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

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

scholarly journals Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures

Viruses ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 940 ◽  
Author(s):  
Seth D. Judson ◽  
Vincent J. Munster
Keyword(s):  
Health Care ◽  
Ebola Virus ◽  
Viral Infections ◽  
Nipah Virus ◽  
Hemorrhagic Fever ◽  
Nosocomial Transmission ◽  
Medical Procedures ◽  
Emerging Viruses ◽  
Pathogenic Viruses ◽  
Infection Control Guidelines

Recent nosocomial transmission events of emerging and re-emerging viruses, including Ebola virus, Middle East respiratory syndrome coronavirus, Nipah virus, and Crimean–Congo hemorrhagic fever orthonairovirus, have highlighted the risk of nosocomial transmission of emerging viruses in health-care settings. In particular, concerns and precautions have increased regarding the use of aerosol-generating medical procedures when treating patients with such viral infections. In spite of increasing associations between aerosol-generating medical procedures and the nosocomial transmission of viruses, we still have a poor understanding of the risks of specific procedures and viruses. In order to identify which aerosol-generating medical procedures and emerging viruses pose a high risk to health-care workers, we explore the mechanisms of aerosol-generating medical procedures, as well as the transmission pathways and characteristics of highly pathogenic viruses associated with nosocomial transmission. We then propose how research, both in clinical and experimental settings, could advance current infection control guidelines.

scholarly journals Anthropogenic Ecological Changes and Spill Over of Viruses - A Review

2021 ◽  
Vol 16 (2) ◽  
pp. 594-599
Author(s):  
Monica Mahajan ◽  
Khushboo Bhardwaj
Keyword(s):  
Natural Environment ◽  
Anthropogenic Activities ◽  
Nipah Virus ◽  
Virus Transmission ◽  
Domestic Species ◽  
Human Contact ◽  
Zoonotic Viruses ◽  
Ecological Changes ◽  
Increased Risk ◽  
Wild Life

Biodiversity protects ecosystem against infectious diseases. Increased human contact with wild life have caused high impact diseases such as SARS, Novel Corona virus, Nipah Virus, Ebola fever and many more. Anthropogenic activities such as hunting, farming, human encroachments, wild life trade, introduction of domestic species, bush meat hunting, road building, mining and increased human wildlife contact rates have lead to massive decline in biodiversity and increased risk of spilling over of dangerous viruses from animals to humans primarily due to host shifts. Human preference to high meat diet is also on rise in many countries. Wet markets have significant contribution in amplifying epizootic virus transmission and increased human exposure. Species in the primate and bat orders harbor a number of zoonotic viruses. Our destruction of nature, loss of habitat and biodiversity possibly tend to promote viral emergence. Invasion of undisturbed places leads to more and more exposure and create habitat where viral transmission is easier. Interference with a natural environment/habitat can, therefore, worsen the health risks. The erosion of biodiversity may lead to proliferation of species that are most likely to transmit new diseases to humans. Preserving habitat, biodiversity and natural environment is therefore one of the essential issues that cannot be put at the back any more.

scholarly journals Management of pregnant women in times of COVID-19 our experience from Kashmir valley

2021 ◽  
Vol 10 (4) ◽  
pp. 1379
Author(s):  
Syed Naseer ◽  
Syed Uzma Andrabi ◽  
Syed Ishfa Andrabi ◽  
Humaira Tabasum
Keyword(s):  
Pregnant Women ◽  
Severe Disease ◽  
Virus Transmission ◽  
Safe Motherhood ◽  
Normal Vaginal Delivery ◽  
Global Public Health ◽  
Transmission Potential ◽  
Medical College ◽  
Global Pandemic ◽  
Increased Risk

Background: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, is a global public health emergency. COVID-19 is a rapidly evolving situation, and there is limited data reporting its impact on pregnant women. Our study aimed to find the symptomatology, clinical courses and outcome of pregnant women with COVID-19 and to assess the vertical transmission potential of COVID-19 in pregnancy.Methods: This prospective observational study was conducted at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Medical College, Department of Gynaecology and obstetrics, Srinagar from May 2020 to September 2020. All COVID-19 positive pregnant patients admitted in our institution were included in our study.Results: The study included 100 Covid-19 positive pregnant women. Most of them were between 30 to 40 years of age. Median gestational age was 32.8 weeks. Comorbidity was present in 18 of our patients. 7 patients had gestational diabetes and 1 with overt diabetes, 5 were hypertensive, 3 had hypothyroidism, 1 with anti-phospholipid antibody syndrome (APLA) and 1 with asthma.44 patients were primigravidae and 56 were multigravidae. 27 patients delivered preterm and 44 with term pregnancy. 47 had undergone caesarean section and 24 normal vaginal delivery.88% of our patients were asymptomatic for covid-19 disease while as 12 patients had Covid-19 disease symptoms. The main complaints reported by patients related to covid-19 disease was mild dry cough and fever (9%). Two patients developed severe covid-19 pneumonia with ARDS and were put on ventilator, expired after 20 days of illness. All neonates were subjected to RT-PCR with none producing positive results.Conclusions: Appropriate and timely management of Covid-19 positive pregnant women is a principle for safe motherhood and healthy offspring in times of global pandemic. The present data do not suggest an increased risk of severe disease among pregnant women. We encourage the breast feeding immediately after delivery as benefits overweigh any potential risks of virus transmission if any.

scholarly journals A Novel Cohorting and Isolation Strategy for Suspected COVID-19 Cases during a Pandemic

2020 ◽  
Author(s):  
Benjamin Patterson ◽  
Michael Marks ◽  
Gemma Martinez-Garcia ◽  
Gabriella Bidwell ◽  
Akish Luintel ◽  
...  
Keyword(s):  
High Risk ◽  
Severe Disease ◽  
Risk Groups ◽  
Low Risk ◽  
Infection Prevention And Control ◽  
High Likelihood ◽  
Patients At Risk ◽  
Risk Patients ◽  
Hospital Acquired ◽  
And Control

Introduction The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem. Methods We implemented a triage tool aimed at minimising hospital acquired COVID-19 particularly to patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (low-likelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in single-occupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission. Results 93 patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. 28 (30%) suspected COVID-19 patients were evaluated to be low risk (groups C & D) and eligible for cohorting. No symptomatic hospital acquired infections were detected in the cohorted patients. Discussion Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease.

Abstract 3651: Reducing Incidence of Hospital Acquired Pneumonia After Acute Stroke Through Implementation Of Simple Bedside Swallow Assessment

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Catherine J Videtto ◽  
Mary Jane Finnegan
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Acute Stroke ◽  
Stroke Care ◽  
Nursing Interventions ◽  
Stroke Patients ◽  
Increased Risk ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Simple Bedside

The incidence of hospital-acquired pneumonia (HAP) has been estimated to occur in acute stroke patients with rates reported as high as approximately 10 - 25%. Mechanical ventilation, multiple infarct locations, dysphagia and abnormal chest x-ray findings all contribute to increased risk for dysphagia and ultimately development of pneumonia. Because fatality rates of 20 - 45% have been reported in HAP, stroke care nurses are urged to comply with guidelines recommending implementation of simple bedside swallow assessments to identify high risk patients and institute appropriate nursing interventions to avoid development of the potentially fatal complication of stroke related pneumonia. A retrospective review of 493 patients admitted to the stroke service of a community hospital was performed to determine incidence of hospital acquired pneumonia in acute stroke patients. The sample of patients were admitted through the emergency department and depending on the severity of stroke, were admitted to either an ICU or step-down unit bed. The simple bedside swallow screen was completed by an emergency department nurse. The patient was not allowed anything by mouth until the assessment was completed. If the assessment revealed the patient had a competent level of cognition, ability to adequately handle secretion in a sitting position, and maintain a venous pulse oxygenation of greater than 94%, the patient was asked to swallow three sequential one ounce medicine cups of water. If coughing, choking, drooling, or oxygen desaturation was assessed, the patient was maintained nothing by mouth until a formal swallow evaluation was completed by a speech therapist. During the period of 1/1/09 - 7/30/11, this hospital’s annual incidence of HAP in the post stroke patient was found to be significantly less than nationally published incidence. The diagnosis of HAP was based upon Center for Disease Control Guidelines for Hospital-Acquired Pneumonia. The patients reported as developing HAP met the criteria of having a primary discharge of stroke and a secondary discharge diagnosis of hospital acquired pneumonia. This community hospital’s mean incidence of hospital acquired pneumonia over the total 31 month study period was 3.6%. A simple bedside swallow screen performed by competent emergency department nurses to detect swallowing difficulty quickly and accurately in stroke patients prior to administering anything by mouth, has achieved the goal of identifying patients at high risk for dysphagia and avoiding the potential complication of hospital acquired pneumonia.

cases, have been from Western Australia, with a further thirteen cases from the Northern Territory. It is also interesting to note that the first confirmed case of encephalitis due to Kunjin virus occurred in Western Australia in 1978, and three additional cases have been diagnosed since, two from Western Australia in 1991 and 1995, and one in Victoria in 1984 (Table 8.1). Most of the cases of Australian encephalitis in Western Australia have occurred in areas distant from the Ord River irrigation area. Of particular significance was the spread of MVE virus from the Kimberley area south to the Pilbara and Gascoyne regions causing one case of encephalitis in 1978 and three cases in 1981. It is hypothesized that movement of virus to the Pilbara region in 1978 was due to an increase in viral activity in the West Kimberley area following heavy rainfall and flooding, and that with subsequent extensive cyclonic rainfall in the Pilbara region, viraemic waterbirds moved south down the narrow coastal strip, introducing the virus into Pilbara (Stanley 1979). It is probable that a similar mechanism may have occurred in 1981. Although there has been evidence (see next section), of MVE virus activity in the Pilbara region in recent years, there have been no further cases. Analysis of the cases of Australian encephalitis has indicated that Aboriginal infants, particularly male infants, are most at risk of fatal or severe disease (Mackenzie et al. 1993a). However, tourists and visitors to the Kimberley region (and Northern Territory) have also been shown to have an increased risk of disease. Sentinel chicken surveillance Following the 1978 outbreak of Australian encephalitis, a number of sentinel chicken flocks were established in the Kimberley area. Six flocks had been established by 1981 and the number rose to twenty-four flocks in twenty-two regional centres in the Kimberley, Pilbara and Gascoyne regions by 1989 (Broom et al. 1989; Mackenzie et al. 1992; 1994c). Each flock contains twelve chickens which are bled at two weekly intervals between November and June, the period of increased risk of virus transmission, and monthly at other times. The sera are then assayed for antibody to MVE and Kunjin viruses in our laboratory in Perth to provide an early warning system of increased virus activity. Initially sera were tested by HI for the presence of antibody, and positive sera were then subjected to neutralization assay to determine the identity of the infecting virus. A more rapid enzyme-linked immunosorbent assay (ELISA) was introduced in 1986 (Broom et al. 1987), and more recently a competitive ELISA using specific monoclonal antibodies to identify the virus is being used (Hall et al. 1992; 1995). Sentinel chicken flocks were also established in 1992 in the Northern Territory to monitor MVE activity (Aldred et al. 1992). The sentinel chicken programme has clearly shown that MVE virus is enzootic in several areas of the Kimberley region, particularly in the Ord River area at Kununurra. Seroconversions in sentinel chickens occur every year during the latter half of the wet season

1998 ◽  
pp. 131-131
Keyword(s):  
Western Australia ◽  
Severe Disease ◽  
Virus Transmission ◽  
Warning System ◽  
Neutralization Assay ◽  
Northern Territory ◽  
Enzyme Linked Immunosorbent Assay ◽  
Wet Season ◽  
Virus Activity ◽  
Increased Risk

scholarly journals 1196. A Multi-faceted, Iterative Program to Increase COVID-19 Vaccine Uptake in a Midwestern HIV Clinic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S688-S689
Author(s):  
Sara H Bares ◽  
Rachelle Carr ◽  
Samantha L Jones ◽  
Nichole N Regan ◽  
Valentina Orduna ◽  
...  
Keyword(s):  
High Risk ◽  
Task Force ◽  
Severe Disease ◽  
High Risk Patient ◽  
Vaccine Uptake ◽  
Poverty Level ◽  
Research Support ◽  
Increased Risk ◽  
Vaccine Completion ◽  
The University

Abstract Background The National Institutes of Health Office of AIDS Research recommend that patients with HIV be prioritized for COVID-19 vaccination due to high rates of co-morbidities and sociodemographic risk factors that place them at increased risk for severe disease. However, COVID-19 vaccines were not distributed specifically to those in high-risk medical categories in Nebraska, and HIV clinics were not included in the state’s COVID-19 vaccine delivery system. As a result, barriers to vaccine uptake emerged and interventions to mitigate them were needed. Methods A multi-faceted and iterative program aimed at improving COVID-19 vaccine uptake was implemented at the University of Nebraska Medical Center’s (UNMC) HIV clinic in Omaha, Nebraska in January 2021. A multidisciplinary task force was established in late January 2021 and met on a weekly basis to provide staff and patient education, linkage to vaccines, and review and analysis of vaccine completion rates as shown in the figure. Outreach interventions were continuously revised based on patient and staff feedback as well as updated data and vaccine availability. Multidisciplinary COVID-19 Task Force Overview Overview of the outreach interventions and activities conducted by the COVID-19 task force Results All 1188 patients of the UNMC HIV clinic were ultimately eligible for the COVID-19 vaccine, but availability was on a rolling basis by age group, profession, county, and, ultimately, co-morbidities. 76% were male, 45.8% non-white, median age 48, and 73% had income less than 400% of federal poverty level. Of the 1188 eligible patients, 63.1% (n=751) had received at least one dose the COVID-19 vaccine and 59.3% (n=705) had completed the COVID-19 vaccine series by June 4, 2021. In comparison, 49.32% of the population of the state of Nebraska had initiated the COVID-19 vaccine series and 43.12% had completed the vaccine series by that date. Among our clinic patients, 27.9% (n=261) of those who had received at least one vaccine were assisted by our task force. 4.5% were noted to have a potential barrier at the time of outreach and these included hesitancy (3.5%), language (1.2%) and transportation (0.9%). Conclusion A multi-faceted and iterative program to improve COVID-19 vaccine uptake in a high-risk patient population resulted in high rates of vaccine completion. Disclosures Sara H. Bares, MD, Gilead Sciences (Grant/Research Support)Janssen (Grant/Research Support)ViiV Healthcare (Grant/Research Support)

scholarly journals Common genetic variants identify therapeutic targets for COVID-19 and individuals at high risk of severe disease

2020 ◽  
Author(s):  
Julie E. Horowitz ◽  
Jack A. Kosmicki ◽  
Amy Damask ◽  
Deepika Sharma ◽  
Genevieve H. L. Roberts ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Genetic Variants ◽  
Severe Disease ◽  
Therapeutic Targets ◽  
Common Genetic Variants ◽  
Increased Risk ◽  
Genetic Burden

The need to identify and effectively treat COVID-19 cases at highest risk for severe disease is critical. We identified seven common genetic variants (three novel) that modulate COVID-19 susceptibility and severity, implicating IFNAR2, CCHCR1, TCF19, SLC6A20 and the hyaluronan pathway as potential therapeutic targets. A high genetic burden was strongly associated with increased risk of hospitalization and severe disease among COVID-19 cases, especially among individuals with few known risk factors.

scholarly journals Effect of the Neutralizing SARS-CoV-2 Antibody Sotrovimab in Preventing Progression of COVID-19: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Anil Gupta ◽  
Yaneicy Gonzalez-Rojas ◽  
Erick Juarez ◽  
Manuel Crespo ◽  
Jaynier Moya ◽  
...  
Keyword(s):  
High Risk ◽  
Emergency Room ◽  
Severe Disease ◽  
Neutralizing Antibody ◽  
Supplemental Oxygen ◽  
Secondary Outcome ◽  
Effective Treatment Option ◽  
Double Blind ◽  
Increased Risk ◽  
High Flow Oxygen

Importance: Older patients and those with underlying comorbidities infected with SARS-CoV-2 may be at increased risk of hospitalization and death from COVID-19. Sotrovimab is a neutralizing antibody designed for treatment of high-risk patients to prevent COVID-19 progression. Objective: To evaluate the efficacy and safety of sotrovimab in preventing progression of mild to moderate COVID-19 to severe disease. Design: Randomized, double-blind, multicenter, placebo-controlled, phase 3 study. Setting: 57 centers in 5 countries. Participants: Nonhospitalized patients with symptomatic, mild to moderate COVID-19 and at least 1 risk factor for disease progression. Intervention: Patients were randomized (1:1) to an intravenous infusion of sotrovimab 500 mg or placebo. Main Outcomes and Measures: The primary efficacy outcome was the proportion of patients with COVID-19 progression, defined as all-cause hospitalization longer than 24 hours for acute illness management or death through day 29. Key secondary outcomes included the proportion of patients with COVID-19 progression, defined as emergency room visit, hospitalization of any duration, or death, and proportion of patients developing severe/critical respiratory COVID-19 requiring supplemental oxygen. Results: Among 1057 patients randomized (sotrovimab, 528; placebo, 529), all-cause hospitalization longer than 24 hours or death was significantly reduced with sotrovimab (6/528 [1%]) vs placebo (30/529 [6%]) by 79% (95% CI, 50% to 91%; P<.001). Secondary outcome results further demonstrated the effect of sotrovimab in reducing emergency room visits, hospitalization of any duration, or death, which was reduced by 66% (95% CI, 37% to 81%; P<.001), and severe/critical respiratory COVID-19, which was reduced by 74% (95% CI, 41% to 88%; P=.002). No patients receiving sotrovimab required high-flow oxygen, oxygen via nonrebreather mask, or mechanical ventilation compared with 14 patients receiving placebo. The proportion of patients reporting adverse events was similar between treatment groups; sotrovimab was well tolerated, and no safety concerns were identified. Conclusions and Relevance: Among nonhospitalized patients with mild to moderate COVID-19, a single 500-mg intravenous dose of sotrovimab prevented progression of COVID-19, with a reduction in hospitalization and need for supplemental oxygen. Sotrovimab is a well-tolerated, effective treatment option for patients at high risk for severe morbidity and mortality from COVID-19.

Contraception and thrombophilia

2009 ◽  
Vol 29 (02) ◽  
pp. 193-196 ◽  
Author(s):  
H. Rott ◽  
A. Kruempel ◽  
G. Kappert ◽  
U. Nowak-Göttl ◽  
S. Halimeh
Keyword(s):  
Chronic Illness ◽  
High Risk ◽  
Children And Adolescents ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
Thromboembolic Events ◽  
Contraceptive Methods ◽  
Secondary Complications ◽  
Increased Risk ◽  
Coagulation Proteins

SummaryThe risk of thromboembolic events (TE) is increased by acquired or inherited thrombo -philias (IT). We know that some hormonal contraceptives also increase the risk of thrombosis, thus, the use of such contraceptives are discussed as contraindications in women with IT. TEs are infrequent events in children and adolescents and in the majority of cases are associated with secondary complications from underlying chronic illness. Although adolescents are not typically considered to be at high-risk for TE, this cohort is frequently using hormonal contraception, leading to an increased risk in cases with unknown IT. The risk of TE with pregnancy alone is higher than associated with combined hormonal contra -ception. Progestin-only methods have not been found to increase the risk of TE with only moderate changes of coagulation proteins compared to normal reference values. Conclusion: Thrombophilic women are good candidates for progestin-only contraceptive methods.

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