The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study

Background

Migrants in the United Kingdom (UK) may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic.

Methods

We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran mixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and mixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed.

Results

Of 30,276 adults in the analyses, 26,492 (87.5 %) were UK-born and 3,784 (12.5 %) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95 % CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60].

Conclusion

Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.

Low treatment rates in patients meeting guideline criteria in diverse practice settings

BACKGROUND AND AIMS

Data on usage of antiviral therapy and application of chronic hepatitis B (CHB) management guidelines in different settings are limited. Our goal is to evaluate the proportion of treatment-eligible patients by 6-month follow-up and treatment rate among eligible patients by 12-month follow-up in diverse settings.

METHODS

In this retrospective cohort study, 1,976 treatment-naïve CHB patients were categorized as primary care physician (PCP) group if seen by community PCP (n = 329), gastroenterology (GI) group if seen by community gastroenterologists (n = 1,268), and hepatology group if seen by university hepatologists (n = 379). Treatment eligibility was based on the US Panel 2008 and American Association for the Study of Liver Diseases (AASLD) 2009 guidelines.

RESULTS

All groups had similar age, gender, and ethnic distribution. GI and hepatology groups had similar treatment eligibility rates by US Panel (53-54 %) and AASLD guidelines (24-25 %). However, treatment rate was significantly higher in hepatology compared to GI group by the US Panel guideline (59 vs. 45 %, P = 0.001). PCP group had the lowest eligibility and treatment rates by both guidelines. Common reasons for non-treatment were perceived "normal" alanine aminotransferase, desire for further observation, and patient refusal. Male gender, age >50, and subspecialty care predicted treatment initiation in treatment-eligible patients.

CONCLUSIONS

Less than half of treatment-eligible patients at primary care clinics received treatment. Community gastroenterology and university liver clinics treated about one-half to two-thirds of eligible patients. Patient and provider education should highlight treatment benefits and the new alanine aminotransferase upper limit of normal.

Evolutionary Dynamics of a Highly Pathogenic Type 2 Porcine Reproductive and Respiratory Syndrome Virus: Analyses of Envelope Protein-Coding Genes

Porcine reproductive and respiratory syndrome virus (PRRSV) has long been an economically devastating swine viral disease. The recent emergence of a highly pathogenic type 2 PRRSV with high mobility and mortality in China, spreading in Vietnam, Laos, and Thailand has placed neighbouring countries at risk. This study applied a codon-based extension of the Bayesian relaxed clock model and the fixed effects maximum-likelihood method to investigate and compare the evolutionary dynamics of type 2 PRRSV for all of known structural envelope protein-coding genes. By comparing the highly pathogenic type 2 PRRSV clade against the typical type 2 PRRSV clade, this study demonstrated that the highly pathogenic clade evolved at high rates in all of the known structural genes but did not display rapid evolutionary dynamics compared with typical type 2 PRRSV. In contrast, the ORF3, ORF5 and ORF6 genes of the highly pathogenic clade evolved in a qualitatively different manner from the genes of the typical clade. At the population level, several codons of the sequence elements that were involved in viral neutralization, as well as codons that were associated with in vitro attenuation/over-attenuation, were predicted to be selected differentially between the typical clade and the highly pathogenic clade. The results of this study suggest that the multigenic factors of the envelope protein-coding genes contribute to diversifying the biological properties (virulence, antigenicity, etc.) of the highly pathogenic clade compared with the typical clade of type 2 PRRSV.

Phylogenetic and phylogeographic analyses of porcine circovirus type 2 among pig farms in Vietnam

This study demonstrated the prevalence of Porcine circovirus type 2 (PCV2) among pig farms in Vietnam. Analyses of the genome, capsid protein and phylogeny classified all 30 Vietnamese PCV2 strains as the PCV2b genotype, belonging to the clusters of 1A, 1B, 1C and recombinant forms. Each viral genome was 1767 nucleotides long and shared 96.0-100% nucleotide sequence identity. The amino acid substitutions in the capsid protein of the Vietnamese PCV2 strains were in immunodominant regions, and the majority of strains (24/30) contained a lysine extension at the C-terminus. Bayesian phylogeographic analysis revealed epidemic links of the PCV2 recombinant cluster within and among countries, which supports a circulating recombinant form of PCV2. Further analysis by the Jameson-Wolf antigenic index indicated antigenic alterations at important sites in the capsid protein (sites 131-133) among the recombinant cluster and the other clusters of PCV2b.

A Bayesian phylogeographical analysis of type 1 porcine reproductive and respiratory syndrome virus (PRRSV)

Understanding viral transmission is an important factor for the effective prevention one of the most devastating swine diseases, porcine reproductive and respiratory syndrome. Focusing on molecular epidemiology of type 1 PRRSV, this study analysed a large ORF5 dataset collected worldwide from 1991 to 2012 using a coalescent-based Bayesian Markov chain Monte Carlo approach. The results suggested that the virus diversified into unique subpopulations in Russia & Belarus and Italy approximately 100 years ago. Previously unreported consecutive diffusions of the virus were identified, which showed that some countries, such as Spain and Germany, acted as distribution sources to some extent. This study also provided statistical evidence for the existence of an ORF5-based phylogeographical structure of type 1 PRRSV, in which the virus tended to cluster by geographical locations more tightly than expected by chance. In contrast to this tight geographical structure, the evolution of the ORF5 gene, based on mapping of non-synonymous/synonymous substitutions, was best described by a non-homogeneous process that could be implicated as a mechanism for viral immune evasion.

Genomic sequence of infectious hypodermal and hematopoietic necrosis virus (IHHNV) KLV-2010-01 originating from the first Korean outbreak in cultured Litopenaeus vannamei

Due to the need to track and monitor genetic diversity, the genome of the infectious hypodermal and hematopoietic necrosis virus (IHHNV) strain KLV-2010-01 in cultured Litopenaeus vannamei shrimp that originated from the first Korean outbreak in 2010 was sequenced and analyzed. The genome, with a length of 3914 nucleotides, was sequenced from the Korean IHHNV. The genome encoded three large and overlapping open reading frames: ORF1 (NS-1) of 2001 bp, ORF2 (NS-2) of 1092 bp and ORF3 (capsid protein) of 990 bp. The overall organization, size and predicted amino acid sequence of the three ORFs in Korean IHHNV were highly similar to those of members of the infectious IHHNV group, and the most closely related strains were IHHNVs described from Ecuador and Hawaii. Additionally, phylogenetic analysis showed that the Korean IHHNV was clustered with lineage III in the infectious IHHNV group and was most similar to IHHNV isolates from Ecuador, China and Taiwan.

Randomised feasibility trial of pre-exposure rabies vaccination with DTP-IPV in infants

BACKGROUND

Pre-exposure vaccination against rabies generally simplifies treatment and could be especially beneficial to children in countries where the disease is enzootic. We studied the feasibility of administering to infants pre-exposure rabies vaccination with combined diphtheria, tetanus, whole-cell pertussis, and inactivated poliomyelitis vaccine (DTP-IPV).

METHODS

84 Vietnamese infants were randomly assigned to groups that received three doses of DTP-IPV vaccine at 2, 3, and 4 months of age alone (n = 43) or with two doses of purified Vero cell rabies vaccine (PVRV) at 2 and 4 months (n = 41). The safety and immunogenicity data of the groups were compared.

FINDINGS

All infants in both groups developed protective antibody concentrations against diphtheria, tetanus, pertussis, and polio. All infants who received the PVRV vaccine developed protective antibody concentrations against rabies. No serious adverse effects were reported, nor did systemic reactions differ between groups.

INTERPRETATION

Administration of PVRV with DTP-IPV proved safe, and elicited what are presumed to be protective antibody concentrations to all antigens in all 41 infants. Confirmation of these results could lead to integration of pre-exposure rabies vaccination into Expanded Programme on Immunisation (EPI) sessions in selected countries where rabies is enzootic.

Se, Zn, Mg, Ca, K, cholesterol, and creatine kinase concentrations in men during the 12 days after an acute myocardial infarction

We determined concentrations of selenium, zinc, magnesium, calcium, potassium, total and high-density lipoprotein cholesterol, and total creatine kinase (EC 2.7.3.2) in plasma (P) and (or) erythrocytes (E) of 32 men at the time of hospital admission for acute myocardial infarction and then on subsequent days 2, 3, 6, 10, and 12. During these 12 days, only P-selenium and high-density lipoprotein cholesterol concentrations remained unchanged. For the other variables, individual comparison of means indicated the dates of significant changes in concentration (p less than 0.05).

[Halogenated inhalation anesthesia with a semiclosed circle system]

Thirty-six patients were anaesthetized for a maxillofacial surgical procedure. Ventilation was controlled by a ventilator (Kontron ABT 4100) with a semi-closed circle system. The flow of fresh gases was 1,200 ml.min-1. The vaporizer for the halogenated anaesthetic agent was placed out of the circle before the ventilator. Halothane was used for maintenance of anaesthesia and isoflurane for induced hypotension in orthognathic surgery. The inspired concentration of the halogenated agent was monitored by an analyser. A linear correlation between the delivered and the inhaled concentration of halogenated agent was established, the latter never reaching the delivered concentration. Monitoring the inspired oxygen concentration was required, so as to maintain a constant value. Carbon dioxide absorption by soda lime was also studied. The known advantages were: substantial economies in nitrous oxide and halogenated agents, prevention of contamination of the operating theatre, humidification and warning of the inspired gases. The use of such a system with the vaporizer out of the circle was safe, all the more so as the concentration of inhaled halogenated agents could be predicted.

Se, Zn, Mg, Ca, K, cholesterol, and creatine kinase concentrations in men during the 12 days after an acute myocardial infarction

We determined concentrations of selenium, zinc, magnesium, calcium, potassium, total and high-density lipoprotein cholesterol, and total creatine kinase (EC 2.7.3.2) in plasma (P) and (or) erythrocytes (E) of 32 men at the time of hospital admission for acute myocardial infarction and then on subsequent days 2, 3, 6, 10, and 12. During these 12 days, only P-selenium and high-density lipoprotein cholesterol concentrations remained unchanged. For the other variables, individual comparison of means indicated the dates of significant changes in concentration (p less than 0.05).

Low lead doses and atherogenic diet in rabbits: biochemical results in blood

Changes in concentrations of blood lead, cholesterol, triacylglycerols, GOT and GPT enzymes, phosphorus, proteins, plasma calcium and magnesium, and erythrocyte magnesium were studied for 25 weeks in 4 groups of 6 rabbits each receiving different diets: I (controls), II (water with 9.66 mumol/l of lead), III (atherogenic) and IV (atherogenic + 9.66 mumol/l of lead). Differences observed, with respect to the diets, for lead, cholesterol, enzymes, proteins and erythrocyte magnesium were evident from the 42nd day on. Low lead doses raised the levels of cholesterol and triacylglycerols in group II, whereas triacylglycerols were lower in the plasma of group IV in comparison with group III and were accumulated in the aorta. The elevation of enzymes in groups III and IV indicated heart and liver dysfunctions. There was a significant drop in erythrocyte magnesium in groups III and IV, which was especially marked in the latter group, with an interaction between the two diets.

Concentrations of lead, magnesium, calcium, zinc and cadmium in twenty rabbit tissues after exposure to low lead doses and atherogenic diet

Four groups of 6 rabbits were subjected to the following diets for 25 weeks: I (controls), II (water with 9.66 mumol/l of lead), III (atherogenic) and IV (atherogenic + 9.66 mumol/l of lead). Lead, magnesium, calcium, zinc and cadmium were then analyzed in 20 dry tissues. At the level of the arteries, veins and skin a tendency was observed toward increased lead concentration in rabbits of groups II and IV, elevated calcium levels in groups III and IV (a tenfold increase of calcium in the aortas), and a higher concentration of cadmium in animals of group II. There was a significant reduction in lead and magnesium concentrations in the liver of animals in groups III and IV because of fibrosis and overabundance of fatty liver cells. The lead level in the liver of animals in group II had slightly increased. Lead concentrations were higher in the kidneys and spleen in groups II and IV. Cadmium levels were significantly lower in the liver, kidneys, adrenal glands and spleen of animals in groups III and IV, whereas in group II they were particularly increased in the liver and kidneys. Very little significant interaction between the two diets was noted. Rabbits in groups III and IV showed notable histopathological alterations in aorta, carotid and femoral arteries, left ventricle and liver. Extrapolation from rabbit to man would be inadvisable.