Cost-Effectiveness Analysis of COVID-19 Inactivated Vaccines in Reducing the Economic Burden of Ischaemic Stroke after SARS-CoV-2 Infection.

Due to significant economic burden and disability from ischaemic stroke and the relationship between ischaemic stroke and SARS-CoV-2 infection, we aimed to explore the cost-effectiveness of the two-dose inactivated COVID-19 vaccination program in reducing the economic burden of ischaemic stroke after SARS-CoV-2 infection. We constructed a decision-analytic Markov model to compare the two-dose inactivated COVID-19 vaccination strategy to the no vaccination strategy using cohort simulation. We calculated incremental cost-effectiveness ratios (ICERs) to evaluate the cost-effectiveness and used number of the ischaemic stroke cases after SARS-CoV-2 infection and quality-adjusted life-years (QALYs) to assess effects. Both one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results. We found that the two-dose inactivated vaccination strategy reduced ischaemic stroke cases after SARS-CoV-2 infection by 80.89% (127/157) with a USD 1.09 million as vaccination program cost, saved USD 3675.69 million as direct health care costs and gained 26.56 million QALYs compared with no vaccination strategy among 100,000 COVID-19 patients (ICER < 0 per QALY gained). ICERs remained robust in sensitivity analysis. The proportion of older patients and the proportion of two-dose inactivated vaccination among older people were the critical factors that affected ICER. This study suggests the importance of COVID-19 vaccination is not only in preventing the spread of infectious diseases, but also in considering its long-term value in reducing the economic burden of non-communicable diseases such as ischaemic stroke after SARS-CoV-2 infection.

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study.

OBJECTIVE: To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019. DESIGN: Observational study. SETTING: 172 countries and territories. DATA SOURCES: Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data. MAIN OUTCOME MEASURES: The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH. RESULTS: Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers. CONCLUSIONS: Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.

COVID-19 Vaccination Coverage among 42,565 Adults Amid the Spread of Omicron Variant in Beijing, China.

Vaccines against coronavirus disease 2019 (COVID-19) have been in use for over two years, but studies that reflect real-world vaccination coverage and demographic determinants are lacking. Using a multistage stratified random cluster sampling method, we planned to directly explore vaccination coverage and the demographic determinants of different doses of COVID-19 vaccines in Beijing, especially in older populations. All 348 community health service centers in 16 districts were involved. We performed multivariable logistic regression analyses to identify demographic determinants of different coverage rates via adjusted odds ratios (aORs) and 95% CIs. Of the 42,565 eligible participants, the total vaccination coverage rates for ≥1 dose, ≥2 doses, ≥3 doses, and 4 doses were 93.3%, 91.6%, 84.9%, and 13.0%, respectively, but decreased to 88.1%, 85.1%, 76.2%, and 3.8% in the older population. Among all participants, younger (aOR = 1.77, 95% CI: 1.60-1.95), male (aOR = 1.15, 95% CI: 1.06-1.23), and better-educated residents (high school and technical secondary school aOR = 1.58, 95% CI: 1.43-1.74; bachelor's degree aOR = 1.53, 95% CI: 1.37-1.70) were more likely to be fully vaccinated. People who lived in rural areas (aOR = 1.45, 95% CI: 1.31-1.60) and held the new rural cooperative health insurance (aOR = 1.37, 95% CI: 1.20-1.57) established a higher rate of full vaccination coverage. No history of chronic disease was positively associated with a higher coverage rate (aOR = 1.81, 95% CI: 1.66-1.97). Occupation also affected vaccination coverage. Demographic factors influencing the rate of vaccination with at least one or three doses were consistent with the results above. Results remained robust in a sensitivity analysis. Given the highly transmissible variants and declining antibody titers, accelerating the promotion of booster vaccination coverage, especially in high-risk groups such as the elderly, is a top priority. For all vaccine-preventable diseases, rapidly clarifying vaccine-hesitant populations, clearing barriers, and establishing a better immune barrier can effectively safeguard people's lives and property and coordinate economic development with epidemic prevention and control.

Duration of viable virus shedding and polymerase chain reaction positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract: a systematic review and meta-analysis.

OBJECTIVES: To assess the duration of viable virus shedding and polymerase chain reaction (PCR) positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract. METHODS: We systematically searched PubMed, Cochrane, and Web of Science for original articles reporting the duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract from November 11, 2021 to December 11, 2022. This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42022357349). We used the DerSimonian-Laird random-effects meta-analyses to obtain the pooled value and the 95% confidence intervals. RESULTS: We included 29 studies and 230,227 patients. The pooled duration of viable virus shedding of the SARS-CoV-2 Omicron variant in the upper respiratory tract was 5.16 days (95% CI: 4.18-6.14), and the average duration of PCR positivity was 10.82 days (95% CI: 10.23-11.42). The duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in symptomatic patients was slightly higher than that in asymptomatic patients, but the difference was not significant (P >0.05). CONCLUSION: The current study improves our understanding of the status of the literature on the duration of viable virus shedding and PCR positivity of Omicron in the upper respiratory tract. Our findings have implications for pandemic control strategies and infection control measures.

Trends of SARS-CoV-2 Infection Among Couriers in Risky Business After the Optimization of Prevention and Control Measures - China, December 2022 to January 2023.

Introduction: On December 7, 2022, China implemented "Ten New Measures" to optimize prevention and control measures for coronavirus disease 2019 (COVID-19). The purpose of this study was to evaluate the national and regional trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among couriers in China from December 2022 to January 2023. Methods: Data from the National Sentinel Community-based Surveillance in China was utilized, including participants from 31 provincial-level administrative divisions and Xinjiang Production and Construction Corps. Participants were tested for SARS-CoV-2 infection twice a week from December 16, 2022 to January 12, 2023. Infection was defined as a positive result for SARS-CoV-2 nucleic acid or antigen. The daily average newly positive rate of SARS-CoV-2 infection and the estimated daily percentage change (EDPC) were calculated. Results: In this cohort, 8 rounds of data were collected. The daily average newly positive rate of SARS-CoV-2 infection decreased from 4.99% in Round 1 to 0.41% in Round 8, with an EDPC of -33.0%. Similar trends of the positive rate were also observed in the eastern (EDPC: -27.7%), central (EDPC: -38.0%) and western regions (EDPC: -25.5%). Couriers and community population showed a similar temporal trend, with the peak daily average newly positive rate of couriers being higher than that of community population. After Round 2, the daily average newly positive rate of couriers decreased sharply, becoming lower than that of community population in the same period. Conclusions: The peak of SARS-CoV-2 infection among couriers in China has passed. As couriers are a key population for SARS-CoV-2 infection, they should be monitored continuously.

Analysis of the Practice of Community-Based Self-Sampling and Its Implication on Prevention and Control of Infectious Diseases - Fengtai District, Beijing Municipality, China, 2022.

What is already known about this topic?: So far, no descriptive analysis has been conducted on community residents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid self-sampling in China. What is added by this report?: This report found that self-sampling had a wide age and regional distribution, with the time from self-sampling to result-reporting typically taking less than one day. Additionally, self-sampling was found to save a considerable amount of manpower and medical resources compared to regular sampling. What are the implications for public health practice?: The experience of prevention and control measures during the coronavirus disease 2019 (COVID-19) pandemic has provided a reference for the prevention and control of other infectious diseases through self-sampling.

Long-term impact of the COVID-19 pandemic on health services utilization in China: A nationwide longitudinal study.

Background: Long-term impact of the COVID-19 pandemic on health services utilization is unknown. We aim to assess the long-term effect of the COVID-19 pandemic on health services utilization in China. Methods: Between Jan 2017 and Dec 2021, we conducted a nationwide longitudinal study using routinely collected data on health services utilization in the National Health Information System of China. We extracted national and provincial data of demographic characteristics, socio-economic characteristics, and health resources. Interrupted time-series segmented negative binominal regression models were used. Results: A total of 34.2 billion health facilities visits and 1.1 billion inpatients discharged were included. The largest negative impact of COVID-19 pandemic on the health services utilization was during containment period, that health facility visits were observed 32% reduction in hospitals (adjusted incidence risk ratios [aRRs] 0.68, 95%CI: 0.50-0.92), 27% reduction in community health centers (aRR 0.73, 95%CI: 0.57-0.93), and 22% reduction township centers (aRR 0.78, 95%CI: 0.67-0.91), respectively. The impact on health facility visits and inpatients discharged were reduced and eliminated over time (all p>0.05). However, the negative impact on utilization rate of beds, average length of stay, average inpatient costs, and average outpatient costs in different level of health facilities still existed two years later (all p<0.05). Conclusions: The impact of the COVID-19 pandemic on health services utilization was largest during containment period and reduced over time, but it still existed two years later. There are disparities in the recovery of health services. Our findings highlighted the importance of maintaining primary healthcare services during the pandemic and strengthen resilient health system on the rapid recovery of medical services.

Trends of SARS-CoV-2 Infection in Sentinel Community-Based Surveillance After the Optimization of Prevention and Control Measures - China, December 2022-January 2023.

Introduction: On December 7, 2022, China implemented the "Ten New Measures" to optimize its prevention and control measures for coronavirus disease 2019 (COVID-19). To provide the latest data after the optimization, we evaluated trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among the community population in China. Methods: We utilized data from the National Sentinel Community-Based Surveillance (NSCS) system in China to assess trends of SARS-CoV-2 infection. NSCS is a national community-based surveillance cohort with 0.42 million participants from all 31 provincial-level administrative divisions (PLADs) and Xinjiang Production and Construction Corps (XPCC). Participants were tested for infection twice a week (a total of eight rounds) from December 16, 2022 to January 12, 2023. SARS-CoV-2 infection was defined as testing positive for SARS-CoV-2 nucleic acid or antigen. We calculated the daily average of newly positive rates of SARS-CoV-2 infection. Results: In this national cohort, the daily average newly positive rate of SARS-CoV-2 infection decreased from 4.13% in Round 1 (December 16-19, 2022) to 0.69% in Round 8 (January 10-12, 2023). The epidemic peak occurred in Round 2 (December 20-22, 2022). Similar trends were observed in urban areas (decreasing from 4.65% to 0.73%), rural areas (decreasing from 2.83% to 0.57%), the eastern region (decreasing from 4.18% to 0.67%), the central region (decreasing from 5.43% to 0.61%), and the western region (decreasing from 3.01% to 0.77%). Conclusions: NSCS data showed that the peak of SARS-CoV-2 infection in China had passed. SARS-CoV-2 infection in community populations in China is currently at a low epidemic level.

Trends of SARS-CoV-2 Infection in Rural Area in Sentinel Community-Based Surveillance - China, December 2022 to January 2023.

Introduction: In late 2022, a rapid transmission of Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred throughout China. The purpose of this study was to provide the latest data and evaluate trends of SARS-CoV-2 infection in rural China among the community population. Methods: Data on SARS-CoV-2 infection among approximately 90,000 participants in rural China were collected by the National Sentinel Community-Based Surveillance (NSCS) system. Participants were tested for SARS-CoV-2 infection (defined as positive for SARS-CoV-2 nucleic acid or antigen) twice weekly from December 16, 2022 to January 12, 2023. The daily average of newly positive rate and its estimated daily percentage change were calculated to describe the national and regional trends of SARS-CoV-2 infection in rural China. Results: In rural China, the daily average new positive rate of SARS-CoV-2 infection peaked at 4.79% between December 20-22, 2022 and then decreased to 0.57% between January 10-12, 2023, with an average decrease of 29.95% per round. The peak of new SARS-CoV-2 infection was slightly earlier and lower in North China (5.28% between December 20-22, 2022) than in South China (5.63% between December 23-26, 2022), and then converged from December 30, 2022 to January 2, 2023. The peak of 6.09% occurred between December 20-22, 2022 in eastern China, while the peak of 5.99% occurred later, between December 27-29, 2022, in central China. Conclusions: Overall, the epidemic wave in rural China peaked between December 20-22, 2022, and passed quickly following the optimization of prevention and control measures. Currently, SARS-CoV-2 infection in community populations in rural China is sporadic.

Assessing acceptability of the fourth dose against COVID-19 among Chinese adults: A population-based survey.

Coronavirus disease 2019 (COVID-19) has wreaked havoc across the globe for approximately three years. Vaccination is a key factor to ending this pandemic, but its protective effect diminishes over time. A second booster dose at the right time is needed. To explore the willingness to receive the fourth dose of the COVID-19 vaccine and its influencing factors, we commenced a national, cross-sectional and anonymous survey in mainland China among people aged 18 and above from October 24 to November 7, 2022. A total of 3,224 respondents were eventually included. The acceptance rate of the fourth dose was 81.1% (95% CI: 79.8-82.5%), while it was 72.6% (95% CI: 71.1-74.2%) for a heterologous booster. Confidence in current domestic situation and the effectiveness of previous vaccinations, and uncertainty about extra protection were the main reasons for vaccine hesitancy. Perceived benefit (aOR = 1.29, 95% CI: 1.159-1.40) and cues to action (aOR = 1.73, 95% CI: 1.60-1.88) were positively associated with the vaccine acceptance, whereas perceived barriers (aOR = 0.78, 95% CI: 0.72-0.84) and self-efficacy (aOR = 0.79, 95% CI: 0.71-0.89) were both negatively associated with it. Additionally, sex, age, COVID-19 vaccination history, time for social media, and satisfaction with the government's response to COVID-19 were also factors affecting vaccination intention. Factors influencing the intention of heterologous booster were similar to the above results. It is of profound theoretical and practical significance to clarify the population's willingness to vaccinate in advance and explore the relevant influencing factors for the subsequent development and promotion of the fourth-dose vaccination strategies.

COVID-19 vaccination in people living with HIV and AIDS (PLWHA) in China: A cross-sectional study.

COVID-19 appears to put people living with HIV and AIDS (PLWHA) at a higher risk of catastrophic consequences and mortality. However, investigations on the hesitancy and vaccination behavior of PLWHA in China were lacking compared to the general population. From January 2022 to March 2022, we conducted a multi-center cross-sectional survey of PLWHA in China. Logistic regression models were used to examine factors associated to vaccine hesitancy and COVID-19 vaccine uptake. Among 1424 participants, 108 participants (7.6%) were hesitant to be vaccinated while 1258 (88.3%) had already received at least one dose of the COVID-19 vaccine. Higher COVID-19 vaccine hesitancy was associated with older age, a lower academic level, chronic disease, lower CD4+ T cell counts, severe anxiety and despair, and high perception of illness. Lower education level, lower CD4+ T cell counts, and significant anxiety and depression were all associated with a lower vaccination rate. When compared to vaccinated participants, those who were not hesitant but nevertheless unvaccinated had a higher presence of chronic disease and lower CD4+ T cell count. Tailored interventions (e.g. targeted education programs) based on these linked characteristics were required to alleviate concerns for PLWHA in promoting COVID-19 vaccination rates, particularly for PLWHA with lower education levels, lower CD4+ T cell counts, and severe anxiety and depression.

Severity and Outcomes of SARS-CoV-2 Reinfection Compared with Primary Infection: A Systematic Review and Meta-Analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection has brought new challenges to the global prevention and control of coronavirus disease 2019 (COVID-19) pandemic; however, current studies suggest that there is still great uncertainty about the risk of severe COVID-19 and poor outcomes after SARS-CoV-2 reinfection. Random-effects inverse-variance models were used to evaluate the pooled prevalence (PP) and its 95% confidence interval (CI) of severity, outcomes and symptoms of reinfection. Random-effects were used to estimate the pooled odds ratios (OR) and its 95%CI of severity and outcomes between reinfections and primary infections. Nineteen studies involving a total of 34,375 cases of SARS-CoV-2 reinfection and 5,264,720 cases of SARS-CoV-2 primary infection were included in this meta-analysis. Among those SARS-CoV-2 reinfection cases, 41.77% (95%CI, 19.23-64.31%) were asymptomatic, and 51.83% (95%CI, 23.90-79.76%) were symptomatic, only 0.58% (95%CI, 0.031-1.14%) manifested as severe illness, and 0.04% (95%CI, 0.009-0.078%) manifested as critical illness. The PPs for SARS-CoV-2 reinfection-related hospitalization, admission to ICU, and death were, respectively, 15.48% (95%CI, 11.98-18.97%), 3.58% (95%CI, 0.39-6.77%), 2.96% (95%CI, 1.25-4.67%). Compared with SARS-CoV-2 primary infection cases, reinfection cases were more likely to present with mild illness (OR = 7.01, 95%CI, 5.83-8.44), and the risk of severe illness was reduced by 86% (OR = 0.14, 95%CI, 0.11-0.16). Primary infection provided some protection against reinfection and reduces the risk of symptomatic infection and severe illness. Reinfection did not contribute to extra risk of hospitalization, ICU, or death. It is suggested to scientifically understand the risk of reinfection of SARS-CoV-2, strengthen public health education, maintain healthy habits, and reduce the risk of reinfection.

Long-Term Consequences of Asymptomatic SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis.

Little is known about the long-term consequences of asymptomatic infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to review the data available to explore the long-term consequences of asymptomatic SARS-CoV-2 infection in the real world. We searched observational cohort studies that described the long-term health effects of asymptomatic SARS-CoV-2 infections. Random-effects inverse-variance models were used to evaluate the pooled prevalence (PP) and its 95% confidence interval (CI) of long-term symptoms. Random effects were used to estimate the pooled odds ratios (OR) and its 95%CI of different long-term symptoms between symptomatic and asymptomatic infections. Five studies involving a total of 1643 cases, including 597 cases of asymptomatic and 1043 cases of symptomatic SARS-CoV-2 infection were included in this meta-analysis. The PPs of long-term consequences after asymptomatic SARS-CoV-2 infections were 17.13% (95%CI, 7.55−26.71%) for at least one symptom, 15.09% (95%CI, 5.46−24.73%) for loss of taste, 14.14% (95%CI, −1.32−29.61%) for loss of smell, and 9.33% (95%CI, 3.07−15.60) for fatigue. Compared with symptomatic SARS-CoV-2 infection, asymptomatic infection was associated with a significantly lower risk of developing COVID-19-related sequelae (p < 0.05), with 80% lower risk of developing at least one symptom (OR = 0.20, 95%CI, 0.09−0.45), 81% lower risk of fatigue (OR = 0.19, 95%CI, 0.08−0.49), 90% lower risk of loss of taste/smell (OR = 0.10, 95%CI, 0.02−0.58). Our results suggested that there were long-term effects of asymptomatic SARS-CoV-2 infection, such as loss of taste or smell, fatigue, cough and so on. However, the risk of developing long-term symptoms in asymptomatic SARS-CoV-2 infected persons was significantly lower than those in symptomatic SARS-CoV-2 infection cases.

Trends and disparities in 44 national notifiable infectious diseases in China: an analysis of national surveillance data from 2010 to 2019.

BACKGROUND: Research assessing the changing epidemiology of infectious diseases in China after the implementation of new health-care reform in 2009 was scarce. We aimed to get the latest trends and disparities of national notifiable infectious diseases by age, sex, province and seasons in China from 2010 to 2019. METHODS: The number of incident cases and deaths, incidence rate and mortality of 44 national notifiable infectious diseases by sex, age groups, and provincial regions from 2010 to 2019 was extracted from the China Information System for Disease Control and Prevention and official reports, and divided into six kinds of infectious diseases by transmission routes and three classes (A, B and C) in this descriptive study. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends of incidence and mortality rate. We calculated concentration index to measure economic-related inequality. Segmented interrupted time-series analysis was used to estimate the impact of the COVID-19 pandemic on the epidemic of notifiable infectious disease. RESULTS: The trend of incidence rate on six kinds of infectious diseases by transmission routes was stable, while only mortality of sexual, blood-borne, and mother-to-child-borne infectious diseases increased from 0.6466 per 100 000 population in 2010 to 1.5499 per 100 000 population in 2019 by 8.76% per year (95%CI: 6.88-10.68). There was a decreasing trend of incidence rate on Class-A infectious diseases (EAPC=-16.30%; 95%CI: -27.93 - -2.79) and Class-B infectious diseases (EAPC=-1.05%; 95%CI: -1.56 - -0.54), while an increasing trend on Class-C infectious diseases (EAPC=6.22%; 95%CI: 2.13~10.48). For mortality, there was a decreasing trend on Class-C infectious diseases (EAPC=-14.76%; 95%CI: -23.46 - -5.07), and an increasing trend on Class-B infectious diseases (EAPC=4.56%; 95%CI: 2.44-6.72). In 2019, the infectious diseases with highest incidence rate and mortality were respiratory diseases (340.95 per 100 000 population), and sexual, blood-borne, and mother-to-child-borne infectious diseases (1.5459 per 100 000 population), respectively. The greatest increasing trend of incidence rate was observed in seasonal influenza, from 4.83 per 100 000 population in 2010 to 253.36 per 100 000 population in 2019 by 45.16% per year (95%CI: 29.81-62.33), especially among female and children aged 0 - 4 years old. The top disease with highest mortality was still AIDs which had the highest average yearly mortality in 24 provinces from 2010 to 2019, and its incidence rate (EAPC=14.99%; 95%CI: 8.75-21.59) and mortality (EAPC=9.65; 95%CI: 7.71-11.63) both increased from 2010 to 2019, especially among people aged 44 - 59 years old and 60 or older. Male incidence rate and mortality were higher than females each year from 2010 to 2018 on 29 and 10 infectious diseases, respectively. Additionally, sex differences of incidence and mortality of AIDS were becoming larger. The curve lay above the equality line, with the negative value of the concentration index, which indicated that economic-related health disparities exist in the distribution of incidence rate and mortality of respiratory diseases (incidence rate: the concentration index = -0.063, P<0.0001; mortality: the concentration index = -0.131, P<0.001), sexual, blood-borne, and mother-to-child-borne infectious diseases (incidence rate: the concentration index = -0.039, P=0.0192; mortality: the concentration index = -0.207, P<0.0001), and the inequality disadvantageous to the poor (pro-rich). Respiratory diseases (Dec, Jan), intestinal diseases (May, Jun, July), zoonotic infectious diseases (Mar-Jul) and vector-borne infectious diseases (Sep-Oct) had distinct seasonal epidemic patterns. In addition, segmented interrupted time-series analyses showed that, after adjusted for potential seasonality, autocorrelation, GDP per capita, number of primary medical institutions and other factors, there was no significant impact of COVID-19 epidemic on the monthly incidence rate of six kinds of infectious diseases by transmission routes from 2018 to 2020 (all P>0.05). CONCLUSIONS: The incidence rates of six kinds of infectious diseases were stable in the past decade, and incidence rates of Class-A and Class-B infectious diseases were deceasing, because of comprehensive prevention and control measures and strengthened health system after the implementation of the new health-care reform in China since 2009. However, age, gender, regional and economic disparities were still observed. Concerted efforts are needed to reduce the impact of seasonal influenza (especially among children aged 0 - 4 years old) and the mortality of AIDs (especially among people aged 44 - 59 years old and 60 or older). More attention should be paid to the disparities on the burden of infectious diseases. This article is protected by copyright. All rights reserved.

Immunogenicity, effectiveness, and safety of COVID-19 vaccines among children and adolescents aged 2-18 years: an updated systematic review and meta-analysis.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, there is an urgent need for safe and effective COVID-19 vaccines to protect children and adolescents. This study aims to provide scientific evidence and recommendations for the application of COVID-19 vaccines in children and adolescents by analyzing the latest studies. METHODS: We systematically searched MEDLINE (accessed through PubMed), Embase, and Web of Science from January 1, 2020, to October 8, 2022. Eligible clinical trials, cohort studies, case‒control studies, and cross-sectional studies with extractable data were included in immunogenicity, effectiveness, and safety analyses. According to the heterogeneity, we chose a fixed-effect model (when I2 ≤ 50) or a random-effects model (when I2 > 50) to pool effect values. RESULTS: A total of 88 articles were included. The seroconversion rates after the first, second, and third doses of the vaccines were 86.10%, 96.52%, and 99.87%, respectively. After the first and second doses, vaccine effectiveness (VE) against severe acute respiratory syndrome coronavirus 2 infection was 42.87% [95% confidence interval (CI) = 27.09%-58.65%] and 63.33% (95% CI = 52.09%-74.56%), respectively. After the first and second doses, VE against COVID-19 was 60.65% (95% CI = 44.80%-76.50%) and 75.77% (95% CI = 63.99%-87.56%), respectively. VE against hospitalization due to COVID-19 after the first and second doses was 72.74% (95% CI = 51.48%-94.01%) and 82.78% (95% CI = 75.78%-89.78%), respectively. The most common adverse events were injection site pain, fatigue/asthenia/tiredness, headache, myalgia/muscle pain, and chills. The incidence rate of myocarditis or pericarditis was 2.42/100,000 people. In addition, the subgroup analysis showed that children aged ≤ 5 years had the lowest incidence of adverse events, and the incidence rate of adverse events was higher for mRNA vaccines than for inactivated vaccines. CONCLUSIONS: COVID-19 vaccines have good immunogenicity, effectiveness, and safety among children and adolescents. We recommend that children and adolescents be vaccinated as soon as possible to protect them and slow the spread of COVID-19.

Millions of excess cases and thousands of excess deaths of malaria occurred globally in 2020 during the COVID-19 pandemic.

Background: The COVID-19 pandemic disrupted malaria-related health care services, leading to an excess burden of malaria. However, there is a lack of research on the indirect global impact of the COVID-19 pandemic on malaria. We aimed to assess the excess burden of malaria due to the COVID-19 pandemic in malaria-endemic countries in 2020. Methods: Based on data from the World Health Organization Global Observatory, we used estimated annual percentage changes (EAPCs) from 2000 to 2019 (model A) and from 2015 to 2019 (model B) to predict the malaria burden in 2020. We calculated the ratios between reported and predicted malaria incidence (incidence rate ratio (IRR)) and mortality rates (mortality rate ratio (MRR)). Results: In 2020, African countries suffered the most from malaria, with the largest number of malaria cases (64.7 million) and deaths (151 thousand) observed in Nigeria. Most countries showed a decrease in malaria incidence and mortality rates from 2000 to 2019, with the strongest decline in incidence rates in Bhutan (EAPC = -35.7%, 95% CI = -38.7 to -32.5%) and mortality rates Ecuador (EAPC = -40.6%, 95% confidence interval (CI) = -46.6 to -33.8%). During the COVID-19 pandemic in 2020, there was a total of 18 million excess malaria cases and 83 291 excess deaths per model A, and 7.4 million excess cases and 33 528 excess deaths per model B globally. Malaria incidence rates increased excessively in over 50% of the malaria-endemic countries, with the greatest increase in Costa Rica (IRR = 35.6) per model A and Bhutan (IRR = 15.6) per model B. Mortality rates had increased excessively in around 70% of the malaria-endemic countries, with the greatest increase in Ecuador in both model A (MRR = 580) and model B (MRR = 58). Conclusions: The emergence of the COVID-19 pandemic indirectly caused an increase in the prevalence of malaria and thwarted progress in malaria control. Global efforts to control the pandemic's impact should be balanced with malaria control to ensure that the goal for global malaria elimination is achieved on time.

Acceptance of the COVID-19 vaccine booster dose and associated factors among the elderly in China based on the health belief model (HBM): A national cross-sectional study.

Background: The reluctance of individuals to obtain solid vaccine-induced immunity represents a fundamental challenge to containing the spread of SARS-CoV-2, including its highly mutated variants. We aimed to assess vaccination acceptance and associated factors for the COVID-19 vaccine booster dose among elderly people (≥60 years old) in China, providing a theoretical and practical reference for universal vaccination policy. Methods: A national anonymous survey was conducted in mainland China from May 25 to June 8, 2022, using a stratified random sampling method. Individuals 60 years of age and above were the target population. A chi-squared test and Cochran-Armitage test for trend were used to compare and examine vaccine acceptance rates by characteristics. Via a backward stepwise method, multivariable logistic regression models were established to assess factors associated with booster dose acceptance. Two-sided P < 0.05 was considered statistically significant. Results: Of 3,321 eligible participants, 82.8% (95% CI: 81.5-84.1%) were willing to receive COVID-19 vaccine booster shots. Concerns about contraindications (38.3%), vaccine safety (32.0%), and limited movement (28.0%) were the main reasons for vaccine hesitancy. Nearly one-third still believed that the booster dose was unnecessary after receiving the initial vaccination. Older adults with a low level of perceived barriers (aOR = 1.86, 95% CI, 1.03-3.38), a high level of perceived benefit (aOR = 2.31, 95% CI, 1.38-3.87), and higher cues to action (moderate, aOR = 2.22, 95% CI, 1.39-3.56; high, aOR = 5.46, 95% CI: 3.44-8.67) were more likely to accept the booster dose. Other major factors affecting the booster dose acceptance rate were occupation, time spent on social media, vaccination history, and a high knowledge score for COVID-19 and vaccines. In addition, for those over 70 years of age, rising awareness of susceptibility could be a better gateway for improving their willingness to get vaccinated. Conclusions: A total of 82.8% of recruited older adults were willing to receive the booster dose. Acceptance behaviors were closely related to occupation, time spent on social media, vaccination history, knowledge factors, perception of barriers, and benefit, as well as action cues. Targeted public health measures are a priority for improving the vaccination coverage of valid immunity among the elderly population, not only to prevent infection and poor prognosis caused by emerging variants but also to reduce the huge disease and economic burden caused by the long-term sequelae after SARS-CoV-2 infection.

Social Media Use, Unhealthy Lifestyles, and the Risk of Miscarriage Among Pregnant Women During the COVID-19 Pandemic: Prospective Observational Study.

BACKGROUND: The COVID-19 pandemic has resulted in changes to normal life and disrupted social and economic function worldwide. However, little is known about the impact of social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women during the COVID-19 pandemic. OBJECTIVE: This study aims to assess the association between social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women in the early stage of the COVID-19 pandemic in China. METHODS: In this prospective cohort study, 456 singleton pregnant women in mainland China were recruited during January and February 2020. Sociodemographic characteristics, history of previous health, social media use, and current lifestyles were collected at baseline, and we followed up about the occurrence of miscarriage. Log-binomial regression models were used to estimate the risk ratios (RRs) of miscarriage for women with different exposures to COVID-19-specific information. RESULTS: Among all the 456 pregnant women, there were 82 (18.0%) who did no physical activities, 82 (18.0%) with inadequate dietary diversity, 174 (38.2%) with poor sleep quality, and 54 (11.8%) spending >3 hours on reading COVID-19 news per day. Women with excessive media use (>3 hours) were more likely to be previously pregnant (P=.03), have no physical activity (P=.003), have inadequate dietary diversity (P=.03), and have poor sleep quality (P<.001). The prevalence of miscarriage was 16.0% (n=73; 95% CI 12.6%-19.4%). Compared with women who spent 0.5-2 hours (25/247, 10.1%) on reading COVID-19 news per day, miscarriage prevalence in women who spent <0.5 hours (5/23, 21.7%), 2-3 hours (26/132, 19.7%), and >3 hours (17/54, 31.5%) was higher (P<.001). Miscarriage prevalence was also higher in pregnant women with poor sleep quality (39/174, 22.4% vs 34/282, 12.1%; P=.003) and a high education level (66/368, 17.9% vs 7/88, 8.0%; P=.02). In the multivariable model, poor sleep quality (adjusted RR 2.06, 95% CI 1.24-3.44; P=.006), 2-3 hours of media use daily (adjusted RR 1.74, 95% CI 1.02-2.97; P=.04), and >3 hours of media use daily (adjusted RR 2.56, 95% CI 1.43-4.59; P=.002) were associated with miscarriage. In the sensitivity analysis, results were still stable. CONCLUSIONS: Pregnant women with excessive media use were more likely to have no physical activity, inadequate dietary diversity, and poor sleep quality. Excessive media use and poor sleep quality were associated with a higher risk of miscarriage. Our findings highlight the importance of healthy lifestyles during the COVID-19 pandemic.