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1.
Journal of the American Medical Directors Association ; 2023.
Article in English | ScienceDirect | ID: covidwho-2180060

ABSTRACT

Objectives During the COVID-19 pandemic, no country with widespread community transmission has avoided outbreaks or deaths in Residential Aged Care Facilities (RACFs). As RACFs residents are at high risk of morbidity and mortality from COVID-19, understanding disease severity risk factors is imperative. Design This retrospective cohort study aimed to compare COVID-19 disease severity (hospitalisation and deaths) and associated risk factors among RACF residents in "[blinded for review]", "[blinded for review]", across Delta and Omicron epidemic periods. Settings and participants Resident case hospitalisation risk (HR) and case fatality risk (CFR) were assessed using "[blinded for review]" RACFs COVID-19 outbreaks data across two epidemic periods;Delta, 994 resident cases linked to 86 outbreaks;and Omicron, 1,882 resident cases linked to 209 outbreaks. Methods Adjusting for outbreak-level clustering, age, sex, up-to-date vaccination status and time since last vaccination, the odds of hospitalisation and death were compared using mixed effects logistic regression. Results The HR and CFR was lower during the Omicron period compared to the Delta period ((HR 8.2% vs 24.6%;OR = 0.17, 95% CI 0.11-0.26) and (CFR 11.4% vs 18.7%;OR = 0.40, 95% CI 0.28-0.56)). During both periods;males had higher odds of hospitalisation and odds of death;being up-to-date with vaccination reduced odds of hospitalisation by 40% (excluding non-emergency patient transfers) and odds of death by 43%;and for each month since last vaccination, odds of hospitalisation increased by 9% and odds of death by 16%. Conclusions and implications This study provides empirical evidence of lower COVID-19 severity among RACF residents in the Omicron period and highlights the importance of up-to-date and timely vaccination to reduce disease severity in this cohort.

2.
Med J Aust ; 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2115786

ABSTRACT

OBJECTIVES: To assess associations between SARS-CoV-2 infection and the incidence of hospitalisation with selected respiratory and non-respiratory conditions in a largely SARS-CoV-2 vaccine-naïve population . DESIGN, SETTING, PARTICIPANTS: Self-control case series; analysis of population-wide surveillance and administrative data for all laboratory-confirmed COVID-19 cases notified to the Victorian Department of Health (onset, 23 January 2020 - 31 May 2021; ie, prior to widespread vaccination rollout) and linked hospital admissions data (admission dates to 30 September 2021). MAIN OUTCOME MEASURES: Hospitalisation of people with acute COVID-19; incidence rate ratios (IRRs) comparing incidence of hospitalisations with defined conditions (including cardiac, cerebrovascular, venous thrombo-embolic, coagulative, and renal disorders) from three days before to within 89 days of onset of COVID-19 with incidence during baseline period (60-365 days prior to COVID-19 onset). RESULTS: A total of 20 594 COVID-19 cases were notified; 2992 people (14.5%) were hospitalised with COVID-19. The incidence of hospitalisation within 89 days of onset of COVID-19 was higher than during the baseline period for several conditions, including myocarditis and pericarditis (IRR, 14.8; 95% CI, 3.2-68.3), thrombocytopenia (IRR, 7.4; 95% CI, 4.4-12.5), pulmonary embolism (IRR, 6.4; 95% CI, 3.6-11.4), acute myocardial infarction (IRR, 3.9; 95% CI, 2.6-5.8), and cerebral infarction (IRR, 2.3; 95% CI, 1.4-3.9). CONCLUSION: SARS-CoV-2 infection is associated with higher incidence of hospitalisation with several respiratory and non-respiratory conditions. Our findings reinforce the value of COVID-19 mitigation measures such as vaccination, and awareness of these associations should assist the clinical management of people with histories of SARS-CoV-2 infection.

4.
Infect Control Hosp Epidemiol ; : 1-8, 2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-2076931

ABSTRACT

OBJECTIVE: Morbidity and mortality from coronavirus disease 2019 (COVID-19) have been significant among elderly residents of residential aged-care services (RACS). To prevent incursions of COVID-19 in RACS in Australia, visitors were banned and aged-care workers were encouraged to work at a single site. We conducted a review of case notes and a social network analysis to understand how workplace and social networks enabled the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) among RACS. DESIGN: Retrospective outbreak review. SETTING AND PARTICIPANTS: Staff involved in COVID-19 outbreaks in RACS in Victoria, Australia, May-October 2020. METHODS: The Victorian Department of Health COVID-19 case and contact data were reviewed to construct 2 social networks: (1) a work network connecting RACS through workers and (2) a household network connecting to RACS through households. Probable index cases were reviewed to estimate the number and size (number of resident cases and deaths) of outbreaks likely initiated by multisite work versus transmission via households. RESULTS: Among 2,033 cases linked to an outbreak as staff, 91 (4.5%) were multisite staff cases. Forty-three outbreaks were attributed to multisite work and 35 were deemed potentially preventable had staff worked at a single site. In addition, 99 staff cases were linked to another RACS outbreak through their household contacts, and 21 outbreaks were attributed to staff-household transmission. CONCLUSIONS: Limiting worker mobility through single-site policies could reduce the chances of SARS-CoV-2 spreading from one RACS to another. However, initiatives that reduce the chance of transmission via household networks would also be needed.

6.
Clin Infect Dis ; 2022 Aug 12.
Article in English | MEDLINE | ID: covidwho-1992158

ABSTRACT

BACKGROUND: Influenza circulated at historically-low levels during 2020 and 2021 due to COVID-19 pandemic travel restrictions. In Australia, international arrivals to Australia were required to undertake 14 days hotel quarantine to limit new introduction of SARS-CoV-2 virus. METHODS: We used routine testing data for travellers arriving on repatriation flights to Darwin, Australia from 3 January to 11 October 2021 to identify importations of influenza virus into Australia and used this information to estimate the risk of a case exiting quarantine while still infectious. Influenza-positive samples were sequenced and cases were followed-up to identify transmission clusters. Data on the number of cases and total passengers was used to infer the risk of influenza cases existing quarantine while infectious. RESULTS: Despite very low circulation of influenza globally, 42 cases were identified among 15,026 returned travellers, of which 30 were A(H3N2), two were A(H1N1)pdm09 and 10 were B/Victoria. Virus sequencing data identified potential in-flight transmission, as well as independent infections prior to travel. Under the quarantine strategy in place at the time, the probability that these cases could initiate influenza outbreaks in Australia neared 0. However, this probability rose as quarantine requirements relaxed. CONCLUSIONS: Detection of influenza virus infections in repatriated travellers provided a source of influenza viruses otherwise unavailable and enabled development of the A(H3N2) vaccine seed viruses included in the 2022 Southern Hemisphere influenza vaccine. Failing to test quarantined returned travellers for influenza, represents a missed opportunity for enhanced surveillance to better inform public health preparedness.

7.
Nat Commun ; 13(1): 2884, 2022 05 24.
Article in English | MEDLINE | ID: covidwho-1860372

ABSTRACT

Human respiratory syncytial virus (RSV) is an important cause of acute respiratory infection with the most severe disease in the young and elderly. Non-pharmaceutical interventions and travel restrictions for controlling COVID-19 have impacted the circulation of most respiratory viruses including RSV globally, particularly in Australia, where during 2020 the normal winter epidemics were notably absent. However, in late 2020, unprecedented widespread RSV outbreaks occurred, beginning in spring, and extending into summer across two widely separated regions of the Australian continent, New South Wales (NSW) and Australian Capital Territory (ACT) in the east, and Western Australia. Through genomic sequencing we reveal a major reduction in RSV genetic diversity following COVID-19 emergence with two genetically distinct RSV-A clades circulating cryptically, likely localised for several months prior to an epidemic surge in cases upon relaxation of COVID-19 control measures. The NSW/ACT clade subsequently spread to the neighbouring state of Victoria and to cause extensive outbreaks and hospitalisations in early 2021. These findings highlight the need for continued surveillance and sequencing of RSV and other respiratory viruses during and after the COVID-19 pandemic, as mitigation measures may disrupt seasonal patterns, causing larger or more severe outbreaks.


Subject(s)
COVID-19 , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Infant , Pandemics/prevention & control , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus Infections/prevention & control , Respiratory Syncytial Virus, Human/genetics , Seasons , Victoria
9.
Nat Commun ; 13(1): 1721, 2022 03 31.
Article in English | MEDLINE | ID: covidwho-1773976

ABSTRACT

Annual epidemics of seasonal influenza cause hundreds of thousands of deaths, high levels of morbidity, and substantial economic loss. Yet, global influenza circulation has been heavily suppressed by public health measures and travel restrictions since the onset of the COVID-19 pandemic. Notably, the influenza B/Yamagata lineage has not been conclusively detected since April 2020, and A(H3N2), A(H1N1), and B/Victoria viruses have since circulated with considerably less genetic diversity. Travel restrictions have largely confined regional outbreaks of A(H3N2) to South and Southeast Asia, B/Victoria to China, and A(H1N1) to West Africa. Seasonal influenza transmission lineages continue to perish globally, except in these select hotspots, which will likely seed future epidemics. Waning population immunity and sporadic case detection will further challenge influenza vaccine strain selection and epidemic control. We offer a perspective on the potential short- and long-term evolutionary dynamics of seasonal influenza and discuss potential consequences and mitigation strategies as global travel gradually returns to pre-pandemic levels.


Subject(s)
COVID-19 , Influenza A Virus, H1N1 Subtype , Influenza Vaccines , Influenza, Human , COVID-19/epidemiology , Humans , Influenza A Virus, H3N2 Subtype , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pandemics/prevention & control , Seasons
10.
Interface Focus ; 12(2): 20210079, 2022 Apr 06.
Article in English | MEDLINE | ID: covidwho-1713825

ABSTRACT

Responses to the early (February-July 2020) COVID-19 pandemic varied widely, globally. Reasons for this are multiple but likely relate to the healthcare and financial resources then available, and the degree of trust in, and economic support provided by, national governments. Cultural factors also affected how different populations reacted to the various pandemic restrictions, like masking, social distancing and self-isolation or self-quarantine. The degree of compliance with these measures depended on how much individuals valued their needs and liberties over those of their society. Thus, several themes may be relevant when comparing pandemic responses across different regions. East and Southeast Asian populations tended to be more collectivist and self-sacrificing, responding quickly to early signs of the pandemic and readily complied with most restrictions to control its spread. Australasian, Eastern European, Scandinavian, some Middle Eastern, African and South American countries also responded promptly by imposing restrictions of varying severity, due to concerns for their wider society, including for some, the fragility of their healthcare systems. Western European and North American countries, with well-resourced healthcare systems, initially reacted more slowly, partly in an effort to maintain their economies but also to delay imposing pandemic restrictions that limited the personal freedoms of their citizens.

11.
Clin Infect Dis ; 75(1): e357-e360, 2022 08 24.
Article in English | MEDLINE | ID: covidwho-1713626

ABSTRACT

A key aim of serosurveillance during the coronavirus disease 2019 (COVID-19) pandemic has been to estimate the prevalence of prior infection, by correcting crude seroprevalence against estimated test performance for polymerase chain reaction (PCR)-confirmed COVID-19. We show that poor generalizability of sensitivity estimates to some target populations may lead to substantial underestimation of case numbers.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , COVID-19 Testing , Humans , Pandemics , Seroepidemiologic Studies
12.
Paediatr Perinat Epidemiol ; 36(4): 508-517, 2022 07.
Article in English | MEDLINE | ID: covidwho-1650172

ABSTRACT

BACKGROUND: Large-scale evaluation of COVID-19 is likely to rely on the quality of ICD coding. However, little is known about the validity of ICD-coded COVID-19 diagnoses. OBJECTIVES: To evaluate the performance of diagnostic codes in detecting COVID-19 during pregnancy. METHODS: We used data from a national cohort of 78,283 individuals with a pregnancy ending between 11 March 2020 and 31 January 2021 in the OptumLabs® Data Warehouse (OLDW). OLDW is a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. We identified all services with an ICD-10-CM diagnostic code of U07.1 and all laboratory claims records for COVID-19 diagnostic testing. We compared ICD-coded diagnoses to testing results to estimate positive and negative predictive values (PPV and NPV). To evaluate impact on risk estimation, we estimated risk of adverse pregnancy outcomes by source of exposure information. RESULTS: Of 78,283 pregnancies, 5644 had a laboratory test result for COVID-19. Testing was most common among older individuals, Hispanic individuals, those with higher socioeconomic status and those with a diagnosed medical condition or pregnancy complication; 52% of COVID-19 cases was identified through ICD-coded diagnosis alone, 19% from laboratory test results alone and 29% from both sources. Agreement between ICD-coded diagnosis and laboratory testing records was high 91% (95% confidence interval [CI] 90, 92). However, the PPV of ICD-code diagnosis was low (36%; 95% CI 33, 39). We observed up to a 50% difference in risk estimates of adverse pregnancy outcomes when exposure was based on laboratory testing results or diagnostic coding alone. CONCLUSIONS: More than one-in-five COVID-19 cases would be missed by using ICD-coded diagnoses alone to identify COVID-19 during pregnancy. Epidemiological studies exclusively relying on diagnostic coding or laboratory testing results are likely to be affected by exposure misclassification. Research and surveillance should draw upon multiple sources of COVID-19 diagnostic information.


Subject(s)
COVID-19 , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Clinical Coding , Databases, Factual , Female , Humans , Pregnancy , Pregnancy Outcome/epidemiology
13.
J Infect Dis ; 225(5): 759-767, 2022 03 02.
Article in English | MEDLINE | ID: covidwho-1597371

ABSTRACT

BACKGROUND: Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with increased risk of adverse perinatal health outcomes, few large-scale, community-based epidemiological studies have been conducted. METHODS: We conducted a national cohort study using deidentified administrative claims data for 78 283 pregnancies with estimated conception before 30 April 2020 and pregnancy end after 11 March 2020. We identified SARS-CoV-2 infections using diagnostic and laboratory testing data, and compared the risk of pregnancy outcomes using Cox proportional hazard models treating coronavirus disease 2019 (COVID-19) as a time-varying exposure and adjusting for baseline covariates. RESULTS: Of the pregnancies, 2655 (3.4%) had a documented SARS-CoV-2 infection. COVID-19 during pregnancy was not associated with risk of miscarriage, antepartum hemorrhage, or stillbirth, but was associated with 2-3 fold higher risk of induced abortion (adjusted hazard ratio [aHR], 2.60; 95% confidence interval [CI], 1.17-5.78), cesarean delivery (aHR, 1.99; 95% CI, 1.71-2.31), clinician-initiated preterm birth (aHR, 2.88; 95% CI, 1.93-4.30), spontaneous preterm birth (aHR, 1.79; 95% CI, 1.37-2.34), and fetal growth restriction (aHR, 2.04; 95% CI, 1.72-2.43). CONCLUSIONS: Prenatal SARS-CoV-2 infection was associated with increased risk of adverse pregnancy outcomes. Prevention could have fetal health benefits.


Subject(s)
COVID-19/diagnosis , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/virology , Pregnancy Outcome/epidemiology , Premature Birth , Adult , COVID-19/epidemiology , COVID-19/transmission , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Premature Birth/epidemiology , Premature Birth/virology , SARS-CoV-2
15.
Emerg Infect Dis ; 28(1): 251-253, 2022 01.
Article in English | MEDLINE | ID: covidwho-1468316

ABSTRACT

During the coronavirus disease pandemic, international travel controls have been widely adopted. To determine the effectiveness of these measures, we analyzed data from 165 countries and found that early implementation of international travel controls led to a mean delay of 5 weeks in the first epidemic peak of cases.


Subject(s)
COVID-19 , Disease Outbreaks/prevention & control , Humans , Pandemics , SARS-CoV-2 , Travel
16.
Infect Dis Health ; 27(1): 15-22, 2022 02.
Article in English | MEDLINE | ID: covidwho-1433274

ABSTRACT

BACKGROUND: Hospital-based contact tracing aims to limit spread of COVID-19 within healthcare facilities. In large outbreaks, this can stretch resources and workforce due to quarantine of uninfected staff. We analysed the performance of a manual contact tracing system for healthcare workers (HCW) at a multi-site healthcare facility in Melbourne, Australia, from June-September 2020, during an epidemic of COVID-19. METHODS: All HCW close contacts were quarantined for 14 days, and tested around day 11, if not already diagnosed with COVID-19. We examined the prevalence and timing of symptoms in cases detected during quarantine, described this group as proportions of all close contacts and of all cases, and used logistic regression to assess factors associated with infection. RESULTS: COVID-19 was diagnosed during quarantine in 52 furloughed HCWs, from 483 quarantine episodes (11%), accounting for 19% (52/270) of total HCW cases. In 361 exposures to a clear index case, odds of infection were higher after contact with an infectious patient compared to an infectious HCW (aOR: 4.69, 95% CI: 1.98-12.14). Contact with cases outside the workplace increased odds of infection compared to workplace contact only (aOR: 7.70, 95% CI: 2.63-23.05). We estimated 30%, 78% and 95% of symptomatic cases would develop symptoms by days 3, 7, and 11 of quarantine, respectively. CONCLUSION: In our setting, hospital-based contact tracing detected and contained a significant proportion of HCW cases, without excessive quarantine of uninfected staff. Effectiveness of contact tracing is determined by a range of dynamic factors, so system performance should be monitored in real-time.


Subject(s)
COVID-19 , Contact Tracing , Hospitals , Humans , Quarantine , SARS-CoV-2
17.
Clin Infect Dis ; 71(16): 2289-2290, 2020 11 19.
Article in English | MEDLINE | ID: covidwho-1383200
18.
Br J Clin Pharmacol ; 88(3): 1143-1151, 2022 03.
Article in English | MEDLINE | ID: covidwho-1360463

ABSTRACT

AIMS: Public health responses to reduce SARS-CoV-2 transmission have profoundly affected the epidemiology and management of other infections. We examined the impact of COVID-19 restrictions on antibiotic dispensing in Australia. METHODS: We used national claims data to investigate antibiotic dispensing trends from November 2015 to October 2020 and whether changes reflected reductions in primary care consultations. We used interrupted time series analysis to quantify changes in monthly antibiotic dispensing and face-to-face and telehealth GP consultations and examined changes by recipient age, pharmacy State and prescriber specialty. RESULTS: Over the study period, an estimated 19 921 370 people had 125 495 137 antibiotic dispensings, 71% prescribed by GPs. Following COVID-19 restrictions, we observed a sustained 36% (95% CI: 33-40%) reduction in antibiotic dispensings from April 2020. Antibiotics recommended for managing respiratory tract infections showed large reductions (range 51-69%), whereas those recommended for non-respiratory infections were unchanged. Dispensings prescribed by GPs decreased from 63.5 per 1000 population for April-October 2019 to 37.0 per 1000 for April-October 2020. Total GP consultation rates remained stable, but from April 2020, 31% of consultations were telehealth. CONCLUSION: In a setting with a low COVID-19 incidence, restrictions were associated with a substantial reduction in community dispensings of antibiotics primarily used to treat respiratory infections, coincident with reported reductions in respiratory viral infections. Our findings are informative for post-pandemic antimicrobial stewardship and highlight the potential to reduce inappropriate prescribing by GPs and specialists for respiratory viral infections.


Subject(s)
Antimicrobial Stewardship , COVID-19 , Anti-Bacterial Agents/therapeutic use , Humans , Inappropriate Prescribing/prevention & control , Pandemics , Practice Patterns, Physicians' , SARS-CoV-2
19.
Open Forum Infect Dis ; 8(7): ofab239, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1309620

ABSTRACT

BACKGROUND: Serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complements nucleic acid tests for patient diagnosis and enables monitoring of population susceptibility to inform the coronavirus disease 2019 (COVID-19) pandemic response. It is important to understand the reliability of assays with different antigen or antibody targets to detect humoral immunity after SARS-CoV-2 infection and to understand how antibody (Ab) binding assays compare to those detecting neutralizing antibody (nAb), particularly as we move into the era of vaccines. METHODS: We evaluated the performance of 6 commercially available enzyme-linked immunosorbent assays (ELISAs), including a surrogate virus neutralization test (sVNT), for detection of SARS-CoV-2 immunoglobulins (IgA, IgM, IgG), total or nAb. A result subset was compared with a cell culture-based microneutralization (MN) assay. We tested sera from patients with prior reverse transcription polymerase chain reaction-confirmed SARS-CoV-2 infection, prepandemic sera, and potential cross-reactive sera from patients with other non-COVID-19 acute infections. RESULTS: For sera collected >14 days post-symptom onset, the assay achieving the highest sensitivity was the Wantai total Ab at 100% (95% CI, 94.6%-100%), followed by 93.1% for Euroimmun NCP-IgG, 93.1% for GenScript sVNT, 90.3% for Euroimmun S1-IgG, 88.9% for Euroimmun S1-IgA, and 83.3% for Wantai IgM. Specificity for the best-performing assay was 99.5% for the Wantai total Ab, and for the lowest-performing assay it was 97.1% for sVNT (as per the Instructions for Use [IFU]). The Wantai Total Ab had the best agreement with MN at 98% followed by Euroimmun S1-IgA, Euro NCP-IgG, and sVNT (as per IFU) with 97%, 97% and 95%, respectively; Wantai IgM had the poorest agreement at 93%. CONCLUSIONS: Performance characteristics of the SARS-CoV-2 serology assays detecting different antibody types are consistent with those found in previously published reports. Evaluation of the surrogate virus neutralization test in comparison to the Ab binding assays and a cell culture-based neutralization assay showed good result correlation between all assays. However, correlation between the cell-based neutralization test and some assays detecting Ab's not specifically involved in neutralization was higher than with the sVNT. This study demonstrates the reliability of different assays to detect the humoral immune response following SARS-CoV-2 infection, which can be used to optimize serological test algorithms for assessing antibody responses post-SARS-CoV-2 infection or vaccination.

20.
Drug Alcohol Depend ; 226: 108882, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1283302

ABSTRACT

BACKGROUND: Comorbid chronic health conditions place people who inject drugs (PWID) at risk of severe health outcomes after influenza infection. However, little is known about the uptake, barriers and correlates of influenza vaccination among PWID. METHODS: During structured surveys, 872 PWID reported whether they had received an influenza vaccination during the last year (disaggregated as pre- or post-March 2020 to ascertain current season vaccine uptake), and if not, the barriers to vaccination. Logistic regression was used to examine demographic, drug use, health and service engagement correlates of vaccine uptake. RESULTS: Thirty-nine percent of participants reported past-year influenza vaccination, with one-quarter (24 %) vaccinated in the current season. The main barriers to vaccination were motivation-based, with few citing issues relating to affordability, supply or perceived stigma. Opioid agonist therapy in the past six months was significantly associated with vaccination. CONCLUSIONS: Influenza vaccine uptake was lower among PWID than the Australian general population. Provision of the vaccine at services commonly accessed by PWID may increase uptake.


Subject(s)
Influenza, Human , Pharmaceutical Preparations , Australia/epidemiology , Cross-Sectional Studies , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Vaccination
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