BACKGROUND: Norovirus is a major cause of endemic acute gastroenteritis (AGE) worldwide. We described the epidemiology, risk factors, and genotypic distribution of noroviruses among hospitalized patients of all ages in Bangladesh. METHODS: From March 2018 to October 2021, 1250 AGE case patients and controls (age, sex, season, and site matched) were enrolled at 10 hospitals. Demographic and clinical information was collected; real-time reverse-transcriptase polymerase chain reaction (RT-PCR) used to test stool specimens, and positive samples were genotyped. RESULTS: Norovirus was detected in 9% of cases (111 of 1250) and 15% (182 of 1250) of controls. Eighty-two percent of norovirus-positive cases were in children <5 years old. Norovirus-positive AGE hospitalizations occurred year-round, with peaks in April and October. Risk factors for norovirus included age <5 years (adjusted odds ratio, 3.1 [95% confidence interval, 1.9-5.2]) and exposure to a patient with AGE in the 10 days before enrollment (3.8 [1.9-7.2]). GII.3[P16] and GII.4 Sydney[P16] were the predominant genotypes. CONCLUSIONS: We highlight the burden of norovirus in hospital settings. Young age and recent exposure to a patient with AGE were risk factors for norovirus. A high prevalence of norovirus among controls might represent asymptomatic reinfections or prolonged shedding from a previous infection; carefully designed longitudinal studies are needed to improve our understanding of norovirus infections in Bangladesh.

BACKGROUND: The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) get tested annually for urethral and rectal chlamydia (CT) and gonorrhea (NG), and pharyngeal NG. There are no national recommendations to screen women and heterosexual men at extragenital sites. We assessed extragenital CT/NG screening among men and women at Louisiana's Parish Health Units (PHU). METHODS: The Louisiana STD/HIV/Hepatitis Program piloted extragenital screening at four PHUs in February 2016 and expanded to eleven PHUs in 2017. Sexual histories were used to identify gender of sex partners and exposed sites. Due to billing restrictions, up to two anatomical sites were tested for CT/NG. RESULTS: From February 2016-June 2019, 70,895 urogenital and extragenital specimens (56,086 urogenital, 13,797 pharyngeal and 1,012 rectal) were collected from 56,086 patients. Pharyngeal CT positivity was 160/7,868 (2.0%) among women, 54/4,838 (1.1%) among MSW (men who have sex with women) and 33/1,091 (3.0%) among MSM. Rectal CT positivity was 51/439 (11.6%) among women and 95/573 (16.6%) among MSM. Pharyngeal NG positivity was 299/7,868 (3.8%) among women, 222/4,838 (4.6%) among MSW and 97/1,091 (8.9%) among MSM. Rectal NG positivity was 20/439 (4.6%) among women and 134/573 (23.4%) among MSM.Urogenital-only screening would have missed: among women,173/3,923 (4.4%) CT and 227/1,480 (15.3%) NG infections; among MSW, 26/2,667 (1%) CT and 149/1,709 (8.7%) NG infections; and among MSM, 116/336 (34.5%) CT and 127/413 (42.1%) NG infections. CONCLUSIONS: Many CT/NG infections would have been missed with urogenital-only screening. MSM had much higher extragenital infection rates than women and MSW.

Introduction: A disproportionately high number of deadly crash-incidents involve fire-tanker rollovers during emergency response driving. Most of these rollover incidents occur at dangerous horizontal curves (“curves”) due to unsafe speed. This study examined the effects of a curve speed warning system (CSWS) on fire tanker drivers’ emergency response behavior to develop system improvement suggestions. Method: Twenty-four firefighters participated in driving tests using a simulator. A fire tanker model, carrying a full tank of water, was used in emergency driving tests performed with and without CSWS. The CSWS was designed using the algorithm for passenger vehicles with a few initial modifications considering the unique requirements of heavy fire tanker and emergency driving. Results: The results indicated that the CSWS was effective in issuing preemptive warnings when the drivers were approaching curves with unsafe speed during emergency response. Warnings occurred more frequently at curves with smaller radius. Although the CSWS improved driving performance, it did not significantly reduce the number of rollover events. A detailed analysis of the rollover events provided suggestions for improvement of CSWS algorithms. Conclusions: To further improve the CSWS algorithm, the following may be considered: including increased safety speed margin below the rollover critical speed, moving the speed warning trigger from the curve apex to the curve entry point, extending the safe speed-control zone to cover the entire curve, and employing artificial intelligence to accommodate individual driving styles. Practical Applications: Fire tankers continue to be at increased risk of rollover during emergency response due to unsafe negotiation of dangerous curves. Development and use of advanced driver assist systems such as CSWS evaluated in this study may be an effective strategy to prevent deadly rollover crash-incidents. The knowledge generated by this study will be useful for system designers to improve the CSWS specifically designed for heavy emergency vehicles. © 2022

Nipah virus (NiV) is an emerging zoonotic virus causing outbreaks of encephalitis and respiratory illnesses in humans, with high mortality. NiV is considered endemic in Bangladesh and Southeast Asia. There are no licensed vaccines against NiV. This study aimed at predicting a dual-antigen multi-epitope subunit chimeric vaccine against surface-glycoproteins G and F of NiV. Targeted proteins were subjected to immunoinformatics analyses to predict antigenic B-cell and T-cell epitopes. The proposed vaccine designs were implemented based on the conservancy, population coverage, molecular docking, immune simulations, codon adaptation, secondary mRNA structure, and in-silico cloning. Total 40 T and B-cell epitopes were found to be conserved, antigenic (vaxijen-value > 0.4), non-toxic, non-allergenic, and human non-homologous. Of 12 hypothetical vaccines, two (NiV_BGD_V1 and NiV_BGD_V2) were strongly immunogenic, non-allergenic, and structurally stable. The proposed vaccine candidates show a negative Z-score (- 6.32 and - 6.67) and 83.6% and 89.3% of most rama-favored regions. The molecular docking confirmed the highest affinity of NiV_BGD_V1 and NiV_BGD_V2 with TLR-4 (ΔG = - 30.7) and TLR8 (ΔG = - 20.6), respectively. The vaccine constructs demonstrated increased levels of immunoglobulins and cytokines in humans and could be expressed properly using an adenoviral-based pAdTrack-CMV expression vector. However, more experimental investigations and clinical trials are needed to validate its efficacy and safety. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10989-022-10431-z.

BACKGROUND: Approximately 20% of chlamydia (CT) and gonorrhea (GC) cases in Louisiana are diagnosed at Parish Health Units (PHU). Patient notification of CT and GC test results involves nurses' phone calls and letters to positive patients, which is time consuming and inefficient. METHODS: In December 2018, electronic results notification was implemented in Caddo PHU using Chexout software to notify enrolled patients via text or email when test results are ready to view in a patient portal. We compared the timeliness of GC/CT results notification and treatment pre- (December 2017-November 2018) and post- (December 2018-November 2019) Chexout implementation. A random sample of patients were interviewed to assess acceptability. RESULTS: During December 2018 - November 2019, 5,432 patients were tested for CT/GC, 3,924 (72%) enrolled in Chexout, and notifications were sent to 3,884 (99%). Among CT positives, 472/568 (83%) viewed results in the portal compared to 2,451/3,356 (73%) CT negatives. Among GC positives, 300/353 (85%) viewed results compared to 2,657/3,571 (74%) GC negatives. Treatment success for CT improved from 493/670 (74%) to 506/568 (89%) and for GC from 332/409 (81%) to 325/353 (92%). Mean time to treatment decreased for CT (13.4 to 10.7 days) and GC (11.3 to 9.2 days). Enrolled patients found Chexout notification satisfactory 168/169 (99%) and easy to use 130/141 (92%). Reasons for declining electronic notification included lack of personal cell phone 55/86 (64%) and confidentiality concerns 42/86 (49%). CONCLUSIONS: Electronic messaging decreased time to notification and increased treatment success. Nurses spent less time notifying patients leaving more time for patient care.

Syphilis rates have continued to rise in the United States. Florida and Louisiana consistently report high numbers of cases. We evaluated rates of reinfection to see if frequent rescreening might lead to earlier treatment and prevent infections. All syphilis records of all stages for males and females aged 15-70 years from the Florida and Louisiana Departments of Health surveillance databases 2000-2018 were evaluated. The first episode of syphilis during this period was considered the initial diagnosis for each person. Demographics of cases and repeaters (individuals reported with two or more cases of syphilis) were examined. Percentages of syphilis cases from repeaters by year were calculated as were percentages from HIV+ males. During 2000-2018, 124,827 syphilis cases were reported from 107,405 individuals: 73,811 (68.7%) males; 33,594 (31.3%) females. There were 12,545 individuals (repeaters) with two or more syphilis diagnoses (n = 17,422 cases; range, 2-10). From 2010 to 2018, repeaters accounted for steadily increasing percentage of all syphilis reported: 2010 (11%), 2013 (16%), 2015 (20%), and 2018 (26%). Among HIV+ male cases the percentage from repeaters also increased: 2010 (28%), 2013 (35%), 2015 (42%), and 2018 (50%). In 2018, 19% of all cases (n = 2455) were from HIV+ males who had a previous syphilis diagnosis. Among HIV+ males diagnosed with syphilis in 2015, 34% had a repeat syphilis diagnosis within 3 years. Most syphilis diagnosed in Florida and Louisiana was among persons infected for the first time. However, some subgroups could possibly benefit from more frequent screening. Males living with HIV who had a prior syphilis diagnosis were at very high risk of repeat infection.

A curve speed warning system (CSWS) for firetrucks was developed and tested in this study. The CSWS algorithm was developed based on guidelines in the public domain for general vehicles and modified for firetrucks for their configuration and emergency driving. Twenty-four firefighters participated in the test in a driving simulator. The results show that the CSWS was effective in issuing preemptive warnings when the drivers were approaching curves with unsafe speed during emergency responses. Drivers reduced their driving speed at curve approaching and entering phases for most challenging curves, without affecting the overall time in completing the test route. Drivers had reduced number of severe braking and decreased average in-curve distance traveled over the safety speed limits, when the CSWS was in use. Drivers also rated the CSWS as assisting, effective and useful. In summary, the CSWS can enhance firetruck safety during emergency driving without sacrificing drivers' precious response time.

BACKGROUND: Nipah virus (NiV) infection, often fatal in humans, is primarily transmitted in Bangladesh through consumption of date palm sap contaminated by Pteropus bats. Person to person transmission is also common and increases the concern of large outbreaks. This study aimed to characterize the molecular epidemiology, phylogenetic relationship, and evolution of the nucleocapsid gene (N gene) of NiV. METHODS: We conducted molecular detection, genetic characterization and Bayesian time-scale evolution analyses of NiV using pooled Pteropid bat roost urine samples from an outbreak area in 2012 and archived RNA samples from NiV case-patients identified during 2012-2018 in Bangladesh. RESULTS: NiV-RNA was detected in 19% (38/456) of bat roost urine samples and among them; nine N gene sequences were recovered. We also retrieved sequences from 53% (21 out of 39) of archived RNA samples from patients. Phylogenetic analysis revealed that all Bangladeshi strains belonged to NiV-BD genotype and had an evolutionary rate of 4.64 × 10(-4) substitutions/site/year. The analyses suggested that the strains of NiV-BD genotype diverged around1995 and formed two sub-lineages. CONCLUSION: This analysis provides further evidence that the NiV strains of the Malaysian and Bangladesh genotypes departed recently and continues to evolve. More extensive surveillance of NiV in bats and human will be helpful to explore strain diversity and virulence potential to infect humans via direct or person-to-person virus transmission.

This manuscript describes the Child Health and Mortality Prevention Surveillance (CHAMPS) network approach to pathologic evaluation of minimally invasive tissue sampling (MITS) specimens, including guidelines for histopathologic examination and further diagnostics with special stains, immunohistochemistry, and molecular testing, as performed at the CHAMPS Central Pathology Laboratory (CPL) at the Centers for Disease Control and Prevention, as well as techniques for virtual discussion of these cases (telepathology) with CHAMPS surveillance locations. Based on review of MITS from the early phase of CHAMPS, the CPL has developed standardized histopathology-based algorithms for achieving diagnoses from MITS and telepathology procedures in conjunction with the CHAMPS sites, with the use of whole slide scanners and digital image archives, for maximizing concurrence and knowledge sharing between site and CPL pathologists. These algorithms and procedures, along with lessons learned from initial implementation of these approaches, guide pathologists at the CPL and CHAMPS sites through standardized diagnostics of MITS cases, and allow for productive, real-time case discussions and consultations.

BACKGROUND: Interventions to prevent HIV in women include screening, partner notification, promoting condoms, and pre-exposure prophylaxis (PrEP). Identifying a woman's risk of acquiring HIV can help guide intervention recommendations. METHODS: We used data from Louisiana's STI and HIV registries to study 13- to 59-year-old women following their first diagnosis of syphilis, (or if none) gonorrhea, or (if none) chlamydia during 2000-2015. We measured rates of HIV reported subsequent to their STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11,000 per year, and effectiveness was estimated as 100%. RESULTS: First STI were: syphilis (6,574), gonorrhea (64,995), or chlamydia (140,034). These 211,603 women had 1,865,488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5,186 HIV diagnoses over 24,359,397 person-years. Rates of HIV diagnosis (per 100,000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7,371,111,000 and could have prevented 546 HIV diagnoses. Limiting PrEP to one year after syphilis or gonorrhea diagnosis would cost $963,847,334 but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis. CONCLUSIONS: Rates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.

BACKGROUND: Louisiana has had the highest rates of congenital syphilis (CS) in the nation since 2012. CS Case Review Boards were established statewide in 2016 to study CS cases and identify interventions. METHODS: We summarized the findings of CS review boards, assessed which cases were preventable by prenatal care providers, reviewed recommended interventions, and assessed subsequent improvement in provider practices. RESULTS: All 79 CS cases reported January 2016-July 2017 were reviewed by boards during August 2016-August 2017.Twenty-six cases (33%) that could have been prevented by prenatal care providers had: lack of rescreening at 28-32 weeks (n=15), lack of any screening (n=5), treatment delay (n=4), or incorrect interpretation of test results (n=2).Twenty-one cases (27%) were possibly preventable by providers including: mother did not return for follow-up and treatment (n=19), late third trimester reactive test with premature delivery (n=1), or incomplete treatment and lack of follow-up by health department staff (n=1).Thirty-two cases (40%) that were unlikely to be prevented by providers had: non-reactive test at 28-32 weeks then reactive test <30 days before delivery (n=10), no prenatal care (n=9), mother adequately treated, case by infant criteria (n=8), first/second trimester non-reactive, reactive at preterm delivery (n=4), or mother adequately treated, reinfected before delivery (n=1). Providers were advised to adhere to CDC recommended syphilis screening and treatment protocols and rapidly report pregnant women with syphilis. Many providers changed their procedures. CONCLUSIONS: CS case review boards identified practices with inadequate screening, treatment, or reporting. Sharing these findings with providers changed practices and may prevent future cases.

BACKGROUND: From 2012 to 2014, rates of congenital syphilis increased in Louisiana and Florida. We evaluated the effectiveness of early (first or second) and third trimester syphilis screening for the prevention of congenital syphilis in these high-morbidity states. METHODS: Reported syphilis cases among pregnant women in Louisiana and Florida during January 1, 2013, to December 31, 2014, were reviewed for documented screening for syphilis in the first 2 trimesters and third trimester. Pregnant women with syphilis were linked to congenital syphilis records and stratified by whether the pregnancy led to a reported congenital syphilis case. RESULTS: Seven hundred ten pregnant women with syphilis in Louisiana and Florida were linked to 155 congenital syphilis cases. Three hundred seventy (52%) pregnant women with syphilis were staged as early syphilis (n = 270) or high-titer late or unknown duration-latent syphilis (n = 100), and 109 (70% of the total) were linked to congenital syphilis cases. Screening in the first 2 trimesters identified 513 pregnant women who tested positive for syphilis, and 470 (92%) potential congenital syphilis were averted. One hundred nine pregnant women tested positive for syphilis in the third trimester, and 85 (78%) had babies without congenital syphilis. During their pregnancy, 85 (12%) women tested negative at least once, and 55 (65%) had babies with congenital syphilis. Thirty-nine women had no reported syphilis screening 30 days or longer before delivery. CONCLUSIONS: Screening for syphilis both early and in the third trimester prevented many pregnant women with syphilis from having a baby with congenital syphilis. Preventing all congenital syphilis would likely require preventing all syphilis among women. © Copyright 2017 American Sexually Transmitted Diseases Association

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh. METHODS: Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Lowenstein-Jensen medium. RESULTS: Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged ≥65 years. CONCLUSIONS: The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.

BACKGROUND: Understanding tuberculosis (TB) transmission dynamics is essential for establishing effective TB control strategies in settings where the burden and risk of transmission are high. The objectives of this study were to evaluate the effect of active screening on controlling TB transmission and also to characterize Mycobacterium tuberculosis strains for investigating transmission dynamics in a correctional setting. METHODS: The study was carried out in Dhaka Central Jail (DCJ), from October 2005 to February 2010. An active case finding strategy for pulmonary TB was established both at the entry point to the prison and inside the prison. Three sputum specimens were collected from all pulmonary TB suspects and subjected to smear microscopy, culture, and drug susceptibility testing as well as genotyping which included deletion analysis, spoligotyping and analysis of mycobacterial interspersed repetitive units (MIRU). RESULTS: A total of 60,585 inmates were screened during the study period. We found 466 inmates with pulmonary TB of whom 357 (77%) had positive smear microscopy results and 109 (23%) had negative smear microscopy results but had positive results on culture. The number of pulmonary TB cases declined significantly, from 49 cases during the first quarter to 8 cases in the final quarter of the study period (p=0.001). Deletion analysis identified all isolates as M. tuberculosis and further identified 229 (70%) strains as 'modern' and 100 (30%) strains as 'ancestral'. Analysis of MIRU showed that 347 strains (85%) exhibited unique patterns, whereas 61 strains (15%) clustered into 22 groups. The largest cluster comprised eight strains of the Beijing M. tuberculosis type. The rate of recent transmission was estimated to be 9.6%. CONCLUSIONS: Implementation of active screening for TB was associated with a decline in TB cases in DCJ. Implementation of active screening in prison settings might substantially reduce the national burden of TB in Bangladesh.

OBJECTIVE: To quantify the association of radiographic osteoarthritis (ROA) in one knee or hip joint with other knee or hip joints. METHODS: We analyzed baseline data from the Johnston County Osteoarthritis Project (n = 3068). We fit 4 models for left/right knee/hip. The Kellgren-Lawrence (KL) radiographic grade severity scale was KL 0/1 (no/questionable ROA), 2 (mild ROA), or 3/4 (moderate/severe ROA). We estimated associations between KL grade in contralateral joints and other joint sites (e.g., worst hip in knee models), adjusting for sex, race/ethnicity (African American/white), age, and measured body mass index, using cumulative odds logistic regression models. Interactions were investigated: race/ethnicity by sex; race/ethnicity and sex by the 2 explanatory variables. RESULTS: Contralateral joint KL grade was strongly associated with KL grade, with OR ranging from 9.2 (95% CI 7.1, 11.9) to 225.0 (95% CI 83.6, 605.7). In the left knee model, the contralateral joint association was stronger among African Americans than whites, but for the other models the associations by race/ethnicity were identical. Models examining other joint sites showed weaker but mostly statistically significant associations (OR 1.4 to 1.8). CONCLUSION: We found a strong multivariable-adjusted association between KL grades in contralateral knees and hips, and a modest association with the other joint site (e.g., knees vs hips). These results suggest that diagnosis of ROA in 1 large joint may be a marker for risk of multijoint ROA, and warrant interventions to reduce the incidence or severity of ROA at these other joints.

The Government of Bangladesh and WHO collaborated in a retrospective vaccine wastage study to estimate overall vaccine wastage rates from January to December 2004 for BCG, measles, DTP and TT. Researchers looked at vaccine distribution and usage patterns in randomly selected districts at both fixed (Upazila) and outreach (Ward) service delivery levels. Wastage was similar at both delivery levels but ranged widely among the sites. Average rates were highest for BCG (84.9%, range 55-93%) and measles (69.7%, range 28-86%) and lower for TT (35.5%, range 10-73%) and DTP (44.4%, range 16-77%). Wastage resulted primarily from opened vials at the ward level but this was reduced at fixed sites where the multi-dose vial policy is followed. A large proportion (30-38%) of records were excluded from the analytic vaccine-specific databases due to data recording errors, mismatches between Ward and Upazila databases, or missing data. The study's results may provide methodological and programmatic guidance for other countries in addressing vaccine wastage issues.