Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy

The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: −1% to −2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: −1.4% to −8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.

Place-Specific Corona Dashboards for Health Policy: Design and Application of a ‘Dutchboard’

Since the outbreak of the corona virus in the end of 2019, many worldwide attempts have been made to monitor and control the COVID-19 pandemic. A wealth of empirical data has been collected and used by national health authorities to understand and mitigate the spread and impacts of the corona virus. In various countries this serious health concern has led to the development of corona dashboards monitoring the COVID-19 evolution. The present study aims to design and test an extended corona dashboard, in which—beside up-to-date daily core data on infections, hospital and intensive care admissions, and numbers of deceased people—also the evolution of vaccinations in a country is mapped out. This dashboard system is next extended with time-dependent contextual information on lockdown and policy stringency measures, while disaggregate information on the geographic spread of the COVID-19 disease is provided by means of big data on contact intensity and mobility motives based on detailed Google Mobility data. Finally, this context-specific corona dashboard, named ‘Dutchboard’, is further extended towards the regional and local level so as to allow also for space-specific ‘health checks’ and assessments.

Exploring drug cost and disease outcome in rheumatoid arthritis patients treated with biologic and targeted synthetic DMARDs in Norway in 2010–2019 – a country with a national tender system for prescription of costly drugs

Background In Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system. Methods RA patients monitored in ordinary clinical practice were recruited from 10 Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process. Results The number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39% in 2010 and 45% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 42 to 67%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47%, from 13.1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75% (13.0 thousand EUR in 2010 and 3.2 thousand EUR in 2019). Conclusions In the period 2010–2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

Incidence of myeloid neoplasms in Spain (2002–2013): a population-based study of the Spanish network of cancer registries

Comprehensive population-based data on myeloid neoplasms (MNs) are limited, mainly because some subtypes were not recognized as hematological cancers prior to the WHO publication in 2001, and others are too rare to allow robust estimates within regional studies. Herein, we provide incidence data of the whole spectrum of MNs in Spain during 2002–2013 using harmonized data from 13 population-based cancer registries. Cases (n = 17,522) were grouped following the HAEMACARE groupings and 2013-European standardized incidence rates (ASRE), incidence trends, and estimates for 2021 were calculated. ASRE per 100,000 inhabitants was 5.14 (95% CI: 5.00–5.27) for myeloproliferative neoplasms (MPN), 4.71 (95% CI: 4.59–4.84) for myelodysplastic syndromes (MDS), 3.91 (95% CI: 3.79–4.02) for acute myeloid leukemia, 0.83 (95% CI: 0.78–0.88) for MDS/MPN, 0.35 (95% CI: 0.32–0.39) for acute leukemia of ambiguous lineage, and 0.58 (95% CI: 0.53–0.62) for not-otherwise specified (NOS) cases. This study highlights some useful points for public health authorities, such as the remarkable variability in incidence rates among Spanish provinces, the increasing incidence of MPN, MDS, and MDS/MPN during the period of study, in contrast to a drop in NOS cases, and the number of cases expected in 2021 based on these data (8446 new MNs).

Knowledge, Attitude, Practice, Behavior and Risk Perception of COVID-19 Pandemic among University Students of Pakistan

Objective: Coronavirus disease 2019 (COVID-19) pandemic has substantially affected students around the globe due to the closure of educational institutes. However, student involvements and contributions are important in combating the disease for this reason current study was designed to assess the knowledge-attitude-practice (KAP), preventive behavior, and risk perception among university students. Methods: A cross-sectional survey-based study was conducted among university students of Punjab, Pakistan from April 1st to June 30th, 2020. The 68 items questionnaire was used to evaluated responses using statistical approaches (student’s t-test, regression-analysis and co-relation analysis) by considering p-value <0.05 statistically significant. Results: A total of 503 university students (medical and non-medical) were selected with the majority of participants were females (83%) and 64.5% were of age ranged from 16 to 21 years old. The participants (80%) reported good disease knowledge with a mean score of 12.06 ± 1.75 (p<0.05), which substantially higher among medical students. Most of the respondents (72%) believed that COVID-19 will be effectively controlled through precautionary measures. In correlation subgroup analysis, a significant relationship (p=0.025) between knowledge and positive attitude were indicated. Fear and knowledge of COVID-19 emerged as strong predictors (p<0.001) of preventive behaviors towards disease. Conclusion: This study demonstrated satisfactory knowledge, positive attitudes, and suitable practices among students towards COVID-19. University students can be involved in public education to aid the health authorities in achieving the targets of educational campaigns with maximum population coverage.

Vaccinators' Perception of HPV Vaccination in the Saa Health District of Cameroon

Introduction: Cervical cancer is the second most prevalent cancer among women in Cameroon. In November 2020, the HPV vaccine was introduced into the expanded programme on immunisation. However, uptake of the vaccine has been slow in the Centre region as opposed to other regions in the country. We therefore sought to describe vaccinators' perception of HPV vaccination in Saa health district.Methods: A self-administered questionnaire with both open-ended and closed questions was used to assess the perception of HPV vaccination among 24 vaccinators from the Saa health district. Quantitative data were summarised as proportions while qualitative data were deductively and inductively coded and thematically analysed.Results: Most vaccinators (75%, n = 18) had a good knowledge about cervical cancer and HPV vaccination. Fourteen (58.3%, n = 14) vaccinators correctly reported the target group, number and spacing of doses for the HPV vaccine. Fourteen (58.3%) vaccinators favoured HPV vaccination while the others (n = 10) were sceptical. Sceptics felt manufacturers hadn't given enough proof of the safety of the vaccine and lacked confidence in government's assessment of the epidemiological situation. The COVID 19 pandemic, fear of infertility and the negative influence of social media were perceived as the main reasons for community hesitancy. Vaccinators criticised health authorities for failing to sensitise the population about the HPV vaccine before its introduction.Conclusion: Vaccinators' perceptions of HPV vaccination may influence the offer of HPV vaccination services. Measures to increase acceptance of HPV vaccination and ownership of the activity among vaccinators have to be put in place.

Melioidosis in Africa: Time to Raise Awareness and Build Capacity for Its Detection, Diagnosis, and Treatment

Melioidosis is a tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei with a mortality of up to 50% in low resource settings. Only a few cases have been reported from African countries. However, studies on the global burden of melioidosis showed that Africa holds a significant unrecognized disease burden, with Nigeria being at the top of the list. The first World Health Organization African Melioidosis Workshop was organized in Lagos, Nigeria, with representatives of health authorities, microbiology laboratories, and clinical centers from across the continent. Dedicated hands-on training was given on laboratory diagnostics of B. pseudomallei. This meeting report summarizes the objectives discussed, such as raising awareness on melioidosis and building capacity for the detection, diagnosis, biosafety, treatment, and prevention of this dreadful neglected disease across Africa by bringing together regional and international experts to share best practices. It is important to join forces with the African Centers for Disease Control, WHO, African Sepsis Alliance, and Antimicrobial Resistance action plans.

COVID-19 patient cohort identification during the SARS-CoV-2 outbreak through a tertiary hospital Electronic Health Record alert system (Preprint)

BACKGROUND On 11th March 2020, the World Health Organization declared a pandemic caused by the coronavirus with 118.629 identified cases and 4.292 confirmed deaths. Up to date, 252 million cases and 5 million deaths have been identified as caused by COVID-19. An epidemic situation is characterized by an overload of patients suffering a particular clinical condition and needing acute medical attention in a short period. Usually, the pathogen n causing the epidemic is either new or emergent, and the knowledge a priori is limited. Information is crucial for public health authorities to establish policies to prevent transmission. Thus, the cycle of knowledge acquisition must be efficient and as short as possible. An interdisciplinary team adapted the electronic health record alert systems for real-time data tool collection for clinical characterization and epidemiological surveillance. This system has been working from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first outbreak up to date OBJECTIVE To share the experience of handling COVID-19 and non-COVID-19 patients' circuits through an Electronic Health Record (EHR) alert system during the pandemic. This system allowed the creation of a COVID-19 hospitalized patient cohort, with implications in the hospital circuit management, patients risk stratification and secondary use for research projects in a period of high uncertainty. Additionally, its integration as an epidemiological surveillance tool favored the submission of updated information to public health authorities. METHODS Almost 30,000 alerts related to COVID-19 were activated in the EHR. Overall, the most frequent were “COVID-19 ruled out” (N = 12,438) followed by “COVID-19 Confirmed Case” (N = 8,999). Up to 13,106 patients (65.7%) were labeled with just one alert during their in-patient stay, while 6,857 (34.3%) received two or more labels. For the alert sequences, 96% were considered logical sequences, 3,1% as low-quality logic sequences, and less than 1% aberrant sequences. Although some temporal variations, all periods had a high rate of logical sequences achieving more than 95%. Preventive medicine professionals activated most COVID-19 alerts and acted as auditors for data quality. When possible, automatic alerts were in place, which became the most frequent. RESULTS Almost 30,000 alerts related to COVID-19 were activated in the EHR. Overall, the most frequent were “COVID-19 ruled out” (N = 12,438) followed by “COVID-19 Confirmed Case” (N = 8,999). Up to 13,106 patients (65.7%) were labeled with just one alert during their in-patient stay, while 6,857 (34.3%) received two or more labels. For the alert sequences, 96% were considered logical sequences, 3,1% as low-quality logic sequences, and less than 1% aberrant sequences. Although some temporal variations, all periods had a high rate of logical sequences achieving more than 95%. Preventive medicine professionals activated most COVID-19 alerts and acted as auditors for data quality. When possible, automatic alerts were in place, which became the most frequent. CONCLUSIONS The EHR integrated system favored in-hospital management of patients during the COVID-19 pandemic. It was helpful for both the institution and the health system, representing an example of interlevel integration. The performance was adequate and robust, with insights at different levels: infection control, patient safety, research, and pandemic response. Preventive Medicine teams should maximize EHR solutions for epidemiological surveillance. CLINICALTRIAL Not required.

Impact of the COVID-19 Pandemic on Clinical Pathways for Non-SARS-CoV-2 Related Diseases in the Lazio Region, Italy

Clinical pathways (CPs) are multidisciplinary clinical governance tools necessary for the care management of the patients, whose aim is to outline the best practicable path within a health organization related to an illness or to a complex clinical situation. The COVID-19 pandemic emergency has created the need for an organizational renewal of care pathways based on the principles of “primary health care” recommended by the WHO. In Italy, the Hospitals and Local Health Authorities (ASL) have tried to guarantee the continuity of non-deferrable treatments and the maximum safety of both patients and health professionals. This study analyzes the organizational and managerial responses adopted in pathology-specific care pathways to assess how CPs as diagnostic tools responded to the COVID-19 pandemic in the first two waves. Twenty-four referents of Operational Units (UU OO) from Hospitals (AO) and Local Health Authorities (ASL) of the Lazio Region (Central Italy) that apply four different CPs responded to a survey, which analyzes the managerial and organizational responses of CPs in regard to different contexts. Results show that the structural and organizational adjustments of the CPs have made it possible to maintain an adequate level of care for specific treatment processes, with some common critical aspects that require improvement actions. The adjustments found could be useful for dealing with new outbreaks and/or new epidemics in order to try to mitigate the potential negative impact, especially on the most vulnerable patient categories.

Evaluation of Preventive Measures and Forecasting of COVID-19 Infection: Case Study Egypt.

Background COVID-19 is a highly infectious disease caused by SARS-CoV-2. This article assessed the effectiveness of preventive measures of COVID-19 infection, including social distancing (SD) and quarantine (Q) of patients and contacts in Egypt. Methods A simple model was developed to predict the infection rate without preventive measures. The article utilizes fertile meta- heuristic technique and particle swarm optimization (PSO), to predict the growth of the disease. Results A correlation between the predicted and actual infected cases, validated the proposed forecasting algorithm. Preventive measures together with the Egyptian Government stay home order reduced 98% of expected infections. PSO analyses showed that infection and death rates will continue to increase particularly with lifting these restrictive preventive measures. Conclusions The advised PSO model could predict COVID-19 infection and death rates with high degree of accuracy. This prediction model could help health authorities in decision making.