Estimating national-level measles case-fatality ratios in low-income and middle-income countries: an updated systematic review and modelling study

Background: To understand the current measles mortality burden, and to mitigate the future burden, it is crucial to have robust estimates of measles case fatalities. Estimates of measles case-fatality ratios (CFRs) that are specific to age, location, and time are essential to capture variations in underlying population-level factors, such as vaccination coverage and measles incidence, which contribute to increases or decreases in CFRs. In this study, we updated estimates of measles CFRs by expanding upon previous systematic reviews and implementing a meta-regression model. Our objective was to use all information available to estimate measles CFRs in low-income and middle-income countries (LMICs) by country, age, and year. Method(s): For this systematic review and meta-regression modelling study, we searched PubMed on Dec 31, 2020 for all available primary data published from Jan 1, 1980 to Dec 31, 2020, on measles cases and fatalities occurring up to Dec 31, 2019 in LMICs. We included studies that previous systematic reviews had included or which contained primary data on measles cases and deaths from hospital-based, community-based, or surveillance-based reports, including outbreak investigations. We excluded studies that were not in humans, or reported only data that were only non-primary, or on restricted populations (eg, people living with HIV), or on long-term measles mortality (eg, death from subacute sclerosing panencephalitis), and studies that did not include country-level data or relevant information on measles cases and deaths, or were for a high-income country. We extracted summary data on measles cases and measles deaths from studies that fitted our inclusion and exclusion criteria. Using these data and a suite of covariates related to measles CFRs, we implemented a Bayesian meta-regression model to produce estimates of measles CFRs from 1990 to 2019 by location and age group. This study was not registered with PROSPERO or otherwise. Finding(s): We identified 2705 records, of which 208 sources contained information on both measles cases and measles deaths in LMICS and were included in the review. Between 1990 and 2019, CFRs substantially decreased in both community-based and hospital-based settings, with consistent patterns across age groups. For people aged 0-34 years, we estimated a mean CFR for 2019 of 1.32% (95% uncertainty interval [UI] 1.28-1.36) among community-based settings and 5.35% (5.08-5.64) among hospital-based settings. We estimated the 2019 CFR in community-based settings to be 3.03% (UI 2.89-3.16) for those younger than 1 year, 1.63% (1.58-1.68) for age 1-4 years, 0.84% (0.80-0.87) for age 5-9 years, and 0.67% (0.64-0.70) for age 10-14 years. Interpretation(s): Although CFRs have declined between 1990 and 2019, there are still large heterogeneities across locations and ages. One limitation of this systematic review is that we were unable to assess measles CFR among particular populations, such as refugees and internally displaced people. Our updated methodological framework and estimates could be used to evaluate the effect of measles control and vaccination programmes on reducing the preventable measles mortality burden. Funding(s): Bill & Melinda Gates Foundation;Gavi, the Vaccine Alliance;and the US National Institutes of Health.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

A Single-Centre Experience of Telephone Assessment of Patients Referred to Two Week-Wait Colorectal Surgery Clinics in England

Aim: Despite Covid-19, hospitalsin the England, United Kingdom continued to assess and manage patients referred on two week-wait (2WW) suspected cancer referral pathways. Most index clinic assessments of such patients were conducted viatelephone. We retrospectively evaluated adistrict general hospital experience of managing patients on a 2WW suspected lower gastrointestinal tract (LGIT)cancer referral pathway, initially assessed via telephone Method: Data were obtained using a prospectively maintained database and electronic patient records. LGIT 2WW referrals between 01/06/2020to 31/10/2020 were included. Data were retrospectively collated and analysed using Excel (Microsoft Corporation, USA) Results: A total 757 patients (median age = 70, interquartile range = [59-79], female = 47.2%) were identified. The majority (n = 629,83.1%) were white Caucasian. All patients were initially assessed virtually and only 3 (0.4%) were re-assessed face-to- face for their index appointment. Sixteen (2.1%) missed at least one prior appointment. The most common presenting complaints included change in bowel habit, rectal bleeding, weight loss, anaemia and abdominal pain, and 415 (54.8%), 269 (35.5%) underwent endoscopy and imaging respectively as the first investigation. Forty four (5.8%) patients had malignant pathology with the majority (n = 37,84.1%) being colorectal in origin. Of those diagnosed with a primary colorectal malignancy 25 (67.6%) underwent surgical or endoscopic treatment, 3 (8.1%) were referred to chemoradiotherapy and 8 (21.6%) were referred for palliation. Conclusion(s): Patients referred on the 2WW LGIT pathway continued to be assessed and managed despite Covid-19. Index telephone clinic assessments are perhaps as effective a tool as face-to- face assessments, for patients referred on this pathway. This warrants further investigation.

The Use of Telephone Versus Face to Face Appointments in Two Week-Wait Colorectal Surgery Clinics -a Single Centre Experience

Aim: Telephone appointments have replaced face-to- face hospital clinic appointments due to the Covid-19 pandemic. We evaluated the impact of telephone appointments on patients referred on a two week-wait (2WW) suspected lower gastrointestinal tract (LGIT) cancer pathway. Method(s): Two independent patient samples between the 01/06/2019-31/ 10/2019 (face-to- face cohort) and 01/06/2020-31/ 10/2020 (telephone cohort) were identified using a prospectively maintained local database and electronic patient records. Data were retrospectively collated using Excel (Microsoft, USA). Chi-square and Man-Whitney- U statistical tests were performed using SPSS (IBM, USA). Result(s): A total 1531 (median age = 70, interquartile range [IQR] = 60-79, female = 679, 44.4%) were analysed. Of these, 757 (49.4%) were assessed via telephone;the remainder were face-to- face (n = 774,50.6%). The age, gender and ethnicity distributions across the two groups were similar. A total of 92 (6%, telephone = 44, face-to- face = 48) patients had malignant pathology and 64 (4.2%) were colorectal cancer (CRC). Of those with a CRC diagnosis, 46 (3.0%, telephone = 26, face-to- face = 20) underwent surgical or endoscopic treatment with curative intent. There was no significant difference in diagnoses made (P = 0.749) or treatment of CRC (P = 0.785) following telephone versus face-face- appointments. The median waiting times for index appointment, investigation and diagnosis for telephone appointments were significantly lower compared to face-to- face appointments (P < 0.001). There was no significant difference in median time to index treatment for CRC between the two groups (P = 0.156). Conclusion(s): Patients referred to 2WW LGIT clinics were efficiently and safely assessed and manged using telephone clinics during the Covid-19 pandemic. The cost-effectiveness and stakeholder views on permanent use of telephone assessments in these clinics must be evaluated.

Index telephone two-week wait lower gastrointestinal clinics as a substitute to face to face outpatient appointments during the COVID-19 pandemic

Purpose/Background: The COVID-19 pandemic led to hospitals in the United Kingdom substituting face-to- face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the impact of virtual two-week wait (2-ww) lower gastrointestinal (LGI) consultations on stakeholders at a district general hospital in England. Methods/Interventions: Patients undergoing index outpatient 2-ww LGI clinic assessment between 01/06/2019-31/ 10/2019 (FtF group) and 01/06/2020-31/ 10/2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets (WTT) was assessed. Environmental and financial impact analyses were performed. Results/Outcomes: In total, 1531 patients were analysed (median age = 70, male = 852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone;the remainder were seen FtF (n = 774, 50.6%). Ninety two (6%, VC = 44, FtF = 48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC);of these, 46 (71.9%, VC = 26, FtF = 20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p < 0.001). The cancer detection rates (p = 0.749), treatments received (p = 0.785) and median time to index treatment for CRC patients (p = 0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p < 0.001). VC appointments saved patients a total of 9288 miles, 0.7 metric tonnes of CO2 emissions and £7482.97. Taxpayers saved £80,242.00 from VCs. No adverse events or complaints were reported in the VC group. Conclusion/Discussion: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits for stakeholders. (Figure Presented).

Te Rito Toi in New Zealand: A Caring Response to the Pandemic

Te Rito Toi is an online open access educational resource designed to help teachers respond to the extraordinary circumstances of the pandemic and provide all children with opportunities to engage with the arts. Central to the Te Rito Toi project was the concept of well-being, one of the United Nations Sustainable Development Goals (SGD 3). The study reported in this article delved into the perspectives of a group of New Zealand educators who used Te Rito Toi after the Covid-19 lockdown to explore the ways in which this resource helped them to engage their students in both individual and collective recovery. The analysis of the interviews revealed the following four themes: 1) building relationships and a sense of belonging;2) enhancing communication and empathy;3) connecting with wider social issues;and 4) contributing to community recovery. © Copyright © 2021 O’Connor and Estellés.

To determine the change in exertional capacity while wearing a variable number of surgical face masks while undergoing an exercise tolerance test

61 Figure 1Time to maximum exertion of each participant when exercising with one, three or five masks[Figure omitted. See PDF]ConclusionLittle evidence exists so far comparing exercise effort with different thickness of facemasks. This study shows that for this sample there is no statistically significant change in exertional effort while wearing either one, three or five surgical masks. This study is limited by the sample size and that all subjects were fit, healthy males. However, it offers a basis for further primary research.

Shot of love: the art of care in schools post

The beginning of the COVID 19 pandemic in 2020 provided the catalyst for the development of arts based resources to assist teachers and students reengage in learning when schools reopened after lockdowns imposed in New Zealand. This article presents the preliminary findings of a case study research project into an online resource to support teachers through the arts, Te Rito Toi, developed in response to COVID 19 and the lengthy closure of schools when children were forced into extended periods of physical isolation. The study reveals that the arts provided a way for teachers and students to rebuild relationships centred around love and care.

Progress towards rubella elimination - WHO European Region, 2005-2019

This study reports the elimination of rubella across Europe, focusing on (1) immunisation activities, (2) surveillance activities, (3) Rubella incidence and genotypes, and (4) regional verification commission and progress towards elimination. Substantial progress towards rubella elimination has been made in the WHO European Region. Verification of elimination is nearly complete, which would make the European Region the second WHO region to achieve rubella elimination, after the Region of the Americas. Sustaining regional rubella elimination will require maintaining high coverage with RCVs through routine immunisation programmes at national and subnational levels, offering supplementary rubella vaccination to susceptible adults, maintaining high-quality laboratory-supported rubella and CRS surveillance for outbreak detection and response and a fully functioning Regional Verification Commission. Because of the COVID-19 pandemic, additional efforts might be needed to strengthen surveillance systems and fill in the immunity gaps.