Successful Delivery of RRT in Ebola Virus Disease

AKI has been observed in cases of Ebola virus disease. We describe the protocol for the first known successful delivery of RRT with subsequent renal recovery in a patient with Ebola virus disease treated at Emory University Hospital, in Atlanta, Georgia. Providing RRT in Ebola virus disease is complex and requires meticulous attention to safety for the patient, healthcare workers, and the community. We specifically describe measures to decrease the risk of transmission of Ebola virus disease and report pilot data demonstrating no detectable Ebola virus genetic material in the spent RRT effluent waste. This article also proposes clinical practice guidelines for acute RRT in Ebola virus disease.     

Risk Profile of Hepatitis E Virus from Pigs or Pork in Canada

The role and importance of pigs and pork as sources of zoonotic hepatitis E virus (HEV) has been debated in Canada and abroad for over 20 years. To further investigate this question, we compiled data to populate a risk profile for HEV in pigs or pork in Canada. We organized the risk profile (RP) using the headings prescribed for a foodborne microbial risk assessment and used research synthesis methods and inputs wherever possible in populating the fields of this RP. A scoping review of potential public health risks of HEV, and two Canadian field surveys sampling finisher pigs, and retail pork chops and pork livers, provided inputs to inform this RP. We calculated summary estimates of prevalence using the Comprehensive Meta‐analysis 3 software, employing the method of moments. Overall, we found the incidence of sporadic locally acquired hepatitis E in Canada, compiled from peer‐reviewed literature or from diagnosis at the National Microbiology Laboratory to be low relative to other non‐endemic countries. In contrast, we found the prevalence of detection of HEV RNA in pigs and retail pork livers, to be comparable to that reported in the USA and Europe. We drafted risk categories (high/medium/low) for acquiring clinical hepatitis E from exposure to pigs or pork in Canada and hypothesize that the proportion of the Canadian population at high risk from either exposure is relatively small.     

Role of Wild Small Ruminants in the Epidemiology of Peste Des Petits Ruminants

Peste des petits ruminants virus (PPRV) causes one of the most contagious and highly infectious respiratory diseases in sheep and goats known as peste des petits ruminants (PPR). Reports of outbreaks of PPR in captive and wild small ruminants have extended the known spectrum of susceptible species to include antelopes. Phylogenetic analysis of nucleoprotein and fusion genes indicates that all PPRVs isolated from wild ungulate outbreaks belong to lineage IV. While it is clear that a number of wildlife species are susceptible to infection, the role of wildlife in the epidemiology of PPR remains uncertain. The available information about the occurrence of disease in free‐ranging wildlife is mainly derived from surveys based on serological evidence. Data on the genetic nature of circulating PPRV strains are scarce. Given the scope of PPR in wild ungulates that are widespread in many countries, current disease surveillance efforts are inadequate and warrant additional investment. This is crucial because domestic and wild ruminants mingle together at several points, allowing inter‐species transmission of PPRV. There is no reason to believe that PPRV circulates in wild animals and acts as a potential source of virus for domestic species. Irrespective of the possibility of wild small ruminants as the reservoir of PPRV, concerns about the role of susceptible species of antelopes need to be addressed, due to the fact that the disease can pose a serious threat to the survival of endangered species of wild ruminants on the one hand and could act as a constraint to the global eradication of PPR on the other hand. In this review, knowledge gained through research or surveillance on the sustainability of PPRV in wild ruminants is discussed.     

Risk factors for HIV infection among circumcised men in Uganda: a case-control study

Introduction

Male circumcision (MC) reduces the risk of HIV infection. However, the risk reduction effect of MC can be modified by type of circumcision (medical, traditional and religious) and sexual risk behaviours post-circumcision. Understanding the risk behaviours associated with HIV infection among circumcised men (regardless of form of circumcision) is critical to the design of comprehensive risk reduction interventions. This study assessed risk factors for HIV infection among men circumcised through various circumcision approaches.

Methods

This was a case-control study which enrolled 155 cases (HIV-infected) and 155 controls (HIV-uninfected), all of whom were men aged 18–35 years presenting at the AIDS Information Center for HIV testing and care. The outcome variable was HIV sero-status. Using SPSS version 17, multivariable logistic regression was performed to identify factors independently associated with HIV infection.

Results

Overall, 83.9% among cases and 56.8% among controls were traditionally circumcised; 7.7% of cases and 21.3% of controls were religiously circumcised while 8.4% of cases and 21.9% of controls were medically circumcised. A higher proportion of cases than controls reported resuming sexual intercourse before complete wound healing (36.9% vs. 14.1%; p<0.01). Risk factors for HIV infection prior to circumcision were:being in a polygamous marriage (AOR: 6.6, CI: 2.3–18.8) and belonging to the Bagisu ethnic group (AOR: 6.1, CI: 2.6–14.0). After circumcision, HIV infection was associated with: being circumcised at >18 years (AOR: 5.0, CI: 2.4–10.2); resuming sexual intercourse before wound healing (AOR: 3.4, CI: 1.6–7.3); inconsistent use of condoms (AOR: 2.7, CI: 1.5–5.1); and having sexual intercourse under the influence of peers (AOR: 2.9, CI: 1.5–5.5). Men who had religious circumcision were less likely to have HIV infection (AOR: 0.4, 95% CI: 0.2–0.9) than the traditionally circumcised but there was no statistically significant difference between those who were traditionally circumcised and those who were medically circumcised (AOR: 0.40, 95% CI: 0.1–1.1).

Conclusions

Being circumcised at adulthood, resumption of sexual intercourse before wound healing, inconsistent condom use and having sex under the influence of peers were significant risk factors for HIV infection. Risk reduction messages should address these risk factors, especially among traditionally circumcised men.     

Quantitative Risk Assessment for the Introduction of African Swine Fever Virus into the European Union by Legal Import of Live Pigs

The recent incursion and spread of African swine fever virus (ASFV) in the Russian Federation and Caucasus region, close to European Union (EU) borders, have increased the concerns regarding the probability of ASFV introduction into the EU. There are many potential routes of ASFV entry into EU, but here we specifically aimed to assess the probability of ASFV introduction by legal trade of pigs, which historically has been one of the most important ways of exotic diseases introduction into the EU. A stochastic model was used to estimate the monthly probability of ASFV introduction for each country of the EU. Results of this model suggest an annual probability for ASFV introduction in the whole EU by this way of 5.22*10⁻³, which approximately corresponds with one outbreak in 192 years. The risk of ASFV introduction via live pigs was highest in Poland (69%), particularly during the months of November and December. As expected, Russian Federation is the country that most contributes to this risk, representing 68% of the overall annual risk. Methods and results presented here may be useful for informing risk‐based surveillance and control programmes and, ultimately, for prevention and control of potential ASFV incursions into the EU.     

Osteoarthritis of the Hip: Epidemiology and Clinical Role

Among 6321 patients who had undergone X-ray examination of the colon 4.7 per cent proved to have osteoarthritis of the hip. A mild osteoarthritis was found to be equally common in both sexes, but in all age groups above 60 severe osteoarthritis of the hip was twice as common in women as in men. Osteoarthritis setting in at an early age was secondary to other hip conditions. in 50 per cent of the patients the arthritis was located laterally and in 24 per cent medially. the medially located osteoarthritis was less troublesome than the lateral.

According to the present study, only half the patients who exhibit radiological evidence of osteoarthritis of the hip actually need treatment. in keeping with the fact that the osteoarthritis was more severe radiologically in women than in the men, the women were also more severely affected by the condition. They more often had to apply for disablement pension, they had more severe pain, and they were more handicapped in activities of daily living.     

Epidemiology of prostate cancer in Asian countries

The incidence of prostate cancer has been increasing worldwide in recent years. The GLOBOCAN project showed that prostate cancer was the second most frequently diagnosed cancer and the fifth leading cause of cancer mortality among men worldwide in 2012. This trend has been growing even in Asian countries, where the incidence had previously been low. However, the accuracy of data about incidence and mortality as a result of prostate cancer in some Asian countries is limited. The cause of this increasing trend is multifactorial. One possible explanation is changes in lifestyles due to more Westernized diets. The incidence is also statistically biased by the wide implementation of early detection systems and the accuracy of national cancer registration systems, which are still immature in most Asian countries. Mortality rate decreases in Australia, New Zealand and Japan since the 1990s are possibly due to the improvements in treatment and/or early detection efforts employed. However, this rate is increasing in the majority of other Asian countries. Studies of latent and incidental prostate cancer provide less biased information. The prevalence of latent and incidental prostate cancer in contemporary Japan and Korea is similar to those in Western countries, suggesting the influence of lifestyle changes on carcinogenesis. Many studies reported evidence of both congenital and acquired risk factors for carcinogenesis of prostate cancer. Recent changes in the acquired risk factors might be associated with the increasing occurrence of prostate cancer in Asian countries. This trend could continue, especially in developing Asian countries.     

The Assessment of African Swine Fever Virus Risk to Belgium Early 2014, using the Quick and Semiquantitative Pandora Screening Protocol

A risk assessment was organized during the early EU ASF outbreaks of early 2014 (February–April) and performed in cooperation with 15 Belgian and European experts on ASFV and its epidemiology in pigs/wild boar. African swine fever (ASF) is considered as one of the most dangerous infectious pig diseases, causing many outbreaks. Since the end of 2013 – early 2014, several outbreaks within the European Union (Lithuania, Poland, Estonia and Latvia) were reported to OIE, which prompted several risk assessments by (inter)national bodies and scientists. In this study, the open source, semiquantitative Pandora risk assessment tool was used for a quick overall screening of the risk posed by ASF to Belgium early 2014. A set of integrated risk scores was calculated within the Pandora framework. Experts scored the questions and uncertainty levels in the Pandora modules individually, after which the calculations were performed and averaged scores were used within pre‐defined risk scales to define and visualize the ASF risk to Belgium. Emergence risk was considered low (Pandora score 0.29), while disease consequences were deemed high (0.93); the resulting multiplicative overall risk of ASFV for Belgium was low (0.27). The Belgian experts tended to give lower risk scores than the European experts, especially for entry risk and trade/public opinion consequences. These risk scores are further interpreted with a due consideration of the qualitative data in the expert remarks and of other ASF risk assessments. The results are similar to more extensive and elaborate risk assessment models/procedures which may require more time and resources. The Pandora tool allows sequential updates to monitor (rates of) increasing risk and provides information for risk managers to organize targeted control.     

Epidemiological Analysis of Influenza A Infection in Cambodian Pigs and Recommendations for Surveillance Strategies

This study analysed the available data of seroprevalence to human influenza viruses in pigs in Cambodia using generalized linear mixed models in order to improve understanding of factors underlying the spread of human influenza viruses in Cambodian pigs. The associations between seroprevalence against seasonal H1N1 influenza virus in pigs and the population density of humans and pigs were not significant. However, a positive association between anti‐H3 antibodies in pigs and the human population density was identified. In contrast, there was a negative association between seroprevalence of H3N2 in pigs and the pig population density. Our study has highlighted the difficulty in identifying epidemiological risk factors when a limited data set is used for analyses. We therefore provide recommendations on data collection for future epidemiological analyses that could be improved by collecting metadata related to the animals sampled. In addition, serosurveillance for influenza A viruses in pigs in high‐risk areas or at slaughterhouses is recommended in resource‐limited countries.     

Serotype Specificity of Antibodies against Foot‐and‐Mouth Disease Virus in Cattle in Selected Districts in Uganda

Uganda had an unusually large number of foot‐and‐mouth disease (FMD) outbreaks in 2006, and all clinical reports were in cattle. A serological investigation was carried out to confirm circulating antibodies against foot‐and‐mouth disease virus (FMDV) by ELISA for antibodies against non‐structural proteins and structural proteins. Three hundred and forty‐nine cattle sera were collected from seven districts in Uganda, and 65% of these were found positive for antibodies against the non‐structural proteins of FMDV. A subset of these samples were analysed for serotype specificity of the identified antibodies. High prevalences of antibodies against non‐structural proteins and structural proteins of FMDV serotype O were demonstrated in herds with typical visible clinical signs of FMD, while prevalences were low in herds without clinical signs of FMD. Antibody titres were higher against serotype O than against serotypes SAT 1, SAT 2 and SAT 3 in the sera investigated for serotype‐specific antibodies. Only FMDV serotype O virus was isolated from one probang sample. This study shows that the majority of the FMD outbreaks in 2006 in the region studied were caused by FMDV serotype O; however, there was also evidence of antibodies to both SAT 1 and SAT 3 in one outbreak in a herd inside Queen Elizabeth national park area.     

利比里亚埃博拉诊治中心医护人员个人防护督查

目的探讨防护督查小组在利比里亚埃博拉诊治中心抗击埃博拉病毒病,实现医务人员零感染中的作用。方法在利比里亚中国埃博拉诊治中心成立防护督查组,建立传染病监控机制。收集6周内督查小组在诊治中心医务人员穿脱防护装备全过程实施24h监控中出现的问题类别及不同周数时间段发生问题的频次,针对问题进行汇总分析、定时反馈、持续改进、制定对策。结果督查小组记录的问题以医务人员脱防护装备的问题为多,发生问题的频次随周数而呈递减趋势。结论在烈性传染病暴发流行时,高度重视防护工作,尤其是采取督查防护方式进行及时、有效,甚至是过度防护及监控措施,对确保医务人员零感染起到了至关重要的作用。     

Epidemiology of ischaemic stroke and traumatic brain injury

Acquired brain injury, including both Ischaemic stroke (IS) and Traumatic Brain injury (TBI), is one of the most common causes of disability and death in adults. Yet there are vast differences in our knowledge of their epidemiology. While the incidence, case-fatality and risk factors for stroke are well established, work needs to continue particularly in low-income countries, where these data remain sparse; and in relation to specific stroke subtypes such as IS. Similar data regarding the epidemiology of TBI are generally lacking. The majority of TBI incidence studies have focussed on hospital-based samples and there are no established criteria from which to design high quality epidemiological studies. The need to establish such criteria separate from those already available for stroke is suggested given the differing demographic profile of TBI as well as differences in seeking of medical attention for TBI. The immense burden of stroke can be reduced by prevention of modifiable risk factors particularly in developing countries where both changing lifestyle and lack of healthcare resources are contributing to rising stroke incidence and mortality. Similarly, studies to date indicate that TBI incidence can be reduced by addressing modifiable risk factors such as alcohol abuse, risk-taking behaviour and socioeconomic disparities.     

Epidemiology and pathophysiology of prostate cancer in African-American men

PURPOSE: Along with increasing age and a positive family history subSaharan African ancestry has long been recognized as an important risk factor for prostate cancer. In the United States the incidence of prostate cancer is approximately 60% higher in African-American than in European-American men and the mortality rate from the disease is more than twice as high. The purpose of this review article is to examine specific reports highlighting racial disparity and its possible causes. MATERIALS AND METHODS: The reports chosen for review of this epidemiology and pathophysiology study were included to demonstrate conditions in which racial differences as well as similarities exist in African-American and European-American men. Reports also include autopsy, biological and clinical studies, and early and late stage prostate cancer. RESULTS: From the 1970s to the current statistical analysis of the National Cancer Institute Surveillance, Epidemiology, and End Results program African-American men have continued to have a significant higher incidence and mortality rate than European-American men. Autopsy studies show a similar prevalence of early small subclinical prostate cancers but a higher prevalence of high grade prostatic intraepithelial neoplasia. Clinical studies show a similarity in prostate cancer outcome when pathological stage is organ confined but a worse outcome when disease is locally advanced and metastatic in African-American vs European-American men. There is increasing genetic evidence that suggest that prostate cancer in African-American vs European-American men may be more aggressive, especially in young men. CONCLUSIONS: Improving the outcome in African-American men with prostate cancer requires awareness of the epidemiological patterns of the disease and willingness on the part of physicians to implement targeted study initiatives with end points designed to detect the disease early in this population and begin appropriate management. It is proposed that a multi-institutional study should be done to demonstrate the ability to decrease racial outcome disparity by education, aggressive testing and treatment.     

“Now that you are circumcised,you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district,Uganda

Introduction : Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub‐Saharan African countries with high HIV prevalence. To sustain its partial protective benefit, it is important that perceived reduced HIV risk does not lead to behavioural risk compensation among circumcised men and their sexual partners. This study explored beliefs that may influence post circumcision sexual behaviours among circumcised men in a programme setting. Methods : Forty‐eight in‐depth interviews were conducted with newly circumcised men in Wakiso district, central Uganda. Twenty‐five men seeking circumcision services at public health facilities in the district were recruited from May to June 2015 and, interviewed at baseline and after 6 months. Participants’ beliefs and sexual behaviours were compared just after circumcision and at follow up to explore changes. Data were managed using atlas.ti7 and analysed following a thematic network analysis framework. Results : Four themes following safe male circumcision emerged from this study. Beliefs related to: (1) sexual cleansing, (2) healing, (3) post SMC sexual capabilities and (4) continued HIV transmission risk. Most men maintained or adopted safer sexual behaviour; being faithful to their partner after circumcision or using condoms with extramarital partners following the knowledge that there was continued HIV risk post circumcision. The most prevalent risky belief was regarding sexual cleansing post circumcision, and as a result of this belief, some men had one off condom‐less sexual intercourse with a casual partner. Some resumed sex before the recommended period due to misunderstanding of what comprised healing. Conclusions : Although most men maintained or adopted safer sexual behaviour, there were instances of risky sexual behaviour resulting from beliefs regarding the first sexual intercourse after circumcision or misunderstandings of what comprised wound healing. If not addressed, these may attenuate the safe male circumcision benefits of risk reduction for HIV.     

Serological and phylogenetic characterization of foot and mouth disease viruses from Uganda during cross‐sectional surveillance study in cattle between 2014 and 2017

Here, we report the results of a cross‐sectional study designed to monitor the circulation and genetic diversity of foot and mouth disease virus (FMDV) in Uganda between 2014 and 2017. In this study, 13,614 sera and 2,068 oral‐pharyngeal fluid samples were collected from cattle and analysed to determine FMDV seroprevalence, circulating serotypes and their phylogenetic relationships. Circulation of FMDV was evidenced by the detection of antibodies against non‐structural proteins of FMDV or viral isolations in all districts sampled in Uganda. Sequence analysis revealed the presence of FMDV serotypes A, O, SAT 1 and SAT 2. FMDVs belonging to serotype O, isolated from 21 districts, were the most prevalent and were classified into six lineages within two East African topotypes, namely EA‐1 and EA‐2. Serotype A viruses belonging to the Africa G‐I topotype were isolated from two districts. SAT 1 viruses grouped within topotypes I and IV and SAT 2 viruses within topotypes VII, IV and X were isolated from six and four districts respectively. Phylogenetic analysis of SAT 1 and SAT 2 sequences from cattle clustered with historical sequences from African buffalo, indicating possible interspecies transmission at the wildlife‐livestock interface. In some cases, Uganda viruses also shared similarities to viral strains recovered from other regions in East Africa. This 3‐year study period provides knowledge about the geographical distribution of FMDV serotypes isolated in Uganda and insights into the genetic diversity of the multiple serotypes circulating in the country. Knowledge of circulating FMDV viruses will assist in antigenic matching studies to devise improved FMDV control strategies with vaccination and vaccine strain selection for Uganda.     

Assessing Potential Risks of Influenza A Virus Transmission at the Pig–Human Interface in Thai Small Pig Farms Using a Questionnaire Survey

Influenza A viruses pose a major public health threat worldwide, especially due to the potential for inter‐species transmission. Farmers could be among the first people to be infected with a novel reassortant virus in a pig herd and may serve as a source of the virus for their communities. In this study, the pig production systems of smallholders in rural Thailand were examined to qualitatively evaluate the potential risks that may contribute to the spread of influenza A viruses. The investigation was based on questionnaire interviews regarding pig farmers' practices and trading activities. We found that extensive pig–human contacts, commingling of pigs and chickens and suboptimal biosecurity practices adopted by farmers and traders may constitute substantial risks for inter‐species influenza virus transmission, thereby posing a threat to pig populations and human public health. The regular practices of using manure as field fertilizer, hiring boars from outside and trading activities could contribute to the potential spread of influenza viruses in the local community. To mitigate the potential risks of influenza A virus transmission and spread in the local community, it is recommended that appropriate public health strategies and disease prevention policies for farmers and traders should be developed including improving biosecurity, encouraging separation of animals raised on farms and minimizing the exposure between pigs and humans. Furthermore, surveillance systems for pig diseases should be targeted around the festival months, and on‐farm identification of pigs should be promoted.