ABSTRACT
Background/Aims According to newspaper Bernama, 6.5% of adolescents in Malaysia aged between 12 and 17 have completed their vaccination and 89.7% of the adult population have completed theirs as of 9th October 2021. The acceptance of patients with rheumatic diseases on Covid-19 vaccination are crucial in the successful long-term protection against COVID-19 infection. We conducted a phone survey to determine the acceptance of COVID-19 vaccination amongst adolescents with underlying rheumatic disease. Methods This was a phone survey. The electronic medical records of all rheumatology patients follow up in rheumatology clinic Hospital Sultan Ismail, Malaysia from 2019 to 2021 were reviewed and patients with the age group between 12 to 21 were identified. Demographic data, diagnosis of the disease and outcome of the survey were collected and analysed. Results Phone survey was done after data extracted from medical records. For those under the age of 18, guardian of the patients was interviewed. A total of 50 patients were identified. Most of the patients were female (46/50) and majority of them were Malay (33/50). This was followed by Chinese (10/50), Indian (4/50) and others (3/50). The mean age group was 18 (range from 13 to 21). 36 of them were having systemic lupus erythematosus (SLE), 5 of them were having juvenile idiopathic arthritis (JIA) ,2 of them were having psoriatic arthritis (PSA) and another 2 of them were having rheumatoid arthritis (RA), followed by RA overlapped SLE, juvenile dermatomyositis, Henoch-Schönlein purpura, SLE overlapped with JIA and mixed connective tissue disease about 1 each respectively. Majority of them patients are keen or already completed COVID-19 vaccination with the acceptance rate of as high as 92% (46/50). Only 8% of them are not keen for vaccination with the only reason of worrying the risk of myocarditis post vaccination (1 SLE patient and 1 PSA patient). Conclusion The overall acceptance rate of COVID-19 vaccination amongst adolescents with rheumatic diseases are very encouraging with the percentage of>90% despite lacking knowledge about vaccination for COVID-19. This result can assist our Ministry of Health in planning for future battles to improve vaccine uptake that hopefully can lead to herd immunity against COVID-19 infection.
ABSTRACT
This report presents a novel approach to estimate the total number of COVID-19 cases in the United States, including undocumented infections, by combining the Centers for Disease Control and Prevention's influenza-like illness surveillance data with aggregated prescription data. We estimated that the cumulative number of COVID-19 cases in the United States by 4 April 2020 was > 2.5 million.
ABSTRACT
Background: Different degrees of liver injury were reported in patients infected by Coronavirus disease 2019 (COVID-19) It is possibly caused by systemic inflammation and adverse drug reactions in severe COVID-19 patients under different medical treatments However, the impact of liver injury on adverse clinical outcomes remains unclear We aimed to examine the impact of liver injury on clinical outcomes in COVID-19 patients Methods: All COVID-19 patients reported to the Department of Health between 23 January 2020 and 1 May 2020 in Hong Kong were identified using an electronic database managed by Hospital Authority, Hong Kong, and retrospectively studied Alanine aminotransferase (ALT)/ aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2x upper limit of normal (ULN) (i.e. 80 U/L) Acute liver injury was defined as ALT and/or AST ≥2xULN, with total bilirubin ≥2xULN (i.e. 38 μmol/L) and/or international normalized ratio (INR) ≥1.7. The primary endpoint was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation, and/or death Results: 1,040 COVID-19 patients were identified. Their mean age was 38±18 years, 560 (53 8%) were male, 4 1% and 0 3% had hepatitis B and C virus infection, respectively;53 (5 1%) were admitted to ICU, 22 (2 1%) received invasive mechanical ventilation, and 4 (0 4%) died Among 816 COVID-19 patients who had serial measurement of liver biochemistries, 184 (22 5%) had ALT/ AST elevation and 15 (1 8%) had acute liver injury Acute liver injury was more common in patients who had hepatitis B/C virus infection than those who did not have (9 4% vs. 1 8%, P=0 026) ALT/AST elevation (adjusted odds ratio [aOR] 7 92, 95% CI 4 14-15 14, P<0 001) and acute liver injury (aOR 6 40, 95% CI 1 78-23 07, P=0 005) were independently associated with development of primary endpoint (Table) Use of lopinavirritonavir ± ribavirin + interferon beta (aOR 1 94, 95% CI 1 20- 3 13, P=0 006) and corticosteroids (aOR 3 92, 95% CI 2 14- 7 16, P<0 001) were independently associated with ALT/AST elevation Use of corticosteroids was associated with acute liver injury (aOR 4 76, 95% CI 1 56-14 50, P=0 006), while all 15 patients who developed acute liver injury also usedlopinavir-ritonavir ± ribavirin ± interferon beta Conclusion: ALT/AST elevation and acute liver injury were independently associated with adverse clinical outcomes in COVID-19 patients Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids were associated with ALT/AST elevation and acute liver injury in COVID-19 patients.