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Henriques P, Caldeira-Araújo H, Brazão MDL, Abreu AM, Vigário AM, Rosa A. Primary Dengue and Long-Term Health Status in Madeira Island, Portugal: A Retrospective Questionnaire-Based Study. Am J Trop Med Hyg 2024; 111:403-411. [PMID: 38955194 PMCID: PMC11310610 DOI: 10.4269/ajtmh.23-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/18/2024] [Indexed: 07/04/2024] Open
Abstract
Dengue is among the most important mosquito-borne viral diseases worldwide. Although its acute manifestations are well known, little is known about the long-term impact of dengue on the population's health status. Madeira Island experienced a single outbreak of autochthonous dengue from September 2012 to March 2013. To extend our knowledge about the clinical impact of the outbreak on this naive population, we applied an online questionnaire to 168 adults diagnosed with dengue at the time to characterize retrospectively their symptoms during the infection and to identify long-term manifestations, possibly triggered by dengue. The most frequent symptoms during the clinical period, reported by more than three-quarters of our participants, were fever, myalgia, extreme tiredness, and headaches, whereas vomiting, pruritus, nausea, retro-orbital pain, and arthralgia occurred in 35% to 50% of participants. In the 8 years after dengue, 61.5% of participants reported at least one recurrent previously nonexistent symptom, the most frequent being headaches, abundant hair loss, extreme tiredness, arthralgia, and myalgia, experienced by 25% to 35% of participants. Nearly 20% of the participants with persistent symptoms reported the onset of chronic illness in the 4 years after dengue, most frequently ophthalmological and autoimmune diseases (5.6% each), versus only 2.2% of chronic disease onset in participants without persistent symptoms. Our results suggest that the occurrence of persistent symptoms after primary dengue might be more frequent than anticipated and may persist for several years, having an impact on the health status and well-being of a considerable proportion of the infected population.
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Affiliation(s)
- Paulo Henriques
- Projeto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
| | - Helena Caldeira-Araújo
- Projeto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
- CQM-Centro de Química da Madeira, Universidade da Madeira, Funchal, Portugal
| | - Maria da Luz Brazão
- Projeto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
- Serviço de Medicina Interna, Hospital Central do Funchal, SESARAM-EPERAM, Funchal, Portugal
| | - Ana Maria Abreu
- Departamento de Matemática, Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Centro de Investigação em Matemática e Aplicações, Universidade de Évora, Évora, Portugal
| | - Ana Margarida Vigário
- Projeto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alexandra Rosa
- Projeto Medicina, Faculdade de Ciências da Vida, Universidade da Madeira, Funchal, Portugal
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2
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Paz-Bailey G, Adams LE, Deen J, Anderson KB, Katzelnick LC. Dengue. Lancet 2024; 403:667-682. [PMID: 38280388 DOI: 10.1016/s0140-6736(23)02576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
Dengue, caused by four closely related viruses, is a growing global public health concern, with outbreaks capable of overwhelming health-care systems and disrupting economies. Dengue is endemic in more than 100 countries across tropical and subtropical regions worldwide, and the expanding range of the mosquito vector, affected in part by climate change, increases risk in new areas such as Spain, Portugal, and the southern USA, while emerging evidence points to silent epidemics in Africa. Substantial advances in our understanding of the virus, immune responses, and disease progression have been made within the past decade. Novel interventions have emerged, including partially effective vaccines and innovative mosquito control strategies, although a reliable immune correlate of protection remains a challenge for the assessment of vaccines. These developments mark the beginning of a new era in dengue prevention and control, offering promise in addressing this pressing global health issue.
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Affiliation(s)
| | - Laura E Adams
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Kathryn B Anderson
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Leah C Katzelnick
- Viral Epidemiology and Immunity Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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3
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Zamli AH, Misnan NA, Lim SY, Zohdi WNWM, Baharum N, Andiappan K. Post-COVID-19 Condition Characterization: Insights From a Cross-Sectional Study in a Malaysian Rehabilitation Center. Asia Pac J Public Health 2023; 35:516-523. [PMID: 37798930 DOI: 10.1177/10105395231203118] [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: 10/07/2023]
Abstract
Although post-COVID-19 condition (PCC) is a major public health concern, studies on PCC in Southeast Asia are lacking. This study aimed to describe PCC symptoms and its functional impact among COVID-19 survivors undergoing outpatient rehabilitation in Malaysia. We evaluated 3037 patients with confirmed COVID-19, referred between November 2020 and September 2022, 3 to 6 months after infection. PCC was diagnosed in 71.1%. Fatigue and dyspnea were the most common symptoms. The PCC patients had reduced respiratory, ambulatory, and musculoskeletal function, and higher fatigue and pain scores, and were less likely to return to work (odds ratio [OR] = 0.55) compared with non-PCC patients. Recognition of PCC symptoms and its functional impact can guide early, tailored, rehabilitation interventions.
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Affiliation(s)
- Akmal Hafizah Zamli
- Department of Rehabilitation Medicine, Sungai Buloh Hospital, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nor Arisah Misnan
- Infectious Disease Department, Sungai Buloh Hospital, Ministry of Health Malaysia, Selangor, Malaysia
| | - Su-Yin Lim
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
- Medical Advancement for Better Quality of Life Impact Lab, Taylor's University, Selangor, Malaysia
| | - Wan Najwa Wan Mohd Zohdi
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Nurakmal Baharum
- Centre for Coordination of Clinical Research Network, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Kavitha Andiappan
- Department of Rehabilitation Medicine, Sungai Buloh Hospital, Ministry of Health Malaysia, Selangor, Malaysia
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4
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Jayasekera MMPT, De Silva NL, Edirisinghe EMDT, Samarawickrama T, Sirimanna SWDRC, Govindapala BGDS, Senanayake G, Wickramaratne DLN, Hettigoda K, Gunawaradana UDIB, Wijayananda KDPB, Wijesinghe RANK. A prospective cohort study on post COVID syndrome from a tertiary care centre in Sri Lanka. Sci Rep 2023; 13:15569. [PMID: 37730947 PMCID: PMC10511420 DOI: 10.1038/s41598-023-42350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
There is a scarcity of follow-up data on post-COVID syndrome and its physical, psychological, and quality of life attributes, particularly from South Asian populations. This study was conducted to assess the prevalence, associations, and impact of the post-COVID syndrome among patients treated at a dedicated COVID-19 treatment unit. A prospective cohort study was conducted to follow-up patients with moderate to severe disease or mild disease with co-morbidities at 2 and 6 weeks, 3 and 6 months and 1 year from discharge. Clinical notes, an interviewer-administered questionnaire and six-item cognitive impairment, Montreal Cognitive Assessment, Fatigue (11-item Chalder) and EQ5D5L questionnaires were used for data collection. All patients had follow-up echocardiograms and symptomatic patients had biochemical and haematological investigations, chest x-rays, high-resolution computed tomography of chest and lung function tests. Among 153 patients {mean age 57.2 ± 16.3 years (83 (54.2% males)}, 92 (60.1%) got the severe disease. At least a single post-COVID symptom was reported by 119 (77.3%), 92 (60.1%), 54 (35.3%) and 25 (16.3%) at 6 weeks, 3 months, 6 months and 1 year respectively. Post-COVID symptoms were significantly associated with disease severity (p = 0.004). Fatigue was found in 139 (90.3%), 97 (63.4%) and 66 (43.1%) patients at 2, 6 and 12 weeks respectively. Dyspnoea {OR 1.136 (CI 95% 0.525-2.455)}, arthralgia {OR 1.83(CI 95% 0.96-3.503)} and unsteadiness {OR 1.34 (CI 95% 0.607-2.957)}were strongly associated with age above 60 years. Both genders were equally affected. In multivariable logistic regression, fatigue and anxiety/depression were associated with poor quality of life (QoL) (p = 0.014, p ≤ 0.001) in 6 weeks. In cardiac assessments, diastolic dysfunction (DD) was detected in 110 (72%) patients at 2 weeks and this number reduced to 64 (41.8%) at 12 weeks. The decline in diastolic dysfunction in elderly patients was significantly higher compared to young patients (p = 0.012). Most post-COVID symptoms, QoL and cognition improve during the first few months. The severity of the disease and older age are associated with post-COVID symptoms. Transient DD may contribute to cardiac symptoms of post-COVID syndrome, especially in elderly patients.
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Affiliation(s)
- M M P T Jayasekera
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
- University Hospital Kotelawala Defence University, Colombo, Sri Lanka.
| | - N L De Silva
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
- University Hospital Kotelawala Defence University, Colombo, Sri Lanka
| | | | - T Samarawickrama
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
- University Hospital Kotelawala Defence University, Colombo, Sri Lanka
| | | | - B G D S Govindapala
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
- University Hospital Kotelawala Defence University, Colombo, Sri Lanka
| | - G Senanayake
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
- University Hospital Kotelawala Defence University, Colombo, Sri Lanka
| | | | - K Hettigoda
- Department of Psychology, University of Peradeniya, Peradeniya, Sri Lanka
| | - U D I B Gunawaradana
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | | | - R A N K Wijesinghe
- Department of Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
- University Hospital Kotelawala Defence University, Colombo, Sri Lanka
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5
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Elmazny A, Magdy R, Hussein M, Elsebaie EH, Ali SH, Abdel Fattah AM, Hassan M, Yassin A, Mahfouz NA, Elsayed RM, Fathy W, Abdel-Hamid HM, Abdelbadie M, Soliman SH. Neuropsychiatric post-acute sequelae of COVID-19: prevalence, severity, and impact of vaccination. Eur Arch Psychiatry Clin Neurosci 2023; 273:1349-1358. [PMID: 36707454 PMCID: PMC9882743 DOI: 10.1007/s00406-023-01557-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023]
Abstract
The potential long-term neuropsychiatric effects of COVID-19 are of global concern. This study aimed to determine the prevalence and predictors of neuropsychiatric post-acute sequelae of COVID-19 among Egyptian COVID-19 survivors and to study the impact of full vaccination before COVID-19 infection on the occurrence and severity of these manifestations. Three months after getting COVID-19 infection, 1638 COVID-19 survivors were screened by phone for possible neuropsychiatric sequelae. Subjects suspected to suffer from these sequelae were invited to a face-to-face interview for objective evaluation. They were requested to rate the severity of their symptoms using visual analogue scales (VAS). The mean age of participants was 38.28 ± 13 years. Only 18.6% were fully vaccinated before COVID-19 infection. Neuropsychiatric post-acute sequelae of COVID-19 were documented in 598 (36.5%) subjects, fatigue was the most frequent one (24.6%), followed by insomnia (16.4%), depression (15.3%), and anxiety (14.4%). Moderate and severe COVID-19 infection and non-vaccination increased the odds of developing post-COVID-19 neuropsychiatric manifestations by 2 times (OR 1.95, 95% CI = 1.415-2.683), 3.86 times (OR 3.86, 95% CI = 2.358-6.329), and 1.67 times (OR 1.67, 95% CI = 1.253-2.216), respectively. Fully vaccinated subjects before COVID-19 infection (n = 304) had significantly lesser severity of post-COVID-19 fatigue, ageusia/hypogeusia, dizziness, tinnitus, and insomnia (P value = 0.001, 0.008, < 0.001, 0.025, and 0.005, respectively) than non-vaccinated subjects. This report declared neuropsychiatric sequelae in 36.5% of Egyptian COVID-19 survivors, fatigue being the most prevalent. The effectiveness of COVID-19 vaccines in reducing the severity of some post-COVID-19 neuropsychiatric manifestations may improve general vaccine acceptance.
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Affiliation(s)
- Alaa Elmazny
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
- College of Medicine and Medial Science, Arabian Gulf University, Manama, Bahrain
| | - Rehab Magdy
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Hussein
- Department of Neurology, Faculty of Medicine, Beni-Suef University, Salah Salem Street, Beni Suef, 62511, Egypt.
| | - Eman H Elsebaie
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sara H Ali
- Department of Otolaryngology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ali M Abdel Fattah
- Department of Gastroenterology, Hepatology, and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mahmoud Hassan
- Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed Yassin
- Department of Critical Care Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Noha A Mahfouz
- Department of Psychiatry Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Radwa M Elsayed
- Department of Family Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Fathy
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Beni Suef, Egypt
| | - Hoda M Abdel-Hamid
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abdelbadie
- Department of Anesthesiology, Surgical ICU and Pain Management, Beni-Suef University, Beni Suef, Egypt
| | - Shaimaa H Soliman
- Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
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6
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Obermoser K, Brigo N, Schroll A, Monfort-Lanzas P, Gostner JM, Engl S, Geisler S, Knoll M, Schennach H, Weiss G, Fuchs D, Bellmann-Weiler R, Kurz K. Positive Effects of Probiotic Therapy in Patients with Post-Infectious Fatigue. Metabolites 2023; 13:metabo13050639. [PMID: 37233680 DOI: 10.3390/metabo13050639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Post-infectious fatigue is a common complication that can lead to decreased physical efficiency, depression, and impaired quality of life. Dysbiosis of the gut microbiota has been proposed as a contributing factor, as the gut-brain axis plays an important role in regulating physical and mental health. This pilot study aimed to investigate the severity of fatigue and depression, as well as the quality of life of 70 patients with post-infectious fatigue who received a multi-strain probiotic preparation or placebo in a double-blind, placebo-controlled trial. Patients completed questionnaires to assess their fatigue (fatigue severity scale (FSS)), mood (Beck Depression Inventory II (BDI-II)), and quality of life (short form-36 (SF-36)) at baseline and after 3 and 6 months of treatment. Routine laboratory parameters were also assessed, including immune-mediated changes in tryptophan and phenylalanine metabolism. The intervention was effective in improving fatigue, mood, and quality of life in both the probiotic and placebo groups, with greater improvements seen in the probiotic group. FSS and BDI-II scores declined significantly under treatment with both probiotics and placebo, but patients who received probiotics had significantly lower FSS (p < 0.001) and BDI-II (p < 0.001) scores after 6 months. Quality of life scores improved significantly in patients who received probiotics (p < 0.001), while patients taking a placebo only saw improvements in the "Physical limitation" and "Energy/Fatigue" subcategories. After 6 months neopterin was higher in patients receiving placebo, while no longitudinal changes in interferon-gamma mediated biochemical pathways were observed. These findings suggest that probiotics may be a promising intervention for improving the health of patients with post-infectious fatigue, potentially through modulating the gut-brain axis.
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Affiliation(s)
- Katharina Obermoser
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Natascha Brigo
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Andrea Schroll
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Pablo Monfort-Lanzas
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80, 6020 Innsbruck, Austria
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innrain 80, 6020 Innsbruck, Austria
| | - Johanna M Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80, 6020 Innsbruck, Austria
| | - Sabine Engl
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Simon Geisler
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80, 6020 Innsbruck, Austria
| | - Miriam Knoll
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schoepfstrasse 41, 6020 Innsbruck, Austria
| | - Harald Schennach
- Central Institute of Blood Transfusion and Immunology, University Hospital, Anichstr. 35, 6020 Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innrain 80, 6020 Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Scholkmann F, May CA. COVID-19, post-acute COVID-19 syndrome (PACS, "long COVID") and post-COVID-19 vaccination syndrome (PCVS, "post-COVIDvac-syndrome"): Similarities and differences. Pathol Res Pract 2023; 246:154497. [PMID: 37192595 DOI: 10.1016/j.prp.2023.154497] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
Worldwide there have been over 760 million confirmed coronavirus disease 2019 (COVID-19) cases, and over 13 billion COVID-19 vaccine doses have been administered as of April 2023, according to the World Health Organization. An infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to an acute disease, i.e. COVID-19, but also to a post-acute COVID-19 syndrome (PACS, "long COVID"). Currently, the side effects of COVID-19 vaccines are increasingly being noted and studied. Here, we summarise the currently available indications and discuss our conclusions that (i) these side effects have specific similarities and differences to acute COVID-19 and PACS, that (ii) a new term should be used to refer to these side effects (post-COVID-19 vaccination syndrome, PCVS, colloquially "post-COVIDvac-syndrome"), and that (iii) there is a need to distinguish between acute COVID-19 vaccination syndrome (ACVS) and post-acute COVID-19 vaccination syndrome (PACVS) - in analogy to acute COVID-19 and PACS ("long COVID"). Moreover, we address mixed forms of disease caused by natural SARS-CoV-2 infection and COVID-19 vaccination. We explain why it is important for medical diagnosis, care and research to use the new terms (PCVS, ACVS and PACVS) in order to avoid confusion and misinterpretation of the underlying causes of disease and to enable optimal medical therapy. We do not recommend to use the term "Post-Vac-Syndrome" as it is imprecise. The article also serves to address the current problem of "medical gaslighting" in relation to PACS and PCVS by raising awareness among the medical professionals and supplying appropriate terminology for disease.
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Affiliation(s)
- Felix Scholkmann
- University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Christian-Albrecht May
- Department of Anatomy, Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
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8
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Berens-Riha N, Bracke S, Rutgers J, Burm C, Van Gestel L, Hens M, Kenyon C, Bottieau E, Soentjens P, Brosius I, Van Esbroeck M, Vercauteren K, van Griensven J, van Dijck C, Liesenborghs L. Persistent morbidity in Clade IIb mpox patients: interim results of a long-term follow-up study, Belgium, June to November 2022. Euro Surveill 2023; 28:2300072. [PMID: 36795501 PMCID: PMC9936596 DOI: 10.2807/1560-7917.es.2023.28.7.2300072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
While mpox was well characterised during the 2022 global Clade IIb outbreak, little is known about persistent morbidity. We present interim results of a prospective cohort study of 95 mpox patients assessed 3-20 weeks post-symptom onset. Two-thirds of participants had residual morbidity, including 25 with persistent anorectal and 18 with genital symptoms. Loss of physical fitness, new-onset/worsened fatigue and mental health problems were reported in 36, 19 and 11 patients, respectively. These findings require attention by healthcare providers.
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Affiliation(s)
| | | | | | | | | | - Matilde Hens
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- University of Cape Town, Cape Town, South Africa
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | | | - Christophe van Dijck
- These authors contributed equally to this work and share last authorship
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Laurens Liesenborghs
- These authors contributed equally to this work and share last authorship
- Institute of Tropical Medicine, Antwerp, Belgium
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9
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Oliveira AMDSS, Carvalho MA, Nacul L, Cabar FR, Fabri AW, Peres SV, Zaccara TA, O’Boyle S, Alexander N, Takiuti NH, Mayaud P, Brizot MDL, Francisco RPV. Post-Viral Fatigue Following SARS-CoV-2 Infection during Pregnancy: A Longitudinal Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15735. [PMID: 36497810 PMCID: PMC9737157 DOI: 10.3390/ijerph192315735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Studies reported post-COVID-19 fatigue in the general population, but not among pregnant women. Our objectives were to determine prevalence, duration, and risk factors of post-viral fatigue among pregnant women with SARS-CoV-2. This study involved 588 pregnant women with SARS-CoV-2 during pregnancy or delivery in Brazil. Three groups were investigated: G1 (n = 259, symptomatic infection during pregnancy); G2 (n = 131, positive serology at delivery); G3 (n = 198, negative serology at delivery). We applied questionnaires investigating fatigue at determined timepoints after infection for G1, and after delivery for all groups; fatigue prevalence was then determined. Cox regression was used to estimate hazard ratio (HR) and 95% CI of the risk of remaining with fatigue in G1. Overall fatigue prevalence in G1 at six weeks, three months and six months were 40.6%, 33.6%, and 27.8%, respectively. Cumulative risk of remaining with fatigue increased over time, with HR of 1.69 (95% CI: 0.89-3.20) and 2.43 (95% CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. Multivariate analysis showed cough and myalgia as independent risk factors in G1. Fatigue prevalence was significantly higher in G1 compared to G2 and G3. Post-viral fatigue prevalence is higher in women infected during pregnancy; fatigue's risk and duration increased with the severity of infection.
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Affiliation(s)
- Ana Maria da Silva Sousa Oliveira
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Mariana Azevedo Carvalho
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Luis Nacul
- Complex Chronic Diseases Program—BC Women’s Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Fábio Roberto Cabar
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Amanda Wictky Fabri
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Stela Verzinhasse Peres
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Tatiana Assuncao Zaccara
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | | | - Neal Alexander
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Nilton Hideto Takiuti
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Philippe Mayaud
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Divisão de Obstetrícia e Ginecología, Hospital Universitário da Universidade de São Paulo, São Paulo 05508-000, Brazil
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Effect of prior Zika and dengue virus exposure on the severity of a subsequent dengue infection in adults. Sci Rep 2022; 12:17225. [PMID: 36241869 PMCID: PMC9568574 DOI: 10.1038/s41598-022-22231-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/11/2022] [Indexed: 01/06/2023] Open
Abstract
Given the structural similarity between Zika and dengue viruses, prior infection from one virus is hypothesized to modulate the severity of a subsequent infection from the other virus. A previous paediatric cohort study observed that a prior Zika infection may increase the risk of a subsequent symptomatic or severe dengue infection. The Colombo Dengue study is a prospective hospital-based cohort study in Sri Lanka that recruits symptomatic adult dengue patients within the first three days of fever. Anti-Dengue Envelope and anti-Zika NS1 IgG antibodies were tested by ELISA (Euroimmun, Lubeck, Germany) in all recruited patients. Associations between pre-morbid seroprevalence for either or both infections and adverse clinical outcomes of the current dengue infection were explored. A total of 507 dengue infected patients were assessed of whom 342 (68%) and 132 (26%) patients had anti-dengue IgG and anti-Zika IgG respectively. People with combined prior dengue and zika exposure as well as prior dengue exposure alone, were at increased risk of plasma leakage, compensated and uncompensated shock, and severe dengue (p < 0·05), compared to people without prior exposure to either infection. The effect of prior Zika exposure alone could not be established due to the small the number of primary dengue infections with prior Zika exposure.
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11
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Kalimuddin S, Teh YE, Wee LE, Paintal S, Sasisekharan R, Low JG, Sheth SK, Ooi EE. Chronic sequelae complicate convalescence from both dengue and acute viral respiratory illness. PLoS Negl Trop Dis 2022; 16:e0010724. [PMID: 35981059 PMCID: PMC9426910 DOI: 10.1371/journal.pntd.0010724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/30/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Long Covid has raised awareness of the potentially disabling chronic sequelae that afflicts patients after acute viral infection. Similar syndromes of post-infectious sequelae have also been observed after other viral infections such as dengue, but their true prevalence and functional impact remain poorly defined. We prospectively enrolled 209 patients with acute dengue (n = 48; one with severe dengue) and other acute viral respiratory infections (ARI) (n = 161), and followed them up for chronic sequelae up to one year post-enrolment, prior to the onset of the Covid-19 pandemic. Baseline demographics and co-morbidities were balanced between both groups except for gender, with more males in the dengue cohort (63% vs 29%, p<0.001). Except for the first visit, data on symptoms were collected remotely using a purpose-built mobile phone application. Mental health outcomes were evaluated using the validated SF-12v2 Health Survey. Almost all patients (95.8% of dengue and 94.4% of ARI patients) experienced at least one symptom of fatigue, somnolence, headache, concentration impairment or memory impairment within the first week of enrolment. Amongst patients with at least 3-months of follow-up, 18.0% in the dengue cohort and 14.6% in the ARI cohort experienced persistent symptoms. The median month-3 SF-12v2 Mental Component Summary Score was lower in patients who remained symptomatic at 3 months and beyond, compared to those whose symptoms fully resolved (47.7 vs. 56.0, p<0.001), indicating that patients who self-reported persistence of symptoms also experienced functionally worse mental health. No statistically significant difference in age, gender distribution or hospitalisation status was observed between those with and without chronic sequelae. Our findings reveal an under-appreciated burden of post-infection chronic sequelae in dengue and ARI patients. They call for studies to define the pathophysiology of this condition, and determine the efficacy of both vaccines as well as antiviral drugs in preventing such sequelae. Chronic sequelae after viral infections such dengue have been observed, but their true prevalence and impact remain undefined. We prospectively enrolled a cohort of 209 patients with dengue and acute viral respiratory infections (ARI) and followed them up chronic sequelae for up to one year. 18% of patients in the dengue cohort and 14.6% of patients in the ARI cohort experienced chronic sequelae such as fatigue, somnolence, headache, concentration impairment and memory impairment. Patients who experienced chronic sequelae also had lower month-3 SF-12v2 Mental Component Summary Scores, suggesting that such those who self-reported persistence of symptoms experienced functionally worse mental health. Overall our findings reveal an under-appreciated burden of chronic sequelae in dengue and ARI patients and call for further studies to define the pathophysiology and potential therapeutic options for this condition.
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Affiliation(s)
- Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
- * E-mail: (S.K.); (E.E.O.)
| | - Yii Ean Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Ram Sasisekharan
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore
- Department of Biological Engineering, Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Jenny G. Low
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
- Viral Research and Experimental Medicine Centre, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Sujata K. Sheth
- Department of Emergency Medicine, Changi General Hospital, Singapore
| | - Eng Eong Ooi
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
- Viral Research and Experimental Medicine Centre, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- * E-mail: (S.K.); (E.E.O.)
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12
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Malavige GN, Jeewandara C, Ogg GS. Dengue and COVID-19: two sides of the same coin. J Biomed Sci 2022; 29:48. [PMID: 35786403 PMCID: PMC9251039 DOI: 10.1186/s12929-022-00833-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many countries in Asia and Latin America are currently facing a double burden of outbreaks due to dengue and COVID-19. Here we discuss the similarities and differences between the two infections so that lessons learnt so far from studying both infections will be helpful in further understanding their immunopathogenesis and to develop therapeutic interventions. MAIN BODY Although the entry routes of the SARS-CoV-2 and the dengue virus (DENV) are different, both infections result in a systemic infection, with some similar clinical presentations such as fever, headache, myalgia and gastrointestinal symptoms. However, while dengue is usually associated with a tendency to bleed, development of micro and macrothrombi is a hallmark of severe COVID-19. Apart from the initial similarities in the clinical presentation, there are further similarities between such as risk factors for development of severe illness, cytokine storms, endothelial dysfunction and multi-organ failure. Both infections are characterised by a delayed and impaired type I IFN response and a proinflammatory immune response. Furthermore, while high levels of potent neutralising antibodies are associated with protection, poorly neutralising and cross-reactive antibodies have been proposed to lead to immunopathology by different mechanisms, associated with an exaggerated plasmablast response. The virus specific T cell responses are also shown to be delayed in those who develop severe illness, while varying degrees of endothelial dysfunction leads to increased vascular permeability and coagulation abnormalities. CONCLUSION While there are many similarities between dengue and SARS-CoV-2 infection, there are also key differences especially in long-term disease sequelae. Therefore, it would be important to study the parallels between the immunopathogenesis of both infections for development of more effective vaccines and therapeutic interventions.
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Affiliation(s)
- Gathsaurie Neelika Malavige
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
| | - Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Graham S Ogg
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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13
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Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med 2022; 28:911-923. [PMID: 35585196 DOI: 10.1038/s41591-022-01810-6] [Citation(s) in RCA: 241] [Impact Index Per Article: 120.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 is not unique in its ability to cause post-acute sequelae; certain acute infections have long been associated with an unexplained chronic disability in a minority of patients. These post-acute infection syndromes (PAISs) represent a substantial healthcare burden, but there is a lack of understanding of the underlying mechanisms, representing a significant blind spot in the field of medicine. The relatively similar symptom profiles of individual PAISs, irrespective of the infectious agent, as well as the overlap of clinical features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), suggest the potential involvement of a common etiopathogenesis. In this Review, we summarize what is known about unexplained PAISs, provide context for post-acute sequelae of SARS-CoV-2 infection (PASC), and delineate the need for basic biomedical research into the underlying mechanisms behind this group of enigmatic chronic illnesses.
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Affiliation(s)
- Jan Choutka
- Department of Chemistry of Natural Compounds, University of Chemistry and Technology, Prague, Czech Republic.
| | - Viraj Jansari
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. .,Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD, USA.
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14
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Buonsenso D, Gennaro LD, Rose CD, Morello R, D'Ilario F, Zampino G, Piazza M, Boner AL, Iraci C, O'Connell S, Cohen VB, Esposito S, Munblit D, Reena J, Sigfrid L, Valentini P. Long-term outcomes of pediatric infections: from traditional infectious diseases to long Covid. Future Microbiol 2022; 17:551-571. [PMID: 35264003 PMCID: PMC8910780 DOI: 10.2217/fmb-2022-0031] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 02/07/2023] Open
Abstract
There is limited evidence available on the long-term impact of SARS-CoV-2 infection in children. In this article, the authors analyze the recent evidence on pediatric long Covid and lessons learnt from a pediatric post-Covid unit in Rome, Italy. To gain a better understanding of the concerns raised by parents and physicians in relation to the potential long-term consequences of this novel infection, it is important to recognize that long-term effect of a post-infectious disease is not a new phenomenon.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Center for Global Health Research & Studies, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Leonardo Di Gennaro
- Department of Diagnostic Imaging, Hemorrhagic & Thrombotic Diseases Center, Oncological Radiotherapy, & Hematology, Foundation ‘A Gemelli’ IRCCS University Hospital, Rome, Italy
| | - Cristina De Rose
- Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Federico D'Ilario
- Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giuseppe Zampino
- Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Michele Piazza
- Pediatric Section, Department of Surgery, Dentistry, pediatrics, & Gynaecology, University of Verona, Verona, Italy
| | - Attilio L Boner
- Pediatric Section, Department of Surgery, Dentistry, pediatrics, & Gynaecology, University of Verona, Verona, Italy
| | | | | | - Valentina B Cohen
- Patient author, member of the CAC Community Advisory Council of Solve ME/CFS Initiative, Pietro Barilla Children's Hospital, Department of Medicine & Surgery, University of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Susanna Esposito
- Pietro Barilla Children's Hospital, Department of Medicine & Surgery, University of Parma, Via Gramsci 14, Parma, 43126, Italy
| | - Daniel Munblit
- Department of pediatrics & pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Joseph Reena
- MSc Immunology, Imperial College London, London, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Piero Valentini
- Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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15
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:889-899. [DOI: 10.1093/trstmh/trac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
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Sigera C, Rodrigo C, de Silva NL, Weeratunga P, Fernando D, Rajapakse S. Direct costs of managing in-ward dengue patients in Sri Lanka: A prospective study. PLoS One 2021; 16:e0258388. [PMID: 34624062 PMCID: PMC8500425 DOI: 10.1371/journal.pone.0258388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential. OBJECTIVE To characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka. METHODS Colombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios. RESULTS From October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients. CONCLUSION As non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.
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Affiliation(s)
- Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, Sydney, NSW, Australia
| | - Nipun L. de Silva
- Department of Clinical Sciences, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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17
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O’Keefe JB, Minton HC, Morrow M, Johnson C, Moore MA, O’Keefe GAD, Benameur K, Higdon J, Fairley JK. Postacute Sequelae of SARS-CoV-2 Infection and Impact on Quality of Life 1-6 Months After Illness and Association With Initial Symptom Severity. Open Forum Infect Dis 2021; 8:ofab352. [PMID: 34395709 PMCID: PMC8360237 DOI: 10.1093/ofid/ofab352] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/29/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Individuals with coronavirus disease 2019 (COVID-19) may have persistent symptoms following their acute illness. The prevalence and predictors of these symptoms, termed postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; PASC), have not been fully described. METHODS Participants discharged from an outpatient telemedicine program for COVID-19 were emailed a survey (1-6 months after discharge) about ongoing symptoms, acute illness severity, and quality of life. Standardized telemedicine notes from acute illness were used for covariates (comorbidities and provider-assessed symptom severity). Bivariate and multivariable analyses were performed to assess predictors of persistent symptoms. RESULTS Two hundred ninety patients completed the survey, of whom 115 (39.7%) reported persistent symptoms including fatigue (n = 59, 20.3%), dyspnea on exertion (n = 41, 14.1%), and mental fog (n = 39, 13.5%), among others. The proportion of persistent symptoms did not differ based on duration since illness (<90 days: n = 32, 37.2%; vs >90 days: n = 80, 40.4%; P = .61). Predictors of persistent symptoms included provider-assessed moderate-severe illness (adjusted odds ratio [aOR], 3.24; 95% CI, 1.75-6.02), female sex (aOR, 1.99; 95% CI, 0.98-4.04; >90 days out: aOR, 2.24; 95% CI, 1.01-4.95), and middle age (aOR, 2.08; 95% CI, 1.07-4.03). Common symptoms associated with reports of worse physical health included weakness, fatigue, myalgias, and mental fog. CONCLUSIONS Symptoms following acute COVID-19 are common and may be predicted by factors during the acute phase of illness. Fatigue and neuropsychiatric symptoms figured prominently. Select symptoms seem to be particularly associated with perceptions of physical health following COVID-19 and warrant specific attention on future studies of PASC.
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Affiliation(s)
- James B O’Keefe
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - H Caroline Minton
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Colin Johnson
- Department of General Surgery, Emory Bariatric Clinic, Emory Healthcare, Atlanta, Georgia, USA
| | - Miranda A Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ghazala A D O’Keefe
- Section of Vitreoretinal Surgery and Diseases, Section of Uveitis and Vasculitis, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karima Benameur
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason Higdon
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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