scholarly journals Comprehensive analysis of the key epidemiological parameters to evaluate the impact of BCG vaccination on COVID-19 pandemic

2020 ◽  
Author(s):  
Niloy R Datta ◽  
Sneha Datta
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Population Density ◽  
Event Rate ◽  
Case Fatality ◽  
High Risk Population ◽  
Bcg Vaccination ◽  
Incidence And Mortality ◽  
The Impact ◽  
Epidemiological Parameters

Globally, the heterogenous coronavirus disease 2019 (COVID-19) case fatality rate (CFR) could be influenced by various epidemiological parameters. Identifying these could help formulate effective public health strategies. Incidence and mortality of COVID-19 for each of the 220 countries as on July 30, 2020 were evaluated against key epidemiological variables, namely - BCG vaccination (ongoing vs. discontinued/never undertaken), %population aged ≥65 years, incidences of ischemic heart disease (IHD), hypertensive heart disease (HHD), cancer, malaria, and diabetes; human development index (HDI) and population density. These were retrieved from the public domains of WHO, UN, World Bank and published reports. The COVID-19 CFRs ranged between 0.0% and 28.3% (mean ± SD: 3.05% ± 3.48). The influence of the individual epidemiological parameters on CFR were evaluated through the event rate estimations. A significantly lower event rate was observed in countries with ongoing BCG vaccination program (ER: with vs without ongoing BCG vaccination: 0.020 vs 0.034, p<0.001). The type of BCG strains used also influenced the ER; this being 0.018, 0.031 and 0.019 for early, late and mixed strains respectively (p=0.008). The epidemiological variables significantly associated with higher COVID-19 event rate were countries with higher %population aged ≥65 years (p<0.001), greater incidence of IHD (p<0.001) and cancer (p=0.003) and better HDI (p=0.003). Incidences of malaria, HHD and diabetes along with population density had no significant impact on COVID-19 CFR. Further, BCG vaccination significantly lowered the COVID-19 ER in each of the high-risk population subgroups - countries with >7.1% population aged ≥65 years (p=0.008), >0.737 HDI (p=0.001), IHD >1171/105 population (p=0.004) and cancer incidence >15726 (p<0.001). The results supports BCG induced trained immunity leading to heterologous immunoprotection against COVID-19. Thus BCG vaccination with early strains could provide a cost-effective prophylaxis, especially in high-risk individuals and bridge the gap till an effective vaccine against SARS-CoV-2 is freely available globally.

scholarly journals Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Maitri Kalra ◽  
Yan Tong ◽  
David R. Jones ◽  
Tom Walsh ◽  
Michael A. Danso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Neoadjuvant Therapy ◽  
Triple Negative ◽  
Residual Disease ◽  
Disease Free Survival ◽  
Parp Inhibition ◽  
High Risk Population ◽  
Risk Population ◽  
The Impact

AbstractPatients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0–11.5 cm) with 1 (0–38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82–4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population.

scholarly journals Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ausenda Machado ◽  
Irina Kislaya ◽  
Amparo Larrauri ◽  
Carlos Matias Dias ◽  
Baltazar Nunes
Keyword(s):  
High Risk ◽  
Influenza Vaccination ◽  
Seasonal Influenza ◽  
Vaccine Coverage ◽  
Vaccination Strategy ◽  
High Risk Population ◽  
Risk Population ◽  
Seasonal Influenza Vaccination ◽  
Severe Influenza ◽  
The Impact

Abstract Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.

Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic

2011 ◽  
Vol 21 (4) ◽  
pp. 436-443 ◽  
Author(s):  
Rachel H. Webb ◽  
Nigel J. Wilson ◽  
Diana R. Lennon ◽  
Elizabeth M. Wilson ◽  
Ross W. Nicholson ◽  
...  
Keyword(s):  
Heart Disease ◽  
New Zealand ◽  
High Risk ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Secondary Prophylaxis ◽  
Accurate Diagnosis ◽  
High Risk Population ◽  
Step Model ◽  
Rheumatic Heart

AbstractAimsEchocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.Methods and resultsTo optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified asdefinite, probable, orpossible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence ofdefiniteandprobablerheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.ConclusionsWe found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Abstract 2143: Improved Long-Term Survival in a High Risk Population Following Drug Eluting Stent Availability

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Maheer Gandhavadi ◽  
Kendrick A Shunk ◽  
Edward J McNulty
Keyword(s):  
High Risk ◽  
Independent Predictor ◽  
Drug Eluting Stent ◽  
High Risk Population ◽  
Term Survival ◽  
Risk Population ◽  
Long Term Survival ◽  
Drug Eluting ◽  
The Impact

Background Data regarding the impact of drug eluting stent (DES) use on long-term outcomes outside trial populations are limited. Methods 1,547 consecutive patients underwent stent implantation from January 2000 until December 2006 at the San Francisco Veterans Affairs Medical Center. To assess the impact of DES availability on mortality, that population was partitioned into a pre-DES cohort (N=591) and a post-DES availability cohort (N=956). Kaplan-Meier survival curves for the two cohorts were compared. Results The entire population was relatively high risk: 37% had diabetes, 38% a reduced ejection fraction, and 53% a prior MI or elevated troponin prior to the procedure. Median follow up was 4.7 years for the pre-DES cohort and 1.8 years for the post-DES cohort. DES were used in 83% of procedures in the post-DES cohort. Survival improved significantly in the post-DES cohort (P = .04, Log Rank)(see Figure ). Baseline characteristics, procedural variables and discharge medications were analyzed in a Cox proportional hazards model (see Table ). DES use was an independent predictor of improved survival (Hazard Ratio for death 0.52, 95% CI .28–.95). Conclusions In an unselected, high risk population, long-term survival improved following the availability of drug eluting stents. After adjusting for potential confounding factors, DES use was an independent predictor of improved survival. Independent Predictors of Death in all 1,547 Patients

Abstract 07: Association of Social Network Characteristics With Cardiovascular Health and Coronary Artery Calcium in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nilay S Shah ◽  
Mark D Huffman ◽  
Sadiya S Khan ◽  
John A Schneider ◽  
Juned Siddique ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Disease ◽  
Social Network ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Calcium ◽  
Cardiovascular Health ◽  
South Asians ◽  
High Risk Population ◽  
Lower Odds

Introduction: South Asian Americans (SAs) have disproportionately high burden of poor cardiovascular health (CVH) and CVD, which may be influenced by people within their social network (SN). We examined the association of SN characteristics and SN member (“alter”) health with CVH and coronary artery calcium (CAC) in SAs to identify targets for CVD prevention in this high-risk community. Hypothesis: Smaller SN size and worse alter health is associated with poor CVH and CAC in SAs. Methods: In 699 SAs in the MASALA Study, SN characteristics (size, density, proportion of kin or SA ethnicity), alter health status (self-report of an alter with high blood pressure [HTN], hyperlipidemia [HL], heart disease, diabetes, or stroke), CVH score (0-14, based on poor, intermediate, or ideal blood pressure, cholesterol, glucose, physical activity, diet, weight, and smoking), and CAC data were collected between 2016-2018. Multiple logistic regression evaluated the association of SN characteristics or alter health with prevalent CVH and CAC. Results: Participants were mean age 59±9 years and 43% women. Mean CVH score was 8.9±1.9, median CAC score 8 (range 0 - 4217). SNs were mean 6±3 people, density 79±26%, 72±28% kin, 88±23% SA ethnicity; 48% had an alter with HTN, 42% with HL, 18% with heart disease, 40% with diabetes, and 2% with stroke. A 1-person larger SN size was associated with a 19% higher odds of ideal vs. poor CVH in men (p=0.02), and an 11% lower odds of CAC in women (p=0.05, Table). In men, having at least 1 alter with HTN or HL was associated with a 58% or 54% lower odds of ideal vs. poor CVH (p=0.03, p=0.04), and having at least 1 alter with HL was associated with a 78% higher odds of CAC (p=0.05). No associations were seen between other SN characteristics, nor alters with other CVD risk factors, and CVH or CAC. Conclusions: In SAs, larger SN size was associated with better CVH. Having a SN member with HTN or HL may be associated with poorer CVH and CAC. Interventions to increase SN size or target SN member CVH may promote CVH in this high-risk population.

scholarly journals Results of Annual Screening in Phase I of the United Kingdom Familial Ovarian Cancer Screening Study Highlight the Need for Strict Adherence to Screening Schedule

2013 ◽  
Vol 31 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Adam N. Rosenthal ◽  
Lindsay Fraser ◽  
Ranjit Manchanda ◽  
Philip Badman ◽  
Susan Philpott ◽  
...  
Keyword(s):  
United Kingdom ◽  
High Risk ◽  
Surgical Intervention ◽  
Transvaginal Ultrasound ◽  
High Risk Population ◽  
Predictive Values ◽  
Strict Adherence ◽  
Screening Interval ◽  
The United Kingdom ◽  
The Impact

Purpose To establish the performance characteristics of annual transvaginal ultrasound and serum CA125 screening for women at high risk of ovarian/fallopian tube cancer (OC/FTC) and to investigate the impact of delayed screening interval and surgical intervention. Patients and Methods Between May 6, 2002, and January 5, 2008, 3,563 women at an estimated ≥ 10% lifetime risk of OC/FTC were recruited and screened by 37 centers in the United Kingdom. Participants were observed prospectively by centers, questionnaire, and national cancer registries. Results Sensitivity for detection of incident OC/FTC at 1 year after last annual screen was 81.3% (95% CI, 54.3% to 96.0%) if occult cancers were classified as false negatives and 87.5% (95% CI, 61.7% to 98.5%) if they were classified as true positives. Positive and negative predictive values of incident screening were 25.5% (95% CI, 14.3 to 40.0) and 99.9% (95% CI, 99.8 to 100) respectively. Four (30.8%) of 13 incident screen-detected OC/FTCs were stage I or II. Compared with women screened in the year before diagnosis, those not screened in the year before diagnosis were more likely to have ≥ stage IIIc disease (85.7% v 26.1%; P = .009). Screening interval was delayed by a median of 88 days before detection of incident OC/FTC. Median interval from detection screen to surgical intervention was 79 days in prevalent and incident OC/FTC. Conclusion These results in the high-risk population highlight the need for strict adherence to screening schedule. Screening more frequently than annually with prompt surgical intervention seems to offer a better chance of early-stage detection.

scholarly journals The Lack of Association Between Bacille Calmette-Guerin Vaccination and Clustering of Aboriginals with Tuberculosis in Western Canada

2005 ◽  
Vol 12 (3) ◽  
pp. 134-138 ◽  
Author(s):  
Victoria J Cook ◽  
Eduardo Hernández-Garduño ◽  
Dennis Kunimoto ◽  
Earl S Hershfield ◽  
E Anne Fanning ◽  
...  
Keyword(s):  
High Risk ◽  
Aboriginal People ◽  
Univariate Analysis ◽  
Transmitted Disease ◽  
High Risk Population ◽  
Western Canada ◽  
Bacille Calmette Guerin ◽  
Major Health Problem ◽  
Bcg Vaccination ◽  
Culture Positive

BACKGROUND: Tuberculosis (TB) remains a major health problem for Aboriginal people in Canada, with high rates of clustering of active TB cases. Bacille Calmette-Guérin (BCG) vaccination has been used as a preventive measure against TB in this high-risk population.OBJECTIVE: The study was designed to determine if BCG vaccination in Aboriginal people influenced recent TB transmission through an analysis of the clustering of TB cases.METHODS: A retrospective analysis of all culture-positive Mycobacterium tuberculosis cases in Aboriginal people in western Canada (1995 to 1997) was performed. Isolates were analyzed using standard methodology for restriction fragment length polymorphism and spoligotyping.RESULTS: Of 256 culture-positive Aboriginal TB cases, BCG status was confirmed in 216 (84%) cases; 34% had been vaccinated with BCG, 57% were male and 56% were living on-reserve. Patients who had been vaccinated with BCG were younger than unvaccinated individuals (mean age 32.4±1.65 years versus 45.0±1.8 years, P<0.0001). Clustering was found in 62% of cases: 59% of non-BCG vaccinated cases were clustered versus 68% of those vaccinated with BCG (P=0.16). Younger patients (younger than 60 years of age) were more likely to be clustered in the univariate analysis (P<0.01). When age, sex, province, and HIV and reserve status were controlled for, BCG vaccination was not associated with clustering (OR 1.3, 95% CI 0.7 to 2.6).CONCLUSIONS: BCG vaccinated Aboriginal people were no less likely to have active TB from recently transmitted disease. BCG vaccination appears to have limited value in preventing clustering of TB cases within this high-risk community.

scholarly journals Estimating the effect of the 2005 change in BCG policy in England: a retrospective cohort study, 2000 to 2015

2019 ◽  
Vol 24 (49) ◽  
Author(s):  
Sam Abbott ◽  
Hannah Christensen ◽  
Nicky J. Welton ◽  
Ellen Brooks-Pollock
Keyword(s):  
High Risk ◽  
Labour Force ◽  
Demographic Data ◽  
Credible Interval ◽  
Incidence Rates ◽  
School Age Children ◽  
School Age ◽  
Bcg Vaccination ◽  
The Uk ◽  
The Impact

Background In 2005 in England, universal Bacillus Calmette–Guérin (BCG) vaccination of school-age children was replaced by targeted BCG vaccination of high-risk neonates. Aim Estimate the impact of the 2005 change in BCG policy on tuberculosis (TB) incidence rates in England. Methods We conducted an observational study by combining notifications from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts relevant to both the universal and targeted vaccination between 1 January 2000 and 31 December 2010. We then estimated incidence rates over a 5-year follow-up period and used regression modelling to estimate the impact of the change in policy on TB. Results In the non-United Kingdom (UK) born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age incidence rate ratio (IRR): 0.74; 95% credible interval (CrI): 0.61 to 0.88 and neonatal IRR: 0.62; 95%CrI: 0.44 to 0.88). We found some evidence that the change in policy was associated with an increase in incidence rates in the UK born school-age population (IRR: 1.08; 95%CrI: 0.97 to 1.19) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96; 95%CrI: 0.82 to 1.14). Overall, we found that the change in policy was associated with directly preventing 385 (95%CrI: −105 to 881) cases. Conclusions Withdrawing universal vaccination at school age and targeting vaccination towards high-risk neonates was associated with reduced incidence of TB. This was largely driven by reductions in the non-UK born with cases increasing in the UK born.

scholarly journals An Epidemic Model SIPHERD and its application for prediction of the spread of COVID-19 infection in India

2020 ◽  
Author(s):  
Ashutosh Mahajan ◽  
Ravi Solanki ◽  
Namitha Sivadas
Keyword(s):  
High Risk ◽  
Population Density ◽  
Epidemic Model ◽  
Disease Spread ◽  
High Population ◽  
High Population Density ◽  
Social Distancing ◽  
Rapid Pace ◽  
The Impact ◽  
Death Cases

AbstractAfter originating from Wuhan, China, in late 2019, with a gradual spread in the last few months, COVID-19 has become a pandemic crossing 9 million confirmed positive cases and 450 thousand deaths. India is not only an overpopulated country but has a high population density as well, and at present, a high-risk nation where COVID-19 infection can go out of control. In this paper, we employ a compartmental epidemic model SIPHERD for COVID-19 and predict the total number of confirmed, active and death cases, and daily new cases. We analyze the impact of lockdown and the number of tests conducted per day on the prediction and bring out the scenarios in which the infection can be controlled faster. Our findings indicate that increasing the tests per day at a rapid pace (10k per day increase), stringent measures on social-distancing for the coming months and strict lockdown in the month of July all have a significant impact on the disease spread.

scholarly journals Falls among patients with hypertension - preliminary study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Swiatoniowska-Lonc ◽  
E Jaciow ◽  
J Polanski ◽  
B Jankowska-Polanska
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Beta Blockers ◽  
The Elderly ◽  
Ischemic Heart ◽  
Risk Of Falling ◽  
Risk Of Falls ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background. Falls among the elderly are a major cause of injury, significant disability and premature death. Hypotension is a potential risk factor for falls in older adults, especially patients with hypertension (HTN) taking antihypertensive drugs. Furthermore, the cardiovascular benefit of treatment of hypertension in older patients is clear, findings from observational studies have raised concerns that antihypertensive therapies in the elderly might also induce adverse effects, including injurious falls.  In spite of the large number of issues related to this topic, the analysis of the causes of falls is insufficient. The aim of the study was to assess the frequency of falls and the impact of selected variables on the occurrence of risk of falls among patients with HTN. Material and methods. 100 patients, including 55 women, with HTN (mean age 69.4 ± 3.29 years) were enrolled into the study. The Tinetti test was used to assess the risk of falls. Sociodemographic and clinical data were obtained from the hospital register. Results. 89% of patients had a high risk of falls and 11% were prone to falls. The average number of falls during the last year in the study group was 1.86 ± 2.82 and in 30% of cases the fall was the cause of hospitalization. Single-factor analysis of the influence of selected variables on the risk of falls showed that higher values of SBP (-0.27; p = 0.007), DBP (-0.279; p = 0.005) and younger age of patients decrease the risk of falls (-0.273; p = 0.006). The linear regression model showed that independent predictors increasing the risk of falling are: use of diuretics (β=4.192; p &lt; 0.001), co-occurrence of ischemic heart disease (β=4.669; p = 0. 007) and co-occurrence of heart failure (β=3.494; p = 0.016), and predictors reducing the risk of falling patients with hypertension are: the use of beta-blockers (β= -4.033; p = 0.013) and higher DBP value (β= -0.123; p = 0.016). Conclusions. Patients with HTN have a high risk of falling. Independent determinants increasing the risk of falling patients with HTN are the use of diuretics and the co-occurrence of ischemic heart disease or heart failure, while beta-blockers and a higher DBP value are factors reducing the risk of falling. Fall risk assessment and implementation of fall prevention should be carried out in everyday practice.

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