Prevention Of COVID-19 Infection Research Articles

P-1963. Changes in COVID-19 Sentiment and Behavior among Healthcare Professionals Over Time in a Rural State

Abstract Background We assessed attitudes towards COVID-19 and use of COVID-19 infection prevention practices during the pandemic among employees at an academic health center in a rural state.Figure 1:Reported Level of Worry about Spreading SARS- CoV-2 Methods We invited all employees aged >18 years reporting prior COVID-19 on a screening survey to participate and randomly selected other participants (Ps) from among those not reporting prior COVID-19 to create a study cohort of 302 participants. Ps completed surveys at 3-month intervals (T0, T3, T6, T9). We used the Chi-squared test to assess changes in Ps’ responses between individual time points.Figure 2:Reported Willingness to Go into Public Places Results At T0 most Ps thought their risk of acquiring COVID-19 either in the hospital or the community was low (< 3%) and < 20% worried that they or their household members would “catch COVID-19.” However, 45% of Ps were worried about spreading SARS-CoV-2 asymptomatically. Ps’ perceived likelihood of getting COVID-19 at the hospital and in the community did not change. The percent of Ps who were very worried about getting COVID-19 was significantly lower at T1 (1.7%), T2 (2.6%), and T3 (5.7%) than at T0 (11.3%; P < .05 for all). The percent of Ps who were very worried that household members would get COVID-19 decreased from T0 (16.6%) to T1 (8.0%; P = .03). After vaccines were introduced, Ps tended to report being less worried about spreading COVID-19, more willing to go to public places and less likely to wear face masks in the public. Shortly after the Delta variant emerged, these sentiments changed direction but did not return to their baseline cautiousness level. Shortly before the Omicron variant emerged, the sentiments of those who were seropositive at any time and those who remained seronegative during the study period diverged, with the latter being more worried about asymptomatic spread, less willing to go to public places and more willing to mask in the community than those who seroconverted. Consistent with these changes, 21 of 26 (80.8%) seroconversions occurred during the Omicron surge.Figure 3:Changes in Reported Use of Face Coverings in Public Conclusion Some attitudes and behaviors changed over time possibly related to vaccine availability and the predominant SARS-Co-V2 variant. Ps who remained seronegative tended to be more concerned about getting COVID-19 and were more likely to continue using COVID-19 infection prevention practices. Disclosures Daniel Diekema, MD, MS, D(ABMM), Affinity Biosensors: Grant/Research Support|bioMerieux, Inc: Grant/Research Support Loreen Herwaldt, MD, 3M: Grant/Research Support|PDI: Grant/Research Support

MRNA-therapy: problems and prospects of application in nephrology

The successful application of messenger RNA (mRNA)-based vaccines for the prevention of COVID-19 infection has drawn the attention of the scientific community to the potential clinical applications of these molecules as innovative and alternative therapeutic approaches in various fields of medicine. As therapeutic agents, mRNAs may be advantageous due to their unique biological properties – the ability to target virtually any genetic component of the cell and encode any proteins and peptides without the need to transfer them to the nuclei of target cells. In addition, these molecules can be rapidly designed/produced and clinically tested. Once the RNA chemistry and delivery system are optimized, the cost of developing new variants of these drugs for newly selected clinical diseases is greatly reduced. However, despite their potential value as novel therapeutic weapons against several kidney diseases, the complex kidney architecture and the inability of oligonucleotide-containing nanoparticles to cross the integral glomerular filtration barrier have greatly reduced their potential application in nephrology. Nevertheless, technical improvements in mRNAs that increase translation efficiency, modulate innate and adaptive immunogenicity, and improve their selective delivery to the site of action are expected to overcome these limitations and the potential for kidneytargeted therapies will greatly expand over the next few years. This is all the more important given that chronic kidney disease (CKD) affects just over 10 % of the world's adult population to some degree, and CKD is projected to become the fifth leading cause of death by 2040, with about half of patients dying from cardiovascular disease. The purpose of this mini-review is to provide a summary of the main benefits of RNAi-based therapies and illustrate the potential future directions and challenges of this promising technology for widespread therapeutic use in nephrology.

Pathophysiology, management and therapeutic challenges of coagulopathy in COVID-19 patients

The pathophysiology of COVID-19-associated coagulopathy is characterized by a complex of interactions within viral factors, abnormal haemostasis, dysfunction of endothelial cells, and inflammatory reactions, necessitating the research to elucidate underlying mechanisms and identify novel therapeutic targets. Severe COVID-19 conditions are frequently coupled with an increased immunological response, dubbed a cytokine storm, which facilitates the release of pro-inflammatory cytokines (e.g., interleukin-6, tumour necrosis factor-alpha). The cytokine storm contributes to widespread inflammation and endothelial activation, disrupting the balance between pro-coagulant and anticoagulant factors. Additionally, it is capable of being transmitted by contacting surfaces that are contaminated and then rubbing the face. Biomarkers such as D-dimer levels serve as valuable tools in risk assessment and monitoring, yet their interpretation requires careful consideration within the clinical context. Although some COVID-19 patients may not exhibit any symptoms, they can still spread the virus to others, and there is proof that the virus can spread via the air in some environments, especially confined areas with inadequate ventilation. Vaccines have been developed and deployed globally to prevent COVID-19 infection and reduce severe illness, hospitalizations, and deaths. Governments and health authorities worldwide have implemented policies including lockdowns, social isolation, mask-wearing, investigation, contact tracking, and vaccination campaigns to control transmission and reduce the impact of the virus. Data were sorted from PubMed, Google Scholar, Springer, Nature, Tailor and Francis, MDPI, BMC and some other related data. This review provides appreciable information on the pathophysiology, management and therapeutic challenges of coagulopathy in Covid-19 patients.

A narrative review focusing on randomized clinical trials of vitamin D supplementation for COVID-19 disease.

Current evidence is inconsistent on whether vitamin D supplementation can prevent COVID-19 infection or improve its clinical outcomes. To better understand and look into the issue, we went through the background knowledge of COVID-19 and vitamin D, searched in Pubmed [by using key words in the title containing "randomized clinical trial", "COVID-19", and "vitamin D (25-hydroxyvitamin D, or cholecalciferol, or calcidiol, or calcifediol) supplementation"] for publications of studies on vitamin D/supplementation in COVID-19 patients, especially those about the randomized clinical trials (RCTs). After reviewing these papers, we did a short background review of vitamin D and the pathophysiology of COVID-19, summarized the key features of the 25 RCTs in text and tabulated in a table of some of the features, commented, compared and discussed the differences between RCTs (for example, change the serum 25-hydroxyvitamin D concentration from nmol/L to ng/mL, making the comparison easier). The take-home question of the review is that serum 25-hydroxyvitamin D concentration is an important indicator of the supplementation effect of vitamin D correction but may not be reliable in predicting the supplementation effect on the clinical outcomes of COVID-19.

The Impact of the COVID-19 Pandemic on Medical-Legal Partnership Services and Cases.

Medical-legal partnerships (MLPs) are innovative, promising models that integrate legal service providers and medical professionals to prevent, detect, and address legal, social, and economic needs arising from social inequities that may negatively impact health. The COVID-19 pandemic impacted health care systems across the United States. MLP workflows and legal services were also interrupted by COVID-19 infection prevention and control measures such as no-visitor policies, social distancing, and the cancellation of non-emergent or routine health care services. We sought to describe the impact of COVID-19 on legal services provided by an MLP by exploring case types and services provided prior to the COVID-19 pandemic and during the pandemic. This is an examination of MLP services provided at a Midwestern academic medical center comparing data from three years prior to the pandemic (2017-2019) to three years during the pandemic (2020-2022). The MLP is a collaboration between the University of Nebraska Medical Center/Nebraska Medicine (an academic medical center) and Legal Aid of Nebraska and Iowa Legal Aid (legal service providers). Case data was drawn from individuals who were MLP patient-clients between 2017 and 2022. The main outcome measures were the number of cases and categories and types of legal services provided by the MLP. Consistent across time, we found that on average 494 cases were closed each year. Consumer/finance cases decreased significantly from pre-COVID-19 to during the pandemic, while family cases increased significantly during the pandemic. Cases related to income maintenance increased across time. Through the COVID-19 pandemic experience and understanding the case mix, MLPs and health care champions can be better prepared to understand some of the challenges that may occur and changes that may be necessary to better serve patient-clients during a public health emergency.

Measures to Prevent and Control COVID-19 in Skilled Nursing Facilities

Skilled nursing facilities (SNFs) experienced high mortality during the COVID-19 pandemic, leading them to adopt preventive measures to counteract viral spread. A critical appraisal of these measures is essential to support SNFs in managing future infectious disease outbreaks. To perform a scoping review of data and evidence on the use and effectiveness of preventive measures implemented from 2020 to 2024 to prevent COVID-19 infection in SNFs in the US. Two analyses were performed. First, an analysis of the federal COVID-19 SNF Database was conducted to describe time trends in COVID-19 incidence, deaths, testing, vaccination, and treatment among SNF residents and staff, as well as shortages in staff and personal protective equipment (PPE). Then, a comprehensive literature search was conducted from May 2023 to April 2024 to identify high-quality evidence on the use and effectiveness of modifiable preventive measures used among SNF residents. Both nonpharmacologic (facility characteristics, PPE, cohorting, and isolation, visitation, staffing, testing) and pharmacologic (vaccination, treatment) measures were reviewed. Nationwide data indicated early shortages of PPE, infrequent testing, and persistent staff shortages in SNFs. Other nonpharmacologic measures, such as visitor restrictions or ventilation modifications, were widely adopted but there were no available national data to quantify their effectiveness. These nonpharmacologic measures lacked high-quality studies to verify effectiveness. In contrast, the effectiveness of vaccination and antiviral treatment was shown in multiple studies. Evidence also showed associations between COVID-19 outcomes in residents and crowding, staff size, hours per residents and networks, and surveillance testing of residents and staff. Despite high initial uptake, up-to-date vaccination status was suboptimal in residents and staff from 2022 to 2024. Only a minority of infected residents received antiviral treatment. This scoping review found that although many preventive measures were implemented in SNFs in the US throughout the COVID-19 pandemic, few were based on clear evidence of their effectiveness. Pharmacologic measures, such as vaccination and antiviral treatment, had more robust evidence supporting their efficacy than nonpharmacologic interventions. Using the scarce resources and staff of SNFs on measures of questionable effectiveness could distract from known effective ones such as vaccination and antiviral treatment. When possible, implementation efforts should be commensurate with the demonstrated effectiveness of available preventive measures.

Development, Pre-Clinical Safety, and Immune Profile of RENOVAC-A Dimer RBD-Based Anti-Coronavirus Subunit Vaccine.

Background: The development of effective and safe vaccines and their timely delivery to the public play a crucial role in preventing and managing infectious diseases. Many vaccines have been produced and distributed globally to prevent COVID-19 infection. However, establishing effective vaccine development platforms and evaluating their safety and immunogenicity remains critical to increasing health security, especially in developing countries. Objectives: Therefore, we developed a local subunit vaccine candidate, RENOVAC, and reported its toxicity and immunogenicity profile in animal models. Methods: First, the synthetic gene-coding tandem RBD linked with the GS linker was cloned into the expression vector and expressed in CHO cells. The protein was then purified and filter sterilized, and 10 µg/dose and 25 µg/dose formulations were finally examined for the 14-day repeated dose toxicity followed by the immunogenic profile in preclinical studies. Results: When administered to Sprague Dawley rats by intramuscular route, the vaccine was well tolerated up to and including the dose of 25 µg/animal, and no toxicologically adverse changes were noted. The observed change in weight of the thymus and spleen might be related to the immunological response to the vaccine. The dimer RBD vaccine demonstrated the ability to generate high levels of specific immunoglobulins (IGs) and neutralization antibodies (NAbs). Finally, changes in the amounts of specific T cells and cytokines after vaccination suggested that the vaccine mainly triggers an immune response by activating CD4+ Th2-cells, which then activate B-cells to provide humoral immunity. Conclusions: The study suggests that, based on its reliable immunogenicity and acceptable safety, the vaccine can be further directed for clinical trials.

Modeling of COVID-19 Growth Cases in Bandung Regency and Bandung City Using Vector Autoregression

COVID-19 is a global health epidemic due to increasing infections and deaths. Indonesia has many confirmed cases with high daily case growth, including the Bandung City and Bandung Regency areas. High mobility between regions can impact the growth of COVID-19 cases. Strategies to prevent the growth of COVID-19 cases need to be carried out by considering the growth of COVID-19 cases in the nearest area. The Vector Autoregression (VAR) model is a forecasting model that can consider geographic impacts. This study aims to model the growth of cases in adjacent areas and have high mobility using the VAR method. The growth of COVID-19 cases in Bandung City and Bandung Regency is integrated into the VAR model to see the impact of each other. The VAR model also considers the impact of case growth in the past on its region's future. Transformation and differencing are carried out on the time series of case growth in each region to achieve time-series stationarity so that the VAR model can be carried out. First-order VAR becomes a model representing the growth of COVID-19 cases in Bandung City and Bandung Regency. The model shows that COVID-19 cases in each region will decrease over time and each region impacts each other. Decreasing cases growth can be caused because people who have been infected and vaccinated have sound immune systems to prevent re-infection. However, prevention still needs to be done to stop the pandemic. Therefore, restrictions on mobility between regions can be used as a strategy to prevent COVID-19 infection.

Bioactive Components in Functional Foods, Mechanism of Action and Impacts on Health with a Focus on COVID-19 –A Review

Functional food plays a critical role on enhancing an individual’s health, in the current scenario. The health benefits of functional foods are elaborated through a review of bioactive components present in these foods. The importance of the components such as minerals, polyols, prebiotics, probiotics, carotenoids, flavonoids, proteins, dietary fibres, vitamins, and fatty acids such as Omega n-3 fatty acids which are present in our daily diet and their role in promoting human health is reviewed in this article. The mechanism of action of these components in the gut and their biochemical responses are discussed. This study also emphasizes the use of controlled delivery of the components by nanotechnological research, typically conducted "in-vitro." A detailed note is included to describe how these bioactive ingredients work to treat and prevent COVID-19 infection. The functional components present in foods such as garlic, green tea, curcumin and so forth, can impede the spike glycoproteins of the COVID 19 virus and the ACE2 (Angiotensin Converting Enzyme) receptors present in the human body. These components act by modulating the host immune response against the SARS CoV2 virus in addition to their own inherent antiviral action. Since COVID infection has become an endemic, the daily dietary supplementation of functional components is a novel idea of battling the same. A few of the adverse effects of the bioactive components are also outlined.

Barriers and facilitators of compliance with infection prevention and control measures during the COVID-19 pandemic in health facilities in Kampala city, Uganda.

During the COVID-19 pandemic, Infection Prevention and Control (IPC) was crucial to reduce the spread of the virus in health facilities. This study explored the barriers and facilitators of IPC compliance among healthcare workers (HCWs) during the COVID-19 pandemic in Kampala City, Uganda. Key informant interviews were conducted with 14 participants in 12 health facilities located in Nakawa division, Kampala City. Of these facilities, 3 were government-owned, and 9 were private not-for-profit. Each health facility's participant was either the IPC focal person or a HCW knowledgeable about the IPC measures implemented there. Transcripts were coded using a newly generated codebook in Atlas.ti version 9, and thematic analysis was carried out to analyze the study findings. Participants identified the fear of contracting the virus as one of the primary facilitators for IPC compliance among HCWs during the COVID-19 pandemic. They explained that the sustainability of IPC measures in health facilities was partly due to HCWs' belief that they served as role models in the community for observing and implementing health-related behaviors, especially regarding COVID-19. Among the barriers, participants mentioned that not all HCWs got the opportunity to be trained on COVID-19 IPC. Only HCWs working in high-risk departments for COVID-19 such as triage or Intensive Care Units were prioritized. However, regardless of the department, all HCWs were exposed to potential COVID-19 patients, and the high workload led them to sometimes skip the required IPC measures. This study found that addressing the spread of COVID-19 among HCWs necessitated a comprehensive approach to IPC in health facilities. This approach should encompass capacity building, as well as provision of necessary supplies. In addition, HCWs, the hospital management and government have a role to play to ensure that IPC is fully implemented in the case of future related outbreaks.

Evaluation of BBIBP-CorV Sinopharm COVID-19 vaccine effectiveness in Sri Lanka: a test-negative case control study

ObjectivesThere is limited research on real-world effectiveness of BBIBP-CorV Sinopharm COVID-19 vaccine. This study evaluated real-world effectiveness of Sinopharm vaccine in Sri Lanka by assessing absolute vaccine efficacy.Design and settingA...

Effectiveness of training on health care workers’ knowledge, attitude and practice regarding COVID-19 infection prevention and control, Yemen, 2021

BackgroundAlthough several training courses for Health Care Workers (HCWs) on COVID-19 were conducted in Yemen, no evaluation has been done to assess the effectiveness of such training on the Knowledge, Attitude and Practice (KAP) of HCWs. Therefore, this study aimed to assess the effectiveness of training on the KAP of HCWs toward infection prevention and control (IPC) for COVID-19, determine the relationship between the change in the KAP of HCWs, and identify the associated factors with the change in KAP.MethodologyA cross-sectional study was conducted from April to December 2021. It was conducted among 186 HCWs working at COVID-19 isolation centers and caring for COVID-19 patients, in all Yemen’s governorates. The data were collected one week before and immediately after the training session. SPSS version 26 was used for data entry and analysis. The median, interquartile range (IQR) and median difference were calculated. The Wilcoxon Signed Ranks Test was used to estimate the significant difference between KAP pre- and post-training scores. Kurskal-Wallis and Mann-Whitney U tests were used to assess the associated factors. Spearman’s correlation coefficient test was used to assess the statistical relationship between the change in KAP. A P value < 0.05 was considered statistically significant.ResultsOut of 186 HCWs, 181 HCWs filled the pre- and post-assessment, with a response rate of 97.3%. The median difference (IQR) in the KAP scores were 3.0 (1.0 and 6.0), 1.0 (-1.0 and 4.0) and 2.0 (-1.0 and 5.0), respectively. However, there are statistical difference in the KAP scores between the pre- and post-training (p value = 0.000, 0.004 and 0.000, respectively). There are significant positive correlations between the change in knowledge, attitude and practice (all p values < 0.01). A significantly change in knowledge was found among those working in epidemiological surveillance (p value = 0.031).ConclusionsThis evaluation concludes that the training program is effective in improving the KAP of HCWs toward IPC for COVID-19. It provides scientific evidence about the importance of training courses for HCWs during the COVID-19 pandemic. Further study is recommended to evaluate the retention of the KAP after a period of training.

COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: A cross-sectional study.

The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The 'chi-square test' and 'modified Poisson regression' were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics. Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1st and 2nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013). Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.

KNOWLEDGE AND BEHAVIOR OF HATTA HOSPITAL HEALTH CARE PROFESSIONALS REGARDING COVID-19 INFECTION PREVENTION AND CONTROL

Healthcare-associated infection represents a public health problem in all countries. COVID-19 patients can rapidly overwhelm the capacities of healthcare systems. As more patients are hospitalized, healthcare workers (HCW) at the frontline of care are at the greatest risk of infection. This study aimed to assess the knowledge and self-reported behavior of healthcare professionals in Hatta Hospital regarding COVID-19 infection prevention and control (IPC) during this emerging infectious disease pandemic. A descriptive cross-sectional study was conducted in Hatta hospital, United Arab Emirates (UAE) among one hundred HCWs using a self-administered questionnaire based on UAE National and World Health Organization (WHO) IPC guidelines. Of the study participants, 66% received COVID-19 IPC training inside Hatta hospital. The mean knowledge and behavior scores were 75.7% ± 9.4 and 87.6% ± 5.9, respectively. Knowledge score and behavior score were not related to gender (p= 0.232, 0.091, respectively ) and to work position (p= 0.882, 0.994, respectively), however, they were related to the previous contact with COVID -19 patients (p= 001, 0.011, respectively ). Nonetheless, gaps in IPC knowledge and behavior have been identified and need improvement. This includes donning and doffing of PPE and optimal use of protective measures especially respirators (N95 or FFP2).

Emergency Knowledge Translation, COVID-19 and indoor air: evaluating a virtual ventilation and filtration consultation program for community spaces in Ontario

BackgroundAn October, 2021 review of Public Health Ontario's COVID-19 guidance for congregate settings such as shelters and long-term care homes demonstrated that this guidance did not include references to ventilation or filtration. In April 2022, an interdisciplinary team with expertise in indoor air quality (IAQ), engineering, epidemiology, community programming and knowledge translation launched a virtual ventilation and filtration consultation program for community spaces in Toronto, Ontario. The program gives people working in community spaces direct access to IAQ experts through 25-min online appointments. The program aims to help reduce the risk of COVID-19 transmission in community spaces, and was designed to help compensate for gaps in public health guidance and action.MethodsRepresentatives from participating organizations (n. 27) received a link to an online survey via email in April 2023. Survey questions explored the impacts of the program on topics such as: purchase and use of portable air filters; maintenance and use of bathroom fans; and, maintenance and modification of HVAC systems. Survey participation was anonymous, and no demographic information was collected from participants.ResultsRepresentatives from 11 organizations completed the survey (40%). Of those who responded, nine (82%) made changes as a result of the program, with eight (73%) making two or more changes such as purchasing portable air filters and increasing routine maintenance of HVAC systems.ConclusionsWhen presented with brief access to expert support and tailored plain language guidance, people working in community spaces increased their use of ventilation and filtration strategies for COVID-19 infection prevention and control.

Healthcare workers’ compliance with COVID-19 prevention and control measures at De Martino Hospital, Mogadishu, Somalia: a cross-sectional study

BackgroundHealthcare workers are a high-risk group for COVID-19 and protecting them is crucial for healthcare delivery. Limited studies have explored compliance with infection prevention and control (IPC) practices among Somali healthcare workers. This study aimed to determine compliance with IPC practices among healthcare workers in De Martino Public Hospital, Somalia.MethodsA cross-sectional study was conducted at the De Martino Public Hospital, Mogadishu, Somalia from August to October 2022, with the participation of 204 healthcare workers (response rate = 97%). Compliance was assessed using responses to 25 questions on a five-point Likert-type scale, and a median score of 20 was used to dichotomize compliance scores. A chi-square test and logistic regression analysis were performed to check the associations between healthcare workers’ socio-demographic information, IPC-related factors, work conditions and practices on COVID-19, and IPC compliance during healthcare interventions using SPSS 23 version.ResultsIn total, 58.3% of the participants had good compliance with IPC. There were significant associations between IPC compliance and the type of healthcare worker (doctors and doctor assistants: 72.3%, nurses and paramedical staff: 67.3%, non-clinical staff: 5.7%, p < 0.01). After adjusting for potential confounding factors, compared to non-clinical staff, doctors and doctor assistants (OR: 12.11, 95% CI: 2.23–65.84) and nurses and paramedical staff (OR: 21.38, 95% CI: 4.23–108.01) had higher compliance with IPC measures. There were no significant associations between compliance and sex, marital status, vaccination status, or smoking (p > 0.05 for all).ConclusionsLow levels of compliance with COVID-19 IPC measures were observed among hospital workers. Prioritizing awareness campaigns and behavior change interventions, especially among non-clinical staff, is crucial for effective COVID-19 infection prevention and control within hospitals.

Improving possible serious bacterial infection (PSBI) management in young infants when referral is not feasible: lessons from embedded implementation research in Ethiopia and Kenya

BackgroundSepsis is a leading cause of neonatal mortality, despite the availability of effective treatment of possible serious bacterial illness (PSBI), including when referral to a hospital is not feasible. Gaps in access and delivery worsened during COVID-19. We conducted embedded implementation research in Ethiopia and Kenya aimed at mitigating the impact of COVID-19 and addressing various implementation challenges to improve PSBI management.MethodsThe implementation research projects were implemented at the subnational level in Ethiopia and Kenya between November 2020-June 2022 (Ethiopia) and December 2020-August 2022 (Kenya). Guided by the implementation research frameworks, both projects conducted mixed formative quantitative and exploratory research from April to May 2021, followed by summative evaluations conducted between June and July 2022. Frameworks encompassed Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), as well as health systems framework that incorporates cascades of care and World Health Organization Health Systems Building Blocks. Results were synthesized across the projects through document review and sharing cross-project measures and strategies through a project community of practice.ResultsDespite differences in settings across the projects, cross-cutting facilitators included community health worker program and support, and existence of guidelines for PSBI management at primary care levels. Barriers included community attitudes towards seeking care for sick newborns, COVID-19 risks and fear, and lack of health care worker competence. Country-specific contextual barriers included supply chain issues, civil conflict (Ethiopia), and labor strikes (Kenya). Strategies chosen to mitigate barriers and support implementation and sustainability in both settings included leveraging community health workers to address resistance to care-seeking, health workers’ training, COVID-19 infection prevention measures, stakeholder engagement, and advocacy to integrate PSBI management into existing programs, policies, and training. Other strategies addressing emerging project-specific barriers, included improving follow-up through a community health desk and PSBI mobile app (Kenya) and supply chain strengthening (Ethiopia). Both projects improved PSBI management coverage, increased adoption and uptake, and informed national policy changes supporting potential for sustainability.ConclusionsPragmatic embedded implementation research effectively supports the identification of barriers and mapping to strategies designed to increase effective coverage of PSBI management when referral is not feasible during the COVID-19 pandemic. Despite differences in context, cross-cutting strategies identified could inform broader scale-up in the region, including during future health system shocks.

The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study.

The National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care. We aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality. With the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions. Overall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56% (2157/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to <1 a year prior. However, we found large variations among regions and practices: December 2020 saw the median practice have 0.9 coded instances per 1000 population compared to at least 36 for the highest decile of practices. On sociodemographics, the TPP cohort with OC instances, when compared (univariate analysis) to the cohort with general practitioner consultations, was more predominantly female (661,235/1,087,919, 60.78% vs 9,172,833/17,166,765, 53.43%), aged 18 to 40 years (349,162/1,080,589, 32.31% vs 4,295,711/17,000,942, 25.27%), White (730,389/1,087,919, 67.14% vs 10,887,858/17,166,765, 63.42%), and less deprived (167,889/1,068,887, 15.71% vs 3,376,403/16,867,074, 20.02%). Looking at the eConsultation code through multivariate analysis, it was more commonly recorded among patients with a history of asthma (adjusted odds ratio [aOR] 1.131, 95% CI 1.124-1.137), depression (aOR 1.144, 95% CI 1.138-1.151), or atrial fibrillation (aOR 1.119, 95% CI 1.099-1.139) when compared to other patients with general practitioner consultations, adjusted for long-term conditions, age, and gender. We successfully queried general practice coding activity relevant to the use of OC systems, showing increased adoption and key areas of variation during the pandemic at both sociodemographic and clinical levels. The work can be expanded to support monitoring of coding quality and underlying activity. This study suggests that large-scale impact evaluation studies can be implemented within the OpenSAFELY platform, namely looking at patient outcomes.

Infectious diseases and global security: Analysis of global control and vaccination strategies

Introduction: Given the recent experience with the COVID-19 vaccine campaign, an optimal global policy to control future pandemics and ensure infectious security globally is highly relevant. Objective: The study aims to determine the optimal vaccination strategy to reduce COVID-19 morbidity and mortality during a pandemic.Methods: A systematic search of studies on infectious disease control and vaccination strategies for the period 2000-2023 in PubMed, Scopus, Web of Science and Google Scholar databases using keywords was conducted for the review. Relevant publications, data extraction and systematisation were selected.Results: The findings of the analysis highlight the importance of integrated interventions in global vaccination strategies, including health systems strengthening, innovative technologies for outbreak detection and international collaboration. Vaccination, as an effective preventive measure, significantly reduces the spread of infectious diseases. Vaccination with different types of vaccines has been shown to improve immune response compared to the use of the same type of vaccine. This approach, where the first and second vaccine doses are different, may increase the effectiveness of the immune response.Conclusions: Studies confirm that vaccination reduces the number of cases and deaths, reducing the economic burden. A variety of vaccines, including mRNA, vector, and inactivated vaccines, provide high efficacy in preventing COVID-19 infection and mortality, especially when a heterologous vaccination regimen is used. This review identifies the most effective infectious disease control strategies for the development of global health recommendations

Medical occurrence and safety of SARS-CoV-2 vaccination outside of the hospital setting.

During COVID-19 pandemic, vaccination has been strongly recommended and advocated to prevent COVID-19 infection and adverse outcomes, particularly among at-risk populations. The vaccination against SARS-CoV-2 (COVAC) occurred at off-site locations capable of accommodating large crowds, distinct from the hospital setting, where a team of intensivists, emergency physicians, and nurses, ensuring prompt medical attention (medical occurrences, MO) in cases of adverse event following immunization. Our aims were to estimate the incidence of MO, and to assess its association with demographics, and vaccine characteristics. Our retrospective cohort study included all subject aged 12years and older who received vaccinations at two large out-of-hospital vaccination hubs (Fiera Milano City, Palazzo delle Scintille), between April 12th and August 31st, 2021. Nine hundred and ninety-five thousand and twenty-eight vaccinations were administrated. MOs incidence rate was 278/100,000 doses (95% confidence interval (CI) 268-289). Most MOs were mild (86.27%) and mainly observed in subjects who received the Comirnaty vaccine; 92 MOs (3.32%) were severe and mostly occurred in recipients of the Vaxzeria vaccine. The incidence rate for hospital transfers following vaccination was 4.7/100,000 doses (95% CI 3.5-6.2) and any level of anaphylaxis occurred in 0.4 cases per 100,000 administrated doses (95% CI 0.3.-0.7). Sex, age, type of vaccine and first dose were associated with incidence of MO. Our results showed a low incidence rate in MOs after COVAC, mainly mild and support the feasibility, effectiveness and safety of vaccinations administered in hubs with a dedicated SEU located outside of the hospital setting.