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Throughout the COVID-19 pandemic, SARS-CoV-2 variants have emerged through viral mutation. Variants demonstrating an increase in transmissibility or virulence; changes in clinical manifestations; or a decrease in the effectiveness of [...]

BackgroundTreatment decisions in kidney transplantation requires patients and clinicians to weigh the benefits and harms of a broad range of medical and surgical interventions, but the heterogeneity and lack of patient-relevant outcomes across trials in transplantation makes these trade-offs uncertain, thus, the need for a core outcome set that reflects stakeholder priorities.MethodsWe convened 2 international Standardized Outcomes in Nephrology-Kidney Transplantation stakeholder consensus workshops in Boston (17 patients/caregivers; 52 health professionals) and Hong Kong (10 patients/caregivers; 45 health professionals). In facilitated breakout groups, participants discussed the development and implementation of core outcome domains for trials in kidney transplantation.ResultsSeven themes were identified. Reinforcing the paramount importance of graft outcomes encompassed the prevailing dread of dialysis, distilling the meaning of graft function, and acknowledging the terrifying and ambiguous terminology of rejection. Reflecting critical trade-offs between graft health and medical comorbidities was fundamental. Contextualizing mortality explained discrepancies in the prioritization of death among stakeholders-inevitability of death (patients), preventing premature death (clinicians), and ensuring safety (regulators). Imperative to capture patient-reported outcomes was driven by making explicit patient priorities, fulfilling regulatory requirements, and addressing life participation. Specificity to transplant; feasibility and pragmatism (long-term impacts and responsiveness to interventions); and recognizing gradients of severity within outcome domains were raised as considerations.ConclusionsStakeholders support the inclusion of graft health, mortality, cardiovascular disease, infection, cancer, and patient-reported outcomes (ie, life participation) in a core outcomes set. Addressing ambiguous terminology and feasibility is needed in establishing these core outcome domains for trials in kidney transplantation.

In British Columbia, Canada, initial growth of the SARSCoV-2 Delta variant was slower than that reported in other jurisdictions. Delta became the dominant variant (>50% prevalence) within ≈7–13 weeks of first detection in regions within the United Kingdom and United States. In British Columbia, it remained at <10% of weekly incident COVID-19 cases for 13 weeks after first detection on March 21, 2021, eventually reaching dominance after 17 weeks. We describe the growth of Delta variant cases in British Columbia during March 1–June 30, 2021, and apply retrospective counterfactual modeling to examine factors for the initially low COVID-19 case rate after Delta introduction, such as vaccination coverage and nonpharmaceutical interventions. Growth of COVID-19 cases in the first 3 months after Delta emergence was likely limited in British Columbia because additional nonpharmaceutical interventions were implemented to reduce levels of contact at the end of March 2021, soon after variant emergence. [ABSTRACT FROM AUTHOR]

This article discusses the impact of the COVID-19 pandemic on respiratory virus surveillance in British Columbia. The BC Centre for Disease Control (BCCDC) and the BCCDC Public Health Laboratory have made enhancements to surveillance and laboratory testing practices, including increased testing and genomic sequencing capacities. Wastewater testing has also been incorporated into viral respiratory illness surveillance. Data accessibility and linkages have improved, allowing for the integration of laboratory data with clinical information and demographic records. The BCCDC and the BCCDC Public Health Laboratory use these comprehensive data to provide timely information on viral respiratory illness through public dashboards. The surveillance system aims to provide relevant information to all users and respond efficiently to changing needs. The data collected inform public health action, clinical management, and prevention strategies for viral respiratory illnesses. [Extracted from the article]

Introduction: The illicit drug toxicity (overdose) crisis has worsened across Canada; between 2016 and 2021, more than 28,000 individuals have died of drug toxicity. Organ donation from persons who experience drug toxicity death (DTD) has increased in recent years. This study examines whether survival after heart or bilateral‐lung transplantation differed by donor cause of death. Methods: We studied transplant recipients in British Columbia who received heart (N = 110) or bilateral‐lung (N = 223) transplantation from deceased donors aged 12–70 years between 2013 and 2019. Transplant recipient survival was compared by donor cause of death from drug toxicity or other. Five‐year Kaplan‐Meier estimates of survival and 3‐year inverse probability treatment weighted Cox proportional hazards models were conducted. Results: DTD donors made up 36% (40/110) of heart and 24% (54/223) of bilateral‐lung transplantations. DTD donors were more likely to be young, white, and male. Unadjusted 5‐year recipient survival was similar by donor cause of death (heart: 87% for DTD and 86% for non‐DTD, p =.75; bilateral‐ lung: 80% for DTD and 76% for non‐DTD, p =.65). Adjusted risk of mortality at 3‐years post‐transplant was similar between recipients of DTD and non‐DTD donor heart (hazard ratio [HR]:.94, 95% confidence interval (CI):.22–4.07, p =.938) and bilateral‐lung (HR: 1.06, 95% CI:.41–2.70, p =.908). Conclusion: Recipient survival after heart or bilateral‐lung transplantation from DTD donors and non‐DTD donors was similar. Donation from DTD donors is safe and should be considered more broadly to increase organ donation. [ABSTRACT FROM AUTHOR]

Background In late 2021, the Omicron severe acute respiratory syndrome coronavirus 2 variant emerged and rapidly replaced Delta as the dominant variant. The increased transmissibility of Omicron led to surges in case rates and hospitalizations; however, the true severity of the variant remained unclear. We aimed to provide robust estimates of Omicron severity relative to Delta. Methods This retrospective cohort study was conducted with data from the British Columbia COVID-19 Cohort, a large provincial surveillance platform with linkage to administrative datasets. To capture the time of cocirculation with Omicron and Delta, December 2021 was chosen as the study period. Whole-genome sequencing was used to determine Omicron and Delta variants. To assess the severity (hospitalization, intensive care unit [ICU] admission, length of stay), we conducted adjusted Cox proportional hazard models, weighted by inverse probability of treatment weights (IPTW). Results The cohort was composed of 13 128 individuals (7729 Omicron and 5399 Delta). There were 419 coronavirus disease 2019 hospitalizations, with 118 (22%) among people diagnosed with Omicron (crude rate = 1.5% Omicron, 5.6% Delta). In multivariable IPTW analysis, Omicron was associated with a 50% lower risk of hospitalization compared with Delta (adjusted hazard ratio [aHR] = 0.50, 95% confidence interval [CI] = 0.43 to 0.59), a 73% lower risk of ICU admission (aHR = 0.27, 95% CI = 0.19 to 0.38), and a 5-day shorter hospital stay (aß = −5.03, 95% CI = −8.01 to −2.05). Conclusions Our analysis supports findings from other studies that have demonstrated lower risk of severe outcomes in Omicron-infected individuals relative to Delta. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate whether factors like remote distances or rural dwellings were responsible in limiting access of patients with kidney failure to kidney transplantation in the United States. Results indicated that these factors did not impact access and increased time for kidney transplantation.

Background: The influenza A(H3N2) vaccine was updated from clade 3C.3a in 2015-2016 to 3C.2a for 2016-2017 and 2017-2018. Circulating 3C.2a viruses showed considerable hemagglutinin glycoprotein diversification and the egg-adapted vaccine also bore mutations.Methods: Vaccine effectiveness (VE) in 2016-2017 and 2017-2018 was assessed by test-negative design, explored by A(H3N2) phylogenetic subcluster and prior season's vaccination history.Results: In 2016-2017, A(H3N2) VE was 36% (95% confidence interval [CI], 18%-50%), comparable with (43%; 95% CI, 24%-58%) or without (33%; 95% CI, -21% to 62%) prior season's vaccination. In 2017-2018, VE was 14% (95% CI, -8% to 31%), lower with (9%; 95% CI, -18% to 30%) versus without (45%; 95% CI, -7% to 71%) prior season's vaccination. In 2016-2017, VE against predominant clade 3C.2a1 viruses was 33% (95% CI, 11%-50%): 18% (95% CI, -40% to 52%) for 3C.2a1a defined by a pivotal T135K loss of glycosylation; 60% (95% CI, 19%-81%) for 3C.2a1b (without T135K); and 31% (95% CI, 2%-51%) for other 3C.2a1 variants (with/without T135K). VE against 3C.2a2 viruses was 45% (95% CI, 2%-70%) in 2016-2017 but 15% (95% CI, -7% to 33%) in 2017-2018 when 3C.2a2 predominated. VE against 3C.2a1b in 2017-2018 was 37% (95% CI, -57% to 75%), lower at 12% (95% CI, -129% to 67%) for a new 3C.2a1b subcluster (n = 28) also bearing T135K.Conclusions: Exploring VE by phylogenetic subcluster and prior vaccination history reveals informative heterogeneity. Pivotal mutations affecting glycosylation sites, and repeat vaccination using unchanged antigen, may reduce VE. [ABSTRACT FROM AUTHOR]