Validation of a rapid and sensitive SARS-CoV-2 screening system developed for pandemic-scale infection surveillance

Without any realistic prospect of comprehensive global vaccine coverage and lasting immunity, control of pandemics such as COVID-19 will require implementation of large scale, rapid identification and isolation of infectious individuals to limit further transmission. Here, we describe an automated, high-throughput testing instrument, designed for population-scale testing for SARS-CoV-2 RNA within 25 minutes from inactivated saliva to result, and capable of reporting 3,840 results per hour. This integrated screening platform incorporates continuous flow loading of samples at random intervals to cost-effectively adjust for fluctuations in testing demand. Protecting vulnerable populations during global pandemics requires rapid and sensitive infection surveillance of asymptomatic carriers. This Sentinel surveillance system offers a feasible and scalable approach to complement vaccination, to curb the spread of COVID-19 variants and future pandemics to save lives.

Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model

Unaddressed hearing loss affects an estimated 466 million people worldwide, costing over $750 billion globally, with rural communities being particularly disadvantaged, due to the greater inequity in access to healthcare services. This mixed-methods study aimed to use the PRECEDE-PROCEED model to develop and pilot a rural community pharmacy-based ear health service, LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Program). The PRECEDE process involved an assessment of the predisposing, reinforcing and enabling constructs to support practice change through a scoping review, stakeholder surveys and interviews and consultation with governing bodies and regulatory authorities. The PROCEED segment structured the evaluation of the service pilot and informed planned implementation, process, impact and outcome evaluation. The pilot study conducted in February 2021 included 20 participants, with the most common ear complaints presented being pain, pressure or blockage. All these participants reported high levels of satisfaction with the service, would recommend the service to others and would attend the pharmacy first before seeing a GP for future ear complaints. The PRECEDE-PROCEED model provides a comprehensive model to guide the design of the LISTEN UP program, an innovative model, expanding services offered by rural community pharmacies, with preliminary results demonstrating high consumer satisfaction.

Epidemiology of chronic kidney disease of undetermined aetiology in Taiwanese farmers: a cross-sectional study from Changhua Community-based Integrated Screening programme

ObjectivesChronic kidney disease of undetermined or non-traditional aetiology (CKDu or CKDnT) has been reported in Mesoamerica among farmers under heat stress. Epidemiological evidence was lacking in Asian countries with similar climatic conditions. The objective of this study was to investigate the prevalence of CKDu and possible risk factors.MethodsWe used the data from the Changhua Community-based Integrated Screening programme from 2005 to 2014, which is the annual screening for chronic diseases in Taiwan’s largest rice-farming county since 2005. Our study population included farmers and non-farmers aged 15–60 years. CKDu was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 at age under 60 years without hypertension, diabetes, proteinuria, haematuria or using Chinese herbal medicine. We estimated the adjusted prevalence OR (POR) of CKDu by farmers, age, sex, education, urbanisation, smoking, body mass index, hyperuricaemia, hyperlipidaemia, heart disease and chronic liver disease.Results5555 farmers and 35 761 non-farmers were included in this study. CKDu accounted for 48.9% of all CKD cases. The prevalence of CKDu was 2.3% in the farmers and 0.9% in the non-farmers. The crude POR of CKDu in farmers compared with non-farmers was 2.73 (2.13–3.50), and the adjusted POR was 1.45 (1.10–1.90). Dehydration (blood urea nitrogen-to-creatinine ratio >20) was found in 22% of the farmers and 14% of the non-farmers.ConclusionsFarmers in subtropical Asian countries are at increased risk of CKDu. Governments should take the CKDu epidemics seriously and provide farmers with occupational health education programmes on thermal hazards.

Timeliness of contact tracing among flight passengers during the COVID-19 epidemic in Vietnam

Background International air travel plays an important role in the global spread of SARS-CoV-2, and tracing of close contacts is an integral part of the public health response to COVID-19. We aimed to assess the timeliness of contact tracing among airline passengers arriving in Vietnam on flights containing COVID-19 cases and investigated factors associated with timeliness of contact tracing. Methods We included data from 2228 passengers on 22 incoming flights between 2 and 19 March 2020. Contact tracing duration was assessed separately for the time between the date of index case confirmation and date of contact tracing initiation (interval I), and the date of contact tracing initiation and completion (interval II). We used log-rank tests and multivariable Poisson regression models to identify factors associated with timeliness. Results The median duration of interval I and interval II was one (IQR: 1–2) and 3 days (IQR: 2–5), respectively. The contact tracing duration was shorter for passengers from flights where the index case was identified through mandatory testing directly upon arrival (median = 4; IQR: 3–5) compared to flights with index case detection through self-presentation at health facilities after arrival (median = 7; IQR: 5–8) (p-value = 0.018). Cumulative hazards for successful tracing were higher for Vietnamese nationals compared to non-Vietnamese nationals (p < 0.001). Conclusions Contact tracing among flight passengers in the early stage of the COVID-19 epidemic in Vietnam was timely though delays occurred on high workload days. Mandatory SARS-CoV-2 testing at arrival may reduce contact tracing duration and should be considered as an integrated screening tool for flight passengers from high-risk areas when entering low-transmission settings with limited contact tracing capacity. We recommend a standardized risk-based contact tracing approach for flight passengers during the ongoing COVID-19 epidemic.

Dynamics of detailed components of metabolic syndrome associated with the risk of cardiovascular disease and death

Few studies quantify a cascade of dynamic transitions on the detailed components of metabolic syndrome (MetS) and subsequent progressions to cardiovascular disease (CVD) and its death. A total of 47,495 subjects repeatedly attending a community-based integrated screening program in Taiwan were recruited. The refined MetS-related classification (RMRC) in relation to five criteria of MetS was defined as free of metabolic disorder (FMD, none of any criteria), mild metabolic disorder (MMD, 1–2 criteria) and MetS. A multistate Markov model was used for modelling such a multistate process. The estimated progression rate from FMD to MMD was 44.82% (95% CI 42.95–46.70%) whereas the regression rate was estimated as 29.11% (95% CI 27.77–30.45%). The progression rate from MMD to MetS was estimated as 6.15% (95% CI 5.89–6.42%). The estimated annual incidence rates of CVD increased with the severity of RMRC, being 1.62% (95% CI 1.46–1.79%) for FMD, 4.74% (95% CI 4.52–4.96%) for MMD, to 20.22% (95% CI 19.52–20.92%) for MetS. The estimated hazard rate of CVD death was 6.1 (95% CI 4.6–7.7) per thousand. Elucidating the dynamics of MetS-related transition and quantifying the incidence and prognosis of CVD provide a new insight into the design and the evaluation of intervention programs for CVD.

Abstract 14811: Disparities in Prevalence of Hypertension and Hypertensive Urgency by Race and Hispanic Origin in the Wisewoman Population, 2014 to 2018

Background: Hypertension is a preventable risk factor for heart disease and stroke. Patients with hypertensive urgency should seek immediate medical assistance to prevent organ damage, injury, disability, or death. Objective: This study examined disparities in the prevalence of hypertension (blood pressure (BP) ≥130/80 mm Hg) and hypertensive urgency (BP ≥180/110 mm Hg) in the WISEWOMAN population. WISEWOMAN represents the Well-Integrated Screening and Evaluation for Women Across the Nation programs that serve a diverse uninsured and underinsured population in the United States. Methods: WISEWOMAN data (January 2014- December 2018) were obtained from 19 state health departments and two Alaska tribal organizations. Women aged 40-64 years with hypertension or hypertensive urgency were identified based on BP readings at a screening visit. The data were stratified, and prevalence was calculated by race and Hispanic origin. Results: In the WISEWOMAN population there were 25,098 women with hypertension. Overall prevalence of hypertension was 38.5 percent and the prevalence of hypertensive urgency was 4.6 percent. Non-Hispanic black (NHB) women had the highest prevalence of hypertension (67.1 percent) followed by non-Hispanic White (NHW) women (40.2 percent) and Hispanic women (26.5 percent). NHB women (6.1 percent) had the highest prevalence of hypertensive urgency followed by NHW women (4.5 percent) and Hispanic women (3.4 percent). Conclusion: Differences in prevalence of women with hypertension and hypertension urgency were statistically significant among race and Hispanic origin. Furthermore, NHB women had disproportionally higher prevalence of hypertension and hypertensive urgency than NHW women and Hispanic women.Keywords: Hypertension, Hypertensive urgency, WISEWOMAN Table 1: Mean Age, Number and Percentages of Women Screened, Women with Hypertension and those with Hypertensive Urgency among WISEWOMAN Participants, 40-64 years old, January 2014- June 2018. By Race and Hispanic origin