Boletim epidemiológico de vírus respiratórios (RS): semana epidemiológica (SE) 34 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 34 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Association between wealth, insurance coverage, urban residence, median age and COVID-19 deaths across states in Nigeria.

This study measures associations between COVID-19 deaths and sociodemographic factors (wealth, insurance coverage, urban residence, age, state population) for states in Nigeria across two waves of the COVID-19 pandemic: February 27th 2020 to October 24th 2020 and October 25th 2020 to July 25th 2021. Data sources include 2018 Nigeria Demographic and Health Survey and Nigeria Centre for Disease Control (NCDC) COVID-19 daily reports. It uses negative binomial models to model deaths, and stratifies results by respondent gender. It finds that overall mortality rates were concentrated within three states: Lagos, Edo and Federal Capital Territory (FCT) Abuja. Urban residence and insurance coverage are positively associated with differences in deaths for the full sample. The former, however, is significant only during the early stages of the pandemic. Associative differences in gender-stratified models suggest that wealth was a stronger protective factor for men and insurance a stronger protective factor for women. Associative strength between sociodemographic measures and deaths varies by gender and pandemic wave, suggesting that the pandemic impacted men and women in unique ways, and that the effectiveness of interventions should be evaluated for specific waves or periods.

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 30 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 30 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

SARS-CoV-2 Infection and Death Rates Among Maintenance Dialysis Patients During Delta and Early Omicron Waves - United States, June 30, 2021-September 27, 2022.

Persons receiving maintenance dialysis are at increased risk for SARS-CoV-2 infection and its severe outcomes, including death. However, rates of SARS-CoV-2 infection and COVID-19-related deaths in this population are not well described. Since November 2020, CDC's National Healthcare Safety Network (NHSN) has collected weekly data monitoring incidence of SARS-CoV-2 infections (defined as a positive SARS-CoV-2 test result) and COVID-19-related deaths (defined as the death of a patient who had not fully recovered from a SARS-CoV-2 infection) among maintenance dialysis patients. This analysis used NHSN dialysis facility COVID-19 data reported during June 30, 2021-September 27, 2022, to describe rates of SARS-CoV-2 infection and COVID-19-related death among maintenance dialysis patients. The overall infection rate was 30.47 per 10,000 patient-weeks (39.64 among unvaccinated patients and 27.24 among patients who had completed a primary COVID-19 vaccination series). The overall death rate was 1.74 per 10,000 patient-weeks. Implementing recommended infection control measures in dialysis facilities and ensuring patients and staff members are up to date with recommended COVID-19 vaccination is critical to limiting COVID-19-associated morbidity and mortality.

How race, sex and age interact in association with COVID-19 outcomes over time: An analysis of Michigan data.

BACKGROUND: COVID-19 has had a disproportionate impact on racial and ethnic minorities compared to White people. Studies have not sufficiently examined how sex and age interact with race/ethnicity, and potentially shape COVID-19 outcomes. We sought to examine disparities in COVID-19 outcomes by race, sex and age over time, leveraging data from Michigan, the only state whose Department of Health and Human Services (DHSS) publishes cross-sectional race, sex and age data on COVID-19. METHODS: This is an observational study using publicly available COVID-19 data (weekly cases, deaths, and vaccinations) from August 31 2020 to June 9 2021. Outcomes for descriptive analysis were age-standardized COVID-19 incidence and mortality rates, case-fatality rates by race, sex, and age, and within-gender and within-race incidence rate ratios and mortality rate ratios. We used descriptive statistics and linear regressions with age, race, and sex as independent variables. RESULTS: The within-sex Black-White racial gap in COVID-19 incidence and mortality decreased at a similar rate among men and women but the remained wider among men. As of June 2021, compared to White people, incidence was lower among Asian American and Pacific Islander people by 2644 cases per 100,000 people and higher among Black people by 1464 cases per 100,000 people. Mortality was higher among those aged 60 or greater by 743.6 deaths per 100,000 people vs those 0-39. The interaction between race and age was significant between Black race and age 60 or greater, with an additional 708.5 deaths per 100,000 people vs White people aged 60 or greater. Black people had a higher case fatality rate than White people. CONCLUSION: COVID-19 incidence, mortality and vaccination patterns varied over time by race, age and sex. Black-White disparities decreased over time, with a larger effect on Black men, and Older Black people were particularly more vulnerable to COVID-19 in terms of mortality. Considering different individual characteristics such as age may further help elucidate the mechanisms behind racial and gender health disparities.

Body temperature as a predictor of mortality in COVID-19.

It remains uncertain if body temperature (BT) is a useful prognostic indicator in coronavirus disease 2019 (COVID-19). We investigated the relationship between BT and mortality in COVID-19 patients. We used a de-identified database that prospectively collected information from patients screened for COVID-19 at the Mount Sinai facilities from February 28, 2020 to July 28, 2021. All patients diagnosed with COVID-19 that had BT data were included. BT at initial presentation, maximum BT during hospitalization, comorbidity, and vaccination status data were extracted. Mortality rate was assessed as a primary outcome. Among 24,293 cases, patients with initial BT below 36 °C had higher mortality than those with BT of 36-37 °C (p < 0.001, odds ratio 2.82). Initial BT > 38 °C was associated with high mortality with an incremental trend at higher BT. In 10,503 in-patient cases, a positive association was observed between mortality and maximum BT except in patients with BT < 36 °C. Multiple logistic regression analyses including the comorbidities revealed that maximum BT was an independent predictor of mortality. While vaccination did not change the distribution of maximum BT, mortality was decreased in vaccinated patients. Our retrospective cohort study suggests that high maximum BT is an independent predictor of higher mortality in COVID-19 patients.

Characteristics of and Deaths among 333 Persons with Tuberculosis and COVID-19 in Cross-Sectional Sample from 25 Jurisdictions, United States.

Little is known about co-occurring tuberculosis (TB) and COVID-19 in low TB incidence settings. We obtained a cross-section of 333 persons in the United States co-diagnosed with TB and COVID-19 within 180 days and compared them to 4,433 persons with TB only in 2020 and 18,898 persons with TB during 2017‒2019. Across both comparison groups, a higher proportion of persons with TB-COVID-19 were Hispanic, were long-term care facility residents, and had diabetes. When adjusted for age, underlying conditions, and TB severity, COVID-19 co-infection was not statistically associated with death compared with TB infection only in 2020 (adjusted prevalence ratio 1.0 [95% CI 0.8‒1.4]). Among TB-COVID-19 patients, death was associated with a shorter interval between TB and COVID-19 diagnoses, older age, and being immunocompromised (non-HIV). TB-COVID-19 deaths in the United States appear to be concentrated in subgroups sharing characteristics known to increase risk for death from either disease alone.

Effectiveness of successive booster vaccine doses against SARS-CoV-2 related mortality in residents of long-term care facilities in the VIVALDI study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused severe disease in unvaccinated long-term care facility (LTCF) residents. Initial booster vaccination following primary vaccination is known to provide strong short-term protection, but data are limited on duration of protection and the protective effect of further booster vaccinations. OBJECTIVE: To evaluate the effectiveness of third, fourth and fifth dose booster vaccination against SARS-CoV-2 related mortality amongst older residents of LTCFs. DESIGN: Prospective cohort study. SETTING: LTCFs for older people in England participating in the VIVALDI study. METHODS: Residents aged >65 years at participating LTCFs were eligible for inclusion if they had at least one polymerase chain reaction or lateral flow device result within the analysis period 1 January 2022 to 31 December 2022. We excluded individuals who had not received at least two vaccine doses before the analysis period. Cox regression was used to estimate relative hazards of SARS-CoV-2 related mortality following 1-3 booster vaccinations compared with primary vaccination, stratified by previous SARS-CoV-2 infection and adjusting for age, sex and LTCF size (total beds). RESULTS: A total of 13,407 residents were included. Our results indicate that third, fourth and fifth dose booster vaccination provide additional short-term protection against SARS-CoV-2 related mortality relative to primary vaccination, with consistent stabilisation beyond 112 days to 45-75% reduction in risk relative to primary vaccination. CONCLUSIONS: Successive booster vaccination doses provide additional short-term protection against SARS-CoV-2 related mortality amongst older LTCF residents. However, we did not find evidence of a longer-term reduction in risk beyond that provided by initial booster vaccination.

Plasma brain natriuretic peptide, D-Dimer, and serum troponin-I as predictors for in-hospital death in patients with COVID-19.

The severe acute respiratory syndrome coronavirus 2, first appeared in Wuhan, China, in December 2019. Since then, a variety of strains of the virus were spread throughout the world, prompting the World Health Organization to declare a pandemic in March 2020. Additionally, Coronavirus disease 2019 (COVID-19) can cause a variety of symptoms, ranging from fatigue and fever to severe respiratory and cardiovascular complications. This study evaluated the role of brain natriuretic peptide (BNP), troponin-I and D-dimer as biomarkers for death prediction in hospitalized patients with COVID-19. The study included 90 patients with COVID -19 diagnosed with PCR-RNA testing. They were divided into survivors and non-survivors. Also, 20 apparently healthy individuals age and sex matched were included as a control group. Plasma BNP and serum troponin-I were measured by enzyme linked immune-sorbent assay (ELISA) technique. D-dimer was measured by a turbidimetric technique. Patients with COVID-19 had significantly elevated levels of serum Troponin-I and plasma BNP in comparison to controls (p < 0.0001, for both). D-dimer, troponin-I and BNP levels were significantly higher in the non-survivors group when compared to the survivors group. Troponin-1 can predict COVID-19 severity with sensitivity, specificity, and accuracy of 55.1%, 66.7%, and 57.8%, respectively at a cutoff value of 0.075 (ng /ml); and area under the receiver operating characteristic (AUC) curve of 0.670 (95% CI: 0.551 - 0.790, p=0.018). BNP can predict COVID-19 severity with sensitivity, specificity, and accuracy of 98.6%, 71.4%, 92.2%, respectively at a cutoff value of 16.02 (Pg /ml) and AUC of 0.872 (95% CI: 0.778 - 0.965, p < 0.001). Univariate and multivariate logistic regression analysis showed that only BNP level can significantly predict death among COVID-19 infected patients. In conclusion, plasma BNP and serum troponin-I could be used as prognostic biomarkers for determination of the severity of COVID-19 and BNP could predict mortality.

Variables Associated with 30-Day Mortality in Very Elderly COVID-19 Patients.

Background: Advanced age increases the risk for severe COVID-19. However, the risk factors for mortality from COVID-19 in very elderly patients (≥80-years-old) are unknown. Objective: Investigate the relationship of mortality with the clinical characteristics of very elderly COVID-19 patients. Materials and Methods: Very elderly patients who were hospitalized with COVID-19 from December 3, 2022 to January 1, 2023 were retrospectively examined. Sociodemographic and clinical variables were recorded and survival was recorded after 30 days. Results: We examined 181 patients (median age: 90.84 years; 114 older than 90 years). The median Barthel index was 30.69, and 55.8% of patients had severe or critical COVID-19 pneumonia. Forty-two patients (33.2%) received a high-flow nasal cannula or non-invasive ventilation, and only 4.4% received mechanical ventilation. The overall mortality was 35.9%, and there was no significant difference in mortality for the 80 to 90-year-old group and the over 90-year-old group (37.7% vs 32.8%, P=0.508). A multivariate analysis showed that the Barthel index (OR, 0.975; 95% CI, 0.962-0.989), serum creatinine (SCr) level (OR, 1.003; 95% CI, 1.000-1.006), white blood cell (WBC) count (OR, 1.160; 95% CI, 1.056-1.276), D-dimer level (OR, 1.060; 95% CI, 1.009-1.113), and corticosteroid use (OR, 0.268; 95% CI, 0.124-0.582) were significantly and independently related to 30-day mortality. A binary classification model based on the multivariate analysis had good predictive value (area under the curve, 0.794). Conclusion: Very elderly COVID-19 patients have a high risk for mortality. The Barthel index, SCr, WBC count, D-dimer level, and corticosteroid use were independently associated with mortality.

Higher urea-to-albumin ratio is associated with mortality risk in critically ill COVID-19 patients.

BACKGROUND: This study aimed to evaluate the ability of the urea-to-albumin ratio (UAR) to predict mortality in critically ill coronavirus disease 2019 (COVID-19) patients. METHODS: This retrospective study included adult patients admitted with COVID-19 at two intensive care units (ICUs) at the University Hospital. Serum urea and albumin concentrations at ICU admission were used to calculate the UAR. All patients were followed up during hospitalization, and the ICU mortality rate was recorded. RESULTS: Two hundred and eleven patients were evaluated. The mean age was 57.8 ± 15.5 years, and 54% were male. Approximately 84.4% of patients were considered to be at nutritional risk by the NRS 2002, and the median UAR was 18.3 (10.5-34.8). The length of stay in the ICU was 10 (6-16) days, 38.4% of the patients required dialysis, and 64.9% died. Age, male sex, need of hemodialysis, lactate level, and inflammatory parameters were associated with higher mortality. Patients non-survivors had a higher UAR (23.7 [13.6-41.8] vs. 10.9 [8.5-16.8]; p < 0.001). The cutoff point with the best performance of UAR in the ROC curve for predicting mortality was ≥12.17 (AUC: 0.7201; CI 95%: 0.656-0.784). Additionally, the risk of mortality was 2.00-fold in the group of patients with UAR ≥12.17 (HR: 2.00 CI: 1.274-3.149; p = 0.003) and remained significant after adjusted analyzes (models 1 and 2). CONCLUSION: Our data suggest that a UAR ≥12.17 increased the risk of mortality by 2.00-fold in critically ill COVID-19 patients.

The impact of ACE2 polymorphisms (rs1978124, rs2285666, and rs2074192) and ACE1 rs1799752 in the mortality rate of COVID-19 in different SARS-CoV-2 variants.

BACKGROUND: Clinical severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes could be influenced by genetic polymorphisms in angiotensin I-converting enzyme (ACE1) and ACE2. This study aims to examine three polymorphisms (rs1978124, rs2285666, and rs2074192) on the ACE2 gene and ACE1 rs1799752 (I/D) in patients who have coronavirus disease 2019 (COVID-19) with various SARS-CoV-2 variants. METHODS: Based on polymerase chain reaction-based genotyping, four polymorphisms in the ACE1 and ACE2 genes have been identified in 2023 deceased patients and 2307 recovered patients. RESULTS: The ACE2 rs2074192 TT genotype was associated with the COVID-19 mortality in all three variants, whereas the CT genotype was associated with the Omicron BA.5 and Delta variants. ACE2 rs1978124 TC genotypes were related to COVID-19 mortality in the Omicron BA.5 and Alpha variants, but TT genotypes were related to COVID-19 mortality in the Delta variant. It was found that ACE2 rs2285666 CC genotypes were associated with COVID-19 mortality in Delta and Alpha variants, and CT genotypes in Delta variants. There was an association between ACE1 rs1799752 DD and ID genotypes in the Delta variant and COVID-19 mortality, whereas there was no association in the Alpha or Omicron BA.5 variants. In all variants of SARS-CoV-2, CDCT and TDCT haplotypes were more common. In Omicron BA.5 and Delta, CDCC and TDCC haplotypes were linked with COVID-19 mortality. In addition to COVID-19 mortality, the CICT, TICT, and TICC were significantly correlated. CONCLUSION: The ACE1/ACE2 polymorphisms had an impact on COVID-19 infection, and these polymorphisms had different effects in various SARS-CoV-2 variants. To confirm these results, however, more research needs to be conducted.

COVID-19 Infection and Death Rates Varied Widely Among U.S. States.

Socioeconomic and political reasons were cited for the differing outcomes.

Association between distance to community health care facilities and COVID-19-related mortality across U.S. counties in the COVID-19-vaccine era.

OBJECTIVE: COVID-19 has caused tremendous damage to U.S. public health, but COVID vaccines can effectively reduce the risk of COVID-19 infections and related mortality. Our study aimed to quantify the association between proximity to a community healthcare facility and COVID-19 related mortality after COVID vaccines became publicly available and explore how this association varied across racial and ethnic groups. RESULTS: Residents living farther from a facility had higher COVID-19-related mortality across U.S. counties. This increased mortality incidence associated with longer distances was particularly pronounced in counties with higher proportions of Black and Hispanic populations.

Prediction of the morbidity and mortality rates of COVID-19 in Egypt using non-extensive statistics.

Non-extenstive statistics play a significant role in studying the dynamic behaviour of COVID-19 to assist epidemiological scientists to take appropriate decisions about pandemic planning. Generic non-extensive and modified-Tsallis statistics are used to analyze and predict the morbidity and mortality rates in future. The cumulative number of confirmed infection and death in Egypt at interval from 4 March 2020 till 12 April 2022 are analyzed using both non-extensive statistics. Also, the cumulative confirmed data of infection by gender, death by gender, and death by age in Egypt at interval from 4 March 2020 till 29 June 2021 are fitted using both statistics. The best fit parameters are estimated. Also, we study the dependence of the estimated fit parameters on the people gender and age. Using modified-Tsallis statistic, the predictions of the morbidity rate in female is more than the one in male while the mortality rate in male is greater than the one in female. But, within generic non-extensive statistic we notice that the gender has no effect on the rate of infections and deaths in Egypt. Then, we propose expressions for the dependence of the fitted parameters on the age. We conclude that the obtained fit parameters depend mostly on the age and on the type of the statistical approach applied and the mortality risk increased with people aged above 45 years. We predict - using modified-Tsallis - that the rate of infection and death in Egypt will begin to decrease till stopping during the first quarter of 2025.

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 25 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 25 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 23 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 23 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

COVID-19 en trabajadores activos durante la cuarentena. Realidad de un sector urbano de Caracas, Venezuela / COVID-19 in active workers during quarantine. Reality of an urban sector of Caracas, Venezuela

La pandemia por COVID-19 resultó un problema para la salud pública mundial, que impactó particularmente al sector de trabajadores que debían trabajar y estar expuestos durante el periodo de cuarentena. Objetivo, analizar la incidencia de COVID-19 y sus características en trabajadores(as) activos(as) durante 34 semanas. Investigación descriptiva y transversal. Población constituida por todos los trabajadores(as) activos de sectores priorizados, con diagnóstico confirmado de COVID-19. De los 1.186 casos confirmados, 658 casos (55%) correspondió a trabajadores activos, una incidencia de 1,7 casos x 1000 (mayor a la esperada), con predominio en trabajadores(as) del sector salud (267casos), choferes del transporte y trabajadores de funerarias (253 casos). El 68,7% menor de 40 años y predominio del sexo masculino (61,2%). En el personal de salud, el 30% correspondió a personal de enfermería y 22% en médicos. La tasa de mortalidad en la población de trabajadores activos fue de 0,07 x cada 1000, con un índice de mortalidad de 0,05 y un índice de recuperación del 95,5%, comportamiento similar al de la población general. Sin embargo, la tasa de letalidad (trabajadores activos positivos fallecidos) fue del 4,4% (29 casos), donde el 75% (22/29) fueron enfermeras y médicos, lo que confirmó al sector salud y trabajadores(as) de servicios, como población trabajadora altamente expuesta y vulnerable, lo que justificó priorizar las medidas de prevención en estos trabajadores, al iniciar el sistema de vigilancia epidemiológica, la vacunación y la dotación con uso adecuado de la protección personal(AU)

The COVID-19 Pandemic was a problem for global public health, which particularly impacted the sector of workers who had to work and were exposed during the quarantine period. The objective was to analyze the incidence of COVID- 19 and its characteristics in active workers during 34 weeks. Descriptive and cross-sectional research. Population made up of all active workers in prioritized sectors, with a confirmed diagnosis of COVID-19. Of the 1,186 confirmed cases, 658 cases (55%) corresponded to active workers, an incidence of 1.7 cases per 1,000 (higher than expected), with a predominance of workers in the health sector (267 cases), transport drivers and funeral home workers (253 cases). 68.7% under 40 years of age and predominance of the male sex (61.2%). In health personnel, 30% corresponded to nursing personnel and 22% to doctors. The mortality rate in the population of active workers was 0.07 x every 1000, with a mortality rate of 0.05 and a recovery rate of 95.5%, behavior similar to that of the general population. However, the fatality rate (deceased positive active workers) was 4.4% (29 cases), where 75% (22/29) were nurses and doctors, which confirmed the health sector and service workers, as a highly exposed and vulnerable working population, which justified prioritizing prevention measures in these workers, by initiating the epidemiological surveillance system, vaccination and provision with adequate use of personal protection(AU)