Actus Santé

Effectiveness of BBIBP-CorV, BNT162b2 and mRNA-1273 vaccines against hospitalisations among children and adolescents during the Omicron outbreak in Argentina

Background: Although paediatric clinical presentations of COVID-19 are usually less severe than in adults, serious illness and death have occurred. Many countries started the vaccination rollout of children in 2021; still, information about effectiveness in the real-world setting is scarce. The aim of our study was to evaluate vaccine effectiveness (VE) against COVID-19-associated-hospitalisations in the 3-17-year population during the Omicron outbreak. Methods: We conducted a retrospective cohort study including individuals aged 3-17 registered in the online vaccination system of the Buenos Aires Province, Argentina. mRNA-1273 and BNT162b2 were administered to 12-17-year subjects; and BBIBP-CorV to 3-11-year subjects. Vaccinated group had received a two-dose scheme by 12/1/2021. Unvaccinated group did not receive any COVID-19 vaccine between 12/14/2021-3/9/2022, which was the entire monitoring period. Vaccine effectiveness (VE) against COVID-19-associated hospitalisations was calculated as (1-OR) x100. Findings: By 12/1/2021, 1,536,435 individuals aged 3-17 who had received zero or two doses of SARS-CoV-2 vaccines were included in this study. Of the latter, 1,440,389 were vaccinated and 96,046 not vaccinated. VE were 78.0% [68.7-84.2], 76.4%[62.9-84.5] and 80.0%[64.3-88.0] for the entire cohort, 3-11 subgroup and 12-17 subgroup, respectively. VE for the entire population was 82.7% during the period of Delta and Omicron overlapping circulation and decreased to 67.7% when Omicron was the only variant present. Interpretation: This report provides evidence of high vaccine protection against associated-hospitalisations in the paediatric population during the Omicron outbreak but suggests a decrease of protection when Omicron became predominant. Application of a booster dose in children aged 3-11 warrants further consideration.
Catégories: Actus Santé

More efficient and inclusive time-to-event trials with covariate adjustment: a simulation study

Adjustment for prognostic covariates increases the statistical power of randomized trials. The factors influencing increase of power are well-known for trials with continuous outcomes. Here, we study which factors influence power and sample size requirements in time-to-event trials. We consider both parametric simulations and simulations derived from the TCGA cohort of hepatocellular carcinoma (HCC) patients to assess how sample size requirements are reduced with covariate adjustment. Simulations demonstrate that the benefit of covariate adjustment increases with the prognostic performance of the adjustment covariate (C-index) and with the cumulative incidence of the event in the trial. For a covariate that has an intermediate prognostic performance (C-index=0.65), the reduction of sample size varies from 1.7% when cumulative incidence is of 10% to 26.5% when cumulative incidence is of 90%. Broadening eligibility criteria usually reduces statistical power while our simulations show that it can be maintained with adequate covariate adjustment. In a simulation of HCC trials, we find that the number of patients screened for eligibility can be divided by 2.7 when broadening eligibility criteria. Last, we find that the Cox-Snell RCS2 is a good approximation of the reduction in sample size requirements provided by covariate adjustment. This metric can be used in the design of time-to-event trials to determine sample size. Overall, more systematic adjustment for prognostic covariates leads to more efficient and inclusive clinical trials especially when cumulative incidence is large as in metastatic and advanced cancers.
Catégories: Actus Santé

Genetically proxied PCSK9 inhibition provides indication of lower prostate cancer risk: a Mendelian randomization study

Background Prostate cancer (PrCa) is the second most prevalent malignancy in men worldwide. Observational studies have linked the use of low-density lipoprotein cholesterol (LDL-c) lowering therapies with reduced risk of PrCa, which may potentially be attributable to confounding factors. In this study, we performed a drug target Mendelian randomization (MR) analysis to evaluate the association of genetically proxied inhibition of LDL-c lowering drug targets on risk of PrCa. Methods and Findings Single-nucleotide polymorphisms (SNPs) in and around HMGCR , NPC1L1 and PCSK9 genes associated with LDL-c (P<5x10-8) from the Global Lipids Genetics Consortium genome-wide association study (GWAS) (N=173,082) were used to proxy the therapeutic inhibition of these targets. Association estimates for the risk of total, advanced and early-onset PrCa were obtained from the PRACTICAL consortium. Replication was performed using genetic instruments from an LDL-c GWAS conducted on male UK Biobank participants of European ancestry (N=201,678), as well as instruments selected based on liver-derived gene expression and circulation plasma levels of targets. We also investigated whether putative mediators may play a role in findings for traits previously implicated in PrCa risk (i.e., lipoprotein a (Lp(a)), body mass index (BMI) and testosterone). Applying MR using the inverse-variance weighted approach accounting for genetic correlations between instruments provided strong evidence supporting an effect of genetically proxied inhibition of PCSK9 (equivalent to a standard deviation (SD) reduction in LDL-c) on lower risk of total PrCa (odds ratio (OR)=0.84, 95% confidence interval (CI)=0.74 to 0.96, P=7.86x10-3) and early-onset PrCa OR=0.70, 95% CI=0.52 to 0.95, P=0.021. Analyses using male-stratified instruments provided consistent results. In contrast, there was little evidence of an association of genetically proxied HMGCR (OR=0.83, 95% CI=0.67 to 1.03, P=0.093) or NPC1L1 (OR=1.27, 95% CI=0.87 to 1.87, P=0.218) inhibition on PrCa risk. Secondary analyses supported a genetically proxied effect of liver-specific PCSK9 expression (OR=0.90, 95% CI=0.86 to 0.95, P=5.50x10-5) and circulating plasma levels of PCSK9 (OR=0.93 per SD reduction in PCSK9, 95% CI=0.87 to 0.997, P=0.04) on PrCa risk. Colocalization using eCAVIAR identified evidence (colocalization posterior probability=0.103) of a shared genetic variant (rs553741) between liver-derived PCSK9 expression and PrCa risk. Moreover, genetically proxied PCSK9 inhibition was strongly associated with Lp(a) levels (Beta= -0.07, 95% CI= -0.10 to -0.03, P=1.44x10-4), but not BMI or testosterone, indicating a putative mediatory role of Lp(a). Conclusions Our study supports a strong association between genetically proxied inhibition of PCSK9 and a lower risk of total and early-onset PrCa. Further evidence from clinical studies is needed to confirm this finding as well as the putative mediatory role of Lp(a).
Catégories: Actus Santé

Plasma biomarkers for diagnosis of Alzheimer's disease and prediction of cognitive decline in individuals with mild cognitive impairment

Background: The last few years have seen major advances in blood biomarkers for Alzheimer's Disease (AD) with the development of ultrasensitive immunoassays, promising to transform how we diagnose, prognose, and track progression of neurodegenerative dementias. Methods: We evaluated a panel of four novel ultrasensitive electrochemiluminescence (ECL) immunoassays against presumed CNS derived proteins of interest in AD in plasma [phosphorylated-Tau181 (pTau181), total Tau (tTau), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP)]. 366 plasma samples from the Massachusetts Alzheimer's Disease Research Center's longitudinal cohort study were examined to differentiate definite AD, other neurodegenerative diseases (OND), and cognitively normal (CN) individuals. A subset of samples were selected to have longitudinal follow up to also determine the utility of this plasma biomarker panel in predicting 4-year risk for cognitive decline in individuals with different levels of cognitive impairment. Results: pTau181, tTau and GFAP were higher in AD compared to CN and OND, while NfL was elevated in AD and further increased in OND. pTau181 performed the best (AD vs CN: AUC=0.88, 2-fold increase; AD vs OND: AUC=0.78, 1.5-fold increase) but tTau also showed excellent discrimination (AD vs CN: AUC=0.79, 1.5-fold increase; AD vs OND: AUC=0.72, 1.3-fold increase). Participants with MCI who progressed to AD dementia had higher baseline plasma concentrations of pTau181, NfL, and GFAP compared to non-progressors with the best discrimination for pTau181 (AUC=0.82, 1.7-fold increase) and GFAP (AUC=0.81, 1.6-fold increase). Conclusions: These new ultrasensitive ECL plasma assays for pTau181, tTau, NfL, and GFAP detect CNS disease with high specificity and accuracy. Moreover, the absolute baseline plasma levels of pTau and GFAP reflect clinical disease aggressiveness over the next 4 years, providing diagnostic and prognostic information that may have utility in both clinical and clinical trial populations. Classification of Evidence: This study provides Class II evidence that plasma levels of pTau181, tTau, NfL, and GFAP are associated with AD and that pTau181 and GFAP are associated with progression from MCI to AD dementia.
Catégories: Actus Santé

Ms Mariya Gabriel delivers a keynote speech at “The Green Pact and the regions, the intelligent cities in the frame of the Green Pact”, an event organized by MEP Iskra Mihailova and the Standard Journal

EU Newsroom - Research and innovation - mar, 19/04/2022 - 00:00

European Commission Реч Brussels, 19 Apr 2022 Уважаема г-жо Михайлова,
Уважаема г-жо Бозукова,
Уважаеми представители на законодателната и изпълнителната власт,
Уважаеми кметове,
Дами и господа,

Catégories: Actus Santé

System Integrated Digital Empowerment and Rehabilitation to promote patient Activation and well-Being (SIDERA^B): Protocol for a Randomized Crossover Trial on Effectiveness and Implementation.

CONTEXT: the current increasing demand for rehabilitation among people with Non-Communicable Diseases (NCDs) requires the identification of home-based digital solutions alternative to conventional in-clinic interventions. OBJECTIVE: this protocol proposes to test the effectiveness of an individualized telerehabilitation platform (SIDERA^B), with respect to the traditional face-to-face rehabilitation, in ensuring the continuity of care in patients with NCDs. DESIGN, SETTING, AND SUBJECTS: this randomized, single-blind, controlled two-period crossover trial will involve about 150 outpatients with NCDs (N=40 with Chronic Heart Failure - CHF, N=60 with Chronic Obstructive Pulmonary Disease - COPD, and N=50 with Parkinson's Disease - PD) from the rehabilitation units of IRCCS Fondazione Don Carlo Gnocchi of Milan. Each participant will experience, consequently, two different types of interventions: rehabilitation with the SIDERA^B system (SIDERA^B - S), which allow for both tele-rehabilitation activities and tele-monitoring of vital parameters, and rehabilitation as usual (Usual Care - U) including a manual of rehabilitative exercises and self-monitoring of vital parameters. INTERVENTIONS: subjects will be randomly assigned to one of the two specified sequences of interventions: U/S/U (the USU group), and S/U (the SU group). Both groups will be assessed at the baseline (T1), after the first intervention (T2), and after the second intervention (T3), with a follow-up evaluation (T4) scheduled only for the USU group. MAIN OUTCOME MEASURES: a multifaceted evaluation including quality of life and clinical/functional measures will be conducted at each time-point of assessment. The primary outcome measures will be 1) change in activation of patients measured by the Patient Activation Measure scale, and 2) change in subject's level of activity and participation measured by the WHO Disability Assessment Schedule 2.0. CONCLUSION: SIDERA^B could represent a promising innovative digital solution able to support the ongoing migration of rehabilitation care from the clinic to the patient's home, for the optimal long-term management of NCDs.
Catégories: Actus Santé

On the hip abduction moment required to balance on one leg: an experimental study

Although the time a patient can stand on one leg is a common clinical test of balance in those prone to fall, a surprising knowledge gap is how much hip abduction muscle strength is required. This is important because hip abduction strength has been shown to be important for compensating for impairments in diabetic neuropathy, for example. As a start we tested the hypothesis that maximum hip abduction muscle endurance time at 50% effort would be longer than the time that 18 young and 17 older healthy adults can stand on one leg. First, maximum hip abduction endurance time at 50% effort as well as maximum abduction strength were measured in the gravity-free plane. Then subjects were asked to balance on their left foot for as long as they could while body segment kinematics and ground reaction data were measured. The results showed that the mean intensity of the hip abduction moment required to stand on one leg exceeded 50% of the maximum hip abduction strength for all four groups (young women and men 53% and 55%, and older women and men 94% and 72% respectively). However, unipedal stance times were not limited by hip abduction 50% effort endurance time (p = 0.9). Therefore a significant portion of the hip abduction moment required to stand on one leg must be carried by passive tissues. The underlying mechanism remains to be explained.
Catégories: Actus Santé

Predictors of COVID-19 vaccine uptake: An online longitudinal study of US Veterans and non-Veterans

Background. To effectively promote vaccine uptake, it is important to understand which people are most and least inclined to be vaccinated and why. Purpose. To identify predictors of COVID-19 vaccine uptake and reasons for non-vaccination. Design. A longitudinal English-language survey study. Setting. Online in December-2020, January-2021, and March-2021. Participants. 930 US respondents (63% Veterans). Measurements. Surveys included questions about respondents' behaviors, well-being, healthcare experiences, and attitudes regarding the pandemic. Results. The proportion of respondents who received [≥]1-dose of a COVID-19 vaccine increased from 18% in January to 67% in March. Older age predicted vaccine uptake in January (OR=2.02[95%CI=1.14-3.78], p<.001) and March (10.92[6.76-18.05], p<.001). In January, additional predictors of vaccine uptake were higher numeracy (1.48[1.20-1.86], p<.001), COVID-19 risk perceptions (1.35[1.03-1.78], p=.029), and believing it is important that adults get the COVID-19 vaccine (1.66[1.05-2.66], p=.033). In March, additional predictors of vaccine uptake were believing it is important that adults get the COVID-19 vaccine (1.63[1.15-2.34], p=.006), previous (January) COVID-19 vaccine intentions (1.37[1.10-1.72], p=.006), and belief in science (0.84[0.72-0.99], p=.041). Concerns about side effects and the vaccine development process were the most common reasons for non-vaccination. Unvaccinated respondents with no interest in getting a COVID-19 vaccine were younger (0.27[0.09-0.77], p=.016), held negative views about COVID-19 vaccines for adults (0.15[0.08-0.26], p<.001), had lower trust in healthcare (0.59[0.36-0.95], p=.032), and preferred to watch and wait in clinically ambiguous medical situations (0.66[0.48-0.89], p=.007). Limitations. Reliance on the accuracy and consistency of self-reported data. Conclusion. These findings offer important insights regarding key predictors of vaccine uptake during the early stages of the COVID-19 vaccine rollout in the US, which can help guide health communications and public outreach. Evidence that attitudes and intentions towards COVID-19 vaccines are important predictors of uptake provides validation for studies which have used these measures and reinforces the need to develop effective strategies for addressing concerns about vaccine safety and development which continue to be at the forefront of vaccine hesitancy.
Catégories: Actus Santé

A retrospective cross-sectional analysis of community perceptions of flu and COVID-19 vaccines at Turtle Creek Primary Care Center

Background: Influenza (flu) and COVID-19 vaccination rates are subpar across the US, especially in racial and/or socioeconomic minority groups who are understudied in public health literature. Objective: The objective of this study was to elucidate the attitudes of Turtle Creek patients towards flu and COVID-19 vaccines, with the goal of establishing targetable vaccine education gaps and ultimately increasing vaccine uptake in the community. Design/Patients: This study was conducted as a retrospective cross-sectional analysis. Authors completed 123 patient phone surveys of patients cared for at the Turtle Creek Primary Care Center inquiring about flu and COVID-19 infection status and vaccination uptake (August 26 - October 10, 2021). Approach/Key Results: Our data revealed a significant association between COVID-19 and flu vaccine acceptance. Additionally, we found a strong association between vaccine acceptance and age, with older patients being more likely to be vaccinated against COVID-19. Using multivariable logistic regression models, we assessed how flu and COVID-19 vaccine acceptance was affected by informational sources participants trusted most. In the COVID-19 models, those who cited trusting medical professionals had higher odds of vaccine acceptance while participants who cited trusting social media had significantly decreased odds of vaccine acceptance. Conclusion: Our study revealed significant trends for flu and COVID-19 vaccine acceptance by sociodemographic factors and trust in the medical system. Using these data, we can create future interventions to overcome vaccine hesitancy.
Catégories: Actus Santé

Examining the experiences of Indigenous families seeking health information for their sick or injured child: a scoping review protocol

Introduction: The Truth and Reconciliation Commission drew attention to the inequalities and systemic harms experienced by Indigenous peoples in Canada and called on the Canadian government and healthcare professionals to close the gap related to access to appropriate healthcare services by Indigenous communities. The Manitoba Metis Federation (self-governing organization representing Red River Metis) identified a need for Red River Metis families to have meaningful resources when seeking emergency care for their children. A better understanding of the experiences of Metis families in seeking child health information is needed to develop culturally relevant pediatric resources. To date, the literature on the experiences of Indigenous families seeking child health information has not been synthesized. A scoping review will map the literature on the experiences of Indigenous families seeking health information to care for a sick or injured child; and identify the barriers and facilitators to accessing this information. Methods and analysis: Joanna Briggs Institute methodology was used to develop the research question, What is the extent and nature of the literature available on the experiences of Indigenous families seeking health information for their sick or injured child? The search strategy, developed with a research librarian with extensive experience in Indigenous Peoples health, includes searching MEDLINE, EMBASE PsycINFO, CINAHL, and Scopus databases; grey literature, by searching the internet and consulting reference lists of key publications; examining key Indigenous research journal articles not indexed in the major biomedical databases; and snowball sampling. Two independent reviewers will screen titles and abstracts against the inclusion criteria, then screen the full texts of selected citations. Data will be extracted, collated and charted to summarize the types of studies, healthcare contexts, health information accessed, how health information was accessed, barriers and facilitators to accessing information and related measures. Ethics and Dissemination: A consultation exercise with a community advisory committee will review results and inform future research. Results will be integrated with findings from other project stages to inform the adaptation of a child health resource for Red River Metis families.
Catégories: Actus Santé

Impact of OSA Treatment Success on Changes in Hypertension and Obesity: A Retrospective Cohort Study

Objective: Pediatric obstructive sleep apnea (OSA) has been shown to lead to the development of chronic cardiometabolic conditions, including obesity and cardiovascular disease. We sought to describe the impact of the success of continuous positive airway pressure (CPAP) and surgery, common treatment options for pediatric OSA, on cardiometabolic conditions. Methods: A retrospective review of patients ([≤]18 years) diagnosed with OSA based on a polysomnogram at a tertiary care pediatric otolaryngology practice from 2015 to 2019 was conducted. Clinical data, including the systolic blood pressure (SBP) values, body mass index (BMI), overall apnea/hypopnea index (AHI) values, and CPAP compliance, were collected. Linear mixed-effects models were developed to observe the relationship between the clinical measurements of each comorbidity and OSA treatment modalities. Results: 507 patients were included. BMI and SBP measures were collected for 230 and 277 patients respectively. The difference-in-difference estimate for the SBP z-score percentile after successful treatment was -5.3 +/- 2.0 percentile units per 100 days. The difference-in-difference estimate for SBP z-score percentile after successful CPAP treatment was -14.4 +/- 4.9 percentile units per 100 days while the estimate after successful surgical treatment was -4.6 +/- 2.3 percentile units per 100 days. No significant differences were found between clinical measures for obese patients in any treatment cohort. Conclusions: The success of OSA management was shown to have a positive impact on SBP in hypertensive patients and no impact on BMI in obese patients. In hypertensive patients, CPAP success tripled improvements in SBP z-score percentile compared to surgical treatment success.
Catégories: Actus Santé

The gut microbiome and early-life growth in a population with high prevalence of stunting

Stunting affects one-in-five children globally and is associated with greater infectious morbidity, mortality and neurodevelopmental deficits. Recent evidence suggests that the early-life gut microbiome affects child growth through immune, metabolic and endocrine pathways, and microbiome perturbations may contribute to undernutrition. We examined early-life fecal microbiome composition and function in 875 stool samples collected longitudinally in 335 children from 1-18 months of age in rural Zimbabwe, from a cluster-randomized trial of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF). Using whole metagenome shotgun sequencing, we examined the effect of the interventions, in addition to environmental or host factors including maternal HIV infection, on the succession of the early-life gut microbiome, and employed extreme gradient boosting machines (XGBoost) to model microbiome maturation and to predict child growth. WASH and IYCF interventions had little impact on the fecal microbiome, however children who were HIV-exposed but uninfected exhibited over-diversification and over-maturity of the early-life gut microbiome in addition to reduced abundance of Bifidobacteria species. Taxonomic microbiome features were poorly predictive of linear and ponderal growth, however functional metagenomic features, particularly B-vitamin and nucleotide biosynthesis pathways, moderately predicted both attained linear and ponderal growth and growth velocity. We find that the succession of the gut microbiome in a population at risk of stunting is unresponsive to WASH and IYCF interventions, but is strongly associated with maternal HIV infection, which may contribute to deficits in growth. New approaches targeting the gut microbiome in early childhood may complement efforts to combat child undernutrition.
Catégories: Actus Santé

Global reports of takotsubo (stress) cardiomyopathy following COVID-19 vaccination: First systematic review and meta-analysis

Background and aims Concerns have been raised recently about takotsubo cardiomyopathy after receiving COVID-19 vaccines, particularly the messenger RNA (mRNA) vaccines. The goal of this study was to compile case reports in order to provide a comprehensive overview of takotsubo cardiomyopathy associated with COVID-19 vaccines. Methods From inception until March 10, 2022, a systematic literature search was conducted in PubMed and Google Scholar. The study included individuals who developed cardiac takotsubo cardiomyopathy as a result of receiving COVID-19 vaccinations, regardless of the type of vaccine or dose. Results Eight studies, including 8 cases, participated in the current systematic review. The median age was 61.6 years; 87.5% were female, while 12.5% were male. 75% of the patients received the mRNA COVID-19 vaccines, while 25% received other types. In addition, takotsubo cardiomyopathy occurred in 62.5% of patients after receiving the first dose and another 25% after the second dose of COVID-19 vaccines. Moreover, the mean number of days to the onset of symptoms was 2.62 days. All cases had an elevated troponin test and abnormal ECG findings. The left ventricular ejection fraction (LVEF) was above 50% among all cases. In terms of the average length of stay in the hospital, 62.5% stayed for 10.2 days, and all cases recovered from their symptoms. Conclusion Takotsubo (stress) cardiomyopathy complications that are associated with COVID-19 vaccination are rare, they can be life-threatening. Chest pain should be considered an alarming symptom, especially in those who had received a second dose of the vaccine in the last 3 days. For diagnosis, CK-MB and troponin are better biomarkers to confirm myocarditis than CRP, ESR, and NT-proBNP. All of cases completely recovered.
Catégories: Actus Santé

Coding Long COVID: Characterizing a new disease through an ICD-10 lens

Naming a newly discovered disease is always challenging; in the context of the COVID-19 pandemic and the existence of post-acute sequelae of SARS-CoV-2 infection (PASC), which includes Long COVID, it has proven especially challenging. Disease definitions and assignment of a diagnosis code are often asynchronous and iterative. The clinical definition and our understanding of the underlying mechanisms of Long COVID are still in flux. The deployment of an ICD-10-CM code for Long COVID in the US took nearly two years after patients had begun to describe their condition. Here we leverage the largest publicly available HIPAA-limited dataset about patients with COVID-19 in the US to examine the heterogeneity of adoption and use of U09.9, the ICD-10-CM code for "Post COVID-19 condition, unspecified." Our results include a characterization of common diagnostics, treatment-oriented procedures, and medications associated with U09.9-coded patients, which give us insight into current practice patterns around Long COVID. We also established the diagnoses most commonly co-occurring with U09.9, and algorithmically clustered them into three major categories: cardiopulmonary, neurological, and metabolic. We aim to apply the patterns gleaned from this analysis to flag probable Long COVID cases occurring prior to the existence of U09.9, thus establishing a mechanism to ensure patients with earlier cases of Long-COVID are no less ascertainable for current and future research and treatment opportunities.
Catégories: Actus Santé

Methadone overdoses increased 48% during the COVID-19 epidemic

Background: The United States (US) is in the middle of an opioid overdose epidemic that has spanned over two decades and continues to escalate. Methadone is long-acting full opioid agonist which has been approved to treat opioid use disorder (OUD). Methadone can cause respiratory depression that may result in mortality. The restrictions on methadone availability including take-home dosing were loosened during the COVID-19 pandemic although there have been concerns about the high street value of diverted methadone. This report examined how fatal overdoses involving methadone have changed over the past two-decades including during the pandemic. Methods: The Center for Disease Control and Preventions Wide-ranging Online Data for Epidemiologic Research (WONDER) database, which draws data from death certificates, was used to find the unintentional methadone related overdose death rate from 1999-2020. Unintentional methadone deaths were defined using the International Statistical Classification of Diseases (ICD), 10th revision codes: X40-44 with only data which was coded for methadone (T40.3). Data from the Automation of Reports and Consolidated Orders System (ARCOS) on methadone overall use, narcotic treatment programs use, and pain management use was gathered for all states, including the District of Columbia, for 2020 and corrected for population. Results: There have been dynamic changes over the past two-decades in overdoses involving methadone. Overdoses increased from 1999 (0.9/million) to 2007 (15.9) and declined until 2019 (6.5). Overdoses in 2020 (9.6) were 48.1% higher than in 2019 (t(50) = 3.05, p < .005). The correlations between overall methadone use (r(49) = +0.75, p < 0.001), and narcotic treatment program use (r(49) = +0.77, p < 0.001) were positive, strong, and statistically significant. However, methadone use for pain treatment was not associated with overdoses (r(49) = -.08, p = .57). Conclusions: Overdoses involving methadone significantly increased by 48.1% in 2020 relative to 2019. This mortality increase is much larger than the 5.3% elevation in calls involving methadone reported to poison control centers in the year following the March 16, 2020 loosening of methadone take-home regulations. Policy changes that were implemented following the COVID-19 pandemic involving methadone may warrant reconsideration.
Catégories: Actus Santé

Estimating the risk of hospitalisation and death in England's remaining unvaccinated population

The roll-out of COVID-19 vaccines in the England has generally been very good - with over 80% of over 12s having received two doses of vaccine by the start of February 2022, and 67% having received a further booster dose. Despite this, there is a small section of the population who remain unvaccinated, either due to lack of access, hesitancy or resistant to vaccination. In this report we estimate that, during 2021, there were approximately 3,500 deaths in unvaccinated people, who could otherwise have reasonably been expected to receive a vaccination. Further, we show that if all of the remaining unvaccinated population in England were to become infected (or reinfected) with the Omicron variant of COVID-19, we would expect to see approximately 11,700 further deaths and 29,600 hospitalisations. These number could fall to 5,300 and 19,600 respectively, if all but the most vaccine resistant individuals become fully vaccinated.
Catégories: Actus Santé

SARS-CoV-2 evolution and immune escape in immunocompromised patients treated with exogenous antibodies

Background: SARSCoV2 mutations conferring escape from neutralizing antibodies can arise in immunocompromised patients with prolonged infection, but the conditions that facilitate immune escape are still not fully understood. Methods: We characterized endogenous immune responses, within host SARSCoV2 evolution, and autologous neutralization of the viral variants that arose in five immunocompromised patients with prolonged infection and B cell deficiencies. Results: In two patients treated with the monoclonal antibody bamlanivimab, viral resistance to autologous serum arose early and persisted for several months, accompanied by ongoing evolution in the spike protein. These patients exhibited deficiencies in both T and B cell arms, and one patient succumbed to disease. In contrast, we did not observe spike mutations in immunologically important regions in patients who did not receive exogenous antibodies or who received convalescent plasma and had intact T cell responses to SARSCoV2. Conclusions: Our results underscore the potential importance of multiple factors the absence of an effective endogenous immune response, persistent virus replication, and selective pressure such as single-agent bamlanivimab in promoting the emergence of SARS-CoV-2 mutations associated with immune evasion. These findings highlight the need for larger clinical studies in immunocompromised populations to better understand the ramifications of different therapies. Our results also confirm that patients with B cell deficiencies can elicit effector T cells and may suggest an important role for T cells in controlling infection, which is relevant to vaccines and therapeutics.
Catégories: Actus Santé

Resistance in Ukraine is also digital

CNRS News - lun, 18/04/2022 - 21:46
Faced with the blocking of numerous websites and control of social media orchestrated by the Kremlin, Ukrainians and Russian anti-war activists are resisting through decentralised messaging services and distribution lists. An overview by Francesca Musiani, a member of the ResisTIC project on digital resistance, which held a conference on 31 March and 1 April in Aubervilliers, near Paris.
Catégories: Actus Santé

Vaccination contre le Covid en France : au 18 avril 2022, 40 703 131 doses de rappel ont été réalisées

1. Données de vaccination du jour et cumulées

Depuis le début de la campagne de rappel, 40 703 131 doses de rappel ont été réalisées1.
En outre, depuis le début de la campagne de vaccination en France, 54 302 561 personnes ont reçu au moins une injection (soit 80,5 % de la population totale2) et 53 395 104 personnes ont désormais un schéma vaccinal complet (soit 79,2 % de la population totale).

1 Le nombre d'injections de rappel est désormais disponible au Jour J de manière quotidienne.
2 Avec l'ouverture de la vaccination aux 12-17 ans, le calcul du taux de vaccination de la population majeure évolue. Le nombre d'injections par classe d'âge n'étant disponible qu'à J+1, nous communiquerons désormais le taux de vaccination de la population majeure à J-1, de manière hebdomadaire chaque mardi. Le taux de vaccination de la population totale n'est pas impacté, il est toujours donné quotidiennement donné à J-J.

Les chiffres tiennent désormais compte des injections pédiatriques.

Données provisoires Injections des dernières 24 heures Cumul total3 (depuis le 27/12/2020) 1ères injections 626 54 302 561 Doses de rappel 2 763 40 703 131 Total injections 4 046 143 289 978 Schémas vaccinaux complets 53 395 104

1 Les chiffres correspondant aux vaccinations frauduleuses (faux certificats de vaccination) sont progressivement déduits du cumul total d'injections. Le total d'injections du jour peut ainsi être exceptionnellement moins élevé que celui de la veille.

2. Comment prendre rendez-vous pour se faire vacciner ?

Pour rappel, la prise de rendez-vous est possible :

  • Via le site internet ;
  • Chez un pharmacien, un médecin de ville (médecin généraliste, médecin spécialiste, ou médecin du travail), dans un cabinet infirmier ou chez une sage-femme, en centre de vaccination, chez votre chirurgien-dentiste, dans un laboratoire de biologie médicale ;
  • Via les dispositifs locaux mis à disposition pour aider à la prise de rendez-vous ;
  • En cas de difficulté, via le numéro vert national (0 800 009 110) qui permet d'être redirigé vers le standard téléphonique d'un centre ou d'obtenir un accompagnement à la prise de rendez-vous.
La campagne de vaccination des enfants de 5 à 11 ans

Depuis le 22 décembre 2021, les enfants de 5 à 11 ans sont éligibles à la vaccination.
La vaccination des enfants des 5 à 11 ans se fait en priorité dans les centres de vaccination avec une ligne pédiatrique, chez le médecin traitant ou pédiatre (ou autre spécialiste), sur son lieu de soin.

Ouverture de la campagne de rappel depuis le 1er septembre

Conformément aux différents avis scientifiques rendus depuis le mois d'avril 2021, le président de la République a annoncé, le 11 août 2021, le lancement d'une campagne de rappel de la vaccination anti-Covid-19 dès le mois de septembre 2021 pour certaines populations prioritaires particulièrement vulnérables. Depuis le 27 novembre, la campagne de rappel est ouverte à toutes les personnes éligibles majeures et l'éligibilité au rappel vaccinal est abaissée à 3 mois après le schéma vaccinal complet initial.
Depuis le 24 janvier 2022, tous les adolescents âgés de 12 à 17 ans sont également éligibles au rappel, six mois après leur schéma vaccinal initial complet.
Depuis le 14 mars 2022, les plus de 80 ans et les résidents des EHPAD et des USLD (unités de soins de longue durée) peuvent recevoir une 2e dose de rappel.
Depuis le 7 avril 2022, les personnes de 60 ans et plus peuvent également recevoir une 2e dose de rappel. Elle est recommandée et peut être administrée dès 3 mois après la 1ère dose de rappel ou la dernière infection pour les personnes âgées de 80 ans et plus, pour les résidents en EHPAD et en USLD ainsi que pour les personnes immunodéprimées, et dès 6 mois après l'injection du premier rappel ou dès 6 mois après la dernière infection pour les personnes de 60 à 79 ans.

Concrètement, les personnes ayant été primo vaccinées selon un schéma à deux doses, recevront leur dose de rappel (ou troisième dose) dès trois mois après la deuxième dose. En cas d'infection survenue au moins 3 mois après le schéma vaccinal complet initial, il n'y a pas d'obligation de faire son rappel. Toutefois, si la personne souhaite voyager dans un pays où le rappel est obligatoire, il reste possible de faire son rappel dès 3 mois après l'infection.

Pour les patients immunodéprimés, un avis médical est recommandé.

Pour les personnes vaccinées avec le Janssen :

  • Si l'infection est intervenue avant l'injection de la dose de Janssen, alors il n'y a pas de dose additionnelle à réaliser, seulement une dose de rappel dans les 2 mois après la première dose.
  • Si l'infection est intervenue après la première injection, deux cas de figure :
    • La personne est positive au Covid-19 moins de 15 jours après sa dose de Janssen : Une dose additionnelle de vaccin doit être réalisée dans le mois après la première dose, puis une dose de rappel dès 3 mois après la dose additionnelle ;
    • La personne est positive au Covid-19 plus de 15 jours après sa dose de Janssen : Elle n'a pas besoin de faire de dose additionnelle, seulement une dose de rappel dès 3 mois après l'infection.

Les personnes ayant eu le Covid-19 plus de 3 mois après leur dose additionnelle n'ont pas besoin de faire leur dose de rappel sauf s'ils voyagent dans un pays où la dose de rappel est obligatoire. Dans ce cas, ils peuvent faire leur dose de rappel dès 3 mois après leur infection.

Le rappel doit être fait avec un vaccin à ARN messager (Pfizer-BioNTech ou Moderna) de manière indifférenciée quel que soit le vaccin utilisé pour la primovaccination. Concrètement, il est ainsi possible de recevoir du Moderna en rappel si l'on a été vacciné avec du Pfizer-BioNTech et inversement.
L'administration de cette dose de rappel chez les adolescents de 12 à 17 ans ne concerne que le vaccin Pfizer-BioNTech, forme 12 ans et plus.

Infographie COVID-19 - Grand public
Infographie COVID19 - Vaccin obligatoire pour certains professionnels
Infographie COVID19 - La dose de rappel

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