Transmission Of Respiratory Infections Research Articles

Respiratory pathogen analysis in pediatric inpatients unraveled the infection pattern of Mycoplasma pneumoniae post the COVID-19 pandemic.

To counteract the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) were implemented globally, exerting a profound influence on a wide spectrum of infectious diseases, encompassing respiratory tract infections (RTIs). Subsequent to the easing of NPIs, China experienced a significant outbreak of Mycoplasma pneumoniae (MP). Over a decade from 2015 to 2024, our study scrutinized 12 common infectious diseases among pediatric children. Etiologically diagnostic data and clinical outcome metrics of children with RTIs, tested for 13 pathogens, were analyzed to evaluate changes during and after the pandemic compared to pre-pandemic periods, with a notable emphasis on age profile and coinfection patterns of MP. Among 57,471 hospitalized children, 23,178 were diagnosed with infectious diseases. Under NPIs, most respiratory infections declined compared to pre-pandemic levels, rebounding by 69.64% in 2023. While the infection rate of common respiratory pathogens decreased, cases of respiratory syncytial virus increased during the period of extensive NPI implementation. In 2023, pediatric intensive care unit durations for these pathogens increased, suggesting greater severity of illness compared to 2019. MP exhibited the highest infection rate (31.38% average), with a notable outbreak post-pandemic due to severity increase in <3 year olds and rise among older children. NPIs reduced MP coinfections and mitigated their severity, while exerting a significant influence on bacterial coinfections with MP over the span of 5 years, in contrast to their impact on viral pathogens. NPIs effectively curb transmission of respiratory infections by most pathogens, resulting in increased average age of MP infections and altered patterns of coinfection post-pandemic.

Quantifying multi-virion aerosols in respiratory infection transmission

Infectious aerosols are expired in various sizes, and the number of contained virions is expected to significantly vary among expired aerosols. To evaluate the effect of the number of contained virions on infection risk, multi-virion aerosols in expired air should be first quantified. In this study, we categorised expired aerosols into traditional aerosol size bins and aerosols containing different number of virions. We quantified the number of virions in aerosols of each size bin and estimated the size distribution of aerosols which contain a certain number of virions when the viral load is known. This analysis helped us to determine the relationship between multi-size aerosols and multi-virion aerosols. Our findings indicate that for long-range airborne transmission, the airborne transmission droplets derived from four COVID-19 outbreak venues contain at most one infectious virion, supporting the one-virion assumption for the considered viral load ranges. However, for short-range airborne transmission, the impact of multi-virion aerosols on infection risk must be considered. Our quantification of multi-virion aerosols for the first time lays the groundwork for incorporating the multi-virion assumption into infection risk assessments.

The effectiveness of interventions to reduce the transmission of acute respiratory infections in care homes: a systematic review.

Care home residents are at high risk from outbreaks of respiratory infections, such as influenza and COVID-19. We conducted a systematic review of randomized controlled trials, to determine which interventions (apart from vaccines) are effective at reducing transmission of acute respiratory illnesses (ARIs) in care homes. We searched CINAHL, Medline, Embase and Cochrane for randomized controlled trials (RCTs) of interventions to prevent transmission of ARIs in care homes (excluding vaccines), to April 2023. A total of 21 articles met inclusion criteria. Two infection control interventions significantly reduced respiratory infections. Oseltamivir significantly reduced risk of symptomatic laboratory-confirmed influenza (OR 0.39, 95%CI 0.16-0.94, three trials), and influenza-like illness (OR 0.50, 95%CI 0.36-0.69), even in a vaccinated population. High dose vitamin D supplementation reduced incidence of ARIs (incidence rate ratio 0.60; 95%CI 0.38-0.94, one trial). Nine other RCTs of vitamin, mineral, probiotic and herbal supplements showed no significant effect. Transmission of respiratory infections in care homes can be reduced by educational interventions to improve infection control procedures and compliance by staff, by antiviral prophylaxis soon after a case of influenza has been detected, and by supplementation with high-dose Vitamin D3. Further research is needed to confirm the effect of high-dose Vitamin D3.

New Web-Based Ventilator Monitoring System Consisting of Central and Remote Mobile Applications in Intensive Care Units

A ventilator central monitoring system (VCMS) that can efficiently respond to and treat patients’ respiratory issues in intensive care units (ICUs) is critical. Using Internet of Things (IoT) technology without loss or delay in patient monitoring data, clinical staff can overcome spatial constraints in patient respiratory management by integrated monitoring of multiple ventilators and providing real-time information through remote mobile applications. This study aimed to establish a VCMS and assess its effectiveness in an ICU setting. A VCMS comprises central monitoring and mobile applications, with significant real-time information from multiple patient monitors and ventilator devices stored and managed through the VCMS server, establishing an integrated monitoring environment on a web-based platform. The developed VCMS was analyzed in terms of real-time display and data transmission. Twenty-one respiratory physicians and staff members participated in usability and satisfaction surveys on the developed VCMS. The data transfer capacity derived an error of approximately 10−7, and the difference in data transmission capacity was approximately 1.99×10−7±9.97×10−6 with a 95% confidence interval of −1.16×10−7 to 5.13×10−7 among 18 ventilators and patient monitors. The proposed VCMS could transmit data from various devices without loss of information within the ICU. The medical software validation, consisting of 37 tasks and 9 scenarios, showed a task completion rate of approximately 92%, with a 95% confidence interval of 88.81–90.43. The satisfaction survey consisted of 23 items and showed results of approximately 4.66 points out of 5. These results demonstrated that the VCMS can be readily used by clinical ICU staff, confirming its clinical utility and applicability. The proposed VCMS can help clinical staff quickly respond to the alarm of abnormal events and diagnose and treat based on longitudinal patient data. The mobile applications overcame space constraints, such as isolation to prevent respiratory infection transmission of clinical staff for continuous monitoring of respiratory patients and enabled rapid consultation, ensuring consistent care.

Social contacts in Switzerland during the COVID-19 pandemic: Insights from the CoMix study

To mitigate the spread of SARS-CoV-2, the Swiss government enacted restrictions on social contacts from 2020 to 2022. In addition, individuals changed their social contact behavior to limit the risk of COVID-19. In this study, we aimed to investigate the changes in social contact patterns of the Swiss population. As part of the CoMix study, we conducted a survey consisting of 24 survey waves from January 2021 to May 2022. We collected data on social contacts and constructed contact matrices for the age groups 0–4, 5–14, 15–29, 30–64, and 65 years and older. We estimated the change in contact numbers during the COVID-19 pandemic to a synthetic pre-pandemic contact matrix. We also investigated the association of the largest eigenvalue of the social contact and transmission matrices with the stringency of pandemic measures, the effective reproduction number (Re), and vaccination uptake. During the pandemic period, 7084 responders reported an average number of 4.5 contacts (95% confidence interval, CI: 4.5–4.6) per day overall, which varied by age and survey wave. Children aged 5–14 years had the highest number of contacts with 8.5 (95% CI: 8.1–8.9) contacts on average per day and participants that were 65 years and older reported the fewest (3.4, 95% CI: 3.2–3.5) per day. Compared with the pre-pandemic baseline, we found that the 15–29 and 30–64 year olds had the largest reduction in contacts. We did not find statistically significant associations between the largest eigenvalue of the social contact and transmission matrices and the stringency of measures, Re, or vaccination uptake. The number of social contacts in Switzerland fell during the COVID-19 pandemic and remained below pre-pandemic levels after contact restrictions were lifted. The collected social contact data will be critical in informing modeling studies on the transmission of respiratory infections in Switzerland and to guide pandemic preparedness efforts.

Reducing Transmission of Airborne Respiratory Pathogens: A New Beginning as the COVID-19 Emergency Ends.

In response to the COVID-19 pandemic, new evidence-based strategies have emerged for reducing transmission of respiratory infections through management of indoor air. This paper reviews critical advances that could reduce the burden of disease from inhaled pathogens and describes challenges in their implementation. Proven strategies include assuring sufficient ventilation, air cleaning by filtration, and air disinfection by germicidal ultraviolet (UV) light. Layered intervention strategies are needed to maximize risk reduction. Case studies demonstrate how to implement these tools while also revealing barriers to implementation. Future needs include standards designed with infection resilience and equity in mind, buildings optimized for infection resilience among other drivers, new approaches and technologies to improve ventilation, scientific consensus on the amount of ventilation needed to achieve a desired level of risk, methods for evaluating new air-cleaning technologies, studies of their long-term health effects, workforce training on ventilation systems, easier access to federal funds, demonstration projects in schools, and communication with the public about the importance of indoor air quality and actions people can take to improve it. https://doi.org/10.1289/EHP13878.

Riboflavin based setup as an alternative method for a preliminary screening of face mask filtration efficiency

Face masks are essential in reducing the transmission of respiratory infections and bacterial filtration efficiency, a key parameter of mask performances, requires the use of Staphylococcus aureus and specialised staff. This study aims to develop a novel method for a preliminary screening of masks or materials filtration efficiency by a green, easy and rapid setup based on the use of a riboflavin solution, a safe autofluorescent biomolecule. The proposed setup is composed of a commercial aerosol generator commonly used for aerosol therapy, custom 3D printed aerosol chamber and sample holder, a filter for downstream riboflavin detection and a vacuum pump. The filtration efficiency of four different masks was assessed using the riboflavin-based setup and the bacterial filtration efficiency (BFE). The averaged filtration efficiency values, measured with both methods, were similar but were higher for the riboflavin-based setup (about 2% for all tested samples) than bacterial filtration efficiency. Considering the good correlation, the riboflavin-based setup can be considered validated as an alternative method to bacterial filtration efficiency for masks and related materials fabrics filtration efficiency screening but This study aims to develop a novel method for a preliminary screening of masks or materials filtration efficiency by a green, easy and rapid setup based on the use of a riboflavin solution, a safe autofluorescent biomolecule, but not to replace regulation approaches. The proposed setup can be easily implemented at low price, is more rapid and eco-friendly and can be performed in chemical-physical laboratories without the needing of biosafety laboratory and specialised operators.

Upper Respiratory Tract Infection and Paraneuronal Transmission of SARS-CoV-2

Upper Respiratory Tract Infection and Paraneuronal Transmission of SARS-CoV-2

Respiratory infection transmission risk and indoor air quality at outpatient departments and emergency treatment units of Sri Lankan teaching hospitals.

Indoor carbon dioxide (CO2) concentration has been used as a proxy of the degree of ventilation and, by extension, as an indicator of the risk of contracting respiratory infections. No publications exist regarding indoor air quality (IAQ) parameters of Sri Lankan hospitals.We measured the levels of CO2 and seven other IAQ parameters during morning rush hours for three days, in outpatient departments (OPDs) and emergency treatment units (ETUs) of all 21 teaching hospitals of Sri Lanka. We measured the same parameters of outdoor air also. We calculated the mean values of those parameters. We looked for correlations between outdoors and OPD and ETU levels of selected air quality parameters.The average CO2 levels of outdoors, OPDs and ETUs respectively were 514ppm (ppm = parts per million), 749ppm and 795ppm. The average levels of PM2.5 (particulate matter with diameters <2.5μm) outdoors, OPDs and ETUs respectively, were 28.7μg/m3,32μg/m3 and 25.6 μg/m3. The average levels of PM10 (particulate matter with diameters <10μm) outdoors, OPDs and ETUs respectively, were 49.4μg/m3, 55.5μg/m3 and 47.9 μg/m3. The median levels of formaldehyde outdoors, OPDs and ETUs respectively, were 0.03mg/m3, 0.04mg/m3 and 0.08mg/m3. The median levels of total volatile organic compounds (VOC) outdoors, OPDs and ETUs respectively were 0.12mg/m3, 0.19mg/m3 and 0.38mg/m3.CO2 levels of air in OPDs and ETUs generally were below the national ceilings but above the ceilings used by some developed countries. Outdoors, OPDs and ETUs air contain PM10, PM2.5 levels higher than WHO ceilings, although below the national ceilings. VOC and formaldehyde levels are generally below the national ceilings. Air in OPDs and ETUs is hotter and humid than national ceilings. Outdoor PM10, PM2.5 levels influence OPDs and ETUs levels. We propose methods to reduce the risk of nosocomial respiratory infections and to improve IAQ of Sri Lankan OPDs and ETUs.

The paradigm shift on transmission of respiratory pathogen infections. Engineering for prevention

The paradigm shift on transmission of respiratory pathogen infections. Engineering for prevention

Airborne transmission risks of tuberculosis and COVID-19 in schools in South Africa, Switzerland, and Tanzania: Modeling of environmental data.

The COVID-19 pandemic renewed interest in airborne transmission of respiratory infections, particularly in congregate indoor settings, such as schools. We modeled transmission risks of tuberculosis (caused by Mycobacterium tuberculosis, Mtb) and COVID-19 (caused by SARS-CoV-2) in South African, Swiss and Tanzanian secondary schools. We estimated the risks of infection with the Wells-Riley equation, expressed as the median with 2.5% and 97.5% quantiles (credible interval [CrI]), based on the ventilation rate and the duration of exposure to infectious doses (so-called quanta). We computed the air change rate (ventilation) using carbon dioxide (CO2) as a tracer gas and modeled the quanta generation rate based on reported estimates from the literature. The share of infectious students in the classroom is determined by country-specific estimates of pulmonary TB. For SARS-CoV-2, the number of infectious students was estimated based on excess mortality to mitigate the bias from country-specific reporting and testing. Average CO2 concentration (parts per million [ppm]) was 1,610 ppm in South Africa, 1,757 ppm in Switzerland, and 648 ppm in Tanzania. The annual risk of infection for Mtb was 22.1% (interquartile range [IQR] 2.7%-89.5%) in South Africa, 0.7% (IQR 0.1%-6.4%) in Switzerland, and 0.5% (IQR 0.0%-3.9%) in Tanzania. For SARS-CoV-2, the monthly risk of infection was 6.8% (IQR 0.8%-43.8%) in South Africa, 1.2% (IQR 0.1%-8.8%) in Switzerland, and 0.9% (IQR 0.1%-6.6%) in Tanzania. The differences in transmission risks primarily reflect a higher incidence of SARS-CoV-2 and particularly prevalence of TB in South Africa, but also higher air change rates due to better natural ventilation of the classrooms in Tanzania. Global comparisons of the modeled risk of infectious disease transmission in classrooms can provide high-level information for policy-making regarding appropriate infection control strategies.

ОБОСНОВАНИЯ ПО ПРИМЕНЕНИЮ ОПЫТА ПРОТИВОТУБЕРКУЛЁЗНОЙ СЛУЖБЫ ДЛЯ АДЕКВАТНОГО РЕАГИРОВАНИЯ В ПЕРИОД ПАНДЕМИИ COVID-19

Objective: To summarize the experience of the anti-tuberculosis care (ATC) units of the Republic of Tajikistan (RT) to optimize medical aid to the population during potential outbreaks of respiratory infectious diseases. Methods: This study examines the experience and lessons learned after the COVID-19 pandemic in the RT, as well as the main provisions recommended for the partial reorganization of the ATC to ensure its readiness to function during outbreaks of respiratory infections. The standards and rules of antituberculosis infection control were used to develop preventive measures against the nosocomial spread of aerogenic infections in healthcare facilities and society. Results: The analysis revealed that maintaining of a sanitary and anti-epidemic regimen in healthcare institutions primarily involved a routine approach to the disinfection of medical facilities. However, in respiratory infections, adopting the experience of ATC RT was beneficial. It included strict adherence to infection control rules, social distancing, avoidance of crowded public places, restriction of unnecessary migration and public events, and the rigorous use of means of personal protection. The ATC also pioneered innovative approaches through various software, which have proven effective even under the restrictions imposed during the COVID-19 pandemic. Conclusion: ATC can serve as a coordinating link and an excellent example of how to prepare the healthcare system for various potential outbreaks of respiratory infections. It is necessary to integrate the ATC with other relevant institutions of the healthcare system, both functionally and structurally, to increase the effectiveness of preventive measures against the transmission of respiratory infections. Keywords: TB care, health care facilities, COVID-19, respiratory infections.

Genetic diversity and molecular analysis of human influenza virus among pilgrims during Hajj

The risk of transmission of respiratory tract infections is considerably enhanced at mass gathering (MG) religious events. Hajj is an annual Islamic MG event with approximately 3 million Muslim pilgrims from over 180 countries concentrated in Makkah, Saudi Arabia. This study aimed to investigate the genetic diversity of influenza viruses circulating among pilgrims during the Hajj pilgrimage. We performed a cross-sectional analytical study where nasopharyngeal swabs (NPs) from pilgrims with respiratory tract illnesses presenting to healthcare facilities during the 2019 Hajj were screened for influenza viruses. Influenza A subtypes and influenza B lineages were determined by multiplex RT–PCR for positive influenza samples. The phylogenetic analysis was carried out for the hemagglutination (HA) gene. Out of 185 nasopharyngeal samples, 54 were positive for the human influenza virus. Of these, 27 were influenza A H1N1 and 19 H3N2, 4 were untypable influenza A, and 4 were influenza B. Phylogenetic analysis revealed that the H1N1 and H3N2 strains differentiated into different and independent genetic groups and formed close clusters with selected strains of influenza viruses from various locations. To conclude, this study demonstrates a high genetic diversity of circulating influenza A subtypes among pilgrims during the Hajj Season. There is a need for further larger studies to investigate in-depth the genetic characteristics of influenza viruses and other respiratory viruses during Hajj seasons.

Number of children in the household influences respiratory morbidities in children with bronchopulmonary dysplasia in the outpatient setting.

Bronchopulmonary dysplasia (BPD), a common complication of prematurity, is associated with outpatient morbidities, including respiratory exacerbations. Daycare attendance is associated with increased rates of acute and chronic morbidities in children with BPD. We sought to determine if additional children in the household conferred similar risks for children with BPD. The number of children in the household and clinical outcomes were obtained via validated instruments for 933 subjects recruited from 13 BPD specialty clinics in the United States. Clustered logistic regression models were used to test for associations. The mean gestational age of the study population was 26.5 ± 2.2 weeks and most subjects (69.1%) had severe BPD. The mean number of children in households (including the subject) was 2.1 ± 1.3 children. Each additional child in the household was associated with a 13% increased risk for hospital admission, 13% increased risk for antibiotic use for respiratory illnesses, 10% increased risk for coughing/wheezing/shortness of breath, 14% increased risk for nighttime symptoms, and 18% increased risk for rescue medication use. Additional analyses found that the increased risks were most prominent when there were threeor more other children in the household. We observed that additional children in the household were a risk factor for adverse respiratory outcomes. We speculate that secondary person-to-person transmission of respiratory viral infections drives this finding. While this risk factor is not easily modified, measures do exist to mitigate this disease burden. Further studies are needed to define best practices for mitigating this risk associated with household viral transmission.

Regional differences in historical diphtheria and scarlet fever notification rates in The Netherlands, 1905-1925: a spatial-temporal analysis.

We describe how rates of two frequently occurring notifiable diseases-diphtheria and scarlet fever-varied between regions of The Netherlands in the early twentieth century, and identify potential factors underlying this variation. Digitized weekly mandatory notification data for 1905-1925, municipality level, were aggregated into 27 'spatial units' defined by unique combinations of province and population density category (high: more than 4500; mid : 1250-4500; low: less than 1250 inhabitants km-2). Generalized additive regression models were fitted to estimate the associations between notification rates and population density, infant mortality rate and household income, while adjusting for temporal trends per spatial unit. Annual per capita notification rates for both diphtheria and scarlet fever tended to rise from the beginning of the period 1905-1925 until peaking around 1918/1919. Adjusted diphtheria notification rates were higher for high- and mid- compared with low-density municipalities (by 71.6 cases per 100 000, 95% confidence interval (CI) : 52.7-90.5; 39.0/100 k, 95% CI : 24.7-53.3, respectively). Scarlet fever showed similar associations with population density (35.7 cases per 100 000, 95% CI : 9.4-62.0; 21.4/100 k, 95% CI: 1.5-41.3). There was considerable spatial variation in notification rates for both diseases in early twentieth century Netherlands, which could partly be explained by factors capturing variation in living conditions and socio-economic circumstances. These findings aid understanding of contemporary respiratory infection transmission.

Targeted Hygiene reduces surface transmission and infection risk for respiratory viruses

Abstract Background In public spaces, the importance of surface contamination in the transmission of respiratory viruses has been debated. This study aimed to compare the spread of a surrogate virus in a hotel lobby before and after a Targeted Hygiene intervention, and to quantify the reduction in risk of infection from respiratory diseases. Methods In a working hotel lobby, 13 fomites were seeded with a bacteriophage (Phi-X174) tracer at 8 am; 4 hours later 25 surfaces were swabbed to determine baseline tracer distribution and contamination levels. This was then repeated with the addition of a pre-determined Targeted Hygiene intervention performed 2 hours after seeding. Four replicate baseline and intervention trials were conducted, and data were compared for statistically significant (p &amp;lt; 0.05) differences. Risk of infection was estimated via Quantitative Microbial Risk Assessment modelling. Results Following the Targeted Hygiene intervention there was a significant reduction in the spread of the tracer (contamination of 13% of sampled surfaces vs. 50% at baseline). Tracer concentrations (PFU/site) were significantly lower overall (9.1E+02 PFU vs. 5.8E+04 PFU, p &amp;lt; 0.0001), including surfaces that had not been disinfected. Our model estimates that the risk of infection from common respiratory viruses via surface transmission was reduced by 97%. Conclusions Extensive spread of surface contamination can occur in a hotel lobby in as little as 4 hours. This study demonstrates how a Targeted Hygiene intervention can significantly disrupt the journey of the germ, even on surfaces not cleaned and disinfected, resulting in a consequent reduction of infection risk via surface transmission of common respiratory infections. This demonstrates the value of carrying out effective hygiene interventions to those managing commercial spaces. Key messages • Targeted Hygiene can significantly reduce the spread of respiratory pathogens via surface transmission, providing a means for facilities managers to achieve high standards using a targeted approach. • The Targeted Hygiene approach can significantly reduce the risk of infection from common respiratory viruses via surface transmission in public spaces.

The Rise of Electroactive Materials in Face Masks for Preventing Virus Infections.

Air-transmitted pathogens may cause severe epidemics, posing considerable threats to public health and safety. Wearing a face mask is one of the most effective ways to prevent respiratory virus infection transmission. Especially since the new coronavirus pandemic, electroactive materials have received much attention in antiviral face masks due to their highly efficient antiviral capabilities, flexible structural design, excellent sustainability, and outstanding safety. This review first introduces the mechanism for preventing viral infection or the inactivation of viruses by electroactive materials. Then, the applications of electrostatic-, conductive-, triboelectric-, and microbattery-based materials in face masks are described in detail. Finally, the problems of various electroactive antiviral materials are summarized, and the prospects for their future development directions are discussed. In conclusion, electroactive materials have attracted great attention for antiviral face masks, and this review will provide a reference for materials scientists and engineers in antiviral materials and interfaces.

Real-World Efficacy of N95, Surgical, and Cloth Masks in Mitigating SARS-CoV-2 Respiratory Infections: A Comprehensive Comparative Study

The effectiveness of different types of masks in mitigating respiratory infections, particularly those caused by SARS-CoV-2, has been a topic of significant interest during the COVID-19 pandemic. In this study, we conducted a comprehensive comparative analysis of the real-world efficacy of N95, surgical, and cloth masks in reducing the transmission of respiratory infections. Using a large sample size and rigorous data collection methods, we evaluated the protective capabilities of each mask type by assessing the number of infections among individuals wearing these masks in various settings. Our findings reveal that N95 masks exhibited the highest level of protection, followed by surgical masks and cloth masks. However, even cloth masks provided a significant level of protection compared to no mask usage. The results of our study underscore the importance of widespread mask usage as a critical public health measure to control the spread of respiratory infections. These findings have significant implications for public health policies and highlight the need for continued adherence to mask-wearing practices.

A single-arm, prospective study comparing translaryngeal ultrasonography with direct visualisation by flexible laryngoscopy for vocal cord assessment in patients undergoing oesophagectomy or mediastinoscopy.

Translaryngeal ultrasonography (TLUSG) for diagnosis of vocal cord palsy, a relatively new, safe and noninvasive bedside technique with minimal risk of respiratory infection transmission, has been effective in patients with thyroid disease. We studied its use as an alternative method to visual inspection by flexible laryngoscopy (FL) for vocal cord assessment in patients undergoing thoracic surgeries. After Institutional Ethics Committee approval and trial registration, in this single-arm, prospective study, the vocal cord function of 110 patients who underwent either total oesophagectomy or mediastinoscopy was assessed immediately after extubation by both FL and TLUSG. A follow-up assessment was done by laryngoscopy using Hopkin's endoscope (HL) and a repeat TLUSG. The primary outcome was the concordance between direct visualisation (FL or HL) and TLUSG. Vocal cords were successfully visualised by TLUSG in 90% of male and all female patients. Findings of FL and TLUSG done at the first assessment matched in 89 (86.4%) out of 103 patients, and the degree of concordance was 0.69 (95% confidence interval [CI] =0.52-0.83). At the second assessment, HL and TLUSG findings matched in 83 (94.3%) out of 88 patients, and the degree of concordance was 0.89 (95% CI = 0.77-0.98). TLUSG is an effective noninvasive alternative to direct visualisation for vocal cord assessment in both male and female patients undergoing thoracic surgery.

Inequalities in access to paid sick leave among workers in England and Wales.

It is poorly understood which workers lack access to sick pay in England and Wales. This evidence gap has been of particular interest in the context of the Covid-19 pandemic given the relationship between presenteeism and infectious disease transmission. This cross-sectional analysis (n=8874) was nested within a large community cohort study based across England and Wales (Virus Watch). An online survey in February 2021 asked participants in work if they had access to paid sick leave. We used logistic regression to examine sociodemographic factors associated with lacking access to sick pay. Only 66% (n=5864) of participants reported access to sick pay. South Asian workers (adjusted odds ratio [OR] 1.40, 95% confidence interval [CI] 1.06-1.83) and those from Other minority ethnic backgrounds (OR 2.93, 95% CI 1.54-5.59) were more likely to lack access to sick pay compared to White British workers. Older workers (OR range 1.72 [1.53-1.93]-5.26 [4.42-6.26]), workers in low-income households (OR 2.53, 95% CI 2.15-2.98) and those in transport, trade, and service occupations (OR range 2.03 [1.58-2.61]-5.29 [3.67-7.72]) were also more likely to lack access to sick pay compared respectively to workers aged 25-44, those in high income households and managerial occupations. Unwarranted age and ethnic inequalities in sick pay access are suggestive of labour market discrimination. Occupational differences are also cause for concern. Policymakers should consider expanding access to sick pay to mitigate transmission of Covid-19 and other endemic respiratory infections in the community, and in the context of pandemic preparation.