Timeliness and equity of infant pertussis vaccination in wales: Analysis of the three dose primary course

Infants aged under one year are at the highest risk of severe complications or death from pertussis infection. Prompt vaccination with a three dose course at two, three and four months of age decreases the amount of time they are vulnerable following waning of maternal antibodies. In Wales, uptake of all three doses of the primary course of pertussis containing vaccine is high. However, timeliness and equity at a population level have not been previously reported.This analysis included 163,733 children born from 1st January 2013 to 31st December 2017. In this cohort 87.9% received the first dose of a pertussis containing vaccine by 12 weeks of age, 87.1% had received all three doses by 24 weeks of age, and 96.3% received three doses by 52 weeks of age.Differences in uptake between those living in the most deprived and least deprived quintiles of Lower Super Output Area (LSOA) were smaller than differences in timeliness, but statistically significant. In 2017 the difference in timely uptake between those living in the most and least deprived quintiles was 4%, 5% and 7% for doses one, two and three respectively. There was a difference of 10% in the proportion of infants receiving all three primary vaccinations on time between the most and least deprived quintile of LSOAs.Consideration is needed on interventions that will help improve timeliness such as enhanced follow up of defaulters, electronic communication between primary care data systems, enhanced health visitor intervention and opportunistic vaccination in those who fail to attend scheduled vaccination appointments. There is also the need for routine monitoring of timeliness and further research into what influences delayed vaccination.     

Midwifery care for women with human immunodeficiency virus disease in pregnancy: A demonstration project at the Johns Hopkins Hospital

Nurse-midwives at the Johns Hopkins Hospital, in conjunction with their colleagues in obstetrics, pediatrics, and infectious disease, are participating in a demonstration project designed to provide continuity of care for women with HIV disease in pregnancy. In the past 19 months, 73 women have been enrolled in the project. This article describes how the midwifery model of care has been integrated into the existing system of routine obstetric care and specialized HIV-related care at the institution. This project could serve as a model for others who are redesigning health care delivery systems to include more nurse-midwives, especially those who are trying to adapt to an ever-increasing number of women experiencing some phase of HIV disease during their pregnancy. A companion article explains the midwifery and medical protocols used in the project and discusses other clinically relevant issues.     

一起天津市集体单位内新型冠状病毒肺炎聚集性疫情流行病学调查

目的 对天津市一起新型冠状病毒肺炎（COVID-19）聚集性疫情进行详细调查和分析,旨在为COVID-19的流行病学特征提供更多证据,并对前期基于有限证据和经验实施的防控措施进行评估。方法 采用描述性研究方法对一起发生在集体单位内的聚集性病例进行三间分布及其他流行病学特征描述。结果 自第一例指示病例于1月15日发病后,该单位相继发现10例确诊病例,且疫情从单位传播到4个家庭内,致7人发病。17例病例年龄中位数为55（19~79）岁;其中10例职工病例全部为男性,7例家庭聚集病例中男性3例,女性4例。职工病例中,8例办公地点在CW车间,2例在行政办公楼。病例的暴露-发病间隔中位数为4 d,其中职工病例暴露-发病间隔中位数为4.5 d,家庭聚集病例为4 d。初期发病未实施隔离措施的病例发病-就诊间隔中位数为4 d,发病期间开始居家隔离的病例发病-就诊间隔中位数为2.5 d,发病前开始居家隔离的病例发病-就诊间隔中位数为0.5 d。结论 COVID-19传播过程中存在单位和家庭聚集性,在疫情发生初期,准确、迅速的采取封控措施完全可以阻止COVID-19聚集性疫情的大范围扩散。     

基于中国双生子人群的冠心病遗传-BMI交互作用研究

目的 分析冠心病患病的遗传-BMI交互作用。方法 利用中国双生子登记系统募集的20 340对≥ 25岁的同性别双生子,构建单变量遗传-环境交互作用模型,通过评估BMI对冠心病遗传效应的修饰作用反映冠心病的遗传-BMI交互作用。结果 调整年龄后,在男性中发现BMI对冠心病患病受到的遗传效应有负向修饰作用,遗传效应修饰系数（β_a）及95% CI为-0.14（-0.22~-0.04）,说明log-BMI每增加1个标准差,冠心病的遗传通径系数减小0.14,从而导致冠心病的遗传效应减小。而且低BMI（<24.0 kg/m²）男性冠心病患病的遗传度为0.77（0.65~0.86）,而高BMI（≥ 24.0 kg/m²）组对应模型中的遗传度为0.56（0.33~0.74）。在女性中未观察到冠心病的遗传-BMI交互作用。结论 中国成年男性双生子人群中发现冠心病患病的遗传-BMI交互作用,且遗传因素在低BMI组冠心病患病中发挥更重要的作用。     

Evaluating the population measles susceptibility in Tianjin,China

BackgroundMeasles is a highly infectious illness requiring herd immunity of 95% to interrupt transmission. China has not reached elimination goals despite high vaccination coverage. We estimated the population susceptibility against measles in Tianjin, China and to tailor awareness raising activities in the measles elimination plan.MethodsAge-specific measles seroprevalence was evaluated by Enzyme-Linked Immunosorbent Assay (ELISA) on 12,164 individual aged 0–44 years in 2009–2018. Measles IgG avidity testing was performed to confirm the relationship of the waning immunity after vaccination and secondary vaccination failures (SVF) on 324 confirmed measles cases in 2013–2018.Results11,108 samples (91.32%) tested positive for measles IgG, 239 (1.96%) tested as equivocal and 817 (6.72%) were negative. The age distribution of measles cases in Tianjin followed a U-shaped curve and was highest for those at <8 months and again at 20–39 years which correlated closely with the age distribution of measles susceptibility based on measles IgG antibody status (r = 0.72, P < 0.001). The seropositivity rate and antibody geometric mean concentration (GMC) for the 2018 study population were significantly lower (χ² = 7.45, P = 0.006 and t = 12.01, P < 0.001) compared to 2009. The multivariate stepwise logistic regression analysis showed that age and region were the risk factors for both measles seropositivity rate and GMC after vaccination. The proportion of high avidity cases increased with age, being significantly higher in 75.31% of cases in patients aged 30–34 years (χ² = 18.04, P = 0.003).ConclusionsHigh immunization coverage in children alone will not be adequate to realizing sufficient levels of population herd immunity, particularly given that the potential susceptibility window in adult. Implementation of supplemental immunization activity (SIA) targeted to appropriate group aged 30–34 years is recommended.     

Does corruption undermine trust in health care? Results from public opinion polls in Croatia

Health and health care provision are one of the most important topics in public policy, and often a highly debated topic in the political arena. The importance of considering trust in the health care sector is highlighted by studies showing that trust is associated, among others, with poor self-related health, and poorer health outcomes. Similarly, corruption has shown to create economic costs and inefficiencies in the health care sector. This is particularly important for a newly democratized country such as Croatia, where a policy responsive government indicates a high level of quality of democracy (Roberts, 2009) and where a legacy of corruption in the health care sector has been carried over from the previous regime. In this study, I assess the relationship between health care corruption and trust in public health care and hypothesize that experience with health care corruption as well as perception of corruption has a negative effect on trust in public care facilities. Data were collected in two surveys, administered in 2007 and 2009 in Croatia. Experience with corruption and salience with corruption has a negative effect on trust in public health care in the 2007 survey, but not in the 2009 survey. While the results are mixed, they point to the importance of further studying this relationship.     

Homeopathic Agents or Vitamins in Reducing Ecchymosis after Oculofacial Surgery: A Report by the American Academy of Ophthalmology

PurposeTo review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.MethodsA literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.ResultsThe agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.ConclusionsThe current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.     

Estimates of pertussis vaccine effectiveness in United States air force pediatric dependents

BackgroundPertussis vaccination compliance is critical for reduction in the prevalence of disease; however, the current acellular pertussis vaccine may not provide sufficient protection from infection. This study examined acellular pertussis vaccine effectiveness (VE) for Air Force dependents less than 12 years of age.MethodsWe conducted a case-control study among Air Force pediatric dependents from 2011 to 2013, comparing cases with positive pertussis test results to controls who received the same lab tests with a negative result. Our study population was categorized by age group and vaccination status based on the Centers for Disease Control and Prevention recommended pertussis vaccination schedule. VE was calculated with respect to vaccination status and pertussis lab results.ResultsWe compared 27 pertussis laboratory positive cases with 974 pertussis laboratory negative controls, 2 months to <12 years old. Comparing completely vaccinated to non-vaccinated patients, the overall VE was 78.3% (95% confidence interval (CI): 48.6, 90.8; p < 0.001). VE was highest among those 15 months to <6 years old: 97.6% (95% CI: 78.5, 99.7; p < 0.001). Children 6 to <12 years old had the lowest VE: 48.5% (95% CI: −74.0, 84.7; p = 0.28). Comparing partially vaccinated patients to nonvaccinated patients yielded 64.2% (95% CI: −7.2, 88.1; p = 0.06) overall VE.ConclusionsAcellular pertussis vaccination was effective at preventing laboratory confirmed pertussis among our Air Force pediatric dependent population, with highest protection among completely vaccinated, young children. Older children received the lowest amount of protection. Partial vaccination had near significant protection. Our overall calculated pertussis VE corroborates other pertussis VE studies looking at similar age groups.