic HPV vaccination. HPV transmission-dynamic models can predict the potential for the global elimination of cervical cancer. The random network model is a new approach that allows individuals to be followed, and to implement a given vaccination policy according to their clinical records. We developed an HPV transmission-dynamic model on a lifetime sexual partners network based on individual contacts, also accounting for the sexual behavior of men who have sex with men (MSM). We analyzed the decline in the prevalence of HPV infection in a scenario of 75% and 90% coverage for both sexes. An important herd immunity effect for men and women was observed in the heterosexual network, even with 75% coverage. However, HPV infections are persistent in the MSM population, with sustained circulation of the virus among unvaccinated individuals. Coverage around 75% of both sexes would be necessary to eliminate HPV-related conditions in women within five decades. Nevertheless, the variation in the decline in infection in the long term between a vaccination coverage of 75% and 90% is relatively small, suggesting that reaching coverage of around 70-75% in the heterosexual network may be enough to confer high protection. Nevertheless, HPV elimination may be achieved if men's coverage is strictly controlled. This accurate representation of HPV transmission demonstrates the need to maintain high HPV vaccination coverage, especially in men, for whom the cost-effectiveness of vaccination is questioned.This work has been supported by the Spanish Ministerio de Economia, Industria y Competitividad (MINECO), the Agencia Estatal de Investigacion (AEI) and Fondo Europeo de Desarrollo Regional (FEDER UE), grant MTM2017-89664-P. Authors also wish to acknowledge Maria Giovanna Ferrario, Victor Latorre, and the Medical Statistics Consulting team (Valencia, Spain) for their collaboration in writing this manuscript.Muñoz-Quiles, C.; Diez-Domingo, J.; Acedo, L.; Sánchez-Alonso, V.; Villanueva Micó, RJ. (2021). On the Elimination of Infections Related to Oncogenic Human Papillomavirus: an Approach using a Computational Network Model. Viruses. 13(5):1-12. https://doi.org/10.3390/v13050906S11213

Excess hospitalizations and mortality associated with seasonal influenza in Spain, 2008–2018

Hospitalization; Influenza; MortalityHospitalització; Grip; MortalitatHospitalización; Gripe; MortalidadBackground Influenza may trigger complications, particularly in at-risk groups, potentially leading to hospitalization or death. However, due to lack of routine testing, influenza cases are infrequently coded with influenza-specific diagnosis. Statistical models using influenza activity as an explanatory variable can be used to estimate annual hospitalizations and deaths associated with influenza. Our study aimed to estimate the clinical and economic burden of severe influenza in Spain, considering such models. Methods The study comprised ten epidemic seasons (2008/2009–2017/2018) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487–488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD codes in time-series models, computed for six age groups and four groups of diagnoses: pneumonia or influenza (ICD-9: 480–488, 517.1; ICD-10: J09–J18), respiratory (ICD-9: 460–519; ICD-10: J00–J99), respiratory or cardiovascular (C&R, ICD-9: 390–459, 460–519; ICD-10: I00–I99, J00–J99), and all-cause. Means, excluding the H1N1pdm09 pandemic (2009/2010), are reported in this study. Results The mean number of hospitalizations with a diagnosis of influenza per season was 13,063, corresponding to 28.1 cases per 100,000 people. The mean direct annual cost of these hospitalizations was €45.7 million, of which 65.7% was generated by patients with comorbidities. Mean annual influenza-associated C&R hospitalizations were estimated at 34,894 (min: 16,546; max: 52,861), corresponding to 75.0 cases per 100,000 (95% confidence interval [CI]: 63.3–86.3) for all ages and 335.3 (95% CI: 293.2–377.5) in patients aged ≥ 65 years. We estimate 3.8 influenza-associated excess C&R hospitalizations for each hospitalization coded with an influenza-specific diagnosis in patients aged ≥ 65 years. The mean direct annual cost of the estimated excess C&R hospitalizations was €142.9 million for all ages and €115.9 million for patients aged ≥ 65 years. Mean annual influenza-associated all-cause mortality per 100,000 people was estimated at 27.7 for all ages. Conclusions Results suggest a relevant under-detected burden of influenza mostly in the elderly population, but not neglectable in younger people.The BARI study was funded by Sanofi. Martinón-Torres F has received support for the present work from the Instituto de Salud Carlos III (Proyecto de Investigación en Salud, Acción Estratégica en Salud): Fondo de Investigación Sanitaria (FIS; PI070069/PI1000540/PI1601569/PI1901090) del plan nacional de I + D + I and ‘fondos FEDER’ and Proyectos GAIN Rescata-Covid_IN845D 2020/23 (GAIN, Xunta de Galicia)

Addressing influenza’s underestimated burden – Iberian experts call to action

Hospitalization; Influenza; PreventionHospitalització; Grip; PrevencióHospitalización; Gripe; PrevenciónHaving a proper understanding of the impact of influenza is a fundamental step towards improved preventive action. This paper reviews findings from the Burden of Acute Respiratory Infections study on the burden of influenza in Iberia, and its potential underestimation, and proposes specific measures to lessen influenza’s impact.The BARI study was funded by Sanofi

Optimización del Transporte de Caña de Azúcar

[Optimizing Transport of Sugar Cane] Tucumán cuenta con 15 ingenios, en los que se procesa la totalidad de la producción de caña de azúcar de la provincia. El transporte de la caña de los distintos productores hacia los ingenios se realiza en la actualidad a partir de convenios particulares que no tienen en cuenta el rendimiento final total de la cosecha. Así, un productor puede enviar la caña de sus tierras a un ingenio distante, aún cuando en el camino los camiones que realizan el transporte pasen por delante de otros ingenios. Este problema es sólo un aspecto de otro mayor, que tiene que ver con la eficiencia global del sistema productivo. Actualmente, durante los primeros y los últimos días de la zafra (cosecha temprana y cosecha tardía), la caña madura no es suficiente para satisfacer la demanda de los ingenios. Inversamente, en el período intermedio la cantidad de caña sobresatura la capacidad de procesamiento. Como consecuencia se produce menos azúcar de la que se podría. Teniendo esto en cuenta, la racionalización del transporte sería un primer paso en el avance hacia un sistema más eficiente. Sin perder de vista este objetivo, la simple puesta en práctica, en el corto plazo, de un criterio optimizado de distribución representaría una mejora respecto de la situación actual. En primer lugar, disminuiría el consumo de combustible. Debe tenerse en cuenta que uno de los subproductos de la caña es el alcohol, a partir del cual se produce el bioetanol, y con el que se rebaja, por ley, un 5% de las naftas. En este sentido, la reducción del consumo de combustibles fósiles adquiere una doble importancia. Por otro lado, un mejor sistema de distribución tendría también una importante repercusión social. Los camiones que transportan la caña viajan usualmente de noche, sin luces y a muy baja velocidad y son, en consecuencia, responsables de numerosos accidentes de tránsito, puesto que no son vistos a tiempo por los automovilistas. La disminución de la cantidad de camiones recorriendo las rutas y caminos de la provincia contribuiría a reducir la cantidad de accidentes. Finalmente, un sistema optimizado de distribución serviría, en vistas del problema general, como herramienta de diagnóstico permitiendo señalar algunos puntos por mejorar. Podrían, por ejemplo, identificarse zonas en las que sería provechoso cambiar la plantación de una variedad de maduración tardía a una de maduración temprana, con la que proveer a los ingenios cercanos en el primer período de zafra

Clinical and laboratory features of children with community-acquired pneumonia are associated with distinct radiographic presentations

Chest radiographs from children with community-acquired pneumonia (CAP) were categorized into three distinct presentations and each presentation was correlated to clinical and laboratory findings. Children < 59 months with CAP presenting to pediatric emergency rooms during two years were enrolled prospectively in eight centers across Europe. Clinical and laboratory data were documented and radiographs obtained from patients. Of the 1107 enrolled patients, radiographs were characterized as 74.9% alveolar CAP, 8.9% non-alveolar CAP, and 16.3% clinical CAP. Alveolar CAP patients had significantly higher rates of fever (90.7%), vomiting (27.6%), and abdominal pain (18.6%), while non-alveolar CAP patients presented more with cough (96.9%). A model using independent parameters that characterize alveolar, non-alveolar, and clinical CAP demonstrated that alveolar CAP patients were significantly older (OR = 1.02) and had significantly lower oxygen saturation than non-alveolar CAP patients (OR = 0.54). Alveolar CAP patients had significantly higher mean WBC (17,760 ± 8539.68 cells/mm3) and ANC (11.5 ± 7.5 cells/mm3) than patients categorized as non-alveolar CAP (WBC 15,160 ± 5996 cells/mm3, ANC 9.2 ± 5.1 cells/mm3) and clinical CAP (WBC 13,180 ± 5892, ANC 7.3 ± 4.7). CONCLUSION: Alveolar CAP, non-alveolar CAP, and clinical CAP are distinct entities differing not only by chest radiographic appearance but also in clinical and laboratory characteristics. Alveolar CAP has unique characteristics, which suggest association with bacterial etiology

Mortality trends in an ambulatory multidisciplinary heart failure unit from 2001 to 2018

To assess mortality trends at 1 and 3 years from 2001 to 2018 in a real-life cohort of HF outpatients from different etiologies with depressed and preserved LVEF. A total of 2368 consecutive patients with HF (mean age 66.4 ± 12.9 years, 71% men, 15.4% with preserved LVEF) admitted to a HF clinic from August 2001 to September 2018 were included in the study. Patients were divided into five quintiles (Q) according to the period of admission. Trends for all-cause and cardiovascular mortality from Q1 to Q5 were assessed by linear regression. Patients with LVEF < 50% had a progressive decrease in the rates of all-cause and cardiovascular death at 1 year (12.1% in Q1 to 6.5% in Q5, p = 0.003; and 8.4% in Q1 to 3.8% in Q5, p = 0.007, respectively) and 3 years (30.5% in Q1 to 17.0% in Q5, p = 0.003; and 23.9% in Q1 to 9.8% in Q5, p = 0.003, respectively). These trends remained significant after adjusting for clinical characteristics and risk. No significant trend in mortality was observed in patients with LVEF ≥ 50%. In a cohort of real-life ambulatory patients with HF, mortality progressively declined in patients with LVEF < 50%, but the same trend was not observed in patients with preserved LVEF

Weight loss in obese patients with heart failure

BACKGROUND: In heart failure (HF), weight loss (WL) has been associated with an adverse prognosis whereas obesity has been linked to lower mortality (the obesity paradox). The impact of WL in obese patients with HF is incompletely understood. Our objective was to explore the prevalence of WL and its impact on long-term mortality, with an emphasis on obese patients, in a cohort of patients with chronic HF. METHODS AND RESULTS: Weight at first visit and the 1-year follow-up and vital status after 3 years were assessed in 1000 consecutive ambulatory, chronic HF patients (72.7% men; mean age 65.8±12.1 years). Significant WL was defined as a loss of ≥5% weight between baseline and 1 year. Obesity was defined as body mass index ≥30 kg/m(2) (N=272). Of the 1000 patients included, 170 experienced significant WL during the first year of follow-up. Mortality was significantly higher in patients with significant WL (27.6% versus 15.3%, P 0.001). In univariable Cox regression analysis, patients with significant WL had 2-fold higher mortality (hazard ratio 1.95 [95% CI 1.39-2.72], P 0.001). In multivariable analysis, adjusting for age, sex, body mass index, New York Heart Association functional class, left ventricular ejection fraction, HF duration, ischemic etiology, diabetes, and treatment, significant WL remained independently associated with higher mortality (hazard ratio 1.89 [95% CI 1.32-2.68], P 0.001). Among obese patients with HF, significant WL was associated with an even more ominous prognosis (adjusted hazard ratio for death of 2.38 [95% CI 1.31-4.32], P=0.004) than that observed in nonobese patients (adjusted hazard ratio 1.83 [95% CI 1.16-2.89], P=0.01). CONCLUSIONS: Weight loss ≥5% in patients with chronic HF was associated with high long-term mortality, particularly among obese patients with HF