Belgian Poison Centre: annual overview 2020

Objective: This study provides an overview of the number and type of calls received by the Belgian Poison Centre (BPC) in 2020. Methods: Data of all calls to the BPC (1 January to 31 December 2020) were collected and analyzed using appropriate statistics (SAS). Results: The BPC received 65,308 calls in 2020 (60,668 in 2019, p<0.05), of which 56,106 (86%) (involving 57,523 victims) were due to an exposure, and 9,202 (14%) were an information request. Despite a minor decrease of 2.3% (21,151 in 2019 versus 20,666 in 2020, p>0.05), the vast majority (35.9%) of exposures were drug-related, of which paracetamol represented 8.2%. Drugs within the category “nervous system” (e.g. antipsychotics, antidepressants, etc.) were most frequently involved (39.6%). There were 11,836 in 2019 versus 12,247 in 2020 (p>0.05). Relating to chemical household products, in the battle against the coronavirus, people bought large quantities and often highly concentrated products, especially products for personal hygiene and cleaning. Poured into smaller containers such as water or soft drink bottles, this led to accidents in which people accidentally drank from the drink container. In an effort to improving cleaning or disinfection, people also started (accidentally) combining or mixing products, with the risk of releasing irritating vapours. Irritation of the mucous membranes and severe shortness of breath were not uncommon. The BPC received 46.1% more calls for bleach and bleach-containing products than in 2019 (835 calls in 2019 compared to 1,220 calls in 2020, p<0.05). A 12.3% increase of cosmetic- and food-related exposures was noted (8,291 in 2019 versus 9,308 in 2020, p<0.05), of which a stable number of exposures (877 in 2019 versus 876 in 2020, p>0.05) were due to essential oils. Exposures to type 1 biocides significantly increased from 322 in 2019 to 1,676 in 2020 (p<0.05), and exposures to type 2 biocides from 406 to 902 (p<0.05). Finally, a 28.2% increase in exposures related to the group “plants, mushrooms and animals” was observed, with 3,256 in 2019 and 4,175 in 2020 (p<0.05). Conclusion: In its history, the BPC has never received as many calls as in 2020, demonstrating its added value in today's and future healthcare. Trends in both, number and type of exposures were impacted by the COVID-19 pandemic.

Impact of COVID-19 on the number and type of calls to the Belgian Poison Centre

Objective: The present study provides an overview of the number and type of calls to the Belgian Poison Centre (BPC), and the impact of COVID-19. Methods: Data of all calls to the BPC (1 January - 31 December 2020) were collected and analysed using appropriate statistics (SAS). Results: The BPC received 65,308 calls in 2020 (60,668 in 2019, p<0.05). The vast majority (35.9%) of exposures were drugrelated (21,151 in 2019 versus 20,666 in 2020, p>0.05), followed by the use of chemical household products (11,836 in 2019 versus 12,247 in 2020 (p>0.05)). A 12.3% increase in the number of cosmetic- and food-related exposures was noted (8,291 in 2019 versus 9,308 in 2020, p<0.05). Within this group, a stable number of exposures (877 in 2019 versus 876 in 2020, p>0.05) due to essential oil exposures were observed. Partly due to the impact of the COVID-19 [1] pandemic, exposures to biocides doubled (104.9%) from 1,964 in 2019 to 4,024 in 2020 (p<0.05). Exposures to type 1 biocides (i.e. human hygiene products, which include alcohol-based hand sanitisers (ABHS)) significantly increased from 322 in 2019 to 1,676 in 2020 (p<0.05), and exposures to type 2 biocides (i.e. disinfectants and algaecides not intended for direct application to humans or animals) from 406 to 902 (p<0.05). In 2020 the BPC received a five-fold increase in the number of calls involving ABHS incidents (both liquid and gel-based, as well as ethanol and isopropanol products) compared to 2019 (1,676 versus 323 in 2019 versus 1,676 in 2020 calls, p<0.05), accounting for 2.6% of all calls in 2020. In 71% of exposures, ingestion was the primary route (1,195/1,676), followed by 28.6% accidental ocular exposures (480/1,676) of which more than half of the incidents involved children (257/480, p<0.05), primarily young children aged 1-4 years (136/257, p<0.05). Finally, as people went into the garden and nature to relax during lockdown, a 28.2% increase in exposures related to the group 'plants, mushrooms and animals' was found, with 3,256 exposures in 2019 and 4,175 in 2020 (p<0.05). Conclusion: In its history, the BPC has never received as many calls as in 2020. The COVID-19 pandemic contributed to a significant number of additional exposures, and requests for toxicologic advice.

Updated results of the COVID-19 in MS global data sharing initiative validate consistent associations of anti-CD20 and other reported risk factors with severe COVID-19 outcomes

Background: As the COVID-19 pandemic continues, evidencebased clinical guidance for managing the care of people with multiple sclerosis (MS) is an ongoing concern. In recent months, data from cohorts of people with MS has indicated that certain demographic and clinical characteristics, including use of some disease- modifying therapies (DMTs), leads to worse outcomes from SARS-CoV-2 infection. The COVID-19 in MS global data sharing initiative, which now includes over 4,500 confirmed COVID- 19 cases in people with MS, gives the opportunity to corroborate previous findings with greater certainty. Methods: Clinician-reported data from 32 countries were aggregated into a dataset of 5,543 patients who had suspected or confirmed COVID-19. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes. These outcomes (hospitalisation, admission to ICU, requiring artificial ventilation, and death) were assessed in patients with suspected/ confirmed COVID-19 using multilevel mixed-effects logistic regression. All models were corrected for age, sex, EDSS, and MS type. DMTs were individually compared to glatiramer acetate (GA), as well as to pooled other DMTs and natalizumab. Results: Of 5,543 patients in the clinician-reported dataset, 909 with suspected and 4,634 with confirmed COVID-19 were included in the analysis. Previous demographic findings were confirmed: male sex, older age, progressive MS, and higher disability were associated with worse outcomes from SARS-CoV-2 infection. Use of anti-CD20 DMTs (ocrelizumab and rituximab) was associated with worse COVID-19 outcomes. Compared to GA, ocrelizumab and rituximab were associated with increased risk of hospitalisation (aOR=1.61(95%CI=1.06-2.43);aOR=2.42(95%CI=1.54-3.81) and ICU admission (aOR=3.13(95%CI=1.22-8.00);aOR=4.46 (95%CI=1.64-12.09)). Rituximab was associated with increased risk of artificial ventilation (aOR=3.57(95%CI=1.38-9.20));ocrelizumab showed a positive trend (aOR=1.86(95%CI=0.76-4.55). Rituximab showed a positive trend with increased risk of death (aOR=2.74(95%CI=0.68-11.09). Associations persisted on restriction to confirmed COVID-19 cases. Conclusions: Analysing the largest international real world dataset of people with MS who have suspected or confirmed COVID- 19 confirms previous findings that male sex, older age, progressive MS, higher disability, the use of anti-CD20 medication (ocrelizumab and rituximab) are associated with worse COVID-19 outcomes.

Motifs d’acceptation ou de refus du vaccin grippal durant la grossesse : étude monocentrique quantitative et qualitative

Introduction La grossesse est un facteur de risque connu de grippe grave et malgré la recommandation de vaccination maternelle depuis 2012 la couverture vaccinale (CV) reste insuffisante chez les femmes enceintes. Notre objectif principal était d’identifier les motifs d’acceptation et de refus vaccinal chez les femmes ayant reçu une proposition préalable par un professionnel de santé (PS). Nos objectifs secondaires étaient d’estimer le niveau de connaissance sur la grippe et le vaccin et la confiance dans les différentes sources d’informations. Matériels et méthodes Une étude monocentrique a été réalisée entre février et mai 2020 via un questionnaire anonyme administré aux femmes hospitalisées en suite de couche dans une maternité de niveau 3 avec mise à disposition du vaccin. Nous avons recueilli les caractéristiques sociodémographiques, le statut vaccinal, et les connaissances et représentations sur la grippe et son vaccin. Des analyses thématiques ont été réalisées pour l’étude des motifs de vaccination et des modèles de régression logistique pour celle des facteurs associés. Résultats Au total, 251 femmes ont été incluses dans l’étude, 176 (70 %) nées en France, 202 (80 %) âgées de 30 ans et plus, 173 (69 %) avec un haut niveau d’étude ;31 (12 %) présentaient une pathologie chronique ciblée par les recommandations et 212 (84 %) ont été vaccinées contre la grippe. La proposition de vaccination, multiple pour une même femme, émanait de plusieurs PS : sage-femme (55 %), gynécologue-obstétricien (50 %), médecin traitant (18 %). La vaccination a eu principalement lieu à la maternité (61 %), dans des cabinets libéraux (21 %) ou en pharmacie (11 %). Les motifs décisifs d’acceptation retrouvés chez les femmes vaccinées étaient la recommandation d’un PS (38 %), la protection du nouveau-né (36 %) ou la perception d’une maladie grave pendant la grossesse (28 %) ;les motifs de refus étaient la peur des effets indésirables du vaccin (74 %) et des doutes sur son intérêt (51 %). Un niveau de confiance plus élevé envers les PS était observé chez les femmes vaccinées. La vaccination était associée à un score élevé de connaissance sur la grippe et le vaccin (OR=8,0 ;IC95 % [2,4–50,1], p=0,005), un antécédent de vaccination grippale (OR=4,2 ;IC95 % [1,8–11,1], p=0,002), un âge maternel entre 30–35 ans (OR=3,6 ;IC95 % [1,3–10,1], p=0,0013), et la présence d’enfant<15 ans au domicile (OR=0,3 ;IC95 % [0,1–0,7], p=0,006). Une majorité des femmes rapportaient être favorable à d’autres vaccinations pendant la grossesse comme la coqueluche (77 %), le VRS (62 %) ou une future vaccination contre la COVID-19 (61 %). Conclusion Ces résultats soulignent le rôle clé de la proposition vaccinale par les PS dans l’acceptation de la vaccination durant la grossesse ainsi que l’importance d’informations personnalisées sur les bénéfices et la sécurité du vaccin pour la mère et son futur enfant. Cette étude ouvre aussi la réflexion sur l’acceptabilité d’autres vaccins, notamment contre la COVID-19.