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Reconciling the first epidemiological findings following emerging disease events : examples from Zika and Hepatitis C

Abstract : Initial epidemiological investigations following emerging disease events may uncover spurious associations and lead to misinterpretations of disease severity. In the French Territories of the Americas, we estimated the risk of Zika-related birth defects to be 7% (95%CI: 5.0%-9.5%) through a prospective cohort of 546 infected pregnant women. When compared to a control group, this estimate decreased to 1.6% (95%CI: 0.4-4.1%). In a surveillance study in four cities in sub-Saharan Africa and Asia, we found highly varied (from 3-35%) proportions of microcephaly when using a standardised definition. Difficulties in reconciling our findings with others comes from a variation in study procedures, a lack of appropriate control groups, and use of problematic definitions for key conditions, such as microcephaly. In Egypt, highly effective direct acting antivirals for hepatitis C virus were introduced in 2014. Through ‘real-life’ cohort studies, found a strong association between liver cancer recurrence and treatment with these new regimens, as well as a non-negligible risk of hepatitis B reactivation following therapy for persons co-infected. We encountered difficulties in drawing conclusions from these finding when compared with others due to variability in research methods as well as in the definitions used for the adverse events. Following an emerging disease event, research priorities and hypotheses can be focused using techniques such as expert opinion elicitation, as well as collaboration through diverse research networks. Transparency as well as use of standardised protocols and case definitions will ameliorate delays in drawing a consensus.
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Anna Funk. Reconciling the first epidemiological findings following emerging disease events : examples from Zika and Hepatitis C. Human health and pathology. Sorbonne Université, 2018. English. ⟨NNT : 2018SORUS150⟩. ⟨tel-02475853⟩

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