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BACKGROUND: The FLURESP project is a public health research funded by the European Commission, with the objective to design a methodological framework to assess the cost-effectiveness of existing public health measures against human influenza pandemics. A dataset has been specifically collected in the frame of the Italian health system. As most of interventions against human influenza are relavant against other respiratory diseases pandemics, potential interests in COVID-19 are discussed. METHODS: Ten public health measures against human influenza pandemics pandemic were selected to be also relevant to other respiratory virus pandemics such as COVID 19: individual (hand washing, using masks), border control (quarantine, fever screening, border closure), community infection (school closure, class dismissal, social distancing, limitation of public transport), reduction of secondary infections (implementation of antibiotic therapy guidelines), pneumococcal vaccination for at-risk people, development of Intensive Care Unit (ICU) capacity, implementation of life support equipments in ICU, screening interventions, vaccination programs targeting health professional and targeting general population. RESULTS: Using mortality reduction as effectiveness criteria, the most cost-effective strategies are "reduction of secondary infections" and "implementation of life support equipment in ICU". The least cost-effective option whatever the level of pandemic events are screening interventions and mass vaccination. CONCLUSIONS: A number of intervention strategies against human influenza pandemics appears relevant against every respiratory virus, including the COVID-19 event. Measures against pandemics should be considered according to their expected effectiveness but also their costs for the society because they impose substantial burden to the population, confirming the interest of considering cost-effectiveness of public health measures to enlighten decision making.
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Previous reports of vaccination uptake rates in dermatology patients are variable. The aim of this audit was to get an upto-date assessment from those attending our service. Future vaccination uptake rates and awareness are likely to be affected by the COVID-19 pandemic. This is one of the last and largest studies of this topic in the pre-COVID-19 era. Patients with psoriasis receiving immunosuppressants are at increased risk of developing infections, primarily respiratory tract infections. Published guidelines recommend that this cohort of patients receive both the influenza and pneumococcal (PPV23) vaccines. We conducted a survey of patients on systemic immunosuppressive medication for their skin disease attending our dermatology department. An audit was completed in August 2019 with a subsequent reaudit in February 2020. An intervention of advertising, staff education and vaccine promotion to patients during consultations was implemented between audits. The study was approved by the hospital audit review board. A total of 104 patients were recorded in August, with 98 recorded in February. Overall, the uptake of the influenza vaccine was 77% and 78% in the respective audits. There was an increase from 63% to 72% in the uptake of the PPV23 vaccine. Those receiving biological medications had a higher uptake of vaccinations than those receiving traditional systemic agents such as methotrexate (approximately 80% vs. 70% for influenza and 62% vs. 70% PPV23 in the respective audits). Over 95% of patients self-reported that they had been advised to acquire vaccinations by the dermatology team. This audit shows that vaccination rates are already high in this cohort of patients, supporting best practice in our centre. There is a tendency to be more compliant with recommendations if receiving a biological agent. There was a small but noticeable increase in uptake after our interventions. A similar French study showed a much lower uptake rate of 3- 25% {Bonhomme A, Freling E, Reigneau M et al. [Vaccination status in psoriasis patients on immunosuppressant therapy (including biologics)]. Ann Dermatol Venereol 2017;144: 92-9 (in French)}. This audit represents one of the largest studies of this topic in dermatology patients.
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Background: During the eleven months of the novel SARS-CoV-2 disease (COVID-19) outbreak in China and its global spread, there is a remarkable understanding of its epidemiology, pathobiol-ogy, and clinical management strategies. While countering a heavy toll on health and the economy, world's regional authorities are enforcing safety guidelines and providing patient care. Currently, there is no globally approved treatment or intervention for COVID-19. Method(s): A structured online literature search for peer-reviewed articles was conducted on PubMed, Europe PMC, Google, WHO, CDC, FDA, and ClinicalTrials portals, using phrases such as COVID-19 treatment and intervention, COVID-19 drugs and COVID-19 vaccines. Result(s): Analysis of the retrieved data showed that as a part of 'Solidarity Clinical Trials', hundreds of treatment and intervention strategies, including antiviral drugs, cytokine antagonists, convalescent plasma therapy, and vaccine candidates, have been registered worldwide. While remdesivir, the anti-Ebola virus drug, has been approved as an 'emergency use' drug in the USA, favipiravir, the anti-flu drug, has been recently approved in Russia. Tocilizumab and sarilumab, the cytokine (IL-6) antagonists, have entered Phase-II/III clinical trials in hospitalized COVID-19 patients. Among the leading vaccine candidates, Phase-III clinical trial results of Moderna, Pfizer and Oxford vaccines seem to be game changers for COVID19. Conclusion(s): The world health authorities have strongly and quickly responded to the COVID-19 pan-demic. Nonetheless, world bodies must unite in combating this health crisis by developing cost-effective drugs and vaccines and making them accessible to resource-poor countries.Copyright © 2021 Bentham Science Publishers.
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Background: The current United Nations sustainable development goal 3 sets to reduce maternal mortality to less than 70 per 100 000 live births by 2030. To monitor whether India is on track to attaining sustainable development goals, it is essential to routinely assess trends of health indicators. Objective(s): This study was conducted to assess trends of maternal mortality and cause-specific maternal death in tertiary care hospitals in Southern India. Method(s): This is a retrospective study of hospital records and death summaries of all maternal deaths between January 1, 2009, and December 31, 2018, at the tertiary care hospital in Southern India. The demographic, clinical, and delivery details of all the maternal deaths were collected. Causes of maternal deaths were classified as direct, indirect, and nonspecific. To observe trends of maternal death, the maternal mortality ratio was calculated for each year, and Pearson's chi-square test was used. Result(s): Maternal mortality ratio was 555/100000 and had a decreasing trend from its highest in 2010 of 1230/100000 to its lowest of 229/100000 in 2017 (t = 7.71 p = 0.02). The majority of women who died were aged 21-35 years, resided in rural, were primigravidae, and had operative delivery. Most of the maternal deaths had been referred to our facility (90.8%) from other healthcare units. Obstetric hemorrhage (27.8%) and puerperal sepsis (37.7%) among direct causes;H1N1 pneumonia (34.8%) among indirect causes were the major causes of maternal death. The number of maternal deaths due to sepsis increased from the beginning until the end of the study from 10% to 50% (t = 5.9, p = 0.01). On the contrary, there was a decline in maternal deaths due to obstetric hemorrhage from 50% to 25% (t = 4.2, p = 0.03). Conclusion(s): Although the maternal mortality ratio has reduced over the years, sepsis was an important cause of maternal deaths.Copyright © 2023 Bentham Science Publishers.
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Background In the USA and other countries, cardiac deaths have been elevated above background rates since the start of the COVID pandemic. This could be directly due to COVID or indirectly due to health system dysfunction (reduced access to optimal cardiac care during pandemic years). Methods Analysis of rates of circulating respiratory viruses, vaccination and cardiac death rates compared to background/usual in multiple countries. Results Cardiac deaths in the USA and most other countries with cause-specific data available since 2020, have been elevated. Excess mortality due to cardiac causes in 2021 was higher in countries with low vaccination rates against COVID. An exception to this trend has been Australia in 2021. In 2022, Australia (like other countries) exhibited elevated rates of cardiac deaths compared to baseline. In 2021, when Australia was pursuing a COVID-zero policy of lockdowns and border closures, which also led to a near Influenza-zero status, cardiac deaths were substantially reduced compared to baseline (Figure). Conclusion The relationship between circulating respiratory virus rates and cardiac deaths is strong in both directions, indicating likely direct causation. In hindsight, this relationship also explains pre-pandemic winter spikes and summer drop-offs in cardiac deaths. Although "COVID fatigue" is common, a policy allowing high rates of circulating COVID and tolerating sub-optimal vaccination rates directly leads to excess cardiac deaths. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Introduction: The SARS-CoV-2 made the world stop its activities, and the only chance of returning to normal life is the vaccine. But like any vaccination, some complications have been reported. We report the case of a patient who presented a myositis following the administration of the Covishield* (AZD1222, ChAdOx1 nCoV-19, AstraZeneca) COVID-19 vaccine. Case Report: 12 hours after his first dose, an 84-year-old patient presented to us reporting a decrea-sed muscle strength: the patient can move against gravity but not against resistance. The biological assessment showed that CK was at 4,250 IU/L, myoglobin was at 144 microgram/L and aldolases at 16.9 U/L. The patient received high doses of corticosteroids. Discussion(s): The development of vaccines and immunization programs reduced the morbidity and mortality of several diseases. Other case reports suggested the possible association between myopathies and the administration of the hepatitis B vaccine and H1N1 plus the seasonal trivalent influenza and other vaccines. The exact mechanism is still unknown, but a presumable autoimmune phe-nomenon is incriminated. Conclusion(s): The main purpose of this case report is to raise awareness about the possible link between the COVID-19 vaccination and polymyositis and the urge to take charge to avoid further complications.Copyright © 2023 Bentham Science Publishers.
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The history of humankind has been a battle against infectious diseases, and highly lethal viral infections have appeared many times. Even in Japan, one-fourth of the population was lost due to smallpox during the Nara period. In the modern era, effective vaccines and drugs were developed, and everyone was optimistic that infectious diseases could be eradicated from the earth by the end of the 20 th century. However, infectious diseases such as AIDS, influenza, SARS, and MERS emerged. In particular, the novel coronavirus pandemic that occurred in Wuhan, China, at the end of 2019 exposed the vulnerability of modern society to infectious diseases. Furthermore, infectious diseases are undergoing significant changes due to human factors such as globalization and the destruction of nature. In this review, I would like to outline the infectious diseases that humans have experienced so far and introduce the fight against the new coronavirus and future infectious disease countermeasures.Copyright © 2022, Japan Society of Drug Delivery System. All rights reserved.
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The history of humankind has been a battle against infectious diseases, and highly lethal viral infections have appeared many times. Even in Japan, one-fourth of the population was lost due to smallpox during the Nara period. In the modern era, effective vaccines and drugs were developed, and everyone was optimistic that infectious diseases could be eradicated from the earth by the end of the 20 th century. However, infectious diseases such as AIDS, influenza, SARS, and MERS emerged. In particular, the novel coronavirus pandemic that occurred in Wuhan, China, at the end of 2019 exposed the vulnerability of modern society to infectious diseases. Furthermore, infectious diseases are undergoing significant changes due to human factors such as globalization and the destruction of nature. In this review, I would like to outline the infectious diseases that humans have experienced so far and introduce the fight against the new coronavirus and future infectious disease countermeasures.Copyright © 2022, Japan Society of Drug Delivery System. All rights reserved.
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[] Objective: To analyze relevant literature on Lianhua Qingwen preparations and clarify the research advances and hot spots in this field,so as to provide references for clinical rational application and further research. Method: Literature related to Lianhua Qingwen preparations in the recent 10 years was retrieved from six databases,including China National Knowledge Infrastructure(CNKI),VIP,Wanfang Data, PubMed,and Web of Science,followed by management and analysis by NoteExpress and CiteSpace. Result: Finally,344 and 76 Chinese and English research articles were included,and the number of publications increased in recent years. The research articles were published in 162 Chinese and 48 English journals. Shijiazhuang Yiling Pharmaceutical Co.,Ltd. and Guangzhou Medical University were institutions with the largest number of Chinese and English publications,respectively. LIU Minyan was the author who had published the most articles. Keywords with high frequency included clinical efficacy,Lianhua Qingwen,inflammatory factors,traditional Chinese medicine,and coronavirus disease-2019(COVID-19). Nineteen clusters,including clinical efficacy,Chinese medicine,Lianhua Qingwen,COVID-19,and influenza A virus,and 47 emergent keywords,including herpes zoster,pneumonia,inflammatory factors,influenza,and gut microbiota,were generated. Conclusion:Cooperation and exchanges in this field are insufficient. Research focuses on the clinical efficacy of Lianhua Qingwen in the treatment of COVID-19 and other diseases,pharmacological action and mechanism of antiviral drugs,and micro-mechanism research focuses on related pathways and target proteins,as well as the combination of Chinese and western medicines.Copyright © 2023, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.
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[] Objective: To analyze relevant literature on Lianhua Qingwen preparations and clarify the research advances and hot spots in this field,so as to provide references for clinical rational application and further research. Method: Literature related to Lianhua Qingwen preparations in the recent 10 years was retrieved from six databases,including China National Knowledge Infrastructure(CNKI),VIP,Wanfang Data, PubMed,and Web of Science,followed by management and analysis by NoteExpress and CiteSpace. Result: Finally,344 and 76 Chinese and English research articles were included,and the number of publications increased in recent years. The research articles were published in 162 Chinese and 48 English journals. Shijiazhuang Yiling Pharmaceutical Co.,Ltd. and Guangzhou Medical University were institutions with the largest number of Chinese and English publications,respectively. LIU Minyan was the author who had published the most articles. Keywords with high frequency included clinical efficacy,Lianhua Qingwen,inflammatory factors,traditional Chinese medicine,and coronavirus disease-2019(COVID-19). Nineteen clusters,including clinical efficacy,Chinese medicine,Lianhua Qingwen,COVID-19,and influenza A virus,and 47 emergent keywords,including herpes zoster,pneumonia,inflammatory factors,influenza,and gut microbiota,were generated. Conclusion:Cooperation and exchanges in this field are insufficient. Research focuses on the clinical efficacy of Lianhua Qingwen in the treatment of COVID-19 and other diseases,pharmacological action and mechanism of antiviral drugs,and micro-mechanism research focuses on related pathways and target proteins,as well as the combination of Chinese and western medicines.Copyright © 2023, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.
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Introduction: During the 2021/22 influenza season, media outlets reported on potential influenza A/B and CoVid-19 coinfection, termed 'flu-rona'. National guidelines (Management of CAP in Adults, BTS, 2009) suggest patients admitted with respiratory infection should undergo respiratory viral PCR (rvPCR) swabbing, severity dependent. We assessed: (1) UK teaching hospital seasonal rvPCR swab data for flu-rona (2) rvPCR swabbing behaviour in respiratory inpatients. Method(s): (1) Collect data on all rvPCR swabs [Panther Analyser] from 1/12/21 for 6 weeks with indication & CoVid swab result within 7 days of rvPCR. (2) Assess rvPCR swabbing in respiratory ward admissions from 1/1/22 for 4 weeks. Result(s): (1) 234 patients underwent rvPCR testing, with none positive for influenza A/B. n=23 were positive for any virus. Haematology-oncology swabbed 136 patients (as per protocol). Of the remainder (n=98), 22.4% (n=22) had respiratory symptoms (RSx) - with one positive rvPCR swab. 10/98 were CoVid positive on concurrent testing, of whom 7 had RSx. (2) 117 patients were admitted to the respiratory ward, of whom 73 had RSx;of these n=53 CoVid positive with only 1 (2%) undergoing rvPCR swab, and 20 CoVid negative with only 2 (10%) undergoing rvPCR swabs (see table) Conclusion(s): We found no flu-rona and low rates of rvPCR swabbing in those with RSx despite national guidelines. While these data suggest rates of flu-rona are likely low, they highlight dangers of diagnostic blindness in the age of CoVid-19 and possible nihilistic beliefs regarding rvPCR testing in general.
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A 40-year-old Japanese woman presented to the outpatient clinic with fever and palpitations 2 days after receiving the influenza vaccine (Influenza HA Vaccine 'KMB') following the second dose of coronavirus disease 2019 (COVID-19) vaccine (COVID-19 vaccine Moderna intramuscular injection). At the first visit, the patient presented with a swollen thyroid gland with mild tenderness, and she was diagnosed with subacute thyroiditis (SAT) based on the presence of thyrotoxicosis (free T3: 5.42 pg/mL;free T4: 2.34 ng/dL;and thyroid-stimulating hormone (TSH): <0.01 muIU/mL), a high C-reactive protein level (5.77 mg/dL), a negative TSH receptor antibody, and characteristic ultrasound findings. The patient's human leukocyte antigen types were A2, A11, B35, B51, DR4, and DR1403. Prednisolone (15 mg/day) was given as an initial dose, after which the fever subsided, and the dose was tapered and discontinued after 6 weeks. The patient was thought to have developed SAT due to influenza vaccination. SAT after influenza vaccination may be overlooked. For patients with SAT, it is necessary to obtain information regarding their vaccination history.Copyright © 2023 The authors.
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Coronavirus disease 2019 (COVID-19), first reported in Wuhan, China, has rapidly spread worldwide. Traditional Chinese medicine (TCM) has been used to prevent and treat viral epidemics and plagues for over 2,500 years. In the guidelines on fighting against COVID-19, the National Health Commission of the People's Republic of China has recommended certain TCM formulas, namely Jinhua Qinggan granule (JHQGG), Lianhua Qingwen granule (LHQWG), Qingfei Paidu decoction (QFPDD), Xuanfei Baidu granule (XFBD), Xuebijing injection (XBJ), and Huashi Baidu granule (HSBD) for treating COVID-19 infected individuals. Among these six TCM formulas, JHQGG and LHQWG effectively treated mild/moderate and severe COVID-19 infections. XFBD therapy is recommended for mild COVID-19 infections, while XBJ and HSBD effectively treat severe COVID-19 infections. The internationalization of TCM faces many challenges due to the absence of a clinical efficacy evaluation system, insufficient research evidence, and a lack of customer trust across the globe. Therefore, evidence-based research is crucial in battling this infectious disease. This review summarizes SARS-CoV-2 pathogenesis and the history of TCM used to treat various viral epidemics, with a focus on six TCM formulas. Based on the evidence, we also discuss the composition of various TCM formulas, their underlying therapeutic mechanisms, and their role in curing COVID-19 infections. In addition, we evaluated the roles of six TCM formulas in the treatment and prevention of other influenza diseases, such as influenza A (H1N1), severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Furthermore, we highlighted the efficacy and side effects of single prescriptions used in TCM formulas.Copyright © 2021
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Background: Decreased hospital admissions for acute exacerbations of COPD (AECOPD) have been reported during the COVID-19 pandemic, but not in relation to admissions for pneumonia, influenza and COVID-19 admissions. Aim(s): To study hospital admission rate for AECOPD, pneumonia, influenza and COVID-19, respectively, in COPD patients during the pandemic compared with a prepandemic period. Method(s): Anonymized data on hospital admissions of patients with COPD and a primary diagnosis code for AECOPD, pneumonia, influenza or COVID-19, were obtained from the hospital patient admission register. The pandemic period (February 2020 - May 2021) was compared to a period prior to the pandemic (June 2017 - January 2020). Monthly admission rates were compared using ANCOVA statistics, controlling for admission month. Result(s): Monthly mean admission rates for AECOPD were 51 (95%CI 45-57) vs. 79 (95%CI 74-83;p<0.001), pneumonia 12 (95%CI 9-15) vs. 27 (95%CI 25-29;p<0.001) and influenza 0 (95%CI -2-1) vs. 3 (95%CI 2-4;p<0.001). Reduced AECOPD rates coincided with rising COVID-19 admissions (Figure 1). Total mean admission rates, including COVID-19, remained reduced, 82 (95%CI 75-90) vs. 109 (95%CI 104-114;p<0.001), across the pandemic period. Conclusion(s): The overall burden of hospital admissions among COPD patients for AECOPD, pneumonia, influenza and COVID-19 was significantly reduced during the pandemic, despite the rise in COVID-19 admissions. (Figure Presented).
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Objective: To determine the frequency and outcomes of invasive pulmonary aspergillosis (IPA) in patients with influenza, COVID-19 and community acquired pneumonia (CAP) admitted in critical care units of a tertiary care hospital in Pakistan. Method(s): A prospective cross sectional study was conducted at the Aga Khan University from Nov 2019-June 2020. Adult patients admitted in critical care units with CAP, influenza and COVID-19 pneumonia were included. IPA was diagnosed as per EORTC/MSG criteria. Clinical information and outcome were collected on predesigned performa. Result(s): A total of 140 patients [70 Influenza, 35 COVID-19 and 35 CAP] were included. Of total, 20(14.2%) patients were found to have invasive aspergillosis with 10/35(28.5%), 9/75(12.8%) and 1/35(2.8%) patients in COVID-19, influenza and CAP groups, respectively. Duration of symptoms was 12.5+/-12.13 days in CAPA and 7.56+/-4.0 days in IAPA patients (p=0.24). Mean APCHE II score was 17.4+/-8.42 and 16.6+/-6.27 in patients with CAPA and IAPA respectively (p=0.85). 9(90%) CAPA patients required vasopressor support compared to 3(33%) patients in IAPA (p=0.020). 7(70%) CAPA patients required invasive mechanical ventilation compared to 4(44%) IAPA patients (p=0.37). Length of stay in hospital was highest in CAPA patients (18.3+/-7.28 days) compared to IAPA patients (11.7+/-5.33 days) (p=0.036). The number of deaths in IAPA patients and CAPA patients was 3(33.3%) and 5(50%), respectively (p=0.526). Conclusion(s): A higher proportion of patients with COVID-19 developed IPA compared to influenza and CAP. CAPA patients had a significantly longer stay in hospital and mortality.