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Many studies, including self-controlled case series (SCCS) studies, are being undertaken to quantify the risks of complications following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). One such SCCS study, based on all COVID-19 cases arising in Sweden over an 8-month period, has shown that SARS-CoV-2 infection increases the risks of AMI and ischemic stroke. Some features of SARS-CoV-2 infection and COVID-19, present in this study and likely in others, complicate the analysis and may introduce bias. In the present paper we describe these features, and explore the biases they may generate. Motivated by data-based simulations, we propose methods to reduce or remove these biases.

Summary Background COVID-19 is a complex disease targeting many organs. Previous studies highlight COVID-19 as a probable risk factor for acute cardiovascular complications. We aimed to quantify the risk of acute myocardial infarction and ischaemic stroke associated with COVID-19 by analysing all COVID-19 cases in Sweden. Methods This self-controlled case series (SCCS) and matched cohort study was done in Sweden. The personal identification numbers of all patients with COVID-19 in Sweden from Feb 1 to Sept 14, 2020, were identified and cross-linked with national inpatient, outpatient, cancer, and cause of death registers. The controls were matched on age, sex, and county of residence in Sweden. International Classification of Diseases codes for acute myocardial infarction or ischaemic stroke were identified in causes of hospital admission for all patients with COVID-19 in the SCCS and all patients with COVID-19 and the matched control individuals in the matched cohort study. The SCCS method was used to calculate the incidence rate ratio (IRR) for first acute myocardial infarction or ischaemic stroke following COVID-19 compared with a control period. The matched cohort study was used to determine the increased risk that COVID-19 confers compared with the background population of increased acute myocardial infarction or ischaemic stroke in the first 2 weeks following COVID-19. Findings 86 742 patients with COVID-19 were included in the SCCS study, and 348 481 matched control individuals were also included in the matched cohort study. When day of exposure was excluded from the risk period in the SCCS, the IRR for acute myocardial infarction was 2·89 (95% CI 1·51–5·55) for the first week, 2·53 (1·29–4·94) for the second week, and 1·60 (0·84–3·04) in weeks 3 and 4 following COVID-19. When day of exposure was included in the risk period, IRR was 8·44 (5·45–13·08) for the first week, 2·56 (1·31–5·01) for the second week, and 1·62 (0·85–3·09) for weeks 3 and 4 following COVID-19. The corresponding IRRs for ischaemic stroke when day of exposure was excluded from the risk period were 2·97 (1·71–5·15) in the first week, 2·80 (1·60–4·88) in the second week, and 2·10 (1·33–3·32) in weeks 3 and 4 following COVID-19; when day of exposure was included in the risk period, the IRRs were 6·18 (4·06–9·42) for the first week, 2·85 (1·64–4·97) for the second week, and 2·14 (1·36–3·38) for weeks 3 and 4 following COVID-19. In the matched cohort analysis excluding day 0, the odds ratio (OR) for acute myocardial infarction was 3·41 (1·58–7·36) and for stroke was 3·63 (1·69–7·80) in the 2 weeks following COVID-19. When day 0 was included in the matched cohort study, the OR for acute myocardial infarction was 6·61 (3·56–12·20) and for ischaemic stroke was 6·74 (3·71–12·20) in the 2 weeks following COVID-19. Interpretation Our findings suggest that COVID-19 is a risk factor for acute myocardial infarction and ischaemic stroke. This indicates that acute myocardial infarction and ischaemic stroke represent a part of the clinical picture of COVID-19, and highlights the need for vaccination against COVID-19. Funding Central ALF-funding and Base Unit ALF-Funding, Region Vasterbotten, Sweden; Strategic funding during 2020 from the Department of Clinical Microbiology, Umea University, Sweden; Stroke Research in Northern Sweden; The Laboratory for Molecular Infection Medicine Sweden.

While previous research on historical changes in heat-related mortality observed decreasing trends over the recent decades, future projections suggest increasing impact of heat on mortality in most regions of the world. This study aimed to analyse temporal changes in temperature-mortality relationships in Prague, Czech Republic in the warm season (May–September), using a daily mortality time series from 1982 to 2019. To investigate possible effect of adaptation to increasing temperature, we divided the study period into four decades (1980s–2010s). We used conditional Poisson regression models to identify decade-specific relative risk of heat-related mortality and to calculate the annual number of heat-attributable deaths and the heat-attributable fraction of total warm season deaths. We estimated their trends over the whole study period by a generalized additive model with non-parametric smoothing spline. Our results showed that the unprecedentedly hot 2010s was associated with approximately twice as large relative risk of heat-related mortality than in previous decades. This resulted in the reversal of the trend in heat-attributable mortality in the 1990s and its increase during the last two decades. Our findings highlight the importance of further improvement of adaptation measures such as heat-and-health warning systems to protect the heat-susceptible population.

Spotted fever group (SFG) rickettsiae are obligatory intracellular bacteria that cause disease in humans and other animals. Ixodid ticks are the principal vectors of SFG rickettsiae. The present study aimed to determine the prevalence and species identity of SFG rickettsiae in ticks and horses from urban and rural areas of western Cuba using PCR assays. Tick samples, collected from 79 horses, consisted of 14 Amblyomma mixtum adults, 111 Dermacentor nitens adults and 19 pools of D. nitens nymphs (2-5 individuals/pool). The PCR results revealed the presence of Rickettsia spp. in 64% of the A. mixtum adults, 16% of the D. nitens adults, and 11% of the pooled samples of D. nitens nymphs. In contrast, Rickettsia spp. was not detected in any of the 200 horse blood samples included in this study. DNA sequence data of the rickettsial 17 kDa antigen gene showed that Rickettsia amblyommatis was present in A. mixtum; and Rickettsia felis in D. nitens. This is the first report of R. felis in D. nitens in Cuba. The present study extends our knowledge of the potential vector spectrum and distribution of SFG rickettsiae pathogens in western Cuba.

BackgroundThe backdrop of the ubiquitous social inequalities has increasingly come into foreground in research on the COVID-19 pandemic, but the lack of high-quality population-based studies limits our understanding of the inequitable outcomes of the disease. The present study seeks to estimate social gradients in COVID-19 hospitalisations, intensive care admissions and death by education, income and country of birth, while taking into account disparities in comorbidities.MethodsWe used a register-based retrospective open cohort design enrolling all 74 659 confirmed SARS-CoV-2-positive cases aged >25 years in Sweden during the first wave of the pandemic (until 14 September 2020). Information was retrieved from multiple registers and linked by the unique Swedish personal identity number concerning COVID-19 case identification; COVID-19 hospitalisations, intensive care admissions and death; comorbidities as measured by the Charlson Comorbidity Index; and sociodemographic information. Social gradients were estimated by the Relative Index of Inequality (RII) using Cox regression.ResultsAdjusted analyses showed significant social gradients in COVID-19 hospitalisation, intensive care admission, across education, income and country of birth, which were unaffected by adjustment for comorbidities. Education and country of birth gradients were stronger for hospitalisation and intensive care admissions but small to non-existent for death. In contrast, income gradients were consistent across all three COVID-19 outcomes.ConclusionSocial gradients in severe COVID-19 outcomes are widespread in Sweden, but appear to be unrelated to pre-existing health disparities. Inequitable outcomes of SARS-CoV-2 infection may therefore be at least partially avoidable and could rely on equitable management of confirmed COVID-19 cases.

Introducción. Babesia caballi, Theileria equi y varias especies de rickettsias son agentes de enfermedades transmitidas por vectores que afectan a los equinos. El objetivo del presente estudio fue detectar infecciones por B. caballi y T. equi en caballos e identificar rickettsias en caballos y garrapatas en la región occidental de Cuba. Métodos. Se estandarizaron 2 ensa- yos de nPCR para la detección de B. caballi y T. equi. Se colectaron muestras de sangre de caballos, y garrapatas. Se realizó identificación por frotis sanguíneo y detección e identifica- ción molecular de B. caballi, T. equi y Rickettsia sp. Resultados. Se observaron formaciones intraeritrocíticas compatibles con B. caballi y T. equi. El nPCR mostró que el 25 % de las Anales de la Academia de Ciencias de Cuba; Vol. 12, 1 (2022): enero-abril ISSN 2304-0106 | RNPS 2308muestras fueron positivas para B. caballi, 73 % para T. equi y 20 % mostraron coinfección. Los resultados se confirmaron con la secuenciación parcial de los genes bc 48 (B. caballi) y ema-1 (T. equi). La secuenciación del gen ARNr 18S de T. equi demostró la presencia de al menos 2 genotipos de aislados de T. equi en Cuba. El ensayo de PCR en tiempo real y la secuenciación revelaron la presencia de Rickettsia amblyommatis en A. mixtum y Rickettsia felis en D. nitens. Como conclusiones estos resultados constituyen la primera evidencia molecular de B. caballi y T. equi en equinos y el primer reporte de Rickettsia felis en D. nitens en Cuba, lo que amplía el conocimiento sobre la distribución de patógenos y el espectro de vectores potenciales contribuyendo al fortalecimiento de los programas de manejo y control.

Background: Men are more severely affected by COVID-19. Testosterone may influence SARS-CoV-2 infection and the immune response. Objective: To clinically, epidemiologically, and experimentally evaluate the effect of antiandrogens on SARS-CoV-2 infection. Designs, settings, and participants: A randomized phase 2 clinical trial (COVIDENZA) enrolled 42 hospitalized COVID-19 patients before safety evaluation. We also conducted a population-based retrospective study of 7894 SARS-CoV-2–positive prostate cancer patients and an experimental study using an air-liquid interface three-dimensional culture model of primary lung cells. Intervention: In COVIDENZA, patients were randomized 2:1 to 5 d of enzalutamide or standard of care. Outcome measurements: The primary outcomes in COVIDENZA were the time to mechanical ventilation or discharge from hospital. The population-based study investigated risk of hospitalization, intensive care, and death from COVID-19 after androgen inhibition. Results and limitations: Enzalutamide-treated patients required longer hospitalization (hazard ratio [HR] for discharge from hospital 0.43, 95% confidence interval [CI] 0.20–0.93) and the trial was terminated early. In the epidemiological study, no preventive effects were observed. The frail population of patients treated with androgen deprivation therapy (ADT) in combination with abiraterone acetate or enzalutamide had a higher risk of dying from COVID-19 (HR 2.51, 95% CI 1.52–4.16). In vitro data showed no effect of enzalutamide on virus replication. The epidemiological study has limitations that include residual confounders. Conclusions: The results do not support a therapeutic effect of enzalutamide or preventive effects of bicalutamide or ADT in COVID-19. Thus, these antiandrogens should not be used for hospitalized COVID-19 patients or as prevention for COVID-19. Further research on these therapeutics in this setting are not warranted. Patient summary: We studied whether inhibition of testosterone could diminish COVID-19 symptoms. We found no evidence of an effect in a clinical study or in epidemiological or experimental investigations. We conclude that androgen inhibition should not be used for prevention or treatment of COVID-19. Funding agencies: This investigator-initiated trial was supported by an unconditional research grant from Astellas Pharma Ltd. The sponsor had no role in the study design; in the data collection, analysis, or interpretation; or in writing the manuscript. AJ is supported by the Knut and Alice Wallenberg Foundation and Swedish Prostate Cancer Federation. KW is supported by the Swedish Cancer Society (CAN 2017/478 and 20 1055 PjF) and the Swedish Prostate Cancer Federation. AKÖ is supported by the Swedish Heart Lung foundation (no. 20200385), and the Knut and Alice Wallenberg Foundation (grants to Science for Life Laboratory, 2020.0182). AMFC is supported by Central ALF-funding, Region Västerbotten (RV-836351), Base unit ALF-funding (RV-939769); Strategic Funding during 2020 from the Department of Clinical Microbiology, Umeå University; and The Laboratory for Molecular Infection Medicine Sweden (MIMS)

ObjectiveTo quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19.DesignSelf-controlled case series and matched cohort study.SettingNational registries in Sweden.Participants1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants.Main outcomes measuresSelf-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event).ResultsCompared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding.ConclusionsThe findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.

Loneliness among older adults is a public health problem that has received particular attention since the emergence of the COVID-19 pandemic. Studies to date have however found a rather modest psychosocial impact of the pandemic on older adults, and scarce research has analyzed this impact using a comprehensive equity lens. The present study used an intersectional approach to examine social inequalities in loneliness before and during the early phase of the pandemic among older adults receiving eldercare in Sweden. The study population (analytical N = 205,529) came from two waves (2019 and 2020) of a total population survey to all older adult (>65 years of age) home care recipients and nursing home residents in Sweden. Loneliness was self-reported by a single-item measure, and survey data were linked to population register data on age, gender, residential setting, income, and country of birth. Additive binomial regression models were used to estimate prevalence differences and discriminatory accuracy according to an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach. Results showed inequalities in loneliness arising particularly in the intersection of country of birth, income, and residential setting. The inequalities widened slightly but ubiquitously following the emergence of the pandemic in 2020, with particularly nursing home residents emerging as a risk group. The discriminatory accuracy of inequalities was consistently low to moderate throughout the analyses but increased marginally during the pandemic in 2020. The study illustrates how social inequalities engenders heterogeneity in the psychosocial risk of older adults before and during the pandemic. These findings should stimulate more nuanced and equity-oriented depictions, research and policies about loneliness among older adults in the peri-pandemic era.

Classical swine fever (CSF), caused by CSF virus (CSFV), is considered one of the most important infectious diseases with devasting consequences for the pig industry. Recent reports describe the emergence of new CSFV strains resulting from the action of positive selection pressure, due mainly to the bottleneck effect generated by ineffective vaccination. Even though a decrease in the genetic diversity of the positively selected CSFV strains has been observed by several research groups, there is little information about the effect of this selective force on the virulence degree, antigenicity and pathogenicity of this type of strains. Hence, the aim of the current study was to determine the effect of the positive selection pressure on these three parameters of CSFV strains, emerged as result of the bottleneck effects induced by improper vaccination in a CSF-endemic area. Moreover, the effect of the positively selected strains on the epidemiological surveillance system was assessed. By the combination of in vitro, in vivo and immunoinformatic approaches, we revealed that the action of the positive selection pressure induces a decrease in virulence and alteration in pathogenicity and antigenicity. However, we also noted that the evolutionary process of CSFV, especially in segregated microenvironments, could contribute to the gain-fitness event, restoring the highly virulent pattern of the circulating strains. Besides, we denoted that the presence of low virulent strains selected by bottleneck effect after inefficient vaccination can lead to a relevant challenge for the epidemiological surveillance of CSF, contributing to under-reports of the disease, favouring the perpetuation of the virus in the field. In this study, B-cell and CTL epitopes on the E2 3D-structure model were also identified. Thus, the current study provides novel and significant insights into variation in virulence, pathogenesis and antigenicity experienced by CSFV strains after the positive selection pressure effect.

In Brazil, glanders remains a serious problem, with the obligatory sacrifice of disease-positive animals without compensation. Each year, glanders cases are reported in several regions of the country, causing severe economic losses and trade restrictions. The present study describes and discusses the occurrence of glanders foci in Brazil during a 12-year period from 2005 to 2016. The highest frequency of reported affected holdings during the study period was in the northeast region. Moreover, during this period, the disease incidence in Brazil showed an overall increasing tendency. The number of affected holdings significantly increased during the last four years of the period, and more cases were noted during the months of May and June. Spatiotemporally, there are four high-risk glanders clusters: (1) cluster A (relative risk [RR = 6.51, P.0001) involved the northeast region from March 2008 to February 2014; (2) cluster B (RR = 17.37, P.0001) involved a southeast region state from March 2013 to June 2015; (3) cluster C (RR = 6.92, P.0001) involved the states in the midwest, southeast, and south regions of Brazil from March 2015 to May 2016; and (4) cluster D (RR = 19.07, P.0001) involved a north region state from October 2015 to April 2016. Only two states of the north region (Acre and Amapá) did not experience glanders during the study period.

El objetivo del estudio fue determinar la seroprevalencia de brucelosis bovina e identificar factores de riesgo para brucelosis en la provincia de Pinar del Río, Cuba. Se realizó un estudio transversal basado en los resultados del programa de vigilancia epidemiológica. La distribución geoespacial se analizó mediante el cálculo de la razón de incidencia estandarizada (SIR) a nivel de municipio. Además, se evaluó la asociación entre los resultados del diagnóstico y factores como el sistema productivo, el sexo y los grupos de edad (36 meses). Se procesaron 12 760 muestras de sangre y 113 resultaron positivas; así, la seroprevalencia estimada en la provincia fue de 0.89% (IC 95 % 0.74-1.06). La enfermedad estuvo presente en tres de los ocho municipios de la provincia (Los Palacios, Consolación del Sur y Pinar del Río), aunque solo en Los Palacios la prevalencia fue significativamente superior a la esperada: 2.40 (1.30-3.28). Además, la razón de prevalencia en animales menores de 12 meses fue 8.33 (1.41-49.42) veces mayor que en animales entre 12 y 24 meses. En conclusión, el municipio de procedencia y la categoría de edad son factores relevantes que deben ser considerados por las autoridades de salud para diseñar estrategias de control de enfermedades en la provincia.

In 2021, the 88th General Session of the World Assembly of National Delegates to the World Organisation for Animal Health (OIE) recognized the estates of Acre, Paraná, the Rio Grande do Sul, and Rondônia as being free of foot-and-mouth disease (FMD) without vaccination. The certification was also extended to some cities in Amazonas and Mato Grosso. The new national strategic plan for 2026, which focuses on creating and maintaining sustainable conditions to expand FMD-free zones without vaccination, imposes new challenges and requires continuous evaluation of the FMD surveillance system. The objective of this research was to evaluate the FMD surveillance system in Brazil using quantitative models through Bayesian network approaches. The research was conducted using the Continental Surveillance and Information System (SivCont) database for Official Veterinary Services in Brazil, which refers to notified vesicular syndromes. The data on states, reported diseases, source of notification, disease confirmation, and timeliness (TL in days) of the delay by owners in notifying (TL.1) after a suspected case of the disease, and the response of Brazilian Veterinary Services after being notified (TL.2), were analysed. The collected data were analysed using Bayesian networks. It was observed that diseases with symptoms identical to FMD are the most notified events. TL.1 was long (mean of 18.96, CI: 18.33-19.59), and a low number of notifications was observed throughout the study period, which increases the chances of disseminating FMD in the population. Meanwhile, TL.2 suggests appropriate effectiveness of the Veterinary Services responding to suspected cases of FMD with interventions in less than 24 h (mean of 1, CI: 0.68-1.31). This study evaluated the performance of Brazilian Veterinary Services facing the report of vesicular diseases in the period 2004-2018. The results can help the states improve the surveillance system and the transition to the vaccination stop. Furthermore, the analytical method presented in the paper could serve as a model for other countries to evaluate the effectiveness of FMD surveillance systems.

Studies projecting the impacts of future climate change on temperature-mortality relationships suggest increasing heat-related mortality in most regions of the world. On the contrary, a reduced risk of heat-related mortality has been observed in many countries over the last decades, suggesting a positive effect of technological development and improved health care systems. However, most of the studies show that the decline in vulnerability of populations to heat has abated in the early 2000s and further decreasing trend is unlikely.In this study, we analysed temperature-mortality relationships in Prague, Czech Republic during 1982–2019. The study was restricted to five warmest months (May–September). To investigate possible changes in the temperature–mortality relationship, the study period was divided in four decades (1980s to 2010s). Conditional Poisson Regression coupled with the Distributed Lag Non-Linear Model (DLNM) was run separately in each decade, to derive decade-specific temperature–mortality associations. A stratum indicator variable composed of year, month, and day of the week was used to control for long-term, seasonal trends and weekly effects. The DLNM approach was applied in order to analyse delayed effects of temperature on mortality. The attributable number of deaths (AD) and the attributable fraction (AF %) of total May–September deaths on hot days was calculated from the model’s outputs, separately for each decade. Hot days were defined as days with daily mean temperature larger than the 95th percentile of the decade-specific May–September distribution.We observed a quadratic trend shape in the number of deaths attributable to heat; maximum in the 2010s and minimum in the 1990s. The total number of heat-attributable deaths increased from ≈500 to almost 900 per decade between the 1980s and the 2010s, which corresponds to the fraction of 0.90 and 1.75 %, respectively, of the total number of deaths in a warm season.

The present study aimed to determine the prevalence of zoonotic vector-borne pathogens, including Anaplasma platys, Anaplasma phagocytophilum, Borrelia burgdorferi sensu lato, Ehrlichia canis and Rickettsia spp. in shelter dogs from Cuba. Blood samples were collected from 100 shelter dogs and examined by molecular methods. Overall, 85 (85%, 95% CI: 77.88&ndash, 92.12) dogs tested positive for at least one vector-borne pathogen using species-specific qPCR assays. Among the positive samples, E. canis was the most prevalent 62% (95% CI: 52.32&ndash, 71.68), followed by A. platys 40% (95% CI: 30.23&ndash, 49.77) and Rickettsia felis 27% (95% CI: 18.15&ndash, 35.85), whereas 36% (95% CI: 26.43&ndash, 45.57) showed co-infections. All samples were negative for A. phagocytophilum and B. burgdorferi s.l. The presence of 248 Rhipicephalus sanguineus ticks collected from the dogs was not statistically associated with the occurrence of infections. Thrombocytopenia was the most frequent haematological alteration found in PCR-positive dogs, it was statistically associated with the presence of E. canis, as well as co-infections (p &lt, 0.05). The phylogenetic analyses of A. platys and E. canis based on 16S rRNA, groEL and gltA genes showed a low genetic diversity between Cuban strains. The present study demonstrates the high prevalence of vector-borne pathogens with zoonotic potential in shelter dogs from Cuba.

Leptospirosis is a zoonotic disease with worldwide distribution. The disease affects dairy and beef cattle, causing infertility, abortion, and reduced milk yield. A cross-sectional study was conducted to determine the seroprevalence of leptospirosis in cattle and the associated risk factors in the province of Manabi, Ecuador. Serum samples from 749 animals from 55 cattle herds were analyzed using the microscopic agglutination test (MAT). Animals were considered positive when titers were ≥ 1:100. The association between the potential risk factors and the positive Leptospira result was modeled at both animal and herd level using a generalized linear model with a binomial distribution and logarithmic link. The seroprevalence was 56.21% at the individual level and 98.18% at the herd level. The most prevalent serovars were Pomona (28.57%) and Icterohaemorragiae (22.30%). At the animal level, only the age was associated with leptospirosis seropositivity. Seroprevalence in animals over three years of age was 1.197 (95% confidence intervals (CI), 1.032 – 1.390), higher compared to animals up to three years old. The seroprevalence of Leptospira spp. was higher in farms with no veterinary assistance (PR = 1.209; 95%CI 1.053 – 1.388) and without a vaccination program against Leptospira (PR = 1.399; 95%CI 1.09 - 1.794). In addition, herds from Junin canton had a significantly higher seroprevalence of Leptospira spp (PR = 1.548; 95%CI 1.213 - 1.977) compared to the Bolivar canton, which had the lowest seroprevalence. In conclusion, more than half of the animals were positive to Leptospiraspp, and almost all herds had at least one positive animal. Furthermore, veterinary assistance and vaccination of cattle must be considered as essential aspects of the disease control program.

The spatial synoptic classification (SSC) is a holistic categorical assessment of the daily weather conditions at specific locations; it is a useful tool for assessing weather effects on health. In this study, we assessed (a) the effect of hot weather types and the duration of heat events on cardiovascular and respiratory mortality in summer and (b) the effect of cold weather types and the duration of cold events on cardiovascular and respiratory mortality in winter. A time-stratified case-crossover design combined with a distributed lag nonlinear model was carried out to investigate the association of weather types with cause-specific mortality in two southern (Skåne and Stockholm) and two northern (Jämtland and Västerbotten) locations in Sweden. During summer, in the southern locations, the Moist Tropical (MT) and Dry Tropical (DT) weather types increased cardiovascular and respiratory mortality at shorter lags; both hot weather types substantially increased respiratory mortality mainly in Skåne. The impact of heat events on mortality by cardiovascular and respiratory diseases was more important in the southern than in the northern locations at lag 0. The cumulative effect of MT, DT and heat events lagged over 14 days was particularly high for respiratory mortality in all locations except in Jämtland, though these did not show a clear effect on cardiovascular mortality. During winter, the dry polar and moist polar weather types and cold events showed a negligible effect on cardiovascular and respiratory mortality. This study provides valuable information about the relationship between hot oppressive weather types with cause-specific mortality; however, the cold weather types may not capture sufficiently effects on cause-specific mortality in this sub-Arctic region. Electronic supplementary material The online version of this article (10.1007/s00484-020-01921-0) contains supplementary material, which is available to authorized users.

The aim of this study was to determine the possible relationship between the presence of lesions called “White Spotted Kidney” (WSK) and the seroprevalence of Leptospira spp in cattle slaughtered in the Manta slaughterhouse, Manabí province, Ecuador. Blood samples were taken from 320 cattle to detect antibodies against Leptospira spp using the microagglutination technique. Likewise, a macroscopic revision of the kidneys was made, and samples were taken for histopathological analysis. The seroprevalence of Leptospira spp was 50.9% and the frequency of kidney injury was 18.13%. The presence of the eight serovars evaluated was found, with the serovars Pomona, Icterohaemorragiae and Bratislava being the most frequent. Animals serologically positive for Leptospira are 40.56 more likely to have specific lesions associated with the disease at the time of slaughter (p, El estudio tuvo como objetivo determinar la posible relación entre la presencia de lesiones denominadas “Riñón con Manchas Blancas” (RMB) y la seroprevalencia de Leptospira spp en bovinos sacrificados en el matadero del cantón Manta, provincia Manabí, Ecuador. Se tomaron muestras de sangre a 320 bovinos para detectar anticuerpos contra bacterias del género Leptospira utilizando la técnica de microaglutinación. Asimismo, se hizo una revisión macroscópica de los riñones y se tomaron muestras para el análisis histopatológico. La seroprevalencia de Leptospira spp fue de 50.9% y la frecuencia de lesiones renales fue de 18.13%. Se encontró la presencia de los ocho serovares evaluados, siendo mayor la frecuencia de los serovares Pomona, Icterohaemorragiae y Bratislava. Los animales serológicamente positivos a Leptospira presentan 40.56 más probabilidad de presentar lesiones específicas asociadas con la enfermedad al momento del sacrificio (p

Much is known about the adverse health impact of high and low temperatures. The Spatial Synoptic Classification is a useful tool for assessing weather effects on health because it considers the combined effect of meteorological factors rather than temperature only. The aim of this study was to assess the association between oppressive weather types and daily total mortality in Sweden. Time-series Poisson regression with distributed lags was used to assess the relationship between oppressive weather (Dry Polar, Dry Tropical, Moist Polar, and Moist Tropical) and daily deaths over 14 days in the extended summer (May to September), and 28 days during the extended winter (November to March), from 1991 to 2014. Days not classified as oppressive weather served as the reference category. We computed relative risks with 95% confidence intervals, adjusting for trends and seasonality. Results of the southern (Sk&aring, ne and Stockholm) and northern (J&auml, mtland and V&auml, sterbotten) locations were pooled using meta-analysis for regional-level estimates. Analyses were performed using the dlnm and mvmeta packages in R. During summer, in the South, the Moist Tropical and Dry Tropical weather types increased the mortality at lag 0 through lag 3 and lag 6, respectively. Moist Polar weather was associated with mortality at longer lags. In the North, Dry Tropical weather increased the mortality at shorter lags. During winter, in the South, Dry Polar and Moist Polar weather increased mortality from lag 6 to lag 10 and from lag 19 to lag 26, respectively. No effect of oppressive weather was found in the North. The effect of oppressive weather types in Sweden varies across seasons and regions. In the North, a small study sample reduces precision of estimates, while in the South, the effect of oppressive weather types is more evident in both seasons.

Considering that several meteorological variables can contribute to weather vulnerability, the estimation of their synergetic effects on health is particularly useful. The spatial synoptic classification (SSC) has been used in biometeorological applications to estimate the effect of the entire suite of weather conditions on human morbidity and mortality. In this study, we assessed the relationships between extremely hot and dry (dry tropical plus, DT+) and hot and moist (moist tropical plus, MT+) weather types in summer and extremely cold and dry (dry polar plus, DP+) and cold and moist (moist polar, MP+) weather types in winter and cardiovascular and respiratory hospitalizations by age and sex. Time-series quasi-Poisson regression with distributed lags was used to assess the relationship between oppressive weather types and daily hospitalizations over 14 subsequent days in the extended summer (May to August) and 28 subsequent days during the extended winter (November to March) over 24 years in 4 Swedish locations from 1991 to 2014. In summer, exposure to hot weather types appeared to reduce cardiovascular hospitalizations while increased the risk of hospitalizations for respiratory diseases, mainly related to MT+. In winter, the effect of cold weather on both cause-specific hospitalizations was small; however, MP+ was related to a delayed increase in cardiovascular hospitalizations, whilst MP+ and DP + increased the risk of hospitalizations due to respiratory diseases. This study provides useful information for the staff of hospitals and elderly care centers who can help to implement protective measures for patients and residents. Also, our results could be helpful for vulnerable people who can adopt protective measures to reduce health risks.

Canine hepatozoonosis caused by Hepatozoon canis is a worldwide distributed tick-borne disease of domestic and wild canids that is transmitted by ingestion of Rhipicephalus sanguineus sensu lato (s.l.) ticks. The present study was aimed to determine the prevalence of Hepatozoon infections in 80 stray dogs from Havana Province in Cuba, and to confirm the species identity and phylogenetic relationships of the causative agent. Samples were screened by microscopical examination of thin blood smears for the presence of Hepatozoon spp. gamonts and by genus-specific SYBR green-based real-time PCR assay targeting the 18S rRNA gene. Direct microscopy examination revealed Hepatozoon gamonts in the peripheral blood of 8 dogs (10.0%; 95% CI: 4.80–18.0%), while 38 animals (47.5%; 95% CI: 36.8–58.4%) were PCR-positive, including all microscopically positive dogs. Hence, the agreement between the two detection methods was ‘poor’ (κ = 0.20). Hematological parameters did not differ significantly between PCR-positive and PCR-negative dogs (p > 0.05). The DNA sequences of the 18S rRNA gene of the Hepatozoon spp. from Cuban dogs showed a nucleotide identity >99% with those of 18S rRNA sequences of Hepatozoon canis isolates from Czech Republic, Brazil and Spain. Phylogenetic analysis revealed that obtained sequences clustered within the Hepatozoon canis clade, different from the Hepatozoon felis or Hepatozoon americanum clades. The present study represents the first molecular characterization of Hepatozoon canis in stray dogs within Cuba.

Background Hemotropic mycoplasmas (aka hemoplasmas) are small bacteria which cause infectious anemia in several mammalian species including humans. Information on hemoplasma infections in Cuban bovines remains scarce and no studies applying molecular methods have been performed so far. The aim of the present study was to utilize real-time PCR and sequence analysis to investigate dairy cattle and buffalo from Cuba for the presence of bovine hemoplasma species. Results A total of 80 blood samples from 39 buffalo and 41 dairy cattle were investigated for the presence of Mycoplasma wenyonii and “Candidatus Mycoplasma haemobos” using two species-specific real-time TaqMan PCR assays. PCR results revealed overall 53 (66.2%; 95% CI: 55.3–75.7%) positive animals for M. wenyonii and 33 (41.2%; 95% CI: 31.1–52.2%) for “Ca. M. haemobos”; the latter were all co-infections with M. wenyonii. The sample prevalences were similar in cattle and buffalo. Based on the sequence analysis of the nearly full-length 16S rRNA gene from two cattle and two buffalo, the presence of M. wenyonii and “Ca. M. haemobos” was confirmed. Statistical analysis revealed that buffalo and cattle one year of age or older were more frequently infected with M. wenyonii or “Ca. M. haemobos” than younger animals. PCR-positivity was not associated with anemia; however, the infection stage was unknown (acute infection versus chronic carriers). Conclusions The high occurrence of bovine hemoplasma infections in buffalo and dairy cattle may have a significant impact on Cuban livestock production. To the best of our knowledge, this is the first molecular evidence of bovine hemoplasma species infection in dairy cattle and buffalo from Cuba and the Caribbean.

International audience; Anaplasmosis and theileriosis are considered the most important tick-borne diseases for livestock production worldwide, causing significant economic losses in tropical and subtropical regions. The present study was aimed to develop a multiplex TaqMan® qPCR assay to simultaneously detect Anaplasma marginale and Theileria annulata and to applied it to investigate naturally infected cattle in Cuba. The assay was highly specific, sensible, and efficient; it was more sensitive than a well-established nested PCR and detected 1 DNA copy of each target. Consistent repeatability and reproducibility within and between multiplex qPCR runs was shown. A total of 223 blood samples collected in western Cuba were analyzed for haemoparasites infection in cattle. The multiplex qPCR assay detected A. marginale in 213 samples (95.5%; CI: 95%; 91.9%-97.5%), but all samples were negative for T. annulata. Additionally, the genetic diversity of A. marginale was assessed using 16S rRNA, MSP1a and MSP4 nucleotide and protein sequences. The MSP1a tandem repeats ranged from three to five, and twelve different MSP1a tandem repeats of A. marginale were found, which presented genotypes C, E, and G in the 5ʹUTR microsatellite region. Phylogenetic analysis using the msp4 gene showed that Cuban strains were closely related to others previously reported in Mexico, Brazil and Asian countries. The multiplex qPCR described here proved to be a rapid, specific and cost-effective mean for the simultaneous detection of A. marginale and T. annulata. Further epidemiological studies using this assay will improve the surveillance of the associated diseases in regions where they are endemic.