scholarly journals Segmentation and shielding of the most vulnerable members of the population as elements of an exit strategy from COVID-19 lockdown

2020 ◽  
Author(s):  
Bram A.D. van Bunnik ◽  
Alex L.K. Morgan ◽  
Paul R. Bessell ◽  
Giles Calder-Gerver ◽  
Feifei Zhang ◽  
...  
Keyword(s):  
General Population ◽  
Vulnerable Population ◽  
Infection Prevention And Control ◽  
Close Monitoring ◽  
Transmission Rates ◽  
Epidemic Curve ◽  
Population Immunity ◽  
Public Health Initiative ◽  
Potential Applications ◽  
Future Policy

AbstractIn this study we demonstrate that the adoption of a segmenting and shielding (S&S) strategy could increase scope to partially exit COVID-19 lockdown while limiting the risk of an overwhelming second wave of infection.The S&S strategy has an antecedent in the “cocooning” of infants by immunisation of close family members (Forsyth et al., 2015), and forms a pillar of infection, prevention and control (IPC) strategies (RCN, 2017). We are unaware of it being proposed as a major public health initiative previously.We illustrate the S&S strategy using a mathematical model that segments the vulnerable population and their closest contacts, the “shielders”. We explore the effects on the epidemic curve of a gradual ramping up of protection for the vulnerable population and a gradual ramping down of restrictions on the non-vulnerable population over a period of 12 weeks after lockdown.The most important determinants of outcome are: i) post-lockdown transmission rates within the general population segment and between the general and vulnerable segments; ii) the fraction of the population in the vulnerable and shielder segments; iii) adherence with need to be protected; and iv) the extent to which population immunity builds up in all segments.We explored the effects of extending the duration of lockdown and faster or slower transition to post-lockdown conditions and, most importantly, the trade-off between increased protection of the vulnerable segment and fewer restrictions on the general population.We illustrate how the potential for the relaxation of restrictions interacts with specific policy objectives. We show that the range of options for relaxation in the general population can be increased by maintaining restrictions on the shielder segment and by intensive routine screening of shielders.We find that the outcome of any future policy is strongly influenced by the contact matrix between segments and the relationships between physical distancing measures and transmission rates. These relationships are difficult to quantify so close monitoring of the epidemic would be essential during and after the exit from lockdown.More generally, S&S has potential applications for any infectious disease for which there are defined proportions of the population who cannot be treated or who are at risk of severe outcomes.

scholarly journals Segmentation and shielding of the most vulnerable members of the population as elements of an exit strategy from COVID-19 lockdown

2021 ◽  
Vol 376 (1829) ◽  
pp. 20200275
Author(s):  
Bram A. D. van Bunnik ◽  
Alex L. K. Morgan ◽  
Paul R. Bessell ◽  
Giles Calder-Gerver ◽  
Feifei Zhang ◽  
...  
Keyword(s):  
General Population ◽  
Protective Measures ◽  
Transmission Rates ◽  
Population Immunity ◽  
Contact Matrix ◽  
Potential Applications ◽  
Pandemic Response ◽  
Future Policy ◽  
The Uk ◽  
Second Wave

This study demonstrates that an adoption of a segmenting and shielding strategy could increase the scope to partially exit COVID-19 lockdown while limiting the risk of an overwhelming second wave of infection. We illustrate this using a mathematical model that segments the vulnerable population and their closest contacts, the ‘shielders’. Effects of extending the duration of lockdown and faster or slower transition to post-lockdown conditions and, most importantly, the trade-off between increased protection of the vulnerable segment and fewer restrictions on the general population are explored. Our study shows that the most important determinants of outcome are: (i) post-lockdown transmission rates within the general and between the general and vulnerable segments; (ii) fractions of the population in the vulnerable and shielder segments; (iii) adherence to protective measures; and (iv) build-up of population immunity. Additionally, we found that effective measures in the shielder segment, e.g. intensive routine screening, allow further relaxations in the general population. We find that the outcome of any future policy is strongly influenced by the contact matrix between segments and the relationships between physical distancing measures and transmission rates. This strategy has potential applications for any infectious disease for which there are defined proportions of the population who cannot be treated or who are at risk of severe outcomes. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

scholarly journals Circulating Noncoding RNAs Have a Promising Future Acting as Novel Biomarkers for Colorectal Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Jia-jun Wang ◽  
Xin Wang ◽  
Yong-xi Song ◽  
Jun-hua Zhao ◽  
Jing-xu Sun ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
General Population ◽  
Malignant Tumors ◽  
Noncoding Rnas ◽  
Screening Methods ◽  
Potential Applications ◽  
Novel Biomarkers ◽  
Noninvasive Biomarkers ◽  
Regulatory Functions ◽  
Resistance To Chemotherapy

Colorectal cancer (CRC) is one of the most common malignant tumors worldwide, causing a large number of cancer-related deaths each year. Patients are usually diagnosed at advanced and incurable stages due to the lack of suitable screening methods for early detection. Noncoding RNAs (ncRNAs), including small and long noncoding RNAs (lncRNA), are known to have significant regulatory functions, and accumulating evidence suggests that circulating ncRNAs have potential applications as noninvasive biomarkers for diagnosing CRC, evaluating its prognosis, or predicting chemosensitivity in the general population. In this review, we summarize the origins of circulating ncRNAs and provide details of single and multiple circulating ncRNAs that might have roles as diagnostic and prognostic biomarkers in CRC. We end by discussing circulating ncRNAs that may distinguish patients with resistance to chemotherapy.

scholarly journals Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study

2021 ◽  
pp. 1-8
Author(s):  
Rebecca Musgrove ◽  
Matthew J. Carr ◽  
Nav Kapur ◽  
Carolyn A. Chew-Graham ◽  
Faraz Mughal ◽  
...  
Keyword(s):  
Older Adults ◽  
General Population ◽  
Cumulative Incidence ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Close Monitoring ◽  
Post Discharge ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Working Age

Background Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. Aims To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge. Method Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001–2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18–64 and ≥65 years with additional stratification by gender and practice-level deprivation. Results The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0–2.3) and 14.1% (95% CI 13.6–14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0–292.0) among working-age adults and 125.4 (95% CI 52.6–298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation. Conclusions Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.

scholarly journals Global certification of wild poliovirus eradication: insights from modelling hard-to-reach subpopulations and confidence about the absence of transmission

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023938 ◽  
Author(s):  
Radboud J Duintjer Tebbens ◽  
Dominika A Kalkowska ◽  
Kimberly M Thompson
Keyword(s):  
General Population ◽  
Endemic Equilibrium ◽  
Single Infection ◽  
Susceptible Population ◽  
Wild Poliovirus ◽  
Population Immunity ◽  
Trade Offs ◽  
Time Required ◽  
Endemic Transmission ◽  
Different Characteristics

ObjectiveTo explore the extent to which undervaccinated subpopulations may influence the confidence about no circulation of wild poliovirus (WPV) after the last detected case.Design and participantsWe used a hypothetical model to examine the extent to which the existence of an undervaccinated subpopulation influences the confidence about no WPV circulation after the last detected case as a function of different characteristics of the subpopulation (eg, size, extent of isolation). We also used the hypothetical population model to inform the bounds on the maximum possible time required to reach high confidence about no circulation in a completely isolated and unvaccinated subpopulation starting either at the endemic equilibrium or with a single infection in an entirely susceptible population.ResultsIt may take over 3 years to reach 95% confidence about no circulation for this hypothetical population despite high surveillance sensitivity and high vaccination coverage in the surrounding general population if: (1) ability to detect cases in the undervaccinated subpopulation remains exceedingly small, (2) the undervaccinated subpopulation remains small and highly isolated from the general population and (3) the coverage in the undervaccinated subpopulation remains very close to the minimum needed to eradicate. Fully-isolated hypothetical populations of 4000 people or less cannot sustain endemic transmission for more than 5 years, with at least 20 000 people required for a 50% chance of at least 5 years of sustained transmission in a population without seasonality that starts at the endemic equilibrium. Notably, however, the population size required for persistent transmission increases significantly for realistic populations that include some vaccination and seasonality and/or that do not begin at the endemic equilibrium.ConclusionsSignificant trade-offs remain inherent in global polio certification decisions, which underscore the need for making and valuing investments to maximise population immunity and surveillance quality in all remaining possible WPV reservoirs.

Maternal and Neonatal Outcomes in Pregnant Women with Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis

Rheumatology ◽  
2021 ◽  
Author(s):  
Wenhui Xie ◽  
Hong Huang ◽  
Lanlan Ji ◽  
Zhuoli Zhang
Keyword(s):  
Psoriatic Arthritis ◽  
General Population ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Meta Analysis ◽  
Clinical Status ◽  
Maternal Outcomes ◽  
Close Monitoring ◽  
Adverse Pregnancy

Abstract Objective Psoriasis and psoriatic arthritis (PsA) are inflammatory diseases that affect women in their reproductive years. We aimed to investigate whether maternal psoriasis and PsA are associated with adverse pregnancy outcomes. Methods We searched multiple electronic databases from inception to 3 August 2020, and reference lists of selected articles. Observational studies reporting at least one pregnancy outcomes in women with psoriasis or PsA with a comparator of general population or healthy subjects were included. Data were pooled by random-effects models and expressed as odds ratio (OR) and 95% confidence interval (CI). Results Overall, 16 studies were included in the meta-analysis. The pooled analyses showed pregnant women with psoriatic diseases have significantly higher risk of adverse maternal outcomes compared with general population (caesarean delivery: 1.33 (1.17-1.52); preterm birth: 1.32 (1.15-1.52); (pre)eclampsia: 1.28 (1.14-1.43); gestational diabetes: 1.19 (1.10-1.30); gestational hypertension: 1.30 (1.18-1.44). However, no statistically increased risks of fetal complications were observed in women with psoriatic diseases (small for gestational age: 1.02 (0.93-1.11); low birth weight: 1.15 (0.93-1.42); congenital malformations: 1.03 (0.93-1.14); Apgar score <7: 1.07 (0.81-1.39); neonatal mortality: 1.13 (0.90-1.43); stillbirth: 1.19 (0.95-1.50)). Subgroup analysis found similar results in women with either psoriasis or PsA regarding maternal outcomes and the magnitude of risk estimates seems to be greater in PsA though without statistical difference. Conclusions Pregnant women with psoriasis and PsA have excess risk of adverse maternal events, but not adverse neonatal events. Close monitoring of the mothers’ clinical status before and during pregnancy is decidedly required in daily practice.

Diphtheria Immunity in Australia: Should we be Concerned?

2020 ◽  
Vol 20 (3) ◽  
pp. 323-329
Author(s):  
Xinting Lu ◽  
Helen E. Quinn ◽  
Rob I. Menzies ◽  
Linda Hueston ◽  
Lyn Gilbert ◽  
...  
Keyword(s):  
Age Groups ◽  
International Travel ◽  
Close Monitoring ◽  
Current Policy ◽  
Population Immunity ◽  
School Based ◽  
Meningococcal Group ◽  
Antibody Levels ◽  
The Impact ◽  
Protective Threshold

Objective: We report the results of the 2007 national serological survey of immunity to diphtheria in Australia to assess the impact of recent schedule changes on diphtheria immunity, and the adequacy of current policy in the context of increased international travel of people and pathogens. Methods: Residual sera (n =1656) collected opportunistically from Australian laboratories in 2007 were tested for diphtheria antibody levels using an enzyme immunoassay, with the protective threshold defined as ≥0.1 IU/mL. About 40% of adults aged ≥30 years are susceptible to diphtheria; following the removal of the 18-month booster and its replacement with a dose in adolescence offered through school-based dTpa vaccination program, 59% of children aged 3 years were susceptible to diphtheria, whilst adolescents demonstrated improved immunity. Results: There is no apparent boosting of diphtheria immunity from meningococcal group C conjugate (MCC) or seven-valent pneumococcal conjugate (7vPCV) vaccines in relevant age groups. Conclusion: Australians who travel to diphtheria-endemic areas should be up-to-date with their vaccinations. Close monitoring of population immunity levels against diphtheria remains important to ensure that immunity does not decline to a level where wide-spread transmission would be possible.V

scholarly journals 459. Outcomes and Factors Associated with a SARS-CoV-2 Positive Test in Asymptomatic and Symptomatic Healthcare Workers of a Mexican Hospital Converted to Treat COVID-19 Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Sandra Rajme-López ◽  
Patricia E Leal-Morán ◽  
Fernanda Gonzalez-Lara ◽  
Abril T Vargas-Fernández ◽  
Eric Ochoa-Hein ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Face Mask ◽  
Lower Percentage ◽  
Infection Prevention And Control ◽  
Surveillance Program ◽  
Median Hospital Stay ◽  
Factors Associated ◽  
Epidemic Curve ◽  
And Control

Abstract Background Starting on 03/16/2020, the hospital was converted to attend only patients with COVID-19. A surveillance program for healthcare workers (HCWs) that included free in-site medical consultation and RT-PCR for detection of SARS-CoV-2 was initiated. On 04/28/2020, screening of HCWs was started to detect asymptomatic carriers. We report the results of such programs updated to 05/21/2020. Methods Sex, worker category, working area, use of personal protective equipment, date of screening, date of onset of symptoms and home address were retrieved from electronic databases. Logistic regression was done to identify factors associated with being a COVID-19 case or carrier, with p< 0.05 being significant. Odds ratios and incidence densities were calculated. Results Of 2566 HCWs in the hospital, 976 (38.0%) underwent screening and 41 (4.2%) were positive for SARS-CoV-2 (7.4 carriers x 10,000 person-days; median follow-up of 55.5 days); none of the latter were diagnosed with COVID-19 after completing a 14-day follow-up. Of HCWs with negative screen results, 6 (0.6%) ultimately developed COVID-19 after a median of 10 days (1.1 cases x 10,000 person-days). Of 232 symptomatic HCWs that did not undergo basal screening, 131 (56.5%) were diagnosed with COVID-19 (8.8 cases x 10,000 person-days). Ten COVID-19 cases (7.6%) were hospitalized and all were discharged without complications after a median hospital stay of 9 days. Factors associated with COVID-19 were working in a non-clinical area (OR=9.3, 95% CI=1.1–78.6) and being a nurse (OR=1.9, 95% CI=1.1–3.4). Factors associated with being a carrier were living in the State of Mexico (OR=3.7, 95% CI=1.8–8.0) and being a hospital cook (OR=3.7, 95% CI=1.7–8.5). Being a physician was associated with not being a carrier (OR=0.07, 95% CI=0.01–0.5). Wearing a face mask at all times tended to be associated with not being a carrier. Hospital epidemic curves closely ressembled those of the community (Mexico City). Hospital Epidemic Curve, 03/16/2020 - 05/21/2020 Conclusion This study suggests that factors present inside and outside of the hospital are associated with COVID-19 and asymptomatic carriage in HCWs. This information is of utmost importance for infection prevention and control policies. Additionally, a lower percentage of severe cases and no deaths were observed in this cohort as compared to others. Disclosures All Authors: No reported disclosures

scholarly journals Burden, risk assessment, surveillance and management of SARS-CoV-2 infection in health workers: a scoping review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Federica Calò ◽  
Antonio Russo ◽  
Clarissa Camaioni ◽  
Stefania De Pascalis ◽  
Nicola Coppola
Keyword(s):  
Risk Assessment ◽  
Prevention And Control ◽  
Health Workers ◽  
Hospital Setting ◽  
Infection Risk ◽  
Infection Prevention And Control ◽  
Close Monitoring ◽  
Increased Risk ◽  
Exposure Prophylaxis ◽  
And Control

Abstract Background Health workers (HWs) are at increased risk for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and a possible source of nosocomial transmission clusters. Despite the increased risk, the best surveillance strategy and management of exposed HWs are not yet well known. The aim of this review was to summarize and critically analyze the existing evidence related to this topic in order to support public health strategies aimed at protecting HWs in the hospital setting. Main text A comprehensive computerized literature research from 1 January 2020 up to 22 May 2020 was made to identify studies analyzing the burden of infection, risk assessment, surveillance and management of HWs exposed to SARS-CoV-2. Among 1623 citation identified using MEDLINE, Embase, Google Scholar and manual search, we included 43 studies, 14 webpages and 5 ongoing trials. Health workers have a high risk of acquiring infection while caring for coronavirus disease 2019 (COVID-19) patients. In particular, some types exposures and their duration, as well as the inadequate or non-use of personal protective equipment (PPE) are associated with increased infection risk. Strict infection prevention and control procedures (IPC), adequate training programs on the appropriate use of PPE and close monitoring of HWs with symptom surveillance and testing are essential to significantly reduce the risk. At the moment there is not enough evidence to provide precise indications regarding pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Conclusions During the spread of COVID-19 outbreak, numerous published papers investigated the epidemiology, risk assessment and prevention and control of SARS-CoV-2. However, more high-quality studies are needed to provide valid recommendations for better management and for the clinical and microbiological surveillance of healthcare personnel.

scholarly journals A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. M. van Niekerk ◽  
A. Stein ◽  
M. H. E. Doting ◽  
M. Lokate ◽  
L. M. A. Braakman-Jansen ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Hospital Ward ◽  
Infection Prevention And Control ◽  
Transmission Rates ◽  
Occupation Group ◽  
Frequency Identification ◽  
Hygiene Compliance

Abstract Background Hand transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against these transmissions is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on hand transmission and spread of these microorganisms for varying hand hygiene compliance levels are unknown. This study aims to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the hand transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group. Methods Spatiotemporal data were collected in a hospital ward of an academic hospital using radio frequency identification technology for 7 days. A potential super-spreader healthcare worker occupation group was identified using the frequency identification sensors’ contact data. The effects of five probability distributions of hand hygiene compliance and three harmful microorganism transmission rates were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk outcomes. Results Nurses, doctors and patients are together responsible for 81.13% of all contacts. Nurses made up 70.68% of all contacts, which is more than five times that of doctors (10.44%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonised nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 98.4 min of visiting 23 rooms while colonised. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm – 7 am) and weekends as compared to weekdays (7 am – 5 pm). Conclusion Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of hand transmissions and spread of harmful microorganisms by super-spreaders in a closed healthcare setting. These insights can be used to evaluate spatiotemporal safety behaviours and develop infection prevention and control strategies.

scholarly journals Determinants of COVID-19 Mortality in Patients With Cancer From a Community Oncology Practice in Brazil

2021 ◽  
pp. 46-55
Author(s):  
Bruno L. Ferrari ◽  
Carlos Gil Ferreira ◽  
Márcia Menezes ◽  
Pedro De Marchi ◽  
Jorge Canedo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
General Population ◽  
Metastatic Disease ◽  
Recursive Partitioning ◽  
Smoking History ◽  
Close Monitoring ◽  
Patients With Cancer ◽  
Multivariable Logistic Regression ◽  
Community Oncology ◽  
Oncology Practice

PURPOSE The COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America. MATERIALS AND METHODS A longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population. RESULTS From March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting ( P < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease. CONCLUSION Mortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.

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