High Prevalence Communities Research Articles

Pathways of Care in the Hospital Visiting Patients Having Mental Health Problems in Central India

Background: There is a high community prevalence of mental health problems in India. Psychiatric patients often consult nonspecialist or unqualified health providers which results in significant treatment delays and poor mental health outcomes. Knowledge of existing treatment-seeking practices may be useful to design specific and effective awareness programs. Objectives: The objectives were to study the types of health-care providers contacted by patients suffering from different mental illnesses as well as assess the treatment delays and associated factors. Methodology: A cross-sectional observational descriptive study was done in a psychiatry clinic of a tertiary health care center and teaching hospital in Central India. The information was collected from consecutive newly visiting patients on two predefined weekdays through face-to-face interviews. A predesigned sociodemographic format and World Health Organization pathways interview schedule were used to assess pathways of care. Results: Data were collected from 157 participants. Majority of participants were males (58%). Mood disorders were the most common diagnostic category (28%), followed by substance-related disorders (23%) and anxiety disorders (21%). Eighty (51%) among the total participants consulted psychiatrist in the first visit. Allopathic practitioners were the second commonly consulted health provider category. The median delay in treatment was maximum in substance-related disorders (7 years). Conclusion: Significant delay in treatment was observed across all diagnostic categories. Training general practitioners in the diagnosis and treatment of mental illnesses and a structured health-care referral system to enhance appropriate psychiatry consultations may be desirable to improve mental health outcomes in India.

A Comparison of Sequelae After a Practice Change From Vancomycin to Ampicillin Containing Antibiotic Regimens for Necrotizing Enterocolitis.

The aim of this study was to compare sequelae and acute kidney injury (AKI) occurrence among patients with necrotizing enterocolitis (NEC) after changing institutional guidelines replacing vancomycin with ampicillin for gram-positive coverage. This was a retrospective, single-center cohort analysis of patients from 2016-2020 (n = 73) with NEC at a surgical neonatal intensive care unit with a high community prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Multivariate logistic regression was utilized to assess associations. Twenty-five (34%) patients had at least 1 sequela related to NEC. Ampicillin containing regimens were not associated with any sequelae type or AKI. Postmenstrual age < 29 weeks at diagnosis ([OR] 5.8 [1.2-28.8], P = .03; and receipt of vasopressors [OR] 3.3 [1.1-10.2], P = .04) were independently associated with sequalae. Stage III NEC was independently associated with AKI, OR 10.6 (2-55.6), P = .005. In conclusion, ampicillin-containing regimens are effective for NEC management at our institution despite a high prevalence of MRSA.

Comparing multiple infection control measures in a nursing home setting: a simulation study.

Compare the effectiveness of multiple mitigation measures designed to protect nursing home residents from infectious disease outbreaks. Agent-based simulation study. Simulation environment of a small nursing home. We collected temporally detailed and spatially fine-grained location information from nursing home healthcare workers (HCWs) using sensor motes. We used these data to power an agent-based simulation of a COVID-19 outbreak using realistic time-varying estimates of infectivity and diagnostic sensitivity. Under varying community prevalence and transmissibility, we compared the mitigating effects of (i) regular screening and isolation, (ii) inter-resident contact restrictions, (iii) reduced HCW presenteeism, and (iv) modified HCW scheduling. Across all configurations tested, screening every other day and isolating positive cases decreased the attack rate by an average of 27% to 0.501 on average, while contact restrictions decreased the attack rate by an average of 35%, resulting in an attack rate of only 0.240, approximately half that of screening/isolation. Combining both interventions impressively produced an attack rate of only 0.029. Halving the observed presenteeism rate led to an 18% decrease in the attack rate, but if combined with screening every 6 days, the effect of reducing presenteeism was negligible. Altering work schedules had negligible effects on the attack rate. Universal contact restrictions are highly effective for protecting vulnerable nursing home residents, yet adversely affect physical and mental health. In high transmission and/or high community prevalence situations, restricting inter-resident contact to groups of 4 was effective and made highly effective when paired with weekly testing.

Risk Factors for Neural-Tube Defects Detected in Utero: A Prospective Community-Based Study from Addis Ababa

BackgroundA recent community-based study from Addis Ababa identifying NTD cases by ultrasound examination of pregnant women showed a higher prevalence of 17 per 1000 foetuses. The risk factors behind the high prevalence remain unclear. MethodsAltogether 891 of the 958 women participated in the ultrasound examination. Thirteen with unaffected twin pregnancies were excluded. Among 878 singleton pregnancies, 15 NTD cases were identified. Serum Folate, vitamin B12 and homocysteine levels were measured in case-mothers and a sub-set of 28 non-case mothers. Because of the modest sample size, exact logistic regression analysis was used to estimate associations between risk factors and NTDs. ResultsSerum vitamin status was generally poor for participants in the study. Still, relatively higher values of folate or vitamin B12 in serum, appeared to be protective for NTD (OR=0.61 per ng/ml, 95% CI: 0.42-0.85 and OR=0.67 per 100 pg/ml, 95% CI: 0.41-1.02, respectively). High serum homocysteine was associated with higher risk of NTD (OR=1.3 per μmol/l, 95% CI: 1.02-1.8). Women aged 30 years or more had an odds ratio of 3.5 (95% CI: 1.1-12) for having a NTD child, and families with NTD children had lower household income. Women in the NTD group also had more spontaneous abortions or stillbirths in previous pregnancies. Self-reported intake of folate did not appear to protect against NTDs. ConclusionWithin this high-prevalence community, poor vitamin status was identified as a risk factor for NTDs detected at ultrasound examination. Improving food security and fortification of foods or food ingredients could be alternative measures.

Knowledge, attitudes, and practices regarding Crimean-Congo hemorrhagic fever in a high-prevalence suburban community, southeast of Iran

Crimean Congo Hemorrhagic Fever (CCHF) is a zoonotic viral disease with a high mortality rate. The World Health Organization has classified it as a high-priority pathogen due to its severity. To manage this disease, knowledge, attitude, and practices (KAP) of the community play an important role. This study was conducted in a suburban area in southeastern Iran, an endemic region with a high occurrence of CCHF. A cross-sectional study was performed among 176 livestock farmers in Zahedan suburb, and data were collected through an interviewer-administered questionnaire. Single-factor and multi-factor analysis of variance was used to identify factors related to participants’ knowledge, attitude, and risk of CCHF. All statistical analyses were conducted using SPSS 24, and a significance level of p ≤ 0.05 was adopted to determine statistical significance. Overall, the knowledge level about CCHF was moderate. Participants demonstrated a better understanding of high-risk occupations compared to the transmission routes and symptoms of CCHF. Conversely, their knowledge about the prevention and treatment of CCHF was found to be inadequate. The participants exhibited a good attitude towards CCHF prevention; most considered it a dangerous disease, believed in the effectiveness of preventive measures, and demonstrated the ability to address perceived obstacles. High-frequency engagement in high-risk behaviors related to CCHF was observed among the study participants. In the multi-factor model, the most critical factors associated with knowledge were age (p = 0.044), CCHF infection (p = 0.047), and CCHF education (p = 0.004). Income (p = 0.001), keeping livestock at home (p = 0.028), and receiving CCHF education (p = 0.012) were the most critical factors associated with attitude toward the risk of CCHF. The most important factors related to CCHF high-risk behavior were age (p = 0.045), gender (p = 0.028), and handling livestock (p < 0.001). These findings emphasize the need for maintaining health educational efforts on CCHF.

Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City.

Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions. We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP. A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13-2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02-1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33-2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20-4.75) on the institutional level. Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.

Geriatric spine fractures – Demography, changing trends, challenges and special considerations: A narrative review

The aim of this manuscript was to summarize the demography and changing trends of geriatric spinal injuries and to enumerate the challenges and special considerations in the care of geriatric spinal injuries. PubMed, Scopus and Embase databases were searched for literature on geriatric spine fractures using MeSH terms ‘aged’, ‘aged, 80 and over’, ‘elderly’, ‘spinal fracture/epidemiology’, spinal fracture/therapy∗’ and keywords pertaining to the same. The search results were screened for appropriate articles and reviewed. There is a high community prevalence of elderly vertebral fractures ranging from 18% to as high as 51%. The proportion of older patients among the spinal injured is rising as well. There is a higher chance of missing spinal injuries in the elderly and clinical guidelines may not be applicable to this patient group. Classification and surgical treatment are different from younger adult counterparts as the elderly osteoporotic spine behaves differently biomechanically. There is a high incidence of respiratory complications both for surgically and conservatively managed groups. Older age generally is associated with a higher complication rate including mortality.

Cross-sectional study of the association of social relationship resources with Staphylococcus aureus colonization in naturally occurring social groups along the US/Mexico border.

Asymptomatic carriage of Staphylococcus aureus is a major risk factor for subsequent clinical infection. Diminishing returns from mitigation efforts emphasize the need to better understand colonization, spread, and transmission of this opportunistic pathogen. While contact with other people presents opportunities for pathogen exposure and transmission, diversity of social connections may be protective against pathogens such as the common cold. This study examined whether social relationship resources, including the amount and diversity of social contacts, are associated with S. aureus colonization. Participants were community members (N = 443; 68% Hispanic) in naturally occurring social groups in southwestern Arizona. Four types of social relationships and loneliness were assessed, and samples from the skin, nose and throat were obtained to ascertain S. aureus colonization. Overall S. aureus prevalence was 64.8%. Neither the amount nor the diversity of social contacts were associated with S. aureus colonization. The concurrent validity of the social relationship assessments was supported by their moderate intercorrelations and by their positive association with self-rated health. The results suggest that the association of social network diversity and susceptibility to the common cold does not extend to S. aureus colonization. Conversely, colonization prevalence was not higher among those with more social contacts. The latter pattern suggests that social transmission may be relatively infrequent or that more intimate forms of social interaction may drive transmission and colonization resulting in high community prevalence of S. aureus colonization. These data inform communicable disease control efforts.

The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence.

dementia may increase care home residents' risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors. we created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality. the cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55-13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05-1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret. whilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19.

Depression onset and its association with community HIV prevalence: A geospatial and panel analyses of nationally representative South African data, 2015–2017

• We compared depression onset overtime among depression-free individuals based on the HIV prevalence of their communities. • Communities with higher HIV prevalence had higher prevalence of depression onset. • Higher community HIV prevalence was associated with depressive consequences for individual residents over time. The scaling up of antiretroviral therapy services over the past decades has led to a remarkable reduction in HIV infections and HIV-related deaths in South Africa (SA). While this is a step in the right direction, it brings a new public health challenge into focus, namely psychological challenges associated with such chronic and often stigmatising condition in SA, home to the largest HIV epidemic. Given the current lack of national-level evidence, we investigated the role of the HIV epidemic on depression onset in SA using nationally representative panel data from the South African National Income Dynamics Study (SA-NIDS). Our incident cohort consisted of 13,020 sampled adult participants who were depression-free in Wave 4 (baseline year of 2015). We then measured the risk of depression onset in Wave 5 (year 2017) based on the level of HIV prevalence in the community where study participants resided at baseline. A High-resolution map of HIV spatial heterogeneity (i.e., community HIV prevalence) was generated using ordinary kriging mapping methods from a separate nationally representative data source that corresponded to the investigation period. Geospatial analyses were conducted to identify the spatial structure of HIV and depression onset, and generalised estimating equations (GEE) regression models were fitted to determine the risk of depression onset over time based on community HIV prevalence. Our geospatial analyses indicated that HIV and depression onset prevalence spatially overlapped in the eastern part of the country, particularly in Gauteng, KwaZulu-Natal, Mpumalanga, and Free State province. The GEE regression analyses indicated that individual residency in a community with high HIV prevalence was significantly associated with a higher risk of depression than a low HIV prevalence community (adjusted odds ratio =1.45, 95% CI=1.12-1.48). For the first time, we identified a geospatial overlap between HIV and depression, with a greater risk of depression onset in high HIV prevalence communities, at a national scale in SA. There is a need for place-based policy interventions that prioritise the availability of and access to mental health services in high HIV prevalent SA communities, in an ageing HIV epidemic.

Prevalence of Sars-Cov-2 in Stem Cell Donors from Anthony Nolan UK Stem Cell Registry: Sars-Cov-2 Testing Programme, Impact on Stem Cell Collections and Managing Risk Going Forward

Introduction The SARS-CoV-2 pandemic risked significant disruption to haematopoietic cell transplantation (HCT). This led to changes in registry operations including widespread use of cryopreservation, Covid-19 screening strategies and deferral periods for positive donors or close contacts. Anthony Nolan (AN), along with UK Aligned Registry partners were some of the few organisations that instigated donor SARS-CoV-2 testing across the donor pathway from April 2020 and are in a unique position to comment on UK stem cell donor prevalence. SARS-COV-2 PCR testing of donor was performed at medical, ahead of G-CSF or BM for cryopreserved collections, before conditioning for fresh collections, and day of donation, in keeping with NICE guidance. Early guidance from JPAC recommended postponing donation three months from resolution of symptoms in donors with coronavirus, with discretionary earlier clearance depending on individual risk assessment and urgency of transplant. Deferral periods were subsequently reduced to 14 days. AN followed public health advice from UK government which included mandatory quarantine for contacts (lifted for vaccinated individuals from 16/8/21) and confirmed cases (legal requirement lifted 24/2/22). Methods Here we report for the first time our 2-year experience of the impact of Covid-19 on our large UK stem cell registry including the SARS-COV-2 prevalence in the UK donors, and impact on collections and cell infusion. This retrospective study included all UK donors (AN and BBMR) selected by UK and International Transplant centres (TCs) to donate PBSC, BM or DLI for paediatric and adult patients between 1st July 2020 and 1st July 2022. This does not include positive donors at verification typing stage or ahead of being selected as preferred donor. Results During study period AN received 1663 work up request for UK donors with 1459 of these donors attending a planned medical. There were 1071 collections (862 PBSC, 89 BM, 120 DLI). 709 (66.2%) of these were cryopreserved. 84 donors tested SARS-CoV-2 positive after being selected and scheduled as a donor giving a prevalence in this two-year period of 5.8%. This occurred before donor clearance was sent to TC in the majority of cases, 47 (56%). 25 (29.8%) occurred after clearance, of these 4 were due to be fresh collections with the intended recipients having commenced transplant conditioning (2 held conditioning and used same donor, 2 used back up donor). There were 8 donors positive on day of donation (7 PBSC, 1 DLI) amounting to 0.75% of all collections. Products were infused in 5 cases (3 fresh, 2 cryo) and discarded in three cases (all cryopreserved). 4 donors were positive within 2 days post donation. We are not aware of any complications or transmitted SARS-CoV-2 from the infused cells. 14 additional donors required mandatory isolation for Covid contact: one of which at a late stage after recipient had commenced conditioning, making a total of 5 post-conditioning cancellations/postponements. For the 84 confirmed SARS-CoV-2 donors, 49 (58.3%) went on to donate with a median deferral from time of original planned collection of 23 days (range 0-106 days). 11 were cancelled for alternative reasons and 24 (28.6%) opted for an alternative donor. During the study period there were a total 34 cryopreserved collections from UK donors not infused (3.2% of UK collections) most commonly due to change in patient circumstances (deterioration or death, 76%). Conclusion AN significantly adapted working during the Covid-19 pandemic. Both cryopreservation and the testing strategy were integral to ensuring the safety of our donors, recipients and collection centre staff and procedures. Covid-19 infection in selected donors (5.6%) led to collection delays (average 23 days) but, whilst each individual case was unfortunate and regrettable, the fact that this transpired to only 5 late-stage (post-conditioning) cancellations/postponements during the study period, does provide reassurance. This highlights during times of high community prevalence having a back-up donor option for planned fresh infusions remains valid advice, and if this cannot be assured then cryopreservation is likely to remain a valuable option. The high number of non-infused products is an area of concern and highlights importance of effective communication between TC and registry, and the importance of completing pre-transplant work up assessment ahead of donor mobilisation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Projected outcomes of universal testing and treatment in a generalised HIV epidemic in Zambia and South Africa (the HPTN 071 [PopART] trial): a modelling study

The long-term impact of universal home-based testing and treatment as part of universal testing and treatment (UTT) on HIV incidence is unknown. We made projections using a detailed individual-based model of the effect of the intervention delivered in the HPTN 071 (PopART) cluster-randomised trial. In this modelling study, we fitted an individual-based model to the HIV epidemic and HIV care cascade in 21 high prevalence communities in Zambia and South Africa that were part of the PopART cluster-randomised trial (intervention period Nov 1, 2013, to Dec 31, 2017). The model represents coverage of home-based testing and counselling by age and sex, delivered as part of the trial, antiretroviral therapy (ART) uptake, and any changes in national guidelines on ART eligibility. In PopART, communities were randomly assigned to one of three arms: arm A received the full PopART intervention for all individuals who tested positive for HIV, arm B received the intervention with ART provided in accordance with national guidelines, and arm C received standard of care. We fitted the model to trial data twice using Approximate Bayesian Computation, once before data unblinding and then again after data unblinding. We compared projections of intervention impact with observed effects, and for four different scenarios of UTT up to Jan 1, 2030 in the study communities. Compared with standard of care, a 51% (95% credible interval 40-60) reduction in HIV incidence is projected if the trial intervention (arms A and B combined) is continued from 2020 to 2030, over and above a declining trend in HIV incidence under standard of care. A widespread and continued commitment to UTT via home-based testing and counselling can have a substantial effect on HIV incidence in high prevalence communities. National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill &amp; Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.

Prompt HIV diagnosis and antiretroviral treatment in postpartum women is crucial for prevention of mother to child transmission during breastfeeding: Survey results in a high HIV prevalence community in southern Mozambique after the implementation of Option B.

World Health Organization recommends promoting breastfeeding without restricting its duration among HIV-positive women on lifelong antiretroviral treatment (ART). There is little data on breastfeeding duration and mother to child transmission (MTCT) beyond 24 months. We compared the duration of breastfeeding in HIV-exposed and HIV-unexposed children and we identified factors associated with postpartum-MTCT in a semi-rural population of Mozambique. This cross-sectional assessment was conducted from October-2017 to April-2018. Mothers who had given birth within the previous 48-months in the Manhiça district were randomly selected to be surveyed and to receive an HIV-test along with their children. Postpartum MTCT was defined as children with an initial HIV positive result beyond 6 weeks of life who initiated breastfeeding if they had a first negative PCR result during the first 6 weeks of life or whose mother had an estimated date of infection after the child's birth. Cumulative incidence accounting for right-censoring was used to compare breastfeeding duration in HIV-exposed and unexposed children. Fine-Gray regression was used to assess factors associated with postpartum-MTCT. Among the 5000 mother-child pairs selected, 69.7% (3486/5000) were located and enrolled. Among those, 27.7% (967/3486) children were HIV-exposed, 62.2% (2169/3486) were HIV-unexposed and for 10.0% (350/3486) HIV-exposure was unknown. Median duration of breastfeeding was 13.0 (95%CI:12.0-14.0) and 20.0 (95%CI:19.0-20.0) months among HIV-exposed and HIV-unexposed children, respectively (p<0.001). Of the 967 HIV-exposed children, 5.3% (51/967) were HIV-positive at the time of the survey. We estimated that 27.5% (14/51) of the MTCT occurred during pregnancy and delivery, 49.0% (2551) postpartum-MTCT and the period of MTCT remained unknown for 23.5% (12/51) of children. In multivariable analysis, mothers' ART initiation after the date of childbirth was associated (aSHR:9.39 [95%CI:1.75-50.31], p = 0.001), however breastfeeding duration was not associated with postpartum-MTCT (aSHR:0.99 [95%CI:0.96-1.03], p = 0.707). The risk for postpartum MTCT was nearly tenfold higher in women newly diagnosed and/or initiating ART postpartum. This highlights the importance of sustained HIV screening and prompt ART initiation in postpartum women in Sub-Saharan African countries. Under conditions where HIV-exposed infants born to mothers on ART receive adequate PMTCT, extending breastfeeding duration may be recommended.

Willingness to accept COVID-19 vaccination among people living with HIV in a high HIV prevalence community

BackgroundPeople living with HIV (PLWH) may have a poorer prognosis with COVID-19 infection and are an important population for COVID-19 vaccination. We assessed the willingness and reasons for COVID-19 vaccine acceptance or hesitancy among PLWH in South Africa.MethodsWe conducted a cross-sectional study consisting of telephone interviews with a randomly selected subset of participants enrolled in a prospective observational cohort study evaluating a decentralized antiretroviral therapy (ART) delivery program in South Africa. Questions assessed willingness to accept a future COVID-19 vaccine, concerns regarding COVID-19 vaccination, and overall vaccine confidence. Interviews were conducted between September 2020 and January 2021. We evaluated participant demographics, sources of COVID-19 information, stigma and medical mistrust, uptake of non-pharmaceutical interventions, and socioeconomic impacts of the COVID-19 pandemic as potential covariates of willingness to accept vaccination.ResultsWe completed interviews with 213 participants; 153 (72%) were female, median age 35y, and 100 (47%) had completed secondary school. Among the participants, 121 (57%) were willing to accept future vaccination, 46 (22%) were unsure, and 45 (21%) stated they did not intend to be vaccinated. Fear of side effects, reported by 42 (20%), was the most common concern about COVID-19 vaccination. Older age was associated with willingness to accept vaccination (aOR 1.75 for every 10-year increase in age, 95% CI 1.10–2.78, p = 0.02), while higher medical mistrust related to COVID-19 (aOR 0.21, 95% CI 0.093–0.45, p < 0.001) and use of social media for COVID-19 information (aOR 0.30, 95% CI 0.11–0.84, p = 0.02) were associated with lower willingness to accept vaccination.ConclusionsIn this cohort of PLWH in South Africa, over half were willing to accept COVID-19 vaccination, although a substantial proportion remained unsure or were not willing to be vaccinated. Public health messaging should emphasize the safety and efficacy of COVID-19 vaccination and address misinformation and medical mistrust among PLWH. Ongoing efforts to ensure access to COVID-19 vaccines for vulnerable populations are crucial.

Covid-19, Vaccination Rates, Infection Rates, Death Rates and Behavioral Interventions: It’s Time to Cut the Bull!

Efficacy of SARS-CoV-2 (COVID-19) vaccines was assessed by comparing infection and death rates in the eight most- and eight least-fully-vaccinated German states. Infection and death rates were measured on three dates in fall 2021. Less-vaccinated states had substantially higher infection and death rates than more-vaccinated states. These effects occurred in the context of a time main effect and a vaccination rate x time interaction: Infection and death rates increased substantially over time, particularly in less-vaccinated states. These increased infection and death rates over time may be due to Germany having few measures other than vaccination in place for controlling the spread of COVID-19, despite the high community prevalence of the Delta variant. The results are discussed in the context of anti-vax rhetoric, policy, strategies for quelling the pandemic, the lack of a synergistic research relationship between the social and medical sciences, and issues related to vaccine equity.

Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality.

ObjectivesInvestigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK.MethodsRetrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases.ResultsA total of 1966 people with IA and 166 602 without tested positive for COVID-19. The incidence rate was 3.5% (1966/56 914) in IA, vs 6% in the general population (166 602/2 760 442), (difference: 2.5%, 95% CI: 2.4%, 2.7%, P ≤0.001). In an adjusted Cox proportional hazard model, IA was not associated with higher mortality (HR: 0.56, 95% CI: 0.18, 1.64, P=0.286). Significant risk factors included shielding (HR: 1.52, 95% CI: 1.40, 1.64, P ≤0.001), hospitalization for previous infections (HR: 1.20, 95% CI: 1.12, 1.28, P ≤0.001), hospitalizations one year pre-pandemic (HR: 1.34, 95% CI: 1.25, 1.44, P ≤0.001) and glucocorticoid use (HR: 1.17, 95% CI: 1.09, 1.25, P ≤0.001).ConclusionsIndividuals with IA had a lower incidence of COVID-19, probably due to shielding. IA was not associated with increased mortality following COVID-19 infection; being vulnerable (shielded), comorbidities and other factors were associated with increased risk. These key risk factors can identify individuals with IA at greater risk from COVID-19 and advised to shield during high community prevalence.

Estimating the contribution of transmission in primary healthcare clinics to community-wide TB disease incidence, and the impact of infection prevention and control interventions, in KwaZulu-Natal, South Africa

BackgroundThere is a high risk of Mycobacterium tuberculosis (Mtb) transmission in healthcare facilities in high burden settings. WHO guidelines on tuberculosis (TB) infection prevention and control (IPC) recommend a range...

Association between periodontitis and chronic kidney disease.

Periodontitis and chronic kidney disease are chronic conditions with high community prevalence across the world. Patients with chronic kidney disease have been noted to have a high burden of periodontitis, and several shared risk factors have been associated with the prevalence and severity of both conditions. However, the precise relationship between the two conditions, and the extent to which each may contribute to the development of the other, remains a matter of debate. The goals of the present work were to: (a) provide the most current and relevant literature overview of the association between periodontitis and chronic kidney disease; (b) explore mechanisms underlying this association; and (c) determine if evidence exists for an independent association between these conditions. We also assessed whether improved oral hygiene and periodontal treatment could reduce the risk of developing chronic kidney disease and, if so, what protocols these strategies involve. Finally, we aimed to reveal gaps in our current knowledge to delineate the directions of future research. Although the exact relationship between these two conditions has not yet been defined, we highlight the importance of the interprofessional interaction between dental practitioners and the nephrology team and the importance of oral health assessment in the management of chronic kidney disease.

Recovery of SARS-CoV-2 from large volumes of raw wastewater is enhanced with the inuvai R180 system

Wastewater-based epidemiology (WBE) for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is a powerful tool to complement syndromic surveillance. Although detection of SARS-CoV-2 in raw wastewater may be prompted with good recoveries during periods of high community prevalence, in the early stages of population outbreaks concentration procedures are required to overcome low viral concentrations. Several methods have become available for the recovery of SARS-CoV-2 from raw wastewater, generally involving filtration. However, these methods are limited to small sample volumes, possibly missing the early stages of virus circulation, and restrained applicability across different water matrices. The aim of this study was thus to evaluate the performance of three methods enabling the concentration of SARS-CoV-2 from large volumes of wastewater: i) hollow fiber filtration using the inuvai R180, with an enhanced elution protocol and polyethylene glycol (PEG) precipitation; ii) PEG precipitation; and iii) skimmed milk flocculation. The performance of the three approaches was evaluated in wastewater from multiple wastewater treatment plants (WWTP) with distinct singularities, according to: i) effective volume; ii) percentage of recovery; iii) extraction efficiency; iv) inhibitory effect; and v) the limits of detection and quantification. The inuvai R180 system had the best performance, with detection of spiked control across all samples, with average recovery percentages of 68% for porcine epidemic diarrhea virus (PEDV), with low variability. Mean recoveries for PEG precipitation and skimmed milk flocculation were 9% and 14%, respectively. The inuvai R180 enables the scalability of volumes without negative impact on the costs, time for analysis, and recovery/inhibition. Moreover, hollow fiber ultrafilters favor the concentration of different microbial taxonomic groups. Such combined features make this technology attractive for usage in environmental waters monitoring.

1339. Impact of COVID-19 Pandemic on Activity of Other Respiratory Viral Pathogen and Norovirus

BackgroundThe COVID-19 pandemic led to the implementation of several strategies (e.g., masking, physical distancing, daycare/school and business closures, hand hygiene, surface disinfection) intended to mitigate the spread of disease in the community. Our objective was to evaluate the impact of these strategies on the activity of respiratory viral pathogens (other than SARS-CoV-2) and norovirus.MethodsAt University of North Carolina (UNC) Hospitals, we compared the percent positivity for respiratory viral pathogens and norovirus by calendar year for 2014-2019 and the first three months of 2020 to the percent positivity in the subsequent months of 2020 and the first quarter of 2021. Patients were included in the study if they had a positive specimen obtained in a clinic, ED or as an inpatient. Three molecular tests were used to detect these viruses: adenoviruses, endemic coronaviruses (OC43, 229E, NL63, HKU1), influenza A (subtypes H3, H1, H1N1pdm), influenza B, metapneumovirus (MPV), parainfluenza viruses 1-4 (PIV), rhinovirus and/or enterovirus (RhV/EV), and respiratory syncytial virus (RSV). Two molecular tests were used to detect norovirus. We calculated point prevalence rates with 95% confidence intervals to assess statistical differences in percent positivity.ResultsThere was a statistically significant decline in percent positivity for endemic coronaviruses, influenza, MPV, PIV, RSV and norovirus during the time-periods after March 2020 when compared to all other time-periods (Figure). RhV/EV, followed by adenovirus were the most prevalent types of respiratory viruses circulating during height of COVID-19. There was a statistically significant decline seen in RhV/EV in April-Dec 2020, but activity increased in 2021. There was no difference seen in adenovirus activity across time-periods.Percent Positivity of Respiratory Viral Pathogens and Norovirus by Time Period ConclusionOur study demonstrated statistically significant decreases in the percent positivity of several respiratory viral pathogens, as well as norovirus, during the time-period of high community prevalence of SARS-CoV-2. Strategies put in place to mitigate SARS-CoV-2 transmission likely contributed to these differences. Non-enveloped viruses like rhinovirus and adenoviruses may have been less impacted by these strategies since they are more resistant to disinfection.Disclosures David J. Weber, MD, MPH, PDI (Consultant) Melissa B. Miller, PhD, D(ABMM), F(AAM), Abbott Molecular (Grant/Research Support)Agena Bioscience (Consultant)ArcBio (Grant/Research Support)Cepheid (Consultant)Luminex Molecular Diagnostics (Consultant)QIAGEN (Consultant)Sherlock Biosciences (Consultant)Talis Biomedical (Consultant)Werfen (Consultant)