The burden of Clostridioides difficile infections in South-East Asia and the Western Pacific: A narrative review.

BACKGROUND: Clostridioides difficile (formerly Clostridium difficile) is well-documented in Europe and North America to be a common cause of healthcare-associated gastrointestinal tract infections. In contrast, C difficile infection (CDI) is infrequently reported in literature from Asia, which may reflect a lack of clinician awareness. We conducted a narrative review to better understand CDI burden in Asia. METHODS: We searched the PubMed database for English language articles related to C difficile, Asia, epidemiology, and molecular characteristics (eg, ribotype, antimicrobial resistance). RESULTS: Fifty-eight articles that met eligibility criteria were included. C difficile prevalence ranged from 7.1% to 45.1 % of hospitalized patients with diarrhea, and toxigenic strains among all C difficile in these patients ranged from 68.2% to 91.9 % in China and from 39.0% to 60.0 % outside of China. Widespread C difficile ribotypes were RT017, RT014/020, RT012, and RT002. Recurrence in patients with CDI ranged from 3.0% to 17.2 %. Patients with CDI typically had prior antimicrobial use recently. High rates of resistance to ciprofloxacin, clindamycin, and erythromycin were frequently reported. CONCLUSION: The regional CDI burden in Asia is still incompletely documented, seemingly due to low awareness and limited laboratory testing. Despite this apparent under recognition, the current CDI burden highlights the need for broader surveillance and for application of preventative measures against CDI in Asia.

The COVID-19 experience in Africa and the Middle East.

AIMS: The experience of Africa and the Middle East with the COVID-19 pandemic has been unique, which can be attributed, in part, to disparities within these regions. METHODS: This review describes COVID-19 emergence, epidemiology, vaccination strategies and uptake, and lessons learned within Africa and the Middle East. RESULTS: For vaccines to be effective in curtailing COVID-19, a global approach to vaccination is required. However, vaccine inequities exist in Africa and the Middle East, with countries with better healthcare infrastructure having advantages in acquiring and delivering vaccines. Currently, the greatest challenges to the effective rollout of COVID-19 vaccination in Africa and the Middle East are funding, healthcare resources, infrastructure, and vaccine access and hesitancy. While mechanisms to support vaccine access in low- and middle-income countries are initiated, their success has been limited and vaccine inequity is arguably the biggest hurdle to a successful response. The collection of surveillance data at both regional and global levels is also critical in response to the pandemic and provides the necessary tools and data to drive vaccine development. CONCLUSION: These considerations of the learnings can help refine the pandemic response and inform countries to better prepare for similar public health emergencies.

Learnings from previous epidemics enabled African nations to respond rapidly and cohesively to the emergence of the COVID-19 pandemic; similarly, nations in the Middle East also drew on previous outbreaks of other viruses to respond robustly, although perhaps less cohesively than the African nations.The populations of Africa and the Middle East share many of the same comorbidities (with the exception of HIV in Africa) and risk factors as other regions of the world, and both have experienced multiple waves of COVID-19 infections as new genetic variants of SARS-CoV-2 have evolved.African and Middle Eastern nations have had a wide range of success in vaccine rollout and uptake due to several factors including national wealth/income, populations with varying levels of vaccine hesitancy, and a range of access to private and/or public healthcare.Current challenges, some of which are being addressed by governmental and international entities, include a lack of vaccine- and surveillance-related infrastructure, needed improvement in regulatory standards, and persistent financial strains on healthcare systems that hinder improvements in vaccine delivery.

COVID-19 in Latin America: A Snapshot in Time and the Road Ahead.

Since its initial detection in Brazil in February 2020, SARS-CoV-2 and the associated COVID-19 pandemic have continued to devastate Latin America. Specific comorbidities, as well as sociodemographic and lifestyle factors that may be more prevalent in underserved areas, have been identified as risk factors for COVID-19 infection or associated adverse outcomes. Dynamics of infections and deaths in Latin America have varied by country and temporally, as has SARS-CoV-2 variant prevalence; however, more recently, the Delta and subsequent Omicron variants have become ubiquitous. Successful pandemic responses have involved robust infection mitigation measures, testing, and smart deployment of healthcare resourcing. While in some Latin American countries up to 90% of the population is fully vaccinated (i.e., 2 doses) against COVID-19, other countries have failed to reach the World Health Organization's 70% target. Continued focus on comprehensive surveillance, strategies to maximize vaccine availability and uptake, and mitigation of collateral damage on other aspects of public health and social services are critical for managing the COVID-19 pandemic. This review summarizes the COVID-19 experience in Latin America, including epidemiology and vaccination. Key learnings and future considerations for the ongoing pandemic response are also discussed.