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1.
Nat Commun ; 13(1): 4834, 2022 08 17.
Article in English | MEDLINE | ID: covidwho-1991592

ABSTRACT

Widespread vaccination campaigns have changed the landscape for COVID-19, vastly altering symptoms and reducing morbidity and mortality. We estimate trends in mortality by month of admission and vaccination status among those hospitalised with COVID-19 in England between March 2020 to September 2021, controlling for demographic factors and hospital load. Among 259,727 hospitalised COVID-19 cases, 51,948 (20.0%) experienced mortality in hospital. Hospitalised fatality risk ranged from 40.3% (95% confidence interval 39.4-41.3%) in March 2020 to 8.1% (7.2-9.0%) in June 2021. Older individuals and those with multiple co-morbidities were more likely to die or else experienced longer stays prior to discharge. Compared to unvaccinated people, the hazard of hospitalised mortality was 0.71 (0.67-0.77) with a first vaccine dose, and 0.56 (0.52-0.61) with a second vaccine dose. Compared to hospital load at 0-20% of the busiest week, the hazard of hospitalised mortality during periods of peak load (90-100%), was 1.23 (1.12-1.34). The prognosis for people hospitalised with COVID-19 in England has varied substantially throughout the pandemic and according to case-mix, vaccination, and hospital load. Our estimates provide an indication for demands on hospital resources, and the relationship between hospital burden and outcomes.


Subject(s)
COVID-19 , Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Hospitals , Humans , SARS-CoV-2
2.
Euro Surveill ; 27(31)2022 08.
Article in English | MEDLINE | ID: covidwho-1987415

ABSTRACT

Following the report of an excess in paediatric cases of severe acute hepatitis of unknown aetiology by the United Kingdom (UK) on 5 April 2022, 427 cases were reported from 20 countries in the World Health Organization European Region to the European Surveillance System TESSy from 1 January 2022 to 16 June 2022. Here, we analysed demographic, epidemiological, clinical and microbiological data available in TESSy. Of the reported cases, 77.3% were 5 years or younger and 53.5% had a positive test for adenovirus, 10.4% had a positive RT-PCR for SARS-CoV-2 and 10.3% were coinfected with both pathogens. Cases with adenovirus infections were significantly more likely to be admitted to intensive care or high-dependency units (OR = 2.11; 95% CI: 1.18-3.74) and transplanted (OR = 3.36; 95% CI: 1.19-9.55) than cases with a negative test result for adenovirus, but this was no longer observed when looking at this association separately between the UK and other countries. Aetiological studies are needed to ascertain if adenovirus plays a role in this possible emergence of hepatitis cases in children and, if confirmed, the mechanisms that could be involved.


Subject(s)
COVID-19 , Hepatitis A , Child , Europe/epidemiology , Hospitalization , Humans , SARS-CoV-2
3.
Stat Methods Med Res ; 31(9): 1656-1674, 2022 09.
Article in English | MEDLINE | ID: covidwho-1932991

ABSTRACT

We compare two multi-state modelling frameworks that can be used to represent dates of events following hospital admission for people infected during an epidemic. The methods are applied to data from people admitted to hospital with COVID-19, to estimate the probability of admission to intensive care unit, the probability of death in hospital for patients before and after intensive care unit admission, the lengths of stay in hospital, and how all these vary with age and gender. One modelling framework is based on defining transition-specific hazard functions for competing risks. A less commonly used framework defines partially-latent subpopulations who will experience each subsequent event, and uses a mixture model to estimate the probability that an individual will experience each event, and the distribution of the time to the event given that it occurs. We compare the advantages and disadvantages of these two frameworks, in the context of the COVID-19 example. The issues include the interpretation of the model parameters, the computational efficiency of estimating the quantities of interest, implementation in software and assessing goodness of fit. In the example, we find that some groups appear to be at very low risk of some events, in particular intensive care unit admission, and these are best represented by using 'cure-rate' models to define transition-specific hazards. We provide general-purpose software to implement all the models we describe in the flexsurv R package, which allows arbitrarily flexible distributions to be used to represent the cause-specific hazards or times to events.


Subject(s)
COVID-19 , Hospitalization , Hospitals , Humans , Intensive Care Units , Probability
4.
Sex Transm Infect ; 98(4): 286-292, 2022 06.
Article in English | MEDLINE | ID: covidwho-1854399

ABSTRACT

OBJECTIVES: Although hepatitis B virus (HBV) vaccination for high-risk groups including gay, bisexual and other men who have sex with men (MSM) is recommended in the UK, data on HBV immunisation coverage are limited. This study aimed to understand the prevalence of HBV infection, susceptibility and immunity due to immunisation among a high-risk population of MSM and heterosexuals who are less likely to attend sexual health services. METHODS: Residual HIV-negative serology samples archived from a national HIV self-sampling service in 2016 were tested for HBV markers using an unlinked anonymous approach. Prevalence of HBV infection, evidence of immunisation and susceptibility were calculated and stratified by individuals' characteristics. Multinomial logistic regression was used to estimate relative risk ratios (RRRs) associated with covariates. RESULTS: Of 2172 samples tested, 1497 (68.9%) were from MSM and 657 (30.2%) were from heterosexuals. Susceptibility to HBV infection was 66.1% among MSM and 77.0% among heterosexuals. Only 29.9% of MSM and 17.4% of heterosexuals had serological evidence of immunisation. Current infection was 1.1% in heterosexuals and 0.2% in MSM. Adjusted analysis showed evidence of immunisation was lower among heterosexuals (RRR 0.66, 95% CI 0.50 to 0.86) and those with no previous HIV test (RRR 0.41, 95% CI 0.31 to 0.54), and higher in those of other white or other ethnicity. CONCLUSIONS: Among MSM and heterosexual users of a self-sampling HIV service, evidence of immunisation to HBV infection was low and susceptibility to infection was comparatively high, suggesting suboptimal delivery of HBV immunisation in sexual health services.


Subject(s)
HIV Infections , Hepatitis B , Sexual and Gender Minorities , Hepatitis B/complications , Hepatitis B/epidemiology , Hepatitis B/prevention & control , Hepatitis B virus , Homosexuality, Male , Humans , Male , Prevalence , Risk Factors
5.
Emerg Infect Dis ; 28(3): 739-742, 2022 03.
Article in English | MEDLINE | ID: covidwho-1703458

ABSTRACT

Since the coronavirus disease pandemic response began in March 2020, tests, vaccinations, diagnoses, and treatment initiations for sexual health, HIV, and viral hepatitis in England have declined. The shift towards online and outreach services happened rapidly during 2020 and highlights the need to evaluate the effects of these strategies on health inequalities.


Subject(s)
COVID-19 , HIV Infections , Hepatitis, Viral, Human , Sexually Transmitted Diseases , England/epidemiology , HIV Infections/diagnosis , HIV Infections/epidemiology , Hepatitis, Viral, Human/epidemiology , Hepatitis, Viral, Human/therapy , Humans , Pandemics/prevention & control , SARS-CoV-2 , Sexually Transmitted Diseases/epidemiology
6.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-326102

ABSTRACT

The introduction of vaccination has changed the landscape for COVID-19 infection, vastly altering the presentation of symptoms and reducing morbidity of infection. We estimate monthly trends and the impact of vaccination upon hospitalised mortality, controlling for baseline demographics and hospital load. We apply competing risks methods to comprehensive public health surveillance data on patients hospitalised with COVID-19 in England. Among a total of 259,727 individuals hospitalised with COVID-19, 51,948 (20.0%) experienced mortality in hospital, with the remainder being discharged or remaining in hospital by end of September 2021. Hospitalised fatality risk ranged from a high of 40.3% (95% confidence interval 39.4, 41.3%) among those admitted in March 2020 to a low of 8.1% (7.2, 9.0%) in June 2021. Older patients and those with multiple co-morbidities were more likely to die in hospital (46.5% for those aged 85 and over vs. 0.5% for those aged 15-24, and 6.3% for those with no comorbidity at baseline vs. 43.0% for those with a Charleson comorbidity index of 5 or above) or else experienced longer stays prior to discharge (median stays of between 5.1-10.4 days for those aged 85+ vs. 0.9-2.4 days for those aged 15-24). The hazard ratio for mortality following hospital admission was 0.72 (0.67, 0.77) among those admitted with a first vaccine dose, and 0.58 (0.54, 0.62) with a second vaccine dose, compared to a reference category of unvaccinated. The prognosis for patients hospitalised with COVID-19 in England has varied substantially throughout the pandemic and is confounded with age, sex, deprivation, baseline comorbidity and hospital load at admission. After controlling for other factors, outcomes for single and double vaccinated patients were significantly improved compared to unvaccinated patients.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323996

ABSTRACT

Background: People who inject drugs (PWID) are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. Methods: A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. Results: In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly;for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. Conclusions: This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.

8.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-314261

ABSTRACT

Background: Trends in hospitalised case-fatality risk (HFR), risk of intensive care unit (ICU) admission and lengths of stay for patients hospitalised for COVID-19 in England over the pre-vaccination era are unknown. Methods: Data on hospital and ICU admissions with COVID-19 at 31 NHS trusts in England were collected by Public Health England's Severe Acute Respiratory Infections surveillance system and linked to death information. We applied parametric multi-state mixture models, accounting for censored outcomes and regressing risks and times between events on month of admission, geography, and baseline characteristics. Findings: 20,785 adults were admitted with COVID-19 in 2020. Between March and June/July/August estimated HFR reduced from 31.9% (95% confidence interval 30.3-33.5%) to 10.9% (9.4-12.7%), then rose steadily from 21.6% (18.4-25.5%) in September to 25.7% (23.0-29.2%) in December, with steeper increases among older patients, those with multi-morbidity and outside London/South of England. ICU admission risk reduced from 13.9% (12.8-15.2%) in March to 6.2% (5.3-7.1%) in May, rising to a high of 14.2% (11.1-17.2%) in September. Median length of stay in non-critical care increased during 2020, from 6.6 to 12.3 days for those dying, and from 6.1 to 9.3 days for those discharged. Interpretation: Initial improvements in patient outcomes, corresponding to developments in clinical practice, were not sustained throughout 2020, with HFR in December approaching the levels seen at the start of the pandemic, whilst median hospital stays have lengthened. The role of increased transmission, new variants, case-mix and hospital pressures in increasing COVID-19 severity requires urgent further investigation.

9.
Euro Surveill ; 26(11)2021 03.
Article in English | MEDLINE | ID: covidwho-1181332

ABSTRACT

BackgroundA multi-tiered surveillance system based on influenza surveillance was adopted in the United Kingdom in the early stages of the coronavirus disease (COVID-19) epidemic to monitor different stages of the disease. Mandatory social and physical distancing measures (SPDM) were introduced on 23 March 2020 to attempt to limit transmission.AimTo describe the impact of SPDM on COVID-19 activity as detected through the different surveillance systems.MethodsData from national population surveys, web-based indicators, syndromic surveillance, sentinel swabbing, respiratory outbreaks, secondary care admissions and mortality indicators from the start of the epidemic to week 18 2020 were used to identify the timing of peaks in surveillance indicators relative to the introduction of SPDM. This timing was compared with median time from symptom onset to different stages of illness and levels of care or interactions with healthcare services.ResultsThe impact of SPDM was detected within 1 week through population surveys, web search indicators and sentinel swabbing reported by onset date. There were detectable impacts on syndromic surveillance indicators for difficulty breathing, influenza-like illness and COVID-19 coding at 2, 7 and 12 days respectively, hospitalisations and critical care admissions (both 12 days), laboratory positivity (14 days), deaths (17 days) and nursing home outbreaks (4 weeks).ConclusionThe impact of SPDM on COVID-19 activity was detectable within 1 week through community surveillance indicators, highlighting their importance in early detection of changes in activity. Community swabbing surveillance may be increasingly important as a specific indicator, should circulation of seasonal respiratory viruses increase.


Subject(s)
COVID-19/prevention & control , Epidemiological Monitoring , Physical Distancing , COVID-19/epidemiology , Humans , United Kingdom/epidemiology
12.
Harm Reduct J ; 17(1): 95, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-953015

ABSTRACT

BACKGROUND: People who inject drugs are at increased health risk in a pandemic due to their greater susceptibility to severe disease and as a consequence of the restrictions put in place to halt the spread of infection. Harm reduction (HR) services, which aim to reduce the negative effects of drug use on health, are likely to be diminished in a pandemic. However, innovative HR interventions and messaging may also develop in response to such a crisis. It is vital to understand the most effective ways to deliver HR in pandemic situations so that guidance can be provided for current and future disruptions to service provision. METHODS: A rapid evidence review was conducted with the aim of exploring what HR interventions and messaging are most effective during a pandemic-type situation. Ten health databases were systematically searched using terms relevant to the research aim. A search was also made of grey literature, including a targeted search of HR messaging from key national and service provider websites. RESULTS: In the initial search, 121 pieces of evidence were identified which, after screening and de-duplication, resulted in 60 for inclusion. The included evidence consists mainly of non-peer reviewed, pre-publication or expert opinion pieces. The rapid findings suggest that HR services should be deemed essential during a pandemic, with staff supported to work safely and social distancing adaptations implemented. Services should be encouraged to operate more flexibly; for instance, in deciding the amounts of take-home supplies of injecting equipment and medications. The evidence on HR communication was very limited but key messages on infection control, uncertain drug supply and accessing services were identified. CONCLUSIONS: This rapid evidence review identifies implications for national policy makers, commissioners and HR service providers. A person-centred rather than disease-centred approach to HR delivered by collaborating partners, as well as prioritizing tailored HR messaging, is recommended. Further research evaluating the delivery of HR services and messaging, particularly focusing on health inequalities, is urgently needed.


Subject(s)
COVID-19/prevention & control , COVID-19/psychology , Harm Reduction , Substance Abuse, Intravenous/prevention & control , Substance Abuse, Intravenous/psychology , Humans , Pandemics
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