Currently, the United States has the largest number of reported coronavirus disease 2019 (COVID-19) cases and deaths globally. Using a geographically diverse surveillance network, we describe risk ...factors for severe outcomes among adults hospitalized with COVID-19.
We analyzed data from 2491 adults hospitalized with laboratory-confirmed COVID-19 between 1 March-2 May 2020, as identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network, which comprises 154 acute-care hospitals in 74 counties in 13 states. We used multivariable analyses to assess associations between age, sex, race and ethnicity, and underlying conditions with intensive care unit (ICU) admission and in-hospital mortality.
The data show that 92% of patients had ≥1 underlying condition; 32% required ICU admission; 19% required invasive mechanical ventilation; and 17% died. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84, and ≥85 years versus 18-39 years (adjusted risk ratios aRRs, 1.53, 1.65, 1.84, and 1.43, respectively); male sex (aRR, 1.34); obesity (aRR, 1.31); immunosuppression (aRR, 1.29); and diabetes (aRR, 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84, and ≥ 85 years versus 18-39 years (aRRs, 3.11, 5.77, 7.67, and 10.98, respectively); male sex (aRR, 1.30); immunosuppression (aRR, 1.39); renal disease (aRR, 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR, 1.28); neurologic disorders (aRR, 1.25); and diabetes (aRR, 1.19).
In-hospital mortality increased markedly with increasing age. Aggressive implementation of prevention strategies, including social distancing and rigorous hand hygiene, may benefit the population as a whole, as well as those at highest risk for COVID-19-related complications.
The H2O2-mediated oxidation of silver nanoparticles (AgNPs) over a range of pH (3.0–14.0) is investigated here, and an electron charging–discharging model capable of describing the experimental ...results obtained is developed. AgNPs initially react with H2O2 to form Ag+ and superoxide, with these products subsequently reacting to reform AgNPs (in-situ-formed AgNPs) via an electron charging–discharging mechanism. Our experimental results show that the AgNP reactivity toward H2O2 varies significantly with pH, with the variation at high pH (>10) due particularly to the differences in the reactivity of H2O2 and its conjugate base HO2 – with AgNPs whereas at lower pH (3–10) the pH dependence of H2O2 decay is accounted for, at least in part, by the pH dependence of the rate of superoxide disproportionation. Our results further demonstrate that the in-situ-formed AgNPs resulting from the superoxide-mediated reduction of Ag+ have a different size and reactivity compared to those of the citrate-stabilized particles initially present. The turnover frequency for AgNPs varies significantly with pH and is as high as 1776.0 min–1 at pH 11.0, reducing to 144.2 min–1 at pH 10.0 and 3.2 min–1 at pH 3.0.
Abstract
Background
Data on risk factors for coronavirus disease 2019 (COVID-19)–associated hospitalization are needed to guide prevention efforts and clinical care. We sought to identify factors ...independently associated with COVID-19–associated hospitalizations.
Methods
Community-dwelling adults (aged ≥18 years) in the United States hospitalized with laboratory-confirmed COVID-19 during 1 March–23 June 2020 were identified from the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET), a multistate surveillance system. To calculate hospitalization rates by age, sex, and race/ethnicity strata, COVID-NET data served as the numerator and Behavioral Risk Factor Surveillance System estimates served as the population denominator for characteristics of interest. Underlying medical conditions examined included hypertension, coronary artery disease, history of stroke, diabetes, obesity, severe obesity, chronic kidney disease, asthma, and chronic obstructive pulmonary disease. Generalized Poisson regression models were used to calculate adjusted rate ratios (aRRs) for hospitalization.
Results
Among 5416 adults, hospitalization rates (all reported as aRR 95% confidence interval) were higher among those with ≥3 underlying conditions (vs without) (5.0 3.9–6.3), severe obesity (4.4 3.4–5.7), chronic kidney disease (4.0 3.0–5.2), diabetes (3.2 2.5–4.1), obesity (2.9 2.3–3.5), hypertension (2.8 2.3–3.4), and asthma (1.4 1.1–1.7), after adjusting for age, sex, and race/ethnicity. Adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults aged ≥65 or 45–64 years (vs 18–44 years), males (vs females), and non-Hispanic black and other race/ethnicities (vs non-Hispanic whites).
Conclusions
Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.
Severe obesity, chronic kidney disease, diabetes, obesity, hypertension, asthma, age ≥45 years, male sex, and non-Hispanic black and other race/ethnicity are associated with increased risk of coronavirus disease 2019–associated hospitalizations.
Background
Estimates of influenza disease burden are broadly useful for public health, helping national and local authorities monitor epidemiologic trends, plan and allocate resources, and promote ...influenza vaccination. Historically, estimates of the burden of seasonal influenza in the United States, focused mainly on influenza‐related mortality and hospitalization, were generated every few years. Since the 2010‐2011 influenza season, annual US influenza burden estimates have been generated and expanded to include estimates of influenza‐related outpatient medical visits and symptomatic illness in the community.
Methods
We used routinely collected surveillance data, outbreak field investigations, and proportions of people seeking health care from survey results to estimate the number of illnesses, medical visits, hospitalizations, and deaths due to influenza during six influenza seasons (2010‐2011 through 2015‐2016).
Results
We estimate that the number of influenza‐related illnesses that have occurred during influenza season has ranged from 9.2 million to 35.6 million, including 140 000 to 710 000 influenza‐related hospitalizations.
Discussion
These annual efforts have strengthened public health communications products and supported timely assessment of the impact of vaccination through estimates of illness and hospitalizations averted. Additionally, annual estimates of influenza burden have highlighted areas where disease surveillance needs improvement to better support public health decision making for seasonal influenza epidemics as well as future pandemics.
Irradiation of Suwannee River fulvic acid (SRFA) at pH 8.1 with simulated sunlight resulted in production of nanomolar concentrations of superoxide and hydrogen peroxide. SRFA contains a redox-active ...chromophore which reduced oxygen to yield superoxide upon photoexcitation. Hydrogen peroxide was generated exclusively via uncatalysed disproportionation of superoxide produced in this way. Superoxide decayed through both uncatalysed disproportionation and an oxidative pathway that did not result in hydrogen peroxide production, whereas hydrogen peroxide did not undergo further reaction to any discernible extent over the one-hour duration of irradiation. Singlet oxygen did not contribute substantially to production of superoxide or hydrogen peroxide but was found to play a critical role in controlling the mechanism and associated rate of superoxide decay in the irradiated solution. A kinetic model based on these observations is presented which provides an excellent description of the experimental results and is also consistent with observations from a wide range of other studies in which various aspects of SRFA redox chemistry and photochemistry have been investigated.
Abstract
Background
Multivalent influenza vaccine products provide protection against influenza A(H1N1)pdm09, A(H3N2), and B lineage viruses. The 2018–2019 influenza season in the United States ...included prolonged circulation of A(H1N1)pdm09 viruses well-matched to the vaccine strain and A(H3N2) viruses, the majority of which were mismatched to the vaccine. We estimated the number of vaccine-prevented influenza-associated illnesses, medical visits, hospitalizations, and deaths for the season.
Methods
We used a mathematical model and Monte Carlo algorithm to estimate numbers and 95% uncertainty intervals (UIs) of influenza-associated outcomes prevented by vaccination in the United States. The model incorporated age-specific estimates of national 2018–2019 influenza vaccine coverage, influenza virus–specific vaccine effectiveness from the US Influenza Vaccine Effectiveness Network, and disease burden estimated from population-based rates of influenza-associated hospitalizations through the Influenza Hospitalization Surveillance Network.
Results
Influenza vaccination prevented an estimated 4.4 million (95%UI, 3.4 million–7.1 million) illnesses, 2.3 million (95%UI, 1.8 million–3.8 million) medical visits, 58 000 (95%UI, 30 000–156 000) hospitalizations, and 3500 (95%UI, 1000–13 000) deaths due to influenza viruses during the US 2018–2019 influenza season. Vaccination prevented 14% of projected hospitalizations associated with A(H1N1)pdm09 overall and 43% among children aged 6 months–4 years.
Conclusions
Influenza vaccination averted substantial influenza-associated disease including hospitalizations and deaths in the United States, primarily due to effectiveness against A(H1N1)pdm09. Our findings underscore the value of influenza vaccination, highlighting that vaccines measurably decrease illness and associated healthcare utilization even in a season in which a vaccine component does not match to a circulating virus.
We estimated that influenza vaccination prevented an estimated 4.4 million illnesses, 2.3 million medical visits, 58 000 hospitalizations, and 3500 deaths in the 2018–2019 influenza season.
The photochemical properties of the organic exudate secreted by a toxic strain of Microcystis aeruginosa were studied by measuring reactive oxygen species (ROS) generation and redox transformations ...of iron in the presence of the organic exudate under acidic (pH 4) and alkaline (pH 8) conditions. Our results show that the organic exudate generates nanomolar concentrations of superoxide and hydrogen peroxide on irradiation with simulated sunlight in a manner consistent with that reported for terrigenous natural organic matter. The photo-generated superoxide plays an important role in Fe(III) reduction under alkaline conditions with nearly 45% of the observed Fe(II) generation on Fe(III) reduction occurring via Fe(III) reduction by superoxide while the rest of the Fe(III) reduction occurs via a ligand-to-metal charge transfer (LMCT) pathway. In contrast, under acidic conditions, 100% of the observed photochemical Fe(II) generation on Fe(III) reduction occurs via a LMCT pathway. These results suggest that steady-state dissolved Fe concentrations and hence Fe availability in natural waters will significantly increase in the presence of these algal exudates. Furthermore, significant diel variation in Fe(II) concentration is to be expected, even in acidic waters, since time scales of light-mediated Fe(III) reduction and thermal Fe(III) reduction differ markedly. A kinetic model is developed that adequately describes both the generation of ROS and the photochemical redox transformations of iron in the presence of M. aeruginosa exudate.
Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases. Immunosuppressed patients have a high risk for influenza complications and an impaired immune ...response to vaccines. The total burden of immunosuppressive conditions in the United States, including those receiving emerging biologic therapies, remains unknown. We used the national claims database MarketScan to estimate the prevalence of immunosuppressive conditions and risk for acute respiratory illnesses (ARIs). We studied 47.2 million unique enrollees, representing 115 million person-years of observation during 2012-2017, and identified immunosuppressive conditions in 6.2% adults 18-64 years of age and 2.6% of children <18 years of age. Among 542,105 ARI hospitalizations, 32% of patients had immunosuppressive conditions. The risk for ARI hospitalizations was higher among enrollees with immunosuppression than among nonimmunosuppressed enrollees. Future efforts should focus on developing improved strategies, including vaccines, for preventing influenza in immunosuppressed patients, who are an increasing population in the United States.
The effects of calcium on iron redox transformations in acidic nonirradiated and irradiated Suwannee River Fulvic Acid (SRFA) solutions are investigated in this study. Our results reveal that, even ...though calcium is redox-inert, it affects the redox transformations of iron with increased Fe(III) reduction rates under irradiated conditions and decreased Fe(II) oxidation rates in the dark in the presence compared to the absence of calcium. While the exact mechanism via which the Fe(III) reduction rate under irradiated conditions is impacted by calcium addition is not clear, the formation of more photolabile weakly complexed Fe(III)SRFA is most consistent with our experimental results. An observed decline in the Fe(II) oxidation rate in nonirradiated and previously irradiated SRFA solutions with the addition of calcium can be rationalized by formation of more weakly bound Fe(II) and Fe(III). The higher Fe(III) reduction rates and lower Fe(II) oxidation rates in the presence compared to the absence of calcium will help to maintain higher concentrations of Fe(II) thereby increasing the bioavailability of iron in calcium-containing waters. On the basis of our experimental results, we have developed a mathematical model that well describes the iron redox transformations mediated by SRFA in calcium-containing waters under irradiated and nonirradiated conditions.
Introduction: A substantial proportion of the Indian population comprises children under 15 years of age. The prevalence of psychosocial disorders in children is increasing, coinciding with a ...decrease in infection-related morbidities. Psychosocial disorders may not only have short-term effects but also have long-lasting effects on the child’s well-being. Aim: To assess the prevalence of psychosocial disorders in children aged 4-10 years and compare it before and after the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted as an online survey originating from Rukmani Birla Hospital, a tertiary care centre in Jaipur, Rajasthan, India. A total of 171 children aged between 4-10 years were included in the study, from February 2021 to June 2021. A structured survey questionnaire was distributed using Google Forms. The Childhood Psychopathological Measurement Schedule (CPMS) was used to assess psychosocial problems in children. CPMS scoring was performed for both the pre-pandemic period (before March 2020) and the post-pandemic period (from March 2020 until the form was filled out) for the same children. The Chi-square test was used to compare the association of demographic variables with the CPMS score. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: The mean age of the children was 6.82±2.06 years, with 47.4% (81/171) being females. A majority of the children, 158 (92.4%), were from an urban setting. The average CPMS score significantly increased from 6.66±7.46 to 11.9±10.8 (p-value <0.05) after one year of the COVID-19 pandemic. Before the pandemic, 28 (16.37%) children had an abnormal CPMS score, while after the pandemic, 73 (42.69%) had an abnormal score. Prior to the pandemic, 96 (56.14%) children had a screen time of 1-2 hours per day, but after the pandemic, 94 (55%) had a screen time of more than four hours. Psychosocial problems were significantly higher in nuclear families before the pandemic (p-value <0.05) and significantly higher in children with increased screen time after the pandemic (p-value <0.01). Conclusion: The COVID-19 pandemic has led to an increase in psychosocial disorders among children. There is an urgent need to address these issues in children at an early stage so that early interventions can be implemented.
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