Rapid in-country sequencing of whole virus genomes to inform rabies elimination programmes.

Genomic surveillance is an important aspect of contemporary disease management but has yet to be used routinely to monitor endemic disease transmission and control in low- and middle-income countries. Rabies is an almost invariably fatal viral disease that causes a large public health and economic burden in Asia and Africa, despite being entirely vaccine preventable. With policy efforts now directed towards achieving a global goal of zero dog-mediated human rabies deaths by 2030, establishing effective surveillance tools is critical. Genomic data can provide important and unique insights into rabies spread and persistence that can direct control efforts. However, capacity for genomic research in low- and middle-income countries is held back by limited laboratory infrastructure, cost, supply chains and other logistical challenges. Here we present and validate an end-to-end workflow to facilitate affordable whole genome sequencing for rabies surveillance utilising nanopore technology. We used this workflow in Kenya, Tanzania and the Philippines to generate rabies virus genomes in two to three days, reducing costs to approximately £60 per genome. This is over half the cost of metagenomic sequencing previously conducted for Tanzanian samples, which involved exporting samples to the UK and a three- to six-month lag time. Ongoing optimization of workflows are likely to reduce these costs further. We also present tools to support routine whole genome sequencing and interpretation for genomic surveillance. Moreover, combined with training workshops to empower scientists in-country, we show that local sequencing capacity can be readily established and sustainable, negating the common misperception that cutting-edge genomic research can only be conducted in high resource laboratories. More generally, we argue that the capacity to harness genomic data is a game-changer for endemic disease surveillance and should precipitate a new wave of researchers from low- and middle-income countries

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

C4 nephritic factor in patients with immune-complex-mediated membranoproliferative glomerulonephritis and C3-glomerulopathy

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Increased Levels of Soluble ST2 in Patients with Active Newly Diagnosed ANCA-Associated Vasculitis

Objective. ST2, a member of the interleukin-1 receptor family, is selectively expressed on Th2 cells and mediates important Th2 functions. IL-33 is a specific ligand of ST2. The aim of the study was to determine whether serum levels of soluble ST2 (sST2) or IL-33 predict activity of the disease in patients with ANCA-associated vasculitides (AAV). Methods. 139 AAV patients and 62 controls were studied. IL-33 and sST2 in the blood were measured with a commercially available ELISA. Results. Newly diagnosed AAV patients had higher sST2 levels than controls (P<0.01). Levels of sST2 were significantly higher in active newly diagnosed AAV patients than in patients with remission (P<0.001). IL-33 levels were higher in AAV patients than in the control groups (P=0.002). However, serum IL-33 levels were not increased in patients with active AAV compared to patients in remission. IL-33 levels were higher in patients with granulomatosis with polyangiitis than in patients with microscopic polyangiitis (P=0.012). Conclusions. Serum sST2, but not serum IL-33, may be a marker of activity in AAV patients

Lessons for rabies control and elimination programmes: a decade of One Health experience from Bali, Indonesia

This Review discusses the advancements made and challenges remaining in One Health around endemic and emerging zoonotic diseases, food safety and food security, antimicrobial resistance, wildlife diseases, and other issues that impact health such as poverty. It highlights the added value of using a One Health approach to coordinate, collaborate, and communicate across multiple sectors and disciplines to address complex health threats at the human-animal-environment interface with the goal of improving health for all. This issue also provides innovative ideas to apply a One Health approach toward the following areas: strengthening human and animal health systems, One Health mechanisms and activities to enhance subnational, national, regional, and global health, synergising tools for capacity assessment and One Health operationalisation across sectors, better integrating wildlife and environmental health, disaster response, reduction of poverty, prevention and control of zoonoses, and progress toward rabies elimination. Collaboration using One Health principles could greatly increase trusted networks for coordination across sectors, help improve global health outcomes, and reduce health threats. Barriers to One Health can be significant and typically include institutional capabilities and culture, poor communication and information sharing across sectors, limited personnel resources, and budgetary constraints. Fortunately, the need for multisectoral, One Health collaboration at the local, national, regional, and global levels is being recognized and steps are being taken to implement and operationalise One Health. Multiple success stories of One Health in action exist and provide real-world examples of the benefits of using a multisectoral, One Health approach. This review aims to shine a light on successes, remaining challenges, and implementation of a multisectoral, One Health approach to decrease the global disease burden in people and animals while promoting environmental health