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The authors developed a computerized algorithm that estimates 'who transmits to whom'--that is, the likeliest transmission paths during an outbreak of person-to-person transmitted illness. This algorithm uses basic information about natural history of the disease, population structure, and chronology of observed symptoms. To assess the algorithm efficacy, the authors built a simulator with parameters describing the disease and the population to simulate random outbreaks of influenza. The algorithm's performance was compared with three reference methods that simulated how human operators would handle such situations. For any size of outbreak, the algorithm outperformed the reference methods and provided a higher proportion of cases for whom the source subject who transmitted infection was identified. The authors also illustrated applicability of the algorithm for describing outbreaks of influenza in nursing homes. The use of this algorithm to draw transmission maps in investigations of outbreaks with person-to-person transmitted agents could potentially guide public health measures regarding the control of such outbreaks. [ABSTRACT FROM AUTHOR]

Background: Zanamivir, a neuraminidase inhibitor, reduces the number of days of illness in influenza-positive patients. New bedside rapid flu tests (RFT) should increase the number of influenza-positive patients whom receive zanamivir appropriately.Objective: To estimate the economic effects of implementing RFT and zanamivir among unvaccinated healthy working adults who consult within 2 days of the onset of influenza-like symptoms.Methods: We constructed a decision tree to perform a cost-benefit analysis from a societal perspective. Clinical outcome, i.e. number of influenza days averted, and societal costs were compared for three strategies: RFT and conditional zanamivir prescription;systematic zanamivir prescription; and no zanamivir. A two-way sensitivity analysis was performed including the proportion of influenza-positive patients.Results: During influenza epidemics, systematic zanamivir prescription provided the best health outcome (0.81 influenza days averted) and minimised societal costs (reduced by 29.80 US dollars per person compared with no zanamivir; 1999 values). RFT with conditional zanamivir averted 0.65 influenza days and saved 14.40 US dollars per person. When the proportion of influenza-positive patients was under 39%, the no zanamivir strategy yielded the greatest societal savings; otherwise, systematic zanamivir was the dominant strategy. Medical costs associated with no zanamivir were 88.70 US dollars per patient consulting with influenza-like illness, and increased to 125.50 US dollars with systematic zanamivir and to 127.60 US dollars with RFT and conditional zanamivir.Conclusions: Due to poor sensitivity of current RFT, systematic zanamivir prescription without RFT for unvaccinated healthy working adults should be recommended during influenza epidemics. [ABSTRACT FROM AUTHOR]

Background: Many hypotheses were raised regarding a role of nutrition in COVID-19 (susceptibility to infection, disease severity) based on the importance of macronutrients, vitamins or minerals for a proper functioning of the immune system. Our objective was to study the associations between dietary intakes and the seroprevalence SARS-CoV-2 infection in a large population-based sample. Methods: Our analyses included 7766 adults from the French NutriNetSante´ cohort who provided at least 6 valid 24h dietary records in the two years preceding the start of the COVID-19 pandemic in France (February 2020). An ELISA assay was used to detect anti-SARS-CoV-2 antibodies: 311 participants were positive and 7455, negative. Associations between dietary intakes and the seroprevalence of anti-SARS-CoV-2 antibodies were investigated using multi-adjusted logistic regressions. Results: A lower seroprevalence of SARS-CoV-2 infection was associated to higher intakes of vitamin B9 (HR = 0.84 (0.72-0.98)), vitamin C (HR = 0.85 (0.75-0.97)), vitamin K (HR = 0.86 (0.74-0.99)), dietary fibres (HR = 0.84 (0.72-0.97)), and fruit and vegetables (HR = 0.84 (0.74-0.97)). Higher intakes of calcium (HR = 1.17 (1.01-1.35)) and dairy products (HR = 1.19 (1.06-1.33)) associated to a higher seroprevalence of SARSCoV-2 infection. No association was observed with other food groups or nutrients or with the overall diet. Conclusions: Based on exhaustive seroprevalence data in a large populationbased sample, our results suggested that higher intakes of vitamin C, folates, vitamin K, dietary fibres and fruit and vegetables were associated with a lower susceptibility to SARSCoV-2 infection. Key messages: Higher intakes of vitamin C, folates, vitamin K, dietary fibres and fruit and vegetables were associated to a lower susceptibility to SARS-CoV-2 infection, assessed with exhaustive seroprevalence data. Beyond its established role in the prevention of noncommunicable diseases, nutrition could also contribute to prevent some infectious diseases such as COVID-19. [ABSTRACT FROM AUTHOR]

Background: Obesity has been identified as an important risk factor for COVID-19 severity. Besides, several reports also suggested that obesity (or a higher BMI) may also be associated with a higher susceptibility to SARS-CoV-2 infection although this remains unclear. Going beyond BMI, our objective was to study several anthropometric characteristics in relation to the seroprevalence of SARS-CoV-2 infection in a large population-based sample. Methods: 21,376 participants from the French NutriNet-Sante´ cohort study were included in the main analyses. An ELISA assay was used to detect anti-SARS-CoV-2 antibodies: 1027 participants were positive and 20,349, negative. Associations between a wide range of anthropometric characteristics (body mass index but also waist and hip circumference and body composition) and the seroprevalence of anti-SARS-CoV-2 antibodies were investigated using multi-adjusted logistic regressions. Results: A positive yet unclear association was observed between BMI and SARS-CoV-2 seroprevalence in women (positive linear trend (P = 0.07) that was significant using restricted cubic splines (P = 0.04), but no association with standard categories of BMI). No association was observed in men. Waist circumference (P = 0.04) and waist-to-hip ratio (P = 0.01) associated with a higher seroprevalence in women while opposite trends were observed in men (P = 0.08 and 0.03 respectively). Body, trunk and visceral fat (all P < 0.05), but not lean or muscle mass, associated with higher seroprevalence, especially in women. Conclusions: Our results highlight a higher susceptibility to SARS-CoV-2 infection in women with higher body fat, suggesting that central adiposity may be an important factor to consider for risk stratification in the population. Key messages: A higher seroprevalence of SARS-CoV-2 infection was observed in women with a higher body fat, but not in men. Central adiposity may be a risk factor for SARS-CoV-2 infection and not only for COVID-19 severity. [ABSTRACT FROM AUTHOR]

Quantifying the role of children in influenza spread is needed to propose efficient strategies to control influenza epidemics. We developed a statistical model to estimate all parameters required in this evaluation. It was applied to a data set consisting of the follow-up of influenza symptoms in 1124 subjects from 334 households during 15 days. For each clinical case, the data were augmented with the unobserved dates of the start and the end of the infectious period. The posterior distribution of the parameters was obtained using Markov Chain Monte Carlo sampling. We estimated that children were more likely to transmit than adults (posterior probability: 98%), but that the average infectious period was similar in children (3.4 days, 95% confidence interval CI [1.8,5.2]) and adults (3.8 days, CI [2.9,4.7]). The posterior probability that children had a larger community risk was 77% and the posterior probability that they were more susceptible than adults was 75%. From simulation, we found that considering a child immune in a household led to a decrease of the probability of infection for adults twice as large as when considering an adult immune, and had the same effect on children as when considering two adults immune. [Copyright &y& Elsevier]

A reply by authors on comments made on recurrence of Hepatocellular Carcinoma (HCC) after Direct Acting Antiviral (DAA) therapy is presented.

BackgroundHospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients’ health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients’ opinions on their satisfaction concerning the organization of hospital discharge. ObjectiveOur primary objective was to compare patients’ opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. MethodsWe created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients’ impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. ResultsOf the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (P

Introduction Les patients ayant une infection chronique par le VHC ont un risque accru de maladies rénales et d’insuffisance rénale. Mais les facteurs associés au risque rénal sont peu connus. Le but de cette étude est d’estimer la prévalence de l’IRC (stade ≥ 3) chez les patients infectés par le VHC et de rechercher une corrélation avec la sévérité de l’hépatopathie. Patients et méthodes Nous avons analysé le DFG estimé (CKDEPI) chez les patients HCV + non transplantés rénaux de la cohorte nationale multicentrique prospective observationnelle ANRS CO22 Hepather. Résultats L’analyse a concerné 8571 patients sur 14379 inclus pour HCV. Les caractéristiques sont : 56 % d’hommes, 57 ± 20 ans, HTA 30 %, infection depuis 17 ± 13 ans, ARN VHC détectable chez 96 %, génotype 1, 2, 3, 4 et 5/6/7 (66 %, 6 %, 13 %, 13 % et 2 % respectivement), 40 % de cirrhose (96 % Child A, MELD moyen 8 ± 3) et 59 % déjà traités par antiviraux (interféron et ribavirine 67 %). La prévalence à l’inclusion d’un DFG ≤ 60 était de 6,3 % (IC95 % : 5,8 –6,9 %). En analyse univariée, les facteurs significativement associés à la prévalence de l’IRC étaient : sexe, âge, IMC, durée d’infection, traitement anti-VHC, diabète, HTA, hypercholestérolémie, bas niveau de diplôme, antécédent de cardiopathie, de transplantation hépatique, génotypes 2 et 5/6/7 ; ni le stade de fibrose/cirrhose ni le score de Child. Les facteurs significativement liés à la prévalence de l’IRC, d’après l’analyse multivariée, sont présentés dans le Tableau 1 . Discussion Dans la cohorte ANRS C0-22 Hepather, la prévalence de l’IRC était de 7,3 %. Conclusion Les facteurs de risque étaient âge, HTA, diabète, hypercholestérolémie, antécédents de cardiopathie mais non-sévérité de l’hépatopathie. Une analyse longitudinale analysera l’effet des combinaisons antivirales C sur la fonction rénale à long terme. [ABSTRACT FROM AUTHOR]