Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Effects of tuberculosis and/or HIV-1 infection on COVID-19 presentation and immune response in Africa

Here the authors describe outcomes of SARS-CoV-2 infection in an African setting of high HIV-1 and tuberculosis prevalence. They find that tuberculosis is a common co-morbidity in patients admitted to hospital with COVID-19 and that the immune response to SARS-CoV-2 is adversely affected by co-existent HIV-1 and tuberculosis

Aménagement et environnement

Fréquemment assimilé aux politiques publiques qui ont accompagné la reconstruction postérieure à la Seconde Guerre mondiale, l'aménagement du territoire tel qu'on le concevait alors visait la modernisation du pays. Il était pensé comme facteur de progrès a priori et reposait sur une conception techniciste qui voyait dans des ingénieurs les seules autorités compétentes, excluant l'expérience des populations. Les nuisances et les bouleversements de tous ordres induits par les aménagements étaient considérés comme négligeables, le prix à payer dans l'intérêt général. Leur contestation ne pouvait être motivée que par l'ignorance ou l'égoïsme. Les dix-neuf contributions réunies dans ce livre proposent une vision nouvelle des aménagements territoriaux. Pensant les territoires comme des champs de négociation où s'affrontent des forces variées, elles cherchent à inclure dans l'étude de leur aménagement la façon dont l'environnement, que les sociétés cherchent à maîtriser et à mettre au service de leurs desseins, réagit à son tour à la transformation imposée. Considérant des aménagements effectués à toutes les périodes de l'histoire, elles cherchent à identifier leur impact économique, social, environnemental ou même culturel, y compris sur le long terme. Une tentative ambitieuse, tant il est vrai que même lorsque les aménagements passés sont identifiés comme des échecs, voire comme des réalisations néfastes, par leurs auteurs eux-mêmes, il est bien rare que cela soit exprimé publiquement

Author Correction: Histone acetylome-wide associations in immune cells from individuals with active Mycobacterium tuberculosis infection

International audienceNo abstract availabl

T cell responses to SARS-1 CoV-2 spike cross-recognize Omicron

The SARS-CoV-2 Omicron variant has multiple Spike (S) protein mutations1,2 that contribute to escape from antibody neutralization3–6 and reduce vaccine protection from infection7,8. The extent to which other components of the adaptive response such as T cells may still target Omicron and contribute to protection from severe outcomes is unknown. We assessed the ability of T cells to react with Omicron spike in participants who were vaccinated with Ad26.CoV2.S, BNT162b2, or unvaccinated convalescent COVID-19 patients (n=70). We found that 70-80% of the CD4+ and CD8+ T cell response to spike was maintained across study groups. Moreover, the magnitude of Omicron cross-reactive T cells was similar to Beta and Delta variants, despite Omicron harboring considerably more mutations. In Omicron-infected hospitalized patients (n=19), there were comparable T cell responses to ancestral spike, nucleocapsid and membrane proteins to those patients hospitalized in previous waves dominated by the ancestral, Beta or Delta variants (n=49). Thus, despite Omicron’s extensive mutations and reduced susceptibility to neutralizing antibodies, the majority of T cell responses, induced by vaccination or infection, cross-recognize the variant. It remains to be determined whether well-preserved T cell immunity to Omicron contributes to protection from severe COVID-19, and is linked to early clinical observations from South Africa and elsewhere9–12

Malnutrition and Gastrointestinal and Respiratory Infections in Children: A Public Health Problem

Infectious disease is the major cause of morbidity and mortality in developing countries, particularly in children. Increasing evidence suggests that protein-calorie malnutrition is the underlying reason for the increased susceptibility to infections observed in these areas. Moreover, certain infectious diseases also cause malnutrition, which can result in a vicious cycle. Malnutrition and bacterial gastrointestinal and respiratory infections represent a serious public health problem. The increased incidence and severity of infections in malnourished children is largely due to the deterioration of immune function; limited production and/or diminished functional capacity of all cellular components of the immune system have been reported in malnutrition. In this review, we analyze the cyclical relationship between malnutrition, immune response dysfunction, increased susceptibility to infectious disease, and metabolic responses that further alter nutritional status. The consequences of malnutrition are diverse and included: increased susceptibility to infection, impaired child development, increased mortality rate and individuals who come to function in suboptimal ways