Screening Strategies in Different Resource Settings

Health care-associated infections/ Hospital-acquired infections (HAIs) have a significant impact on patients' morbidity and mortality. The risk of HAIs in resource-limited settings (RLS) has been reported 2-20 times higher than that in developed countries. Moreover, multi-drug- resistant organisms (MDROs) have emerged and spread throughout the world. In addition, increases in HAIs were observed during the COVID-19 pandemic throughout the world.Thus, screening strategies/surveillance of MDROs were recommended as a core component of infection prevention and control (IPC) measures for the effective HAIs prevention. We review and summarize current critical knowledge on screening strategies in different resource settings, especially on guidelines for the prevention and control of carbapenem- resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPsA) in health care facilities. The guidelines (especially WHO) were strongly recommended for surveillance of CRE-CRAB-CRPsA infections and surveillance cultures of asymptomatic CRE colonization. There were conditional recommended on surveillance cultures of the environment for CRE-CRAB-CRPsA colonization/contamination. The surveillance cultures (stool samples or rectal swabs) allowed the early introduction of IPC measures to prevent transmission to other patients and the hospital environment. Given the clinical importance of CRE-CRAB-CRPsA infections, regular ongoing active surveillance of infections were required in all microbiology laboratory settings. In addition, surveillance cultures for asymptomatic CRE colonization should also be performed, guided by local epidemiology and risk assessment. The surveillance cultures of asymptomatic CRE colonization should be considered for patients with previous CRE colonization and patients with a history of recent hospitalization in endemic CRE settings or contacted CRE colonized/ infected patients. In contrast, the evidence available on surveillance cultures for CRAB and CRPsA colonization in asymptomatic patients was not sufficiently relevant for the recommendation. Nowadays, the CRE surveillance strategies have been implemented in various methods from traditional culture- based methods to molecular assays. The limitation of microbiology laboratory capacity for MDROs in RLS was concerning. However, the surveillance data would help with appropriate IPC measure implementation and outbreak investigations. Thus, the proper screening strategies and strengthening microbiology laboratory capacity, especially in RLS are challenge for improving IPC measures and patient outcomes.Copyright © 2023

Safety surveillance of covid-19 vaccines using large-linked database

In the global drive to vaccinate against SARS-CoV-2, millions of people have received at least one dose of a COVID- 19 vaccine. Vaccination safety is the key to the success of immunisation programs and in combating vaccine hesitancy among the public. Post-licensure safety monitoring of COVID-19 vaccines is essential to detect rare or severe vaccine-associated adverse events in the population and provide ongoing data of safety issues. Passive surveillance is the primary method most widely used to collect adverse events following immunisation (AEFI) via voluntary reporting. Monitoring through active surveillance is strongly encouraged to improve vaccine safety monitoring and provide more robust data. The SAFECOVAC project was initiated to evaluate risk of serious adverse events following COVID-19 vaccination. It leverages on the availability of nationwide COVID- 19 vaccine registry, hospital admission database, and other data sources to create a large-linked database. Uniquely for Malaysia, diverse vaccine portfolio was used and we are able to compare the risk estimate for the three major vaccine types of different platform i.e., mRNA-based vaccine (BNT162b2), inactivated vaccine (CoronaVac), and adenovirus vector-based vaccine (ChAdOx1). Current data shows that safety of COVID-19 vaccine is assured and findings are fairly consistent with data from other countries.

Zooanthropogenic potential of SARS-CoV-2 virus: Implications for vaccine-mediated immunity

The human pandemic caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in December, 2019 is still continuing in various parts of the world. The SARS-CoV-2 has evolved through sporadic mutations and recombination events and the emergence of alternate variants following adaptations in humans and human-to-animal transmission (zooanthraponosis) has raised concerns over the efficacy of vaccines against new variants. The animal reservoir of SARS-CoV-2 is unknown despite reports of SARS-CoV- 2-related viruses in bats and pangolins. A recent report of back-andforth transmission of SARS-CoV-2 between humans and minks on mink farms in the Netherlands has sparked widespread interest in zooanthroponotic transmission of SARS-CoV-2 followed by reemergence to infect human populations. The risk of animal to human transmission depends on virus-host interaction in susceptible species that may be short-term or long term risks. The short term risk might be due to infection to humans during the viremic stage in susceptible animals. The long term risk might be either due to persistence of the virus at population level or latency of infection leading to risk of evolution and re-emergence of the virus. Experimental studies have identified a range of animals that are susceptible and permissive to SARS-CoV-2 infection viz. cats, ferrets, hamsters, mink, non-human primates, tree shrews, raccoon dogs, fruit bats, and rabbits. The health impacts of SARS-CoV-2 infection in animals are unknown and it is likely that other susceptible species have not been discovered yet. Apart from farmed animals, stray cats and rodents have been identified as a potential opportunity for ongoing transmission in intense farming situations. Recognizing animal species that are most susceptible to infection is the first step in preventing ongoing transmission from humans. Minimizing the risk of zooanthraponosis requires multi-sectoral coordination that includes implementation of strict biosecurity measures such as controlled access to farms that house susceptible animals, bio-secure entry and exit protocols, disinfection protocols in farm, down time for animal transport vehicles and daily assessments of human handlers for exposure to SARS-CoV- 2. Hence, active surveillance in animal species that are prioritized based on risk assessment need to be initiated in coordination with health and environment sectors for early identification of emerging and re-emerging variants of SARS-CoV-2 virus in animals.

Trends in Definitive Therapy for Prostate Cancer during the Covid-19 Pandemic: A Grade-by-Gradeanalysis

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic placed a significant burden on the US healthcare system. Moreover, many healthcare systems triaged cases based on the severity of disease. Therefore, we assessed the impact of the COVID-19 pandemic on prostate cancer management according to the International Society of Urological Pathology (ISUP) grade groups. METHOD(S): We retrospectively analyzed the National Cancer Database (NCDB) for patients with prostate cancer between 2018- 2020. We divided our cohort into "Pre-Pandemic" (2018/2019) and "Pandemic" (2020) periods. Men were classified according to their ISUP grade group at diagnosis. Hospital characteristics and patient-level clinical and sociodemographic variables were extracted. Our primary outcome was the utilization of definitive treatment (surgery or radiation) versus expectant management (active surveillance, watchful waiting, or no treatment). We performed multivariable logistic regressions to predict the type of management for each ISUP grade group across the two periods adjusting for clinical and socioeconomic covariates. RESULT(S): A total of 398,719 men with a diagnosis of prostate cancer were reported during the "Pre-Pandemic" (70.6%) and "Pandemic" (29.4%) periods. Overall, 24.5% had an ISUP 1, 30.6% an ISUP 2, 18.2% an ISUP 3, 13% ISUP 4, and 13.8% ISUP 5 disease (Table 1). Treatment was less likely during the "Pandemic" compared to the "Pre-Pandemic" period for ISUP grade group 1 (aOR 0.80;95% CI 0.77 - 0.83;p-value <0.001), for ISUP grade group 2 (aOR 0.85;95% CI 0.81 - 0.89;p-value <0.001) and for ISUP grade group 3 (aOR 0.87;95% CI 0.80 - 0.96;p-value <0.003). However, no differences in treatment trends were found for ISUP grade groups 4 and 5 across the two time periods. CONCLUSION(S): During the COVID-19 pandemic, patients with prostate cancers ISUP grade groups 1, 2, and 3 were more likely to receive expectant management than definitive treatment;however, this was not true for patients with more aggressive diseases. This finding suggests a high capacity of facilities to appropriately risk stratify and prioritize higher-risk cases during a public health emergency. A limitation of our study is the inability to assess the treatment trends of men diagnosed in the last 2020 quarter due to the lack of follow-up.

Spontaneous rectus sheath hematoma in a patient with COVID-19 and chronic myeloid leukemia. A case report and literature review.

Introduction: Rectus sheath hematoma is a rare entity. This report presents a clinical case of a rectus sheath hematoma in a patient with COVID-19 pneumonia and chronic myeloid leukemia, along with a review of the literature. Case Report: A 55-year-old male patient, hospitalized for COVID-19 pneumonia and chronic myeloid leukemia, presents with tachycardia and hypotension. Computed tomography shows a rectus sheath hematoma. Surgical management was performed to control bleeding and drainage of the hematoma. There were no postoperative complications or need for reoperation. Discussion(s): Hemorrhagic complications in patients with COVID-19 are seldomly reported. Bleeding is a possible complication in patients with chronic myeloid leukemia. It is important to take into account rectus sheath hematoma in patients with COVID-19 and/or chronic myeloid leukemia who present with abdominal pain, for early management by a multidisciplinary team. Conclusion(s): Active surveillance and a high index of suspicion are key to identifying potential bleeding complications in patients with COVID-19 and/or chronic myeloid leukemia.Copyright © 2023, Sociedad de Cirujanos de Chile. All rights reserved.

Etiology of acute febrile illness in the peruvian amazon as determined by modular formatted quantitative PCR: a protocol for RIVERA, a health facility-based case-control study.

BACKGROUND: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. METHODS: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. DISCUSSION: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 h and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific prevalent pathogens as a cause of acute illness. STUDY REGISTRATION: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú.

Multi-centre review of systemic anti-cancer prescribing patterns and treatment drop off rates in the United Kingdom 2018-2021

Background: The treatment landscape of metastatic renal cell carcinoma (mRCC) has evolved over recent years with several systemic anti-cancer therapies (SACT) licensed across different lines of treatment. There is ongoing discussion amongst oncology professionals about how best to optimise treatments in terms of sequencing to maximise the potential number of lines or to give the best treatments first. A previous south-west UK audit was completed in 2021 reviewing the drop off rates across 5 UK sites identifying that 69% of patients were able to receive second line therapy and 34% were able to receive third line therapy. Method(s): In this study we conducted retrospective analysis of all patients who commenced treatment with SACT for mRCC between 1st January 2018 and 30th June 2021 in 18 centres across the 4 nations of the United Kingdom. All NHS reimbursed treatment options including the COVID interim treatment guideline options were included. Patients who received SACT as part of a clinical trial were also included. Patients who continued on their respective lines of treatment were censored. We also identified patients who had been on a period of active surveillance before staring SACT in this cohort. Result(s): 1549 patients (71% male: 29% female) were included. IMDC subgroup patients included 21.6%favourable, 52.3% intermediate, 25.1%poor and 1% unavailable. 9.1% of patients had been on active surveillance before starting SACT - defined as a period of longer than 3 months from mRCC diagnosis to starting SACT. Of those patients that started SACT 60.5% of eligible patients had 2nd line therapy, 25.3% had 3rd line, 7.2% received 4th line therapy and only 1% had 5th line therapy. In the 1st line setting 58.9% received single agent VEGF TKI, 24.5% received combination ipilimumab and nivolumab (IO-IO) immunotherapy, 14 % received IO/ VEGF TKI combination and 2.6% received other/trial treatment. The single agent VEGF TKI ratio for 1st line SACT declined year by year with rising IO-IO and IO/VEGF TKI combination ratios seen. In the secondand third-line settings cabozantinib (33.2% 2nd line and 44.4% 3rd line) and nivolumab (32.8% 2nd line and 22.6% 3rd line) were the most common options. Disease progression or death was the most common cause of SACT discontinuation amounting to 57.4%, 62.5% and 79% of SACT cessation in the 1st, 2nd and 3rd lines respectively. Treatment toxicity SACT discontinuation rates were 22.8%, 21.4% and 10.9% for 1st, 2nd and 3rd lines respectively. Conclusion(s): These results suggest that with more treatment options available, including combination/immunotherapy therapies, more patients are able to receive second- and third-line therapies. That said there remains significant drop off rates mostly driven by disease progression that would support the use of our most effective therapies in the upfront setting.

Assessment of Adverse events following Immunization of COVID - 19 vaccination in Health Care Workers (HCWs) of Shaheed Hasan Khan Mewati Govt. Medical College Nalhar, Nuh, Haryana, India

Background: We assess the profile of adverse events following immunization of COVID - 19 vaccination of COVISHIELD in health care workers (HCWs) in Shaheed Hasan Khan Mewati Govt. Medical college Nalhar, Nuh, Haryana, India. Method(s): The Cross sectional and prospective observational study was conducted with a period of 3 months or till the desired sample size recruited in the study with follow up period of 15 days for all those subjects who were vaccinated for covid-19 in SHKM, GMC Hospital to look for AEFI with sample size more than 300. Active surveillance was done on days 3, 6 and 9 after days of vaccination for AEFI). Any AEFI noted will be managed as per the standard guidelines. Result(s): We present the results of an interim analysis of 400 patients out of total 550 participants with 244(61.00%) male and 156 (39.00%) female participants respectively. AEFIs following first dose were reported in 400 participants and 269 participants after second dose. Fever was the major AEFI with 150(37.50%) after first dose and 78(28.99%) after second dose respectively. In the study age wise AEFIs percentage of participants were also calculated. In the present study different systemic diseases percentage also calculated. Conclusion(s): The AEFIs associated with the COVISHIELD (ChAdOx1 nCoV-19), the COVID-19 vaccine injected in hospital health care workers is found to be safe for use in except for a few minor reactions.Copyright © RJPT. All right reserved.

Feasibility Assessment of a School Nurse-Led Approach Using Chronic Absenteeism to Establish the School-Based Active Surveillance Process.

This article shares what was learned from the feasibility assessment of a nurse-led school-based active surveillance (SBAS) pilot to track chronic absenteeism using myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an exemplar. This pilot encompassed a 3-year period with training and feedback from school nurses (SNs) on data collection and ME/CFS. SNs found that the SBAS process helped them effectively identifying undiagnosed conditions. The assessment revealed the importance of focusing outreach efforts and establishing relationships with the school leadership in developing health policies and programs in the school setting. The pilot data were used to develop a manual to guide SNs for the SBAS process. This can be viewed as a model for SNs in establishing a surveillance to identify and track conditions like ME/CFS. With overlapping symptoms of Long COVID to ME/CFS, this assessment may provide insights for additional efforts to understand the impact of Long COVID on students' education.

Success and failures in MRSA infection control during the COVID-19 pandemic.

Private sector facilities in the United States have experienced a resurgence of Methicillin-resistant Staphylococcus aureus (MRSA) hospital-onset infections during the COVID-19 pandemic, which eliminated all gains that were achieved over the last decade. The third quarter of 2021, the Standardized Infection Ratio for hospital onset MRSA bloodstream infections was 1.17, well above the baseline value of 1.0. In contrast, the Veterans Health Administration (VHA) has been able to maintain its mitigation efforts and low rates of MRSA hospital-onset infections through the second quarter of fiscal year 2022 (Mar. 31, 2022), the most recent available data. The difference may be explained not only by the VHA's use of uniform mitigating policies which rely on active surveillance and contact precautions, but also on the VAH's ability to maintain adequate staffing during the pandemic. Future research into MRSA mitigation is warranted and this data supports the need for healthcare system transformation.

The v-safe after vaccination health checker: Active vaccine safety monitoring during CDC's COVID-19 pandemic response.

The Centers for Disease Control and Prevention (CDC) developed and implemented the v-safe after vaccination health checker (v-safe) to monitor COVID-19 vaccine safety and as an active surveillance supplement to existing CDC vaccine safety monitoring programs. V-safe allows persons who received COVID-19 vaccines to report on post-vaccination experiences and how symptoms affected their health at daily, weekly, and monthly timepoints after vaccination. Text message reminders are sent linking to Internet-based health check-in surveys. Surveys include questions to identify v-safe participants who may be eligible to enroll in a separate pregnancy registry activity that evaluates maternal and infant outcomes in those pregnant at the time of vaccination or receiving vaccine in the periconception period. We describe the development of and enhancements to v-safe, data management, promotion and communication to vaccination sites and partners, publications, strengths and limitations, and implications for future systems. We also describe enrollment in v-safe over time and demographics of persons participating in v-safe during the first year of operation (December 14, 2020 - December 13, 2021). During this time, 9,342,582 persons submitted 131,543,087 v-safe surveys. The majority of participants were female (62.3 %) and non-Hispanic White (61.2 %); median age was 49.0 years. Most participants reported receiving an mRNA COVID-19 vaccine as their first recorded dose (95.0 %). V-safe contributed to CDC's vaccine safety assessments for FDA-authorized COVID-19 vaccines by enabling near real-time reporting of reactogenicity once the COVID-19 vaccination program began in the community, encouraging reports to the Vaccine Adverse Event Reporting System and facilitating enrollment in a large post-vaccination pregnancy registry. Given that v-safe is an integral component of the most comprehensive safety monitoring program in U.S. history, we believe that this approach has promise as a potential application for future pandemic response activities as well as rollout of novel vaccines in a non-pandemic context.

Clinical phenotypes of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19

The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre-quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America. Objective(s): To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru. Patients and Method: A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Peru), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes. Result(s): 58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 +/- 3.5 years and 67.2% were males. Gastrointes-tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation. Conclusion(s): In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients. Copyright © 2022, Sociedad Chilena de Pediatria. All rights reserved.

Sources of COVID-19 Exposure Among Health Care Personnel in a Large Tertiary Care Medical Center

Background. Introduction: Health care personnel (HCP) are at increased risk for SARS-CoV-2 exposure. However, the exposure sources among HCP are poorly understood. Methods. Design(s): We conducted active surveillance for all employed HCP newly diagnosed with COVID-19 between March 2020 and February 2022. We inquired about their sources of exposure using a standardized health department checklist and CDC guidance for managing healthcare personnel with SARS-CoV-2 infection or exposure. Results. Among all 8,766 HCP, 2,220 (25.3%) tested positive. Among positive cases, 749 (33.7%), 651 (29.3%), and 221 (10%) were among ancillary services HCP, RNs, and allied HCP, respectively (Table 1). The majority of the sources of exposures were unknown (57.8%), followed by household (26.2%), community (10.5%), and health care (5.5%), respectively. The incidence of COVID-19 increased with level of patient contact regardless of source of exposure. The majority of the cases, N=1054 (47.5%), occurred among HCP who were not up-to-date on COVID-19 vaccines and had unknown exposure, and vaccination status varied by source of exposure (Table 2). HCP COVID-19 cases mirrored transmission in the community (Figure). Conclusion. The majority of HCP cases had no known exposure to SARS-CoV-2 and were not up-to-date on COVID-19 vaccines highlighting the importance of vaccination as the single most effective mean to COVID-19 prevention among HCP.

Effectiveness of COVID-19 Vaccines Against Severe Disease and Death and its Durability Over Time Against the Omicron Variant

Background. We aimed to estimate COVID-19 Vaccine Effectiveness (VE) and its durability against severe disease (intubation) and death in the Greek population, for all vaccines currently in use. Methods. Nationwide active surveillance and vaccination registry data between January 2021 - April 2022 were used to estimate VE via quasi-Poisson regression as one minus Incidence Rate Ratio, adjusted for age and calendar time. Interaction terms were included to assess VE by age group, by variant (delta vs omicron) and by time since vaccination (compared to the first month after vaccination). Results. VE results are summarized in Figures 1-3. After 2-doses (of any vaccine) VE was >95% against delta and >85% against omicron in the 15-59 and 60-79 age groups, but waned significantly at 6 months by 5-10% in the 15-59 group and 15-20% in the 60-79 group. In the 80+ age group, 2-dose VE was much lower against omicron at around 60%, waning to 50% at 6 months. With 3 vaccine doses VE surged to >95% against both delta and omicron in all age groups except 80+, who had VE against omicron of =90%;however there was again substantial waning at 6 months by about 10-15% in all groups. In the 80+ age group, VE against omicron dropped to 81.4% (95% CI 76.7-85.2%) for death and 57.7% (95% CI 38.5-70.9%) for intubation. There was little to no evidence of variation in VE between combinations of different vaccines (BNT162b2, mRNA-1273, ChAdOx1 nCov-19 and Ad26.COV2.S), although the majority of the population received 2- or 3-dose BNT162b2. Vaccination prevented an estimated 39,018 COVID-19 deaths (95% CI: 37,791- 40,608) over the study period. Conclusion. COVID-19 vaccination remains extremely effective in preventing severe disease and death, even in the context of the omicron variant, as long as 3 doses have been administered. Even after 3 doses, however, effectiveness wanes substantially in the course of 6 months. Additional strategies will be therefore needed in order to minimize COVID-19 mortality and morbidity, including boosting doses especially in the elderly, improved vaccines, early diagnosis and treatment of high-risk groups and measures to reduce community transmission of current or novel SARS-CoV-2 immune escape variants.

COVID-19 Vaccination Uptake Among Health Care Workers (HCW) Requesting Medical Exemptions to Vaccination

Background. New York State adopted a COVID-19 vaccination requirement for all healthcare workers in September 2021, but they allowed medical exemptions. We examined reasons and frequency of medical exemption requests in an academic medical center. Methods. We conducted active surveillance of all medical exemption requests in a tertiary care academic center in Central NY. Age, gender, reason for request, prior acceptance of other required vaccines, letter of support from employee provider, adjudication of the request, and impact of the decision on COVID-19 vaccine acceptance were collected prospectively since the mandate became effective. Results. Among 8,776 HCWs, 108 requested medical exemptions, among those 57 (53%) were denied, 39 (36%) were granted temporary exemption, and 12 (11%) were permanent (Table). Females were more likely to request medical exemptions compared to males, 92 (85%) versus 16 (15%), respectively. Overall, 94 (87%) of the HCWs had a letter from their provider in support of their exemption. Nevertheless, only 47%of those qualified for permanent or temporary exemption usingCDCguidelines. The most common reasons for requesting exemption included: having natural immunity, receiving monoclonal antibodies, experiencing a common reaction to previous COVID-19 vaccination, and having an underlying medical condition (Figure 1). The majority of individuals who had a request denied or who received a temporary medical exemption were subsequently vaccinated, 63% and 79%, respectively (Figure 2). Demographic and other characteristics among health care workers (HCW) requesting medical exemptions. Conclusion. Females were more likely to request a medical exemption to vaccination and their requests were often supported by their providers. Future efforts should focus on educating both health care providers and the public about actual medical contraindications or precautions to vaccination to improve overall vaccination rates.

Whole-Genome Sequencing of Porcine Epidemic Diarrhea Virus by Illumina MiSeq Platform

Porcine epidemic diarrhea virus (PEDV) belongs to the genus Alphacoronavirus of the family Coronaviridae. PEDV was identified as an emerging pathogen in US pig populations in 2013. Since then, this virus has been detected in at least 31 states in the USA and has caused significant economic loss to the swine industry. Active surveillance and characterization of PEDV are essential for monitoring the virus. Obtaining comprehensive information about the PEDV genome can improve our understanding of the evolution of PEDV viruses, and the emergence of new strains, and can enhance vaccine designs. In this chapter, both a targeted amplification method and a random-priming method are described to amplify the complete genome of PEDV for sequencing using the MiSeq platform. Overall, this protocol provides a useful two-pronged approach to complete whole-genome sequences of PEDV depending on the amount of virus in the clinical samples. Copyright © Springer Science+Business Media New York 2016

Different containment strategies on COVID-19 infection and its impact

Introduction: In the earlier days of COVID-19 pandemic, the cases grew rapidly in an increasing number of countries, triggering bold policy responses. The impact of different containment strategies had yet to show any relationship with the cases. It became a question that would strict restriction in any way impact the spread of infection significantly and should it be a common practice among everywhere else in the world. Therefore, policy makers wondered if strict restrictions would impact the spread significantly and should this be practiced elsewhere in the world. Material(s) and Method(s): This rapid review assessed the effectiveness of different containment strategies used in suppressing COVID-19 infection in different countries from January 2020 to November 2020. Searches were done in PubMed, Cochrane Central Register of Clinical Trials, WHO database, ResearchGate. We identified 492 studies and screened for duplication. Using the inclusion and exclusion criteria, 25 studies were included. Result(s) and Conclusion(s): Different countries instituted containment strategies in different ways, such as Movement Control Order in Malaysia, Circuit Breaker in Singapore, COVID-19 Alert System Levels in New Zealand, etc. Most containment strategies had different success levels that depended on the time of implementation and whether the community accepted these new lifestyles and regulation. Sweden and New Zealand showed a high degree of success in combating COVID-19 despite their big population and less personal invasive methods in terms of containment strategies. Countries like United States, Japan, Singapore, Malaysia, and South Korean's responses to COVID-19 could be hard to replicate. However, all countries needed to improve on three main competencies, namely, technology enforcement, strong public health governance and public partnership. A nationwide lockdown could not promise a country to be free from the outbreak, but the response time and early detection with active surveillance was critical in slowing the spread and growth of new cases in managing this pandemic.

Changes in Inpatient Hospital Services During the COVID-19 Pandemic in Thailand: A Descriptive and Costing Study

Background: The COVID-19 pandemic forced policy makers to find solutions to protect hospitals from revenue shortfalls and provide high quality of care for COVID-19 and other patients. In Thailand, hospitals have adjusted the hospital services arrangement to new normal hospital services to prevent the spread of coronavirus while maintaining essential hospital services for non-COVID-19 patients. Objective(s): To describe the COVID-19 patient flow and estimate the costs of the new normal hospital services implemented in six public hospitals across Thailand. Material(s) and Method(s): The authors conducted a cross-sectional study to describe the COVID-19 patient flow in each participating hospital between January and November 2020, representing the first wave of the COVID-19 outbreak in Thailand. Data were collected from hospital staff interviews, hospital historical budget review, and hospital databases. The hospital costs of the new normal hospital services were estimated using an activity-based costing approach from the provider's perspective. Result(s): The COVID-19 patients could access the new normal hospital services through three channels including 1) walk-in, 2) transfer from other hospitals, and 3) active surveillance from communities. The ratio of costs of the new normal hospital services during the COVID-19 outbreak and the normal situation were one to two times and one to five times for patients with mild infection admitted to secondary and tertiary care hospitals, respectively, but one to three times for those with moderate-to-severe infection admitted to tertiary care hospitals. Conclusion(s): The COVID-19 pandemic imposed additional costs to Thai hospitals. The magnitude of the incremental costs depended on COVID-19 severity and hospital level. Copyright © 2022 Medical Association of Thailand. All rights reserved.

Epidemiology, Risk Factors, Clinical features and Outcome of Candida auris in Royal Hospital over the Last Four Years (2017-2020)

Objectives: Candida auris is a new strain of fungal pathogen that had emerged in many countries worldwide, including Oman. Te invasive infections were linked to high mortality, one of the reasons being multidrug-resistant to major classes of antifungals. Te ability to spread from patient to patient, or from contaminated environment to patients within health care settings and tendency to cause major outbreaks. Te study mainly aims to describe the trend of Candida auris emergence and distributions during the last four years and its outcome. Moreover, we identify the risk factors associated with Candida auris infection or colonization to assess the incidence, susceptibility, and resistance pattern as well as asses the implementations and efectiveness of the infection prevention and control measures applied to control the outbreak. Method(s): A retrospective descriptive cohort was conducted in Royal hospital. Target population are adult patients admitted to Royal hospital from 2017 to 2020, looking for patients positive with Candida auris from any sample (screening and clinical) during the study period were defned as infections or colonization cases. Result(s): Overall incidence increasing in trend since 2017, which is contributed to many reasons including implementation of active surveillance and COVID pandemic. Diabetes milletus and recent admission in another hospital within 6 months were considered statistically significant risk factors in relation to the infection. Mortality rate was 40.0%. Median of length of hospital stay = 31 (1-380). Statistically Significant risk factors in relation to mortality were chronic kidney disease, intubation, infection, and age. Conclusion(s): Early notifcation of the cases is vital for early implementation of infection control preventive measures. Active surveillance at Royal Hospital was refected efectively in controlling the outbreak at the intensive unit care in few months. Current data on the signifcant risk factors will be utilized later to set a criteria for screening high risk patients for colonization.

A Case-Based Monitoring Approach to Evaluate Safety of COVID-19 Vaccines in a Partially Integrated Health Information System: A Study Protocol.

In response to Coronavirus disease 2019 (COVID-19) global pandemic, various COVID-19 vaccines were rapidly administered under emergency use authorization. Rare outcomes associated with COVID-19 vaccines might be less likely to be captured in clinical trials, leading to a knowledge gap in real-world vaccine safety. In contrast with high-income countries, many low-to-middle income countries have limited capacity to conduct active surveillance, owing to the absence of large and fully-integrated health information databases. This paper describes the study protocol, which aims to investigate risk of prespecified adverse events of special interests following COVID-19 vaccination in a partially integrated health information system with non-shareable electronic health records. The SAFECOVAC study is a longitudinal, observational retrospective study of active safety surveillance using case-based monitoring approach. This involves linkage of several administrative databases and hospitalization data monitoring to identify adverse events of special interests following administration of COVID-19 vaccines in Malaysia. The source population comprises of all individuals who received at least one dose of COVID-19 vaccine. Self-controlled design and vaccinated case-coverage design will be employed to assess risk of adverse events of special interests and determine the association with vaccine exposure. Data on vaccination records will be obtained from the national COVID-19 vaccination register to identify the vaccination platforms, doses and the timing of vaccinations. The outcome of this study is hospitalization for the adverse events of special interests between March 2021 and June 2022. The outcomes will be obtained through linkage with hospital admission database and national pharmacovigilance database. Findings will provide analysis of real-world data which can inform deliberations by government and public health decision makers relative to the refinement of COVID-19 vaccination recommendations.