Complement-fixation test reactions to eight viruses of the family Togaviridae were studied in 372 serum samples (157 rodents, 172 domestic animals, 43 humans) from Pakistan. Antibodies to each tested virus were detected. The highest over-all prevalence rates were for West Nile (WN) (7.8%), Japanese encephalitis (JE) (3.2%) and Zika (ZIKA) (2.4%) viruses, followed by Sindbis (SIN), Chikungunya (CHIK), Uganda S (UGS) and Royal Farm (RF) viruses (1.6 to 1.3%). One human serum (male, age 58 years) reacted with Dengue-1 (DEN) virus antigen (titre 1:32). Antibodies to each virus except RF were detected in human sera; antibodies to RF virus were detected only in rodent and domestic animal sera. The roles of rodents in the epidemiology of WN, JE and ZIKA viruses should be investigated. At least six of these eight viruses cause fevers in humans (fevers of unknown origin comprise about one third of the febrile episodes recorded in Pakistan).

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BackgroundHepatitis C virus (HCV) infection and schistosomiasis are major public health problems in the Nile Delta of Egypt. To control schistosomiasis, mass treatment campaigns using tartar emetic injections were conducted in the 1960s through 1980s. Evidence suggests that inadequately sterilized needles used in these campaigns contributed to the transmission of HCV in the region. To corroborate this evidence, this study evaluates whether HCV infections clustered within houses in which household members had received parenteral treatment for schistosomiasis.MethodsA serosurvey was conducted in a village in the Nile Delta and residents were questioned about prior treatment for schistosomiasis. Sera were evaluated for the presence of antibodies to HCV. The GEE2 approach was used to test for clustering of HCV infections, where correlation of HCV infections within household members who had been treated for schistosomiasis was the parameter of interest.ResultsA history of parenteral treatment for schistosomiasis was observed to cluster within households, OR for clustering: 2.44 (95% CI: 1.47–4.06). Overall, HCV seropositivity was 40% (321/796) and was observed to cluster within households that had members who had received parenteral treatment for schistosomiasis, OR for clustering: 1.76 (95% CI: 1.05–2.95). No such evidence for clustering was found in the remaining households.ConclusionClustering of HCV infections and receipt of parenteral treatment for schistosomiasis within the same households provides further evidence of an association between the schistosomiasis treatment campaigns and the high HCV seroprevalence rates currently observed in the Nile delta of Egypt.

Abstract. Residents of Egypt's Nile river delta have among the world's highest seroprevalence of hepatitis C virus (HCV) infection. To assess the impact of HCV on chronic liver disease, we studied the association between HCV, other hepatitis viruses, and cirrhotic liver disease in a cross-sectional, community-based survey of 801 persons aged Ն 10 years living in a semi-urban, Nile delta village. Residents were systematically sampled using questionnaires, physical examination, abdominal ultrasonography and serologically for antibodies to HCV (confirmed by a thirdgeneration immunoblot assay) and to hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis E virus (HEV). The seroprevalence of HCV increased with age from 19% in persons 10-19 years old to about 60% in persons 30 years and older. Although no practices that might facilitate HCV transmission were discovered, the seroprevalence of HCV was significantly associated with remote (Ͼ 1 year) histories of schistosomiasis. Sonographic evidence of cirrhosis was present in 3% (95% CI: 1%, 4%) of the population (0.7% of persons under 30 years of age and in 5% of older persons), and was significantly associated with HCV seroreactivity. Our findings are consistent with the hypothesis that past mass parenteral chemotherapy campaigns for schistosomiasis facilitated HCV transmission, and that HCV may be a major cause of the high prevalence of liver cirrhosis in this Nile village.

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ObjectivesEven though several effective vaccines are available to combat the COVID-19 pandemic, wide disparities in vaccine distribution, and vaccine acceptance rates between high- and low-income countries appear to be major threats toward achieving population immunity. Our global descriptive study aims to inform policymakers on factors affecting COVID-19 vaccine acceptance among healthcare workers (HCWs) in 12 countries, based on income index. We also looked for possible predictors of vaccine acceptance among the study sample.MethodsA structured questionnaire prepared after consultation with experts in the field and guided by the “Report of the SAGE working group on vaccine hesitancy” was administered among 2,953 HCWs. Upon obtaining informed consent, apart from demographic information, we collected information on trust in vaccines and health authorities, and agreement to accept a COVID-19 vaccine.ResultsAlthough 69% of the participants agreed to accept a vaccine, there was high heterogeneity in agreement between HCWs in low and lower-middle income countries (L-LMICs) and upper-middle- and high-income countries (UM-HICs), with acceptance rates of 62 and 75%, respectively. Potential predictors of vaccine acceptance included being male, 50 years of age or older, resident of an UM-HIC, updating self about COVID-19 vaccines, greater disease severity perception, greater anxiety of contracting COVID-19 and concern about side effects of vaccines.ConclusionsCOVID-19 vaccine acceptance among HCWs in L-LMICs was considerably low as compared to those from UM-HICs. The lowest vaccine acceptance rates were among HCWs from the African continent. This underlines the need for the implementation of country-specific vaccine promotion strategies, with special focus on increasing vaccine supply in L-LMICs.

AimsTo characterize the population pharmacokinetics of indometacin in preterm infants with symptomatic patent ductus arteriosus and to investigate the influence of various factors on the response to treatment. MethodsData were collected from 35 infants (gestational age 25-34 weeks; postnatal age 1-77 days) in neonatal units in Belfast and Copenhagen. Infants received an initial course of up to three doses of intravenous indometacin (0.1-0.2 mg kg -1 ) as considered appropriate by the treating physician. For those infants who did not respond to therapy or in whom the ductus reopened, a second course was sometimes g iven. Population analysis of the 185 plasma concentrations obtained was conducted using NONMEM and pharmacokinetic and demographic differences between responders and nonresponders were compared. ResultsThe concentration-time course of indometacin was best described by a one-compar tment model. The final population parameter estimates of clearance (CL) and volume of distribution (V) (standardized to the median weight of 1.17 kg) were 0.00711 l h -1 and 0.266 l, respectively. CL increased from birth by approximately 3.38% per day and V by approximately 1.47% per day. Concomitant digoxin therapy resulted in a 30% decrease in V. Interindividual variability in CL and V was 41% and 21%, respectively. Interoccasion variability for CL was 43%. Residual variability corresponded to a standard deviation of 0.148 mg l -1 . Closure occurred in 75% of infants with a plasma concentration ≥ 0.4 mg l -1 24 h after the last dose. ConclusionsDosing regimens for indometacin should take into account the weight and postnatal age of the infant and any concomitant digoxin therapy. The population estimates can be used to determine typical values of CL and V allowing the prediction of individualized doses of indometacin that should increase the probability of achieving a 24 h plasma concentration ≥ 0.4 mg l -1 . Although the pharmacokinetic estimates will be affected by both interindividual and within-individual variation, it is anticipated that this approach will decrease the variability of exposure and optimize treatment outcome.J. M. Smyth et al. 25058 :3 Br J Clin Pharmacol