Adult Javanese migrants to Indonesian Papua at high risk of severe disease caused by malaria

Migrants from Java arrive in hyperendemic Papua, Indonesia lacking exposure to endemic malaria. We evaluated records of evacuation to hospital with a diagnosis of severe malaria from a transmigration village in northeastern Papua. During the first 30 months, 198 residents with severe disease were evacuated (7·5 evacuations/100 person-years). During this period the risk of evacuation for adults (>15 years of age) was 2·8. (95% CI=2·1–3·8; P<0·0001) relative to children, despite apparently equal exposure to risk of infection. Relative risk (RR) for adults was greatest during the first 6 months (RR>16; 95% CI[ges ]2·0–129; P=0·0009), and diminished during the second 6 months (RR=9·4; 95% CI=2·7–32·8; P<0·0001) and the third 6 months (RR=3·7; 95% CI=1·7–7·9; P=0·0004). During the next two 6-month intervals, the RR for adults was 1·6 and 1·5 (95% CI range 0·8–2·6; P<0·18). Adults lacking chronic exposure were far more likely to progress to severe disease compared to children during initial exposure, but not after chronic exposure to infection.

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Management of malaria with acute renal failure

African Journal of Nephrology ◽

10.21804/3-2-864 ◽

1999 ◽

Vol 3 (2) ◽

Author(s):

Polrat Wilairatana ◽

Sornchai Looareesuwan ◽

Guy H. Neild

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Vietnam War ◽

Severe Malaria ◽

Falciparum Malaria ◽

Severe Disease ◽

Severe Anaemia ◽

Common Complication ◽

Risk Of Infection ◽

Severe Falciparum Malaria

In parts of the world, such as Africa, where Plasmodium falciparum is endemic and its transmission is stable, severe malaria affects mainly children. Cerebral malaria and severe anaemia are common but multi-organ failure involving the kidneys or liver is very rare. Surviving children develop immunity and thus as adults rarely develop severe disease III. In contrast, in other tropical countries where transmission of P. falciparum is unstable and the risk of infection low, severe malaria can occur at any age. Severe malaria is defined as parasitaemia greater than 5% or vital organ dysfunction. Acute renal failure (ARF) is a common complication of severe falciparum malaria in non-immune individuals. At the Bangkok hospital for Tropical Disease, 5,210 patients with falciparum malaria were admitted during the period 1991-1997 of whom 112 patients (2.12%) had ARF. In a recent study of 560 cases of severe adult malaria in Vietnam, 28% of patients had renal failure on admission and 41% at some stage, with 14% overall requiring dialysis [2]. Overall, however, ARF is not a common complication of malaria. During the Vietnam war, the reported incidence was 19 cases in 3,000 malarial admissions in 1965/6 and 8 of 2003 admissions n 1966 [3,4].

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Personalized stratification of back to work risk amidst COVID-19: A machine learning approach (Preprint)

10.2196/preprints.22030 ◽

2020 ◽

Author(s):

Carson Lam ◽

Jacob Calvert ◽

Gina Barnes ◽

Emily Pellegrini ◽

Anna Lynn-Palevsky ◽

...

Keyword(s):

Machine Learning ◽

High Risk ◽

Learning Algorithm ◽

Severe Disease ◽

High Specificity ◽

Population Level ◽

The United States ◽

Health Condition ◽

Available P ◽

Severe Illness

BACKGROUND In the wake of COVID-19, the United States has developed a three stage plan to outline the parameters to determine when states may reopen businesses and ease travel restrictions. The guidelines also identify subpopulations of Americans that should continue to stay at home due to being at high risk for severe disease should they contract COVID-19. These guidelines were based on population level demographics, rather than individual-level risk factors. As such, they may misidentify individuals at high risk for severe illness and who should therefore not return to work until vaccination or widespread serological testing is available. OBJECTIVE This study evaluated a machine learning algorithm for the prediction of serious illness due to COVID-19 using inpatient data collected from electronic health records. METHODS The algorithm was trained to identify patients for whom a diagnosis of COVID-19 was likely to result in hospitalization, and compared against four U.S policy-based criteria: age over 65, having a serious underlying health condition, age over 65 or having a serious underlying health condition, and age over 65 and having a serious underlying health condition. RESULTS This algorithm identified 80% of patients at risk for hospitalization due to COVID-19, versus at most 62% that are identified by government guidelines. The algorithm also achieved a high specificity of 95%, outperforming government guidelines. CONCLUSIONS This algorithm may help to enable a broad reopening of the American economy while ensuring that patients at high risk for serious disease remain home until vaccination and testing become available.

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COVID-19 in a Cohort of Patients with Congenital Myasthenic Syndrome

Journal of Neuromuscular Diseases ◽

10.3233/jnd-210699 ◽

2021 ◽

pp. 1-3

Author(s):

Setareh Alabaf ◽

Karen O'Connell ◽

Sithara Ramdas ◽

David Beeson ◽

Jacqueline Palace

Keyword(s):

High Risk ◽

Neuromuscular Transmission ◽

Genetic Disorders ◽

Severe Disease ◽

Congenital Myasthenic Syndrome ◽

Referral Centre ◽

History Of ◽

Myasthenic Syndrome ◽

The Uk ◽

Rare Group

Congenital Myasthenic Syndrome (CMS) are a rare group of genetic disorders of neuromuscular transmission. Some subtypes of CMS can be associated with respiratory and bulbar weakness and these patients may therefore be at high risk of developing a severe disease from COVID-19. We screened 73 patients with genetically confirmed CMS who were attending the UK national referral centre for evidence of previous Severe Acute Respiratory Syndrome Corona Virus 2 infection and their clinical outcome. Of 73 patients, seven had history of confirmed COVID-19. None of the infected patients developed a severe disease, and there were no signals that CMS alone carries a high risk of severe disease from COVID-19.

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491. Aerosol-Generating Medical Procedures: Transmission of SARS-CoV-2 and Emerging Viruses

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.684 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S312-S312

Author(s):

Seth D Judson ◽

Vincent J Munster

Keyword(s):

High Risk ◽

Severe Disease ◽

Experimental Studies ◽

Virus Transmission ◽

Nosocomial Transmission ◽

Medical Procedures ◽

Emerging Viruses ◽

Zoonotic Viruses ◽

Increased Risk ◽

Hospital Acquired

Abstract Background During the pandemic of coronavirus disease 2019 (COVID-19), many questions arose regarding risks for hospital-acquired or nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Aerosol generating medical procedures (AGMPs), techniques that can generate infectious, virus-laden aerosols, could potentially amplify transmission among healthcare workers (HCWs). Thus, it was widely recommended that HCWs use airborne precautions when performing AGMPs. However, in clinical settings it is often unclear what procedures constitute AGMPs and how the risk varies by procedure or pathogen. We set out to further define AGMPs and assess the risk for nosocomial transmission of SARS-CoV-2 and other high-risk viruses via AGMPs. Methods We identified potential AGMPs and emerging viruses that were high-risk for nosocomial transmission through reviewing experimental and clinical data. Potential AGMPs were those associated with previous virus transmission or mechanically capable of transmission. High-risk viruses were defined as those that cause severe disease in humans for which limited therapies or interventions exist, are infectious via aerosols in humans or non-human primates (NHPs), found in the respiratory tract of infected humans or NHPs, and had previous evidence of nosocomial transmission. Results We identified multiple potential AGMPs, which could be divided into those that generate aerosols or induce a patient to form aerosols, as well as eight families of high-risk viruses. All of the viruses were emerging zoonotic RNA viruses. In the family Coronaviridae, we identified potential evidence for SARS-CoV-1, MERS-CoV, and SARS-CoV-2 transmission via AGMPs. SARS-CoV-1 and SARS-CoV-2 were also found to be similarly stable when aerosolized. Conclusion Multiple emerging zoonotic viruses pose a high risk for nosocomial transmission through a variety of AGMPs. Given the similar stability of SARS-CoV-2 with SARS-CoV-1 when aerosolized and prior nosocomial transmission of SARS-CoV-1 via AGMPs, we suspect that certain AGMPs pose an increased risk for SARS-CoV-2 transmission. Additional experimental studies and on-site clinical sampling during AGMPs are necessary to further risk stratify AGMPs. Disclosures All Authors: No reported disclosures

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Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽

10.1007/s15010-021-01657-y ◽

2021 ◽

Author(s):

Johanna Koehler ◽

Barbara Ritzer ◽

Simon Weidlich ◽

Friedemann Gebhardt ◽

Chlodwig Kirchhoff ◽

...

Keyword(s):

High Risk ◽

Tertiary Care Hospital ◽

Severe Disease ◽

Treatment Options ◽

Tertiary Care ◽

Antibody Therapy ◽

Additional Treatment ◽

Care Hospital ◽

Cross Sectional ◽

Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

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Ethnic disparities in COVID-19: increased risk of infection or severe disease?

The Lancet ◽

10.1016/s0140-6736(21)01428-8 ◽

2021 ◽

Vol 398 (10298) ◽

pp. 389-390

Author(s):

Daniel Pan ◽

Christopher A Martin ◽

Joshua Nazareth ◽

Clareece R Nevill ◽

Jatinder S Minhas ◽

...

Keyword(s):

Severe Disease ◽

Ethnic Disparities ◽

Risk Of Infection ◽

Increased Risk

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The relative risk of noncervical high‐risk human papillomavirus‐related (pre)malignancies after recurrent cervical intraepithelial neoplasia grade 3: A population‐based study

International Journal of Cancer ◽

10.1002/ijc.32834 ◽

2019 ◽

Vol 147 (3) ◽

pp. 897-900 ◽

Cited By ~ 1

Author(s):

Diede L. Loopik ◽

Renée M. Ebisch ◽

Joanna IntHout ◽

Willem J. Melchers ◽

Leon F. Massuger ◽

...

Keyword(s):

Human Papillomavirus ◽

Relative Risk ◽

High Risk ◽

Cervical Intraepithelial Neoplasia ◽

Intraepithelial Neoplasia ◽

Population Based ◽

Cervical Intraepithelial Neoplasia Grade ◽

Population Based Study ◽

Grade 3

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Neutralizing Antibody Therapeutics for COVID-19

Viruses ◽

10.3390/v13040628 ◽

2021 ◽

Vol 13 (4) ◽

pp. 628

Author(s):

Aeron C. Hurt ◽

Adam K. Wheatley

Keyword(s):

High Risk ◽

Neutralizing Antibodies ◽

Controlled Trial ◽

Antiviral Treatment ◽

Severe Disease ◽

Neutralizing Antibody ◽

Supplemental Oxygen ◽

European Medicines Agency ◽

Global Public Health ◽

Public Health Burden

The emergence of SARS-CoV-2 and subsequent COVID-19 pandemic has resulted in a significant global public health burden, leading to an urgent need for effective therapeutic strategies. In this article, we review the role of SARS-CoV-2 neutralizing antibodies (nAbs) in the clinical management of COVID-19 and provide an overview of recent randomized controlled trial data evaluating nAbs in the ambulatory, hospitalized and prophylaxis settings. Two nAb cocktails (casirivimab/imdevimab and bamlanivimab/etesevimab) and one nAb monotherapy (bamlanivimab) have been granted Emergency Use Authorization by the US Food and Drug Administration for the treatment of ambulatory patients who have a high risk of progressing to severe disease, and the European Medicines Agency has similarly recommended both cocktails and bamlanivimab monotherapy for use in COVID-19 patients who do not require supplemental oxygen and who are at high risk of progressing to severe COVID-19. Efficacy of nAbs in hospitalized patients with COVID-19 has been varied, potentially highlighting the challenges of antiviral treatment in patients who have already progressed to severe disease. However, early data suggest a promising prophylactic role for nAbs in providing effective COVID-19 protection. We also review the risk of treatment-emergent antiviral resistant “escape” mutants and strategies to minimize their occurrence, discuss the susceptibility of newly emerging SARS-COV-2 variants to nAbs, as well as explore administration challenges and ways to improve patient access.

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