Case Definition Criteria Research Articles

Anaphylaxis post-COVID-19 vaccinations in Singapore.

Anaphylaxis was the first serious adverse event (AE) of special interest surfaced in Singapore following coronavirus disease 2019 (COVID-19) vaccination. Individuals who developed physician-diagnosed severe allergic reactions to the mRNA vaccines would be medically ineligible for mRNA vaccines and offered non-mRNA alternatives. This paper describes anaphylaxis reports received by the Health Sciences Authority (HSA) and presents a review of individuals who received heterologous COVID-19 vaccination. Reports of anaphylaxis associated with the COVID-19 vaccines received till 31 July 2022 were reviewed and adjudicated using the Brighton Collaboration case definition criteria by an HSA-appointed expert panel. Additional review was conducted for cases with heterologous vaccination for any subsequent reactions until administration of third dose of COVID-19 vaccines. Among 112 adjudicated anaphylaxis cases, majority occurred in females, adults and persons with allergy histories, which were consistent with global observations. Most cases (71%) occurred within 30 minutes of vaccination. The reporting incidence rates (IRs) of 0.67 and 0.55 per 100,000 administered doses for Comirnaty and Spikevax vaccines, respectively, were comparable with IRs reported overseas, whereas the IRs for non-mRNA vaccines (Sinovac-CoronaVac and Nuvaxovid) were much higher at 4.14 and 29.82 per 100,000 administered doses, respectively, likely due to selection bias. Review of the 20 cases following heterologous vaccination found varying reactions to subsequent vaccinations. Anaphylaxis is a rare but serious AE in which outcomes can be mitigated with timely medical intervention. The case review helped to guide vaccination strategies and added to the cumulative knowledge of safety with heterologous vaccination.

Long COVID Is Not a Functional Neurologic Disorder.

Long COVID is a common sequela of SARS-CoV-2 infection. Data from numerous scientific studies indicate that long COVID involves a complex interaction between pathophysiological processes. Long COVID may involve the development of new diagnosable health conditions and exacerbation of pre-existing health conditions. However, despite this rapidly accumulating body of evidence regarding the pathobiology of long COVID, psychogenic and functional interpretations of the illness presentation continue to be endorsed by some healthcare professionals, creating confusion and inappropriate diagnostic and therapeutic pathways for people living with long COVID. The purpose of this perspective is to present a clinical and scientific rationale for why long COVID should not be considered as a functional neurologic disorder. It will begin by discussing the parallel historical development of pathobiological and psychosomatic/sociogenic diagnostic constructs arising from a common root in neurasthenia, which has resulted in the collective understandings of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and functional neurologic disorder (FND), respectively. We will also review the case definition criteria for FND and the distinguishing clinical and neuroimaging findings in FND vs. long COVID. We conclude that considering long COVID as FND is inappropriate based on differentiating pathophysiologic mechanisms and distinguishing clinical findings.

Characteristics of surveillance systems for suicide and self-harm: A scoping review.

Suicide is a complex public health issue. Surveillance systems play a vital role in identifying trends and epidemiologic needs, informing public health strategies, and tailoring effective context-based suicide prevention interventions. To identify and summarise the characteristics of specific surveillance systems and general health behaviour that include data onsuicide and self-harm. A scoping review following the JBI recommendations and PRISMA-ScR guidelines identified 29 relevant studies on suicide and self-harm surveillance systems. A systematic search was performed on Cinahl, Embase, Lilacs-Latin American and Caribbean Health Sciences Literature, PubMed-US National Library of Medicine, Scopus, and Google Scholar. The eligibility criteria include papers that use qualitative, quantitative or mixed methods with no restrictions on time or language. The following papers were excluded regarding euthanasia and assisted suicide, as well as papers that did not explicitly describe suicide, self-harm, and surveillance systems. Two researchers independently screened the materials for eligibility and extracted data from the included studies. Data analysis was conducted using content analysis. Twenty-nine references were included, and 30 surveillance systems were identified and classified into general health behaviour surveillance (n = 15) and specific systems for suicide and self-harm (n = 15). General health behaviour systems often operate at national data collection level, collecting non-fatal data in healthcare settings, mainly emergency departments. The specific systems exhibited greater variability in terms of context, involved actors, data collection level, data collection procedures, and case classification. Limitations found by the studies pointed mostly to case definitions and data quality. Co-production, intersectoral collaboration, clear case definition criteria and data standardisation are essential to improve surveillance systems for suicide and self-harm. This review identified the characteristics of surveillance systems for suicide and self-harm. Monitoring and evaluation are crucial for ongoing relevance and impact on prevention efforts.

Can a consensus occur on a research case definition for ME/CFS?

ABSTRACT Introduction: Many controversies have emerged around developing a consensus on a research case definition for ME and ME/CFS. To determine if there might be a consensus among patients, healthcare workers, and researchers, a brief questionnaire was distributed to an international group of patients to assess key issues involving ME and ME/CFS case definitions. Method: Respondents were asked questions about core symptoms and other critical case definition issues. Results: Overall, post-exertional malaise, cognitive impairment, fatigue, and unrefreshing sleep were the most endorsed core symptoms with at least 80% consensus among participants. Considerable support occurred for the ME-ICC (Myalgic Encephalomyelitis-International Consensus Criteria) and the Canadian Consensus Criteria (CCC), whereas the Fukuda Criteria received the least support. Items rated as important for a research case definition included the severity of the illness, onset type, duration of illness, illness course, exclusions, and comorbidities. Conclusions: The implications of these findings for developing a consensus on research case definition criteria are discussed.

Criteria for Assessing the Epidemiological Situation of Pertussis in Russian Federation

Relevance. Differences in case definition criteria and diagnostic recommendations of pertussis between different countries, pose challenges in the analysis and effective control of disease. An important component of successful surveillance is laboratory diagnostics, which, if used in a timely and quality manner, can influence the rate of reported cases. In addition, current criteria for epidemiological surveillance do not sufficiently take into account the severity of the disease and the vaccination status of the patient, which makes it difficult to take effective preventive measures. Aims. Assess the epidemiological situation regarding pertussis infection in Russia to propose criteria for epidemiological surveillance. Materials and methods. The data was obtained from official state statistics (form No. 2 «Information on infectious and parasitic diseases», No. 5 «Information on preventive vaccinations», No. 6 «Information on the contingents of children and adults vaccinated against infectious diseases») and analytical tables developed at G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology, including information on each case of pertussis and collected from the Rospotrebnadzor Directorates in the Russian Federation (in 2017–2022). Statistical data processing and plotting were carried out with R version 4.1.2. Results. From 2002 to 2017, the incidence of pertussis in Russia did not exceed the established norms. However, in 2019 there was an increase in incidence. In 2023, the incidence of pertussis reached record levels over the past 22 years – 19.0 per 100 thousand population. Vaccination rates against pertussis have remained high since 2003. The structure of cases shows that the majority of pertussis cases occur among unvaccinated children in the first year of life; deaths from pertussis are recorded annually, mainly among unvaccinated children under 2 years of age. From 2017 to 2019, the incidence among the unvaccinated was significantly higher than among the vaccinated; in 2020-2022, incidence among the unvaccinated decreased, but remained higher than among the vaccinated during the period of COVID-19 restrictive measures. There was no statistically significant difference in the distribution of pertussis severity in the periods before and after the COVID19 pandemic. Outbreaks of infection are mostly without spread, and in 2020-2022 the proportion of such outbreaks has increased. Schools remain the main site of infection, but the proportion of cases in kindergartens has increased. Conclusions. The following criteria for epidemiological well-being are proposed: subject to the achievement of timely vaccination coverage in 95% of people of decreed ages and timely implementation of anti-epidemic measures, there should be no deaths from pertussis, the incidence of pertussis should be sporadic and registered predominantly (more than 50% of cases) in the form of mild forms, the majority of pertussis cases occur among unvaccinated children in the first year of life (no more than 30% of vaccinated cases) and outbreaks without the spread of infection should prevail (more than 50% of cases) over outbreaks with spread.

Socio-demographic Profile and Complications of Measles in Children: A Hospital Based Study

Background: Measles is a self-limited viral disease. But it can cause serious complications in young children and still remains as an important cause of mortality and morbidity in under five children worldwide.
 Objectives: The aim of the study was to determine the complications of measles in hospitalized children and to observe the socio-demographic profile of them.
 Methods: A prospective observational study was conducted in Dr M R Khan Shishu Hospital and Institute of Child Health from March to December 2019. Children of 6 months to 10 years who came with signs and symptoms of measles according to the case definition criteria by WHO, like fever with maculopapular rash associated with cough, runny nose and conjunctivitis were included in the study. Their sociodemographic profile was recorded and different complications were noted.
 Results: A total of 86 children suffering from measles with different complications were admitted during the study period. They were from 6 months to 10 years. Among them 59% were below 1 year, 80% were below 4 years and 94% were less than 7 years. Thirty eight percent children were from lower and thirty percent from middle socioeconomic background. Pneumonia was the main complication found in 62(72%) cases followed by diarrhea 28(32%), oral ulcer 26(30%), croup 5(6%) and febrile seizure 4(4.6%). Most (79%) of the children, had normal nutritional status. Among 62 children aged 9 months to 10 years, only 16(26%) received 2 doses of measles vaccine, 14(23%) only the first dose and 32(52%) was not vaccinated at all. Vaccination rate was poor (27%) in low socio-economic condition. The mortality rate was 1(1.16%).
 Conclusion: About 60% of the children, suffering from measles, were less than one year of age. Fifty nine percent of them were not vaccinated. The children developed complications like pneumonia, diarrhea, oral ulcers etc. Vaccination status was poor in low socio-economic condition. So, awareness should be created about timely vaccination of measles.
 DS (Child) H J 2022; 38(2): 84-88

Epidemiological and clinical characteristics of Mpox Cases in Serbia in 2022

Abstract Introduction Mpox viral infection, previously known as an endemic zoonosis typical for West and South Africa, appeared in the Republic of Serbia in early summer among young and middle-aged men, particularly Belgrade's citizens. The aim of this study is to evaluate the epidemiological and clinical characteristics of Mpox cases registered in Serbia in 2022. Methods We conducted a national observational study using the national surveillance anonymized data of people who met case definition criteria on Mpox infection and confirmation by the polymerase chain reaction method. Clinical data were collected by standardized case investigation form used for epidemiological and clinical evaluation of cases. Results A total of 43 cases reported from the 17th of June to the 5th of October 2022 were men, aged between 20 and 54 (median age, 35 years), 74,4% living in Belgrade. Three-quarters of cases reported sex with other men as a potential disease transmission route. Out of the total, 15 (34,9%) Mpox cases had HIV co-infection. HIV-positive patients were older than negative cases (p = 0,023). The mean incubation period among patients who reported exposition to a probable or confirmed case was 9,3 (2-22) days. The most common systemic symptoms were fever (86%) and lymphadenopathy (44,2%). Three patients with common symptoms of fever were hospitalized. All cases presented a rash, mostly in pustule form (90,7%). The dominant localization of the skin lesions was the anogenital region (62,5%), whereas 9,3% of the patient's lower extremities were affected. Conclusions In Serbia, the outbreak of Mpox infection affected young and middle-aged men, mainly situated in the capital of Serbia. The disease had a polymorphic presentation, including a characteristical rash of the anogenital region implying the main transmission route. Key messages • Health promotion and community engagement regarding Mpox are very important in large urban settings. • Risk communication should be prioritized to promote safe sexual practices in vulnerable populations.

Varicella zoster virus reactivation reported with isatuximab use

Isatuximab is a CD38-directed antibody indicated for the treatment of relapsed or refractory multiple myeloma. The Division of Pharmacovigilance at the U.S. Food and Drug Administration (FDA) reviewed case reports from postmarketing sources, including the FDA Adverse Event Reporting System (FAERS), PubMed, and Embase, to investigate a potential association between isatuximab and the risk of varicella zoster virus (VZV) reactivation. We identified 20 reports of which 15 met our case definition and causality criteria. All 15 patients (80% male, median age = 60 years) received isatuximab for a hematologic neoplasm; eight (53%) for previously untreated multiple myeloma. All cases described additional risk factors for VZV reactivation, including concomitant proteasome inhibitor and/or immunomodulatory drug (n = 10, 67%) use. Based on this postmarket analysis, the U.S. Prescribing Information for isatuximab was updated to include this new safety information, including recommendations for antiviral prophylaxis.

Multisystem Inflammatory Syndrome in Children Following COVID-19 Vaccination: A Sex-Stratified Analysis of the VAERS Database Using Brighton Collaboration Criteria.

Multisystem inflammatory syndrome in children (MIS-c) is an uncommon, but serious, inflammatory response that occurs after SARS-CoV-2 infection. As time went by, MIS-c was also reported as a potential adverse event following COVID-19 vaccination. A descriptive analysis was performed of Individual Case Safety Reports (ICSRs) associated with anti COVID-19 vaccines and related to the pediatric population from 2020 to 2022. The present pharmacovigilance study aimed to describe cases of MIS-c following COVID-19 vaccination, stratified by sex, reported in the Vaccine Adverse Events Reporting System (VAERS) and meeting the Brighton Collaboration criteria for case definition. We assessed all suspected cases through the case definition and classification of the Brighton Collaboration Group, and only definitive, probable, and possible cases were included in the analysis. The Reporting Odds Ratio (ROR) with 95% Confidence Interval (CI) was computed to assess if males have a lower/higher probability of reporting ICSRs with MIS-c compared with females. Overall, we found 79 cases of potentially reported MIS-c following vaccination. This study demonstrated that MIS-c following vaccination was more commonly reported for male subjects with a median age of 10 years (IQR 10.0-11.4), especially after the first dose of anti COVID-19 vaccines with a median time to onset of 27 days. Even so, the rate of occurrence of MIS-c following anti COVID-19 vaccines is lower (0.12/100,000 vaccinated subjects; 95% CI, 0.12-0.13). Overall, all ICSRs were serious and caused or prolonged hospitalization. Finally, disproportionality analysis showed that males had a higher reporting probability of MIS-c compared with females following immunization with mRNA COVID-19 vaccines. Since only a few years of marketing are available, further data from real-life contexts are needed.

SARS-CoV-2 Reinfections and Long COVID in the Post-Omicron Phase of the Pandemic.

We are reviewing the current state of knowledge on the virological and immunological correlates of long COVID, focusing on recent evidence for the possible association between the increasing number of SARS-CoV-2 reinfections and the parallel pandemic of long COVID. The severity of reinfections largely depends on the severity of the initial episode; in turn, this is determined both by a combination of genetic factors, particularly related to the innate immune response, and by the pathogenicity of the specific variant, especially its ability to infect and induce syncytia formation at the lower respiratory tract. The cumulative risk of long COVID as well as of various cardiac, pulmonary, or neurological complications increases proportionally to the number of SARS-CoV-2 infections, primarily in the elderly. Therefore, the number of long COVID cases is expected to remain high in the future. Reinfections apparently increase the likelihood of long COVID, but less so if they are mild or asymptomatic as in children and adolescents. Strategies to prevent SARS-CoV-2 reinfections are urgently needed, primarily among older adults who have a higher burden of comorbidities. Follow-up studies using an established case definition and precise diagnostic criteria of long COVID in people with or without reinfection may further elucidate the contribution of SARS-CoV-2 reinfections to the long COVID burden. Although accumulating evidence supports vaccination, both before and after the SARS-CoV-2 infection, as a preventive strategy to reduce the risk of long COVID, more robust comparative observational studies, including randomized trials, are needed to provide conclusive evidence of the effectiveness of vaccination in preventing or mitigating long COVID in all age groups. Thankfully, answers not only on the prevention, but also on treatment options and rates of recovery from long COVID are gradually starting to emerge.

Measles Infection and Vaccination Status against Measles in Children during 2019-2020: A Hospital Based Study in Chattogram

Background: Despite widespread availability of a safe and cost-effective vaccine, Measles outbreak is reported from different regions of Bangladesh in the recent past. This study was aimed to Identify the related features of Measles infection in children during the upsurge of Measles infection in Chattogram during 2019-2020, when Bangladesh was about to achieve Measles elimination.
 Materials and methods: This prospective observational study included all the Measles infected children admitted in the Pediatric Ward of Chittagong Medical College Hospital, Chattogram during the period from September 2019-February 2020. In this hospital patients up to 12 years after neonatal period are admitted. Patients whose guardian did not give consent were excluded. Measles cases were diagnosed clinically according to case definition criteria by WHO. Demographic, clinical features, Measles vaccination status of both affected children & their mother and associated complications were recorded in a predesigned form. Data were analyzed and results were given in a tabulated form. The aim of this study was to evaluate the characteristics of Measles infection and their vaccination status in children during its upsurge in 2019-2020.
 Results: Affected children 13(20%) were suffered in spite of vaccination. Among the 65 affected children 44 (67.6%) were below one year of age, youngest one was 2 months old. Male to female ratio was 1.8:1. 80% (n=52) children were not vaccinated, 35 of them not yet attained the age of vaccination. 17 children attained the age but vaccination was delayed due to cough and cold, fever, bronchopneumonia or Measles itself. Complications were common among them, Bronchopneumonia 47 (72.3%) and Purulent conjunctivitis 38 (58.5%). There was no case fatality.
 Conclusion: Children are being affected by Measles before attaining the age of first dose of vaccination and incompletely vaccinated or unvaccinated children have a role in the upsurge of Measles.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 33-37

Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico

To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C). We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospi-talized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria be-tween May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups. Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and lab-oratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symp-toms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C. Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, signifi-cant differences such as severity of clinical presentation with multi-organ involvement and worst inflammato-ry response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C thanpatients with KD. Similar results have been observed in other studies where both disorders were compared.

Comparative Analysis on Clinical Characteristics Among Patients with Acute Hepatitis A Virus (HAV) and Patients with Acute Hepatitis E Virus (HEV): A Single-Center Retrospective Study from Bulgaria.

The acute viral hepatitis was one of the most common conditions in daily clinical practice varying in different parts of the world. The aim of the present study was to perform a comparative analysis on clinical characteristics among patients with acute hepatitis A virus (HAV) infection and patients with acute hepatitis E virus (HEV) infection admitted to the Military Medical Academy (MMA), Sofia, Bulgaria. A retrospective study was performed at MMA, between 1 January 2016 and 31 December 2021. The etiological diagnosis was confirmed by enzyme-linked immunosorbent assay (ELISA) HAV/HEV IgM serology assays. The current survey included 231 patients with mean age 45.11 ± 16.08 years (95% confidence interval: 43.04-47.19). According to the case definition, inclusion and exclusion criteria, persons were divided into two groups: patients with acute HAV infection (68.4%; 158/231) and patients with acute HEV infection (31.6%; 73/231). Males with HEV had 3.091 times the odds of comorbidity "hypertension" than males with HAV (p = 0.032). There were almost equal odds of increased ALT (odds ratio = 0.999; p = 0.003) in men with HEV and men with HAV. Females with HEV had 5.161 times the odds of comorbidity "hypertension" compared with females with HAV (p = 0.049). We found almost equal odds for elevated ALT in women with HEV and women with HAV (OR = 0.999; p = 0.025). In the non-elderly group (<60-year-old), HEV individuals had 4.544 and 10.560 times the odds of comorbidities "hypertension" and "cardiovascular diseases" compared with HAV patients (p < 0.05). We found almost equal odds for elevated ALT in HEV patients and HAV participants (OR = 0.998; p = 0.002). The results from the current study may support the physicians daily care for patients with acute HAV and acute HEV.

To Study and Compare the Efficacy of LM Potency and Centesimal Potency of Homoeopathic Medicine Acid Phosphoricum in Management of Type-2 Diabetes Mellitus

Background: Diabetes Mellitus has emerged as one of the prominent leading risk factors for cardio-vascular diseases. The prevalence rate of Diabetes Mellitus in India is said to be 25% in urban and 10% in the rural population. If we were to see the gender wise prevalence of Diabetes Mellitus in urban India, it is approximately 30-45% in males and 25-38% in females. However, only about 26% of the treated diabetic patients had their blood sugar level within normal limits. This study aims to study the efficacy of 50-Millesimal potency in management of Type-2 Diabetes Mellitus. Methods: It was a randomized parallel group study, wherein 50 patients satisfying the case definition, inclusion and exclusion criteria were selected for the study of which 25 patients were administered L M Potency of the homoeopathic medicine Acid Phosphoricum and remaining 25 patients were administered Centesimal potency of homoeopathic medicine Acid Phosphoricum. The subjects were clinically assessed every week. Investigations were done at baseline, blood sugar levels every month and HbA1C every 3 months of treatment till the end of the study period. All the data was measured and analysed at entry and every 3 months till the completion of the study period. Results: At the end of the study, significant decrease in the blood sugar and HbA1C levels was recorded in case of LM Potency as compared to Centesimal potencies. Conclusion: LM Potencies are more efficient in management of Type-2 Diabetes Mellitus as compared to Centesimal scale of potencies.

Mosquito-borne viruses causing human disease in Fennoscandia-Past, current, and future perspectives.

Five different mosquito-borne viruses (moboviruses) significant to human disease are known to be endemic to Fennoscandia (Sindbis virus, Inkoo virus, Tahyna virus, Chatanga virus, and Batai virus). However, the incidence of mosquito-borne virus infections in Fennoscandia is unknown, largely due to underdiagnosing and lack of surveillance efforts. The Fennoscandian moboviruses are difficult to prevent due to their method of transmission, and often difficult to diagnose due to a lack of clear case definition criteria. Thus, many cases are likely to be mis-diagnosed, or even not diagnosed at all. Significant long-term effects, often in the form of malaise, rashes, and arthralgia have been found for some of these infections. Research into mobovirus disease is ongoing, though mainly focused on a few pathogens, with many others neglected. With moboviruses found as far north as the 69th parallel, studying mosquito-borne disease occurring in the tropics is only a small part of the whole picture. This review is written with the objective of summarizing current medically relevant knowledge of moboviruses occurring in Fennoscandia, while highlighting what is yet unknown and possibly overlooked.

Baseline Inappropriate Antibiotic Use in Primary Care Patients with Viral Respiratory Tract Infections with 2019 and 2020.

Context: Respiratory tract infection (RTI) is the leading cause of avoidable antimicrobial use in primary care. How the COVID-19 pandemic has impacted antibiotic prescribing practices across Canada is unknown. The purpose of this study was to examine rates of antibiotic prescribing for RTI in primary care during the first year of the pandemic (2020), compared to baseline in 2019. Study Design and Analysis: Cross sectional study. Dataset: Canadian Primary Care Sentinel Surveillance Network electronic medical record data from sites in British Columbia, Alberta, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland. Population Studied: Patients that met the case definition criteria for an RTI or a Urinary Tract Infection (UTI) in 2019, and in 2020. Outcome measures: We examined oral antibiotic prescribing for patients who were identified as having a primary care visit for RTI. The same analysis was repeated for urinary tract infection (UTI) as a tracer condition. The antibiotic use considered avoidable for RTI was defined by Choosing Wisely Canada. Results: A total of 1,692,876 patients with a valid birth year and sex and at least one visit to primary care in 2019 and 2020 were included. Patient visits for RTI decreased from 2.3% in 2019 to 1.6% in 2020 (p<.0001), as did patient visits for UTI (1.1% vs 0.7%, p<.0001). In 2019, 28.0% of patients visits for RTI were prescribed an antibiotic, and this proportion decreased significantly to 20.6% in 2020 (<.0001). The drop in antibiotic prescriptions for RTI was driven by a decrease in prescribing for common cold (13.6% vs. 11.3%, <.0001) and for acute bronchitis/asthma (15.2% vs. 7.3%, p<.0001). In comparison, antibiotic prescribing for visits related to UTI increased marginally between 2019 and 2020 (71.6% vs. 72.3%, p=0.007). Conclusions: A significant decrease in antibiotic prescribing for RTI across primary care was observed during the first year of the COVID-19 pandemic, likely related to the changes in epidemiology and care delivery models in primary care. CPCSSN can provide pan-Canadian surveillance of antibiotic prescribing practices in primary care that can be used for provider feedback and quality improvement.

Respiratory tract outbreak modeling with case definition criteria: A proposal for a standardized clinical approach in nursing homes

ObjectivesThis study aimed to monitor respiratory tract outbreaks in nursing homes (NH) by applying standardized case definition criteria, pathogen identification and estimated mortality impact. Patients and methodsThis longitudinal, observational study described NH outbreaks with temperature (T°), upper respiratory sign, lower respiratory sign (LRS), general status deterioration, general signs, and mortality. Viral examinations allowed for analysis of developing outbreaks based on positive, negative, or no tests (Flu+/Flu−/NT-Flu). ResultsForty-six influenza identification episodes (Flu+, 1067 patients), 14 Flu− (409 patients), and 18 NT-Flu (381 patients) were analyzed. Viral examinations were conducted mainly among residents with T° (84.8% [302/356]). A specific temperature pattern was observed in Flu+ outbreaks: 35.1% of infected residents with T° without LRS, 15.6% in Flu− episodes, and 17.1% vs. 29.1% in LRS without T°. A median temperature (MT) of ≥38.3 °C was observed in Flu+ outbreaks. MT analysis of the 18 NT-Flu episodes identified five outbreaks with high temperatures (MT ≥38.2 °C) and high mortality. Conversely, the 13 NT-Flu outbreaks with lower MT (<38.0 °C) were associated with lower total mortality. Similar clinical pictures led to closely comparable all-cause mortality impacts, particularly in Flu+, Flu−, and NT-Flu with MT of ≥38.2 °C. ConclusionsValidated sign/symptom monitoring highlighted some specificities of respiratory NH outbreaks and could be a complementary approach, taking into account common and atypical clinical pictures, assessing mortality and initiating virological investigations and infection control measures.

Frequency and Risk Factors of Seizures in Children During Induction Remission Chemotherapy for Acute Lymphoblastic Leukemia (ALL)

Background: Seizure is one of the most common CNS complications among patients receiving chemotherapy for acute lymphoblastic leukemia (ALL). Seizures are seen in 8-13% of patients with ALL. Most seizure occurs during the induction and consolidation phases of treatment. However, not much is known about the risk factors of these seizure.&#x0D; Materials &amp; Method: This prospective observational study was conducted in the department of Pediatric Hematology and Oncology, BSMMU. One hundred and five newly diagnosed admitted children with ALL aged &gt;1 year to &lt;18 years, from May 2017 to March 2018 for induction remission chemotherapy and who fulfilled the criteria of case definition were enrolled into this study.&#x0D; Results: This study showed that seizure frequency was14.3% in children with ALL getting induction remission chemotherapy. Female patients developed seizures more than males which was statistically significant by univariate analysis (p = 0.029) but was not found to be a risk factor by multivariate analysis (p = 0.059). All the seizures developed in B-lineage ALL but there was no statistically significant association between lineage of ALL with development of seizures.&#x0D; Conclusions: In this study slightly higher frequency of seizure in ALL patients on induction remission chemotherapy was found than previous studies (14.3% vs. 13%). Females developed seizures more than males.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 94-98

Development of the Chinese Haemovigilance Network and reporting of adverse transfusion reactions from 2018 to 2020.

To advance blood transfusion safety, the Chinese Haemovigilance Network (CHN) was put into operation in 2018. This report describes the development of the CHN and evaluates its role by analysing reported adverse transfusion reactions (ATRs) from 2018 to 2020. All data in this study were obtained from the CHN online reporting platform. A timeline of CHN development is presented, and the activities of CHN-enrolled facilities are analysed by year. The reported ATRs were analysed in detail for ATR types, blood components involved and adherence to case definition, severity and imputability criteria. Incidence rates were calculated and compared with international examples. During 2018-2020, a total of 3061 ATRs were reported through the CHN online reporting system. The rate of reported ATRs in all facilities and the 10 highest reporting facilities was 0.7‰ and 1.8‰, respectively. When analysed by year, the incidence rate showed an increasing trend from 2018 to 2020. Allergic (68.2%) and febrile non-haemolytic transfusion reaction (27.1%) were the most common. The vast majority of ATRs (92.0%) were not serious, but serious cases of transfusion-associated circulatory overload, transfusion-associated dyspnoea and hypotensive reaction were common. Most (86.0%) of reported cases were definitely or probably associated with transfusion. Under-reporting of ATRs occurs in many Chinese hospitals, but the establishment of CHN has increased ATR recognition and management. More effort will be needed in the future to detect transfusion problems and improve transfusion practice in China.

Etiology of meningitis among adults in three quaternary hospitals in Mozambique, 2016-2017: The role of HIV.

BackgroundMeningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique.MethodWe performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (≥18 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing.ResultsRetrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include Neisseria meningitidis (8.9%; 14/158), Escherichia coli (6.3%; 10/158), Haemophilus influenzae (5.1%; 8/158) and S. aureus (4.4%; 7/158), which represent (24.7%; 39/158) of the total confirmed cases.ConclusionAltogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care.