Surveillance of COVID-19 in a Vaccinated Population: A Rapid Literature Review

Objectives: With the availability of COVID-19 vaccines, public health focus is shifting to post-vaccination surveillance to identify breakthrough infections in vaccinated populations. Therefore, the objectives of these reviews are to identify scientific evidence and international guidance on surveillance and testing approaches to monitor the presence of the virus in a vaccinated population. Method: We searched Ovid MEDLINE, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, EBM Reviews - Cochrane Central Register of Controlled Trials, and EBM Reviews - Cochrane Database of Systematic Reviews. We also searched the Web of Science Core Collection. A grey literature search was also conducted. This search was limited to studies conducted since December 2020 and current to June 13th, 2021. There were no language limitations. COVID-19 surveillance studies that were published after December 2020 but did not specify whether they tested a vaccinated population were also considered for inclusion. For the international guidance review, a grey literature search was conducted, including a thorough search of Google, websites of international government organizations (e.g., Center for Disease Control and Prevention [CDC], World Health Organization [WHO]), and McMaster Health Forum (CoVID-END). This search was primarily examining surveillance guidance published since December 2020 (to capture guidance specific to vaccinations) and any relevant pre-December 2020 guidance. Results: Thirty-three studies were included for data synthesis of scientific evidence on surveillance of COVID-19. All the studies were published between April and June 2021. Twenty-one studies were from peer-reviewed journals. Five approaches to monitoring post-vaccination COVID-19 cases and emerging variants of concern were identified, including screening with reverse transcriptase polymerase chain reaction (RT-PCR) and/or a rapid antigen test, genomic surveillance, wastewater surveillance, metagenomics, and testing of air filters on public buses. For population surveillance, the following considerations and limitations were observed: variability in person-to-person testing frequency; lower sensitivity of antigen tests; timing of infections relative to PCR testing can result in missed infections; large studies may fail to identify local variations; and loss of interest in testing by participants in long follow-up studies. Through comprehensive grey literature searching, 68 international guidance documents were captured for full-text review. A total of 26 documents met the inclusion criteria and were included in our synthesis. Seven overarching surveillance methods emerged in the literature. PCR-testing was the most recommended surveillance method, followed by genomic screening, serosurveillance, wastewater surveillance, antigen testing, health record screening, and syndromic surveillance. Conclusion: Evidence for post-vaccination COVID-19 surveillance was derived from studies in partially or fully vaccinated populations. Population PCR screening, supplemented by rapid antigen tests, was the most frequently used surveillance method and also the most commonly recommended across jurisdictions. Most recent guidance on COVID-19 surveillance is not specific to vaccinated individuals, or it is in effect but has not yet been updated to reflect that. Therefore, more evidence-informed guidance on testing and surveillance approaches in a vaccinated population that incorporates all testing modalities is required.

Early Detection of Cerebral Herniation by Continuous Electroencephalography and Quantitative Analysis

Continuous electroencephalography (cEEG) and quantitative analysis of EEG (qEEG) are used in various circumstances such as detecting seizures, identifying acute or delayed cerebral ischemia, monitoring sedative therapy, or assessing prognosis. The authors report 2 cases: (1) Case #1 was a patient with unilateral cerebral edema and uncal herniation with asymmetric cEEG and qEEG changes detected an hour before clinical examination changes were noted and (2) Case #2 was a patient with diffuse cerebral edema and trans-tentorial herniation with symmetric cEEG and qEEG changes detected an hour before clinical examination changes were noted. These cases demonstrate the ability of cEEG and qEEG in early detection of different types of cerebral herniation. qEEG can be utilized by intensive care unit (ICU) staff not trained in EEG interpretation as a surveillance method to detect cerebral herniation, which may provide an opportunity for early intervention in high-risk patients.

A Well Flux Surveillance and Production Ramp-Up Method for Openhole Standalone Screen Completion

Summary Well surveillance requires practical models to balance the reward of maximizing production with the risk of ramping up production too much, which damages the completion. In this paper we present a method to monitor and ramp up production for openhole standalone screen (OH-SAS) completion. The objective is to optimize production using pressure transient analyses to assess the completion impairment and failure risks during the production ramp-up process. The flux model incorporates filter-cake pinholes, which are formed from nonuniform deposition and cleanup of filter cake during drilling and completion operations. Pinholes cause concentrated fluxes and increase completion failure risks. The method comprises three components, which are (1) determine pinhole properties from laboratory tests, (2) relate completion pressure drop of production through pinholes to pressure transient analyses, and (3) distribute fluxes in the standalone screen wellbore. Examples are presented and show that the completion pressure drop as a function of flow rate is nonlinear and higher with pinholes than without pinholes. By not incorporating pinholes, operations can potentially limit ramp-up. Flux distribution examples show that the largest impingement or radial velocity is at the top section of screen. The axial annular flow velocity or scouring velocity is two orders of magnitude larger than the screen impingement velocity. An integrated flux surveillance method for OH-SAS completion is presented for field applications.

Post-Bacille Calmette–Guerin surveillance for non-muscle invasive bladder cancer: do random biopsies offer an advantage?

Background The optimal surveillance method for recurrence of non-muscle invasive bladder cancer (NMIBC) after intravesical BCG treatment is unknown. The aim of this study is to assess the difference between two surveillance methods: cystoscopy with bladder biopsies and office-based flexible cystoscopy in detecting NMIBC recurrence and time to recurrence. Methods Charts of patients who underwent transurethral resection of bladder tumor with subsequent intravesical Bacillus Calmette–Guerin (BCG) treatment were reviewed between January 2015 and December 2018. Baseline demographics and oncological parameters were compared between the two methods of surveillance. Then, the role of the surveillance method for NMIBC recurrence and time to recurrence were evaluated in backward logistic regression and hazard ratios estimated in Cox regression models, respectively. Results Fifty-one patients (50.5%) underwent office-based flexible cystoscopy and 50 patients (49.5%) had bladder biopsies. The patients undergoing either surveillance methods were comparable for baseline demographic and oncological parameter. The predictors of recurrence and earlier BCG relapse were increased body mass index, the presence of multifocal tumors, the presence of concurrent carcinoma in situ, and tumor size at presentation. Bladder cancer recurrence was mostly affected by multifocality of the disease [OR 3.61 95%CI (1.17–11.15)] and the presence of concomitant carcinoma in situ [4.35 (1.29–14.68)]. Yet, the surveillance method neither predicted a higher recurrence yield nor earlier diagnosis. Conclusion In our cohort, there is neither difference in recurrence yield nor earlier diagnosis of recurrence between office-based flexible cystoscopy and bladder biopsies. Larger prospective studies are needed to assess the generalizability of these findings.

Trends in relevant excess mortality in Peru and nine areas during the first wave of COVID-19 pandemic between January and May 2020: A descriptive study

Introduction: COVID-19 has arrived the main capitals of Peru and caused direct and indirect deaths. Though mortality data is reported through SINADEF, relevant excess mortality (REM) remains unknown.Objective: To estimate the monthly relevant excess mortality for all causes and non-related with violent and COVID-19 causes between January and May 2020 in Peru and nine areas with the highest absolute numbers of deaths by COVID-19. Material and Methods: To estimate relevant excess mortality, we calculated the monthly upper and lower limits of historical mortality (95% confidence interval) and the average for the last 3 years (2017-2019). REM was considered when observed values exceed the estimated upper limit plus corresponding 2 standard deviations. We also determined REM excluding non-related with violent and COVID-19 causes.Findings: Relevant excess mortality of 35 deaths per 100 000 population from all causes during April and May 2020 were found in Peru with no difference when we excluded violent deaths. In addition, Callao had the highest REM followed by Lima, Ucayali, Loreto, Piura, Ica, Ancash, and La Libertad. In country and capitals analysis, male and individuals over 60 years were the most affected groups.Discussion: Relevant excess mortality determination is a needed, easy and low-cost approach to monitor the progress of COVID pandemic and to evaluate the effectiveness of policy measures. This surveillance method should expand to the 25 locations of Peru. Conclusion: COVID-19 accounted for 45% of the relevant excess all-cause deaths, leaving 54.29% unattributed to COVID-19. Hence, it is necessary to rethink the policy measures in order to avoid direct and indirect deaths attributed to the pandemic.

POST-DISHCARGE SURVEILLANCE IN SURGICAL SITE INFECTION: VALIDATION OF AN INSTRUMENT

ABSTRACT Objective: to create and validate an instrument for detecting potential cases of surgical site infection through post-discharge telephone surveillance. Method: a methodological study using psychometric analyzes to develop and validate an instrument for conducting post-discharge surveillance of surgical site infection. Results: the instrument had a total content validity coefficient equal to 0.87. It was applied to a sample of 100 patients and compared to a medical and nursing physical examination to detect surgical site infection, resulting in satisfactory Cohen’s kappa (0.83), Cronbach’s alpha (0.87) and Comparative Fit Index (0.998). The difference between the time spent on telephone calls for patients positive for surgical site infection was statistically greater than the time spent on calls for patients negative for surgical site infection (p <0.001). Sensitivity was 76.4%, with specificity of 100%, negative predictive values of 92.5%, positive values of 100% and accuracy of 94%. Conclusion: the instrument was validated in content, criteria and constructo stages.