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Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.
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Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.
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Background. Down syndrome (DS) is associated with an increased risk of infections attributed to immune defects. Whether individuals with DS are at an increased risk of severe COVID-19 remains unclear. Methods. In a matched cohort study, we evaluated the risk of COVID-19 infection and severe COVID-19 disease in individuals with DS and their matched counterparts in a pre-COVID-19 vaccination period at Kaiser Permanente Southern California. Multivariable Cox proportion hazard regression was used to investigate associations between DS and risk of COVID-19 infection and severe COVID-19 disease. Results. Our cohort included 2,541 individuals with DS and 10,164 without DS matched on age, sex, and race/ethnicity (51.6% female, 53.3% Hispanic, median age 25 years [interquartile range 14 - 38]), with pulmonary disease as the most common comorbidity (13.1%) followed by diabetes (5.4%). While the rate of COVID-19 infection in individuals with DS was 32% lower than their matched counterparts (adjusted hazard ratio [aHR] 0.68, 95% CI: 0.56-0.83), the rate of severe COVID-19 disease was 6-fold higher (aHR 6.14, 95% CI: 1.87-20.16) (Table 1). The Kaplan-Meier plot demonstrated similar cumulative incidence for those with and without DS at the beginning of the pandemic, followed by a rate increase in July 2020 (at 4 months of follow-up), and in November 2020 (at 8 months of follow-up) (Figure 1), after which the cumulative incidence for those with DS was consistently higher. Figure 2 demonstrated consistently higher cumulative incidence estimates of COVID-19 hospitalization for those with DS than those without. (Table Presented) Conclusion. Although the risk of COVID-19 infection is lower, the risk of severe disease is higher in individuals with DS compared to their matched counterparts. Better infection monitoring, early treatment, and promotion of vaccine for COVID-19 are warranted for DS populations.
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Background. While a 3-dose mRNA-1273 primary series is recommended for moderately or severely immunocompromised (IC) individuals in the U.S., some IC individuals do not complete the 3-dose series. We conducted a matched cohort study to evaluate the relative vaccine effectiveness (rVE) of the 3-dose mRNA-1273 primary series vs. 2 doses of mRNA-1273 in preventing SARS-CoV-2 infection and severe COVID-19 disease in IC individuals. Methods. IC individuals aged >=18 years with >=12 months of Kaiser Permanente Southern California membership who received 3 doses of mRNA-1273 >=24 days apart were 1:1 matched with randomly selected IC 2-dose recipients on age, sex, race/ethnicity, and 2nd dose date. Third doses were accrued from 08/12/2021 to 12/31/2021, with follow-up through 1/31/2022, spanning the delta and omicron periods. Outcomes were SARS-CoV-2 infection (positive molecular test or diagnosis code), COVID-19 hospitalization, and COVID-19 hospital death. Adjusted hazard ratios (aHR) with confidence intervals (CI) were estimated by Cox proportional hazards models. Adjusted rVE (%) was calculated as (1-aHR) x 100. Results. Our study included 21,942 3-dose and 21,942 2-dose mRNA-1273 IC recipients. Adjusted rVE of 3 doses compared to 2 doses of mRNA-1273 against SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19 hospital death were 55.0% (95% CI: 50.8-58.9%), 83.0% (75.4-88.3%), and 87.1% (30.6-97.6%), respectively (Table 1). Adjusted rVE against SARS-CoV-2 infection ranged from 43.0% to 59.1% across subgroups of age, sex, race/ethnicity, history of SARS-CoV-2 infection, pregnancy, and comorbidities (Table 2). Point estimates of the 3-dose rVE were higher against COVID-19 infection and hospitalization in the first 3 months, compared to 3-6 months after the 3rd dose (Table 3). Conclusion. Three doses of mRNA-1273 provide additional protection against SARS-CoV-2 infection and severe outcomes for IC individuals, compared to 2 doses, highlighting the importance of completing 3-doses for IC populations. However, possible waning of protection against SARS-CoV-2 infection and severe outcomes after 3 months supports the ACIP recommendation of a booster dose at least 3 months after the 3rd primary series dose for adequate protection of IC individuals. (Table Presented).
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The pandemic of coronavirus disease 2019 (COVID-19) posed a severe threat to the public health worldwide. We focus on frail elderly adults who are the most vulnerable population, especially residents of long-term care facilities or nursing homes. Studies have shown a strong correlation between frailty and COVID-19 mortality in the older population. Meanwhile, older adults possess various characteristics in immune responses, symptoms presentation, and disease outcomes. Frailty decreases resilience in older people and makes the situation more complex. Moreover, frailty is a strong predictor of prognosis in COVID-19 infected patients. Vaccination is considered an excellent way to stop SARS-CoV-2 spreading. Frail elderly adults are the most vulnerable population, and vaccination programs are implemented first in this group. However, most clinical trials did not enroll frail elderly adults in studies of COVID-19 vaccine development. Real-world evidence of vaccination in older adults with frailty is scanty. We reviewed available data from long-term care facilities and nursing homes. We focused on immune responses, vaccine effectiveness, and safety of the COVID-19 vaccine. Vaccination could elicit antibody titers and cellular T cells responses in frail elderly adults. SARS-CoV-2 infection, hospital admission, and mortality in residents and staff in long-term care facilities were decreased. COVID-19 vaccination was safe and could prevent disease outbreak in long-term care facilities. Nevertheless, doctors should evaluate frailest or terminal elderly adults carefully. Frailty-based vaccination program could help to evaluate who should receive the COVID-19 vaccine. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
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OBJECTIVE: The effects of SARS-CoV-2 were initially studied in the respiratory system, but research has now shown manifestations in multiple organ systems. SARS-CoV-2 is known to enter target cells through the ACE- 2 receptor, which is expressed in the testes. Due to this, the testes has been purported to be a potential target for SARS-CoV-2 infection. To date, studies have suggested that there is only a minor risk for shedding of SARS-CoV-2 into the semen.1 The objective of this study is to compare semen analysis parameters in a subset of healthy sperm donors prior to, during, and after testing positive for COVID-19. MATERIALSAND METHODS: The study included semen analyses (SA) from qualified sperm donors aged 19-38, with 2-5 days of abstinence who donated sperm prior to COVID infection, during active COVID infection, and post COVID infection. Semen was collected in the course of sperm bank operation and samples were collected concurrent with incidental positive test results obtained through COVID screening. Primary outcomes included ejaculate volume (mL), average concentration (M/mL), and percent motility (%). The standard operating procedure for sperm donation dictated that morphology is performed when they are first accepted into the program, thus was not recorded for these samples. Data were compared and analyzed by ANOVA. RESULTS: A total of five qualified sperm donors met inclusion criteria for this study. When comparing semen analyses across the three time points, there was not a significant difference in concentration (p=0.7460), percent motility (p=0.9135), or ejaculate volume (p=0.9241) [Table 1]. CONCLUSIONS: Sperm quality measures as evidenced in qualified, healthy sperm donors are not significantly different when comparing sperm samples prior to COVID infection, during active COVID infection, and after recovery from COVID infection. Although limited by a small sample size, our findings are reassuring to those with SARS-CoV-2 infection, as there appears to be no adverse association with sperm quality. IMPACT STATEMENT: Sperm quality in healthy, qualified donors is not affected by active SARS-CoV-2 infection.
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OBJECTIVE: It has been suggested that geographic variations in environmental toxins may impact sperm quality. Previously, we published findings that demonstrated a decline in sperm quality over an eleven year period across six regions of the United States (US).1 The current study investigates whether there was a decrease in sperm quality from a diverse set of US sperm donors across six regions in the US over a sixteen year period. Additionally, this study sought to evaluate changes between semen analysis (SA) parameters in an era of sperm collection during the COVID-19 pandemic. MATERIALS AND METHODS: Semen analyses (SA) from sperm donors aged 19-38, with 2-5 days abstinence, from 9 different geographic regions from January 2005-April 2021 were examined. The sperm donors originated from one of the following regions: Palo Alto, Los Angeles, Westwood, International Nordic Cryo Bank Denmark, Indianapolis, Cambridge, New York, Houston, and Spokane, WA. Donation date, BMI, and geographic region were recorded. Data was analyzed as a whole as well as by individual region. Primary outcomes were ejaculate volume (mL), average concentration (M/mL), motility (%), and total motile count (M). Data was analyzed using a general estimate equation (GEE) model with an exchangeable working correlation structure to account for repeated measures. RESULTS: A total of 176,706 SA specimens (from 3,532 unique donors) were analyzed. Controlling for BMI, there was a significant decline in average concentration (M/mL) (β=-1.89, p<0.0001), sperm motility (%) (β=-0.2892, p<0.0001) and total motile sperm (M) (β=-4.53, p<0.0001) over the 16-year study period. There were significant decreases in SA parameters within all geographic regions (Spokane only had two unique donors and could not be examined). Indianapolis showed a significant decrease in sperm concentration and total motile sperm, but also displayed an increase in sperm motility over the study period. CONCLUSIONS: Time related decline in sperm quality continues to be evident at a national level in young, healthy sperm donors. There was a decline across all geographic regions in all parameters except for ejaculate volume. How this decline in sperm counts impacts fertility has yet to be determined. Our modern environment involves increased exposures to endocrine disruptors and changes to lifestyle (including smoking, diet, and stress) that are postulated to impair male fertility by interfering with spermatogenesis. While a causative link to these risk factors remains to be elucidated further studies are necessary to evaluate whether this temporal decline in sperm count correlates with decreased fecundity. IMPACT STATEMENT: Sperm concentration, motility, and total motile sperm continue to decline across young, healthy sperm donors across the continental United States.
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Purpose: Currently, the Covid-19 pandemic is changing how consumers shop, encouraging deeper levels and increased reliance on e-commerce systems and social media such as online communities. The online interaction of consumers is more important and brings many uncertainties, which impact the original commerce environment. This study aim to investigate the ethical consideration of information credibility and perceived privacy risk from a psychology perspective in marketing, this study draws on social support theory from social psychology to develop a research model to investigate the role of information credibility and perceived privacy risk on social commerce websites. Design/methodology/approach: This study investigated social commerce websites and communities. The research data of this study was collected through a questionnaire from consumers on three famous social commerce platforms. Using PLS-SEM to perform data analysis, this study research the importance of information credibility, perceived privacy risk and trust on social commerce websites. Findings: The findings discuss individuals' reaction to privacy issues and to understand the motives to disclose or reveal personal information within a marketing or consumption context. The research also explores the theoretical implications by integrating theories from information systems and social psychology to investigate ethical issues in social commerce. Originality/value: Covid-19 makes peer-to-peer communication in online communities is developing collaborative consumption, and information produced in these communities can influence the decisions of consumers. Covid-19 has exacerbated such a change in social commerce environment. Therefore, information credibility plays an important role in developing online communities. It is important to look at the psychological antecedents that drive consumers' willingness to share their personal information when using online communities. The author has clarified which aspects of trust in social commerce should be strategized, including information trustworthiness, perceived privacy risks, social support and information sharing. These are the details that companies should pay more attention to when operating social commerce. Only by paying more attention to these details and giving consumers a positive feeling can consumers' trust be maintained or enhanced, ultimately leading to a successful trust economy. © 2022, Emerald Publishing Limited.
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Worldwide attention has been drawn to the recent COVID-19 outbreak. Many studies have shown that under the pandemic, elderlies, especially those with chronic diseases, are more vulnerable than youths. Upon infection, older people tend to endure a higher hospitalization and mortality rate, and the mortality rate after acute hospitalization appears even higher for frail elderlies than non-frail ones. Moreover, older COVID-19 patients can exhibit different, atypical clinical manifestations such as falls, delirium, general weakness, functional decline, and other geriatric syndromes indicating frailty. Therefore, this review suggests that the most effective way to improve the prognosis of COVID-19 infection in the elderly is to avoid the occurrence of frailty.