REACT-1 round 8 final report: high average prevalence with regional heterogeneity of trends in SARS-CoV-2 infection in the community in England during January 2021

AbstractIn early January 2021, England entered its third national lockdown of the COVID-19 pandemic to reduce numbers of deaths and pressure on healthcare services, while rapidly rolling out vaccination to healthcare workers and those most at risk of severe disease and death. REACT-1 is a survey of SARS-CoV-2 prevalence in the community in England, based on repeated cross-sectional samples of the population. Between 6th and 22nd January 2021, out of 167,642 results, 2,282 were positive giving a weighted national prevalence of infection of 1.57% (95% CI, 1.49%, 1.66%). The R number nationally over this period was estimated at 0.98 (0.92, 1.04). Prevalence remained high throughout, but with suggestion of a decline at the end of the study period. The average national trend masked regional heterogeneity, with robustly decreasing prevalence in one region (South West) and increasing prevalence in another (East Midlands). Overall prevalence at regional level was highest in London at 2.83% (2.53%, 3.16%). Although prevalence nationally was highest in the low-risk 18 to 24 year old group at 2.44% (1.96%, 3.03%), it was also high in those over 65 years who are most at risk, at 0.93% (0.82%, 1.05%). Large household size, living in a deprived neighbourhood, and Black and Asian ethnicity were all associated with higher levels of infections compared to smaller households, less deprived neighbourhoods and other ethnicities. Healthcare and care home workers, and other key workers, were more likely to test positive compared to other workers. If sustained lower prevalence is not achieved rapidly in England, pressure on healthcare services and numbers of COVID-19 deaths will remain unacceptably high.

Download Full-text

Pneumococcal Vaccination Coverage and Uptake Among Adults in Switzerland

10.1101/2021.10.29.21265674 ◽

2021 ◽

Author(s):

Kyra D Zens ◽

Phung Lang

Keyword(s):

At Risk ◽

Kidney Disease ◽

Vaccination Coverage ◽

Severe Disease ◽

Pneumococcal Vaccination ◽

Opportunistic Pathogen ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Factors Affecting ◽

Increased Risk

Streptococcus pneumoniae, or pneumococcus, is a common, opportunistic pathogen which can cause severe disease, particularly in adults 65+. In Switzerland, vaccination is recommended for children under 5 and for adults with health predispositions; vaccination of healthy adults 65+ is not recommended. In 2020 we conducted a nationwide, cross-sectional survey of vaccination records to evaluate pneumococcal vaccination coverage and factors affecting uptake among adults 18-85. We found that nationwide coverage was 4.5% without significant regional differences. Coverage was comparable between men and women and between those aged 18-39 (3.0%) and 40-64 (3.2%). Coverage was significantly higher among those 65-85 (9.6%). While 2.7% of individuals reporting no health predisposition were vaccinated, 14.8% with asthma or chronic pulmonary disease, 27.1% with immunosuppression, 12.9% with diabetes, 11.6% with heart, liver, or kidney disease, and 25.9% with >1 health risk were vaccinated. Adjusted odds of vaccination for all health predispositions except heart, liver, or kidney disease were significantly increased. Among unvaccinated individuals "not enough information about the topic" and "not suggested by a doctor/healthcare provider" were the major reasons for abstaining from vaccination. Respondents reporting a health predisposition were significantly less likely to report "not at increased risk due to chronic health conditions or age" as a reason for not being vaccinated (3.7% versus 29.1%) and were more likely to report willingness to be vaccinated in the future compared to those not-at-risk (54.2% versus 39.9%). Our results indicate that pneumococcal vaccination coverage in Switzerland is low among both individuals 65-85 and among those with predisposing health risks. It appears that at-risk individuals are aware of their increased risk, but feel they do not have enough information on the topic to seek vaccination, or have not been recommended a vaccination from their physician.

Download Full-text

Prevalence of unmet needs for spasticity management in care home residents in the East Midlands, United Kingdom: a cross-sectional observational study

Clinical Rehabilitation ◽

10.1177/0269215519859621 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1819-1830 ◽

Cited By ~ 1

Author(s):

Laura Edwards ◽

Benjamin Ellis ◽

Clare Donnellan ◽

Hanan Osman ◽

Naseer Haboubi ◽

...

Keyword(s):

United Kingdom ◽

Observational Study ◽

Unmet Needs ◽

Care Home ◽

Unmet Need ◽

Passive Movement ◽

Cross Sectional ◽

The United Kingdom ◽

East Midlands

Objective: To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. Design: Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. Setting: 22 care homes in Derbyshire and Nottinghamshire. Subjects: 60 care home residents with upper motor neuron syndrome–related spasticity. Interventions: No intervention. When unmet needs around spasticity management were identified, the participant’s general practitioner was advised of these in writing. Main measures: Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. Results: Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. Conclusion: Care home residents in this study had high levels of unmet need for spasticity management.

Download Full-text

REACT-1 round 9 interim report: downward trend of SARS-CoV-2 in England in February 2021 but still at high prevalence

10.1101/2021.02.18.21251973 ◽

2021 ◽

Cited By ~ 4

Author(s):

Steven Riley ◽

Caroline E. Walters ◽

Haowei Wang ◽

Oliver Eales ◽

David Haw ◽

...

Keyword(s):

Care Home ◽

Age Groups ◽

Healthcare Services ◽

Asian Ethnicity ◽

North West ◽

North East ◽

Transmission Study ◽

Large Household ◽

The Difference ◽

Home Workers

AbstractBackground and MethodsEngland entered its third national lockdown of the COVID-19 pandemic on 6th January 2021 with the aim of reducing the daily number of deaths and pressure on healthcare services. The real-time assessment of community transmission study (REACT-1) obtains throat and nose swabs from randomly selected people in England in order to describe patterns of SARS-CoV-2 prevalence. Here, we report data from round 9a of REACT-1 for swabs collected between 4th and 13th February 2021.ResultsOut of 85,473 tested-swabs, 378 were positive. Overall weighted prevalence of infection in the community in England was 0.51%, a fall of more than two thirds since our last report (round 8) in January 2021 when 1.57% of people tested positive. We estimate a halving time of 14.6 days and a reproduction number R of 0.72, based on the difference in prevalence between the end of round 8 and the beginning of round 9. Although prevalence fell in all nine regions of England over the same period, there was greater uncertainty in the trend for North West, North East, and Yorkshire and The Humber. Prevalence fell substantially across all age groups with highest prevalence among 18- to 24-year olds at 0.89% (0.47%, 1.67%) and those aged 5 to12 years at 0.86% (0.60%, 1.24%). Large household size, living in a deprived neighbourhood, and Asian ethnicity were all associated with increased prevalence. Healthcare and care home workers were more likely to test positive compared to other workers.ConclusionsThere is a strong decline in prevalence of SARS-CoV-2 in England among the general population five to six weeks into lockdown, but prevalence remains high: at levels similar to those observed in late September 2020. Also, the number of COVID-19 cases in hospitals is higher than at the peak of the first wave in April 2020. The effects of easing of social distancing when we transition out of lockdown need to be closely monitored to avoid a resurgence in infections and renewed pressure on health services.

Download Full-text

REACT-1 round 8 interim report: SARS-CoV-2 prevalence during the initial stages of the third national lockdown in England

10.1101/2021.01.20.21250158 ◽

2021 ◽

Author(s):

Steven Riley ◽

Haowei Wang ◽

Oliver Eales ◽

Caroline E. Walters ◽

Kylie E. C. Ainslie ◽

...

Keyword(s):

Care Home ◽

Healthcare Services ◽

Individual Characteristics ◽

Cumulative Number ◽

Extreme Pressure ◽

Asian Ethnicity ◽

Adult Age ◽

The Third ◽

Mobility Data ◽

Time Space

AbstractBackgroundHigh prevalence of SARS-CoV-2 virus in many northern hemisphere populations is causing extreme pressure on healthcare services and leading to high numbers of fatalities. Even though safe and effective vaccines are being deployed in many populations, the majority of those most at-risk of severe COVID-19 will not be protected until late spring, even in countries already at a more advanced stage of vaccine deployment.MethodsThe REal-time Assessment of Community Transmission study-1 (REACT-1) obtains throat and nose swabs from between 120,000 and 180,000 people in the community in England at approximately monthly intervals. Round 8a of REACT-1 mainly covers a period from 6th January 2021 to 15th January 2021. Swabs are tested for SARS-CoV-2 virus and patterns of swab-positivity are described over time, space and with respect to individual characteristics. We compare swab-positivity prevalence from REACT-1 with mobility data based on the GPS locations of individuals using the Facebook mobile phone app. We also compare results from round 8a with those from round 7 in which swabs were collected from 13th November to 24th November (round 7a) and 25th November to 3rd December 2020 (round 7b).ResultsIn round 8a, we found 1,962 positives from 142,909 swabs giving a weighted prevalence of 1.58% (95% CI, 1.49%, 1.68%). Using a constant growth model, we found no strong evidence for either growth or decay averaged across the period; rather, based on data from a limited number of days, prevalence may have started to rise at the end of round 8a. Facebook mobility data showed a marked decrease in activity at the end of December 2020, followed by a rise at the start of the working year in January 2021. Between round 7b and round 8a, prevalence increased in all adult age groups, more than doubling to 0.94% (0.83%, 1.07%) in those aged 65 and over. Large household size, living in a deprived neighbourhood, and Black and Asian ethnicity were all associated with increased prevalence. Both healthcare and care home workers, and other key workers, had increased odds of swab-positivity compared to other workers.ConclusionDuring the initial 10 days of the third COVID-19 lockdown in England in January 2021, prevalence of SARS-CoV-2 was very high with no evidence of decline. Until prevalence in the community is reduced substantially, health services will remain under extreme pressure and the cumulative number of lives lost during this pandemic will continue to increase rapidly.

Download Full-text

PP18 Ambulance attendance at diabetes or diabetes-related emergencies in care homes – cross sectional database study

Emergency Medicine Journal ◽

10.1136/emermed-2019-999abs.18 ◽

2019 ◽

Vol 36 (10) ◽

pp. e8.3-e9

Author(s):

A Niroshan Siriwardena ◽

Graham Law ◽

Murray D Smith ◽

Mohammad Iqbal ◽

Viet-Hai Phung ◽

...

Keyword(s):

Cost Model ◽

Care Home ◽

Care Quality ◽

Care Homes ◽

Physiological Status ◽

Cross Sectional ◽

East Midlands ◽

Patients With Diabetes ◽

Care Quality Commission ◽

Ambulance Attendance

BackgroundDiabetes, which affects over 1 in 5 nursing or care home residents, may lead to diabetes-related emergencies with ambulance call-outs and hospitalisation. Our aim was to investigate the epidemiology of diabetes-related emergencies in care home residents which involved an ambulance attendance.MethodsWe used a cross-sectional design to investigate emergency ambulance attendances to people in nursing and residential care homes presenting with diabetes-related emergencies across the East Midlands between January 2012 and December 2017. We used clinical and dispatch data from East Midlands Ambulance Service NHS Trust (EMAS) and care home data from the Care Quality Commission, including call category, timing, location, place of residence, clinical or physiological status, treatments, outcome (conveyance) and costs in the analysis.ResultsOverall 219722 (6.7% of 3.3 million) attendances were to care home residents of which 12080 were for diabetes-related emergencies. Of 3152 care home patients categorised as having a ‘diabetic problem’ 1,957 (62.1%) were conveyed to hospital. This was not significantly different to the rate for other patients, taking into account other factors, despite access to trained staff in care homes. Statistically significant factors associated with conveyance included reduced consciousness level (OR 0.91, 95% CI 0.87–0.95), elevated heart (1.01, 1.01–1.02) or respiratory rate (1.08, 1.06–1.10), no treatment for hypoglycaemia (0.54, 0.34–0.86) or additional co-morbid medical (but not psychiatric) problems. Cost to EMAS was significantly lower when a patient was conveyed, by some £18 (95% CI £11.94–£24.12), but this would not outweigh downstream NHS costs arising from hospital care. For the simulation in which all trusts mean NHS Reference Costs were used, conveyance was no longer significant in the cost model.ConclusionConveyance to hospital was common for care home patients with diabetes-related emergencies and more likely when conscious level was impaired, certain physiological measures abnormal or treatment for hypoglycaemia was not given.

Download Full-text

A serological framework to investigate acute primary and post-primary dengue cases reporting across the Philippines

BMC Medicine ◽

10.1186/s12916-020-01833-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Joseph R. Biggs ◽

Ava Kristy Sy ◽

Oliver J. Brady ◽

Adam J. Kucharski ◽

Sebastian Funk ◽

...

Keyword(s):

At Risk ◽

Immune Status ◽

Case Reports ◽

Severe Disease ◽

Dengue Infection ◽

Significant Proportion ◽

The Philippines ◽

Dengue Case ◽

Cross Sectional ◽

Populations At Risk

Abstract Background In dengue-endemic countries, targeting limited control interventions to populations at risk of severe disease could enable increased efficiency. Individuals who have had their first (primary) dengue infection are at risk of developing more severe secondary disease, thus could be targeted for disease prevention. Currently, there is no reliable algorithm for determining primary and post-primary (infection with more than one flavivirus) status from a single serum sample. In this study, we developed and validated an immune status algorithm using single acute serum samples from reporting patients and investigated dengue immuno-epidemiological patterns across the Philippines. Methods During 2015/2016, a cross-sectional sample of 10,137 dengue case reports provided serum for molecular (anti-DENV PCR) and serological (anti-DENV IgM/G capture ELISA) assay. Using mixture modelling, we re-assessed IgM/G seroprevalence and estimated functional, disease day-specific, IgG:IgM ratios that categorised the reporting population as negative, historical, primary and post-primary for dengue. We validated our algorithm against WHO gold standard criteria and investigated cross-reactivity with Zika by assaying a random subset for anti-ZIKV IgM and IgG. Lastly, using our algorithm, we explored immuno-epidemiological patterns of dengue across the Philippines. Results Our modelled IgM and IgG seroprevalence thresholds were lower than kit-provided thresholds. Individuals anti-DENV PCR+ or IgM+ were classified as active dengue infections (83.1%, 6998/8425). IgG− and IgG+ active dengue infections on disease days 1 and 2 were categorised as primary and post-primary, respectively, while those on disease days 3 to 5 with IgG:IgM ratios below and above 0.45 were classified as primary and post-primary, respectively. A significant proportion of post-primary dengue infections had elevated anti-ZIKV IgG inferring previous Zika exposure. Our algorithm achieved 90.5% serological agreement with WHO standard practice. Post-primary dengue infections were more likely to be older and present with severe symptoms. Finally, we identified a spatio-temporal cluster of primary dengue case reporting in northern Luzon during 2016. Conclusions Our dengue immune status algorithm can equip surveillance operations with the means to target dengue control efforts. The algorithm accurately identified primary dengue infections who are at risk of future severe disease.

Download Full-text

REACT-1 round 9 final report: Continued but slowing decline of prevalence of SARS-CoV-2 during national lockdown in England in February 2021

10.1101/2021.03.03.21252856 ◽

2021 ◽

Cited By ~ 2

Author(s):

Steven Riley ◽

Haowei Wang ◽

Oliver Eales ◽

David Haw ◽

Caroline E. Walters ◽

...

Keyword(s):

Cross Sections ◽

Care Home ◽

Age Groups ◽

Healthcare Services ◽

Vaccine Uptake ◽

Final Report ◽

Subsequent Increase ◽

Transmission Study ◽

Rate Of Decline ◽

Using Data

AbstractBackgroundEngland will start to exit its third national lockdown in response to the COVID-19 pandemic on 8th March 2021, with safe effective vaccines being rolled out rapidly against a background of emerging transmissible and immunologically novel variants of SARS-CoV-2. A subsequent increase in community prevalence of infection could delay further relaxation of lockdown if vaccine uptake and efficacy are not sufficiently high to prevent increased pressure on healthcare services.MethodsThe PCR self-swab arm of the REal-time Assessment of Community Transmission Study (REACT-1) estimates community prevalence of SARS-CoV-2 infection in England based on random cross-sections of the population ages five and over. Here, we present results from the complete round 9 of REACT-1 comprising round 9a in which swabs were collected from 4th to 12th February 2021 and round 9b from 13th to 23rd February 2021. We also compare the results of REACT-1 round 9 to round 8, in which swabs were collected mainly from 6th January to 22nd January 2021.ResultsOut of 165,456 results for round 9 overall, 689 were positive. Overall weighted prevalence of infection in the community in England was 0.49% (0.44%, 0.55%), representing a fall of over two thirds from round 8. However the rate of decline of the epidemic has slowed from 15 (13, 17) days, estimated for the period from the end of round 8 to the start of round 9, to 31 days estimated using data from round 9 alone (lower confidence limit 17 days). When comparing round 9a to 9b there were apparent falls in four regions, no apparent change in one region and apparent rises in four regions, including London where there was a suggestion of sub-regional heterogeneity in growth and decline. Smoothed prevalence maps suggest large contiguous areas of growth and decline that do not align with administrative regions.Prevalence fell by 50% or more across all age groups in round 9 compared to round 8, with prevalence (round 9) ranging from 0.21% in those aged 65 and over to 0.71% in those aged 13 to 17 years. Round 9 prevalence was highest among Pakistani participants at 2.1% compared to white participants at 0.45% and Black participants at 0.83%. There were higher adjusted odds of infection for healthcare and care home workers, for those working in public transport and those working in education, school, nursery or childcare and lower adjusted odds for those not required to work outside the home.ConclusionsCommunity prevalence of swab-positivity has declined markedly between January and February 2021 during lockdown in England, but remains high; the rate of decline has slowed in the most recent period, with a suggestion of pockets of growth. Continued adherence to social distancing and public health measures is required so that infection rates fall to much lower levels. This will help to ensure that the benefits of the vaccination roll-out programme in England are fully realised.

Download Full-text

Minerals Intake Distributions in a Large Sample of Iranian at-Risk Population Using the National Cancer Institute Method: Do They Meet Their Requirements?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000232 ◽

2015 ◽

Vol 85 (3-4) ◽

pp. 129-144 ◽

Cited By ~ 3

Author(s):

Zahra Heidari ◽

Awat Feizi ◽

Leila Azadbakht ◽

Nizal Sarrafzadegan

Keyword(s):

At Risk ◽

National Cancer Institute ◽

Population Based ◽

Cross Sectional Study ◽

Normal Function ◽

Dietary Intakes ◽

Middle Aged ◽

Cross Sectional ◽

Nutritional Interventions ◽

High Prevalence

Abstract. Background: Minerals are required for the body’s normal function. Aim: The current study assessed the intake distribution of minerals and estimated the prevalence of inadequacy and excess among a representative sample of healthy middle aged and elderly Iranian people. Methods: In this cross-sectional study, the second follow up to the Isfahan Cohort Study (ICS), 1922 generally healthy people aged 40 and older were investigated. Dietary intakes were collected using 24 hour recalls and two or more consecutive food records. Distribution of minerals intake was estimated using traditional (averaging dietary intake days) and National Cancer Institute (NCI) methods, and the results obtained from the two methods, were compared. The prevalence of minerals intake inadequacy or excess was estimated using the estimated average requirement (EAR) cut-point method, the probability approach and the tolerable upper intake levels (UL). Results: There were remarkable differences between values obtained using traditional and NCI methods, particularly in the lower and upper percentiles of the estimated intake distributions. A high prevalence of inadequacy of magnesium (50 - 100 %), calcium (21 - 93 %) and zinc (30 - 55 % for males > 50 years) was observed. Significant gender differences were found regarding inadequate intakes of calcium (21 - 76 % for males vs. 45 - 93 % for females), magnesium (92 % vs. 100 %), iron (0 vs. 15 % for age group 40 - 50 years) and zinc (29 - 55 % vs. 0 %) (all; p < 0.05). Conclusion: Severely imbalanced intakes of magnesium, calcium and zinc were observed among the middle-aged and elderly Iranian population. Nutritional interventions and population-based education to improve healthy diets among the studied population at risk are needed.

Download Full-text

A Silenced Population

Crisis ◽

10.1027/0227-5910/a000470 ◽

2017 ◽

Vol 38 (6) ◽

pp. 433-442 ◽

Cited By ~ 1

Author(s):

Kim Gryglewicz ◽

Melanie Bozzay ◽

Brittany Arthur-Jordon ◽

Gabriela D. Romero ◽

Melissa Witmeier ◽

...

Keyword(s):

At Risk ◽

Depressive Symptomatology ◽

The United States ◽

Future Research ◽

At Risk Youth ◽

Peer Relationship ◽

Student Records ◽

Cross Sectional ◽

Increased Risk ◽

Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

Download Full-text

Binge Eating and Problem Gambling are Associated with Common and Distinct Deficits in Emotion Regulation among Community Women: Results from a Prospective Study

10.31234/osf.io/v9nbs ◽

2020 ◽

Author(s):

Sarah Farstad ◽

Kristin M. von Ranson

Keyword(s):

At Risk ◽

Emotion Regulation ◽

Binge Eating ◽

Problem Gambling ◽

Prospective Study ◽

Emotion Dysregulation ◽

Behavioral Addiction ◽

Negative Urgency ◽

Cross Sectional ◽

Severe Problem

To elucidate similarities and differences between binge eating and a behavioral addiction, this prospective study compared facets of emotion regulation that were associated with problem gambling, the only formally recognized behavioral addiction, and binge eating. Community-based women (N = 202) who engaged in at-risk binge eating (n = 79), at-risk gambling (n = 36), or both (n = 87) completed four online assessments over six months. Baseline and six-month surveys assessed self-reported emotion dysregulation (using the DERS and UPPS-P), binge eating (using the EDE-Q), and gambling (using the PGSI); abbreviated two- and four-month surveys assessed only binge eating and gambling. Binge eating and problem gambling were both associated with emotion dysregulation, and greater positive urgency was correlated with more severe problem gambling but less frequent binge eating. Negative urgency explained no unique variance in binge eating or problem gambling changes over time, once other facets of emotion dysregulation (i.e., positive urgency and facets assessed by the DERS) were included. Thus, previous cross-sectional research may have overestimated the association of negative urgency with both binge eating and problem gambling. Overall, these findings suggest that binge eating and problem gambling are associated with common as well as distinct emotion regulation deficits.

Download Full-text