Treatment of SARS-CoV-2 Infection in US Nursing Homes—Reply

In Reply Dr Bergman highlights a number of important potential barriers to COVID-19 antiviral treatment use in nursing homes, including rapidly evolving guidelines concerning the use of monoclonal antibodies, insufficient supply of recommended monoclonal antibodies, and high staffing needs to administer monoclonal antibodies intravenously. These factors likely contributed to the low antiviral treatment rates observed in our study, when monoclonal antibodies were the only treatment available.

Leggi
Novembre 2023

Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021: a systematic literature review and meta-analysis of 3740 studies and 231 million people

Objective
China concentrates a large part of the global burden of HBV infection, playing a pivotal role in achieving the WHO 2030 global hepatitis elimination target.

Methods
We searched for studies reporting HBV surface antigen (HBsAg) seroprevalence in five databases until January 2023. Eligible data were pooled using a generalised linear mixed model with random effects to obtain summary HBsAg seroprevalence. Linear regression was used to estimate annual percentage change (APC) and HBsAg prevalence in 2021.

Results
3740 studies, including 231 million subjects, were meta-analysed. HBsAg seroprevalence for the general population decreased from 9.6% (95% CI 8.4 to 10.9%) in 1973–1984 to 3.0% (95% CI 2.1 to 3.9%) in 2021 (APC=–3.77; p

Leggi
Novembre 2023

Impact of SARS-CoV-2 infection on patients with systemic lupus erythematosus in England prior to vaccination: a retrospective observational cohort study

Objectives
Determine the prevaccination healthcare impact of COVID-19 in patients with systemic lupus erythematosus (SLE) in England.

Design
Retrospective cohort study of adult patients with SLE from 1 May to 31 October 2020.

Setting
Clinical Practice Research Datalink (CPRD) Aurum and Hospital Episode Statistics (HES) databases from general practitioners across England combining primary care and other health-related data.

Participants
Overall, 6145 adults with confirmed SLE diagnosis ≥1 year prior to 1 May 2020 were included. Most patients were women (91.0%), white (67.1%), and diagnosed with SLE at age

Leggi
Novembre 2023

Chronic Hepatitis B Virus Infection and Risk of Stroke Types: A Prospective Cohort Study of 500 000 Chinese Adults

Stroke, Ahead of Print. BACKGROUND:Stroke is a leading cause of mortality and permanent disability in China, with large and unexplained geographic variations in rates of different stroke types. Chronic hepatitis B virus infection is prevalent among Chinese adults and may play a role in stroke cause.METHODS:The prospective China Kadoorie Biobank included >500 000 adults aged 30 to 79 years who were recruited from 10 (5 urban and 5 rural) geographically diverse areas of China from 2004 to 2008, with determination of hepatitis B surface antigen (HBsAg) positivity at baseline. During 11 years of follow-up, a total of 59 117 incident stroke cases occurred, including 11 318 intracerebral hemorrhage (ICH), 49 971 ischemic stroke, 995 subarachnoid hemorrhage, and 3036 other/unspecified stroke. Cox regression models were used to estimate adjusted hazard ratios (HRs) for risk of stroke types associated with HBsAg positivity. In a subset of 17 833 participants, liver enzymes and lipids levels were measured and compared by HBsAg status.RESULTS:Overall, 3.0% of participants were positive for HBsAg. HBsAg positivity was associated with an increased risk of ICH (adjusted HR, 1.29 [95% CI, 1.16–1.44]), similarly for fatal (n=5982; adjusted HR, 1.36 [95% CI, 1.16–1.59]) and nonfatal (n=5336; adjusted HR, 1.23 [95% CI, 1.06–1.44]) ICH. There were no significant associations of HBsAg positivity with risks of ischemic stroke (adjusted HR, 0.97 [95% CI, 0.92–1.03]), subarachnoid hemorrhage (adjusted HR, 0.87 [95% CI, 0.57–1.33]), or other/unspecified stroke (adjusted HR, 1.12 [95% CI, 0.89–1.42]). Compared with HBsAg-negative counterparts, HBsAg-positive individuals had lower lipid and albumin levels and higher liver enzyme levels. After adjustment for liver enzymes and albumin, the association with ICH from HBsAg positivity attenuated to 1.15 (0.90–1.48), suggesting possible mediation by abnormal liver function.CONCLUSIONS:Among Chinese adults, chronic hepatitis B virus infection is associated with an increased risk of ICH but not other stroke types, which may be mediated through liver dysfunction and altered lipid metabolism.

Leggi
Novembre 2023

Systematic review of seroprevalence of SARS-CoV-2 antibodies and appraisal of evidence, prior to the widespread introduction of vaccine programmes in the WHO European Region, January-December 2020

Objectives
Systematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes.

Design
A systematic review of the literature.

Data sources
We searched MEDLINE, EMBASE and the preprint servers MedRxiv and BioRxiv in the WHO ‘COVID-19 Global literature on coronavirus disease’ database using a predefined search strategy. Articles were supplemented with unpublished WHO-supported Unity-aligned seroprevalence studies and other studies reported directly to WHO Regional Office for Europe and European Centre for Disease Prevention and Control.

Eligibility criteria
Studies published before the widespread implementation of COVID-19 vaccination programmes in January 2021 among the general population and blood donors, at national and regional levels.

Data extraction and synthesis
At least two independent researchers extracted the eligible studies; a third researcher resolved any disagreements. Study risk of bias was assessed using a quality scoring system based on sample size, sampling and testing methodologies.

Results
In total, 111 studies from 26 countries published or conducted between 1 January 2020 and 31 December 2020 across the WHO European Region were included. A significant heterogeneity in implementation was noted across the studies, with a paucity of studies from the east of the Region. Sixty-four (58%) studies were assessed to be of medium to high risk of bias. Overall, SARS-CoV-2 seropositivity prior to widespread community circulation was very low. National seroprevalence estimates after circulation started ranged from 0% to 51.3% (median 2.2% (IQR 0.7–5.2%); n=124), while subnational estimates ranged from 0% to 52% (median 5.8% (IQR 2.3%–12%); n=101), with the highest estimates in areas following widespread local transmission.

Conclusions
The low levels of SARS-CoV-2 antibody in most populations prior to the start of vaccine programmes underlines the critical importance of targeted vaccination of priority groups at risk of severe disease, while maintaining reduced levels of transmission to minimise population morbidity and mortality.

Leggi
Novembre 2023

Prevalence and determinants of high-risk human papilloma virus among men who have sex with men in Benin: a cross-sectional study embedded in a demonstration project on pre-exposure prophylaxis against HIV

Objectives
This study aims to assess the prevalence and factors associated with anal high-risk human papilloma virus (HR-HPV).

Design
A cross-sectional study conducted from 24 August 2020 to 24 November 2020.

Setting
Primary care, Cotonou, Benin.

Participants
204 HIV-negative men who have sex with men initiating oral pre-exposure prophylaxis.

Primary outcome measure
Anal HR-HPV genotypes using GeneXpert HPV assay. Fourteen HR-HPV were evaluated: HPV-16 and HPV-18/45 in 2 distinct channels and the 11 other genotypes as a pooled result (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68). The potential independent variables analysed included anal gonorrhoea and chlamydia infections, and sociodemographic and sexual behaviour factors. To assess the determinants of HR-HPV, univariate and multivariate Poisson regression models were performed by using SAS V.9.4.

Results
Mean age±SD was 25.9±4.8 years. 131/204 men claimed insertive sex procured more pleasure. Thirty-two participants, accounting for 15.7% of the study sample, had gonorrhoea and/or chlamydia. The prevalence of any HR-HPV genotype was 36.3% (95% CI 30.0% to 43.0%). In total, 7.8% of men had HPV-16 and 7.4% had HPV-18/45. The prevalence for the pooled genotypes (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68) was 29.9%. Receptive anal sex during the last 6 months was strongly associated with prevalent HR-HPV infections. The adjusted proportion ratio (aPR) was 1.93 (95% CI 1.31 to 2.83). Gonorrhoea and chlamydia were also associated with the outcome of interest; p value for both infections was

Leggi
Novembre 2023

Abstract 15614: Pericardial and Abdominal Visceral Adiposity Are Associated With Increased Risk of Hospitalization or Death From SARS-CoV-2 Infection: A Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study

Circulation, Volume 148, Issue Suppl_1, Page A15614-A15614, November 6, 2023. BackgroundObesity increases risk of death from SARS-CoV-2 infection. Excess ectopic fat may increase this risk through inflammation, hypercoagulability, and immune dysfunction. We hypothesized that greater pericardial (PAT) and visceral adipose tissue (VAT) would associate with higher risk of hospitalization or death from SARS-CoV-2.MethodsC4R collected SARS-CoV-2 outcomes from US-based cohort studies. These were linked to chest and abdominal CT scans obtained from Jackson Heart (2007-2010) and CARDIA (2010-2011) studies. We standardized PAT across cohorts and VAT within each cohort to account for differences in VAT measurement protocols. Our outcome was COVID-related hospitalization or death from March 2020 to February 2023 assessed via questionnaires, serosurvey, and record review. Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, and cohort. We adjusted for body mass index (BMI) at COVID assessment in secondary models.ResultsWe included 3002 subjects with mean (SD) age of 62 (6) years, of whom 62% were women, 41% White, 59% Black, 59% never smokers, and 13% current smokers. Sixty-one subjects (2%) had SARS-CoV-2 related hospitalization or death. Every 1-standard deviation (SD) increment in PAT volume was associated with 79% higher odds of hospitalization or death (95%CI 1.38-2.33, Fig A); the estimate was similar after adjusting for BMI (OR 1.71, 95%CI 1.27-2.31). Abdominal VAT was associated with higher odds of hospitalization or death (OR 1.47 per 1 SD, 95%CI 1.20-1.81, Fig B), even after adjustment for BMI (OR 1.35, 95%CI 1.05-1.72).ConclusionGreater pericardial or visceral adiposity measured 10-15 years prior to SARS-CoV-2 emergence, was associated with higher odds of hospitalization or death from SARS-CoV-2 independent of BMI. Lowering PAT and VAT may have collateral benefit for those who develop SARS-CoV-2 infection. Further study of the role of visceral adipose in viral infection is needed.

Leggi
Novembre 2023