A 2-month field cohort study of SARS-CoV-2 in saliva of BNT162b2 vaccinated nursing home workers

Background Nursing home (NH) residents have been severely affected during the COVID-19 pandemic because of their age and underlying comorbidities. Infection and outbreaks in NHs are most likely triggered by infected workers. Screening for asymptomatic NH workers can prevent risky contact and viral transmission to the residents. This study examined the effect of the BNT162b2 mRNA COVID‑19 (Comirnaty®; BioNTech and Pfizer) vaccination on the saliva excretion of SARS-CoV-2 among NH workers, through weekly saliva RT-qPCR testing. Methods A 2-month cohort study was conducted among 99 NHs in the Walloon region (Belgium), at the start of February 2021. Three groups of workers, i.e., non-vaccinated (n = 1618), one-dosed vaccinated (n = 1454), and two-dosed vaccinated (n = 2379) of BNT162b2 mRNA COVID‑19 vaccine, were followed-up weekly. Their saliva samples were used to monitor the shedding of SARS-CoV-2. All positive samples were sequenced and genotyped to identify the circulating wild-type virus or variants of concern. Results The protection fraction against the excretion of the SARS-CoV-2 in the saliva samples of the workers after the second dose is estimated at 0.90 (95% CI: 0.18; 0.99) at 1 week and 0.83 (95% CI: 0.54; 0.95) at 8 weeks. We observe more circulating SARS-CoV-2 and a greater variability of viral loads in the unvaccinated group compared to those of the vaccinated group. Conclusions This field cohort study advances our knowledge of the efficacy of the mRNA BNT162b2 COVID-19 vaccine on the viral shedding in the saliva specimens of vaccinated NH workers, contributing to better decision-making in public health interventions and management.

Using Threshold Analysis to Assess the Robustness of Public Health Intervention Recommendations from Network Meta-Analyses: Application to Poison Prevention in Households with Children Under Five

BackgroundIn the appraisal of clinical interventions, complex evidence synthesis methods, such as network meta-analysis (NMA), are commonly used to investigate the effectiveness of multiple interventions in a single analysis. The results from a NMA can inform clinical guidelines directly or be used as inputs into a decision-analytic model assessing the cost-effectiveness of the interventions. However, there is hesitancy in using complex evidence synthesis methods when evaluating public health interventions. This is due to significant heterogeneity across studies investigating such interventions and concerns about their quality. Threshold analysis has been developed to help assess and quantify the robustness of recommendations made based on results obtained from NMAs to potential limitations of the data. Developed in the context of clinical guidelines, the method may prove useful also in the context of public health interventions. In this paper, we illustrate the use of the method in the study investigating the effectiveness of interventions aiming to increase the uptake of poison prevention behaviours in homes with children aged 0-5.MethodsRandom effects NMA was carried out to assess the effectiveness of several interventions for increasing the uptake of poison prevention behaviours, focusing on the safe storage of other household products outcome. Threshold analysis was then applied to the NMA to assess the robustness of the intervention recommendations made based on the NMA.Results15 studies assessing seven interventions were included in the NMA. The results of the NMA indicated that complex intervention, including Education, Free/low-cost equipment, Fitting equipment and Home safety inspection, was the most effective intervention at promoting poison prevention behaviours. However, the threshold analyses highlighted that this intervention recommendation was not robust.Conclusions In our case study, threshold analysis allowed us to demonstrate that the intervention recommendation for promoting poison prevention behaviours was not robust to changes in the evidence due to potential bias. Therefore, caution should be taken when considering such interventions in practice. We have illustrated the potential benefit of threshold analysis and, therefore, encourage the use of the method in practice as a sensitivity analysis for NMA of public health interventions.

Cerebral venous sinus thrombosis related to vaccine-induced immune thrombotic thrombocytopenia: First reported case in Vietnam

Vaccination remains one of the most important public health interventions to control and mitigate the impacts of COVID-19 worldwide. A number of post-vaccination reactions have caused concern and are the cause of vaccine hesitancy. Vaccine-induced immune thrombotic thrombopenia (VITT) has been reported in several countries such as Norway at a rate of 1 per 26000 doses of the ChAdOx1 nCoV vaccine (AstraZeneca), 15 per 8 million doses of Ad26.COV2.S (Janssen; Johnson & Johnson) vaccines in the US. In Vietnam, 11.5 million doses of AstraZeneca vaccine have been administered since the commencement of a nation-wide vaccination program five months ago. We report the first case of cerebral venous thrombosis related to VITT which was promptly diagnosed and successfully treated with rivaroxaban alone. Thus, VITT is very rare in Vietnamese people vaccinated with the AstraZeneca vaccine in the prevention of COVD-19 infection.

Public health priority setting: A case for priority to the worse off in well-being during the COVID-19 pandemic

In Norway, priority for health interventions is assigned on the basis of three official criteria: health benefit, resources, and severity. Responses to the COVID-19 pandemic have mainly happened through intersectoral public health efforts such as lockdowns, quarantines, information campaigns, social distancing and, more recently, vaccine distribution. The aim of this article is to evaluate potential priority setting criteria for public health interventions. We argue in favour of the following three criteria for public health priority setting: benefit, resources and improving the well-being of the worse off. We argue that benefits and priority to the worse off may reasonably be understood in terms of individual well-being, rather than only health, for public health priority setting. We argue that lessons from the COVID-19 pandemic support our conclusions. Keywords: COVID-19, Prioritarianism, Priority Setting, Public Health, Severity

Policing the coronavirus pandemic: Nigeria police senior officers’ views on preparedness, response, legitimacy and post-COVID policing

In the wake of pandemic policing occasioned by COVID-19, Nigeria police have been facing challenges of a lack of legitimacy, together with what is termed the militarization of police operations. This has impacted considerably on police–community relations. Meanwhile, early reports on the police response to the pandemic indicated high levels of lockdown violation, despite adoption of a militarized option in the enforcement of restriction orders. In reviewing one of the first police interventions on a public health crisis in Nigeria, a qualitative study was conducted among top-ranking police officers who supervised the enforcement of lockdown and other COVID-19 measures. Sixteen interviews were conducted and a thematic analysis of the narratives was carried out. Police unpreparedness for public health interventions, and public resistance to the use of repressive, force-led styles of policing were identified as major impediments to positive pandemic policing. Therefore, police officers are advised to ensure the application of procedurally just practices in their interactions with the public.

Meeting Needs of Diverse Older Adults and Caregivers During Public Health Emergencies: What Can We Learn From COVID-19?

With support from the CDC Foundation and technical assistance from the Centers for Disease Control and Prevention, NORC at the University of Chicago conducted studies to examine the needs and concerns of older adults and unpaid caregivers during COVID-19, including their trusted sources of COVID-19 information and available public health interventions. Methods included a nationally representative survey of 1,030 adults aged 50+ years using computer-assisted telephone and web interviewing; online focus groups with older adults and caregivers in Spanish and English; a survey and interviews with stakeholder organizations; secondary analysis of U.S. caregiver surveys; analysis of public social media posts; and searches of peer-reviewed and grey literature in Spanish and English to identify interventions. Results suggest that needs and concerns differed among older adult subpopulations, including racial and ethnic minority populations, people with lower incomes, rural and tribal populations, people with limited English proficiency, and people with disabilities as well as caregivers. Older adults perceived news media, the internet, and healthcare providers as important resources for COVID-19 information, although trusted sources varied by race and ethnicity, urbanicity, and income. Findings suggested the need to increase awareness of existing public health interventions and resources to support older adults and caregivers during public health emergencies like COVID-19. Strategies for tailoring communication for diverse older adults and caregivers include partnering with national organizations, leveraging community-level infrastructure, and disseminating information through trusted sources. Studying the needs of older adults and caregivers during COVID-19 can inform future public health emergency response priorities.

Harm reduction must be recognised an essential public health intervention during crises

The COVID-19 had a substantial impact on the provision of harm reduction services for people who use drugs globally. These front-line public health interventions serve a population that due to stigma, discrimination and criminalisation, faces barriers to accessing health and social services and are particularly vulnerable to public health crises. Despite this, the pandemic has seen many harm reduction services close, reduce operations or have their funding reduced. Simultaneously, around the world, harm reduction services have been forced to adapt, and in doing so have demonstrated resilience, flexibility and innovation. Governments must recognise the unique abilities of harm reduction services, particularly those led by the community, and identify them as essential health services that must be protected and strengthened in times of crisis.