The future of road transport

A perfect storm of new technologies and new business models is transforming not only our vehicles, but everything about how we get around, and how we live our lives. The JRC report “The future of road transport - Implications of automated, connected, low-carbon and shared mobility” looks at some main enablers of the transformation of road transport, such as data governance, infrastructures, communication technologies and cybersecurity, and legislation. It discusses the potential impacts on the economy, employment and skills, energy use and emissions, the sustainability of raw materials, democracy, privacy and social fairness, as well as on the urban context. It shows how the massive changes on the horizon represent an opportunity to move towards a transport system that is more efficient, safer, less polluting and more accessible to larger parts of society than the current one centred on car ownership. However, new transport technologies, on their own, won't spontaneously make our lives better without upgrading our transport systems and policies to the 21st century. The improvement of governance and the development of innovative mobility solutions will be crucial to ensure that the future of transport is cleaner and more equitable than its car-centred present.JRC.C.4-Sustainable Transpor

Utilisation des prélèvements de sang séché sur papier buvard pour le diagnostic et le suivi thérapeutique des maladies infectieuses

International audienceThe use of blood collected and dried on filter paper - dried blood spot (DBS) - have started in the middle of the 20th century. DBS sampling can be performed outside care facilities, by capillary puncture, transported in a simple and safe manner by mail, and used with most laboratory methods for antibodies, antigen, or nucleic acids testing. The benefits of this blood collection and transport means explain the growing interest for DBS in the recent years. DBS sampling has shown clinical utility to improve in vitro diagnostics of infectious diseases in hard to reach populations, key populations and people living in low-income countries. DBS can be used at all stages of the therapeutic cascade: screening, confirmation, quantification of nucleic acids, resistance genotyping. Numerous studies dedicated to HIV, viral hepatitis B and C diagnosis using DBS have been reported. The performance of HIV RNA testing on DBS to identified virological failure on therapy is high but not optimal due to the dilution of dried blood in the elution buffer that reduces the analytical sensitivity and due to the contamination by intracellular HIV DNA. Good sensibility and sensitivity have been reported for infant HIV diagnosis and diagnosis of hepatitis B and C using DBS. Variabilities in the pre-analytical steps - including DBS preparation and nucleic acid extraction - limit inter-laboratory comparisons. Too few manufacturers have proposed technical notes for using their assays on DBS and very few assays have pursued regulatory approval for in vitro diagnostic on DBS. Regulatory approvals remain exceptional. Despite these limitations, DBS sampling is a main tool to improve access to infectious disease diagnosis worldwide and is now recommended by international recommendations.Les débuts de l’emploi du sang collecté et séché sur papier buvard – « dried blood spot » (DBS) – remonte au milieu du XXe siècle. Le prélèvement DBS peut être réalisé en dehors des structures de soins, par ponction capillaire, transporté de manière simple et sûre par voie postale, et utilisé avec la plupart des méthodes de laboratoire pour l’analyse d’anticorps, d’antigène, ou d’acides nucléiques. Ces caractéristiques avantageuses expliquent l’intérêt croissant pour ce mode de prélèvement et de transport du sang. Le prélèvement DBS a montré son utilité clinique pour améliorer le diagnostic in vitro des maladies infectieuses dans les populations d’accès difficiles, les populations clés et chez les personnes vivant dans les pays à faibles ressources économiques. Le DBS est utilisable à toutes les étapes de la cascade thérapeutique : dépistage, confirmation, quantification des acides nucléiques, génotypages de résistances. C’est dans le domaine de la prise en charge du VIH et des hépatites virales B et C que le plus d’études basées sur le DBS ont été réalisées. Les performances des tests ARN VIH sur DBS pour l’identification de l’échec virologique sous traitements sont élevées mais pas optimales, du fait de la dilution du sang séché dans le tampon d’élution qui réduit la sensibilité analytique et de la contamination par l’ADN proviral intracellulaire. Des performances élevées sont rapportées pour le diagnostic VIH pédiatrique et le diagnostic des hépatites B et C. La variabilité des méthodes pré-analytiques – notamment la préparation des DBS et l’extraction des acides nucléiques – limite les possibilités de comparaisons inter-laboratoires. Trop peu de fabricants ont proposé des notices techniques pour l’usage de leurs trousses sur DBS et les approbations réglementaires des tests commercialisés pour l’usage sur DBS demeurent exceptionnelles. Le prélèvement sur DBS malgré ces limites et contraintes est un outil majeur pour améliorer l’accès au diagnostic des maladies infectieuses dans le monde et fait désormais l’objet de recommandations internationales

Spike Antibody Levels of Nursing Home Residents With or Without Prior COVID-19 3 Weeks After a Single BNT162b2 Vaccine Dose

International audienceThis study compares IgG antibody levels after a single dose of the BNT162b2 (Pfizer-BioNTech) vaccine in nursing home residents with vs without prior COVID-19

Accuracy of real-time PCR and digital PCR for the monitoring of total HIV DNA under prolonged antiretroviral therapy

International audienceAbstract Total HIV DNA is a standard marker to monitor the HIV reservoir in people living with HIV. We investigated HIV DNA quantification accuracy by a real-time PCR kit (qPCR) and digital PCR (dPCR) method within the same set of primers and probes. Among 48 aviremic patients followed for up to 7 years with qPCR, the mean coefficient of variation of total HIV DNA between two successive measurements was 77% (± 0.42log 10 HIVDNA copies/10 6 PBMC). The total HIV DNA quantified by the two PCR methods has a high correlation (0.99 and 0.83, for 8E5 and PLHIV samples, respectively), but we observed better repeatability and reproducibility of the dPCR compared to the qPCR (CV of 11.9% vs. 24.7% for qPCR, p-value = 0.024). Furthermore, we highlighted a decay of the number of HIV copies in the 8E5 cell line qPCR standard over time (from 0.73 to 0.43 copies per cell), contributing to variations of HIV DNA results in patients whose HIV reservoir should be theoretically stabilized. Our study highlighted that absolute quantification of total HIV DNA by dPCR allows more accurate monitoring of the HIV reservoir than qPCR in patients under prolonged antiretroviral therapy

Analysing different exposures identifies that wearing masks and establishing COVID-19 areas reduce secondary-attack risk in aged-care facilities

International audienceBackground The COVID-19 epidemic has spread rapidly within aged-care facilities (ACFs), where the infection-fatality ratio is high. It is therefore urgent to evaluate the efficiency of infection prevention and control (IPC) measures in reducing SARS-CoV-2 transmission.Methods We analysed the COVID-19 outbreaks that took place between March and May 2020 in 12 ACFs using reverse transcription–polymerase chain reaction (RT–PCR) and serological tests for SARS-CoV-2 infection. Using maximum-likelihood approaches and generalized linear mixed models, we analysed the proportion of infected residents in ACFs and identified covariates associated with the proportion of infected residents.Results The secondary-attack risk was estimated at 4.1%, suggesting a high efficiency of the IPC measures implemented in the region. Mask wearing and the establishment of COVID-19 zones for infected residents were the two main covariates associated with lower secondary-attack risks.Conclusions Wearing masks and isolating potentially infected residents appear to be associated with a more limited spread of SARS-CoV-2 in ACFs

Atypical symptoms, SARS-CoV-2 test results, and immunization rates in 456 residents from eight nursing homes facing a COVID-19 outbreak

International audienceBackground: Frail older persons may have an atypical presentation of coronavirus disease 2019 (COVID-19). The value ofreal-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for identifying severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) nursing homes (NHs) residents is not known. Objective: To determine whether (i) atypical symptoms may predict rRT-PCR results and (ii) rRT-PCR results may predictimmunisation against SARS-CoV-2 in NH residents. Design: A retrospective longitudinal study. Setting: Eight NHs with at least 10 rRT-PCR-positive residents. Subjects: A total of 456 residents. Methods: Typical and atypical symptoms recorded in residents’ files during the 14 days before and after rRT-PCR testing were analysed. Residents underwent blood testing for IgG-SARS-CoV-2 nucleocapsid protein 6 to 8 weeks after testing. Univariate and multivariate analyses compared symptoms and immunisation rates in rRT-PCR-positive and negative residents. Results: A total of 161 residents had a positive rRT-PCR (35.3%), 17.4% of whom were asymptomatic before testing. Temperature >37.8◦C, oxygen saturation <90%, unexplained anorexia, behavioural change, exhaustion, malaise and fallsbefore testing were independent predictors of a further positive rRT-PCR. Among the rRT-PCR-positive residents, 95.2% developed SARS-CoV-2 antibodies vs 7.6% in the rRT-PCR-negative residents. Among the residents with a negative rRT-PCR, those who developed SARS-CoV-2 antibodies more often had typical or atypical symptoms (P=0.02 and <0.01,respectively). Conclusion: This study supports a strategy based on (i) testing residents with typical or unexplained atypical symptoms for an early identification of the first SARS-CoV-2 cases, (ii) rT-PCR testing for identifying COVID-19 residents, (iii) repeated wide-facility testing (including asymptomatic cases) as soon as a resident is tested positive for SARS-CoV-2 and (iv) implementing SARS-CoV-2 infection control measures in rRT-PCR-negative residents when they have unexplained typicalor atypical symptoms

QuantiFERON-TB Gold Plus Assay in Patients With Latent vs. Active Tuberculosis in a Low Incidence Setting: Level of IFN-γ, CD4/CD8 Responses, and Release of IL-2, IP-10, and MIG

International audienceObjectives We analyzed the results of the QuantiFERON Glod Plus assay (QFT) and cytokine patterns associated with active tuberculosis (ATB) among patients with positive QFT. Methods A total of 195 patients are QFT-positive, among which 24 had an ATB and 171 had a latent tuberculosis infection (LTBI). Interferon-gamma (IFN-γ) secretion was analyzed relative to interleukin-2 (IL-2), IFN-γ inducible protein or CXCL-10 (IP-10), and monokine induced by IFN-γ or CXCL-9 (MIG) secretion, and then compared between two sets of peptide antigens [tube 1 - cluster of differentiation 4 (CD4 + ) T cell stimulation; tube 2 - CD4 + /CD8 + T cell response]. Results Higher IFN-γ responses were measured in the ATB group ( p = 0.0089). The results showed that there was a lower ratio of tube 1/tube 2 IFN-γ concentrations in the ATB group ( p = 0.0009), and a median [interquartile ranges (IQR)] difference between the two sets at −0.82 IU/ml (−1.67 to 0.18) vs. −0.07 IU/ml (−0.035 to 0.11, p &lt; 0.0001) in the ATB group compared to the LTBI group, respectively. In addition, patients with low ratios of IL-2/IFN-γ, IP-10/IFN-γ, and MIG/IFN-γ were much more likely to have ATB. Conclusion High levels of IFN-γ secretion, preferential IFN-γ response in tube 2, and lower secretion of IL-2, IP-10, and MIG release relative to IFN-γ secretion were more likely observed in subjects with ATB. These features of T cell response may be helpful in low prevalence settings to suspect ATB in patients tested positive for IFN-γ release assays (IGRA)

Dried Blood Spot Tests for the Diagnosis and Therapeutic Monitoring of HIV and Viral Hepatitis B and C

International audienceBlood collected and dried on a paper card - dried blood spot (DBS) - knows a growing interest as a sampling method that can be performed outside care facilities by capillary puncture, and transported in a simple and safe manner by mail. The benefits of this method for blood collection and transport has recently led the World Health Organization to recommend DBS for HIV and hepatitis B and C diagnosis. The clinical utility of DBS sampling to improve diagnostics and care of HIV and hepatitis B and C infection in hard to reach populations, key populations and people living in low-income settings was highlighted. Literature about usefulness of DBS specimens in the therapeutic cascade of care - screening, confirmation, quantification of nucleic acids, and resistance genotyping -, was reviewed. DBS samples are suitable for testing antibodies, antigens, or nucleic acids using most laboratory methods. Good sensibility and specificity have been reported for infant HIV diagnosis and diagnosis of hepatitis B and C. The performance of HIV RNA testing on DBS to identified virological failure on antiretroviral therapy is also high but not optimal because of the dilution of dried blood in the elution buffer, reducing the analytical sensitivity, and because of the contamination by intracellular HIV DNA. Standardized protocols are needed for inter-laboratory comparisons, and manufacturers should pursue regulatory approval for in vitro diagnostics using DBS specimens. Despite these limitations, DBS sampling is a clinically relevant tool to improve access to infectious disease diagnosis worldwide

Antibody response after first and second BNT162b2 vaccination to predict the need for subsequent injections in nursing home residents

International audienceAbstract We explored antibody response after first and second BNT162b2 vaccinations, to predict the need for subsequent injections in nursing home (NH) residents. 369 NH residents were tested for IgG against SARS-CoV-2 Receptor-Binding Domain (RBD-IgG) and nucleoprotein-IgG (SARS-CoV-2 IgG II Quant and SARS-CoV-2 IgG Alinity assays, Abbott Diagnostics). In NH residents with prior SARS-CoV-2 infection, the first dose elicited high RBD-IgG levels (≥ 4160 AU/mL) in 99/129 cases (76.9%), with no additional antibody gain after the second dose in 74 cases (74.7%). However, a low RBD-IgG level (< 1050 AU/mL) was observed in 28 (21.7%) residents. The persistence of nucleoprotein-IgG and a longer interval between infection and the first dose were associated with a higher RBD-IgG response (p < 0.0001 and p = 0.0013, respectively). RBD-IgG below 50 AU/mL after the first dose predicted failure to reach the antibody concentration associated with a neutralizing effect after the second dose (≥ 1050 AU/mL). The BNT162b2 vaccine elicited a strong humoral response after the first dose in a majority of NH residents with prior SARS-CoV-2 infection. However, about one quarter of these residents require a second injection. Consideration should be given to immunological monitoring in NH residents to optimize the vaccine response in this vulnerable population

Online self-sampling kits to screen multipartner MSM for HIV and other STIs: Participant characteristics and factors associated with kit use in the first three months of the MemoDepistages program, France, 2018

International audienc