A Vaccination Strategy for Ontario COVID-19 Hotspots and Essential Workers

Ontario’s initial mass COVID-19 vaccination strategy in place until April 8, 2021 was based on per-capita regional allocation of vaccines with subsequent distribution – in order of relative priority – by age, chronic health conditions and high-risk congregate care settings, COVID-19 hotspots, and essential worker status. Early analysis of Ontario’s COVID-19 vaccine rollout reveals inequities in vaccine coverage across the province, with residents of higher risk neighbourhoods being least likely get vaccinated. Accelerating the vaccination of COVID-19 hotspots and essential workers will prevent considerably more SARS-CoV-2 infections and COVID-19 hospitalizations, ICU admissions and deaths as compared with Ontario’s initial mass vaccination strategy (Figure 1).

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

BMC Public Health ◽

10.1186/s12889-019-7958-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 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.

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Let them go! Compassionate release for disabled prisoners with chronic health conditions during the COVID-19 public health emergency

Disability Studies Quarterly ◽

10.18061/dsq.v41i3.8305 ◽

2021 ◽

Vol 41 (3) ◽

Author(s):

Sara Schotland

Keyword(s):

Public Health ◽

High Risk ◽

Ethnic Discrimination ◽

Public Health Emergency ◽

Chronic Health Conditions ◽

Health Conditions ◽

Critical Disability Studies ◽

Physical Impairments ◽

Serious Illness ◽

Cognitive Limitations

Inmates with disabilities are at high risk of serious illness and death from COVID-19 due to crowded and unsanitary conditions. The punishment for serious crimes is incarceration—not exposure to a dangerous, contagious virus. Prisoners have human rights, notwithstanding the loss of most of their civic rights. Critical Disability Studies draws attention to multiple and overlapping injustices and oppressions. Prisoners with disabilities often suffer from race and ethnic discrimination, poverty, trauma, multiple physical impairments, mental illness, and/or cognitive limitations. This essay calls for action to accelerate compassionate release of disabled inmates, many of whom are at high risk for COVID-19, and offers recommendations for improving conditions of confinement for disabled inmates who remain incarcerated.

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Can Vitamin D Positively Impact COVID-19 Risk and Severity Among Older Adults: A Review of the Evidence

Journal Of Aging Research And Healthcare ◽

10.14302/issn.2474-7785.jarh-20-3650 ◽

2020 ◽

Vol 3 (2) ◽

pp. 1-14

Author(s):

Ray Marks

Keyword(s):

Older Adults ◽

Vitamin D ◽

Health Status ◽

High Risk ◽

Well Being ◽

The Body ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Vitamin D Levels

Background The coronavirus Covid-19 strain that emerged in December 2019, continues to produce a widespread and seemingly intractable negative impact on health and longevity in all parts of the world, especially, among older adults, and those with chronic health conditions. Aim The first aim of this review article was to examine, summarize, synthesize, and report on the research base concerning the possible use of vitamin-D supplementation for reducing both Covid-19 risk and severity, especially among older adults at high risk for Covid-19 infections. A second was to provide directives for researchers or professionals who work or are likely to work in this realm in the future. Methods All English language relevant publications detailing the possible efficacy of vitamin D as an intervention strategy for minimizing Covid-19 infection risk published in 2020 were systematically sought. Key words used were: Vitamin D, Covid-19, and Coronavirus. Databases used were PubMed, Scopus, and Web of Science. All relevant articles were carefully examined and those meeting the review criteria were carefully read, and described in narrative form. Results Collectively, these data reveal vitamin D is a powerful steroid like compound that is required by the body to help many life affirming physiological functions, including immune processes, but its deficiency may seriously impact the health status and well being of the older adult and others. Since vitamin D is not manufactured by the body directly, ensuring those who are deficient in vitamin D may prove a helpful overall preventive measure as well as a helpful treatment measure among older adults at high risk for severe Covid-19 disease outcomes. Conclusions Older individuals with chronic health conditions, as well as healthy older adults at risk for vitamin D deficiency are likely to benefit physically as well as mentally, from efforts to foster adequate vitamin D levels. Geriatric clinicians can expect this form of intervention to reduce infection severity in the presence of Covid-19 infection, regardless of health status, and subject to careful study, researchers can make a highly notable impact in this regard.

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Validation of a Modified Submaximal Balke Protocol to Assess Cardiorespiratory Fitness in Individuals at High Risk of or With Chronic Health Conditions—A Pilot Study

Frontiers in Sports and Active Living ◽

10.3389/fspor.2021.642538 ◽

2021 ◽

Vol 3 ◽

Author(s):

Gert Sander Hamre Eike ◽

Eivind Aadland ◽

Ellen Eimhjellen Blom ◽

Amund Riiser

Keyword(s):

Heart Rate ◽

High Risk ◽

Body Mass ◽

Cardiorespiratory Fitness ◽

Treadmill Walking ◽

Chronic Health Conditions ◽

Model Fit ◽

Health Conditions ◽

Walking Test ◽

Chronic Health

Objectives: This study aims to validate a submaximal treadmill walking test for estimation of maximal oxygen consumption (VO2max) in individuals at high risk of or with chronic health conditions.Method: Eighteen participants (age 62 ± 16 years; VO2max 31.2 ± 5.9 ml kg−1 min−1) at high risk of getting or with established chronic diseases performed two valid modified Balke treadmill walking protocols, one submaximal protocol, and one maximal protocol. Test duration, heart rate (HR), and rate of perceived exertion (RPE) were measured during both tests. VO2max was measured during the maximal test. VO2max was estimated from the submaximal test by multiple regression using time to RPE ≥ 17, gender, age, and body mass as independent variables. Model fit was reported as explained variance (R2) and standard error of the estimate (SEE).Results: The model fit for estimation of VO2max from time to RPE ≥ 17 at the submaximal test, body mass, age, and gender was R2 = 0.78 (SEE = 3.1 ml kg−1 min−1, p ≤ 0.001). Including heart rate measurement did not improve the model fit.Conclusions: The submaximal walking test is feasible and valid for assessing cardiorespiratory fitness in individuals with high risk of or chronic health conditions.

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Late Morbidity and Mortality Among Medulloblastoma Survivors Diagnosed Across Three Decades: A Report From the Childhood Cancer Survivor Study

Journal of Clinical Oncology ◽

10.1200/jco.18.00969 ◽

2019 ◽

Vol 37 (9) ◽

pp. 731-740 ◽

Cited By ~ 16

Author(s):

Ralph Salloum ◽

Yan Chen ◽

Yutaka Yasui ◽

Roger Packer ◽

Wendy Leisenring ◽

...

Keyword(s):

High Risk ◽

Cumulative Incidence ◽

Chronic Health Conditions ◽

Health Conditions ◽

Special Education Services ◽

Education Services ◽

Late Mortality ◽

Childhood Cancer Survivor Study ◽

Standard Risk

PURPOSE Treatment of medulloblastoma has evolved from surgery and radiotherapy to contemporary multimodal regimens. However, the impact on long-term health outcomes remains unknown. METHODS Cumulative incidence of late mortality (5 or more years from diagnosis), subsequent neoplasms (SNs), and chronic health conditions were evaluated in the Childhood Cancer Survivor Study among 5-year survivors of medulloblastoma diagnosed between 1970 and 1999. Outcomes were evaluated by treatment exposure, including historical therapy (craniospinal irradiation [CSI] ≥ 30 Gy, no chemotherapy), high risk (CSI ≥ 30 Gy + chemotherapy), standard risk (CSI < 30 Gy + chemotherapy), and by treatment decade (1970s, 1980s, 1990s). Rate ratios (RRs) and 95% CIs estimated long-term outcomes using multivariable piecewise exponential models. RESULTS Among 1,311 eligible survivors (median age, 29 years [range, 6 to 60 years]; median time from diagnosis, 21 years [range, 5 to 44 years]), the 15-year cumulative incidence rate of all-cause late mortality was 23.2% (diagnosed 1970s) versus 12.8% (1990s; P = .002), with a recurrence-related mortality rate of 17.7% versus 9.6% ( P = .008). Lower late mortality rates as a result of other health-related causes were not observed. Among 997 survivors who completed a baseline survey, the 15-year cumulative incidence of SNs was higher among survivors with multimodal therapy (standard risk, 9.5%; historical, 2.8%; P = .03). Survivors treated in the 1990s had a higher cumulative incidence of severe, disabling, life-threatening, and fatal chronic health conditions (56.5% in 1990s v 39.9% in 1970s; P < .001) and were more likely to develop multiple conditions (RR, 2.89; 95% CI, 1.31 to 6.38). However, survivors of standard-risk therapy were less likely to use special education services than high-risk therapy survivors (RR, 0.84; 95% CI, 0.75 to 0.93). CONCLUSION Historical changes in medulloblastoma therapy that improved 5-year survival have increased the risk for SNs and debilitating health conditions for survivors yet reduced the need for special education services.

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Temporal trends in late-onset morbidity and mortality after medulloblastoma diagnosed across three decades: A report from the Childhood Cancer Survivor Study (CCSS).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10516 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10516-10516 ◽

Cited By ~ 1

Author(s):

Ralph Salloum ◽

Yan Chen ◽

Yutaka Yasui ◽

Roger Packer ◽

Wendy M. Leisenring ◽

...

Keyword(s):

Special Education ◽

High Risk ◽

Cumulative Incidence ◽

Chronic Health Conditions ◽

Health Conditions ◽

Long Term Outcomes ◽

Late Mortality ◽

Life Threatening ◽

Standard Risk

10516 Background: Therapy for medulloblastoma and primitive neuroectodermal tumor has evolved from surgery and adjuvant radiotherapy to risk-adapted multimodal regimens. The impact of these changes in treatment on long-term outcomes remains unknown. Methods: Cumulative incidence of late mortality ( > 5 years from diagnosis), subsequent malignant neoplasms (SMN), chronic health conditions and psychosocial functioning were evaluated among 5-year survivors in CCSS diagnosed between 1970 and 1999. Survivors were stratified according to treatment decade (1970s, 1980s, 1990s) and treatment exposure (surgery + craniospinal irradiation [CSI] ≥30 Gy, no chemotherapy; surgery + CSI ≥30 Gy + chemotherapy [high-risk therapy], surgery + CSI ˂30 Gy + chemotherapy [standard-risk therapy]). Rate ratios (RRs), odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for long-term outcomes among treatment eras and exposure groups using multivariable piecewise-exponential models. Results: Among 1,380 eligible survivors (median [range] age 29 [6-20] years; 21.4 [5-44] years from diagnosis), the 15-year cumulative incidence of all-cause (21.9% 1970s vs. 12.8% 1990s; p = 0.003) and recurrence-related (16.2% vs 9.6%, p = 0.03) late mortality decreased with no reduction in mortality attributable to late effects of therapy including SMN. Among 959 participants, the incidence of SMN did not decrease by era or by treatment group. However, survivors treated in the 1990s had an increased cumulative incidence of severe, life-threatening and fatal health conditions (16.9% 1970s vs 25.4% 1990s; p = 0.03), and were more likely to develop multiple severe or life-threatening health conditions, RR = 2.98 (95% CI, 1.10-8.07). Survivors of standard-risk therapy were less likely to use special education services than high-risk therapy patients, OR = 0.51 (95% CI, 0.33-0.78). Conclusions: Historical changes in therapy have improved 5-year survival, reduced risk of late mortality due to disease recurrence, and reduced special education utilization, at the cost of increased risk for multiple, severe and life-threatening chronic health conditions.

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