Real-World Effectiveness of the Varicella Vaccine among Children and Adolescents in Qatar: A Case-Control Study.

BACKGROUND: Despite the availability of a highly efficacious vaccine, varicella outbreaks are still being reported globally. In this study, we evaluated the real-world effectiveness of varicella vaccination among children between the ages of 1 and 18 years old during the period 2017 to 2019 in Qatar. METHODS: A matched case-control study was conducted that included all reported varicella-infected children who visited the primary healthcare system in Qatar from January 2017 to December 2019. The cases were children under the age of 18 years who were clinically diagnosed with varicella. The controls were of the same age, who visited the Primary Health Care Corporation (PHCC) during 2017-2019 with a skin rash where varicella infection was ruled out. The data on varicella vaccination for each participant were obtained from the electronic database in the PHCC during the study period. RESULTS: We included 862 cases of varicella and 5454 matched controls, with a median age of 8 years (IQR 3-12); 47.4% were female and almost 50% were of Qatari nationality. The year 2019 had the highest varicella infection count with a total of 416 cases. The cases were less likely to be vaccinated against varicella, with approximately a quarter (25.6%) of cases and 36.7% of the controls having either one or two doses of the vaccine (p < 0.001). Compared to not being vaccinated, a single dose vaccination showed a 56% reduction in the odds of varicella infection [OR 0.44, 95% CI: 0.34-0.55; p < 0.000], and a two-dose vaccination showed an 86% reduction in the odds of varicella infection [OR 0.13, 95% CI: 0.06-0.29; p < 0.000]. CONCLUSION: In this multicultural setting, a two-dose varicella vaccination shows reasonable protection against varicella infection.

Antibiotics Prescriptions Pattern among Patients Visiting Primary Health Care Centers (PHCC) before and during COVID-19 Pandemic: A Cross-Sectional Population-Based Study from Qatar.

BACKGROUND: The COVID-19 pandemic, caused by the novel coronavirus 2 (SARS-CoV-2), has been associated with an increased risk of secondary bacterial infections. Numerous studies have reported a surge in antibiotic usage during the COVID-19 pandemic. This study aims to examine the impact of the COVID-19 pandemic on the frequency and patterns of antibiotic prescriptions at Primary Health Care Centers (PHCC) in Qatar, comparing the period before and during the pandemic. METHODS: This population-based, cross-sectional study analyzed all antibiotic prescriptions issued in two-month intervals before COVID-19 (November and December 2019) and during the initial wave (June and July 2020) of COVID-19. The study included 27 PHCCs in Qatar. RESULTS: Prior to the COVID-19 outbreak, the PHCCs dispensed a total of 74,909 antibiotic prescriptions in November and December. During the first wave of COVID-19, the number decreased to 29,273 prescriptions in June and July 2020. Antibiotics were most commonly prescribed for adults and least commonly for the elderly, both before and during the COVID-19 period. In the pre-COVID-19 period, Betalactams and macrolides accounted for the majority (73%) of all antibiotic prescriptions across all age groups. However, during the COVID-19 period, Betalactams and other antibiotics such as Nitrofurantoin and Metronidazole (73%) were the most frequently prescribed. CONCLUSION: The rate of antibiotic prescriptions during the first wave of COVID-19 was lower compared to the two months preceding the pandemic at the PHCC in Qatar.

Barriers of Appropriate Antibiotic Prescription at PHCC in Qatar: Perspective of Physicians and Pharmacists.

The Ministry of Public Health in Qatar developed the NAP (National Action Plan to combat Antimicrobial Resistance (AMR) in collaboration with WHO Regional Office for the Eastern Mediterranean (WHO/EMRO). Among the major factors shaping AMR is antimicrobial prescribing and use. Tailoring Antimicrobial Resistance Program is a behavior change methodology that is utilized to adapt behavior change in relation to antimicrobial use. This study explores barriers of appropriate antibiotic (AB) prescription from the physicians' and pharmacists' perspectives at primary healthcare centers in Qatar. Data were collected from 50 participants across two PHCCs: 30 physicians and 20 pharmacists. Two different interview guides were constructed: One for physicians and one for pharmacists. In-depth, face-to-face, five focus groups were conducted and transcribed verbatim. Inductive qualitative analysis, involving discovering the themes in the interviews, was followed. Data were analyzed using constant comparative techniques. The Major themes arose from the analysis revealed that patients, practitioners mainly physicians, and the organization itself, played a role in shaping these barriers in the two primary healthcare centers. The findings would help develop and pilot behavior change interventions among patients, physicians and pharmacists with the aim of optimizing appropriate antibiotic prescription and use, which would support the implementation of the antibiotic stewardship program. Effective behavior change interventions should consider multiple factors including individual and organizational factors to optimize appropriate antibiotic prescription.

Force-dependent extracellular matrix remodeling by early-stage cancer cells alters diffusion and induces carcinoma-associated fibroblasts.

It is known cancer cells secrete cytokines inducing normal fibroblasts (NFs) to become carcinoma-associated fibroblasts (CAFs). However, it is not clear how the CAF-promoting cytokines can effectively navigate the dense ECM, a diffusion barrier, in the tumor microenvironment to reach NFs during the early stages of cancer development. In this study, we devised a 3D coculture system to investigate the possible mechanism of CAF induction at early stages of breast cancer. We found that in a force-dependent manner, ECM fibrils are radially aligned relative to the tumor spheroid. The fibril alignment enhances the diffusion of exosomes containing CAF-promoting cytokines towards NFs. Suppression of force generation or ECM remodeling abolishes the enhancement of exosome diffusion and the subsequent CAF induction. In summary, our finding suggests that early-stage, pre-metastatic cancer cells can generate high forces to align the ECM fibrils, thereby enhancing the diffusion of CAF-promoting exosomes to reach the stroma and induce CAFs.

Cell-Cell Adhesion and Myosin Activity Regulate Cortical Actin Assembly in Mammary Gland Epithelium on Concaved Surface.

It has been demonstrated that geometry can affect cell behaviors. Though curvature-sensitive proteins at the nanoscale are studied, it is unclear how cells sense curvature at the cellular and multicellular levels. To characterize and determine the mechanisms of curvature-dependent cell behaviors, we grow cells on open channels of the 60-µm radius. We found that cortical F-actin is 1.2-fold more enriched in epithelial cells grown on the curved surface compared to the flat control. We observed that myosin activity is required to promote cortical F-actin formation. Furthermore, cell-cell contact was shown to be indispensable for curvature-dependent cortical actin assembly. Our results indicate that the actomyosin network coupled with adherens junctions is involved in curvature-sensing at the multi-cellular level.

Improving Influenza Vaccination Rate among Primary Healthcare Workers in Qatar.

The purpose of this study was to improve influenza vaccination, and determine factors influencing vaccine declination among health care workers (HCW) in Qatar. We launched an influenza vaccination campaign to vaccinate around 4700 HCW in 22 Primary Health Care Corporation (PHCC) centers in Qatar between 1st and 15th of November, 2015. Our target was to vaccinate 60% of all HCW. Vaccine was offered free of charge at all centers, and information about the campaign and the importance of influenza vaccination was provided to employees through direct communication, emails, and social media networks. Staff were reported as vaccinated or non-vaccinated using a declination form that included their occupation, place of work and reasons for declining the vaccine. Survey responses were summarized as proportional outcomes. We exceeded our goal, and vaccinated 77% of the target population. Only 9% declined to take the vaccine, and the remaining 14% were either on leave or had already been vaccinated. Vaccine uptake was highest among aides (98.1%), followed by technicians (95.2%), and was lowest amongst pharmacists (73.2%), preceded by physicians (84%). Of those that declined the vaccine, 34% provided no reason, 18% declined it due to behavioral issues, and 21% declined it due to medical reasons. Uptake of influenza vaccine significantly increased during the 2015 immunization campaign. This is attributed to good planning, preparation, a high level of communication, and providing awareness and training to HCW with proper supervision and monitoring.