Decline In Case Fatality Rate Research Articles

Prevalence of Japanese encephalitis infection in children below 15 years’ age, Bihar

Japanese encephalitis (JE) is the leading cause of acute encephalitis syndromes (AES). Although Bihar has comprehensive data on JE, it ranks third behind Uttar Pradesh and Assam in terms of reported cases. We wanted to determine the incidence of JE cases in Bihar and the endemic districts. In Patna, Muzaffarpur and Gaya, Bihar, this study revealed that JEV is one of the major causes of AES and its epidemiology. We analyzed blood and CSF samples from AES patients delivered to a viral diagnostic laboratory between January 2018 and December 2022 for IgM antibodies against JEV using the enzyme immunoassay recommended by NIV, Pune, India. We detected JEV IgM in 193 (8.79 %) of 2195 individuals. Patient demographics included age, gender and place of residence. Most patients were 6–10 years old and had the disease in June. We need to increase awareness initiatives and cross-sector prevention despite the decline in case fatality rate.

From the Editor’s Desk...

From the Editor’s Desk...

Long-term effectiveness of population-wide multifaceted interventions for hepatocellular carcinoma in Taiwan

Taiwan has launched a series of population-wide interventions to prevent hepatocellular carcinoma (HCC) related to hepatitis B and C virus infection since 1984. We took this opportunity to investigate the impact of each intervention on the incidence and case-fatality rate of HCC, and assessed their relative contributions to the overall reduction in mortality during this period. Population-based registry data on HCC mortality and incidence from individuals aged 0 to 84 years between 1979 and 2016 were collected before (Period 1) and after universal hepatitis B vaccination from 1984 (Period 2), universal health care from 1995 (Period 3), and viral hepatitis therapy from 2003 (Period 4). A Bayesian Poisson regression model was used for mortality decomposition analysis to estimate the respective contributions of these interventions to the reduction in age-specific incidence and case-fatality rates. Mortality declined substantially in children, young- and middle-aged groups, but only slightly decreased in the elderly group. The declining trends in mortality were in part explained by incidence reduction and in part by a remarkable decline in case-fatality rate attributed to universal health care. Hepatitis B vaccination led to a 35.9% (26.8% to 44.4%) reduction in incidence for individuals aged 30 years or below, whereas antiviral therapy reduced the incidence of HCC by 14.9% (11.8% to 17.9%) and 15.4% (14.1% to 16.6%) for individuals aged 30-49 years and 50-69 years, respectively. Vaccination and antiviral therapy were effective in reducing HCC incidence and mortality for the young and middle-aged groups, while the case-fatality rate was improved by universal health care for all age groups. Since 1984, a series of population-wide interventions have been launched in Taiwan to prevent viral hepatitis-related hepatocellular carcinoma, including a universal hepatitis B vaccination program (from 1984), universal health care (from 1995), and a national viral hepatitis therapy program (from 2004). Vaccination and antiviral therapy were effective in reducing HCC incidence and mortality for the young and middle-aged groups, while the case-fatality rate was improved by universal health care for all age groups.

Factors affecting mortality for the novel coronavirus infection in different regions of the Russian Federation

Background. The influence of such factors as population density, practices for testing for the SARS-CoV-2 (combined with quarantine/self-isolation for infected individuals and their contacts) and ambient temperature on the spread of the novel coronavirus infection and related mortality in the 85 different regions of the Russian Federation isn’t well characterized.Materials and methods. Population density in the different regions of the Russian Federation is measured as the number of persons per square kilometer of settled areas; ambient temperature is measured as the mean for January and July values; practices for testing for SARS-CoV-2 are characterized via case-fatality rates (the percent of deaths among cases with known outcome (recovered + fatal)) — under more active testing for SARSCoV-2, greater numbers of mild/moderate cases of infection are detected, resulting in the decline in case-fatality rates, i.e. the intensity of testing is inversely proportional to the case-fatality rate.Results. The correlation between population density and rates of mortality for COVID-19 per 100,000 persons on November 22, 2020 in the 85 different regions of the Russian Federation is 0.53 (0.36; 0.67); the correlation between case-fatality rates and rates of mortality for COVID-19 per 100,000 persons on Nov. 22, 2020 in the different regions of the Russian Federation is 0.62 (0.47; 0.74). Results of the linear regression suggest a positive association between population density, as well as case-fatality rates and rates of mortality for COVID-19 in the different regions of Russia, and a negative association between ambient temperature and rates of mortality for the novel coronavirus infection.Conclusions. Lower population density, more active testing for SARS-CoV-2 and higher ambient temperature are associated with lower rates of mortality for COVID-19. In particular, additional measures should be implemented towards testing of different categories of individuals for SARS-CoV-2, including those seeking testing on their own initiative, those seeking medical help with respiratory symptoms, and contacts of confirmed COVID-19 cases.

Impact of lockdown on Covid-19 case fatality rate and viral mutations spread in 7 countries in Europe and North America

BackgroundSevere acute respiratory syndrome CoV-2 (SARS-CoV-2) caused the first coronavirus disease 2019 (COVID-19) outbreak in China and has become a public health emergency of international concern. SARS-CoV-2 outbreak has been declared a pandemic by WHO on March 11th, 2020 and the same month several Countries put in place different lockdown restrictions and testing strategies in order to contain the spread of the virus.MethodsThe calculation of the Case Fatality Rate of SARS-CoV-2 in the Countries selected was made by using the data available at https://github.com/owid/covi-19-data/tree/master/public/data. Case fatality rate was calculated as the ratio between the death cases due to COVID-19, over the total number of SARS-CoV-2 reported cases 14 days before. Standard Case Fatality Rate values were normalized by the Country-specific ρ factor, i.e. the number of PCR tests/1 million inhabitants over the number of reported cases/1 million inhabitants. Case-fatality rates between Countries were compared using proportion test. Post-hoc analysis in the case of more than two groups was performed using pairwise comparison of proportions and p value was adjusted using Holm method. We also analyzed 487 genomic sequences from the GISAID database derived from patients infected by SARS-CoV-2 from January 2020 to April 2020 in Italy, Spain, Germany, France, Sweden, UK and USA. SARS-CoV-2 reference genome was obtained from the GenBank database (NC_045512.2). Genomes alignment was performed using Muscle and Jalview software. We, then, calculated the Case Fatality Rate of SARS-CoV-2 in the Countries selected.ResultsIn this study we analyse how different lockdown strategies and PCR testing capability adopted by Italy, France, Germany, Spain, Sweden, UK and USA have influenced the Case Fatality Rate and the viral mutations spread. We calculated case fatality rates by dividing the death number of a specific day by the number of patients with confirmed COVID-19 infection observed 14 days before and normalized by a ρ factor which takes into account the diagnostic PCR testing capability of each Country and the number of positive cases detected. We notice the stabilization of a clear pattern of mutations at sites nt241, nt3037, nt14408 and nt23403. A novel nonsynonymous SARS-CoV-2 mutation in the spike protein (nt24368) has been found in genomes sequenced in Sweden, which enacted a soft lockdown strategy.ConclusionsStrict lockdown strategies together with a wide diagnostic PCR testing of the population were correlated with a relevant decline of the case fatality rate in different Countries. The emergence of specific patterns of mutations concomitant with the decline in case fatality rate needs further confirmation and their biological significance remains unclear.

SARS-CoV-2: March toward adaptation.

After an initial period of rising numbers of infected subjected by SARS-CoV-2 and deaths by COVID-19, currently some areas of the World are experiencing a reduction of cases Different degrees of lockdown and social distancing measures greatly helped in limiting the spread of the disease The contribution of other external factors like weather conditions and population density, though not as significant, seemed nonetheless to have played an additional role in shaping the course of the epidemic A third factor still subject of debate is how and how much the mutations observed in SARS-CoV-2 provide an indication of viral fitness and adaptation, and their role first into the initial phases of transmission and now during the reduction of viral spreading Aim of this commentary is to provide an overview of the status of the pandemic situation linking together the different factors implicated in current situation, and to summarize some strategies that could help us to better manage either a second wave of this virus or a potential new threat of similar nature This article is protected by copyright All rights reserved

Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006-2016.

Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006-March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89-0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

Trends of major disease outbreaks in the African region, 2003–2007

Communicable disease outbreaks cause millions of deaths throughout Sub-Saharan Africa each year. Most of the diseases causing epidemics in the region have been nearly eradicated or brought under control in other parts of the world. In recent years, considerable effort has been directed toward public health initiatives and strategies with a potential for significant impact in the fight against infectious diseases. In 1998, the World Health Organization African Regional Office (WHO/AFRO) launched the Integrated Disease Surveillance and Response (IDSR) strategy aimed at mitigating the impact of communicable diseases, including epidemic-prone diseases, through improving surveillance, laboratory confirmation and appropriate and timely public health interventions. Over the past decade, WHO and its partners have been providing technical and financial resources to African countries to strengthen epidemic preparedness and response (EPR) activities. This review examined the major epidemics reported to WHO/AFRO from 2003 to 2007. we conduct a review of documents and reports obtained from WHO/AFRO, WHO inter-country team, and partners and held meeting and discussions with key stakeholders to elicit the experiences of local, regional and international efforts against these epidemics to evaluate the lessons learned and to stimulate discussion on the future course for enhancing EPR. The most commonly reported epidemic outbreaks in Africa include: cholera, dysentery, malaria and hemorrhagic fevers (e.g. Ebola, Rift Valley fever, Crimean-Congo fever and yellow fever). The cyclic meningococcal meningitis outbreak that affects countries along the "meningitis belt" (spanning Sub-Saharan Africa from Senegal and The Gambia to Kenya and Ethiopia) accounts for other major epidemics in the region. The reporting of disease outbreaks to WHO/AFRO has improved since the launch of the IDSR strategy in 1998. Although the epidemic trends for cholera showed a decline in case fatality rate (CFR) suggesting improvement in detection and quality of response by the health sector, the number of countries affected has increased. Major epidemic diseases continue to occur in most countries in the region. Among the major challenges to overcome are: poor coordination of EPR, weak public health infrastructure, lack of trained workers and inconsistent supply of diagnostic, treatment and prevention commodities. To successfully reduce the levels of morbidity and mortality resulting from epidemic outbreaks, urgent and long-term investments are needed to strengthen capacities for early detection and timely and effective response. Effective advocacy, collaboration and resource mobilization efforts involving local health officials, governments and the international community are critically needed to reduce the heavy burden of disease outbreaks on African populations.

Trends in postacute myocardial infarction management and mortality in patients with diabetes. A population-based study from 1995 to 2001

To compare trends in coronary revascularization use and case fatality rate (CFR) following acute myocardial infarction in patients with and without diabetes. A retrospective study of 77,552 patients, 20 years of age or older (25% with diabetes), who were hospitalized for a first acute myocardial infarction in the province of Quebec between April 1995 and December 2001 was conducted. Administrative databases were used to identify patients and assess outcomes. Compared with patients without diabetes, patients with diabetes underwent more coronary artery bypass graft (CABG) surgeries (11.1% versus 8.3%; P<0.0001) but fewer percutaneous coronary interventions (17.1% versus 20.2%; P<0.0001). The use of percutaneous coronary intervention increased substantially over time in both populations, driven mainly by an increase during the index admission (20.6% versus 16.6% per year; P=0.1144 in patients with and without diabetes, respectively). The use of CABG during the index admission increased markedly among patients with diabetes compared with those without (10.3% versus 5.3% per year; P=0.0072); however, at one-year following discharge, CABG use remained stable in patients with diabetes and fell in those without (-0.7% versus -5.3% per year; P=0.2046). Concomitantly, patients with diabetes presented a similar decline in CFR compared with patients without diabetes. The decline was more pronounced during the index admission (-5.0% versus -4.1% per year; P=0.282) than at one-year following discharge (-2.5% versus -2.5% per year; P=0.629) in patients with and without diabetes, respectively. However, fatal outcome remained higher in patients with diabetes than without, with an adjusted RR of 1.21 (95% CI 1.18 to 1.24) at one-year follow-up. Overall, coronary revascularization use and CFR improved over time in patients with diabetes. Nevertheless, the mortality rate in patients with diabetes remains higher than in patients without diabetes, indicating that additional progress is required to improve the poorer prognosis in this population.

Pattern and spatial distribution of plague in Lushoto, north-eastern Tanzania

A review of plague records from 1986 to 2002 and household interviews were carried out in the plague endemic villages to establish a pattern and spatial distribution of the disease in Lushoto district, Tanzania. Spatial data of households and village centres were collected and mapped using a hand held Global Positioning System and Geographical Information System. During the 16-year period, there were 6249 cases of plague of which 5302 (84.8%) were bubonic, 391 (6.3%) septicaemic, and 438 (7.0%) pneumonic forms. A total of 118 (1.9%) cases were not categorized. Females and individuals aged 7-18 years old were the most affected groups accounting for 54.4% (95% CI: 52.4-56.0) and 47.0% (95% CI: 45-49) of all reported cases, respectively. Most cases were found in villages at high altitudes (1700-1900m); and there was a decline in case fatality rate (CFR) in areas that experienced frequent outbreaks. Overall, there was a reduction in mean reporting time (from symptoms onset to admission) to an average of 1.35 days (95% CI: 1.30-1.40) over the years, although this remained high among adult patients (>18 years). Despite the decrease in the number of cases and CFR over the years, our findings indicate that Lushoto district experiences human plague epidemic every year; with areas at high altitudes being more prone to outbreaks. The continued presence of plague in this focus warrants further studies. Nonetheless, our findings provide a platform for development of an epidemic preparedness plan to contain future outbreaks.

Scaling up of Facility-Based Neonatal Care--A District Health System Experience

With proportion of neonatal mortality increasing within under-five deaths, innovative approaches and stronger health systems are needed in neonatal care. We present data of a scaled-up neonatal facility in a District Government Headquarters hospital in Southern India. The special care neonatal unit (SCNU) was a community propelled, public private partnership worked out on the principles of private funding of public institutions and effective budgeting of the public health care system. In the first phase the unit was optimized over 3 years with non-governmental organizations (NGO) and government support from a basic nursery to a SCNU. The unit was operational through fixed maintenance budget from government and mobilized funds from NGOs and beneficiaries. Community health workers were motivated for effective utilization. In the second phase the unit's performance was studied and statistically analyzed in two time frames before and 5 years into the upgradation process. Neonatal admissions from the district increased by 14.65%. Hospital stillbirth, early neonatal and perinatal mortality rates showed significant decline (p < 0.05). There was a 48.59% (CI: 25.46-77.80) increase in antenatal referrals from community health centers. Caesarian sections for neonatal parameters that affect obstetric decisions showed percent changes of 163.25 (CI: 31.18-430.45) and 73.4 (CI: 14.15-164.39) for prematurity and low birth weight (LBW), respectively. Significant decline in case fatality rates for LBW, sepsis and birth asphyxia (p < 0.001) were observed. The district perinatal mortality rate showed a decline. Within the purview of financial constraints of the public health system, private funding, public-private cooperation and effective budgeting may become significant. Motivation of health workers and community to effectively utilize public health care services sets an evolutionary process of referral and vertical linkage of health care system.

Epidemiology of sepsis: Recent advances

Sepsis, as defined by an expert consensus definition, is the development of the systemic inflammatory response syndrome in the presence of infection. Using this clinically applicable definition, several studies have evaluated the epidemiology of sepsis over the past decade. The current incidence of sepsis is at least 240 patients per 100,000 people in the United States population, whereas for severe sepsis it is between 51 and 95 patients per 100,000 people. The incidence rate for sepsis has been increasing over the past two decades, driving an increase in the number of deaths despite a decline in case-fatality rates. Sepsis is the tenth leading cause of death in the United States and accounts for more than 17 billion dollars in direct healthcare expenditures.

Significant Decline in Case Fatality after Acute Myocardial Infarction in Denmark--a Population-based Study from 1994 to 2001

Objective: We evaluated trends in in-hospital case fatality after acute myocardial infarction (AMI) in Denmark and analysed changes in the hospitalization rate for AMI. Design: National population-based registries were used to identify patients ( S 30 years) who were admitted for their first AMI from 1994 to 2001. Results: The annual relative decline in case-fatality rate was constant at 10.5% (95% confidence interval (CI) 9.5-11.5%). The decline was similar for both genders at all ages. The hospitalization rate decreased from 1994 to 1999 at an annual average of 4.3% (95% CI 3.4-5.1%). In 2000 and 2001 the average annual increase was 7-8%. Conclusion: The case-fatality rate after AMI declined significantly in Denmark, similar to other Western countries, but the level is still higher than that of the USA. The increasing hospitalization rate coincided with changes in risk factors in the general population. However, the influence of introducing troponins in the diagnosis of AMI and diagnosis-related grouping may in particular account for the increased hospitalization rate.

Attack rate, mortality and case fatality for acute myocardial infarction in Sweden during 1987-95. Results from the national AMI register in Sweden.

To assess trends in attack rate, mortality and case-fatality of acute myocardial infarction (AMI) in Sweden. All 303 324 Swedes discharged from hospitals, or deceased, with a diagnosis of AMI between 1987 and 1995. Analysis based on the National AMI Register in Sweden. The National AMI Register was assembled by linking the records of the National Hospital Discharge Register and the National Cause of Death Register in Sweden. Age-standardized attack rate, mortality and case fatality rates for AMI. Between 1987 and 1995, the age-standardized attack rate of AMI declined by 11% for men and 10% for women, whilst mortality from AMI decreased by 14% for both sexes. The decrease was most pronounced for men below the age of 64, with a reduction of 22% in attack rate and nearly 30% in mortality. There was no change over time in the case fatality rates on the date of attack, including also deaths outside hospital, whilst case fatality within 28 days decreased from 49 to 45% amongst men, and 45 to 42% amongst women. This reduction persisted over 1 year of follow-up. The decrease in attack rate of AMI in Sweden may be attributed both to changes in risk factors amongst the population and to improved medical intervention. The decline in case fatality rates indicates that improved treatment of patients with AMI has contributed to the reduction in mortality. However, the high, and essentially unchanged, proportion of deaths outside hospital stresses the importance of disease prevention.

Decline of coronary heart disease mortality in Finland during 1983 to 1992: roles of incidence, recurrence, and case-fatality. The FINMONICA MI Register Study.

The rate of coronary heart disease (CHD) mortality in eastern Finland has been the highest in the world. The official mortality statistics suggest, however, that is has declined by 60% during the past 20 years. The aim of the present study was to examine the contributions of incidence, recurrence, and case fatality of coronary events to the trends in CHD mortality in three areas of Finland. Population-based myocardial infarction registers have been operating in the provinces of North Karelia and Kuopio in eastern Finland and the Turku/Loimaa area in southwestern Finland from 1983 to 1992. During this 10-year period, each suspected coronary event in persons 35 to 64 years of age was evaluated for registration. Of these, 13,566 fulfilled the criteria of myocardial infarction or coronary death. Almost one fourth (22.4%) of the coronary events were sudden, out-of-hospital deaths. Among men, the average change in mortality was -7.1% per year (95% confidence interval, -8.4% to -5.8%) in North Karelia, -5.0% per year (-7.0% to -3.0%) in Kuopio, and -4.9% per year (-8.2% to -1.6%) in Turku/Loimaa. Among women, the corresponding changes were -5.6% (-11.1% to -0.1%), -4.4% (-8.1% to -0.7%), and -8.1% (-13.0% to -3.2%). In eastern Finland, the decline in CHD mortality was due to a decline in recurrent coronary events but also in the incidence of first coronary events, whereas in southwestern Finland, the decline in case-fatality rate had the major role. The decline in CHD mortality rate in Finland appears to be the result of a successful combination of primary and secondary prevention measures and improvements in acute coronary care.

Secular trends in stroke in the Framingham study

Trends in stroke incidence, prevalence, fatality, and severity were examined in Framingham Study subjects, aged 55 to 64, during 3 successive decades beginning in 1953, 1963, and 1973. There was no significant decline in incidence or prevalence of total stroke and transient ischemic attacks (TIAs). In women, but not men, incidence of completed ischemic stroke declined significantly. Stroke severity did decrease significantly and severe neurologic deficit was less frequent in later decades; fewer patients with stroke were unconscious on admission to the hospital. There was no substantial change in the case mix and no significant decline in hemorrhage to account for the decline in severity. The proportion of isolated TIAs increased significantly over the 30 years studied, yielding an apparent decline in case-fatality rates, which was significant only in men. Secular trends in stroke incidence and fatality did not follow a clear pattern. There was a significant decline in stroke severity, but incidence of infarction fell only in women. The decline in total case-fatality rate occurred only in men, resulting largely from an increased incidence of isolated TIAs.

Secular trends in stroke incidence and mortality. The Framingham Study.

The reduction in US stroke mortality has been attributed to declining stroke incidence. However, evidence is accumulating of a trend in declining stroke severity. We examined secular trends in stroke incidence, prevalence, and fatality in Framingham Study subjects aged 55-64 years in three successive decades beginning in 1953, 1963, and 1973. No significant decline in overall stroke and transient ischemic attack incidence or prevalence occurred. In women, but not men, incidence of completed ischemic stroke declined significantly. Stroke severity, however, decreased significantly over time. Stroke with severe neurological deficit decreased in later decades, with a fall in rates of severe stroke cases in which patients were unconscious on admission to the hospital. There was no substantial change in the case mix of infarcts and hemorrhages and no decline in hemorrhage to account for the decline in severity. The proportion of isolated transient ischemic attacks increased significantly over the 30 years studied, yielding an apparent and significant decline in case-fatality rates in men only. Secular trends in stroke incidence and fatality did not follow a clear or definite pattern of decline. While a significant decline in stroke severity occurred over three decades, incidence of infarction fell only in women. The decline in total case fatality rates occurred only in men and resulted largely from an increased incidence of isolated transient ischemic attacks. The severity of completed stroke was significantly lower in the later decades under study.

Trends in Hospitalization Rates for Heart Failure in the United States, 1973-1986

Discharge data from a representative sample of short-stay US hospitals were examined to obtain information regarding trends in the prevalence of congestive heart failure from 1973 through 1986. During this 14-year period, the number of discharges more than doubled and the age-adjusted rates increased from 53% to 88% among the four major sex-race groups. On average, nonwhite men experienced annual hospitalization rates 33% higher than white men, while for women the corresponding nonwhite rates were 50% higher. Hospitalization rates during this period remained constant for persons younger than 55 years but rose sharply in the elderly. Concurrently, a slight decline in case fatality rates for an individual hospitalization was seen. The two factors accounting for the growing prevalence of congestive heart failure seem to be the increasing average age of the population and the longer survival of persons with chronic heart disease. The role of improved medical therapy during the period of this study remains uncertain. Increasing demands to provide care for the congestive heart failure syndrome are likely to continue in the coming years, and medical facilities should develop new intervention strategies to treat or prevent the underlying conditions leading to heart failure as well as decrease the need for hospitalization in this common disorder.