- Mass gatherings and vaccines usefulness.

Introduction: Mass gatherings (MGs) are usually pre-planned large events that are known to amplify the risk of infectious disease (1). Although, the risk and pattern of diseases at mass gatherings vary depending on the features of the event such as crowding, shared accommodation, possibilities of the participants to prolonged exposure and close contact with infectious individuals, type of activities, and also the characteristics of the participants including their age & immunity to infectious agents, many of these can be prevented by appropriate vaccinations (2, 3). The aim of this article is to present a summary of the risk of vaccine-preventable diseases in MGs. Method(s): The method used to develop this article weas based on a litterature review. A summaryzing process of the documented risk of vaccine-preventable diseases in MGs was conducted to extract the most useful knowledge on this topic. It explored also available evidence on the effectiveness of vaccination policies for reducing disease transmission associated with these events and also the outstanding questions that need to be addressed for future consideration of some new and promising vaccines. Pubmed- Medline, Scopus, web of science and google Scholar were used to search over the published litterature. Result(s): The current Hajj vaccination policy includes mandatory vaccination for all pilgrims against meningococcal disease. This is in addition to mandatory vaccination against yellow fever, polio and Sarscov2 for pilgrims coming from endemic region. The Saudi Ministry of Health also strongly recommends seasonal influenza vaccination for all pilgrims, particularly those at high risk of infection complications. Data on the vaccination requirements for other mass gathering events such as Kumbh Mela and other religious, sports and entertainment events are still clearly lacking. Travelers to the FIFA 2022, Qatar, were advised to remain up-to-date with routine vaccines. Apart from the hajj settings, no data are available on the possible impact of the current vaccination policy on the control of infectious disease transmission in mass gatherings. The available data demonstrate that the current vaccination policy and health requirement for hajj is effectively contributing towards controlling the transmission of infectious diseases associated with Hajj pilgrimage (37), however evidence on effectiveness is clearly lacking. Moreover, there is no vaccination policy as part of health requirements for attendance in Kumbh Melain India. Conclusion(s): While taking into account local immunization policies of countries of origin and countries of travel, for diseases with known effective prequalified vaccines, WHO recommends that travelers at risk of developing complications, or at increased risk of acquiring and spreading infection such as those attending mass events, should consider vaccination as a preventive measure. Such policies are effective when these are driven by evidence and its effectiveness are measured through large scale studies. Mots cles: Mass Gatherings, Vaccines, Vaccination, Prevention Declaration de liens d'interets: Les auteurs n'ont pas precise leurs eventuels liens d'interets.Copyright © 2023

Outbreaks of different viral etiologies amidst COVID-19 pandemic

The COVID-19 pandemic has severely affected public health system and surveillance of other communicable diseases across the globe. The lockdown, travel constraints and COVID phobia turned down the number of people with illness visiting to the clinics or hospitals. Besides this, the heavy workload of SARS-CoV-2 diagnosis has led to the reduction in differential diagnosis of other diseases. Consequently, it added to the underlying burden of many diseases which remained under-diagnosed. Amidst the pandemic, the rise of emerging and re-emerging infectious diseases was observed worldwide and reported to the World Health Organization i.e., Crimean Congo Hemorrhagic Fever (2022, Iraq;2021 India), Nipah virus (2021, India), Zika virus (2021, India), and H5N1 influenza (2021, India), Monkeypox (2022, multicountry outbreak), Ebola virus disease (2022, DRC, Uganda;2021, DRC, Guinea;2020, DRC), Marburg (2022, Ghana;2021, Guinea), Yellow fever (2022, Uganda, Kenya, West and Central Africa;2021, Ghana, Venezuela, Nigeria;2020, Senegal, Guinea, Nigeria, Gabon;2020, Ethiopia, Sudan, Uganda), Dengue (2022, Nepal, Pakistan, Sao Tome, Temor-Leste;2021, Pakistan), Middle east respiratory syndrome coronavirus (2022, Oman, Qatar;2021, Saudi Arabia, UAE;2020, Saudi Arabia, UAE), Rift valley fever (2021, Kenya;2020, Mauritania), wild poliovirus type 1 (2022, Mozambique), Lassa fever (2022, Guinea, Togo, Nigeria;2020, Nigeria), Avian Influenza (H3N8) (2022, China), Avian Influenza (H5N1) (2022, USA), H10N3 influenza (2021, China), Hepatitis E virus (2022, Sudan), Measles (2022, Malawi, Afghanistan;2020, Burundi, Mexico), Mayaro virus disease (2020, French Guiana), Oropouche virus disease (2020, French Guiana). All these diseases were associated with high morbidity and burdened the public health system during the COVID-19 pandemic. During this critical public health menace, majority of the laboratory workforce was mobilized to the SARS-CoV-2 diagnosis. This has limited the surveillance efforts that likely led to under diagnosis and under-detection of many infectious pathogens. Lockdowns and travel limitations also put a hold on human and animal surveillance studies to assess the prevalence of these zoonotic viruses. In addition, lack of supplies and laboratory personnel and an overburdened workforce negatively impacted differential diagnosis of the diseases. This is especially critical given the common symptoms between COVID-19 and other pathogens causing respiratory illnesses. Additionally, the vaccination programs against various vaccine preventable diseases were also hampered which might have added to the disease burden. Despite these challenges, the world is better prepared to detect and respond to emerging/re-emerging pathogens. India now has more than 3000 COVID-19 diagnostic laboratories and an enhanced hospital infrastructure. In addition, mobile BSL-3 facilities are being validated for onsite sampling and testing in remote areas during outbreak situations and surveillance activities. This will undoubtedly be valuable as the COVID-19 pandemic evolves as well as during future outbreaks and epidemics. In conclusion, an increase in the emergence and re-emergence of viruses demonstrates that other infectious diseases have been neglected during the COVID-19 pandemic. Lessons learned from the infrastructure strengthening, collaborations with multiple stakeholders, increased laboratory and manufacturing capacity, large-scale COVID-19 surveillance, extensive network for laboratory diagnosis, and intervention strategies can be implemented to provide quick, concerted responses against the future threats associated with other zoonotic pathogens.

A Perspective on Current Flavivirus Vaccine Development: A Brief Review.

The flavivirus genus contains several clinically important pathogens that account for tremendous global suffering. Primarily transmitted by mosquitos or ticks, these viruses can cause severe and potentially fatal diseases ranging from hemorrhagic fevers to encephalitis. The extensive global burden is predominantly caused by six flaviviruses: dengue, Zika, West Nile, yellow fever, Japanese encephalitis and tick-borne encephalitis. Several vaccines have been developed, and many more are currently being tested in clinical trials. However, flavivirus vaccine development is still confronted with many shortcomings and challenges. With the use of the existing literature, we have studied these hurdles as well as the signs of progress made in flavivirus vaccinology in the context of future development strategies. Moreover, all current licensed and phase-trial flavivirus vaccines have been gathered and discussed based on their vaccine type. Furthermore, potentially relevant vaccine types without any candidates in clinical testing are explored in this review as well. Over the past decades, several modern vaccine types have expanded the field of vaccinology, potentially providing alternative solutions for flavivirus vaccines. These vaccine types offer different development strategies as opposed to traditional vaccines. The included vaccine types were live-attenuated, inactivated, subunit, VLPs, viral vector-based, epitope-based, DNA and mRNA vaccines. Each vaccine type offers different advantages, some more suitable for flaviviruses than others. Additional studies are needed to overcome the barriers currently faced by flavivirus vaccine development, but many potential solutions are currently being explored.

Preventing yellow fever epidemics in Asian megacities: how can cities control mosquito-transmitted diseases?

The COVID-19 pandemic has reminded us of the ever present threat from infectious diseases, this includes the ones we know about already and future unknowns. The mosquito-transmitted disease yellow fever has claimed thousands of lives over the centuries and it hasn't gone away. It is still endemic in tropical areas of Africa and Latin America, where it is kept at bay through constant surveillance, mass vaccination campaigns and some natural immunity within local populations. Despite this there are serious outbreaks from time to time. The Aedes mosquitoes capable of transmitting the virus from person to person, are now widespread in warmer countries worldwide, moreover they thrive in urban areas. With increased international movement, the fear is that infected travellers could unwittingly introduce the virus into countries where people have little or no immunity. Densely populated Asian megacities are a major concern. There are simple measures citizens can take to protect themselves and their homes from the bite of infected mosquitoes, but city leaders must be at the forefront of a coordinated response bringing together diverse stakeholders to ensure a robust and sustainable defence.

Summary of global surveillance data of infectious diseases in January 2023

In January 2023, a total of 64 infectious diseases were reported globally, affecting 235 countries and regions. Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were COVID-19 (235), monkeypox (110), dengue fever (31), measles (27) and cholera (15). The top five infectious diseases with highest case fatality rates were Nipah virus disease (62.5%), Ebola virus disease (47.0%), Crimean-Congo haemorrhagic fever (37.5%), Lassa fever (15.1%) and West Nile fever (7.6%). The top five infectious diseases with greatest number of deaths were COVID-19, malaria, cholera, measles and dengue fever. The prevalent infectious diseases in Asia were COVID-19, cholera and dengue fever, the prevalent infectious diseases in Africa were COVID-19, cholera, yellow fever, Lassa fever, malaria and monkeypox, the prevalent infectious diseases in America were COVID-19, cholera, monkeypox, dengue fever and chikungunya fever, the prevalent infectious disease in Europe were COVID-19, monkeypox and invasive group A streptococcus infection.

Research in brief

A nasal monoclonal antibody Investigations following a pilot trial of foralumab, the nasal monoclonal antibody a monoclonal antibody develop for inflammatory conditions and now repurposed for COVID-19, revealed decreased inflammatory markers and the same gene expression modulation seen in patients with multiple sclerosis. A subsequent gene expression analysis found changes in gene expression patterns (including NKG7, TGF beB1 and GIMAP7) involved with the anti-inflammatory effects of the drug, not only in COVID-19 patients, but also in a patient with multiple sclerosis, meaning the drug may be used for several diseases. For more on COVID-19 drug resistance see Sci Adv 2023;published online March 29. https://www.science.org/doi/10.1126/sciadv.ade8778 For more on the new target for COVID-19 drugs see eLife 2023;published online March 21. https://doi.org/10.7554/eLife.83710 For more on the nasal monoclonal antibody see Proc Natl Acad Sci USA 2023;published online March 7. https://doi.org/10.1073/pnas.2220272120 For more on antibodies for yellow fever see Sci Transl Med 2023;published online March 29. https://doi.org/10.1126/scitranslmed.ade5795 For more on a new drug for mpox see J Med Virol 2023;published online March 10. https://doi.org/10.1002/jmv.28652 For more on the transmission of bacterial vaginosis see Cell Rep Med 2023;published online March 21. https://doi.org/10.1016/j.xcrm.2023.100981 For more on endolysin see J Invest Dermatol 2023;published online March 6. https://doi.org/10.1016/j.jid.2023.01.039

Summary of global surveillance data of infectious diseases in December 2022

In December 2022, a total of 68 infectious diseases were reported globally, affecting 235 countries and regions. Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were COVID-19 (235), monkeypox (110), dengue fever (28), measles (27) and cholera (14). The top five infectious diseases with highest case fatality rates were Ebola virus disease (47.0%), Rift Valley fever (44.2%), Crimean-Congo haemorrhagic fever (40.0%), Lassa fever (17.6%) and West Nile fever (7.6%). The top five infectious diseases with greatest number of deaths were COVID-19, malaria, cholera, dengue fever and measles. The prevalent infectious diseases in Asia were COVID-19, cholera and dengue fever, the prevalent infectious diseases in Africa were COVID-19, cholera, yellow fever, Lassa fever, monkeypox, malaria and measles, the prevalent infectious diseases in America were COVID-19, cholera, monkeypox, dengue fever and chikungunya fever, the prevalent infectious disease in Europe were COVID-19, monkeypox and invasive group A streptococcus infection.

Enhancing vaccination of key populations: lessons and actions

Vaccination is effective in preventing the increase of disease, especially emerging infectious diseases (EIDs), and it is particularly important for people in close contact with infected sources and susceptible populations who are at increased risk of getting infectious diseases due to behavior, occupation or health. Despite targeted vaccination guidelines, inadequate vaccination of the key populations fails to receive widespread attention, resulting in a high-risk transition of disease from key populations to general populations. Strengthening the vaccination of the susceptible groups can effectively block the spread of pathogens to general populations, and reduce the consumption of medical resources in universal vaccination, which has significant economic value. In this review, we describe the prevalence of EIDs, analyze the experience and lessons of infectious disease vaccination in key populations through several cases, and further explore the causes for the decline in vaccination rates of key populations. According to the trends of EIDs, a plan to strengthen the vaccination of key populations is proposed to effectively prevent the transition of EIDs from key populations to general populations.

Summary of national data of class A, B and C communicable diseases in China, December 2022

In December 2022 (from 00: 00, 1 December to 24: 00, 31 December), except COVID-19, a total of 278 907 cases of notifiable communicable diseases, including 2 384 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, no cases and no deaths were reported. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A (H7N9) virus were reported. For the remaining 21 communicable diseases except COVID-19 in class B, a total of 148 573 cases were reported, a decrease of 29% compared with last month (210 178 cases) and a decrease of 46% compared with the same period in 2021 (273 361 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and AIDS, accounting for 96% of the total reported cases in class B. A total of 2 384 deaths were reported, an increase of 28% (521 deaths) compared with last month (1 863 deaths) and a decrease of 14% compared with the same period in 2021 (2 763 deaths). In class C communicable diseases, a total of 130 334 cases were reported, a decrease of 33% compared with last month (195 072 cases) and a decrease of 69% compared with the same period in 2021 (420 015 cases). The first 3 diseases in terms of reported case number were influenza, other infectious diarrhea, and hand foot and mouth disease (HFMD), accounting for 96% of the total reported cases in class C. Compared with last month, except filariasis which had no incidence, the reported case number of leprosy was same, and the disease with reported case increase was echinococcosis (47 cases, 48%), the reported cases of other diseases all decreased, the first 3 diseases with reported case decreases were HFMD (22 886 cases, 45%), other infectious diarrhea (21 962 cases, 43%) and influenza (14 775 cases, 18%). Compared with the same period in 2021, except filariasis which had no incidence, the reported cases of other diseases all decreased, the first 3 diseases with reported case decreases were influenza (181 158 cases, 73%), other infectious diarrhea (53 502 cases, 65%) and HFMD (46 674 cases, 63%). No death caused by class C communicable disease was reported, same to last month and a decrease of 7 deaths compared with the same period in 2021 (7 deaths).

Weekly epidemiological record

Yellow fever transmission in Africa included outbreaks and cases in countries with a history of YF mass vaccination campaigns (Cameroon, Central African Republic, Ghana), escalating the concern raised by the re-emergence of outbreaks in West Africa in 2020. In 2021, those outbreaks affected populations that had not been reached by immunization services, including people living in areas with compromised security and people missed in large-scale campaigns. The resurgence of intense viral transmission highlights the importance of achieving and maintaining equitable, high vaccination coverage of all at-risk populations. COVID-19 continued to impact YF control in 2021. The type of effect changed as countries prioritized vaccination against COVID-19, which led to postponement or de-prioritization of YF vaccination in some countries and affected vaccine acceptance. Despite the challenges, priority countries made good progress in implementing the Eliminate Yellow fever Epidemics (EYE) strategy in 2021, with >48 million people reached through reactive, catch-up and preventive YF vaccination campaigns in Africa.

Distinct and dynamic activation profiles of circulating dendritic cells and monocytes in mild COVID-19 and after yellow fever vaccination.

Dysregulation of the myeloid cell compartment is a feature of severe disease in hospitalized COVID-19 patients. Here, we investigated the response of circulating dendritic cell (DC) and monocyte subpopulations in SARS-CoV-2 infected outpatients with mild disease and compared it to the response of healthy individuals to yellow fever vaccine virus YF17D as a model of a well-coordinated response to viral infection. In SARS-CoV-2-infected outpatients circulating DCs were persistently reduced for several weeks whereas after YF17D vaccination DC numbers were decreased temporarily and rapidly replenished by increased proliferation until 14 days after vaccination. The majority of COVID-19 outpatients showed high expression of CD86 and PD-L1 in monocytes and DCs early on, resembling the dynamic after YF17D vaccination. In a subgroup of patients low CD86 and high PD-L1 expression were detected in monocytes and DCs coinciding with symptoms, higher age and lower lymphocyte counts. This phenotype was similar to that observed in severely ill COVID-19 patients, but less pronounced. Thus, prolonged reduction and dysregulated activation of blood DCs and monocytes were seen in a subgroup of symptomatic non-hospitalized COVID-19 patients while a transient coordinated activation was characteristic for the majority of patients with mild COVID-19 and the response to YF17D vaccination. This article is protected by copyright. All rights reserved.

Yellow fever outbreak in Kenya: A review.

Yellow fever (YF) is a viral acute hemorrhagic illness caused by infected mosquitoes of the flavivirus family. The first yellow fever outbreak in Kenya was in 1992. Similar outbreaks were recorded in the western part of the country in 1993, 1995, and 2011, particularly in the Rift Valley province of Kenya. In early 2022, the viral acute illness resurfaced and hit Kenya. On January 12, 2022, the first case was discovered, with over 14 patients suffering from fever, jaundice, and joint and muscle pains. On March 4, 2022, a yellow fever outbreak re-emerged in Kenya, affecting 11 wards in Isiolo County. The fatality rate recorded was 11.3% (six deaths), with Chari accounting for 39.6% of the total 21 cases, Cherab 14 (26.4%), and 5 Garba Tulla (9.4%). This has the potential to further endanger the nation's economic growth while also negatively impacting people's daily lives in a part of the world that is already dealing with the catastrophic impacts of the coronavirus pandemic. However, there is no curative therapy for yellow fever. The only options for curbing its spread are through vaccination and preventive measures. Hence, Kenya's government must take responsibility for requiring vaccination of its citizens, implement an active national disease surveillance protocol, and set up anti-yellow fever campaigns in the country.

Spike ferritin nanoparticle (SpFN) WRAIR's COVID-19 vaccine and SARS-CoV-2 spike receptor-binding domain ferritin nanoparticle RFN vaccine from American Walter Reed Institute during pandemic of SARS-CoV-2

In general, it can only be stated that new or emerging diseases are dangerous diseases and have high potential for spreading. Their common denominator is high mortality, dangerous spread in the population and limited treatment options. Today, there is a real possibility of introducing these diseases from the areas of their occurrence due to massive tourism, population migration and foreign workers. Another possibile way of their spread may be abuse in the form of bioterrorism, i.e. the use of an infectious agent as a biological weapon. The World Health Organization (WHO) continuously monitors and quantifies dangerous events in several well-defined categories (e.g. nuclear hazards, chemical hazards, natural disasters), however, annual as well as long-term statistics lead infectious diseases worldwide, which, due to epidemics and pandemics, account for more than 80% of the overall picture. The current SARS-CoV-2 pandemic is unprecedented. This is also because it is the first pandemic in human history, during which we are able to develop both drugs and vaccines against the biological agent. Copyright © 2022, EEZY Publishing, s.r.o.. All rights reserved.

Leveraging Lessons Learned from Yellow Fever and Polio Immunization Campaigns during COVID-19 Pandemic, Ghana, 2021.

Ghana is a yellow fever-endemic country and experienced a vaccine-derived polio outbreak in July 2019. A reactive polio vaccination campaign was conducted in September 2019 and preventive yellow fever campaign in November 2020. On March 12, 2020, Ghana confirmed its first COVID-19 cases. During February-August 2021, Ghana received 1,515,450 COVID-19 vaccines through the COVID-19 Vaccines Global Access initiative and other donor agencies. We describe how systems and infrastructure used for polio and yellow fever vaccine deployment and the lessons learned in those campaigns were used to deploy COVID-19 vaccines. During March-August 2021, a total of 1,424,008 vaccine doses were administered in Ghana. By using existing vaccination and health systems, officials in Ghana were able to deploy COVID-19 vaccines within a few months with <5% vaccine wastage and minimal additional resources despite the short shelf-life of vaccines received. These strategies were essential in saving lives in a resource-limited country.

Defective Interfering Particles with Broad-Acting Antiviral Activity for Dengue, Zika, Yellow Fever, Respiratory Syncytial and SARS-CoV-2 Virus Infection.

More than 100 arboviruses, almost all of which have an RNA genome, cause disease in humans. RNA viruses are causing unprecedented health system challenges worldwide, many with little or no specific therapies or vaccines available. Certain species of mosquito can carry dengue virus (DENV), Zika virus (ZIKV) and yellow fever virus (YFV), where co-infection of these viruses has occurred. Here, we found that purified synthetic defective interfering particles (DIPs) derived from DENV type 2 (DENV-2) strongly suppressed replication of the aforementioned viruses, respiratory syncytial virus (RSV) and also the novel emerging virus SARS-CoV-2 in human cells. DENV DIPs produced in bioreactors, purified by column chromatography, and concentrated are virus-like particles that are about half the diameter of a typical DENV particle, but with similar ratios of the viral structural proteins envelope and capsid. Overall, DIP-treated cells inhibited DENV, ZIKV, YFV, RSV, and SARS-CoV-2 by at least 98% by mechanisms which included interferon (IFN)-dependent cellular antiviral responses. IMPORTANCE DIPs are spontaneously derived virus mutants with deletions in genes that block viral replication. DIPs play important roles in modulation of viral disease, innate immune responses, virus persistence and virus evolution. Here, we investigated the antiviral activity of highly purified synthetic DIPs derived from DENV, which were produced in bioreactors. DENV DIPs purified by column chromatography strongly inhibited five different RNA viruses, including DENV, ZIKV, YFV, RSV, and SARS-CoV-2 in human cells. DENV DIPs inhibited virus replication via delivery of a small, noninfectious viral RNA that activated cellular innate immunity, resulting in robust type 1 interferon responses. The work here presents a pathway for DIP production which is adaptable to Good Manufacturing Practice, so that their preclinical testing should be suitable for evaluation in subjects.

The COVID-19 Impact on the Trends in Yellow Fever and Lassa Fever Infections in Nigeria.

Lassa fever (LF) and yellow fever (YF) belong to a group of viral hemorrhagic fevers (VHFs). These viruses have common features and damages the organs and blood vessels; they also impair the body's homeostasis. Some VHFs cause mild disease, while some cause severe disease and death such as in the case of Ebola or Marburg. LF virus and YF virus are two of the most recent emerging viruses in Africa, resulting in severe hemorrhagic fever in humans. Lassa fever virus is continuously on the rise both in Nigeria and neighboring countries in West Africa, with an estimate of over 500,000 cases of LF, and 5000 deaths, annually. YF virus is endemic in temperate climate regions of Africa, Central America (Guatemala, Honduras, Nicaragua, El Salvador), and South America (such as Brazil, Argentina, Peru, and Chile) with an annual estimated cases of 200,000 and 30,000 deaths globally. This review examines the impact of the COVID-19 pandemic on the trend in epidemiology of these two VHFs to delineate responses that are associated with protective or pathogenic outcomes.

A LESSON ON ANCHORING BIAS DURING A PANDEMIC: A CASE PRESENTATION

SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anchoring bias is a cognitive bias where one relies too heavily on initial information early on in the decision making process, affecting subsequent decisions due to future arguments being discussed in relation to the "anchor. Overemphasis on COVID-19 due to the pandemic has impacted the timely diagnosis and treatment of other diseases. CASE PRESENTATION: A 39-year-old man with a past medical history of COVID 19 in 12/2020 presents to the ED with increasing weakness, chest pain, recurrent fevers, diarrhea, and cough. CXR revealed bilateral infiltrates suggestive of pneumonia/pulmonary edema. Patient was empirically started on ceftriaxone. CT chest was suspicious of COVID-19;however repeat testing was negative. Diarrhea did not improve. Patient later admitted to recent travel to Jamaica. Ova and parasite, C-difficile, and stool culture were negative. On hospital day 8, the patient was intubated and placed on mechanical ventilation for worsening hypoxic respiratory failure Infectious disease was consulted for recurrent fevers of unknown origin and diarrhea with recent travel. Testing for typhoid fever, hantavirus, malaria, HIV, zika virus, chikungunya, dengue, and yellow fever were performed. Consent was obtained for HIV testing. HIV antibody tests were positive, CD4 count of 7, and viral load greater than 900k. Since a new diagnosis of AIDS with a CD4 count of 7 was obtained, the patient was subsequently tested for opportunistic infections such as TB. TB sputum PCR testing was positive but AFB smear was negative for TB. Antiretroviral and tuberculosis treatments were initiated. DISCUSSION: Anchoring bias can delay critical diagnoses and impede patient care if it is not recognized. According to Watson et. al, one way physicians circumvent the thought of pretest probability when ordering tests based on patient history and the subsequent list of differential diagnoses is anchoring bias. Bypassing the pretest probability also alters the sensitivity and specificity of testing because results that do not confirm or rule out a top differential diagnosis are thought to be inaccurate and are then repeated attributing the initial result to a bad specimen or an improper collection of the specimen. CONCLUSIONS: The case presented exemplifies clearly the concept of anchoring bias. Upon initial presentation, the patient had nonspecific symptoms such as weakness, chest pain, recurrent fevers, diarrhea, and cough, all of which can be symptoms of COVID 19 in the setting of a global pandemic. It is clear that the initial diagnosis based on these symptoms was COVID 19. When initial testing was negative, anchoring bias still played a role in the decision to test the patient once again, despite the first negative test. Repeat testing still did not support the diagnosis of COVID 19, which expanded the differential diagnosis and ultimately led to the correct diagnosis of AIDS with concomitant TB infection. Reference #1: Saposnik, et. Al. Cognitive Biases Associated with Medical Decisions: A Systematic Review. BMC Med Inform Decis Mak. 2016 Nov. 3. PMID: 27809908 Reference #2: Harada, et. al. COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era. Eur J Case Rep Intern Med. 2020 Oct 23. PMID: 33194872. Reference #3: Singh, et. al. The Global Burden of Diagnostic Errors in Primary Care. BMJ Qual Saf. 2016 Aug 16. PMID: 27530239. DISCLOSURES: No relevant relationships by Sagar Bhula

Biopower, racism, and yellow fever

Protection includes access to pharmacies and health-care services, information, resources, people, and goods that can shape one's life or lead to one's death. The 1793 yellow fever epidemic in Philadelphia was thought by some, including physician and signer of the US Declaration of Independence, Benjamin Rush, to originate from rotten coffee grounds left in the port. Long known as the “stranger's disease” due to misguided perceptions that only visitors and outsiders harboured yellow fever and brought it to New Orleans and other places, Olivarius takes a different approach in arguing that only the so-called acclimated were bestowed with vestiges of power in the form of local capital, networking opportunities, recognition from local credit houses and businesses, and status. While some public officials attempted to mitigate the potential impact of voting in the election by calling for increased access to mail-in ballots and more accessible and safer polling places, for instance, others hoped the impacts of COVID-19 might suppress “unwanted” voters from participating in the election.

A phylogenetic perspective of antiviral species of the genus Artemisia (Asteraceae-Anthemideae): A proposal of anti SARS-CoV-2 (COVID-19) candidate taxa.

Introduction: Different classes of disease-causing viruses are widely distributed universally. Plant-based medicines are anticipated to be effective cures for viral diseases including the COVID-19, instigated by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). This study displays the phylogenetic perspective of Artemisia and proposes some candidate taxa against different viral diseases, including SARS-CoV-2. Methods: Data of Artemisia with antiviral activity were obtained from different published sources and electronic searches. A phylogenetic analysis of the nrDNA ITS sequences of reported antiviral Artemisia species, along with the reference species retrieved from the NCBI GenBank database, was performed using the maximum likelihood (ML) approach. Results: In total, 23 Artemisia species have been documented so far with antiviral activity for 17 different types of viral diseases. 17 out of 23 antiviral Artemisia species were included in the ITS phylogeny, which presented the distribution of these antiviral Artemisia species in clades corresponding to different subgenera of the genus Artemisia. In the resultant ML tree, 10 antiviral Artemisia species appeared within the subgenus Artemisia clade, 2 species appeared within the subgenus Absinthium clade, 3 species appeared within the subgenus Dracunculus clade, and 2 species appeared within the subgenus Seriphidium clade. Discussion: Artemisia species from different subgenera with antiviral activity are prevalent in the genus, with most antiviral species belonging to the subgenus Artemisia. A detailed analysis of taxa from all subgenera, particularly the subgenus Artemisia, is therefore proposed in order to discover compounds with potential anti-SARS-CoV-2 activity.

Plant-Derived Recombinant Vaccines against Zoonotic Viruses.

Emerging and re-emerging zoonotic diseases cause serious illness with billions of cases, and millions of deaths. The most effective way to restrict the spread of zoonotic viruses among humans and animals and prevent disease is vaccination. Recombinant proteins produced in plants offer an alternative approach for the development of safe, effective, inexpensive candidate vaccines. Current strategies are focused on the production of highly immunogenic structural proteins, which mimic the organizations of the native virion but lack the viral genetic material. These include chimeric viral peptides, subunit virus proteins, and virus-like particles (VLPs). The latter, with their ability to self-assemble and thus resemble the form of virus particles, are gaining traction among plant-based candidate vaccines against many infectious diseases. In this review, we summarized the main zoonotic diseases and followed the progress in using plant expression systems for the production of recombinant proteins and VLPs used in the development of plant-based vaccines against zoonotic viruses.