A Rare Case of Streptococcus equi Subspecies Zooepidemicus Bacteremia.

Streptococcus equi subspecies zooepidemicus (S. zooepidemicus) is a zoonotic pathogen that primarily infects horses, pigs, and dogs. Although rare, it has also been shown to infect humans who consume unpasteurized dairy food or have direct contact with horses. Here, we present a case of S. zooepidemicus bacteremia in a patient without a clear mode of transmission. An 86-year-old male with a past medical history of coronary artery disease, heart failure with reduced ejection fraction, complete heart block status post pacemaker, hypertension, hyperlipidemia, and type 2 diabetes mellitus presented to the Emergency Department with fever and chills. He had fevers and rigors for three days but denied weight loss, cough, sore throat, or rashes. In the Emergency Department, vital signs revealed a fever of 101.2 degrees Fahrenheit and a heart rate of 110 with other stable vital signs. The physical exam was unremarkable except for tachycardia, and laboratory work revealed no leukocytosis but elevated inflammatory markers and elevated lactate. Computed tomography of the chest, abdomen, and pelvis did not reveal any source of infection. Blood cultures grew S. zooepidemicus and the Infectious Diseases team was consulted, who started the patient on Penicillin G. Due to concern for pacer-lead infective endocarditis, transthoracic and transesophageal echocardiograms were performed, which did not show valvular vegetations. Repeat blood cultures showed clearance of the infection, and the patient was ultimately discharged on amoxicillin. While our patient denied consuming unpasteurized dairy products or having direct contact with horses, upon further questioning, he did endorse family members who occasionally interacted with horses. This case is valuable as it adds to the sparse literature on S. zooepidemicus infections specifically in humans. Extensive history taking is of utmost importance when a clear source of infection is not easily identifiable. Further research is also needed to better understand the various modes of transmission of this bacterium to better target and caution those at an increased risk of infection.

Did I text you? The influence of the mode of transmission on destination memory.

In a society where people often communicate through digital technology, it is crucial to investigate whether the transmission mode influences destination memory performance (our capacity to remember to whom we transmitted certain information). In Experiment 1, we asked young adults (N = 31) to share of a set of familiar proverbs only by typing and the rest by both typing and saying them aloud. Better destination memory was observed when the information was transmitted by the two means (aloud and typing). Did this better performance occur because participants shared the information aloud or because the information was transmitted by two means? In Experiment 2, young adults (N = 34) shared familiar proverbs aloud, by typing, or simultaneously aloud and by typing. Results showed that transmission aloud led to a better destination memory than typing, and no further improvement occurred when the transmission was both aloud and by typing. Additionally, no differences were observed regarding item memory, supporting the idea that item and destination memories are two different types of memory.

Viruela del mono: una nueva amenaza para los dentistas. Vías de contagio / Monkeypox: a new threat to dentists. Contagion routes

El propósito de esta revisión es resumir la virología del virus de la viruela del mono, su transmisión, epidemiología, manifestaciones clínicas, manifestaciones orales, tratamiento y las posibles implicaciones para los dentistas. Se analizan los riesgos de transmisión a trabajadores de la salud. Un paciente asintomático o con síntomas tempranos no específicos puede acudir a la clínica dental para tratamiento odontológico. Los pacientes contagiados asintomáticos o con contacto con el virus, si el tratamiento no es urgente, deben respetar 21 días de cuarentena tras la exposición. Las gotículas respiratorias y los aerosoles a los que estamos expuest os los odontólogos al atender a los pacientes son una de las principales vías de transmisión.Sin embargo, la profesión odontológica está preparada para este nuevo reto ya que aún estamos aplicando todas las medidas de prevención aprendidas con la pandemia de COVID-19 (mascarillas FFP2, gafas, guantes, ventilación, etc) (AU)

The purpose of this review is to summarize the virology of the monkeypox virus, transmission, epidemiology, clinical features, oral manifestations, treatment, and possible implications for dentists. The risks of transmission to health workers are analyzed. A patient with no symptoms or early non-specific symptoms may come to the dental clinic for treatment. These patients or those who have been in contact with the virus, if the treatment is not urgent, must wait 21 days after exposure, which is the quarantine time. Respiratory droplets and aerosols to which dentists are exposed when caring for patients are one of the main routes of transmission. The dental profession is prepared for this new challenge as we are still applying all the prevention measures learned from the COVID-19 pandemic (FFP2 masks, goggles, gloves, ventilation, etc.) (AU)

Epidemiology and clinical spectrum of pediatric patients with human immunodeficiency virus (HIV) infection: A 15 years' experience.

Objective: To view the different patterns of presentation of HIV in pediatric population along with mode of transmission and associated co infections and co morbidities. Methods: It was a retrospective study conducted at Pakistan Institute of Medical Sciences, Islamabad, in which we evaluated the records of pediatric patients diagnosed with HIV from 2005 to 2020. All the data like age, gender, area, presenting complaints, examination findings at the time of diagnosis, mode of transmission, co infection and co morbidities were recorded. Descriptive analysis was done to calculate frequencies and means of the variables. SPSS 20 was used for data analysis. Results: Ninety four participants were evaluated with male to female ratio as 1.8:1 and mean age of 5.2 years. Majority of patients (44%) were below 4 years. Fever (55%) was the most reported symptom followed by cough (39%), diarrhoea (29%), pallor (27%), shortness of breath (26%), weight loss (23%) and failure to thrive (22%). Co infection with TB was present in (16%). Eight (9%) patients were thalassaemic. Mother to child transmission (60%) was the commonest mode of transmission followed by blood transfusion (23%) and parenteral transmission (6%). Conclusion: In children HIV is more prevalent in males especially under 4 years with fever, cough, diarrhea and pallor being the common symptoms at presentation. Tuberculosis is the commonest co infection as we are endemic for TB and mother to child transmission is the commonest mode of transmission as there was no outbreak in our area.

AIDS in the era of antiretroviral therapy: Changes in incidence rates and predictors of AIDS among people living with HIV under clinical care in Germany, a cohort study 1999-2018.

OBJECTIVES: This study examined the incidence rates and predictive utility of established prognostic factors for the progression to AIDS among people living with HIV under clinical care. METHODS: We used data from two observational cohorts of people living with HIV in Germany between 1999 and 2018. The outcome measure was the first AIDS-defining event that occurred during follow-up. Incidence rates (IRs) per 1000 person-years (PY) were calculated by years of follow-up and calendar periods. We used Cox models in our prediction analyses, including CD4 count, viral load, and age at baseline to estimate the predictive performance. Additionally, we included transmission mode to examine its predictive utility. RESULTS: A total of 23 299 people living with HIV were included in the analyses. Of these, 1832 developed a first AIDS event during follow-up, constituting an overall rate of 14.6/1000 PY (95% confidence interval [CI] 13.9-15.2). IRs were highest in the first year of follow-up (45.6/1000 PY, 95% CI 42.6-48.8) and then declined continuously. IRs were highest among people living with HIV who enrolled between 1999 and 2003 (36.1/1000 PY, 95% CI 32.6-40.0). A low CD4 count, high viral load, and older age at baseline increased the likelihood of progressing to AIDS. Adding transmission mode to the models did not improve the predictive performance. CONCLUSIONS: The rates of a first AIDS event among people living with HIV have continuously declined in Germany. Health outcomes depend on a person's CD4 count, viral load, and age but not on transmission mode. To further reduce the number of AIDS cases, the focus should be on groups more likely to present in progressed stages of their HIV infection.

Clinical and Genetic Characterization of Familial Central Precocious Puberty.

CONTEXT: Central precocious puberty (CPP) can have a familial form in approximately one-quarter of the children. The recognition of this inherited condition increased after the identification of autosomal dominant CPP with paternal transmission caused by mutations in the MKRN3 and DLK1 genes. OBJECTIVE: We aimed to characterize the inheritance and estimate the prevalence of familial CPP in a large multiethnic cohort; to compare clinical and hormonal features, as well as treatment response to GnRH analogs (GnRHa), in children with distinct modes of transmission; and to investigate the genetic basis of familial CPP. METHODS: We retrospectively studied 586 children with a diagnosis of CPP. Patients with familial CPP (n = 276) were selected for clinical and genetic analysis. Data from previous studies were grouped, encompassing sequencing of MKRN3 and DLK1 genes in 204 patients. Large-scale parallel sequencing was performed in 48 individuals from 34 families. RESULTS: The prevalence of familial CPP was estimated at 22%, with a similar frequency of maternal and paternal transmission. Pedigree analyses of families with maternal transmission suggested an autosomal dominant inheritance. Clinical and hormonal features, as well as treatment response to GnRHa, were similar among patients with different forms of transmission of familial CPP. MKRN3 loss-of-function mutations were the most prevalent cause of familial CPP, followed by DLK1 loss-of-function mutations, affecting, respectively, 22% and 4% of the studied families; both affected exclusively families with paternal transmission. Rare variants of uncertain significance were identified in CPP families with maternal transmission. CONCLUSION: We demonstrated a similar prevalence of familial CPP with maternal and paternal transmission. MKRN3 and DLK1 loss-of-function mutations were the major causes of familial CPP with paternal transmission.

Factors influencing the acquisition of COVID infection among high-risk contacts of COVID-19 patients in Madurai district-A case control study.

Introduction: COVID is a new disease; understanding the transmission dynamics and epidemiological characteristics may help in developing the effective control measures. The study is done 1. To determine the various factors influencing the acquisition of COVID-19 infection among high-risk contacts 2. To estimate the secondary attack rate among high-risk contacts 3. To determine the factors in COVID index cases influencing their secondary attack rate. Methodology: Unmatched case control study was conducted from March to August 2020 among 139 COVID index cases in Madurai district from March-May (Reference period) and their 50 COVID positive (cases), 551 COVID negative (controls) high-risk contacts. Case investigation form* and contact tracing Proforma*were used to collect data. Chi-square test and independent sample t test were used to find out the association. Univariate* and Multivariate logistic regression* were used to predict the risk of various factors in acquisition of COVID infection with the help of adjusted and unadjusted odds ratio. P value < 0.05 was considered statistically significant. Results: Male contacts (P = 0.005, OR = 2.520), overcrowding (P = 0.007, OR = 3.810), and duration of exposure to index case (for 4-7 days P = 0.014, OR = 2.902, for >7 days P = 0.001, OR = 6.748 and for > 12 hours/day P = 0.000, OR = 5.543) were significant factors predicted to be associated with acquisition of COVID infection among high-risk contacts. Reproductive number (R0)* estimated was 1.3. Secondary attack rate (SAR)* estimated among high-risk contacts was 8.32%. Index cases whose outcome was death (P = 0.026); symptomatic index cases (P = 0.000), cases with fever (P = 0.001); sorethroat (P = 0.019); breathlessness (P = 0.010); cough (P = 0.006) and running nose (P = 0.002) had significantly higher mean SAR than their counterparts. Conclusion: Contacts with above said risk factors who were found to be more prone to infection could be given special focus to prevent the transmission in them.

Characteristics of heterosexually-acquired compared to homosexually-acquired HIV and implications for clinical practice: results from the Australian HIV Observational Database.

Heterosexuals living with HIV report feeling additional HIV stigma compared to homosexual men, which may affect clinical outcomes. Yet, beyond routinely collected surveillance data, little is known about the characteristics of individuals who acquire HIV heterosexually and clinical outcomes by mode of sexual acquisition have not been directly compared. Using data from the Australian HIV Observational Database, we compared clinical characteristics of those with heterosexually-acquired (Het-HIV) to homosexually-acquired HIV (Hom-HIV) to investigate any differences and their implications for clinical management. 513 Het-HIV and 1467 Hom-HIV patients were included and contributed 3,127 and 9,457 person-years of follow-up, respectively. Compared with Hom-HIV, Het-HIV were more often born outside Australia (62.5% vs 39.9%, p<0.001), less likely to have Hepatitis C (4.8% vs 7.8%, p=0.029) and had lower median CD4 counts at diagnosis (292 vs 450 cells/µL, p<0.001) and cART initiation (270 vs 340 cells/µL, p<0.001). Despite these lower CD4 counts, there were no significant differences between groups for time to the major clinical endpoints of cART initiation, viral suppression, virological failure or all-cause mortality. Het-HIV had a lower risk of loss-to-follow-up than Hom-HIV (aHR 0.78; 95% CI 0.64-0.95). Further studies examining factors associated with, and interventions to inform retention in care are required.

Viral RNA and Infectious Influenza Virus on Mobile Phones of Patients With Influenza in Hong Kong and the United States.

Mobile phones are among the most highly touched personal objects. As part of a broader study on the contribution of fomites to influenza transmission, between 2017 and 2019, we swabbed mobile phones from 138 patients with influenza in 2 locations. Influenza viral RNA detection rates were 23% (23 of 99 phones) and 36% (14 of 39) in Hong Kong and Maryland, respectively. In Hong Kong, infectious influenza virus was recovered from 3 of 23 mobile phones which had influenza viral RNA detected. Mobile phone influenza contamination was positively associated with upper respiratory tract viral load and negatively associated with age. Cleaning personal objects of patients with influenza should be recommended, and individuals should avoid sharing objects with these patients.

Risk factors and on-site simulation of environmental transmission of SARS-CoV-2 in the largest wholesale market of Beijing, China.

From June 11, 2020, a surge in new cases of coronavirus disease 2019 (COVID-19) in the largest wholesale market of Beijing, the Xinfadi Market, leading to a second wave of COVID-19 in Beijing, China. Understanding the transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the personal behaviors and environmental factors contributing to viral transmission is of utmost important to curb COVID-19 rise. However, currently these are largely unknown in food markets. To this end, we completed field investigations and on-site simulations in areas with relatively high infection rates of COVID-19 at Xinfadi Market. We found that if goods were tainted or personnel in market was infected, normal transaction behaviors between sellers and customers, daily physiological activities, and marketing activities could lead to viral contamination and spread to the surroundings via fomite, droplet or aerosol routes. Environmental factors such as low temperature and high humidity, poor ventilation, and insufficient hygiene facilities and disinfection practices may contribute to viral transmission in Xinfadi Market. In addition, precautionary control strategies were also proposed to effectively reduce the clustering cases of COVID-19 in large-scale wholesale markets.

Viral Cultures for Coronavirus Disease 2019 Infectivity Assessment: A Systematic Review.

BACKGROUND: We aimed to review the evidence from studies relating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) culture with the results of reverse-transcription polymerase chain reaction (RT-PCR) and other variables that may influence the interpretation of the test, such as time from symptom onset. METHODS: We searched LitCovid, medRxiv, Google Scholar, and the World Health Organization coronavirus disease 2019 (COVID-19) database for COVID-19 up to 10 September 2020. We included studies attempting to culture or observe SARS-CoV-2 in specimens with RT-PCR positivity. Studies were dual-extracted and the data summarized narratively by specimen type. Where necessary, we contacted corresponding authors of included papers for additional information. We assessed quality using a modified Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) risk-of-bias tool. RESULTS: We included 29 studies reporting attempts at culturing, or observing tissue infection by, SARS-CoV-2 in sputum, nasopharyngeal or oropharyngeal, urine, stool, blood, and environmental specimens. The quality of the studies was moderate with lack of standardized reporting. The data suggest a relationship between the time from onset of symptom to the timing of the specimen test, cycle threshold (Ct), and symptom severity. Twelve studies reported that Ct values were significantly lower and log copies higher in specimens producing live virus culture. Two studies reported that the odds of live virus culture were reduced by approximately 33% for every 1-unit increase in Ct. Six of 8 studies reported detectable RNA for >14 days, but infectious potential declined after day 8 even among cases with ongoing high viral loads. Four studies reported viral culture from stool specimens. CONCLUSIONS: Complete live viruses are necessary for transmission, not the fragments identified by PCR. Prospective routine testing of reference and culture specimens and their relationship to symptoms, signs, and patient co-factors should be used to define the reliability of PCR for assessing infectious potential. Those with high Ct are unlikely to have infectious potential.

Fulminant Septic Shock with Pasteurella multocida in a Young Infant: No Bite, Scratch, or Lick!

This is a case of Pasteurella multocida septic shock encountered in a 7-week-old infant without any bites, scratch marks, or history of licks by pet animals (dog and cats in household). The infant required 3 days of vasopressor support and 4 days of mechanical ventilation to achieve normal hemodynamics. This is an unidentified route of transmission and our literature search for this topic discovered reported cases of life-threatening presentation with Pasteurella infections in the absence of a bite or any form of invasive contact with animals. We believe that this is an important public safety message to restrict animal contact of young infants to prevent severe infection.

Epidemiological characteristics and transmission routes of COVID-19 asymptomatic infected patients in Shaanxi Province / 西安交通大学学报(医学版)

【Objective】 To assess the epidemiological characteristics and transmission risk of asymptomatic COVID-19 infection in Shaanxi Province. 【Methods】 A dense population database of COVID-19 cases in Shaanxi Province was constructed as of March 26, 2020, and 28 asymptomatic infected patients were selected through case epidemiological investigation report for descriptive analysis. 【Results】 In Shaanxi Province, the majority of asymptomatic COVID-19 infections were in the 20-59 years old group, and women took up a higher proportion than men. 82.14% of asymptomatic infections were found in the centralized isolation state. Nearly 80% of asymptomatic infections and confirmed cases were mainly exposed by living together in the family. The median number of days from last contact with the source of infection for all asymptomatic infected persons was 13, with 3 (10.71%) showing clinical symptoms. Epidemiological investigations showed that asymptomatic infections could spread as a result of shared family life. 【Conclusion】 At present, imported cases in Shaanxi Province continue to exist. Considering the concealed transmission of asymptomatic infections, prevention and control work is still facing challenges.

COVID-19: An International Public Health Concern.

This review presents a synopsis on the current COVID-19 pandemic, with focus on preventive measures. COVID-19 is a new viral infection, and is in form of a positive-sense, single-stranded RNA Coronavirus which belongs to an expanded group of viruses which were identified six decades ago. Importantly, the new COVID-19 belongs to the group of SARS-CoV, and it originated in bats but infected humans through smuggled pangolins. At first, the mode of transmission of infection was animal-to-person, but person-to-person and community transmission of the virus has been confirmed in many parts of the world. With an incubation period of between two-fourteen days, signs and symptoms of infection are mild to high respiratory illness; characterized with cough, breathing problems (shortness of breath), high temperature (Fever), tiredness (Fatigue) and nausea. Presently, no vaccines or specific treatment is available for COVID-19, in light of the aforementioned; prevention is the only substantial and less expensive option. With the envisaged explosive community transmission of COVID-19 in the coming weeks in places with limited daily testing, especially in African countries, it is recommended among many that social distancing which includes avoiding any form of contact with people; either through greetings, hugging or shaking of hands and large gatherings, avoid contact with animal items, dead or alive animals, sick and dead people from areas experiencing COVID-19 epidemic, and basic hygienic practices like thorough washing of hands with clean water and antiseptic soap for the duration of at least twenty seconds should be practiced always. However, in the absence of the aforementioned, an alcohol-based hand gel should be used on the hands frequently. Furthermore, health care workers should adhere strictly to the standard preventive measures in areas of heightened COVID-19 epidemic.

Is there any perceptiveness about the mode of transmission of human immunodeficiency virus/acquired immune deficiency syndrome? An analysis among the adolescent tribal students in Tamil Nadu.

BACKGROUND: Cognizance about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among the community is still lacking. Seldom studies done in tribal area and to indentify the awareness about HIV/AIDS among the adolescent tribal students in Jawadhu hills of Tamil Nadu, with the objectives includes on social, demographical, and knowledge about HIV/AIDS were taken. For primary data, survey method and secondary data from various literatures gathered. MATERIALS AND METHODS: Schedule tribe adolescent students, between the age groups of 13-21 years, from 8th to 12th standard, exclusively from Vellore and Tiruvannamalai educational districts, were taken, by applying STRATA method. RESULTS: A total of 938 students from various tribal schools participated. Amongst them, 507 (54%) were males and 431 (46%) were females. Half of the respondents (50%) agreed that blood transfusion, intravenous drug use, and sharing infected needles are the major modes of transmission. Nearly 35% agreed that HIV/AIDS is transmitted by hugging, tattooing, dirty hands, breastfeeding, kissing on cheeks, shaving at the barber shop, shaking hands with AIDS patients, homosexuality and are food and waterborne. CONCLUSIONS: Formal HIV/AIDS education should be mandatory in their curriculum, where teachers get an opportunity to deliver the scientific information about HIV/AIDS. To acquire better knowledge about HIV/AIDS, sex education should be included in the mainstream of curriculum with the assistance of educational consultants, professional social workers, and also local non-governmental organizations to conduct further mindfulness camps about the HIV/AIDS.

Impact of COVID-19 prevalence and mode of transmission on mortality cases over WHO regions.

With the current outbreak of coronavirus disease 2019 (COVID-19), countries have been on rising preparedness to detect and isolate any imported and locally transmitted cases of the disease. It is observed that mode of transmission of the disease varies from one country to the other. Recent studies have shown that COVID-19 cases are not influenced by race and weather conditions. In this study, effect of modes of transmission of COVID-19 is considered with respect to prevalence and mortality counts in World Health Organisation (WHO) regions. Also, a negative binomial model is formulated for new death cases in all WHO regions as a function of confirmed cases, confirmed new cases, total deaths and modes of transmission, with the goal of identifying a model that predicts the total new death cases the best. Results from this study show that there is strong linear relationship among the COVID-19 confirmed cases, total new deaths and mode of transmission in all WHO regions. Findings highlight the significant roles of modes of transmission on total new death cases over WHO regions. Mode of transmission based on community transmission and clusters of cases significantly affects the number of new deaths in WHO regions. Vuong test shows that the formulated negative binomial model fits the data better than the null model.

Potential fecal transmission of SARS-CoV-2: Current evidence and implications for public health.

Coronavirus disease 2019 (COVID-19) emerged in Hubei Province, China in December 2019 and has since become a global pandemic, with hundreds of thousands of cases and over 165 countries affected. Primary routes of transmission of the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are through respiratory droplets and close person-to-person contact. While information about other potential modes of transmission are relatively sparse, evidence supporting the possibility of a fecally mediated mode of transmission has been accumulating. Here, current knowledge on the potential for fecal transmission is briefly reviewed and the possible implications are discussed from a public health perspective.

Assessment of the knowledge of the modes of transmission and prevention of malaria among pregnant women attending antenatal clinic at the Nkwen Health Center Bamenda, Cameroon.

INTRODUCTION: Malaria is a life threatening disease caused by the Plasmodium parasite, transmitted through the bites of infected female anopheles' mosquitoes. According to the latest WHO data published in 2017, malaria deaths in Cameroon reached 9.161 deaths accounting for 4.14% of total deaths. The age adjusted death rate is 29.11 per 100,000 and Cameroon is ranked the 30th in the world with a high prevalence of malaria. The aim of this study was therefore, to access the knowledge of the modes of transmission and prevention of malaria among pregnant women attending Antenatal Clinic (ANC) at the Nkwen Health Center, Bamenda. METHODS: This was a cross-sectional hospital based survey study. The researchers recruited 51 eligible women in the Nkwen Health Centre and used a validated and pre-tested questionnaires to collect data. Collected data were entered into Excel and analysed using descriptive statistics and the results presented in tables and figures. RESULTS: Sixty four percent of the women have basic knowledge about the mode of malaria transmission. Thirty six percent of the women had little knowledge about malaria transmission modes and the possible dangers of the disease. CONCLUSION: Slightly above 50% of pregnant women have basic knowledge on the modes of malaria transmission. Lack of knowledge regarding the modes of malaria transmission can be one of the reasons why there is still quite a high level of malaria prevalence among pregnant women attending ANC at the Nkwen Health Center, Bamenda. There is therefore, a need to educate women on malaria transmission modes.

Individual-level key associations and modes of exposure for hepatitis C virus infection in the Middle East and North Africa: a systematic synthesis.

PURPOSE: To identify, map, and synthesize the individual-level key associations and modes of exposure for hepatitis C virus (HCV) infection in the Middle East and North Africa (MENA), the most affected region by HCV. METHODS: Source of data was the MENA HCV Epidemiology Synthesis Project database, populated through systematic literature searches. Risk factors determined to be statistically significant after adjustment for confounders were extracted and categorized into key associations or modes of exposure. RESULTS: In total, 329 risk factors were identified from 109 articles in 14 of 24 MENA countries. Among key associations, age was most frequently reported (n = 39; 34.2%), followed by other infections/diseases (n = 20; 17.5%), and incarceration (n = 17; 14.9%). Among modes of exposure, health care-related exposures were most frequently reported (n = 127; 59.5%), followed by injecting drug use exposures (n = 45; 20.9%), community-related exposures (n = 34; 15.8%), and sexual-related exposures (n = 8; 3.7%). Blood transfusion, hemodialysis, surgical and other medical procedures, dental work, and medical injections were identified as key health care-related exposures. CONCLUSIONS: Health care appears to be the primary driver of prevalent (and possibly incident) infections in MENA, followed by injecting drug use. HCV screening should target the identified modes of exposure. Commitment to prevention should be an integral component of HCV response to achieve HCV elimination by 2030, with focus on strengthening infection control in health care facilities, improving injection safety and blood screening, and expanding harm reduction services for people who inject drugs.