RISK FACTORS FOR ANTIBODY LOSS AFTER HEPATITIS E VIRUS NATURAL INFECTION AND VACCINATION

Hepatitis E virus (HEV) is a vaccine-preventable emerging infectious disease causing 20 million infections in developing countries every year. In South East Asia, HEV causes yearly outbreaks, with the majority of disease seen in adults, surprising for an enterically transmitted pathogen. These outbreaks suggest that antibody persistence after exposure to HEV is not long lasting. We revisited 170 subjects with a documented HEV infection from Bangladesh and China and 97 subjects vaccinated with the HEV239 vaccine during a phase III trial in China to retest their serum for anti-HEV antibodies 6 to 10 years after exposure. Overall, 22.1% (95%CI: 17.3-27.6%) no longer had detectable antibodies at follow-up. Antibody loss was greater among the naturally infected subjects compared to the vaccinated subjects, 24.1% (95%CI: 17.9-31.3%) versus 18.6% (95%CI: 11.4-27.7%), although not statistically significant (p=0.292). Among all the subjects, age at exposure was associated with antibody loss, with younger age increasing the risk of antibody loss (RR: 0.87 per 10 years, 95% CI: 0.76-1.00, p=0.057). Among the subjects from Bangladesh, each 10 year increase in age at infection decreased the risk of antibody loss by 50% across univariate and multivariate Poisson regression models (p<0.05). This age-dependent antibody loss could partially explain cross-sectional sero-prevalence data from South East Asia where children have reportedly low antibody prevalence. In multivariate models, factors that increased the risk of exposure to HEV were generally associated with antibody persistence among the naturally infected subjects. However, this pattern was not found in the vaccinated subjects. This is one of the first studies to compare long term antibody persistence after HEV exposure in both naturally infected and vaccinated individuals, exploring characteristics associated with antibody persistence. The development of a successful, subunit vaccine has increased the need to understand the duration of antibodies and protection after HEV infection and vaccination in order to implement the most cost effective disease control and vaccination strategies

Review article: Incubation periods of mosquito-borne viral infections: a systematic review

Mosquito-borne viruses are a major public health threat, but their incubation periods are typically uncited, non-specific, and not based on data. We systematically review the published literature on six mosquito-borne viruses selected for their public health importance: chikungunya, dengue, Japanese encephalitis, Rift Valley fever, West Nile, and yellow fever viruses. For each, we identify the literature's consensus on the incubation period, evaluate the evidence for this consensus, and provide detailed estimates of the incubation period and distribution based on published experimental and observational data. We abstract original data as doubly interval-censored observations. Assuming a log-normal distribution, we estimate the median incubation period, dispersion, 25th and 75th percentiles by maximum likelihood. We include bootstrapped 95% confidence intervals for each estimate. For West Nile and yellow fever viruses, we also estimate the 5th and 95th percentiles of their incubation periods

Replication Data for: Mortality Risk Factors among National Football League Players: An Analysis using Player Career and Biometric Data

Long-term adverse health outcomes, particularly those associated with concussions, are of growing concern among elite athletes, especially American football players. These include chronic traumatic encephalopathy, depression, and mortality. Concussions can be difficult to diagnose, and there is mounting evidence that even sub-clinical blows, especially when they occur frequently, can also lead to adverse health outcomes. Certain player attributes such as playing style and position of play, along with on-field events such as number of tackles and sacks are likely to be strong predictors for the risk of developing adverse long-term negative health outcomes from repeated, yet mild, trauma

Predicting attitudes toward mitigation interventions and social distancing behaviors at the onset of the COVID-19 pandemic in the United States

ABSTRACTAim The goal of this research was to assess the influence of adult attachment, personality, and cultural orientation on social distancing and attitudes toward COVID-19 mitigation interventions.Methods Survey data was collected across two samples (NMTurk = 201, Nsnowball = 242) in the US from April 29 to May 11, 2020. Adult attachment was assessed via the Experiences in Close Relationships Scale-Short Form (ECR-S; Wei, M., Russell, D. W., Mallinckrodt, B., & Vogel, D. L. (2007). The experiences in close relationship scale (ECR)-short form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88(2), 187–204), personality was assessed via the Ten Item Personality Inventory (TIPI; Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003). A very brief measure of the Big-Five personality domains. Journal of Research in Personality, 37(6), 504–528), cultural orientation was assessed via the Horizontal and Vertical Individualism and Collectivism Scale (Triandis, H. C., & Galfand, M. J. (1998). Converging measurement of horizontal and vertical individualism and collectivism. Journal of Personality and Social Psychology, 74(1), 118–128), and social distancing and attitudes toward mitigation interventions were assessed via self-report measures developed for this assessment.Results In the MTurk sample, agreeableness (β = .19) and conscientiousness (β = .26) predicted positive mitigation intervention attitudes. Agreeableness (β = .24) and vertical collectivism (β = .25) positively predicted social distancing, while attachment anxiety (β = −.32) and vertical individualism (β = −.32) negatively predicted social distancing. In our snowball sample, residing primarily in New York, openness (β = .18) and horizontal collectivism (β = .16) predicted positive intervention attitudes, while horizontal individualism (β = −.20) predicted negative attitudes. Social contact in this sample was low and not associated with predictor variables. In both samples, mitigation attitudes and social distancing were only moderately correlated.Implications Our findings highlight the inherent inconsistency between attitudes and behaviors as well as the potential impact of mandated interventions on both attitudes and behavior

Seroprevalence of hepatitis E virus antibodies in adults and children from upstate New York: A cross-sectional study.

Hepatitis E virus (HEV) is a major cause of viral hepatitis around the world, especially in developing countries. Recently, HEV has also been recognized as important cause of hepatitis in Europe and Japan, however, there is a paucity of clinical data from the United States. The overall seroprevalence of HEV antibodies is around 10% in the United States, but considerable variation is seen based on geographic location, year, and assay used. In this study, 63 adults and 417 children from New York State were tested for anti-HEV IgG antibodies using the commercially available Wantai IgG assay. The overall seroprevalence of HEV antibodies among adult participants was 9.52% (95% CI: 3.58-19.59%). Positive adults tended to be older than HEV negative adults, all positive adults were female. Only 3 (0.7%, 95% CI:: 0.15-2.09%) of the children were positive, all positive children were male. These results are consistent with global and United States trends in HEV seroprevalence

An exploratory case control study of risk factors for hepatitis E in rural Bangladesh.

Hepatitis E virus (HEV) is the major cause of epidemic and sporadic hepatitis globally. Outbreaks are associated with fecal contamination of drinking water, yet the environmental reservoir of HEV between epidemics remains unclear. In contrast to neighboring countries, where epidemics and sporadic disease co-occur, HEV-endemic communities in rural Bangladesh seldom report outbreaks; sporadic hepatitis E is reported from urban and rural areas of the country. Besides typical enteric risk factors, other routes for HEV infection and disease are unclear. We conducted monthly household surveillance of a southern Bangladeshi community of 23,500 people to find incident cases of acute hepatitis E over a 22 month period. An algorithm was used to capture 279 candidate cases, of which 46 were confirmed acute HEV infections. An exploratory case-control study was conducted to identify putative risk factors for disease. Nearly 70% of cases were over 15 years old. Female gender seemed protective (OR:0.34) against hepatitis E in this conservative setting, as was the use of sanitary latrines (OR:0.28). Socioeconomic status or animal exposures were not significant predictors of disease, although outdoor employment and recent urban travel were. Unexpectedly, recent contact with a "jaundiced" patient and a history of injection exposure in the 3 months prior to disease (OR:15.50) were significant. Susceptible individuals from "endemic" communities share similar enteric exposure risks to those commonly associated with tourists from non-endemic countries. This study also raises the novel possibility of parenteral and person-to-person transmission of HEV in non-epidemic, sporadic disease settings

Hepatitis E virus antibody prevalence, RNA frequency, and genotype among blood donors in Cambodia (Southeast Asia)

International audienceBackground: Recent studies conducted in developed countries described hepatitis E virus (HEV) as an emerging infectious threat to blood safety. However, data on HEV among blood donors from southeast Asia are lacking.Study design and methods: Between July and August 2014, we assessed the presence of HEV immunoglobulin (Ig)G and IgM in 301 Cambodian blood donors. All samples were further tested for the presence of HEV RNA using an in-house reverse transcription-polymerase chain reaction. ORF2/ORF3 phylogenetic analysis was performed on positive HEV RNA specimens.Results: We found HEV IgG in 28.2% of blood donors from Cambodia. Three blood donors tested positive for HEV IgM with three distinct patterns: IgM(+)/IgG(-)/RNA(-) (n = 1), IgM(+)/IgG(+)/RNA(-) (n = 1), and IgM(+)/IgG(+)/RNA(+) (n = 1). Thus, the prevalence rates of HEV IgM and HEV RNA were 1.0 and 0.3%. Interestingly, the viremic blood donor harbored a HEV strain that belonged to Genotype 3 (HEV-3) and clustered with a Cambodian riverine HEV-3 isolate.Conclusion: Due to the high frequency of Cambodian blood donors with positive HEV IgG, we conclude that HEV is endemic in this country. Large-scale studies must be considered to determine whether Cambodian blood donation screening is warranted to enhance blood safety in regard to HEV. In addition, our findings suggest that river water may be a significant source of exposure to HEV-3