PLOS ONE: [sortOrder=DATE_NEWEST_FIRST, sort=Date, newest first, q=subject:"Infectious diseases"]PLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/search/feed/atom?sortOrder=DATE_NEWEST_FIRST&sort=Date,+newest+first&unformattedQuery=subject:%22Infectious+diseases%22All PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-28T18:54:45ZA novel sORF gene mutant strain of <i>Yersinia pestis</i> vaccine EV76 offers enhanced safety and improved protection against plagueXiao GuoYouquan XinZehui TongShiyang CaoYuan ZhangGengshan WuHongyan ChenTong WangYajun SongQingwen ZhangRuifu YangZongmin Du10.1371/journal.ppat.10121292024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Xiao Guo, Youquan Xin, Zehui Tong, Shiyang Cao, Yuan Zhang, Gengshan Wu, Hongyan Chen, Tong Wang, Yajun Song, Qingwen Zhang, Ruifu Yang, Zongmin Du</p>
We recently identified two virulence-associated small open reading frames (sORF) of <i>Yersinia pestis</i>, named <i>yp1</i> and <i>yp2</i>, and null mutants of each individual genes were highly attenuated in virulence. Plague vaccine strain EV76 is known for strong reactogenicity, making it not suitable for use in humans. To improve the immune safety of EV76, three mutant strains of EV76, Δ<i>yp1</i>, Δ<i>yp2</i>, and Δ<i>yp1&yp2</i> were constructed and their virulence attenuation, immunogenicity, and protective efficacy in mice were evaluated. All mutant strains were attenuated by the subcutaneous (<i>s</i>.<i>c</i>.) route and exhibited more rapid clearance in tissues than the parental strain EV76. Under iron overload conditions, only the mice infected with EV76Δ<i>yp1</i> survived, accompanied by less draining lymph nodes damage than those infected by EV76. Analysis of cytokines secreted by splenocytes of immunized mice found that EV76Δ<i>yp2</i> induced higher secretion of multiple cytokines including TNF-α, IL-2, and IL-12p70 than EV76. On day 42, EV76Δ<i>yp2</i> or EV76Δ<i>yp1&yp2</i> immunized mice exhibited similar protective efficacy as EV76 when exposed to <i>Y</i>. <i>pestis</i> 201, both via <i>s</i>.<i>c</i>. or intranasal (<i>i</i>.<i>n</i>.) routes of administration. Moreover, when exposed to 200–400 LD<sub>50</sub> <i>Y</i>. <i>pestis</i> strain 201Δ<i>caf1</i> (non-encapsulated <i>Y</i>. <i>pestis</i>), EV76Δ<i>yp2</i> or EV76Δ<i>yp1&yp2</i> are able to afford about 50% protection to <i>i</i>.<i>n</i>. challenges, significantly better than the protection afforded by EV76. On 120 day, mice immunized with EV76Δ<i>yp2</i> or EV76Δ<i>yp1&yp2</i> cleared the <i>i</i>.<i>n</i>. challenge of <i>Y</i>. <i>pestis</i> 201-<i>lux</i> as quickly as those immunized with EV76, demonstrating 90–100% protection. Our results demonstrated that deletion of the <i>yp2</i> gene is an effective strategy to attenuate virulence of <i>Y</i>. <i>pestis</i> EV76 while improving immunogenicity. Furthermore, EV76Δ<i>yp2</i> is a promising candidate for conferring protection against the pneumonic and bubonic forms of plague.A clinically attenuated double-mutant of porcine reproductive and respiratory syndrome virus-2 that does not prompt overexpression of proinflammatory cytokines during co-infection with a secondary pathogenChia-Ming SuJineui KimJunyu TangYu Fan HungFederico A. ZuckermannRobert HusmannPatrick RoadyJiyoun KimYoung-Min LeeDongwan Yoo10.1371/journal.ppat.10121282024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Chia-Ming Su, Jineui Kim, Junyu Tang, Yu Fan Hung, Federico A. Zuckermann, Robert Husmann, Patrick Roady, Jiyoun Kim, Young-Min Lee, Dongwan Yoo</p>
Porcine reproductive and respiratory syndrome virus (PRRSV) is known to suppress the type I interferon (IFNs-α/β) response during infection. PRRSV also activates the NF-κB signaling pathway, leading to the production of proinflammatory cytokines during infection. In swine farms, co-infections of PRRSV and other secondary bacterial pathogens are common and exacerbate the production of proinflammatory cytokines, contributing to the porcine respiratory disease complex (PRDC) which is clinically a severe disease. Previous studies identified the non-structural protein 1β (nsp1β) of PRRSV-2 as an IFN antagonist and the nucleocapsid (N) protein as the NF-κB activator. Further studies showed the leucine at position 126 (L126) of nsp1β as the essential residue for IFN suppression and the region spanning the nuclear localization signal (NLS) of N as the NF-κB activation domain. In the present study, we generated a double-mutant PRRSV-2 that contained the L126A mutation in the nsp1β gene and the NLS mutation (ΔNLS) in the N gene using reverse genetics. The immunological phenotype of this mutant PRRSV-2 was examined in porcine alveolar macrophages (PAMs) in vitro and in young pigs in vivo. In PAMs, the double-mutant virus did not suppress IFN-β expression but decreased the NF-κB-dependent inflammatory cytokine productions compared to those for wild-type PRRSV-2. Co-infection of PAMs with the mutant PRRSV-2 and <i>Streptococcus suis (S</i>. <i>suis)</i> also reduced the production of NF-κB-directed inflammatory cytokines. To further examine the cytokine profiles and the disease severity by the mutant virus in natural host animals, 6 groups of pigs, 7 animals per group, were used for co-infection with the mutant PRRSV-2 and <i>S</i>. <i>suis</i>. The double-mutant PRRSV-2 was clinically attenuated, and the expressions of proinflammatory cytokines and chemokines were significantly reduced in pigs after bacterial co-infection. Compared to the wild-type PRRSV-2 and <i>S</i>. <i>suis</i> co-infection control, pigs coinfected with the double-mutant PRRSV-2 exhibited milder clinical signs, lower titers and shorter duration of viremia, and lower expression of proinflammatory cytokines. In conclusion, our study demonstrates that genetic modification of the type I IFN suppression and NF-κB activation functions of PRRSV-2 may allow us to design a novel vaccine candidate to alleviate the clinical severity of PRRS-2 and PRDC during bacterial co-infection.Factors associated with hepatitis A susceptibility among men who have sex with men using HIV pre-exposure prophylaxis in Northeastern Brazil: A cross-sectional studyHareton Teixeira VechiMônica Baumgardt BayCláudio Henrique Silva de FreitasJúlia Gomes Fernandes Costa de Sant’annaCarlos BritesKenio Costa de Lima10.1371/journal.pone.03013972024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Hareton Teixeira Vechi, Mônica Baumgardt Bay, Cláudio Henrique Silva de Freitas, Júlia Gomes Fernandes Costa de Sant’anna, Carlos Brites, Kenio Costa de Lima</p>
Hepatitis A virus (HAV) infection has disproportionately affected more men who have sex with men (MSM), occurring in outbreaks, despite being vaccine-preventable. We determined the prevalence and factors associated with HAV susceptibility among cisgender MSM on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. From September 30, 2021 to June 19, 2023, 282 cisgender MSM receiving HIV PrEP were enrolled into this cross-sectional study. Sociodemographic and clinical information were collected. Blood samples were collected for screening of sexually transmitted infections (STIs) and serum samples were tested for IgM and total anti-HAV antibodies. Non-reactive results for total anti-HAV antibodies were found in 106 of 282 (37.6%) participants. Factors associated with HAV susceptibility included age <30 years (prevalence ratio [PR]: 2.02; 95% confidence interval [95% CI]: 1.61–2.53), having health insurance (PR: 1.39; 95% CI: 1.19–1.64), sex only with cisgender men (PR: 1.52; 95% CI: 1.23–1.89), non-steady partner (PR: 1.20; 95% CI: 1.01–1.43) and no lifetime history of STIs (PR: 1.25; 95% CI: 1.03–1.53). Identifying clinical correlates of HAV susceptibility in key populations is a fundamental step towards development of public policy focused on prevention, especially following the recent hepatitis A outbreak in Brazil.Older women’s experience with COVID-19 pandemic: A study of risk perception and coping among culturally and linguistically diverse population in South AustraliaNoore Alam SiddiqueeMohammad HamiduzzamanHelen McLarenEmi Patmisari10.1371/journal.pone.03013662024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Noore Alam Siddiquee, Mohammad Hamiduzzaman, Helen McLaren, Emi Patmisari</p>
Background <p>A global catastrophe–the COVID-19 pandemic–appears to have two-dimensional health consequences for older adults: high risk of being infected and psychological distress. There is limited evidence on how the pandemic has impacted the life and coping of older adults who are culturally and linguistically diverse (CALD), women in particular. This study explored the COVID-19 risk perception and coping strategies of older CALD women in South Australia.</p> Methods <p>A mixed-methods research design was employed, involving a 31-items coping and emergency preparation scale for survey and semi-structured interviews with participants. The older CALD women were approached through 11 multicultural NGOs. One hundred and nine women participants from 28 CALD communities completed the online surveys; 25 of them agreed to a telephone interview and provided their contact details. 15 older CALD women ultimately participated in interviews.</p> Results <p>Mean sum-score of dread risk, unknown risk, and fear (M: 43.5; SD: 4.9) indicated that the participants were somewhat anxious and worried. Mean sum-score of coping (M: 79.8; SD: 9.3) reported their compliance with expert advice and disinfection practices but accessing health information (M: 2.8; SD 1.4) and tendency to minimize anxiety (M: 2.1; SD: 1.2) were below neutral. Significant variations were found in coping in terms of age, meaning that the women aged 75 years and older were less likely to cope with the pandemic (<i>P</i> = 0.01). Emergency preparation differed based on the participants’ residence and occupation status. The deductive-inductive thematic analysis of interview data was framed around three priori themes: risks of being affected, emotional and behavioral coping, and emergency preparation and access to services.</p> Conclusions <p>Evidence shows a fear among the older CALD women with an endeavor to cope and prepare for emergency situations. This suggests the requirements for interventions that improve coping and reduce the risk of stress among them.</p>Prozone masks elevated SARS-CoV-2 antibody level measurementsMicaela N. SandovalSamuel P. McClellanStephen J. PontJessica A. RossMichael D. SwartzMark A. SilbermanEric Boerwinkle10.1371/journal.pone.03012322024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Micaela N. Sandoval, Samuel P. McClellan, Stephen J. Pont, Jessica A. Ross, Michael D. Swartz, Mark A. Silberman, Eric Boerwinkle</p>
We report a prozone effect in measurement of SARS-CoV-2 spike protein antibody levels from an antibody surveillance program. Briefly, the prozone effect occurs in immunoassays when excessively high antibody concentration disrupts the immune complex formation, resulting in a spuriously low reported result. Following participant inquiries, we observed anomalously low measurement of SARS-CoV-2 spike protein antibody levels using the Roche Elecsys® Anti-SARS-CoV-2 S immunoassay from participants in the Texas Coronavirus Antibody Research survey (Texas CARES), an ongoing prospective, longitudinal antibody surveillance program. In July, 2022, samples were collected from ten participants with anomalously low results for serial dilution studies, and a prozone effect was confirmed. From October, 2022 to March, 2023, serial dilution of samples detected 74 additional cases of prozone out of 1,720 participants’ samples. Prozone effect may affect clinical management of at-risk populations repeatedly exposed to SARS-CoV-2 spike protein through multiple immunizations or serial infections, making awareness and mitigation of this issue paramount.Impact of COVID-19 vaccination on liver transplant recipients. Experience in a reference center in MexicoDaniel Azamar-LlamasJosealberto Sebastiano Arenas-MartinezAntonio Olivas-MartinezJose Victor JimenezEric Kauffman-OrtegaCristian J García-CarreraBruno Papacristofilou-RiebelingFabián E Rivera-LópezIgnacio García-Juárez10.1371/journal.pone.03011982024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Daniel Azamar-Llamas, Josealberto Sebastiano Arenas-Martinez, Antonio Olivas-Martinez, Jose Victor Jimenez, Eric Kauffman-Ortega, Cristian J García-Carrera, Bruno Papacristofilou-Riebeling, Fabián E Rivera-López, Ignacio García-Juárez</p>
Background and aims <p>COVID-19 vaccination has proved to be effective to prevent symptomatic infection and severe disease even in immunocompromised patients including liver transplant patients. We aim to assess the impact of COVID-19 vaccination on the mortality and development of severe and critical disease in our center.</p> Methods <p>A retrospective cohort study of LT patients in a reference center between March 2020 and February 2022. Demographic data, cirrhosis etiology, time on liver transplantation, immunosuppressive therapies, and vaccination status were recorded at the time of diagnosis. Primary outcome was death due to COVID-19, and secondary outcomes included the development of severe COVID-19 and intensive care unit (ICU) requirement.</p> Results <p>153 of 324 LT recipients developed COVID-19, in whom the main causes of cirrhosis were HCV infection and metabolic-associated fatty liver disease. The vaccines used were BNT162b2 (48.6%), ChAdOx1 nCoV-19 (21.6%), mRNA-1273 vaccine (1.4%), Sputnik V (14.9%), Ad5-nCoV-S (4.1%) and CoronaVac (9.5%). Case fatality and ICU requirement risk were similar among vaccinated and unvaccinated LT patients (adjusted relative case fatality for vaccinated versus unvaccinated of 0.68, 95% CI 0.14–3.24, p = 0.62; adjusted relative risk [aRR] for ICU requirement of 0.45, 95% CI 0.11–1.88, p = 0.27). Nonetheless, vaccination was associated with a lower risk of severe disease (aRR for severe disease of 0.32, 95% CI 0.14–0.71, p = 0.005).</p> Conclusions <p>Vaccination reduces the risk of severe COVID-19 in LT patients, regardless of the scheme used. Vaccination should be encouraged for all.</p>Saliva sampling method influences oral microbiome composition and taxa distribution associated with oral diseasesCristian RocaAlaa A. AlkhateebBryson K. DeanhardtJade K. MacdonaldDonald L. ChiJeremy R. WangMatthew C. Wolfgang10.1371/journal.pone.03010162024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Cristian Roca, Alaa A. Alkhateeb, Bryson K. Deanhardt, Jade K. Macdonald, Donald L. Chi, Jeremy R. Wang, Matthew C. Wolfgang</p>
Saliva is a readily accessible and inexpensive biological specimen that enables investigation of the oral microbiome, which can serve as a biomarker of oral and systemic health. There are two routine approaches to collect saliva, stimulated and unstimulated; however, there is no consensus on how sampling method influences oral microbiome metrics. In this study, we analyzed paired saliva samples (unstimulated and stimulated) from 88 individuals, aged 7–18 years. Using 16S rRNA gene sequencing, we investigated the differences in bacterial microbiome composition between sample types and determined how sampling method affects the distribution of taxa associated with untreated dental caries and gingivitis. Our analyses indicated significant differences in microbiome composition between the sample types. Both sampling methods were able to detect significant differences in microbiome composition between healthy subjects and subjects with untreated caries. However, only stimulated saliva revealed a significant association between microbiome diversity and composition in individuals with diagnosed gingivitis. Furthermore, taxa previously associated with dental caries and gingivitis were preferentially enriched in individuals with each respective disease only in stimulated saliva. Our study suggests that stimulated saliva provides a more nuanced readout of microbiome composition and taxa distribution associated with untreated dental caries and gingivitis compared to unstimulated saliva.The Impacts of COVID-19 Restrictions on Quality Adjusted Life Years (QALY): Heterogeneous effects and post-pandemic recoveryRaimundo AtalPaula BedregalJosé A. CarrascoFelipe GonzálezRodrigo HarrisonCecilia Vizcaya10.1371/journal.pone.03008912024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Raimundo Atal, Paula Bedregal, José A. Carrasco, Felipe González, Rodrigo Harrison, Cecilia Vizcaya</p>
Objectives <p>Estimate the effects of non-pharmacological interventions used to prevent the spread of COVID-19 on the quality of life, measured by Quality Adjusted Life Years (QALYs).</p> Methods <p>A survey on 1,506 heads of households from Chile in May of 2022. Respondents were asked basic socioeconomic questions and a version of the EQ-5D-5L questionnaire that was used to calculate the evolution of HRQoLs. Comparisons of means in HRQoLs measures before the pandemic, at the peak of restrictions, and at the moment of the survey were performed.</p> Results <p>The average HRQoL of the population before the pandemic was similar to other countries in the region (0.96). At the peak of restrictions (June 2020–August 2021), the average HRQoL decreased to 0.87 (-9%). At the time of survey (May 2022), the average HQRoL was 0.91 (4%). Assuming the recovery trend continued, pre-pandemic HRQoLs would be reached by January 2024. Altogether, the pandemic would have reduced QALYs by 0.2 in average. The effect is larger and the recovery slower among women. Our estimates imply that the restrictions to manage the pandemic came at a cost of 2.4 months of life years for the average (surviving) person, 1.8 months for men and 3.4 for women.</p> Conclusions <p>Our results suggest that COVID-19 had worse effects on life quality than previously thought. These effects are more significant among women than among men. Efforts to improve life quality and speed up its recovery could have large positive consequences for the population.</p>Ethical care in patients with Covid-19: A grounded theoryHamideh AzimiRafat Rezapour-NasrabadFariba BorhaniAkram Sadat Sadat HoseiniFariba Bolourchifard10.1371/journal.pone.03001562024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Hamideh Azimi, Rafat Rezapour-Nasrabad, Fariba Borhani, Akram Sadat Sadat Hoseini, Fariba Bolourchifard</p>
Background <p>Providing ethical care during the Covid-19 pandemic has become an inevitable challenge due to facing limitations such as fear of contracting the disease, lack of equipment and emergence of ethical conflicts; So that there is no clear picture of how to provide ethical care for patients with Covid-19. The study aimed to explain the ethical care process of patients with Covid-19.</p> Method <p>This qualitative study was conducted in 2021–2023 using the grounded theory research method. Data were collected through conducting 21 semi-structured interviews with 19 participants (16 staff nurses, and 3 supervisor). Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin.</p> Results <p>The results indicated that starting the process with a problem means a challenge of how to do the right or correct thing for the patient. This process is driven by the feeling of duty and inner commitment to do the right thing. The sense of responsibility or commitment is directly related to the degree of faith in a person. The actions that a nurse takes to fulfill her sense of commitment is called the faith-based behavior process. The process of behavior based on faith is done through two steps. Attaining the satisfaction of God and as well as the satisfaction of one’s conscience is the nurses’ ultimate goal of doing the right work and being committed.</p> Conclusion <p>The process of ethical care of patients with Covid-19 can be different according to the degree of faith and environmental conditions. A higher level of faith and more helpful environmental conditions, the greater the nurse’s inner commitments in the first and second steps, as a result, the satisfaction of God and conscience will be greater.</p>Changing COVID-19 cases and deaths detection in FloridaKok Ben TohDerek A. T. CummingsIra M. Longini Jr.Thomas J. Hladish10.1371/journal.pone.02991432024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Kok Ben Toh, Derek A. T. Cummings, Ira M. Longini Jr., Thomas J. Hladish</p>
Epidemic data are often difficult to interpret due to inconsistent detection and reporting. As these data are critically relied upon to inform policy and epidemic projections, understanding reporting trends is similarly important. Early reporting of the COVID-19 pandemic in particular is complicated, due to changing diagnostic and testing protocols. An internal audit by the State of Florida, USA found numerous specific examples of irregularities in COVID-19 case and death reports. Using case, hospitalization, and death data from the the first year of the COVID-19 pandemic in Florida, we present approaches that can be used to identify the timing, direction, and magnitude of some reporting changes. Specifically, by establishing a baseline of detection probabilities from the first (spring) wave, we show that transmission trends among all age groups were similar, with the exception of the second summer wave, when younger people became infected earlier than seniors, by approximately 2 weeks. We also found a substantial drop in case-fatality risk (CFR) among all age groups over the three waves during the first year of the pandemic, with the most drastic changes seen in the 0 to 39 age group. The CFR trends provide useful insights into infection detection that would not be possible by relying on the number of tests alone. During the third wave, for which we have reliable hospitalization data, the CFR was remarkably stable across all age groups. In contrast, the hospitalization-to-case ratio varied inversely with cases while the death-to-hospitalization ratio varied proportionally. Although specific trends are likely to vary between locales, the approaches we present here offer a generic way to understand the substantial changes that occurred in the relationships among the key epidemic indicators.Human-animal entanglements in bushmeat trading in Sierra Leone: An ethnographic assessment of a potential zoonotic interfaceJack JenkinsWahab LawundehTommy HansonHannah Brown10.1371/journal.pone.02989292024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Jack Jenkins, Wahab Lawundeh, Tommy Hanson, Hannah Brown</p>
‘Bushmeat’ markets are often portrayed as chaotic spaces where exotic wild animals are sold. They are hypothesized to be important sites for zoonotic disease transmission, given the prolonged and intense nature of the cross-species encounters that occur within them. Whilst such markets have received some attention from researchers, rich qualitative descriptions of everyday practices in these markets are rare. Depictions of wild animal markets as sites for potential viral amplification often rely on exoticizing assumptions and narratives rather than actual evidence, and in some cases are based more on ideology than on science. We provide an in-depth ethnographic account of two bushmeat markets in Bo, Sierra Leone. Our analysis goes beyond common assumptions that zoonotic risk is located solely in the knowledge and behaviours of traders. Our account sheds light on the modes of touch, closeness and contact that shape this hypothesised zoonotic interface, outlining the possible risks to different people who use and spend time in the market. We found that inadequate infrastructure and sanitation facilities created risks of zoonotic disease transmission for diverse actors including traders, customers, children, and the wider public. Butchering and trading practices frequently resulted in people directly and indirectly encountering animal fluids. We also discuss how public health management of these markets focused on individual behaviours rather than on improving conditions. Urgent sanitary reform and infrastructure upgrades in these sites that support the economic needs of traders could encourage voluntary compliance with biosafety measures amongst traders seeking to balance responsibilities to family and public health. Our study reveals the value of moving beyond exoticized narratives about bushmeat markets to yield situated insights for reducing risk at this interface.Analyst optimism, information disclosure, and stock price collapse risk: Empirical insights from China’s A-share marketYang LiYingchun ZhangRui MaRuixuan Wang10.1371/journal.pone.02970552024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Yang Li, Yingchun Zhang, Rui Ma, Ruixuan Wang</p>
This study selects stock data of listed companies in China’s A-share stock market from 2011 to 2020 as research samples. Using a fixed-effects model, it examines the impact of analyst optimism on stock price collapses and the moderating effect of information disclosure quality. Simultaneously, it conducts additional research to explore the potential transmission mechanisms involved. The main findings are as follows: Firstly, a positive correlation exists between analyst optimism and the risk of stock price collapse. Secondly, improving information disclosure quality of listed companies can enhance the positive impact of analyst optimism on the risk of stock price collapses and expedite the market’s adjustment of overly optimistic valuations of listed companies. Additionally, analyst optimism can increase the risk of stock price collapses by affecting institutional ownership. These findings provide theoretical support for regulatory authorities to revise and improve the "information disclosure evaluation" system, regulate the analyst industry, guide analyst behavior, and encourage listed companies to enhance internal governance and improve information disclosure practices.Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling studyLinda J. CobiacNina T. RogersJean AdamsSteven CumminsRichard SmithOliver MyttonMartin WhitePeter Scarborough10.1371/journal.pmed.10043712024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Linda J. Cobiac, Nina T. Rogers, Jean Adams, Steven Cummins, Richard Smith, Oliver Mytton, Martin White, Peter Scarborough</p>
Background <p>The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England.</p> Methods and findings <p>We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: −10.3 to −19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: −1,830 QALYs [−3,260 to −501], Q4: 652 QALYs [−336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: −0.9 to −0.62) for females and 0.94% (−1.1 to −0.76) for males.</p> Conclusions <p>We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.</p>HIV stigma and other barriers to COVID-19 vaccine uptake among Georgian people living with HIV/AIDS: A mixed-methods studyTamar ZurashviliTsira ChakhaiaElizabeth J. KingJack DeHovitzMamuka Djibuti10.1371/journal.pgph.00030692024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Tamar Zurashvili, Tsira Chakhaia, Elizabeth J. King, Jack DeHovitz, Mamuka Djibuti</p>
We conducted a study in Georgia to examine behavioral insights and barriers to COVID-19 vaccine uptake among people living with HIV (PLWH). Between December 2021-July 2022, we collected quantitative data to evaluate participants’ demographics, COVID-19 knowledge, attitude, perception, and HIV stigma as potential covariates for being vaccinated against COVID-19. We conducted a multivariate analysis to define the factors independently associated with COVID-19 vaccination among PLWH. We collected qualitative data to explore individual experiences of their positive or negative choices, main barriers, HIV stigma, and preferences for receiving vaccination. Of the total 85 participants of the study, 52.9% were vaccinated; 61.2% had concerns with the disclosure of HIV status at the vaccination site. Those who believed they would have a severe form of COVID-19 were more likely to be vaccinated (OR = 23.8; 95% CI: 5.1–111.7). The association stayed significant after adjusting for sex, age, education level, living area, health care providers’ unfriendly attitudes, and their fear of disclosing HIV status at vaccination places. Based on the qualitative study, status disclosure was a significant barrier to receiving care; therefore, PLWH prefer to receive COVID-19 vaccination integrated in HIV services. Conclusions: In this study, around half of the participants were not vaccinated against COVID-19. The main reasons for not being vaccinated included stigma, misleading health beliefs, and low awareness about COVID-19. An integrated service delivery model may improve vaccination uptake among PLWH in Georgia.The socioeconomic impact of the COVID-19 lockdown on families affected by childhood respiratory illnesses in Cape Town, South AfricaMichaile G. AnthonyGraeme HoddinottMargaret Van NiekerkIsabelle DewandelCarla McKenzieCarien BekkerHelena RabieAndrew RedfernMarieke M. van der Zalm10.1371/journal.pgph.00030202024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Michaile G. Anthony, Graeme Hoddinott, Margaret Van Niekerk, Isabelle Dewandel, Carla McKenzie, Carien Bekker, Helena Rabie, Andrew Redfern, Marieke M. van der Zalm</p>
The COVID-19 pandemic impacted families globally, directly and indirectly. Children presenting with respiratory illnesses are affected by emerging health systems and socioeconomic changes in the COVID-19 era. We explored the socioeconomic impacts of the COVID-19 lockdown on families with a respiratory illness diagnosed in their child in Cape Town, South Africa. This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of COVID-19. We conducted 21 semi-structured interviews to explore the socioeconomic impact of the COVID-19 pandemic on families with a child affected by respiratory illnesses. We used case descriptive analysis and thematically organised common and divergent experiences. We found that socioeconomic challenges in low-income communities were exacerbated: 1) loss of pre-COVID sources of income (loss of income, employment and working hours), 2) shrinking employment opportunities due to business closures and strict preventative measures, 3) family network dependence to cope with financial pressures, 4) impact on education, implicating additional pressures due to lack of resources for adequate home schooling and 5) caregivers’ mental health and wellbeing being impacted, causing stress and anxiety due to loss of income. This study shows that the COVID-19 lockdown impacted the socioeconomic aspects of families caring for a child with a respiratory illness. Care became more complicated and adversely impacted the family’s emotional well-being and health-seeking behaviour. These impacts should be more carefully considered in order to strengthen health services and global health messaging in future pandemics.