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Estimating the incidence of infections caused by SARS-CoV-2 that are frequently asymptomatic is challenging when using routine passive surveillance methods. Antibodies can provide a record of previous infection, whether symptomatic [...]

Background: Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill‐equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals. Methods: A consortium, including the International Medical Corps, Harvard Humanitarian Initiative, and others, responded to a request from the Ukrainian Ministry of Health. The ATLS curriculum, translated into Ukrainian, guided the training, with US‐based instructors sent to Ukraine for teaching. Despite logistical challenges, such as missile attacks and curfews, the courses ran in multiple Ukrainian cities over 3 months. Course effectiveness was evaluated through pre‐ and post‐course knowledge tests, self‐efficacy surveys, and satisfaction assessments. Results: Ten ATLS courses trained 213 Ukrainian healthcare providers across five deployments. Significant improvements in knowledge scores (p < 0.05) and enhanced self‐reported confidence in trauma management were observed. Notably, no casualties were reported among instructors or students, highlighting program safety despite security challenges. Conclusions: Our study demonstrates successful ATLS course implementation in an active war zone, filling a critical gap in trauma education in Ukraine. Despite challenges, the program significantly enhanced participants' trauma care knowledge and confidence. Collaboration between international and local partners was pivotal. This model can serve as a valuable framework for trauma education globally, improving outcomes in conflict zones and resource‐limited settings. [ABSTRACT FROM AUTHOR]

The ongoing Russia-Ukraine war has significantly increased trauma related civilian injuries and deaths at the front lines and throughout Ukraine. Early assessments identified an immediate need for trauma education and training among first responders due to the rapidly rising trauma volume and strained prehospital resources. In response, an academic-non-governmental organization was formed to develop, and deliver, a live in-person prehospital training course throughout Ukraine. To determine the impact of targeted needs-based training on first responder preparedness, knowledge, and confidence to manage trauma patients. A new 16-hour course containing lectures, skills stations, case studies, and simulation called Prehospital Trauma Fundamentals (PHTF) was developed using needs assessments and international training standards. Course materials were translated into Ukrainian, and courses were taught with live bidirectional interpretation as required. 10 courses were taught from August-November 2022 by both non-Ukrainian and Ukrainian instructors. Pre- and post- knowledge and self-confidence assessments measured course effectiveness. Six-to-eight-week follow-up surveys were also distributed. Data were analyzed using McNemar's test for paired data and Wilcoxon matched-pairs signed-rank test. This project was determined to not require Institutional Review Board approval by the Mass General Brigham Office of Human Research Affairs. 268 first responders were trained in Kyiv, Dnipro, Odessa, and Zaporizhzhia. Participants were predominantly female (65%), median age was 35yrs. Of 193 matched re-to post-course knowledge assessments, scores increased from 53.4%[SD15.4%] to 74.4%[SD15.6%](p<0.001). Assessment scores increased for most participants (93.3%). Self-confidence surveys demonstrated improved comfort handling trauma patients (71.7%v83.3%;p<0.001), preparedness to manage life-threatening conditions (46.1%v66.1%;p<0.0001), and belief in an organized approach to trauma care (59.2%v90.5%;p<00001). Nervousness decreased (63.1%v52.5%;p<0.05) and sense of skill deficit decreased (79.0%v33.7%;p<0.0001). 59 (22.0%) participants completed the follow-up survey; 100% stated the training has or will have a life-saving effect in their patient management. Most (62.7%) had already applied course skills and taught (64.4%) others course skills or information. PHTF increased participant knowledge, preparedness, and confidence to care for trauma patients. Participants successfully applied information taught during the ongoing conflict, which suggests value in delivering targeted educational programs just before or during large-scale events. This course and lessons learned from its development and delivery can serve as a starting point for delivering first responder trauma education in other conflict and austere settings. Additional training through this project remains ongoing. [ABSTRACT FROM AUTHOR]

Background The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)–infected children receiving highly active antiretroviral therapy following immune reconstitution. We conducted a systematic review to synthesize available evidence regarding measles seroprevalence and measles vaccine immunogenicity, efficacy, and safety in HIV-infected adolescents and adults to provide the evidence base for recommendations on the need for measles vaccination. Methods We conducted searches of 8 databases through 26 September 2017. Identified studies were screened independently by 2 reviewers. Results The search identified 30 studies meeting inclusion criteria. Across studies, measles seroprevalence among HIV-infected adolescents and adults was high (median, 92%; 27 studies), with no significant difference compared to HIV-uninfected participants (10 studies). In 6 studies that evaluated the immunogenicity of MCVs among seronegative HIV-infected adults, measles seropositivity at end of follow-up ranged from 0% to 56% (median, 39%). No severe adverse events were reported following measles vaccination in HIV-infected patients. Conclusions Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, and the low response to vaccination, these studies do not support the need for an additional dose of MCV in HIV-infected adolescents and adults. These findings support WHO guidelines that measles vaccine be administered to potentially susceptible, asymptomatic HIV-infected adults, and may be considered for those with symptomatic HIV infection if not severely immunosuppressed. Measles-susceptible adolescents and adults, regardless of HIV status, may require targeted vaccination efforts to reach critical vaccination thresholds and achieve regional elimination goals. [ABSTRACT FROM AUTHOR]

Background: The efficacy of voluntary male medical circumcision (VMMC) for human immunodeficiency virus (HIV) prevention in men was demonstrated in 3 randomized trials. This led to the adoption of VMMC as an integral component of the United States President's Emergency Plan for AIDS Relief (PEPFAR) combination HIV prevention program in sub-Saharan Africa. However, evidence on the individual-level effectiveness of VMMC programs in real-world, programmatic settings is limited., Methods: A cohort of initially uncircumcised, non-Muslim, HIV-uninfected men in the Rakai Community Cohort Study in Uganda was followed between 2009 and 2016 during VMMC scale-up. Self-reported VMMC status was collected and HIV tests performed at surveys conducted every 18 months. Multivariable Poisson regression was used to estimate the incidence rate ratio (IRR) of HIV acquisition in newly circumcised vs uncircumcised men., Results: A total of 3916 non-Muslim men were followed for 17 088 person-years (PY). There were 1338 newly reported VMMCs (9.8/100 PY). Over the study period, the median age of men adopting VMMC declined from 28 years (interquartile range [IQR], 21-35 years) to 22 years (IQR, 18-29 years) (P for trend < .001). HIV incidence was 0.40/100 PY (20/4992.8 PY) among newly circumcised men and 0.98/100 PY (118/12 095.1 PY) among uncircumcised men with an adjusted IRR of 0.47 (95% confidence interval, .28-.78). The effectiveness of VMMC was sustained with increasing time from surgery and was similar across age groups and calendar time., Conclusions: VMMC programs are highly effective in preventing HIV acquisition in men. The observed effectiveness is consistent with efficacy in clinical trials and supports current recommendations that VMMC is a key component of programs to reduce HIV incidence., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)