Open Forum Infectious Diseases最新文献

{"title":"HIV Clinical Providers' Awareness, Attitudes, and Willingness to Support Patient Outreach Efforts for HIV Cure-Directed Research in Philadelphia, United States.","authors":"Steven Meanley, William B Carter, William R Short, David S Metzger, Amy Onorato, Luis J Montaner, Karine Dubé","doi":"10.1093/ofid/ofae687","DOIUrl":"10.1093/ofid/ofae687","url":null,"abstract":"<p><strong>Background: </strong>Ethical patient outreach is critical for engaging patients with HIV in HIV cure-directed research. We sought to examine HIV clinical providers' awareness of current HIV cure-directed research strategies investigated through the Martin Delaney Collaboratories (MDC) and providers' attitudes toward patient outreach for HIV cure-directed research and to identify opportunities for clinical provider education on MDC research strategies.</p><p><strong>Methods: </strong>We conducted a 1-time, cross-sectional, web-based survey with 64 HIV clinical providers (physicians, physician assistants, and nurses) in Philadelphia. A descriptive analysis was generated to determine clinical providers' awareness of MDC research strategies and attitudes toward patient outreach. Bivariate analyses were conducted to evaluate differences in awareness and attitudes by provider characteristics.</p><p><strong>Results: </strong>Most providers were aware of MDC strategies, and nearly three-fourths of providers reported familiarity with 1 of the 2 Philadelphia MDC research programs. Providers overwhelmingly endorsed the need for clinicians to assist with patient outreach for HIV cure-directed research and were willing to recommend patients to participate. Enthusiasm for patient outreach waned if a study required a patient to undergo analytic treatment interruptions (ATIs). Providers identified preferred resources for receiving HIV cure-directed research updates, including webinars with continuing education credit and conferences.</p><p><strong>Conclusions: </strong>Our study's findings advocate for added investment toward developing resources that better engage clinical providers about HIV cure-directed research updates and ongoing studies, including the importance of ATIs. As gatekeepers to patient participation on HIV cure-directed studies, added efforts to increase provider knowledge of specific HIV cure-directed research will advance patient education and ethical outreach.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae687"},"PeriodicalIF":3.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yield of Targeted Polymerase Chain Reaction in Probable Early-Onset Sepsis: A Prospective Cohort Study in Term and Near-Term Neonates With Negative Blood Culture Results.","authors":"Fleur M Keij, Corné H W Klaassen, René F Kornelisse, Mireille van Westreenen, Gerdien A Tramper-Stranders","doi":"10.1093/ofid/ofae681","DOIUrl":"10.1093/ofid/ofae681","url":null,"abstract":"<p><strong>Background: </strong>Discriminating noninfected from infected neonatal cases remains challenging, and subsequently many neonates are treated with antibiotics in the first week of life. We aimed to study the additional value of a targeted polymerase chain reaction (PCR) for group B streptococcus (GBS) and <i>Escherichia coli</i> on leftover blood culture media from term and near-term neonates with probable early-onset sepsis (EOS).</p><p><strong>Methods: </strong>Leftover blood culture material from neonates participating in the RAIN study was stored after 5 days of incubation. The RAIN study evaluated intravenous-oral antibiotic switch in probable bacterial infection, defined as risk factors and/or clinical signs and elevated inflammatory parameters but negative blood culture results. We applied 2 targeted PCRs for GBS and <i>E coli</i>, the main pathogens in EOS, and analyzed the samples batchwise in triplicate for each PCR.</p><p><strong>Results: </strong>PCR was performed in triplicate on blood culture media from 284 neonates. In 23 neonates, the PCR result was positive (3 cycle threshold values <37) for GBS (n = 1) or <i>E coli</i> (n = 22). Inflammatory parameters did not discriminate for positive PCR result, nor did risk factors for sepsis, such as maternal GBS status and prolonged rupture of membranes. However, 96% of neonates with a positive PCR result were born vaginally vs 74% in the PCR-negative group (<i>P</i> = .05); furthermore, 96% vs 81% (<i>P</i> = .21) of neonates had clinical symptoms.</p><p><strong>Conclusions: </strong>Blood culture-negative \"probable\" EOS in neonates is accompanied by an 8% rate of PCR positivity, suggesting low-grade bacteriemia after birth with yet unclear clinical consequences. Further research should focus on how PCR can contribute to more targeted antibiotic use of neonates, specifically in those highly suspected of infection but in the absence of a positive blood culture result.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae681"},"PeriodicalIF":3.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enterovirus D68: Genomic and Clinical Comparison of 2 Seasons of Increased Viral Circulation and Discrepant Incidence of Acute Flaccid Myelitis-Maryland, USA.","authors":"Amary Fall, Omar Abdullah, Lijie Han, Julie M Norton, Nicholas Gallagher, Michael Forman, C Paul Morris, Eili Klein, Heba H Mostafa","doi":"10.1093/ofid/ofae656","DOIUrl":"10.1093/ofid/ofae656","url":null,"abstract":"<p><strong>Background: </strong>Enterovirus D68 (EV-D68) is associated with severe respiratory disease and acute flaccid myelitis (AFM). The 2022 outbreaks showed increased viral circulation and hospital admissions, but the expected rise in AFM cases did not occur. We analyzed EV-D68 genomes and infection outcomes from 2022 (a year without a national increase in AFM cases) and 2018 (a year with a national surge in AFM cases) to understand how viral genomic changes might influence disease outcomes.</p><p><strong>Methods: </strong>Residual respiratory samples that tested positive for rhinovirus/enterovirus at the Johns Hopkins Health System between 2018 and 2022 were collected for EV-D68 polymerase chain reaction, genotyping, and whole genome sequencing. Clinical and metadata were collected in bulk from the electronic medical records.</p><p><strong>Results: </strong>A total of 351 EV-D68 cases were identified, with most cases in children aged <5 years. Infections in 2018 were associated with higher odds of hospital admissions and intensive care unit care. Of 272 EV-D68 genomes, subclades B3 and A2/D1 were identified with B3 predominance (95.2%). A comparative analysis of the 2018 and 2022 whole genomes identified a cluster of amino acids (554D, 650T, 918T, 945N, 1445I, 1943I) that was associated with higher odds of severe outcomes.</p><p><strong>Conclusions: </strong>Our results show significant differences in the clinical outcomes of EV-D68 infections in 2018 and 2022 and highlight a 2018 cluster of genomic changes associated with these differences. Seasonal viral genomic surveillance-with in vitro characterization of the significance of these changes to viral fitness, immune responses, and neuropathogenesis-should shed light on the viral determinants of AFM.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 11","pages":"ofae656"},"PeriodicalIF":3.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nontuberculous Mycobacterial Infective Endocarditis: A Systematic Review of Clinical Characteristics and Outcomes.","authors":"Durga Shankar Meena, Deepak Kumar, Gopal Krishana Bohra, Naresh Midha, Mahendra Kumar Garg","doi":"10.1093/ofid/ofae688","DOIUrl":"10.1093/ofid/ofae688","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) due to nontuberculous mycobacteria (NTM) is a rare infection, and several outbreaks have been reported in the last 2 decades. However, the clinical spectrum is still poorly understood. This systematic review aimed to evaluate the clinical characteristics and outcomes in NTM IE.</p><p><strong>Methods: </strong>We searched the major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords to December 2023. We included studies based on predefined diagnostic criteria, and relevant data were collected on clinical presentation and treatment outcomes. The study was registered with PROSPERO (CRD42023492577).</p><p><strong>Results: </strong>A total of 97 studies were reviewed, encompassing 167 patients with NTM IE. The earliest cases were reported in 1975, involving <i>M chelonae</i> and <i>M fortuitum</i>. <i>M chimaera</i> was the most prevalent species (38.9%), though rapidly growing NTM (RGM) were more common than slow-growing NTM (SGM; 59.3% vs 40.7%). Disseminated NTM infection occurred in 84% of cases, with bone marrow infiltration and osteomyelitis as frequent manifestations. Prosthetic valves were the main risk factor, present in 63.5% of cases. In native valve IE, nearly all cases (n = 27, 96%) were attributed to RGM. The overall mortality rate was 44.9%, with conservative management without surgery associated with poorer outcomes (66.7% vs 30.6%). Mortality was comparable between SGM and RGM IE, although relapses were more common in SGM IE (17.6% vs 1.9%).</p><p><strong>Conclusions: </strong>This review highlights the changing epidemiology of NTM IE with the emergence of RGM IE. Disseminated infections in the setting of prosthetic valves warrant NTM evaluation. The high mortality rate necessitates the role of early surgery.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae688"},"PeriodicalIF":3.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiology, Risk Factors, and Outcomes of Bacteremia in Patients With Hematologic Malignancies and Febrile Neutropenia in Uganda.","authors":"Margaret Lubwama, Sarah E Holte, Yuzheng Zhang, Kelvin R Mubiru, George Katende, Jackson Orem, David P Kateete, Freddie Bwanga, Warren Phipps","doi":"10.1093/ofid/ofae682","DOIUrl":"10.1093/ofid/ofae682","url":null,"abstract":"<p><strong>Background: </strong>We determined the etiology, risk factors, and outcomes associated with bacteremia in patients with hematologic malignancies and febrile neutropenia (FN) at the Uganda Cancer Institute (UCI).</p><p><strong>Methods: </strong>UCI adult and pediatric inpatients with hematologic malignancies and FN were prospectively enrolled and followed up to determine 30-day mortality. Blood drawn from participants with FN was cultured in the BACTEC 9120 blood culture system. Antimicrobial susceptibility testing was performed with the disk diffusion method on identified bacteria. Logistic regression and Cox proportional hazards regression were applied to estimate associations between participant characteristics and FN, bacteremia, and mortality.</p><p><strong>Results: </strong>Of 495 participants, the majority (n = 306 [62%]) were male. Median age was 23 years (interquartile range, 11-42 years). Of the 132 participants who experienced FN, 43 (33%) had bacteremia. Participants with younger age (odds ratio [OR], 0.98; <i>P</i> = .05), severe neutropenia (OR, 2.9; <i>P</i> = .01), hypotension (OR, 2.46; <i>P</i> = .04), mucositis (OR, 2.77; <i>P</i> = .01), and receipt of chemotherapy (OR, 2.25; <i>P</i> = .03) were more likely to have bacteremia. Fifty (78%) bacteria isolated were gram negative. <i>Escherichia coli</i> (n = 25 [50%]) was predominant. Thirty-seven of 43 (86%) episodes were caused by multidrug-resistant (MDR) bacteria. Thirty-day overall survival for participants with bacteremia was significantly lower than that for participants with no bacteremia (<i>P</i> = .05). MDR bacteremia (hazard ratio, 1.84; <i>P</i> = .05) was associated with increased risk of death.</p><p><strong>Conclusions: </strong>Bacteremia was frequent in patients with hematologic cancer and FN and was associated with poor survival. MDR bacteria were the main cause of bacteremia and mortality. There is a need for robust infection control and antimicrobial stewardship programs in cancer centers in sub-Saharan Africa.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae682"},"PeriodicalIF":3.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Oral Antibiotics for Bone and Joint Infections: Lessons Learned and Opportunities for Improvement.","authors":"Marten R Hawkins, Elizabeth Thottacherry, Prerak Juthani, Jenny Aronson, Amy Chang, Derek F Amanatullah, Jessie Markovits, Sa Shen, Marisa Holubar, Jason R Andrews, Julie Parsonnet, Daisuke Furukawa","doi":"10.1093/ofid/ofae683","DOIUrl":"10.1093/ofid/ofae683","url":null,"abstract":"<p><strong>Background: </strong>Although intravenous antibiotics have historically been the standard of care for bone and joint infections, clinical trial data have highlighted the safety and efficacy of oral antibiotics. Despite this, intravenous antibiotics are still commonly used, and evaluations of institutional guidelines advancing oral antibiotic use are limited.</p><p><strong>Methods: </strong>In April 2023, we implemented a new institutional guideline to preferentially treat patients with bone and joint infections with oral antibiotics. The postguideline cohort was compared with a historical preguideline cohort via retrospective chart review. The primary outcome was the proportion of patients discharged exclusively on oral antibiotics. Secondary outcomes included 90-day treatment failure, length of stay, and adverse effects.</p><p><strong>Results: </strong>One hundred eighty-six patients (53 preguideline and 133 postguideline) were included in the analysis. Patients in the postguideline cohort were more likely to be discharged exclusively on oral antibiotics (25% vs 70%; <i>P</i> < .01), with no difference in 90-day treatment failure (8% vs 9%; <i>P</i> = .75). Patients in the postguideline cohort had a shorter length of stay than preguideline (median, 8 vs 7 days; <i>P</i> = .04) and trended toward fewer peripherally inserted central catheter-related adverse events (6% vs 1%; <i>P</i> = .07).</p><p><strong>Conclusions: </strong>An institutional guideline was effective in increasing the proportion of patients with bone and joint infections discharged on oral antibiotics. We observed similar clinical outcomes after implementing the guidelines while reducing length of hospital stay.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae683"},"PeriodicalIF":3.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Significance of Hyponatremia in Tuberculous Meningitis: A Prospective Cohort in Indonesia.","authors":"Sofiati Dian, Edwin Ardiansyah, Lidya Chaidir, Arjan van Laarhoven, Rovina Ruslami, Bachti Alisjahbana, Ahmad Rizal Ganiem, Reinout van Crevel","doi":"10.1093/ofid/ofae673","DOIUrl":"10.1093/ofid/ofae673","url":null,"abstract":"<p><strong>Background: </strong>Hyponatremia is common in tuberculous meningitis (TBM), but its impact on disease severity and outcomes is unclear.</p><p><strong>Methods: </strong>In a cohort of 864 adult patients with TBM in Indonesia, we assessed the prevalence and prognostic significance of hyponatremia, classified as moderate (120-130 mEq/L) or severe (<120 mEq/L). Patients received standard antituberculous therapy and corticosteroids and were followed for 1-year mortality.</p><p><strong>Results: </strong>Hyponatremia occured in 86.8% of patients, with 26% classified as severe. Severe hyponatremia associated with male, younger age, a lower Glasgow Coma Scale (GCS), and markers of more severe disease (<i>P</i> < .05). One-year mortality was 46.5% and associated with older age, HIV infection, lower GCS, markers of neurologic severity, fever, and thrombocytosis. Severe hyponatremia predicted mortality in univariate analysis showed no impact in HIV-positive patients.</p><p><strong>Conclusions: </strong>Hyponatremia reflects disease severity in TBM but does not independently predict mortality, suggesting limited benefit from agressive correction.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae673"},"PeriodicalIF":3.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Events Reported During Weekly Isoniazid-Rifapentine (3HP) Tuberculosis Preventive Treatment Among People With Human Immunodeficiency Virus in Uganda.","authors":"Jillian L Kadota, Allan Musinguzi, Hélène E Aschmann, Lydia Akello, Fred Welishe, Jane Nakimuli, Christopher A Berger, Noah Kiwanuka, Patrick P J Phillips, Achilles Katamba, David W Dowdy, Adithya Cattamanchi, Fred C Semitala","doi":"10.1093/ofid/ofae667","DOIUrl":"10.1093/ofid/ofae667","url":null,"abstract":"<p><strong>Background: </strong>Short-course tuberculosis (TB) prevention regimens, including 12 weeks of isoniazid and rifapentine (3HP), are increasingly used in high-TB-burden countries. Despite established safety and tolerability in efficacy trials, 3HP-related adverse events (AEs) could differ in routine settings. Real-world data on AE type, frequency, and timing are crucial for health systems considering 3HP programmatic scale-up.</p><p><strong>Methods: </strong>We reviewed AEs among people with human immunodeficiency virus (HIV) participating in a pragmatic implementation trial of facilitated 3HP taken by directly observed therapy (DOT) or self-administered therapy (SAT) in Kampala, Uganda, and classified them using the Common Terminology Criteria for Adverse Events. We assessed AE timing and summarized related clinical actions including laboratory tests, diagnoses made, medications prescribed, and treatment interruptions.</p><p><strong>Results: </strong>Among 1655 people with HIV treated between July 2020 and September 2022, 270 (16.3%) reported 451 events; main issues included general (7%), nervous system (6%), musculoskeletal (5%), gastrointestinal (5%), and dermatologic (3%) disorders. Most (61%) occurred within 6 weeks of initiating 3HP. Among those with events, 211 (78%) required further clinician evaluation, 202 (75%) required laboratory testing, 102 (38%) had medications prescribed, 40 (15%) had treatment paused, and 14 (5%) discontinued 3HP. Women, those multidimensionally impoverished, and DOT recipients were more likely to report an AE. SAT users and later enrollees were more likely to have 3HP interrupted or stopped due to an AE.</p><p><strong>Conclusions: </strong>In a routine setting, 3HP was safe, with 16% of people with HIV reporting AEs and only 3% requiring temporary or permanent treatment interruption. These findings support 3HP expansion in routine HIV/AIDS care settings for TB prevention. <b>Clinical Trials Registration.</b> NCT03934931.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 11","pages":"ofae667"},"PeriodicalIF":3.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Spotted Fever Group Rickettsioses in Kilimanjaro Region, Tanzania.","authors":"Thomas R Bowhay, Matthew P Rubach, Ângelo J F Mendes, William L Nicholson, Jamie L Perniciaro, Michael J Maze, Ganga S Moorthy, Jo E B Halliday, Kathryn J Allan, Blandina T Mmbaga, Wilbrod Saganda, Bingileki F Lwezaula, Rudovick R Kazwala, Sarah Cleaveland, Katrina J Sharples, Venance P Maro, John A Crump","doi":"10.1093/ofid/ofae664","DOIUrl":"https://doi.org/10.1093/ofid/ofae664","url":null,"abstract":"<p><strong>Background: </strong>Knowledge gaps exist on risk factors for spotted fever group rickettsioses (SFGR) in sub-Saharan Africa. We sought to identify SFGR risk factors in Kilimanjaro Region, Tanzania.</p><p><strong>Methods: </strong>We recruited febrile patients presenting at 2 hospitals in Moshi from February 2012 through May 2014. Standardized clinical and risk factor questionnaires were administered. SFGR exposure was defined as a <i>Rickettsia africae</i> immunofluorescence antibody reciprocal titer ≥64, and acute SFGR as a ≥4-fold rise between paired sera. Logistic regression was used to identify associations.</p><p><strong>Results: </strong>Of 1190 participants providing ≥1 serum sample, the median age was 21.8 (range, 0.3-100.2) years, 646 (54.3%) were female, and 650 (54.6%) had SFGR exposure. Of 731 participants with paired sera, 67 (9.2%) had acute SFGR. On multivariable analysis, odds of acute SFGR were higher in the age group 0-2 years (adjusted odds ratios [aORs] for older age groups, <0.36; <i>P</i> < .011), rural residence (aOR, 4.1; <i>P</i> = .007), and areas with maximum daily temperature <26°C (aORs for higher temperature groups, <0.42; <i>P</i> < .035). Odds of SFGR exposure were higher in those working in the garden (aOR, 1.8; <i>P</i> = .010) and seeing a dog (aOR, 1.5; <i>P</i> = .010). Odds of SFGR exposure were lower in the age group 0-2 years (aORs for older age groups, >1.5; <i>P</i> < .026), female sex (aOR, 0.62; <i>P</i> < .001), and being from the Chaga tribe (aOR, 0.68; <i>P</i> = .003).</p><p><strong>Conclusions: </strong>Those aged <2 years, rural residents, and persons residing in areas with cooler temperatures had increased odds of SFGR. Our results identify groups for further research on tick exposure and for targeted prevention interventions.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae664"},"PeriodicalIF":3.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectivity and Immunogenicity of Live-Attenuated Respiratory Syncytial Virus Vaccines in Human Immunodeficiency Virus-Exposed Uninfected Children.","authors":"Matthew S Kelly, Coleen K Cunningham, Elizabeth J McFarland, Mark J Giganti, Jane C Lindsey, Charlotte Perlowski, Jennifer L Libous, Patrick Jean-Philippe, Jack Moye, Ruth A Karron, Peter L Collins, Ursula J Buchholz","doi":"10.1093/ofid/ofae679","DOIUrl":"10.1093/ofid/ofae679","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory illness among young children. Human immunodeficiency virus (HIV)-exposed, uninfected (HEU) children experience a higher burden of RSV disease and have immune abnormalities that may influence their responses to live-attenuated RSV vaccines.</p><p><strong>Methods: </strong>In a pooled analysis of clinical trials of 7 live-attenuated, intranasal RSV vaccines conducted by the IMPAACT Network among children 6 to <25 months of age with serum RSV-neutralizing titers of <1:40, the infectivity and immunogenicity of these vaccines were compared among HEU and HIV-unexposed, uninfected (HUU) children. Nasal washes were collected during the first 28 days after vaccination. Serum RSV-neutralizing and anti-RSV F glycoprotein immunoglobulin G (IgG) antibodies were measured prior to and 56 days after vaccination, and before and after the following winter season.</p><p><strong>Results: </strong>Of 156 children, 90 (58%) were HUU and 66 (42%) were HEU. Seventy-six (84%) HUU and 63 (95%) HEU participants were infected with vaccine (shed vaccine virus and/or had a ≥4-fold rise in serum RSV antibodies at 56 days after vaccination). HUU children had higher serum RSV-neutralizing and anti-RSV F IgG titers prior to vaccination. Compared to HEU children, lower percentages of HUU children had ≥4-fold rises in RSV-neutralizing (67% vs 88%) and anti-RSV F IgG (70% vs 89%) titers at 56 days after vaccination.</p><p><strong>Conclusions: </strong>Live-attenuated RSV vaccines are highly immunogenic in HEU children. Given their increased burden of RSV disease and higher early childhood mortality in some settings, HEU children should be prioritized for vaccination against RSV as these vaccines become available.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"11 12","pages":"ofae679"},"PeriodicalIF":3.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}