The joint determination of morbidity and vaccination in the spatiotemporal epidemiology of COVID-19

This paper examines the mutual dependence between COVID-19 morbidity and vaccination rollout. A theory of endogenous immunization is proposed in which the decision to become vaccinated varies directly with the risks of contagion, and the public self-selects into self-protection. Hence, COVID-19 morbidity varies inversely with vaccination rollout, and vaccination rollout varies directly with COVID-19 morbidity. The paper leverages the natural sequencing between morbidity and immunization to identify the causal order in the dynamics of this relationship. A modified SIR model is estimated using spatial econometric methods for weekly panel data for Israel at a high level of spatial granularity. Connectivity between spatial units is measured using physical proximity and a unique mobility-based measure. Spatiotemporal models for morbidity and vaccination rollout show that not only does morbidity vary inversely with vaccination rollout, vaccination rollout varies directly with morbidity. The utility of the model for public health policy targeting, is highlighted.

Agent-based simulation of COVID-19 containment measures: the case of lockdowns in cities

The effectiveness and political feasibility of COVID-19 containment measures such as lockdowns, are contentious. This stems in part from an absence of tools for their rigorous evaluation. Common epidemiological models such as the SEIR model generally lack the spatial resolution required for micro-level containment actions, the visualization capabilities for communicating measures such as localized lockdowns and the scenario-testing capabilities for assessing different alternatives. We present an individual-level ABM that generates geo-social networks animated by agent-agent and agent-building interactions. The model simulates real-world contexts and is demonstrated for the city of Jerusalem. Simulation outputs yield much useful information for evaluating the effectiveness of lockdowns. These include network-generated socio-spatial contagion chains for individual agents, dynamic building level contagion processes and neighborhood-level patterns of COVID-19 imports and exports useful in identifying super-spreader neighborhoods. The policy implications afforded by these various outputs are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12076-023-00336-w.

Cascades - Mapping the multi-disciplinary landscape in a post-pandemic world

This paper introduces the Special Issue on Cascading Effects in Disaster Risk Management. It reviews the contributions and highlights their multi-disciplinary interpretations of cascades. It proceeds to discuss whether the on-going unfolding of the COVID-19 pandemic illustrates the cascades metaphor.

Evaluation and management of vaginitis

OBJECTIVE

To evaluate recent advances in our understanding of the clinical relevance, diagnosis, and treatment of vaginal infections, and to determine an efficient and effective method of evaluating this clinical problem in the outpatient setting.

DATA SOURCES

Relevant papers on vaginitis limited to the English language obtained through a MEDLINE search for the years 1985 to 1997 were reviewed.

DATA SYNTHESIS

Techniques that enable the identification of the various strains of candida have helped lead to a better understanding of the mechanisms of recurrent candida infection. From this information a rationale for the treatment of recurrent disease can be developed. Bacterial vaginosis has been associated with complications, including upper genital tract infection, preterm delivery, and wound infection. Women undergoing pelvic surgery, procedures in pregnancy, or pregnant women at risk of preterm delivery should be evaluated for bacterial vaginosis to decrease the rate of complications associated with this condition. New, more standardized criteria for the diagnosis of bacterial vaginosis may improve diagnostic consistency among clinicians and comparability of study results. Use of topical therapies in the treatment of bacterial vaginosis are effective and associated with fewer side effects than systemic medication. Trichomonas vaginalis, although decreasing in incidence, has been associated with upper genital tract infection. Therapy of T. vaginalis infection has been complicated by an increasing incidence of resistance to metronidazole.

CONCLUSIONS

Vaginitis is a common medical problem in women that is associated with significant morbidity and previously unrecognized complications. Research in recent years has improved diagnostic tools as well as treatment modalities for all forms of vaginitis.

Bacon therapy and furuncular myiasis

OBJECTIVE

To evaluate a simple, noninvasive method for removing fly larvae from patients with furuncular myiasis.

DESIGN

Case series.

SETTING

Ambulatory office of a tertiary care center.

PATIENTS

Three patients who presented with Dermatobia hominis infestation.

INTERVENTION

The patients with D hominis infestation were treated with the application of bacon fat over the larval apertures.

MAIN OUTCOME MEASURE

Removal of intact larvae.

RESULTS

Within 3 hours of the application of bacon, the larvae had migrated sufficiently far out of the skin to be removed with tweezers. Ten larvae were removed with this method. There were no treatment failures or complications.

CONCLUSIONS

Furuncular myiasis will be seen more frequently in temperate areas as individuals travel to endemic areas. We describe the clinical characteristics of myiasis and a simple method of treatment that permits rapid diagnosis and cure.

Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus

Within the past 18 months, we have seen four cases of neurosyphilis at our institution (two of meningovascular syphilis, one of acute syphilitic meningitis, and one of asymptomatic neurosyphilis) in young homosexual men with serologic evidence of exposure to human immunodeficiency virus (HIV). Two of the four patients had neurosyphilis despite previous adequate therapy for early syphilis with benzathine penicillin. Meningovascular syphilis developed in one patient within four months after a primary infection, in a manner consistent with an accelerated course of syphilitic infection. These findings suggest the possibility that HIV infection may alter the natural course of syphilis because of the profound defects in cell-mediated immunity it causes. The possible potentiating effects of HIV on Treponema pallidum infection suggest the need for lumbar puncture in the evaluation of HIV-seropositive patients with syphilis, as well as modifications of the currently recommended treatment regimens for primary, secondary, and latent syphilis and neurosyphilis in this patient population. Neurosyphilis should probably be added to the growing list of infectious complications of the acquired immunodeficiency syndrome (AIDS) and may be the first such complication to appear.

Ophthalmoscopic and histologic findings in cytomegalovirus retinitis treated with BW-B759U

Recent reports have suggested a role for BW-B759U in the treatment of cytomegalovirus retinitis. The present study presents the ophthalmoscopic features in three treated patients, and examines the microscopic findings in the eyes of the first patient ever treated with BW-B759U for cytomegalovirus retinitis. Ophthalmoscopic findings of improvement on drug therapy included remission of perivascular infiltration, stabilization of the extent of the retinal area involved, and development of a pigmented chorioretinal scar in the involved area. Relapses occurred with cessation of therapy, and repeated courses of therapy were required. One patient developed a rhegmatogenous detachment with retinal breaks in an atrophic area of treated retinitis. Electron microscopic examination of the eyes of one patient disclosed the persistence of cytomegalovirus inclusions in retinal cells despite previous drug therapy. These findings suggest a virostatic action for BW-B759U.

Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome

We conducted virus-isolation studies on 56 specimens from the nervous system of 45 patients in order to determine whether human T-cell lymphotropic virus Type III (HTLV-III) is directly involved in the pathogenesis of the neurologic disorders frequently encountered in the acquired immunodeficiency syndrome (AIDS) and the AIDS-related complex. We recovered HTLV-III from at least one specimen from 24 of 33 patients with AIDS-related neurologic syndromes. In one patient, HTLV-III was isolated from the cerebrospinal fluid during acute aseptic meningitis associated with HTLV-III seroconversion. HTLV-III was also isolated from cerebrospinal fluid from six of seven patients with AIDS or its related complex and unexplained chronic meningitis. In addition, of 16 patients with AIDS-related dementia, 10 had positive cultures for HTLV-III in cerebrospinal fluid, brain tissue, or both. Furthermore, we cultured HTLV-III from the spinal cord of a patient with myelopathy and from the sural nerve of a patient with peripheral neuropathy. These findings suggest that HTLV-III is neurotropic, is capable of causing acute meningitis, is responsible for AIDS-related chronic meningitis and dementia, and may be the cause of the spinal-cord degeneration and peripheral neuropathy in AIDS and AIDS-related complex.

Treatment of cytomegalovirus retinitis with 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine

Cytomegalovirus infections can cause significant morbidity and mortality in immunosuppressed patients, and present antiviral agents have had little efficacy against these infections. We describe the use of an acyclic nucleoside 9-[2-hydroxy-1-(hydroxymethyl) ethoxy methyl]guanine (BW B759U), in the treatment of two patients with cytomegalovirus retinitis. The efficacy of this agent was evident, with healing of retinal lesions and resolution of viremia and viral shedding. BW B759U appears to be similar pharmacokinetically to intravenous acyclovir in terms of half-life, peak serum levels, and renal excretion.

Phenotypic properties of atypical lymphocytes in cytomegalovirus-induced mononucleosis

The phenotypic properties of the surface of the atypical lymphocytes seen in cytomegalovirus-induced (CMV) mononucleosis were evaluated. Mononuclear cells from peripheral blood were obtained from adult patients within seven to 35 days of the onset of acute CMV mononucleosis. Sheep red blood cell rosetting techniques were used to obtain populations depleted of, or enriched for, T cells. Cell populations were further purified for helper/inducer lymphocytes (T4), cytotoxic/suppressor lymphocytes (T8), or non-T-lymphocytes by monoclonal-antibody binding and by complement-lysis techniques. Cytocentrifuge preparations of the cell fractions were evaluated and atypical lymphocytes were identified by morphological characteristics. The appearance and disappearance of atypical lymphocytes paralleled and antedated the increase and subsequent decrease in T8 cells seen in these patients. A total of 69% +/- 22% of the atypical lymphocytes in the lymphocyte population were of the T8 phenotype, whereas 13% +/- 10% of the atypical lymphocytes were of the T4 phenotype and 18% +/- 13% were non-T lymphocytes. Thus, atypical lymphocytes in CMV mononucleosis reside predominantly, but not exclusively, in the T8 cell population.

Risk of nosocomial infection with human T-cell lymphotropic virus III (HTLV-III)

Infection with human T-cell lymphotropic virus III (HTLV-III) is closely linked to the acquired immunodeficiency syndrome (AIDS). We evaluated the risk of nosocomial infection with HTLV-III by testing for antibodies to HTLV-III among hospital employees, including victims of needle-stick exposure, endoscopists, pathologists, and laboratory workers. Assays for antibody against the virus were performed by enzyme-linked immunosorbent assay and electrophoretic (Western blot) techniques. Although all 22 of our patients with AIDS and 6 of 7 with AIDS-related complex were found to have antibodies to HTLV-III when both assays were employed, none of the 85 employees with nosocomial exposure to specimens from patients with AIDS were positive for HTLV-III antibody. These studies must be regarded as preliminary, but they suggest that when current hospital isolation procedures are employed, the risk of nosocomial transmission of HTLV-III is low.

Antineutrophil antibodies in infectious mononucleosis

Antineutrophil antibodies were detected in the serum of 12 of 14 patients with acute Epstein-Barr virus-induced infectious mononucleosis. These antibodies were present in two patients with mononucleosis and severe neutropenia, and in 10 patients with mononucleosis uncomplicated by severe neutropenia. Antineutrophil antibodies were not detected in serum from five patients with cytomegalovirus-induced mononucleosis, or five renal allograft recipients with primary or reactivation Epstein-Barr virus infection. This study suggests that antineutrophil antibodies are among those produced by the polyclonal activation induced by Epstein-Barr virus during acute infectious mononucleosis.