Confirmed COVID-19 Cases per Economic Activity during Autumn Wave in Belgium

Some occupational sectors, such as human health and care, food service, cultural and sport activities, have been associated with a higher risk of SARS-CoV-2 infection than other sectors. To curb the spread of SARS-CoV-2, it is preferable to apply targeted non-pharmaceutical interventions on selected economic sectors, rather than a full lockdown. However, the effect of these general and sector-specific interventions on the virus circulation has only been sparsely studied. We assess the COVID-19 incidence under different levels of non-pharmaceutical interventions per economic activity during the autumn 2020 wave in Belgium. The 14-day incidence of confirmed COVID-19 cases per the Statistical Classification of Economic Activities in the European Community (NACE–BEL) sector is modelled by a longitudinal Gaussian-Gaussian two-stage approach. This is based on exhaustive data on all employees in all sectors. In the presence of sanitary protocols and minimal non-pharmaceutical interventions, many sectors with close contact with others show considerably higher COVID-19 14-day incidences than other sectors. The effect of stricter non-pharmaceutical interventions in the general population and non-essential sectors is seen in the timing of the peak incidence and the width and height of the post-peak incidence. In most sectors incidences returned to higher levels after the peak than before and this decrease took longer for the health and care sector. Sanitary protocols for close proximity occupations may be sufficient during periods of low-level virus circulation, but progressively less with increasing circulation. Stricter general and sector-specific non-pharmaceutical interventions adequately decrease COVID-19 incidences, even in close proximity in essential sectors under solely sanitary protocols.

The Burden of Penile Cancer in Bali Compared to Other Provinces in Indonesia

Objective: In Indonesia, 45% of the total penile cancer cases are concentrated in Bali province, where penile cancer is ranked as the most common cancer during 2013. However, the incidences of penile cancer in Bali and other provinces in Indonesia are still unknown. The purpose of this study is to determine the age-standardized incidence rate (ASR), age-specific incidence rate (AR), and crude rate incidence (CRI) of penile cancer in Bali and other provinces in Indonesia. Methods: The data were obtained from 11 provinces in Indonesia over a period of 10 years (2004-2013). The samples were 1032 new cases of penile cancer collected manually from the registry. ASR, AR, and CRI were calculated based on the number of new penile cancer cases per 100,000 men in a given province. Indonesian population standard was used to calculate the age-standardized incidence rate. Result: There were variations on ASR, AR, and CRI for penile cancer in Indonesia. We found that the average CRI in Indonesia is 0.1 per 100,000 men. The incidence is found to be higher in Bali compared to other provinces. The average ASR in Bali is 2.1 per 100,000 men, CRI is 2.5 per 100,000 men, and the peak of AR being 12.9 per 100,000 men in the age group of 55-64 years old. The incidence of penile cancer is found to increase with age. In Bali, the peak incidence is in the 6th and 7th decades of life. The ASR and CRI of penile cancer in other provinces were less than 1 per 100,000 males. Conclusion: The highest incidence of penile cancer is found in the Bali province compared to other provinces in Indonesia. This problem requires more serious attention and further research to identify the risk factors.

Spatially varying effects of measured confounding variables on disease risk

Background The presence of considerable spatial variability in incidence intensity suggests that risk factors are unevenly distributed in space and influence the geographical disease incidence distribution and pattern. As most human common diseases that challenge investigators are complex traits and as more factors associated with increased risk are discovered, statistical spatial models are needed that investigate geographical variability in the association between disease incidence and confounding variables and evaluate spatially varying effects on disease risk related to known or suspected risk factors. Information on geography that we focus on is geographical disease clusters of peak incidence and paucity of incidence. Methods We proposed and illustrated a statistical spatial model that incorporates information on known or hypothesized risk factors, previously detected geographical disease clusters of peak incidence and paucity of incidence, and their interactions as covariates into the framework of interaction regression models. The spatial scan statistic and the generalized map-based pattern recognition procedure that we recently developed were both considered for geographical disease cluster detection. The Freeman-Tukey transformation was applied to improve normality of distribution and approximately stabilize the variance in the model. We exemplified the proposed method by analyzing data on the spatial occurrence of sudden infant death syndrome (SIDS) with confounding variables of race and gender in North Carolina. Results The analysis revealed the presence of spatial variability in the association between SIDS incidence and race. We differentiated spatial effects of race on SIDS incidence among previously detected geographical disease clusters of peak incidence and incidence paucity and areas outside the geographical disease clusters, determined by the spatial scan statistic and the generalized map-based pattern recognition procedure. Our analysis showed the absence of spatial association between SIDS incidence and gender. Conclusion The application to the SIDS incidence data demonstrates the ability of our proposed model to estimate spatially varying associations between disease incidence and confounding variables and distinguish spatially related risk factors from spatially constant ones, providing valuable inference for targeted environmental and epidemiological surveillance and management, risk stratification, and thorough etiologic studies of disease.

Temporal Profile of Pneumonia After Stroke

Background and Purpose: The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies. Methods: We analyzed individual patient data stored in the VISTA (Virtual International Stroke Trials Archive) from randomized acute stroke trials with an inclusion window up to 24 hours after stroke onset and assessed the occurrence of pneumonia in the first 90 days after stroke. Adjusted odds ratios and hazard ratios were calculated for the association between pneumonia and poor outcome and death by means of logistic and Cox proportional hazard regression, respectively, at different times of follow-up. Results: Of 10 821 patients, 1017 (9.4%) had a total of 1076 pneumonias. Six hundred eighty-nine (64.0%) pneumonias occurred in the first week after stroke. The peak incidence was on the third day and the median time of onset was 4.0 days after stroke (interquartile range, 2–12). The presence of a pneumonia was associated with an increased risk of poor outcome (adjusted odds ratio, 4.8 [95% CI, 3.8–6.1]) or death (adjusted hazard ratio, 4.1 [95% CI, 3.7–4.6]). These associations were present throughout the 90 days of follow-up. Conclusions: Two out of 3 pneumonias in the first 3 months after stroke occur in the first week, with a peak incidence on the third day. The most optimal period to assess pneumonia prevention strategies is the first 4 days after stroke. However, pneumonia occurring later was also associated with poor functional outcome or death.

Epidemiological features of malignant mesothelioma in the Republic of Belarus

Based on the data of the Belarusian Cancer Register for 2000–2019 the dynamics and structure of incidence of mesothelioma in the Republic of Belarus are studied. We calculated incidence rates, age-standardized incidence rates, taking into account the gender and place of residence of patients, cumulative risk. The analysis of the structure was carried out both for the whole population and separately for men and women, as well as for the urban and rural population.We detected that the incidence rates of malignant mesothelioma in the Republic of Belarus are significantly lower than those in the Western Europe region and the Central and Eastern European region. For the period from 2000 to 2019 the dynamics of the incidence rates of mesothelioma in the Republic is characterized by a moderate tendency to decrease, and in the general structure of the incidence rate both among men and among women, pleural mesothelioma is the dominant localization. The population of regions where asbestos-cement manufacturing is located has no higher risk of developing malignant mesothelioma in comparison with population levels.The estimated incidence of mesothelioma in men is 2 times higher than the incidence of women, and this excess is independent of age differences between these two populations. The highest incidence rates for men are observed at the age of 75–79 years, while the peak incidence for men living in the city falls at the earlier age – 70–74 years. Among women living both in the city and in rural areas, the peak incidence falls at the age of 80–84 years.

Estimating the Transmissibility of Mumps: A Modelling Study in Wuhan City, China

Despite the adoption of a national immunization program in China, the incidence of mumps remains high. This study aimed to describe the epidemiological characteristics, including the time, region, occupation, and age, of mumps in Wuhan from 2005 to 2018 and to evaluate its transmissibility. In this study, the susceptible–exposed–infectious–asymptomatic–recovered (SEIAR) model fitted the actual incidence data of mumps. The effective reproduction number (Rt) was used to evaluate and compare the transmission capacity in different areas. From 2005 to 2018, there were 36,415 cases. The incidence of mumps was highest among people aged 5–10 years (460.02 per 100,000). The SEIAR model fitted the reported mumps data well (P < 0.01). The median transmissibility (Rt) was 1.04 (range = 0–2.50). There were two peak spreads every year (from March to May and from October to December). The Rt peak always appeared in the first 2 months of the peak incidence rate. The peak time of the epidemic spread of mumps was 1–2 months earlier than the peak incidence rate. The prevention and control measures of vaccination for children aged 5–10 years should be taken before the peak transmission capacity each year, 2 months before the peak of the outbreak, to reduce the spread of mumps.

IBD in the Postpartum Period: Spotlight on Maternal Outcomes

Lay Summary With the peak incidence of IBD in the reproductive years, concerns related to pregnancy are frequently raised. This period is unique in that care involves more than one patient: the pregnant woman and her child/children. For long, focus has been primarily on infant outcomes. This study brings attention to maternal outcomes.

Myasthenia gravis during pregnancy: what care should be taken?

Myasthenia gravis (MG) is an autoimmune disease in which the peak incidence is among women of childbearing age. For this reason, there is an overlap between the occurrence of this disease and pregnancy. It is known that MG symptoms can worsen during pregnancy and postpartum, and that pregnancy has special characteristics in MG patients. Children born to myasthenic mothers are at risk of having transient neonatal myasthenia. We briefly review the main relationships between MG and pregnancy, and we make recommendations for MG therapy, pregnancy, delivery, breastfeeding and newborns.

Adult aplastic anemia in Thailand: incidence and treatment outcome from a prospective nationwide population-based study

The incidence and outcomes of aplastic anemia (AA) in Asia remain limited. This study aimed to explore the incidence and outcomes of patients with adult AA across the country of Thailand. This is a prospective multi-center nationwide population-based observational study of AA patients aged at least 15 years old, diagnosed from August 2014 to July 2016, with a longitudinal follow-up period over 2 years. There were 348 newly diagnosed adult AA patients during the enrollment period, giving an annual incidence of 4.6 per million. The incidence of severe (SAA) and very severe aplastic anemia (VSAA) (3.8 per million) was higher than non-severe AA (NSAA, 0.8 per million). The peak incidence was observed in the patients aged from 80 to 89 years old (14.4 per million). The 2-year overall survival (OS) in NSAA, SAA, and VSAA were 65.5%, 49.3%, and 20.1%, respectively (P < 0.001). With regard to the response to immunosuppressive therapy, the overall response rate (ORR) in SAA/VSAA treated with rabbit anti-thymocyte globulin with/without cyclosporin A (rATG ± CsA) were significantly superior to those treated with CsA alone, or anabolic steroids (44.4% vs 36.4% and 31.2%, respectively, P < 0.001). The 2-year OS in SAA/VSAA treated with rATG ± CsA, CsA, and anabolic steroids were 54.8%, 54.5%, and 37.6% (P = 0.037), respectively. The incidence of adult AA in Thailand is higher than those in Western countries, and the peak incidence is in the elderly. rATG ± CsA provided a better response than anabolic steroids, translating to the superior survival in SAA/VSAA treated with rATG ± CsA.