Contact Tracing for Influenza A(H1N1)pdm09 Virus–infected Passenger on International Flight

In April 2009, influenza A(H1N1)pdm09 virus infection was confirmed in a person who had been symptomatic while traveling on a commercial flight from Mexico to the United Kingdom. Retrospective public health investigation and contact tracing led to the identification of 8 additional confirmed cases among passengers and community contacts of passengers.     

The economic impact of H1N1 on Mexico's tourist and pork sectors

By examining tourist arrivals and pork output and trade statistics, this analysis estimates the economic impact to the Mexican tourism and pork sectors because of the H1N1 influenza pandemic. It also assesses the role of the international response in the context of this economic impact. For tourism, losing almost a million overseas visitors translated into losses of around $US2.8bn, which extended over a five‐month period, mostly because of the slow return of European travellers. For the pork industry, temporal decreases in output were observed in most of the country and related to H1N1 incidence (p = 0.048, r = 0.37). By the end of 2009, Mexico had a pork trade deficit of $US27m. The losses derived from this pandemic were clearly influenced by the risk perception created in tourist‐supplying and pork trade partners. Results suggest that the wider economic implications of health‐related emergencies can be significant and need to be considered in preparedness planning. For instance, more effective surveillance and data gathering would enable policy to target emergency funding to the sectors and regions hardest hit. These results also stress the importance of being familiar with trade networks so as to be able to anticipate the international response and respond accordingly. Copyright © 2012 John Wiley & Sons, Ltd.     

SARS-CoV-2 outbreak impact on a trauma unit

BACKGROUND From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2(SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study.AIM To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma.METHODS We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic(from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up.RESULTS The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected(P 0.001), and had a higher mortality rate during hospitalization and follow-up(P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment(P = 0.03).CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.     

Management of thymomatous myasthenia gravis – Case report of a rare Covid19 infection sequelae

IntroductionSARS CoV19 infection can predispose to many autoimmune and neurological conditions, thymomatous myasthenia gravis being one of them. The rarity of these case poses therapeutic dilemmas about their further management.Presentation of caseA 61 year old gentleman who had covid19 infection 2 months back, presented with new onset myasthenia gravis and an anterior mediastinal mass. He was diagnosed as a case of anti acetyl choline receptor antibody positive thymomatous myasthenia gravis. The patient was posted for video assisted thoracoscopic excision of thymoma. The procedure was uneventful and patient was discharged with improvement in myasthenic symptoms. Histopathological examination confirmed the diagnosis of WHO Type A Spindle cell thymoma.DiscussionSARS CoV19 infection is associated with an array of autoimmune disorders due to various proposed phenomenon including molecular mimicry and loss of immune tolerance. Post infectious thymomatous myasthenia gravis is extremely uncommon, and can be managed with open, minimally invasive or robotic approach.ConclusionThis is the first documented case of post covid19 infection thymomatous myasthenia gravis to the best of our knowledge, managed with minimally invasive thoracoscopic surgery. Further research is required for documentation of the natural history of the disease and therapeutic outcomes.     

Status and strategies for the management of head and neck cancer during COVID‐19 pandemic: Indian scenario

In India, oral cancer is the most common head and neck cancer (HNC) in men, mainly caused by the consumption of smoked and smokeless tobacco. During the current pandemic, delaying surgery for even 1 or 2 months may lead to more extensive surgery or inoperability, where only supportive care can be provided. Being semi‐emergent in nature, treatment for these patients is currently on hold or delayed in most centers across the country. This study was conducted to assess the impact of COVID‐19 pandemic and inability of the health system to treat HNC in a timely fashion and how surgeons are coping to this emergent situation. This article highlights the situation in India, a country burdened with one of the highest incidence rates of HNC.     

Eating behaviors and weight outcomes in bariatric surgery patients amidst COVID-19

BackgroundRecent studies suggest that eating habits are an area particularly affected by the lockdown imposed by many countries to curb the COVID-19 epidemic. Individuals that received bariatric surgery may represent a particularly susceptible population to the adverse effects of lockdown for its potential impact on eating, psychological, and weight loss outcomes.ObjectivesThis study seeks to investigate the incremental impact of COVID-19 lockdown on treatment outcomes of postbariatric patients in the risk period for weight regain.SettingMain hospital center.MethodsThis work uses data from an ongoing longitudinal study of bariatric patients assessed before surgery (T₀), 1.5 years after sugery (T₁), and 3 years after surgery (T₂). Two independent groups were compared: the COVID-19_Group (n = 35) where T₀ and T₁ assessments were conducted before the pandemic started and T₂ assessment was conducted at the end of the mandatory COVID-19 lockdown; and the NonCOVID-19_Group (n = 66), covering patients who completed T₀, T₁, and T₂ assessments before the epidemic began. Assessment included self-report measures for disordered eating, negative urgency, depression, anxiety, stress, and weight outcomes.ResultsGeneral linear models for repeated measures showed that the COVID-19_Group presented significantly higher weight concern (F = 8.403, P = .005, ?²_p = .094), grazing behavior (F = 7.166, P = .009, ?²_p = .076), and negative urgency (F = 4.522, P = .036, ?²_p = .05) than the NonCOVID-19_Group. The COVID-19_Group also showed less total weight loss (F = 4.029, P = .05, ?²_p = .04) and larger weight regain at T₂, with more COVID-19_Group participants experiencing excessive weight regain (20% versus 4.5%).ConclusionThese results show evidence for the impact of the coronavirus outbreak on eating-related psychopathology and weight outcomes in postbariatric surgery patients.     

The Impact of Pandemic Influenza A H1N1 2009 on Australian Lung Transplant Recipients

Influenza A H1N1 2009 led to 189 deaths during the Australian pandemic. Community‐acquired respiratory viruses not only can cause prolonged allograft dysfunction in lung transplant recipients but have also been linked to bronchiolitis obliterans syndrome (BOS). We report the impact of the 2009 H1N1 pandemic on Australian lung transplant recipients. An observational study of confirmed H1N1 cases was conducted across five Australian lung transplant programs during the pandemic. An electronic database collected patient demographics, clinical presentation, management and outcomes up to a year follow‐up. Twenty‐four H1N1 cases (mean age 43 ± 14 years, eight females) were identified, incidence of 3%. Illness severity varied from upper respiratory tract symptoms only in 29% to lung allograft dysfunction (≥10% decline FEV1) in 75% to death in 5 (21%) cases (pre‐existing BOS grade 3, n = 4). Treatment with oseltamivir occurred in all but one case confirmed after death, reduced immunosuppression, n = 1, augmented corticosteroid therapy, n = 16, and mechanical/noninvasive ventilation, n = 4. There was BOS grade decline within a year in six cases (32%). In conclusion, Australian lung transplant recipients were variably affected by the H1N1 pandemic mirroring the broader community with significant morbidity and mortality. After initial recovery, a considerable proportion of survivors have demonstrated BOS progression.     

Beyond Rabies: Are Free‐Ranging Skunks (Mephitis mephitis) in British Columbia Reservoirs of Emerging Infection?

Wild animal reservoirs are an important source of emerging and zoonotic infection. Skunks (Mephitis mephitis) are a reservoir of skunk strain rabies virus in Canada, with the exception of some areas including the province of British Columbia (BC). Beyond rabies, the reservoir status of skunks for emerging and zoonotic pathogens in BC is unknown. From March 2011 to February 2015, 50 free‐ranging skunks were necropsied and tested for 4 pathogens: influenza A, Aleutian disease virus (ADV), Leptospira spp. and Salmonella spp. Two skunks (4%) with respiratory disease caused by influenza A (H1N1) pdm09 were detected during the human flu season suggesting that skunks may represent a target population for reverse zoonosis of this strain of influenza A virus. High prevalence of ADV infection was detected (43/50, 86%). Two of the infected skunks exhibited Aleutian disease (AD) suggesting that skunks act as both a reservoir and a target population for the virus. Most studies of ADV have focused on the potential for infection of free‐ranging species living near mink farms. Our study suggests that urban skunks may be a primary host for the virus independent of domestic mink. Whether skunks act as a reservoir of ADV infection for other peridomestic species will depend on host specificity of the viral strains. Leptospira interrogans was detected in 18% (9/49) of the skunks. Identification of the serovar(s) detected is needed to determine any public health risk of leptospirosis following exposure to infected skunks. Salmonella spp. was isolated from three of 43 skunks (7%), specifically S. Typhimurium, S. Muenchen and S. Enteritidis. These serotypes cause disease in humans, but the low prevalence of infection suggests there is a low risk for zoonotic transmission.