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1.
Pediatric Critical Care Medicine ; 17:17, 2022.
Article in English | MEDLINE | ID: covidwho-2161261

ABSTRACT

OBJECTIVES: To describe trends in critical illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children over the course of the COVID-19 pandemic. We hypothesized that PICU admission rates were higher in the Omicron period compared with the original outbreak but that fewer patients needed endotracheal intubation.

2.
Frontiers in public health ; 10, 2022.
Article in English | EuropePMC | ID: covidwho-1989830

ABSTRACT

Background COVID-19 vaccination significantly reduces the risk of infection and its associated morbidity and mortality. However, poor uptake of the COVID-19 vaccination was reported among the high-risk group of older people amidst emerging variants of concern. This community case study reports an outreach program in Singapore, COVE (COVID-19 Vaccination for the Elderly) initiated by healthcare workers in a cluster of primary care clinics. They assessed the vaccine hesitancy among these older persons, addressed their concerns and facilitated their vaccination appointment during a brief phone conversation. Method Twenty one thousand six hundred and sixty three unvaccinated adults aged ≥60 years were contacted by healthcare worker volunteers over two phases from June to October 2021. In phase I, they contacted adults aged above 70 years over 2 weeks. Adults who were uncontactable in phase I and those aged 60–69 years were sent SMS in phase II. Data were analyzed via descriptive data analysis. Results After phase 1, 65.5% (n = 5,646/8,617) of older adults had received at least one dose of the COVID-19 vaccine. The respondents expressed intention to vaccinate (39%, n = 3,390), requested to seek further information (25%, n = 2,138), reported access barrier (8%, n = 715), or were concerned of the vaccine adverse effects (3%, n = 288). Vaccination was refused by 24% (n = 2,086) of the respondents. Eventually 60.4% (n = 13,082/21,663) of them were vaccinated 3 months after COVE implementation. Conclusion The COVE program increased the COVID-19 vaccination uptake of older adults from 84.6 to 96.3%. A person-centric proactive approach by healthcare workers addressed vaccine hesitancy and optimized vaccination. The outreach scheduling of vaccination appointments is key in promoting vaccination uptake among older adults.

3.
Vaccines (Basel) ; 10(7)2022 Jul 14.
Article in English | MEDLINE | ID: covidwho-1928706

ABSTRACT

Background: Gut microbiota can be associated with COVID-19 vaccine immunogenicity. We investigated whether recent antibiotic use influences BNT162b2 vaccine immunogenicity. Methods: BNT162b2 recipients from three centers were prospectively recruited. Outcomes of interest were seroconversion of neutralising antibody (NAb) at day 21, 56 and 180 after first dose. We calculated the adjusted odds ratio (aOR) of seroconversion with antibiotic usage (defined as ever use of any antibiotics within six months before first dose of vaccine) by adjusting for covariates including age, sex, smoking, alcohol, and comorbidities. Results: Of 316 BNT162b2 recipients (100 [31.6%] male; median age: 50.1 [IQR: 40.0-57.0] years) recruited, 29 (9.2%) were antibiotic users. There was a trend of lower seroconversion rates in antibiotic users than non-users at day 21 (82.8% vs. 91.3%; p = 0.14) and day 56 (96.6% vs. 99.3%; p = 0.15), but not at day 180 (93.3% vs. 94.1%). A multivariate analysis showed that recent antibiotic usage was associated with a lower seroconversion rate at day 21 (aOR 0.26;95% CI: 0.08-0.96). Other factors associated with a lower seroconversion rate after first dose of the BNT162b2 vaccine included age ≥ 60 years (aOR: 0.34;95% CI: 0.13-0.95) and male sex (aOR: 0.14, 95% CI: 0.05-0.34). There were no significant factors associated with seroconversion after two doses of BNT16b2, including antibiotic use (aOR: 0.03;95% CI: 0.001-1.15). Conclusions: Recent antibiotic use may be associated with a lower seroconversion rate at day 21 (but not day 56 or 180) among BNT162b2 recipients. Further long-term follow-up data with a larger sample size is needed to reach a definite conclusion on how antibiotics influence immunogenicity and the durability of the vaccine response.

4.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880842
5.
Inoculating Cities: Case Studies of Urban Pandemic Preparedness ; : 133-153, 2021.
Article in English | Scopus | ID: covidwho-1783068

ABSTRACT

With strong urban population growth expected, porous borders, increasing interconnectivity and the country’s location in the Greater Mekong Subregion zoonoses hotspot, improving urban pandemic preparedness in Myanmar are both a domestic and regional imperative. The country is leveraging the strengths and experiences of various vertical health programs, especially the national malaria and tuberculosis programs, and building on them to create public health emergency operations centers to address urban public health challenges including the COVID-19 pandemic. These efforts, in tandem with health system strengthening;improving laboratory and diagnostic facilities;building human resource capacity for surge and emergency response;and public-private partnerships with both the health and non-health sectors may serve as a viable model for effective urban pandemic preparedness in Myanmar’s cities as well as other low-resource settings. © 2021 Elsevier Inc. All rights reserved.

6.
Endosc Int Open ; 9(3): E284-E288, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1114736

ABSTRACT

Background and study aims The COVID-19 pandemic has caused a major disruption in the healthcare system. This study determined the impact of the first wave of COVID-19 on the number and outcome of patients hospitalized for upper gastrointestinal bleeding (UGIB) in Hong Kong. Patients and methods Records of all patients hospitalized for UGIB in Hong Kong public hospitals between October 2018 and June 2020 were retrieved. The number and characteristics of patients hospitalized for UGIB after COVID-19 was compared by autoregressive integrated moving average (ARIMA) model prediction and historical cohort. Results Since the first local case of COVID-19, there was an initial drop in UGIB hospitalizations (observed 29.8 vs predicted 35.5 per week; P  = 0.05) followed by a rebound (39.8 vs 26.7 per week; P  < 0.01) with a turning point at week 14 (Petitt's test, P  < 0.001). There was a negative association between the number of COVID-19 cases and the number of patients hospitalized for UGIB (Pearson correlation -0.53, P  < 0.001). Patients admitted after the outbreak of COVID-19 had lower hemoglobin (7.5 vs baseline 8.3 g/dL; P  < 0.01) and a greater need for blood transfusion (64.5 % vs baseline 50.4 %; P  < 0.01), but similar rates of all-cause mortality (6.9 % vs 7.1 %; P  = 0.82) and rebleeding (6.7 % vs 5.1 %; P  = 0.11). There was also a higher proportion of patients with variceal bleeding (10.5 % vs baseline 5.3 %; P  < 0 .01). Conclusions There was a dynamic change in the number of patients hospitalized for UGIB in Hong Kong during the first wave of the COVID-19 outbreak, with more obvious impact during the initial phase only.

7.
Gastroenterology ; 160(3): 973-974, 2021 02.
Article in English | MEDLINE | ID: covidwho-1093363
12.
Gastroenterology ; 159(1): 81-95, 2020 07.
Article in English | MEDLINE | ID: covidwho-40729

ABSTRACT

BACKGROUND & AIMS: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong. METHODS: We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model. RESULTS: Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log10 copies per milliliter in patients with diarrhea vs 3.9 log10 copies per milliliter in patients without diarrhea (P = .06). In a meta-analysis of 60 studies comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6% (95% confidence interval [CI], 12.3-24.5); 11.8% of patients with nonsevere COVID-19 had gastrointestinal symptoms (95% CI, 4.1-29.1), and 17.1% of patients with severe COVID-19 had gastrointestinal symptoms (95% CI, 6.9-36.7). In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1% (95% CI, 38.3-57.9); of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus (95% CI, 49.6-85.1). CONCLUSIONS: In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Diarrhea/virology , Feces/virology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Viral Load , Betacoronavirus/genetics , Betacoronavirus/pathogenicity , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Diarrhea/diagnosis , Diarrhea/epidemiology , Endoscopy, Gastrointestinal/standards , Gastrointestinal Tract/diagnostic imaging , Gastrointestinal Tract/virology , Hong Kong/epidemiology , Humans , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Prevalence , RNA, Viral/isolation & purification , SARS-CoV-2
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