Cochrane Review: Interventions for the interruption or reduction of the spread of respiratory viruses

Measles Immunization Status of Health Care Workers: A Cross-Sectional Study Exploring Factors Associated with Lack of Immunization According to the Health Belief Model

Suboptimal levels of measles vaccination coverage make Italy a country where the circulation of the virus is still endemic. In the past decade, several nosocomial outbreaks of measles occurred in Italy that rapidly spread the infection among large numbers of hospitalized patients and susceptible healthcare workers (HCWs). A cross-sectional study was conducted at the University Hospital of Palermo (Italy) to estimate the rate of HCWs immunization and to investigate the factors associated with lack of immunization. The attitude to the immunization practice was evaluated by exploring the Health Belief Model. Overall, 118 HCWs were enrolled, with a mean age of 31 years and 59.3% male. About half of the sample (45.8%, n = 54) was found not to be immunized against measles. Multivariable analysis showed that the factors directly associated with the non-immunization status against measles were female sex (OR = 3.70, p = 0.056), being an HCW different from a physician (OR = 10.27, p = 0.015), having a high perception of barriers to vaccination (OR = 5.13, p = 0.047), not being immunized for other exanthematous diseases such as chickenpox (OR = 9.93, p = 0.003), mumps (OR = 33.64, p < 0.001) and rubella (OR = 10.12, p= 0.002). There is a need to contrast the low adherence of HCWs to measles vaccination by identifying effective strategies to increase immunization coverage and limiting the risk of further nosocomial measles outbreaks.

Decrease of infectious complications in outpatients with autoimmune diseases from 2019 to 2020 under the COVID-19 pandemic: A single-centre, retrospective cohort study in Japan

OBJECTIVES

To examine how the novel coronavirus disease (COVID-19) has changed infectious complications in outpatients with autoimmune diseases.

METHODS

We performed a retrospective, record-linked cohort study and questionnaire about lifestyle changes in patients who visited our department in 2019 and 2020.

RESULTS

We surveyed 1316 outpatients in 2019 and 1284 in 2020. The most common underlying diseases were rheumatoid arthritis (842 vs. 814) and systemic lupus erythematosus (SLE) (126 vs. 127). No significant difference in median age (66 vs. 67 years), respiratory comorbidities (30.4% vs. 32.0%), or corticosteroid use (42.2% vs. 44.3%) was found between the years. Immunomodulating agents were used more in 2020 (33.1% vs. 39.7%, p < .001). Total number of infections (28.0/100 vs. 19.4/100 person-years), pneumonia (3.6 vs. 1.6), influenza (2.1 vs. 0.1), and nonviral dermatological infections (3.8 vs. 2.1) were significantly lower in 2020. No significant difference was found for herpes zoster (2.2 vs. 1.8), urinary tract infections (3.3 vs. 3.8), or gastrointestinal infections (2.9 vs. 3.0). According to the questionnaire, 75% of the respondents became more conscious about wearing masks and 81% began to use hand sanitizer during the pandemic.

CONCLUSION

Under the COVID-19 pandemic, some infectious complications have decreased in outpatients with autoimmune diseases.

Knowledge, Attitude, Practice, and Fear of COVID-19: an Online-Based Cross-cultural Study

The study aimed to measure Knowledge, Attitude, and Practice (KAP) and fear level towards COVID-19 and explore its cross-cultural variances in knowledge by sociodemographic factors among the general population of 8 different countries over 5 continents. It was a cross-sectional online survey. This survey was conducted in April 2020 among 1296 participants using the “Google Form” platform. Considering the social distancing formula and pandemic situation, we collect data using popular social media networks. Univariate and bivariate analyses were used to explore the collected data on KAP, fear, and sociodemographic factors. Overall knowledge score was 9.7 ± 1.7 (out of 12), and gender differences (female vs male: 9.8 ± 1.6 vs 9.5 ± 1.9) were significant (p = 0.008) in the bivariate analysis. Knowledge score variances were found significant in some regions by gender, marital status, and education qualification. The highest and lowest mean knowledge scores were recorded in the Middle East (10.0 ± 1.7) and Europe (9.3 ± 2.0). Despite having a high fear score (22.5 ± 5.6 out of 35), 78.35% of respondents were positively and 81.7% in a good practice level. Fear score rankings: Middle East (1st; 23.8 ± 5.5), Europe (2nd; 23.2 ± 5.8), Africa (3rd; 22.7 ± 5.0), South Asia (4th; 22.1 ± 5.7), Oceania (5th; 21.9 ± 5.8), and North America (6th; 21.7 ± 5.5). Fear and knowledge were not correlated. KAP and fear variation exist among geographical regions. Gender, marital status, and education qualification are factors in knowledge variances for some regions. KAP and fear measures can help health education programs consider some sociodemographic factors and regions during an outbreak of highly contagious disease and uplift a positive attitude and good practice.

Long, thin transmission chains of Severe Acute Respiratory Syndrome Coronavirus 2 may go undetected for several weeks at low to moderate reproduction numbers: Implications for containment and elimination strategy

Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) infections almost always caused overt symptoms, so effective case and contact management enabled its effective eradication within months. However, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) usually causes only mild symptoms, so transmission chains may grow to include several individuals before at least one index case becomes ill enough to self-report for diagnosis and care. Here, simple mathematical models were developed to evaluate the implications of delayed index case detection for retrospective contact tracing and management responses. Specifically, these simulations illustrate how: (1) Contact tracing and management may effectively contain most but not all large SARS-CoV-2 clusters arising at foci with high reproduction numbers because rapidly expanding transmission chains ensure at least one overtly symptomatic index case occurs within two viral generations a week or less apart. (2) However, lower reproduction numbers give rise to thinner transmission chains extending through longer sequences of non-reporting asymptomatic and paucisymptomatic individuals, often spanning three or more viral generations (≥2 weeks of transmission) before an overtly symptomatic index case occurs. (3) Consequently, it is not always possible to fully trace and contain such long, thin transmission chains, so the community transmission they give rise to is underrepresented in surveillance data. (4) Wherever surveillance systems are weak and/or transmission proceeds within population groups with lower rates of overt clinical symptoms and/or self-reporting, case and contact management effectiveness may be more severely limited, even at the higher reproduction numbers associated with larger outbreaks. (5) Because passive surveillance platforms may be especially slow to detect the thinner transmission chains that occur at low reproduction numbers, establishing satisfactory confidence of elimination may require that no confirmed cases are detected for two full months, throughout which presumptive preventative measures must be maintained to ensure complete collapse of undetected residual transmission. (6) Greater scope exists for overcoming these limitations by enhancing field surveillance for new suspected cases than by improving diagnostic test sensitivity. (7) While population-wide active surveillance may enable complete traceability and containment, this goal may also be achievable through enhanced passive surveillance for paucisymptomatic infections, combining readily accessible decentralized testing with population hypersensitization to self-reporting with mild symptoms. Containment and elimination of SARS-CoV-2 will rely far more upon presumptive, population-wide prevention measures than was necessary for SARS-CoV-1, necessitating greater ambition, political will, investment, public support, persistence and patience. Nevertheless, case and contact management may be invaluable for at least partially containing SARS-CoV-2 transmission, especially larger outbreaks, but only if enabled by sufficiently sensitive surveillance. Furthermore, consistently complete transmission chain containment may be enabled by focally enhanced surveillance around manageably small numbers of outbreaks in the end stages of successful elimination campaigns, so that their endpoints may be accelerated and sustained.

Community practice of using face masks for the prevention of COVID-19 in Saudi Arabia

Community face masking is possibly of great value in reducing COVID-19 transmission, especially when universally adopted with high compliance. The aim of this study is to investigate the knowledge, common misconceptions, barriers, and the compliance of the community with the use of face masks for the prevention of COVID-19. A validated questionnaire was administered to the participants through a web link by using various social media. The collected data were statistically analyzed for significant differences according to demographic variables. The average knowledge of face masks and their role in preventing COVID-19 transmission was 95.64%, with no differences among most of the demographical factors. Older groups and females demonstrated a better attitude towards wearing face masks than other groups did (p<0.001). Another significant difference in the participant's attitude was noticed between the various educational levels, employment, and nationality (p<0.001). Of the total respondents, 88.2% encouraged wearing face masks. Misconceptions about wearing face masks were very low. The frequency of wearing face masks at public places, workplaces, or social gatherings was 87.2%, 80.5%, and 47.5% respectively. There was a significant variation in the compliance with wearing face masks between the various groups based on age, gender, nationality, and employment status (p<0.001). The inconvenience in wearing face masks was reported by 36.3%. Face irritation and ear pain were reported by 70.2% and 43.5%, respectively. The inconvenience of wearing face masks with eyeglasses was reported by 44.3% of those wearing eyeglasses. In general, the study demonstrated a good attitude among participants towards wearing face masks. Although the respondents in the study were aware of the benefits of wearing face masks, the barriers may have decreased their desire to do so. These barriers include difficulty in breathing, discomfort, face irritation, and ear pain.

Quarantine practices and COVID-19 transmission in a low-resource setting: Experience of Kerala, India

INTRODUCTION

Disease transmission patterns of COVID-19 have shown that masking, social distancing, contact tracing and quarantine measures are important strategies for reducing transmission. The effective implementation of quarantine is determined by the commitment of the people and monitoring by the State. The aim of the study was to find out the effectiveness of home quarantine practises and its role in determining SARS CoV2 transmission.

METHODS

Record-based retrospective cohort study was conducted among expatriates of Kerala who were on quarantine at their homes and later tested positive for SARS -CoV-2. Quarantine practises were categorised as strict room quarantine, incomplete room quarantine, home quarantine and no quarantine. Risk of transmission was assessed using risk ratios. Multiple logistic regression analysis was performed to find out the determinants of SARS CoV2 transmission.

RESULTS

The median (IQR) age and duration of quarantine of 95 study participants were found to be 35 (29, 44) years and 7 (3,13) days, respectively. Majority of the participants practised strict room quarantine (57%), whereas 11.6%, 16.8% and 14.7% practiced incomplete room, home and no quarantine, respectively. Home quarantine without room quarantine had 24 times odds for transmitting disease [OR (95%CI)): 24.14 (4.87--119.75), P < 0.001] and not being in quarantine for any duration before being diagnosed was found to be 14 times riskier when compared with strict room quarantine [OR (95%CI)): 14.44 (2.42-86.17), P = 0.003].

DISCUSSION

Low-resource settings successful in the initial phases of COVID-19 pandemic should make periodic revisions in the quarantine guidelines while continually promoting physical distancing strategies.

Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand?

The coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.

Effects of the SARS-CoV2-Lockdown on Pediatric Care in the Rhine-Main Area

BACKGROUND

The effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and lockdown on pediatric diseases and care are not well characterized in Germany.

PATIENTS AND METHODS

To investigate the effects of the lockdown on pediatric medical care in the Rhine-Main area, a survey asking 115 pediatricians and an analysis of the inpatient admissions at the Department for Children and Adolescents Goethe-University, Frankfurt in April 2020 compared to April 2019 was performed.

RESULTS

65/115 (56.5%) pediatricians answered the survey. Pediatricians estimated the reduction of patient consultations in April 2020 vs. 2019 by 40% (median), however, according to their practice administration software, patient visits decreased by 30%. The median number of cases with the diagnosis J21 (acute bronchitis) were significantly less in April 2020 vs. April 2019 (50 vs. 10 cases per pediatrician; p<0.001). Simultaneously, hospital admissions decreased by 43.7% from 402 total cases in April 2019 to 226 cases in April 2020. Hospital admissions due to acute respiratory tract infections or asthma exacerbations as well as neonatal and oncological disorders were significantly reduced compared to the previous year (83.7; 38.1 and 22.1% respectively less to 2019).

CONCLUSION

The lockdown in April 2020 resulted in significantly fewer visits to pediatricians in general practice and hospital admissions, especially for acute respiratory tract infections. The health and economic consequences are discussed.

Comparison of the effectiveness of antibody and cell-mediated immunity against inhaled and instilled influenza virus challenge

BACKGROUND

To evaluate immunity against influenza, mouse challenge studies are typically performed by intranasal instillation of a virus suspension to anesthetized animals. This results in an unnatural environment in the lower respiratory tract during infection, and therefore there is some concern that immune mechanisms identified in this model may not reflect those that protect against infectious virus particles delivered directly to the lower respiratory tract as an aerosol.

METHOD

To evaluate differences in protection against instilled and inhaled virus, mice were immunized with influenza antigens known to induce antibody or cell-mediated responses and then challenged with 100 LD50 A/PR/8/34 (PR8) in the form of aerosol (inhaled) or liquid suspension (instilled).

RESULTS

Mice immunized with recombinant adenovirus (Ad) expressing hemagglutinin were protected against weight loss and death in both challenge models, however immunization with Ad expressing nucleoprotein of influenza A (NPA) or M2 resulted in greater protection against inhaled aerosolized virus than virus instilled in liquid suspension. Ad-M2, but not Ad-NPA-immunized mice were protected against a lower instillation challenge dose.

CONCLUSIONS

These results demonstrate differences in protection that are dependent on challenge method, and suggest that cell-mediated immunity may be more accurately demonstrated in mouse inhalation studies. Furthermore, the data suggest immune mechanisms generally characterized as incomplete or weak in mouse models using liquid intranasal challenge may offer greater immunity against influenza infection than previously thought.