More testing and surveillance needed for COVID-19

Last night (23 March) Australia’s deputy chief medical officer, Dr Paul Kelly, said that new protocols determining who can be tested for the virus that causes COVID-19 will be announced in the coming days. Here, Professor Lidia Morawska and Professor Guy B. Marks argue that much more testing is needed, and why

Allergen-Specific IL-5 Responses in Early Childhood Predict Asthma at Age Eight

<div><p>Background</p><p>The pattern of development of allergen-specific T cell cytokine responses in early childhood and their relation to later disease is poorly understood. Here we describe longitudinal changes in allergen-stimulated T cell cytokine responses and their relation to asthma and allergic disease during the first 8 years of life.</p><p>Methods</p><p>Subjects with a family history of asthma, who were enrolled antenatally in the Childhood Asthma Prevention Study (public trials registration number ACTRN12605000042640), had skin prick tests, clinical evaluation for asthma and eczema, and <i>in vitro</i> assessment of T cell cytokine responses to HDM extract performed at ages 18 months (n = 281), 3 years (n = 349), 5 years (n = 370) and 8 years (n = 275). We measured interleukin (IL-) 13 at 3, 5 and 8 years, and IL-5, IL-10, and interferon-γ (IFN-γ), at 18 months, 3, 5 and 8 years by ELISA. A cohort analysis was undertaken. Independent effects of cytokine responses at each age on the risk of asthma and allergic outcomes at age 8 years were estimated by multivariable logistic regression.</p><p>Results</p><p>HDM-specific IL-5 responses increased with age. HDM-specific IL-13 and IL-10 responses peaked at age 5 years. HDM-specific IL-5 responses at 3 years, 5 years and 8 years were significantly associated with the presence of asthma and atopy at 8 years. IL-13 responses at 3 years, 5 years and 8 years were significantly associated with atopy at 8 years, but this association was not independent of the effect of IL-5. Other HDM-specific cytokine responses were not independently related to asthma or eczema at 8 years.</p><p>Conclusion</p><p>HDM-specific IL-5 responses at age 3 years or later are the best measure of T cell function for predicting asthma at age 8 years.</p></div

Waste-to-Energy processes: what is the impact on air pollutants and health? A critical review of the literature

Background: Worldwide, governments are committing to better waste management. In Australia, only half of the waste generated each year is recycled. Meanwhile, there is increased demand for energy, while also reducing greenhouse gas emissions for climate change mitigation. While recovering energy (as electricity or heat) from waste is an end use in the waste hierarchy scheme, it has a number of economic and environmental benefits. The health benefits (or risks) of this recovery, however, are less clear.Methods: To summarise current understanding of the health benefits/risks with Waste-to-Energy (WtE) processes, a critical literature review was performed using Google Scholar. Search terms and Boolean operators used were "energy from waste" OR "waste to energy" AND "air pollution" OR "air quality" and health. Patents and citations were excluded. Further, inclusion criteria for papers were: (a) published in a peer-review, open-access journal; (b) published up to and including the year 2018, and; (c) published in English.Results: We found that WtE health impacts have been little studied. Several earlier? studies have assessed the health implications of waste incineration, however evidence suggests that WtE may have less health impact compared to waste incineration or fossil fuel combustion. The most comprehensive assessment to-date of the effects of combustion emissions showed WtE processes had a 64% lower health risk than incinerating unsorted municipal waste, but the increased concentration of some items in incinerated waste may lead to greater emissions of carcinogens. As well as better/more accurate methods to assign exposures, life-cycle analyses are needed to evaluate the impacts of WtE to human health, and how it compares to other methods of waste reduction and disposal in the waste hierarchy.Conclusions: A full assessment of environmental impacts of waste management activities associated with WtE should consider direct pollutant emissions and conversely, the positive effects of using this waste stream for energy generation, especially when benefits may outweigh the risks as is possible with modern, properly managed WtE facilities. As such, a life-cycle assessment of waste streams including reducing, recycling and reusing should be performed as a next step.<br/

Relative risk of HDM-specific cytokine response and presence of atopy, asthma and eczema.

<p>The relative risk of HDM-specific IL-5, IL-13 and IL-10 responses at each time point and the presence of atopy (a), asthma (b) and eczema (c). Relative risks for low responders (10–50 pg/mL) and high responders (>50 pg/mL) compared with non-responders (<10 pg/mL) are shown with 95% CIs. Relative risks are not adjusted for other cytokines measured at the same age. n.a. = non applicable.</p

Flowchart for Childhood Asthma Prevention Study (followed to age 8 years).

<p>The size of the cohort at each assessment (18 months, 3 years, 5 years, 8 years): number of participants, number of blood samples, number of valid cytokine responses.</p

Contact investigation in households of patients with tuberculosis in Hanoi, Vietnam: a prospective cohort study.

SETTING: Existing tuberculosis control strategies in Vietnam are based on symptomatic patients attending health services for investigation. This approach has not resulted in substantial reductions in the prevalence of tuberculosis disease, despite the National Tuberculosis Program achieving high treatment completion rates. Alternative approaches are being considered. OBJECTIVE: To determine the feasibility and yield of contact investigation in households of patients with smear positive pulmonary tuberculosis among household members of tuberculosis patients in Hanoi, Vietnam. METHODS: Household contacts of patients with smear positive pulmonary tuberculosis were recruited at four urban and rural District Tuberculosis Units in Hanoi. Clinical and radiological screening was conducted at baseline, six months and 12 months. Sputum microscopy and culture was performed in contacts suspected of having tuberculosis. MIRU-VNTR molecular testing was used to compare the strains of patients and their contacts with disease. RESULTS: Among 545 household contacts of 212 patients, four were diagnosed with tuberculosis at baseline (prevalence 734 cases per 100,000 persons, 95% CI 17-1451) and one was diagnosed with tuberculosis during the subsequent 12 months after initial screening (incidence 180 cases per 100,000 person-years, 95% CI 44-131). Two of these cases were culture positive for M. tuberculosis and both had identical or near-identical MIRU-VNTR strain types. CONCLUSION: Household contacts of patients with potentially infectious forms of tuberculosis have a high prevalence of disease. Household contact investigation is feasible in Vietnam. Further research is required to investigate its effectiveness

HDM-specific cytokine responses in asthmatic and non-asthmatic children.

<p>Box and whisker plots showing the distribution of HDM-specific IL-5, IL-13, IL-10 and IFN-γ cytokine responses at 18 months, 3, 5 and 8 years in asthmatic and non-asthmatic children at 8 years.</p

Characteristics of the study population at different ages.

<p>Characteristics of the study population at different ages.</p

HDM-specific cytokine responses in atopic and non-atopic children.

<p>Box and whisker plots showing the distribution of HDM-specific IL-5, IL-13, IL-10 and IFN-γ cytokine responses at 18 months, 3, 5 and 8 years in atopic and non-atopic children at 8 years.</p