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Lumpy skin disease virus (LSDV) is a member of the capripoxvirus (CPPV) genus of the Poxviridae family. LSDV is a rapidly emerging, high-consequence pathogen of cattle, recently spreading from Africa and the Middle East into Europe and Asia. We have sequenced the whole genome of historical LSDV isolates from the Pirbright Institute virus archive, and field isolates from recent disease outbreaks in Sri Lanka, Mongolia, Nigeria and Ethiopia. These genome sequences were compared to published genomes and classified into different subgroups. Two subgroups contained vaccine or vaccine-like samples (“Neethling-like” clade 1.1 and “Kenya-like” subgroup, clade 1.2.2). One subgroup was associated with outbreaks of LSD in the Middle East/Europe (clade 1.2.1) and a previously unreported subgroup originated from cases of LSD in west and central Africa (clade 1.2.3). Isolates were also identified that contained a mix of genes from both wildtype and vaccine samples (vaccine-like recombinants, grouped in clade 2). Whole genome sequencing and analysis of LSDV strains isolated from different regions of Africa, Europe and Asia have provided new knowledge of the drivers of LSDV emergence, and will inform future disease control strategies.

Background: Outbreaks of contagious ecthyma (CE) are frequently reported in sheep and goat flocks in Nigeria with severe clinical outcomes. CE is a debilitating and economically important disease primarily affecting sheep and goats caused by the Orf virus (ORFV). Despite field reports of CE in the country, there is no concise country-wide epidemiological data on the disease and limited genetic data of circulating Nigerian ORFV are available in the public domain. Aim: An epidemiological survey of CE and molecular characterization of ORFV circulating in Nigeria from 2014-2016. Method: Data were collected using designed questionnaires, administered to veterinarians and farmers in selected States of Nigeria. Samples collected during passive surveillance for CE from 2014 to 2016 which were analyzed by polymerase chain reaction (PCR). The A32L and B2L genes of circulating ORFV were characterized. Results: Analysis of the questionnaire showed that 69.54% (n=82/118) of the farmers claimed to have experienced CE in their flocks with average morbidity and mortality rates of 25% and 15%, respectively. A total of 113 veterinarians participated in the study, with 69.9% (n=79) familiar with CE and claimed CE causes morbidity rates of 25%-37% and mortality rates of 10%-15% in sheep and goats. Laboratory results revealed that ORFV was detected in 72% (18/25) of outbreak samples analyzed by Real-time PCR. Phylogenetic analysis of A32L and B2L genes revealed that Nigerian ORFV sequences belong to clusters I and II and are similar to viruses from India, Ethiopia, and China. Conclusions: This study is the first nationwide epidemiological data on the status of CE in sheep and goats in Nigeria. It is also the first report of molecular characterization of two genes of ORFV circulating and causing outbreaks in small ruminants in the country. This study showed that CE is under-reported, widespread and of economic importance to sheep and goat farmers in Nigeria.

Lumpy Skin disease (LSD) is an economically important disease in cattle caused by the LSD virus (LSDV) of the genus Capripoxvirus, while pseudocowpox (PCP) is a widely distributed zoonotic cattle disease caused by the PCP virus (PCPV) of the genus Parapoxvirus. Though both viral pox infections are reportedly present in Nigeria, similarities in their clinical presentation and limited access to laboratories often lead to misdiagnosis in the field. This study investigated suspected LSD outbreaks in organized and transhumance cattle herds in Nigeria in 2020. A total of 42 scab/skin biopsy samples were collected from 16 outbreaks of suspected LSD in five northern States of Nigeria. The samples were analyzed using a high-resolution multiplex melting (HRM) assay to differentiate poxviruses belonging to Orthopoxvirus, Capripoxvirus, and Parapoxvirus genera. LSDV was characterized using four gene segments, namely the RNA polymerase 30 kDa subunit (RPO30), G-protein-coupled receptor (GPCR), the extracellular enveloped virus (EEV) glycoprotein and CaPV homolog of the variola virus B22R. Likewise, the partial B2L gene of PCPV was also analyzed. Nineteen samples (45.2%) were positive according to the HRM assay for LSDV, and five (11.9%) were co-infected with LSDV and PCPV. The multiple sequence alignments of the GPCR, EEV, and B22R showed 100% similarity among the Nigerian LSDV samples, unlike the RPO30 phylogeny, which showed two clusters. Some of the Nigerian LSDVs clustered within LSDV SG II were with commonly circulating LSDV field isolates in Africa, the Middle East, and Europe, while the remaining Nigerian LSDVs produced a unique sub-group. The B2L sequences of Nigerian PCPVs were 100% identical and clustered within the PCPV group containing cattle/Reindeer isolates, close to PCPVs from Zambia and Botswana. The results show the diversity of Nigerian LSDV strains. This paper also reports the first documented co-infection of LSDV and PCPV in Nigeria.

Abstract Peste‐des‐petits‐ruminants (PPR) and Goat pox (GTP) are two devastating and economically important transboundary animal diseases of small ruminants in Africa and Asia that have been difficult to control. This study however, investigated an outbreak of PPR and GTP in a mixed flock of indigenous sheep and goats in Kanam, North Central Nigeria. A total of nine sera and seven tissues (lungs, spleen, scab and skin) samples were collected and analysed in the laboratory using competitive enzyme linked immunosorbent assay (cELISA) for PPR antibodies and polymerase chain reaction (PCR) for detection of PPR virus (PPRV) and GTP virus (GTPV). Gene fragments of the nucleoprotein of PPRV and the G‐protein‐coupled chemokine receptor (GPCR) of GTPV were amplified and sequenced to confirm the presence of the causative viruses. Serologically, antibodies to PPRV were detected in all (9/9) sera collected. GTPV and PPRV was detected in corresponding samples (42.8% n = 3/7) of the scab/skin samples collected by both PCR and RT‐PCR technique. The phylogenetic analysis of PPRV revealed that the virus belongs to lineage IV and clustered with viruses from Gabon and Cameroon. Similarly, the GTPV also clustered with other sequences from Burkina Faso and Yemen. The positive cELISA, RT‐PCR and PCR results from samples collected from the same animals confirmed co‐infection of PPR and GTP in this mixed flock of sheep and goats. This is the first report of concurrent infection of PPR and GTP in mixed flock of sheep and goats in Nigeria. Our findings underscore the need for farmers to vaccinate their flock to control spread and economic losses as result of these diseases.

Camel contagious ecthyma (CCE) is a viral disease of camelids that is caused by a Parapoxvirus (PPV) which is a DNA virus of the viral family: Poxviridae. Diseases affecting camels in Nigeria are scarcely reported. CCE or the laboratory detection of camel PPV (CPPV) has not been reported in Nigeria. This study investigated and described the clinical presentation of CCE and molecular detection of CPPV in Nigeria. Suspected cases of CCE were reported in a farm, live animal market and abattoir, in three different states (Bauchi, Plateau and Zamfara) in Northern Nigeria. Skin scabs, lungs, liver and intestine samples were collected. Polymerase chain reaction (PCR) was carried out using the primers which targets the RPO30 gene fragment of the genus PPV. The clinical signs observed from the suspected cases of CCE were proliferative skin lesions, papules, scabs on the lips and nares. CPPV was detected in 80.0% (4/5) of the samples collected by PCR. CCE was diagnosed based on clinical signs and PCR results. This is the first report of CCE in Nigeria. Further studies should be carried out to genetically characterize the CPPV circulating in Nigeria.

Abstract  Secondary syringe exchange (SSE) refers to the exchange of sterile syringes between injection drug users (IDUs). To date there has been limited examination of SSE in relation to the social networks of IDUs. This study aimed to identify characteristics of drug injecting networks associated with the receipt of syringes through SSE. Active IDUs were recruited from syringe exchange and methadone treatment programs in Montreal, Canada, between April 2004 and January 2005. Information on each participant and on their drug-injecting networks was elicited using a structured, interviewer-administered questionnaire. Subjects’ network characteristics were examined in relation to SSE using regression models with generalized estimating equations. Of 218 participants, 126 were SSE recipients with 186 IDUs in their injecting networks. The 92 non-recipients reported 188 network IDUs. Networks of SSE recipients and non-recipients were similar with regard to network size and demographics of network members. In multivariate analyses adjusted for age and gender, SSE recipients were more likely than non-recipients to self-report being HIV-positive (OR = 3.56 [1.54–8.23]); require or provide help with injecting (OR = 3.74 [2.01–6.95]); have a social network member who is a sexual partner (OR = 1.90 [1.11–3.24]), who currently attends a syringe exchange or methadone program (OR = 2.33 [1.16–4.70]), injects daily (OR = 1.77 [1.11–2.84]), and shares syringes with the subject (OR = 2.24 [1.13–4.46]). SSE is associated with several injection-related risk factors that could be used to help focus public health interventions for risk reduction. Since SSE offers an opportunity for the dissemination of important prevention messages, SSE-based networks should be used to improve public health interventions. This approach can optimize the benefits of SSE while minimizing the potential risks associated with the practice of secondary exchange. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine the prevalence and correlates of Chlamydia trachomatis in Canadian street youth. METHODS: A cross-sectional study of street youth between the ages of 15-24 years was conducted over a 9-month period in seven large urban centers across Canada. Youth were recruited through 'drop-in' centers, outreach work, and mobile vans in each city. Information was collected through a nurse-administered questionnaire. Youth were asked to provide urine to test for chlamydia trachomatis by polymerase chain reaction. Separate logistic regression models were run for males and females controlling for age. RESULTS: The prevalence rate of chlamydia was 8.6% in 1355 youth (95% CI = (7.1%, 10.1%)). Higher prevalence rates were found in females than in males (10.9% vs. 7.3%, respectively) and in Aboriginal youth than in non-Aboriginal youth (13.7% vs. 6.6%, respectively). Four variables were associated with increased risk of chlamydia infection in females: Aboriginal status; self-perceived risk; having no permanent home; and having been in foster care. One predictor of chlamydia for males was having had a social worker. CONCLUSIONS: A high prevalence of chlamydia was found in this vulnerable population in comparison to other Canadian youth. Having been in foster care and having had a social worker were found to have a strong association with chlamydia. [ABSTRACT FROM AUTHOR]

Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Respondent-driven sampling (RDS) is a successful data collection method used in hard-to-reach populations, like those experiencing or at high risk of drug dependence. Since its introduction in 1997, identifying appropriate methods for estimating population means and sampling variances has been challenging and numerous approaches have been developed for making inferences about these quantities. To guide researchers and practitioners in deciding which approach to use, this article reviews the literature on these methodological developments., Methods: A systematic review using four electronic databases was conducted in order to summarize the progress of RDS inference over the last 20 years and to provide insight to researchers on using the appropriate estimators in analyzing RDS data. Two independent reviewers selected the relevant abstracts and articles; thirty-two studies were included. The content of the studies was further categorized into developing and evaluating RDS mean and variance estimators., Results: The population mean estimator RDSI EGO and the sampling variance estimators associated with tree boot strapping were identified as promising methods as the most robust population mean and variance estimate, respectively; as these estimators rely on a fewer assumptions., Conclusions: RDS holds substantial promise as a sampling method for understanding populations at high risk. The varied approaches to inference with RDS data each rely on different assumptions, but some require fewer assumptions than others and provide more robust and accurate inferences, when their corresponding assumptions are met., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Control of sexually transmitted infections and blood-borne pathogens is challenging due to their presence in groups exhibiting complex social interactions. In particular, sharing injection drug use equipment and selling sex (prostitution) puts people at high risk. Previous work examining the involvement of risk behaviours in social networks has suggested that social and geographic distance of persons within a group contributes to these pathogens' endemicity. In this study, we examine the role of place in the connectedness of street people, selected by respondent driven sampling, in the transmission of blood-borne and sexually transmitted pathogens. A sample of 600 injection drug users, men who have sex with men, street youth and homeless people were recruited in Winnipeg, Canada from January to December, 2009. The residences of participants and those of their social connections were linked to each other and to locations where they engaged in risk activity. Survey responses identified 101 unique sites where respondents participated in injection drug use or sex transactions. Risk sites and respondents' residences were geocoded, with residence representing the individuals. The sociospatial network and estimations of geographic areas most likely to be frequented were mapped with network graphs and spatially using a Geographic Information System (GIS). The network with the most nodes connected 7.7% of respondents; consideration of the sociospatial network increased this to 49.7%. The mean distance between any two locations in the network was within 3.5 kilometres. Kernel density estimation revealed key activity spaces where the five largest networks overlapped. Here, the combination of spatial and social entities in network analysis defines the overlap of vulnerable populations in risk space, over and above the person to person links. Implications of this work are far reaching, not just for understanding transmission dynamics of sexually transmitted infections by identifying activity "hotspots" and their intersection with each social network, but also for the spread of other diseases (e.g. tuberculosis) and targeting prevention services.

Background: The incidence of syphilis in Ottawa, Ontario, has risen substantially since 2000 to six cases per 100,000 in 2003, again to nine cases per 100,000 in 2007, and recently rose to 11 cases per 100,000 in 2010. The number of cases reported in the first quarter of 2010 was more than double that in the first quarter of 2009., Objective: In May 2010, the Ontario Ministry of Health and Long Term Care requested the assistance of the Field Epidemiology Program to describe the increase in infectious syphilis rates and to identify social network sources and prevention messages., Methods: Syphilis surveillance data were routinely collected from January 1, 2009 to July 15, 2010, and social networks were constructed from an enhanced social network questionnaire. Univariate comparisons between the enhanced surveillance group and the remaining cases from 2009 on non-normally distributed data were conducted using Kruskal-Wallis tests and χ(2) tests., Results: The outbreak cases were comprised of 89% men. Seventeen of the 19 most recent cases consented to answer the questionnaire, which revealed infrequent use of condoms, multiple sex partners and sex with a same-sex partner. Information regarding social venues where sex partners were met was plotted together with sexual partnerships, linking 18 cases and 40 contacts, representing 37% of the outbreak population and connecting many of the single individuals and dyads., Conclusion: Uncovering the places sex partners met was an effective proxy measure of high-risk activities shared with infected individuals and demonstrates the potential for focusing on interventions at one named bar and one Internet site to reach a high proportion of the population at risk.

Objective: We previously identified a high prevalence of Hepatitis C (HCV) amongst solvent-using injection drug users (S-IDU) relative to other injection drug users within the same locality. Here we incorporated social network variables to better characterize some of the behavioural characteristics that may be putting this specific subgroup of IDU at elevated disease risk., Methods: A cross-sectional survey of at-risk populations was carried out in Winnipeg, Canada in 2009. Individuals reporting any history of injection drug and/or solvent use were included in the study. Associations between subgroup membership, infection with HCV and HIV and individual and social network variables were examined., Results: In relation to other IDU, S-IDU were more likely to be infected with HCV, to report ever having shared a syringe, and to associate with other IDU. They were further differentiated in terms of their self-reported sexual orientation, ethnicity and in the injection drugs typically used., Conclusion: Solvent use stands as a proxy measure of numerous other characteristics that put this group of IDU at higher risk of infection. Provision of adequate services to ostracized subpopulations may result in wider population-level benefits.

Background: Respondent driven sampling (RDS) was designed for sampling "hidden" populations and intended as a means of generating unbiased population estimates. Its widespread use has been accompanied by increasing scrutiny as researchers attempt to understand the extent to which the population estimates produced by RDS are, in fact, generalizable to the actual population of interest. In this study we compare two different methods of seed selection to determine whether this may influence recruitment and RDS measures., Methods: Two seed groups were established. One group was selected as per a standard RDS approach of study staff purposefully selecting a small number of individuals to initiate recruitment chains. The second group consisted of individuals self-presenting to study staff during the time of data collection. Recruitment was allowed to unfold from each group and RDS estimates were compared between the groups. A comparison of variables associated with HIV was also completed., Results: Three analytic groups were used for the majority of the analyses-RDS recruits originating from study staff-selected seeds (n = 196); self-presenting seeds (n = 118); and recruits of self-presenting seeds (n = 264). Multinomial logistic regression demonstrated significant differences between the three groups across six of ten sociodemographic and risk behaviours examined. Examination of homophily values also revealed differences in recruitment from the two seed groups (e.g. in one arm of the study sex workers and solvent users tended not to recruit others like themselves, while the opposite was true in the second arm of the study). RDS estimates of population proportions were also different between the two recruitment arms; in some cases corresponding confidence intervals between the two recruitment arms did not overlap. Further differences were revealed when comparisons of HIV prevalence were carried out., Conclusions: RDS is a cost-effective tool for data collection, however, seed selection has the potential to influence which subgroups within a population are accessed. Our findings indicate that using multiple methods for seed selection may improve access to hidden populations. Our results further highlight the need for a greater understanding of RDS to ensure appropriate, accurate and representative estimates of a population can be obtained from an RDS sample.

We utilized public health data and a geographic information system (ArcGIS) to study long-distance sexual partnerships (opposite and same sex partnerships) among chlamydia, gonorrhea, and coinfected STI (sexually transmitted infection) cases. The top 10% of relationships among chlamydia and gonorrhea cases and their contacts equaled or exceeded 198 km and 237 km respectively; the top 15% of partnerships among coinfected cases equaled or exceeded 207 km. This research also detected proportionately more long-distance partnerships among gonorrhea cases than among chlamydia cases. Wasserheit and Aral's four-phase model for understanding the impact of control programs on STI incidence over time offers one framework for interpreting these results: as chlamydia was in an early decline phase during the period under study, while gonorrhea had reached a phase of low endemicity, our results could suggest that in later phases of an STI control program, the overall proportion of long-distance relationships among cases and contacts may increase., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: The risk-related behaviours and practices associated with injection drug use remain a driver of HIV and hepatitis C virus (HCV) transmission throughout the world. Here we evaluated HIV and HCV transmission patterns in the context of social networks of injection drug users (IDU) recruited from a higher incidence region in order to better understand factors that contribute to ongoing transmission among IDU., Methods: IDU recruited through a chain-referral method provided biological specimens for analysis. HIV and HCV positive specimens were sequenced and analyzed using phylogenetic methods (Neighbour-joining and bayesian) and transmission patterns of HIV and HCV evaluated in the context of the recruitment networks., Results: Among the 407 recruited IDU, HCV and HIV prevalence were 60.6% and 10.1%, respectively; 98% of HIV positive individuals were co-infected with HCV. Thirty-six percent of HCV sequences were associated with clusters, compared to 67% of HIV sequences. Four (16.7%) of the 24 HCV clusters contained membership separated by 2 or fewer recruitment cycles, compared to 10 (41.6%) derived from more than one recruitment component. Two (28.6%) of the 7 HIV clusters contained membership separated by 2 or fewer recruitment cycles while 6 (85.7%) were composed of inter component membership., Conclusions: Few HIV and HCV transmissions coincided with the recruitment networks, suggesting that they occurred in a different social context or a context not captured by the recruitment network. However, among the complete cohort, a higher degree of HIV clustering indicates many are recent infections originating from within current social networks, whereas a larger proportion of HCV infections may have occurred earlier in injecting history and in the context of a different social environment.

Background: Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada., Methods: Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression., Results: A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepatitis C (AOR: 3.5; 95%CI: 1.3,14.7), to have shared needles in the last six months (AOR: 2.6; 95%CI:1.0,6.8), and to have injected talwin & Ritalin (AOR: 10.0; 95%CI: 3.8,26.3)., Interpretation: High hepatitis C prevalence, even after controlling for risky injection practices, suggests that solvent users may form closed networks of higher risk even amongst an already high-risk IDU population. Understanding the social-epidemiological context of initiation and maintenance of solvent use is necessary to address the inherent inequalities encountered by this subpopulation of substance users, and may inform prevention strategies for other marginalized populations.

The identification and progression of a potent and selective series of isoquinoline inhibitors of IkappaB kinase-beta (IKK-beta) are described. Hit-generation chemistry based on IKK-beta active-site knowledge yielded a weakly potent but tractable chemotype that was rapidly progressed into a series with robust enzyme and cellular activity and significant selectivity over IKK-alpha.

porB DNA sequence analysis and Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) methods were compared for their abilities to discriminate strains and to identify epidemiologically congruent pairs of N. gonorrhoeae. Both methods provided high-level discrimination of strains. NG-MAST further differentiated large porB-based clusters. However, considerations of cost suggest that porB DNA sequence analysis is a useful tool for preliminary molecular analysis of the epidemiology of N. gonorrhoeae.

Our objective was to examine the association between HIV and HCV discordant infection status and the sharing of drug equipment by injection drug users (IDUs). IDUs were recruited from syringe exchange and methadone treatment programmes in Montreal, Canada. Characteristics of participants and their injecting partners were elicited using a structured questionnaire. Among 159 participants and 245 injecting partners, sharing of syringes and drug preparation equipment did not differ between concordant or discordant partners, although HIV-positive subjects did not share with HIV-negative injectors. Sharing of syringes was positively associated with discordant HIV status (OR=1.85) and negatively with discordant HCV status (OR=0.65), but both results were not statistically significant. Sharing of drug preparation equipment was positively associated with both discordant HIV (OR=1.61) and HCV (OR=1.18) status, but both results were non-significant. Factors such as large injecting networks, frequent mutual injections, younger age, and male gender were stronger predictors of equipment sharing. In conclusion, IDUs do not appear to discriminate drug equipment sharing partners based at least on their HCV infection status. The results warrant greater screening to raise awareness of infection status, post-test counselling to promote status disclosure among partners, and skill-building to avoid equipment sharing between discordant partners.

Objectives: We used cluster analysis to subdivide a population of injection drug users and identify previously unknown behavioral heterogeneity within that population., Methods: We applied cluster analysis techniques to data collected in a cross-sectional survey of injection drug users in Winnipeg, Manitoba. The clustering variables we used were based on receptive syringe sharing, ethnicity, and types of drugs injected., Results: Seven clusters were identified for both male and female injection drug users. Some relationships previously revealed in our study setting, such as the known relationship between Talwin (pentazocine) and Ritalin (methylphenidate) use, injection in hotels, and hepatitis C virus prevalence, were confirmed through our cluster analysis approach. Also, relationships between drug use and infection risk not previously observed in our study setting were identified, an example being a cluster of female crystal methamphetamine users who exhibited high-risk behaviors but an absence or low prevalence of blood-borne pathogens., Conclusions: Cluster analysis was useful in both confirming relationships previously identified and identifying new ones relevant to public health research and interventions.

Objectives: (i) To distinguish Neisseria gonorrhoeae isolates in Shanghai by porB typing; (ii) to ascertain the congruence of porB DNA sequence typing with cases linked epidemiologically; (iii) to determine the association of specific PorB mutations with antimicrobial resistance to penicillin or tetracycline., Methods: porB DNA sequences of 174 N. gonorrhoeae isolates, collected from 143 male patients and 31 female sexual partners in Shanghai were determined. Phylogenetic analysis was used to determine sequence associations and concordance with epidemiologically linked cases. PorB protein sequences were compared with the wild-type sequence to identify mutations associated with antimicrobial resistance to penicillin and tetracycline., Results: porB1a genotypes comprised 27.0% of the isolates and included 15 distinct DNA sequences, while 73.0% of the isolates carried porB1b genotypes with 63 distinct DNA sequences. porB DNA sequence typing was congruent with patient-reported sexual contacts. In addition, porB DNA sequence analysis revealed a number of strains with identical DNA sequences not identified through traditional epidemiological methods. The porB1b isolates had a significantly higher percentage of chromosomally mediated resistance to tetracycline and higher MIC50s to penicillin and ciprofloxacin. G120K/A121D mutations were observed in 71.1% of PIB isolates and were associated with resistance to penicillin and/or tetracycline. The majority of the PIA isolates (82.1%) also carried G120D/A121G double mutations. The index of discrimination for porB DNA sequence analysis was 95%., Conclusions: The porB1b genotype was found to be predominant in Shanghai. porB DNA sequence typing was sufficiently discriminatory for differentiating N. gonorrhoeae isolates and was congruent with epidemiological linkages. Novel porB sequences of N. gonorrhoeae and novel mutations of PorB proteins were identified.

Increases in the rates of sexually transmitted infections (STIs) suggest that control programmes may not be effectively targeting diverse subpopulations. The objective of this investigation was to examine STI transmission within different groups, using both social network analysis and cluster analysis. Routine partner notification data were analysed from individuals diagnosed with, or exposed to an STI in Manitoba. Groups were identified and characterized. Three different clusters of groups were identified, comprised of demographically and clinically distinct individuals. A greater understanding of disease transmission patterns within these groups will aid in the development of targeted education and prevention programmes for all STIs.

Objective: To identify and compare the drug-injecting network characteristics of cocaine and heroin injectors associated with a risk of HIV and hepatitis C virus (HCV)., Methods: Active injectors were recruited from syringe exchange and methadone programs. Characteristics of all participants and their social networks were elicited. Regression analysis using generalized estimating equations examined the network characteristics of injection drug users (IDUs) relative to cocaine or heroin use in the past 6 months., Results: Of 282 IDUs, 228 (81%) used cocaine and 54 (19%) used heroin as their primary injected drug. In analyses adjusted for age and gender, cocaine injectors compared with heroin injectors were more likely to live in unstable housing (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.49 to 8.40), self-report HCV infection (OR = 4.69, 95% CI: 2.14 to 10.31), and have a greater number of IDUs in their social network (OR = 1.61, 95% CI: 1.14 to 2.28) and were less likely to be polydrug users (OR = 0.06, 95% CI: 0.02 to 0.16) and to have social support (OR = 0.97, 95% CI: 0.95 to 0.99). The injecting networks of cocaine users were more likely to have members who were older (OR = 1.08, 95% CI: 1.04 to 1.12), had a history of shooting gallery use (OR = 2.27, 95% CI: 1.08 to 4.76), and had shorter relationships with the subject (OR = 0.91, 95% CI: 0.85 to 0.97)., Conclusions: Beyond personal behaviors, HIV and HCV infection risk seems to be linked to social network traits that are determined by drug type. Prevention efforts to control the spread of bloodborne viruses among IDUs could benefit from tailoring interventions according to the type of drug used.

Aim: To examine the scientific evidence regarding the association between characteristics of social networks of injection drug users (IDUs) and the sharing of drug injection equipment., Methods: A search was performed on MEDLINE, EMBASE, BIOSIS, Current Contents, PsycINFO databases and other sources to identify published studies on social networks of IDUs. Papers were selected based on their examination of social network factors in relation to the sharing of syringes and drug preparation equipment (e.g. containers, filters, water). Additional relevant papers were found from the reference list of identified articles., Results: Network correlates of drug equipment sharing are multi-factorial and include structural factors (network size, density, position, turnover), compositional factors (network member characteristics, role and quality of relationships with members) and behavioural factors (injecting norms, patterns of drug use, severity of drug addiction). Factors appear to be related differentially to equipment sharing., Conclusions: Social network characteristics are associated with drug injection risk behaviours and should be considered alongside personal risk behaviours in prevention programmes. Recommendations for future research into the social networks of IDUs are proposed.

Aims: Despite the establishment of syringe exchange programmes, syringe-sharing behaviour remains common among some injection drug users (IDU). Previous studies have identified several individual- and social network-level variables associated with syringe sharing. We examine the extent to which each of these variables is related independently to this behaviour within a diverse study population., Design, Setting and Participants: A cross-sectional survey of 435 IDU conducted between December 2003 and September 2004 in Winnipeg, Canada., Measurements: Individual and social-network variables were obtained from a survey instrument administered through a personal interview. Syringe sharing was defined as receptive syringe sharing in the last 6 months. Logistic regression analysis with generalized estimating equations was used to determine simultaneously the role of individual-level and risk network member-level variables on the odds of syringe sharing., Findings: Individuals' relationship to a risk network member (sex partner, OR: 15.3 95% CI: 7.6-30.8; family member, OR: 3.4 95% CI: 1.3-9.0) and difficulty of access to syringes (OR: 3.6 95% CI: 1.3-9.9) were predictive of syringe sharing. Dyads who 'often' pooled resources to obtain drugs were at 4.9 times (95% CI: 2.1-11.6) the odds of syringe sharing, while those who 'sometimes' pooled resources were at 2.8 times (95% CI: 1.1-6.7) the odds, compared to those who 'never' pooled resources together., Conclusions: Syringe sharing in this population depended on both the availability of clean syringes and social network relationships. Adopting interventions that take into account relationships and behaviours that shape social norms present in networks/dyads would be a necessary prevention strategy alongside the provision of clean syringes.

Background: Although comprising up to 80% of the commercial sex industry in Canada, indoor female sex workers (FSW) are generally not represented in research because they are a hidden population and difficult to access., Objectives: This paper describes a community-academic partnership model that was established to gain access to, deliver outreach services to, and conduct community-based research with the indoor commercial sex industry in four cities in British Columbia., Methods: The project employed an ongoing community consultation, peer-delivered approach to reaching this overlooked segment of the commercial sex industry. Peers (former and current FSW) were hired, trained, and supported as outreach workers and participated in the development, implementation, and evaluation of the project. Outreach teams visited sex establishments to deliver harm reduction materials and provide education, support, and referrals. The teams developed rapport with establishment managers and staff to facilitate research recruitment and data collection. The community team leader met with managers in targeted business to describe the study and elicit permission to recruit workers. The team leader conducted in-person interviews with consenting FSW., Observations: During the first 2 years of the project, more than 50 sex establishments were visited by outreach teams and 37 allowed repeat visits. Research interviews have been conducted with 49 FSW in seven establishments from four cities., Conclusions: Although the high cost in terms of time and resources must be recognized, this project represents a successful research and outreach model that permits access to the hidden commercial sex industry.

Objectives: To determine the antimicrobial susceptibility of Neisseria gonorrhoeae from Shanghai and to type the quinolone resistance-determining regions (QRDRs) of ciprofloxacin-resistant isolates., Methods: N. gonorrhoeae isolates (n = 159) were consecutively collected from male patients in Shanghai and examined for their antimicrobial susceptibilities to penicillin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone. The mutation profiles of the QRDRs of gyrA and parC were determined for 103 isolates including one susceptible isolate and one isolate with intermediate levels of susceptibility to ciprofloxacin., Results: High percentages of the 159 isolates were resistant to ciprofloxacin (98.7%), penicillin (93.1%) and tetracycline (56.5%). Penicillinase-producing N. gonorrhoeae (PPNG, 37.8%) or penicillinase-producing/tetracycline-resistant N. gonorrhoeae (PP/TRNG, 13.8%) accounted for 51.6% of the isolates. Chromosomal resistance to penicillin was observed in 41.5% of the isolates. Tetracycline resistance was noted in 56.5% of the isolates with 20.1% carrying plasmid-mediated resistance and 36.4% being chromosomally resistant. All isolates were susceptible to ceftriaxone and spectinomycin, although a trend to decreased susceptibility was noted. QRDR mutations were observed in the 101 ciprofloxacin-resistant isolates and the one ciprofloxacin-intermediate isolate, in contrast to the ciprofloxacin-susceptible isolate tested. Mutations in the QRDRs comprised four predominant (65.0% of the 103 isolates) patterns of a total of 19 patterns. Mutations in parC were significantly associated with higher MICs of ciprofloxacin., Conclusions: Spectinomycin and ceftriaxone are currently recommended for the treatment of gonorrhoea in Shanghai. Although the present study indicates that these antimicrobials should remain effective, the identification of isolates with decreased susceptibility underscores the importance of ongoing antimicrobial susceptibility surveillance to monitor and respond to the emergence of resistant isolates.

Background: Previous studies have used social network variables to improve our understanding of HIV transmission. Similar analytic approaches have not been undertaken for hepatitis C (HCV) or B (HBV), nor used to conduct comparative studies on these pathogens within a single setting., Methods: A cross-sectional survey consisting of a questionnaire and blood sample was conducted on injection drug users in Winnipeg between December 2003 and September 2004. Logistic regression analyses were used to correlate respondent and personal network data with HCV, HBV and HIV prevalence., Results: At the multivariate level, pathogen prevalence was correlated with both respondent and IDU risk network variables. Pathogen transmission was associated with several distinct types of high-risk networks formed around specific venues (shooting galleries, hotels) or within users who are linked by their drug use preferences. Smaller, isolated pockets of IDUs also appear to exist within the larger population where behavioural patterns pose a lesser risk, unless or until, a given pathogen enters those networks., Conclusion: The findings suggest that consideration of both respondent and personal network variables can assist in understanding the transmission patterns of HCV, HBV, and HIV. It is important to assess these effects for multiple pathogens within one setting as the associations identified and the direction of those associations can differ between pathogens.

Purpose: Persistence of sexually transmitted infections (STI) in a population is due to the activities of a small proportion of the population with STI, who transmit infection on average to one or more susceptible sex partners during an infectious period. Within these groups, the average number of transmissions by infectious people to susceptible people in a closed group is measured by the reproductive number; a threshold, above which endemic infection is likely occur and below which, in the rest of the population, it is unlikely to occur. We hypothesized that people with repeated bacterial STI's and their sex partners include the theoretical core group and that they differ from singly infected noncore individuals., Methods: Data on infected individuals and nominated sex partners for the years 1990-1992 were extracted from the notifiable disease and health insurance registries in Manitoba, Canada. Individuals with repeated gonorrhea, chlamydia and coinfected infections were compared using logistic regression, and reproductive numbers were calculated using sex partner data., Results: Of the three groups, the coinfected were youngest, and they were largely of aboriginal descent and had the lowest incomes. Repeaters were older; they had higher incomes, and there were fewer aboriginal people in this group. Chlamydia repeaters had even higher incomes, and this group comprised the least number of aboriginal people. The reproductive numbers showed the same gradient; (1.09, 1.01, and 2.41, respectively.), Conclusions: These data show that these groups do not contribute equally to STI endemicity and indicate that sexual network structure affects epidemic thresholds.

Background: Despite widespread efforts to control it, Chlamydia trachomatis remains the most frequently diagnosed bacterial sexually transmitted infection (STI). Analysis of sexual networks has been proposed as a novel tool for control of and research into STI. In the present study, we combine molecular genotype data, analysis of geographic clusters, and sociodemographic descriptors to facilitate analysis of large sexual networks., Methods: Individual chlamydia genotypes found in Manitoba, Canada, were analyzed to identify geographic clusters, and the identified clusters were further characterized by statistical analysis of sociodemographic variables., Results: A total of 10 geographic clusters of chlamydia-genotype infection were identified. Clusters in Winnipeg showed no or little geographic overlap and could be further differentiated on the basis of the sociodemographic characteristics of the individuals within a cluster. Several clusters in northern Manitoba overlapped geographically but, nonetheless, could be differentiated on the basis of the sociodemographic characteristics of the infected individuals., Conclusions: On the basis of results of the combined analyses, each geographic cluster appeared to represent a relatively distinct transmission network within the larger sexual network. The geographic analysis of the molecular data provided a basis for establishment of potential epidemiological connections between small groups of unlinked individuals. Analytic approaches of the type described here would help to decipher the patterns that exist within large social network data sets and would be applicable to many types of infectious agents.

Objectives: Sexual partnerships can be viewed as networks in order to study disease transmission. We examined the transmission of Neisseria gonorrhoeae in a localised outbreak in Alberta, Canada, using measures of network centrality to determine the association between risk of infection of network members and their position within the sexual network. We also compared risk in smaller disconnected components with a large network centred on a social venue., Methods: During the investigation of the outbreak, epidemiological data were collected on gonorrhoea cases and their sexual contacts from STI surveillance records. In addition to traditional contact tracing information, subjects were interviewed about social venues they attended in the past year where casual sexual partnering may have occurred. Sexual networks were constructed by linking together named partners. Univariate comparisons of individual network member characteristics and algebraic measures of network centrality were completed., Results: The sexual networks consisted of 182 individuals, of whom 107 were index cases with laboratory confirmed gonorrhoea and 75 partners of index cases. People who had significantly higher information centrality within each of their local networks were found to have patronised a popular motel bar in the main town in the region (p = 0.05). When the social interaction through the bar was considered, a large network of 89 individuals was constructed that joined all eight of the largest local networks. Moreover, several networks from different communities were linked by individuals who served as bridge populations as a result of their sexual partnering., Conclusion: Asking clients about particular social venues emphasised the importance of location in disease transmission. Network measures of centrality, particularly information centrality, allowed the identification of key individuals through whom infection could be channelled into local networks. Such individuals would be ideal targets for increased interventions.

Sexual and social network analysis have been proposed as novel sexually transmitted disease control and research tools. Here, the concordance between chlamydia genotype data and a large sexual network constructed from routinely collected contact tracing data was examined. A sexual network was constructed for Manitoba, Canada, from province-wide contact tracing data. Positive chlamydia specimens from the same time period were collected and genotyped by omp1 DNA sequencing. A high degree of concordance was found between transmission events, on the basis of molecular data, and proposed transmission events, on the basis of sexual network data. Discordant results appeared to occur when a portion of the network contained potential core group members or in areas where contact tracing is difficult to carry out. The agreement between the molecular and epidemiologic data suggests that the use of routine contact tracing data is a valid approach for the construction of sexual networks.

This paper summarises the results of the R0 equation in sexually transmitted infection (STI) repeaters in Manitoba, Canada, in the early 1990s, with both concurrent and more recent descriptions of sexual networks in the same population. The research presented provides empirical network and sex partner data to refine definitions of sexual networks and core groups in phase IV epidemics. New challenges for both practice and research are also discussed.

Research on risk behaviors for sexually transmitted infections (STIs) has revealed that they seldom correspond with actual risk of infection. Core groups of people with high-risk behavior who form networks of people linked by sexual contact are essential for STI transmission, but have been overlooked in epidemiological studies. Social network analysis, a subdiscipline of sociology, provides both the methods and analytical techniques to describe and illustrate the effects of sexual networks on STI transmission. Sexual networks of people from Colorado Springs, Colorado, and from Winnipeg, Manitoba, Canada, infected with chlamydia during a 6-month period were compared. In Winnipeg, 442 networks were identified, comprising 571 cases and 663 contacts, ranging in size from 2 to 20 individuals; Colorado Springs data yielded 401 networks, comprising 468 cases and 700 contacts, ranging in size from 2 to 12 individuals. Taking differing partner notification methods and the slightly smaller population size in Colorado Springs into account, the networks from both places were similar in both size and structure. These smaller, sparsely linked networks, peripheral to the core, may form the mechanism by which chlamydia can remain endemic, in contrast with larger, more densely connected networks, closer to the core, which are associated with steep rises in incidence.

Background: Methods for accessing large sexual networks are essential for investigating the mechanisms for the spread of sexually transmitted infections., Goal: Four samples of cases were compared with the total population to determine which identified the largest networks., Study Design: Individuals with positive test results for chlamydia during a 6-month period were selected from a laboratory database and linked with sex partner information from a notifiable disease registry. Sexual networks were constructed for a random sample, people with positive results from two or more tests for chlamydia, people with positive tests results for both gonorrhea and chlamydia, and the preceding two groups combined., Results: The coinfected people combined with the repeaters yielded the highest proportion (47.8%) of large networks (>10 people), followed by the coinfected people, the repeaters, and finally the random sample., Conclusions: People coinfected with chlamydia and gonorrhea and those with repeated chlamydial infection present ideal opportunities for both research and prevention.

Background and Objectives: Despite sharing common modes of transmission, characteristics of individuals infected with Chlamydia trachomatis differ in several respects from those with Neisseria gonorrhoeae infection. Further characterization of women at high risk for chlamydial infection is needed to deliver appropriate and effective preventive, diagnostic, and therapeutic care to this population., Goal of This Study: The demographic and socioeconomic characteristics of women with laboratory confirmed chlamydia, gonorrhea, or coinfection were compared with those of control women who tested negative for both pathogens., Study Design: A random sample of 400 women in Manitoba, Canada, who had undergone testing for sexually transmitted diseases at a public health laboratory in 1988 were studied. After linkage with medical insurance and census databases, logistic regression analysis was used to compare age, ethnicity, urban status, and mean income (using postal codes) of women with gonorrhea alone, chlamydia alone, and coinfection, with the same data for women who tested negative for both organisms., Results: Young age, North American Indian status, urban residence, and low mean income according to postal code were significantly associated with gonococcal and chlamydial infection in the study population, compared with women who tested negative for both infections. Young age, Indian status, and urban residence also were associated with gonorrhea infection alone. Only young age and Indian status were associated with chlamydial infection. Mean incomes of women with chlamydial infection alone and control subjects were higher than those of women with gonorrhea and gonorrhea and chlamydia coinfection., Conclusions: Differences in the demographic and socioeconomic characteristics of women with gonorrhea, chlamydia, and coinfection suggest the existence of multiple reservoirs of infection due to these agents in the study population. The preventive, diagnostic, and therapeutic strategies of sexually transmitted disease control programs must be adapted to the individual needs of identified high-risk groups.

The hydrolytic degradation of poly(hydroxybutyrate) together with a series of hydroxybutyrate-hydroxyvalerate copolymers has been studied. The effects of copolymer composition and molecular weight are presented together with the results of varying pH and temperature on the degradation rate. Degradation has been monitored by weight loss and water uptake measurements together with goniophotometric, surface energy and scanning electron microscopic studies. Some comparisons with the more widely used so-called 'biodegradable' polymers, poly(glycolic acid), poly(dioxanone) and the glycolic-lactic acid (90:10) copolymers are presented together with the effect of blood plasma on the degradation process.

The hydrolytic degradation of poly(hydroxybutyrate)-poly(hydroxyvalerate) (PHB-PHV) copolymers in the form of blends with the polysaccharides amylose, dextran, dextrin and sodium alginate, has been studied under a range of conditions (pH 2.3, 7.4 and 10.6 and at 37 degrees C and 70 degrees C). The hydrolytic degradation of the PHB-PHV copolymers was found to be dramatically affected by the presence of polysaccharides. Its progress was characterized by an initial increase in the wet weight, with concurrent decrease in the dry weight as the polysaccharides eroded from the matrix. Surface energy measurements and goniophotometry proved to be particularly useful in monitoring this stage of the degradation process. The concurrent increase in internal porosity leads to the eventual collapse of the matrix, a process which occurs, but less rapidly, in the degradation of the unblended PHB-PHV copolymers. Information obtained from molecular weight and crystallinity studies enabled a comprehensive profile of the overall degradation process to be built up.