Association of Type of Vaccination Center With Time to Emergency Department Presentation for Acute COVID-19 Infection: An Exploratory Analysis

Objective The objective of this study was to identify potential associations between coronavirus disease 2019 (COVID-19) vaccination center reception location and time to presentation to the emergency department for acute COVID-19 infection. The a priori hypothesis was that there are significant differences in the outcome based on vaccination administration center type. Methods This was a cross-sectional, observational study conducted within a hospital in Lakeland, Florida, between October 2021 and May 2022. Participants were at least 18 years old with confirmed severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection and at least two COVID-19 symptoms at enrollment. Patients with prior confirmed COVID-19 diagnosis and hospitalization within 10 days of screening were excluded. Participants were sampled from within the emergency department of the institution. The primary outcome was time to presentation to the emergency department for acute COVID-19 infection since the last vaccination dose from each sampled COVID-19 vaccination center location. Results A total of 93 participants were analyzed. Of these, 48 (52%) participants received COVID-19 vaccination. Participants vaccinated at vaccine clinics demonstrated a significantly longer mean survival time (288.2 (29.9)) compared to other sites. Significant predictors of hospitalization were age (aOR, 1.09, 95%CI 1.02-1.16, p < 0.01), sex (aOR: 10.05, 95%CI 1.52-66.54, p < 0.05), physical function (aOR, 0.90, 95%CI 0.83-0.97, p < 0.01) and number of medications (aOR, 1.34, 95%CI 1.14-1.58, p < 0.001).  Conclusions This exploratory analysis highlights the need for further investigation into both characteristics of healthcare institutions and individual-level factors that may play a role in the prolonged prevention of emergency department presentations due to COVID-19 infection. Increased transparency of data regarding practices related to the administration of COVID-19 vaccines across various institutions may be beneficial in further understanding the role of COVID-19 vaccinations in preventing symptomatic disease across local and global communities.

Unpacking COVID-19 Vaccine Attitudes: Exploring Hesitancy and Acceptance Among Undergraduate Students in Bangladesh

BACKGROUND

Vaccine hesitancy is a significant global health concern, and mass vaccination is essential in preventing the spread of COVID-19. Undergraduate students need to be prioritized for vaccination as they continue their academic curriculum physically. However, limited research explores vaccine hesitancy and acceptance among undergraduate students in Bangladesh. Therefore, this study evaluated vaccine hesitancy and acceptance among this population.

METHOD

A web-based cross-sectional study was conducted between May and June 2021 using a structured questionnaire to assess COVID-19 vaccine hesitancy and acceptance among undergraduate students in Bangladesh. The Oxford Covid-19 Vaccine Hesitancy Scale was used to measure vaccine hesitancy. The study used convenient sampling.

RESULT

Across the country, 334 undergraduate students participated in this study on COVID-19 vaccine acceptance, with a mean age of 22.4 years. Most participants were male and unmarried, most having spent four years at university. 89.52% of participants would accept a COVID-19 vaccine if it were suggested by educational institutions or available, while 4.49% refused to receive the COVID-19 vaccine. Participants showed low levels of vaccine hesitancy, with a mean score of 10.77 on the Oxford COVID-19 Vaccine Hesitancy Scale. Most participants had a positive attitude towards receiving the vaccine, with the majority wanting to get it as soon as it becomes available. No association was found between vaccine acceptance and participants' background characteristics.

CONCLUSION

Our study found a high level of vaccine acceptance among undergraduate students in Bangladesh, indicating that this group can be vaccinated quickly, significantly accelerating vaccination goals. However, further large-scale studies are recommended among vulnerable groups, including school and college students, to ensure vaccine preparedness.

Immune Thrombocytopenic Purpura Following COVID-19 Infection: A Case Report and Literature Review

Immune thrombocytopenic purpura (ITP) has been described following both coronavirus disease 2019 (COVID-19) infection and COVID-19 vaccination. ITP is a challenging diagnosis of exclusion, and the pathophysiology of these complications is not well understood but believed to be autoimmune in nature. We describe a severe case of ITP following COVID-19 infection in a patient without a history of hematologic or autoimmune disease and his subsequent uneventful course following COVID-19 vaccination. The current Centers for Disease Control and Prevention (CDC) advisory does not identify a history of ITP as a contraindication to COVID-19 vaccination. We compare our study, which describes an uneventful COVID-19 vaccination course with cases that have described recurrences and relapses of ITP following both COVID-19 infection and COVID-19 vaccination. These reports suggest that the placement of some patients into a unique subset among all patients with ITP may be prudent with regard to future COVID-19 vaccination. Through a literature review, we discuss a broader picture of how COVID-19 infection-associated ITP may differ from COVID-19 mRNA vaccination-associated ITP in its demographics, etiology, and outcomes.

Impact of SARS-CoV-2/COVID-19 on Provision of Medical Care to Patients With Systemic Autoimmune Rheumatic Disease and the Practice of Rheumatology

The SARS-CoV-2 pandemic has had a significant impact on the healthcare field that resulted in changes to the way safe and effective medical care is delivered. The effects range from service disruption including ambulatory clinic closure due to both patient and provider concerns, to lack of capacity in hospital services. In rheumatology, there were other effects including viral infection-related autoantibody production, concerns about the use of systemic immunosuppression in the presence of an infectious pandemic and even concerns for viral infection-induced flares of rheumatic disease. Coronavirus disease 2019 (COVID-19) led to the rapid adoption of innovative technologies that permitted the introduction and increased use of telemedicine via a number of platforms. Rapid discoveries and innovations led to the development of diagnostic and therapeutic agents in the management of COVID-19. Scientific advancement and discoveries around COVID-19 infection, symptoms, autoantibody production, chronic sequela and the repurposing of rheumatic immunosuppressive agents led to improved survival and an expanded role for the rheumatologist. Rheumatologists may sometimes be involved in the diagnosis and management of the hospitalized COVID-19 patient. In the ambulatory clinic, a rheumatologist also helps to differentiate between symptoms of long COVID and those of systemic autoimmune rheumatic disease (SARD). Rheumatologists must also grapple with the concerns related to immunosuppressive therapy and the risk of COVID-19 infections. In addition, there are concerns around vaccine effectiveness in people with SARD and those on immunosuppressive medications. Although the SARS-CoV-2 pandemic and the effects on healthcare resulted in difficulties, both patients and providers have risen to the challenge. The long-term outcome of COVID-19 for the medical system and rheumatologists in particular is not yet fully understood and will need further study. This review concentrates on the changing role of the rheumatologists, improved understanding of rheumatic disease and immunosuppressive therapies in the wake of the pandemic and how this has led to an improvement in the care of patients with COVID-19.

Ruptured Renal Abscess From Streptococcus agalactiae Invasion in a Postpartum Female

Streptococcus agalactiae (Group B Streptococcus or GBS)is an exceptionally rare causative organism of a ruptured renal abscess. We report a case of this normally commensal organism causing a large ruptured renal abscess in a 17-year-old postpartum female. Although S. agalactiae is known to cause postpartum neonatal morbidity and mortality, it has rarely caused invasive infections in the last 20 years in adults. While this diagnosis often presents with nonspecific findings that can easily be overlooked during the postpartum period, the patient responded well to the established treatment of broad-spectrum antibiotics and a percutaneous drain.

Epidemiological Study of COVID-19 Fatalities and Vaccine Uptake: Insight From a Public Health Database in Ontario, Canada

Coronavirus disease (COVID-19) has reached millions of people worldwide and is responsible for millions of deaths around the world. Research on fatalities in rural communities remains limited. In addition, the scientific literature has not yet reported on the distribution of vaccines in Canada and compared the findings to the age distribution of COVID-19 fatalities in Canada to see whether the vaccines have been distributed to the highest age category populations. This research article used data from the Government of Ontario and Statistics Canada to analyze the number of cases, fatalities, case fatality rates (CFRs) by demographic factors, such as age, gender, urban-rural status, and compared the findings to national vaccination rates by age. As of June 11, 2021, this study found that among the 528,819 cases among 14.8 million people. Among this population, there were 8875 fatalities in Ontario with 82.208% (n=7296) of fatalities occurred in people over 70 years, and 93.183% in people over 60 years (n=8,270). Additionally, the odds ratio of a fatal event was 9,652 times higher in people over 90 years (95% CI: 4418, 31124, p<0.001) as compared with less than 20 years. Men had a higher number of fatalities (n=4,490, CFR=1.721%) compared with women (n=4,385, CFR=1.692%), and a higher odd of fatal events only when adjusted for age and gender (OR=1.66, 95% CI: 1.57, 1.74, p<0.001). Urban areas had 92.034% of fatalities (n=8,168) and had a CFR of 1.632%. In contrast, rural areas comprised 4.451% of total fatalities (n=395) and had the highest CFR (2.267%). The unadjusted odds of a fatality were 1.41 (95% CI: 1.27, 1.56) in rural areas compared with urban areas. Across Canada as of May 29, 2021, people over 80 years old received 1,530,318 vaccines with 91.98% of this population age group receiving at least one and 457,664 being fully vaccinated (27.51%). In Ontario, as the number of people with at least one vaccine increased for people over 90 years, the number of fatalities was reduced from about 8 per day prior to vaccines to approximately two per day. Furthermore, once the vaccination rates exceeded 75% in ages 60 years and over 50% in the younger age groups, the number of fatalities per day among all age groups was approximately one per day. In summary, age was found to be a significant factor for COVID-19 mortality in Ontario and vaccine uptake in Ontario was followed by decreases in COVID-19 mortality.