Important Public Health Measure Research Articles

Use of Adjuvanted Quadrivalent Influenza Vaccine in Older-Age Adults: A Systematic Review of Economic Evidence.

Influenza vaccination is an important public health measure that can reduce disease burden, especially among older persons (those aged 65 and over) who have weaker immune systems. Evidence suggests enhanced vaccines, including adjuvanted quadrivalent vaccines (aQIV), may be particularly effective in this group. This study reports the results of a systematic review of the cost-effectiveness of aQIV in this population. The review was undertaken and reported in accordance with good practice guidelines. Medline and EMBASE were searched from 2013 to the present. Pre-selected eligibility criteria were employed and quality assessment undertaken using the Consensus Health Economic Criteria (CHEC-extended) checklist and Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 checklists. A total of 124 records were returned, with 10 full text papers retained. All were modelling studies and exhibited heterogeneity in approach, perspective, and parameter estimation. Nine papers reported cost-effectiveness ranging from EUR 6694/QALY to EUR 20,000/QALY in evaluations employing a payer perspective and from EUR 3936/QALY to EUR 17,200/QALY in those using a societal perspective. Results remained robust to a range of sensitivity analyses. One paper that reported contrary findings adopted a distinct modelling approach. It is reasonable to conclude that there is a broad consensus as to the cost-effectiveness of aQIV in this population group.

Population reduction in salt intake for the prevention of cardiovascular disease: the “Four Imperatives”

Salt consumption is now much greater than needed for survival. High salt intake increases blood pressure in both animals and humans. Conversely, a reduction in salt intake causes a dose-dependent reduction in blood pressure in men and women of all ages and ethnic groups, and in patients already on medication. The risk of strokes and heart attacks rises with increasing blood pressure, and a reduction of blood pressure with drugs reduces the risk. However, most events occur in individuals with ‘normal’ blood pressure levels. Non-pharmacological prevention is therefore the only option to reduce such events in the population at large. Reduction in population salt intake reduces the number of vascular events. It is one of the most important public health measures to reduce the global cardiovascular burden. Salt reduction policies are feasible and effective (preventive imperative), cost-saving (economic imperative), powerful, rapid, equitable (political imperative) and life-saving (moral imperative). The World Health Organization recommends reducing salt consumption by 30% globally by 2025, aiming to reduce salt consumption to less than 5g per day, eventually.

Adherence to the Mediterranean Diet and Urinary Sodium Excretion in people at high risk of dementia

Abstract Background Both adequate sodium intake and adherence to the Mediterranean Diet (MedDiet) are largely described as important factors for the prevention and control of hypertension and cerebrovascular diseases. However, data regarding sodium intake in the MedDiet is scarce. This study aims to quantify the association between the MedDiet adherence and sodium excretion. Methods This cross-sectional analysis was carried out under the MIND-Matosinhos randomized controlled trial, a community-based program for Portuguese adults at high risk of dementia. The adherence to the MedDiet was assessed through the Portuguese version of the Mediterranean Diet Adherence Screener questionnaire, and a score ≥10 indicated a high adherence. A 24h urine collection was used to evaluate creatinine and sodium excretion. Excessive sodium excretion was defined as ≥ 2000 mg/day. Sociodemographic, lifestyle and health-related data were obtained through structured questionnaires. The association between the adherence to the MedDiet and urinary sodium excretion (recoded into two categories by the median) was quantified by calculating Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) using a binary logistic regression. Results A total of 126 individuals (24 to 83 years old; median age of 70.0) was included in this study (58.7% female). High adherence to the MedDiet was observed among 15.9% of the sample whereas excessive sodium excretion was reported by 84.1%. After adjusting for confounders, participants with high adherence to the MedDiet showed a higher sodium excretion (OR = 4.05; 95% CI: 1.33-12.37). Conclusions A high adherence to the MedDiet was associated with a higher sodium excretion. Thus, an increased adherence to this dietary pattern seems to have limited effects on the adequacy of sodium intake. This highlights the importance of public health measures to reduce sodium intake when following a MedDiet namely by improving consumer empowerment. Key messages • Despite the well-known protective effect of the Mediterranean Diet on hypertension and cerebrovascular diseases, the role of sodium intake within this dietary pattern is still understudied. • The Mediterranean Diet can be an important source of hidden sodium, which enhances the need to invest in public health measures to reduce sodium intake, namely through culinary medicine education.

Prevalence of Rotavirus, Adenovirus, and Hepatitis A Virus in a Tertiary Care Hospital in Somalia

Rotavirus, one of the viral infectious agents that is transmitted mainly through the fecal-oral route and spreads easily in regions with poor sanitation conditions, is the most common causative agent of acute gastroenteritis in children under five years of age worldwide, and enteric adenoviruses are other frequently encountered causative agents of gastroenteritis in childhood. Hepatitis A virus (HAV) is also transmitted in similar routes and is endemic in regions with poor sanitation conditions and limited access to clean water and is usually acquired in early childhood in these regions. In this study conducted in Mogadishu Somalia, rotavirus and adenovirus antigen test (immunochromatographic rapid test) results in patients admitted to a tertiary hospital in the 9-month period between February 2019 and October 2019 and ELISA based HAV antibody test results studied in 2018-2019 were retrospectively examined and it was aimed to determine the distribution of positivity rates of these viruses by age, gender, and year. During the study period, 1136 patients (mean age 6.33±12.36) were tested for rotavirus and adenovirus antigens, and 362 patients (mean age 21.26±18.45) were tested for anti-HAV IgM/IgG antibodies. The positivity rates of rotavirus and adenovirus were found as 17.8% and 5.1%, respectively. The positivity rates of anti-HAV IgM and IgG antibodies were 26.5% and 85.4%. The age group with the highest rotavirus test positivity was babies under one year old (27.3%), positivity rate was also high in children aged 1-2 years old (20.9%), and this distribution was similar for adenovirus. Although a small number of patients were tested in under five years of age, anti-HAV IgG seropositivity was 60% and above in all age groups. The highest anti-HAV IgM positivity rates were observed in children 2-<5 and 5-15 years of age, 52.9% and 44% respectively. Rotavirus antigen positivity was found at high levels in the three-month period covering June, July, and August 2019. In July (2019), it was observed that the number of rotavirus and adenovirus antigen test requests were increased, and also, at the same time the highest positivity rates for both viruses were observed; 31.2% and 9.5% for rotavirus and adenovirus. Rotavirus and enteric adenovirus co-infection was detected in 2.4% (27/1136) of the patients, and 23 (85.2%) of these were under five years of age children. Our study results show that children under the age of two are especially affected by rotavirus and adenovirus infections in Somalia and indicate that HAV infections are acquired at an early childhood. We can say that it may be useful to review vaccination programs as an important public health measure to reduce the burden of mortality and morbidity associated with HAV and rotavirus, which have a high prevalence and also have protective vaccines.

COVID‐19 booster dose vaccination of healthcare workers in Qatar: A web‐based cross‐sectional survey

AbstractBackgroundVaccines are an important public health measure and effective strategy to protect the population from COVID‐19. Front‐line healthcare personnel should receive priority in vaccination programs. However, the reported hesitancy among healthcare workers (HCWs) toward the COVID‐19 vaccines cannot be ignored. It widely influences the level of vaccine hesitancy in the general population. Hesitancy, fear, and anxiety were documented in first and second rounds of COVID‐19 vaccination. This study assessed the acceptance of COVID‐19 booster doses among the HCWs in Qatar.MethodsA web‐based cross‐sectional online survey was conducted using the 7C Vaccine Readiness Scale to evaluate the preparedness of the HCWs to receive COVID‐19 vaccines. Descriptive and inferential statistics were used to identify factors associated with preparedness for vaccination.ResultsA total of 382 participants completed the survey. Allied health professionals scored the least on the readiness score (−7.0 ± 9.9) compared to the physicians (3.1 ± 7.2) and nurses (3.0 ± 7.8). Physicians scored higher on confidence (58.8%), calculation (64.7%), and complacency (60.8%). Nurses scored higher on constraints (51.6%), collective responsibility (62.7%), and compliance (39.1%), and allied health professionals scored higher on (67.9%) conspiracy. There was a significant association between readiness score and not being infected with COVID‐19, post‐vaccine symptom experience, and hesitancy for the initial two doses.ConclusionThis study reports higher complacency and constraints with the perception of lower risks and the lack of interest in taking collective responsibility among the HCWs. Addressing vaccine hesitancy among them is critical to ensure successful vaccination campaigns and promote community safety during future pandemics.

Community water fluoridation: legislation and evidence base

With passage of the 2022 Health and Care Act, the legislation governing water fluoridation in England has changed. This article provides an overview of the changes and implications for decision-making in relation to this important public health measure and an overview of the evidence base. CPD/Clinical Relevance: This article will help members of the dental team understand how fluoridation responsibilities are handled in England and the considerations around the evidence base.

Surveying a Sample of the Spanish Ophthalmologic Community about Vaccination against Herpes Zoster.

There are currently two authorized vaccines against herpes zoster (HZ) that have been shown to be safe and effective in its prevention: Zostavax, a zoster vaccine live (ZVL), and Shingrix, a recombinant zoster Vaccine (RZV). Because ophthalmologists work with vision-threatening complications of zoster, such as herpes zoster ophthalmicus (HZO), they are in a good position to advocate for vaccination. Our aim was to determine the current knowledge among Spanish ophthalmologists about the effectiveness of the available vaccines against HZ. A Google Forms questionnaire was created and used as the survey platform for this study. It was an anonymous online survey of 16 questions, which was shared among Spanish ophthalmologists in-training and consultants from 27 April 2022 to 25 May 2022. The survey was completed by a total of 206 ophthalmologists of all subspecialties. We obtained responses from 17 of the 19 regions of Spain. Fifty-five percent of the respondents agreed that HZ is a frequent cause of vision loss. However, 27% of the professionals were unaware of the existence of vaccines against HZ and 71% of them did not know in which cases it could be indicated. Only nine ophthalmologists (4%) had ever suggested vaccination against HZ to their patients. Despite this, 93% considered it important to recommend vaccination against HZ if it proved to be safe and effective. Considering the sequelae, complications, and the existence of safe and effective vaccines against HZ, vaccination of the target population could be considered an important public health measure. We are convinced that it is time for ophthalmologists to take an active role in HZO prevention.

Daily implementation of health-protective behaviors and family life during the early months of the COVID-19 pandemic.

The coronavirus disease (COVID-19) pandemic has necessitated the use of health-protective behaviors (HPB), such as social distancing, staying at home, frequent handwashing, and wearing facemasks to mitigate the transmission of disease. An investigation of interpersonal costs associated with the use of HPB can help inform strategies to promote their sustained implementation. This study examined the daily associations between the implementation of HPB and family functioning and assessed moderation by coparenting quality, economic strain, and the number of days that state-level stay-at-home policies had been in effect, during the early days of the pandemic. Mothers and fathers from 155 families with children who were 9 years old, on average, completed daily reports of HPB, parental stress, and family relationship quality over eight consecutive days in April or May of 2020. Hierarchal linear models showed that HPB was associated with increased levels of parental stress and interparental conflict. Negative coparenting relations exacerbated the next-day association between HPB and interparental conflict. HPB was also associated with increased levels of parent-child and interparental closeness, but these linkages dissipated for families who had spent more days under state-level stay-at-home policies. Although crucial for public health, the implementation of HPB may have detrimental short-term effects on daily family life. Family support and interventions are necessary to minimize the psychosocial burden of these important public health measures and increase their sustained adherence.

The Future of INCOG (Is Now).

The Future of INCOG (Is Now).

Non-pharmaceutical interventions and the emergence of pathogen variants.

Non-pharmaceutical interventions (NPIs), such as social distancing and contact tracing, are important public health measures that can reduce pathogen transmission. In addition to playing a crucial role in suppressing transmission, NPIs influence pathogen evolution by mediating mutation supply, restricting the availability of susceptible hosts, and altering the strength of selection for novel variants. Yet it is unclear how NPIs might affect the emergence of novel variants that are able to escape pre-existing immunity (partially or fully), are more transmissible or cause greater mortality. We analyse a stochastic two-strain epidemiological model to determine how the strength and timing of NPIs affect the emergence of variants with similar or contrasting life-history characteristics to the wild type. We show that, while stronger and timelier NPIs generally reduce the likelihood of variant emergence, it is possible for more transmissible variants with high cross-immunity to have a greater probability of emerging at intermediate levels of NPIs. This is because intermediate levels of NPIs allow an epidemic of the wild type that is neither too small (facilitating high mutation supply), nor too large (leaving a large pool of susceptible hosts), to prevent a novel variant from becoming established in the host population. However, since one cannot predict the characteristics of a variant, the best strategy to prevent emergence is likely to be an implementation of strong, timely NPIs.

Parental Attitudes, Intentions, Decisions, and Psychological Wellbeing Regarding COVID-19 Vaccination: Preschool, School-Age, and Adolescent Caregivers.

The vaccination of all children may be one of the most important public health measures for preventing a wider spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the community. Therefore, the purpose of this study was to investigate the attitude, intention, decision making, and psychological well-being among the caregivers of children who received SARS-CoV-2 vaccination in Taiwan. The caregivers of children (98 preschool children, 191 school-age children, and 154 adolescents) who received COVID-19 vaccination were invited to fill in the following questionnaires: Adopting Self-Protective Behavior Scale, Drivers of COVID-19 Vaccination Acceptance Scale, Impact of Event Scale, Chinese Health Questionnaire, and Parental Bonding Instrument. Compared to the caregivers of adolescents, the caregivers of preschool children exhibited more protective behaviors toward the COVID-19 pandemic. The caregivers of preschool children also displayed a higher emotional impact than those of adolescents and took a greater interest in the family's opinion about vaccination. Finally, we found that COVID-19 ideological invasion and protective parenting style were significantly related to the prevalence of mental illness among caregivers. The results of this study can be used as an important reference for vaccination health care and policy formulation for adolescents with regard to COVID-19.

Salt intake reduction using umami substance-incorporated food: a secondary analysis of NHANES 2017-2018 data.

Excessive salt intake raises blood pressure and increases the risk of non-communicable diseases (NCD), such as CVD, chronic kidney disease and stomach cancer. Reducing the Na content of food is an important public health measure to control the NCD. This study quantifies the amount of salt reduced by using umami substances, i.e. glutamate, inosinate and guanylate, for adults in the USA. The secondary data analysis was performed using data of the US nationally representative cross-sectional dietary survey, the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Per capita daily salt intake corresponding to the NHANES food groups was calculated in the four hypothetical scenarios of 0 %, 30 %, 60 % and 90 % market share of low-Na foods in the country. The salt reduction rates by using umami substances were estimated based on the previous study results. The USA. 4139 individuals aged 20 years and older in the USA. Replacing salt with umami substances could help the US adults reduce salt intake by 7·31-13·53 % (7·50-13·61 % for women and 7·18-13·53 % for men), which is equivalent to 0·61-1·13 g/d (0·54-0·98 g/d for women and 0·69-1·30 g/d for men) without compromising the taste. Approximately, 21·21-26·04 % of the US adults could keep their salt intake below 5 g/d, the WHO's recommendation in the scenario where there is no low-Na product on the market. This study provides essential information that the use of umami substances as a substitute for salt may help reduce the US adults' salt intake.

Rapid Protocol Development, Study Startup and Enrolment of a Prospective Study of COVID-19 Vaccination for Patients with Cancer: A Collaborative Approach.

COVID-19 is an unprecedented global health emergency. It has been highly disruptive for patients with cancer, both due to an increased burden of severe illness and due to pressure on healthcare systems. COVID-19 vaccination has been an important public health measure for this patient group. The aim of this study was to describe the rapid design and startup of a multicentre study of COVID-19 vaccine response for vulnerable patients with cancer. Study startup: We set up a multicentre prospective observational study of COVID-19 vaccination response for Australian patients with cancer. Due to intensive collaboration between health services, the funding body and laboratories, we were able to develop a protocol and enrol the first patient within 52 days of the initial study proposal. Rapid startup was further enabled by prompt availability of funding and by high-level engagement of institutional review boards, allowing expedited review. Study enrolment: We rapidly enroled more than 500 patients, 80% within 4 months of study opening. Engagement and follow-up were maintained throughout the course of up to five serial vaccination doses. Our study is an example of intensive collaboration inspired by the COVID-19 pandemic and may serve as an example of an agile research response to real-time public health challenges.

Reducing salt intake with umami: A secondary analysis of data in the UK National Diet and Nutrition Survey.

Reducing sodium content in foods is an important public health measure to reduce salt intake and decrease the incidence of noncommunicable diseases, such as cardiovascular disease and chronic kidney disease. This study quantified the amount of salt intake that could potentially be reduced by using umami substances, including glutamate, inosinate, and guanylate, without compromising taste, for adults in the United Kingdom (UK). We used data comprised of 1834 adults aged 20 years and over from the National Diet and Nutrition Survey (NDNS RP) 2016/2017-2018/2019. Four hypothetical scenarios in which the market share of low-sodium foods accounts for 0%, 30%, 60%, or 90% of consumed products were considered in the analyses. Per capita daily salt intake corresponding to the NDNS RP food groups was calculated for each scenario, and the salt intake was aggregated by gender and age groups. Replacing salt with umami substances could help UK adults reduce daily salt intake by 9.09%-18.59% (9.21%-18.43% for women; 8.83%-19.43% for men), which is equivalent to 0.45-0.92 g/day of salt reduction (0.41-0.82 g/day for women; 0.50-1.10g/day for men). The use of umami substances may serve as one method for the UK government to encourage salt intake reduction, particularly in the context of food product reformulation, as 80% of salt consumed in the country comes from processed foods. Empirical studies with sensory evaluation should be conducted to confirm consumer tolerance. The food industry should also be engaged in conversations regarding the addition of umami to food products in the United Kingdom.

Comparison of Dose-Response Relationships for Two Isolates of SARS-CoV-2 in a Nonhuman Primate Model of Inhalational COVID-19.

Background: As the COVID-19 pandemic has progressed, numerous variants of SARS-CoV-2 have arisen, with several displaying increased transmissibility. Methods: The present study compared dose-response relationships and disease presentation in nonhuman primates infected with aerosols containing an isolate of the Gamma variant of SARS-CoV-2 to the results of our previous study with the earlier WA-1 isolate of SARS-CoV-2. Results: Disease in Gamma-infected animals was mild, characterized by dose-dependent fever and oronasal shedding of virus. Differences were observed in shedding in the upper respiratory tract between Gamma- and WA-1-infected animals that have the potential to influence disease transmission. Specifically, the estimated median doses for shedding of viral RNA or infectious virus in nasal swabs were approximately 10-fold lower for the Gamma variant than the WA-1 isolate. Given that the median doses for fever were similar, this suggests that there is a greater difference between the median doses for viral shedding and fever for Gamma than for WA-1 and potentially an increased range of doses for Gamma over which asymptomatic shedding and disease transmission are possible. Conclusions: These results complement those of previous studies, which suggested that differences in exposure dose may help to explain the range of clinical disease presentations observed in individuals with COVID-19, highlighting the importance of public health measures designed to limit exposure dose, such as masking and social distancing. The dose-response data provided by this study are important to inform disease transmission and hazard modeling, as well as to inform dose selection in future studies examining the efficacy of therapeutics and vaccines in animal models of inhalational COVID-19.

The cutaneous manifestations of COVID-19, personal protective equipment and treatment

Since the beginning of COVID-19 pandemic in late 2019, the symptoms and signs detailed in the medical literature and the media concentrated on the effect of causative virus SARS-COV-2 on the respiratory tract, the coagulopathy associated with severe forms of the disease and the febrile flu like illness in the mild cases. The widespread publicising of the symptoms has been one of the important public health measures in combatting the rapid spread of COVID-19. Less known is the direct or indirect effect of COVID-19 on the skin and underlying soft tissue. Recognising the various cutaneous manifestations may prove a useful tool in early detection and management of COVID-19.

Information available on consumer-facing websites may affect adherence to important public health measures such as reducing sodium consumption.

Information available on consumer-facing websites may affect adherence to important public health measures such as reducing sodium consumption.

O15 - Introduction of the London Measure of Unplanned Pregnancy at the booking visit

Estimating pregnancy intention is an important public health measure. In the Australian maternity practice setting, pregnancy intention is not consistently reported. Usually, this enquiry consists of a single question, with a dichotomous outcome, about whether the pregnancy was planned or not, with midwives being the health professionals responsible for asking this question. The London Measure of Unplanned Pregnancy(LMUP) is a psychometrically validated measure of the degree of intention of a current or recent pregnancy. The aim of this study is to present the first year of implementation of the LMUP and examine rates of unwanted, ambivalent and intended pregnancies and their demographic associations. We performed a retrospective review of the first year of LMUP data entered in the electronic maternity medical records of women booked for public antenatal care at the two maternity hospitals in Sydney. Routinely collected data from the antenatal booking visit along with sociodemographic information, living situation, relationship status and country of birth were also collected. We identified that 4993 women who booked in for public antenatal care during the study period of whom 44.8% (2791) had all six items of the LMUP completed. Primiparous women accounted for 52% of bookings, and2385 pregnancies were unplanned. 29% of pregnancies were unintended with an 8-fold higher risk in those having their 4th or more birth compared to those having their first. Unintended pregnancies can have serious health, social and financial consequences and we have identified that women are missing out on access to contraception between pregnancies. Our findings are critical research in an emerging area of midwifery which will inform policy and practice and to develop service models that meet women’s needs and scope of practice of Midwives.

The Impact of the COVID-19 Pandemic and Vaccination on Dental Restorative Practices in the Geriatric Population

Objective: Vaccines were considered as one of the most important public health measures during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to quantify and compare restorative dental practices of geriatric patients during pre-pandemic, prevaccination, and post-vaccination periods. Materials and Methods: Dental records of patients aged older than 65 who presented to Bursa Oral and Dental Health Training and Research Hospital were included in the study. Restorative dental practices during the three periods: pre-pandemic period (01.01.2019−10.03.2020), pre-vaccination period (11.03.2020−13.02.2021) and post-vaccination period (14.02.2021−01.09.2021) were reviewed according to the patient’s age (young-old, middle-old and old-old), sex, tooth number (anterior and posterior), restoration type (occlusal, proximal, or cervical) and the type of restoration material (amalgam or composite). Results: Anterior restorations accounted for more than half (53%) of all restorations in the pre-COVID-19 pandemic period and 46.5% and 55.4% of restorations in the pre- and post-vaccination periods, respectively. The distribution of posterior amalgam restorations in the pre-pandemic period (31.5%) was higher than the pandemic period; in contrast, the composite restorations were higher during the pandemic pre-vaccination (73.9%) and post-vaccination (76.3%) periods (p<0.001). The males (odds ratio (OR): 1.17, 95% CI: 1.03-1.34, p=0.02) and middle-old (OR: 0.79, 95% CI: 0.64-0.96, p=0.019) were more likely to use restorative dental services as compared to females and youngold age, respectively. Conclusion: Vaccination had a noticeable effect on increased admissions of geriatric patients and restorative dental treatments compared to the pre-vaccination period. In addition, in the post-COVID-19 vaccination period, composite restorations seem to have replaced amalgam restorations.

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May-July 2021.

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6–31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others.