Risk factors for disease severity among children with Covid-19: a clinical prediction model.

BACKGROUND: Children account for a significant proportion of COVID-19 hospitalizations, but data on the predictors of disease severity in children are limited. We aimed to identify risk factors associated with moderate/severe COVID-19 and develop a nomogram for predicting children with moderate/severe COVID-19. METHODS: We identified children ≤ 12 years old hospitalized for COVID-19 across five hospitals in Negeri Sembilan, Malaysia, from 1 January 2021 to 31 December 2021 from the state's pediatric COVID-19 case registration system. The primary outcome was the development of moderate/severe COVID-19 during hospitalization. Multivariate logistic regression was performed to identify independent risk factors for moderate/severe COVID-19. A nomogram was constructed to predict moderate/severe disease. The model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, and accuracy. RESULTS: A total of 1,717 patients were included. After excluding the asymptomatic cases, 1,234 patients (1,023 mild cases and 211 moderate/severe cases) were used to develop the prediction model. Nine independent risk factors were identified, including the presence of at least one comorbidity, shortness of breath, vomiting, diarrhea, rash, seizures, temperature on arrival, chest recessions, and abnormal breath sounds. The nomogram's sensitivity, specificity, accuracy, and AUC for predicting moderate/severe COVID-19 were 58·1%, 80·5%, 76·8%, and 0·86 (95% CI, 0·79 - 0·92) respectively. CONCLUSION: Our nomogram, which incorporated readily available clinical parameters, would be useful to facilitate individualized clinical decisions.

A Traceable Vaccine Supply Management System.

Everyone should be vaccinated, but the eligibility and safety of the vaccine are always overlooked by most people. The outbreak of COVID-19 has led many countries to intensify the development and production of the COVID-19 vaccine. and some countries have even required universal vaccination against this epidemic. However, such popularization of vaccination has also exposed various flaws in vaccine management that existed in the past, and vaccinators have become more concerned about the effectiveness of their vaccinations. In this paper, we propose a blockchain-based traceable vaccine management system. First, the system uses smart contracts to store the records generated during the whole process, from vaccine production to vaccination. Second, the proposed scheme uses the Edwards-curve digital signature algorithm (EdDSA) to guarantee the security and integrity of these data. Third, the system participants can access the corresponding data according to their authority to ensure the transparency of the whole system operation process. Finally, this paper will also conduct a security analysis of the whole system to ensure that the system can resist potential attacks by criminals.

Determinants of mental and financial health during COVID-19: Evidence from data of a developing country

Mental and emotional issues are the top-level concerns of public health worldwide. These issues surged during Coronavirus (COVID-19) pandemic due to varied medical, social, and personal reasons. The social determinants highlighted in the literature mainly focus on household solutions rather than on increasing the financial wellbeing of individuals, especially for the most vulnerable groups where the psychological distress coming from the social inequalities cannot be entirely treated. Hence, this study attempts to familiarize the financial capability (the financial literacy, attitude, skills and behavior required for effective financial management) construct into public health domain in the times of COVID-19 as a determinant of psychological distress, and also explores the role of gender in it. The study uses Ordinary Least Square (OLS) regression analysis and employs mental distress questions and Organization for Economic Cooperation and Development (OECD) 2018 financial capability toolkit to collect data from a large sample of households from all over Pakistan. It is inferred that the higher the financial capability, the lower the financial and mental distress during COVID-19. Additionally, females are less financially knowledgeable, depict poor financial behaviors, and face more psychological issues than their counterparts. Age and education are also linked to mental stress during COVID-19. Finally, gender plays a moderating role in financial behavior, and financial and mental stress of households. As evident, COVID-19 is not going away soon hence the findings are relevant for policymakers to proactively plan for the pandemic's upcoming waves and help people be better financially equipped to fight against this or any upcoming crisis, and achieve better mental and physical health.

Risk factors associated with household transmission of SARS-CoV-2 in Negeri Sembilan, Malaysia.

AIM: Households are a significant venue for the transmission of SARS-CoV-2. We conducted a study to characterise the transmission dynamics and identify risk factors for household transmission of SARS-CoV-2 in Negeri Sembilan, Malaysia. METHODS: This retrospective observational study included 185 families of paediatric COVID-19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio-demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS-CoV-2. RESULTS: Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID-19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case. CONCLUSIONS: High rates of household transmission of COVID-19 were found, indicating households were a major setting of transmission of SARS-CoV-2. Our data provide insight into the risk factors for household transmission of SARS-CoV-2 in Malaysia.

Clinical and epidemiological characteristics of children with COVID-19 in Negeri Sembilan, Malaysia.

OBJECTIVES: To describe the clinical and epidemiological characteristics of children with coronavirus disease 2019 (COVID-19) in the state of Negeri Sembilan, Malaysia in the setting of mandatory hospital isolation and quarantine for all confirmed cases. METHODS: A multi-centre, retrospective observational study was performed among children aged ≤12 years with laboratory-proven COVID-19 between 1 February and 31 December 2020. RESULTS: In total, 261 children (48.7% males, 51.3% females) were included in this study. The median age was 6 years [interquartile range (IQR) 3-10 years]. One hundred and fifty-one children (57.9%) were asymptomatic on presentation. Among the symptomatic cases, fever was the most common presenting symptom. Two hundred and forty-one (92.3%) cases were close contacts of infected household or extended family members. Twenty-one (8.4%) cases had abnormal radiological findings. All cases were discharged alive without requiring supplemental oxygen therapy or any specific treatment during hospitalization. The median duration of hospitalization was 7 days (IQR 6-10 days). One (2.1%) of the uninfected guardians accompanying a child in quarantine tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) upon discharge. CONCLUSIONS: COVID-19 in children was associated with mild symptoms and a good prognosis. Familial clustering was an important epidemiologic feature in the outbreak in Negeri Sembilan. The risk of transmission of SARS-CoV-2 from children to guardians in hospital isolation was minimal despite close proximity.

COVID-19 in a premature infant.

We report a case of COVID-19 in a 29-week preterm infant. This child is the youngest reported case of SARS-CoV-2 infection in Malaysia, and to the best of our knowledge, one of the youngest documented cases of established vertical transmission of SARS-CoV-2 reported in literature. Our report highlights the clinical course, timelines of viral shedding by real-time reverse transcription-PCR and antibody seroconversion in a premature infant infected with SARS-CoV-2. In addition, we discuss the challenges faced in managing a preterm infant infected with SARS-CoV-2 and the knowledge gaps that need to be explored.