Archive for July 27, 2016

2016-04 HCV – Guidelines for the screening, care and treatment – Updated WHO

Globally, the morbidity and mortality attributable to hepatitis C virus (HCV) infection continues to increase. Approximately 700 000 persons die each year from HCVrelated complications, which include cirrhosis, hepatocellular carcinoma (HCC) and liver failure. HCV infection can be cured by antiviral treatment; however, due to the asymptomatic nature of the disease, many infected persons are unaware of their infection and, for those who are diagnosed, access to treatment remains poor in many settings.

The field of HCV therapeutics continues to evolve rapidly and, since the World Health Organization (WHO) issued its first Guidelines for the screening, care and treatment of persons with hepatitis C infection in 2014, several new medicines have been approved by at least one stringent regulatory authority. These medicines, called direct-acting antivirals (DAAs), are transforming the treatment of HCV, enabling regimens that can be administered orally, are of shorter duration (as short as eight weeks), result in cure rates higher than 90%, and are associated with fewer serious adverse events than the previous interferoncontaining regimens. WHO is updating its hepatitis C treatment guidelines to provide recommendations for the use of these new medicines….

PDF

http://apps.who.int/iris/bitstream/10665/205035/1/9789241549615_eng.pdf

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July 27, 2016 at 2:21 pm

Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection – MARCH 2015

These are the first World Health Organization (WHO) guidelines for the prevention, care and treatment of persons living with chronic hepatitis B (CHB) infection, and complement similar recently published guidance by WHO on the prevention, care and treatment of infection due to the hepatitis C virus (HCV).

The recommendations in these guidelines promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment; prioritize treatment for those with most advanced liver disease and at greatest risk of mortality; and recommend the preferred use of nucleos(t)ide analogues with a high barrier to drug resistance (tenofovir and entecavir, and entecavir in children aged 2–11 years) for first- and second-line treatment. Recommendations for the treatment of HBV/HIV-coinfected persons are based on the WHO 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which will be updated in 2015.

These recommendations provide opportunities to save lives, improve clinical outcomes of persons living with CHB, reduce HBV incidence and transmission, and stigma due to disease, but they also pose practical challenges to policymakers and implementers in low- and middle-income countries….

PDF

http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf?ua=1

July 27, 2016 at 2:20 pm

Staphylococcal and Streptococcal Superantigen Exotoxins

Clin. Microbiol. Rev. July 2013 26(3): 422-447

Adam R. Spaulding, Wilmara Salgado-Pabón, Petra L. Kohler, Alexander R. Horswill, Donald Y. M. Leung, and Patrick M. Schlievert

Department of Microbiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USAa

Department of Microbiology, University of Minnesota Medical School, Minneapolis, Minnesota, USAb

Department of Pediatrics, National Jewish Health, Denver, Colorado, USAc

This review begins with a discussion of the large family of Staphylococcus aureus and beta-hemolytic streptococcal pyrogenic toxin T lymphocyte superantigens from structural and immunobiological perspectives.

With this as background, the review then discusses the major known and possible human disease associations with superantigens, including associations with toxic shock syndromes, atopic dermatitis, pneumonia, infective endocarditis, and autoimmune sequelae to streptococcal illnesses.

Finally, the review addresses current and possible novel strategies to prevent superantigen production and passive and active immunization strategies.

PDF

http://cmr.asm.org/content/26/3/422.full.pdf+html

July 27, 2016 at 10:20 am

The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network

Infection Control & Hospital Epidemiology July 2016 V.37 N.7 P.761 – 767

Carline van den Doola1 c1, Anja Haenena1, Tjalling Leenstraa1 and Jacco Wallingaa1a2

a1 Center for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

a2 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

OBJECTIVE

Recerntly, the role of the healthcare network, defined as a set of hospitals linked by patient transfers, has been increasingly considered in the control of antimicrobial resistance. Here, we investigate the potential impact of nursing homes on the spread of antimicrobial-resistant pathogens across the healthcare network and its importance for control strategies.

METHODS

Based on patient transfer data, we designed a network model representing the Dutch healthcare system of hospitals and nursing homes. We simulated the spread of an antimicrobial-resistant pathogen across the healthcare network, and we modeled transmission within institutions using a stochastic susceptible–infected–susceptible (SIS) epidemic model. Transmission between institutions followed transfers. We identified the contribution of nursing homes to the dispersal of the pathogen by comparing simulations of the network with and without nursing homes.

RESULTS

Our results strongly suggest that nursing homes in the Netherlands have the potential to drive and sustain epidemics across the healthcare network. Even when the daily probability of transmission in nursing homes is much lower than in hospitals, transmission of resistance can be more effective because of the much longer length of stay of patients in nursing homes.

CONCLUSIONS

If an antimicrobial-resistant pathogen emerges that spreads easily within nursing homes, control efforts aimed at hospitals may no longer be effective in preventing nationwide outbreaks. It is important to consider nursing homes in planning regional and national infection control and in implementing surveillance systems that monitor the spread of antimicrobial resistance.

 

PDF

http://journals.cambridge.org/download.php?file=%2F6653_BB27F58016F0886B221459DABFA12141_journals__ICE_ICE37_07_S0899823X16000593a.pdf&cover=Y&code=9e120b31b8ffbac891f4e05f6aebbcf2

July 27, 2016 at 10:18 am


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