International Dispersal of Dengue through Air Travel: Importation Risk for Europe

<div><p>Background</p><p>The worldwide distribution of dengue is expanding, in part due to globalized traffic and trade. <i>Aedes albopictus</i> is a competent vector for dengue viruses (DENV) and is now established in numerous regions of Europe. Viremic travellers arriving in Europe from dengue-affected areas of the world can become catalysts of local outbreaks in Europe. Local dengue transmission in Europe is extremely rare, and the last outbreak occurred in 1927–28 in Greece. However, autochthonous transmission was reported from France in September 2010, and from Croatia between August and October 2010.</p><p>Methodology</p><p>We compiled data on areas affected by dengue in 2010 from web resources and surveillance reports, and collected national dengue importation data. We developed a hierarchical regression model to quantify the relationship between the number of reported dengue cases imported into Europe and the volume of airline travellers arriving from dengue-affected areas internationally.</p><p>Principal Findings</p><p>In 2010, over 5.8 million airline travellers entered Europe from dengue-affected areas worldwide, of which 703,396 arrived at 36 airports situated in areas where <i>Ae. albopictus</i> has been recorded. The adjusted incidence rate ratio for imported dengue into European countries was 1.09 (95% CI: 1.01–1.17) for every increase of 10,000 travellers; in August, September, and October the rate ratios were 1.70 (95%CI: 1.23–2.35), 1.46 (95%CI: 1.02–2.10), and 1.35 (95%CI: 1.01–1.81), respectively. Two Italian cities where the vector is present received over 50% of all travellers from dengue-affected areas, yet with the continuing vector expansion more cities will be implicated in the future. In fact, 38% more travellers arrived in 2013 into those parts of Europe where <i>Ae. albopictus</i> has recently been introduced, compared to 2010.</p><p>Conclusions</p><p>The highest risk of dengue importation in 2010 was restricted to three months and can be ranked according to arriving traveller volume from dengue-affected areas into cities where the vector is present. The presence of the vector is a necessary, but not sufficient, prerequisite for DENV onward transmission, which depends on a number of additional factors. However, our empirical model can provide spatio-temporal elements to public health interventions.</p></div

Adult attention deficit hyperactivity disorder (ADHD) in ASD

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by core symptoms of inattention, impulsivity, and hyperactivity. ADHD has been considered for a long time as a childhood condition, fading as children grew up. Instead, ADHD changes its clinical presentation over the lifespan, but persists in most cases in adulthood with its associated impairment. It is only since 2013, with the release of DSM-5, that it is possible to diagnose ADHD in the presence of ASD. This change was based on studies performed in children, adolescents, and adults that found high comorbidity rates between ASD and ADHD. Studies investigating the co-occurrence of such disorders at a genetic, at structural and functional neuroimaging levels indicate that they share common genetic risk factors, involve similar biological mechanisms, and affect the same brain regions. The co-existence of both disorders causes a significant burden. Individuals with ASD presenting ADHD symptomatology exhibit a more severe phenotype, with more autistic traits, greater impairment in adaptive behavior, and increased risk for developing additional psychiatric conditions. Pharmacotherapeutic treatments for ADHD, such as methylphenidate and atomoxetine, have been studied in individuals with ADHD+ASD, demonstrating efficacy in decreasing the severity of ADHD symptoms, although with lower effect sizes than in people with only ADHD. The diagnosis of ADHD is established clinically and requires the use of rating scales as well as clinical interviews for avoiding the risk of misdiagnosis. The stigma surrounding individuals with ADHD is huge, therefore it is necessary to increase awareness about this disorder among both the public and healthcare professionals, in order to reduce the barriers that patients face to get access to proper diagnosis and treatment

COVID-19 due to the B.1.617.2 (Delta) variant compared to B.1.1.7 (Alpha) variant of SARS-CoV-2: a prospective observational cohort study

The Delta (B.1.617.2) variant was the predominant UK circulating SARS-CoV-2 strain between May and December 2021. How Delta infection compares with previous variants is unknown. This prospective observational cohort study assessed symptomatic adults participating in the app-based COVID Symptom Study who tested positive for SARS-CoV-2 from May 26 to July 1, 2021 (Delta overwhelmingly the predominant circulating UK variant), compared (1:1, age- and sex-matched) with individuals presenting from December 28, 2020 to May 6, 2021 (Alpha (B.1.1.7) the predominant variant). We assessed illness (symptoms, duration, presentation to hospital) during Alpha- and Delta-predominant timeframes; and transmission, reinfection, and vaccine effectiveness during the Delta-predominant period. 3581 individuals (aged 18 to 100 years) from each timeframe were assessed. The seven most frequent symptoms were common to both variants. Within the first 28 days of illness, some symptoms were more common with Delta versus Alpha infection (including fever, sore throat, and headache) and some vice versa (dyspnoea). Symptom burden in the first week was higher with Delta versus Alpha infection; however, the odds of any given symptom lasting ≥ 7 days was either lower or unchanged. Illness duration ≥ 28 days was lower with Delta versus Alpha infection, though unchanged in unvaccinated individuals. Hospitalisation for COVID-19 was unchanged. The Delta variant appeared more (1.49) transmissible than Alpha. Re-infections were low in all UK regions. Vaccination markedly reduced the risk of Delta infection (by 69-84%). We conclude that COVID-19 from Delta or Alpha infections is similar. The Delta variant is more transmissible than Alpha; however, current vaccines showed good efficacy against disease. This research framework can be useful for future comparisons with new emerging variants. © 2022, The Author(s)