Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases as of April 2, 2020. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. Here, to better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screen 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children have neutralizing activity, including one that neutralized at a dilution > 1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.

In January 2017, the UK Government made public a Memorandum of Understanding (MoU) between the Department of Health, National Health Service (NHS) Digital and the Home Office. This Memorandum allows for the more expedited sharing of a patient's non-clinical data, specifically from the NHS England to the Home Office. The Government justified the MoU as in the 'public interest to support effective immigration enforcement'. In this review, we seek to unpack this justification by providing, first, a background to the MoU, placing it in the context of creating a 'hostile environment' for migrants - a project initially sought by Theresa May in her time as Home Secretary. We then explore the potential impact of data sharing on individual health, public health and on health professionals. We conclude that the MoU could threaten both individual and public health, while placing health professionals in an unworkable position both practically and in terms of their duties to patients around confidentiality. As such, we agree with colleagues' position that it should be suspended, at least until a full consultation and health impact assessment can be carried out.

Background Industry sponsorship of public health research has received increasing scrutiny, and, as a result, many multinational corporations (MNCs), such as The Coca-Cola Company and Mars Inc., have committed to transparency with regard to what they fund, and the findings of funded research. However, these MNCs often fund charities, both national and international, which then support research and promote industry-favourable policy positions to leaders. We explore whether one industry funded charity, the International Life Sciences Institute (‘ILSI’), is the scientifically objective, non-lobby, internationally-credible body that it suggests it is, so as to aid the international health and scientific communities to judge ILSI’s outputs. Methods Between June 2015 and February 2018, U.S. Right to Know), a non-profit consumer and public health group, submitted five U.S. state Freedom of Information requests (FOIs) to explore ILSI engagement with industry, policy makers, and/or researchers, which garnered a total of 17,163 pages for analysis. Two researchers explored these documents to assess the activities and conduct of ILSI against its purported objectives. Results Within the received documents we identified instances of ILSI seeking to influence research, conferences, public messages, and policy, including instances of punishments for ILSI bodies failing to promote industry-favourable messaging. We identified ILSI promoting its agenda with national and international bodies to influence policy and law, causing the World Health Organization to withdraw from official relations with what it now considers a private sector entity. Conclusions ILSI seeks to influence individuals, positions, and policy, both nationally and internationally, and its corporate members deploy it as a tool to promote their interests globally. Our analysis of ILSI serves as a caution to those involved in global health governance to be wary of putatively independent research groups, and to practice due diligence before relying upon their funded studies and/or engaging in relationship with such groups.

Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. To better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screened 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but nine were seropositive in April for a period seroprevalence of >1%. Most seropositive children (8/10) were not suspected of having had COVID-19. The sera of most seropositive children had neutralizing activity, including one that neutralized at a dilution >1:18,000. Therefore, among children seeking medical care, the frequency of SARS-CoV-2 infection increased markedly during the early Seattle outbreak despite few positive viral tests.

Mineral mining is among the world's most hazardous occupations. It is especially dangerous in southern Africa, where mining activity is a leading cause of HIV and tuberculosis epidemics. Inside mines, silica dust exposure causes long-term pulmonary damage. Living conditions are often substandard; poorly ventilated living quarters facilitate tuberculosis and airborne disease spread, and high rates of alcohol and tobacco use compromise immune responses. Family segregation, a legacy of apartheid's migrational labor system, increases the likelihood of risky sexual activity. Sex trafficking in women increases risks of HIV and other sexually transmitted diseases, and labor trafficking in men through poorly regulated labor brokering impedes access to health care. Labor migration spreads mining hazards to rural, labor-supplying communities. Cross-border care is often inadequate or nonexistent, contributing to significantly greater rates of extensive and multi-drug resistance in miners, ex-miners, their families, and communities. Miners in high-income countries, working for the same transnational companies, do not experience elevated rates of death and disability. Cost-effective interventions can reduce HIV incidence through social housing, curb trafficking of high-risk groups, stop tuberculosis spread through screening and detection, and reduce drug resistance by standardizing cross-border care. Urgent action is needed to respond to mining's staggering, yet avoidable disease toll in sub-Saharan Africa.

BackgroundSex workers are disproportionately affected by HIV compared with the general population. Most studies of HIV risk among sex workers have focused on individual-level risk factors, with few studies assessing potential structural determinants of HIV risk. In this Article, we examine whether criminal laws around sex work are associated with HIV prevalence among female sex workers.MethodWe estimate cross-sectional, ecological regression models with data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation from the US State Department's Country Reports on Human Rights Practices and country-specific legal documents; the rule of law and gross-domestic product per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injecting drug use among sex workers. Although data from two countries include male sex workers, the numbers are so small that the findings here essentially pertain to prevalence in female sex workers.FindingsCountries that have legalised some aspects of sex work (n=17) have significantly lower HIV prevalence among sex workers than countries that criminalise all aspects of sex work (n=10; β=–2·09, 95% CI −0·80 to −3·37; p=0·003), even after controlling for the level of economic development (β=–1·86; p=0·038) and the proportion of sex workers who are injecting drug users (−1·93; p=0·026). We found that the relation between sex work policy and HIV among sex workers might be partly moderated by the effectiveness and fairness of enforcement, suggesting legalisation of some aspects of sex work could reduce HIV among sex workers to the greatest extent in countries where enforcement is fair and effective.InterpretationOur findings suggest that the legalisation of some aspects of sex work might help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair.

AbstractObjective:There are concerns that some non-profit organisations, financed by the food industry, promote industry positions in research and policy materials. Using Freedom of Information (FOI) requests, we test the proposition that the International Life Sciences Institute (ILSI), one prominent non-for profit in international health and nutrition research, promotes industry positions.Design:U.S. Right to Know filed five FOI from 2015 to 2018 covering communications with researchers at four US institutions: Texas A&M, University of Illinois, University of Colorado and North Carolina State University. It received 15 078 pages, which were uploaded to the University of California San Francisco’s Industry Documents Library. We searched the Library exploring it thematically for instances of: (1) funding research activity that supports industry interests; (2) publishing and promoting industry-sponsored positions or literature; (3) disseminating favourable material to decision makers and the public and (4) suppressing views that do not support industry.Results:Available emails confirmed that ILSI’s funding by corporate entities leads to industry influence over some of ILSI activities. Emails reveal a pattern of activity in which ILSI sought to exploit the credibility of scientists and academics to bolster industry positions and promote industry-devised content in its meetings, journal and other activities. ILSI also actively seeks to marginalise unfavourable positions.Conclusions:We conclude that undue influence of industry through third-party entities like ILSI requires enhanced management of conflicts of interest by researchers. We call for ILSI to be recognised as a private sector entity rather than an independent scientific non-profit, to allow for more appropriate appraisal of its outputs and those it funds.

Abstract:Background: Sex workers are disproportionately affected by HIV and other STIs compared with the general population. To date, most studies of HIV risk among sex workers focus on individual-level risk factors, with few studies evaluating potential structural determinants of HIV risk. In this paper we examine whether criminal laws around sex work are associated with HIV prevalence among sex workers.Method: To test our hypothesis, we estimate cross-sectional, ecological regression models using data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation on U.S. State Department's Country Reports on Human Rights Practices; the Rule of Law and GDP per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injection drug use among sex workers.Findings: We found that countries which have legalised some aspects of sex work (n = 10) have significantly lower HIV prevalence among sex workers than those which have not (n = 17) (β = -2.09, 95% CI: -0.80 to -3.37, p = 0.003), even after controlling for the level of economic development and the proportion of sex workers who are injecting drug users.