Leveraging epidemiological principles to evaluate Sweden's COVID-19 response.

In the response to COVID-19, countries have implemented response strategies along a continuum of population- and venue-level specificity ranging from suppression to mitigation strategies. Suppression strategies generally include population-wide shelter-in-place mandates or lockdowns, closure of nonessential physical venues, travel bans, testing and contact tracing, and quarantines. Sweden followed a mitigation strategy focused on risk-tailored approaches to mitigate specific acquisition risks among the elderly, minimizing the disruption to education and the delivery of other health care services, and recommendations for social distancing to minimize the disease burden. To date, Sweden has reported higher case counts and attributable mortality than other Scandinavian countries and lower than other Northern European countries. However, there are several limitations with comparison given heterogeneity in testing strategies, suspected and confirmed case definitions, and assessment of attributable mortality. The decisions in Sweden also reflect social priorities such as equity being a foundational principle of Swedish social systems. Consistently, in-person education for those aged less than 16 years continued throughout. Notably, the mitigation strategy did not eliminate the inequitable impacts of COVID-19 cases and mortality in Sweden with higher-exposure and generally lower-income occupations being associated with higher risks intersecting with these communities often residing in more dense multigenerational households. From January 1 to November 15, there has been a 1.8% increase in all-cause mortality in 2020 compared with the average of 2015-2019, representing an excess of 14.3 deaths per 100,000 population. However, the final assessment of excess deaths in Sweden in 2020 including stratification by age and integration of secular trends can only be calculated in the coming years. In response to increasing cases in the fall of 2020, Sweden has continued to leverage business-oriented regulations and public-oriented guidelines for social distancing rather than police-enforced mandates. Ultimately, pandemics present no winners. Countries have implemented a range of different COVID-19 prevention and mitigation strategies responsive to their own priorities and legal systems including equity and the balancing of competing health priorities. Given these varied approaches, countries that pursued elimination, suppression, or mitigation strategies can collaboratively learn from both successes and challenges of the different strategies to inform COVID-19 and future pandemic responses.

Herpes zoster-associated mortality in Europe: a systematic review.

BACKGROUND: Reactivation of latent varicella zoster virus, partly due to age-related immunosenescence and immunosuppressive conditions, results in herpes zoster (HZ) and its associated complications. The management of the most important complication, post-herpetic neuralgia (PHN), is challenging, particularly in the elderly, and is generally unsatisfactory. No previous reviews have reported the incidence of HZ-associated mortality. METHODS: We carried out a systematic literature review to identify studies and databases providing data for HZ-associated mortality in adults aged ≥ 50 years in Europe. RESULTS: We identified 12 studies: Belgium (1); France (1); Germany (1); the Netherlands (2); Portugal (1); Spain (4) and England/Wales (2) and 4 databases from Europe: France; Germany and England/Wales. The incidence was available from eight studies; it was highest in those aged ≥ 95 in France (19.48/100,000). In the European (WHO) database, the overall mortality ranged from 0 to > 0.07/100,000. The age- and gender-specific HZ mortality rates from the other databases showed that while in younger age groups the HZ mortality rate was higher in males, in older patients the rate was much higher in women. The case fatality rate was 2 and 61/100,000 in those 45-65 and ≥ 65 years, respectively. A similar increase with age was seen for the hospital fatality rate; 0.6% in those 45-65 years in the UK and 7.1% in those ≥ 80 in Spain. CONCLUSIONS: Although the data were sparse and heterogeneous, HZ-associated mortality clearly increases with age. In addition, the elderly who develop HZ often have underlying diseases and are at increased risk of functional decline and loss of independence. Mortality should be taken into account in health-economics models.

Impact of comorbidities and surgery on health related transitions in pancreatic cancer admissions: a multi state model.

AIM: Pancreatic cancer is one of the least common tumors, nevertheless it is one of the most lethal. This lethality is mainly due to the fact that the vast majority of patients are diagnosed in an advanced stage. The objective of this work is investigate how different covariates affect the transition to death after a first admission due to pancreatic cancer. METHODS: We analyze the impact of different factors on health related transitions after a first hospital admission related to pancreatic cancer based on a multi state model. RESULTS: Transitions of interest include the transition to death (i.e. survival time), but also the time between a first admission and discharge or between discharge and readmission. We consider comorbidities, the type of admission, and especially the performance of pancreas surgery as covariates with a potential effect on the transition intensities. CONCLUSION: The multi state model allows for a very detailed analysis since all covariate effects may change depending on the current state of the patient.

Tetanus vaccination in adult population: coverage, registration and compliance.

OBJECTIVES: To ascertain correct tetanus vaccination coverage (CTVC), defined as any user who received the complete primary series of three adult doses of T or Td and/or up-to-date 10-yearly booster doses, with an official record thereof, among adults and assess percentage compliance with tetanus vaccination recommendation among the population lacking CTVC. RESULTS: A total of 776 subjects took part, all of whom gave their consent. Mean age was 47.2 (SD: 20.2) years, and of the total 453 (58.4%) were women (p < 0.001). Overall CTVC was 71.6% (95% CI: 68.3-74.8), with the rate being lowest in the 35- to 45-year age group (59.8%) and 100% among the 14-year-olds. Of the 197 unvaccinated subjects, only 27 finally accepted vaccine recommendation. METHODS: The study was undertaken in two phases. Phase I: the prevalence of tetanus immunization was ascertained, using clinical interviews and examination of health records, in a representative sample of patients (> or = age 14 years) who sought emergency care at a 24-hour Medical Emergency Service in the Principality of Asturias (Spain) from April to May 2007. Phase II: a longitudinal prospective study was conducted in June 2007 on a subgroup of patients eligible for vaccination. Statistical significance was set at p < 0.05. CONCLUSIONS: In Spain, adult immunization against tetanus is inadequate. A single dedicated register including all the different levels in the Health System and increase Health promotion education programmes would be necessary in order to reach the correct tetanus vaccination coverage.