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Aim This study aimed to assess the awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia. Materials and Methods We conducted a cross-sectional study among 326 undergraduate pharmacy students in Lusaka, Zambia, from February to April 2021. Data were analysed using Stata version 16.1. Multivariable logistic regression was used to determine key factors influencing vaccine acceptance. Results Of the 326 participants, 98.8% were aware of the COVID-19 vaccines, but only 24.5% would accept vaccination. Compared to other religions, being of Christian faith was associated with reduced odds of awareness of the COVID-19 vaccine (aOR=0.01, 95% CI: 0.01-0.20). Conversely, factors associated with vaccine acceptance were being male, single and unemployed. Compared to females, male respondents were 86% more likely to accept the vaccine if it was made available (aOR=1.86, 95% CI: 1.10-3.14). In addition, unmarried respondents were 2.65 times as likely to accept vaccination than married respondents (aOR=2.65, 95% CI: 1.06-6.63). Conversely, unemployed respondents were less likely to accept vaccination than their employed counterparts (aOR=0.32, 95% CI: 0.16-0.46). Barriers to the acceptability of the vaccine were possible side effects (78.5%) and scepticism about its effectiveness (10.2%). Conclusion There was significant vaccine hesitancy toward COVID-19 vaccines among Zambian pharmacy students despite their awareness of the vaccines. Health authorities must work collaboratively with training institutions to mitigate vaccine hesitancy, especially with healthcare students being a key part of the future healthcare workforce overseeing disease prevention strategies.
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[This corrects the article DOI: 10.1007/s11858-022-01447-2.].
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The purpose of the work described in this paper is to emphasize the importance of using mathematical models and mathematical modelling in order to be able to understand and to learn possible behaviours in epidemic situations such as that of the COVID-19 pandemic, besides suggesting modelling techniques with which to evaluate certain sanitary decisions and policies which do, in fact, affect society as a whole. The mathematical tools that are used derive from nonlinear systems of difference equations (possibly viable at a high school level, using spreadsheets or adequate software) as well as nonlinear systems of ordinary differential equations (therefore using mathematical tools and software well within the reach of undergraduate students of many courses). This purpose is accomplished by motivating students and learners to study existing SIR-type models and modifying them in order to have a fully understandable translation of dynamics for infectious diseases such as COVID-19 in several different realistic scenarios, that is to say, situations that consider social distancing policies, widespread vaccination programmes, as well as possible and even probable results when in the presence of negationist postures and attitudes. Several modelling choices referring to real-life situations are shown and explored. These models are analysed and discussed, implicitly proposing similar attitudes and evaluations in learning environments. Conclusions are drawn, stimulating further work using the described mathematical tools and resources. Supplementary Information: The online version contains supplementary material available at 10.1007/s11858-022-01447-2.
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Eukaryotic chromatin is highly organized in the 3D nuclear space and dynamically regulated in response to environmental stimuli. This genomic organization is arranged in a hierarchical fashion to support various cellular functions, including transcriptional regulation of gene expression. Like other host cellular mechanisms, viral pathogens utilize and modulate host chromatin architecture and its regulatory machinery to control features of their life cycle, such as lytic versus latent status. Combined with previous research focusing on individual loci, recent global genomic studies employing conformational assays coupled with high-throughput sequencing technology have informed models for host and, in some cases, viral 3D chromosomal structure re-organization during infection and the contribution of these alterations to virus-mediated diseases. Here, we review recent discoveries and progress in host and viral chromatin structural dynamics during infection, focusing on a subset of DNA (human herpesviruses and HPV) as well as RNA (HIV, influenza virus and SARS-CoV-2) viruses. An understanding of how host and viral genomic structure affect gene expression in both contexts and ultimately viral pathogenesis can facilitate the development of novel therapeutic strategies.
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Background: Smart phone mobile application (Breathe Easy app) with data dashboard (https://www.zephyrx.com/) receive and display results of remote FVC accelerated in use during COVID-19 pandemic. Objective(s): We assessed the reliability of FVC as reported with in-clinic Conventional (Viaire and Vyasis, USA) and inclinic portable and at-home portable (MIR Spirobank Smart, Italy) spirometers that calculated FVC as percentage of predicted values based on GLI (Global Lung Index)-2012 reference standard. Method(s): In this retrospective study, twenty-two ALS patients were analyzed from a total of 95 ALS patients seen in clinic between July 2020 and June 2021. Independent analysis of FVC % predicted values acquired with portable spirometer was performed using GLI-2012 online calculator equations based on age, height, gender and ethnicity. To confirm that the same reference standard GLI-2012 was displayed by the software application, a web-based tool was used to calculate % predicted FVC to confirm that spirometric values were standardized according to GLI-2012 (glicalculator. ersnet.org). Result(s): A third of dashboard-reported measurements were found to be 1% less than calculated measurements (29 out of 87 portable spirometry measurements) and appeared to be a fairly consistent difference in the first 1/3 of FVC followed longitudinally. Query was brought to the attention of the ZephyRx software development team. Dashboard algorithm was assessed to investigate for possible systematic error to account for the difference. The automated dashboard reporting of age using exact birth date to one decimal place on the day of testing as opposed to birth year used with manual calculations was confirmed to result in the 1% predicted difference in manually calculated FVC. Discussion(s): Reported difference in spirometric values can be due to systematic difference in spirometric reference standards or a true difference in pulmonary function (1). ALS-specific digital health technology require vetting by independent ALS neuromuscular and pulmonary researchers and quality testing needs to occur within the clinical realm (2).
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Background: COVID-19 pandemic presents new opportunities to augment respiratory monitoring complementary to remote telehealth services. Stratification of vital capacity may allow for characterization of FVC and disease trajectory clusters (1). Objective(s): In this implementation science study, we assessed the feasibility of measuring FVC in seated upright and supine positions obtained with in-clinic-conventional (Viaire and Vyasis, USA), in-clinic-portable and at-home-portable (MIR Spirobank Smart, Italy) spirometers with respiratory therapist coaching. Method(s): Electronic health records of 22/95 ALS clinic patients (23%) from single-center in Central New York that launched AHT between July 2020 and June 2021 was reviewed in this IRB-approved retrospective study. Mean age of patients was 65 years old and 9 were males. Patients were stratified according to baseline seated FVC % predicted by conventional method: Group A, FVC >80%, Group B, 60-80%, Group C <60% predicted. Patients unable to come to clinic received spirometers by mail followed with remote training with respiratory therapists without conventional spirometry. Result(s): Pearson correlation coefficient was used to evaluate the correlation between FVC measurement using conventional and portable spirometry by position. Bland-Altman analysis was performed to evaluate the mean difference (conventional - portable) with 95% limits of agreement. Measurement of seated FVC acquired during the same clinic visit (N=13) were highly correlated in liters (R2=0.95, p<0.0001) and % predicted (R2=0.952, p<0.0001). Bland- Altman analysis showed good agreement with a mean difference of 0.147L, 0.345 to 0.639L);4.154% predicted, (8.004 to 16.311%). In-clinic supine FVC (N=4) were highly correlated in liters (R2=0.987, p=0.007) and % predicted (R2=0.987, p=0.007) with a mean difference of =0.33L, (0.101 to 0.761L);8.5% predicted, (0.043-17.043%). Supine vital capacity measurements were more frequently obtained with AHT 35/52 (67.31%) vs. 9/21(42.86%) with Conventional spirometry. Safety concerns associated with patient transfers were the most frequently encountered barrier in performing supine testing in clinic. Reason for drop out for 2/22 patients with no remote AHT was attributed to perceived aggravation of anxiety from readily viewing FVC results on smartphone and low baseline FVC (<50% predicted). AHT led to prompt initiation of NIV in 5/22 patients, of which 3 were homebound, had low FVC at initial AHT (12-48% predicted), low ALS FRSR (14-28 out of 48) and received remote AHT training without conventional spirometry. An ongoing slow vital capacity (NCT05106569) prospective clinical study in ALS will determine if frequent respiratory surveillance from home using AHT leads to better outcomes in relation to use of NIV.
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During COVID-19, attention was drawn to a lack of functional governance frameworks for health emergencies. Routine governance structures were neither agile, nor flexible enough to operate with the speed required for urgent and coordinated action within complex and far-reaching responses. WHO's Emergency Response Framework has significantly contributed to a stronger WHO response capacity in the European Region by providing accountabilities, responsibilities, delegation of authority, and rapid access to resources for response, while also allowing for participating members to be held accountable for their actions. We argue that now is the time to move health emergency management forwards by supporting States in strengthening their emergency governance architectures.
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The COVID-19 pandemic has taught us that preparedness for and resilience against health emergencies is critical. To improve preparedness for health emergencies, the emergency preparedness and response governance architecture at all levels should be strengthened. It should be based on cross-cutting, whole-of- government, and whole-of-society approaches, moving away from siloed perspectives. Moreover, resilience against health emergencies should be based on universal health coverage and anchored in the International Health Regulations (IHR) 2005 core capacities implementation. Capacities and capabilities that are required to improve health services for national and global health security should also be strengthened.
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Introduction: The South African Health Products Regulatory Authority (SAHPRA) utilises various AEFI reporting tools to monitor vaccine safety in the country. In 2020, SAHPRA in collaboration with the National Department of Health's (NDoH) Expanded Programme on Immunisation (EPI), joined the African Union Smart Safety Surveillance programme, as one of four pilot countries, to introduce an electronic adverse event following immunisation (AEFI) reporting system (Med Safety App) for healthcare professionals and consumers [1]. On 17/05/2021, the NDoH introduced its national COVID-19 vaccination programme. SAHPRA launched a microsite during 2021, to provide feedback to the public on AEFI with the COVID-19 vaccines. Objective(s): To provide an overview of COVID-19 vaccine safety surveillance and describe causality assessment outcomes for serious AEFI reported during the first year of COVID-19 vaccine administration. Method(s): All severe and/or serious AEFI are investigated by provincial EPI surveillance teams, followed by causality assessment conducted by the National Immunisation Safety Expert Committee (NISEC), using the World Health Organization (WHO) methodology [2]. Causality assessment outcomes are classified based on the final diagnoses determined during the assessment by NISEC according to WHO categories, seriousness, Medical Dictionary for Regulatory Activities (MedDRA) system organ class and patient demographics. Data were collected retrospectively from the SAHPRA COVID-19 AEFI microsite and the EPI national AEFI database. Result(s): By 01/04/2022, 33,063,221 COVID-19 vaccine doses had been administered, with 5 815 spontaneous AEFI reports (0.0173%) submitted. Of these, 2,571 (0.008%) were reported as serious. Spontaneous reporting of AEFI increased significantly compared to pre-COVID-19 vaccine introduction. The most frequently reported AEFIs were side effects already listed in the product information. No safety concerns were raised based on causality assessment outcomes for 273 serious cases analysed by 01/04/2022. Over two thirds of these cases were classified as coincidental (70.7%) as cardiac-, respiratory- or vascular disorders (MedDRA system organ class), with 12.1% classified as vaccine product related (see table below). The presentation will include all causality assessments conducted up to 31/08/2022, and more detailed information about causality assessed cases will be available in the public domain at the time of the conference and will be included in the presentation. Conclusion(s): Vaccine safety surveillance and monitoring trends of reported AEFI are vital measures to ensure that the benefits of immunisation are maintained in the interest of public health and efficient vaccination programmes. Transparent communication with the public is important to maintain public confidence in vaccines and prevent all AEFI being misinterpreted as caused by the vaccine.
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Introduction: The South African Health Products Regulatory Authority (SAHPRA) utilises various AEFI reporting tools to monitor vaccine safety in the country. In 2020, SAHPRA in collaboration with the National Department of Health's (NDoH) Expanded Programme on Immunisation (EPI), joined the African Union Smart Safety Surveillance programme, as one of four pilot countries, to introduce an electronic adverse event following immunisation (AEFI) reporting system (Med Safety App) for healthcare professionals and consumers [1]. On 17/05/2021, the NDoH introduced its national COVID-19 vaccination programme. SAHPRA launched a microsite during 2021, to provide feedback to the public on AEFI with the COVID-19 vaccines. Objective: To provide an overview of COVID-19 vaccine safety surveillance and describe causality assessment outcomes for serious AEFI reported during the first year of COVID-19 vaccine administration. Methods: All severe and/or serious AEFI are investigated by provincial EPI surveillance teams, followed by causality assessment conducted by the National Immunisation Safety Expert Committee (NISEC), using the World Health Organization (WHO) methodology [2]. Causality assessment outcomes are classified based on the final diagnoses determined during the assessment by NISEC according to WHO categories, seriousness, Medical Dictionary for Regulatory Activities (MedDRA) system organ class and patient demographics. Data were collected retrospectively from the SAHPRA COVID-19 AEFI microsite and the EPI national AEFI database. Results: By 01/04/2022, 33,063,221 COVID-19 vaccine doses had been administered, with 5 815 spontaneous AEFI reports (0.0173%) submitted. Of these, 2,571 (0.008%) were reported as serious. Spontaneous reporting of AEFI increased significantly compared to pre-COVID-19 vaccine introduction. The most frequently reported AEFIs were side effects already listed in the product information. No safety concerns were raised based on causality assessment outcomes for 273 serious cases analysed by 01/04/2022. Over two thirds of these cases were classified as coincidental (70.7%) as cardiac-, respiratory- or vascular disorders (MedDRA system organ class), with 12.1% classified as vaccine product related (see table below). The presentation will include all causality assessments conducted up to 31/08/2022, and more detailed information about causality assessed cases will be available in the public domain at the time of the conference and will be included in the presentation. Conclusion: Vaccine safety surveillance and monitoring trends of reported AEFI are vital measures to ensure that the benefits of immunisation are maintained in the interest of public health and efficient vaccination programmes. Transparent communication with the public is important to maintain public confidence in vaccines and prevent all AEFI being misinterpreted as caused by the vaccine.
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Background: Acute myocarditis is a rare complication of messenger RNA (mRNA) COVID-19 vaccination. Case: A 36-year-old female with hypertension, smoking, prior alcohol use, chronic pancreatitis and prior COVID-19 infection was transferred for surgical intervention for median arcuate ligament syndrome (MALS). She noted abdominal pain, chest discomfort, dyspnea, orthopnea, and lower extremity edema which began 5 days after the second dose of BNT162b2 COVID-19 vaccine. Physical exam revealed rales, abdominal distention and pitting edema. 12 lead ECG showed a nonspecific ST abnormality. Troponins were 19,222 ng/L (ref < 17 ng/L). Brain natriuretic peptide level was 4734 pg/mL (ref<100 pg/mL). Testing for active COVID-19 infection was negative. Chest x-ray demonstrated a right pleural effusion. Transthoracic echocardiogram revealed apical wall akinesis. Cardiac catheterization showed normal coronary vasculature. Cardiac MRI showed late gadolinium enhancement (LGE) in the basal anterolateral, mid-anterior and midanterolateral walls. Decision-making: Myocarditis should be suspected with elevated cardiac biomarkers, new unexplained heart failure and normal coronary angiography. Despite apical dysfunction, Takutsubo (stress) cardiomyopathy was less likely given CMR findings of LGE. Acute COVID-19 infection is well known to be associated with acute myocarditis but testing was negative. Testing for other potential etiologies (HIV, EBV, toxicology) was also negative. There was no history of collagen-vascular disease. Surgical and gastrointestinal consultations noted symptoms were consistent with acute heart failure rather than MALS. Timing was most consistent with vaccine induced myocarditis given onset within days of second injection with an mRNA vaccine. Based on the above findings decision was made to begin the patient on guideline directed medical therapy (GDMT) with diuretics, ace inhibition and beta blockade. Conclusion: While most common in young males, myocarditis following shortly after mRNA vaccine administration should be considered in patients without another etiology and with appropriate timing of symptom development. Most patients will improve with GDMT.
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Sement is die wereld se belangrikste boumateriaal, en dit het Afrika, as 'n opkomende mark, afhanklik gemaak van die sementbedryf as 'n kritieke instrument om ekonomiese infrastruktuurgroei te bevorder. Vandag se uitdagende ekonomiese klimaat het sementprodusente ook toenemend afhanklik gemaak van spesialiste om hul bedrywighede op te gradeer, te moderniseer en in stand te hou. Die doel van hierdie navorsing is om te evalueer hoe ingenieursdiensorganisasies wat in Afrika werksaam is tans hul sake met hierdie sementprodusente bedryf. Die navorsing toon dat die literatuur oor stelselingenieurswese nie ten volle gebruik maak van waarde-ingenieurskonsepte nie. Die studie het hierdie gebrek aan samewerking identifiseer en 'n nuwe waarde-ingenieursisteemmodel voorgestel wat gebruik kan word om die gebruik van ingenieursdienste en -produkte in die Afrika-sementbedryf te bevorder en te versterk.Alternate :Cement is the worlds most important building material, and it has made Africa, as an emerging market, dependent on the cement industry as a critical tool to promote economic infrastructure growth. Todays challenging economic climate has also made cement producers increasingly dependent on specialists to upgrade, modernise, and maintain their operations. The objective of this research was to evaluate how engineering service organisations operating in Africa currently conduct their business with these cement producers. The research also showed that the literature on systems engineering does not make full use of value engineering concepts. The study identified this lack of collaboration, and proposed a new value engineering systems model that can be used to promote and strengthen the use of engineering services and products in the African cement industry.
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During COVID-19, attention was drawn to a lack offunctional governance frameworks for health emergencies. Routine governance structures were neither agile, nor flexible enough to operate with the speed required for urgent and coordinated action within complex and far-reaching responses. WHO’s Emergency Response Framework has significantly contributed to a stronger WHO response capacity in the European Region by providing accountabilities, responsibilities, delegation of authority, and rapid access to resources for response, while also allowing for participating members to be held accountable for their actions. We argue that now is the time to move health emergency management forwards by supporting States in strengthening their emergency governance architectures.
ABSTRACT
The COVID-19 pandemic has taught us that preparednessfor and resilience against health emergencies is critical. To improve preparedness for health emergencies, the emergency preparedness and response governance architecture at all levels should be strengthened. It should be based on cross-cutting, whole-of-government, and whole-of-society approaches, moving away from siloed perspectives. Moreover, resilience against health emergencies should be based on universal health coverage and anchored in the International Health Regulations (IHR) 2005 core capacities implementation. Capacities and capabilities that are required to improve health services for national and global health security should also be strengthened.
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Influenza is a highly contagious, acute respiratory viral infection responsible for annual epidemics causing severe morbidity and mortality. Vaccination remains the most effective, live-saving preventative strategy, especially amongst populations at high risk of developing influenza-related complications. The inactivated trivalent seasonal influenza vaccine contains two World Health Organization (WHO)-recommended influenza A and one influenza B strains, while the quadrivalent vaccine contains an additional B strain, providing broader protection against co-circulating influenza B lineages. Healthcare workers are instrumental in ensuring effective communication about the benefits of influenza vaccination to achieve optimal seasonal influenza vaccination coverage. This article provides an updated overview of the influenza vaccines with special consideration of the current COVID-19 pandemic.