scholarly journals A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020

2022 ◽  
Vol 27 (1) ◽  
Author(s):  
Kathryn S Willebrand ◽  
Lauren Pischel ◽  
Amyn A Malik ◽  
Samuel M Jenness ◽  
Saad B Omer
Keyword(s):  
Attack Rate ◽  
The United States ◽  
Median Number ◽  
Transmission Dynamics ◽  
Mitigation Measures ◽  
Confined Space ◽  
Susceptible Population ◽  
Comprehensive Review ◽  
Cruise Ships ◽  
Epidemiological Information

Background Cruise ships provide an ideal setting for transmission of SARS-CoV-2, given the socially dense exposure environment. Aim To provide a comprehensive review of COVID-19 outbreaks on cruise ships. Methods PubMed was searched for COVID-19 cases associated with cruise ships between January and October 2020. A list of cruise ships with COVID-19 was cross-referenced with the United States Centers for Disease Control and Prevention’s list of cruise ships associated with a COVID-19 case within 14 days of disembarkation. News articles were also searched for epidemiological information. Narratives of COVID-19 outbreaks on ships with over 100 cases are presented. Results Seventy-nine ships and 104 unique voyages were associated with COVID-19 cases before 1 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (interquartile range (IQR): 1–17.8), with two notable outliers: the Diamond Princess and the Ruby Princess, which had 712 and 907 cases, respectively. The median attack rate for COVID-19 was 0.2% (IQR: 0.03–1.5), although this distribution was right-skewed with a mean attack rate of 3.7%; 25.9% (27/104) of voyages had at least one COVID-19-associated death. Outbreaks involving only crew occurred later than outbreaks involving guests and crew. Conclusions In the absence of mitigation measures, COVID-19 can spread easily on cruise ships in a susceptible population because of the confined space and high-density contact networks. This environment can create superspreader events and facilitate international spread.

scholarly journals 386. A Systematic Review of COVID-19 Transmission Dynamics and Clinical Response on Cruise Ships Globally Between January and October 2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S294-S295
Author(s):  
Kathryn Willebrand ◽  
Lauren Pischel ◽  
Amyn A Malik ◽  
Samuel Jenness ◽  
Saad Omer
Keyword(s):  
Systematic Review ◽  
Attack Rate ◽  
Final Analysis ◽  
Median Number ◽  
Mitigation Measures ◽  
Flow Diagram ◽  
Confined Space ◽  
Susceptible Population ◽  
Cruise Ships ◽  
The Right

Abstract Background Cruise ships provide an ideal setting for efficient transmission of SARS-CoV- 2 given a socially dense exposure environment. No systematic review of transmission of COVID-19 on cruise ships to date has been completed. Methods MEDLINE was searched in accordance with PRIMSA guidelines for COVID-19 cases associated with cruise ships. A list of cruise ships with COVID-19 was crossed referenced with the Centers for Disease Controls’ list of cruise ships that had at least one COVID-19 case associated with them within 14 days of disembarkation. News articles were also searched for epidemiologic information. 43 full text articles from MEDLINE and 177 from news sources were included in the final analysis. Narratives of the outbreak in ships with over 100 cases are presented. PRISMA Flow Diagram PRISMA Flow diagram of articles screened, reviewed, and analyzed Results A total of 80 ships and 104 unique voyages on cruise ships were identified with at least one COVID-19 case before 30 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (intraquartile range (IQR) 1–17.8), with two notable outliers the Diamond Princess and Ruby Princess which had 712 and 907 cases respectively. The median attack rate for COVID-19 was 0.2% (IQR 0.03% -1.5%), though this distribution was skewed to the right with a mean attack rate of 3.7%. 25.9% of voyages had at least one associated death. Outbreaks involving only crew were later than outbreaks with guests and crew. Cases of COVID-19 on cruise ships in 2020 Number of cases of COVID-19 on cruise ships by date COVID-19 outbreak identified and if case was a guest or crew member. Percent of COVID-19 cases that were crew in 2020 Percent of COVID-19 cases that were in crew members by date outbreak identified in 2020 Percent of passengers on cruise ships that were crew Percentage of passengers on cruise ships that were crew members in 2020 by date outbreak identified Conclusion COVID-19 can spread easily on cruise ships in a susceptible population when there is an absence of mitigation measures due to the confined space and high-density of contact networks. This can not only create super spreader events but also facilitate international spread. Disclosures All Authors: No reported disclosures

scholarly journals Considerations for a Respiratory Syncytial Virus Vaccine Targeting an Elderly Population

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 624
Author(s):  
Laura M. Stephens ◽  
Steven M. Varga
Keyword(s):  
Respiratory Syncytial Virus ◽  
Disease Burden ◽  
Elderly Population ◽  
Vaccine Development ◽  
The Elderly ◽  
The United States ◽  
Susceptible Population ◽  
Age Related ◽  
Syncytial Virus ◽  
Tract Infections

Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.

scholarly journals Household COVID-19 risk and in-person schooling

Science ◽  
2021 ◽  
pp. eabh2939
Author(s):  
Justin Lessler ◽  
M. Kate Grabowski ◽  
Kyra H. Grantz ◽  
Elena Badillo-Goicoechea ◽  
C. Jessica E. Metcalf ◽  
...  
Keyword(s):  
United States ◽  
Online Survey ◽  
Positive Association ◽  
The United States ◽  
Mitigation Measures ◽  
Office Work ◽  
School Based ◽  
Increased Risk ◽  
Extra Curricular Activities ◽  
Low Levels

In-person schooling has proved contentious and difficult to study throughout the SARS-CoV-2 pandemic. Data from a massive online survey in the United States indicates an increased risk of COVID-19-related outcomes among respondents living with a child attending school in-person. School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extra-curricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed. Among teachers, working outside the home was associated with an increase in COVID-19-related outcomes, but this association is similar to other occupations (e.g., healthcare, office work). While in-person schooling is associated with household COVID-19 risk, this risk can likely be controlled with properly implemented school-based mitigation measures.

scholarly journals Aripiprazole Lauroxil, a Novel Injectable Long-Acting Antipsychotic Treatment for Adults with Schizophrenia: A Comprehensive Review

2021 ◽  
Vol 13 (3) ◽  
pp. 279-296
Author(s):  
Kunal Maini ◽  
Haley Gould ◽  
Jessica Hicks ◽  
Fatima Iqbal ◽  
James Patterson ◽  
...  
Keyword(s):  
Partial Agonist ◽  
Antipsychotic Agent ◽  
The United States ◽  
Mental Health Disorder ◽  
Oral Dosage ◽  
Antipsychotic Treatment ◽  
Comprehensive Review ◽  
Social Commitment ◽  
Hearing Voices ◽  
Long Acting

Purpose of Review. This is a comprehensive review of the literature regarding the use of Aripiprazole lauroxil for schizophrenia. This review presents the background, evidence, and indications for using aripiprazole lauroxil to treat schizophrenia in the context of current theories on the development of schizophrenia. Recent Findings. Schizophrenia is a chronic mental health disorder that currently affects approximately 3.3 million people in the United States. Its symptoms, which must be present for more than six months, are comprised of disorganized behavior and speech, a diminished capacity to comprehend reality, hearing voices unheard by others, seeing things unseen by others, delusions, decreased social commitment, and decreased motivation. The majority of these symptoms can be managed with antipsychotic medication. Aripiprazole lauroxil is a long-acting intramuscular injection that works as a combination of partial agonist activity at D2 and 5-HT1A receptors combined with antagonist activity at 5-HT2A receptors. It can be dosed as a 4-, 6-, or 8-week injection, depending on oral dosage. Aripiprazole lauroxil was FDA approved in October of 2015. Summary. Schizophrenia is a severe psychiatric disorder if left untreated. There are multiple medications to help treat schizophrenia. One antipsychotic agent, aripiprazole lauroxil, offers long duration injections that optimize and improve compliance. Known side effects include weight gain, akathisia, neuroleptic malignant syndrome, tardive dyskinesia, and orthostatic hypotension. Aripiprazole lauroxil is an FDA-approved drug that can be administered monthly, every six weeks, or every two months and has been shown to be both safe and effective.

Estimating costs of adverse events (AEs) and healthcare resource use (HRU) in patients with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) receiving tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel): A summary of real-world evidence.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19551-e19551
Author(s):  
Hongbo Yang ◽  
Cynthia Zhengyun Qi ◽  
Anand Dalal ◽  
Vamsi Bollu ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Real World ◽  
B Cell Lymphoma ◽  
The United States ◽  
Median Number ◽  
Cost Burden ◽  
Real World Evidence ◽  
Car T ◽  
Grade 3 ◽  
Cost Implications ◽  
The Cost

e19551 Background: The AE rates and HRU reported in multiple real-world evidence (RWE) studies of chimeric antigen receptor T-cell (CAR-T) therapies tisa-cel and axi-cel in r/r DLBCL have differed from those in their clinical trials. However, the cost implications from these findings are not well understood in existing literature. This study summarizes information from these RWE studies of tisa-cel and axi-cel and quantifies the associated costs. Methods: A literature review was conducted to identify RWE studies reporting AE rates and HRU of tisa-cel and axi-cel in the United States (US). AE rates and HRU were summarized and the associated costs were estimated using a micro-costing approach. Costs of AE management included hospitalization and pharmacy costs, such as intensive care unit (ICU) stays, inpatient admissions, and medications for the treatment of cytokine release syndrome (CRS) and neurotoxicity events (NE). HRU costs included hospitalization, ICU stays, and outpatient visit costs. Unit costs were from public health databases that are representative of US healthcare system and from literature. Costs were inflated to 2020 US dollars. A range was reported to present evidence if inputs are available from multiple studies. Results were summarized for tisa-cel and axi-cel separately. Results: Four publications were identified: Jaglowski 2019, Pasquini 2019, Riedell 2019, and Jacobson 2020. Across studies, grade 3+ CRS and NE occurred in 1%-4% and 0%-5% of tisa-cel-treated patients and 7%-16% and 20%-35% of axi-cel-treated patients, respectively. Tocilizumab usage was reported in 14%-20% of tisa-cel- and 62%-71% of axi-cel-treated patients. CAR-T infusion was inpatient for 36% of tisa-cel- and 92%-100% of axi-cel-treated patients. The median hospitalization days was 2 for tisa-cel and 15-16 for axi-cel. ICU transfer was observed for 7% and 28%-38% of tisa-cel- and axi-cel-treated patients, respectively, with median stays of 4 and 5 days, respectively. The median number of outpatient visits within 28 days after infusion was 6 for tisa-cel and 4 for axi-cel. The total estimated costs for managing AEs per patient were $843-$1,962 for tisa-cel and $5,979-$10,878 for axi-cel. The total estimated HRU costs per patient were $3,321 for tisa-cel and $32,394-33,166 for axi-cel. Conclusions: RWE studies suggest that patients with r/r DLBCL receiving tisa-cel had numerically lower AE rates, HRU, and cost burden than those receiving axi-cel in the US. The additional cost burden for axi-cel was primarily driven by the incremental ICU and hospitalization care due to a higher proportion of inpatient infusion among patients receiving axi-cel. Further research is warranted to compare the costs associated with the two CAR-Ts in r/r DLBCL.

scholarly journals Men who have sex with men in China have relatively low numbers of sexual partners

2011 ◽  
Vol 3 (1) ◽  
pp. 10 ◽  
Author(s):  
Lei Zhang ◽  
Eric Pui Fung Chow ◽  
David P. Wilson
Keyword(s):  
Median Number ◽  
Sexual Partners ◽  
Hiv Prevalence ◽  
Comprehensive Review ◽  
The Past ◽  
Male Sexual Partners ◽  
Sex With Men ◽  
Over Time

HIV prevalence is increasing rapidly among men who have sex with men (MSM) in China and potentially associated with the number of male sexual partners that each man has on average. This study estimates the distribution of the number of male sexual partners among Chinese MSM through a comprehensive review of English and Chinese published literature. The overall median number of male sexual partners of Chinese MSM in the past 6 months China was estimated to be 1.5 (95% CI, 1.1-1.9) and 3.8 (95% CI 1.5-6.9) sexual partners in the past 6-month and 12-month periods respectively. An estimated 31% of sexual partners of MSM in China are regular partners, 54% are casual partners, and 16% are commercial partners. The reported numbers of sexual partners has not changed over time during the past decade. The numbers of male sexual partners reported by Chinese MSM is consistently lower than other settings and may not be sufficient to explain the recent rapid increase in HIV prevalence.

scholarly journals HIV Transmission Dynamics Among Foreign-Born Persons in the United States

2017 ◽  
Vol 76 (5) ◽  
pp. 445-452 ◽  
Author(s):  
Eduardo E. Valverde ◽  
Alexandra M. Oster ◽  
Songli Xu ◽  
Joel O. Wertheim ◽  
Angela L. Hernandez
Keyword(s):  
United States ◽  
Hiv Transmission ◽  
The United States ◽  
Transmission Dynamics ◽  
Foreign Born

scholarly journals Diverse local epidemics reveal the distinct effects of population density, demographics, climate, depletion of susceptibles, and intervention in the first wave of COVID-19 in the United States

2020 ◽  
Author(s):  
Niayesh Afshordi ◽  
Benjamin Holder ◽  
Mohammad Bahrami ◽  
Daniel Lichtblau
Keyword(s):  
United States ◽  
Population Density ◽  
The United States ◽  
Effective Response ◽  
Susceptible Population ◽  
Local Climate ◽  
Climate Conditions ◽  
Mortality And Morbidity ◽  
Social Distancing ◽  
The Impact

The SARS-CoV-2 pandemic has caused significant mortality and morbidity worldwide, sparing almost no community. As the disease will likely remain a threat for years to come, an understanding of the precise influences of human demographics and settlement, as well as the dynamic factors of climate, susceptible depletion, and intervention, on the spread of localized epidemics will be vital for mounting an effective response. We consider the entire set of local epidemics in the United States; a broad selection of demographic, population density, and climate factors; and local mobility data, tracking social distancing interventions, to determine the key factors driving the spread and containment of the virus. Assuming first a linear model for the rate of exponential growth (or decay) in cases/mortality, we find that population-weighted density, humidity, and median age dominate the dynamics of growth and decline, once interventions are accounted for. A focus on distinct metropolitan areas suggests that some locales benefited from the timing of a nearly simultaneous nationwide shutdown, and/or the regional climate conditions in mid-March; while others suffered significant outbreaks prior to intervention. Using a first-principles model of the infection spread, we then develop predictions for the impact of the relaxation of social distancing and local climate conditions. A few regions, where a significant fraction of the population was infected, show evidence that the epidemic has partially resolved via depletion of the susceptible population (i.e., “herd immunity”), while most regions in the United States remain overwhelmingly susceptible. These results will be important for optimal management of intervention strategies, which can be facilitated using our online dashboard.

scholarly journals "Hurricane" Sandy

2018 ◽  
Vol 5 (2) ◽  
pp. 157-192
Author(s):  
Cheryl L. Pollak
Keyword(s):  
United States ◽  
New York ◽  
Local Governments ◽  
The United States ◽  
Hurricane Sandy ◽  
Small Business Administration ◽  
Mitigation Measures ◽  
District Court ◽  
Flood Insurance ◽  
Recent Experience

On the evening of October 29, 2012, “Hurricane” Sandy made land- fall on the New York coastline, battering the land with strong winds, torrential rain, and record-breaking storm surges. Homes and commercial structures were destroyed; roads and tunnels were flooded; and more than 23,000 people sought refuge in temporary shelters, with many others facing weeks without power and electricity. At the time, Sandy was heralded as one of the costliest hurricanes in the his- tory of the United States; the second costliest hurricane only to Katrina, which hit New Orleans in 2005. Unfortunately, recent experience with Hurricanes Florence, Maria, Harvey, and Irma suggest that this pattern of devastating superstorms may become the new norm as climate change produces more extreme and unpredictable weather events. In Sandy’s aftermath, as individuals returned to their homes, or what remained of them, and communities began to rebuild, the true cost of the storm became apparent. A year after the storm, the Federal Emergency Management Agency (“FEMA”) estimated that over $1.4 billion in assistance was provided to 182,000 survivors of the dis- aster; another $3.2 billion was provided to state and local governments for debris removal, infrastructure repair, and emergency protective measures. More than $2.4 billion was provided to individuals and businesses in the form of low-interest loans through the Small Business Administration (“SBA”), and millions more were spent on grants de- signed to implement mitigation measures in the future and to provide unemployment assistance to survivors. Before the storm, homeowners paid premiums for flood insurance provided through the National Flood Insurance Program (“NFIP”), and for homeowner’s insurance provided by dozens of private insurers. In the months following the storm, they began to file claims for assistance in rebuilding their homes. While many such claims were re- solved successfully, many homeowners were unhappy with the settlement amounts offered by their insurance carriers and felt compelled to file lawsuits in the surrounding state and federal courts. Many of those lawsuits were filed in the United States District Court for the Eastern District of New York (“EDNY”). This case study describes the EDNY’s specifically crafted, unique approach to handling the mass litigation that ensued from Sandy’s devastation, documents some of the problems that the Court faced during that mass litigation, and describes some of the lessons learned from the Court’s experience.

scholarly journals SARS-CoV-2 Genomic Surveillance Reveals Little Spread From a Large University Campus to the Surrounding Community

2021 ◽  
Vol 8 (11) ◽  
Author(s):  
Andrew L Valesano ◽  
William J Fitzsimmons ◽  
Christopher N Blair ◽  
Robert J Woods ◽  
Julie Gilbert ◽  
...  
Keyword(s):  
The United States ◽  
Incidence Rates ◽  
Transmission Dynamics ◽  
University Of Michigan ◽  
University Campus ◽  
High Incidence ◽  
Study Interval ◽  
Washtenaw County ◽  
The University ◽  
Subsequent Wave

Abstract Background Coronavirus disease 2019 (COVID-19) has had high incidence rates at institutions of higher education (IHE) in the United States, but the transmission dynamics in these settings are poorly understood. It remains unclear to what extent IHE-associated outbreaks have contributed to transmission in nearby communities. Methods We implemented high-density prospective genomic surveillance to investigate these dynamics at the University of Michigan and the surrounding community during the Fall 2020 semester (August 16–November 24). We sequenced complete severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from 1659 individuals, including 468 students, representing 20% of cases in students and 25% of total cases in Washtenaw County over the study interval. Results Phylogenetic analysis identified >200 introductions into the student population, most of which were not related to other student cases. There were 2 prolonged student transmission clusters, of 115 and 73 individuals, that spanned multiple on-campus residences. Remarkably, <5% of nonstudent genomes were descended from student clusters, and viral descendants of student cases were rare during a subsequent wave of infections in the community. Conclusions The largest outbreaks among students at the University of Michigan did not significantly contribute to the rise in community cases in Fall 2020. These results provide valuable insights into SARS-CoV-2 transmission dynamics at the regional level.

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