Influenza vaccine in chronic obstructive pulmonary disease among elderly male veterans

Background Prior studies have established those elderly patients with chronic obstructive pulmonary disease (COPD) are at elevated risk for developing influenza-associated complications such as hospitalization, intensive-care admission, and death. This study sought to determine whether influenza vaccination could improve survival among elderly patients with COPD. Materials/Methods This study included Veterans (age ≥ 65 years) diagnosed with COPD that received care at the United States Veterans Health Administration (VHA) during four influenza seasons, from 2012–2013 to 2015–2016. We linked VHA electronic medical records and Medicare administrative files to Centers for Disease Control and Prevention National Death Index cause of death records as well as influenza surveillance data. A multivariable time-dependent Cox proportional hazards model was used to compare rates of mortality of recipients of influenza vaccination to those who did not have records of influenza vaccination. We estimated hazard ratios (HRs) adjusted for age, gender, race, socioeconomic status, comorbidities, and healthcare utilization. Results Over a span of four influenza seasons, we included 1,856,970 person-seasons of observation where 1,199,275 (65%) had a record of influenza vaccination and 657,695 (35%) did not have a record of influenza vaccination. After adjusting for comorbidities, demographic and socioeconomic characteristics, influenza vaccination was associated with reduced risk of death during the most severe periods of influenza seasons: 75% all-cause (HR = 0.25; 95% CI: 0.24–0.26), 76% respiratory causes (HR = 0.24; 95% CI: 0.21–0.26), and 82% pneumonia/influenza cause (HR = 0.18; 95% CI: 0.13–0.26). A significant part of the effect could be attributed to “healthy vaccinee” bias as reduced risk of mortality was also found during the periods when there was no influenza activity and before patients received vaccination: 30% all-cause (HR = 0.70; 95% CI: 0.65–0.75), 32% respiratory causes (HR = 0.68; 95% CI: 0.60–0.78), and 51% pneumonia/influenza cause (HR = 0.49; 95% CI: 0.31–0.78). However, as a falsification study, we found that influenza vaccination had no impact on hospitalization due to urinary tract infection (HR = 0.97; 95% CI: 0.80–1.18). Conclusions Among elderly patients with COPD, influenza vaccination was associated with reduced risk for all-cause and cause-specific mortality.

Respiratory symptoms and respiratory deaths: A multi-cohort study with 45 years observation time

This study determined the association between respiratory symptoms and death from respiratory causes over a period of 45 years. In four cohorts of random samples of Norwegian populations with 103,881 participants, 43,731 persons had died per 31 December 2016. In total, 5,949 (14%) had died from respiratory diseases; 2,442 (41%) from lung cancer, 1,717 (29%) chronic obstructive pulmonary disease (COPD), 1,348 (23%) pneumonia, 119 (2%) asthma, 147 (2%) interstitial lung disease and 176 (3%) other pulmonary diseases. Compared with persons without respiratory symptoms the multivariable adjusted hazard ratio (HR) for lung cancer deaths increased with score of breathlessness on effort and cough and phlegm, being 2.6 (95% CI 2.1–3.2) for breathlessness score 3 and 2.1 (95% CI 1.7–2.5) for cough and phlegm score 5. The HR of COPD death was 6.4 (95% CI 5.4–7.7) for breathlessness score 3 and 3.0 (2.4–3.6) for cough and phlegm score 5. Attacks of breathlessness and wheeze score 2 had a HR of 1.6 (1.4–1.9) for COPD death. The risk of pneumonia deaths increased also with higher breathlessness on effort score, but not with higher cough and phlegm score, except for score 2 with HR 1.5 (1.2–1.8). In this study with >2.4 million person-years at risk, a positive association was observed between scores of respiratory symptoms and deaths due to COPD and lung cancer. Respiratory symptoms are thus important risk factors, which should be followed thoroughly by health care practitioners for the benefit of public health.

Effect of covid-19 pandemic on in-hospital mortality

Objective: This study aimed to examine the effect of the pandemic on hospital mortality and patient admission in four months since March 2020 when the Ministry of Health announced the first confirmed COVID-19 case in Turkey and the first wave occurred. Material-Method: This research is a single-centre, retrospective, cross-sectional descriptive study. It covers the periods between March 01 and Jun 30 of 2018, 2019, and 2020. Results: Between 2018-2020, 897522, 972799, and 395438 patients were admitted to our Hospital, respectively. It was observed that the number of admissions decreased by 55-60% in 2020 compared to the previous years (p=0.001). Moreover, 205318 (22.9%) of the admissions in 2018, 229278 (23.6%) of the admissions in 2019, and 1127293 (32%) of the admissions in 2020 were emergency room (ER) admissions. Especially in 2020, there was a significant increase in the overall in-hospital (p=0.001) and ER (p=0.001 mortality rates compared to previous years. In-hospital mortality was found to be higher, especially in patients with suspected COVID-19 (p=0.001). It was found that the number of deaths due to respiratory causes was significantly increased in 2020 compared to the previous years (p=0.001). Conclusion: The COVID-19 pandemic has led to significant changes in mortality rates and causes of mortality compared to previous years. Although the pandemic has affected all healthcare systems, ER and intensive care units (ICU) are seriously affected.

Causes of sudden death - autopsy review in a tertiary referral center

Background: The incidence of sudden death has been increasing steadily all over the worldparticularly in the urban population for the last 5 years. World health organization [WHO] hasdefined sudden death as “Death within 24 hrs from the onset of symptoms”. It can be defined asdeaths that are sudden, unexpected, clinically unexplained, or otherwise obscure even though thereneed to be no unnatural element in their causation. Materials and methods: Complete analysisand review of all autopsy/post-mortem specimens received in the Department of Pathology, KIMS,Hubballi between September 2017 to June 2019 done to find out the cause of death. Results:During the study period, a total of 153 cases of sudden death were received, age ranged from 6months to 72 years, with male preponderance. The cause of death were, 67 cases - cardiac causes[43.7%], 15 cases- respiratory causes [9.8%], 7 cases of sepsis [4.5%], 6 cases of Miliary TB[3.9%], CNS- 5 cases [3.2%], Hepatobiliary [2.6%], Renal- 2 cases [1.3%], Gastrointestinal 2cases [1.3%] Malignancy – 1 case [0.65%], Inconclusive 44 - cases [ 28.7%]. Conclusion: Thisstudy concludes that sudden death can occur at any age with the most common cause being cardiacdiseases and few among these are preventable. Therefore, creating awareness about the risk factorsand prevention of disease progression can reduce the incidence of sudden deaths.

The impact of seasonal respiratory virus transmission on syndromic surveillance for COVID-19 in Ontario, Canada

ABSTRACTBackgroundSyndromic surveillance systems for COVID-19 are being increasingly used to track and predict outbreaks of confirmed cases. Seasonal circulating respiratory viruses share syndromic overlap with COVID-19, and it is unknown how they will impact the performance of syndromic surveillance tools. Here we investigated the role of non-SARS-CoV-2 respiratory virus test positivity on COVID-19 two independent syndromic surveillance systems in Ontario, Canada.MethodsWe compared the weekly number of reported COVID-19 cases reported in the province of Ontario against two syndromic surveillance metrics: 1) the proportion of respondents with a self-reported COVID-like illness (CLI) from COVID Near You (CNY) and 2) the proportion of emergency department visits for upper respiratory conditions from the Acute Care Enhanced Surveillance (ACES) system. Separately, we plotted the percent positivity for other seasonal respiratory viruses over the same time period and reported Pearson’s correlation coefficients before and after the uncoupling of syndromic tools to COVID-19 cases.ResultsThere were strong positive correlations of both CLI and ED visits for upper respiratory causes with COVID-19 cases up to and including a rise in entero/rhinovirus (r = 0.86 and 0.87, respectively). There was a strong negative correlation of both CLI and ED visits for upper respiratory causes with COVID-19 cases (r = −0.85 and −0.91, respectively) during a fall in entero/rhinovirus.InterpretationTwo methods of syndromic surveillance showed strong positive correlations with COVID-19 confirmed case counts before and during a rise in circulating entero/rhinovirus. However, as positivity for enterovirus/rhinovirus fell in late September 2020, syndromic signals became uncoupled from COVID-19 cases and instead tracked the fall in entero/rhinovirus. This finding provides proof-of-principle that regional transmission of seasonal respiratory viruses may complicate the interpretation of COVID-19 surveillance data. It is imperative that surveillance systems incorporate other respiratory virus testing data in order to more accurately track and forecast COVID-19 disease activity.

Sudden cardiac death in cancer patients: results from the Paris-Sudden Death Expertise Centre

Background Sudden cardiac death (SCD) in cancer patients regardless of their therapies has not been addressed. Methods Population-based registry (2011) via multiple sources to collect every case of SCD in Paris and its suburbs, covering a population of 6.6 million. Data of SCD patients (2011–2017) were analysed by identifying patients with known cancer or past medical history of cancer. Categorical variables were compared using chi-square test or Fisher's exact test; continuous variables using Student t-test or Wilcoxon rank sum test, as appropriate. Results Of 22,570 out of hospital cardiac arrests, 3,311 SCD patients (124 cancer patients and 3,187 non cancer patients) were admitted alive to the hospital and were included in the analysis. Characteristics of patients and cardiac arrest circumstances differed on univariate analysis (Table). The final aetiology of SCD varied: more respiratory causes to SCD (pulmonary embolism and hypoxia) among cancer patients and less acute coronary artery syndromes. Conclusions SCD in cancer patients differs significantly when compared to non-cancer patients. Coronary events are less prominent whereas respiratory causes are common aetiologies in cancer. Funding Acknowledgement Type of funding source: None

COVID-19 mortality according to civilian records

In this short report, we bring some data-driven analyses of COVID-19 mortality in Brazil. The impact of COVID-19 is evaluated by comparing the 2019 and 2020 civilian death records. There is evidence of a considerable excess of deaths since the pandemic started with respect to the previous year. In some states, it is clear that not all excess of deaths in 2020 is due to COVID-19, but to other respiratory causes that did not present the same prevalence in the previous year. Because of this unusual behavior of respiratory deaths, we may infer the evidence of a huge amount of under-reporting deaths due to the COVID-19. The data also shows that COVID-19 has produced an excess death in all ages besides people above 90 and below 10 years. In addition, when separates by sex, data indicate a larger increase in the deaths among males than females.