BackgroundAs global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal ...injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations.ResultsThe global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%.ConclusionsCertain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.
BackgroundDrowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 ...mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study’s objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.MethodsUnintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning.ResultsGlobally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes.ConclusionsThere has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.
Abstract
Background
In-depth immunogenicity studies of tixagevimab-cilgavimab (T-C) are lacking, including following breakthrough coronavirus disease 2019 (COVID-19) in vaccinated patients with ...hematologic malignancy (HM) receiving T-C as pre-exposure prophylaxis.
Methods
We performed a prospective, observational cohort study and detailed immunological analyses of 93 patients with HM who received T-C from May 2022, with and without breakthrough infection, during a follow-up period of 6 months and dominant Omicron BA.5 variant.
Results
In 93 patients who received T-C, there was an increase in Omicron BA.4/5 receptor-binding domain (RBD) immunoglobulin G (IgG) antibody titers that persisted for 6 months and was equivalent to 3-dose-vaccinated uninfected healthy controls at 1 month postinjection. Omicron BA.4/5 neutralizing antibody was lower in patients receiving B-cell–depleting therapy within 12 months despite receipt of T-C. COVID-19 vaccination during T-C treatment did not incrementally improve RBD or neutralizing antibody levels. In 16 patients with predominantly mild breakthrough infection, no change in serum neutralization of Omicron BA.4/5 postinfection was detected. Activation-induced marker assay revealed an increase in CD4+ (but not CD8+) T cells post infection, comparable to previously infected healthy controls.
Conclusions
Our study provides proof-of-principle for a pre-exposure prophylaxis strategy and highlights the importance of humoral and cellular immunity post–breakthrough COVID-19 in vaccinated patients with HM.
In 93 vaccinated patients with hematologic malignancy receiving tixagevimab-cilgavimab, humoral and cellular immunity was assessed. In 16 patients with mild breakthrough infection, there was no change in serum neutralization of Omicron BA.4/5, but there was an increase in CD4+ T cells postinfection.
Abstract
Background
The determinants of coronavirus disease 2019 (COVID-19) disease severity and extrapulmonary complications (EPCs) are poorly understood. We characterized relationships between ...severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNAemia and disease severity, clinical deterioration, and specific EPCs.
Methods
We used quantitative and digital polymerase chain reaction (qPCR and dPCR) to quantify SARS-CoV-2 RNA from plasma in 191 patients presenting to the emergency department with COVID-19. We recorded patient symptoms, laboratory markers, and clinical outcomes, with a focus on oxygen requirements over time. We collected longitudinal plasma samples from a subset of patients. We characterized the role of RNAemia in predicting clinical severity and EPCs using elastic net regression.
Results
Of SARS-CoV-2–positive patients, 23.0% (44 of 191) had viral RNA detected in plasma by dPCR, compared with 1.4% (2 of 147) by qPCR. Most patients with serial measurements had undetectable RNAemia within 10 days of symptom onset, reached maximum clinical severity within 16 days, and symptom resolution within 33 days. Initially RNAemic patients were more likely to manifest severe disease (odds ratio, 6.72 95% confidence interval, 2.45–19.79), worsening of disease severity (2.43 1.07–5.38), and EPCs (2.81 1.26–6.36). RNA loads were correlated with maximum severity (r = 0.47 95% confidence interval, .20–.67).
Conclusions
dPCR is more sensitive than qPCR for the detection of SARS-CoV-2 RNAemia, which is a robust predictor of eventual COVID-19 severity and oxygen requirements, as well as EPCs. Because many COVID-19 therapies are initiated on the basis of oxygen requirements, RNAemia on presentation might serve to direct early initiation of appropriate therapies for the patients most likely to deteriorate.
Measurement of severe acute respiratory syndrome coronavirus 2 RNA from the plasma of patients with coronavirus disease 2019, using digital polymerase chain reaction, can predict disease severity, clinical deterioration, and extrapulmonary complications and may help guide patient triage and management.
Burden of disease has been used to assess population health status. This article presents the first estimations of burden of disease in Vietnam in 2008 using disability-adjusted life years (DALYs). ...DALYs were calculated using the Global Burden of Disease (GBD) methods. Incidence, prevalence of diseases, and causes of death was extracted from Vietnam data. Disability weights were borrowed from GBD and Dutch research. In 2008, the total burden of disease in Vietnam was 12.3 million DALYs. Noncommunicable diseases dominated the total burden of diseases in Vietnam, accounting for 71% of the total burden, and cardiovascular disease was the leading cause group of premature death. While pneumonia was an important cause of burden in Vietnamese children, stroke and depression were the main causes of disease burden among adults. The study provides a snapshot of Vietnamese health status and offers guidance for health policymaking in Vietnam.
We previously reported a new community-based mosquito control that resulted in the elimination of Aedes aegypti in 40 of 46 communes in northern and central Vietnam. During 2007 and 2008, we ...revisited Nam Dinh and Khanh Hoa provinces in northern and central Vietnam, respectively, to evaluate whether or not these programs were still being maintained 7 years and 4.5 years after formal project activities had ceased, respectively. Using a previously published sustainability framework, we compared 13 criteria from Tho Nghiep commune in Nam Dinh where the local community had adopted our community-based project model using Mesocyclops from 2001. These data were compared against a formal project commune, Xuan Phong, where our successful intervention activities had ceased in 2000 and four communes operating under the National Dengue Control Program with data available. In Khanh Hoa province, we compared 2008 data at Ninh Xuan commune with data at project completion in 2003 and benchmarked these, where possible, against an untreated control commune, Ninh Binh, where few control activities had been undertaken. The three communes where the above community-based strategy had been adopted were rated as well-sustained with annual recurrent total costs (direct and indirect) of $0.28-0.89 international dollars per person.
Immunocompromised hematology patients are vulnerable to severe COVID-19 and respond poorly to vaccination. Relative deficits in immunity are, however, unclear, especially after 3 vaccine doses. We ...evaluated immune responses in hematology patients across three COVID-19 vaccination doses. Seropositivity was low after a first dose of BNT162b2 and ChAdOx1 (∼26%), increased to 59%–75% after a second dose, and increased to 85% after a third dose. While prototypical antibody-secreting cells (ASCs) and T follicular helper (Tfh) cell responses were elicited in healthy participants, hematology patients showed prolonged ASCs and skewed Tfh2/17 responses. Importantly, vaccine-induced expansions of spike-specific and peptide-HLA tetramer-specific CD4+/CD8+ T cells, together with their T cell receptor (TCR) repertoires, were robust in hematology patients, irrespective of B cell numbers, and comparable to healthy participants. Vaccinated patients with breakthrough infections developed higher antibody responses, while T cell responses were comparable to healthy groups. COVID-19 vaccination induces robust T cell immunity in hematology patients of varying diseases and treatments irrespective of B cell numbers and antibody response.
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•COVID-19 vaccines elicit robust SARS-CoV-2-specific T cells in hematology patients•Prevalent TCRαβ motifs occur within tetramer+ T cells in hematological patients•Conversely, perturbed antibody responses and skewing of Tfh and ASC/Tfh kinetics occur•Breakthrough infection patients have higher antibodies and comparable T cell responses
Nguyen et al. define antibody, B, and T cell responses following COVID-19 vaccination in patients with hematological malignancy that are immunocompromised and vulnerable to severe COVID-19 infection. COVID-19 vaccination induces robust T cell immunity in hematology patients with diseases and treatments impacting B cell immunity irrespective of B cell numbers and antibody responses.
Immunocompromised haematology patients are vulnerable to severe COVID-19 and respond poorly to vaccination. Relative deficits in immunity are however unclear, especially after 3 vaccine doses. We ...evaluated immune responses in haematology patients across three COVID-19 vaccination doses. Seropositivity was low after 1
st
dose of BNT162b2 and ChAdOx1 (∼26%), increased to 59-75% after 2
nd
dose, and 85% after 3
rd
dose. While prototypical antibody-secreting cells (ASCs) and T-follicular helper (Tfh) responses were elicited in healthy participants, haematology patients showed prolonged ASCs and skewed Tfh2/17 responses. Importantly, vaccine-induced expansions of spike-specific and peptide-HLA tetramer-specific CD4
+
/CD8
+
T-cells, together with their TCR repertoires, were robust in heamatology patients, irrespective of B-cell numbers, and comparable to healthy participants. Vaccinated patients with breakthrough infections developed higher antibody responses, while T-cell responses were comparable to healthy groups. COVID-19 vaccination induces robust T-cell immunity in haematology patients of varying diseases and treatments, irrespective of B-cell numbers and antibody response.
Nguyen et al. define antibody, B and T cell responses following COVID-19 vaccination in haematological malignancy patients that are immunocompromised and vulnerable to severe COVID-19 infection. COVID-19 vaccination induces robust T-cell immunity in haematology patients with diseases and treatments impacting B cell immunity, irrespective of B-cell numbers and antibody responses.
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