Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

A fast, very-high-energy γ -ray flare from BL Lacertae during a period of multi-wavelength activity in June 2015

The mechanisms producing fast variability of the γ-ray emission in active galactic nuclei (AGNs) are under debate. The MAGIC telescopes detected a fast, very-high-energy (VHE, E > 100 GeV) γ-ray flare from BL Lacertae on 2015 June 15. The flare had a maximum flux of (1.5 ± 0.3) × 10-10 photons cm-2 s-1 and halving time of 26 ± 8 min. The MAGIC observations were triggered by a high state in the optical and high-energy (HE, E > 100 MeV) γ-ray bands. In this paper we present the MAGIC VHE γ-ray data together with multi-wavelength data from radio, optical, X-rays, and HE γ rays from 2015 May 1 to July 31. Well-sampled multi-wavelength data allow us to study the variability in detail and compare it to the other epochs when fast, VHE γ-ray flares have been detected from this source. Interestingly, we find that the behaviour in radio, optical, X-rays, and HE γ-rays is very similar to two other observed VHE γ-ray flares. In particular, also during this flare there was an indication of rotation of the optical polarization angle and of activity at the 43 GHz core. These repeating patterns indicate a connection between the three events. We also test modelling of the spectral energy distribution based on constraints from the light curves and VLBA observations, with two different geometrical setups of two-zone inverse Compton models. In addition we model the γ-ray data with the star-jet interaction model. We find that all of the tested emission models are compatible with the fast VHE γ-ray flare, but all have some tension with the multi-wavelength observations

A fast, very-high-energy gamma-ray flare from BL Lacertae during a period of multi-wavelength activity in June 2015

The mechanisms producing fast variability of the gamma-ray emission in active galactic nuclei (AGNs) are under debate. The MAGIC telescopes detected a fast, very-high-energy (VHE, E > 100 GeV) gamma-ray flare from BL Lacertae on 2015 June 15. The flare had a maximum flux of (1.5 +/- 0.3)-10(-10) photons cm(-2) s(-1) and halving time of 26 +/- 8 min. The MAGIC observations were triggered by a high state in the optical and high-energy (HE, E > 100 MeV) gamma-ray bands. In this paper we present the MAGIC VHE gamma-ray data together with multi-wavelength data from radio, optical, X-rays, and HE gamma rays from 2015 May 1 to July 31. Well-sampled multi-wavelength data allow us to study the variability in detail and compare it to the other epochs when fast, VHE gamma-ray flares have been detected from this source. Interestingly, we find that the behaviour in radio, optical, X-rays, and HE gamma-rays is very similar to two other observed VHE gamma-ray flares. In particular, also during this flare there was an indication of rotation of the optical polarization angle and of activity at the 43 GHz core. These repeating patterns indicate a connection between the three events. We also test modelling of the spectral energy distribution based on constraints from the light curves and VLBA observations, with two different geometrical setups of two-zone inverse Compton models. In addition we model the gamma-ray data with the star-jet interaction model. We find that all of the tested emission models are compatible with the fast VHE gamma-ray flare, but all have some tension with the multi-wavelength observations

Pulmonary function test and computed tomography features during follow-up after SARS, MERS and COVID-19: a systematic review and meta-analysis.

Background The COVID-19 pandemic follows severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remain unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19. Methods This systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random-effects model) and proportion of CT features (Freeman-Tukey transformation random-effects model) were performed. Findings Persistent reduction in the diffusing capacity for carbon monoxide following SARS and COVID-19 infection is seen at 6 months follow-up, and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity, linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation are reported less often. Severe/critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/moderate infection. Interpretation Persistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome. It is yet to be determined if this is a regressive or progressive disease