Application of the double bounded dichotomous choice model to the estimation of parent's willingness to pay for the hand foot mouth disease vaccination: A survey in Selangor, Malaysia.

Hand foot and mouth disease (HFMD) is a notifiable viral disease in Malaysia, and is transmitted primarily among young children. Although vaccines for enteroviruses 71 (EV-71) were approved in China against HFMD, the availability and the acceptance of the vaccine in the Malaysia are unknown. This study investigated and ascertained the determinants of willingness-to-pay (WTP) for HFMD vaccination in Selangor Malaysia. This study adopted a cross-sectional, contingent valuation method involving 390 parents of young children aged six and below. The double bounded dichotomous choice (DBDC) approach was employed to assess the WTP for HFMD vaccine among respondents. A bivariate probit model was used to assess the key determinants of WTP for HFMD vaccine, while the mean WTP was measured using the Krinsky and Robb procedure. We found that 279 (71.5%) of parents were willing to pay for the HFMD vaccination. The estimated single bounded mean WTP was MYR460.23 (equivalent to US$ 102.17) for two doses of HFMD vaccination. The double bounded analysis revealed that the vaccine's price, poor education background and lower income were the key factors that significantly affected the WTP, with the estimated mean WTP being MYR394.00 (US$ 87.47). In conclusion, most Malaysian parents are willing to pay for the HFMD vaccination. The estimated WTP identifies the optimal price point for HFMD vaccination in Malaysia. Furthermore, the government should focus on an awareness programme for the HFMD vaccination among parents who have lower income or education level.

Hand Foot Mouth Disease During the SARS-CoV-2 Pandemic: A Multicentric Study.

OBJECTIVES: This prospective observational study aimed to identify the current trend of the circulating viral strains responsible for HFMD outbreak in four tertiary care centers in Rajasthan, amidst the COVID-19 pandemic (April-October 2022). METHODS: Cases with suspected HFMD, presenting to our skin outpatient department were assessed clinically and serologically (IgM antibodies against coxsackie virus (CV) A6, A16 and enterovirus 71) for evidence of the disease. RESULTS: We identified 718 new HFMD patients (161 adults) with peaks in May and August, 2022. Male:female ratio decreased with increasing age. Most children were asymptomatic. A total of 385/409 patients assessed serologically, were found positive, most commonly against CV-A6. CONCLUSION: Though HFMD typically affects young children, an unusually higher proportion of adults were affected during the current pandemic. There were some subtle differences between pediatric and adult presentation of HFMD.

Hand Foot Mouth Disease During the SARS-CoV-2 Pandemic: A Multicentric Study.

OBJECTIVES: This prospective observational study aimed to identify the current trend of the circulating viral strains responsible for HFMD outbreak in four tertiary care centers in Rajasthan, amidst the COVID-19 pandemic (April-October 2022). METHODS: Cases with suspected HFMD, presenting to our skin outpatient department were assessed clinically and serologically (IgM antibodies against coxsackie virus (CV) A6, A16 and enterovirus 71) for evidence of the disease. RESULTS: We identified 718 new HFMD patients (161 adults) with peaks in May and August, 2022. Male:female ratio decreased with increasing age. Most children were asymptomatic. A total of 385/409 patients assessed serologically, were found positive, most commonly against CV-A6. CONCLUSION: Though HFMD typically affects young children, an unusually higher proportion of adults were affected during the current pandemic. There were some subtle differences between pediatric and adult presentation of HFMD.

Virtual flavonoids screening identifies potent compounds against enterovirus A71 and coxsackievirus A16 (preprint)

Worldwide outbreaks of hand, foot, and mouth disease (HFMD) are caused by enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16). Since no anti-HFMD drugs are currently available, it is interesting to study potential viral inhibitors. Rupintrivir is a rhinovirus 3C protease (3Cpro) inhibitor with apparent inhibitory activity against HFMD. This study constructs pharmacophore models of the EV-A71 and CV-A16 3Cpro complexed with rupintrivir using molecular dynamics (MD) simulations. Both models had similar pharmacophore features, including hydrogen bond donors and acceptors and hydrophobic interactions. These pharmacophore models were then used as a template to screen 39 flavonoid compounds as potential novel inhibitors. Diosmin, epigallocatechin gallate (EGCG), and RTH-011 showed high binding affinities for EV-A71 and CV-A16 3Cpro. They formed hydrogen bonds with important surrounding residues in both proteins, including H40, L127, T142, A144, T145, H161, I162, G163, and G164. In addition, their effective concentrations against rhabdomyosarcoma (RD) cell infection by EV-A71 and CV-A16 were determined. EGCG had the highest half maximal effective concentration (EC50) of 12.86 ± 1.30 µM for EV-A71 and 15.54 ± 1.50 µM for CV-A16, while diosmin had EC50 of 21.01 ± 1.57 µM for EV-A71 and 30.68 ± 3.25 µM for CV-A16. Both compounds were non-toxic in RD cells, with 50% cytotoxic concentrations of > 100 µM for EGCG and > 500 µM for diosmin. In addition, MD simulation analysis showed that EGCG had a higher binding affinity than diosmin, supported by its significantly lower solvated binding free energies and greater numbers of contact atoms and key binding residues. Moreover, previous studies reported EGCG’s inhibitory effect on other viruses, such as severe acute respiratory syndrome coronavirus 2. Therefore, our findings suggest that EGCG can effectively inhibit the EV-A71 and CV-A16 3Cpro.

Human exposure risk assessment for infectious diseases due to temperature and air pollution: an overview of reviews (preprint)

Air pollution and global temperature change are expected to affect infectious diseases. Yet to date overview of systematic reviews assessing the exposure risk of air pollutants and temperature on infectious diseases is unavailable. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature were searched. Systematic reviews and meta-analyses investigated the exposure risk of pollutants or temperature on infectious diseases were included. Two investigators screened literature, extracted data and performed the risk of bias assessments independently. A total of 23 articles met the inclusion criteria, which 3 (13%) were "low" quality and 20 (87%) were "critically low" quality. COVID-19 morbidity was associated with long-term exposure PM2.5 (RR = 1.056 per 1μg/m  3, 95% CI: 1.039-1.072) and NO2 (RR = 1.042 per 1 μg/m 3, 95% CI: 1.017-1.068). In addition, for each 1°C increase in temperature, the risk of dengue fever morbidity increased 13% (RR = 1.130 per 1°C, 95% CI: 1.120-1.150), infectious diarrhea morbidity increased 8% (RR =1.080 per 1°C, 95% CI: 1.050-1.200), and hand, foot and mouth disease (HFMD) morbidity increased 5% (RR = 1.050 per 1 °C, 95% CI: 1.020-1.080). In conclusion, PM2.5 and NO2 increased the risk of COVID-19 and temperatures were associated with dengue, infectious diarrhoea and HFMD morbidity. Moreover, the exposure risk of temperature on COVID-19 need to be further explored. 

Factors associated with covid-19 that trigger oral infections in the child population / Factores asociados al covid-19 desencadenantes de infecciones bucodentales en la población infantil

La presencia de un nuevo coronavirus se propagó de manera inesperada alrededor de todo el mundo, desencadenando una crisis mundial sin precedentes. Ya para el año 2020, habían más de 7,9 millones de casos, y 434.796 muertes, en más de 200 países. En ese momento, se implementaron medidas de aislamiento y distanciamiento social en todo el mundo para contener el acelerado propagación de covid-19; entre las consecuencias, las clínicas dentales, se cerraron temporalmente y se suspendió la atención dental electiva, lo que conllevó a un aumento en el desarrollo de enfermedades bucodentales. Con relación a los niños y jóvenes, hubo un aumento en este tipo de enfermedades. Los niños se vieron obligados a pasar la mayor parte de su tiempo en el hogar con la adquisición de hábitos alimentarios incorrectos, ingesta de refrescos y bebidas energéticas que, además de contener altas cantidades de azúcares, su contenido ácido produce erosión dental y hace que el esmalte tejido menos resistente al ataque de bacterias cariogénicas. En este trabajo se analizó una población de 96 niños en edad escolar durante un periodo de dos años de 2020 al 2022. Los resultados mostraron que 100% de los escolares presentaron caries dentales al momento de su evaluación en enero 2022, mientras que 47% del total presentaron dientes obturados y el 64% del total de casos, perdieron algunas de sus piezas dentales. Estos resultados son, posiblemente, debido al desconocimiento de los escolares sobre la higiene para la prevención de las caries dental y sus consecuencias, siendo la más perjudicial la pérdida prematura de dientes temporales, lo que hace necesario implementar programas sobre la promoción y prevención en la salud bucodental en escolares, docentes, y padres y representantes(AU)

The presence of a new coronavirus spread unexpectedly around the world, triggering an unprecedented global crisis. By 2020, there were more than 7.9 million cases, and 434,796 deaths, in more than 200 countries. At that time, isolation and social distancing measures were implemented around the world to contain the accelerated spread of covid-19; Among the consequences, dental clinics were temporarily closed, and elective dental care was suspended, which led to an increase in the development of oral diseases. In relation to children and young people, there was an increase in this type of illness. The children were forced to spend most of their time at home with the acquisition of incorrect eating habits, intake of soft drinks and energy drinks that, in addition to containing high amounts of sugar, their acid content produces dental erosion and makes the enamel tissue less resistant to attack by cariogenic bacteria. In this work, a population of 96 school-age children was analyzed during a two-year period from 2020 to 2022. The results showed that 100% of the schoolchildren had dental caries at the time of their evaluation in January 2022, while 47% of the total had filled teeth and 64% of the total cases lost some of their teeth. These results are possibly due to the lack of knowledge of schoolchildren about hygiene for the prevention of dental caries and its consequences, the most damaging being the premature loss of temporary teeth, which makes it necessary to implement programs on promotion and prevention in the oral health in schoolchildren, teachers, and parents and representatives(AU)

Explanation of hand, foot, and mouth disease cases in Japan using Google Trends before and during the COVID-19: infodemiology study.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) pandemic affects common diseases, but its impact on hand, foot, and mouth disease (HFMD) is unclear. Google Trends data is beneficial for approximate real-time statistics and because of ease in access, is expected to be used for infection explanation from an information-seeking behavior perspective. We aimed to explain HFMD cases before and during COVID-19 using Google Trends. METHODS: HFMD cases were obtained from the National Institute of Infectious Diseases, and Google search data from 2009 to 2021 in Japan were downloaded from Google Trends. Pearson correlation coefficients were calculated between HFMD cases and the search topic "HFMD" from 2009 to 2021. Japanese tweets containing "HFMD" were retrieved to select search terms for further analysis. Search terms with counts larger than 1000 and belonging to ranges of infection sources, susceptible sites, susceptible populations, symptoms, treatment, preventive measures, and identified diseases were retained. Cross-correlation analyses were conducted to detect lag changes between HFMD cases and search terms before and during the COVID-19 pandemic. Multiple linear regressions with backward elimination processing were used to identify the most significant terms for HFMD explanation. RESULTS: HFMD cases and Google search volume peaked around July in most years, excluding 2020 and 2021. The search topic "HFMD" presented strong correlations with HFMD cases, except in 2020 when the COVID-19 outbreak occurred. In addition, the differences in lags for 73 (72.3%) search terms were negative, which might indicate increasing public awareness of HFMD infections during the COVID-19 pandemic. The results of multiple linear regression demonstrated that significant search terms contained the same meanings but expanded informative search content during the COVID-19 pandemic. CONCLUSIONS: The significant terms for the explanation of HFMD cases before and during COVID-19 were different. Awareness of HFMD infections in Japan may have improved during the COVID-19 pandemic. Continuous monitoring is important to promote public health and prevent resurgence. The public interest reflected in information-seeking behavior can be helpful for public health surveillance.

Characterizing Aerosol Generating Procedures with Background Oriented Schlieren (preprint)

The potential for characterizing aerosol generating procedures (AGPs) using background oriented schlieren (BOS) flow visualization was investigated in two clinical situations. A human-scale BOS system was used on a manikin simulating jet ventilation and extubation. A novel approach to representation of the BOS images using line integral convolution allows direct evaluation of both magnitude and direction of the refractive index gradient field. Plumes issuing from the manikin's mouth were clearly visualized and characterized in both experiments, and it is recommended that BOS be adapted into a clinical tool for risk evaluation in clinical environments.

Predicting Hand, Foot, and Mouth Disease in Japan Using Google Trends: Infodemiology Study (preprint)

Objectives: We aimed to predict the number of hand, foot, and mouth disease (HFMD) infections before and during the COVID-19 pandemic using Internet search data. Methods: We obtained actual HFMD cases from the National Institute of Infectious Disease and Internet search data using Google Trends between 2004 and 2021 in Japan. We calculated the Pearson correlation coefficients between actual HFMD cases and the search topic "HFMD" from 2004 to 2021. We conducted a cross-correlation analysis between the actual HFMD cases and 43 HFMD-related search terms before and during the pandemic. We identified the most significant predictors of HFMD infection using stepwise multiple linear regression. Results: We found that actual HFMD cases and Internet search volume peaked around July in most years, except for 2020 and 2021. The search topic "HFMD" presented a strong correlation with actual HFMD cases, but the correlation was weaker in 2004, 2008, and 2020. Results from stepwise multiple linear regression exhibited that the search terms "infect," "daycare," "vomit," "HFMD," "eczema," "pain," and "high fever were the most significant predictors before the pandemic, while "infect," "enterovirus," "herpangina," "kindergarten," "myocarditis," "HFMD," "contact infection," "blister," "high fever" "dermatology," and "plantar" were the most significant predictors during the pandemic. Conclusions: The predictors for HFMD infections before and during the COVID-19 pandemic were different. The awareness of HFMD infection in Japan may improved during the COVID-19 pandemic. Continuous monitoring is important to promote public health and prevent resurgence. Public interest reflected in information-seeking behavior can be helpful for public health surveillance.

An update on oral clinical courses among patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection: A clinical follow-up (a prospective prevalent cohort) study (preprint)

Abstract Introduction Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. Materials and Methods A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted at the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study had two follow-up phases: Hospital and patient-home-based. Results A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n=10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n=6), xerostomia (n=5), and thickening of saliva (n=1). The oral mucosal lesions per se consisted of aphthous lesions (n=3), candidiasis (n=1), geographic tongue (n=1), and localized gingivitis (n=1). On the other hand, the four weeks home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n=10) to 29% (n=16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. Discussion The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.

Virology and immune dynamics reveal high household transmission of ancestral SARS-CoV-2 strain (preprint)

Background: Household studies are crucial for understanding the transmission of SARS-CoV-2 infection, which may be underestimated from PCR testing of respiratory samples alone. We aim to combine assessment of household mitigation measures; nasopharyngeal, saliva and stool PCR testing; along with mucosal and systemic SARS-CoV-2 specific antibodies, to comprehensively characterise SARS-CoV-2 infection and transmission in households. Methods: Between March and September 2020, we obtained samples from 92 participants in 26 households in Melbourne, Australia, in a 4-week period following onset of infection with ancestral SARS-CoV-2 variants. Results: The secondary attack rate was 36% (24/66) when using nasopharyngeal swab (NPS) PCR positivity alone. However, when respiratory and non-respiratory samples were combined with antibody responses in blood and saliva, the secondary attack rate was 76% (50/66). SARS-CoV-2 viral load of the index case and household isolation measures were key factors that determine secondary transmission. In 27% (7/26) of households, all family members tested positive by NPS for SARS-CoV-2 and were characterised by lower respiratory Ct-values than low transmission families (Median 22.62 vs 32.91; IQR 17.06 to 28.67 vs 30.37 to 34.24). High transmission families were associated with enhanced plasma antibody responses to multiple SARS-CoV-2 antigens and the presence of neutralising antibodies. Three distinguishing saliva SARS-CoV-2 antibody features were identified according to age (IgA1 to Spike 1, IgA1 to nucleocapsid protein (NP), suggesting that adults and children generate distinct mucosal antibody responses during the acute phase of infection. Conclusion: Utilising respiratory and non-respiratory PCR testing, along with measurement of SARS-CoV-2 specific local and systemic antibodies, provides a more accurate assessment of infection within households and highlights some of the immunological differences in response between children and adults.

Oral lesions and saliva alterations of COVID-19 patients in an intensive care unit: A retrospective study.

AIM: To detect the type and frequency of oral lesions and clinical conditions suggestive of saliva alterations in COVID-19 patients in an intensive care unit (ICU), as well as to describe the patient´s management in each case METHODS: Information about oral conditions and mechanical ventilation was collected from oral medicine records of COVID-19 patients in an ICU (n = 519) RESULTS: From the total collected, 472 patients (90.9%) were examined by the oral medicine staff. In 242/472 patients (51.3%), alterations in the oral cavity were noted. The most frequent changes were mechanical trauma (18.1%, derived mainly from intubation), vascular/coagulation disturbances (24.1%, petechiae, bruises, varicoses, and oral bleeding), and saliva alterations (24.4%, dry mouth, and sialorrhea). Infectious lesions were mentioned in the oral medicine records (16.9%), most associated with a viral infection (15.7%), mainly herpesvirus. Improved oral change protocols included oral hygiene, use of specific medications, and laser therapy CONCLUSION: COVID-19 patients in the ICU often showed dryness in the oral and mucosa oral lesions related to vascular/coagulation disturbances, and mechanical trauma derived from orotracheal tube. An oral medicine staff must be aligned with the ICU multidisciplinary team to manage COVID-19 patients, as well as to establish diagnoses and oral cavity treatments.

A Rare Case of Plasmablastic Lymphoma in a Patient with HIV and SARS-CoV-2 Infections.

Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection, oral Kaposi's sarcoma, hairy leukoplakia, periodontal diseases (linear gingival erythema and necrotizing ulcerative periodontitis), xerostomia, human papillomavirus-associated warts, aphthous ulcers, non-Hodgkin's lymphoma, histoplasmosis, carcinoma, exfoliative cheilitis, and HIV salivary gland disease. Non-Hodgkin's lymphoma (NHL) is the most common cancer in people living with HIV (PLWH), and the incidence is increased for aggressive B-cell NHL. Plasmablastic lymphoma (PbL) is a rare and aggressive B-cell malignancy that is often unresponsive to chemotherapy and usually has a poor prognosis. We hereby present the case of a patient with a recent history of COVID-19 infection who was diagnosed with HIV and NHL, with manifestations in the oral cavity and a favorable evolution after the introduction of antiviral therapy, specific chemotherapy, and radiotherapy. Dental expertise is necessary for the appropriate management of oral manifestations of HIV infection or AIDS, and lymphoma should be included in the differential diagnosis of any oral lesions.

COVID-19 and its manifestations in the oral cavity: A systematic review.

BACKGROUND: SARS-CoV-2 is the virus responsible for coronavirus disease-19 (COVID-19) disease, which has been shown to trigger multiple affectations. One of the first tissue areas to come into contact with the virus is the oral cavity, which develops various alterations. Hence, the objective of this systematic review was to identify the main signs and symptoms of this disease in the oral cavity, and the following research question was established: What are the main oral signs and symptoms in COVID-19-positive persons? METHODS: The electronic databases of PUBMED, SCOPUS, and SCIENCE DIRECT were analyzed, the keywords "ORAL DISEASES," "ORAL MANIFESTACTIONS," and "COVID-19" were used taking into account the following inclusion criteria: studies whose main objective was oral manifestations secondary to the confirmation of COVID-19, plus clinical cases, case series, and retrospective or prospective studies. For the assessment of the risk of bias the JBI Critical Appraisal Checklist for Case Series tool was used. RESULTS: A total of 18 studies were included, the most common initial signs/symptoms after contagion of SARS-CoV-2 were dysgeusia, dry mouth, and burning mouth, and the main signs/symptoms were the presence of ulcerative lesions, dysgeusia, and Candida albicans infections. CONCLUSIONS: It is very important to detect any alteration in the mucosa in patients with COVID-19 and to provide assertive treatment to avoid complications, and try to maintain adequate oral hygiene throughout the course of the disease to avoid the colonization of opportunistic microorganisms and to avoid complications both orally and systemically.

Nine-month presence of SARS-CoV-2 in saliva: a case report (preprint)

SARS-CoV-2 is a novel coronavirus that mainly affects the upper airways. Approximately one third of all detected cases is asymptomatic. We report an asymptomatic individual who tested positive for SARS-CoV-2 over a period of nine months. Of this individual, whole mouth saliva was tested by a novel fluorescence in situ hybridization-based assay which detects only the active form of the virus. During the observation period of nine months, there was a possible co-infection with a second SARS-CoV-2 variant accompanied by none or very low antibody production until the possible co-infection. We suspect that the SARS-CoV-2 infection in this individual is limited to the salivary glands and does not spread (much) throughout the systemic compartment(s) of the body.

The Influence of Propolis on Dental Plaque Reduction and the Correlation between Dental Plaque and Severity of COVID-19 Complications-A Literature Review.

Current studies suggest that cariogenic bacteria in dental plaque influence the severity of COVID-19 complications since the oral cavity is a reservoir for respiratory pathogens potentially responsible for the development of hospital-acquired pneumonia. This article focuses on the association between dental plaque and COVID-19 concerning the influence of altered oral biofilm on the risk of increased severity of SARS-CoV-2 infection. Moreover, it concentrates on the usefulness of propolis, with its apitherapeutic antibacterial properties, for treating oral bacterial infections co-occurring with SARS-CoV-2 infection. A review of the literature on PubMed, Cochrane Library and Medline between 2000 and 2021 revealed 56 published articles indicating that a link between dental plaque and COVID-19 complications was probable. Furthermore, they indicated that propolis may minimize COVID-19 severity by reducing dental plaque accumulation. The possibility that improved oral health could reduce the risk of COVID-19 complications should be of interest to scientists.