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1.
Front Public Health ; 9: 642636, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34497789

RESUMO

Background: Although annual influenza vaccination is recommended for healthcare providers (HCPs), vaccination rate among HCPs in India is generally low. This cross-sectional survey was conducted to evaluate physicians' awareness, attitude, and current practices toward influenza vaccination in high-risk groups in India. Methods: The survey was performed in June-July 2020, wherein consulting physicians, pulmonologists, diabetologists, obstetricians/gynecologists, or cardiologists across 14 cities completed a 39-item questionnaire consisting of 3 sections, one each on awareness, attitude, and practice patterns. Descriptive statistics were used to summarize the study results. Statistical analysis was performed for comparison of subgroups by physician specialty, city of practice (metro/non-metro), and zone of practice (north/south/east/west). Level of statistical significance was set at p < 0.05. Results: In all, 780 physicians completed the survey. Of these, 3.97, 53.08, and 42.95% had high, medium, and low level of awareness about influenza/influenza vaccination, respectively. Statistically significant (p < 0.05) between-group differences were found by physician specialty and zone of practice. In terms of attitude toward vaccination of high-risk group subjects, only 0.9% physicians were "extremely concerned," while the majority (92.56%) were "quite concerned" and 6.54% were a "little concerned," with no reported significant differences between different subgroups. With regard to practice patterns, 82.82% of physicians offered influenza vaccines to their patients, 32.69% vaccinated 10-25% of patients per month, and 38.85% required and offered the vaccine to their office staff. Physicians' reasons for not prescribing influenza vaccines to patients included fear of side effects (16.54%), cost (15.64%), lack of awareness about availability (15.38%), absence of belief that it is beneficial (14.36%), history of side effects (13.46%), and patients' fear of needles (11.28%). Conclusion: These findings suggest the need to implement educational strategies among physicians to enhance their awareness about influenza vaccination and improve their attitudes and current practices toward influenza vaccination especially in high-risk groups in India.


Assuntos
Influenza Humana , Médicos , Atitude do Pessoal de Saúde , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Influenza Humana/prevenção & controle , Vacinação
2.
CMAJ Open ; 9(3): E848-E854, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34493551

RESUMO

BACKGROUND: When vaccine supplies are anticipated to be limited, necessitating the vaccination of certain groups earlier than others, the assessment of values and preferences of stakeholders is an important component of an ethically sound vaccine prioritization framework. The objective of this study was to conduct a priority-setting exercise to establish an expert stakeholder perspective on the relative importance of COVID-19 vaccination strategies in Canada. METHODS: The priority-setting exercise included a survey of stakeholders that was conducted from July 22 to Aug. 14, 2020. Stakeholders included clinical and public health expert groups, provincial and territorial committees and national Indigenous groups, patient and community advocacy representatives and experts, health professional associations and federal government departments. Survey results were analyzed to identify trends. RESULTS: Of 155 stakeholders contacted, 76 surveys were received for a participation rate of 49%. During a period of anticipated initial vaccine scarcity for all pandemic scenarios, stakeholders generally considered the most important vaccination strategy to be protecting those who are most vulnerable to severe illness and death from COVID-19. This was followed in importance by strategies to protect health care capacity, minimize transmission of SARS-CoV-2 and protect critical infrastructure. INTERPRETATION: This priority-setting exercise established that there is general alignment in the values and preferences across stakeholder groups: the most important vaccination strategy at the time of limited initial vaccine availability is to protect those who are most vulnerable. The findings of this priority-setting exercise provided a timely expert perspective to guide early public health planning for COVID-19 vaccines.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Prioridades em Saúde/ética , Vacinação/métodos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Vacinas contra COVID-19/provisão & distribuição , Canadá/epidemiologia , Fortalecimento Institucional/organização & administração , Transmissão de Doença Infecciosa/prevenção & controle , Ocupações em Saúde/estatística & dados numéricos , Ocupações em Saúde/tendências , Prioridades em Saúde/organização & administração , Humanos , Saúde Pública/legislação & jurisprudência , SARS-CoV-2/genética , SARS-CoV-2/imunologia , Índice de Gravidade de Doença , Participação dos Interessados , Inquéritos e Questionários/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Populações Vulneráveis
3.
BMC Health Serv Res ; 21(Suppl 1): 370, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511089

RESUMO

BACKGROUND: Household survey data are frequently used to measure reproductive, maternal, newborn, child and adolescent health (RMNCAH) service utilisation in low and middle income countries. However, these surveys are typically only undertaken every 5 years and tend to be representative of larger geographical administrative units. Investments in district health management information systems (DHMIS) have increased the capability of countries to collect continuous information on the provision of RMNCAH services at health facilities. However, reliable and recent data on population distributions and demographics at subnational levels necessary to construct RMNCAH coverage indicators are often missing. One solution is to use spatially disaggregated gridded datasets containing modelled estimates of population counts. Here, we provide an overview of various approaches to the production of gridded demographic datasets and outline their potential and their limitations. Further, we show how gridded population estimates can be used as alternative denominators to produce RMNCAH coverage metrics in combination with data from DHMIS, using childhood vaccination as examples. METHODS: We constructed indicators on the percentage of children one year old for diphtheria, pertussis and tetanus vaccine dose 3 (DTP3) and measles vaccine dose (MCV1) in Zambia and Nigeria at district levels. For the numerators, information on vaccines doses was obtained from each country's respective DHMIS. For the denominators, the number of children was obtained from 3 different sources including national population projections and aggregated gridded estimates derived using top-down and bottom-up geospatial methods. RESULTS: In Zambia, vaccination estimates utilising the bottom-up approach to population estimation substantially reduced the number of districts with > 100% coverage of DTP3 and MCV1 compared to estimates using population projection and the top-down method. In Nigeria, results were mixed with bottom-up estimates having a higher number of districts > 100% and estimates using population projections performing better particularly in the South. CONCLUSIONS: Gridded demographic data utilising traditional and novel data sources obtained from remote sensing offer new potential in the absence of up to date census information in the estimation of RMNCAH indicators. However, the usefulness of gridded demographic data is dependent on several factors including the availability and detail of input data.


Assuntos
Serviços de Saúde do Adolescente , Adolescente , Criança , Família , Humanos , Renda , Lactente , Recém-Nascido , Vacina contra Sarampo , Vacinação
4.
Bull World Health Organ ; 99(9): 653-660, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475602

RESUMO

Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization's WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization's target of reducing premature deaths due to noncommunicable disease by 25% by 2025.


Assuntos
Anticoagulantes/economia , Custos de Medicamentos , Medicamentos Essenciais/provisão & distribuição , Medicamentos Genéricos/provisão & distribuição , Acesso aos Serviços de Saúde/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Custos e Análise de Custo , Medicamentos Essenciais/economia , Medicamentos Genéricos/economia , Custos de Cuidados de Saúde , Humanos
5.
PLoS Comput Biol ; 17(9): e1009288, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34473693

RESUMO

Mass vaccination offers a promising exit strategy for the COVID-19 pandemic. However, as vaccination progresses, demands to lift restrictions increase, despite most of the population remaining susceptible. Using our age-stratified SEIRD-ICU compartmental model and curated epidemiological and vaccination data, we quantified the rate (relative to vaccination progress) at which countries can lift non-pharmaceutical interventions without overwhelming their healthcare systems. We analyzed scenarios ranging from immediately lifting restrictions (accepting high mortality and morbidity) to reducing case numbers to a level where test-trace-and-isolate (TTI) programs efficiently compensate for local spreading events. In general, the age-dependent vaccination roll-out implies a transient decrease of more than ten years in the average age of ICU patients and deceased. The pace of vaccination determines the speed of lifting restrictions; Taking the European Union (EU) as an example case, all considered scenarios allow for steadily increasing contacts starting in May 2021 and relaxing most restrictions by autumn 2021. Throughout summer 2021, only mild contact restrictions will remain necessary. However, only high vaccine uptake can prevent further severe waves. Across EU countries, seroprevalence impacts the long-term success of vaccination campaigns more strongly than age demographics. In addition, we highlight the need for preventive measures to reduce contagion in school settings throughout the year 2021, where children might be drivers of contagion because of them remaining susceptible. Strategies that maintain low case numbers, instead of high ones, reduce infections and deaths by factors of eleven and five, respectively. In general, policies with low case numbers significantly benefit from vaccination, as the overall reduction in susceptibility will further diminish viral spread. Keeping case numbers low is the safest long-term strategy because it considerably reduces mortality and morbidity and offers better preparedness against emerging escape or more contagious virus variants while still allowing for higher contact numbers (freedom) with progressing vaccinations.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Vacinação em Massa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , União Europeia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Vacinação em Massa/legislação & jurisprudência , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem
6.
BMC Health Serv Res ; 21(1): 945, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503501

RESUMO

BACKGROUND: Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. METHODS: We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. RESULTS: We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. CONCLUSIONS: Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.


Assuntos
Assistência Farmacêutica , Farmácias , Adulto , Criança , Estudos Transversais , Instalações de Saúde , Humanos , Estudos Retrospectivos
7.
World J Emerg Surg ; 16(1): 46, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507603

RESUMO

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.


Assuntos
COVID-19/epidemiologia , Saúde Global , Pandemias , Pesquisa Biomédica , COVID-19/diagnóstico , COVID-19/terapia , Vacinas contra COVID-19 , Atenção à Saúde/organização & administração , Política de Saúde , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Cooperação Internacional , Vacinação em Massa/organização & administração , Pandemias/prevenção & controle , Política , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração
8.
Infect Dis Poverty ; 10(1): 118, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530923

RESUMO

BACKGROUND: There are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas. This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad, the second-most populous city in Iran. METHODS: The 2021 age structure of the urban census tracts was integrated into the enhanced two-step floating catchment area model to improve accuracy. The model was developed based on three different access scenarios: only public hospitals, only public healthcare centres and both (either hospitals or healthcare centres) as potential vaccination facilities. The weighted decision-matrix and analytic hierarchy process, based on four criteria (i.e. service area, accessibility index, capacity of vaccination centres and distance to main roads), were used to choose potential vaccination centres looking for the highest suitability for residents. Global Moran's index (GMI) was used to measure the spatial autocorrelation of the accessibility index in different scenarios and the proposed model. RESULTS: There were 26 public hospitals and 271 public healthcare centres in the study area. Although the exclusive use of public healthcare centres for vaccination can provide the highest accessibility in the eastern and north-eastern parts of the study area, our findings indicate that including both public hospitals and public healthcare centres provide high accessibility to vaccination in central urban part. Therefore, a combination of public hospitals and public healthcare centres is recommended for efficient vaccination coverage. The value of GMI for the proposed model (accessibility to selected vaccination centres) was calculated as 0.53 (Z = 162.42, P < 0.01). Both GMI and Z-score values decreased in the proposed model, suggesting an enhancement in accessibility to COVID-19 vaccination services. CONCLUSIONS: The periphery and poor areas of the city had the least access to COVID-19 vaccination centres. Measuring spatial access to COVID-19 vaccination centres can provide valuable insights for urban public health decision-makers. Our model, coupled with geographical information systems, provides more efficient vaccination coverage by identifying the most suitable healthcare centres, which is of special importance when only few centres are available.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Acesso aos Serviços de Saúde , Cobertura Vacinal , Atenção à Saúde , Disparidades em Assistência à Saúde , Humanos , Irã (Geográfico) , SARS-CoV-2 , Análise Espacial
9.
BMC Health Serv Res ; 21(1): 967, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521408

RESUMO

BACKGROUND: New drugs including cancer drugs and orphan drugs are becoming increasingly more expensive. Risk sharing arrangements (RSAs) could manage the risk based on both financial impact and the health outcome of new drugs if reimbursed. To improve patients' access to new drugs under uncertainties, many developed countries have adopted RSAs. In this study, we aimed to understand the effects of RSAs in South Korea on patients' access. METHODS: We reviewed current status of RSA drugs in South Korea. The number of appraisals and time gap between market approval and reimbursement per RSA drug were considered to quantify improvement of patients' access as they showed how rapidly decisions on reimbursement of RSA drugs were derived. Then, we applied a comparative analysis to determine whether the RSA drugs in South Korea were reimbursed in the UK, Italy, and Australia. Most data for this study were obtained from websites of the governmental department/agencies responsible for appraisal of drug reimbursement in each country. And literatures related to RSAs were investigated as well. RESULTS: The eligibility for Korean RSAs had two key components - drugs for cancer and rare diseases and not having other alternative treatments. As of the first half of 2019, there were 39 RSA drugs reimbursed in South Korea, the majority of which were financial-based schemes. Refund and expenditure cap were the representative types (89.7%). After introduction of RSAs, the time gap and number of appraisals were decreased. Based on the indications of RSA drugs, the level of drug coverage in South Korea was found lower than Italy, similar to the UK, and higher than Australia. CONCLUSIONS: RSAs in South Korea significantly enhanced patients' access to new drugs and led to the alleviation of patients' out-of-pocket expenses. The drug coverage of South Korea had a level comparable to that of other countries. This study provides implications for countries that have a dual mission of containing pharmaceutical expenditure and improving access to new drugs.


Assuntos
Antineoplásicos , Neoplasias , Preparações Farmacêuticas , Humanos , Neoplasias/tratamento farmacológico , Produção de Droga sem Interesse Comercial , República da Coreia
10.
ACS Infect Dis ; 7(9): 2637-2649, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34467755

RESUMO

As the existing therapeutic modalities for the treatment of cryptococcal meningitis (CM) have suboptimal efficacy, repurposing existing drugs for the treatment of CM is of great interest. The FDA-approved anthelmintic benzimidazoles, albendazole, mebendazole, and flubendazole, have demonstrated potent but variable in vitro activity against Cryptococcus neoformans, the predominant fungal species responsible for CM. We performed molecular docking studies to ascertain the interaction of albendazole, mebendazole, and flubendazole with a C. neoformans ß-tubulin structure, which revealed differential binding interactions and explained the different in vitro efficacies reported previously and observed in this investigation. Despite their promising in vitro efficacy, the repurposing of anthelmintic benzimidazoles for oral CM therapy is significantly hampered due to their high crystallinity, poor pharmaceutical processability, low and pH-dependent solubility, and drug precipitation upon entering the intestine, all of which result in low and variable oral bioavailability. Here, we demonstrate that the anthelmintic benzimidazoles can be transformed into partially amorphous low-melting ionic liquids (ILs) with a simple metathesis reaction using amphiphilic sodium docusate as a counterion. In vitro efficacy studies on a laboratory reference and a clinical isolate of C. neoformans showed 2- to 4-fold lower IC90 values for docusate-based ILs compared to the pure anthelmintic benzimidazoles. Furthermore, using a C. neoformans strain with green fluorescent protein (GFP)-tagged ß-tubulin and albendazole and its docusate IL as model candidates, we showed that the benzimidazoles and their ILs reduce the viability of C. neoformans by interfering with its microtubule assembly. Unlike pure anthelmintic benzimidazoles, the docusate-based ILs showed excellent solubility in organic solvents and >30-fold higher solubility in bioavailability-enhancing lipid vehicles. Finally, the docusate ILs were successfully incorporated into SoluPlus, a self-assembling biodegradable polymer, which upon dilution with water formed polymeric micelles with a size of <100 nm. Thus, the development of docusate-based ILs represents an effective approach to improve the physicochemical properties and potency of anthelmintic benzimidazoles to facilitate their repurposing and preclinical development for CM therapy.


Assuntos
Anti-Helmínticos , Cryptococcus neoformans , Líquidos Iônicos , Preparações Farmacêuticas , Anti-Helmínticos/farmacologia , Benzimidazóis/farmacologia , Ácido Dioctil Sulfossuccínico , Simulação de Acoplamento Molecular , Solubilidade
11.
Allergy Asthma Proc ; 42(5): 378-385, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34474707

RESUMO

Background: Infectious diseases are a leading cause of morbidity and mortality worldwide. As of 2018, the total world population of children < 5 years of age was roughly estimated at 679 million. Of these children, an estimated 5.3 million died of all causes in 2018, with an estimated 700,000 who died of vaccine-preventable infectious diseases; 99% of the children who died had lived in low- and middle-income countries. The infectious diseases that remain major causes of mortality for which vaccines have been shown to provide proven preventive success include, in order of prevalence, are those caused by Streptococcus pneumoniae, Rotavirus, Bordetella pertussis, measles virus, Haemophilus influenzae type b and influenza virus. Objective: The purpose of the present report was to address the global burden of these six vaccine-preventable infectious diseases in children < 5 years of age, together with implications for the prevention of coronavirus disease 2019 (COVID-19) infection in children. Methods: The current immunization strategies for the prevention of the six vaccine-preventable infectious diseases in children are reviewed as a framework for new strategies of vaccine prevention of COVID-19 in children. Results: The burden of addressing vaccine prevention of future infectious disease in children can be effectively pursued through knowledge gained from past experiences with vaccine usage in these six vaccine-preventable childhood infectious diseases. Conclusion: Issues with regard to the burden of disease mortality, disease transmission, and available vaccines as well as vaccine successes and shortcomings for specific pathogens can serve as important landmarks for effective use of future vaccines. Although much success has been made globally in preventing these childhood deaths, much remains to be done.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Saúde Global/estatística & dados numéricos , Vacinação em Massa , Doenças Preveníveis por Vacina/epidemiologia , COVID-19/epidemiologia , Mortalidade da Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Países em Desenvolvimento , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Prevalência , Recusa de Vacinação , Doenças Preveníveis por Vacina/prevenção & controle
12.
J Agric Food Chem ; 69(37): 10761-10773, 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34516106

RESUMO

Unfavorable bioavailability is an important aspect underlying the failure of drug candidates. Computational approaches for evaluating drug-likeness can minimize these risks. Over the past decades, computational approaches for evaluating drug-likeness have sped up the process of drug development and were also quickly derived to pesticide-likeness. As a result of many critical differences between drugs and pesticides, many kinds of methods for drug-likeness cannot be used for pesticide-likeness. Therefore, it is crucial to comprehensively compare and analyze the differences between drug-likeness and pesticide-likeness, which may provide a basis for solving the problems encountered during the evaluation of pesticide-likeness. Here, we systematically collected the recent advances of drug-likeness and pesticide-likeness and compared their characteristics. We also evaluated the current lack of studies on pesticide-likeness, the molecular descriptors and parameters adopted, the pesticide-likeness model on pesticide target organisms, and comprehensive analysis tools. This work may guide researchers to use appropriate methods for developing pesticide-likeness models. It may also aid non-specialists to understand some important concepts in drug-likeness and pesticide-likeness.


Assuntos
Praguicidas , Preparações Farmacêuticas , Disponibilidade Biológica , Simulação por Computador , Desenvolvimento de Medicamentos
13.
MMWR Morb Mortal Wkly Rep ; 70(37): 1306-1311, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34529645

RESUMO

Data from randomized clinical trials and real-world observational studies show that all three COVID-19 vaccines currently authorized for emergency use by the Food and Drug Administration* are safe and highly effective for preventing COVID-19-related serious illness, hospitalization, and death (1,2). Studies of vaccine effectiveness (VE) for preventing new infections and hospitalizations attributable to SARS-CoV-2, the virus that causes COVID-19), particularly as the B.1.617.2 (Delta) variant has become predominant, are limited in the United States (3). In this study, the New York State Department of Health linked statewide immunization, laboratory testing, and hospitalization databases for New York to estimate rates of new laboratory-confirmed COVID-19 cases and hospitalizations by vaccination status among adults, as well as corresponding VE for full vaccination in the population, across all three authorized vaccine products. During May 3-July 25, 2021, the overall age-adjusted VE against new COVID-19 cases for all adults declined from 91.8% to 75.0%. During the same period, the overall age-adjusted VE against hospitalization was relatively stable, ranging from 89.5% to 95.1%. Currently authorized vaccines have high effectiveness against COVID-19 hospitalization, but effectiveness against new cases appears to have declined in recent months, coinciding with the Delta variant's increase from <2% to >80% in the U.S. region that includes New York and relaxation of masking and physical distancing recommendations. To reduce new COVID-19 cases and hospitalizations, these findings support the implementation of a layered approach centered on vaccination, as well as other prevention strategies such as masking and physical distancing.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/diagnóstico , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Técnicas de Laboratório Clínico , Humanos , Pessoa de Meia-Idade , New York/epidemiologia , SARS-CoV-2/isolamento & purificação , Adulto Jovem
14.
Nat Commun ; 12(1): 5215, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34471122

RESUMO

Achieving sufficient worldwide vaccination coverage against SARS-CoV-2 will require additional approaches to currently approved viral vector and mRNA vaccines. Subunit vaccines may have distinct advantages when immunizing vulnerable individuals, children and pregnant women. Here, we present a new generation of subunit vaccines targeting viral antigens to CD40-expressing antigen-presenting cells. We demonstrate that targeting the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein to CD40 (αCD40.RBD) induces significant levels of specific T and B cells, with long-term memory phenotypes, in a humanized mouse model. Additionally, we demonstrate that a single dose of the αCD40.RBD vaccine, injected without adjuvant, is sufficient to boost a rapid increase in neutralizing antibodies in convalescent non-human primates (NHPs) exposed six months previously to SARS-CoV-2. Vaccine-elicited antibodies cross-neutralize different SARS-CoV-2 variants, including D614G, B1.1.7 and to a lesser extent B1.351. Such vaccination significantly improves protection against a new high-dose virulent challenge versus that in non-vaccinated convalescent animals.


Assuntos
Antígenos CD40/imunologia , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Glicoproteína da Espícula de Coronavírus/imunologia , Animais , Células Apresentadoras de Antígenos/imunologia , Linfócitos B/imunologia , Convalescença , Humanos , Macaca , Camundongos , Mutação , Domínios Proteicos , Reinfecção/prevenção & controle , SARS-CoV-2/genética , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/genética , Linfócitos T/imunologia , Vacinação , Vacinas de Subunidades/imunologia
15.
BMJ Open ; 11(9): e049562, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475171

RESUMO

OBJECTIVE: This trial aimed to determine if return rates of consent forms for vaccination could be improved when Vaxcards were offered as an incentive to school children. SETTING: Nineteen schools in South East Melbourne participated. INTERVENTIONS: Students in the experimental arm received a pack of Vaxcards when they returned their government consent form. OUTCOME MEASURES: Return of 'yes' consent forms for vaccination as part of a local government council vaccine programme was the primary outcome of this trial. Return rates were compared between the intervention and control schools and with historical return rates. RESULTS: Secondary school students (N=3087) from 19 schools participated. Compared with historical returns, a small global reduction in 'yes' responses to consent forms of -4.21% in human papilloma virus consent 'yes' responses and -4.69% for diphtheria, tetanus and pertussis was observed across all schools. No difference between the experimental and control groups was observed. CONCLUSIONS: Low 'yes' consent rates and reduction in consent rates between 2018 and 2019 for all groups are concerning. This finding highlights the need for behaviour change interventions across all groups to increase vaccine confidence. Lack of effect of incentivisation with Vaxcards in this study may have been due to the timing of receiving the cards (after the decision to vaccinate had been made, not before) and the limited intensity of the intervention. Optimising the timing and the intensity of exposure to Vaxcards could improve the outcome. TRIAL REGISTRATION NUMBER: ACTRN12618001753246.


Assuntos
Vacinação , Vacinas , Criança , Humanos , Programas de Imunização , Instituições Acadêmicas , Estudantes
16.
BMJ Open ; 11(9): e052016, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475188

RESUMO

BACKGROUND: Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES: The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN: This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS: Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS: Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.


Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Adolescente , Feminino , Humanos , Imunização , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Vacinação , Cobertura Vacinal
17.
BMJ Open ; 11(9): e048000, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479934

RESUMO

OBJECTIVE: To examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017. DESIGN: Repeated cross-sectional study. SETTING: Drug poisoning deaths in Ireland. PARTICIPANTS: National Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017. OUTCOME MEASURES: The primary outcome was trends in drug poisoning death rates by sex. The secondary outcomes were trends in drug poisoning death rates involving (1) any CNS (Central Nervous System) depressants, (2) ≥2 CNS depressants and (3) specific drugs/drug classes (eg, prescription opioids, benzodiazepines, antidepressants, alcohol, cocaine and heroin) by sex. Joinpoint regression was used to examine trends, stratified by sex, in the ASR of drug poisoning deaths (2004-2017), change points over time and average annual percentage changes (AAPCs) with 95% CI. RESULTS: Increased ASR for all drug poisoning deaths from 6.86 (95% CI 6.01 to 7.72) per 100 000 in 2004 to 8.08 (95% CI 7.25 to 8.91) per 100 000 in 2017 was mainly driven by increasing deaths among men (AAPC 2.6%, 95% CI 0.2 to 5.1), with no significant change observed among women. Deaths involving ≥2 CNS depressants increased for both men (AAPC 5.6%, 95% CI 2.4 to 8.8) and women (AAPC 4.0%, 95% CI 1.1 to 6.9). Drugs with the highest significant AAPC increases for men were cocaine (7.7%, 95% CI 2.2 to 13.6), benzodiazepines (7.2%, 95% CI 2.9 to 11.6), antidepressants (6.1%, 95% CI 2.4 to 10.0) and prescription opioids (3.5%, 95% CI 1.6 to 5.5). For women, the highest AAPC was for antidepressants (4.2%, 95% CI 0.2 to 8.3), benzodiazepines (3.3%, 95% CI 0.1 to 6.5) and prescription opioids (3.0%, 95% CI 0.7 to 5.3). CONCLUSION: Drugs implicated in drug poisoning deaths vary by sex. Policy response should include prescription monitoring programmes and practical harm reduction information on polydrug use, especially CNS depressant drugs.


Assuntos
Overdose de Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Preparações Farmacêuticas , Envenenamento , Analgésicos Opioides , Estudos Transversais , Feminino , Humanos , Irlanda/epidemiologia , Masculino
18.
J Pak Med Assoc ; 71(9): 2281-2282, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34580533

RESUMO

Medication is essential for diabetes care, and this is reflected in the Essential Medicines lists prepared by the World Health Organization and various countries. The need for essential diagnostics, and essential devices, however, has not been addressed adequately. In this communication, we call for creating a list of the essential diagnostics and devices that are required in primary and secondary/ tertiary diabetes care. We hope that this will encourage policymakers and clinicians to work together, to ensure that these are made available, accessible, and affordable for all patients.


Assuntos
Diabetes Mellitus , Medicamentos Essenciais , Custos e Análise de Custo , Diabetes Mellitus/diagnóstico , Humanos , Atenção Primária à Saúde , Organização Mundial da Saúde
19.
Euro Surveill ; 26(36)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34505565

RESUMO

The intention to get the COVID-19 vaccine increased from 48% (November 2020) to 75% (March 2021) as national campaigning in the Netherlands commenced. Using a mixed method approach we identified six vaccination beliefs and two contextual factors informing this increase. Analysis of a national survey confirmed that shifting intentions were a function of shifting beliefs: people with stronger intention to vaccinate were most motivated by protecting others and reopening society; those reluctant were most concerned about side effects.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Intenção , Países Baixos , SARS-CoV-2 , Vacinação
20.
Diabetes Metab Syndr ; 15(5): 102271, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34500380

RESUMO

BACKGROUND AND AIMS: The survey aimed to assess COVID-19 vaccine acceptance and hesitancy rate among patients with diabetes and address barriers and beliefs that affect acceptance to take COVID-19 vaccine. METHODS: A quantitative research approach with cross-sectional design was used to collect data from March-May'2021. Saudi residents with diabetes, aged ≥18 years were included. RESULTS: Of the total 709 participants, 42.2% had family member with COVID-19, 14.7% had COVID-19, 34.0% had been with someone who had COVID-19. 34.7% of participants taken COVID-19 vaccination, 36.2% were willing to take, while 79.0% supported COVID-19 vaccine. Main reasons behind uncertainties towards vaccinations were relatively fast production, not many trials done and about genetic component. 44.6% got information about COVID-19 and vaccination through television, social media, and ministry website. On adjusting models, female gender, longer duration of diabetes and no history of influenza vaccine significantly associated with COVID vaccine uptake. CONCLUSION: Participants are willing to vaccinate but show some fear and misinformation. It is imperative that due efforts are made for increasing vaccine willingness, and availability of precise information holds key to success. Otherwise, state will have to continue to funnel in resources towards post-on-set disease management, consuming a lot more resources than preventive measures like vaccination.


Assuntos
Vacinas contra COVID-19/uso terapêutico , Diabetes Mellitus/epidemiologia , Recusa de Vacinação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Arábia Saudita/epidemiologia , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Recusa de Vacinação/psicologia , Recusa de Vacinação/estatística & dados numéricos , Adulto Jovem
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