Legislation allowing dairy farmers to treat milk fever with intravenous calcium results in more treatments and lower case fatality

AbstractTo estimate the level of community exposure to SARS-CoV-2 in Ghana, we conducted phased seroprevalence studies of 2729 participants in selected locations across Ghana. Phase I screening (August 2020) covered a total of 1305 individuals screened at major markets/lorry stations, major shopping malls, hospitals and research institutions involved in COVID-19 work. The screening was performed using a strip-in-cassette lateral flow type Rapid Diagnostic Test (RDT) kit that simultaneously and separately detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. In Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure rate was significantly higher among individuals tested at markets/lorry stations (26.9%) compared to those at Shopping Malls (9.4%). The 41–60-years age group had the highest exposure rate (27.2%). People with only a basic level or no formal education had a higher exposure rate (26.2%) than those with tertiary level education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Phases II and III screening activities in October and December 2020, respectively, showed no evidence of increased seroprevalence, indicating either a reduced transmission rate or loss of antibody expression in a subset of the participants. The Upper East region has the lowest exposure rate, with only 4 of 200 participants (2%) seropositivity. Phase IV screening in February 2021 showed that exposure rates in the upper income earners (26.2%) had almost doubled since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases, which began in December 2020. The Phase IV results suggest that seroprevalence levels have become so high that the initial socioeconomic stratification of exposure has been lost. Overall, the data indicates a much higher COVID-19 seroprevalence in the Greater Accra Region than was officially acknowledged, likely implying a considerably lower case fatality rate than the current national figure of 0.84%. Additionally, the high exposure levels seen in the communities suggest that COVID-19 in Ghana still predominantly presents with none-to-mild symptoms. Our results lay the foundation for more extensive SARS-CoV-2 surveillance in Ghana and the West African sub-region, including deploying rapid antigen test kits in concert to determine the actual infection burden since antibody development lags infection.

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An Intracerebral Hemorrhage Care Bundle Is Associated with Lower Case Fatality

Annals of Neurology ◽

10.1002/ana.25546 ◽

2019 ◽

Vol 86 (4) ◽

pp. 495-503 ◽

Cited By ~ 12

Author(s):

Adrian R. Parry‐Jones ◽

Camilla Sammut‐Powell ◽

Kyriaki Paroutoglou ◽

Emily Birleson ◽

Joshua Rowland ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Case Fatality ◽

Care Bundle ◽

Lower Case

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Thrombolytic therapy with or without a vena cava filter results in a lower case fatality rate in unstable patients with acute pulmonary embolism

Evidence-Based Medicine ◽

10.1136/eb-2012-100848 ◽

2012 ◽

Vol 18 (2) ◽

pp. e19-e19

Author(s):

Marie Méan ◽

Said A Ibrahim

Keyword(s):

Pulmonary Embolism ◽

Thrombolytic Therapy ◽

Case Fatality Rate ◽

Acute Pulmonary Embolism ◽

Vena Cava ◽

Case Fatality ◽

Vena Cava Filter ◽

Fatality Rate ◽

Lower Case

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Contact Tracing is Associated with Lower COVID-19 Case Fatality Rates: Evidence from 40 countries

10.21203/rs.3.rs-61325/v1 ◽

2020 ◽

Author(s):

ABDULLAH YALAMAN ◽

GOKCE BASBUG ◽

CEYHUN ELGIN ◽

ALISON P. GALVANI

Keyword(s):

Panel Data ◽

Early Detection ◽

Medical Care ◽

Regression Models ◽

Case Fatality ◽

Control Measures ◽

Contact Tracing ◽

Regression Analyses ◽

Cross Sectional ◽

Lower Case

Abstract The coronavirus disease (COVID-19) outbreak has killed over 725,000 people since its emergence in late 2019. As of early August 2020, there has been substantial variability in the policies and intensity of diagnostic efforts between countries. In this paper, we quantitatively evaluate the effectiveness of the national contact tracing policy in decreasing case fatality rates of COVID-19 in 40 countries. Our regression analyses indicate that countries that utilize comprehensive contact tracing have significantly lower case fatality rates. The association of contact tracing policy and case fatality rates is robust and observed in regression models using cross-sectional and panel data, even controlling for the number of tests conducted and non-pharmaceutical control measures adopted by governments. Our results suggest that comprehensive contact tracing is instrumental not only to curtailing transmission but also to reducing case fatality rates by early detection and isolation of secondary cases and ultimately diminishing the burden on the healthcare system and speeding the rate at which infected individuals receive the medical care they need to maximize their chance of recovery.

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Giant intracranial aneurysms: natural history and 1-year case fatality after endovascular or surgical treatment

Journal of Neurosurgery ◽

10.3171/2019.8.jns183078 ◽

2019 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Julius Dengler ◽

Daniel Rüfenacht ◽

Bernhard Meyer ◽

Veit Rohde ◽

Matthias Endres ◽

...

Keyword(s):

Natural History ◽

Treatment Outcomes ◽

Prospective Cohort ◽

Retrospective Cohort ◽

Intracranial Aneurysms ◽

Case Fatality ◽

Index Hospitalization ◽

Clinical Trial Registration ◽

Giant Intracranial Aneurysms ◽

Lower Case

OBJECTIVEClinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs.METHODSIn this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality.RESULTSThe retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23–2.16) in ruptured GIAs and 3.96 (95% CI 2.57–6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5–30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality.CONCLUSIONSRupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.Clinical trial registration no.: NCT02066493 (clinicaltrials.gov)

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Human Genetic Variation and Yellow Fever Mortality during 19th Century U.S. Epidemics

mBio ◽

10.1128/mbio.01253-14 ◽

2014 ◽

Vol 5 (3) ◽

Cited By ~ 11

Author(s):

Lauren E. Blake ◽

Mariano A. Garcia-Blanco

Keyword(s):

Genetic Variation ◽

19Th Century ◽

Yellow Fever ◽

Statistical Significance ◽

Case Fatality ◽

The United States ◽

Incidence Rates ◽

Host Factors ◽

Human Genetic Variation ◽

Lower Case

ABSTRACT We calculated the incidence, mortality, and case fatality rates for Caucasians and non-Caucasians during 19th century yellow fever (YF) epidemics in the United States and determined statistical significance for differences in the rates in different populations. We evaluated nongenetic host factors, including socioeconomic, environmental, cultural, demographic, and acquired immunity status that could have influenced these differences. While differences in incidence rates were not significant between Caucasians and non-Caucasians, differences in mortality and case fatality rates were statistically significant for all epidemics tested (P < 0.01). Caucasians diagnosed with YF were 6.8 times more likely to succumb than non-Caucasians with the disease. No other major causes of death during the 19th century demonstrated a similar mortality skew toward Caucasians. Nongenetic host factors were examined and could not explain these large differences. We propose that the remarkably lower case mortality rates for individuals of non-Caucasian ancestry is the result of human genetic variation in loci encoding innate immune mediators. IMPORTANCE Different degrees of severity of yellow fever have been observed across diverse populations, but this study is the first to demonstrate a statistically significant association between ancestry and the outcome of yellow fever (YF). With the global burden of mosquito-borne flaviviral infections, such as YF and dengue, on the rise, identifying and characterizing host factors could prove pivotal in the prevention of epidemics and the development of effective treatments.

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Seasonal upsurge of pneumococcal meningitis in the Central African Republic

Wellcome Open Research ◽

10.12688/wellcomeopenres.14868.2 ◽

2019 ◽

Vol 3 ◽

pp. 134

Author(s):

Thomas Crellen ◽

V. Bhargavi Rao ◽

Turid Piening ◽

Joke Zeydner ◽

M. Ruby Siddiqui

Keyword(s):

Bacterial Meningitis ◽

Pneumococcal Meningitis ◽

Central African Republic ◽

Vaccine Coverage ◽

Case Fatality ◽

Dry Season ◽

Meningococcal Meningitis ◽

Meningitis Belt ◽

Lower Case ◽

Vaccination Campaigns

A high incidence of bacterial meningitis was observed in the Central African Republic (CAR) from December 2015 to May 2017 in three hospitals in the northwest of the country that are within the African meningitis belt. The majority of cases were caused by Streptococcus pneumoniae (249/328; 75.9%), which occurred disproportionately during the dry season (November-April) with a high case-fatality ratio of 41.6% (95% confidence interval [CI] 33.0, 50.8%). High rates of bacterial meningitis during the dry season in the meningitis belt have typically been caused by Neisseria meningitidis (meningococcal meningitis), and our observations suggest that the risk of contracting S. pneumoniae (pneumococcal) meningitis is increased by the same environmental factors. Cases of meningococcal meningitis (67/328; 20.4%) observed over the same period were predominantly group W and had a lower case fatality rate of 9.6% (95% CI 3.6, 21.8%). Due to conflict and difficulties in accessing medical facilities, it is likely that the reported cases represented only a small proportion of the overall burden. Nationwide vaccination campaigns in the CAR against meningitis have been limited to the use of MenAfriVac, which targets only meningococcal meningitis group A. We therefore highlight the need for expanded vaccine coverage to prevent additional causes of seasonal outbreaks.

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Seasonal upsurge of pneumococcal meningitis in the Central African Republic

Wellcome Open Research ◽

10.12688/wellcomeopenres.14868.1 ◽

2018 ◽

Vol 3 ◽

pp. 134 ◽

Cited By ~ 1

Author(s):

Thomas Crellen ◽

V. Bhargavi Rao ◽

Turid Piening ◽

Joke Zeydner ◽

M. Ruby Siddiqui

Keyword(s):

Bacterial Meningitis ◽

Pneumococcal Meningitis ◽

Central African Republic ◽

Vaccine Coverage ◽

Case Fatality ◽

Dry Season ◽

Meningococcal Meningitis ◽

Meningitis Belt ◽

Lower Case ◽

Vaccination Campaigns

A high incidence of bacterial meningitis was observed in the Central African Republic (CAR) from December 2015 to May 2017 in three hospitals in the northwest of the country that are within the African meningitis belt. The majority of cases were caused by Streptococcus pneumoniae (249/328; 75.9%), which occurred disproportionately during the dry season (November-April) with a high case-fatality ratio of 41.6% (95% confidence interval [CI] 33.0, 50.8%). High rates of bacterial meningitis during the dry season in the meningitis belt are typically caused by Neisseria meningitidis (meningococcal meningitis), and our observations suggest that the risk of contracting S. pneumoniae (pneumococcal) meningitis is increased by the same environmental factors. Cases of meningococcal meningitis (67/328; 20.4%) observed over the same period were predominantly type W and had a lower case fatality rate of 9.6% (95% CI 3.6, 21.8%). Due to conflict and difficulties in accessing medical facilities, it is likely that the reported cases represented only a small proportion of the overall burden and that there is high underlying prevalence of S. pneumoniae carriage in the community. Nationwide vaccination campaigns in the CAR against meningitis have been limited to the use of MenAfriVac, which targets only meningococcal meningitis type A. We therefore highlight the need for expanded vaccine coverage to prevent additional causes of seasonal outbreaks.

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Trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence in selected regions across Ghana

Wellcome Open Research ◽

10.12688/wellcomeopenres.16890.1 ◽

2021 ◽

Vol 6 ◽

pp. 173

Author(s):

Peter Kojo Quashie ◽

Joe Kimanthi Mutungi ◽

Francis Dzabeng ◽

Daniel Oduro-Mensah ◽

Precious C. Opurum ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Phase I ◽

Formal Education ◽

Tertiary Education ◽

Case Fatality ◽

Formal Sector ◽

Lower Case ◽

Upper East Region ◽

Second Wave ◽

Phase Iv

Background: We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana. Methods: Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. Results: During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence. Conclusions: Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.

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