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Morris SE, Zipfel CM, Peer K, Madewell ZJ, Brenner S, Garg S, Paul P, Slayton RB, Biggerstaff M. Modeling the Impacts of Antiviral Prophylaxis Strategies in Mitigating Seasonal Influenza Outbreaks in Nursing Homes. Clin Infect Dis 2024; 78:1336-1344. [PMID: 38072652 DOI: 10.1093/cid/ciad764] [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: 08/30/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Antiviral chemoprophylaxis is recommended for use during influenza outbreaks in nursing homes to prevent transmission and severe disease among non-ill residents. Centers for Disease Control and Prevention (CDC) guidance recommends prophylaxis be initiated for all non-ill residents once an influenza outbreak is detected and be continued for at least 14 days and until 7 days after the last laboratory-confirmed influenza case is identified. However, not all facilities strictly adhere to this guidance and the impact of such partial adherence is not fully understood. METHODS We developed a stochastic compartmental framework to model influenza transmission within an average-sized US nursing home. We compared the number of symptomatic illnesses and hospitalizations under varying prophylaxis implementation strategies, in addition to different levels of prophylaxis uptake and adherence by residents and healthcare personnel (HCP). RESULTS Prophylaxis implemented according to current guidance reduced total symptomatic illnesses and hospitalizations among residents by a median of 12% and 36%, respectively, compared with no prophylaxis. We did not find evidence that alternative implementations of prophylaxis were more effective: compared to full adoption of current guidance, partial adoption resulted in increased symptomatic illnesses and/or hospitalizations, and longer or earlier adoption offered no additional improvements. In addition, increasing uptake and adherence among nursing home residents was effective in reducing resident illnesses and hospitalizations, but increasing HCP uptake had minimal indirect impacts for residents. CONCLUSIONS The greatest benefits of influenza prophylaxis during nursing home outbreaks will likely be achieved through increasing uptake and adherence among residents and following current CDC guidance.
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Affiliation(s)
- Sinead E Morris
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey M Zipfel
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komal Peer
- Division of Environmental Health Science and Practice, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephan Brenner
- Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Prabasaj Paul
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel B Slayton
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Biggerstaff
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Srikanth P, Doe RL, Croteau G, Cohen MA. Low-cost interventions to improve ventilation in long-term care facilities. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024:1-10. [PMID: 38652919 DOI: 10.1080/15459624.2024.2328295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Residents of long-term care facilities are particularly vulnerable to communicable diseases. Low-cost interventions to increase air exchange rates (AERs) may be useful in reducing the transmission of airborne communicable diseases between long-term care residents and staff. In this study, carbon dioxide gas was used as a tracer to evaluate the AER associated with the implementation of low-cost ventilation interventions. Under baseline conditions with the room's door closed, the mean AER was 0.67 ACH; while baseline conditions with the door open had a significantly higher mean AER of 3.87 ACH (p < 0.001). Subsequently opening a window with the door open increased mean AER by 1.49 ACH (p = 0.012) and adding a fan in the window further increased mean AER by 1.87 ACH (p < 0.001). Regression analyses indicated that the flow rate of air entering through the window, both passively and through the use of a fan, was significantly associated with an increase in AER (p < 0.001). These results indicate that low-cost interventions that pull outside air into resident rooms were effective in improving the air exchange rates in these facilities. While implementation of these interventions is dependent on facility rules and isolation requirements of residents with airborne communicable diseases, these interventions remain viable options for long-term care facilities to improve resident room ventilation without requiring costly ventilation system upgrades.
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Affiliation(s)
- Pranav Srikanth
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington
- Washington State Department of Health, Olympia, Washington
| | - Rebecca L Doe
- Washington State Department of Health, Olympia, Washington
| | - Gerry Croteau
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington
| | - Martin A Cohen
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington
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3
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Bartsch SM, Weatherwax C, Wasserman MR, Chin KL, Martinez MF, Velmurugan K, Singh RD, John DC, Heneghan JL, Gussin GM, Scannell SA, Tsintsifas AC, O'Shea KJ, Dibbs AM, Leff B, Huang SS, Lee BY. How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value. J Am Med Dir Assoc 2024; 25:639-646.e5. [PMID: 38432644 PMCID: PMC10990766 DOI: 10.1016/j.jamda.2024.02.005] [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: 08/18/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To evaluate the epidemiologic, clinical, and economic value of an annual nursing home (NH) COVID-19 vaccine campaign and the impact of when vaccination starts. DESIGN Agent-based model representing a typical NH. SETTING AND PARTICIPANTS NH residents and staff. METHODS We used the model representing an NH with 100 residents, its staff, their interactions, COVID-19 spread, and its health and economic outcomes to evaluate the epidemiologic, clinical, and economic value of varying schedules of annual COVID-19 vaccine campaigns. RESULTS Across a range of scenarios with a 60% vaccine efficacy that wanes starting 4 months after protection onset, vaccination was cost saving or cost-effective when initiated in the late summer or early fall. Annual vaccination averted 102 to 105 COVID-19 cases when 30-day vaccination campaigns began between July and October (varying with vaccination start), decreasing to 97 and 85 cases when starting in November and December, respectively. Starting vaccination between July and December saved $3340 to $4363 and $64,375 to $77,548 from the Centers for Medicare & Medicaid Services and societal perspectives, respectively (varying with vaccination start). Vaccination's value did not change when varying the COVID-19 peak between December and February. The ideal vaccine campaign timing was not affected by reducing COVID-19 levels in the community, or varying transmission probability, preexisting immunity, or COVID-19 severity. However, if vaccine efficacy wanes more quickly (over 1 month), earlier vaccination in July resulted in more cases compared with vaccinating later in October. CONCLUSIONS AND IMPLICATIONS Annual vaccination of NH staff and residents averted the most cases when initiated in the late summer through early fall, at least 2 months before the COVID-19 winter peak but remained cost saving or cost-effective when it starts in the same month as the peak. This supports tethering COVID vaccination to seasonal influenza campaigns (typically in September-October) for providing protection against SARS-CoV-2 winter surges in NHs.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Colleen Weatherwax
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | | | - Kevin L Chin
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Marie F Martinez
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Kavya Velmurugan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Danielle C John
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA
| | - Jessie L Heneghan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Sheryl A Scannell
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Alexandra C Tsintsifas
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Kelly J O'Shea
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Alexis M Dibbs
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Bruce Leff
- Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA.
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Baranowska-Tateno K, Micek A, Gniadek A, Wójkowska-Mach J, Różańska A. Healthcare-Associated Infections and Prevention Programs in General Nursing versus Residential Homes-Results of the Point Prevalence Survey in Polish Long-Term Care Facilities. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:137. [PMID: 38256397 PMCID: PMC10820304 DOI: 10.3390/medicina60010137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The number of residents of long-term care facilities (LTCFs) is expected to increase. Determining the epidemiological situation in the context of organizational conditions is therefore extremely important for planning the necessary future activities in the field of infection prevention. The aim of this study was to analyze the prevalence rates in Polish nursing vs. residential homes, in the context of the medical and functional burdens of residents and the organizational conditions of both types of units. Material and Methods: the data that were analyzed came from a point prevalence survey of infections and antibiotic consumption in LTCFs, conducted in accordance with the HALT-3 protocol in Poland in 2017, between April and June. Results: This study included a total of 2313 residents in 24 LTCFs. The most common risk factors for infections in the study population were urinary and fecal incontinence (77.0%), impaired mobility (the patient was in a wheelchair or lying down) (68.7%), and impaired spatial and temporal orientation (52.5%). The median prevalence in nursing homes (NHs) was 3.2% and that in residential homes (RHs) was 0.7%, but without statistical significance. The median for the entire group was 2.6%. A total of 93 healthcare-related infections were detected in 91 residents. The most frequently reported forms of infections were urinary tract infections, lower respiratory tract infections, and skin infections. A statistically significant positive correlation was found only between the percentage of residents with pressure ulcers and other wounds and the incidence of gastrointestinal infections (correlation coefficient = 0.413, p < 0.05). Infection prevention and control measures were implemented mainly in nursing homes, and in residential homes, only hand hygiene procedures were commonly available. Conclusions: For the two types of LTCFs, the epidemiological situation in terms of nosocomial infections is diverse. Consequently, both types of facilities require different approaches to infection control and prevention and outcomes analysis.
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Affiliation(s)
- Katarzyna Baranowska-Tateno
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, 31-121 Cracow, Poland;
| | - Agnieszka Micek
- Statistical Laboratory, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Cracow, Poland;
| | - Agnieszka Gniadek
- Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Jagiellonian University Medical College, 31-121 Cracow, Poland;
| | - Anna Różańska
- Department of Microbiology, Jagiellonian University Medical College, 31-121 Cracow, Poland;
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5
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Stirrup O, Krutikov M, Azmi B, Monakhov I, Hayward A, Copas A, Shallcross L. COVID-19-related mortality and hospital admissions in the VIVALDI study cohort: October 2020 to March 2023. J Hosp Infect 2024; 143:105-112. [PMID: 37949372 PMCID: PMC10927615 DOI: 10.1016/j.jhin.2023.10.021] [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: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Long-term-care facilities (LTCFs) were heavily affected by COVID-19 early in the pandemic, but the impact of the virus has reduced over time with vaccination campaigns and build-up of immunity from prior infection. OBJECTIVES To evaluate the mortality and hospital admissions associated with SARS-CoV-2 in LTCFs in England over the course of the VIVALDI study, from October 2020 to March 2023. METHODS We included residents aged ≥65 years from participating LTCFs who had available follow-up time within the analysis period. We calculated incidence rates (IRs) of COVID-19-linked mortality and hospital admissions per calendar quarter, along with infection fatality ratios (IFRs, within 28 days) and infection hospitalization ratios (IHRs, within 14 days) following positive SARS-CoV-2 test. RESULTS A total of 26,286 residents were included, with at least one positive test for SARS-CoV-2 in 8513 (32.4%). The IR of COVID-19-related mortality peaked in the first quarter (Q1) of 2021 at 0.47 per 1000 person-days (1 kpd) (around a third of all deaths), in comparison with 0.10 per 1 kpd for Q1 2023 which had a similar IR of SARS-CoV-2 infections. There was a fall in observed IFR for SARS-CoV-2 infections from 24.9% to 6.7% between these periods, with a fall in IHR from 12.1% to 8.8%. The population had high overall IRs for mortality for each quarter evaluated, corresponding to annual mortality probability of 28.8-41.3%. CONCLUSIONS Standardized real-time monitoring of hospitalization and mortality following infection in LTCFs could inform policy on the need for non-pharmaceutical interventions to prevent transmission.
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Affiliation(s)
- O Stirrup
- Institute for Global Health, University College London, London, UK.
| | - M Krutikov
- UCL Institute of Health Informatics, London, UK
| | - B Azmi
- UCL Institute of Health Informatics, London, UK
| | | | - A Hayward
- UCL Institute of Epidemiology & Healthcare, London, UK; Health Data Research UK, London, UK
| | - A Copas
- Institute for Global Health, University College London, London, UK
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6
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Lakon CM, Hipp JR. Socio-spatial health disparities in Covid-19 cases and deaths in United States skilled nursing facilities over 30 months. Am J Infect Control 2024; 52:3-14. [PMID: 37562597 DOI: 10.1016/j.ajic.2023.07.008] [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: 03/30/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND This study investigated whether socio-spatial factors surrounding United States skilled nursing facilities related to Covid-19 case counts among residents, staff, and facility personnel and deaths among residents. METHODS With data on 12,403 United States skilled nursing facilities and Census data we estimated multilevel models to assess relationships between facility and surrounding area characteristics from June 2020 to September 2022 for cumulative resident and facility personnel case counts and resident deaths. RESULTS Facilities with more Black or Latino residents experienced more cases incident rate ratios (IRR = 1.005; 1.004) and deaths (IRR = 1.008) among residents during the first 6 months of the pandemic but were no different thereafter. Facilities with more racial and ethnic heterogeneity and percent Black or Latino in the surrounding buffer experienced more Covid-19 cases and deaths in the first 6 months, but no such differences were observed in the subsequent 24 months. Facilities surrounded by higher percent Latino consistently experienced more cases among staff and facility personnel over the study period (IRR = 1.006; 1.001). CONCLUSIONS Findings indicated socio-spatial health disparities in cases among residents, staff, and facility personnel in the first 6 months of the pandemic, with some disparities fading thereafter. This pattern likely suggests the importance of the adoption and adherence to pandemic-related safety measures in skilled nursing facilities nationwide.
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Affiliation(s)
- Cynthia M Lakon
- Department of Health, Society, & Behavior, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine
| | - John R Hipp
- Department of Criminology, Law and Society in the School of Social Ecology, and Department of Sociology, University of California, Irvine.
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Reses HE, Dubendris H, Haas L, Barbre K, Ananth S, Rowe T, Mothershed E, Hall E, Wiegand RE, Lindley MC, Meyer S, Patel SA, Benin A, Kroop S, Srinivasan A, Bell JM. Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines Among Nursing Home Residents - National Healthcare Safety Network, United States, December 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1371-1376. [PMID: 38127673 PMCID: PMC10754267 DOI: 10.15585/mmwr.mm7251a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Nursing home residents are at risk for becoming infected with and experiencing severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Fall 2023 is the first season during which vaccines are simultaneously available to protect older adults in the United States against all three of these respiratory viruses. Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents during the current 2023-24 respiratory virus season. As of December 10, 2023, 33.1% of nursing home residents were up to date with vaccination against COVID-19. Among residents at 20.2% and 19.4% of facilities that elected to report, coverage with influenza and RSV vaccines was 72.0% and 9.8%, respectively. Vaccination varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. There is an urgent need to protect nursing home residents against severe outcomes of respiratory illnesses by continuing efforts to increase vaccination against COVID-19 and influenza and discussing vaccination against RSV with eligible residents during the ongoing 2023-24 respiratory virus season.
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Moa A, Kunasekaran M, Akhtar Z, Costantino V, MacIntyre CR. Systematic review of influenza vaccine effectiveness against laboratory-confirmed influenza among older adults living in aged care facilities. Hum Vaccin Immunother 2023; 19:2271304. [PMID: 37929779 PMCID: PMC10629430 DOI: 10.1080/21645515.2023.2271304] [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: 07/09/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
We estimated the effectiveness of influenza vaccines in preventing laboratory-confirmed influenza among older adults in aged care. Electronic database searches were conducted using search terms, and studies were selected as per the selection criteria. Fourteen studies were included for final review. The studies exhibited considerable variation in reported vaccine effectiveness (VE) across different seasons. Among the observational studies, VE ranged from 7.2% to 89.8% against laboratory-confirmed influenza across different vaccines. Randomized clinical trials demonstrated a 17% reduction in infection rates with the adjuvanted trivalent vaccine. The limitations include the small number of included studies conducted in different countries or regions, varied seasons, variations in diagnostic testing methods, a focus on the A/H3N2 strain, and few studies available on the effectiveness of enhanced influenza vaccines in aged care settings. Despite challenges associated with achieving optimal protection, the studies showed the benefits of influenza vaccination in the elderly residents.
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Affiliation(s)
- Aye Moa
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Zubair Akhtar
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Valentina Costantino
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
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9
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Lv L, Wu XD, Yan HJ, Zhao SY, Zhang XD, Zhu KL. The disparity in hesitancy toward COVID-19 vaccination between older individuals in nursing homes and those in the community in Taizhou, China. BMC Geriatr 2023; 23:828. [PMID: 38066433 PMCID: PMC10709861 DOI: 10.1186/s12877-023-04518-5] [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: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Older individuals are priority coronavirus disease 2019 (COVID-19) vaccine recipients. Our aim was to investigate the prevalence of and factors influencing vaccine hesitancy in older individuals living in nursing homes and communities. METHODS A self-administered COVID-19 vaccine hesitancy survey was conducted from September 2021 to December 2021 among people aged ≥ 60 years in eight nursing homes (382 participants) and the community (112 participants) in Taizhou, China. The response rate was 72.1% (382/530) for older adults in nursing homes and 68.7% (112/163) for older adults in the community. RESULTS We found that 58.1% of the older individuals in nursing homes and 36.6% of those in the community were hesitant to receive the COVID-19 vaccine and that there was a statistically significant difference (P < 0.001). Multiple logistic regression results indicated that the main factors influencing hesitation among the older individuals in nursing homes were being male (Odds Ratio (OR) = 1.67, 95% Confidence Interval (CI): 1.01-2.76); their cognitive level, including having a high perceived risk of COVID-19 infection (OR = 3.06, 95% CI: 1.73-5.43) or the perception of low vaccine safety (OR = 3.08, 95% CI: 1.545- 6.145); anxiety (OR = 3.43, 95% CI: 1.96-5.99); and no previous influenza vaccination (OR = 1.82, 95% CI: 1.13-2.93); whereas those for older individuals in the community were comorbid chronic diseases (OR = 3.13, 95% CI: 1.11- 8.78) and community workers not recommending the vaccine (OR = 8.223, 95% CI: 1.77-38.27). CONCLUSION The proportion of older individuals in nursing homes who were hesitant to receive the COVID-19 vaccine was significantly higher than for older individuals in the community. Targeted measures should be implemented to reduce vaccine hesitancy and improve vaccination rates in response to the special environment of nursing homes and the characteristics of this population.
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Affiliation(s)
- Li Lv
- The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, Zhejiang Province, China
| | - Xu-Dong Wu
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Huan-Jun Yan
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Shuang-Ying Zhao
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Xiao-Dong Zhang
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Ke-Lei Zhu
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China.
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Temte JL, Checovich MM, Barlow S, Shult PA, Reisdorf E, Haupt TE, Hamrick I, Mundt MP. Rapid Detection of Influenza Outbreaks in Long-Term Care Facilities Reduces Emergency Room Visits and Hospitalization: A Randomized Trial. J Am Med Dir Assoc 2023; 24:1904-1909. [PMID: 37421970 DOI: 10.1016/j.jamda.2023.05.035] [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: 01/20/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To assess whether the use of rapid influenza diagnostic tests (RIDTs) for long-term care facility (LTCF) residents with acute respiratory infection is associated with increased antiviral use and decreased health care utilization. DESIGN Nonblinded, pragmatic, randomized controlled trial evaluating a 2-part intervention with modified case identification criteria and nursing staff-initiated collection of nasal swab specimen for on-site RIDT. SETTING AND PARTICIPANTS Residents of 20 LTCFs in Wisconsin matched by bed capacity and geographic location and then randomized. METHODS Primary outcome measures, expressed as events per 1000 resident-weeks, included antiviral treatment courses, antiviral prophylaxis courses, total emergency department (ED) visits, ED visits for respiratory illness, total hospitalizations, hospitalizations for respiratory illness, hospital length of stay, total deaths, and deaths due to respiratory illness over 3 influenza seasons. RESULTS Oseltamivir use for prophylaxis was higher at intervention LTCFs [2.6 vs 1.9 courses per 1000 person-weeks; rate ratio (RR) 1.38, 95% CI 1.24-1.54; P < .001]; rates of oseltamivir use for influenza treatment were not different. Rates of total ED visits (7.6 vs 9.8/1000 person-weeks; RR 0.78, 95% CI 0.64-0.92; P = .004), total hospitalizations (8.6 vs 11.0/1000 person-weeks; RR 0.79, 95% CI 0.67-0.93; P = .004), and hospital length of stay (35.6 days vs 55.5 days/1000 person-weeks; RR 0.64, 95% CI 0.0.59-0.69; P < .001) were lower at intervention as compared to control LTCFs. No significant differences were noted for respiratory-related ED visits or hospitalizations or in rates for all-cause or respiratory-associated mortality. CONCLUSIONS AND IMPLICATIONS The use of low threshold criteria to trigger nursing staff-initiated testing for influenza with RIDT resulted in increased prophylactic use of oseltamivir. There were significant reductions in the rates of all-cause ED visits (22% decline), hospitalizations (21% decline), and hospital length of stay (36% decline) across 3 combined influenza seasons. No significant differences were noted in respiratory-associated and all-cause deaths between intervention and control sites.
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Affiliation(s)
- Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA.
| | - Mary M Checovich
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Shari Barlow
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Peter A Shult
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Thomas E Haupt
- Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA
| | - Irene Hamrick
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
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11
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Gettler EB, Talbot HK, Zhu Y, Ndi D, Mitchel E, Markus TM, Schaffner W, Harris B, Talbot TR. Traditional definition of healthcare-associated influenza underestimates cases associated with other healthcare exposures in a population-based surveillance system. Infect Control Hosp Epidemiol 2023; 44:1816-1822. [PMID: 37073852 PMCID: PMC10665871 DOI: 10.1017/ice.2023.64] [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: 12/16/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To provide comprehensive population-level estimates of the burden of healthcare-associated influenza. DESIGN Retrospective cross-sectional study. SETTING US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2012-2013 through 2018-2019 influenza seasons. PATIENTS Laboratory-confirmed influenza-related hospitalizations in an 8-county catchment area in Tennessee. METHODS The incidence of healthcare-associated influenza was determined using the traditional definition (ie, positive influenza test after hospital day 3) in addition to often underrecognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a noninfluenza illness in the preceding 7 days. RESULTS Among the 5,904 laboratory-confirmed influenza-related hospitalizations, 147 (2.5%) had traditionally defined healthcare-associated influenza. When we included patients with a positive influenza test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a noninfluenza illness in the preceding 7 days, we identified an additional 1,031 cases (17.5% of all influenza-related hospitalizations). CONCLUSIONS Including influenza cases associated with preadmission healthcare exposures with traditionally defined cases resulted in an 8-fold higher incidence of healthcare-associated influenza. These results emphasize the importance of capturing other healthcare exposures that may serve as the initial site of viral transmission to provide more comprehensive estimates of the burden of healthcare-associated influenza and to inform improved infection prevention strategies.
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Affiliation(s)
- Erin B. Gettler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - H. Keipp Talbot
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danielle Ndi
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Mitchel
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tiffanie M. Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan Harris
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas R. Talbot
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Hickey J, Rancourt DG. Predictions from standard epidemiological models of consequences of segregating and isolating vulnerable people into care facilities. PLoS One 2023; 18:e0293556. [PMID: 37903148 PMCID: PMC10615287 DOI: 10.1371/journal.pone.0293556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/15/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVES Since the declaration of the COVID-19 pandemic, many governments have imposed policies to reduce contacts between people who are presumed to be particularly vulnerable to dying from respiratory illnesses and the rest of the population. These policies typically address vulnerable individuals concentrated in centralized care facilities and entail limiting social contacts with visitors, staff members, and other care home residents. We use a standard epidemiological model to investigate the impact of such circumstances on the predicted infectious disease attack rates, for interacting robust and vulnerable populations. METHODS We implement a general susceptible-infectious-recovered (SIR) compartmental model with two populations: robust and vulnerable. The key model parameters are the per-individual frequencies of within-group (robust-robust and vulnerable-vulnerable) and between-group (robust-vulnerable and vulnerable-robust) infectious-susceptible contacts and the recovery times of individuals in the two groups, which can be significantly longer for vulnerable people. RESULTS Across a large range of possible model parameters including degrees of segregation versus intermingling of vulnerable and robust individuals, we find that concentrating the most vulnerable into centralized care facilities virtually always increases the infectious disease attack rate in the vulnerable group, without significant benefit to the robust group. CONCLUSIONS Isolated care homes of vulnerable residents are predicted to be the worst possible mixing circumstances for reducing harm in epidemic or pandemic conditions.
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Affiliation(s)
- Joseph Hickey
- Correlation Research in the Public Interest, Ottawa, Ontario, Canada
| | - Denis G. Rancourt
- Correlation Research in the Public Interest, Ottawa, Ontario, Canada
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13
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Alsaif F, Twigg M, Scott S, Blyth A, Wright D, Patel A. A systematic review of barriers and enablers associated with uptake of influenza vaccine among care home staff. Vaccine 2023; 41:6156-6173. [PMID: 37673716 DOI: 10.1016/j.vaccine.2023.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Barriers and enablers to vaccination of care home (CH) staff should be identified in order to develop interventions to address them that increase uptake and protect residents. We aimed to synthesis the evidence describing the barriers and enablers that affect the influenza vaccination uptake of care home (CH) staff. METHOD We searched PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, IBSS, SCOPUS to identify quantitative, qualitative or mixed-method studies. Data related to health or social care workers in CHs reported barriers or enablers were extracted and mapped to the Theoretical Domains Framework (TDF); the data within each domain were grouped and categorized into key factors affecting influenza vaccine uptake among CH staff. RESULTS We screened 4025 studies; 42 studies met our inclusion criteria. Thirty-four (81 %) were surveys. Five theoretical domains were frequently reported as mediators of influenza vaccine uptake: Beliefs about consequences (32 studies), Environmental context and resources (30 studies), Emotions (26 studies), Social influences (25 studies), Knowledge (22 studies). The low acceptance rate of the influenza vaccine among CH staff can be attributed to multiple factors, including insufficient understanding of the vaccine, its efficacy, or misconceptions about the vaccine (knowledge), perceiving the vaccine as ineffective and unsafe (beliefs about consequences), fear of influenza vaccine and its side effects (emotions), and experiencing limited accessibility to the vaccine (environmental context and resources). CONCLUSION Interventions aimed at increasing influenza vaccine uptake among CH staff should focus on addressing the barriers identified in this review. These interventions should include components such as enhancing knowledge by providing accurate information about vaccine benefits and safety, addressing negative beliefs by challenging misconceptions, managing concerns and fears through open communication, and improving accessibility to the vaccine through convenient on-site options. This review provides a foundation for the development of tailored Interventions to improve influenza vaccine uptake among CH staff.
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Affiliation(s)
- Faisal Alsaif
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Michael Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Sion Scott
- School of Healthcare, University of Leicester, University Road, Leicester LE1 7RH, UK.
| | - Annie Blyth
- School of Economics, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - David Wright
- School of Healthcare, University of Leicester, University Road, Leicester LE1 7RH, UK.
| | - Amrish Patel
- School of Economics, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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14
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Henriques HR, Sousa D, Faria J, Pinto J, Costa A, Henriques MA, Durão MC. Learning from the covid-19 outbreaks in long-term care facilities: a systematic review. BMC Geriatr 2023; 23:618. [PMID: 37784017 PMCID: PMC10546730 DOI: 10.1186/s12877-023-04319-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has devastatingly affected Long-Term Care Facilities (LTCF), exposing aging people, staff members, and visitors. The world has learned through the pandemic and lessons can be taken to adopt effective measures to deal with COVID-19 outbreaks in LTCF. We aimed to systematically review the available evidence on the effect of measures to minimize the risk of transmission of COVID-19 in LTCs during outbreaks since 2021. METHODS The search method was guided by the preferred reporting items for systematic reviews (PRISMA) and the reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. The search was performed in April 2023. Observational and interventional studies from the databases of PubMed, Web of Science, Scopus, Cochrane Systematic Reviews, CINAHL, and Academic Search were systematically reviewed. We included studies conducted in the LTCF with outbreaks that quantitatively assess the effect of non-pharmacological measures on cases of COVID-19. Two review authors independently reviewed titles for inclusion, extracted data, and undertook the risk of bias according to pre-specified criteria. The quality of studies was analyzed using the Joanna Briggs Institute Critical Appraisal. RESULTS Thirteen studies were included, with 8442 LTCF experiencing COVID-19 outbreaks and 598 thousand participants (residents and staff members). Prevention and control of COVID-19 infection interventions were grouped into three themes: strategic, tactical, and operational measures. The strategic measures reveal the importance of COVID-19 prevention and control as LTCF structural characteristics, namely the LTCF size, new admissions, infection control surveillance, and architectural structure. At the tactical level, the lack of personal and long staff shifts is related to COVID-19's spread. Operational measures with a favorable effect on preventing COVID-19 transmission are sufficient. Personal protective equipment stock, correct mask use, signaling, social distancing, and resident cohorting. CONCLUSIONS Operational, tactical, and strategic approaches may have a favorable effect on preventing the spread of COVID-19 in LTCFs experiencing outbreaks. Given the heterogeneous nature of the measures, performing a meta-analysis was not possible. Future research should use more robust study designs to explore similar infection control measures in LTCFs during endemic situations with comparable outbreaks. TRIAL REGISTRATION The protocol of this systematic review was registered in PROSPERO (CRD42020214566).
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Affiliation(s)
- Helga Rafael Henriques
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal.
| | - Diana Sousa
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal
| | - José Faria
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal
| | - Joana Pinto
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal
| | - Andreia Costa
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal
- Instituto de Saúde Ambiental - ISAMB, Lisbon Medical School - Avenida Professor Egas Moniz MB, 1649-028, Lisbon, Portugal
| | - Maria Adriana Henriques
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal
- Instituto de Saúde Ambiental - ISAMB, Lisbon Medical School - Avenida Professor Egas Moniz MB, 1649-028, Lisbon, Portugal
| | - Maria Cândida Durão
- Escola Superior de Enfermagem de Lisboa, CIDNUR - Nursing Research, Innovation and Development Centre of Lisbon, Avenida Prof Egas Moniz, 1600-190, Lisbon, Portugal
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15
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Gravningen K, Nymark P, Wyller TB, Kacelnik O. A new automated national register-based surveillance system for outbreaks in long-term care facilities in Norway detected three times more severe acute respiratory coronavirus virus 2 (SARS-CoV-2) clusters than traditional methods. Infect Control Hosp Epidemiol 2023; 44:1451-1457. [PMID: 36524319 PMCID: PMC10507514 DOI: 10.1017/ice.2022.297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop and test a new automated surveillance system that can detect, define and characterize infection clusters, including coronavirus disease 2019 (COVID-19), in long-term care facilities (LTCFs) in Norway by combining existing national register data. BACKGROUND The numerous outbreaks in LTCFs during the COVID-19 pandemic highlighted the need for accurate and timely outbreak surveillance. As traditional methods were inadequate, we used severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as a model to test automated surveillance. METHODS We conducted a nationwide study using data from the Norwegian preparedness register (Beredt C19) and defined the study population as an open cohort from January 2020 to December 2021. We analyzed clusters (≥3 individuals with positive SARS-CoV-2 test ≤14 days) by 4-month periods including cluster size, duration and composition, and residents' mortality associated with clusters. RESULTS The study population included 173,907 individuals; 78% employees and 22% residents. Clusters were detected in 427 (43%) of 993 LTCFs. The median cluster size was 4-8 individuals (maximum, 50) by 4-month periods, with a median duration of 9-17 days. Employees represented 60%-82% of cases in clusters and were index cases in 60%-90%. In the last 4-month period of 2020, we detected 107 clusters (915 cases) versus 428 clusters (2,998 cases) in the last period of 2021. The 14-day all-cause mortality rate was higher in resident cases from the clusters. Varying the cluster definitions changed the number of clusters. CONCLUSION Automated national surveillance for SARS-CoV-2 clusters in LTCFs is possible based on existing data sources and provides near real-time detailed information on size, duration, and composition of clusters. Thus, this system can assist in early outbreak detection and improve surveillance.
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Affiliation(s)
- Kirsten Gravningen
- Department of Infection Prevention and Preparedness, Norwegian Institute of Public Health (NIPH), Oslo, Norway
- Department of Microbiology and Infection Control, Akershus University Hospital, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petter Nymark
- Department of Infection Prevention and Preparedness, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Torgeir B. Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Oliver Kacelnik
- Department of Infection Prevention and Preparedness, Norwegian Institute of Public Health (NIPH), Oslo, Norway
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16
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Collini F, Bonaccorsi G, Del Riccio M, Bruschi M, Forni S, Galletti G, Gemmi F, Ierardi F, Lorini C. Does Vaccine Confidence Mediate the Relationship between Vaccine Literacy and Influenza Vaccination? Exploring Determinants of Vaccination among Staff Members of Nursing Homes in Tuscany, Italy, during the COVID-19 Pandemic. Vaccines (Basel) 2023; 11:1375. [PMID: 37631943 PMCID: PMC10458978 DOI: 10.3390/vaccines11081375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Low coverage of influenza vaccination in nursing home (NH) staff may be attributed to factors such as vaccine confidence (VC) and vaccine literacy (VL). Our study aimed to evaluate the role of VL and VC in predicting the intention to get the influenza vaccine in a sample of employees of NHs in Tuscany, Italy. METHODS Data from staff members in Tuscany were collected using an online questionnaire that examined influenza vaccination history, intentions, demographic information, health status, and VL. Statistical analyses explored the relationships between VC, VL, and vaccination intentions. RESULTS The study included 1794 respondents, (86.3%) and assistants/aides (58.1%), with a median age of 46 years. The intention to get vaccinated was significantly higher among those with health risk conditions, and there was a positive association between VC and VL, specifically its interactive/critical component. The mediation analysis showed that VC completely mediated the relationship between VL and the intention to get vaccinated, with significant effects observed in different subgroups. CONCLUSIONS VC is a key factor that mediates the effect of VL on vaccine intention. These results suggest that interventions aimed at improving VL alone may not be sufficient to increase vaccine uptake unless VC is also addressed.
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Affiliation(s)
- Francesca Collini
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
| | | | - Marco Del Riccio
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Mario Bruschi
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Silvia Forni
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
| | - Giacomo Galletti
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
| | - Fabrizio Gemmi
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
| | - Francesca Ierardi
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
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Beogo I, Sia D, Collin S, Phaelle Gedeon A, Louismé MC, Ramdé J, Gagnon MP, Tchouaket Nguemeleu E. Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies. JMIR Aging 2023; 6:e46753. [PMID: 37578824 PMCID: PMC10463087 DOI: 10.2196/46753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/20/2023] [Accepted: 06/09/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disproportionately and severely affected older adults, namely those living in long-term care facilities (LTCFs). Aside from experiencing high mortality rates, survivors were critically concerned by social isolation and loneliness (SIL). To address this serious public health concern and stay connected with LTCF residents, information and communication technology (ICT) platforms (eg, video calls) were used as an alternative to maintaining social interactions amid the visiting restriction policy. OBJECTIVE This paper aimed to synthesize the effects of ICT-related communication interventions using SMS text messaging or chat, video, voice mail, or photo to address SIL in LTCF residents during the COVID-19 pandemic. METHODS In total, 2793 references published in English and French in 2019 and onward were obtained from 10 relevant databases: PsycINFO-Ovid, Ovid-MEDLINE, CINAHL-EBSCO, Cochrane Library, Web of Science, Scopus, DirectScience, Communication & Mass Media Complete, IEEE Xplore, and ACM Digital Library. A 2-person screening approach was used, and the studies were screened independently and blindly. A narrative synthesis was performed to interpret the results of the included studies, and their quality was appraised. RESULTS In total, 4 studies were included in the review. ICT-related applications were used to ensure connectedness to address SIL. ICT interventions consisted mainly of videoconferencing, intergroup video call sessions between residents, and chatting (SMS text messages and phone calls). Roughly 3 classes of mediating ICT tools were used: video calls using software applications (eg, Skype); robot systems embedding video telephones; and ordinary telecommunication such as telephone, internet, social media platforms, and videoconferencing. This review has included the role of humanoid robots in LTCFs as an innovation avenue because of their multipurpose use (eg, communication tools and remotely operable). CONCLUSIONS Remote social capitalization through ICT applications has become an avenue to reduce SIL among LTCF residents. This review examined a social connection approach that will remain relevant and even be fostered after the COVID-19 pandemic. As families remain the main stakeholders of LTCFs, this study's findings could inform policy makers and frontline managers to better shape programs and initiatives to prevent or reduce SIL in LTCFs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/36269.
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Affiliation(s)
| | - Drissa Sia
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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18
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Boyer J, König E, Friedl H, Pux C, Uhlmann M, Schippinger W, Krause R, Zollner-Schwetz I. Sustained Increase in Very Low Influenza Vaccination Coverage in Residents and Healthcare Workers of Long-Term Care Facilities in Austria after Educational Interventions. Vaccines (Basel) 2023; 11:1066. [PMID: 37376455 DOI: 10.3390/vaccines11061066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Residents of long-term care facilities (LTCFs) are particularly at risk for influenza infections. We aimed to improve influenza vaccination coverage among residents and healthcare workers (HCWs) in four LTCFs by implementing educational programs and enhanced vaccination services. We compared vaccination coverage before and after the interventions (2017/18 and 2018/19 seasons). Data on vaccination adherence were recorded during a four-year observational period (2019/20 to 2022/23 seasons). Following the interventions, vaccination coverage increased significantly from 5.8% (22/377) to 19.1% (71/371) in residents and from 1.3% (3/234) to 19.7% (46/233) in HCWs (p < 0.001). During the observational period (2019/20 to 2022/23 seasons), vaccination coverage remained high in residents but decreased in HCWs. Vaccination adherence was significantly higher in residents and HCWs in LTCF 1 compared to the other three LTCFs. Our study suggests that a bundle of educational interventions and enhanced vaccination services can be an effective method for improving influenza vaccination coverage in LTCFs in both residents and HCWs. However, vaccination rates are still well below the recommended targets and further efforts are needed to increase vaccine coverage in our LTCFs.
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Affiliation(s)
- Johannes Boyer
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Elisabeth König
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Herwig Friedl
- Institute of Statistics, Graz University of Technology, 8010 Graz, Austria
| | - Christian Pux
- Geriatric Health Centers of the City of Graz, 8020 Graz, Austria
| | - Michael Uhlmann
- Geriatric Health Centers of the City of Graz, 8020 Graz, Austria
| | | | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Ines Zollner-Schwetz
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
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19
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Andersen MP, Mills EHA, Meddis A, Sørensen KK, Butt JH, Køber L, Poulsen HE, Phelps M, Gislason G, Christensen HC, Schou M, Fosbøl EL, Gerds TA, Kragholm K, Torp-Pedersen C. All-cause mortality among Danish nursing home residents before and during the COVID-19 pandemic: a nationwide cohort study. Eur J Epidemiol 2023; 38:523-531. [PMID: 37012504 PMCID: PMC10069726 DOI: 10.1007/s10654-023-00994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
A substantial part of mortality during the COVID-19-pandemic occurred among nursing home residents which caused alarm in many countries. We investigate nursing home mortality in relation to the expected mortality prior to the pandemic. This nationwide register-based study included all 135,501 Danish nursing home residents between 2015 until October 6, 2021. All-cause mortality rates were calculated using a standardization method on sex and age distribution of 2020. Survival probability and lifetime lost for 180 days was calculated using Kaplan Meier estimates. Of 3,587 COVID-19 related deaths, 1137 (32%) occurred among nursing home residents. The yearly all-cause mortality rates per 100,000 person-years in 2015, 2016, and 2017 were 35,301 (95% CI: 34,671-35,943), 34,801 (95% CI: 34,180-35,432), and 35,708 (95% CI: 35,085-36,343), respectively. Slightly elevated mortality rates per 100,000 person-years were seen in 2018, 2019, 2020, and 2021 of 38,268 (95% CI: 37,620-38,929), 36,956 (95% CI: 36,323-37,600), 37,475 (95% CI: 36,838-38,122), and 38,536 (95% CI: 37,798-39,287), respectively. For SARS-CoV-2-infected nursing home residents, lifetime lost difference was 42 days (95% CI: 38-46) in 2020 versus non-infected in 2018. Among vaccinated in 2021, lifetime lost difference was 25 days (95% CI: 18-32) for SARS-CoV-2-infected versus non-infected. Even though a high proportion of COVID-19 fatalities took place in nursing homes and SARS-CoV-2-infection increased the risk of individual death, the annual mortality was only slightly elevated. For future epidemics or pandemics reporting numbers of fatal cases in relation to expected mortality is critical.
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Affiliation(s)
| | | | - Alessandra Meddis
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Kold Sørensen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
- Department of Endocrinology, Copenhagen University Hospital at Bispebjerg Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Gunnar Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Alexander Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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20
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Quinn E, Hsiao KH, Johnstone T, Gomez M, Parasuraman A, Ingleton A, Hirst N, Najjar Z, Gupta L. Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study. JMIR Form Res 2023; 7:e38080. [PMID: 36763638 PMCID: PMC10013678 DOI: 10.2196/38080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. OBJECTIVE The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. METHODS The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. RESULTS Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. CONCLUSIONS FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales.
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Affiliation(s)
- Emma Quinn
- Public Health Unit, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Kai Hsun Hsiao
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Travers Johnstone
- Public Health Unit, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Maria Gomez
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Arun Parasuraman
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Andrew Ingleton
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Nicholas Hirst
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Zeina Najjar
- Public Health Unit, Sydney Local Health District, Sydney, Australia
| | - Leena Gupta
- Public Health Unit, Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
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21
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains asymptomatic in 33% to 90% of older adults depending on their immune status from prior infection, vaccination, and circulating strain. Older adults symptomatic with SARS-CoV-2 often both present atypically, such as with a blunted fever response, and develop more severe disease. Early and late reports showed that older adults have increased severity of coronavirus disease 2019 (COVID-19) with higher case fatality rates and higher intensive care needs compared with younger adults. Infection and vaccine-induced antibody response and long-term effects of COVID-19 also differ in older adults.
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22
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Chirico I, Pappadà A, Giebel C, Ottoboni G, Valente M, Gabbay M, Chattat R. The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy. Aging Ment Health 2023; 27:512-520. [PMID: 35333142 DOI: 10.1080/13607863.2022.2056137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The COVID-19 pandemic and public health measures caused serious consequences for several population cohorts, including people with dementia in care homes and their families. The aim of this study was to explore the impact of COVID-19 on care home residents with dementia as experienced by family carers in Italy. Specifically, strategies implemented to overcome the pandemic's constraints, their influence upon care, and consequences for everyday life of residents with dementia and carers were investigated. METHODS Semi-structured interviews explored participants' experiences of the pandemic, its restrictions and the services' status during lockdown. Transcripts were analysed via thematic analysis. RESULTS 26 family carers were interviewed. Three themes emerged: (1) COVID-19 restrictions negatively affected both residents with dementia and family carers, (2) Changing policies in care homes during COVID-19, and (3) Technology use in care homes during COVID-19. COVID-19 restrictions severely affected care home residents with dementia, disrupted their daily living, and accelerated their cognitive decline. Consequently carers' emotional burdens increased. Care home response strategies (safe visiting and digital solutions) were critical, though they were not enough to compensate for the lack of close in-person contacts. CONCLUSIONS Mixed evidence emerged about the feasibility of care home strategies and their associated benefits. To meet arising needs and possible future pandemic waves, there is a need for updated health strategies. These should prioritise a continuity of therapeutic activities and minimize negative effects on residents' quality of life, whilst incorporating feasible and accessible digital solutions to provide remote communication and psychological support for family carers.
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Affiliation(s)
| | | | - Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | | | - Marco Valente
- Department of Psychology, University of Bologna, Italy
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Italy
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23
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Sanz-Muñoz I, López-Mongil R, Sánchez-Martínez J, Sánchez-de Prada L, González MDG, Pérez-SanJose D, Rojo-Rello S, Hernán-García C, Fernández-Espinilla V, de Lejarazu-Leonardo RO, Castrodeza-Sanz J, Eiros JM. Evolution of antibody profiles against SARS-CoV-2 in experienced and naïve vaccinated elderly people. Front Immunol 2023; 14:1128302. [PMID: 36911673 PMCID: PMC9992205 DOI: 10.3389/fimmu.2023.1128302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The third dose of the COVID-19 vaccine is especially necessary in people over 65 years of age due to their lower immune response. Methods We designed a multicentre, prospective observational study including 98 people ≤65 years old who lived in two nursing homes in Valladolid, Spain. One of the groups had previous experience with SARS-CoV-2 (n=68;69.4%) and the other was naïve (n=30;30.6%). We evaluated the response to the three doses of the Comirnaty vaccine and the dynamics of antibodies during 5 consecutive serum samplings: 2 after the first two doses of vaccination, one three months after the first dose, another at 6 months and the last one month after the third dose. IgG antibodies against SARS-CoV-2 S1, RBD and N antigens were analysed. Results Both groups increased the level of Abs against S1 and RBD, but the experienced group showed a 130-fold higher humoral response due to hybrid immunisation (infection+vaccination). The response to vaccination with Comirnaty against COVID-19 was higher in those ≤65 years with previous experience than those who were naïve. However, the amount of antibodies against S1 and RBD equalised at 6 months. After the third dose, both groups raised the amount of antibodies to a similar level. The reinfections suggested by the analysis of antibodies against N were frequent in both groups. Discussion The third dose showed a clear benefit for elderly people, with the reinforcement of the antibody levels after the decline suffered after six months of the first two doses.
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Affiliation(s)
- Iván Sanz-Muñoz
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León, (ICSCYL), Soria, Spain
| | | | - Javier Sánchez-Martínez
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León, (ICSCYL), Soria, Spain
| | - Laura Sánchez-de Prada
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Marta Domínguez-Gil González
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Microbiology Unit, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Diana Pérez-SanJose
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Silvia Rojo-Rello
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Microbiology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina Hernán-García
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Preventive Medicine and Public Health Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Virginia Fernández-Espinilla
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Preventive Medicine and Public Health Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Javier Castrodeza-Sanz
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Preventive Medicine and Public Health Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José María Eiros
- National Influenza Centre, Edificio Rondilla, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Microbiology Unit, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.,Microbiology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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24
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Ratti M, Concina D, Rinaldi M, Salinelli E, Di Brisco AM, Ferrante D, Volpe A, Panella M. Vaccination Strategies against Seasonal Influenza in Long Term Care Setting: Lessons from a Mathematical Modelling Study. Vaccines (Basel) 2022; 11:vaccines11010032. [PMID: 36679877 PMCID: PMC9861048 DOI: 10.3390/vaccines11010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND seasonal influenza in nursing homes is a major public health concern, since in EU 43,000 long term care (LTC) facilities host an estimated 2.9 million elderly residents. Despite specific vaccination campaigns, many outbreaks in such institutions are occasionally reported. We explored the dynamics of seasonal influenza starting from real data collected from a nursing home located in Italy and a mathematical model. Our aim was to identify the best vaccination strategy to minimize cases (and subsequent complications) among the guests. MATERIALS AND METHODS after producing the contact matrices with surveys of both the health care workers (HCW) and the guests, we developed a mathematical model of the disease. The model consists of a classical SEIR part describing the spreading of the influenza in the general population and a stochastic agent based model that formalizes the dynamics of the disease inside the institution. After a model fit of a baseline scenario, we explored the impact of varying the HCW and guests parameters (vaccine uptake and vaccine efficacy) on the guest attack rates (AR) of the nursing home. RESULTS the aggregate AR of influenza like illness in the nursing home was 36.4% (ward1 = 56%, ward2 = 33.3%, ward3 = 31.7%, ward4 = 34.5%). The model fit to data returned a probability of infection of the causal contact of 0.3 and of the shift change contact of 0.2. We noticed no decreasing or increasing AR trend when varying the HCW vaccine uptake and efficacy parameters, whereas the increase in both guests vaccine efficacy and uptake parameter was accompanied by a slight decrease in AR of all the wards of the LTC facility. CONCLUSION from our findings we can conclude that a nursing home is still an environment at high risk of influenza transmission but the shift change room and the handover situation carry no higher relative risk. Therefore, additional preventive measures in this circumstance may be unnecessary. In a closed environment such as a LTC facility, the vaccination of guests, rather than HCWs, may still represent the cornerstone of an effective preventive strategy. Finally, we think that the extensive inclusion of real life data into mathematical models is promising and may represent a starting point for further applications of this methodology.
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Affiliation(s)
- Matteo Ratti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
- Correspondence:
| | - Diego Concina
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Maurizio Rinaldi
- Department of Pharmaceutical Science (DSF), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Ernesto Salinelli
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Agnese Maria Di Brisco
- Department of Studies for Economics and Business (DiSEI), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Alessandro Volpe
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Massimiliano Panella
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy
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25
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Tan MP, Sekawi Z, Abdul Manap R, Razali RM, Mahadzir H, Nordin N, Koh KC, Wong PL, Hasmuk K, Harrun NH, Mokhtar SA. A Malaysian consensus recommendation for the prevention of influenza in older persons. BMC Infect Dis 2022; 22:943. [PMID: 36522615 PMCID: PMC9756619 DOI: 10.1186/s12879-022-07920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Older persons are at high-risk of developing severe complications from influenza. This consensus statement was developed to provide guidance on appropriate influenza prevention strategies relevant to the Malaysian healthcare setting. METHODS Under the initiative of the Malaysian Influenza Working Group (MIWG), a panel comprising 11 multi-speciality physicians was convened to develop a consensus statement. Using a modified Delphi process, the panellists reviewed published evidence on various influenza management interventions and synthesised 10 recommendations for the prevention of influenza among the aged population via group discussions and a blinded rating exercise. RESULTS Overall, annual influenza vaccination is recommended for individuals aged ≥ 60 years, particularly those with specific medical conditions or residing in aged care facilities (ACFs). There is no preference for a particular vaccine type in this target population. Antiviral agents can be given for post-exposure chemoprophylaxis or when vaccine contraindication exists. Infection control measures should serve as adjuncts to prevent the spread of influenza, especially during Hajj. CONCLUSION This consensus statement presents 10 evidence-based recommendations that can be adopted by healthcare providers to prevent influenza among the aged population in Malaysia. It could also serve as a basis for health policy planning in other lower- and middle-income countries.
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Affiliation(s)
- Maw-Pin Tan
- grid.10347.310000 0001 2308 5949Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, Jalan Profesor DiRaja Ungku Aziz, 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Zamberi Sekawi
- grid.11142.370000 0001 2231 800XUniversiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Roslina Abdul Manap
- grid.412113.40000 0004 1937 1557National University of Malaysia, Cheras, Selangor Malaysia
| | - Rizah Mazzuin Razali
- grid.412516.50000 0004 0621 7139Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Hazlina Mahadzir
- Hospital Canselor Tuanku Muhriz, Cheras, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Nordiana Nordin
- KPJ Damansara Specialist Hospital, Petaling Jaya, Selangor Malaysia
| | - Kar-Chai Koh
- Poliklinik Kepong Baru, Kepong, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Pui-Li Wong
- grid.10347.310000 0001 2308 5949Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia
| | - Kejal Hasmuk
- grid.413018.f0000 0000 8963 3111University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia
| | | | - Siti Aisah Mokhtar
- grid.11142.370000 0001 2231 800XUniversiti Putra Malaysia, Serdang, Selangor Malaysia
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26
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Riester MR, Roberts AI, Silva JBB, Howe CJ, Bardenheier BH, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents. Open Forum Infect Dis 2022; 9:ofac634. [PMID: 36540392 PMCID: PMC9757686 DOI: 10.1093/ofid/ofac634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Disparities in influenza vaccination exist between Hispanic and non-Hispanic White US nursing home (NH) residents, but the geographic areas with the largest disparities remain unknown. We examined how these racial/ethnic disparities differ across states and hospital referral regions (HRRs). METHODS This retrospective cohort study included >14 million short-stay and long-stay US NH resident-seasons over 7 influenza seasons from October 1, 2011, to March 31, 2018, where residents could contribute to 1 or more seasons. Residents were aged ≥65 years and enrolled in Medicare fee-for-service. We used the Medicare Beneficiary Summary File to ascertain race/ethnicity and Minimum Data Set assessments for influenza vaccination. We calculated age- and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic White and Hispanic (any race) resident-seasons. Positive pp differences were considered disparities, where the proportion of non-Hispanic White residents vaccinated was greater than the proportion of Hispanic residents vaccinated. States and HRRs with ≥100 resident-seasons per age-sex stratum per racial/ethnic group were included in analyses. RESULTS Among 7 442 241 short-stay resident-seasons (94.1% non-Hispanic White, 5.9% Hispanic), the median standardized disparities in influenza vaccination were 4.3 pp (minimum, maximum: 0.3, 19.2; n = 22 states) and 2.8 pp (minimum, maximum: -3.6, 10.3; n = 49 HRRs). Among 6 758 616 long-stay resident-seasons (93.7% non-Hispanic White, 6.5% Hispanic), the median standardized differences were -0.1 pp (minimum, maximum: -4.1, 11.4; n = 18 states) and -1.8 pp (minimum, maximum: -6.5, 7.6; n = 34 HRRs). CONCLUSIONS Wide geographic variation in influenza vaccination disparities existed across US states and HRRs. Localized interventions targeted toward areas with high disparities may be a more effective strategy to promote health equity than one-size-fits-all national interventions.
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Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Anthony I Roberts
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Epidemiologic Research, Brown University, Providence, Rhode Island, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Westat LLC, Rockville, Maryland, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Modelling, Epidemiology, and Data Science, Global Medical Affairs, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, Swiftwater, Pennsylvania, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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27
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Kunasekaran M, Moa A, Hooshmand E, Trent M, Poulos CJ, Chughtai AA, Heslop DJ, Raina MacIntyre C. Effectiveness estimates for enhanced trivalent influenza vaccines in an aged care summer outbreak. Vaccine 2022; 40:7170-7175. [PMID: 36328885 DOI: 10.1016/j.vaccine.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022]
Abstract
An influenza outbreak occurred during summer (February 2019) in an aged-care facility in Sydney, Australia. Residents had not received the annual 2019 influenza vaccine while 76.7% had received 2018 influenza vaccines about 9 months prior. Overall, 2018 influenza vaccine effectiveness during this outbreak was high (93.6%). The effectiveness of the high-dose trivalent vaccine (HD-TIV) and adjuvanted trivalent (a-TIV) vaccine were 89.8% (95% confidence interval: 18.8%-98.7%) and 72.5% (95% confidence interval: -106.7%-96.3%) respectively. The differences in effectiveness between HD-TIV, a-TIV and SD-QIV, during the summer outbreak were not significant.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Aye Moa
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Elmira Hooshmand
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Mallory Trent
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
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28
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Kunasekaran M, Poulos CJ, Chughtai AA, Heslop DJ, MacIntyre CR. Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019. Vaccine 2022; 40:7238-7246. [PMID: 36328882 DOI: 10.1016/j.vaccine.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIM Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019. METHODS Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination. RESULTS From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group. CONCLUSION The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia; College of Public Service and Community Solutions and College ofHealth Solutions, Arizona StateUniversity, Tempe, AZ, USA
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Does Influenza Vaccination Reduce the Risk of Contracting COVID-19? J Clin Med 2022; 11:jcm11185297. [PMID: 36142944 PMCID: PMC9504696 DOI: 10.3390/jcm11185297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
The concurrent timing of the COVID-19 pandemic and the seasonal occurrence of influenza, makes it especially important to analyze the possible effect of the influenza vaccine on the risk of contracting COVID-19, or in reducing the complications caused by both diseases, especially in vulnerable populations. There is very little scientific information on the possible protective role of the influenza vaccine against the risk of contracting COVID-19, particularly in groups at high-risk of influenza complications. Reducing the risk of contracting COVID-19 in high-risk patients (those with a higher risk of infection, complications, and death) is essential to improve public well-being and to reduce hospital pressure and the collapse of primary health centers. Apart from overlapping in time, COVID-19 and flu share common aspects of transmission, so that measures to protect against flu might be effective in reducing the risk of contracting COVID-19. In this study, we conclude that the risk of contracting COVID-19 is reduced if patients are vaccinated against flu, but the reduction is small (0.22%) and therefore not clinically important. When this reduction is analysed based on the risk factor suffered by the patient, statistically significant differences have been obtained for patients with cardiovascular problems, diabetics, chronic lung and chronic kidney disease; in all four cases the reduction in the risk of contagion does not reach 1%. It is worth highlighting the behaviour that is completely different from the rest of the data for institutionalized patients. The data for these patients does not suggest a reduction in the risk of contagion for patients vaccinated against the flu, but rather the opposite, a significant increase of 6%. Socioeconomic conditions, as measured by the MEDEA deprivation index, explain increases in the risk of contracting COVID-19, and awareness campaigns should be increased to boost vaccination programs.
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Kunasekaran MP, Chughtai AA, Heslop DJ, Poulos CJ, MacIntyre CR. Influenza cases in nine aged care facilities in Sydney, Australia over a three-year surveillance period, 2018-2020. Vaccine 2022; 40:4253-4261. [PMID: 35691870 DOI: 10.1016/j.vaccine.2022.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Influenza outbreaks in aged care facilities are a major public health concern. In response to the severe 2017 influenza season in Australia, enhanced influenza vaccines were introduced from 2018 onwards for those over 65 and more emphasis was placed on improving vaccination rates among aged care staff. During the COVID-19 pandemic, these efforts were then further escalated to reduce the additional burden that influenza could pose to facilities. METHODS An observational epidemiological study was conducted from 2018 to 2020 in nine Sydney (Australia) aged care facilities of the same provider. De-identified vaccination data and physical layout data were collected from participating facility managers from 2018 to 2020. Active surveillance of influenza-like illness was carried out from 2018 to 2020 influenza seasons. Correlation and Poisson regression analyses were carried out to explore the relationship between physical layout variables to occurrence of influenza cases. RESULTS Influenza cases were low in 2018 and 2019, and there were no confirmed influenza cases identified in 2020. Vaccination rates increased among staff by 50.5% and residents by 16.8% over the three-year period of surveillance from 2018 to 2020. For each unit increase in total number of beds, common areas, single rooms, all types of rooms (including double occupancy rooms), the influenza cases increased by 1.02 (95% confidence interval:1.018-1.025), 1.04 (95% confidence interval: 1.019-1.073), 1.03 (95% confidence interval: 1.016-1 0.038) and 1.02 (95% confidence interval:1.005-1.026) times which were found to be statistically significant. For each unit increase in the proportion of shared rooms, influenza cases increased by 1.004 (95% confidence interval:1.0001-1.207) which was found to be statistically significant. CONCLUSIONS There is a relationship between influenza case counts and aspects of the physical layout such as facility size, and this should be considered in assessing risk of outbreaks in aged care facilities. Increased vaccination rates in staff and COVID-19 prevention and control measures may have eliminated influenza in the studied facilities in 2020.
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Affiliation(s)
- Mohana Priya Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Abrar Ahmad Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Chandini Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia
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Blumberg S, Lu P, Kwan AT, Hoover CM, Lloyd-Smith JO, Sears D, Bertozzi SM, Worden L. Modeling scenarios for mitigating outbreaks in congregate settings. PLoS Comput Biol 2022; 18:e1010308. [PMID: 35857774 PMCID: PMC9342784 DOI: 10.1371/journal.pcbi.1010308] [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: 07/12/2021] [Revised: 08/01/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
The explosive outbreaks of COVID-19 seen in congregate settings such as prisons and nursing homes, has highlighted a critical need for effective outbreak prevention and mitigation strategies for these settings. Here we consider how different types of control interventions impact the expected number of symptomatic infections due to outbreaks. Introduction of disease into the resident population from the community is modeled as a stochastic point process coupled to a branching process, while spread between residents is modeled via a deterministic compartmental model that accounts for depletion of susceptible individuals. Control is modeled as a proportional decrease in the number of susceptible residents, the reproduction number, and/or the proportion of symptomatic infections. This permits a range of assumptions about the density dependence of transmission and modes of protection by vaccination, depopulation and other types of control. We find that vaccination or depopulation can have a greater than linear effect on the expected number of cases. For example, assuming a reproduction number of 3.0 with density-dependent transmission, we find that preemptively reducing the size of the susceptible population by 20% reduced overall disease burden by 47%. In some circumstances, it may be possible to reduce the risk and burden of disease outbreaks by optimizing the way a group of residents are apportioned into distinct residential units. The optimal apportionment may be different depending on whether the goal is to reduce the probability of an outbreak occurring, or the expected number of cases from outbreak dynamics. In other circumstances there may be an opportunity to implement reactive disease control measures in which the number of susceptible individuals is rapidly reduced once an outbreak has been detected to occur. Reactive control is most effective when the reproduction number is not too high, and there is minimal delay in implementing control. We highlight the California state prison system as an example for how these findings provide a quantitative framework for understanding disease transmission in congregate settings. Our approach and accompanying interactive website (https://phoebelu.shinyapps.io/DepopulationModels/) provides a quantitative framework to evaluate the potential impact of policy decisions governing infection control in outbreak settings.
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Affiliation(s)
- Seth Blumberg
- University of California San Francisco, Francis I. Proctor Foundation, San Francisco, California, United States of America
- Modeling Infectious Diseases in Healthcare Network, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- University of California San Francisco, Department of Medicine, San Francisco, California, United States of America
| | - Phoebe Lu
- University of California San Francisco, Francis I. Proctor Foundation, San Francisco, California, United States of America
- Modeling Infectious Diseases in Healthcare Network, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ada T. Kwan
- University of California San Francisco, Department of Medicine, San Francisco, California, United States of America
| | - Christopher M. Hoover
- University of California San Francisco, Francis I. Proctor Foundation, San Francisco, California, United States of America
- Modeling Infectious Diseases in Healthcare Network, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James O. Lloyd-Smith
- University of California Los Angeles, Department of Ecology and Evolutionary Biology, Los Angeles, California, United States of America
| | - David Sears
- University of California San Francisco, Department of Medicine, San Francisco, California, United States of America
| | - Stefano M. Bertozzi
- University of California Berkeley, School of Public Health, Berkeley, California, United States of America
- University of Washington, Department of Global Health, Seattle, Washington, United States of America
- National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - Lee Worden
- University of California San Francisco, Francis I. Proctor Foundation, San Francisco, California, United States of America
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Muñoz-Miralles R, Bonet-Esteve A, Rufas-Cebollero A, Fuster-Casanovas A, Pelegrin-Cruz X, Vidal-Alaball J. Influenza vaccination in coronavirus times: Primary Care professionals' intention to get vaccinated in Central Catalonia (VAGCOVID). A cross sectional study. Hum Vaccin Immunother 2022; 18:2067442. [PMID: 35776921 PMCID: PMC9302504 DOI: 10.1080/21645515.2022.2067442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Influenza vaccination is the main measure of prevention against epidemic flu. Although recommended, vaccination coverage remains low. The lack of knowledge about the evolution of influenza in the context of the SARS-CoV-2 coronavirus pandemic led to the recommendation of influenza vaccination to people at risk and professionals to avoid a greater burden than the one already posed by SARS-CoV-2. The aim of the study is to determine health professionals' intention to vaccinate against seasonal flu in the 2020-2021 campaign, in the context of the SARS-CoV-2 pandemic, and to analyse the factors that influence it. Cross-sectional study through a structured survey aimed at Primary Care professionals in Central Catalonia. A total of 610 participants responded to the survey, 65.7% of whom intended to get vaccinated against influenza in this campaign, and 11.1% did not know or did not answer. The intention to get vaccinated is associated with the professional category and the number of years of professional practice. The profile of the professionals who intend to get vaccinated against flu includes professionals with a history of vaccination, who participate in on-call duties and perceive that their dependents were at risk of becoming ill. During the SARS-CoV-2 pandemic, although almost two-thirds of the respondents showed a clear intention to get vaccinated against influenza, 11% were doubtful. To improve influenza vaccination uptake among health professionals, strategies need to be devised to target those professionals who are hesitant or reluctant to vaccinate.
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Affiliation(s)
- Raquel Muñoz-Miralles
- Centre d'Atenció Primària Plaça Catalunya, SAP Bages-Berguedà-Solsonès, Gerència Territorial Catalunya Central Institut Català de la Salut, Manresa, Spain
| | - Anna Bonet-Esteve
- Unitat de Farmàcia, GerènciaTerritorial Catalunya Central Institut Català de la Salut, SantFruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, SantFruitós de Bages, Spain
| | - Anna Rufas-Cebollero
- Centre d'Atenció Primària Manlleu, SAP Osona, Gerència Territorial Catalunya Central, Institut Català de la Salut, Manlleu, Spain
| | - Aïna Fuster-Casanovas
- la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i GurinaUnitat de Suport a , Sant Fruitós de Bages, Spain
| | - Xavier Pelegrin-Cruz
- Departament de Matemàtiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, SantFruitós de Bages, Spain.,la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i GurinaUnitat de Suport a , Sant Fruitós de Bages, Spain.,Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
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Torres ML, Palma Díaz D, Oliver-Parra A, Millet JP, Cosialls D, Guillaumes M, Rius C, Vásquez-Vera H. Inequities in the incidence and mortality due to COVID-19 in nursing homes in Barcelona by characteristics of the nursing homes. PLoS One 2022; 17:e0269639. [PMID: 35696404 PMCID: PMC9191699 DOI: 10.1371/journal.pone.0269639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Residents of Nursing Homes (NHs) have suffered greater impacts from the COVID-19 pandemic. However, the rates of COVID-19 in these institutions are heterogeneously distributed. Describing and understanding the structural, functional, and socioeconomic differences between NHs is extremely important to avoid new outbreaks.
Objectives
Analyze inequalities in the cumulative incidences (CIs) and in the mortality rates (MRs) due to COVID-19 in the NHs of Barcelona based on the characteristics of the NHs.
Methods
Exploratory ecological study of 232 NHs. The dependent variables were the cumulative incidence and mortality rate due to COVID-19 in NHs between March and June 2020. Structural variables of the NHs were evaluated such as neighborhood socioeconomic position (SEP), isolation and sectorization capacity, occupancy, overcrowding and ownership.
Results
The cumulative incidence and mortality rate were higher in the low SEP neighborhoods and lower in those of high SEP neighborhoods. Regarding the isolation and sectorization capacity, Type B NHs had a higher risk of becoming infected and dying, while Type C had a lower risk of dying than Type A. Greater overcrowding was associated with greater morbidity and mortality, and higher occupancy was associated with higher incidence. The risk of becoming infected and dying in public NHs was significantly higher than for-profit NH.
Conclusions
The social components together with the functional and infrastructure characteristics of the NHs influence the cumulative incidence and the mortality rate by COVID-19. It is necessary to redefine the care model in the NHs to guarantee the health of the residents.
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Affiliation(s)
- Mayara Louise Torres
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - David Palma Díaz
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alba Oliver-Parra
- Consorci Sanitari de Barcelona, Barcelona, Catalonia, Spain
- Oficina de Residències de Barcelona, Barcelona, Catalonia, Spain
| | - Joan-Pau Millet
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Delfí Cosialls
- Consorci Sanitari de Barcelona, Barcelona, Catalonia, Spain
- Oficina de Residències de Barcelona, Barcelona, Catalonia, Spain
| | - Montserrat Guillaumes
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Rius
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Hugo Vásquez-Vera
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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de Fougerolles TR, Damm O, Ansaldi F, Chironna M, Crépey P, de Lusignan S, Gray I, Guillen JM, Kassianos G, Mosnier A, de Lejarazu RO, Pariani E, Puig-Barbera J, Schelling J, Trippi F, Vanhems P, Wahle K, Watkins J, Rasuli A, Vitoux O, Bricout H. National influenza surveillance systems in five European countries: a qualitative comparative framework based on WHO guidance. BMC Public Health 2022; 22:1151. [PMID: 35681199 PMCID: PMC9178537 DOI: 10.1186/s12889-022-13433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Influenza surveillance systems vary widely between countries and there is no framework to evaluate national surveillance systems in terms of data generation and dissemination. This study aimed to develop and test a comparative framework for European influenza surveillance. Methods Surveillance systems were evaluated qualitatively in five European countries (France, Germany, Italy, Spain, and the United Kingdom) by a panel of influenza experts and researchers from each country. Seven surveillance sub-systems were defined: non-medically attended community surveillance, virological surveillance, community surveillance, outbreak surveillance, primary care surveillance, hospital surveillance, mortality surveillance). These covered a total of 19 comparable outcomes of increasing severity, ranging from non-medically attended cases to deaths, which were evaluated using 5 comparison criteria based on WHO guidance (granularity, timing, representativeness, sampling strategy, communication) to produce a framework to compare the five countries. Results France and the United Kingdom showed the widest range of surveillance sub-systems, particularly for hospital surveillance, followed by Germany, Spain, and Italy. In all countries, virological, primary care and hospital surveillance were well developed, but non-medically attended events, influenza cases in the community, outbreaks in closed settings and mortality estimates were not consistently reported or published. The framework also allowed the comparison of variations in data granularity, timing, representativeness, sampling strategy, and communication between countries. For data granularity, breakdown per risk condition were available in France and Spain, but not in the United Kingdom, Germany and Italy. For data communication, there were disparities in the timeliness and accessibility of surveillance data. Conclusions This new framework can be used to compare influenza surveillance systems qualitatively between countries to allow the identification of structural differences as well as to evaluate adherence to WHO guidance. The framework may be adapted for other infectious respiratory diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13433-0.
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Affiliation(s)
| | - Oliver Damm
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | | | - Maria Chironna
- Department of Interdisciplinary Medicine - Hygiene Section, University of Bari, Bari, Italy
| | - Pascal Crépey
- Université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes, France
| | - Simon de Lusignan
- University of Oxford, Oxford, UK.,Royal College of General Practitioners, London, UK
| | | | | | | | | | | | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Philippe Vanhems
- CIRI, Centre International de Recherche en Infectiologie, (Team (PHE3ID), Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France.,Hospices Civils de Lyon and Hospices Civils de Lyon (HCL), Lyon, France
| | - Klaus Wahle
- Westfälische Wilhelms-Universität, Munich, Germany
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Meng X, Zhao H, Ou R, Zeng Q, Lv H, Zhu H, Ye M. Epidemiological and Clinical Characteristics of Influenza Outbreaks Among Children in Chongqing, China. Front Public Health 2022; 10:760746. [PMID: 35493383 PMCID: PMC9051075 DOI: 10.3389/fpubh.2022.760746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Influenza is a global serious public health threat. Seasonal influenza among children in Chongqing has been a heavy health burden. To date, few studies have examined the spatial and temporal characteristics of influenza. This research sheds new light on correlating them with influenza outbreaks with data of over 5 years (2014–2018). All cluster outbreaks among preschool and school-age children reported in Chongqing were collected through the Public Health Emergency Management Information System. The demographical, epidemiological, and clinical data of the cases were analyzed. From 2014 to 2018, a total of 111 preschool- and school-based influenza-like illness outbreaks involving 3,549 cases were identified. Several clinical symptoms that were analyzed in this study showed significant contrast between influenza A and B. Spatial autocorrelation analysis over the 5-year data detected Xiushan district being the most likely cluster. The exploration of the spatial distribution and clinical characteristics of influenza cluster of children in Chongqing could help the effective implementation of health policies. Future studies should be conducted to monitor the outbreaks of influenza among children.
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Affiliation(s)
- Xuchen Meng
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Clinical College, Chongqing Medical University, Chongqing, China
| | - Han Zhao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Rong Ou
- The Library, Chongqing Medical University, Chongqing, China
| | - Qing Zeng
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Huiqun Lv
- The Library, Chongqing Medical University, Chongqing, China
| | - Hua Zhu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
- *Correspondence: Mengliang Ye
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Christiansen JM, Meyer AM, Pickert L, Pfister R, Polidori MC. Challenges in the performance of real-life studies in older patients: focus on long-term care facilities. GERIATRIC CARE 2022. [DOI: 10.4081/gc.2022.10384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Research on geriatric conditions and atypical disease presentation in poorly studied patients’ groups is becoming increasingly important. Aim of the present investigation was addressing prevalence and prognostic significance of aortic valve stenosis (AVS) in older residents of long-term care facilities (LTCF). For the planned recruitment of 500 LTCF guests of a German metropolitan area, study investigators were trained and in the performance of a cardiologic examination and of the comprehensive geriatric assessment- based multidimensional prognostic index (MPI). After five attempts to obtain permission to conduct the study in 30 institutions, patients’ recruitment was stopped with 22 participants included from one institution. AVS was suspected in two patients, in agreement with the reported prevalence data. The MPI value correlated with social support (P=0.002) and geriatric syndromes (P=0.004). This structured attempt at investigating presence and prognostic signature of AVS in older LTCF guests was challenged by logistic obstacles strongly hindering diagnosis of potentially treatable conditions which, if undisclosed, negatively impact on survival and quality of life.
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Lai A, Caimi B, Franzetti M, Bergna A, Velleca R, Gatti A, Rossi PL, D’Orso M, Pregliasco F, Balotta C, Calicchio G. Durability of Humoral Responses after the Second Dose of mRNA BNT162b2 Vaccine in Residents of a Long Term Care Facility. Vaccines (Basel) 2022; 10:vaccines10030446. [PMID: 35335078 PMCID: PMC8954729 DOI: 10.3390/vaccines10030446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Residents of long-term care facilities (LTCFs) have been dramatically hit by the COVID-19 pandemic on a global scale as older age and comorbidities pose an increased risk of severe disease and death. The aim of the study was to assess the quantity and durability of specific antibody responses to SARS-CoV-2 after the first cycle (two doses) of BNT162b2 vaccine. To achieve this, SARS-CoV-2 Spike-specific IgG (S-IgG) titers was evaluated in 432 residents of the largest Italian LTCF at months 2 and 6 after vaccination. By stratifying levels of humoral responses as high, medium, low and null, we did not find any difference when comparing the two time points; however, the median levels of antibodies halved overtime. As positive nucleocapsid serology was associated with a reduced risk of a suboptimal response at both time points, we conducted separate analyses accordingly. In subjects with positive serology, the median level of anti-S IgG slightly increased at the second time point, while a significant reduction was observed in patients without previous exposure to the virus. At month 6, diabetes alone was associated with an increased risk of impaired response. Our data provide additional insights into the longitudinal dynamics of the immune response to BNT162b2 vaccination in the elderly, highlighting the need for SARS-CoV-2 antibody monitoring following third-dose administration.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.)
- Correspondence: ; Tel.: +39-025-0319-775
| | - Barbara Caimi
- Azienda Servizi alla Persona, Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, 20146 Milan, Italy; (B.C.); (R.V.); (A.G.); (P.L.R.); (G.C.)
| | - Marco Franzetti
- Infectious Diseases Unit, Legnano General Hospital, ASST Ovest Milanese, 20025 Legnano, Italy;
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.)
| | - Rossella Velleca
- Azienda Servizi alla Persona, Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, 20146 Milan, Italy; (B.C.); (R.V.); (A.G.); (P.L.R.); (G.C.)
| | - Antonella Gatti
- Azienda Servizi alla Persona, Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, 20146 Milan, Italy; (B.C.); (R.V.); (A.G.); (P.L.R.); (G.C.)
| | - Pier Luigi Rossi
- Azienda Servizi alla Persona, Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, 20146 Milan, Italy; (B.C.); (R.V.); (A.G.); (P.L.R.); (G.C.)
| | - Marco D’Orso
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy;
| | - Fabrizio Pregliasco
- Department of Biomedical Sciences, IRCCS Istituto Ortopedico Galeazzi, University of Milan, 20161 Milan, Italy;
| | - Claudia Balotta
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy; (A.B.); (C.B.)
| | - Giuseppe Calicchio
- Azienda Servizi alla Persona, Istituti Milanesi Martinitt e Stelline e Pio Albergo Trivulzio, 20146 Milan, Italy; (B.C.); (R.V.); (A.G.); (P.L.R.); (G.C.)
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Dube WC, Kellogg JT, Adams C, Collins MH, Lopman BA, Johnson TM, Amin AB, Weitz JS, Fridkin SK. Quantifying Risk for SARS-CoV-2 Infection among Nursing Home Workers For 2020/2021 Winter Surge of the COVID-19 Pandemic in Georgia, U.S.A. J Am Med Dir Assoc 2022; 23:942-946.e1. [PMID: 35346612 PMCID: PMC8885283 DOI: 10.1016/j.jamda.2022.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- William C Dube
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph T Kellogg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Carly Adams
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew H Collins
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Theodore M Johnson
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Avnika B Amin
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Joshua S Weitz
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA; School of Physics, Georgia Institute of Technology, Atlanta, GA, USA; Institut de Biologie, École Normale Supérieure, Paris, France
| | - Scott K Fridkin
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
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Fitzgerald EA, Freeman M, Rianto M, Di Rezze B. Responses to infectious disease outbreaks in supported living environments for individuals with neurodevelopmental disorders: a scoping review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 69:644-653. [PMID: 37547550 PMCID: PMC10402852 DOI: 10.1080/20473869.2021.2012007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/31/2021] [Accepted: 11/21/2021] [Indexed: 08/08/2023]
Abstract
Background: Individuals with neurodevelopmental disorders (NDD) are facing unprecedented challenges due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Congregate living, and conditions associated with NDD place increased challenges during infectious disease outbreaks and there is a need to understand evidence-based response procedures. The aim was to (1) map and synthesize literature regarding emergency response protocol in supported living environments for individuals with NDD and (2) identify gaps in the literature of response protocols in supported living environments for individuals with NDD. Methods: A scoping review was conducted to understand the published literature on emergency response across supported living environments for individuals with NDD during emergency situations and infectious disease outbreaks. Results: The ten studies included in the review detailed protocols including treatment, testing, isolation, surveillance, improved cleaning, use of protective equipment, and contact with public health professionals. The environment of supported living settings, and symptoms associated with NDD impacted the spread and severity of disease. Conclusion: The research findings highlight the susceptibility, severity and impact of infectious disease outbreaks for individuals with NDD in supported living environments. This research will promote the establishment and development of appropriate care and response during emergency situations in supported living environments.
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Affiliation(s)
- E. A. Fitzgerald
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - M. Freeman
- School of Rehabilitation Science, CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - M. Rianto
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - B. Di Rezze
- School of Rehabilitation Science, CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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40
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Yoshimura A, Sasahara T, Ae R, Kosami K, Akine D, Ogawa M, Hamabata K, Hatakeyama S, Morisawa Y, Cui L. Influenza Outbreak and a Group Meal in a Geriatric Long-term Care Facility in Japan. Biocontrol Sci 2022; 26:207-210. [PMID: 35013017 DOI: 10.4265/bio.26.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Influenza outbreaks at geriatric long-term care facilities (g-LTCFs) can be deadly and their prevention is important. However, the factors influencing disease transmission in g-LTCFs remain controversial. In this descriptive study, we tried to identify the potential risk factors influencing influenza outbreaks that occurred in different influenza seasons within a single g-LTCF with 100 residents in Gunma Prefecture. We reviewed the detailed facility records for all influenza cases in both residents and staff between January 2012 and June 2020. Facility preventive measures were also reviewed. We found that community meals may have been a potential source of transmission leading to the outbreaks. When influenza infection is noted, implementation of strict preventive measures and restriction of meal provision to resident rooms may help to prevent disease transmission and the development of an outbreak. Such measures may also be useful to prevent the transmission of other serious droplet-borne diseases within g-LTCFs.
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Affiliation(s)
| | - Teppei Sasahara
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University.,Division of Public Health, Center for Community Medicine, Jichi Medical University.,Division of Bacteriology, School of Medicine, Jichi Medical University
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Dai Akine
- Health Service Center, Jichi Medical University.,Division of Infectious Diseases, Jichi Medical University Hospital
| | | | - Kenji Hamabata
- Gerontological Nursing, School of Nursing, Jichi Medical University
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital
| | - Yuji Morisawa
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University.,Division of Infectious Diseases, Jichi Medical University Hospital
| | - Longzhu Cui
- Division of Bacteriology, School of Medicine, Jichi Medical University
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41
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Beogo I, Tchouaket EN, Sia D, Bationo NJC, Collin S, Tapp D, Kassim SA, Ramdé J, Gagnon MP. Promising best practices implemented in long-term care homes during COVID-19 pandemic to address social isolation and loneliness: a scoping review protocol. BMJ Open 2022; 12:e053894. [PMID: 34980621 PMCID: PMC8724591 DOI: 10.1136/bmjopen-2021-053894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics. METHODS AND ANALYSIS We will follow Arksey and O'Malley's framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers' 'Methodology for Scoping Reviews'. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from 'Evidence for Policy and Practice Information'. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis. ETHICS AND DISSEMINATION Formal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.
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Affiliation(s)
- Idrissa Beogo
- École des sciences infirmières / School of Nursing, Pavillon Roger-Guindon / Roger-Guindon Hall, Faculté des sciences de la santé / Faculty of Health Sciences, Université d'Ottawa / University of Ottawa, Ottawa, 451, chemin Smyth Road, Pièce 3236A / Room 3236A, Office: 613-562-5800 ext. 8148, Ontario, Canada
| | - Eric Nguemeleu Tchouaket
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Drissa Sia
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | | | - Stephanie Collin
- Faculté des sciences de l'éducation, Université Laval, Québec, Québec, Canada
| | - Diane Tapp
- École des hautes études publiques, Faculté des arts et des sciences sociales, Université de Moncton, Nouveau Brunswick, Moncton, Canada
| | - Said Abasse Kassim
- Faculté des sciences infirmières, Université Laval, Québec, Québec, Canada
| | - Jean Ramdé
- Centre de recherche en gestion des services de santé, Département de management, Faculté des sciences de l'administration, Université Laval, Québec, Québec, Canada
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42
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Quigley A, Stone H, Nguyen PY, Chughtai AA, MacIntyre CR. COVID-19 outbreaks in aged-care facilities in Australia. Influenza Other Respir Viruses 2021; 16:429-437. [PMID: 34866321 PMCID: PMC8983895 DOI: 10.1111/irv.12942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background Aged‐care facilities (ACF’s) provide unique challenges when implementing infection control methods for respiratory outbreaks such as COVID‐19. Research on this highly vulnerable setting is lacking and there was no national reporting data of COVID‐19 cases in ACFs in Australia early in the pandemic. We aimed to estimate the burden of aged‐care worker (ACW) infections and outbreaks of COVID‐19 in Australian aged‐care. Methods A line list of publicly available aged‐care related COVID‐19 reported cases from January 25 to June 10, 2020 was created and was enhanced by matching data extracted from media reports of aged‐care related COVID‐19 relevant outbreaks and reports. Rate ratios (RR) were used to predict risk of infection in ACW and aged‐care residents, and were calculated independently, by comparing overall cases to ACW and aged‐care residents' cases. Results A total of 14 ACFs with COVID‐19 cases were recorded by June 2020 nationwide, with a high case fatality rate (CFR) of 50% (n = 34) and 100% (n = 3) seen in two ACFs. Analysis on the resident risk found that the COVID‐19 risk is 1.27 times higher (unadjusted RR 1.27 95% confidence interval [CI] 1.00 to1.61; P = 0.047) as compared with the risk of infection in the general population. In over 60% of cases identified in ACFs, the source of infection in the index case was unknown. A total of 28 deaths associated within ACFs were reported, accounting for 54.9% of total deaths in New South Wales and 26.9% of total deaths in Australia. Conclusions This high‐risk population requires additional prevention and control measures, such as routine testing of all staff and patients regardless of symptoms. Prompt isolation and quarantine as soon as a case is confirmed within a facility is essential.
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Affiliation(s)
- Ashley Quigley
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Haley Stone
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Phi Yen Nguyen
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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43
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Paap KC, van Loon AM, van Rijs SM, Helmich E, Buurman BM, Smalbrugge M, Hertogh CMPM. Symptom- and Prevention-Based Testing of COVID-19 in Nursing Home Residents: A Retrospective Cohort Study. Gerontol Geriatr Med 2021; 7:23337214211055338. [PMID: 34790840 PMCID: PMC8591646 DOI: 10.1177/23337214211055338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/13/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023] Open
Abstract
Nursing homes (NH) residents with COVID-19 can either be tested because of presence of core symptoms (S-based) or because of transmission prevention (TP-based). The investigated study sample included all NH residents who underwent SARS-CoV-2 RT-PCR testing between March 16, 2020 and May 31, 2020 (n = 380). Clinical symptoms, temperature, and oxygen saturation were extracted from medical records, 7 days before to 14 days after testing. COVID-19 was confirmed in 81 (21%) residents; 36 (44%) S-based and 45 (56%) TP-based: 45. Cycle threshold (CT) values did not differ between the groups. In the 7 days prior to the test falling (32%), somnolence (25%) and fatigue (21%) occurred in both groups. Two days before the test, we observed a stronger decrease in oxygen saturation and an increase in temperature for the S-based group compared to the T-based group that remained up to 10 days after testing. Residents within the S-based group were 2.5 times more likely to increased mortality within 30 days than residents in the TP-based group (HR, 2.56; 95% 1.3–5.2). Although, 73% of the T-based group did eventually develop core symptoms. Thus, attention to falling and daily measures of temperature and oxygen saturation can contribute to earlier detection.
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Affiliation(s)
- Kelly C Paap
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Amsta Healthcare Organisation, Amsterdam, The Netherlands
| | - Anouk M van Loon
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Esther Helmich
- Amsta Healthcare Organisation, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
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44
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Emergency preparedness: What is the future? ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e29. [PMID: 36168490 PMCID: PMC9495548 DOI: 10.1017/ash.2021.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental phases spanning the entire disaster life cycle: mitigation, preparedness, response, and recovery. Increasing frequency of outbreaks and epidemics of emerging and reemerging infectious diseases in the last decade has emphasized the significance of healthcare emergency preparedness programs, but the coronavirus disease 2019 (COVID-19) pandemic has tested healthcare facilities’ emergency plans and exposed vulnerabilities in healthcare emergency preparedness on a scale unexperienced in recent history. We review the 4 phases of emergency management and explore the lessons to be learned from recent events in enhancing health systems capabilities and capacities to mitigate, prepare for, respond to, and recover from biological threats or events, whether it be a pandemic or a single case of an unknown infectious disease. A recurring cycle of assessing, planning, training, exercising, and revising is vital to maintaining healthcare system preparedness, even in absence of an immediate, high probability threat. Healthcare epidemiologists and infection preventionists must play a pivotal role in incorporating lessons learned from the pandemic into emergency preparedness programs and building more robust preparedness plans.
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45
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Arienti C, Brambilla L, Campagnini S, Fanciullacci C, Giunco F, Mannini A, Patrini M, Tartarone F, Carrozza MC. Mortality and characteristics of older people dying with COVID-19 in Lombardy nursing homes, Italy: An observational cohort study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:40. [PMID: 34484372 PMCID: PMC8384010 DOI: 10.4103/jrms.jrms_1012_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/14/2020] [Accepted: 01/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aim of the study was to describe the epidemiological characteristics of Nursing Homes (NHs) residents infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to compute the related case-fatality rate. MATERIALS AND METHODS The outcomes were mortality and case-fatality rate with related epidemiological characteristics (age, sex, comorbidity, and frailty). RESULTS During the COVID-19 outbreak lasted from March 1 to May 7, 2020, 330 residents died in Fondazione Don Gnocchi NHs bringing the mortality rate to 27% with a dramatic increase compared to the same period of 2019, when it was 7.5%. Naso/oropharyngeal swabs resulted positive for COVID-19 in 315 (71%) of the 441of the symptomatic/exposed residents tested. The COVID-19 population was 75% female, with a 17% overall fatality rate and sex-specific fatality rates of 19% and 13% for females and males, respectively. Fifty-six percent of deaths presented SARS-CoV-2-associated pneumonia, 15% cardiovascular, and 29% miscellaneous pathologies. CONCLUSION Patients' complexity and frailty might influence SARS-CoV-2 infection case-fatality rate estimates. A COVID-19 register is needed to study COVID-19 frail patients' epidemiology and characteristics.
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Affiliation(s)
| | | | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Maria Chiara Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
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46
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Oh HS, Jeong SY, Ryu M, Yang Y. An observational study of hand-to-face contact via videotaping of Korean older people in daily life settings. Int J Older People Nurs 2021; 17:e12414. [PMID: 34420266 DOI: 10.1111/opn.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 03/27/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to quantify hand-to-face contact (HFC) and identify the related factors that influence HFC in the daily life of Korean older people. METHODS From November 20-December 4, 2018, 30 older people were enrolled and were each videotaped for their daily activities for two hours in total. The videotaped HFC data were classified by frequency, duration, site of contact, and as self-contact with membranes (eye, nose and mouth) or non-membranes (head, forehead, chin, cheek and ear). RESULTS Of the 4826 self-contacts, 1311 HFC (560 membrane contacts [42.7%], 751 non-membrane contacts [57.3%]) were observed in 60 person-hours. The mean contact frequency (mean/person) of membrane and non-membrane contact was 18.7 times (nose, 9.3; mouth, 5.7; and eye, 3.6) and 24.6 (highest with the chin, 8.5), respectively. The mean contact duration (seconds/contact) for membrane and non-membrane contacts was 3.4 s (nose, 3.1; mouth, 3.7; and eye, 3.0) and 6.3 s (highest with the chin, 8.2), respectively. Contact exposure (frequency-duration/second/person) of the membrane and non-membrane was 3510.7 (nose, 1002.3; mouth, 639.3; and eye, 92.3) and 11,727.1 (highest with the chin, 2,965.6), respectively. The frequency and duration of HFC differed by age, economic activity and household income. CONCLUSIONS HFC was highest at the nose in Korean older people, followed by the mouth. Consequently, education about avoiding HFC of the nose and hygienic care of the nose should be a nursing priority. Awareness of the risks of HFC and the prophylactic effects of vigorous hand hygiene should be strengthened among the elderly to prevent the spread of infectious diseases via hand contact.
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Affiliation(s)
- Hyang Soon Oh
- Department of Nursing, College of Life Science and Natural Resources, Sunchon National University 255, Suncheon-si, Republic of Korea
| | - Sun Young Jeong
- College of Nursing, Konyang University 158, Daejeon, Republic of Korea
| | - Mikyung Ryu
- Department of Nursing, Division of Nursing and Public Health, Daegu University, Daegu, Republic of Korea
| | - Youngran Yang
- College of Nursing, Jeonbuk National University, Jeonju-si, Republic of Korea
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Dronavalli M, Lord H, Alexander K, Boonwaat L, Pal N, Fletcher-Lartey SM. Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care. J Epidemiol Glob Health 2021; 10:184-189. [PMID: 32538036 PMCID: PMC7310780 DOI: 10.2991/jegh.k.200402.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/20/2020] [Indexed: 11/25/2022] Open
Abstract
Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.
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Affiliation(s)
- Mithilesh Dronavalli
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre for Excellence, Wollongong, NSW, Australia
| | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Leng Boonwaat
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Narugopal Pal
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Boyle CA, Ravichandran U, Hankamp V, Ilbawi N, Conway-Svec C, Shifley D, Hensing T, Kim S, Halasyamani L. Safe Transitions and Congregate Living in the Age of COVID-19: A Retrospective Cohort Study. J Hosp Med 2021; 16:jhm.3657. [PMID: 34424185 DOI: 10.12788/jhm.3657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND COVID-19 represents a grave risk to residents in skilled nursing facilities (SNFs). OBJECTIVE To determine whether establishment of an appropriate-use committee was associated with a reduction in SNF utilization. DESIGNS, SETTING, AND PARTICIPANTS Retrospective cohort study at NorthShore University HealthSystem, a multihospital integrated health system in northern Illinois. Participants were patients hospitalized from March 19, 2019, to July 16, 2020. INTERVENTION Creation of a multidisciplinary committee to assess appropriateness of discharge to SNF following hospitalization. MAIN OUTCOME AND MEASURES Primary outcome was total discharges to SNFs. Secondary outcomes were new discharges to SNFs, readmissions, length of stay (LOS), and COVID-19 incidence following discharge. RESULTS Matched populations pre and post intervention were each 4424 patients. Post intervention, there was a relative reduction in total SNF discharges of 49.7% (odds ratio [OR], 0.42; 95% CI, 0.38-0.47) and in new SNF discharges of 66.9% (OR, 0.29; 95% CI, 0.25-0.34). Differences in readmissions and LOS were not statistically significant. For patients discharged to a SNF, 2.99% (95% CI, 1.59%-4.39%) developed COVID-19 within 30 days, compared with 0.26% (95% CI, 0.29%-0.93%) of patients discharged to other settings (P < .001). CONCLUSION Implementing a review committee to assess for appropriateness of SNF use after a hospitalization during the COVID-19 pandemic is highly effective. There was no negative impact on safety or efficiency of hospital care, and reduced SNF use likely prevented several cases of COVID-19. This model could serve as a template for other hospitals to reduce the risks of COVID-19 in SNFs and as part of a value-based care strategy.
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Affiliation(s)
- Christopher A Boyle
- NorthShore University HealthSystem, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | | | | | - Nadim Ilbawi
- NorthShore University HealthSystem, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | | | - Diane Shifley
- NorthShore University HealthSystem, Evanston, Illinois
| | - Thomas Hensing
- NorthShore University HealthSystem, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Susan Kim
- NorthShore University HealthSystem, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Lakshmi Halasyamani
- NorthShore University HealthSystem, Evanston, Illinois
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
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49
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Belmin J, Lutzler P, Hidoux P, Drunat O, Lafuente-Lafuente C. First-Dose Coronavirus 2019 Vaccination Coverage among the Residents of Long-Term Care Facilities in France. Gerontology 2021; 68:546-550. [PMID: 34380133 PMCID: PMC8450844 DOI: 10.1159/000517793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) experienced severe burden from the Coronavirus 2019 (COVID-19), and vaccination against SARS-CoV-2 is a major issue for their residents. OBJECTIVE The objective of this study was to estimate the vaccination coverage rate among the residents of French LTCFs. METHOD Participants and settings: 53 medical coordinators surveyed 73 LTCFs during the first-dose vaccination campaign using the BNT162b2 vaccine, conducted by health authorities in January and early February 2021. MEASUREMENTS in all the residents being in the LTCF at the beginning of the campaign, investigators recorded age, sex, history of clinical or asymptomatic COVID-19, serology for SARS-CoV-2 or severe allergy, current end-of-life situation, infectious or acute disease, refusal of vaccination by the resident or by the representative person of vaccine, and the final status, vaccinated or not. RESULTS Among the 4,808 residents, the average coverage rate for COVID-19 vaccination was 69%, and 46% of the LTCFs had a coverage rate <70%. Among unvaccinated residents, we observed more frequently a history of COVID-19 or a positive serology for SARS-CoV-2 (44.6 vs. 11.2% among vaccinated residents, p < 0.001), a history of severe allergy (3.7 vs. 0.1%, p < 0.001), end-of-life situation (4.9 vs. 0.3%, p < 0.001), current infectious or acute illness (19.6 vs. 0.3%, p < 0.001), and refusal of vaccination by residents or representative persons (38.9 vs. 0.4%, p < 0.001). CONCLUSIONS About 3 out of 10 residents remained unvaccinated, and half of the LTCFs had a coverage rate <70%. This suggests that COVID-19 will remain a threat to many LTCFs after the vaccination campaigns.
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Affiliation(s)
- Joël Belmin
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, Ivry-sur-Seine, France.,Faculté de médecine, Sorbonne Université, Paris, France
| | | | | | - Olivier Drunat
- Hôpital Bretonneau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmelo Lafuente-Lafuente
- Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, Ivry-sur-Seine, France.,Faculté de médecine, Sorbonne Université, Paris, France.,CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France
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Bays D, Williams H, Pellis L, Curran-Sebastian J, O'Mara O, Team PHEJM, Finnie T. Insights gained from early modelling of COVID-19 to inform the management of outbreaks in UK prisons. Int J Prison Health 2021; 17:380-397. [PMID: 34339114 PMCID: PMC8753626 DOI: 10.1108/ijph-09-2020-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/24/2020] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE In this work, the authors present some of the key results found during early efforts to model the COVID-19 outbreak inside a UK prison. In particular, this study describes outputs from an idealised disease model that simulates the dynamics of a COVID-19 outbreak in a prison setting when varying levels of social interventions are in place, and a Monte Carlo-based model that assesses the reduction in risk of case importation, resulting from a process that requires incoming prisoners to undergo a period of self-isolation prior to admission into the general prison population. DESIGN/METHODOLOGY/APPROACH Prisons, typically containing large populations confined in a small space with high degrees of mixing, have long been known to be especially susceptible to disease outbreaks. In an attempt to meet rising pressures from the emerging COVID-19 situation in early 2020, modellers for Public Health England's Joint Modelling Cell were asked to produce some rapid response work that sought to inform the approaches that Her Majesty's Prison and Probation Service (HMPPS) might take to reduce the risk of case importation and sustained transmission in prison environments. FINDINGS Key results show that deploying social interventions has the potential to considerably reduce the total number of infections, while such actions could also reduce the probability that an initial infection will propagate into a prison-wide outbreak. For example, modelling showed that a 50% reduction in the risk of transmission (compared to an unmitigated outbreak) could deliver a 98% decrease in total number of cases, while this reduction could also result in 86.8% of outbreaks subsiding before more than five persons have become infected. Furthermore, this study also found that requiring new arrivals to self-isolate for 10 and 14 days prior to admission could detect up to 98% and 99% of incoming infections, respectively. RESEARCH LIMITATIONS/IMPLICATIONS In this paper we have presented models which allow for the studying of COVID-19 in a prison scenario, while also allowing for the assessment of proposed social interventions. By publishing these works, the authors hope these methods might aid in the management of prisoners across additional scenarios and even during subsequent disease outbreaks. Such methods as described may also be readily applied use in other closed community settings. ORIGINALITY/VALUE These works went towards informing HMPPS on the impacts that the described strategies might have during COVID-19 outbreaks inside UK prisons. The works described herein are readily amendable to the study of a range of addition outbreak scenarios. There is also room for these methods to be further developed and built upon which the timeliness of the original project did not permit.
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Affiliation(s)
- Declan Bays
- Emergency Response Department, Public Health England, London, UK
| | - Hannah Williams
- Emergency Response Department, Public Health England, London, UK
| | - Lorenzo Pellis
- Department of Mathematics, The University of Manchester, Manchester, UK
| | | | - Oscar O'Mara
- Her Majesty's Prison and Probation Service, London, UK
| | | | - Thomas Finnie
- Emergency Response Department, Public Health England, London, UK
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