ABSTRACT
Purpose: The Food and Drug Administration (FDA) expanded the approved age range for the 9vHPV vaccine from 9-26 years to 9-45 years in 2018. However, research has still pointed to low vaccination rates among adult women. This could likely be due to missed opportunities as they must have aged out and be ineligible for the vaccine prior to the expansion. Therefore, this study assesses a better understanding of patient's (particularly mothers) preferences of receiving the HPV vaccine to provide quantitative estimates of potential vaccine uptake. Methods: We conducted a descriptive questionnaire survey among women participating in an Open-Label Clinical Trial evaluating the Immunogenicity of the 9vHPV Vaccination Regimen over 6 months among women aged 16 to 45 years old. The survey was fielded to a sample of 245 women receiving care at Boston Medical Center, who had not yet received the HPV vaccine. We used a two-sided Fisher's exact test (because >20% of the expected cell count is less than 5) to compare the responses to two closed-ended questions: "If your daughter or son's doctor offered you the HPV vaccine during your child's visit, would you decide to get the vaccine?” and "Would you prefer to receive the HPV vaccine through your primary care physician instead of your child's care doctor?”. The mean and standard deviation (sd) were reported for continuous variables whereas proportions were reported for dichotomous and categorical data. All analyses were performed using SAS (9.4). Results: We had a diverse study population with a mean age of 32 years (sd=7.86), 25.75% were African American, 20.60% were Hispanics, 21.46 % were Asians, 18.88% were White and 13.31% were Others. We used cross tabulation to describe the relationship between the two variables of interest. Results indicate that 85.11% of women are willing to receive the vaccine from their child's doctor;however, are unwilling to receive it through their own primary care provider. Whereas 7.76% women preferred receiving the vaccine from their primary care physician and are unsure or unwilling to get it from their child's doctor. Also, 67.74% of women indicated their willingness to get the vaccine from their child's doctor;however, were unsure about getting it through their primary care physician. We did a two-sided Fisher's exact test of proportions of p < 0.0001 and concluded that there is a statistically significant difference between women who preferred receiving the HPV vaccine through their child's provider and women willing to receive it through their primary care provider (assuming a significance level of 0.05). Conclusions: Our findings suggest that mothers would prefer getting the HPV vaccine for themselves at their child's doctor visit, if it was offered to them. Influenza and Covid vaccines are offered to parents/guardians in pediatric offices, and this should be implemented for HPV vaccine as well. This would increase the vaccination rates, given children tend to have an increased number of visits prior to the adolescent years and parents are likely to accompany their children to these visits. Sources of Support: cdc.gov.
ABSTRACT
Purpose: Several national- and state-level studies have been predicting the course of the COVID-19 pandemic using supervised machine learning algorithms. However, the comparison of such models has not been discussed before. This is the first-ever research wherein the two leading models, susceptible-infected-recovered (SIR) and logistic are compared. The purpose of this study is to observe their utility, at both the National and Municipal Corporation level in India. Design/methodology/approach: The modified SIR and the logistic were deployed for analysis of the COVID-19 patients’ database of India and three Municipal Corporations, namely, Akola, Kalyan-Dombivli and Mira-Bhayander. The data for the study was collected from the official notifications for COVID-19 released by respective government websites. Findings: This study provides evidence to show the superiority of the modified SIR over the logistic model. The models give accurate predictions for a period up to 14 days. The prediction accuracy of the models is limited due to change in government policies. This can be observed by the drastic increase in the COVID-19 cases after Unlock 1.0 in India. The models have proven that they can effectively predict for both National and Municipal Corporation level database. Practical implications: The modified SIR model can be used to signify the practicality and effectiveness of the decisions taken by the authorities to contain the spread of coronavirus. Originality/value: This study modifies the SIR model and also identifies and fulfills the need to find a more accurate prediction algorithm to help curb the pandemic. © 2021, Emerald Publishing Limited.
ABSTRACT
Background: SARS CoV-2, the virus that causes Coronavirus Disease of 2019 (COVID-19), most commonly presents as a febrile respiratory illness. Atypical symptoms are being increasingly recognized including myalgias, anosmia, vomiting, and diarrhea. Pediatric COVID-19 infections are usually mild, self-limiting, and rarely require hospitalization. We describe a case of severe upper gastrointestinal bleeding as the only initial symptom of COVID-19 infection in a child with sickle cell disease (SCD). Case: A 12-year-old male with SCD, HbSS subtype, with a history of splenectomy presented to our Emergency Department (ED) with acute onset progressively worsening hematemesis for the past 24 hours. He denied fever, cough, melena, peptic ulcer disease, family history of excessive bleeding, or regular nonsteroidal anti-inflammatory drug use. Upon arrival, the patient had tachycardia, hypotension (HR 150, BP 86/40), and cool extremities with delayed capillary refill. His temperature was 100.0F with an oxygen saturation of 100% on room air. His initial laboratory results were significant for hemoglobin of 4.1 g/dL, (baseline 7-8 g/dL), reticulocytes 13.7%, venous blood gas pH of 7.17, lactate of 7.3, white blood cell count of 21.7 K/uL, and prothrombin time (PT) of 19.9 seconds / INR of 1.7. His hepatic and renal function tests were within normal limits. In the ED, the patient received a normal saline bolus, two units of packed red blood cells, pantoprazole, famotidine, ondansetron, tranexamic acid, and ceftriaxone. His chest X-ray was unremarkable. A nasopharyngeal COVID-19 swab was sent. Pediatric gastroenterology and hematology were consulted, and he was admitted to the pediatric intensive care unit. The following day he underwent esophagogastroduodenoscopy which showed diffuse hemorrhagic gastropathy with superficial mucosal bleeding and without frank ulcers (Figure 1). An abdominal ultrasound revealed a normal gallbladder, no portal hypertension, and known absent spleen. His nasopharyngeal swab was positive for COVID-19. Helicobacter pylori testing was sent and reported negative. He received Vitamin K and two units of fresh frozen plasma for his coagulopathy resulting in normalization in his PT/INR. He did not have any further hematemesis but developed melena which improved, and he was discharged with a hemoglobin of 9.3 g/dL. Discussion: To date, we have not seen reports of either upper gastrointestinal bleeding as the only initial presenting symptom of COVID-19 or endoscopic visualization of gastric lumen during acute infection. The petechial hemorrhaging located at the body of the greater curvature and fundus of the stomach is an unusual site and indicated the underlying coagulopathy as the cause for bleeding. Our patient's mild coagulopathy is consistent with other reports of critically ill COVID-19 patients. This case highlights the importance of maintaining a high index of suspicion for COVID-19 infection in an immunocompromised pediatric patient with severe bleeding or new coagulopathy within our current medical climate.