Abstract Influenza continues to have a major worldwide impact, resulting in considerable human suffering and economic burden. The regular recurrence of influenza epidemics is thought to be caused by ...antigenic drift, and a number of studies have shown that sufficient changes can accumulate in the virus to allow influenza to reinfect the same host. To address this, influenza vaccine content is reviewed annually to ensure protection is maintained, despite the emergence of drift variants; however, it is not always possible to capture every significant drift, partly due to the timing of the recommendations. Vaccine mismatch can impact on vaccine effectiveness, and has significant epidemiological and economical consequences, as was seen most apparently in the 1997–1998 influenza season. To meet the challenge of antigenic drift, vaccines that confer broad protection against heterovariant strains are needed against seasonal, epidemic and pandemic influenza. In addition to the use of vaccine adjuvants, emerging research areas include development of a universal vaccine and the use of vaccines that exploit mechanisms of cross-protective immunity.
Ebola is a highly lethal virus, which has caused at least 14 confirmed outbreaks in Africa between 1976 and 2006. Using data from two epidemics in Democratic Republic of Congo (DRC) in 1995 and in ...Uganda in 2000, we built a mathematical model for the spread of Ebola haemorrhagic fever epidemics taking into account transmission in different epidemiological settings. We estimated the basic reproduction number (R0) to be 2·7 (95% CI 1·9–2·8) for the 1995 epidemic in DRC, and 2·7 (95% CI 2·5–4·1) for the 2000 epidemic in Uganda. For each epidemic, we quantified transmission in different settings (illness in the community, hospitalization, and traditional burial) and simulated various epidemic scenarios to explore the impact of control interventions on a potential epidemic. A key parameter was the rapid institution of control measures. For both epidemic profiles identified, increasing hospitalization rate reduced the predicted epidemic size.
Summary
Background More than 50 years after the introduction of corticosteroids, few studies have focused on corticosteroid‐induced adverse events after long‐term systemic therapy.
Objectives To ...assess the frequency, risk factors and patient’s opinion regarding clinical adverse events occurring early during prednisone therapy.
Patients and methods We conducted a cohort study in two French centres. All consecutive patients starting long‐term (≥ 3 months), high dosage (≥ 20 mg day−1) prednisone therapy were enrolled. The main clinical adverse events attributable to corticosteroids were assessed after 3 months of therapy, by comparison with baseline status. The patient’s opinion regarding the disability induced by these adverse events was recorded. Risk factors of frequently observed adverse effects were identified by using logistic regression.
Results Eighty‐eight patients were enrolled and 80 were monitored for at least 3 months (women 76%; mean age 59·1 ± 18·7 years; giant cell arteritis 39%; mean baseline prednisone dosage 54 ± 17 mg day−1). Lipodystrophy was the most frequent adverse event 63·0% (51·0–73·1), was considered the most distressing by the patients and was most frequent in women and young patients. Neuropsychiatric disorders occurred in 42 patients 52·5% (41·0–63·8), necessitating hospitalization in five cases. Skin disorders were noted by 37 patients 46·2% (35·0–57·7) and were more frequent in women. Muscle cramp and proximal muscle weakness were reported by 32·5% (22·5–43·9) and 15% (8·0–24·7) of patients, respectively. Newly developed hypertension occurred in 8·7% (2·9–20·3) of patients. Lastly, 39% (19·7–61·4) of the premenopausal women reported menstrual disorders.
Conclusions Lipodystrophy and neuropsychiatric disorders are common adverse events of long‐term prednisone therapy and are particularly distressing for the patients concerned. The impact of these adverse events on adherence to corticosteroid therapy is not known.
SARS-CoV-2 infection is more severe in patients undergoing rituximab (RTX) treatment. Humoral response to vaccination is severely impaired in patients already treated with RTX, but data on antibody ...persistence in patients initiating RTX are lacking. We evaluated the impact of RTX initiation on humoral response to SARS-CoV-2 vaccination in previously vaccinated patients with immune-mediated inflammatory diseases. We performed a retrospective, multicenter study evaluating the evolution of anti-spike antibodies and breakthrough infections after initiation of RTX in previously vaccinated patients with protective levels of anti-SARS-CoV-2 antibodies. Threshold for anti-S antibodies positivity and protection were 30 and 264 BAU/mL, respectively. We included 31 previously vaccinated patients initiating RTX (21 female, median age 57 years). At first RTX infusion, 12 (39%) patients had received 2 doses of vaccine, 15 (48%) had received 3 doses, and 4 (13%) had received 4 doses. The most frequent underlying diseases were ANCA-associated vasculitis (29%) and rheumatoid arthritis (23%). Median anti-S antibody titers at RTX initiation, 3 months, and 6 months were 1620 (589–2080), 1055 (467–2080), and 407 (186–659) BAU/mL, respectively. Overall, antibody titers waned by almost two-fold at 3 months and four-fold at 6 months. Median antibody titers were significantly higher in patients who received ≥3 doses compared to those who received only 2 doses. Three patients developed SARS-CoV-2 infection without any severe symptom. Anti-SARS-CoV-2 antibody titers in previously vaccinated patients decline after RTX initiation similarly to general population. Specific monitoring is useful to anticipate prophylactic strategies.
Key Points
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Anti-SARS-CoV-2 antibody titers in previously vaccinated patients decline after rituximab initiation similarly to the general population.
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The number of dose of vaccine before rituximab initiation is associated with higher antibody titers at month 3.
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Monitoring antibody levels is mandatory to initiate prophylactic strategies in this population.
Overmedicalization refers to non-validated medical practices, with no clear benefits, potentially harmful and therefore unnecessarily costly. Awareness is growing with respect to this serious public ...health problem. Permanent expansion of diagnostic or therapeutic interventions, disease mongering, inadequate management of diagnostic uncertainty, conflict of interest or lack of commitment by physicians and patients in shared decision making. Overmedicalization is made possible by a lack of training of health professionals and users on medical decision process. Only a multidisciplinary research program, involving medical and non-medical worlds, will allow the implementation of corrective actions.
Transitioning to Good Health and Well-Being addresses critical issues of health in the context of sustainability, which need to be tackled in order to achieve Agenda 2030. Acknowledging the dramatic ...improvements that have been made in the past decades with regards to health, we also face disparities that remain amongst and within countries. While life expectancy has more than doubled, we are, at the same time, confronted with the challenges that come along with population growth alongside environmental change, migration, ageing, and economic disparities. In its 2018 progress report concerning SDG 3, the UN stated that, while the quality of global health is increasing, “people are still suffering needlessly from preventable diseases”, both infectious and non-communicable, "and too many are dying prematurely". Although we are on the verge of eradicating, poliomyelitis, which disables 350’000 children each year, we continue to have few answers for outbreaks of emerging infectious diseases. Making progress against these outbreaks with strong health systems, particularly in neglected or inaccessible regions, is deeply connected to further issues targeted by the UN SDGs such as (restricted) access to clean water, healthy food, or continuing political instabilities as well as gender inequalities. Transitioning to Good Health and Well-Being, therefore, offers a vessel for a productive reflection and conversation on the meaning of and possibilities for global health, giving voice to a range of scholars, strategists and practitioners. Transitioning to Good Health and Well-Being is part of MDPI's new Open Access book series Transitioning to Sustainability. With this series, MDPI pursues environmentally and socially relevant research which contributes to efforts toward a sustainable world. Transitioning to Sustainability aims to add to the conversation about regional and global sustainable development according to the 17 SDGs. The book series is intended to reach beyond disciplinary, even academic boundaries.
Summary
Objectives
: The aim of this manuscript is to provide a brief overview of the scientific challenges that should be addressed in order to unlock the full potential of using data from a general ...point of view, as well as to present some ideas that could help answer specific needs for data understanding in the field of health sciences and epidemiology.
Methods
: A survey of uses and challenges of big data analyses for medicine and public health was conducted. The first part of the paper focuses on big data techniques, algorithms, and statistical approaches to identify patterns in data. The second part describes some cutting-edge applications of analyses and predictive modeling in public health.
Results
: In recent years, we witnessed a revolution regarding the nature, collection, and availability of data in general. This was especially striking in the health sector and particularly in the field of epidemiology. Data derives from a large variety of sources, e.g. clinical settings, billing claims, care scheduling, drug usage, web based search queries, and Tweets.
Conclusion
: The exploitation of the information (data mining, artificial intelligence) relevant to these data has become one of the most promising as well challenging tasks from societal and scientific viewpoints in order to leverage the information available and making public health more efficient.
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