孕妇新型冠状病毒肺炎及疫苗的流行病学研究进展

新型冠状病毒肺炎（COVID-19）是一种由新型冠状病毒（新冠病毒）引起的急性呼吸道传染性疾病。由于妊娠期间的生理变化,孕妇易感COVID-19,尤其是新冠病毒变异株流行期间,孕妇不良妊娠结局的发生风险可能更高。目前尚缺乏孕妇接种新冠病毒疫苗（新冠疫苗）的随机临床试验证据,各国关于孕妇接种新冠疫苗的推荐存在差异,这给孕妇COVID-19的防控带来了一定挑战。本文回顾了国内外妊娠期感染新冠病毒的重要研究进展,论述了妊娠期患COVID-19对孕妇、胎儿及婴儿的危害,以及真实世界研究中妊娠期接种新冠疫苗的有效性和安全性等,以期为今后开展孕妇相关研究,制定防控措施提供参考。     

新型冠状病毒肺炎集中医学观察点的卫生与消毒

目的总结新型冠状病毒肺炎集中医学观察点的卫生与消毒工作经验,为类似工作提供参考。方法现场调查17所观察点,记录发现的问题并提出整改意见。结果 6所观察点卫生防护距离不足500 m,少数观察点无法做到医学观察区与清洁区完全分离,部分酒店观察点房间通风不好,普遍存在隔离观察室卫生管理困难,部分观察点存在过度消毒的问题。结论部分观察点不宜被设为医学观察点,部分观察点的卫生与消毒情况有待改进。建议从行政管理角度改善加强观察点的卫生与消毒工作。     

疫苗时代新型冠状病毒肺炎疫情防控策略

新型冠状病毒肺炎(新冠肺炎)疫情暴发初期,全球主要采取保持社交距离,戴口罩等非药物干预措施.随着新冠疫苗研发的成功以及部分国家的紧急使用,全球新冠肺炎疫情防控开始进入预防接种和非药物干预措施并举的阶段.由于初期疫苗供应短缺,不同国家的接种策略存在差异.为了控制新冠肺炎疫情,全球新冠疫苗接种率需为47％～85％,应增加疫...     

新型冠状病毒肺炎疫苗上市前疫苗犹豫情况及相关影响因素研究

目的 了解新型冠状病毒肺炎(简称新冠肺炎)疫苗上市前的疫苗犹豫发生情况及相关影响因素,为在疫苗上市早期采取针对性的干预措施提供科学依据.方法 自行设计调查问卷并通过网络发放,比较疫苗犹豫者和接受者在社会人口学信息、对新冠肺炎的认知情况、对疫苗的一般性认知情况,以及信心、自满和便利性等维度的差异.采用单因素和多因素log...     

新型冠状病毒疫苗研发进展及接种意愿分析

新型冠状病毒肺炎（COVID-19）自2019年末爆发后迅速造成全球大流行,对公共卫生健康构成众大威胁。引发COVID-19的严重急性呼吸系统综合征冠状病毒-2（SARS-CoV-2）是高致病性病毒,各国采取多种防疫措施均未能从根本控制病毒传播,有效的疫苗对应控制疫情发生发展具有重要作用。各国通力合作,大力研发安全、有效的新型冠状病毒疫苗,本研究综述了新型冠状病毒疫苗研发的进展以及各国民众的疫苗接种意愿。     

全球卫生安全指数评估有效性分析

目的  研究全球卫生安全指数（Global Health Security Index,GHSI）与COVID-19疫情的关系,探索GHSI的价值。 方法  对来自公开数据库的159个国家（地区）进行横断面研究。用Spearman分析GHSI与COVID-19大流行的相关性,并绘制相关性矩阵。拟合多元线性回归模型控制各国社会经济及健康状况等因素,进一步研究GHSI与COVID-19大流行相关指标的关联。 结果  159个国家（地区）2021年GHSI总分平均（41.19±13.41）分,最小值16.10分（也门）,最大值75.90分（美国）。截至2021年12月31日159个国家（地区）COVID-19粗病死率0.02（0.01,0.03）,最小值< 0.01（不丹）,最大值0.20（也门）。每百万人口总确诊病例数50 844.42（5 807.88,101 572.70）例,最小值22.26（瓦努阿图共和国）,最大值251 608.38（斯洛伐克）。每百万人口总死亡病例数590.71（105.66,1 533.20）,最小值3.10（布隆迪）,最大值6 075.95（秘鲁）。多元线性回归分析显示,GHSI检测报告评分与每百万人口总确诊病例呈负相关（β=-0.34,P=0.038）,与每百万人口总死亡病例呈负相关（β=-0.42,P=0.025）;GHSI国际规范评分与每百万人口总确诊病例呈负相关（β=-0.49,P=0.041）,GHSI卫生系统评分与每百万人口总死亡病例呈正相关（β=0.65,P=0.003）,GHSI风险环境评分与粗病死率呈负相关（β=-0.91,P=0.044）。 结论  GHSI在评估各国家（地区）应对COVID-19大流行的能力方面缺乏有效性,但仍存在一定价值。     

新型冠状病毒肺炎疫情防控面临的挑战

2019年12月湖北省武汉市报告的不明原因重症肺炎聚集性病例事件被确定为新型冠状病毒感染。WHO于2020年2月11日将该病命名为COVID-19。截至3月10日,新型冠状病毒肺炎已造成包括我国在内的114个国家和地区出现了11.8万病例。3月11日WHO评估认为,新型冠状病毒肺炎疫情已呈现大流行特征。当前新型冠状病毒肺炎防控工作面临巨大挑战,主要是由于病原溯源困难、传染源分布广泛、传播途径多样、易感人群免疫水平较低、传染性较强和疫苗研发尚需时日等因素的影响。     

新型冠状病毒肺炎疫苗有效性评价中的相关问题探讨

新型冠状病毒肺炎出现以来,席卷了全球各个国家和地区,安全且有效的新型冠状病毒肺炎疫苗是控制新型冠状病毒肺炎疫情最有效手段之一。新型冠状病毒肺炎疫苗的关键性临床研究通常采用安慰剂对照的保护效力试验,以观察疫苗是否可以有效降低疾病的发病率。本文即将对新冠疫苗保护效力临床试验中研究设计和研究终点的考量、统计学评价方法、主要估...     

新型冠状病毒肺炎疫情下公立医院卫生应急管理思考

新型冠状病毒肺炎疫情的全国暴发与蔓延给防控带来巨大的挑战,公立医院作为传染病疫情救治的主战场承受着巨大的压力。由于新发疾病的不确定性,此次疫情早期的风险识别、风险预警,乃至此后的救治等链条都存在着亟待完善之处,更需要在未来的医院卫生应急风险防控上基于多部门、多系统的协同治理,在提高风险意识、完善应急机制、加强监测预警、强化常态化的预案管理等方面提高疫情分析和研判能力,同时借力互联网医疗的信息对接、共享与交流提升诊疗能力,最大限度保障医务人员的健康安全。     

全球卫生法:全球卫生治理的新趋势

全球化对全球人口的健康产生了深刻影响.疾病全球化呼吁公共卫生治理的全球化.全球卫生治理与传统的国际卫生治理在治理主体、治理方式、治理结构及价值取向等方面存在区别.全球卫生治理的目标是让全世界人民获得可能的最高水平的健康标准.人人享有健康的美好理想只有通过全球卫生"善治"才能实现.而实现全球卫生"善治"的主要机制是国际卫...     

Access to food and health care during the COVID-19 pandemic by disability status in the United States

BackgroundThe COVID-19 pandemic has impacted people's access to food and health care. People with disabilities may be disproportionately affected by these outcomes due to structural and social barriers.Objective/HypothesisTo examine the relative prevalence of food insufficiency and unmet health care needs among the U.S. residents by vision, hearing, cognition, and mobility disability.MethodsWe used data from the Household Pulse Survey wave conducted from April 14 to April 26, 2021, when questions about functional disability were first included. Participants were asked about difficulty seeing, hearing, remembering or concentrating, and walking or climbing stairs. The outcomes of interest were food insufficiency, delaying needed medical care and not getting needed medical care. Poisson regression models with robust variance adjusted for potential confounders were used to examine the prevalence ratio of each of these outcomes by disability status in separate models for each type of disability.ResultsDuring April 14–26, 2021, 39.5% adults in the U.S. reported cognitive disability, 30.8% reported vision disability, 23.2% reported mobility disability, and 14.9% reported hearing disability. Adults with any type of disability were more likely than those without to experience food insufficiency (range of prevalence rate ratios [PRR]: 1.67–1.96), and delay (range of PRR: 1.48–1.87) or not get (range of PRR: 1.60–2.07) needed medical care.ConclusionsThese disparities suggest there is an urgent need to address the negative impact of the COVID-19 pandemic on people with disabilities. The prioritization of disability data collection is key in achieving that goal.     

Vaccines: New challenges,new paradigms,new opportunities: Report of the 22nd DCVMN Annual General Meeting

The Developing Countries Vaccine Manufacturers Network held its 22nd Annual General Meeting in October 2021. Vaccine manufacturing experts, leaders from global public health organizations and dignitaries from governments and multilateral organizations discussed the challenges and opportunities emerging from the COVID-19 pandemic. Over 350 delegates from 33 countries, representing over 70 organizations partook in the meetings deliberations.The development and scaled-up production of several safe and effective vaccines against COVID-19 resulted in over 12 billion doses being produced by the end of 2021. Unfortunately, this scientific achievement and outstanding industry effort has been overshadowed by the striking inequity in access to COVID-19 vaccines. High and upper middle-income countries have received 75% of the vaccines, while in Africa, less than 5% of the people are fully vaccinated. The inequitable access to vaccines is an issue of national health security, which has stressed the need to establish local vaccine manufacturing capacity in Africa. Key partnerships, initiatives and the deliberate strategies required to achieve sustainable manufacturing on the continent were discussed. The ability to acquire technology, access markets and financing mechanisms, and workforce development were reported as key enablers to achieving a healthy ecosystem.Innovative vaccine technologies, new regulatory approaches, and the importance of voluntary technology transfers in increasing the global supply capacity of both COVID-19 vaccines and traditional vaccines were highlighted. In reviewing the lessons learned from the pandemic, speakers shared a consensus that innovation and partnerships will be central to any solution proposed to mitigate the current pandemic and prepare for future ones.     

With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines

Although COVID-19 vaccines are becoming increasingly available, their ability to effectively control and contain the spread of the COVID-19 pandemic is highly contingent on an array of factors. This paper discusses how limitations to vaccine accessibility, issues associated with vaccine side effects, concerns regarding vaccine efficacy, along with the persistent prevalence of vaccine hesitancy among the public, including health care professionals, might impact the potential of COVID-19 vaccines to curb the pandemic. We draw insights from the literature to identify practical solutions that could boost people’s adoption of COVID-19 vaccines and their accessibility. We conclude with a discussion on health experts’ and government officials’ moral and ethical responsibilities to the public, even in light of the urgency to adopt and endorse “the greatest amount of good for the greatest number” utilitarian philosophy in controlling and managing the spread of COVID-19.     

COVID-19 vaccination intention and activation among health care system employees: A mixed methods study

BackgroundAchieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees.MethodsThe study was conducted from December 2020 – May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4–6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion.ResultsPrior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as “immunization advocates”, 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention.ConclusionThe findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.     

Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China

BackgroundCOVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public’s attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates.ObjectiveThe aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics.MethodsWe conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights.ResultsA total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6%, 95% CI 74.6%-76.5%). Women (3778/4921, 76.8%; odds ratio 1.18, 95% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8%; odds ratio 1.13, 95% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI 71%-73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI 76.3%-78.2%).ConclusionsAmong our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers’ actions on COVID-19 vaccine distribution with the preferences of their constituencies.     

COVID-19 vaccine uptake,effectiveness, and waning in 82,959 health care workers: A national prospective cohort study in Wales

BackgroundWhile population estimates suggest high vaccine effectiveness against SARS-CoV-2 infection, the protection for health care workers, who are at higher risk of SARS-CoV-2 exposure, is less understood.MethodsWe conducted a national cohort study of health care workers in Wales (UK) from 7 December 2020 to 30 September 2021. We examined uptake of any COVID-19 vaccine, and the effectiveness of BNT162b2 mRNA (Pfizer-BioNTech) against polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection. We used linked and routinely collected national-scale data within the SAIL Databank. Data were available on 82,959 health care workers in Wales, with exposure extending to 26 weeks after second doses.ResultsOverall vaccine uptake was high (90%), with most health care workers receiving the BNT162b2 vaccine (79%). Vaccine uptake differed by age, staff role, socioeconomic status; those aged 50–59 and 60+ years old were 1.6 times more likely to get vaccinated than those aged 16–29. Medical and dental staff, and Allied Health Practitioners were 1.5 and 1.1 times more likely to get vaccinated, compared to nursing and midwifery staff. The effectiveness of the BNT162b2 vaccine was found to be strong and consistent across the characteristics considered; 52% three to six weeks after first dose, 86% from two weeks after second dose, though this declined to 53% from 22 weeks after the second dose.ConclusionsWith some variation in rate of uptake, those who were vaccinated had a reduced risk of PCR-confirmed SARS-CoV-2 infection, compared to those unvaccinated. Second dose has provided stronger protection for longer than first dose but our study is consistent with waning from seven weeks onwards.     

Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies

ImportanceThe success in ending the COVID-19 pandemic rests partly on the mass uptake of the COVID-19 vaccine. Little work has been done to understand vaccine willingness among older adolescents and young adults. This is important since this age group may be less likely to adhere to public health guidelines.ObjectiveTo understand willingness of getting a vaccine and reasons for vaccine hesitancy among a sample of older adolescents and young adults.DesignData were from the Well-Being and Experiences study (The WE Study), a longitudinal community-based sample of older adolescents and young adults collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664).SettingThe study setting was a community-based observational longitudinal study.ParticipantsParticipants for the study were aged 14 to 17 years old at baseline in 2016–17 (n = 1000). Data were also collected on one parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 2020, respectively.ExposuresThe main exposures were sociodemographic factors, health conditions, COVID-19 knowledge, and adversity history.Main OutcomesThe main outcomes were COVID-19 vaccine willingness, hesitancy, and reasons for hesitancy.ResultsWillingness to get a COVID-19 vaccine was 65.4%. Willingness did not differ by age, sex, or mental health conditions, but did differ for other sociodemographic characteristics, physical health conditions, COVID-19 knowledge, practicing social/physical distancing, and adversity history. The most common reasons for not wanting a vaccine were related to safety, knowledge, and effectiveness. Sex differences were noted.Conclusions and RelevanceIncreasing uptake of the COVID-19 vaccine among older adolescents and young adults may rely on targeting individuals from households with lower income, financial burden, and adversity history, and generating public health messaging specifically aimed at vaccine safety, how it works to protect against illness, and why it is important to protect oneself against a COVID-19 infection.     

Exploring the attitudes,concerns, and knowledge regarding COVID-19 vaccine by the parents of children with rheumatic disease: Cross-sectional online survey

BackgroundVaccination programs are effective strategies in preventing infectious diseases and controlling epidemics. Vaccination against SARS-CoV-2 in children has not yet been approved globally, and it is unclear what attitude families will take when it is approved in children. We aimed to investigate the underlying causes of vaccine acceptance, hesitation, and refusal, as well as concerns about the acceptability of the COVID-19 vaccine by parents of children with rheumatic diseases.MethodsParents of children followed up with a diagnosis of rheumatic disease in the pediatric rheumatology outpatient clinic of a university hospital were included in the study. We applied a closed web-based online survey conducted cross-sectionally and sent to the participants via mobile smartphones.ResultsFor fathers, mothers, and their children, acceptance rates for a COVID-19 vaccine were 64.2%, 57.7%, and 41.8%, respectively. In the multivariate analysis, factors affecting parents' acceptance of vaccines for their children were as follows: “Receiving antirheumatic medications regularly (AOR 5.40, 95% CI 1.10–26.33, p = 0.03), the previous history of getting special recommended vaccines (AOR 4.12, 95% CI 1.12–27.85, p = 0.03), relying on vaccines for ending pandemic (AOR 8.84, 95% CI 2.80–27.85, p = 0.001), complying with the pandemic measures entirely (AOR 5.24, 95% CI 1.46–18.74, p = 0.01)“. The two most common reasons for vaccine rejection were fear of the side effects of the vaccine and its possible interaction with rheumatic drugs used by children.ConclusionAccording to our survey, parents were more likely to accept a COVID-19 vaccine for themselves than their children. The success of COVID-19 vaccination programs sources highly on people's willingness to accept the vaccine. It is crucial to vaccinate children for achieving herd immunity and in terms of avoiding vaccine hesitancy. Larger data examining the causes of concerns in parents of both healthy children and children with chronic diseases should be delineated.     

新冠肺炎医疗队医务人员感染防控相关需求调查

 

目的 调查驰援武汉抗疫医务人员对正确穿脱防护用品了解情况以及疫区感染防控知识需求。方法 自行设计调查表,依托网络平台对安徽省驰援武汉抗疫医疗队医务人员的感染防控相关需求及心理负担情况进行调查。结果 共调查625名医务人员,调查对象以女性为主（66.88%）,年龄主要为30~39岁（57.60%）。医疗队员来源科室主要为重症监护病房（ICU）和呼吸科（分别为151、131名）。在疫区实践操作培训前有590名（94.40%）医务人员接受过防护用品理论和操作视频培训,但还有35名（5.60%）之前未接受过相关培训。在对医院感染监控人员依赖情况的调查中,6个条目的回答结果中希望医院感染监控人员给予指导帮助的均占98%以上。66.08%的医务人员在疫区实践操作前有担心害怕的感觉,71.68%的医务人员存在可能暴露后的恐惧和心理阴影,91.20%的医务人员希望建立一个医院感染的心理咨询平台,91.36%的医务人员在疫区实践操作培训后担心害怕的感觉减轻。护理专业人员在疫区实践操作培训前有担心害怕的感觉、存在可能暴露后的恐惧和心理阴影、希望建立一个医院感染的心理咨询平台的比率（68.76%、74.19%、92.84%）均高于临床及影像专业人员（59.26%、65.43%、86.42%）;差异均有统计学意义（均P<0.05）。结论 医院感染监控人员在医疗队员入岗前进行穿脱防护用品实操演示培训,建立标准流程,指导落实驻地生活工作等方面的消毒方法与注意事项,能够明显减轻医务人员的心理负担,使其掌握科学的防控方法,降低医务人员感染的风险。