How many lives do COVID vaccines save? Evidence from Israel.

Background: In December 2020, Israel began a mass vaccination program with the rapid rollout of the Pfizer-BioNTech COVID-19 BNT162b2 vaccine for adults in Israel. The campaign vaccinated fewer people than necessary for herd immunity. However, at the same time, government stringency measures in terms of closing public life were decreased. Real-world observational data were used to examine the effect of mass vaccination on Covid-19 mortality. Methods: The study period to examine the effect of vaccination on mortality was chosen to capture when at least 90% of the population over age 70 were vaccinated for less than seven months. Projected deaths as expected from vaccine efficacy and actual mortality data were compared for the study population with examination of potential confounding effects of government stringency. Average government stringency (Oxford Stringency Index) was calculated in the study period and the preceding period of the pandemic. Potential confounding effects of an age shift in the distribution of deaths were examined by analyzing the distributions of deaths and cases before and after the study period. Results: Confirmed deaths from COVID-19 in the population over 70 after mass vaccination were recorded as 370, versus 408 expected from applying person-days of vaccine efficacy, and 5,120 estimated without vaccinations. Conclusions: Vaccines against COVID-19 saved more lives than expected by simply applying individual vaccine efficacy to the vaccinated population in Israel, despite a loosening of government stringency.

A Decline and Age Shift in Malaria Incidence in Rural Mali following Implementation of Seasonal Malaria Chemoprevention and Indoor Residual Spraying

ABSTRACTMany African countries have reported declines in malaria incidence, attributed to the implementation of control strategies. In Mali, artemisinin-based combination therapy (ACT) was introduced in 2004, and long-lasting insecticide-treated nets (LLINs) have been partially distributed free of charge since 2007. In the Malian town of Bandiagara, a study conducted from 2009 to 2013 showed a stable incidence of malaria compared with 1999, despite the implementation of ACTs and LLINs. Since 2016, seasonal malaria chemoprevention has been scaled up across the country. In addition to these strategies, the population of Bandiagara benefited from indoor residual spray implementation in 2017 and 2018 and continued universal bed net coverage. This study aimed to measure the incidence of malaria in Bandiagara, given this recent scaling up of control strategies. A cohort of 300 children aged 6 months to 15 years was followed up from October 2017 to December 2018. We performed monthly cross-sectional surveys to measure anemia and the prevalence of malaria infection by microscopy. The overall incidence of symptomatic malaria was 0.5 episodes/person-year. Malaria incidence in children up to 5 years old significantly declined since 2012 and since 1999 (incidence rate ratio estimates: 6.7 [95% CI: 4.2–11.4] and 13.5 [95% CI: 8.4–22.7]), respectively. The average prevalence of malaria parasitemia was 6.7%. Malaria incidence was higher in children older than 5 years than in those younger than 5 years, highlighting the need to extend malaria control efforts to these older children.

Cancer models and statistical analysis of age distribution of cancers

In this paper, mathematical mutational models of the age distribution of cancers are obtained. These are two models -- a simple model and a complex model, which takes into account the growth of the cell population and the transmission of mutations to daughter cells. Using the resulting formulas, we approximated real age-specific cancer incidence datasets in women (colon, lung, mammary, stomach) and men (colon, lung, prostate, stomach). We estimated parameters such as the average number of mutations (per cell per unit of time) and number of mutations required for cancer to occur. The number of mutations averaged (over four types of cancer) required for cancer to occur is 72 (mutations per cell for women) and 221 (mutations per cell for men) for the complex mutational model. The average (for four types of cancer) mutation rate is estimated at 0.05 mutations per year (per cell for women) and at 0.07 mutations per year (per cell for men). The mutational models do not provide a quantitative explanation for the occurrence of cancer due to cellular mutations. As an alternative to mutational models, a model of a single carcinogenic event with an age shift is considered. The model approximates real data better and explains quantitatively the real age distributions of cancers.

COVID-19 Confirmed Case Incidence Age Shift to Young Persons Age 0-19 and 20-39 Years Over Time: Washington State March - April 2020

BackgroundAs the coronavirus (COVID-19) epidemic passes the peak infection rate in some states and counties a phased re-opening with changes of stay-at-home restrictions and social distancing recommendations may lead to an increase of nonessential work, social activities and gathering, especially among younger persons.MethodsA longitudinal cohort analysis of Washington State Department of Health COVID-19 confirmed case age distribution March 1-April 19 2020 for proportional change over time using chi square tests for significance (N = 13,934).ResultsFrom March 1st to April 19, 2020 age distribution shifted with a 10% decline in cases age 60 years and older and a 20% increase in age 0-19/20-39 years (chi-square = 223.10, p <.001). Number of cases over the eight-week analysis period were 0-19 years n = 515, 20-39 years n = 4078, 40-59 years n =4788, 60-79 years n = 3221, 80+ years n = 1332. New cases increased steadily among 0-19 and 20-39-year olds. After the peak (March 22, 2020), there was no decline among age 0-19 and a lesser decline among age 20-39 than older groups. As incidence declined in older age groups, the combined percentage of cases age 0-19 and 20-39 increased from 20% to 40% of total cases.ConclusionsIncreased COVID-19 infection among children and young adults is not without serious morbidity and mortality risk to them and others they may come in contact with, indicating a targeted approach for awareness and safety measures is advisable to reduce incidence among the supposedly less vulnerable but more mobile young population age 0-19 and 20-39 years.

A decline and age shift in malaria incidence in rural Mali following implementation of seasonal malaria chemoprevention and indoor residual spraying

BackgroundDeclines in malaria incidence attributed to the implementation of control strategies have been reported in many African countries. The declines are often accompanied by a shift in clinical burden to older children. In Mali, artemisinin-based combination therapy (ACT) was introduced in 2004, and Long-lasting insecticide-treated nets (LLINs) have been partially distributed free of charge since 2007. In Bandiagara, a study conducted from 2009 to 2013 showed a stable incidence of malaria compared to 1999 despite the use of ACTs and LLINs. Since 2016, seasonal malaria chemoprevention (SMC) has been scaled up across the country. In addition to these strategies, the population of Bandiagara benefited the universal bed net coverage and indoor residual spray (IRS) implementation in 2017 and 2018.This study aimed to measure the incidence of malaria in the context of recent scaling-up of control strategies.MethodsA cohort of 300 children aged 6 months to 15 years was followed from October 2017 to December 2018 in Mali. Monthly cross-sectional surveys were done to measure the prevalence of malaria infection by microscopy and anaemia. The study outcomes included the monthly prevalence of malaria infection and the incidence of symptomatic malaria.ResultsThe incidence of symptomatic malaria was 0.5 episodes/person-year. The average prevalence of malaria parasitaemia was 6.7%. The incidence was higher in the oldest age group than the youngest one (0.6 episodes/person-year in children above 10 years vs 0.29 in 6 months to 5 years age group).ConclusionsThis study showed a reduction of malaria incidence compared to 1999 and 2009-2013. An age shift in the susceptibility to malaria was also observed; older children experienced more clinical malaria than younger ones. These findings suggest to extend malaria control efforts to older children.

The seniors boom and economic repercussions: Waterloo Region economic development opportunities for growth in an aging society

<p>The population in Canada is aging, and even the ‘Silicon Valley of the North’ Waterloo Region is no exception. Aging societies can have a positive impact on the Economy; however, proper policies and programs must be in place in order to thrive through the peak of the Baby Boom retirement wave in 2026. This paper discusses research and recommendations from literature reviews and best practices found among municipalities regarding methods to thrive in an aging society. It is hoped that this paper will aid economic developers and supporting organizations to prepare for the impending age shift through adapting new employment, service, and built environment policies and programs. Adapting economic development now may prevent future economic downturns due to changes in work, lifestyle, and spending habits that are expected throughout the aging and retirement of the baby boom generation. </p><p><strong>Keywords: </strong>Older adults, senior, caregiver, age friendly, anti-aging, adaptive employment</p>

ORIGINAL ARTICLE: CLINICAL PROFILE AND EPIDEMIOLOGICAL ASPECTS OF DIPHTHERIA CASES IN RUANG ISOLASI KHUSUS RSUD DR SOETOMO FROM JANUARY UNTIL DECEMBER 2015

Background Diphtheria is a vaccine-preventable disease and is eradicated mostly in developed countries. But the prevalence of diphtheria cases still remains endemic in developing countries such as Indonesia, mainly in East Java. Purpose: To study the clinical profile and epidemiological aspects of diphtheria cases admitted in Ruang Isolasi Khusus RSUD Dr. Soetomo in 2015. Method: This research is a hospital-based, cross-sectional study. The samples are all patients admitted in Ruang Isolasi Khusus RSUD Dr Soetomo with the diagnosis of diphtheria in 2015. Results: There were 23 diphtheria cases reported in Ruang Isolasi Khusus RSUD Dr. Soetomo in 2015. The most prevalent age group was 6 until 10 years old (56.52%) and the most common gender was male (57%). Most of the patients came from a non-endemic area (82.61%) and most of them are not fully vaccinated (73.91%). There are more unknowledgeable mothers (91%) about DPT immunization. The most prevalent clinical manifestations are fever, dysphagia and pseudomembrane (100%). Tonsillar diphtheria (86.96%) was the most prevalent type of diphtheria presented. There were no complications and mortality reported and the main managements used were isolation (100%), antibiotics (100%) and anti diphteria serum (82.61%). Conclusion: There is an age shift in the occurrence of diphtheria to 6 until 10 years of age. The immunization coverage especially the booster dose is still low among the patients. Less knowledge about DPT immunization contributes to low childhood immunization coverage. No complications and mortality reported.

Re-emergence of diphtheria in Kerala: the need for change in vaccination policy

Background Diphtheria cases continue to occur in India despite a national vaccination program targeting the disease. Outbreaks of diphtheria have been known to occur in areas of low immunization coverage. An age shift has been noted to older children and adults in recent outbreaks from the Indian states of Andhra Pradesh, Karnataka, Delhi and Assam. Kerala witnessed its largest outbreak of Diphtheria in recent times from 2015 to 2017.Methods: Surveillance data from the Regional PEID Cell during the outbreak period was analysed and epidemiological data generated.Results: A total of 734 cases of diphtheria were reported during this period with eight deaths (Case fatality rate=1.08%). The mean age of the cases was 17.4 years (±13.9). More than 72% of the cases occurred in children above 10 year of age and 68% of the cases were either unimmunized or partially immunized. 32% of the cases were immunized for age. Of these, immunized children, 88% were above 10 years of age, indicating waning immunity with age. The existence of a sizeable unimmunized cohort in the adolescent age group and waning immunity among immunized were two major factors contributing to the outbreak.Conclusions: An age shift has been observed in the occurrence of Diphtheria cases during the outbreak in Kerala. Booster doses with Td vaccine during adolescence in addition to maintaining a high immunization coverage in the routine immunization program, with special emphasis on pockets of low coverage is essential for preventing the reemergence of diphtheria.

Association of Human Cytomegalovirus and Epstein-Barr Virus with Breast Cancer

Breast cancer forms the most common cancer in women worldwide [1,2] and in Arab countries [3]. Breast cancer accounts for about 1/3 of the registered female cancer in Iraq [4] and with incidence rate of 31.1/ 100 000 in Iraqi women , while it was 18.4 for Iran, 22.4 for Saudi Arabia, 23.0 for Syria, 28.3 for Turkey, 47.0 for Jordan, and 47.7 for Kuwait [5,6]. Recent study in Iraq reported a trend for breast cancer to affect younger age group [7]. This study shows that the highest frequency of breast cancer (32.4%) was in women with age of 21-30 years. Unfortunately, 79.7% of breast cancer cases were in women with age of ≤ 40 years. In addition, 14.9% of breast cancer cases were in women with age of 16-18 years and 52.7% were in those with age of ≤ 30 years. This age shift pattern of breast cancer in Iraqi women was not consistent with previous studies in Iraq [6-12], Arab countries and globally [13,14]. The peak frequency of our study was 21-30 years, while previous studies in Iraq [15-21] indicated that breast cancer frequency peak was in fifth decade of life, in Asian countries in 40-50 years and it was 60-70 years in Western countries [22].