October 20, 2022

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Clinical Reports

Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students
Adverse childhood experiences (ACEs) are associated with poor mental health and suicidal behaviors. The prevalences of poor current mental health and past-year suicide attempts among adolescents reporting four or more ACEs during the COVID-19 pandemic were four and 25 times as high as those without ACEs, respectively. Exposure to specific ACE types (e.g., emotional abuse) were associated with higher prevalences of poor mental health and suicidal behaviors. Primary prevention and intervention strategies for ACEs and their acute and long-term impacts, including early identification and trauma-informed mental health service and support provision, could help address the U.S. child and adolescent mental health and suicide crisis.

Antiviral Therapeutics and Vaccines

Severe COVID-19 outcomes after full vaccination of primary schedule and initial boosters: pooled analysis of national prospective cohort studies of 30 million individuals in England, Northern Ireland, Scotland, and Wales
Between Dec 8, 2020, and Feb 28, 2022, 16,208,600 individuals completed their primary vaccine schedule and 13,836,390 individuals received a booster dose. Between Dec 20, 2021, and Feb 28, 2022, 59 510 (0·4%) of the primary vaccine group and 26 100 (0·2%) of those who received their booster had severe COVID-19 outcomes. The risk of severe COVID-19 outcomes reduced after receiving the booster (rate change: 8·8 events per 1000 person-years to 7·6 events per 1000 person-years). Older adults (≥80 years vs18–49 years; aRR 3·60 [95% CI 3·45–3·75]), those with comorbidities (≥5 comorbidities vs none; 9·51 [9·07–9·97]), being male (male vs female; 1·23 [1·20–1·26]), and those with certain underlying health conditions—in particular, individuals receiving immunosuppressants (yes vs no; 5·80 [5·53–6·09])—and those with chronic kidney disease (stage 5 vs no; 3·71 [2·90–4·74]) remained at high risk despite the initial booster. Individuals with a history of COVID-19 infection were at reduced risk (infected ≥9 months before booster dose vs no previous infection; aRR 0·41 [95% CI 0·29–0·58]). Older people, those with multimorbidity, and those with specific underlying health conditions remain at increased risk of COVID-19 hospitalization and death after the initial vaccine booster and should, therefore, be prioritized for additional boosters, including novel optimized versions, and the increasing array of COVID-19 therapeutics.
Successful immunomodulators for treatment of COVID-19 have opened the pathway for comparative trials
These is sufficient data showing efficacy of both baricitinib and tocilizumab compared to standard of care, and in overlapping levels of severity both therapies are good options for patients with severe illness. Though studies published on populations earlier in the pandemic of baricitinib included few patients on mechanical ventilators, an analysis of patients on mechanical ventilators or ECMO in the COV-BARRIER study showed a mortality reduction.The data supporting sarilumab is more sparse, which is why recommendations by the IDSA and NIH guideline panels are measured and recommend sarilumab only when better-studied therapies are not available. In the absence of more robust studies, to recommend it on parity with tocilizumab and baricitinib is premature. As standards of care for severe COVID-19 have advanced, standards of evidence should as well.

Epidemiology

Prediction of upcoming global infection burden of influenza seasons after relaxation of public health and social measures during the COVID-19 pandemic
For this modelling study, researchers used surveillance data on influenza virus activity for 11 different locations and countries in 2017–22. They implemented a data-driven mechanistic predictive modelling framework to predict future influenza seasons on the basis of pre-COVID-19 dynamics and the effect of PHSMs during the COVID-19 pandemic. Researchers simulated the potential excess burden of upcoming influenza epidemics in terms of fold rise in peak magnitude and epidemic size compared with pre-COVID-19 levels. They also examined how a proactive influenza vaccination program could mitigate this effect. Researchers estimated that COVID-19 PHSMs reduced influenza transmissibility by a maximum of 17·3% (95% CI 13·3–21·4) to 40·6% (35·2–45·9) and attack rate by 5·1% (1·5–7·2) to 24·8% (20·8–27·5) in the 2019–20 influenza season. They estimated a 10–60% increase in the population susceptibility for influenza, which might lead to a maximum of 1–5-fold rise in peak magnitude and 1–4-fold rise in epidemic size for the upcoming 2022–23 influenza season across locations, with a significantly higher fold rise in Singapore and Taiwan. The infection burden could be mitigated by additional proactive one-off influenza vaccination programs. These results suggest the potential for substantial increases in infection burden in upcoming influenza seasons across the globe. Strengthening influenza vaccination programs is the best preventive measure to reduce the effect of influenza virus infections in the community.