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Men living with HIV/AIDS in sub-Saharan Africa are less likely to test for HIV than women. We conducted a scoping review in May of 2016 to identify how masculine norms influence men's HIV testing in sub-Saharan Africa. Our review yielded a total of 13 qualitative studies from 8 countries. Masculine norms create both barriers and facilitators to HIV testing. Barriers included emotional inexpression, gendered communication, social pressures to be strong and self-reliant, and the fear that an HIV positive result would threaten traditional social roles (i.e., husband, father, provider, worker) and reduce sexual success with women. Facilitators included perceptions that HIV testing could restore masculinity through regained physical strength and the ability to re-assume the provider role after accessing treatment. Across sub-Saharan Africa, masculinity appears to play an important role in men's decision to test for HIV and further research and interventions are needed to address this link.

Introduction Contact tracing for chronic hepatitis B infection is an important activity for preventing the spread of hepatitis B infection. In the UK, the 'Green Book' recommends that all sexual and household contacts of individuals with chronic hepatitis B should be tested and vaccinated if required. This audit aimed to evaluate contact tracing in primary care. Barriers to effective follow-up of contacts of patients with chronic hepatitis B were explored and recommendations made. Methods and results Mixed method, including a survey of general practitioners and review of hepatitis B surveillance data from 1 June 2015 to 31 December 2015 held by NHS Grampian Health Protection Team. The audit was carried out in August 2016. Contact tracing was mainly by patient referral. Only 20% (4/20) of identified close contacts were tested. No contact eligible for vaccination was vaccinated, and 57% (8/14) of general practitioners who completed the audit questionnaire suggested that general practitioners do not have a role in contact tracing. Barriers identified were: lack of time, lack of resources and contacts being registered with a different practice. Conclusions This audit suggests that contact tracing for chronic hepatitis B in primary care is largely incomplete. Moving contact tracing from general practice to health protection teams in Boards may be a pragmatic way of improving follow-up activities.

Contact tracing is a crucial component of the control of many infectious diseases, but is an arduous and time consuming process. Procedures that increase the efficiency of contact tracing increase the chance that effective controls can be implemented sooner and thus reduce the magnitude of the epidemic. We illustrate a procedure using Graph Theory in the context of infectious disease epidemics of farmed animals in which the epidemics are driven mainly by the shipment of animals between farms. Specifically, we created a directed graph of the recorded shipments of deer between deer farms in Pennsylvania over a timeframe and asked how the properties of the graph could be exploited to make contact tracing more efficient should Chronic Wasting Disease (a prion disease of deer) be discovered in one of the farms. We show that the presence of a large strongly connected component in the graph has a significant impact on the number of contacts that can arise., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

INTRODUCTION Bacterial sexually transmitted infections (STIs) contribute to a significant burden of ill-health despite being easy to diagnose and treat. STI management guidelines provide clinicians with evidence-based guidance on best-practice case management. AIM To determine the extent of adherence to STI management guidelines for partner notification, follow up and testing for reinfection following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. METHODS Retrospective review of electronic patient records for individuals diagnosed with chlamydia or gonorrhoea in eight primary care clinics in Wellington, New Zealand. At each clinic, 40 clinical records were reviewed (320 in total). Outcome measures were: overall numbers (%) of cases with documented evidence of reason for testing, sexual history, treatment, advice, partner notification and follow up. Partner notification outcomes were: n (%) with evidence of partner notification discussion and n (%) with partners advised, tested and treated. Proportions retested between 6 weeks and 6 months and n (%) positive on retesting were also determined. RESULTS Presenting features and treatment were generally well documented. Recent sexual history including number of partners was documented for half of cases reviewed (159/320). Partner notification discussion was documented for 74% (237/320) of cases, but only 24.4% (78/320) had documentation on numbers of partners notified and 17% (54/320) on numbers of partners treated. Testing for reinfection between 6 weeks and 6 months occurred for 24.7% (79/320), of whom 19% (15/79) re-tested positive. CONCLUSIONS This research suggests there are gaps in important aspects of patient care following bacterial STI diagnosis - a factor that may be perpetuating our high rates of infection. A more systematic approach will be needed to ensure people diagnosed with an STI receive the full cycle of care in line with best practice guidelines.

Yaws is a disabling bacterial infection found primarily in warm and humid tropical areas. The World Health Organization strategy mandates an initial round of total community treatment (TCT) with single-dose azithromycin followed either by further TCT or active case-finding and treatment of cases and their contacts (the Morges strategy). We sought to investigate the effectiveness of the Morges strategy. We employed a stochastic household model to study the transmission of infection using data collected from a pre-TCT survey conducted in the Solomon Islands. We used this model to assess the proportion of asymptomatic infections that occurred in households without active cases. This analysis indicated that targeted treatment of cases and their household contacts would miss a large fraction of asymptomatic infections (65%-100%). This fraction was actually higher at lower prevalences. Even assuming that all active cases and their households were successfully treated, our analysis demonstrated that at all prevalences present in the data set, up to 90% of (active and asymptomatic) infections would not be treated under household-based contact tracing. Mapping was undertaken as part of the study "Epidemiology of Yaws in the Solomon Islands and the Impact of a Trachoma Control Programme," in September-October 2013.

Bakgrunn: I norsk helsevesen gjennomføres omfattende tiltak for å hindre spredning av meticillinresistente Staphylococcus aureus (MRSA). Vi ønsket å undersøke hvor mange smitteoppsporinger som gjøres rundt nyoppdagede MRSA-tilfeller hos pasienter og ansatte i sykehus, og hvor ofte smitteoppsporingene fører til ytterligere funn hos helsepersonell., Materiale Og Metode: I denne retrospektive observasjonsstudien bidro smittevernenhetene ved åtte helseforetak i landets fire helseregioner med opplysninger om MRSA-funn hos helsepersonell etter gjennomførte MRSA-smitteoppsporinger. Data ble innhentet fra 14 ulike somatiske sykehus i årene 2012-15., Resultater: 10 142 ansatte i helsevesenet ble testet for MRSA, med positivt funn hos 31 ansatte (0,31 %). Hos 19 ansatte (0,19 %) ble det påvist samme MRSA-stamme som hos indekskasus. I kun to av 351 smitteoppsporinger (0,57 %) ble samme MRSA-stamme funnet hos mer enn én ansatt., Fortolkning: MRSA-smitteoppsporing i norske sykehus har et betydelig omfang, men det er sjelden det påvises MRSA hos helsepersonell i forbindelse med smitteoppsporing.

Background: The End TB Strategy calls for systematic screening of selected high-risk groups including contacts of tuberculosis (TB) cases to facilitate early TB case detection. Contact investigation is not usually routinely practiced in low TB burden countries, such as Ghana, with consequent paucity of data on the yield of TB case detection from such interventions. This study's objective was to document the outcomes and feasibility of implementing contact investigation activities under programmatic conditions in Ghana., Methods: Retrospective analyses were conducted of abstracted data from the National TB Program, following a contact investigation intervention for TB cases diagnosed in 10 facilities in Accra from June 2010 to December 2014. Various proportions and yield from number of contacts needed to screen (NNS) and number needed to test (NNT) to detect a TB case were assessed., Results: Overall, out of the 8519 listed contacts of 3267 index cases, 8166 (96%) were screened and 614 (7.5%) were identified as presumptive TB. Out of these, 438 (71%) underwent sputum smear microscopy/evaluation and 53 TB cases were diagnosed. Of these, 56.6% were males, and 49% had sputum smear-positive TB, 38% had sputum smear-negative TB, and 7% had extra-pulmonary TB. The NNS and NNT to detect a TB case of all forms were 154 and 8, respectively. The proportion of TB cases with contacts listed and proportion of contacts screened annually were 88-96% and 83-100%, respectively. The proportion of presumptive TB cases tested and proportion of TB cases diagnosed among contacts tested that were 100% and 36%, respectively, in 2010 dropped to 40% and 14%, respectively, by 2014., Conclusions: The study demonstrates that contact identification and prioritization components of a contact investigation were feasible, but overall yield of TB cases may have been lower due to the declining rate of clinical evaluation of presumptive TB contacts over time. Addressing barriers to accessing appropriate diagnostic tests may enhance yield from contact investigation in Ghana.

Primary Mycobacterium tuberculosis transmission is an important driver of the global epidemic of resistance to tuberculosis drugs. A few studies have compared tuberculosis infection in contacts of index cases with different drug-resistant profiles, suggesting that contacts of multidrug-resistant (MDR) tuberculosis cases are at higher risk. Repeated tuberculosis exposure in contacts of MDR tuberculosis patients through recurrent tuberculosis may modify this relationship. We compared tuberculosis infection in household contacts of MDR and drug-susceptible (DS) tuberculosis patients from six cities in southeastern China and investigated whether repeated tuberculosis exposure was a mediating factor. Tuberculosis infection was defined as a tuberculin skin test induration ≥ 10 mm. In all, 111 (28.0%) of 397 household contacts of MDR tuberculosis patients and 165 (24.7%) of 667 contacts of DS tuberculosis index cases were infected with tuberculosis. In a multivariate model not including the previous tuberculosis exposure, contacts of MDR tuberculosis patients had a higher likelihood of tuberculosis infection (adjusted odds ratio [AOR] = 1.37; 95% confidence interval [CI] = 1.01-1.84; P = 0.041). In a separate multivariate model adjusted for the previous tuberculosis exposure, the odds ratio of tuberculosis infection flipped and contacts of MDR cases were now at lower risk for tuberculosis infection (AOR = 0.55; 95% CI = 0.38-0.81; P = 0.003). These findings suggest prior tuberculosis exposure in contacts strongly mediates the relationship between tuberculosis infection and the index drug resistance profile. Prior studies showing lower risk of developing tuberculosis among contacts of MDR tuberculosis patients may be partially explained by a lower rate of tuberculosis infection at baseline.

Understanding the dynamics of disease spread is key to developing effective interventions to control or prevent an epidemic. The structure of the network of contacts over which the disease spreads has been shown to have a strong influence on the outcome of the epidemic, but an open question remains as to whether it is possible to estimate contact network features from data collected in an epidemic. The approach taken in this paper is to examine the distributions of epidemic outcomes arising from epidemics on networks with particular structural features to assess whether that structure could be measured from epidemic data and what other constraints might be needed to make the problem identifiable. To this end, we vary the network size, mean degree, and transmissibility of the pathogen, as well as the network feature of interest: clustering, degree assortativity, or attribute-based preferential mixing. We record several standard measures of the size and spread of the epidemic, as well as measures that describe the shape of the transmission tree in order to ascertain whether there are detectable signals in the final data from the outbreak. The results suggest that there is potential to estimate contact network features from transmission trees or pure epidemic data, particularly for diseases with high transmissibility or for which the relevant contact network is of low mean degree. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

A growing evidence base supports expansion of partner notification in HIV testing services (HTS) in sub-Saharan Africa. In 2015, a cross-sectional study was conducted in Njombe region, Tanzania, to evaluate partner notification within facility-based HTS. Men and women newly diagnosed with HIV were enrolled as index clients and asked to list current or past sexual partners for referral to HTS. Successful partner referral was 2.5 times more likely among married compared to unmarried index clients and 2.2 times more likely among male compared to female index clients. In qualitative analysis, male as well as female index clients mentioned difficulties notifying past or casual partners, and noted disease symptoms as a motivating factor for HIV testing. Female index clients mentioned gender-specific challenges to successful referral. Women may need additional support to overcome challenges in the partner notification process. In addition to reducing barriers to partner notification specific to women, a programmatic emphasis on social strengths of males in successfully referring partners should be considered.

Background: Chlamydia prevalence remains high despite scaling-up control efforts. Transmission is not effectively interrupted without partner notification (PN) and (timely) partner treatment (PT). In the Netherlands, the follow-up of partners is not standardized and may depend on GPs' time and priorities. We investigated current practice and attitude of GPs towards PN and PT to determine the potential for Patient-Initiated Partner Treatment, which is legally not supported yet., Methods: Multiple data-sources were combined for a landscape analysis. Quantitative data on (potential) PT were obtained from prescriptions in the national pharmacy register (2004-2014) and electronic patient data from NIVEL-Primary Care Database (PCD) and from STI consultations in a subgroup of sentinel practices therein. Furthermore, we collected information on current practice via two short questionnaires at a national GP conference and obtained insight into GPs' attitudes towards PN/PT in a vignette study among GPs partaking in NIVEL-PCD., Results: Prescription data showed Azithromycin double dosages in 1-2% of cases in the pharmacy register (37.000 per year); probable chlamydia-specific repeated prescriptions or double dosages of other antibiotics in NIVEL-PCD (115/1078) could not be interpreted as PT for chlamydia with certainty. STI consultation data revealed direct PT in 6/100 cases, via partner prescription or double doses. In the questionnaires the large majority of GPs (>95% of 1411) reported to discuss PN of current and ex-partner(s) with chlamydia patients. Direct PT was indicated as most common method by 4% of 271 GPs overall and by 12% for partners registered in the same practice. Usually, GPs leave further steps to the patients (83%), advising patients to tell partners to get tested (56%) or treated (28%). In the vignette study, 16-20% of 268 GPs indicated willingness to provide direct PT, depending on patient/partner profile, more (24-45%) if patients would have the chance to notify their partner first., Conclusion: GPs in the Netherlands already treat some partners of chlamydia cases directly, especially partners registered in the same practice. Follow-up of partner notification and treatment in general practice needs more attention. GPs may be open to implement PIPT more often, provided there are clear guidelines to arrange this legally and practically.

Background: Young adults, including college students, have higher rates of chlamydia than the general population. Patient-delivered partner therapy (PDPT) is a partner treatment option for sex partners of individuals diagnosed with chlamydia or gonorrhea. We examined college health center use of PDPT in a national sample of colleges., Methods: During 2014 to 2015, we collected data from 482 colleges and universities (55% of 885 surveyed), weighting responses by institutional characteristics abstracted from a national database (eg, 2-year vs 4-year status). We asked whether the school had a student health center and which sexual and reproductive health (SRH) services were offered. We also assessed the legal and perceived legal status of PDPT in states where schools were located. We then estimated PDPT availability at student health centers and measured associations with legal status and SRH services., Results: Most colleges (n = 367) reported having a student health center; PDPT was available at 36.6% of health centers and associated with perceived legality of PDPT in the state in which the college was located (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.17-18.28). Patient-delivered partner therapy was significantly associated with availability of SRH services, including sexually transmitted disease diagnosis and treatment of STI (56.2% vs 1.1%), gynecological services (60.3% vs 12.2%), and contraceptive services (57.8% vs 7.7%) (all P < .001). Compared with schools taking no action, PDPT was more likely to be available at schools that notified partners directly (OR, 8.29; 95% CI, 1.28-53.85), but not schools that asked patients to notify partners (OR, 3.47; 95% CI, 0.97-12.43)., Conclusions: PDPT was more likely to be available in colleges that offered SRH services and where staff believed PDPT was legal. Further research could explore more precise conditions under which PDPT is used.

Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with adverse birth outcomes. Untreated partners contribute to high rates of STI reinfection; thus, partner notification and treatment remain important components of STI care and control. A prospective cohort study was conducted among 300 pregnant women presenting to the antenatal clinic at Princess Marina Hospital in Gaborone, Botswana who enrolled in an STI screening study. Following informed consent and sample collection for CT/NG/TV testing, participants were asked if they were willing to disclose their STI result and to deliver medications to their partner(s). Those who tested positive were asked at a follow-up appointment if they notified their partners. Among the 300 participants, 294 (98%) said they would be willing to tell their partner(s) about their test results if they tested positive, and 284 (95%) said they would be willing to give their partner(s) medication if the option was available. Of those who tested positive and returned for a test of cure, 27 of 32 (84%) reported that they told their partner about the results, and 20 of 32 (63%) reported that their partner received treatment. Almost all pregnant women reported willingness to tell their partner the STI test result and give their partner medications. At test of cure, most women reported informing their partner, although actual treatment receipt was lower. Our findings suggest that pregnant women are willing to utilize patient-based partner notification, but actual partner treatment might be lower than intended.

Background: This paper analyzes the trends of key indicators reflecting the epidemiological situation of leprosy in nine different states of the Republic of the Sudan after the introduction of a systematic contact screening in 2010., Methods: The routinely assessed data from the leprosy control program from 2010 to 2016 were analyzed., Results: Despite, intense contact screening, the overall number of new cases detected showed a decreasing trend. The female:male ratio among new cases was constantly low. The overall average number of contacts needed to screen in order to detect a new case among contacts was 64. However, this number varied significantly in the nine states under investigation, with the best yield being observed in the state with the lowest case detection rate., Conclusions: The total number of new cases of leprosy in nine states of the Republic of the Sudan has shown declining tendencies since 2010. Our data are not suggestive of a significant impact of contact screening on the trends of leprosy key indicators. Overall, contact screening proved to be efficient in most states, including those that exhibited very low annual new case detection rates (ANCDRs). Sensitization of personnel undergoing training and measures improving access of females to leprosy services are urgently needed., (© The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Household contact studies, a mainstay of tuberculosis transmission research, often assume that tuberculosis-infected household contacts of an index case were infected within the household. However, strain genotyping has provided evidence against this assumption. Understanding the household versus community infection dynamic is essential for designing interventions. The misattribution of infection sources can also bias household transmission predictor estimates. We present a household-community transmission model that estimates the probability of community infection, that is, the probability that a household contact of an index case was actually infected from a source outside the home and simultaneously estimates transmission predictors. We show through simulation that our method accurately predicts the probability of community infection in several scenarios and that not accounting for community-acquired infection in household contact studies can bias risk factor estimates. Applying the model to data from Vitória, Brazil, produced household risk factor estimates similar to two other standard methods for age and sex. However, our model gave different estimates for sleeping proximity to index case and disease severity score. These results show that estimating both the probability of community infection and household transmission predictors is feasible and that standard tuberculosis transmission models likely underestimate the risk for two important transmission predictors. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

To help health policy makers gain response time to mitigate infectious disease threats, it is essential to have an efficient epidemic surveillance. One common method of disease surveillance is to carefully select nodes (sentinels, or sensors) in the network to report outbreaks. One would like to choose sentinels so that they discover the outbreak as early as possible. The optimal choice of sentinels depends on the network structure. Studies have addressed this problem for static networks, but this is a first step study to explore designing surveillance systems for early detection on temporal networks. This paper is based on the idea that vaccination strategies can serve as a method to identify sentinels. The vaccination problem is a related question that is much more  well studied for temporal networks. To assess the ability to detect epidemic outbreaks early, we calculate the time difference (lead time) between the surveillance set and whole population in reaching 1% prevalence. We find that the optimal selection of sentinels depends on both the network's temporal structures and the infection probability of the disease. We find that, for a mild infectious disease (low infection probability) on a temporal network in relation to potential disease spreading (the Prostitution network), the strategy of selecting latest contacts of random individuals provide the most amount of lead time. And for a more uniform, synthetic network with community structure the strategy of selecting frequent contacts of random individuals provide the most amount of lead time.

Background: Investigation of household contacts exposed to infectious tuberculosis (TB) is widely recommended by international guidelines to identify secondary cases of TB and limit spread. There is little data to guide the use of contact investigations outside of the household, despite strong evidence that most TB infections occur outside of the home in TB high burden settings. In older adolescents, the majority of infections are estimated to occur in school. Therefore, as part of a project to increase active case finding in Swaziland, we performed school contact investigations following the identification of a student with infectious TB., Methods: The Butimba Project identified 7 adolescent TB index cases (age 10-20) with microbiologically confirmed disease attending 6 different schools between June 2014 and March 2015. In addition to household contact investigations, Butimba Project staff worked with the Swaziland School Health Programme (SHP) to perform school contact investigations. At 6 school TB screening events, between May and October 2015, selected students underwent voluntary TB screening and those with positive symptom screens provided sputum for TB testing., Results: Among 2015 student contacts tested, 177 (9%) screened positive for TB symptoms, 132 (75%) produced a sputum sample, of which zero tested positive for TB. Household contact investigations of the same index cases yielded 40 contacts; 24 (60%) screened positive for symptoms; 19 produced a sputum sample, of which one case was confirmed positive for TB. The odds ratio of developing TB following household vs. school contact exposure was significantly lower (OR 0.0, 95% CI 0.0 to 0.18, P = 0.02) after exposure in school., Conclusion: School-based contact investigations require further research to establish best practices in TB high burden settings. In this case, a symptom-based screening approach did not identify additional cases of tuberculosis. In comparison, household contact investigations yielded a higher percentage of contacts with positive TB screens and an additional tuberculosis case.

Introduction: The prevention of reinfection of sexually transmitted infections (STIs) is highly dependent on the level of risk perception and the subsequent adoption of preventive behaviors. While perceived risk is assumed to be key to adoption of preventive measures, the evidence regarding the predictors of perceived risk to STI reinfection are limited., Methods: This paper is based on a cross sectional facility based survey conducted in North Ethiopia from January to June; 2015. Patients attending public health facilities for STI care responded to a structured questionnaire at clinic exist. Ordinal logistic regression was employed to identify factors associated with risk perception., Results: Of the 1082 STI patients who participated in the study, 843(77.91%) indicated a high perceived risk of STI reinfection. The major factor associated with low perceived risk of reinfection was willingness to notify partner; the odds of being willing to notify partner was greater among those who perceived low risk (AOR=3.01, 95% CI: 2.13-4.25). In addition, low perceived risk was associated with female index cases (AOR=1.49, 95% CI: 1.07-2.08), those who had high school education and above (AOR=1.68, 95% CI: 1.07-2.65), those aged 25 years and above (AOR=1.52, 95% CI: 1.09-2.12), those who had a single partner (AOR=1.82, 95% CI: 1.20-2.74), and those who had low perceived stigma (AOR=1.42, 95% CI: 1.04-1.95)., Conclusion: The perceived risk of STI reinfection is high and strongly associated with willing to notify partner. Efforts to prevent STI reinfection need to consider interventions that enhance partner notification.

Background: Public health approaches to sexually transmitted infection (STI) prevention in resource-limited countries rely on patients to self-notify sex partners of their STI. However, a majority of partners go uninformed and remain untreated and infectious., Methods: Anonymous surveys collected from 776 men and women receiving STI clinic services in Cape Town, South Africa., Results: Half of patients surveyed intended to inform their partners, while half did not intend to notify partners. Women were more likely than men to intend to notify their partners. Patients who completed formal education were also more likely to indicate intentions to notify partners. There were no associations between numbers of partners patients had or partner types with intentions to notify partners. Among both men and women, concerns about adverse partner reactions were associated with intentions not to notify partners. Multivariable analyses stratified by gender and controlling for confounds showed that intentions to notify partners were significantly related to men's concerns that their partner could react violently against them and women's concerns that their partner may leave them and refuse to see them again., Conclusions: Interventions that assist patients to develop strategies to safely inform their partners are needed to increase patient-initiated partner notification., (© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Improved partner notification (PN) after HIV diagnosis could help control HIV among men who have sex with men (MSM). However, there is little evidence exploring what this experience is like for Australian MSM and how achievable it is in the era of the Internet and smartphones. Fifteen of 39 invited MSM recently diagnosed with HIV undertook a semistructured interview about PN. Interviews were thematically analyzed using a combined deductive/inductive approach. Three main themes arose: fear of PN and HIV disclosure, partners' unexpected reactions, and the need for more patient support. MSM found PN difficult and uncomfortable and described fear about potential repercussions of PN; however, they felt it was the right thing to do. Regular partners were more likely to be notified, and in person, because of the availability of contact information but more notably because of a sense of moral responsibility. Men commonly had few contact details for casual partners and preferred PN strategies that allowed them to remain anonymous, largely reflecting the reasons for and ways in which they met casual partners: online or through apps and predominantly for once-off, anonymous sex. Most described unexpected positive responses from partners who were contacted personally by the men. Our study also showed that participants required professional support to carry out PN, especially with casual partners, as well as support around understanding the implications of and treatments relating to being HIV positive. PN could be improved by offering more options that allow the index patient to remain anonymous, particularly when notifying casual partners.

Infectious diseases in livestock can be transmitted through fomites: objects able to convey infectious agents. Between-farm spread of infections through fomites is mostly due to indirect contacts generated by on-farm visits of personnel that can carry pathogens on their clothes, equipment, or vehicles. However, data on farm visitors are often difficult to obtain because of the heterogeneity of their nature and privacy issues. Thus, models simulating disease spread between farms usually rely on strong assumptions about the contribution of indirect contacts on infection spread. By using data on veterinarian on-farm visits in a dairy farm system, we built a simple simulation model to assess the role of indirect contacts on epidemic dynamics compared to cattle movements (i.e. direct contacts). We showed that including in the simulation model only specific subsets of the information available on indirect contacts could lead to outputs widely different from those obtained with the full-information model. Then, we provided a simple preferential attachment algorithm based on the probability to observe consecutive on-farm visits from the same operator that allows overcoming the information gaps. Our results suggest the importance of detailed data and a deeper understanding of visit dynamics for the prevention and control of livestock diseases.

Understanding human mixing patterns is the key to provide public health decision makers with model-based evaluation of strategies for the control of infectious diseases. Here we conducted a population-based survey in Tomsk, Russia, asking participants to record all their contacts in physical person during the day. We estimated 9.8 contacts per person per day on average, 15.2 when including additional estimated professional contacts. We found that contacts were highly assortative by age, especially for school-age individuals, and the number of contacts negatively correlated with the age of the participant. The network of contacts was quite clustered, with the majority of contacts (about 72%) occurring between family members, students of the same school/university, and work colleagues. School represents the location where the largest number of contacts was recorded - students contacted about 7 individuals per day at school. Our modeling analysis based on the recorded contact patterns supports the importance of modeling age-mixing patterns - we show that, in the case of an epidemic caused by a novel influenza virus, school-age individuals would be the most affected age group, followed by adults aged 35-44 years. In conclusion, this study reveals an age-mixing pattern in general agreement with that estimated for European countries, although with several quantitative differences. The observed differences can be attributable to sociodemographic and cultural differences between countries. The age- and setting-specific contact matrices provided in this study could be instrumental for the design of control measures for airborne infections, specifically targeted on the characteristics of the Russian population., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Since the beginning of the 21 st century, beside tuberculin skin tests (TST) and chest X-rays, interferon-gamma release assays (IGRA) have become available for diagnosing latent tuberculosis infection. In 2006, the Governmental Institute of Public Health of Lower Saxony (NLGA) established the IGRA in its laboratory, using the QuantiFERON-TB ® Gold In-Tube (QFT). A cohort of 19 309 contact persons who were investigated during contact tracing by local public health departments (LPHD) was analyzed. Within 3 years, 75% of LPHDs in Lower Saxony established the QFT for tuberculosis contact tracing. Between 2007 and 2014 the percentage of contact persons≥15 years of age with initial TST declined from 65.1 to 1.7%. For contact persons<15 years of age, this proportion declined from 81.7% (2007) to 10.1% (2014). The proportion of contact persons who reported a country of birth outside Germany rose from 21.3 to 28.8% between 2008 and 2013. Cases from South Eastern European countries were increasingly reported, seldom from states of the former Soviet Union. 14.1% of the investigated contact persons had a positive QFT. 449 persons with a negative result underwent a second test within 4 months; 4% of these tested positive. Within a period of 8 years, the TST was replaced by the QFT in Lower Saxony, not least because of the modified recommendations for environmental contact tracing in tuberculosis of the German Central Committee against Tuberculosis (DZK). Higher specificity of the QFT and thus fewer X-rays, omission of the second visit for interpreting the TST, and the inappropriate package size of the TST for smaller LPHDs are further arguments in favor for the QFT. But unspecific use of the QFT must be avoided; otherwise, the value of the QFT result declines. The increasing number of contact persons with migration background and the changing countries of origin are a challenge for all who are involved in tuberculosis contact tracing., (© Georg Thieme Verlag KG Stuttgart · New York.)

Although the World Health Organization recommends contact investigations around air travel-associated sputum smear-positive tuberculosis (TB) patients, evidence suggests that the information thus obtained may have overestimated the risk of TB infection because it involved some contacts born in countries with high TB burden who were likely to have been infected with TB in the past, or because tuberculin skin tests were used, which are less specific than the interferon gamma release assay (IGRA) particularly in areas where Bacillus Calmette-Guérin (BCG) vaccination coverage is high. We conducted a questionnaire survey on air travel-associated TB contact investigations in local health offices of Japan from 2012 to 2015, focusing on IGRA positivity. Among 651 air travel-associated TB contacts, average positivity was 3.8% (95% confidence interval (CI): 2.5-5.6) with a statistically significant increasing trend with older age (p < 0.0094). Positivity among 0-34 year-old contacts was 1.0% (95% CI: 0.12-3.5%), suggesting their risk of TB infection is as small as among Japanese young adults with low risk of TB infection (positivity: 0.85-0.90%). Limiting the contact investigation to fewer passengers (within two seats surrounding the index case, rather than two rows) seems reasonable in the case of aircraft with many seats per row., (This article is copyright of The Authors, 2017.)

Objectives: Partner notification (PN) is a key public health intervention in the control of STIs. Data regarding its clinical effectiveness in the context of HIV are lacking. We sought to audit HIV PN outcomes across the UK., Methods: All UK sexual health and HIV services were invited to participate. Clinical audit consisted of retrospective case-note review for up to 40 individuals diagnosed with HIV per site during 2011 (index cases) and a review of PN outcomes for up to five contacts elicited by PN per index case., Results: 169/221 (76%) clinical services participated (93% sexual health/HIV services, 7% infectious diseases/HIV units). Most (97%) delivered PN for HIV. Data were received regarding 2964 index cases (67% male; 50% heterosexual, 52% white). PN was attempted for 88% of index cases, and outcomes for 3211 contacts were audited (from an estimated total of 6400): 519 (16%) were found not to be at risk of undiagnosed HIV infection, 1399 (44%) were informed of their risk and had an HIV test, 310 (10%) were informed of the risk but not known to have tested and 983 (30%) were not informed of their risk of HIV infection. Of 1399 contacts tested through PN, 293 (21%) were newly diagnosed with HIV infection. Regular partners were most likely to test positive (p<0.001)., Conclusions: HIV PN is a highly effective diagnostic strategy. Non-completion of PN thus represents a missed opportunity to diagnose HIV in at-risk populations. Vigorous efforts should be made to pursue PN to identify people living with, and at risk of, HIV infection., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives: The objective of the study was to present the findings of an audit tool aimed at assessing contact tracing activities during an Ebola outbreak., Methods: The tool was based on Ebola guidelines and observations in the field. It was composed of 38 indicators covering contact tracing preparatives, resources, procedures and results., Results: All contact tracing teams were assessed in Boké and Conakry prefectures (24 supervisors, 22 community workers, 442 contacts) between 1 July and 10 August 2015. Contact lists had less than a 40% accomplishment rate. 7% of the contacts were not seen by community workers or supervisors. 'No touch policy' was fully respected., Conclusion: Audit checklist helped to systematically identify critical issues related to contact tracing., (© The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The 2014 outbreak of Ebola virus disease which emerged in the month of March in the year 2014 in Guinea has been declared as a public health emergency of international concern., Objectives: The objectives of the review article are to assess the role of contact tracing in the Ebola outbreak and to identify the challenges faced by the health workers while performing contact tracing., Methods: An extensive search of all materials related to the Ebola outbreak and contact tracing was carried out in PubMed, Medline, World Health Organization website and Google Scholar search engines. Keywords used in the search included Ebola virus disease, West-Africa, contact tracing, World Health Organization. Overall 60 articles were selected and included in the discussion., Results: Contact tracing is an important strategy in epidemiology and refers to the identification and diagnosis of those individuals who have come in contact with an infected person. It ultimately aims to reduce the time span required to detect and treat a case of an infectious disease and hence significantly minimize the risk of transmission to the subsequent susceptible individuals. In-fact, contact tracing continues to remain an important measure, as it aids the epidemiologist in containing the infection., Conclusion: The strategy of contact tracing has a great potential to significantly reduce the incidence of cases of Ebola virus disease. However, its success is eventually determined by the level of trust between the community and the public health system and the quality of the diagnostic & treatment services.

Partner notification (PN) is an important strategy to control sexually transmitted infections. The objective of this study was to assess the outcomes of PN in order to improve control of sexually transmitted infections. We retrospectively reviewed heterosexual male gonorrhea cases who presented for treatment to Bangrak Hospital during 2008 to determine the percent PN, the percent of successful partner management (SPM) and the factors associated with both. We used univariate and multivariate analyses to determine significant associations between characteristics of index cases and PN outcomes. We reviewed the medical records of 418 index cases. The median age of the subjects reviewed was 30 years old (range: 14-63). Six hundred ninety-two partners were identified. Of those, 367 partners (53.0%) were notified by 311 index cases; 95 partners (25.9% of the notifications) of the 89 index cases presented for treatment. The medical records of 92 partners were available to review: 61 (66%) had gonorrhea, chlamydia, or genital herpes infections. The median period from being notified to seeking care was 2.5 days (range: 0-92); 80% sought care within 9 days of notification. Spouses and girlfriends were the major partners being notified and had greater SPM. On multivariate analysis, a greater notification rate was found among index cases who were government workers or had a steady relationship. A higher SPM rate was associated with index cases who were aged ≥25 years, married or had a steady relationship. The PN rate among the studied index cases was inadequate. Further studies are needed to develop successful methods to improve PN rates and SPM rates in order to improve sexually transmitted infection control in the study population.

Introduction: Reconstruction of HIV transmission links allows to trace the spread and dynamics of infection and guide epidemiological interventions. The aim of this study was to characterize transmission networks among subtype B infected patients from Poland., Material and Methods: Maximum likelihood phylogenenetic trees were inferred from 966 HIV-1 subtype B protease/reverse transcriptase sequences from patients followed up in nine Polish HIV centers. Monophyletic clusters were identified using 3% within-cluster distance and 0.9 bootstrap values. Interregional links for the clusters were investigated and time from infection to onward transmission estimated using Bayesian dated MCMC phylogeny., Results: Three hundred twenty one (33.2%) sequences formed 109 clusters, including ten clusters of ≥5 sequences (n = 81, 8.4%). Transmission networks were more common among MSM (234 sequences, 68.6%) compared to other infection routes (injection drug use: 28 (8.2%) and heterosexual transmissions: 59 (17.3%) cases, respectively [OR:3.5 (95%CI:2.6-4.6),p<0.001]. Frequency of clustering increased from 26.92% in 2009 to 50.6% in 2014 [OR:1.18 (95%CI:1.06-1.31),p = 0.0026; slope +2.8%/year] with median time to onward transmission within clusters of 1.38 (IQR:0.59-2.52) years. In multivariate models clustering was associated with both MSM transmission route [OR:2.24 (95%CI:1.38-3.65),p<0.001] and asymptomatic stage of HIV infection [OR:1.93 (95%CI:1.4-2.64),p<0.0001]. Additionally, interregional networks were linked to MSM transmissions [OR:4.7 (95%CI:2.55-8.96),p<0.001]., Conclusions: Reconstruction of the HIV-1 subtype B transmission patterns reveals increasing degree of clustering and existence of interregional networks among Polish MSM. Dated phylogeny confirms the association between onward transmission and recent infections. High transmission dynamics among Polish MSM emphasizes the necessity for active testing and early treatment in this group.

Objectives: To describe and explore data from the surveillance of chlamydia, syphilis, gonorrhoea and genital warts by the Belgian Network of Sentinel General Practices (SGP) over the first 2 years (2013 and 2014) and to estimate the incidence of these 4 sexually transmitted infections (STIs). A special focus is put on data quality., Design: Retrospective observational study., Setting: General practices from the nationwide representative SGP network., Outcome Measures: Agreement between data distributions by year, agreement between SGP-based incidence and incidence based on mandatory notification, missingness of patient age or gender and incompleteness of sexual risk history of patients., Results: 306 new STI episodes were reported from 298 patients, corresponding with an episode-based incidence of 91.9/100 000 (95% CI 81.9 to 102.8) general practice patients, with almost half of it due to chlamydia. The incidence of chlamydia in men was significantly higher in 2014 than in 2013. Population characteristics were similarly distributed in 2013 and 2014. The SGP-based incidence of gonorrhoea and syphilis in Flanders were in agreement with the incidence based on mandatory notification of cases. Patient age or gender was missing from 35 episodes (11.4%). Independent determinants of missingness of patient age or gender were the Flemish region (OR 3.46; 95% CI 1.02 to 11.73) and genital warts infection (OR 2.23; 95% CI 1.07 to 4.63). An incomplete sexual risk history was reported for 54.6% STI episodes. The odds for an incomplete sexual history were higher for older patients (OR 1.72; 95% CI 1.06 to 2.76) and for patients infected with syphilis, gonorrhoea or co-infection(s) (OR 1.71; 95% CI 1.03 to 2.83)., Conclusions: Incompleteness of reports about patients with STI sexual risk histories is important from the perspective of quality of data and of quality of care. Together with the low rates of both HIV testing and discussion of partner notification, this suggests that a general practice guideline is needed., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Introduction: The National tuberculosis program (NTP) in Ivory Coast recommends that children under 5 years living in a family environment with contagious tuberculosis patients, should receive Prophylactic treatment with INH (PTI), whatever the result of the tuberculin skin test (positive or negative) and their BCG status (vaccinated or not), at a dose of 5mg/kg/day for 6 months. We conducted this study to check the implementation of this recommendation in three support services of tuberculosis in Abidjan, the economic capital., Material and Method: We conducted a multicenter, cross-sectional and descriptive study over 3 years (2011-2013), on consented patients, adolescents and adults aged at least 15 years, with a first episode of infectious pulmonary tuberculosis, in order to look for information on the INH prophylaxis in children under 5 years living under the same roof. We made patients interviews during their visit for bacteriological sputum controls at the second month of TB treatment., Results: Of a total of 412 patients (53% males and 47% females) with a mean age of 34.5 years and with a low level of instruction (66.5%), we noticed 639 children under 5 years living under the same roof with them. Information on the screening of contact children was given to 71% of interviewed patients (291/412). Of the 339 children examined among 639 contacts, 234 (69%) had received only an intradermoreaction (IDR) and PTI was finally administered to 64% of them (217/339)., Conclusion: High proportion of contact children under 5 not examined is a major concern for the NTP and a missed opportunity to prevent additional cases of tuberculosis among children., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The risk of communicable disease transmission during air travel is of public health concern and has received much attention over the years. We retrospectively reviewed information from nine flights (≥ 8 hours) associated with infectious tuberculosis (TB) cases in Ireland between September 2011 and November 2014 to investigate whether possible transmission had occurred. Twenty-four flights notified in Ireland associated with sputum smear-positive pulmonary TB cases with a history of air travel were reviewed. Nine were suitable for inclusion and analysed. Six cases of infectious TB travelled on nine flights. A total of 232 passengers were identified for contact tracing; 85.3% (n = 198) had sufficient information available for follow-up. In total, 12.1% (n = 24) were reported as screened for TB. The results revealed no active TB cases among passengers and 16.7% (n = 4) were diagnosed with latent TB infection (LTBI) all of whom had other risk factors. Despite the limited sample size, we found no evidence of M. tuberculosis transmission from infectious passengers. This study identified challenges in obtaining complete timely airline manifests, leading to inadequate passenger information for follow-up. Receipt of TB screening results from international colleagues was also problematic. The challenge of interpreting the tuberculin skin test results in determining recent vs earlier infection was encountered., Competing Interests: Conflicts of Interest: None declared., (This article is copyright of The Authors, 2016.)

Expedited treatment of index patients testing positive for uncomplicated Chlamydia trachomatis via paper treatment vouchers that can be redeemed at a community pharmacy is feasible., (© The Author(s) 2016.)

Background: New strategies to support partner notification (PN) are critical for STD control and require detailed understanding of how specific individual and partnership characteristics guide notification decisions., Methods: From 2011 to 2012, 397 MSM and TW recently diagnosed with HIV, syphilis, or another STD completed a survey on anticipated notification of recent sexual partners and associated factors. Qualitative interviews were conducted with a subset of participants to provide further depth to quantitative findings. Prevalence ratios and generalized estimating equation (GEE) models were used to analyze participant- and partner-level factors associated with anticipated PN., Results: Among all partners reported, 52.5% were described as "Very Likely" or "Somewhat Likely" to be notified. Anticipated notification was more likely for main partners than casual (adjusted Prevalence Ratio [aPR], 95% CI: 0.63, 0.54-0.75) or commercial (aPR, 95% CI: 0.44, 0.31-0.62) partners. Other factors associated with likely notification included perception of the partner as an STD source (aPR, 95% CI: 1.27, 1.10-1.48) and anticipated future sexual contact with the partner (aPR, 95% CI: 1.30, 1.11-1.52). An HIV diagnosis was associated with a lower likelihood of notification than non-HIV STDs (aPR: 0.68, 0.55-0.86). Qualitative discussion of the barriers and incentives to PN reflected a similar differentiation of anticipated notification according to partnership type and type of HIV/STD diagnosis., Discussion: Detailed attention to how partnership characteristics guide notification outcomes is essential to the development of new PN strategies. By accurately and thoroughly assessing the diversity of partnership interactions among individuals with HIV/STD, new notification techniques can be tailored to partner-specific circumstances., Competing Interests: The authors have declared that no competing interests exist.

Background: Non-attendance at TB contact screening clinics has been highlighted as a common phenomenon across a number of sites during recruitment to the PREDICT TB Study. This has obvious implications for the safety of patients, their communities and for NHS resources. The objective of this study was to explore why adults who have been in contact with TB do, and do not, attend their screening appointment, thereby allowing identification of interventions to reduce non-attendance., Methods: A multi-method approach was taken using 15 questionnaires with adults who attended for screening, 15 telephone questionnaires with adults who did not attend and in-depth interviews with 8 TB nurses. Interviews were coded to trace emerging descriptive themes, then refined through an iterative process of interpretation and recoding., Results: Findings from the questionnaires and interviews were categorized into three principle themes following analysis: awareness, hospital factors and leadership. These themes deconstruct the complex phenomena of patients' lack of attendance at this TB contact screening service., Conclusion: Recommendations related to issues of leadership, outreach services, flexibility of clinic timing and awareness amongst both the local community and GPs were made., (© The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aim: To analyze the factors associated with the time to initiating tuberculosis contact investigations in the Somme department, France., Methods: All reported tuberculosis cases and all their contacts screened between 2007 and 2011 were retrospectively included. Univariate and multivariate analyses were conducted to determine the factors associated with a "system delay"≤1 month and a "contact delay"≤0 days., Results: The mean time between the mandatory notification of a case of tuberculosis and the date set for the contact's screening (system delay) was 35.3 days and the average time between that date and when the contact was actually screened (contact delay) was 12.5 days. In multivariate analysis, a smear-positive sputum sample (OR: 3.68; 95% CI: 1.63-8.30) and a diagnosis at the university hospital (OR: 2.61; 95% CI: 1.14-5.96) were significantly associated with a system delay≤1 month. A smear-positive sputum sample (OR: 1.35; 95% CI: 1.08-1.69), male gender (OR: 1.21; 95% CI: 1.01-1.49), being born in a foreign country (OR: 1.31; 95% CI: 1.02-1.69), being a family member (OR: 1.37; 95% CI: 1.05-1.77), or being another type of close contact of the case (OR: 2.47; 95% CI: 1.81-3.36) were significantly associated with a contact delay≤0 days., Conclusion: System and contact delays were longer than recommended, and the factors associated with the lengthening of these delays need to be taken into account., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the yield and determinants of retrospective TB contact investigation in selected zones in Ethiopia., Materials and Methods: This was a community-based cross-sectional study conducted during June-October 2014.Trained lay providers performed symptom screening for close contacts of index cases with all types of TB registered for anti-TB treatment within the last three years. We used logistic regression to determine factors associated with TB diagnosis among the contacts., Results: Of 272,441 close contacts of 47, 021 index cases screened, 13,886 and 2, 091 had presumptive and active TB respectively. The yield of active TB was thus 768/100, 000, contributing 25.4% of the 7,954 TB cases reported from the study zones over the study period. The yield was highest among workplace contacts (12,650/100, 000). Active TB was twice more likely among contacts whose index cases had been registered for TB treatment within the last 12 months compared with those who had been registered 24 or more months earlier (adjusted odds ratio, AOR: 1.77 95% CI 1.42-2.21). Sex or clinical type of TB in index cases was not associated with the yield. Smear negative (SS-) index cases (AOR: 1.74 955 CI 1.13-2.68), having index cases who registered for treatment within <12 months (AOR: 2.41 95% CI 1.51-3.84) and being household contact (AOR: 0.072 95% CI 0.01-0.52) were associated with the occurrence of active TB in children., Conclusions: The yield of retrospective contact investigation was about six times the case notification in the study zones, contributing a fourth of all TB cases notified over the same period. The yield was highest among workplace contacts and in those with recent past history of contact. Retrospective contact screening can serve as additional strategy to identify high risk groups not addressed through currently recommended screening approaches.

Background: The utilization of routine health information systems (HIS) for surveillance of assisted partner services (aPS) for HIV in sub-Saharan is sub-optimal, in part due to poor data quality and limited use of information technology. Consequently, little is known about coverage, scope and quality of HIV aPS. Yet, affordable electronic data tools, software and data transmission infrastructure are now widely accessible in sub-Saharan Africa., Methods: We designed and implemented a cased-based surveillance system using the HIV testing platform in 18 health facilities in Kenya. The components of this system included an electronic HIV Testing and Counseling (HTC) intake form, data transmission on the Global Systems for Mobile Communication (GSM), and data collection using the Open Data Kit (ODK) platform. We defined rates of new HIV diagnoses, and characterized HIV-infected cases. We also determined the proportion of clients who reported testing for HIV because a) they were notified by a sexual partner b) they were notified by a health provider, or c) they were informed of exposure by another other source. Data collection times were evaluated., Results: Among 4351 clients, HIV prevalence was 14.2 %, ranging from 4.4-25.4 % across facilities. Regardless of other reasons for testing, only 107 (2.5 %) of all participants reported testing after being notified by a health provider or sexual partner. A similar proportion, 1.8 % (79 of 4351), reported partner notification as the only reason for seeking an HIV test. Among 79 clients who reported HIV partner services as the reason for testing, the majority (78.5 %), were notified by their sexual partners. The majority (52.8 %) of HIV-infected patients initiated their HIV testing, and 57.2 % tested in a Voluntary Counseling and Testing (VCT) site co-located in a health facility. Median time for data capture was 4 min (IQR: 3-15), with a longer duration for HIV-infected participants, and there was no reported data loss., Conclusion: aPS surveillance using new technologies is feasible, and could be readily expanded into HIV registries in Kenya and other sub-Saharan countries. Partner services are under-utilized in Kenya but further documentation of coverage and implementation gaps for HIV and aPS services is required.

An acute gastroenteritis (AG) outbreak occurred among participants in an obstacle race in France in the summer of 2015. An investigation in two phases was conducted to identify the source of infection and document the extent of the outbreak. First, a message on a social media website asked racers to report any symptoms by email to the Regional Health Agency of Provence-Alpes-Côte d'Azur. Second, a retrospective cross-sectional study was conducted through an interactive questionnaire for all participants, followed by an analytical study of potential risks factors. Of 8,229 persons registered, 1,264 adults reported AG resolved within 48 hours. Of adults who reported AG, 866 met the case definition. Age group, departure time and ingestion of mud were associated with AG. Twenty stool specimens tested negative for bacteria. All four stool samples tested for viruses were positive for norovirus genogroup I and genotype 2. No indicator bacteria for faecal contamination were found in drinking water but muddy water of ponds tested positive. The outbreak was possibly caused by human-to-human transmission of a norovirus introduced by one or more persons and transmitted through contaminated mud. Risks related to similar races should be assessed and recommendations be proposed to raise awareness among health authorities and organisers.

Background: Chronic hepatitis B virus (HBV) infection frequently causes liver disease, and early identification can improve outcome. The burden of chronic HBV infection in many economically developed nations lies in migrant populations. Targeted HBV testing of migrants, and contact tracing for those diagnosed, are public health objectives but uptake has been fragmentary. This qualitative study aimed to investigate understanding of hepatitis B and response to testing and contact tracing amongst people of Somali ethnicity living in Bristol, UK., Methods: The views of 30 people of Somali ethnicity living in Bristol were explored through focus groups and semi-structured interviews. Transcripts of audio-recorded interviews and focus groups were imported into NVivo10 and inductive thematic analysis undertaken., Results: Most participants lacked awareness of hepatitis B, and often co-identified hepatitis B with 'jaundice'. There were frequent misconceptions regarding transmission, natural history and diagnosis, with hepatitis B commonly viewed as a relatively trivial, short lived, symptomatic disease. Hepatitis B was generally not stigmatised. Lack of understanding of the disease was cited as the major barrier to targeted testing and contact tracing., Conclusion: These findings suggest public health initiatives to promote hepatitis B testing and contact tracing within migrant Somali populations should focus on improving hepatitis B understanding, particularly its natural history and diagnosis, and avoid translation of 'hepatitis B' into terms meaning 'jaundice' to address misperception of low susceptibility and low severity., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Introduction: Tuberculosis screening in children is important to identify and treat latent tuberculosis infection and thus avoid progression to disease., Methods: It is a prospective study realized in 83 children between November 2009 and January 2013 who consulted after a household contact for tuberculosis in the pediatric department B of Abderrahmen Mami hospital of Ariana., Results: The mean age of the children was 4.8 years (3 months-15 years). A latent tuberculosis infection was diagnosed in 31.3% of children, 10.8% had tuberculosis and 57.8% were considered healthy. Fifty-seven children (68.7%) had a close daytime contact with the index and 57.8% slept in the same bedroom of the contaminator. The identified risk factors were the diagnosis delay of the index of more than 30 days (P=0.023), presence of cavitations on the chest X-ray of the index (P=0.029) and a close daytime contact (P=0.004)., Conclusion: Our study showed a high rate of contamination in children with a household contact. Efforts are needed to shorten the time to diagnosis of adults' tuberculosis., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the yield and effectiveness of contact investigations conducted around potentially infectious tuberculosis (TB) patients with no positive respiratory culture for Mycobacterium tuberculosis in New York City (NYC)., Design: All TB patients without a positive respiratory culture from 2003 to 2012 were extracted from the NYC TB registry, and all patients eligible for contact investigation and their contacts were evaluated. Patients without a positive respiratory culture were defined as eligible for contact investigation if they had a respiratory nucleic acid amplification result positive for M tuberculosis, a cavitary chest radiograph, or a positive respiratory acid-fast bacilli smear., Setting: NYC, New York., Main Outcome Measures: To evaluate the yield of the investigations, the number of contacts identified and the outcome of testing was quantified. Potential transmission was defined on the basis of whether active TB patients were detected among the contacts and if a contact had a TB test conversion., Results: From 2003 to 2012, there were 2191 TB patients without a positive respiratory culture in NYC, 374 (17%) of which were considered eligible for contact investigation. A total of 11 096 contacts were identified around 300 (80%) eligible patients, 136 of whom had a diagnosis of TB infection; of those with TB infection who initiated preventive treatment, 66% completed treatment. Potential transmission was identified around 14 patients, with the identification of 2 additional cases of active TB and 15 contacts with TB infection test conversion., Conclusions: Conducting contact investigations around patients without a positive respiratory culture yielded evidence of possible transmission and led to the identification and treatment of new TB cases and those with TB infection. These findings suggest that these investigations should be conducted in settings where resources permit.

Injection drug users (IDUs) are at high risk of acquiring and spreading various blood-borne infections including human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and a number of sexually transmitted infections. These infections can spread among IDUs via risky sexual and needle-sharing contacts. To accurately model the spread of such contagions among IDUs, we build a bi-layer network that captures both types of risky contacts. We present methodology for inferring important model parameters, such as those governing network structure and dynamics, from readily available data sources (e.g., epidemiological surveys). Such a model can be used to evaluate the efficacy of various programs that aim to combat drug addiction and contain blood-borne diseases among IDUs. The model is especially useful for evaluating interventions that exploit the structure of the contact network. To illustrate, we instantiate a network model with data collected by a needle and syringe program in Chicago. We model sexual and needle-sharing contacts and the consequent spread of HIV and HCV. We use the model to evaluate the potential effects of a peer education (PE) program under different targeting strategies. We show that a targeted PE program would avert significantly more HIV and HCV infections than an untargeted program, highlighting the importance of reaching individuals who are centrally located in contact networks when instituting prevention programs., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Syphilis outbreaks in urban men who have sex with men (MSM) are an ongoing public health challenge in many high-income countries, despite intensification of efforts to screen and treat at-risk individuals. We sought to understand how population-level coverage of asymptomatic screening impacts the ability to control syphilis transmission., Methods: We developed a risk-structured deterministic compartmental mathematical model of syphilis transmission in a population of sexually active MSM. We assumed a baseline level of treatment of syphilis cases due to seeking medical care in all scenarios. We evaluated the impact of sustained annual population-wide screening coverage ranging from 0% to 90% on syphilis incidence over the short term (20 years) and at endemic equilibrium., Results: The relationship between screening coverage and equilibrium syphilis incidence displayed an inverted U-shape relationship, with peak equilibrium incidence occurring with 20-30% annual screening coverage. Annual screening of 62% of the population was required for local elimination (incidence <1 case per 100 000 population). Results were qualitatively similar in the face of differing programmatic, behavioural and natural history assumptions, although the screening thresholds for local elimination differed. With 6-monthly or 3-monthly screening, the population coverage required to achieve local elimination was reduced to 39% or 23%, respectively., Conclusions: Although screening has the potential to control syphilis outbreaks, suboptimal coverage may paradoxically lead to a higher equilibrium infection incidence than that observed in the absence of intervention. Suboptimal screening programme design should be considered as a possible contributor to unsuccessful syphilis control programmes in the context of the current epidemic., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

We aimed to model the incidence of infection with Mycobacterium tuberculosis among adults using data on infection incidence in children, disease prevalence in adults, and social contact patterns. We conducted a cross-sectional face-to-face survey of adults in 2011, enumerating "close" (shared conversation) and "casual" (shared indoor space) social contacts in 16 Zambian communities and 8 South African communities. We modeled the incidence of M. tuberculosis infection in all age groups using these contact patterns, as well as the observed incidence of M. tuberculosis infection in children and the prevalence of tuberculosis disease in adults. A total of 3,528 adults participated in the study. The reported rates of close and casual contact were 4.9 per adult per day (95% confidence interval: 4.6, 5.2) and 10.4 per adult per day (95% confidence interval: 9.3, 11.6), respectively. Rates of close contact were higher for adults in larger households and rural areas. There was preferential mixing of close contacts within age groups and within sexes. The estimated incidence of M. tuberculosis infection in adults was 1.5-6 times higher (2.5%-10% per year) than that in children. More than 50% of infections in men, women, and children were estimated to be due to contact with adult men. We conclude that estimates of infection incidence based on surveys in children might underestimate incidence in adults. Most infections may be due to contact with adult men. Treatment and control of tuberculosis in men is critical to protecting men, women, and children from tuberculosis., (© The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Introduction: Syphilis, similar to most other sexually transmitted infections, disproportionally affects females more than males, including the risk of adverse outcome of pregnancy and infection in foetus., Objective: To describe and analyse all cases of syphilis among female patients (pregnant and non-pregnant) treated in Bialystok, Poland in 2000-2015., Material and Methods: Retrospective analysis of sociodemographic, epidemiological and clinical characteristics of pregnant and non-pregnant syphilis-positive females., Results: From 2000 to 2015, 47 females were treated for syphilis: 17 (36.2%) were pregnant and 30 (63.8%) non-pregnant. The majority of patients in both groups were residents of urban areas (64.7% and 73.3%, P=0.6), and were married or in a long-standing relationship (94.1% and 60.0%, P=0.01). At least five lifetime sexual contacts had 17.5% of pregnant and 3.3% of non-pregnant females (P=0.04). The steady partner was the most probable source of infection in both groups (76.6% and 66.6%, P=0.4). Early latent syphilis was the most frequent stage of the disease in the pregnant women (94.1%) and secondary syphilis in the non-pregnant females (43.3%). In 58.8% of the pregnant females the first serological test for syphilis was performed after 10th week of pregnancy and nearly half of them did not present to any follow-up visit after treatment. In about one third of patients sexual contacts were not examined., Conclusions: Syphilis among females, especially pregnant ones, remains a problem in North-East Poland. Syphilis screening is frequently conducted too late in the pregnancy, increasing the risk of infection in the foetus. Pregnant females frequently do not attend follow-up visits. Contact notification should also be improved.

Introduction: HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment, care, and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However, partner notification strategies must be feasible in the healthcare setting and acceptable to the population., Methods: We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study, newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive, contract, and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners, after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group, a healthcare provider notified partners directly., Results: Although most index participants and partners expressed a preference for passive notification, they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing, including the opportunity to change behaviour., Conclusions: Provider-assisted partner notification is not preferred, but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged.

Objective: To examine outcomes of public health management of notified enteric fever cases in South-East Queensland over the past five years., Methods: Notification records of typhoid and paratyphoid infection in South-East Queensland 2008-2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts., Results: Sixty-nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2-6.0) and contacts were 4.4 (95%CI 3.0-6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post-treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6-48/1,000)., Conclusions: Local transmission risk of enteric fever in South-East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post-treatment. More complex clearance/screening regimens are associated with decreased compliance., Implications: Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South-East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission., (© 2015 Public Health Association of Australia.)