October 26, 2023

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Health Worker Burnout

Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey, United States, 2018–2022
Health workers faced overwhelming demands and experienced crisis levels of burnout before the COVID-19 pandemic; the pandemic presented unique challenges that further impaired their mental health. Data from the General Social Survey Quality of Worklife Module were analyzed to compare self-reported mental health symptoms among U.S. adult workers from 2018 (1,443 respondents, including 226 health workers) and 2022 (1,952, including 325 health workers). Logistic regression was used to examine associations between health workers’ reported perceptions of working conditions and anxiety, depression, and burnout. Results: From 2018 to 2022, health workers reported an increase of 1.2 days of poor mental health during the previous 30 days (from 3.3 days to 4.5 days); the percentage who reported feeling burnout very often (11.6% to 19.0%) increased. In 2022, health workers experienced a decrease in odds of burnout if they trusted management (odds ratio [OR] = 0.40), had supervisor help (OR = 0.26), had enough time to complete work (OR = 0.33), and felt that their workplace supported productivity (OR = 0.38), compared with those who did not. Harassment at work was associated with increased odds of anxiety (OR = 5.01), depression (OR = 3.38), and burnout (OR = 5.83). Positive working conditions were associated with less burnout and better mental health. CDC’s National Institute for Occupational Safety and Health has developed a national campaign, Impact Wellbeing, to provide employers of health workers with resources to improve the mental health of these workers.

Mpox

Mpox Neutralising Antibodies at 6 Months from Mpox Infection or MVA-BN Vaccination: A Comparative Analysis
Over 80 000 cases of mpox (formerly known as monkeypox) infection have been confirmed since May 2022. Infection elicits both cell-mediated and humoral immunity. Modified Vaccinia Ankara Bavarian Nordic (MVA-BN) vaccine has been used during the outbreak for infection control, showing an effectiveness of 66–78%. Second episodes of mpox and cases of breakthrough infections among fully vaccinated individuals have been reported. This opens questions regarding the durability and strength of protection following infection and vaccination. The aim of this study is to compare the neutralising antibody response at 6 months from mpox infection or MVA-BN vaccination. Analysis concludes people vaccinated with MVA-BN were found to develop frequently low or medium mpox neutralising antibodies when compared with infected individuals, as reported in 2023. One in ten vaccinated individuals showed no detectable neutralising antibodies at 6 months, whereas every person with mpox infection developed antibodies. People living with HIV, when compared with people without HIV, developed more frequently low or medium neutralising antibody responses, which might be related to premature cellular senescence

COVID

Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy
In this population-based cohort study of 142 006 live births in Ontario, Canada, maternal mRNA COVID-19 vaccination during pregnancy was associated with lower risks of severe neonatal morbidity, neonatal death, and neonatal intensive care unit admission and no increase in neonatal readmission or hospital admission up to age 6 months, compared with no maternal COVID-19 vaccination before delivery. Maternal mRNA COVID-19 vaccination during pregnancy was not associated with increased adverse newborn and early infant outcomes and may be protective against adverse newborn outcomes.
Duration of SARS-CoV-2 Culturable Virus Shedding in Children
COVID-19 quarantine and self-isolation policies continue to interrupt education. These policies, while typically more stringent than for routine viral illnesses, are guided by few data; the duration of SARS-CoV-2 infectivity in children is largely unknown. Authors evaluated duration of infectivity and its association with vaccination using live viral recovery over a 10-day window after a positive COVID-19 test result in children in Los Angeles County. In this cohort study, children aged 7 to 18 years who had a positive result via polymerase chain reaction test for COVID-19 were recruited between April and September 2022. Of the 75 participants who successfully completed study protocol, 52 (69.3%) were vaccinated, 40 (53.3%) were aged between 7 and 12 years, 38 (50.7%) were male, and 37 (49.3%) were female. Median duration of infectivity was 3 (95% CI, 3-3) days, with 14 participants (18.7%) infectious on day 5 and 3 (4.0%) on day 10. The median duration of infectivity among vaccinated children was 3 (95% CI, 3-3) days and among unvaccinated children, 3 (95% CI, 2-3) days. Among vaccinated children, duration of infectivity was similar for children who received a booster vs those who did not. Authors observed a median duration of infectivity of 3 days after a positive test result in children with the SARS-CoV-2 Omicron variant. There was no association between duration of infectivity and vaccination or booster status. These results are consistent with a study in adults with the Omicron variant, which found no association between vaccination status and infectivity duration and a slightly longer median duration of infectivity of 5 days. Findings suggest that current policies requiring isolation for 5 days after a positive test might be appropriate, as the majority of children were not infectious by day 5. Additionally, return-to-school policies may not need to discriminate by vaccine or booster status.
A retrospective cohort study of prescribing outcomes in outpatients treated with nirmatrelvir–Ritonavir for COVID-19 in an interdisciplinary community clinic
Large observational studies have demonstrated the real-world effectiveness of nirmatrelvir–ritonavir in preventing severe COVID-19 in higher risk individuals, but have provided limited information on other aspects of nirmatrelvir-ritonavir use. Authors’ objective was to evaluate prescribing outcomes such as the prevalence of drug-drug interactions (DDI), adverse drug events (ADE) and treatment adherence in an outpatient community clinic setting. They conducted a single-centre retrospective cohort study of adult outpatients prescribed nirmatrelvir–ritonavir in their community COVID-19 assessment clinic in Toronto, Ontario between March 3 and September 20, 2022. They performed a descriptive analysis of the patient population, DDIs, DDI interventions, treatment adherence, ADEs and clinical outcomes of patients prescribed nirmatrelvir–ritonavir. There were 637 individuals prescribed nirmatrelvir–ritonavir during the study period. The median age was 70, the median number of risk factors for severe disease were 2, 45% were immunocompromised and 82% had received 3 or more COVID-19 vaccine doses. 95% (542/572) completed the 5-day course of therapy with 68% (388/572) having complete symptom resolution by 28-day. Eleven percent (60/572) experienced recurrent symptoms following the completion of nirmatrelvir–ritonavir. Over 70% had one or more clinically significant DDIs requiring mitigation and 62% of patients experienced at least one ADE, which was most commonly dysgeusia or gastrointestinal-related. Ninety-five percent (542/572) of patients completed therapy as prescribed. Overall, hospitalization within 28 days was 3.3% with 1.2% attributed to COVID-19 and there were no deaths. Nirmatrelvir–ritonavir was associated with a high prevalence of clinically significant DDIs, which required mitigation strategies and a high frequency of mild ADEs. Collaborative assessment to address medication alterations resulted in high treatment adherence.
Nirmatrelvir and Molnupiravir and Post–COVID-19 Condition in Older Patients
While the COVID-19 pandemic appears to be winding down, its effects are still felt by the millions of people worldwide experiencing post–COVID-19 condition (PCC, or long COVID).1 The antiviral drug nirmatrelvir (marketed as Paxlovid [Pfizer], in combination with ritonavir) and molnupiravir (Lagevrio [Merck]) are recommended as first- and second-line treatments for acute illness in patients with specific risk factors (eg, diabetes). However, there are still no US Food and Drug Administration–approved drugs for the treatment or prevention of PCC. Recent studies among US veterans (mostly male) suggest that nirmatrelvir and molnupiravir reduce the risk of some sequelae of COVID-19. Researchers performed a cohort study of the 2 drugs in PCC in older patients who were Medicare enrollees. The cohort came from Medicare enrollees aged 65 years or older diagnosed with COVID-19 between January and September 2022. COVID-19 was identified with an outpatient International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code of U07.1. Overall, among 3 975 690 outpatients with COVID-19, 57% remained in the study after exclusion. Among them, 19.5% received nirmatrelvir and 2.6% received molnupiravir. PCC incidence among patients receiving nirmatrelvir was 11.8%, 13.7% for molnupiravir, and 14.5% for neither, absolute risk reduction was 2.7% for nirmatrelvir, 0.8% for molnupiravir, with hazard ratios (HRs) of 0.87 (95% CI, 0.86-0.88; P < .001) for nirmatrelvir and 0.92 (95% CI, 0.90-0.94; P < .001) for molnupiravir, compared with no treatment. Sensitivity analysis of only patients with the COVID-19 code showed a similar pattern but smaller effect sizes (nirmatrelvir: HR, 0.93 [95% CI, 0.92-0.94; P < .001], molnupiravir: HR, 0.96 [95% CI, 0.93-0.99; P = .001]). In an interaction analysis, authors found significantly smaller effect sizes in females than males (HRs for nirmatrelvir: 0.89 vs 0.84; molnupiravir: 0.95 vs 0.88). Female sex; Asian, Black, and Hispanic races; and indicators of low income were associated with increased risk of PCC. The most common symptoms in PCC were fatigue (29.9%), dyspnea (22.4%), and cough (21%).
Intravenous Vitamin C for Patients Hospitalized With COVID-19 Two Harmonized Randomized Clinical Trials
Researchers sought to determine if vitamin C administered intravenously to patients hospitalized with COVID-19 improve organ support–free days (composite outcome of in-hospital mortality and days alive and free of intensive care unit–based respiratory and cardiovascular support) up to day 21. In 2 prospectively harmonized randomized clinical trials, the use of vitamin C vs control (placebo or no vitamin C) yielded posterior probabilities for efficacy of 8.6% among 1568 critically ill patients and 2.9% among 1022 patients who were not critically ill regarding the odds of improvement for organ support–free days. Meaning: Among hospitalized patients with COVID-19, there was a low probability that vitamin C improved organ support–free days.
Association Between Guillain-Barré Syndrome and COVID-19 Infection and VaccinationA Population-Based Nested Case-Control Study
Authors aimed to assess the association between Guillain-Barré syndrome (GBS) and both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccine. A nested case-control study was conducted in a cohort of 3,193,951 patients aged 16 years or older, without a diagnosis of prior GBS, from the largest health care provider in Israel. Participants were followed from January 1, 2021, until June 30, 2022, for the occurrence of GBS. Ten randomly selected controls were matched to each case of GBS on age and sex. We assessed both SARS-CoV-2 infection and COVID-19 vaccine administration in the prior 6 weeks in cases and controls. Overall, 76 patients were diagnosed with GBS during follow-up and were matched to 760 controls. A positive test for SARS-CoV-2 was detected in 9 (11.8%) cases and 18 (2.4%) controls. An administration of COVID-19 vaccine was detected in 8 (10.5%) cases (all Pfizer-BioNTech [BNT162b2] vaccine) and 136 (17.9%) controls (134 Pfizer-BioNTech vaccine). Multivariable conditional logistic regression models showed that the odds ratio for GBS associated with SARS-CoV-2 infection and COVID-19 vaccine administration was 6.30 (95% CI 2.55–15.56) and 0.41 (95% CI 0.17–0.96), respectively. The results were similar when exposure to SARS-CoV-2 infection or COVID-19 vaccine administration was ascertained in the prior 4 and 8 weeks, although did not reach statistical significance for COVID-19 vaccine at 4 weeks. The study suggests that SARS-CoV-2 infection is associated with increased risk of GBS, whereas Pfizer-BioNTech COVID-19 vaccine is associated with decreased risk of GBS.
SARS-CoV-2 infection correlates with male benign prostatic hyperplasia deterioration
This study explores the correlation between SARS-CoV-2 infection and male benign prostatic hyperplasia (BPH) complications using large-scale real world data. All male patients attending the public healthcare system in Hong Kong receiving alpha-blocker monotherapy for LUTS from 2021 to 2022 were included in this study. Patients with and without positive polymerase chain reaction (PCR) test for SARS-CoV-2 are selected as the exposure group and control group, respectively. Baseline characteristics are retrieved, with propensity score matching performed to ensure balance of covariates between the two groups. BPH complications were then compared and subgroup analyses were performed. After propensity score matching, 17,986 patients were included for analysis, among which half had PCR-confirmed SARS-CoV-2 infection (n = 8993). When compared to controls, the SARS-CoV-2 group demonstrated statistically significant higher incidence of retention of urine (4.55% vs. 0.86%, p < 0.001), haematuria (1.36% vs. 0.41%, p < 0.001), clinical urinary tract infection (UTI) (4.31% vs. 1.49%, p < 0.001), culture-proven bacteriuria (9.02% vs. 1.97%, p < 0.001) and addition of 5ARI (0.50% vs. 0.02%, p < 0.001). Subgroup analysis demonstrated similar differences across different age groups. There are no statistically significance differences in incidence of retention, haematuria, or addition of 5ARI across different COVID-19 severities. It was concluded that SARS-CoV-2 infection is associated with increased incidence of urinary retention, haematuria, UTI and the addition of combination therapy in the short term, regardless of COVID-19 severity. This is the largest study demonstrating the detrimental urological effects of SARS-CoV-2 infection.