Top Infectious Disease News of the Week—November 10, 2019

#5: CDC Reports Sharp Increase in Candidemia Among Injection Drug Users

Cases of candidemia associated with injection drug use are on the rise, according to a recent study by the US Centers for Disease Control and Prevention (CDC), suggesting that the opioid crisis and increases in heroin use are shifting the landscape for these infections.

The study, published in Clinical Infectious Diseases, involved surveillance of 9 states during 2017. Investigators identified 1191 cases of candidemia, including 128 (10.7%) among injection drug users (IDU). Among patients ages 19-44 years, the proportion of candidemia involving injection drug users was 34.6%.

“We found that the proportion of candidemia cases associated with injection drug use rose nearly three-fold during 2014-2017, which likely reflects the rise in injection drug use due to the nation’s opioid crisis,” Snigdha Vallabhaneni, MD, MPH, medical epidemiologist at the CDC, told Contagion^®. “Nearly 1 in 8 patients with candidemia had a recent history of injection drug use. Doctors usually think of Candida bloodstream infections (candidemia) as something that only affects people who have spent a long time in the intensive care unit, undergone major abdominal surgery or have cancer. Although injection drug use is a known risk factor for candidemia, we are now beginning to understand the extent to which injection drug use contributes to candidemia.”

Read the full article.

#4: Global Vaccination Coverage Remains Unchanged at 86% Since 2010

Global vaccination coverage has remained steady at 85% to 86% since 2010, according to the US Centers for Disease Control and Prevention (CDC).

About two-thirds (129 of 194) of World Health Organization member countries have surpassed the Global Vaccine Action Plan national vaccination coverage goal of 90% by 2020, according to the CDC’s report, Global Vaccination Coverage, 2018. That is up from 123 in countries that had surpassed the goal last year.

In 2018, 19.4 million children worldwide were not fully vaccinated, including 13.5 million who hadn’t received any doses of the diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP).

Read the full article.

#3: ECDC Confirms Locally-Acquired Zika Cases in France

Zika virus was previously only found in regions of Asia, the Pacific Islands, South America, and Africa. Incidents elsewhere were all attributed to travelers, rather than the native mosquito population. In the United States, all Zika cases have been linked to travel outside the United States.

The European Centre for Disease Prevention and Control (ECDC) has now confirmed 3 locally-acquired cases of Zika virus in Hyères, a town in the south of France, occurred in August 2019.

The third individual who became infected had no travel history to Zika-endemic countries, and resides near the location where the first 2 cases were identified. The impacted individuals were likely part of the same transmission cycle, as they developed symptoms around the same time.

Read the full article.

#2: How Fear Inhibits HIV Testing and Treatment in African Men

In the push to make HIV testing and treatment more widely available, especially in underserved areas, it can be sobering to realize that availability does not always mean utilization. A recent study of men living in Cote d’Ivoire, or Africa’s Ivory Coast, demonstrated that deeply held beliefs about the stigma of HIV translated to shame, fear, and—for too many—lack of action.

A team of investigators at Johns Hopkins Bloomberg School of Public Health in Baltimore, partnering with Felix Houphouet-Boigny University in Cote d’Ivoire, got face to face with local men in discussions in November and December 2016. Using focus groups and personal interviews, the team talked with 227 men who lived in urban areas about their thoughts on HIV testing and its aftermath. The men were classified as either HIV status unknown, living with HIV but not in treatment, and living with HIV and getting treatment.

The results of the study, published in PLOS ONE, provided some explanation for the fact that while 1 out of 40 adults in the country are infected with HIV, fewer than one quarter of the men know their HIV status. Women are a little more informed, with 43% of them knowing their HIV status. What accounts for the low rate of testing in Cote d’Ivoirian men? Simply put, most of them are afraid of the repercussions of having a positive test result.

Read the full article.

#1: Emphasizing Inclusion of Black Women in Efforts to End the HIV Epidemic

Rasheeta Chandler, PhD, RN, APRN-BC, FNP-BC, FAANP, FAAN, assistant professor, Department of Nursing, Emory University emphasizes including of black women in efforts to end the HIV epidemic and discusses an app she is developing to help women access information about sexual health.

Chandler: Some of the social determinants that make black women susceptible to HIV acquisition are environmental. Sometimes they are in relationships with men that they don't know is either in multiple relationships or sometimes they do know. So partnerships or relationships could make them susceptible.

Other social determinants could be violence related to partner relationships, so kind of having that male dominance when it comes to being able to prevent HIV acquisition because they don't feel as comfortable requesting for their partner to use a condom. So those negotiation options for them are communication with partners. More broadly social determinants are, again, access to health care, working a lot around the fact that there is structural racism, so that can feed into that lack of health care access and information access. For instance, with PrEP, we know that communities of color could use PrEP much more than other communities, but yet, the information is not often provided to them in a way that is maybe clearly defined as this is something that could be used by us, particularly with black women. So those are some of the social determinants that like scream at us in the line of work that I do.

Watch the full interview.