Travel Medicine and Infectious Disease

BackgroundThe Gonococcal Isolate Surveillance Project (GISP) is a sentinel surveillance system to monitor the spread of antimicrobial-resistant (AMR) gonorrhea. Under GISP surveillance strategy, urethral isolates are utilized for monitoring the spread of the resistance and the obtained estimates are used for informing the gonorrhea treatment guidelines. In 2017, the enhanced Gonococcal Isolate Surveillance Project (eGISP) was established which also includes the non-urethral isolates. Using eGISP estimates for informing the gonorrhea treatment guidelines is an alternative surveillance strategy that can be used. MethodsWe utilized our previously developed continuous-time agent-based model of gonorrhea transmission among the US men who have sex with men (MSM) population and calculated the total number of discounted quality-adjusted life years (QALYs) and total discounted costs over 25 years under GISP and eGISP surveillance strategy. We also evaluated cost-effectiveness of both surveillance strategies. ResultsUnder GISP surveillance strategy, $2.9M (95% uncertainty interval: $23,131, $9.4M) were saved and 31.3 (0, 134.9) QALYs were gained in the simulated cohort of 10,000 US MSM over 25 years compared to no surveillance. Performing eGISP surveillance strategy instead would result in additional $57,449 (-$100,914, $221,663) saved and 0.59 (-0.79, 2.5) QALYs gained. ConclusionThe current GISP surveillance strategy significantly reduces the costs and increases the health benefits compared to no surveillance. However, switching from the current strategy to eGISP strategy is cost saving and should be considered in order to improve the population health and reduce the financial burden of gonorrhea.

BackgroundThe lifetime prevalence of anaphylaxis from all triggers is estimated to range from 0.05 % to 2.6 %. Data on anaphylaxis in the Latin American region and Colombia are scant. ObjectiveEstimate the prevalence, incidence and mortality for anaphylaxis in Colombia. MethodsRecords with diagnosis of anaphylaxis (ICD-10 code T78.0-T78.2) of Information System of Social Protection (SISPRO) between 2010 and 2015 were included. To determine the prevalence, incidence and mortality for anaphylaxis, population estimates from the National Statistics Department of Colombia (DANE) were used. ResultsThe average estimated annual prevalence of anaphylaxis were 25.1 cases per million. The average estimated annual incidence of anaphylaxis were 3.2 cases per million. Most cases range between 45 and 49 years age. On average 8.4 cases of anaphylaxis deaths per year were estimated. The average estimated annual mortality of anaphylaxis were 0.16 cases per million. ConclusionsBoth under-diagnosis and under-report of anaphylaxis are common in the world. Population studies in Colombia, with diagnoses of based primarily on clinical history and clinical criteria for accurate and early identification of anaphylaxis recently established are required.

This paper investigates COVID-19 exported cases by country and the time it takes between entry until case confirmation for the exported cases using publicly available data. We report that the average days from entry to confirmation is 7.7, 5.0 and 4.7 days for travelers from China, Italy, and Iran respectively. Approximately, one-third of all exported cases were confirmed within 3 days of entry suggesting these travelers were mildly symptomatic or symptomatic in arrival. We also found that earlier exported cases from each country had a longer time between entry to confirmation by an average of 3 days compared to later exports. Based upon our data, reported exported cases from South Korea were far fewer in comparison to those from China, Italy and Iran. Therefore, we suggest that careful monitoring of likely symptomatic travelers and better public awareness may lead to faster confirmation as well as reduced transmission of COVID-19 pandemic.

BackgroundAs of 4 September 2020, a total of 53,996 monkeypox cases were confirmed globally. Currently, most monkeypox cases are concentrated in Europe and the Americas, while many countries outside these regions are also continuously observing imported cases. We aimed to estimate the potential global risk of monkeypox importation and consider hypothetical scenarios of travel restrictions by varying passenger volumes via airline travel network. MethodPassenger volume data for the airline network, and the time of first confirmed monkeypox case for a total of 1680 airports in 176 countries (and territories) were extracted from publicly available data sources. A survival analysis technique in which the hazard function was a function of effective distance was utilized to estimate the importation risk. Scenarios which selectively reduced the passenger volume from/to countries with detected monkeypox cases and increased/decreased the global passenger volume to the level of 2019 (high volume) or 2021 (low volume) regardless of monkeypox detection were considered for travel restrictions. ResultsThe arrival time ranged from 9 to 48 days since the first case was identified in the UK on 6 May 2022. The estimated risk of importation showed that regardless of the geographic region, most locations will have an intensified importation risk by 31 December 2022. Travel restrictions had a minor impact on the global airline importation risk against monkeypox. ConclusionsInstead of preventing the importation of monkeypox cases via airline networks, high risk countries should enhance local capacities for the identification of monkeypox and prepare to carry out contact tracing and isolation.

BackgroundMonkeypox (mpox) is a zoonotic disease originating from the Congo Basin (Clade I) and West Africa (Clade II). In 2022, mpox spread to non-endemic European countries, predominantly through human transmission associated with sexual contact. The outbreak in Europe was primarily with the Clade IIb lineage, which is less virulent. The World Health Organization (WHO) declared this outbreak a Public Health Emergency of International Concern (PHEIC) in 2022, which ended in May 2023 after a decline in cases. However, in July 2024, a resurgence of the more virulent Clade I occurred in the Democratic Republic of Congo (DRC), leading WHO to declare mpox a PHEIC again, due to the risk of global spread. Understanding epidemiology and risk factors of mpox is vital for effective public health measures. Methodology and principal findingsA search conducted from 2014 to 2024 across PubMed, Scopus and Embase identified 38 studies on mpox in Europe, which were included for qualitative analysis. The key themes identified were epidemiology and risk factors/ behaviors. High-risk behaviors include sexual contact among men who have sex with men (MSM) with multiple partners, living with HIV, and frequent travel to endemic regions. Conclusions and significanceWith no definitive cure for mpox, public health measures such as surveillance, monitoring, and contact tracing are essential. Additionally, encouraging case-control studies is crucial for exploring other potential risk behaviors and design behavioral interventions, vaccination campaigns and awareness programs aimed at reducing high-risk behaviors among these populations. Although the number of cases in Europe did not surge in August 2024, proactive measures are necessary to prevent further spread.

ObjectiveThanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis health outcomes have improved. This paper evaluates the costs and the health-related quality of life implications of these guidelines. Design and settingA sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015. Study participantsData for patients aged [&ge;]16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months. Primary and secondary outcome measuresPatient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS), and the EuroQoL; health care costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Scare perspective. ResultsA total of 49 patients were included, 35 treated within 48 hours "early" (median [IQR] 8.25 [3.7-20.5]) and 14 treated after 48 hours (median [IQR] 93.9 [66.7 - 100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0-3) compared to 4 (29%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, {pound}23,086 (95% CI: {pound}15,186 to {pound}30,987) vs {pound}42,405 (95% CI: {pound}25,457 to {pound}59,354) [p<0.04]. A -{pound}20,218 (95% CI: -{pound}52,173 to {pound}11,783) cost difference was observed at 12-month follow-up post discharge. ConclusionsThis study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment. Article SummaryO_ST_ABSStrengths and limitations of this studyC_ST_ABS- Admissions to acute hospitals with suspected encephalitis, using predetermined inclusion criteria were recruited across 29 hospitals in the UK within a 3-year period, giving the largest cohort of prospectively recruited HSV encephalitis cases in the UK to date. - Precise definitions to characterise those individuals with proven HSV encephalitis were applied thus ensuring accurate diagnoses. - Individuals were followed up systematically for 12 months after discharge for clinical, and quality of life data providing the first study to assess the effect of treatment delays on health care resources, costs and health related quality of life. - The analysis is limited by its relatively small sample size due to it being a rare disease, and the case record forms although thorough may not capture all health care costs incurred. This is particularly so for primary care and community care contact outside of the study hospitals.

BackgroundMpox (formerly Monkeypox) virus has affected the lives of thousands of individuals both in endemic and non-endemic countries. Before the May 2022 outbreak, Mpox infections were sporadically endemic in Central and Western Africa, still research into Mpox has been limited and lacking epidemiological data. Thus, identification of potential risk factors to better understand who is at risk of being infected is critical for future prevention and control. ObjectiveTo synthesize comprehensive evidence on risk factors associated with human Mpox transmission both in endemic and non-endemic countries from inception to March 31, 2024. MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in conducting the systematic review. Electronic databases were searched. Two reviewers sifted the articles that were included in the review: firstly, by title and abstract, and secondly, by full text. We used the Newcastle-Ottawa Scale (NOS) to assess the risk of bias for included articles. Fixed or random effects meta-analysis were conducted when at least two studies reported odds ratios (OR), relative risks (RR), with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic and sensitivity analysis was also done. The study protocol has been registered under PROSPERO with ID: CRD42023459895. Results947 articles were identified from the database search and 31 articles were eligible to be included in the systematic review. The findings of the meta-analysis showed that interaction with infected animals (OR = 5.61, 95% CI = 2.83, 11.13), HIV (OR = 4.46, 95% CI = 3.27, 6.08), other STIs (OR = 1.76, 95% CI = 1.42, 2.91), sexual contact/activities (OR = 1.53, 95% CI = 1.13, 4.82), contact with an infected person (OR = 2.39, 95%CI = 1.87, 3.05), being identified as men who have sex with men (MSM) (OR = 2.18, 95%CI = 1.88, 2.51), and having multiple sexual partners Mpox (OR = 1.61, 95%CI = 1.24, 2.09), were associated with an increased risk of contracting Mpox. However, patients who were vaccinated against smallpox had a lower risk of Mpox infection (OR = 0.24, 95%CI = 0.11, 0.55). ConclusionThis study is the first meta-analysis on reported risk factors for Mpox. Our analysis demonstrated that certain factors were associated with increased risk of Mpox, whereas smallpox vaccination had a protective role against contracting Mpox. The study findings could facilitate future strategic public health planning and targeted intervention. Key messages of this articleO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIMpox (monkeypox) is a zoonotic infectious disease of notable global public health importance due to recent outbreaks in non-endemic countries. C_LIO_LIPrior outbreaks of Mpox have been associated with travel to endemic areas in Western and Central Africa, contact with infected animals, and close contact with infectious lesions, particularly among household members. C_LI What this study addsO_LIThis study is the first meta-analysis on reported risk factors for Mpox. Our study findings add to the body of evidence on Mpox research efforts and could assist in future Mpox global strategic intervention and control. C_LIO_LIOur meta-analysis revealed a strong correlation between increased risk of Mpox infection, HVI, other STIs, physical and sexual contacts, and being identified as MSM. C_LIO_LIWhile HIV infection may be a risk factor for Mpox, Mpox lesions could also facilitate the transmission of HIV and other STIs. C_LI How this study might affect research, practice or policyO_LIThe results of this systematic review and meta-analysis provide evidence to support policymakers in future Mpox intervention and prevention in both endemic and non-endemic countries based on identified risk factors. C_LI

Background and AimsWolbachia are bacteria that inhibit dengue virus replication within the mosquito. A cluster-randomized trial found Wolbachia reduced virologically-confirmed dengue cases by 77% and previous models predicted Wolbachia to be highly cost-effective in Indonesia, Vietnam, and Brazil. in Colombia, Wolbachia was introduced in the Aburra Valley in 2015 and Cali in 2020. To inform decisions about future extensions, we performed economic evaluations of the potential expansion of Wolbachia deployments to 11 target Colombian cities. MethodsWe assembled quantities and the distribution by severity of reported dengue cases from Colombias national disease surveillance system and the health service provision registry (RIPS). An epidemiological panel of three experts estimated the shares of non-medical cases and adjustments for under-reporting and misclassifications. We determined costs (in 2020 US dollars) of treating dengue illness from the benchmark insurance tariff, RIPS data on treatment services per symptomatic dengue case, and the national government database for establishing insurance premiums. A cluster randomized trial quantified the effectiveness of Wolbachia against symptomatic dengue cases. ResultsProjecting impact over 10 years for Cali, we estimated a net health-sector savings of USD4.95 per person. We also estimated averting 369 disability-adjusted life years (DALYs) per 100,000 population. From a societal perspective, at 10 years Wolbachia deployment is expected to have highly favorable ConclusionsOver 10 years, Wolbachia is highly beneficial on economic grounds, and almost universally cost saving. That is, Wolbachias savings in health care costs alone would more than offset deployment costs nationally and in 9 target cities (those with adjusted annual dengue incidence at least 50/100,000 population). In these 9 target cities, Wolbachia would generate at least USD3.00 in benefits per dollar invested, giving substantial confidence that Wolbachia deployment would be cost-beneficial in Colombia.

BackgroundPre-travel testing programs are being implemented around the world to curb COVID-19 and its variants from incoming travelers. A common approach is a single pre-travel test, 72 hours before departure, such as in Hawaii; however this raises concerns for those who are incubating or those infected after pre-travel testing or during transit. We need a rapid method to assess the effectiveness of pre-travel testing programs, and we use Hawaii as our case study. MethodsWe invited travelers departing from Kahului main airport at the end of their visit to Maui (major tourist destination among the Hawaiian islands) and performed COVID-19 PCR testing. Eligible participants needed a negative pre-travel test and a Hawaiian stay [&le;] 14 days. We designed for anonymous testing at the end of travel so that travel plans would be unaffected, and we aimed for [&ge;] 70% study participation. ResultsAmong consecutive eligible travelers, 282 consented and 111 declined to participate, leading to a 72% (67-76%, 95% confidence interval) participation rate. Among 281 tested participants, two were positive with COVID-19, with an estimated positivity rate of 7 cases per 1,000 travelers. The top states of residence are California (58%) and Washington (21%). The mean length of stay was 7.7 {+/-} 0.2 days. Regarding pre-travel testing, 87% had non-nasopharyngeal tests and 66% had self-administered tests. ConclusionsThis positivity rate leads to an estimated 17-30 infected travelers arriving daily to Maui in November-December 2020, and an estimated 52-70 infected travelers arriving daily to Hawaii during the same period. These counts surpass the Maui District Health Offices projected ability to accommodate 10 infected visitors daily in Maui; therefore, an additional mitigation layer for travelers is recommended. This rapid field study can be replicated widely in airports to assess effectiveness of pre-travel programs and can be expanded to evaluate COVID-19 importation and its variants.

The study sought to investigate how the number of confirmed cases of COVID-19 have evolved in the most recent three months across the world, and what insights the trends may provide about the second half of the pandemics first year using a situation analysis approach based on national income, temperature, trade intensity with China, and location defined by longitude and latitude. The study confirmed the negative relationship between COVID-19 cases and temperature. It contributed to the resolution of the conflicting results about latitude after organizing it into a categorical variable instead of its continuous form. This approach works because the average temperature in the 15{degrees}S to 15{degrees}N region remains similar to the average temperatures in both the Above 15{degrees}N region and the Below 15{degrees}S region during their summer months because the 15{degrees}S to 15{degrees}N region does not experience the marked seasonal changes in temperature. Given the negative association between temperature and case numbers, this suggests that countries in the 15{degrees}S to 15{degrees}N region might continue exhibiting the low numbers they have thus far exhibited through the second half of this year, even as numbers climb in the Below 15{degrees}S region. To succeed, their policymakers must control importation of the disease by implementing effective testing, quarantining, and contact tracing for people entering their borders. Policymakers in countries Below 15{degrees}S region may manage their inherent risks by applying lessons learned from countries in the Above 15{degrees}N region during these past months. Such preventative measures may allow the world to avoid the drastic lockdown policies and facilitate rapid global economic recovery from this pandemic.

As of 10 July 2021, there have been over 186 million cases of COVID-19 and more than four million died as a result of this disease. The COVID-19 outbreak has also contributed to tremendous global decline in trade flows. The rapid spread of COVID-19 and the measures implemented by governments to contain the pandemic have had serious consequences for the worlds economies. While the pandemic has affected the international movement of people, goods and services, there is still limited systematic research regarding the possible associations between the COVID-19 measures on countries international trade flows. To fill this gap, we conducted regression analysis based on country level time series data from the United Nations and World Bank datasets. The results of the random effects panel regression models show that, the country import and export values are positively affected by health-related policies, while there is a negative association between stringency measures and import and export values. More specifically, school closing, stay-at-home requirements, and testing policy measures were found to have significant negative effects on countries trade values. In contrast, facial covering policies were found to have significant positive effects on countries import, export and total trade values.

BackgroundDengue is a major public health challenge and a growing problem due to climate change. The release of Aedes aegypti mosquitoes infected with the intracellular bacterium Wolbachia is a novel form of vector control against dengue. However, there remains a need to evaluate the benefits of such an intervention at a large scale. In this paper, we evaluate the potential economic impact and cost-effectiveness of scaled Wolbachia deployments as a form of dengue control in Vietnam - targeted at the highest burden urban areas. MethodsTen settings within Vietnam were identified as priority locations for potential future Wolbachia deployments (using a population replacement strategy). The effectiveness of Wolbachia deployments in reducing the incidence of symptomatic dengue cases was assumed to be 75%. We assumed that the intervention would maintain this effectiveness for at least 20 years (but tested this assumption in the sensitivity analysis). A cost-utility analysis and cost-benefit analysis were conducted. ResultsFrom the health sector perspective, the Wolbachia intervention was projected to cost US$420 per disability-adjusted life year (DALY) averted. From the societal perspective, the overall cost-effectiveness ratio was negative, i.e. the economic benefits outweighed the costs. These results are contingent on the long-term effectiveness of Wolbachia releases being sustained for 20 years. However, the intervention was still classed as cost-effective across the majority of the settings when assuming only 10 years of benefits. ConclusionOverall, we found that targeting high burden cities with Wolbachia deployments would be a cost-effective intervention in Vietnam and generate notable broader benefits besides health gains.

Typhoid remains a preventable disease that primarily affects low- and middle-income countries. We conducted a scoping review to synthesize evidence on the epidemiological models and economic analyses of typhoid conjugate vaccine (TCV), focusing on the cost of illness of typhoid, the cost of vaccination, cost-effectiveness, and public health benefits of TCV. A search was conducted across PubMed, Web of Science, International Health Technology Assessment, Scopus, and the National Health Service Economic Evaluation Database, following Arksey and OMalleyss framework. Screening and data extraction were managed using Covidence and an Excel-based template. Extracted data included study design, population, outcomes, model parameters, and cost-effectiveness data, converted to 2024, United States Dollars (USD) for comparability. Findings were summarized by key outcomes. The economic burden of typhoid varied by region, care type, and demographics. Direct medical costs ranged from USD 1.3 to USD 1543, direct non-medical costs varied from USD 1.3 to USD 60.1, and indirect costs ranged from USD 14.1 to USD 794. Cost of vaccination per dose ranged from USD 2.80 - USD 5.40 (India), USD 0.87 - USD 1.01 (Malawi), and USD 2.99 (Zimbabwe), while the cost of delivering the vaccine ranged from USD 0.48- USD 0.99 (financial) and USD 1.11 - USD 1.87 (economic) per dose. Models predicted 2-94% case reductions and 0-100% mortality reductions. Economic evaluations reported ICERs of USD 124 to USD 53,773 per DALY averted and USD - 4,251 to USD 103,344 per QALY gained, with high-incidence settings often resulting in cost savings. Sensitive parameters were typhoid incidence rate, vaccine efficacy, and vaccination costs. TCV introduction is influenced by disease burden, vaccination costs, and health outcomes, which vary by region. Cost-effectiveness depends on incidence, perspective, and vaccine strategy, emphasizing the need for context-specific evaluations. Targeted strategies, particularly in high-incidence and urban areas, are often cost-effective and sometimes cost-saving.

BackgroundPakistan has a hepatitis C virus (HCV) infection prevalence of 6-9% and aims to achieve World Health Organization (WHO) targets for elimination of HCV by the year 2030 through scaling HCV diagnosis and accelerating access to care. The clinical and economic benefits of various HCV testing strategies have not yet been evaluated in Pakistan. ObjectiveTo evaluate the potential cost-effectiveness of a reference laboratory-based (CEN) confirmatory testing approach vs a molecular near-patient point-of-care (POC) confirmatory approach to screen the general population for HCV in Pakistan. MethodsWe developed a decision-analytic model comparing HCV testing under two scenarios: screening with an anti-HCV antibody test (Anti-HCV) followed by either POC nucleic acid testing (NAT) (Anti-HCV-POC), or reference laboratory NAT (Anti-HCV-CEN), using data from published literature, the Pakistan Ministry of Health, and expert judgment. Outcome measures included: number of HCV infections identified per year, percentage of individuals correctly classified, total costs, average costs per individual tested, and cost-effectiveness. Sensitivity analysis was also performed. ResultsAt a national level for a tested population of 25 million, the Anti-HCV-CEN strategy would identify 142,406 more HCV infections in one year and increase correct classification of individuals by 0.57% compared with the Anti-HCV-POC strategy. The total annual cost of HCV testing was reduced using the Anti-HCV-CEN strategy by $7.68 million ($0.31 per person). Thus, incrementally, the Anti-HCV-CEN strategy costs less and identifies more HCV infections than Anti-HCV-POC. ConclusionsAnti-HCV-CEN would provide the best value for money when scaling up HCV testing in Pakistan. Significance statementO_LIHepatitis C virus (HCV) infection constitutes a major medical and public health burden in Pakistan C_LIO_LIWidespread testing is important to identify those that are chronically infected in order to link them to treatment services C_LIO_LIThe optimal and most cost-effective testing approach to scale up HCV testing to support elimination efforts in Pakistan has not been established C_LIO_LIHigh throughput reference laboratory testing would provide the best value for money when scaling-up HCV testing in Pakistan C_LI

PurposeThe Gamma variant of SARS-CoV-2, first detected in travellers from Brazil, was found to have high transmissibility and virulence; following this finding, this paper aims to describe the epidemiology of Gamma cases in England from its first detection on 12 February 2021 to 31 August 2021. MethodsThe demographic analysis of Gamma cases was stratified by travel exposure. Travel-associated cases were further analysed by countries travelled from, stratified by categories set in place by the Red (highest risk countries), Amber, Green (lowest risk countries) travel policy, which was implemented from May to October 2021. ResultsThere were 251 confirmed Gamma cases detected in England in the study period. 35.1% were imported, 5.6% were secondary, and 29.5% were not travel associated. Early cases were predominantly travel-associated, with later cases likely obtained through community transmission. 51.0% of travel-related cases were travellers from Amber countries, and 40.2% had at least one Red country in their journey. ConclusionThe Gamma variant has not seen the same expansion as other variants such as Delta, most likely due to Delta out-competing community transmission of Gamma. Findings indicate the travel policy requiring quarantine for Red and Amber list travellers may have also contributed to preventing onward transmission of Gamma.

The global spread of infectious diseases was influenced by human movement dynamics, particularly for highly transmissible diseases like COVID-19. Asymptomatic COVID-19 cases lacked symptoms before diagnosis, posing a challenge for containment. Their contribution to air travel remains understudied. This retrospective cross-sectional study investigated the role of asymptomatic COVID-19 cases in air travel and their impact on the global spread of the virus. Through our analysis of 11,775 COVID-19 cases in Hong Kong (January 2020-April 2021), log-binomial regression models assessed the association between asymptomatic status and air travel behavior 14 days before diagnosis. The Wilcoxon rank-sum test compared median flight durations between asymptomatic and symptomatic cases. Results revealed two-thirds of cases with air travel history were asymptomatic, with asymptomatic airport or flight crew ten times more likely to travel than symptomatic counterparts (adjusted PRR=10, 95% CI: 4.00-25.00). For non-crew individuals, the adjusted PRR was 1.14 (95% CI: 1.12-1.16). Median flight duration for asymptomatic cases was 4.6 person-hours shorter than symptomatic ones (p<0.01). These findings highlight the significant contribution of asymptomatic cases to air travel and suggest under-detection during initial travel restrictions. Our study emphasizes proactive public health measures early in pandemics involving airborne infections, irrespective of symptom presentation.

Poultry eggs are a critical source of protein, vitamins, and minerals for people worldwide; facing the current global egg shortage is a significant concern. The shortage results from various factors, including avian flu outbreaks, changes in consumer demand, and supply chain disruptions caused by the COVID-19 pandemic. The economic crisis caused by the pandemic has also impacted the availability and affordability of eggs, particularly in low-income countries. The global egg shortage has implications for public health, particularly for vulnerable populations who rely on eggs for essential nutrients. One Health, an approach that recognizes the interconnectedness of human, animal, and environmental health, provides a useful framework for understanding and addressing the egg shortage. One Health approach to the egg shortage involves collaboration between agriculture and environmental sectors to address the root causes of the lack and ensure the sustainable production and distribution of eggs. Addressing the global egg shortage requires a multifaceted approach considering the complex social, economic, and environmental factors. One Health perspective offers a way to understand and address the interconnected factors contributing to the shortage to ensure access to affordable, nutritious eggs for all in a healthy way.

In addition, the usual socioeconomic and sanitary exposures to Hepatitis A Virus (HAV), men who have sex with men (MSM) are also exposed through sexual behavior. ObjectiveThis research aims to estimate the HAV seroprevalence and its predictors among young MSM. MethodsThis cross-sectional study, conducted in Rio de Janeiro/Brazil, included participants sequentially between 2019 and 2022. Inclusion criteria were cisgender males aged 18 to 35 who reported sex with men in the previous six months, had never received the HAV vaccine, and had no chronic immune-mediated conditions. Predictors represented sexual practices, use of different substances, sexually transmitted infections, signs or symptoms, water consumption and sanitation, and socio-demographic. The outcome of all the analyses was HAV serology (positive vs. negative). The main analysis compared the prediction performances of the random forest regression model with penalized GLM with internal cross-validation or bootstrap. ResultsThe HAV seroprevalence was 39.6%. The compared models included from 16 to 42 predictors, always representing all predictor dimensions. "Chemsex" was identified as a predictor of HAV seroprevalence. A generation effect, interactions among race, education, and source of income were also identified as HAV predictors. The best model had excellent calibration and a moderate discrimination with an area under the ROC curve of 0.714 and an R2 of 0.187. We provide a web calculator at https://pedrobrasil.shinyapps.io/INDWELL/. ConclusionThis study reveals a high susceptibility of cisgender young MSM to HAV infection. These findings highlight the enduring impact of socioeconomic inequities on enteric virus exposure and underscore the need for targeted public health strategies. One may use the prediction model to estimate the risk of seropositivity/susceptibility to HAV in aid of deciding either to perform a HAV test or to vaccinate against HAV, or even to estimate HAV seroprevalence in MSM populations where the HAV test is not easily available. HIGHLIGHTSO_LIThe susceptibility to Hepatitis A infection among men who have sex with men (MSM) in Rio de Janeiro is approximately 60%. C_LIO_LIUsual exposures to Hepatitis A, such as socio-economic, sanitary, and the generation effect, are linked to Hepatitis A seroprevalence similarly in the MSM population. C_LIO_LIIn addition to the traditional exposures to Hepatitis A virus, there is evidence linking directly sexual behaviors and preferences, and use of drugs to engaging in sex ("chemsex") to Hepatitis A seropositivity. C_LIO_LIWe developed an instrument to predict Hepatitis A seropositivity among men who have sex with men with good performance. C_LI ETHICS STATEMENTAll procedures were performed in compliance with the good clinical practice document of the Americas (PAHO) and the Brazilian national Resolution n{degrees} 510/2016 and Resolution n{degrees} 466/2012 from the National Health Council (Conselho Nacional de Saude - CNS). The institutional Ethics Committee (Instituto Nacional de Infectologia Evandro Chagas - Fundacao Oswaldo Cruz) approved this research on March 22nd, 2018, with the number CAAE 80901917.0.0000.5262 (accessible at https://plataformabrasil.saude.gov.br/login.jsf). All participants gave written informed consent, and the privacy rights of human subjects were always observed.

BackgroundCOVID-19 has proven to be more difficult to manage for many reasons including its high infectivity rate. One of the potential ways to limit its spread is by controlling international travel. The objective of this systematic review is to identify, critically-appraise and summarize evidence on international travel-related control measures. MethodsThis review is based on the Cochrane review: International travel-related control measures to contain the COVID-19 pandemic and followed the same methods. In brief, we searched for clinical and modelling studies in general health and COVID-19-specific bibliographic databases. The primary outcome categories were (i) cases avoided, (ii) a shift in epidemic development and, (iii) cases detected. Secondary outcomes were other infectious disease transmission outcomes, healthcare utilisation, resource requirements and adverse effects if identified in studies assessing at least one primary outcome. ResultsWe assessed 66 full-text articles that met with our inclusion criteria. Seventeen new studies (modelling = 9, observational = 8) were identified in the updated search. Most studies were of critical to moderate risk of bias. The added studies did not change the main conclusions of the Cochrane review nor the quality of the evidence (very low to low certainty). However, it did add to the evidence base for most outcomes. ConclusionsWeak evidence supports the use of international travel-related control measures to limit the spread of COVID-19 via air travel. Real-world studies are required to support these conclusions.

The panzootic highly pathogenic avian influenza (HPAI) H5N1 virus has now been detected on the Australian mainland, with incursions from the sub-Antarctic region posing an increasing threat to domestic wildlife and poultry populations. Our study aimed to predict the risk of HPAI H5N1 poultry outbreaks across Australia at the local government area (LGA) level using a range of influential risk factors. We first used a Maximum Entropy (MaxEnt) model to estimate the environmental suitability for HPAI H5N1 occurrence across Australia. The resulting suitability layer was then integrated with five additional predictor layers, including abundance data for two Southern Ocean wild birds, one of which has introduced HPAI H5N1 into Australia; abundance data for 28 native Australian wild birds; native bird flyways across Australia; Australian chicken density; and poultry farm density. The six layers were aggregated and averaged to generate an HPAI H5N1 risk map for poultry outbreaks across Australian LGAs. Although most incursions have occurred in Western Australia (WA) and South Australia (SA), we identified New South Wales (NSW) and Victoria (VIC) as having the highest predicted risk of HPAI H5N1 poultry outbreaks. Additional high-risk areas were identified in WA, SA, and Tasmania (TAS). In contrast, the Northern Territory (NT) and large parts of Queensland (QLD), WA, and SA were predicted to be at low risk. These findings provide a spatially explicit framework to support targeted surveillance, preparedness, and biosecurity measures aimed at mitigating the impact of future HPAI H5N1 outbreaks in Australian poultry.