中小学校学生流感疫苗接种效果评估和卫生经济学评价

目的评估中小学校学生流感疫苗接种效果,开展疫苗接种的卫生经济学评价,为制定流感疫苗接种策略提供依据。方法采用易感者-潜伏者-显性感染者/隐性感染者-移出者/恢复者(susceptible-exposed-infectious/asymptomatic-removed/recovered,SEIARR)动力学模型对既往疫情数据进行模拟,计算累计罹患率评估疫苗接种效果,计算成本-效果和成本-效益进行卫生经济学评价。结果当流感疫苗接种率为0%、50%、70%和90%时,疫情平均累积罹患率为99.79%(99.75%,99.82%)、70.84%(70.58%,71.09%)、56.81%(56.17%,57.45%)和34.29%(32.46%,36.20%),流感疫苗接种率越高,累计罹患率越低;当疫苗接种率为50%、70%和90%时,疫苗的成本-效果比为:141.03(139.86,142.19)元、133.16(131.34,135.08)元和112.90(110.03,116.11)元,疫苗的成本-效益比为:6.27(6.22,6.32)元、6.65(6.56,6.74)元和7.88(7.66,8.09)元;流感疫苗接种率越高,疫苗的成本-效果越好,成本-效益越高。结论接种流感疫苗能有效降低疫情的累计罹患率,提高接种率能有效增加疫苗接种的卫生经济学效应。     

Specifics of chronic fatigue syndrome coping strategies identified in a French flash survey during the COVID-19 containment

The COVID-19 pandemic has focused health systems on supporting patients affected by this virus. Meanwhile in the community, many other contained patients could only use self-care strategies, especially in countries that have set up a long and strict containment such as France. The study aimed to compare coping strategies deployed by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS; a poorly recognised syndrome) to those with better known and referenced chronic conditions. An online flash survey was conducted during the containment period in partnership with French Patients Organizations including ME/CFS national association. Therefore, ‘Brief COPE’ version of Lazarus and Folkman's Ways of Coping Check List has been adapted to the specificity of the containment. The survey was e-distributed in France from 15 April to 11 May 2020. Differences of coping strategies were analyzed using Wilcoxon–Mann–Withney test. Amongst 637 responses, 192 were complete, presenting a wide variety of diseases, including 93 ME/CFS. The latter have significantly different coping strategies than recognised diagnosed diseases patients: similar uses of emotion focused coping but less uses of seek social support and problem-focused copings. In conclusion, coping strategies are different for those who deal with the daily experience of ME/CFS, highly disabling chronic condition with diagnostic ambiguity, low degree of medical and social recognition and without treatment. Better understanding of those strategies is needed to provide the means for health promotion researchers, managers and clinicians, to accompany those patients.     

2018—2020年珠海市学校流感样病例暴发疫情流行特征及影响因素分析

目的 分析珠海市2018—2020年学校流感样病例暴发疫情的流行特征和影响疫情规模的相关因素,为制定防控策略提供依据。方法 采用描述流行病学方法分析学校流感样病例暴发疫情流行特征,采用χ2检验和Logistic回归分析疫情规模的影响因素。结果 2018—2020年珠海市学校累计报告67起流感样病例暴发疫情,累计发病人数1 746例。发病高峰为每年3月—6月和12月—次年1月,主要发生在小学,流感样病例的发病年龄高峰为6～8岁。病原体主要为B型、A(H3N2)亚型和A(H1N1)亚型流感病毒。暴发疫情涉及病例咽痛发生率>50%的学校发生大规模流感样病例暴发疫情的风险是咽痛发生率≤50%学校的4.308倍(95%CI:1.100～16.864)。结论 2018—2020年珠海市学校流感样病例暴发疫情主要集中在冬春季节的小学,高咽痛发生率是学校发生大规模疫情流感样病例暴发疫情的危险因素。     

Improving health care for disabled people in COVID-19 and beyond: Lessons from Australia and England

COVID-19 has exacerbated pre-existing difficulties children and adults with disability face accessing quality health care. Some people with disability are at greater risk of contracting COVID-19 because they require support for personal care and are unable to physically distance, e.g. those living in congregate settings. Additionally, some people with disability have health conditions that put them at higher risk of poor outcomes if they become infected. Despite this, governments have been slow to recognise, and respond to, the unique and diverse health care needs of people with disability during COVID-19. While some countries, including Australia, have improved access to high-quality health care for people with disability others, like England, have failed to support their citizens with disability. In this Commentary we describe the health care responses of England and Australia and make recommendations for rapidly improving health care for people with disability in the pandemic and beyond.     

Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination

ObjectivesQuantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents.DesignRetrospective cohort.Setting and ParticipantsShort- and long-stay U.S. NH residents aged ≥65 years.MethodsWe linked Minimum Data Set (MDS) and Medicare data to LTCFocUS and other facility data. We included residents with 6-month continuous enrollment in Medicare and an MDS assessment between October 1, 2013, and March 31, 2014. Residents were classified as short-stay (<100 days in NH) or long-stay (≥100 days in NH). We fit multivariable logistic regression models to assess the relationships between 27 resident and NH-level characteristics and receipt of influenza vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparity in influenza vaccination between White versus Black and White versus Hispanic NH residents. Analyses were repeated separately for short- and long-stay residents.ResultsOur study included 630,373 short-stay and 1,029,593 long-stay residents. Proportions vaccinated against influenza included 67.2% of White, 55.1% of Black, and 54.5% of Hispanic individuals among short-stay residents and 84.2%, 76.7%, and 80.8%, respectively among long-stay residents. Across 4 comparisons, the crude disparity in influenza vaccination ranged from 3.4 to 12.7 percentage points. By equalizing 27 prespecified characteristics, these disparities could be reduced 37.7% to 59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors across all analyses. Characteristics unmeasured in our data (eg, NH staff attitudes and beliefs) may have also contributed significantly to the disparity.Conclusions and ImplicationsThe racial/ethnic disparity in influenza vaccination was most dramatic among short-stay residents. Intervening on factors associated with NH quality would likely reduce these disparities; however, future qualitative research is essential to explore potential contributors that were unmeasured in our data and to understand the degree to which these factors contribute to the overall disparity in influenza vaccination.     

Etiology of Severe Acute Respiratory Infections,Bangladesh, 2017

In April 2017, surveillance detected a surge in severe acute respiratory infections (SARI) in Bangladesh. We collected specimens from SARI patients and asymptomatic controls for analysis with multipathogen diagnostic tests. Influenza A(H1N1)pdm09 was associated with the SARI epidemic, suggesting that introducing vaccines and empiric antiviral drugs could be beneficial.     

Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission,France, 2016–17

We detected 3 genotypes of highly pathogenic avian influenza A(H5N8) virus in France during winter 2016–17. Genotype A viruses caused dramatic economic losses in the domestic duck farm industry in southwestern France. Our phylogenetic analysis suggests that genotype A viruses formed 5 distinct geographic clusters in southwestern France. In some clusters, local secondary transmission might have been started by a single introduction. The intensity of the viral spread seems to correspond to the density of duck holdings in each production area. To avoid the introduction of disease into an unaffected area, it is crucial that authorities limit the movements of potentially infected birds.     

COVID-19 and Infant Hospitalizations for Seasonal Respiratory Virus Infections,New Zealand, 2020

In March 2020, a national elimination strategy for coronavirus disease was introduced in New Zealand. Since then, hospitalizations for lower respiratory tract infection among infants <2 years of age and cases of respiratory syncytial or influenza virus infection have dramatically decreased. These findings indicate additional benefits of coronavirus disease control strategies.     

“Together in a pressure cooker”: Parenting children with disabilities during the COVID-19 lockdown

BackgroundCOVID-19 has had a disproportionate and unprecedented impact on children with disabilities, their parents and families. This impact has been particularly evident during periods of lockdowns and severe restrictions.ObjectiveThis study employed the social model of disability to illuminate negative and positive experiences of Israeli parents of children with disabilities during the first COVID-19 lockdown, as well as the way social environments, particularly educational and welfare services, shape that experience.MethodsThe study draws upon thematic analysis of written responses of 80 Israeli parents to open-ended questions.ResultsThree main themes were found: (1) lack of responsiveness of both informal and formal supports to family needs, mainly in the educational and welfare systems; (2) juggling multiple roles and tasks along with the parents' routinely intensive caregiving role; and (3) the impact on the family's wellbeing and relationships.ConclusionThese results are discussed in light of the social model of disability, showing how social restrictions and barriers affect both negative and positive experiences of these families. Also discussed are practical implications for future crises.