Background Many countries reported declines in acute respiratory infections (ARIs) following public health and social measures to mitigate COVID-19. Objectives We describe the potential association with pandemic restrictions on the occurrence of non-COVID ARIs in Greenland, which experienced a late but sudden introduction of COVID-19. Methods We included national electronic medical records on ARIs in Greenland across three periods: pre-pandemic (January 2018–February 2020), pandemic (March 2020–June 2022), and endemic (July 2022–December 2023). Severe ARIs were defined using a case definition based on ICD-10/ICPC-2-R codes. Oral penicillin prescriptions served as a proxy for mild ARIs due to limited primary care data. We calculated ARI incidence and used Poisson regression to compare periods. Data on Influenza A/B and RSV PCR testing activity and results were included. Results During the pandemic, all ARIs decreased by 14% (IRR 0.86 [95% CI 0.84–0.88]) compared to pre-pandemic levels. In the endemic period, mild ARIs increased by 3% (IRR 1.03 [95% CI 1.02–1.06]), while severe ARIs increased by 40% (IRR 1.40 [95% CI 1.22–1.60]). The Influenza A/B positive rate declined during the pandemic (20.7% to 8.3%) but increased in the endemic period (14.2%), whereas RSV positive rate increased during the pandemic (19.8% to 57.2%). Conclusions We observed declines in mild and severe ARIs during the pandemic in Greenland. Unlike many other countries, mild ARIs did not rise during the endemic period, likely due to preventive travel measures limiting the spread of SARS-CoV-2 while allowing ongoing exposure to other respiratory viruses in society, preventing an infection rebound.

Background Early diagnosis of chronic hepatitis B virus (CHB) prevents onward transmission and liver disease progression. In Norway, CHB infections are concentrated among migrants from countries with a high CHB prevalence. Objectives To calculate time from migration to diagnosis and proportion presenting late (a hospital consultation for end-stage liver disease within 24 months after CHB diagnosis) among diagnosed cases of CHB in Norway from 2008–2022. Method We analysed linked national registry data and described each outcome by year, age, sex, region of residence and country of birth. We explored factors associated with time from migration to diagnosis in accelerated failure time models and presented adjusted time ratios (aTR) with 95% confidence intervals (CI). Results Among 10,542 cases of CHB, 273 (2.6%) presented late, with a higher proportion in older age groups (≥60 years: 11%). The median time from migration to diagnosis among 3,665 cases who migrated from 2008 onwards was 1.1 years (interquartile range: 0.3–3.1). Compared to cases from high-prevalence countries with a high proportion of refugees or asylum seekers to Norway, cases born in other high-prevalence countries (aTR: 1.37, 95% CI: 1.26–1.50) or low-prevalence countries (aTR: 1.66, 95% CI: 1.49–1.89) had a longer time from migration to diagnosis. Conclusion Among persons diagnosed with CHB in Norway, 2–3% present with severe liver disease within 2 years of CHB diagnosis. Initiatives to improve testing strategies could focus on migrants from high-prevalence countries arriving for reasons other than refuge or who arrived several years ago but have not yet been tested.

Background Acute respiratory infections (ARIs) are a major global health concern, particularly for children and the elderly. Although rhinoviruses are the primary pathogens causing ARIs, their epidemiology during reduced population mobility and behavioral changes is not well understood. This study aimed to assess whether the Swedish COVID-19 measures changed the epidemiology of Rhinovirus and ARI-causing viruses other than SARS-CoV-2 in the western part of Sweden in 2020. Methods A total of 13,791 nasopharyngeal samples from ARI-patients were analyzed for 19 different viruses and bacteria by qPCR. Of the 3,607 samples positive for any virus, 2,018 were positive for rhinovirus (RV) and enterovirus (EV), and 106 contained adenoviruses. Among the EV/RV reactive samples, 249 strains were typed using partial sequencing of 5’UTR and 204 by VP1 or VP4-VP2. Results After week 12 when the interventions were implemented, most of the ARI-causing viruses were EV/RV and adenoviruses, besides SARS-CoV-2. In September-October 2020, an outbreak caused by RV-A strains predominantly infected children younger than 13 years and individuals within the age range of their parents. RV-A strains were identified in 118 of 242 (49%) RV-positive samples, followed by RV-C (36%) and RV-B (10%). Before the first wave of SARS-CoV-2, a RV-C outbreak affected all age groups. Conclusions This study shows that the moderate Swedish interventions against SARS-CoV-2 were more effective against the spread of ARI-causing virus among adults over 56 years than among young children. These results suggest the need for new strategies for preventing the spread of ARI pathogens like RV and EV, which cause disease in all age groups and can lead to large outbreaks.

Introduction Candida albicans is the most frequent fungal organism causing vertebral spondylodiskitis. Given limited research, this study aimed to describe patient characteristics, treatment, and outcomes of the C. albicans spondylodiscitis patients in Southern Denmark using a case series and literature review. Methods We conducted a retrospective review of all consecutive patients treated for infectious spondylodiscitis during 2009-2023 at the Department of Infectious Diseases, Odense University Hospital, Denmark. All medical records were reviewed and cases of C. albicans were included. A review of the English literature from the last decade was conducted with a predefined search string. We excluded articles not aligning with our objectives. Results Among five fungal cases, four were C. albicans infections. Two patients presented with pain/fever in the vertebra column. All were initially treated as having bacterial spondylodiscitis. Half of the patients had positive blood cultures and all had positive biopsies taken. The two remaining patients had experienced candidemia within one year prior to being diagnosed with spondylodiscitis. All were initially treated with fluconazole with a median duration of 9 months (range 6–12 months). The median time to diagnosis was 27 days (range 23–35 days). Two patients died during treatment. The median follow-up was 7 months (range 6–8 months). Thirteen studies were included in the literature review. Conclusion The study described the characteristics, treatment and outcome of C. albicans spondylodiscitis patients in Southern Denmark. Noting prior candidemia episodes can improve early identification and outcomes. Furthermore, our patients exhibit clinical similarities to those in the literature review.

Background Infections of the aorta and its branches can occur either in native tissue, known as infective native aortic aneurysms (INAAs), or following vascular surgery involving native or prosthetic grafts, referred to as vascular graft or endograft infections (VGEIs). Objectives First, this study aimed to assess the all-cause on-year mortality of patients with INAAs and VGEIs. Second, this study described patients’ characteristics and prognostic factors. Methods This observational study included patients hospitalised for INAA or VGEI, between 2014 and 2022, at Nancy University Hospital (France). Data were retrospectively collected from patients’ medical record (ClinicalTrials.gov ID NCT05660733). Results Forty-seven patients were included in the INAAs group versus 40 in the VGEIs group. A history of immunosuppression or autoimmune disease were more frequent in INAAs patients. VGEIs patients had more chronic organ failure or cardiovascular pathology. The most commonly affected site was the infrarenal aorta, with thoracic involvement being more frequent in the INAAs group. Staphylococcus aureus was the most frequent identified pathogen (38.3% vs. 27.5%). There was no significant difference between groups in terms of all-cause 1-year mortality (40.4% in the INAAs group vs. 32.5% in the VGEIs group, log-rank test, p = .4803). The absence of surgery worsened the prognosis in the overall population (HR 2.8, 95% CI [1.2–6.3], p = .0125); this was also observed in the INAA group. Conclusions Despite different comorbidities and clinical presentations between groups, there was no significant difference in 1-year mortality. Surgical management appeared to be associated with improved outcomes.

Background Tick-borne encephalitis (TBE) is a viral disease primarily spread by ticks. The diagnosis is mainly based on detection of IgM and IgG antibodies against TBE virus (TBEV) in serum and cerebrospinal fluid (CSF). The kinetics of TBEV IgM in the CSF is largely unexplored. Objectives Our aim was to determine the duration and strength of the IgM antibody response in serum and CSF during and after previously diagnosed clinical TBE, and to investigate whether such antibody levels correlated with severity and residual symptoms. Methods Sixty-nine paired samples from serum and CSF of 31 TBE patients were analysed with the ReaScan TBE IgM test both in the emergency stage and during repeated follow-up visits for up to six years. Recovery was evaluated with Glasgow outcome scale (GOS), a global scale for assessing disability and social participation. Results At the first sampling, 30/31 patients were TBEV IgM positive in serum and 28/31 in CSF. In individual patients, IgM antibodies were detected in both body fluids up to one year after onset of disease. No association was found between IgM levels and disease severity. However, patients with better recovery at 3 months’ follow-up had significantly higher levels of IgM in serum and CSF compared to patients with severe disability. Conclusions Detection of TBEV IgM antibodies facilitates early diagnosis and in cases where the IgM response is long-lasting, there is an opportunity for diagnosis later after onset of disease. Improved recovery after three months seems to be associated with stronger IgM response.

Background Despite the progress made in managing HIV, the mortality trends among general population in the US remains understudied. Our aim is to analyse the trends in HIV-related mortality among US residents by demographic characteristics and association with social vulnerability index (SVI). Methods We abstracted national mortality data from the multiple cause of death files in the CDC WONDER database. The ICD-10 Codes (B20-B24) were used to identify HIV deaths among US population from 1999 to 2023. Trends in age-adjusted mortality rate (AAMR) were assessed using Joinpoint regression analysis. For 10-year increment age-groups, crude mortality rates were reported. Results were expressed as annual percentage changes (APC), average annual percentage changes (AAPC), and 95% confidence intervals (CI). SVI was obtained from CDC for each county. Results Between 1999 and 2023, a total of 271,932 HIV-infected patients died within the US (AAMR= 3.4 per 100,000; 95% CI: 3.3–3.5). Overall mortality trends decreased at an annual rate of −4.34% (95% CI: −5.25, −3.41) from 1999 through 2023 in the whole population. Specifically, the trends are higher among males age groups 45–54 years (overall rising in age 65 and above), African Americans, South Region and Large metropolitan areas. States in the top 90th percentile included District of Columbia, Florida, Maryland, Louisiana, New York, and Georgia. Union county followed by Miami-Dade are highly affected within Florida State which ranks second after District of Columbia. SVI was independently associated with HIV mortality with strong association throughout the United States counties. Conclusions HIV mortality among US population has decreased overall from 1999 to 2023, but with varying trends by race and ethnicity. This highlights the need for enhanced public health surveillance to better understand the scope of HIV mortality and identify high-risk demographic and regional subgroups for targeted interventions.

Background Hepatitis E virus (HEV) infection is endemic in China. However, there are scarce data of HEV infection among hospital attendees seeking medical treatment or examination for various reasons. Objective We aim to investigate the prevalence and incidence of HEV infection by time, age, sex, and across departments in a tertiary hospital. Methods Paired results of anti-HEV immunoglobulin G (IgG) and IgM of 31,181 unique subjects during 2021–2022 were analysed. Results Overall seropositivity (95% confidence interval) of anti-HEV IgG and IgM was 41.25% (40.71%–41.80%) and 2.35% (2.19%–2.53%), respectively. Acute hepatitis E was more prevalent during winter–early spring and among adults aged 31–70. Anti-HEV IgG seroprevalence increased with age, levelling off at > 60 years of age. Not only the seropositivity, but also the levels of anti-HEV IgG were significantly lower in women than men of middle and old age. Young patients from the Department of Neurology had a significantly higher ratio of past HEV infection, while patients with manifestations of hepatitis, gastrointestinal symptoms or hematological diseases had higher seropositivity of anti-HEVIgM and should have high priority to HEV screening. Conclusion Heterogeneity of HEV seroprevalence was noted at different times of the year, between sexes, among age groups and across departments in general hospital. The concentration of HEV-infected patients in a few departments supports a more focused screening strategy in health-care settings.

Background The diagnosis of congenital Chagas disease in newborns relies on the microhematocrit method which exhibits reduced sensitivity during the early stages of infection and quantitative PCR for Trypanosoma cruzi, which is applied only in specialised centre due to its technical complexity. Consequently, the majority of congenital transmission cases are confirmed after an extended period of serological monitoring, resulting in delayed treatments and reduced cure rates. The need for new, accurate tests for the timely diagnosis of the disease in newborns is evident. Objectives We developed a lateral flow assay based on IgM detection (IgM-LFA) using the novel chimeric antigen CP4, which have demonstrated high performance in IgM-ELISA, as previously reported by our group. Methods The accuracy of IgM-LFA was evaluated comparatively with IgM-ELISA using 28 serum samples from infants up to three months old, congenitally infected (n = 11) or non-infected (n = 17) with T. cruzi. Additionally, it was assessed for its agreement with microhematocrit and quantitative PCR, through estimating the Cohen’s Kappa coefficient (k). Results The IgM-LFA showed 100% specificity and 81.82% sensitivity and IgM-ELISA gave 100% specificity and sensitivity when evaluated against the standard algorithm diagnosis for congenital Chagas disease. Notably, the IgM-LFA identified two additional cases in relation to microhematocrit and showed a correlation of k = 0.84 with quantitative PCR, corresponding to almost perfect agreement with this molecular test. Conclusion These results suggest that IgM-LFA has the potential to facilitate decentralised detection of congenital Chagas disease, contributing to the early and enhance detection of infected newborns.