Academic literature on the topic 'Household contacts'

Abstract Background Since December 2019, SARS-CoV-2 has extended to most parts of China with >80 000 cases and to at least 100 countries with >60 000 international cases as of 15 March 2020. Here we used a household cohort study to determine the features of household transmission of COVID-19. Methods A total of 105 index patients and 392 household contacts were enrolled. Both index patients and household members were tested by SARS-CoV-2 RT-PCR. Information on all recruited individuals was extracted from medical records and confirmed or supplemented by telephone interviews. The baseline characteristics of index cases and contact patients were described. Secondary attack rates of SARS-CoV-2 to contact members were computed and the risk factors for transmission within the household were estimated. Results Secondary transmission of SARS-CoV-2 developed in 64 of 392 household contacts (16.3%). The secondary attack rate to children was 4% compared with 17.1% for adults. The secondary attack rate to the contacts within the households with index patients quarantined by themselves since onset of symptoms was 0% compared with 16.9% for contacts without quarantined index patients. The secondary attack rate to contacts who were spouses of index cases was 27.8% compared with 17.3% for other adult members in the households. Conclusions The secondary attack rate of SARS-CoV-2 in household is 16.3%. Age of household contacts and spousal relationship to the index case are risk factors for transmission of SARS-CoV-2 within a household. Quarantine of index patients at home since onset of symptoms is useful to prevent the transmission of SARS-Co-2 within a household.

Abstract Background Household transmission of SARS-CoV-2 is an important component of the community spread of the pandemic. Little is known about the factors associated with household transmission, at the level of the case, contact or household, or how these have varied over the course of the pandemic. Methods The Household Transmission Evaluation Dataset (HOSTED) is a passive surveillance system linking laboratory-confirmed COVID-19 cases to individuals living in the same household in England. We explored the risk of household transmission according to: age of case and contact, sex, region, deprivation, month and household composition between April and September 2020, building a multivariate model. Results In the period studied, on average, 5.5% of household contacts in England were diagnosed as cases. Household transmission was most common between adult cases and contacts of a similar age. There was some evidence of lower transmission rates to under-16s [adjusted odds ratios (aOR) 0.70, 95% confidence interval (CI) 0.66–0.74). There were clear regional differences, with higher rates of household transmission in the north of England and the Midlands. Less deprived areas had a lower risk of household transmission. After controlling for region, there was no effect of deprivation, but houses of multiple occupancy had lower rates of household transmission [aOR 0.74 (0.66–0.83)]. Conclusions Children are less likely to acquire SARS-CoV-2 via household transmission, and consequently there was no difference in the risk of transmission in households with children. Households in which cases could isolate effectively, such as houses of multiple occupancy, had lower rates of household transmission. Policies to support the effective isolation of cases from their household contacts could lower the level of household transmission.

Background: ​ During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: ​ We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results: Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: ​ If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.

Background: ​ During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: ​ We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results: Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: ​ If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.

OBJECTIVETo determine the risk ofClostridium difficiletransmission from index cases withC. difficileinfection (CDI) to their household contacts and domestic pets.DESIGNA prospective study from April 2011 to June 2013.SETTINGPatients with CDI from Canadian tertiary care centers.PARTICIPANTSPatients with CDI, their household human contacts, and pets.METHODSEpidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. Pulsed-field gel electrophoresis (PFGE) was performed onC. difficileisolates. Probable transmission was defined as the conversion of aC. difficileculture–negative contact toC. difficileculture–positive contact with a PFGE pattern indistinguishable or closely related to the index case. Possible transmission was defined as a contact with a positiveC. difficileculture at baseline with a strain indistinguishable or closely related to the index case.RESULTSA total of 51 patients with CDI participated in this study; 67 human contacts and 15 pet contacts were included. Overall, 9 human contacts (13.4%) wereC. difficileculture positive; 1 contact (1.5%) developed CDI; and 8 contacts were asymptomatic. Of 67 human contacts, probable transmission occurred in 1 human contact (1.5%) and possible transmission occurred in 5 human contacts (7.5%). Of 15 pet contacts, probable transmission occurred in 3 (20%) and possible transmission occurred in 1 (6.7%).CONCLUSIONSThere was a high proportion ofC. difficileculture positivity at 13.4% among human contacts and asymptomatic carriage of domestic pets reached 26.7%. These results suggest that household transmission ofC. difficilemay be a source of community-associated cases.Infect Control Hosp Epidemiol2016;1–7

Carriage of Neisseria lactamica among household contacts of meningococcal disease (MCD) cases was investigated during an epidemic in Auckland, New Zealand. The overall carriage rate for N. lactamica was 10·5% (95% CI 7·4–13·5%) with a peak carriage rate in 2-year-olds of 61·5% (95% CI 26·6–88·1%). Factors associated with a significant (P < 0·05) increase in the likelihood of carriage included runny nose, the number of people per bedroom and youth. Genetic analysis of isolates revealed a striking correlation of strains within the same household but a high level of diversity between households, suggesting that household contact is an important factor in acquisition. For household contacts aged less than 5 years, there was a higher rate of carriage amongst those in contact with MCD cases under 8 years old than for contacts of cases aged 8 years and over. It is likely that development of MCD is a reflection of the nature and intensity of the exposure to a virulent strain of N. meningitidis, coupled with an absence of host resistance among those individuals not carrying N. lactamica.

IntroductionThe World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation.MethodsWe performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children <5 years, and anyone unable to complete sputum testing to clinic. Sputum testing results and/or follow-up instructions were returned by automated SMS texts. The primary outcome was completion of a full TB evaluation within 14 days; secondary outcomes were TB and HIV diagnoses and treatments among screened contacts.ResultsThere were 471 contacts of 190 index patients allocated to the intervention and 448 contacts of 182 index patients allocated to the standard-of-care. CHWs identified 190/471 (40%) intervention and 213/448 (48%) standard-of-care contacts requiring TB evaluation. In the intervention arm, CHWs obtained sputum from 35/91 (39%) of sputum-eligible contacts and SMSs were sent to 95/190 (50%). Completion of TB evaluation in the intervention and standard-of-care arms at 14 days (14% versus 15%; difference −1%, 95% CI −9% to 7%, p=0.81) and yields of confirmed TB (1.5% versus 1.1%, p=0.62) and new HIV (2.0% versus 1.8%, p=0.90) diagnoses were similar.ConclusionsHome-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components.

SUMMARYBoth case-ascertained household studies, in which households are recruited after an ‘index case’ is identified, and household cohort studies, where a household is enrolled before the start of the epidemic, may be used to test and estimate the protective effect of interventions used to prevent influenza transmission. A simulation approach parameterized with empirical data from household studies was used to evaluate and compare the statistical power of four study designs: a cohort study with routine virological testing of household contacts of infected index case, a cohort study where only household contacts with acute respiratory illness (ARI) are sampled for virological testing, a case-ascertained study with routine virological testing of household contacts, and a case-ascertained study where only household contacts with ARI are sampled for virological testing. We found that a case-ascertained study with ARI-triggered testing would be the most powerful design while a cohort design only testing household contacts with ARI was the least powerful. Sensitivity analysis demonstrated that these conclusions varied by model parameters including the serial interval and the risk of influenza virus infection from outside the household.

Airborne infectious diseases such as influenza are primarily transmitted from human to human by means of social contacts, and thus easily spread within households. Epidemic models, used to gain insight into infectious disease spread and control, typically rely on the assumption of random mixing within households. Until now, there has been no direct empirical evidence to support this assumption. Here, we present the first social contact survey specifically designed to study contact networks within households. The survey was conducted in Belgium (Flanders and Brussels) from 2010 to 2011. We analysed data from 318 households totalling 1266 individuals with household sizes ranging from two to seven members. Exponential-family random graph models (ERGMs) were fitted to the within-household contact networks to reveal the processes driving contact between household members, both on weekdays and weekends. The ERGMs showed a high degree of clustering and, specifically on weekdays, decreasing connectedness with increasing household size. Furthermore, we found that the odds of a contact between older siblings and between father and child are smaller than for any other pair. The epidemic simulation results suggest that within-household contact density is the main driver of differences in epidemic spread between complete and empirical-based household contact networks. The homogeneous mixing assumption may therefore be an adequate characterization of the within-household contact structure for the purpose of epidemic simulations. However, ignoring the contact density when inferring based on an epidemic model will result in biased estimates of within-household transmission rates. Further research regarding the implementation of within-household contact networks in epidemic models is necessary.

Objective: Secondary Attack Rate (SAR) of COVID-19 varies across various populations. We aim to assess global articles reporting SAR in non-household contacts of COVID-19 patients through systematic review approach. Methods: Four databases - MEDLINE, SCOPUS, Google Scholar and EMBASE were systematically searched for retrieval of articles reporting SAR of COVID-19 in various contacts. Initial search provided 436 articles, which through series of evaluation finally yielded 14 articles. Result: Findings suggested that SAR in various contacts varies widely. Substantial number of studies (50%) were from China; however, the two largest studies were from India. Irrespective of type of contacts, overall SAR ranged from 0.55-6%. Highest risk was found from non-household close (family, friends) contacts (2.2-22.31%) followed by casual contact (travel, meal and health-care contacts). In spite of prolonged contact with the patients, SAR was lowest in health-care workers (0-7.3%). Review highlighted that the included studies were suffering from limitations of missing data and continuously evolving operational guidelines. Conclusion: The review showed that studies furnishing SAR data in non-household contacts are limited in number and exact mode of transmission is yet not clear. Six-percent of overall SAR indicates that though the disease is infectious in nature and proper precautions must be taken, not everybody that comes in contact with the index case is infected. However, with greater risk in non-household close contacts, it is important to identify vulnerable population and implement effective preventive strategies in them. Review also indicated serious data gaps in the published literature and stipulated need of more global studies.

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Effective control of leprosy has challenged the organization of health services, due to the long incubation period and the high prevalence of cases, and the sequelae and disabilities resulting from the disease. Based on this assumption, this research consists of a descriptive epidemiological and longitudinal study of recorded cases of leprosy, whose goal is to analyze the prevalence of leprosy parallel to the transmission chain in the city of Imperatriz-MA, from 2002 to 2012. s Research was performed with patients with leprosy living in the City of Imperatriz-MA, duly registered in SINAN (Information System for Notifiable Diseases). Among the findings, are: 35% of reported cases presented in the form of multibacillary borderline classification; age of most patients were ≥ 15 years; examined in relation to contacts not been possible to achieve the goal proposed by the Ministry of Health, and in some years, the low coverage did not influence the increased incidence of leprosy; decreased the number of deaths and the dropout rate significantly; and failure in completing the records of the type of reactions presented mainly in the period 2002-2005. Analyzing the epidemiological situation of leprosy in the village of Imperatriz-MA, it is concluded that the remains endemic despite the significant decrease in the number cases during this period, and that eradication of the disease in the state of Maranhão, is a distant reality, with a prevalence of cases 10:54 10.0 per thousand in 2012 in the municipality of the study.
O controle efetivo da hanseníase tem desafiado a organização dos serviços de saúde, em razão do longo período de incubação e pela alta prevalência de casos, além das sequelas e incapacidades decorrentes da doença. Partindo desse pressuposto, esta pesquisa consiste em um estudo epidemiológico descritivo e longitudinal dos casos registrados de hanseníase, cujo objetivo é analisar a prevalência da hanseníase paralela à cadeia de transmissão no Município de Imperatriz-MA, no período de 2002 a 2012. A pesquisa foi realizada com portadores de Hanseníase residentes no Município de Imperatriz-MA, devidamente registrado no SINAN (Sistema de Informação de Agravos de Notificação). Dentre os resultados encontrados, destacam-se: 35% dos casos notificados apresentaram-se na forma dimorfa de classificação multibacilar; idade da maioria dos portadores era ≥ 15 anos; em relação aos contatos examinados não foi possível atingir a meta proposta pelo ministério da Saúde, e, em alguns anos, a baixa cobertura não influenciou no aumento da incidência da hanseníase; houve redução do número de óbitos e da taxa de abandono de forma significativa; e falha no preenchimento dos registros quanto ao tipo de reações apresentadas, principalmente no período de 2002 a 2005. Ao analisar a situação epidemiológica da hanseníase no município de Imperatriz-Ma, concluise que a endemia se mantém, apesar da diminuição significativa do número de casos neste período, e que a erradicação dessa doença no estado do Maranhão, é uma realidade ainda distante, com prevalência de 10.54 casos por 10.0 mil habitantes em 2012 no município do estudo.

Objective: Describe the prevalence of Bordetella pertussis via PCR in children under 5 years old hospitalized as probable cases of pertussis and report the most common clinical features among them. Results: A positive PCR result for B. pertussis was observed in 20.5% of our samples (18/88), one-third of them were from infants between 2 and 3 months old. The most common symptoms were paroxysms of coughing (88.9%), difficulty breathing (72.2%), cyanosis (77.8%) and fever (50%). The mother was the most common symptomatic carrier (27.8%), followed by uncles/aunts (22.2%) among children with pertussis.
This work was supported by fourth research incentive of the Universidad Peruana de Ciencias Aplicadas (UPC), Lima‑Peru.
Revisión por pares

Hanseníase é uma das mais antigas e instigantes doenças que acometem o ser humano. Ferramentas moleculares e imunológicas são avaliadas em diversos estudos epidemiológicos, porém com resultados controversos devido à alta complexidade da doença e metodologias utilizadas. Este estudo descreve o uso da sorologia anti PGL-I e da detecção de DNA em swab nasal para caracterizar a epidemiologia molecular do Mycobacterium leprae em pacientes e contatos domiciliares de pacientes com hanseníase. Em pacientes com hanseníase a positividade nos testes ELISA anti PGL-I e PCR para a detecção do DNA de M. leprae em swab nasal são inversamente associadas ao teste de Mitsuda e são diretamente associadas com o índice baciloscópico e as formas clínicas no espectro da doença, aumentando em direção às formas bacilíferas. As porcentagens gerais de positividade em pacientes foram 63,3% para o ELISA anti PGL-I e 34,2% para a PCR para detecção do DNA de M. leprae em swab nasal. Nos contatos domiciliares de pacientes com hanseníase as porcentagens gerais para o ELISA anti PGL-I e para a PCR para detecção do DNA de M. leprae em swab nasal foram 13,3% e 4,7% respectivamente. Os contatos com resultados positivos nestas metodologias representam portadores sadios ou com infecção subclínica e podem participar na transmissão e manutenção do M. leprae na comunidade, mesmo que os mesmos não venham a adoecer. É imperativo para o controle da hanseníase o monitoramento de contatos domiciliares em regiões endêmicas para detecção precoce de novos casos e a quimioprofilaxia deve ser utilizada como prevenção para o desenvolvimento da doença e interrupção da transmissão.
Leprosy is one of the oldest and most instigating diseases to affect humans. Molecular and immunological tools are evaluated in epidemiological studies; however, the results present controversies mainly due to disease complexity and methodologies. This study describes the application of anti PGL-I serology and nasal swab DNA detection to characterize Mycobacterium leprae molecular epidemiology in patients and household contacts of leprosy patients. Among leprosy patients the positivity to the anti PGL-I ELISA and the PCR for the detection of M. leprae DNA in nasal swabs are inversely associated to the lepromin test and arte directly associated to the bacillary index and the clinical forms in the disease spectrum, increasing towards baciliferous forms. The overall positivity percentages were 63.3% for the anti PGL-I ELISA and 34.2% for the PCR for the detection ofM. leprae DNA in nasal swabs. Among household contacts of leprosy patients the overall percentages for the anti PGL-I ELISA and for the PCR for the detection of M. leprae DNA in nasal swabs were 13.3% e 4.7% respectively. Among leprosy patients, assays positivity is associated with the clinical presentation of the disease, increasing towards bacilliferous subtypes. Positive results in contacts represent healthy carriers and subclinical infection and these individuals can participate in transmission and spread of M. leprae in the community, even though they may not develop the disease. In endemic regions, contact monitoring is imperative in leprosy control for early case detection and chemoprophylaxis must be applied as prevention to disease development and disruption of transmission.
Dissertação (Mestrado)

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Tuberculosis (TB) is an important public health problem in Brazil, where it occupies the 18th place in the ranking of countries with the highest rates of tuberculosis. An investigation of contacts of the person diagnosed with TB is considered essential in the prevention of illness and in the early diagnosis of active TB in the population, therefore thus, be carried out mainly by primary health care, chosen as the preferred gateway to the person with TB. The study aimed to investigate the occurrence of tuberculosis among household contacts. This is a quantitative, descriptive study performed with the household contacts of tuberculosis of in the city of Caxias - MA. The study sample was composed by 64 household contacts of patients reported as a case of tuberculosis, in the period January to December 2015. Data collection occurred from April to May 2016. The incidence rate of the disease among contacts it was around 4.7%. Observed higher percentage with monthly income between one to two minimum salaries (78.7%), female (57.4%), age group 20-39 years (32.8%), brown (80.4%), single (54.1%), incomplete primary education (36.1%), and first degree relatives with the index case (62.3%). When analyzed household contacts diagnosed with the disease was observed monthly income below a minimum salary (66.7%), female (66.7%), age group 20-39 years (33.4%), white (66.7%), married / stable union (100%), complete primary education (66.7%) and the degree of non-blood relatives prevailed in all contacts (100%). With respect to the patient contact convivial time with the index case, it was observed that (66.7%) were between 06-10 years of convival. With regard the clinical form of the disease, a large percentage of contacts with diagnosis of the disease (66.7%) had pulmonary TB. By the results obtained it was possible find that the incidence of tuberculosis found among household contacts deserves better attention, because, the surveillance of contacts is an important strategy for the reduction of cases of the disease. It is expected that the results observed in this study can be used by the municipal administration, in view of that all contacts should be evaluated, thus, strengthening existing activities and creating new strategies to achieve better results.
A tuberculose (TB) é um importante problema de saúde pública no Brasil onde ocupa o 18º lugar no ranking de nações com maiores índices de tuberculose. A investigação dos contatos da pessoa diagnosticada com TB é considerada essencial na prevenção do adoecimento e no diagnóstico precoce da TB ativa na população, devendo assim, ser realizada essencialmente pela atenção primária à saúde, eleita como a porta de entrada preferencial para a pessoa com TB. O estudo buscou investigar a ocorrência de tuberculose entre contatos domiciliares. Trata-se de um estudo quantitativo, descritivo realizado com contatos domiciliares de tuberculose no Município de Caxias-MA. A amostra do estudo foi composta por 64 contatos domiciliares de pacientes notificados como caso de tuberculose, no período de Janeiro a Dezembro de 2015. A coleta de dados ocorreu no período de abril a maio de 2016. A taxa de incidência da doença entre os contatos ficou em torno de 4,7%. Observaram-se maiores percentuais com renda mensal entre um a dois salários mínimos (78,7%), sexo feminino (57,4%), faixa etária de 20 a 39 anos (32,8%), pardos (80,4%), solteiros (54,1%), ensino fundamental incompleto (36,1%), e parentesco de primeiro grau com o caso índice (62,3%). Quando analisados os contatos domiciliares diagnosticados com a doença observou-se renda mensal abaixo de um salário mínimo (66,7%), sexo feminino (66,7%), faixa etária de 20 a 39 anos (33,4%), brancos (66,7%), casado/união estável (100%), ensino fundamental completo (66,7%) e o grau de parentesco não sanguíneo predominou em todos os contatos (100%). Com relação ao tempo de convívio do contato doente com o caso índice observou-se que (66,7%) possuíam entre 06 a 10 anos de convívio. No que diz respeito a forma clínica da doença, um grande percentual dos contatos com diagnóstico da doença (66,7%) apresentaram a forma pulmonar. Pelos resultados obtidos foi possível constatar que a incidência de tuberculose encontrada entre os contatos domiciliares merece uma melhor atenção, pois, a vigilância dos contatos é uma estratégia importante para a diminuição de casos da doença. Espera-se que os resultados observados neste estudo possam ser utilizados pela gestão municipal, tendo em vista que todos os contatos devam ser avaliados, dessa forma, fortalecendo as ações já existentes e criando novas estratégias para alcançar melhores resultados.

Background The incidence of TB in children under 15 years, accounts for 8% of the global TB burden. In 2018, the World Health Organisation (WHO) estimated that there were approximately 11 000 multi-drug resistant (MDR) TB cases in South Africa. Despite having very clear guidelines on TB treatment programs and management, availability of inexpensive diagnostic tests, curative and preventive therapies, and the widespread use of the BCG vaccines, South Africa continues to have the highest the number of MDR-TB cases per capita. Levofloxacin is used as part of the group of fluoroquinolones in the drug regimen recommended in the treatment of MDR-TB patients. In addition to investigating the clinical impact of levofloxacin as preventative antibiotic therapy, the expected costs of the intervention will be a critical input to determining feasibility and costs effectiveness, which will inform policy and implementation considerations. Methods We performed a cost analysis on using existing data from the Tuberculosis Child Multi-drug-resistant Preventative Therapy (TB-CHAMP) trial, conducted from a TB control program perspective. We used data from 510 childhood household contacts of MDR-TB patients in South Africa that were treated with levofloxacin for 6 months as a preventative therapy for MDR-TB. In our analysis we evaluated the estimated health system cost associated with provision of levofloxacin to childhood contacts of MDRTB patients in South Africa. Results The mean total cost of treating a child household contact, irrespective of their weight band is ZAR 5,289.79. When the cost were analysed by weight categories we found that the cost increased by weight category; ZAR 2,146.78 (under 5 kg), ZAR 4,714.58 (between 5-15.9 kg) and ZAR 6,606.67 (over 16 kg). We performed a comprehensive sensitivity analysis and found that the scheduled clinic visits were the major cost driver. Aside from the scheduled visits we observed that there was an increase in additional health service utilization for children with a weight more than 5kg. Conclusion We envisage that based on our analysis we will be able to inform policy decisions about the management and prevention of childhood household contacts of MDR-TB patients in developing TB themselves.

Leprosy is an important health problem in Brazil, with a high detection rate despite the application of the multidrug therapy. The nasal mucosa is considered the preferential site of entry and exit of the Mycobacterium leprae, although some lesions have been found in the buccal mucosa. However, the buccal mucosa involvement in bacilli transmission has never been investigated. We have shown the presence of the M. leprae DNA in buccal swabs of leprosy patients (334) and household contacts (1288) through conventional polymerase chain reaction (PCR), and results were correlated with clinical and other laboratorial evaluations. The overall positivity for patients was 18.26%, divided into 12.03% and 21.23% for paucibacillary and multibacillary forms, respectively. Among contacts, the positivity reached 6.83%, which were considered either as healthy carriers or sub-clinically infected, when the ELISA test presented a positive anti-PGL-1 result. This study showed important evidences that the buccal mucosa may be a secondary site of M. leprae transmission and infection. Furthermore, contacts with positive PCR may be actively involved in the transmission. Our findings have great epidemiological relevance, especially for the leprosy control programs and for the dentistry clinics, and must be considered in the new strategies of control and prevention.
A hanseníase é um importante problema de saúde pública no Brasil, com elevada taxa de detecção, apesar da aplicação da poliquimioterapia. A mucosa nasal é considerada o local preferencial de entrada e saída do Mycobacterium leprae, embora algumas lesões tenham sido encontradas na mucosa bucal. No entanto, o envolvimento da mucosa oral na transmissão do bacilo nunca foi investigado. Nós mostramos a presença do DNA do M. leprae em swab bucal de pacientes com hanseníase (334) e contatos domiciliares (1288) por meio da reação em cadeia da polimerase (PCR) convencional, e os resultados foram correlacionados com outras avaliações clínica e laboratorial. A positividade geral de pacientes foi de 18,26%, dividida em 12,03% e 21,23% para as formas paucibacilares e multibacilares, respectivamente. Entre os contatos, a positividade alcançou 6,83%, que foram considerados como portadores sadios ou infectados subclínicos, quando o teste ELISA anti-PGL-1 apresentou resultado positivo. Este estudo mostrou evidências importantes de que a mucosa bucal pode ser um sítio secundário de infecção e transmissão do M. leprae. Além disso, contatos com PCR positivo podem estar envolvidos ativamente na transmissão. Nossos resultados têm grande relevância epidemiológica, especialmente para os programas de controle da hanseníase e para as clínicas de odontologia, e devem ser considerados em novas estratégias de controle e prevenção.
Mestre em Ciências da Saúde

Background: Household contacts (HHCs) of pulmonary TB patients are at high risk of Mycobacterium tuberculosis (Mtb) infection and early disease development. Tuberculin skin test (TST) has been traditionally used to identify infected individuals; however, its use is limited by low specificity in populations with high levels of BCG vaccination or significant exposure to non-tuberculosis mycobacteria (NTM), and reduced sensitivity in immunocompromised individuals. Interferon-gamma release assays (IGRAs) such as QuantiFERON-TB Gold In-Tube (QFT-GIT) using Mtb specific antigens provide an alternative to TST for infection detection. IGRAs are now widely used for the detection of Mtb infection and are included in the guidelines of many countries with a low incidence of TB. Despite a growing body of literature on IGRAs, the relationship between the magnitude of T-cell Interferon-γ responses to Mtb specific antigens and risk of progression to disease has not been studied. Objective The main objective of this study was to determine whether HHCs with high (≥10 IU/ml) levels of IFN-γ in response to Mtb specific antigens (ESAT-6, CFP-10 or TB 7.7) in the QFT-GIT assay are at higher risk of developing TB compared to those with low (> 0.35-<10 IU/ml) levels. Other secondary objectives included to determine the following: the performance and operational characteristics of QFT-GIT in a field setting; risk factors associated with positive QFT-GIT results; concordance between the two tests; incidence rates of TB in HHCs with positive and negative QFT-GIT and TST results at baseline as well as positive and negative predictive values. Method: This study was nested within a large community randomized trial called ZAMSTAR implemented in 16 communities in Zambia and 8 communities in the Western Cape Province of South Africa. A cohort of HIV-positive and HIV-negative adult (≥ 15 years) HHCs were prospectively followed for 2-4 years. Consenting HHCs had blood drawn for HIV antibodies. QFT-GIT test was performed according to the manufacturer's instructions. TST were performed according to the standard IUATLD protocol. A standardized questionnaire was used to collect information on risk factors for TB and TB treatment information (for those with TB). Results: The feasibility studies showed three main findings. Firstly, the sensitivity of QFT-GIT was greater than that of TST overall, at all the standard TST cut-offs and when stratified by HIV status. The sensitivity of QFT-GIT was 85.6% (95%CI: 77.0-91.9) (indeterminate results excluded) compared to that of TST at 51.6% (95% CI: 40.9-62.2) at a cut-off of ≥ 10 mm. Secondly, test-retest reproducibility of QFT-GIT was high at 91.74% (ICC: 0.90; 95% CI 0.82-0.97). Thirdly, in this setting, some biological and operational factors that affected the performance of QFT-GIT were identified such as HIV positivity, low CD4+ T-lymphocytes, delayed incubation of blood samples and power outages. 8 For the main study, the study population at baseline consisted of 1,789 HHCs who were predominantly women (71%); median age was 28 years (IQR: 21-43); HIV positivity rate was 27.9%. Prevalence of tuberculous infection was 63.7% as measured by QFT-GIT and 39.6% by TST. There was a low level of agreement between the tests regardless of TST cut-off point (% agreement=59.7%; kappa=0.24). QFT+/TST- discordance (575/719; 80%) was more frequent than QFT-/TST+ discordance (144/719; 20%) at TST ≥10 mm. Risk factors associated with QFT-GIT positivity were identified at baseline. In multivariable analysis adjusted for sex, age, and community, HIV status was negatively associated with QFTGIT positivity (aOR: 0.48; 95% CI: 0.37–0.63; p<0.001) whereas residing in an urban area (aOR: 2.37; 95% CI: 1.10–5.13; p<0.03), smear status of index (OR: 1.26; 95% CI: 0.91-1.76; p=0.15) and country (aOR: 1.93; 95% CI: 1.48–2.51; p<0.001) were positively associated with QFT-GIT positivity. Similar results were obtained for TST. From a total of 1789 HHCs seen at baseline, 1113 (62.2%) HHCs entered follow-up and were included in the main analysis. The overall incidence rate of TB was 20.96/1000 pyrs (95% CI: 15.93-27.58). TB incidence rate was higher among test positive HHCs compared to those who were negative (IRR for QFT-GIT: 1.65; 95% CI: 0.86-3.37; p=0.06) and for TST (IRR: 1.88; 95%CI: 1.04-3.41; p=0.01). Results were similar in univariable analysis (QFT-GIT: 1.66 (95%CI: 0.88-3.11; p=0.11) and TST: 1.89 (95%CI: 1.09-3.28; p=0.02)) and multivariable analysis adjusted for sex, age and HIV (QFT-GIT: 2.20 (95%CI: 1.14-4.25; p=0.02) and TST: 2.19 (95%CI: 1.24-3.86; p=0.007)). Overall, PPV for QFT-GIT was 5.38% (95%CI: 3.84-7.31), compared to TST, 6.57% (95% CI: 4.41- 9.36). Overall for QFT-GIT, the IRR was higher among HIV negative HHCs (IRR: 3.85; 95%CI: 0.90-34.51; p=0.07) compared to HIV positives (IRR; 1.93; 95%CI: 0.88-4.57; p=0.04). Overall for TST, the IRR for HIV negatives (IRR: 2.21; 95%CI: 0.78-6.72; p=0.05) was similar to that among HIV positives (IRR: 2.32; 95%CI: 1.09-5.00; p=0.009). Univariable analysis showed similar results for both tests. In multivariable analyses adjusted for age, sex and country as an effect modifier, the HR for developing TB was 4.72 (95%CI: 1.35-16.46; p=0.01) in HIV positive QFT-GIT positives compared to 2.13 (95%CI: 0.81-5.60; p=0.12) in HIV positives TST positive HHCs. Risk factors for TB were identified. In multivariable analyses, adjusted for age, sex , HIV status and country there was strong evidence that occasional smoking, (HR: 4.07; 95%CI:1.31-12.63), HIV positivity (HR: 4.60; 95%CI:2.48-8.56), smear positivity of the index (HR: 2.00 ; 95%CI:1.04- 3.87) and country (HR: 1.79 ; 95%1.02-3.15; p=0.04) ) were associated with incidence of TB. Out of the 1,113 HHCs who entered follow-up, 406 HHCs had IFN-γ levels <0.35 IU/ml and were excluded leaving 707 HHCs in analysis for the primary objective. Out of these 536 (75.8%) had IFN-gamma levels ≥ 0.35 and <10 IU/ml (low IFN-γ levels) while 171 (24.2%) HHCs had ≥ 10 IU/ml (high IFN-γ levels). Out of the 707 HHCs that entered follow-up, 38 (5.4%) HHCs developed active TB over 1558.0 person-years (pyrs) of follow-up, giving an incidence rate of 24.39/1000 pyrs (95% CI: 17.75- 33.52).TB incidence rates were 24.51/1000 pyrs (9 cases/367.2 pyrs) in HHCs with high levels and 24.35 (29 cases/1190.7 pyrs) among those with low levels of IFN-γ, giving an IRR of 1.0 (95% CI: 0.42-2.18; p=0.48). Overall, unadjusted HR in HHCs with high IFN-γ levels was 1.02 (95%CI: 0.48-2.15; p=0.96) while in multivariable analysis adjusted for age, sex, country and HIV as an effect modifier, HR was 1.74 (95%CI: 0.63-4.79; p=0.29). TB incidence rates in HIV positives was 51.94/1000 pyrs (3 cases/57.8 pyrs) in HHCs with high levels and 65.29/1000 pyrs (19 cases/291.0 pyrs) among those with low levels of IFN-γ, giving an IRR of 0.79 (95%CI: 0.15-2.70; p=0.38).TB incidence rates in HIV negatives were 19.56/1000 pyrs (6 cases/306.7 pyrs) in HHCs with high levels and 11.47 (10 cases/871.7 pyrs) among those with low levels of IFN-γ, giving an IRR of 1.70 (95%CI: 0.51-5.18, p=0.16). Unadjusted HR among HIV negative HHCs was 1.73 (95%CI: 0.63-4.77; p=0.29) and 0.75 (95%0.22-2.55; p=0.65) among HIV positive ones respectively. In multivariable analysis adjusted for age, sex and country, the HR remained similar as unadjusted analysis for both HIV negatives and positives. For all the groups used for sensitivity analysis of the primary question, HHCs with the highest IFN-γ levels had increased IRRs ranging from 1.5 to 2 compared to the reference sub-group. For HIV negatives, HHCs with the highest IFN-γ levels had the highest IRRs in all groups apart from one group. HIV negative HHCs with the highest IFN-γ levels had increased IRRs ranging from 4 to 5-fold compared to the reference sub-group. In comparison, HIV positive HHCs with the highest IFN-γ levels had increased IRRs ranging from 1.6 to 2.6 compared to the reference sub-group. Conclusions: The principal finding in this study is that there was no difference in incidence rates between HHCs with low and high levels (overall IRR: 1.0 (95% CI: 0.42-2.18)). Another principal finding was that there was strong evidence of a five-fold increased risk of TB in HIV positive QFT-GIT positive HHCs compared to HIV positive QFT-GIT negative ones (aHR : 4.72; 95%CI: 1.35-16.46; P=0.01). For all the groups used in the sensitivity analysis of the primary question, HHCs with the highest IFN-γ levels had increased IRRs ranging from 1.5 to 2 compared to the reference sub-group. The feasibility studies emphasized the need for stringent sample collection and processing techniques to ensure the accuracy of QFT-GIT results.

Chapter 2 provides a narrative account of Vincent de Paul’s activities between 1612 and 1617. It concentrates on new connections with prominent dévots in Paris, whose sponsorship provided him with opportunities for material stability and for the expansion of his rather limited pastoral experience. These included his patron employers, the high noble Gondi family, and Pierre de Bérulle, founder of the French Oratory, and founding figure of the French School of Spirituality. The appointments that resulted from these contacts were a preceptorship in the Gondi household, followed by a role as spiritual director to Madame de Gondi, and two sojourns as curé of the parishes of Clichy and Châtillon-lès-Dombes.

This chapter explores the connections anti-Mormons made between private and public in Mormonism. They contended that the institution of polygamy was inseparable from the practice of political theocracy in Utah and that polygamy replaced the marital contract with male tyranny in the household. That tyranny, by extension, replaced the fraternal contract of a republican social order with patriarchal political despotism that flew in the face of American political values. Moreover, anti-Mormons claimed that because of polygamy, the structure of government in Utah was imbued with Church authority and constituted the invasion of an illegal polygamic theocracy into republican government. Indeed, anti-Mormons convinced themselves that Mormon polygamic theocracy was a grave threat to republican government and threatened the very essence of Americanness.

The genus Corynebacterium contains the species Corynebacterium diphtheriae and the non-diphtherial corynebacteria. C. diphtheriae is the major human pathogen in this genus, but several species of nondiphtheria corynebacteria appear to be emerging as important pathogens.Zoonotic corynebacteria rarely cause disease in humans, but recent reports have indicated that the frequency and severity of infection associated with Corynebacterium ulcerans has increased in many countries. In the past most human C.ulcerans infections have occurred through close contact with farm animals or by consumption of unpasteurised dairy products. However, recently, there have been cases of human infection following close contact with household pets. Rhodococcus equi appears to be emerging as an important pathogen in immunocompromised patients, especially those with acquired immunodeficiency syndrome (AIDS). Human infections caused by Corynebacterium pseudotuberculosis is still a very rare occurrence.Antibiotics in combination with surgery and vaccination are the treatment of choice for human infection. Control of human infection is best achieved by raising awareness in those at risk (e.g. domestic pet owners, sheep shearers, the immunocompromised), clinicians involved in treating these groups and by vaccination. Reducing prevalence in the animal population could be achieved by improving hygiene in farms and husbandry practices, reducing minor injuries (e.g. cuts and abrasions) during routine procedures, and by vaccination.

This paper documents the shift in the literature on prices from being exclusively a macro-topic featuring in the study of inflation, national income accounting, and cross-country income comparisons to one that is firmly rooted in micro-involving economic analysis of household behaviour, welfare, and the distributional implications of changes in relative prices. This paper brings together results from some of the recent studies on Indian National Sample Survey data that examine the effect of price changes on inequality and poverty. It also contains evidence on spatial prices in the context of a large heterogeneous country such as India.

AbstractSmallholder farmers who grow the staple maize crop rely mainly on rain-fed agricultural production, and yields are estimated to have decreased by over 50% largely due to climate change. Climate-smart agriculture (CSA) technologies, as adaptive strategies, are thus increasingly being promoted to overcome problems of declining agricultural productivity and reduced technical efficiency. This study analyzed profitability and profit efficiency in maize (Zea mays) production as a result of CSA technology adoption using cost-benefit analysis and stochastic profit frontier model. The study used data from a cross-sectional household survey of 386 households drawn from 4 districts in Mashonaland East province located in the northeastern part of Zimbabwe. Results from the cost-benefit analysis reveal that maize performs best under CSA technologies. The profit inefficiency model shows that extension contact, number of local traders, and adoption of CSA had significant negative coefficients indicating that as these variables increase, profit efficiency among maize-growing farmers increases. This implies that profit inefficiency in maize production can be reduced significantly with improvement in extension contact, access to farm gate/local markets, and adoption of CSA. The findings call for development practitioners to incorporate market linkages that bring buyers closer to the farmers, support for extension to be able to have frequent contacts with farmers, and promotion of CSA adoption.

AbstractMigration implies both benefits and costs. The latter include a possible breakdown of social networks, and thus a loss of social capital. Although there is some literature on the evolution of family networks after migration, not as much is known about friendship. This article assesses the quality of friendships between German emigrants and their friends who stayed in Germany. In particular, it asks three research questions: (a) How does the quality of relationships with friends in Germany differ from the quality of other relationships after migration? (b) How is friendship quality after migration related to socio-demographic or socio-economic factors? And (c) is there a link between friendship quality and the subjective well-being of emigrants? Results indicate that friendship quality measured as frequency of contact with friends falls in the middle range of contact frequency, as emigrants typically have more contact with partners and children, but less contact with some other relatives, compared to close friends. Furthermore, several determinants of contact frequency (e.g. gender, age, length of stay and household constellation) can be identified and correlations with various aspects of subjective well-being were found.

AbstractDuring the coronavirus crisis, educational activities and nearly all social contact with friends and family were conducted via online communication tools. Such tools can only be used effectively if an individual has suitable internet access. Thankfully, the Netherlands is one of the EU leaders when it comes to Next Generation Access (NGA) coverage, with 98% of Dutch households having access to these high-speed connections; this is well above the USA (94%) and EU (87%) averages. However, this still means that nearly 344,000 individuals living in the Netherlands lack a strong internet connection. Here, we contend that the coronavirus crisis, and especially the associated lockdown wherein individuals were strongly encouraged to not leave their homes, has made it clear that high-speed internet access is a necessary good for modern social living.

AbstractMunicipal solid waste (MSW) generated in developing countries usually contains a high percentage of organic material. When not properly managed, organic waste is known for creating many environmental issues. Greenhouse gas (GHG) emissions, soil and water contamination, and air pollution are a few examples. On the other hand, proper and sustainable management of organic waste can not only bring economic gains but also reduce the waste volume that is sent for final disposal. Composting is one such recovery method, in which the end product – compost – eventually helps the agricultural industry, and other sectors, making the process an excellent example of nexus thinking in integrated management of environmental resources. The aim of this chapter is to discuss how Cajicá, a small city in Colombia, approached this issue in a methodical way to eventually became one of the leading organic waste composting examples in the whole world, as recognised by the United Nations Environment Programme in 2017. Cajicá launched a source separation and composting initiative called Green Containers Program (GCP) in 2008, based on a successful pilot project conducted in 2005. The organic waste separated at source collected from households, commercial entities, schools, and universities are brought to a privately operated composting plant chosen by the city to produce compost. The compost plant sells compost to the agricultural sector. The participants in the GCP could also receive a bag of compost every 2 months as a token of appreciation. The Cajicá case presents us with many lessons of good practice, not only in the sustainable management of waste but also in stakeholder engagement. It specifically shows how stakeholders should be brought together for long-lasting collaboration and the benefits to society. Finding the correct business model for the project, efforts made in educating the future generation, and technology adaptation to local conditions are also seen as positive experiences that others can learn from in the case of Cajicá’s GCP. Some of the concerns and potential threats observed include the high dependency GCP has on two institutions: the programme financially depends completely on the municipality, and the composting operation depends completely on one private facility. GCP will benefit from having contingency plans to reduce the risk of having these high dependencies.

Relying on primary source documents, Cecilia Gamberini outlines the reality of Sofonisba Anguissola’s experiences in the Household of Queen Isabel of Valois following the artist’s appointment to the Spanish court in 1559. Anguissola’s position is generally credited to her two roles there: painter and lady-in-waiting. The author argues that while Anguissola’s appointment was due in part to her remarkable painted self-representations, it was also facilitated by a largely overlooked network of familial contacts and the political climate of the time. Analyses of Anguissola’s behaviour in the Queen’s Household also offers a glimpse into the young woman’s personality, which was at times irreverent and rebellious, and the opportunity for new attributions.

This chapter focuses on the myriad ways in which one can model contacts between individuals. The two most important aspects of contacts for infection transmission are (1) the number of contacts per unit of time, and (2) the number of different individuals with whom these contacts occur. Aspect 1 is concerned not only with variation in the number of transmission opportunities during a pairing, but also with the duration of the pairing. Aspect 2 concerns spatial or social networks with variation in the set of potential “contactees.” This could be the entire population, a dynamic subset of the population, or a fixed subset of the population. The remainder of the chapter discusses the new aspects that arise in heterogeneous populations where different types of individuals are recognized; consistency conditions; populations that consist of very many small groups, like a community of households, with intense within-group contact; graphs and networks; and the pair approximation technique.

The Transfusion Safety Study is collecting data concerning the transmission of transfusion-acquired infections from patients with congenital hematologic disorders to household members. Of 233 patients for whom information is presently available, 128 (55%) were anti-HIV-positive. The 128 positive patients lived in 123 households with 174 members; 16 contacts were positive by EIA and immunoblot.These data provide further evidence of relatively high risk of HIV infection of sexual contacts. The three anti-HIV-positive children are all infants born to anti-HIV-positive wivesof infected hemophiliacs. Passively acquired antibody has not been excluded for two; the third was positive at ten months of age. Thus, vertical transmission may be a very important mechanism of perpetuating the HIV reservoir.

More people than ever are living in cities, and in these cities, more and more people are living alone. Using the example of Vienna, this paper investigates the subjective well-being of single households in the city. Previous research has identified positive and negative aspects of living alone (e.g., increased freedom vs. missing social embeddedness). We compare single households with other household types using data from the Viennese Quality of Life Survey (1995–2018). In our analysis, we consider overall life satisfaction as well as selected dimensions of subjective wellbeing (i.e., housing, financial situation, main activity, family, social contacts, leisure time). Our findings show that the subjective well-being of single households in Vienna is high and quite stable over time. While single households are found to have lower life satisfaction than two-adult households, this result is mainly explained by singles reporting lower satisfaction with family life. Compared to households with children, singles are more satisfied with their financial situation, leisure time and housing, which helps to offset the negative consequences of missing family ties (in particular with regard to single parents).

We develop and estimate a model of child care markets that endogenizes both demand and supply. On the demand side, families with a child make consumption, labor supply, and child-care decisions within a static, unitary household model. On the supply side, child care providers make entry, price, and quality decisions under monopolistic competition. Child development is a function of the time spent with each parent and at the child care center; these inputs vary in their impact. We estimate the structural parameters of the model using the 2003 Early Childhood Longitudinal Study, which contains information on parental employment and wages, child care choices, child development, and center quality. We use our estimates to evaluate the impact of several policies, including vouchers, cash transfers, quality regulations, and public provision. Among these, a combination of quality regulation and vouchers for working families leads to the greatest gains in average child development and to a large expansion in child care use and female labor supply, all at a relatively low fiscal cost.

The main recommendations of the panel report can be summarised under five key headings:  Building blocks: The ultimate aim should be to build rich, detailed and testable narratives situated within a European context, and addressing phenomena from the longue durée to the short-term over international to local scales. Chronological control is essential to this and effective dating strategies are required to enable generation-level analysis. The ‘serendipity factor’ of archaeological work must be enhanced by recognising and getting the most out of information-rich sites as they appear. o There is a pressing need to revisit the archives of excavated sites to extract more information from existing resources, notably through dating programmes targeted at regional sequences – the Western Isles Atlantic roundhouse sequence is an obvious target. o Many areas still lack anything beyond the baldest of settlement sequences, with little understanding of the relations between key site types. There is a need to get at least basic sequences from many more areas, either from sustained regional programmes or targeted sampling exercises. o Much of the methodologically innovative work and new insights have come from long-running research excavations. Such large-scale research projects are an important element in developing new approaches to the Iron Age.  Daily life and practice: There remains great potential to improve the understanding of people’s lives in the Iron Age through fresh approaches to, and integration of, existing and newly-excavated data. o House use. Rigorous analysis and innovative approaches, including experimental archaeology, should be employed to get the most out of the understanding of daily life through the strengths of the Scottish record, such as deposits within buildings, organic preservation and waterlogging. o Material culture. Artefact studies have the potential to be far more integral to understandings of Iron Age societies, both from the rich assemblages of the Atlantic area and less-rich lowland finds. Key areas of concern are basic studies of material groups (including the function of everyday items such as stone and bone tools, and the nature of craft processes – iron, copper alloy, bone/antler and shale offer particularly good evidence). Other key topics are: the role of ‘art’ and other forms of decoration and comparative approaches to assemblages to obtain synthetic views of the uses of material culture. o Field to feast. Subsistence practices are a core area of research essential to understanding past society, but different strands of evidence need to be more fully integrated, with a ‘field to feast’ approach, from production to consumption. The working of agricultural systems is poorly understood, from agricultural processes to cooking practices and cuisine: integrated work between different specialisms would assist greatly. There is a need for conceptual as well as practical perspectives – e.g. how were wild resources conceived? o Ritual practice. There has been valuable work in identifying depositional practices, such as deposition of animals or querns, which are thought to relate to house-based ritual practices, but there is great potential for further pattern-spotting, synthesis and interpretation. Iron Age Scotland: ScARF Panel Report v  Landscapes and regions:  Concepts of ‘region’ or ‘province’, and how they changed over time, need to be critically explored, because they are contentious, poorly defined and highly variable. What did Iron Age people see as their geographical horizons, and how did this change?  Attempts to understand the Iron Age landscape require improved, integrated survey methodologies, as existing approaches are inevitably partial.  Aspects of the landscape’s physical form and cover should be investigated more fully, in terms of vegetation (known only in outline over most of the country) and sea level change in key areas such as the firths of Moray and Forth.  Landscapes beyond settlement merit further work, e.g. the use of the landscape for deposition of objects or people, and what this tells us of contemporary perceptions and beliefs.  Concepts of inherited landscapes (how Iron Age communities saw and used this longlived land) and socal resilience to issues such as climate change should be explored more fully.  Reconstructing Iron Age societies. The changing structure of society over space and time in this period remains poorly understood. Researchers should interrogate the data for better and more explicitly-expressed understandings of social structures and relations between people.  The wider context: Researchers need to engage with the big questions of change on a European level (and beyond). Relationships with neighbouring areas (e.g. England, Ireland) and analogies from other areas (e.g. Scandinavia and the Low Countries) can help inform Scottish studies. Key big topics are: o The nature and effect of the introduction of iron. o The social processes lying behind evidence for movement and contact. o Parallels and differences in social processes and developments. o The changing nature of houses and households over this period, including the role of ‘substantial houses’, from crannogs to brochs, the development and role of complex architecture, and the shift away from roundhouses. o The chronology, nature and meaning of hillforts and other enclosed settlements. o Relationships with the Roman world

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.