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2.
Euro Surveill ; 25(25)2020 06.
Article in English | MEDLINE | ID: covidwho-621605

ABSTRACT

Sentinel surveillance of acute hospitalisations in response to infectious disease emergencies such as the 2009 influenza A(H1N1)pdm09 pandemic is well described, but recognition of its potential to supplement routine public health surveillance and provide scalability for emergency responses has been limited. We summarise the achievements of two national paediatric hospital surveillance networks relevant to vaccine programmes and emerging infectious diseases in Canada (Canadian Immunization Monitoring Program Active; IMPACT from 1991) and Australia (Paediatric Active Enhanced Disease Surveillance; PAEDS from 2007) and discuss opportunities and challenges in applying their model to other contexts. Both networks were established to enhance capacity to measure vaccine preventable disease burden, vaccine programme impact, and safety, with their scope occasionally being increased with emerging infectious diseases' surveillance. Their active surveillance has increased data accuracy and utility for syndromic conditions (e.g. encephalitis), pathogen-specific diseases (e.g. pertussis, rotavirus, influenza), and adverse events following immunisation (e.g. febrile seizure), enabled correlation of biological specimens with clinical context and supported responses to emerging infections (e.g. pandemic influenza, parechovirus, COVID-19). The demonstrated long-term value of continuous, rather than incident-related, operation of these networks in strengthening routine surveillance, bridging research gaps, and providing scalable public health response, supports their applicability to other countries.


Subject(s)
Hospitals, Pediatric/statistics & numerical data , Immunization Programs/standards , Patient Admission/statistics & numerical data , Population Surveillance/methods , Vaccination/adverse effects , Vaccines/administration & dosage , Australia/epidemiology , Canada/epidemiology , Child , Child, Preschool , Data Accuracy , Health Policy , Hospitalization/statistics & numerical data , Humans , National Health Programs/standards , Public Health Surveillance , Vaccination/statistics & numerical data
3.
Mol Diagn Ther ; 24(3): 251-262, 2020 06.
Article in English | MEDLINE | ID: covidwho-634822

ABSTRACT

This opinion article discusses the increasing attention paid to the role of activating damage-associated molecular patterns (DAMPs) in initiation of inflammatory diseases and suppressing/inhibiting DAMPs (SAMPs) in resolution of inflammatory diseases and, consequently, to the future roles of these novel biomarkers as therapeutic targets and therapeutics. Since controlled production of DAMPs and SAMPs is needed to achieve full homeostatic restoration and repair from tissue injury, only their pathological, not their homeostatic, concentrations should be therapeutically tackled. Therefore, distinct caveats are proposed regarding choosing DAMPs and SAMPs for therapeutic purposes. For example, we discuss the need to a priori identify and define a context-dependent "homeostatic DAMP:SAMP ratio" in each case and a "homeostatic window" of DAMP and SAMP concentrations to guarantee a safe treatment modality to patients. Finally, a few clinical examples of how DAMPs and SAMPs might be used as therapeutic targets or therapeutics in the future are discussed, including inhibition of DAMPs in hyperinflammatory processes (e.g., systemic inflammatory response syndrome, as currently observed in Covid-19), administration of SAMPs in chronic inflammatory diseases, inhibition of SAMPs in hyperresolving processes (e.g., compensatory anti-inflammatory response syndrome), and administration/induction of DAMPs in vaccination procedures and anti-cancer therapy.


Subject(s)
Inflammation/drug therapy , Inflammation/metabolism , Molecular Targeted Therapy/methods , Biomarkers/blood , Cell-Free Nucleic Acids/blood , Chronic Disease , Coronavirus Infections/drug therapy , HMGB1 Protein/blood , Homeostasis , Humans , Immunity, Innate/drug effects , Immunity, Innate/physiology , Pathogen-Associated Molecular Pattern Molecules/metabolism , S100 Proteins/blood , Vaccination
5.
J Am Soc Nephrol ; 31(9): 2117-2121, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-724272

ABSTRACT

BACKGROUND: Racial and ethnic disparities in vaccination rates for seasonal influenza exist. Whether such disparities extend to patients with ESKD, who simultaneously are at risk for complications of infection and have extensive contact with health care providers, has not been investigated. METHODS: To determine whether the proportion of patients vaccinated at a dialysis facility differs according to the facility's racial and ethnic composition, we examined dialysis facility data reported to the Centers for Medicare and Medicaid Services. The main outcome was the proportion of facility patients vaccinated for influenza among 6735 Medicare-certified facilities operating between 2014 and 2017. RESULTS: Among dialysis facilities, the mean percentage of patients vaccinated during the influenza season was 72.1%. Facilities with higher proportions of Black and Hispanic patients had significantly lower vaccination percentages than less diverse facilities. The average proportion of patients vaccinated at each facility decreased significantly from 2014 to 2017 (a decrease of 1.05% vaccinated per year) and decreased significantly more so among facilities with higher minority proportions. The share of vaccinated patients in facilities in the quartile with the highest proportion of Black patients decreased 1.21% per year compared with a decrease of 0.88% per year in facilities in the quartile with the lowest proportion of Black patients. We found similar trends for Hispanic patients. CONCLUSIONS: Rates of seasonal influenza vaccination are modestly but significantly lower among dialysis facilities with larger proportions of minority patients, and the gap seems to be widening over time. As wide-scale vaccination efforts grow more urgent amid the current COVID-19 pandemic, these disparities must be addressed to protect patients and communities equitably.


Subject(s)
Healthcare Disparities , Influenza Vaccines/immunology , Renal Dialysis , Vaccination/statistics & numerical data , African Continental Ancestry Group , Aged , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Kidney Failure, Chronic/therapy , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Seasons
6.
J Prev Med Hyg ; 61(2): E125-E129, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-721658

ABSTRACT

Introduction: The global COVID-19 pandemic is placing a heavy burden on health services. One result could be a general reduction in routine vaccination activities. In Tuscany (Central Italy), paediatricians (in agreement with the regional health service) administer and register paediatric vaccinations of their patients. The aim of the present study was to evaluate the impact of the COVID-19 epidemic on paediatric vaccinations administered by Tuscan paediatricians, as a proxy of adherence to vaccinations during this epidemic period. Methods: Four hundred members of the Tuscany section of the Italian Federation of Paediatricians (FIMP) were invited to participate in a semi-structured online survey. Results: During the COVID-19 pandemic, almost all (98.2%) of the 223 respondents reported a general decline in outpatient paediatric visits; 65.8% reported a more than 60% reduction (144 answers) in comparison with the situation before the COVID-19 pandemic. A total of 208 paediatricians (93.3%) continued to vaccinate in the period considered: 66/208 (31.7%) reported a reduction in parents' compliance with mandatory vaccination (hexavalent and MMRV vaccines), and 88/208 (42.3%) reported a reduction in compliance with non-mandatory vaccinations. Almost all paediatricians declared having taken preventive actions to counter the spread of SARS-CoV-2. Discussion and conclusions: Although the majority of Tuscan paediatricians continued to vaccinate during the lock-down, some parents decided to postpone their children's scheduled vaccinations, mainly owing to fears concerning the safety of access to health services. When Italian immunization coverage data on the first months of 2020 become available, it will be possible to assess the real impact of the COVID-19 pandemic on paediatric vaccinations. It is crucial to continue vaccinating against preventable infectious diseases in order to avoid other possible epidemic outbreaks. The pandemic must not be seen as an obstacle to compliance with the vaccination schedule, but rather as an excellent opportunity to underline the importance of all recommended vaccinations.


Subject(s)
Attitude of Health Personnel , Betacoronavirus , Coronavirus Infections/epidemiology , Immunization Schedule , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Vaccination/statistics & numerical data , Child , Female , Humans , Italy , Male , Pandemics , Pediatricians/statistics & numerical data , Surveys and Questionnaires
11.
J Theor Biol ; 505: 110422, 2020 11 21.
Article in English | MEDLINE | ID: covidwho-703142

ABSTRACT

For various infectious diseases, vaccination has become a major intervention strategy. However, the importance of social distancing has recently been highlighted during the ongoing COVID-19 pandemic. In the absence of vaccination, or when vaccine efficacy is poor, social distancing may help to curb the spread of new virus strains. However, both vaccination and social distancing are associated with various costs. It is critical to consider these costs in addition to the benefits of these strategies when determining the optimal rates of application of control strategies. We developed a game-theoretic epidemiological model that considers vaccination and social distancing under the assumption that individuals pursue the maximization of payoffs. By using this model, we identified the individually optimal strategy based on the Nash strategy when both strategies are available and when only one strategy is available. Furthermore, we determined the relative costs of control strategies at which individuals preferentially adopt vaccination over social distancing (or vice versa).


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Game Theory , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Social Distance , Vaccination/methods , Choice Behavior , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy
12.
AAPS PharmSciTech ; 21(6): 225, 2020 Aug 05.
Article in English | MEDLINE | ID: covidwho-696899

ABSTRACT

In the race for a safe and effective vaccine against coronavirus disease (COVID)-19, pharmaceutical formulation science plays a critical role throughout the development, manufacturing, distribution, and vaccination phases. The proper choice of the type of vaccine, carrier or vector, adjuvant, excipients, dosage form, and route of administration can directly impact not only the immune responses induced and the resultant efficacy against COVID-19, but also the logistics of manufacturing, storing and distributing the vaccine, and mass vaccination. In this review, we described the COVID-19 vaccines that are currently tested in clinical trials and provided in-depth insight into the various types of vaccines, their compositions, advantages, and potential limitations. We also addressed how challenges in vaccine distribution and administration may be alleviated by applying vaccine-stabilization strategies and the use of specific mucosal immune response-inducing, non-invasive routes of administration, which must be considered early in the development process.


Subject(s)
Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Viral Vaccines/pharmacology , Viral Vaccines/therapeutic use , Animals , Drug Compounding , Humans , Immunity, Mucosal , Vaccination , Viral Vaccines/chemistry
13.
Pharmazie ; 75(8): 375-380, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-695239

ABSTRACT

Diabetes mellitus (DM) is one of the major risk factors for COVID-19 complications as it is one of the chronic immune-compromising conditions especially if patients have uncontrolled diabetes, poor HbA1c and/or irregular blood glucose levels. Diabetic patients' mortality rates with COVID-19 are higher than those of cardiovascular or cancer patients. Recently, Bacillus Calmette-Guérin (BCG) vaccine has shown successful results in reversing diabetes in both rats and clinical trials based on different mechanisms from aerobic glycolysis to beta cells regeneration. BCG is a multi-face vaccine that has been used extensively in protection from tuberculosis (TB) and leprosy and has been repositioned for treatment of bladder cancer, diabetes and multiple sclerosis. Recently, COVID-19 epidemiological studies confirmed that universal BCG vaccination reduced morbidity and mortality in certain geographical areas. Countries without universal policies of BCG vaccination (Italy, Nederland, USA) have been more severely affected compared to countries with universal and long-standing BCG policies that have shown low numbers of reported COVID-19 cases. Some countries have started clinical trials that included a single dose BCG vaccine as prophylaxis from COVID-19 or an attempt to minimize its side effects. This proposed research aims to use BCG vaccine as a double-edged weapon countering both COVID-19 and diabetes, not only as protection but also as therapeutic vaccination. The work includes a case study of regenerated pancreatic beta cells based on improved C-peptide and PCPRI laboratory findings after BCG vaccination for a 9 year old patient. The patient was re-vaccinated based on a negative tuberculin test and no scar at the site of injection of the 1st BCG vaccination at birth. The authors suggest and invite the scientific community to take into consideration the concept of direct BCG re-vaccination (after 4 weeks) because of the reported gene expressions and exaggerated innate immunity consequently. As the diabetic MODY-5 patient (mutation of HNF1B, Val2Leu) was on low dose Riomet® while eliminating insulin gradually, a simple analytical method for metformin assay was recommended to ensure its concentration before use as it is not approved yet by the Egyptian QC labs.


Subject(s)
BCG Vaccine/administration & dosage , Coronavirus Infections/immunology , Diabetes Mellitus/immunology , Insulin-Secreting Cells/cytology , Pneumonia, Viral/immunology , Animals , BCG Vaccine/immunology , Child , Coronavirus Infections/complications , Diabetes Mellitus/physiopathology , Humans , Male , Pandemics , Pneumonia, Viral/complications , Rats , Regeneration/immunology , Risk Factors , Vaccination/methods
14.
Virus Res ; 287: 198108, 2020 10 02.
Article in English | MEDLINE | ID: covidwho-694184

ABSTRACT

Viral infections are dangerous diseases for human health worldwide, which lead to significant morbidity and mortality each year. Because of their importance and the lack of effective therapeutic approaches, further attempts should be made to discover appropriate alternative or complementary treatments. Melatonin, a multifunctional neurohormone mainly synthesized and secreted by the pineal gland, plays some roles in the treatment of viral infections. Regarding a deadly outbreak of COVID-19 across the world, we decided to discuss melatonin functions against various viral infections including COVID-19. Therefore, in this review, we summarize current evidence on melatonin therapy for viral infections with focus on possible underlying mechanisms of melatonin actions.


Subject(s)
Antiviral Agents/pharmacology , Betacoronavirus/drug effects , Coronavirus Infections/virology , Melatonin/pharmacology , Pneumonia, Viral/virology , Antioxidants , Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Host-Pathogen Interactions , Humans , Melatonin/therapeutic use , Oxidative Stress/drug effects , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Signal Transduction/drug effects , Vaccination , Viral Vaccines/administration & dosage , Viral Vaccines/immunology , Virus Diseases/drug therapy , Virus Diseases/metabolism , Virus Diseases/virology
15.
Int J Environ Res Public Health ; 17(15)2020 Aug 03.
Article in English | MEDLINE | ID: covidwho-693363

ABSTRACT

Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette-Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests). Currently-more than four months after declaration of the pandemic-the BCG-hypothesis needs reexamining. An ecological study was conducted by obtaining data of 61 factors in 173 countries, including BCG vaccine coverage (%), using morbidity and mortality as outcomes, obtained from open resources. 'Urban population (%)' and 'insufficient physical activity (%)' in each country was positively associated with morbidity, but not mortality, after adjustment for PCR-tests. On the other hand, recent BCG vaccine coverage (%) was negatively associated with mortality, but not morbidity, even with adjustment for percentage of the population ≥ 60 years of age, morbidity, PCR-tests and other factors. The results of this study generated a hypothesis that a national BCG vaccination program seems to be associated with reduced mortality of COVID-19, although this needs to be further examined and proved by randomized clinical trials.


Subject(s)
BCG Vaccine/administration & dosage , Betacoronavirus/isolation & purification , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Coronavirus Infections/virology , Humans , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/virology , Research Design , Vaccination/methods
17.
Vaccine ; 38(33): 5085-5088, 2020 07 14.
Article in English | MEDLINE | ID: covidwho-680832

ABSTRACT

While a human challenge study holds the prospect of accelerating the development of a vaccine for the coronavirus SARS-CoV-2, it may be opposed due to risks of harm to participants and researchers. Given the increasing number of human deaths and severe disruption to lives worldwide, we argue that a SARS-CoV-2 challenge study is ethically justifiable as its social value substantially outweighs the risks. Such a study should therefore be seriously considered as part of the global research response towards the COVID-19 pandemic. In this paper, we contribute to the debate by addressing the misperception that a challenge study for the coronavirus would lower scientific and ethical standards for vaccine research and development, and examine how it could be ethically conducted. We also set out information that needs to be disclosed to prospective participants to obtain their consent.


Subject(s)
Biomedical Research/ethics , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Vaccination/ethics , Viral Vaccines/therapeutic use , Betacoronavirus , Humans , Informed Consent , Pandemics/ethics , Risk , Viral Vaccines/administration & dosage
20.
Prev Chronic Dis ; 17: E69, 2020 07 23.
Article in English | MEDLINE | ID: covidwho-671674

ABSTRACT

Community pharmacists assist patients to manage disease and prevent complications. Despite the enormous challenge the coronavirus disease 2019 (COVID-19) pandemic has dealt to the health care system, community pharmacists have maintained the delivery of critical health services to communities, including those most at risk for COVID-19. Community pharmacists are in a key position to deliver priority pandemic responses including point-of-care testing for chronic disease management, vaccinations, and COVID-19 testing.


Subject(s)
Betacoronavirus , Community Pharmacy Services/organization & administration , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Pandemics/prevention & control , Pharmacists , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Professional Role , Adult , Child , Coronavirus Infections/epidemiology , Delivery of Health Care , Disease Management , Humans , Pneumonia, Viral/epidemiology , Point-of-Care Testing , United States/epidemiology , Vaccination
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