Prevalence and risk of acquisition of methicillin-resistant Staphylococcus aureus among households: A systematic review.

OBJECTIVE: Many studies have reported methicillin-resistant Staphylococcus aureus (MRSA) transmission from patients infected or colonized with MRSA to their household contacts, but the importance of household transmission for persistence of MRSA in the community and reintroduction into healthcare settings is not well understood. METHODS: This review was performed to evaluate evidence on (1) MRSA prevalence, (2) MRSA contact positivity, and (3) MRSA carriage duration in household contacts of MRSA-positive individuals. The MEDLINE and Embase databases were searched covering the period from January 1, 1960 to November 15, 2019 for studies with data on these outcomes. A random-effects model meta-analysis was conducted with included studies to calculate pooled prevalence ratios. RESULTS: A total 22 relevant articles were included. The meta-analysis showed that the pooled prevalence of MRSA among culture-positive MRSA household contacts was 25.0% (95% confidence interval 20.0-30.0%). A subset of studies with adequate comparison groups reported higher colonization prevalence among household contacts of MRSA-positive individuals compared with household contacts of MRSA-negative individuals. MRSA contact positivity varied between 19.0% and 33.0%, but variation in sampling frequency and follow-up duration made between-study comparisons challenging. CONCLUSIONS: Substantial MRSA transmission occurs in household settings. Improved understanding of household transmission dynamics and the relationship between transmission in healthcare and household settings will be critical to inform improved strategies to control MRSA.

Estimating the Population Size of Males Who Inject Drugs in Myanmar: Methods for Obtaining Township and National Estimates.

Estimating the sizes of key populations at risk for HIV is crucial for HIV prevention and treatment. We provide findings of population size estimates (PSE) of males who inject drugs (MWID) in Myanmar, provide an intuitive method for countries to extrapolate subnational estimates into national estimates and provide guidance on how to maximize the utility of current PSE techniques. We used unique object and service multipliers, and successive sampling PSE in conjunction with a respondent driven sampling survey of MWID in ten Myanmar townships in 2014. Township estimates were assessed at a stakeholder meeting for biases and coded into ranges of high, medium and low MWID prevalence areas. Using the sampled townships as benchmarks for a range of MWID proportion estimates, national level MWID size estimates were derived by multiplying the adult male population for all townships with their corresponding proportion estimates. Final PSE ranged from high (4.12%), medium (1.02%) and low (0.11%), with the final agreed national point estimate of 83,000 MWID. Using estimates from survey data, this can translate into actual numbers of MWID living with HIV and practicing risky injecting and sexual behaviors. Although PSE are vital for monitoring HIV epidemics, no guidance exists for interpreting results of different PSE techniques or for extrapolating these results into national estimates. Assessing bias and gaining consensus on township level estimates and deriving ranges of MWID PSE throughout the country using stakeholder input is intuitive and accessible to countries.