Shigellosis and giardiasis among people living with HIV in Washington, DC, 2012-2016

Background: Shigellosis and giardiasis are transmitted via food, water, and fecal-oral contact. CDC has recently reported increased shigellosis among men who have sex with men (MSM) and among people living with HIV (PLWH), particularly stage 3. Our goal was to characterize the incidence and risk factors associated with shigellosis and giardiasis among PLWH in Washington, DC, in an era of robust availability of antiretroviral treatment. Methods: We conducted a retrospective analysis of HIV, shigellosis and giardiasis cases reported to the District of Columbia Department of Health from 2012 to 2016. We used LinkPlus to probabilistically match individuals with reported HIV and Shigella or Giardia. We conducted bivariate analysis on gender, race/ethnicity, and age for Shigella-HIV, Giardia-HIV and HIV alone. Among men, we conducted bivariate analysis for HIV transmission risk factors. Among those with Shigella-HIV or Giardia-HIV, we compared CD4 cell count, HIV stage, HIV viral load, and viral suppression (VS) using laboratory data within 8 weeks before or after the incident enteric infection. We compared the incidence of shigellosis and giardiasis in the general population versus among those living with HIV in 2016. Results: During 2012-2016, 250 DC residents were reported with shigellosis (2.1 per 100,000 in 2016) and 412 with giardiasis (7.3 per 100,000 in 2016). The proportion with HIV coinfection was 20.4% for shigellosis and 10.6% for giardiasis. Incidence rate ratio (PLWH versus general population) was 25.8 for shigellosis and 9.6 for giardiasis. 40.9% of coinfection cases, versus 15.9% HIV alone, were ages 25-34 at the end of 2016 (p Conclusion: PLWH in DC disproportionately acquired shigellosis and giardiasis in 2012-2016. Factors associated with shigellosis and giardiasis among PLWH include male gender, white race, being in the 25-34 age group, and MSM. Among the Shigella-HIV and Giardia-HIV cases, most did not have stage 3 HIV, but we found low viral suppression rates. Our data supports the need for obtaining a thorough sexual history, focused HIV prevention and antiretroviral adherence counseling, and provides information to target high risk groups in DC

A multidisciplinary approach to improving women’s health in semi‐urban Ecuador

ObjectiveTo examine women’s reasons for seeking care at The Quito Project (TQP), a student‐led organization that aims to improve the health, education, and well‐being of a semi‐urban community in Quito, Ecuador, and to explore the need for additional preventative interventions.MethodsAn oral survey was administered to 86 adult patients in 2008. We also completed a chart review to evaluate patient demographics and medical conditions.ResultsSixty‐three (73.3%) survey respondents were female. Nearly three‐quarters of the women reported an income below the minimum wage; 60% reported that the cost of medical care posed a burden. Fifty‐two percent sought care at TQP because the services were free. Additionally, 77% of women reported going to the doctor only when ill and did not access preventative services.ConclusionsBy offering medical, dental, and tutoring services, along with preventative health workshops, TQP addresses established barriers to achieving adequate women’s health. Survey results have reinforced TQP’s focus on prevention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135173/1/ijgo70.pd

Household transmission of seasonal influenza from HIV-infected and HIV-uninfected individuals in South Africa, 2013-2014

BACKGROUND : We estimated the household secondary infection risk (SIR) and serial interval (SI) for influenza transmission from HIV-infected and HIV-uninfected index cases. METHODS : Index cases were the first symptomatic person in a household with influenza-like illness, testing influenza positive on real-time reverse transcription polymerase chain reaction (rRT-PCR). Nasopharyngeal swabs collected from household contacts every 4 days were tested by rRT-PCR. Factors associated with SIR were evaluated using logistic regression. RESULTS : We enrolled 28 HIV-infected and 57 HIV-uninfected index cases. On multivariable analysis, HIV-infected index cases were less likely to transmit influenza to household contacts (odds ratio [OR] 0.2; 95% confidence interval [CI], 0.1–0.6; SIR 16%, 18/113 vs 27%, 59/220). Factors associated with increased SIR included index age group 1–4 years (OR 3.6; 95% CI, 1.2–11.3) and 25–44 years (OR 8.0; 95% CI, 1.8–36.7), and contact age group 1–4 years (OR 3.5; 95% CI, 1.2–10.3) compared to 5–14 years, and sleeping with index case (OR 2.7; 95% CI, 1.3–5.5). HIV infection of index case was not associated with SI. CONCLUSIONS : HIV-infection was not associated with SI. Increased infectiousness of HIV-infected individuals is likely not an important driver of community influenza transmission.The National Institute for Communicable Diseases of the National Health Laboratory Service and the US Centers for Disease Control and Prevention [co-operative agreement number: 5U51IP000155.https://academic.oup.com/jid2020-05-15hj2019Medical Virolog

Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis.

Herbal medicines are used by patients with IBD despite limited evidence. We present a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating treatment with herbal medicines in active ulcerative colitis (UC). A search query designed by a library informationist was used to identify potential articles for inclusion. Articles were screened and data were extracted by at least two investigators. Outcomes of interest included clinical response, clinical remission, endoscopic response, endoscopic remission, and safety. We identified 28 RCTs for 18 herbs. In pooled analyses, when compared with placebo, clinical response rates were significantly higher for Indigo naturalis (IN) (RR 3.70, 95% CI 1.97-6.95), but not for Curcuma longa (CL) (RR 1.60, 95% CI 0.99-2.58) or Andrographis paniculata (AP) (RR 0.95, 95% CI 0.71-1.26). There was a significantly higher rate of clinical remission for CL (RR 2.58, 95% CI 1.18-5.63), but not for AP (RR 1.31, 95% CI 0.86-2.01). Higher rates of endoscopic response (RR 1.56, 95% CI 1.08-2.26) and remission (RR 19.37, 95% CI 2.71-138.42) were significant for CL. CL has evidence supporting its use as an adjuvant therapy in active UC. Research with larger scale and well-designed RCTs, manufacturing regulations, and education are needed

Oral Cholera Vaccine Coverage, Barriers to Vaccination, and Adverse Events following Vaccination, Haiti, 2013

In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1–4, 5–14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours

Intra-host and intra-household diversity of influenza A viruses during household transmissions in the 2013 season in 2 peri-urban communities of South Africa.

Limited information is available on influenza virus sequence drift between transmission events. In countries with high HIV burdens, like South Africa, the direct and indirect effect of HIV on influenza sequence drift between transmission events may be of public health concern. To this end, we measured hemagglutinin sequence diversity between influenza transmission events using data and specimens from a study investigating household transmission dynamics of seasonal influenza viruses in 2 peri-urban communities in South Africa during the 2013 influenza season. Thirty index cases and 107 of 110 eligible household contacts were enrolled into the study, 47% (14/30) demonstrating intra-household laboratory-confirmed influenza transmission. In this study 35 partial hemagglutinin gene sequences were obtained by Sanger sequencing from 11 index cases (sampled at enrolment only) and 16 secondary cases (8 cases sampled at 1 and 8 cases sampled at 2 time-points). Viral sequence identities confirmed matched influenza transmission pairs within the 11 households with corresponding sequenced index and secondary cases. Phylogenetic analysis revealed 10 different influenza viral lineages in the 14 households. Influenza A(H1N1)pdm09 strains were shown to be genetically distinct between the 2 communities (from distinct geographic regions), which was not observed for the influenza A(H3N2) strains. Intra-host/intra-household influenza A(H3N2) sequence drift was identified in 2 households. The first was a synonymous mutation between the index case and a household contact, and the second a non-synonymous mutation between 2 serial samples taken at days 0 and 4 post enrolment from an HIV-infected secondary case. Limited inter-household sequence diversity was observed as highlighted by sharing of the same influenza strain between different households within each community. The limited intra-household sequence drift is in line with previous studies also using Sanger sequencing, corroborating the presence of strict selective bottlenecks that limit sequence variance. We were not able to directly ascertain the effect of HIV on influenza sequence drift between transmission events

Households with secondary transmissions of influenza A(H1N1)pdm09 (n = 6) and A(H3N2) (n = 5) investigated for drift in the hemagglutinin gene, South Africa, 2013.

<p>Households with secondary transmissions of influenza A(H1N1)pdm09 (n = 6) and A(H3N2) (n = 5) investigated for drift in the hemagglutinin gene, South Africa, 2013.</p

2013 Household transmission study design and sample selection [13].

<p>2013 Household transmission study design and sample selection [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0198101#pone.0198101.ref013" target="_blank">13</a>].</p