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Kiiza D, Semanda JN, Kawere BB, Ajore C, Wasswa CK, Kwiringira A, Tumukugize E, Sserubidde J, Namyalo N, Wadria RB, Mukiibi P, Kasule J, Chemos I, Ruth AW, Atugonza R, Banage F, Wibabara Y, Ampaire I, Driwale A, Vosburgh W, Nelson L, Lamorde M, Boore A. Strategies to Enhance COVID-19 Vaccine Uptake among Prioritized Groups, Uganda-Lessons Learned and Recommendations for Future Pandemics. Emerg Infect Dis 2024; 30:1326-1334. [PMID: 38916545 PMCID: PMC11210662 DOI: 10.3201/eid3007.231001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
COVID-19 vaccination was launched in March 2021 in Uganda and initially prioritized persons >50 years of age, persons with underlying conditions, healthcare workers, teachers, and security forces. However, uptake remained low 5 months after the program launch. Makerere University's Infectious Diseases Institute supported Uganda's Ministry of Health in optimizing COVID-19 vaccination uptake models by using point-of-care, place of worship, and place of work engagement and the Social Assistance Grant for Empowerment model in 47 of 135 districts in Uganda, where we trained influencers to support mobilization for vaccination outreach under each model. During July-December, vaccination rates increased significantly in targeted regions, from 92% to 130% for healthcare workers, 40% to 90% for teachers, 25% to 33% for security personnel, 6% to 15% for persons >50 years of age, and 6% to 11% for persons with underlying conditions. Our approach could be adopted in other targeted vaccination campaigns for future pandemics.
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Watanuki D, Tamakoshi A, Kimura T, Asakura T, Saijo M. Patient Characteristics and Public Health Office Factors Associated With Long Reporting Delay of COVID-19 Cases in Sapporo City, Japan. J Epidemiol 2024; 34:129-136. [PMID: 37032110 PMCID: PMC10853042 DOI: 10.2188/jea.je20220359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND For therapeutic efficacy, molnupiravir and nirmatrelvir-ritonavir must be started to treat patients within 5 days of disease onset to treat patients with novel coronavirus disease 2019 (COVID-19). However, some patients spend more than 5 days from disease onset before reporting to the Public Health Office. This study aimed to clarify the characteristics of patients with reporting delay. METHODS This study included data from 12,399 patients with COVID-19 who reported to the Public Health Office from March 3rd, 2021 to June 30th, 2021. Patients were stratified into "linked" (n = 7,814) and "unlinked" (n = 4,585) cases depending on whether they were linked to other patients. A long reporting delay was defined as the difference between the onset and reporting dates of 5 days or more. Univariate and multivariate analyses were performed using log-binomial regression to identify factors related to long reporting delay, and prevalence ratios with corresponding 95% confidence intervals were calculated. RESULTS The proportion of long reporting delay was 24.4% (1,904/7,814) and 29.3% (1,344/4,585) in linked and unlinked cases, respectively. Risks of long reporting delay among linked cases were living alone and onset on the day with a higher 7-day daily average confirmed cases or onset on weekends; whereas, risks for unlinked cases were age over 65 years, without occupation, and living alone. CONCLUSION Our results suggest the necessity to establish a Public Health Office system that is less susceptible to the rapid increase in the number of patients, promotes educational activities for people with fewer social connections, and improves access to health care.
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Affiliation(s)
- Daichi Watanuki
- Department of Public Health, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Kimura
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Asakura
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Masayuki Saijo
- Public Health Office, Health and Welfare Bureau, Sapporo Municipal Government, Sapporo, Japan
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Kwok KO, Wei WI, Mcneil EB, Tang A, Tang JWT, Wong SYS, Yeoh EK. Comparative analysis of symptom profile and risk of death associated with infection by SARS-CoV-2 and its variants in Hong Kong. J Med Virol 2024; 96:e29326. [PMID: 38345166 DOI: 10.1002/jmv.29326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024]
Abstract
The recurrent multiwave nature of coronavirus disease 2019 (COVID-19) necessitates updating its symptomatology. We characterize the effect of variants on symptom presentation, identify the symptoms predictive and protective of death, and quantify the effect of vaccination on symptom development. With the COVID-19 cases reported up to August 25, 2022 in Hong Kong, an iterative multitier text-matching algorithm was developed to identify symptoms from free text. Multivariate regression was used to measure associations between variants, symptom development, death, and vaccination status. A least absolute shrinkage and selection operator technique was used to identify a parsimonious set of symptoms jointly associated with death. Overall, 70.9% (54 450/76 762) of cases were symptomatic with 102 symptoms identified. Intrinsically, the wild-type and delta variant caused similar symptoms among unvaccinated symptomatic cases, whereas the wild-type and omicron BA.2 subvariant had heterogeneous patterns, with seven symptoms (fatigue, fever, chest pain, runny nose, sputum production, nausea/vomiting, and sore throat) more frequent in the BA.2 cohort. With ≥2 vaccine doses, BA.2 was more likely than delta to cause fever among symptomatic cases. Fever, blocked nose, pneumonia, and shortness of breath remained jointly predictive of death among unvaccinated symptomatic elderly in the wild-type-to-omicron transition. Number of vaccine doses required for reducing occurrence varied by symptoms. We substantiate that omicron has a different clinical presentation compared to previous variants. Syndromic surveillance can be bettered with reduced reliance on symptom-based case identification, increased weighing on symptoms predictive of death in outcome prediction, individual-based risk assessment in care homes, and incorporating free-text symptom reporting.
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Affiliation(s)
- Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Edward B Mcneil
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Arthur Tang
- School of Science, Engineering and Technology, RMIT University, Ho Chi Minh City, Vietnam
| | - Julian W-T Tang
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Clinical Microbiology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eng Kiong Yeoh
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Bostancı Ö, Karaduman E, Çolak Y, Yılmaz AK, Kabadayı M, Bilgiç S. Respiratory muscle strength and pulmonary function in unvaccinated athletes before and after COVID-19 infection: A prospective cohort study. Respir Physiol Neurobiol 2023; 308:103983. [PMID: 36343877 PMCID: PMC9635222 DOI: 10.1016/j.resp.2022.103983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE We investigated abnormalities and recovery in respiratory function after COVID-19 infection in an unvaccinated elite athlete population. METHODS Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). RESULTS The most frequent reported symptoms were fatigue with 80% and muscle/joint pain and headache with 50%, whereas only 10% reported dyspnoea and 30% cough. During follow-up, MIP was up to 13% and MEP up to 8% lower following COVID-19 infection. Likewise, FEV1 was up to 2% and FVC up to 5% lower. While MEP and FEV1 rapidly normalised, MIP and FVC still remained abnormal after 52 days of COVID-19 infection, thereby leading to a restrictive ventilatory pattern. PEF seemed unaffected during follow-up. CONCLUSIONS COVID-19 decreases respiratory function in unvaccinated athletes despite reporting few respiratory symptoms and having mild disease. An initiative aimed at reducing the long-term adverse effects following COVID-19 infection seems warranted, which perhaps may be avoided through vaccination.
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Affiliation(s)
- Özgür Bostancı
- Faculty of Sport Sciences, University of Ondokuz Mayıs, Samsun, Türkiye
| | - Emre Karaduman
- Faculty of Sport Sciences, University of Ondokuz Mayıs, Samsun, Türkiye.
| | - Yunus Çolak
- Department of Respiratory Medicine and the Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Ali Kerim Yılmaz
- Faculty of Sport Sciences, University of Ondokuz Mayıs, Samsun, Türkiye
| | - Menderes Kabadayı
- Faculty of Sport Sciences, University of Ondokuz Mayıs, Samsun, Türkiye
| | - Sait Bilgiç
- Faculty of Medicine, University of Ondokuz Mayıs, Samsun, Türkiye
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Axenhus M, Frederiksen KS, Zhou RZ, Waldemar G, Winblad B. The impact of the COVID-19 pandemic on mortality in people with dementia without COVID-19: a systematic review and meta-analysis. BMC Geriatr 2022; 22:878. [PMCID: PMC9675075 DOI: 10.1186/s12877-022-03602-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Significant mortality amongst vulnerable populations, such as people living with dementia, might go undetected during pandemic conditions due to refocus of care efforts. There is an urgent need to fully evaluate the pandemic impact on mortality amongst people living with dementia in order to facilitate future healthcare reforms and prevent deaths. The purpose of this study was to determine whether there was any significant difference in mortality amongst people with dementia without COVID-19 during the COVID-19 pandemic compared to previous years. Methods A literature search was conducted in 5 databases. The relative risk ratio and confidence interval was used to estimate the change in mortality rates amongst people with dementia during the COVID-19 pandemic. The I2 value was used to assess heterogeneity, publication bias, and sensitivity analyses were performed. Results Pooled analysis of 11 studies showed that mortality amongst people living with dementia was significantly increased during the COVID-19 pandemic for people with dementia without COVID-19. Mortality risk increased by 25% during the time period studied. Subgroup analysis was not performed due the low number of included studies. Conclusions The results of this study suggest that people with dementia had a significant increased mortality during the pandemic even if they did not have COVID-19. People with dementia should participate in efforts that reduce general social spread and pandemic impact on healthcare system such as vaccinations, mask mandates, and testing. These results have clinical implications as preventing direct COVID-19 infection is not enough to adequately protect people living with dementia from increased mortality. Measures to limit social spread of infections and help support patients should also be a focus for clinicians. Further research should focus on the identification of mechanisms and other explanations for increased mortality as well as contributing factors such as living in care homes and differences between countries with various pandemic strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03602-6.
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Affiliation(s)
- Michael Axenhus
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
| | - Kristian Steen Frederiksen
- grid.5254.60000 0001 0674 042XDanish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robin Ziyue Zhou
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Gunhild Waldemar
- grid.5254.60000 0001 0674 042XDanish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDept. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bengt Winblad
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
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Association between obesity and COVID-19 mortality and length of stay in intensive care unit patients in Brazil: a retrospective cohort study. Sci Rep 2022; 12:13737. [PMID: 35962010 PMCID: PMC9372981 DOI: 10.1038/s41598-022-17197-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022] Open
Abstract
The present study aimed to evaluate the association between obesity and COVID-19 mortality and length of stay in ICU patients, and how these associations were modified by age groups. We performed a retrospective multicenter cohort study with data obtained from a hospital-based registry. The sample consisted of 8183 ICU hospitalized patients who tested positive for SARS-CoV-2. Cox proportional models were used to evaluate the association between BMI categories and COVID-19 mortality and generalized linear models for the length of stay in the ICU. After adjusting for confounders, those in the younger group with severe obesity had an increased risk of COVID-19 mortality compared to those with normal/overweight (HR 1.27; 95% CI 1.01–1.61). An increased risk of death was also observed for patients with underweight (HR 3.74; 95% CI 1.39–10.07). For patients aged ≥ 60 year, mild/moderate obesity was associated with reduced mortality risk (HR 0.87; 95% CI 0.78–0.97). For the age group < 60 year, the length of stay in ICU for those patients with severe obesity was 35% higher compared to the normal/overweight category (eβ 1.35; 95% CI 1.21–1.51). Conversely, for the survivors in the underweight category, the length of stay in ICU was 51% lower compared to the normal/overweight group (eβ 0.49; 95% CI 0.31–0.78). In the age group ≥ 60 year, mild/moderate obesity was associated with an increased length of stay in the ICU (eβ 1.10; 95% CI 1.01–1.21), adjusting for confounders. These findings could be helpful for health professionals to identify subgroups at higher risk for worse outcomes.
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Kammar-García A, Castillo-Martínez L, Mancilla-Galindo J, Villanueva-Juárez JL, Pérez-Pérez A, Rocha-González HI, Arrieta-Valencia J, Remolina-Schlig M, Hernández-Gilsoul T. SOFA Score Plus Impedance Ratio Predicts Mortality in Critically Ill Patients Admitted to the Emergency Department: Retrospective Observational Study. Healthcare (Basel) 2022; 10:healthcare10050810. [PMID: 35627947 PMCID: PMC9140899 DOI: 10.3390/healthcare10050810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. Aims: This study aimed to evaluate the combination of the SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the Emergency Department (ED). Methods: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 h after admission to the ED. A Cox regression analysis was performed to evaluate the mortality risk of the initial SOFA score plus the Imp-R. Harrell’s C-statistic and decision curve analyses (DCA) were performed. Results: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during their hospital stay. Of the latter, 40.6% died in the ED. The SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of the SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with an area under the curve (AUC) of 0.80 (95% CI: 74–0.86), 0.79 (95% CI: 0.74–0.86) and 0.75 (95% CI: 0.66–0.84), respectively. The DCA showed that combining the SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. Conclusions: The addition of the Imp-R to the baseline SOFA score on admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.
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Affiliation(s)
- Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City 10200, Mexico;
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (H.I.R.-G.); (J.A.-V.)
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (L.C.-M.); (J.L.V.-J.)
| | - Javier Mancilla-Galindo
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04360, Mexico;
- Licenciatura en Nutrición, Facultad de Ciencias de la Salud, Universidad Autónoma de Tlaxcala, Tlaxcala 90750, Mexico
| | - José Luis Villanueva-Juárez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (L.C.-M.); (J.L.V.-J.)
| | - Anayeli Pérez-Pérez
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (A.P.-P.); (M.R.-S.)
| | - Héctor Isaac Rocha-González
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (H.I.R.-G.); (J.A.-V.)
| | - Jesús Arrieta-Valencia
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (H.I.R.-G.); (J.A.-V.)
| | - Miguel Remolina-Schlig
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (A.P.-P.); (M.R.-S.)
| | - Thierry Hernández-Gilsoul
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (A.P.-P.); (M.R.-S.)
- Correspondence: ; Tel.: +52-555-4870-900 (ext. 5010)
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