Illness tracking in SARS-CoV-2 tested persons using a smartphone app: a non-interventional, prospective, cohort study

There are few data on the range and severity of symptoms of SARS-CoV-2 infection or the impact on life quality in infected, previously healthy, young adults such as Swiss Armed Forces personnel. It is also unclear if an app can be used to remotely monitor symptoms in persons who test positive. Using a smartphone app called ITITP (Illness Tracking in Tested Persons) and weekly pop-up questionnaires, we aimed to evaluate the spectrum, duration, and impact of symptoms reported after a positive SARS-CoV-2 test according to sex, age, location, and comorbidities, and to compare these to responses from persons who tested negative. We followed up 502 participants (57% active participation), including 68 (13.5%) positive tested persons. Hospitalisation was reported by 6% of the positive tested participants. We found that positives reported significantly more symptoms that are typical of COVID-19 compared to negatives. These symptoms with odds ratio (OR > 1) were having difficulty breathing (OR 3.35; 95% CI: 1.16, 9.65; p = 0.03), having a reduced sense of taste (OR 5.45; 95% CI: 1.22, 24.34; p = 0.03) and a reduced sense of smell (OR 18.24; 95% CI: 4.23, 78.69; p < 0.001). Using a random forest model, we showed that tiredness was the single symptom that was rated as having a significant impact on daily activities, whereas the other symptoms, although frequent, had less impact. The study showed that the use of an app was feasible to remotely monitor symptoms in persons infected with SARS-CoV-2 and could be adapted for other settings and new pandemic phases such as the current Omicron wave. Keywords: Ageusia; COVID-19; SARS-CoV-2 infection; agnosia; app; illness; omicron; remote monitoring; symptoms; tiredness

Persistence, prevalence, and polymorphism of sequelae after COVID-19 in unvaccinated, young adults of the Swiss Armed Forces: a longitudinal, cohort study (LoCoMo)

Background: Persistent COVID-19 sequelae could have global, public health ramifications. We therefore aimed to describe sequelae presenting more than 180 days after COVID-19-focussing on several organ systems, general health, and laboratory parameters-in non-hospitalised, unvaccinated, young adults. Methods: We did a longitudinal cohort study of all army bases in Switzerland. Eligible participants were personnel of the Swiss Armed Forces (SAF) who were aged 18-30 years with a positive or negative RT-PCR test for SARS-CoV-2 during their service between March 1, 2020, and Dec 31, 2020. Exclusion criteria were unwillingness to participate in testing. Females or men with a known reproductive anomaly were excluded from the optional component of male fertility testing. COVID-19 was defined as a positive diagnostic RT-PCR test result for SARS-CoV-2 with concurrent symptoms compatible with COVID-19. Participants were subdivided into four groups: control group (ie, serologically negative), asymptomatic infection group (ie, serologically positive but with no symptoms), non-recent COVID-19 group (>180 days since positive PCR test), and recent COVID-19 group (≤180 days since positive PCR test). Outcomes of interest were part of a comprehensive, intensive test battery that was administered during a single day. The test battery quantified the effect of SARS-CoV-2 infection on cardiovascular, pulmonary, neurological, renal, ophthalmological, male reproductive, psychological, general health, and laboratory parameters. This study was registered with ClinicalTrials.gov, number NCT04942249. Findings: Between May 20, 2021, and Nov 26, 2021, we enrolled 501 participants. 29 (6%) of 501 were female and 464 (93%) were male, and the median age was 21 years (IQR 21-23). Eight (2%) of 501 had incomplete data and were not included into the study groups. 177 participants had previous COVID-19 that was more than 180 days (mean 340 days) since diagnosis (ie, the non-recent COVID-19 group) compared with 251 serologically negative individuals (ie, the control group). We included 19 participants in the recent COVID-19 group and 46 in the asymptomatic infection group. We found a significant trend towards metabolic disorders in participants of the non-recent COVID-19 group compared with those in the control group: higher BMI (median 24·0 kg/m2 [IQR 22·0-25·8] vs 23·2 kg/m2 [27·1-25·0]; p=0·035), lower aerobic threshold (39% [36-43] vs 41% [37-46]; p=0·012), and higher blood cholesterol (4·2 μM [3·7-4·7] vs 3·9 μM [3·5-4·5]; p<0·0001) and LDL concentrations (2·4 μM [1·9-2·9] vs 2·2 μM [1·7-2·7]; p=0·001). The only significant psychosocial difference was found in the results of the Chalder Fatigue scale with the non-recent COVID-19 group reporting higher fatigue scores than the control group (median 12 points [IQR 11-15] vs 11 [9-14]; p=0·027). No significant differences in other psychosocial questionnaire scores, ophthalmological outcomes, and sperm quality or motility were reported between the control group and non-recent COVID-19 group. Interpretation: Young, previously healthy, individuals largely recover from SARS-CoV-2 infection. However, the constellation of higher BMI, dyslipidaemia, and lower physical endurance 180 days after COVID-19 is suggestive of a higher risk of developing metabolic disorders and possible cardiovascular complications. These findings will guide future investigations and follow-up management

Augmentation des températures et menace du paludisme en Europe : un retour indésirable ?

Rising temperatures pose a threat to malaria transmission in Europe. Anopheles vectors are becoming more stable and widespread, putting some areas at increased risk of transmission for extended periods. By 2030 or 2050, the period of susceptibility is expected to extend to 3-6 months in some European countries and Anopheles mosquitoes are expected to migrate northward. In addition, climate change has led to a substantial increase in the number of climate refugees in Europe, increasing the risk of spread of the disease from endemic areas to susceptible regions. Urgent action is needed to prevent the transmission of malaria and other climate change-related diseases in Europe

Meaningful higher education in Kakuma refugee camp: A case study of why context and contextualization matter

In recent years, higher education in refugee contexts has begun to receive increasing attention within the humanitarian-development sector. Resource constraints, coupled with the technology and innovation zeitgeist in international development drives, have helped to create a higher education space where courses in refugee camps are typi- cally delivered via online learning platforms directly from Western education providers. As the space develops, a shift in attention is beginning to occur, such that the legitimacy of online learning for refugees is now being questioned. At the heart of this question are the issue of contextualization and a call for greater emphasis to be placed on blended learn- ing approaches that better reflect the realities of refugee learners. In this case study, the authors compare and evaluate a contextualized medical studies course that was delivered via blended learning in the Kakuma refugee camp in 2019 with a non-contextualized ver- sion of the same course that was delivered in the Dadaab refugee camp in 2018. The study explores the contextualization process and finds that the contextualized course achieved better learning outcomes than did the non-contextualized version of the course

Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis

BACKGROUND Respiratory tract infections (RTIs) are common in travellers due to the year-round or seasonal presence of respiratory pathogen and exposure to crowded environments during the itinerary. No study has systematically examined the burden of RTI infections among travellers. The aim of this systematic review and meta-analysis is to evaluate the prevalence of RTIs and symptoms suggestive of RTIs among travellers according to risk groups and/or geographic region, and to describe the spectrum of RTIs. METHODS The systematic review and meta-analysis was registered in PROSPERO (CRD42022311261). We searched Medline, Embase, Scopus, Cochrane Central, Web of Science, Science Direct and preprint servers MedRxiv, BioRxiv, SSRN and IEEE Xplore on 1 February 2022. Studies reporting RTIs or symptoms suggestive of RTIs in international travellers after 1 January 2000 were eligible. Data appraisal and extraction were performed by two authors, and proportional meta-analyses were used to obtain estimates of the prevalence of respiratory symptoms and RTIs in travellers and predefined risk groups. FINDINGS A total of 429 articles on travellers' illness were included. Included studies reported 86 841 symptoms suggestive of RTIs and 807 632 confirmed RTIs. Seventy-eight percent of reported respiratory symptoms and 60% of RTIs with available location data were acquired at mass gatherings events. Cough was the most common symptom suggestive of respiratory infections, and the upper respiratory tract was the most common site for RTIs in travellers. The prevalence of RTIs and respiratory symptoms suggestive of RTIs were 10% [8%; 14%] and 37% [27%; 48%], respectively, among travellers. Reporting of RTIs in travellers denoted by publication output was found to correlate with global waves of new respiratory infections. INTERPRETATION This study demonstrates a high burden of RTIs among travellers and indicates that travellers' RTIs reflect respiratory infection outbreaks. These findings have important implications for understanding and managing RTIs among travellers

Mobile apps for travel medicine and ethical considerations: A systematic review

BACKGROUND The advent of mobile applications for health and medicine will revolutionize travel medicine. Despite their many benefits, such as access to real-time data, mobile apps for travel medicine are accompanied by many ethical issues, including questions about security and privacy. METHODS A systematic literature review as conducted following PRISMA guidelines. Database screening yielded 1795 results and seven papers satisfied the criteria for inclusion. Through a mix of inductive and deductive data extraction, this systematic review examined both the benefits and challenges, as well as ethical considerations, of mobile apps for travel medicine. RESULTS Ethical considerations were discussed with varying depth across the included articles, with privacy and data protection mentioned most frequently, highlighting concerns over sensitive information and a lack of guidelines in the digital sphere. Additionally, technical concerns about data quality and bias were predominant issues for researchers and developers alike. Some ethical issues were not discussed at all, including equity, and user involvement. CONCLUSION This paper highlights the scarcity of discussion around ethical issues. Both researchers and developers need to better integrate ethical reflection at each step of the development and use of health apps. More effective oversight mechanisms and clearer ethical guidance are needed to guide the stakeholders in this endeavour

Mobile apps for travel medicine and ethical considerations: A systematic review

Background: The advent of mobile applications for health and medicine will revolutionize travel medicine. Despite their many benefits, such as access to real-time data, mobile apps for travel medicine are accompanied by many ethical issues, including questions about security and privacy. Methods: A systematic literature review as conducted following PRISMA guidelines. Database screening yielded 1795 results and seven papers satisfied the criteria for inclusion. Through a mix of inductive and deductive data extraction, this systematic review examined both the benefits and challenges, as well as ethical considerations, of mobile apps for travel medicine. Results: Ethical considerations were discussed with varying depth across the included articles, with privacy and data protection mentioned most frequently, highlighting concerns over sensitive information and a lack of guidelines in the digital sphere. Additionally, technical concerns about data quality and bias were predominant issues for researchers and developers alike. Some ethical issues were not discussed at all, including equity, and user involvement. Conclusion: This paper highlights the scarcity of discussion around ethical issues. Both researchers and developers need to better integrate ethical reflection at each step of the development and use of health apps. More effective oversight mechanisms and clearer ethical guidance are needed to guide the stakeholders in this endeavour

Infectious disease risks at the Rugby World Cup 2023 in France – Beware of Aedes and co!

International audienceAs we approach the 2023 Rugby World Cup in France, which will start on September 8th, 2023, can we anticipate and mitigate infectious disease risks? With more than 600,000 international visitors expected to attend at venues throughout France there is a need to consider typical risks for mass gatherings and specific risks based on local epidemiology. The venues for the games are in Saint-Denis, Toulouse, Nantes, Marseille, Saint-Etienne, Lille, Lyon, Nice, Bordeaux (Fig. 1). Typical for large sporting events are gastrointestinal infections, respiratory infections such as influenza and sexually transmitted infections [1,2] but this editorial focuses on arthropod-borne infections. A main concern currently in France is the potential for the transmission of arboviral infections such as dengue, chikungunya, and possibly Zika and other vector-borne infections such as West Nile virus and Usutu virus. Vector-borne diseases are transmitted by arthropods such as mosquitoes, ticks, and sandflies. They can cause a range of illnesses, from mild fevers to severe neurological complications and even death. Local transmission of arboviral infections is increasing in Europe with several autochthonous cases of infection reported since 2020 especially in the South of France in the regions of Occitania and Provence-Alpes—Cote d’Azur where 65 autochthonous dengue cases were reported in 2022 and four cases in 2023 [[3], [4], [5], [6]]. The last French autochthonous chikungunya outbreak occurred in 2017 with nine cases in Le Cannet-des-Maures (Var department) [7]. Three cases of French autochthonous Zika were documented in 2017 in Hyères (Var department) [8]. The Aedes mosquito is the vector of dengue and chikungunya and the Zika virus. Aedes albopictus, first detected in 2004 in the South of France, has spread northwards and is now widely distributed. Optimal climatic conditions have led to an increase in Aedes overwintering survival, frequency of biting and faster viral development in the mosquito