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Special Issue "Old and New Epidemiological Alerts: Prevention and Control of COVID-19, Candida auris, Measels, MDR and Other Infectious Diseases"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 33937

Special Issue Editors

Dr. Jadwiga Wojkowska-Mach
E-Mail Website
Guest Editor
Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Jagiellonian University, 31-121 Krakow, Poland
Interests: infection prevention and control; surveillance of healthcare-associated infection; surveillance of antimicrobial resistance; surveillance of antimicrobial use
Special Issues, Collections and Topics in MDPI journals
Dr. Maria Luisa Moro
E-Mail Website
Guest Editor
Agenzia Sanitaria e Sociale Regione Emilia-Romagna, Bologna, Italy
Interests: epidemiology; hygiene and public health; infection prevention in long term-care facilities; antibiotics consumption
Dr. Monika Chlebowicz
E-Mail Website
Guest Editor
Faculty of Medical Sciences, University of Groningen, 9713GZ Groningen, The Netherlands
Interests: molecular diagnostics of infectious diseases; microbiology; genomics; next generation sequencing; genotyping
Dr. Anna Różańska
E-Mail Website
Guest Editor
Jagiellonian University Medical College, Czysta Str. 18, 31-121 Krakow, Poland
Interests: infection prevention and epidemiology; multidrug resistant organisms; public health

Special Issue Information

Dear Colleagues,

Medicine, rapidly developing in all its branches, certainly has contributed to a longer and more pleasant human life. Having solved many major health problems, we still have to face some, and are discovering new ones. By this I mean, for instance, new aetiological factors of infectious diseases, such as the COVID-19, the Zika virus, Candida auris, or multidrug-resistant (MDR) microorganisms.

Some of the old problems are still recurring. The only infectious disease that has been successfully eradicated is smallpox, whereas other such diseases still pose a threat, which is well illustrated by the epidemic of measles in Europe since 2017. According to a report by the ECDC, large outbreaks with fatalities are ongoing in countries that had previously eliminated or interrupted endemic transmission. As we can see, even the diseases we thought we knew well can surprise us.

MDR microorganisms and healthcare-associated infections (HAIs) remain significant challenges, both in hospitals and in long-term care facilities. They may cause patients or residents to suffer from additional ailments, and sometimes result in death. The existing problem of MDR microorganisms and HAIs shows us that, in order to properly follow the primum non nocere principle in healthcare, we should take into account all of the epidemiological, biological, organizational, and social aspects of healthcare.

We need to better understand the vital role that infection prevention and control play in improving healthcare systems. That is why this Special Issue of the International Journal of Environmental Research and Public Health will be devoted to Old and New Epidemiological Alerts: COVID-19, Candida Auris, Measels, MDR, Epidemiology, and Prevention. You are most welcome to join the discussion.

Dr. Jadwiga Wojkowska-Mach
Dr. Maria Luisa Moro
Dr. Monika Chlebowicz
Dr. Anna Różańska
Guest Editors

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Keywords

  • infection prevention and control
  • surveillance of infections
  • epidemiology of infections
  • health policy
  • public health
  • COVID-19
  • Candida auris
  • multidrug-resistant microorganisms
  • Healthcare-associated infections

Published Papers (18 papers)

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Article
Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units
Int. J. Environ. Res. Public Health 2022, 19(12), 7544; https://doi.org/10.3390/ijerph19127544 - 20 Jun 2022
Viewed by 287
Abstract
Introduction: Patients in neurosurgical units are particularly susceptible to healthcare-associated infections (HAI) due to invasive interventions in the central nervous system. Materials and methods: The study was conducted between 2014 and 2019 in neurosurgery units in Poland. The aim of the study was [...] Read more.
Introduction: Patients in neurosurgical units are particularly susceptible to healthcare-associated infections (HAI) due to invasive interventions in the central nervous system. Materials and methods: The study was conducted between 2014 and 2019 in neurosurgery units in Poland. The aim of the study was to investigate the epidemiology and microbiology of HAIs and to assess the effectiveness of surveillance conducted in two hospital units. Both hospitals ran (since 2012) the unified prospective system, based on continuous surveillance of HAIs designed and recommended by the European Centre for Disease Prevention and Control (protocol version 4.3) in the Healthcare-Associated Infections Surveillance Network (HAI-Net). In study hospitals, HAIs were detected by the Infection Prevention Control Nurse (IPCN). The surveillance of healthcare infections in hospital A was based mainly on analysis of microbiological reports and telephone communication between the epidemiological nurse and the neurosurgery unit. HAI monitoring in hospital B was an outcome of daily personal communication between the infection prevention and control nurse and patients in the neurosurgery unit (HAI detection at the bedside) and assessment of their health status based on clinical symptoms presented by the patient, epidemiological definitions, microbiological and other diagnostic tests (e.g., imaging studies). In hospital A, HAI monitoring did not involve personal communication with the unit but was rather based on remote analysis of medical documentation found in the hospital database. Results: A total of 12,117 patients were hospitalized. There were 373 HAIs diagnosed, the general incidence rate was 3.1%. In hospital A, the incidence rate was 2.3%, and in hospital B: 4.8%. HAI types detected: pneumonia (PN) (n = 112, 0.9%), (urinary tract infection (UTI) (n = 108, 0.9%), surgical site infection (SSI) (n = 96, 0.8%), bloodstream infection (BSI) (n = 57, 0.5%), gastrointestinal system infection (GI) (n = 13, 0.1%), skin and soft tissue (SST) (n = 9, 0.1%). HAI with invasive devices: 44 ventilator-associated pneumonia (VAP) cases (45.9/1000 pds with ventilator); catheter-associated urinary tract infection (CA-UTI): 105 cases (2.7/1000 pds with catheter); central venous catheter (CVC-BSI): 18 cases (1.9/1000 pds with CVC). The greatest differences between studied units were in the incidence rate of PN (p < 0.001), UTI (p < 0.001), and SSI (p < 0.05). Conclusions: The way HAIs are diagnosed and qualified and the style of work of the infection control team may have a direct impact on the unit epidemiology with the application of epidemiological coefficients. Prospective surveillance run by the infection prevention and control nurse in hospital B could have been associated with better detection of infections expressed in morbidity, especially PN and UTI, and a lower risk of VAP. In hospital A, the lower incidence might have resulted from an inability to detect a UTI or BSI and less supervision of VAP. The present results require further profound research in this respect. Full article
Article
The Seroprevalence of SARS-CoV-2 Antibodies among HealthCare Workers in University Hospital in Krakow before the Era of Vaccination
Int. J. Environ. Res. Public Health 2022, 19(7), 4044; https://doi.org/10.3390/ijerph19074044 - 29 Mar 2022
Viewed by 510
Abstract
Background: Knowledge of occupational health is crucial to the safety of healthcare workers in the pandemic period. The aim of our study was the rating of SARS-CoV-2 seroprevalence in connection with selected demographic, social, and organizational factors, as well as the identification of [...] Read more.
Background: Knowledge of occupational health is crucial to the safety of healthcare workers in the pandemic period. The aim of our study was the rating of SARS-CoV-2 seroprevalence in connection with selected demographic, social, and organizational factors, as well as the identification of key elements determining the safety of HCWs and patients of the University Hospital in Krakow. Methods: This was a non-interventional, uncontrolled, open, single-center, cross-sectional online survey on the preparedness for the COVID-19 epidemic and the seroprevalence of medical and non-medical HCWs and students. Serum specimens from 1221 persons were tested using an immunoassay analyzer based on the ECLIA technique for the anti-SARS-CoV-2 antibodies IgM + IgG. Results: The total seroprevalence was 42.7%. In medical students it was 25.2%, while in physicians it was 43.4% and in nurses/midwives it was 48.1%. Of those who tested positive, 21.5% did not know their serological status. The use of personal protective equipment did not have any significant impact on the result of testing for anti-SARS-CoV-2 antibodies. The risk of developing the disease was not influenced by sex, professional work experience, workplace, or intensity of contact with the patient. Among the studied elements, only care of COVID-19 patients significantly increased the risk. The protective factor was starting work between the waves of the epidemic (June–September 2020). Conclusions: PPE is only one element of infection prevention and control—without other components, such as hand hygiene, it can be dangerous and contribute to self-infection. It is also very important to test healthcare workers. Not being aware of the COVID-19 status of HCWs poses a threat to other staff members, as well as patients and the family and friends of the infected. Thus, extreme caution should be applied when employing respirators with exhalation valves during the COVID-19 pandemic. Full article
Article
Post-Discharge Clostridioides difficile Infection after Arthroplasties in Poland, Infection Prevention and Control as the Key Element of Prevention of C. difficile Infections
Int. J. Environ. Res. Public Health 2022, 19(6), 3155; https://doi.org/10.3390/ijerph19063155 - 08 Mar 2022
Viewed by 539
Abstract
Clostridioides difficile is still one of the most common causes of hospital-acquired infectious diarrhea (CDI), and the incidence of CDI is one of the indicators that allows conclusions to be derived on the correctness of antibiotic administration. The objective of this observational study [...] Read more.
Clostridioides difficile is still one of the most common causes of hospital-acquired infectious diarrhea (CDI), and the incidence of CDI is one of the indicators that allows conclusions to be derived on the correctness of antibiotic administration. The objective of this observational study was the analysis of post-discharge CDI incidence in patients undergoing hip or knee arthroplasty, in order to specify optimum conditions for the surgical procedures and outpatient postoperative care. One-year observational study. Public Polish hospitals. Retrospective records for 83,525 surgery patients having undergone hip or knee arthroplasty were extracted from the Polish National Health Fund databases. CDI and/or antibiotic prescriptions in the 30 day post-surgery period were expressed per 1000 surgeries with antibiotic prescription on discharge or in ambulatory care, respectively. The CDI incidence rate was 34.4 per 10,000 patients, and 7.7 cases per 100,000 post-surgery patient-days. Patients who were prescribed at least one antibiotic were diagnosed with CDI more often than patients who had no antibiotic treatment (55.0/1000 patients vs. 1.8/1000 patients). In the multifactorial analysis, the following factors were significant: being at least 65 years of age, trauma as the cause of surgery, length of stay over 7 days, HAIs other than CDI and taking beta-lactams and/or quinolones but not macrolides in the post-discharge period. Postoperative antibiotic prescription in patients undergoing joint replacement surgery is the main risk factor for CDI. These observations indicate the necessity of improvement of infection control programs as the key factor for CDI prevention. Full article
Article
Circulation of Respiratory Viruses in Hospitalized Adults before and during the COVID-19 Pandemic in Brescia, Italy: A Retrospective Study
Int. J. Environ. Res. Public Health 2021, 18(18), 9525; https://doi.org/10.3390/ijerph18189525 - 09 Sep 2021
Cited by 3 | Viewed by 1110
Abstract
Different preventive public health measures were adopted globally to limit the spread of SARS-CoV-2, such as hand hygiene and the use of masks, travel restrictions, social distance actions such as the closure of schools and workplaces, case and contact tracing, quarantine and lockdown. [...] Read more.
Different preventive public health measures were adopted globally to limit the spread of SARS-CoV-2, such as hand hygiene and the use of masks, travel restrictions, social distance actions such as the closure of schools and workplaces, case and contact tracing, quarantine and lockdown. These measures, in particular physical distancing and the use of masks, might have contributed to containing the spread of other respiratory viruses that occurs principally by contact and droplet routes. The aim of this study was to evaluate the prevalence of different respiratory viruses (influenza viruses A and B, respiratory syncytial virus, parainfluenza viruses 1, 2, 3 and 4, rhinovirus, adenovirus, metapneumovirus and human coronaviruses) after one year of the pandemic. Furthermore, another aim was to evaluate the possible impact of these non-pharmaceutical measures on the circulation of seasonal respiratory viruses. This single center study was conducted between January 2017–February 2020 (pre-pandemic period) and March 2020–May 2021 (pandemic period). All adults >18 years with respiratory symptoms and tested for respiratory pathogens were included in the study. Nucleic acid detection of all respiratory viruses was performed by multiplex real time PCR. Our results show that the test positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus and human coronaviruses decreased with statistical significance during the pandemic. Contrary to this, for adenovirus the decrease was not statistically significant. Conversely, a statistically significant increase was detected for rhinovirus. Coinfections between different respiratory viruses were observed during the pre-pandemic period, while the only coinfection detected during pandemic was between SARS-CoV-2 and rhinovirus. To understand how the preventive strategies against SARS-CoV-2 might alter the transmission dynamics and epidemic patterns of respiratory viruses is fundamental to guide future preventive recommendations. Full article
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Article
Virulence and Drug-Resistance of Staphylococcus aureus Strains Isolated from Venous Ulcers in Polish Patients
Int. J. Environ. Res. Public Health 2021, 18(9), 4662; https://doi.org/10.3390/ijerph18094662 - 27 Apr 2021
Cited by 1 | Viewed by 1316
Abstract
Infected chronic venous ulcers (VUs) represent a major health problem. We analysed the aerobic microbiome in the VUs, the virulence, and drug-resistance of Staphylococcus aureus (SA) strains. Swabs from 143 outpatients and inpatients Polish subjects were collected. SA strains were tested for drug [...] Read more.
Infected chronic venous ulcers (VUs) represent a major health problem. We analysed the aerobic microbiome in the VUs, the virulence, and drug-resistance of Staphylococcus aureus (SA) strains. Swabs from 143 outpatients and inpatients Polish subjects were collected. SA strains were tested for drug sensitivity using a phenotyping method and for methicillin-resistant SA (MRSA) and macrolide-lincosamide-streptogramin B (MLSB) resistance using PCR. We analysed virulence genes, the genetic similarity of strains, and performed Staphylococcal cassette chromosome mec typing and Staphylococcal protein A typing. SA was isolated as a single one in 34.9% of cases, 31.5% paired with another pathogen, and 33.6% S. aureus combined with at least two other strains. The majority of SA isolates (68.5%) possessed the virulence lukE gene. Drug resistance was significantly common in hospitalised than in ambulatory patients (OR 3.8; 95%CI 1.8–7.91). MLSB (altogether in 19.6% isolates) were observed mostly in non-hospitalised patients (OR 9.1; 95%CI 1.17–71.02), while MRSA was detected in 11.9% of strains equally. Hospitalisation and patient’s age group (aged > 78.0 or < 54.5 years) were significant predictors of the multi-drug resistant SA (MDR-SA). Over 30% of the infected VUs were associated with multi-species biofilms and presence of potentially highly pathogenic microorganisms. Elderly hospitalised patients with chronic venous ulcers are prone to be infected with a MDR-SA. Full article
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Article
Patient Safety Related to Microbiological Contamination of the Environment of a Multi-Profile Clinical Hospital
Int. J. Environ. Res. Public Health 2021, 18(7), 3844; https://doi.org/10.3390/ijerph18073844 - 06 Apr 2021
Cited by 2 | Viewed by 1198
Abstract
Nosocomial infections pose a serious burden for hospitals, patients, and the entire society. The aim of the study was to assess the microbiological cleanliness of the hospital environment through quantitative and qualitative analysis of microbiological contamination of air and surfaces in inpatient treatment [...] Read more.
Nosocomial infections pose a serious burden for hospitals, patients, and the entire society. The aim of the study was to assess the microbiological cleanliness of the hospital environment through quantitative and qualitative analysis of microbiological contamination of air and surfaces in inpatient treatment facilities, based on the example of a large clinical hospital in Poland. Data were collected between 2012 and 2018 in premises of a large teaching hospital in Gdansk using the sedimentation method and the impact method using the Aerideal apparatus (Biomerieux). In the analyzed clinical center, the microbiological cleanliness tests in most of the hospital rooms in the analyzed period showed an acceptable number of saprophytic microorganisms. Of all the tested samples, 1159 (21.8%) were positive, indicating the presence of microorganisms in the tested sample. Species potentially pathogenic for hospital patients were identified, constituting 20.8% of all positive samples (4.6% of all samples). Significantly higher proportion of microorganisms potentially dangerous to patients were isolated from sanitary facilities. Due to the potentially pathogenic microorganisms detected in the tested samples, the authors suggest that in the analyzed hospital, the areas requiring a specific level of microbiological purity should be designated and described, with [specifically] defined cleaning and disinfection protocols. Full article
Article
Prevalence and Risk Factors of Infection in the Representative COVID-19 Cohort Munich
Int. J. Environ. Res. Public Health 2021, 18(7), 3572; https://doi.org/10.3390/ijerph18073572 - 30 Mar 2021
Cited by 22 | Viewed by 3121
Abstract
Given the large number of mild or asymptomatic SARS-CoV-2 cases, only population-based studies can provide reliable estimates of the magnitude of the pandemic. We therefore aimed to assess the sero-prevalence of SARS-CoV-2 in the Munich general population after the first wave of the [...] Read more.
Given the large number of mild or asymptomatic SARS-CoV-2 cases, only population-based studies can provide reliable estimates of the magnitude of the pandemic. We therefore aimed to assess the sero-prevalence of SARS-CoV-2 in the Munich general population after the first wave of the pandemic. For this purpose, we drew a representative sample of 2994 private households and invited household members 14 years and older to complete questionnaires and to provide blood samples. SARS-CoV-2 seropositivity was defined as Roche N pan-Ig ≥ 0.4218. We adjusted the prevalence for the sampling design, sensitivity, and specificity. We investigated risk factors for SARS-CoV-2 seropositivity and geospatial transmission patterns by generalized linear mixed models and permutation tests. Seropositivity for SARS-CoV-2-specific antibodies was 1.82% (95% confidence interval (CI) 1.28–2.37%) as compared to 0.46% PCR-positive cases officially registered in Munich. Loss of the sense of smell or taste was associated with seropositivity (odds ratio (OR) 47.4; 95% CI 7.2–307.0) and infections clustered within households. By this first population-based study on SARS-CoV-2 prevalence in a large German municipality not affected by a superspreading event, we could show that at least one in four cases in private households was reported and known to the health authorities. These results will help authorities to estimate the true burden of disease in the population and to take evidence-based decisions on public health measures. Full article
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Article
Compliance with Standard Precautions and Its Relationship with Views on Infection Control and Prevention Policy among Healthcare Workers during COVID-19 Pandemic
Int. J. Environ. Res. Public Health 2021, 18(7), 3420; https://doi.org/10.3390/ijerph18073420 - 25 Mar 2021
Cited by 6 | Viewed by 2229
Abstract
Background: Standard precautions prevent the spread of infections in healthcare settings. Incompliance with infection control guidelines of healthcare workers (HCWs) may increase their risk of exposure to infectious disease, especially under pandemics. The purpose of this study was to assess the level [...] Read more.
Background: Standard precautions prevent the spread of infections in healthcare settings. Incompliance with infection control guidelines of healthcare workers (HCWs) may increase their risk of exposure to infectious disease, especially under pandemics. The purpose of this study was to assess the level of compliance with the infection prevention and control practices among HCWs in different healthcare settings and its relationship with their views on workplace infection control measures during the COVID-19 pandemic. Methods: Nurses in Hong Kong were invited to respond to a cross-sectional online survey, in which their views on workplace infection and prevention policy, compliance with standard precautions and self-reported health during pandemics were collected. Results: The respondents were dissatisfied with workplace infection and prevention policy in terms of comprehensiveness (62%), clarity (64%), timeliness (63%), and transparency (60%). For the protective behavior, the respondents did not fully comply with the standard precautions when they were involved in medical care. Their compliance was relatively low when having proper patient handling (54%) and performing invasive procedures (46%). A multivariate analysis model proved that the level of compliance of the standard precautions was positively associated with the satisfaction on infection control and prevention policy among high risk group (0.020; 95% CI: 0.005–0.036), while older respondents had higher level of compliance among the inpatient and outpatient groups (coefficient range: 0.065–0.076). The higher level of compliance was also significantly associated with working in designated team and having chronic condition of the respondents among high-risk and inpatient groups. Conclusions: Standard precautions are the most important elements to reduce cross-transmission among HCWs and patients while the satisfaction on infection control and prevention policy would increase the compliance among the high-risk group. An overall suboptimal compliance and poor views on the infection prevention and control guidelines is a warning signal to healthcare system especially during pandemics. Full article
Article
Healthcare-Associated Laboratory-Confirmed Bloodstream Infections—Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland
Int. J. Environ. Res. Public Health 2021, 18(5), 2785; https://doi.org/10.3390/ijerph18052785 - 09 Mar 2021
Cited by 4 | Viewed by 1261
Abstract
Introduction: Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. Objectives: The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among [...] Read more.
Introduction: Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. Objectives: The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. Patients and methods: Data on 4218 LC-BSIs were collected between 2016–2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. Results: Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. Conclusions: The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis. Full article
Article
Prevalence and Antimicrobial Susceptibility Profiles of Microorganisms Associated with Lower Reproductive Tract Infections in Women from Southern Poland—Retrospective Laboratory-Based Study
Int. J. Environ. Res. Public Health 2021, 18(1), 335; https://doi.org/10.3390/ijerph18010335 - 05 Jan 2021
Cited by 7 | Viewed by 1962
Abstract
Objective: Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections. The aim of the study was to analyze the etiological factors of the vaginal dysbacteriosis, and [...] Read more.
Objective: Female infections affecting the genital tract include sexually transmitted diseases, endogenous infections such as vulvovaginal candidiasis, bacterial vaginosis (BV) or aerobic vaginitis (AV) and healthcare-associated infections. The aim of the study was to analyze the etiological factors of the vaginal dysbacteriosis, and the antimicrobial susceptibility of the dominant bacterial and fungal infections in different age groups of outpatient women from the Silesian Region. Materials and methods: A retrospective laboratory-based multi-center study encompassed 4994 women of different ages in Silesian Voivodeship, in the south of Poland; patients who had vaginal swabs collected as per physicians’ orders during the period from 1 January 2017 until 30 June 2018 were included in the study. The inclusion criteria were: non-hospitalized female, aged ≤80, with suspected vulvovaginal candidiasis or bacterial vaginosis and clinical sings of infections. Results: Gram-positive cocci were the ones most often isolated: Enterococcus faecalis (29.2%) and Streptoccoccus agalactiae (13.1%), followed by bacilli from the Enterobacteriaceae group, including Escherichia coli (26.3%). The presence of Streptococcus agalactiae was confirmed in 13.1%, slightly more often in the 45–80 age group, and Gardnerella vaginalis in 6.4%, most often in women aged 15–24. The prevalence of yeast-like infections was 24.3%, Candida albicans accounted for 78.3%, whereas among C. non-albicans spp.—C. glabrata dominated (14.9%) followed by C. parapsilosis (3.8%). The highest resistance was observed only in Streptococcus agalactiae as the MLSB mechanism (Macrolide-lincosamide-streptogramin B) was identified in 38.6% of strains. The prevalence of vulvovaginal candidiasis was 24.3%, the highest in women aged 15–44. Conclusions: Drug resistance in studied vulvovaginitis was associated only with Streptococcus agalactiae. A high proportion of yeast-like aetiology was found, probably associated with recurrent infections. In the analyzed cases only the Amsel criteria and culture methods were used for diagnosis without preparations and microbiological Nugent criteria. Full article
Article
Correlation between COVID-19 Morbidity and Mortality Rates in Japan and Local Population Density, Temperature, and Absolute Humidity
Int. J. Environ. Res. Public Health 2020, 17(15), 5477; https://doi.org/10.3390/ijerph17155477 - 29 Jul 2020
Cited by 48 | Viewed by 3437
Abstract
This study analyzed the morbidity and mortality rates of the coronavirus disease (COVID-19) pandemic in different prefectures of Japan. Under the constraint that daily maximum confirmed deaths and daily maximum cases should exceed 4 and 10, respectively, 14 prefectures were included, and cofactors [...] Read more.
This study analyzed the morbidity and mortality rates of the coronavirus disease (COVID-19) pandemic in different prefectures of Japan. Under the constraint that daily maximum confirmed deaths and daily maximum cases should exceed 4 and 10, respectively, 14 prefectures were included, and cofactors affecting the morbidity and mortality rates were evaluated. In particular, the number of confirmed deaths was assessed, excluding cases of nosocomial infections and nursing home patients. The correlations between the morbidity and mortality rates and population density were statistically significant (p-value < 0.05). In addition, the percentage of elderly population was also found to be non-negligible. Among weather parameters, the maximum temperature and absolute humidity averaged over the duration were found to be in modest correlation with the morbidity and mortality rates. Lower morbidity and mortality rates were observed for higher temperature and absolute humidity. Multivariate linear regression considering these factors showed that the adjusted determination coefficient for the confirmed cases was 0.693 in terms of population density, elderly percentage, and maximum absolute humidity (p-value < 0.01). These findings could be useful for intervention planning during future pandemics, including a potential second COVID-19 outbreak. Full article
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Article
Epidemiology of Shiga Toxin-Producing Escherichia coli Infections in Southern Italy after Implementation of Symptom-Based Surveillance of Bloody Diarrhea in the Pediatric Population
Int. J. Environ. Res. Public Health 2020, 17(14), 5137; https://doi.org/10.3390/ijerph17145137 - 16 Jul 2020
Cited by 5 | Viewed by 2424
Abstract
Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the [...] Read more.
Shiga toxin-producing Escherichia coli (STEC) infections result in a significant public health impact because of the severity of the disease that, in young children especially, can lead to hemolytic–uremic syndrome (HUS). A rise in the number of HUS cases was observed in the Apulia region of Italy from 2013 to 2017, and so, in 2018, a symptom-based surveillance system for children with bloody diarrhea (BD) was initiated in order to detect and manage STEC infections. The objective of the study was to describe the epidemiology of STEC infections in children from June 2018 to August 2019. Children <15 years old with BD were hospitalized and tested for STEC. Real-time PCR for virulence genes (stx1, stx2, eae) and serogroup identification tests were performed on stool samples/rectal swabs of cases. STEC infection was detected in 87 (10.6%) BD cases. The median age of STEC cases was 2.7 years, and 60 (68.9%) were <4. Of these 87 cases, 12 (13.8%) came from households with diarrhea. The reporting rate was 14.2/100,000, with the highest incidence in cases from the province of Bari (24.2/100,000). Serogroups O26 and O111 were both detected in 22/87 (25.3%) cases. Co-infections occurred in 12.6% of cases (11/87). Twenty-nine STEC were positive for stx1, stx2, and eae. Five cases (5.7%) caused by O26 (n = 2), O111 (n = 2), and O45 (n = 1) developed into HUS. A risk-oriented approach based on the testing of children with BD during the summer may represent a potentially beneficial option to improve the sensitivity of STEC surveillance, not only in Italy but also in the context of Europe as a whole. Full article
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Article
Characteristics of and Public Health Emergency Responses to COVID-19 and H1N1 Outbreaks: A Case-Comparison Study
Int. J. Environ. Res. Public Health 2020, 17(12), 4409; https://doi.org/10.3390/ijerph17124409 - 19 Jun 2020
Cited by 11 | Viewed by 2235
Abstract
Background: Recently, the novel coronavirus disease (COVID-19) has already spread rapidly as a global pandemic, just like the H1N1 swine influenza in 2009. Evidences have indicated that the efficiency of emergency response was considered crucial to curb the spread of the emerging infectious [...] Read more.
Background: Recently, the novel coronavirus disease (COVID-19) has already spread rapidly as a global pandemic, just like the H1N1 swine influenza in 2009. Evidences have indicated that the efficiency of emergency response was considered crucial to curb the spread of the emerging infectious disease. However, studies of COVID-19 on this topic are relatively few. Methods: A qualitative comparative study was conducted to compare the timeline of emergency responses to H1N1 (2009) and COVID-19, by using a set of six key time nodes selected from international literature. Besides, we also explored the spread speed and peak time of COVID-19 and H1N1 swine influenza by comparing the confirmed cases in the same time interval. Results: The government’s entire emergency responses to the epidemic, H1N1 swine influenza (2009) completed in 28 days, and COVID-19 (2019) completed in 46 days. Emergency responses speed for H1N1 was 18 days faster. As for the epidemic spread speed, the peak time of H1N1 came about 4 weeks later than that of COVID-19, and the H1N1 curve in America was flatter than COVID-19 in China within the first four months after the disease emerged. Conclusions: The speed of the emergency responses to H1N1 was faster than COVID-19, which might be an important influential factor for slowing down the arrival of the peak time at the beginning of the epidemic. Although COVID-19 in China is coming to an end, the government should improve the public health emergency system, in order to control the spread of the epidemic and lessen the adverse social effects in possible future outbreaks. Full article
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Article
Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties
Int. J. Environ. Res. Public Health 2020, 17(9), 3167; https://doi.org/10.3390/ijerph17093167 - 02 May 2020
Cited by 8 | Viewed by 1330
Abstract
Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. Material and methods: The study was conducted [...] Read more.
Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. Material and methods: The study was conducted in 2012–2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). Results: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. Conclusions: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety. Full article
Article
Development of an Assessment Method for Investigating the Impact of Climate and Urban Parameters in Confirmed Cases of COVID-19: A New Challenge in Sustainable Development
Int. J. Environ. Res. Public Health 2020, 17(8), 2801; https://doi.org/10.3390/ijerph17082801 - 18 Apr 2020
Cited by 44 | Viewed by 4097
Abstract
Sustainable development has been a controversial global topic, and as a complex concept in recent years, it plays a key role in creating a favorable future for societies. Meanwhile, there are several problems in the process of implementing this approach, like epidemic diseases. [...] Read more.
Sustainable development has been a controversial global topic, and as a complex concept in recent years, it plays a key role in creating a favorable future for societies. Meanwhile, there are several problems in the process of implementing this approach, like epidemic diseases. Hence, in this study, the impact of climate and urban factors on confirmed cases of COVID-19 (a new type of coronavirus) with the trend and multivariate linear regression (MLR) has been investigated to propose a more accurate prediction model. For this propose, some important climate parameters, including daily average temperature, relative humidity, and wind speed, in addition to urban parameters such as population density, were considered, and their impacts on confirmed cases of COVID-19 were analyzed. The analysis was performed for three case studies in Italy, and the application of the proposed method has been investigated. The impacts of parameters have been considered with a delay time from one to nine days to find out the most suitable combination. The result of the analysis demonstrates the effectiveness of the proposed model and the impact of climate parameters on the trend of confirmed cases. The research hypothesis approved by the MLR model and the present assessment method could be applied by considering several variables that exhibit the exact delay of them to new confirmed cases of COVID-19. Full article
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Review

Jump to: Research, Other

Review
An Overview of Thermal Infrared Imaging-Based Screenings during Pandemic Emergencies
Int. J. Environ. Res. Public Health 2021, 18(6), 3286; https://doi.org/10.3390/ijerph18063286 - 22 Mar 2021
Cited by 15 | Viewed by 2032
Abstract
Infrared thermal imaging (IRI) is a contact-less technology able to monitor human skin temperature for biomedical applications and in real-life contexts. Its capacity to detect fever was exploited for mass screening during past epidemic emergencies as well as for the current COVID-19 pandemic. [...] Read more.
Infrared thermal imaging (IRI) is a contact-less technology able to monitor human skin temperature for biomedical applications and in real-life contexts. Its capacity to detect fever was exploited for mass screening during past epidemic emergencies as well as for the current COVID-19 pandemic. However, the only assessment of fever may not be selective for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Hence, novel approaches for IRI data analysis have been investigated. The present review aims to describe how IRI have been employed during the last epidemics, highlighting the potentialities and the limitations of this technology to contain the contagions. Specifically, the methods employed for automatic face recognition and fever assessment and IRI’s performances in mass screening at airports and hospitals are reviewed. Moreover, an overview of novel machine learning methods for IRI data analysis, aimed to identify respiratory diseases, is provided. In addition, IRI-based smart technologies developed to support the healthcare during the COVID-19 pandemic are described. Finally, relevant guidelines to fully exploit IRI for COVID-19 identification are defined, to improve the effectiveness of IRI in the detection of the SARS-CoV-2 infection. Full article
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Other

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Commentary
Measles and Rubella during COVID-19 Pandemic: Future Challenges in Japan
Int. J. Environ. Res. Public Health 2021, 18(1), 9; https://doi.org/10.3390/ijerph18010009 - 22 Dec 2020
Cited by 5 | Viewed by 2116
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted essential health services. Simultaneously, it has created opportunities for citizens to raise awareness of personal hygiene, mask wearing, and other preventive measures. This brief report aims to clarify the epidemiological trends of measles and [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted essential health services. Simultaneously, it has created opportunities for citizens to raise awareness of personal hygiene, mask wearing, and other preventive measures. This brief report aims to clarify the epidemiological trends of measles and rubella in Japan and to explore future challenges for controlling these diseases during and after the COVID-19 pandemic. Although Japan eliminated measles in 2015, the number of measles patients has gradually increased since then, and reached 744 in 2019. In the 2010s, Japan experienced two large rubella epidemics, and the majority of the patients were reported in Tokyo and other metropolitan areas. While the transmission of measles and rubella seems to be suppressed during the COVID-19 pandemic, closing the gap in routine childhood vaccination will be challenging in any country. Moreover, supplementary immunization campaigns for adults have also been disrupted, and they must be invigorated. While the pandemic has a devastating effect on a global scale, it should be utilized as a good opportunity to regain faith in vaccines, implement an evidence-based vaccination policy, and strengthen international cooperation. Full article
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Brief Report
COVID-19 Pandemic and the Crisis of Health Systems: The Experience of the Apulia Cancer Network and of the Comprehensive Cancer Center Istituto Tumori “Giovanni Paolo II” of Bari
Int. J. Environ. Res. Public Health 2020, 17(8), 2763; https://doi.org/10.3390/ijerph17082763 - 16 Apr 2020
Cited by 6 | Viewed by 1703
Abstract
On 11 March 2020, the World Health Organization declared a new disease caused by a novel virus characterized by rapid human-to-human transmission and named severe acute respiratory syndrome coronoavirus-2 (SARS-CoV-2) a pandemic. In terms of this ongoing international scenario, we report the situation [...] Read more.
On 11 March 2020, the World Health Organization declared a new disease caused by a novel virus characterized by rapid human-to-human transmission and named severe acute respiratory syndrome coronoavirus-2 (SARS-CoV-2) a pandemic. In terms of this ongoing international scenario, we report the situation in Apulia, a region of southern Italy that, as of April 2, has not yet been overwhelmed by this health emergency. In particular, we consider the care models that have been adopted, especially those that manage the requests of cancer patients. Full article
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