Seasonal Influenza Vaccine: Uptake, Attitude, and Knowledge Among Patients Receiving Immunoglobulin Replacement Therapy.

Influenza is a potential cause of severe disease in the immunocompromised. Patients with hypogammaglobulinemia, in spite of adequate replacement therapy, are at risk of significant morbidity and adverse outcomes. A seasonal vaccine is the primary prophylactic countermeasure to limit disease. The aim of this study was to evaluate the attitude, knowledge, and influenza vaccine uptake among Irish patients receiving immunoglobulin replacement therapy (IgRT), as well as uptake in co-habitants. Fifty-seven percent of patients receiving IgRT at a regional immunology referral center completed a questionnaire evaluation. Seventy-six percent of IgRT patients received the influenza vaccine for the 2019 season. Ninety-eight percent recognized that influenza could be prevented with vaccination, and 81% deemed it a safe treatment. Ninety-three percent correctly identified that having a chronic medical condition, independent of age, was an indication for vaccination. Despite excellent compliance and knowledge, many were not aware that vaccination was recommended for co-habitants, and only 24% had full vaccine coverage at home. Those who received advice regarding vaccination of household members had higher rates of uptake at home. This study demonstrates awareness and adherence to seasonal influenza vaccine recommendations among patients receiving IgRT. Over three quarters felt adequately informed, the majority stating physicians as their information source. We identified an easily modifiable knowledge gap regarding vaccination of household members. This data reveals a need to emphasize the importance of vaccination for close contacts of at-risk patients, to maintain optimal immunity and health outcome.

Rapid transition to home omalizumab treatment for chronic spontaneous urticaria during the COVID-19 pandemic: A patient perspective.

Efforts to reduce non-urgent hospital attendances during the COVID-19 pandemic have been the focus of much attention from healthcare professionals worldwide. In Ireland, due to funding constraints omalizumab is only available for hospital-based administration. Fifty-eight patients with chronic spontaneous urticaria and angioedema (CSU) receiving omalizumab in our centre were rapidly transitioned to home self-administration at the start of the pandemic. We conducted an anonymised patient survey after 3 months of home therapy with the aim of characterizing the patient experience throughout this period. 41 patients participated in our questionnaire (71% response rate). 93% of patients favored self-injection of omalizumab from home, with respondents citing cost savings, time savings, improved flexibility, fewer hospital visits, and less risk of exposure to COVID-19 infection as particular benefits. Concerns regarding home administration including injecting incorrectly, forgetting a dose, or having a reaction were reported very infrequently. Eighty-three percent (83%) of patients wished to continue with home therapy long-term. This survey highlights broadly positive experiences for patients rapidly transitioning to home omalizumab administration. This data will be useful to inform healthcare funders in decisions regarding patient-centred care in CSU. Facilitating home omalizumab therapy in suitable CSU patients should be strongly considered in the post-pandemic setting.

Field validation of a conservation network on the Eastern Shore of Maryland, USA, using breeding birds as bio-indicators.

Maryland's Green Infrastructure (GI) is a network of large, intact natural areas (hubs), interconnected by linear swaths of riparian or upland vegetation (corridors). The GI serves significant ecological functions and provides the bulk of the state's natural support system. This study examined whether the GI as mapped does, in fact, identify Maryland's most ecologically valuable forested lands, using forest interior dwelling birds (hereafter called "forest birds") as bio-indicators. We conducted bird point counts within forest both inside and outside of hubs on Maryland's Eastern Shore. We also collected a wide variety of habitat data. We found that both the condition of a forest and its surrounding landscape influenced the bird communities. On average, forest bird richness was significantly higher within hubs; furthermore, almost all sites with at least five forest bird species present were in hubs. Forest bird richness and abundance were highest in undisturbed, mature broadleaf forest with wetlands and streams nearby. We detected a significant relationship between forest bird richness and the ecological score of a finer-scale landscape assessment, focused on "cells" of about 0.1 ha in size. This field study also validated the Rapid Field Assessment (RFA) protocol developed in 2001 to assess, on the ground, the relative condition of individual sites or properties within the GI. Forest bird richness and abundance were positively correlated with the RFA community scores. Our results underscore the importance of maintaining regional biological diversity by retaining large blocks of forest, especially mature forest containing streams and wetlands.