Search

ObjectiveTo determine characteristics associated with COVID-19 vaccine coverage among individuals aged 50 years and above in England since the beginning of the programme.DesignObservational cross-sectional study assessed by logistic regression and mean prevalence margins.SettingCOVID-19 vaccinations delivered in England from 8 December 2020 to 17 May 2021.Participants30 624 257/61 967 781 (49.4%) and 17 360 045/61 967 781 (28.1%) individuals in England were recorded as vaccinated in the National Immunisation Management System with a first dose and a second dose of a COVID-19 vaccine, respectively.InterventionsVaccination status with COVID-19 vaccinations.Main outcome measuresProportion, adjusted ORs and mean prevalence margins for individuals not vaccinated with dose 1 among those aged 50–69 years and dose 1 and 2 among those aged 70 years and above.ResultsOf individuals aged 50 years and above, black/African/Caribbean ethnic group was the least likely of all ethnic groups to be vaccinated with dose 1 of the COVID-19 vaccine. However, of those aged 70 years and above, the odds of not having dose 2 was 5.53 (95% CI 5.42 to 5.63) and 5.36 (95% CI 5.29 to 5.43) greater among Pakistani and black/African/Caribbean compared with white British ethnicity, respectively. The odds of not receiving dose 2 was 1.18 (95% CI 1.16 to 1.20) higher among individuals who lived in a care home compared with those who did not. This was the opposite to that observed for dose 1, where the odds of being unvaccinated was significantly higher among those not living in a care home (0.89 (95% CI 0.87 to 0.91)).ConclusionsWe found that there are characteristics associated with low COVID-19 vaccine coverage. Inequalities, such as ethnicity are a major contributor to suboptimal coverage and tailored interventions are required to improve coverage and protect the population from SARS-CoV-2.

The impact of COVID-19 disruptions on global Bacillus Calmette-Guérin (BCG) coverage and paediatric tuberculosis (TB) mortality is still unknown. To fill this evidence-gap and guide mitigation measures, we estimated the impact of COVID-19 disruptions on global BCG coverage and paediatric TB mortality. First, we used data from multiple sources to estimate COVID-19-disrupted BCG vaccination coverage. Second, using a static mathematical model, we estimated the number of additional paediatric TB deaths in the first 15 years of life due to delayed/missed vaccinations in 14 scenarios—varying in duration of disruption, and magnitude and timing of catch-up. We estimated a 25% reduction in global BCG coverage within the disruption period. The best-case scenario (3-month disruption, 100% catch-up within 3 months) resulted in an additional 886 (0.5%) paediatric TB deaths, and the worst-case scenario (6-month disruption with no catch-up) resulted in an additional 33,074 (17%) deaths. The magnitude of catch-up was found to be the most influential variable in minimising excess paediatric TB mortality. Our results show that ensuring catch-up vaccination of missed children is a critical priority, and delivery of BCG alongside other routine vaccines may be a feasible way to achieve catch-up. Urgent action is required to support countries with recovering vaccination coverages to minimise paediatric deaths.

ObjectiveTo determine characteristics associated with COVID-19 vaccine coverage among individuals aged 50 years and above in England since the beginning of the programme.DesignObservational cross-sectional study assessed by logistic regression and mean prevalence margins.SettingCOVID-19 vaccinations delivered in England from 08 December 2020 – 17 May 2021.Participants30,624,257/ 61,967,781 (49.4%) and 17,360,045/ 61,967,781 (28.1%) individuals in England were recorded as vaccinated in the National Immunisation Management System with a first dose and a second dose of a COVID-19 vaccine, respectively.InterventionsVaccination status with COVID-19 vaccinations.Main Outcome MeasuresProportion, adjusted odds ratios and mean prevalence margins for individuals not vaccinated with dose 1 among those aged 50-69 years old and dose 1 and 2 among those aged 70 years old and above.ResultsAmong individuals aged 50 years and above, Black/African/Caribbean ethnic group was the least likely of all ethnic groups to be vaccinated with dose 1 of the COVID-19 vaccine. However, among those aged 70 years and above, the odds of not having dose 2 was 5.53 (95% CI 5.42 to 5.63) and 5.36 (90% CI 5.29 to 5.43) greater among Pakistani and Black/African/Caribbean compared to White British ethnicity, respectively. The odds of not receiving dose 2 was 1.18 (95% CI 1.16 to 1.20) higher among individuals who lived in a care home compared to those who did not. This was the opposite to that observed for dose 1, where the odds of not being vaccinated was significantly higher among those not living in a care home (0.89 (95% CI 0.87 to 0.91)).ConclusionsWe found that there are characteristics associated with low COVID-19 vaccine coverage. Inequalities, such as ethnicity are a major contributor to suboptimal coverage and tailored interventions are required to improve coverage and protect the population from SARS-CoV-2.Article summaryStrengths and Limitations of this studyThis is the is the first study assessing characteristics associated with COVID-19 vaccine coverage for all individuals aged 50 years and above in England.This study uses data from the National Immunisation Management System (NIMS) which is based on all individuals in England with a registered NHS number.This centralised national system captures individual level data for both vaccination status and demographic characteristics and allows for linkage to other datasets such as health care worker and care home resident status.This study does not include those without an NHS number and, therefore, it is possible we have underestimated the number of vaccines delivered and odds of not being vaccinated for characteristics such as ethnic groups where we have seen the greatest impact.Residual errors in data entry on the point of care apps at the vaccination sites may have also occurred, though these errors are not likely to be widespread.

BackgroundIn 2020, the COVID-19 pandemic and control measures such as national lockdowns threatened to disrupt routine childhood immunisation programmes. Initial reports from the early weeks of lockdown in the UK and worldwide suggested that uptake could fall putting children at risk from multiple other infectious diseases. In Scotland and England, enhanced surveillance of national data for childhood immunisations was established to inform and rapidly assess the impact of the pandemic on infant and preschool immunisation uptake rates.Methods and findingsWe undertook an observational study using routinely collected data for the year prior to the pandemic (2019), and immediately before, during and after the first period of the UK ‘lockdown’ in 2020. Data were obtained for Scotland from the Public Health Scotland “COVID19 wider impacts on the health care system” dashboard (https://scotland.shinyapps.io/phs-covid-wider-impact/) and for England from ImmForm.Five vaccinations delivered at different ages were evaluated; three doses of the ‘6-in-1’ DTaP/IPV/Hib/HepB vaccine and two doses of MMR. Uptake in the periods in 2020 compared to that in the baseline year of 2019 using binary logistic regression analysis. For Scotland, we analysed timely uptake of immunisations, defined as uptake within four weeks of the child becoming eligible by age for each immunisation and data were also analysed by geographical region and indices of deprivation. For both Scotland and England, we assessed whether immunisations were up to date at approximately 6 months (all doses 6-in-1) and 16-18 months (first MMR) of age.We found that uptake rates within four weeks of eligibility in Scotland for all the five vaccine visits were higher during the 2020 lockdown period than in 2019. The difference ranged from 1.3% for the first dose of the 6-in-1 vaccine (95.3 vs 94%, OR 1.28, CI 1.18-1.39) to 14.3% for the second MMR dose (66.1 vs 51.8 %, OR 1.8, CI 1.74-1.87). Significant increases in uptake were seen across all deprivation levels, though, for MMR, there was evidence of greater improvement for children living in the least deprived areas.In England, fewer children who had been due to receive their immunisations during the lockdown period were up to date at 6 months (6-in-1) or 18 months (first dose MMR). The fall in percentage uptake ranged from 0.5% for first 6-in1 (95.8 vs 96.3%, OR 0.89, CI 0.86-0.91) to 2.1% for third 6-in-1 (86.6 vs 88.7%, OR 0.82, CI 0.81-0.83).ConclusionsThis study suggests that the national lockdown in Scotland was associated with a positive effect on timely childhood immunisation uptake, however in England a lower percentage of children were up to date at 6 and 18 months. Reason for the improve uptake in Scotland may include active measures taken to promote immunisation at local and national level during this period. Promoting immunisation uptake and addressing potential vaccine hesitancy is particularly important given the ongoing pandemic and COVID-19 vaccination campaigns.

A nosocomial infection - also called infection can be defined as An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. Patient care is provided in facilities which range from highly equipped clinics and technologically advanced university hospitals to front-line primary health centers with only basic facilities. Despite progress in public health and hospital care, infections continue to develop in hospitalized patients, and may also affect hospital staff. Many factors promote infection among hospitalized patients: decreased immunity among patients the increasing variety of medical procedures and invasive techniques creating potential routes of infection and the transmission of drug-resistant bacteria among crowded hospital populations, where poor infection control practices may facilitate transmission.

Summary Background BCG has been recommended at birth in countries with a high tuberculosis burden for decades, yet delayed vaccination is widespread. To support a WHO guidance review, we estimated the potential global tuberculosis mortality benefit of administering BCG on time and consequences of later administration. Methods We estimated age-specific BCG coverage in 152 high-burden countries using data from large, nationally representative household surveys, to parameterise a static mathematical model, calibrated to global childhood tuberculosis deaths in 2016. 12 hypothetical scenarios explored the effect of BCG delivery at birth, 6 weeks, 6 months, or 9–12 months, on tuberculosis deaths per global birth cohort by age 15 years, including delivery at the time of the first diphtheria–tetanus–pertussis vaccine (DTP1) or the first measles-containing vaccine (MCV1). We assumed constant vaccine efficacy by age, but varied coverage and degree of vaccination delay, including no delay. Findings In 152 high-burden countries, we estimated that BCG coverage in 2016 was 37% at 1 week of age, 67% at 6 weeks, and 92% at 3 years. Modelled scenarios in which 92% BCG coverage was achieved at birth reduced tuberculosis deaths in the global birth cohort by 5449 (95% uncertainty range 218–15 071) or 2·8% (0·1–7·0) by age 15 years. 100% coverage at birth reduced tuberculosis deaths by 16·5% (0·7–41·9). Later administration increased tuberculosis deaths—eg, BCG vaccination at 6 weeks, the recommended age of DTP1, increased tuberculosis deaths by 0·2% (0–0·4), even if BCG reached DTP1 coverage levels (94% at 3 years). Interpretation Reducing delays and increasing coverage at birth would substantially reduce global paediatric tuberculosis mortality. Modelled scenarios whereby BCG was administered later in the infant schedule were all estimated to increase tuberculosis deaths, even with increased coverage. The WHO recommendation for BCG at birth should be maintained and emphasised. Funding WHO.

Poly(vinyl chloride) (PVC) was modified with three different ionomers including thiosulphate, thiourea and sulphite for improving the biocompatibility of the polymer. All ionomers were prepared by nucleophilic substitution using a phase transfer catalyst method. The modified forms of PVC were characterized using ultraviolet-visible (UV-Vis) spectroscopy, Fourier Transform Infrared (FTIR) spectroscopy, scanning electron microscopy (SEM) and thermal gravimetric analysis (TGA). They were found to be less stable thermally compared to the untreated polymer. The biocompatibility of the polymers was evaluated by assessing their wettability via contact angle measurements and by performing hemolysis and thrombogenicity assays. Their cellular biocompatibility was evaluated by assessing their adhesion and proliferation, and by carrying out cytotoxicity assays and nuclear staining. The results reveal that modification of the polymer with the specified ionomers significantly enhances the bio- and blood-compatibility properties.

Recently published guidelines on Psychosocial Management of Diabetes in India provide evidence-based recommendations for the whole nation. However, they do not fully address the myriad socio-cultural issues prevalent in the North Eastern states. The eight North Eastern states of India house 45 million people, belonging to 220 ethnic groups who speak an equal number of dialects, and follow distinctly unique cultures, which impact health-related behavior. Such diversity is difficult to cover in any national guideline. This lacuna makes it necessary to have a document, which addresses the specific needs and requirements of diabetes care professionals in the North-east of India. This consensus statement aims to highlight evidence- and experience-based strategies for psychosocial management of diabetes, based upon the unique ethnographic constitution of this part of the country. It is based upon the results of a daylong focused group discussion, held at Sonapur, Assam, on 9th February 2013, involving key opinion leaders from most North-eastern states, including all geographical divisions of Assam. Recommendations are classified into three domains: General, psychological, and socio-cultural, and graded by the weight they should have in clinical practice. Eighteen recommendations of varying strength are made, to help professionals identify the psycho-socio-cultural determinants of diabetes, and to explore the role of psycho-socio-cultural interventions in devising support strategies for people with diabetes and their families. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management in the North-east and help achieve a qualitative improvement in diabetes care. The guidelines may also be useful for diabetes care professionals working with other indigenous groups across the world.