Furthermore, using a unique study design the authors controlled for demographic, biological, economic, and environmental variables associated with COVID-19 outcomes, including age, seasonality, ...population density, income, and health risks to identify contextual factors subject to policy control. ...the level of trust in governments, interpersonal trust, and less government corruption were directly proportional to fewer infections and higher vaccination rates in high-income and middle-income countries. ...GBD researchers have brought to light important knowledge gaps due to varying quality and quantity of data from across the world.
Middle East respiratory syndrome Memish, Ziad A; Perlman, Stanley; Van Kerkhove, Maria D ...
The Lancet (British edition),
03/2020, Letnik:
395, Številka:
10229
Journal Article
Recenzirano
Odprti dostop
The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen that was first identified in humans in Saudi Arabia and Jordan in 2012. Intermittent sporadic cases, ...community clusters, and nosocomial outbreaks of MERS-CoV continue to occur. Between April 2012 and December 2019, 2499 laboratory-confirmed cases of MERS-CoV infection, including 858 deaths (34·3% mortality) were reported from 27 countries to WHO, the majority of which were reported by Saudi Arabia (2106 cases, 780 deaths). Large outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and in South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by WHO as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. This Seminar provides an update on the current knowledge and perspectives on MERS epidemiology, virology, mode of transmission, pathogenesis, diagnosis, clinical features, management, infection control, development of new therapeutics and vaccines, and highlights unanswered questions and priorities for research, improved management, and prevention.
A novel coronavirus (MERS-CoV) was recently identified as the cause of severe respiratory disease. In this report from Saudi Arabia, a family cluster of infection over a 6-week period is described, ...suggesting possible limited person-to-person transmission.
MERS-CoV was first reported in September 2012 in samples obtained from a Saudi Arabian businessman who died from acute respiratory and renal failure.
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As of May 28, 2013, a total of 49 cases of human MERS-CoV infection with 26 deaths have been reported to the World Health Organization (WHO). MERS-CoV is the first betacoronavirus belonging to lineage C that is known to infect humans.
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It belongs to the Coronaviridae family, a group of large, enveloped single-stranded RNA viruses that are known for their genomic plasticity and their ability to cause a range of infections in mammalian and avian hosts. MERS-CoV . . .
...whether these events are due to change in monkeypox virus transmission properties or increased virulence remains unknown. Compared with RNA viruses, the monkeypox virus is a large DNA virus, which ...makes itself more stable and efficient than RNA viruses at detecting and repairing mutations. ...it is unlikely that the virus has evolved to increase human transmission. The unprecedented manifold increase in monkeypox cases seen in the past 3 weeks outside Africa yet again highlights that developing effective capacity at source is crucial for effective global public health preparedness and surveillance for zoonotic threats to global health security.1,2 Rapid garnering of financial and political support for this is required to fuel reassurance, rather than fear and stigmatisation. iStock/Biod AZ, NH, DA, FN, and RK are members of the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics funded by the European and Developing Countries Clinical Trials Partnership, which is supported by Horizon 2020, the EU's Framework Programme for Research and Innovation.
Tuberculosis is the number one cause of death from infectious disease globally and drug-resistant forms of the disease are a major risk to global health security. On the occasion of World ...Tuberculosis Day (March 24, 2018), we provide an up-to-date review of the status of the tuberculosis epidemic, recommended diagnostics, drug treatments and vaccines, progress in delivery of care and prevention, progress in research and development, and actions needed to accelerate progress. This Review is presented in the context of the UN Sustainable Development Goals and WHO's End TB Strategy, which share the aim of ending the global tuberculosis epidemic. In 2016, globally there were an estimated 10·4 million new cases of tuberculosis, and 600 000 new cases with resistance to rifampicin (the most powerful first-line drug). All countries and age groups are affected by tuberculosis, but most cases (90%) in 2016 were in adults, and almost two-thirds were accounted for by seven countries: India, Indonesia, China, Philippines, Pakistan, South Africa, and Nigeria. The sex ratio (male to female) was 1·9 and 10% of patients with newly diagnosed tuberculosis were also HIV-positive. There were 1·7 million deaths from tuberculosis in 2016, including 0·4 million deaths among people co-infected with HIV (officially classified as deaths caused by HIV/AIDS). Progress in care and prevention means that the global mortality rate (deaths per 100 000 people per year) is decreasing by 3·4% per year and incidence (new cases per 100 000 people per year) is decreasing by 1·9% per year. From 2000 to 2016, the annual global number of tuberculosis deaths decreased by 24% and the mortality rate declined by 37%. Worldwide, an estimated 53 million deaths were averted through successful treatment. Nonetheless, major gaps in care and prevention remain. For example, the 6·3 million new cases of tuberculosis reported globally in 2016 represented only 61% of the estimated incidence; only one in five of the estimated number of people with drug-resistant tuberculosis was enrolled in treatment. Pipelines for new diagnostics, drugs, and vaccines are progressing, but slowly. Actions needed to accelerate progress towards global milestones and targets for reductions in the burden of tuberculosis disease set for 2020, 2025, 2030, and 2035 include closing coverage gaps in testing, reporting of cases, and overall access to health care, especially in countries that account for the largest share of the global gap; multisectoral efforts to reduce prevalence of major risk factors for infection and disease; and increased investment in research and development.
All three coronaviruses induce excessive and aberrant non-effective host immune responses that are associated with severe lung pathology, leading to death.2–4 Similar to patients with SARS-CoV and ...MERS-CoV, some patients with 2019-nCoV develop acute respiratory distress syndrome (ARDS) with characteristic pulmonary ground glass changes on imaging. In most moribund patients, 2019-nCoV infection is also associated with a cytokine storm, which is characterised by increased plasma concentrations of interleukins 2, 7, and 10, granulocyte-colony stimulating factor, interferon-γ-inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1 alpha, and tumour necrosis factor α.2–6 In those who survive intensive care, these aberrant and excessive immune responses lead to long-term lung damage and fibrosis, causing functional disability and reduced quality of life.7,8 Specific drugs to treat 2019-nCoV will take several years to develop and evaluate. Infection with 2019-nCoV appears to be initially associated with an increased Th2 response,4 which might reflect a physiological reaction to curb overt inflammatory responses, a clinical phenomenon that guided the optimal timing of interferon treatment in patients with sepsis, resulting in increased survival.14 Interleukin 17 blockade might benefit those patients who have a 2019-nCoV infection and increased plasma concentration of interleukin 17.
A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person ...transmission were identified. The median incubation period was 5.2 days.
Respiratory viruses are an emerging threat to global health security and have led to worldwide epidemics with substantial morbidity, mortality, and economic consequences. Since the severe acute respiratory syndrome (SARS) pandemic in 2003–2004,
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two additional human coronaviruses — HKU-1 and NL-63 — have been identified, both of which cause mild respiratory infection and are distributed worldwide.
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In September 2012, the World Health Organization (WHO) reported two cases of severe community-acquired pneumonia caused by a novel human β-coronavirus, subsequently named the Middle East respiratory syndrome coronavirus (MERS-CoV).
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Since then, MERS-CoV has been identified as the cause of pneumonia . . .
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can ...easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
According to the WHO report,1 in 2017 there was a shortfall of US$3·5 billion of the estimated budget required for tuberculosis prevention and care in low-income and middle-income countries. In ...addition to budgetary issues, global tuberculosis control efforts are unlikely to succeed unless the underlying socioeconomic determinants of the tuberculosis outbreak are addressed.3,4 Achieving universal coverage and access to health care is an acknowledged human right. Increased resources are essential for advancing and facilitating cross-continent research collaborations on development of new diagnostics, drugs, and oral treatment regimens and for reducing duration of therapy and improving treatment outcomes for all forms of tuberculosis.
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