•New oral antivirals Paxlovid and Lagevrio can prevent the progression of COVID-19.•Oral antiviral treatment of early-stage COVID-19 poses a risk of significant drug-drug interactions ...(DDI).•Polypharmacy is frequent in patients at high risk of severe COVID-19.•Danish prescription data show frequent use of drugs prone to interact with Paxlovid.•Guidance for physicians managing DDI with COVID-19 treatment is needed.
The oral antiviral drugs nirmatrelvir/ritonavir (NMV/r) and molnupiravir have been approved for early outpatient treatment of COVID-19 to prevent severe disease. Ritonavir, contained in NMV/r, is known to have significant drug-drug interactions (DDI) with several drugs frequently used by the elderly. This communication puts the problem with DDI with oral antiviral COVID-19 treatment into perspective by assessing the percentage of the elderly population at risk of severe COVID-19, using drugs with significant DDI with oral antivirals.
We estimated the size of the Danish population at risk of significant DDI with antiviral COVID-19 treatment using the number of claimed prescriptions for drugs predicted to interact with NMV/r in Denmark in 2020.
Danish prescription data demonstrate the extensive use of drugs likely to interact with NMV/r. Anticoagulants contraindicated during NMV/r treatment were used by 20% of people ≥65 years and 30% of people ≥80 years. Statins that must be paused during NMV/r treatment were used by 15-18%. More than one in five used either analgesics, calcium channel blockers, or digoxin.
There is major potential for significant DDI with NMV/r in the elderly population at risk of severe COVID-19 disease. This calls for clear guidance for prescribers to ensure patient safety and treatment success.
•Nirmeltravir/ritonavir is indicated for early treatment of COVID-19.•Coadministration of nirmeltravir/ritonavir with simvastatin or lovastatin is contraindicated.•The pragmatic solution is to ...withhold statins during treatment with nirmeltravir/ritonavir.•Withholding statins will not expose the patients for an increased risk of cardiovascular events.
What causes fever in Côte d'Ivoire? Larsen, Carsten Schade
Travel medicine and infectious disease,
September-October 2021, 2021-09-00, 20210901, Letnik:
43
Journal Article
Recenzirano
The first step to improve management of patients with acute febrile illness in Sub Saharan Africa is to have data from studies that provide clinicians with a more precise picture of the distribution ...of microbial agents causing fever. The study shows that malaria is still the leading cause of fever in Côte d'Ivoire with almost half of febrile patients being positive for malaria, 94% caused by P. falciparum, but also a high (24.6%) prevalence of asymptomatic malaria. ...the role of R. felix in febrile illnesses needs further elucidation.
Tick-borne encephalitis (TBE) is rapidly spreading to new areas in many parts of Europe. While vaccination remains the most effective method of protection against the disease, vaccine uptake is low ...in many endemic countries.
We conducted a literature search of the MEDLINE database to identify articles published from 2018 to 2023 that evaluated the immunogenicity and effectiveness of TBE vaccines, particularly Encepur, when booster doses were administered up to 10 years apart. We searched PubMed with the MeSH terms 'Encephalitis, Tick-Borne/prevention and control' and 'Vaccination' for articles published in the English language.
Long-term immunogenicity data for Encepur and real-world data on vaccine effectiveness and breakthrough infections following the two European TBE vaccines, Encepur and FSME-Immun, have shown that extending the booster interval from 3-5 years to 10 years does not negatively impact protection against TBE, regardless of age. Such extension not only streamlines the vaccination schedules but may also increase vaccine uptake and compliance among those living in endemic regions.
...numerous symptomatic Danish travelers returning from Ischgl were neither tested nor put in quarantine. There are more than 180 SARS-CoV-2 vaccine candidates in development, the majority using the ...spike protein as antigen 7. ...mutations in the spike protein may have implication on immunity, risk of reinfection, vaccine efficacy and treatment with convalescent plasma. Since the middle of September 2020, no new cases of infection with Cluster 5 have been identified and it is likely that it does not circulate any longer.
Abstract
Background
Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the ...epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data.
Methods
Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed.
Results
A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World.
Conclusions
Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.
Risk of infestation increases in warm, moist and sandy conditions contaminated by dog or cat feces. According to the patients, approximately half of the students at the high school did acquire CLM ...and many were treated by local doctors. A study from Barbados 4 showed that one-fourth of 140 travelers on a group vacation got infected with CLM with risk factors being younger age and not wearing protective foot wear while walking at the beach.
Yearly influenza vaccination is strongly recommended for older adults and patients with chronic diseases including cardiovascular disease (CVD); however, vaccination rates remain suboptimal, ...particularly among younger patients. Electronic letters incorporating behavioral nudges are highly scalable public health interventions which can potentially increase vaccination, but further research is needed to determine the most effective strategies and to assess effectiveness across different populations. The purpose of NUDGE-FLU-CHRONIC and NUDGE-FLU-2 are to evaluate the effectiveness of electronic nudges delivered via the Danish governmental electronic letter system in increasing influenza vaccination among patients with chronic diseases and older adults, respectively.
Both trials are designed as pragmatic randomized implementation trials enrolling all Danish citizens in their respective target groups and conducted during the 2023/2024 influenza season. NUDGE-FLU-CHRONIC enrolls patients aged 18-64 years with chronic diseases. NUDGE-FLU-2 builds upon the NUDGE-FLU trial conducted in 2022/2023 and aims to expand the evidence by testing both previously successful and new nudges among adults ≥65 years during a subsequent influenza season. Persons with exemptions from the electronic letter system are excluded from both trials. In both trials, participants are randomized in a 2.45:1:1:1:1:1:1 ratio to either receive no electronic letter (usual care) or to receive one of 6 different behaviorally informed electronic letters. NUDGE-FLU-CHRONIC has randomized 299,881 participants with intervention letters delivered on September 24, 2023, while NUDGE-FLU-2 has randomized 881,373 participants and delivered intervention letters on September 13, 2023. Follow-up is currently ongoing. In both trials, the primary endpoint is receipt of influenza vaccination on or before January 1, 2024, and the secondary endpoint is time to vaccination. Clinical outcomes including respiratory and cardiovascular hospitalizations, all-cause hospitalization, and mortality are included as prespecified exploratory endpoints. Prespecified individual-level pooled analyses will be conducted across NUDGE-FLU, NUDGE-FLU-CHRONIC, and NUDGE-FLU-2.
NUDGE-FLU-CHRONIC is the first nationwide randomized trial of electronic nudges to increase influenza vaccination conducted among 18-64-year-old high-risk patients with chronic diseases. NUDGE-FLU-2 will provide further evidence on the effectiveness of electronic nudges among older adults ≥65 years. Collectively, the NUDGE-FLU trials will provide an extensive evidence base for future public health communications.
NUDGE-FLU-CHRONIC: Clinicaltrials.gov: NCT06030739, registered September 11, 2023, https://clinicaltrials.gov/study/NCT06030739. NUDGE-FLU-2: Clinicaltrials.gov: NCT06030726, registered September 11, 2023, https://clinicaltrials.gov/study/NCT06030726.
Objective
To estimate the economic burden of non‐communicable diseases (NCDs) in people living with HIV (PLWH) in Denmark.
Methods
We conducted a cohort study using population‐based Danish medical ...registries including all adult residents of the Central Denmark Region registered with a first‐time HIV‐diagnosis during the period 2006–2017. For each PLWH, we matched 10 persons without HIV from the background population by birth year, sex and municipality of residence. Information on healthcare utilization and costs for the PLWH and non‐HIV cohorts was retrieved from register data. For each cohort, we estimated the annual costs for major disease categories (HIV care, other somatic care, and psychiatric care) in the period from 3 years before to 9 years after diagnosis/matching date.
Results
We identified 407 PLWH and 4070 persons from the background population. The total healthcare costs during the study period were approximately three times higher for PLWH compared to the non‐HIV cohort (€76 198 vs. €23 692). Average annual cost of hospital care, primary care and selected prescription medicine was estimated to be €6987 per year in the years after the diagnosis compared to €2083 per year in the non‐HIV cohort. In PLWH, the cost of NCDs and psychiatric care was approximately two times higher than the cost of HIV care.
Conclusion
PLWH have higher healthcare costs stemming from three areas: excess cost due to the HIV infection, the treatment of NCDs, and psychiatric care.
Cutaneous larva migrans is a common disease in the tropics and among travelers. The itchy, serpentigious rash often appears within days to weeks after transmission. There are only few reported cases ...of late relapses. Here, we present a case of a relapse of cutaneous larva migrans more than one year after exposure.
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