Tick-borne encephalitis (TBE) in Switzerland: Does the prolongation of vaccine booster intervals result in an increased risk of breakthroughs?

Background: In 2006, the Swiss Federal Office of Public Health decided recommending a prolongation of vaccine booster intervals after the 3rd dose for the prevention of tick-borne encephalitis (TBE) from 3 to 10 years. Methods: To ascertain whether this amendment resulted in an increased rate of vaccine breakthroughs we conducted a retrospective analysis of surveillance data collected 2000–2019 by mandatory reporting to the Swiss Federal Office of Public Health (FOPH). Fractions of breakthroughs (with 95% confidence intervals)—0 to 3 years vs. > 3 to 10 years after the 3rd vaccination dose—were compared across time periods and age groups. Results: Among 3205 notified TBE cases, known vaccination status was reported in 2562 (79.9%), including 103 patients with ≥3 vaccine doses (4.0%). Among those, there were 39 patients who had received the last dose within 3 years and 48 patients in the > 3 to 10 years group. During the 2010 to 2019 period in which the new booster strategy was implemented there were 23 and 38 breakthroughs, respectively, and the annual breakthrough rate was 7.7 (95% C.I. 5.0–11.7) cases during the first three years after the last dose, and 5.4 (95% C.I. 3.9–7.5) cases in following seven years. We observed no significant trend of TBE breakthroughs with increasing age. Increasing numbers of TBE and of vaccine breakthroughs over time have been associated with spreading endemicity and higher vaccination coverage in Switzerland. Conclusions: there is no indication that extended booster intervals resulted in an increased rate of breakthroughs, but there was a marked public health benefit with respect to increased acceptability of TBE immunization in the general population.

Adapting and Testing a Brief Intervention to Reduce Maternal Anxiety During Pregnancy (ACORN): Report of a Feasibility Randomized Controlled Trial

Background. We investigated the acceptability and feasibility of a new brief intervention for maternal prenatal anxiety within maternity services. Results. 114 pregnant women attending their 12-week scan at a prenatal clinic with elevated symptoms of anxiety (GAD-7 score of ≥ 7) were randomly assigned to either the ACORN intervention + Treatment as usual (TAU) (n=57) or to usual care only (n= 57). The ACORN intervention consisted of 3 group sessions, led by a midwife and psychological therapist, for women and their partners. The intervention included psychoeducation about anxiety, strategies for problem-sovling and tolerating uncertainty during pregnancy, including communicating about these with others, and mindfulness exercises. Engagement rates with ACORN met or exceeded those in primary care services in England. In the intervention arm, 77% (n= 44) of participants attended at least one session, 51% (n=29) were adherent, defined as attending two or more sessions. Feedback was positive, and women in the ACORN treatment group demonstrated some evidence of a larger drop in their levels of anxiety than the women in the TAU-only group (Cohen’s d = 0.42). Conclusion. The ACORN intervention was acceptable to women and their partners and resulted in reductions in anxiety. With further evaluation in a larger-scale trial with child outcomes, there is significant potential for large scale public health benefit.

Pharmacists’ involvement in COVID-19 vaccination across Europe: a situational analysis of current practice and policy

One year since the emergence of the COVID-19 pandemic, rapid response measures have been implemented internationally to mitigate the spread of the virus. Following rapid and successful pre-clinical and human trials, several vaccines have been authorised for use across Europe through the European Medicines Agency and national regulatory authorities. Clinical trials have shown promising results including important reductions in disease severity, hospitalisation and mortality. In order to maximise the public health benefit of available vaccines, there is a pressing need to vaccinate a large proportion of the population. Internationally, this has prompted coordination of existing services at enormous scale, and development and implementation of novel vaccination strategies to ensure maximum inoculation over the shortest possible timeframe. Pharmacists are being promoted as healthcare professionals that enhance roll-out of COVID-19 vaccination programmes. This paper aims to summarise current policy and practice in relation to pharmacists’ involvement in COVID-19 vaccination in 13 countries across Europe.

The Frequency and Characteristics of Facial Injury Following COVID-19 Social Distancing Laws: Newcastle, (Australia) Observations

The imposition of COVID-19 social distancing laws serendipitously decreased the frequency and altered the characteristics of facial injury presentation. The purpose of this study was to determine whether the devolution of social distancing laws had the opposite effect. Materials and methods: The authors undertook a retrospective study of the clinical records of a cohort of patients who sustained a facial injury during COVID-19 social distancing devolution. The primary predictor valuable was the 8 week devolution of social distancing. Other variables consisted of a heterogeneous set of factors grouped into logical categories: demographic, injury specifics, and treatment. A descriptive statistical analysis was undertaken on the assembled results. Results: The study found that the absolute numbers of facial injury presentation rose from 73 to 120; a 64% increase. The study also found that there was an alteration to the characteristics of facial injury presentation across the study variables. Conclusion: The initial imposition and subsequent devolution of COVID-19 social distancing measures had a serendipitous public health benefit. Initially there was a decrease in the frequency of facial injury presentation followed by an increase upon cessation of social distancing restrictions

Determining the acceptability of testing contacts of confirmed COVID-19 cases to improve secondary case ascertainment

ABSTRACT Background UK asymptomatic contacts of confirmed COVID-19 cases are not routinely tested for SARS-CoV-2. Testing contacts may improve case ascertainment and reduce onward transmission. This study investigated the acceptability of SARS-CoV-2 testing among contacts of confirmed cases as an integral part of the contact-tracing process. Methods A cross-sectional descriptive survey of case contacts was conducted in the UK. All contacts who completed a telephone call with the NHS Test and Trace Agile Lighthouse team were eligible for inclusion and were offered a molecular test. Consenting participants were sent a self-swab kit. Results Of the 1523 individuals contacted, 602 (39.5%) accepted the test offer. Of the 240 (39.9%) samples returned for testing, 16.3% tested polymerase chain reaction-positive for SARS-CoV-2. Most individuals who declined with a reason (638/905; 70.5%) reported they had already taken or booked a SARS-CoV-2 test, or were part of a testing programme. Matched laboratory records confirmed 73.1% of those who declined were tested by another route. Conclusions Most case contacts were tested, either through arranging a test by themselves or by accepting the study offer. Results demonstrate high acceptability, with substantial test positivity, indicating that there is public health benefit in offering tests to contacts as a routine part of the contact-tracing process.

Wastewater monitoring, surveillance and epidemiology: a review of terminology for a common understanding

ABSTRACT Response to the COVID-19 (coronavirus disease 2019) pandemic saw an unprecedented uptake in bottom-up efforts to incorporate community wastewater testing to inform public health. While not a new strategy, various specialized scientific advancements were achieved to establish links between wastewater concentrations of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and public health outcomes. Maximizing public health benefit requires collaboration among a broad range of disciplinary experts, each bringing their own historical context to the central goal of protecting human health. One challenge has been a lack of shared terminology. Standardized terminology would provide common ground for this rapidly growing field. Based on the review herein, we recommend categorical usage of the term ‘wastewater-based epidemiology’ to describe the science of relating microbes, chemicals or other analytes in wastewater to public health. We further recommend the term ‘wastewater surveillance’ to describe continuous monitoring of health outcomes (either microbes or chemicals) via wastewater. We suggest that ‘wastewater tracking’ and ‘wastewater tracing’ be used in more narrow ways, specifically when trying to find the source of a health risk. Finally, we suggest that the phrase ‘wastewater monitoring’ be abandoned, except in rare circumstances when ensuring wastewater discharge is safe from a public health perspective.

Proportion of Dementia Explained by Five Key Factors in Jamaica

Background: Dementia has no known cure and age is its strongest predictor. Given that populations in the Caribbean are aging, a focus on policies and programs that reduce the risk of dementia and its risk factors is required. Objective: To estimate the proportion of dementia in the Jamaican setting attributable to key factors. Methods: We analyzed the contribution of five modifiable risk factors to dementia prevalence in Jamaica using a modified Levin’s Attributable Risk formula (low educational attainment, diabetes, smoking status, depression, and physical inactivity). Four sources of data were used: risk factor prevalence was obtained from the Jamaica Health and Lifestyle Survey, 2008, relative risk data were sourced from published meta-analyses, shared variance among risk factors was determined using cross-sectional data from the Health and Social Status of Older Persons in Jamaica Study. Estimated future prevalence of dementia in Jamaica was sourced from a published ADI/BUPA report which focused on dementia in the Americas. We computed the number of dementia cases attributable to each risk factor and estimated the effect of a reduction in these risk factors on future dementia prevalence. Results: Accounting for the overlapping of risk factors, 34.46% of dementia cases in Jamaica (6548 cases) were attributable to the five risk factors under study. We determined that if each risk factor were to be reduced by 5% –10% per decade from 2010–2050, dementia prevalence could be reduced by up to 14.0%. Conclusion: As the risk factors for dementia are shared with several of the main causes of death in Jamaica, a reduction in risk factors by even 5% can result in considerable public health benefit.