Clinical Infectious Diseases

BACKGROUND: There is limited information on the risk of hospital-acquired COVID-19 among high-risk hospitalized patients after exposure to an infected patient or healthcare worker (HCW) in a non-outbreak setting. METHODS: This study was conducted at a tertiary care cancer center in New York City from March 10, 2020, until February 28, 2021. In early April 2020, the study institution implemented universal SARS-CoV-2 testing at admission and retesting every three days through the hospital stay...

Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor derived clusters of ehrlichiosis are described here. During the summer of 2020, two cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis (HLH)...

BACKGROUND: Age-related comorbidities accumulate faster in people with HIV (PWH) than in those without (PWoH). We evaluated whether a validated multimorbidity scale, the Charlson Index, predicted neurocognitive trajectories in PWH. METHODS: Scaled scores a comprehensive neuropsychological battery were averaged across all visits. Multilevel modeling examined between- and within-person predictors of global neurocognition. At the between-person level, averaged Charlson scores were examined as a predictor of neurocognitive change rate, covarying for HIV disease characteristics...

BACKGROUND: Outbreaks of SARS-CoV-2 in long term care facilities (LTCFs) cause significant morbidity and mortality. Mapping viral transmission within and between by combining genomic sequencing with epidemiologic investigations enables targeting infection control interventions. METHODS: We conducted weekly surveillance of residents and staff in LTCFs in Santa Clara County, CA with at least one confirmed COVID-19 case between March and July 2020. Positive samples were referred for whole genome sequencing...

BACKGROUND: Older age is a risk factor for TB in low incidence settings. Using data from the U.S. National TB Surveillance System and American Community Survey, we estimated trends and racial/ethnic differences in TB incidence among US-born cohorts aged ≥50 years. METHODS: 42,000 TB cases among US-born persons ≥50 years were reported during 2001-2019. We used generalized additive regression models to decompose the effects of birth cohort and age on TB incidence rates, stratified by sex and race/ethnicity...

BACKGROUND: Pregnancy increases the risk of tuberculosis and its complications. A 3-month regimen of weekly isoniazid and rifapentine (3HP) is safe and effective for tuberculosis prevention in adults and children, including those with HIV, but 3HP has not been evaluated in pregnancy. METHODS: IMPAACT 2001 was a Phase I/II trial evaluating the pharmacokinetics and safety of 3HP among pregnant women with indications for tuberculosis preventative therapy in Haiti, Kenya, Malawi, Thailand, and Zimbabwe (NCT02651259)...

BACKGROUND: Evidence for vaccine effectiveness (VE) against influenza-associated pneumonia has varied by season, location, and strain. We estimate VE against hospitalization for radiographically identified influenza-associated pneumonia during 2015-2016 to 2017-2018 seasons in the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN). METHODS: Among adults aged ≥18 years admitted to 10 US hospitals for acute respiratory illness (ARI), clinician-investigators used keywords from reports of chest imaging performed during 3 days around hospital admission to assign a diagnosis of 'definite/probable pneumonia'...

No abstract text is available yet for this article.

BACKGROUND: The epidemiology and risk of COVID-19 among travelers at international borders remain unclear. METHODS: We conducted descriptive and individually matched case-control studies using a nationwide register for COVID-19 testing of travelers from August 3 to October 31, 2020 at airport/port quarantine stations across Japan. Cases defined as COVID-19-positive travelers on arrival were individually matched with four controls for arrival date and airport/port...

Emerging infectious disease epidemics require a rapid response from health systems; however, evidence-based consensus guidelines are generally absent early in the course of events. Formed in 2017 by five high-level isolation units spanning three continents, the experience of the Global Infectious Disease Preparedness Network (GIDPN) early in the course of COVID-19 provides a model for accelerating best practice development and improving decision-making in health emergencies. The network served as a platform for real-time, open and transparent information-sharing during unknowns of an active outbreak by clinicians caring for patients, by researchers conducting clinical trials and transmission and infection prevention studies, and by teams advising local and national policymakers...

BACKGROUND: Severe malaria can be deadly and requires treatment with intravenous artesunate (IVAS). The Centers for Disease Control and Prevention provided IVAS starting April 1, 2019 for all patients with severe malaria in the United States. This study describes the safety and effectiveness of IVAS in these patients. METHODS: Patients meeting criteria for severe malaria April 2019-December 2020 who received IVAS were included. Demographic, clinical, laboratory, adverse event, and outcome information were collected...

BACKGROUND: Optimized tuberculosis (TB) screening in high burden settings is essential for case finding. We evaluated digital chest x-ray with computer-aided detection (CAD) software (d-CXR) for identifying undiagnosed TB in three primary health clinics in South Africa. METHODS: The cross-sectional study consented adults who were sequentially screened for TB using the World Health Organization (WHO) four symptom questionnaire and d-CXR. Participants reporting ≥1 TB symptom and/or CAD score ≥60 (suggestive of TB) provided two spot sputum for Xpert MTB/RIF Ultra (Xpert Ultra) and liquid culture testing respectively...

BACKGROUND: Vaccine regulatory decision-making is based on vaccine efficacy against etiologically confirmed outcomes; however, these outcomes may underestimate the preventable disease burden. To quantify this underestimation, we compared vaccine-preventable disease incidence (VPDI) of clinically defined outcomes to radiologically/etiologically confirmed outcomes. METHODS: We performed a systematic review of efficacy trials for several vaccines (1997-2019) and report results for pneumococcal conjugate vaccines [CRD42019145268]...

BACKGROUND: Several SARS-CoV-2 lineages with mutations at the spike protein receptor binding domain (RBD) have reduced susceptibility to antibody neutralization, and have been classified as Variants of Concern (VOCs) or Variants of Interest (VOIs). Here, we systematically compared the neutralization susceptibility and RBD binding of different VOCs/VOIs, including B.1.617.1 (kappa variant) and P.3 (theta variant) which were first detected in India and the Philippines, respectively. METHODS: The neutralization susceptibility of the VOCs/VOIs (B...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). METHODS: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults ≥16 years old attending 17 public sector primary care services in rural South Africa between July 2014 and March 2019. RESULTS: Among 20,599 individuals (69% women), CD4 counts were available for 74%...

BACKGROUND: The prevention of tuberculosis (TB) in child contacts of TB cases and people living with HIV is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT. METHODS: Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases, by utilizing mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes...

BACKGROUND: Demography is changing, with people living longer with comorbidities. In this nationwide population-based study, we investigated the serotype-specific invasive pneumococcal disease (IPD) risk in individuals with comorbidities, and effects of the pneumococcal conjugated vaccine (PCV) child immunization program. METHODS: Cases included 14096 serotyped IPD episodes in Sweden between 2006-2015. Controls (n=137289), matched to cases by age, sex, region, and calendar time, were selected from the general population...

Recently emerged SARS-CoV-2 variants may pose a threat to immunity. A systematic landscape of neutralizing antibodies against emerging variants is needed. We systematically searched for studies that evaluated neutralizing antibodies titers induced by previous infection or vaccination against SARS-CoV-2 variants and collected individual data. We identified 106 studies meeting the eligibility criteria. Lineage B.1.351 (Beta), P.1 (Gamma) and B.1.617.2 (Delta) significantly escaped natural-infection-mediated neutralization, with an average of 4...