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1.
Pediatr Clin North Am ; 69(3): 547-571, 2022 06.
Article in English | MEDLINE | ID: covidwho-2105692

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. More than 5 million children have been infected in the United States. Risk factors for more severe disease progression include obesity, pulmonary disease, gastrointestinal disorders, and neurologic comorbidities. Children with COVID-19 are admitted to the pediatric intensive care unit because of severe acute COVID-19 illness or COVID-19-associated multisystem inflammatory syndrome in children. The delta surge of 2021 was responsible for an increased disease burden in children and points to the key role of vaccinating children against this sometimes-deadly disease.


Subject(s)
COVID-19 , COVID-19/complications , COVID-19/epidemiology , Child , Humans , Intensive Care Units, Pediatric , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , United States/epidemiology
2.
Top Antivir Med ; 30(3): 490-521, 2022.
Article in English | MEDLINE | ID: covidwho-2101976

ABSTRACT

The 2022 Conference on Retroviruses and Opportunistic Infections provided a rich source of new data and comprehensive reviews on antiviral therapy. For COVID-19, intramuscular sotrovimab was noninferior to intravenous sotrovimab, serostatus did not predict the efficacy of sotrovimab, and molnupiravir appeared safe and modestly effective in decreasing hospitalization rates. Trials from low- and middle-income countries provided data to support transitioning those on first-line therapy with or without virologic suppression and those virologically suppressed on second-line therapy to dolutegravir-based regimens. Additional data supported the use of lenacapavir as a long-acting antiretroviral drug. Data across the United States demonstrate the negative impact of the COVID-19 pandemic on the HIV care continuum, although enhanced outreach efforts and decentralization of antiretroviral therapy delivery were associated with improvements in care engagement outcomes. Researchers described potential mechanisms for the emergence of integrase strand transfer inhibitor resistance. Studies on proviral genotyping high-lighted the limitations of its use in predicting clinically significant resistance. Several studies looked at the epidemiology and treatment of hepatitis C and B and the status of current hepatitis C virus elimination efforts. Data presented on HIV, COVID-19, and maternal and pediatric health included 2-year virologic outcome data of very early antiretroviral therapy in potentially reducing the latent HIV reservoir in infants with HIV. Data presented on COVID-19 and HIV therapeutics in children included SARS-CoV-2-neutralizing monoclonal antibodies in children younger than 12 years of age, remdesivir in hospitalized infants and children, and long-acting therapies for HIV treatment in children.


Subject(s)
COVID-19 , HIV Infections , HIV-1 , Hepatitis, Viral, Human , Child , Humans , United States/epidemiology , HIV Infections/drug therapy , COVID-19/drug therapy , Pandemics , SARS-CoV-2 , Virus Latency , Anti-Retroviral Agents/therapeutic use
3.
Top Antivir Med ; 30(2): 426-453, 2022.
Article in English | MEDLINE | ID: covidwho-2101695

ABSTRACT

At the 2022 Conference on Retroviruses and Opportunistic Infections, several speakers discussed disparities in HIV and COVID-19 infections and outcomes. Although the lifetime risk of HIV infection in the United States is higher overall in males than females, Black females have higher risk than White males. In 12 countries in sub-Saharan Africa, women aged 15 to 34 years accounted for more than half of all infections. Because knowledge of HIV serostatus is important for treatment and for prevention, several novel strategies were evaluated in the distribution of HIV self-test kits to undertested populations in the United States and sub-Saharan Africa. Data were presented on new products in the pre-exposure prophylaxis (PrEP) pipeline, including long-acting injectable cabotegravir, islatravir, vaginal rings, and in-situ forming implants. Challenges remain in the rollout of oral PrEP, and a number of innovative strategies to address barriers were discussed. Models suggest that the greatest impact of novel PrEP agents would be to increase the pool of persons using PrEP, rather than through improved efficacy. COVID-19 caused substantial declines in HIV and sexually transmitted infection prevention and treatment services, which have started to rebound, but are not yet at prepandemic levels in several settings.


Subject(s)
Anti-HIV Agents , COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , Sexually Transmitted Diseases , Male , Female , Humans , United States/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , SARS-CoV-2 , Sexually Transmitted Diseases/drug therapy , Anti-HIV Agents/therapeutic use
4.
MMWR Morb Mortal Wkly Rep ; 71(44): 1401-1406, 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2100531

ABSTRACT

On August 31, 2022, the Food and Drug Administration (FDA) authorized bivalent formulations of BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines; these vaccines include mRNA encoding the spike protein from the original (ancestral) strain of SARS-CoV-2 (the virus that causes COVID-19) and from the B.1.1.529 (Omicron) variants BA.4 and BA.5 (BA.4/BA.5). These bivalent mRNA vaccines were authorized for use as a single booster dose ≥2 months after completion of primary series or monovalent booster vaccination; Pfizer-BioNTech bivalent booster was authorized for persons aged ≥12 years and Moderna for adults aged ≥18 years.*,† On September 1, 2022, the Advisory Committee on Immunization Practices (ACIP) recommended that all persons aged ≥12 years receive an age-appropriate bivalent mRNA booster dose.§ To characterize the safety of bivalent mRNA booster doses, CDC reviewed adverse events and health impacts reported after receipt of bivalent Pfizer-BioNTech and Moderna booster doses during August 31-October 23, 2022, to v-safe,¶ a voluntary smartphone-based U.S. safety surveillance system established by CDC to monitor adverse events after COVID-19 vaccination, and the Vaccine Adverse Event Reporting System (VAERS),** a U.S. passive vaccine safety surveillance system managed by CDC and FDA (1). During August 31-October 23, 2022, approximately 14.4 million persons aged ≥12 years received a bivalent Pfizer-BioNTech booster dose, and 8.2 million adults aged ≥18 years received a bivalent Moderna booster dose.†† Among the 211,959 registrants aged ≥12 years who reported receiving a bivalent booster dose to v-safe, injection site and systemic reactions were frequently reported in the week after vaccination (60.8% and 54.8%, respectively); fewer than 1% of v-safe registrants reported receiving medical care. VAERS received 5,542 reports of adverse events after bivalent booster vaccination among persons aged ≥12 years; 95.5% of reports were nonserious and 4.5% were serious events. Health care providers and patients can be reassured that adverse events reported after a bivalent booster dose are consistent with those reported after monovalent doses. Health impacts after COVID-19 vaccination are less frequent and less severe than those associated with COVID-19 illness (2).


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , Humans , United States/epidemiology , Adolescent , COVID-19 Vaccines/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , BNT162 Vaccine , SARS-CoV-2 , Vaccines, Synthetic/adverse effects , RNA, Messenger
5.
World J Gastroenterol ; 28(39): 5735-5749, 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2099935

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) was perhaps the most severe global health crisis in living memory. Alongside respiratory symptoms, elevated liver enzymes, abnormal liver function, and even acute liver failure were reported in patients suffering from severe acute respiratory disease coronavirus 2 pneumonia. However, the precise triggers of these forms of liver damage and how they affect the course and outcomes of COVID-19 itself remain unclear. AIM: To analyze the impact of liver enzyme abnormalities on the severity and outcomes of COVID-19 in hospitalized patients. METHODS: In this study, 684 depersonalized medical records from patients hospitalized with COVID-19 during the 2020-2021 period were analyzed. COVID-19 was diagnosed according to the guidelines of the National Institutes of Health (2021). Patients were assigned to two groups: those with elevated liver enzymes (Group 1: 603 patients), where at least one out of four liver enzymes were elevated (following the norm of hospital laboratory tests: alanine aminotransferase (ALT) ≥ 40, aspartate aminotransferase (AST) ≥ 40, gamma-glutamyl transferase ≥ 36, or alkaline phosphatase ≥ 150) at any point of hospitalization, from admission to discharge; and the control group (Group 2: 81 patients), with normal liver enzymes during hospitalization. COVID-19 severity was assessed according to the interim World Health Organization guidance (2022). Data on viral pneumonia complications, laboratory tests, and underlying diseases were also collected and analyzed. RESULTS: In total, 603 (88.2%) patients produced abnormal liver test results. ALT and AST levels were elevated by a factor of less than 3 in 54.9% and 74.8% of cases with increased enzyme levels, respectively. Patients in Group 1 had almost double the chance of bacterial viral pneumonia complications [odds ratio (OR) = 1.73, P = 0.0217], required oxygen supply more often, and displayed higher biochemical inflammation indices than those in Group 2. No differences in other COVID-19 complications or underlying diseases were observed between groups. Preexisting hepatitis of a different etiology was rarely documented (in only 3.5% of patients), and had no impact on the severity of COVID-19. Only 5 (0.73%) patients experienced acute liver failure, 4 of whom died. Overall, the majority of the deceased patients (17 out of 20) had elevated liver enzymes, and most were male. All deceased patients had at least one underlying disease or combination thereof, and the deceased suffered significantly more often from heart diseases, hypertension, and urinary tract infections than those who made recoveries. Alongside male gender (OR = 1.72, P = 0.0161) and older age (OR = 1.02, P = 0.0234), diabetes (OR = 3.22, P = 0.0016) and hyperlipidemia (OR = 2.67, P = 0.0238), but not obesity, were confirmed as independent factors associated with more a severe COVID-19 infection in our cohort. CONCLUSION: In our study, the presence of liver impairment allows us to predict a more severe inflammation with a higher risk of bacterial complication and worse outcomes of COVID-19. Therefore, patients with severe disease forms should have their liver tests monitored regularly and their results should be considered when selecting treatment to avoid further liver damage or even insufficiency.


Subject(s)
COVID-19 , Liver Failure, Acute , Pneumonia, Viral , United States , Humans , Male , Female , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Pneumonia, Viral/complications , Liver Failure, Acute/complications , Inflammation/complications
6.
Acta Odontol Latinoam ; 35(2): 144-154, 2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2101108

ABSTRACT

The aim of this study was to analyze oral health actions in four municipalities in Brazil during the COVID-19 pandemic according to a theoretical framework model on oral healthcare management. It was a qualitative study carried out in two stages. A theoretical-empirical model on the significance of oral healthcare management was developed, following the Grounded Theory method. Fourteen dentists and five healthcare managers participated, through open interview. Subsequently, collaborative research was performed, and the model was applied to analyze the documents produced to address the pandemic by each of four municipalities in Santa Catarina State. The model provided a framework for analyzing actions for coping with the pandemic regarding oral health services. Actions were identified in all dimensions of the model: reduction in supply of dental care due to restricted access to elective services; search for biosafety care standards; dissemination of standardized science-based guidelines; attempt to maintain comprehensive dental assistance through re-adaptation of specialized services and collective actions; and relocation of oral health professionals to assist in other sectors. The oral health care management framework can serve as a reference for redesigning oral health actions and services in other municipalities during the COVID-19 pandemic, in a broader perspective.


Analisar as ações de saúde bucal em quatro municípios brasileiros durante a pandemia de COVID-19, segundo um modelo de referencial teórico sobre gestão da atenção à saúde bucal. Estudo qualitativo realizado em dois momentos. Foi desenvolvido um modelo teórico-empírico sobre o significado da gestão do cuidado em saúde bucal, seguindo o método da Teoria Fundamentada nos Dados. Participaram 14 dentistas e cinco gestores de saúde, por meio de entrevista aberta. Posteriormente, no segundo momento, foi realizada uma pesquisa colaborativa, e o modelo foi aplicado para analisar os documentos produzidos em cada município para o enfrentamento local da pandemia, em quatro municípios do Estado de Santa Catarina, sul do Brasil. O modelo forneceu uma estrutura para analisar as ações de enfrentamento da pandemia nos serviços de saúde bucal. Foram identificadas ações em todas as dimensões do modelo: redução da oferta de atendimento odontológico devido à restrição de acesso aos serviços eletivos; a busca por padrões de assistência à biossegurança; disseminação de diretrizes padronizadas e com base científica; a tentativa de manter a assistência odontológica integral por meio da readaptação de serviços especializados e ações coletivas; e realocação de profissionais de saúde bucal para atendimento em outros setores. O referencial de gestão da atenção à saúde bucal pode servir de referência para redesenhar as ações e serviços de saúde bucal em outros municípios em período de pandemia de COVID-19, em uma perspectiva mais ampla.


Subject(s)
COVID-19 , Pandemics , United States , Humans , Brazil/epidemiology , Pandemics/prevention & control , Cities , Grounded Theory , COVID-19/prevention & control
7.
Nurs Clin North Am ; 57(2): 245-258, 2022 06.
Article in English | MEDLINE | ID: covidwho-1819287

ABSTRACT

This article highlights the critical role of advanced practice registered nurses in the care of older adults living in nursing homes. This population is one of the frailest, marginalized, and often neglected in the United States. The COVID-19 pandemic impact on nursing homes resulted in a stunning number of infections and subsequent resident deaths. This is a shameful reminder of the many challenges and gaps in the nursing home industry including inadequate staffing, high staff turnover, improper isolation technique, and lack of fundamental knowledge of how to adequately implement infection prevention and control processes. Strong advanced practice registered nurse leadership may have mitigated some of these factors.


Subject(s)
COVID-19 , Nurses , Aged , Humans , Leadership , Nursing Homes , Pandemics , United States
13.
Infect Control Hosp Epidemiol ; 42(4): 392-398, 2021 04.
Article in English | MEDLINE | ID: covidwho-2096426

ABSTRACT

OBJECTIVE: The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection. METHODS: All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020. RESULTS: Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%-6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67-7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection. CONCLUSIONS: The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19-positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.


Subject(s)
COVID-19/epidemiology , Health Personnel/statistics & numerical data , SARS-CoV-2 , Seroepidemiologic Studies , United States Department of Veterans Affairs/statistics & numerical data , Adolescent , Adult , COVID-19/etiology , Female , Humans , Male , Michigan/epidemiology , Middle Aged , Occupational Exposure/statistics & numerical data , Risk Factors , United States/epidemiology , Young Adult
17.
Infect Control Hosp Epidemiol ; 42(2): 236-237, 2021 02.
Article in English | MEDLINE | ID: covidwho-2096319
19.
J Infect Dis ; 226(9): 1556-1561, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2097370

ABSTRACT

BACKGROUND: To inform public health policy, it is critical to monitor coronavirus disease 2019 vaccine effectiveness (VE), including against acquiring infection. METHODS: We estimated VE using self-reported vaccination in a retrospective cohort of repeat blood donors who donated during the first half of 2021, and we demonstrated a viable approach for monitoring VE via serological surveillance. RESULTS: Using Poisson regression, we estimated an overall VE of 88.8% (95% confidence interval, 86.2-91.1), adjusted for demographic covariates and variable baseline risk. CONCLUSIONS: The time since first reporting vaccination, age, race and/or ethnicity, region, and calendar time were statistically significant predictors of incident infection.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , United States , Retrospective Studies , Blood Donors , Vaccine Efficacy , Cohort Studies
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