scholarly journals Switching vaccination among target groups to achieve improved long-lasting benefits

2021 ◽  
Vol 8 (6) ◽  
pp. 210292
Author(s):  
Ruiyun Li ◽  
Ottar N. Bjørnstad ◽  
Nils Chr. Stenseth
Keyword(s):  
High Risk ◽  
Focus Groups ◽  
Age Groups ◽  
Risk Groups ◽  
Health Impact ◽  
Older Age ◽  
Mathematical Framework ◽  
To Come ◽  
Indirect Risk ◽  
Roll Out

The development of vaccines has opened a way to lower the public health and societal burden of COVID-19 pandemic. To achieve sustainable gains in the long term, switching the vaccination from one target group to a more diverse portfolio should be planned appropriately. We lay out a general mathematical framework for comparing alternative vaccination roll-out strategies for the year to come: single focus groups: (i-a) the high-risk older age groups and (i-b) the core-sociable groups; and two focus groups: (ii-a) mixed vaccination of both the high-risk and core-sociable groups simultaneously and (ii-b) cyclic vaccination switching between groups. Featuring analyses of all relevant data including age pyramids for 15 representative countries with diverse social mixing patterns shows that mixed strategies that result in both direct and indirect protection of high-risk groups may be better for the overall societal health impact of COVID-19 vaccine roll-out. Of note, over time switching the priority from high-risk older age groups to core-sociable groups responsible for heightened circulation and thus indirect risk may be increasingly advantageous.

scholarly journals Emerging trends in the epidemiology of invasive mycoses in England and Wales (1990–9)

2001 ◽  
Vol 126 (3) ◽  
pp. 397-414 ◽  
Author(s):  
T. L. LAMAGNI ◽  
B. G. EVANS ◽  
M. SHIGEMATSU ◽  
E. M. JOHNSON
Keyword(s):  
Disease Surveillance ◽  
Fungal Infections ◽  
Communicable Disease ◽  
Pneumocystis Carinii ◽  
Age Groups ◽  
Public Health Problem ◽  
Risk Groups ◽  
Older Age ◽  
England And Wales ◽  
Invasive Mycoses

Invasive fungal infections are becoming an increasing public health problem owing to the growth in numbers of susceptible individuals. Despite this, the profile of mycoses remains low and there is no surveillance system specific to fungal infections currently existing in England and Wales. We analysed laboratory reports of deep-seated mycoses made to the Communicable Disease Surveillance Centre between 1990 and 1999 from England and Wales. A substantial rise in candidosis was seen during this period (6·76–13·70 reports per million population/year), particularly in the older age groups. Rates of cryptococcosis in males fluctuated over the decade but fell overall (1·05–0·66 per million population/year), whereas rates of female cases gradually rose up until 1998 (0·04–0·41 per million population/year). Reports of Pneumocystis carinii in men reduced substantially between 1990 and 1999 (2·77–0·42 per million population/year) but showed little change in women. Reports of aspergillosis fluctuated up until 1996, after which reports of male and female cases rose substantially (from 0·08 for both in 1996 to 1·92 and 1·69 per million population/year in 1999 for males and females respectively), largely accounted for by changes in reporting practice from one laboratory. Rates of invasive mycoses were generally higher in males than females, with overall male-to-female rate ratios of 1·32 (95% CI 1·25–1·40) for candidosis, 1·30 (95% CI 1·05–1·60) for aspergillosis, 3·99 (95% CI 2·93–5·53) for cryptococcosis and 4·36 (95% CI 3·47–5·53) for Pneumocystis carinii. The higher male than female rates of reports is likely to be a partial reflection of HIV epidemiology in England and Wales, although this does not fully explain the ratio in infants and older age groups. Lack of information on underlying predisposition prevents further identification of risk groups affected. Whilst substantial under-reporting of Pneumocystis carinii and Cryptococcus species was apparent, considerable numbers of superficial mycoses were mis-reported indicating a need for clarification of reporting guidelines. Efforts to enhance comprehensive laboratory reporting should be undertaken to maximize the utility of this approach for surveillance of deep-seated fungal infections.

Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women

2015 ◽  
Vol 43 (1) ◽  
Author(s):  
Panagiota Kitsantas ◽  
Kathleen F. Gaffney ◽  
Huichuan Wu
Keyword(s):  
High Risk ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Maternal Age ◽  
Age Groups ◽  
Risk Groups ◽  
Obese Women ◽  
Drinking Alcohol ◽  
Pregnancy Risk ◽  
Cart Analysis

AbstractRecent studies indicate that older women are more likely to consume alcohol during pregnancy, but subgroups at highest risk within the context of maternal age have not been identified. This study identifies subgroups at risk for alcohol use during pregnancy among three age categories using classification and regression trees (CART) analysis.Using the 2002–2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records of U.S. women), logistic regression and classification trees were constructed separately for age groups, ≤24, 25–29, and ≥30 years.Overall, 6.5% of women reported drinking alcohol during the last trimester of pregnancy. Alcohol consumption by age group was: 3.7% for ≤24, 5.7% for 25–29, and 10.1% for ≥30 years of age. Women ≤24 years were at greater risk of consuming alcohol if they also smoked (5.8%). Among nonsmokers, higher levels of education and being Hispanic were associated with a 35% increase in alcohol use. Distinct high-risk subgroups emerged for the 25–29-year-old group. Specifically, 12.8% of non-obese women who reported having experienced abuse during pregnancy also reported drinking alcohol in the last trimester. About 16% of women ≥30 years with at least 16 years of education, White or Hispanic with normal or underweight BMI, drank alcohol during their last trimester.Given limited health care resources for prevention and treatment, the early identification of high-risk groups for prenatal alcohol use is critical. This study provides evidence that risk factors contributing to alcohol consumption during pregnancy may differ by maternal age.

scholarly journals Younger ages at risk of Covid-19 mortality in communities of color

2020 ◽  
Vol 4 ◽  
pp. 69 ◽  
Author(s):  
Keith P. Klugman ◽  
Solomon Zewdu ◽  
Barbara E. Mahon ◽  
Scott F. Dowell ◽  
Padmini Srikantiah ◽  
...  
Keyword(s):  
South Africa ◽  
High Risk ◽  
Age Groups ◽  
Risk Groups ◽  
Minority Communities ◽  
Communities Of Color ◽  
Younger Age ◽  
Disaggregated Data ◽  
The Uk ◽  
Selection Of

More than 85% of Covid-19 mortality in high income countries is among people 65 years of age or older. Recent disaggregated data from the UK and US show that minority communities have increased mortality among younger age groups and in South Africa initial data suggest that the majority of deaths from Covid-19 are under 65 years of age. These observations suggest significant potential for increased Covid-19 mortality among younger populations in Africa and South Asia and may impact age-based selection of high-risk groups eligible for a future vaccine.

scholarly journals Incidence, clinical features, and outcomes of COVID-19 in Canada: impact of sex and age

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Jacob O’Brien ◽  
Kevin Y. Du ◽  
Chun Peng
Keyword(s):  
Incidence Rate ◽  
Age Groups ◽  
Case Fatality ◽  
Risk Groups ◽  
Older Age ◽  
Reproductive Age ◽  
Term Care ◽  
Severity Of The Disease ◽  
Lower Incidence Rate ◽  
The Impact

AbstractMale sex and older age have been reported to be associated with worse outcomes from COVID-19. It was postulated that estrogens may play a role in reducing the severity of the disease and may therefore offer a treatment option for COVID-19 patients. However, more female cases and deaths from COVID-19 have been recorded in Canada. To determine the potential role of estrogens, we analyzed COVID-19 data from Canada, focusing on the impact of sex and age. Although the overall incidence rate is higher in females than in males, when several high risk groups, including health care workers and long-term care residences, which are predominantly females, were excluded, we found that females had a lower incidence rate than males between the ages of 20s to 70s. Interestingly, this sex-based difference is more evident in females of the reproductive ages (20–49) than in postmenopausal patients (60s or older). Males have significantly higher hospitalization, ICU admission, and case fatality rates; however, a greater difference was observed in the older age groups. Finally, symptom manifestation varied between sexes. Some of the symptoms, which were more frequently observed in patients who recovered than patients who died, were more commonly observed in females of the reproductive age compared to their male counterparts. Since only females of the reproductive age have much higher circulating estrogens than males, these findings suggest that estrogens may play a role in reducing COVID-19 incidence and in the development of symptoms, especially those related to better survival.

Prevalence of high-risk human papillomavirus in uterine cervical lesions among older Japanese women.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5084-5084
Author(s):  
Kazuhiro Takehara ◽  
Hiroko Nakamura ◽  
Osamu Samura ◽  
Tomoya Mizunoe ◽  
Akihisa Saito ◽  
...  
Keyword(s):  
High Risk ◽  
Age Groups ◽  
Hpv Infection ◽  
Japanese Women ◽  
Older Age ◽  
Age Group ◽  
Hpv 16 ◽  
Younger Age ◽  
Hpv Genotypes ◽  
High Risk Hpv

5084 Background: To estimate the prevalence and genotypes of high-risk human papillomavirus (HPV) among older Japanese women, using liquid-based cytology (LBC). Methods: ThinPrep LBC specimens were collected from 11,039 Japanese women (age range, 14-98 years). After classifying cytodiagnosis, specimens were analyzed for HPV DNA using the multiplex polymerase chain reaction method. Cervical smear specimens from 1,302 women showed positive results. To examine the prevalence of HPV in women defined as negative for intraepithelial lesion or malignancy (NILM), 2,563 samples were randomly selected from the remaining 9,737 women. Comparisons were made between women ≥50 years of age (older age group) and women <50 years of age (younger age group). Written informed consent was obtained from all patients. In this study, the high-risk HPV genotypes encountered were 16, 18, 31, 33, 35, 45, 52, and 58. Results: In the older age group with abnormal smear findings, HPV genotypes were detected in 49.7% (148/298), including high-risk HPV genotypes in 40.9% (122/298). In the younger age group with abnormal smear findings, HPV genotypes were detected in 71.7% (720/1004), including high-risk HPV genotypes in 58.1% (583/1,004). In NILM, HPV-positive rates were 4.5% (39/873) in the older age group and 11.8% (199/1,690) in the younger age group. In high-grade squamous intraepithelial lesion (HSIL) or more severe cytological findings, HPV genotypes of each group (older age group/younger age group) were detected in 61.7%/83.1%, and high-risk HPV genotypes were detected in 56.4%/74.7% of women. In positive cervical smears, HPV 16 was the most frequently detected (28.5%) in the younger age group, while HPV 52 (31.3%) and 58 (27.2%) were detected more frequently than HPV 16 (18.4%) in the older age group. Conclusions: In Japan, although HPV infection as a cause of abnormal cervical cytology is more frequent among younger age groups than in older age groups, high-risk HPV infection was more highly associated with older individuals (older age group/younger age group: abnormal smear findings, 82.4%/81.0%; HSIL or more severe cytological findings, 91.3%/89.9%). In older age groups, HPV 52 and 58 were more frequent than HPV 16.

Multicentre study of physical abuse and limb fractures in young children in the East Anglia Region, UK

2019 ◽  
Vol 104 (10) ◽  
pp. 956-961 ◽  
Author(s):  
Piers D Mitchell ◽  
Richard Brown ◽  
Tengyao Wang ◽  
Rajen D Shah ◽  
Richard J Samworth ◽  
...  
Keyword(s):  
High Risk ◽  
Young Children ◽  
Physical Abuse ◽  
Child Protection ◽  
Significant Variation ◽  
Age Groups ◽  
High Standard ◽  
Risk Groups ◽  
Case Conference ◽  
East Anglia

ObjectiveTo determine if the detection of physical abuse in young children with fractures is of uniform high standard in the East Anglia Region of the UK, and whether we can identify areas for improvement in our detection of high-risk groups.DesignMulticentre retrospective 4-year study.Setting7 hospitals across the East Anglia Region of Britain (East Anglia Paediatric Physical Abuse and Fractures study).ParticipantsAge groups and fractures indicated as being at higher risk for physical abuse (all children under 12 months of age, and fractures of humerus and femur in children under 36 months of age).Outcome measuresOur criterion for physical abuse was the decision of a multiagency child protection case conference (CPCC).ResultsProbability of CPCC decision of physical abuse was highest in infants, ranging from 50% of fractures sustained in the first month of life (excluding obstetric injuries) to 10% at 12 months of age. Only 46%–86% of infants (under 12 months) with a fracture were assessed by a paediatrician for physical abuse after their fracture. Significant variation in the use of skeletal surveys and in CPCC decision of physical abuse was noted in children attending different hospitals.ConclusionsIt is a concern that significant variation between hospitals was found in the investigation and detection of physical abuse as confirmed by CPCC decisions. To minimise failure to detect true cases of physical abuse, we recommend that all high-risk children should be assessed by a paediatrician prior to discharge from the emergency department. Our proposed criteria for assessment (where we found probability of CPCC decision of physical abuse was at least 10%) are any child under the age of 12 months with any fracture, under 18 months of age with femur fracture and under 24 months with humeral shaft fracture (not supracondylar).

Myelodysplastic Syndromes in Patients Younger Than Age 50

2006 ◽  
Vol 24 (34) ◽  
pp. 5358-5365 ◽  
Author(s):  
Andrea Kuendgen ◽  
Corinna Strupp ◽  
Manuel Aivado ◽  
Barbara Hildebrandt ◽  
Rainer Haas ◽  
...  
Keyword(s):  
High Risk ◽  
Median Survival ◽  
Myelodysplastic Syndromes ◽  
Age Groups ◽  
Young Patients ◽  
Risk Groups ◽  
Classification Systems ◽  
Risk Scores ◽  
International Prognostic Scoring System ◽  
Risk Categories

Purpose Myelodysplastic syndromes (MDS) mainly occur in the elderly but can affect younger individuals too. The latter require special consideration to identify suitable candidates for allogeneic stem-cell transplantation, a potentially curative approach carrying a high risk of treatment-related complications. Patients and Methods We report the largest series of young MDS patients as yet, including 232 patients younger than 50 years. Their clinical characteristics and prognosis are compared with 2,496 patients older than 50 years. Results Survival was significantly longer in the younger versus older age group (40 v 23 months, respectively; P < .00005). The difference arose from patients belonging to the low- and intermediate-I–risk categories of the International Prognostic Scoring System (median survival not reached v 45 months, respectively; P < .00005). In contrast, survival was identical for both age groups (8 months for both younger and older patients; P = .81) in the intermediate-II–and high-risk categories. Established classification systems and risk scores were applicable to young patients with primary MDS. Interestingly, a particularly large difference in median survival time was seen between the intermediate-I–and intermediate-II–risk groups (176 v 8 months, respectively). For low-risk patients, the overall survival rate was more than 86% at 20 years. Conclusion According to these results, aggressive treatment approaches should rarely be recommended to younger MDS patients belonging to the low and intermediate-I risk groups.

scholarly journals Vaccine optimization for COVID-19: Who to vaccinate first?

2020 ◽  
Vol 7 (6) ◽  
pp. eabf1374
Author(s):  
Laura Matrajt ◽  
Julia Eaton ◽  
Tiffany Leung ◽  
Elizabeth R. Brown
Keyword(s):  
Mathematical Model ◽  
High Risk ◽  
Vaccination Coverage ◽  
Age Groups ◽  
Vaccine Effectiveness ◽  
Older Age ◽  
Evidence Based ◽  
Ethical Considerations ◽  
Younger Age ◽  
Vaccine Shortages

Vaccines, when available, will likely become our best tool to control the COVID-19 pandemic. Even in the most optimistic scenarios, vaccine shortages will likely occur. Using an age-stratified mathematical model paired with optimization algorithms, we determined optimal vaccine allocation for four different metrics (deaths, symptomatic infections, and maximum non-ICU and ICU hospitalizations) under many scenarios. We find that a vaccine with effectiveness ≥50% would be enough to substantially mitigate the ongoing pandemic, provided that a high percentage of the population is optimally vaccinated. When minimizing deaths, we find that for low vaccine effectiveness, irrespective of vaccination coverage, it is optimal to allocate vaccine to high-risk (older) age groups first. In contrast, for higher vaccine effectiveness, there is a switch to allocate vaccine to high-transmission (younger) age groups first for high vaccination coverage. While there are other societal and ethical considerations, this work can provide an evidence-based rationale for vaccine prioritization.

scholarly journals Vaccine optimization for COVID-19: who to vaccinate first?

2020 ◽  
Author(s):  
Laura Matrajt ◽  
Julie Eaton ◽  
Tiffany Leung ◽  
Elizabeth R Brown
Keyword(s):  
Mathematical Model ◽  
High Risk ◽  
Vaccination Coverage ◽  
Age Groups ◽  
Vaccine Effectiveness ◽  
Older Age ◽  
Evidence Based ◽  
Ethical Considerations ◽  
Younger Age ◽  
Vaccine Shortages

A vaccine, when available, will likely become our best tool to control the cur- rent COVID-19 pandemic. Even in the most optimistic scenarios, vaccine shortages will likely occur. Using an age-stratified mathematical model paired with optimization algorithms, we determined optimal vaccine allocation for four different metrics (deaths, symptomatic infections, and maximum non- ICU and ICU hospitalizations) under many scenarios. We find that a vaccine with effectiveness ≥50% would be enough to substantially mitigate the ongo- ing pandemic provided that a high percentage of the population is optimally vaccinated. When minimizing deaths, we find that for low vaccine effective- ness, irrespective of vaccination coverage, it is optimal to allocate vaccine to high-risk (older) age-groups first. In contrast, for higher vaccine effectiveness, there is a switch to allocate vaccine to high-transmission (younger) age-groups first for high vaccination coverage. While there are other societal and ethical considerations, this work can provide an evidence-based rationale for vaccine prioritization.

scholarly journals Community pharmacist-administered seasonal influenza vaccination: a national customer survey

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Dominik Stämpfli ◽  
Adrian Martinez-De la Torre ◽  
Sophie Du Pasquier ◽  
Danielle Stegmann ◽  
Andrea Brügger ◽  
...  
Keyword(s):  
High Risk ◽  
Influenza Vaccination ◽  
Community Pharmacist ◽  
Seasonal Influenza ◽  
Age Groups ◽  
Risk Groups ◽  
Injection Technique ◽  
Equal Distribution ◽  
Seasonal Influenza Vaccination ◽  
Influenza Vaccinations

Abstract Background In Switzerland, the influenza vaccination is recommended for high-risk groups and people who have contact with high-risk groups. Since 2015, Swiss pharmacists are allowed to vaccinate healthy adults after acquiring a certificate of competence for vaccination and blood sampling techniques. We aimed to assess customers of the seasonal influenza vaccination in pharmacies in regard to their satisfaction, motivation, and reasons. Methods Swiss pharmacies collected survey data during a period of 12 weeks from mid-October 2019 to mid-January 2020. Each participating pharmacy was sent 20 questionnaires to be handed out to vaccinated customers. The questionnaire was available in German and French and subdivided into four sections: demographic information, satisfaction, reasons for getting the vaccination, and reasons for choosing a pharmacy as a place of vaccination. We tested for statistical differences in answer tendencies across strata on questionnaire language, age groups, and levels of education. Results Of the 1600 surveys sent, 80 pharmacies sent back 656 completed questionnaires (return rate, 41%). Main age bracket was 65–74 years (26.2%), followed by 55–64 years (24.7%), with an equal distribution of reported sex (female, 49.5%). Of the respondents, 99% would have recommended the service and 88.5% felt very comfortable being vaccinated by a pharmacist. Satisfaction included injection technique, used facilities, preparatory discussions, and pricing of the service. Easy scheduling was a main motivation for choosing a pharmacy as the vaccination provider. We identified minor differences in answer tendencies across questionnaire language and age groups, but not across levels of education. Conclusion Customer satisfaction with community pharmacist-administered seasonal influenza vaccinations is high in Switzerland.

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