Cryptosporidium in rivers of the world: the GloWPa-Crypto model

Diarrhoeal disease is very common around the world. Knowing more about the global burden of diarrhoeal disease and about the geographical distribution of pathogen pollution is important for decision making and water and sanitation planning. The objective of this thesis is to increase knowledge on the sources, fate and transport of Cryptosporidium in rivers worldwide using spatially explicit modelling. I present the Global Waterborne Pathogen model for Cryptosporidium (GloWPa-Crypto), the first global model of waterborne pathogen emissions to and concentrations in rivers. The model is used to provide information on pathogen concentrations in data-sparse regions, identify hotspot regions, identify the relative contribution of different sources, and in scenario analysis to study the impacts of global change or management strategies. Furthermore, the model can be applied in the analysis of risk, burden of disease and health-based treatment targets, and make a valuable contribution in meeting the Sustainable Development Goals.</p

Asymmetric aerosol volume transmission: A computational approach toward infection prevention efficiency of face masks

Wearing face masks is considered as one of the infection prevention and control options for respiratory viruses (e.g., SARS-CoV-2) that acts by blocking virus-laden aerosols. It is generally thought that aerosol blockage occurs when air passes through the face mask fabric. We calculated air flows through face masks and through peripheral leakages, based on reported breathing resistance values of face masks (FFP/N95, surgical masks, and cloth masks) and found that most of the inhaled and exhaled air passes through these peripheral leakages. Nevertheless, face masks remain effective as an infection prevention option, because additional calculations showed that the majority of aerosol volume cannot follow the tortuous path of air around the face mask. The filtering efficiency through the peripheral leakages can be described as a function of breathing conditions, vocal activities, the leakage geometry and tortuous pathway, aerosol properties (diameter, composition) and ambient conditions (e.g., evaporation, ventilation). Inclusion of these parameters explains the asymmetric filtering behavior of face masks, i.e., the risk of infection from person A to person B does not necessarily equal the risk of infection from person B to person A. Our findings explain thus why masking an infectious person is more effective than masking an exposed person. Establishing that the tortuous pathway of air around the face mask is the sole contributor to face mask efficiency opens new opportunities for designing safer face masks

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Quantitative Microbial Risk Assessment for Airborne Transmission of SARS-CoV-2 via Breathing, Speaking, Singing, Coughing, and Sneezing.

A risk assessment model, AirCoV2, for exposure to SARS-CoV-2 particles in aerosol droplets was developed. Previously published data on droplets expelled by breathing, speaking, singing, coughing, and sneezing by an infected person were used as inputs. Scenarios encompassed virus concentration, exposure time, and ventilation. Newly collected data of virus RNA copies in mucus from patients are presented

Global Occurrence and Emission of Rotaviruses to Surface Waters

Group A rotaviruses (RV) are the major cause of acute gastroenteritis in infants and young children globally. Waterborne transmission of RV and the presence of RV in water sources are of major public health importance. In this paper, we present the Global Waterborne Pathogen model for RV (GloWPa-Rota model) to estimate the global distribution of RV emissions to surface water. To our knowledge, this is the first model to do so. We review the literature to estimate three RV specific variables for the model: incidence, excretion rate and removal during wastewater treatment. We estimate total global RV emissions to be 2 × 1018 viral particles/grid/year, of which 87% is produced by the urban population. Hotspot regions with high RV emissions are urban areas in densely populated parts of the world, such as Bangladesh and Nigeria, while low emissions are found in rural areas in North Russia and the Australian desert. Even for industrialized regions with high population density and without tertiary treatment, such as the UK, substantial emissions are estimated. Modeling exercises like the one presented in this paper provide unique opportunities to further study these emissions to surface water, their sources and scenarios for improved management

Correction: Global Occurrence and Emission of Rotaviruses to Surface Waters. Pathogens 2015, 4, 229–255

The authors wish to make the following corrections to their paper [1].[...

Quantitative Microbial Risk Assessment for Airborne Transmission of SARS-CoV-2 via Breathing, Speaking, Singing, Coughing, and Sneezing.

A risk assessment model, AirCoV2, for exposure to SARS-CoV-2 particles in aerosol droplets was developed. Previously published data on droplets expelled by breathing, speaking, singing, coughing, and sneezing by an infected person were used as inputs. Scenarios encompassed virus concentration, exposure time, and ventilation. Newly collected data of virus RNA copies in mucus from patients are presented