Sisonke phase 3B open-label study: Lessons learnt for national and global vaccination scale-up during epidemics

Sisonke is a multicentre, open-label, single-arm phase 3B vaccine implementation study of healthcare workers (HCWs) in South Africa, with prospective surveillance for 2 years. The primary endpoint is the rate of severe COVID‑19, including hospitalisations and deaths. The  Sisonke study enrolled and vaccinated participants nationally at potential vaccination roll-out sites between 17 February and 26 May 2021. After May 2021, additional HCWs were vaccinated as part of a sub-study at selected clinical research sites. We discuss 10 lessons learnt to strengthen national and global vaccination strategies:(i) consistently advocate for vaccination to reduce public hesitancy; (ii) an electronic vaccination data system (EVDS) is critical; (iii) facilitate access to a choice of vaccination sites, such as religious and community centres, schools, shopping malls and drive-through centres; (iv) let digitally literate people help elderly and marginalised people to register for vaccination; (v) develop clear 'how to' guides for vaccine storage, pharmacy staff and vaccinators; (vi) leverage instant messaging platforms, such as WhatsApp, for quick communication among staff at vaccination centres; (vii) safety is paramount - rapid health assessments are needed at vaccination centres to identify people at high risk of serious adverse events, including anaphylaxis or thrombosis with thrombocytopenia syndrome. Be transparent about adverse events and contextualise vaccination benefits, while acknowledging the small risks; (viii) provide real-time, responsive support to vaccinees post vaccination and implement an accessible national vaccine adverse events surveillance system; (ix) develop efficient systems to monitor and investigate COVID‑19 breakthrough infections; and (x) flexibility and teamwork are essential in vaccination centres across national, provincial and district levels and between public and private sectors.

Racial and ethnic disparities in COVID-19 disease incidence independent of comorbidities, among people with HIV in the US

OBJECTIVES

To define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.

DESIGN

Observational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020.

METHODS

We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.

RESULTS

Among 16,056 PWH in care, of whom 44.5% were Black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4 count < 350, including 7% < 200; 95.5% were on antiretroviral therapy, and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and Black PWH respectively, than non-Hispanic White PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or Black identity, lowest historical CD4 count <350 (proxy for CD4 nadir), current low CD4/CD8 ratio, diabetes, and obesity.

CONCLUSIONS

Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWHPWH with immune exhaustion as evidenced by lowest historical CD4 or current low CD4:CD8 ratio had greater risk of COVID-19.

Heroin smoking by "chasing the dragon" in young opiate users in Ireland: stability and associations with use to "come down" off "Ecstasy"

We explored the frequency of commencing opiate use by "chasing the dragon" to "come down" off Ecstasy and the stability of heroin smoking in young opiate takers by assessing 102 subjects in Dublin using a semistructured interview. Ninety-two subjects had used Ecstasy. Of these, 68 reported "chasing" to "come down" off Ecstasy at some point in their history and were found to have used Ecstasy more frequently and in larger amounts. Thirty-six reported that their first experience of using opiates was to "come down" off Ecstasy, 28 citing this as their main reason for commencement.Eighty-six of the 102 commenced opiates by "chasing" heroin, 61 of whom progressed to injecting after a mean of 2.9 years. This was associated with starting illicit drug use earlier, starting heroin earlier, and a history of using Ecstasy. Implications for service planners in developing responses to illicit drug use among adolescents are discussed.

Primary staphylococcal pneumonia in young children: a review of 100 cases

Staphylococcus aureus (S. aureus) is responsible for a small proportion of acute respiratory infections in children. Nevertheless a high index of suspicion is required because of the potential for rapid progression, the need for antibiotics different to those routinely administered in the treatment of pneumonia, and the high incidence of complications. There are few data from developing countries. The objective of this retrospective review was to document the natural history of primary staphylococcal pneumonia at Red Cross Childrens' Hospital in Cape Town over a 7-year period (1989-1995). Staphylococcal pneumonia was defined as acute pneumonia with microbiological evidence of S. aureus or with characteristic radiological features. One hundred patients were identified. The median age was 5 months, 78 patients being below one year of age. Cough and fever were present in almost all patients at the time of presentation. Tachypnoea, recession, dullness, and crepitations were commonly elicited signs. Initial chest radiographs revealed empyema, pleural effusion, or pyopneumothorax in 67 patients. A further 26 patients developed such changes on subsequent chest radiographs. Pneumatocoeles were identified in 37 patients--most of these were only noted on radiographs taken some days after admission. Microbiological confirmation was obtained in 92 cases. S. aureus was isolated in 23/98 blood cultures, 62/67 pleural aspirates, and from tracheal aspirates in 16 cases. Intercostal drains were inserted in 67 cases and 20 children underwent thoracotomy. The case fatality rate was 7 per cent. This study shows that primary staphylococcal pneumonia is chiefly a disease of infants. Symptoms and signs were similar as for other forms of acute pneumonia, although in the majority of cases chest radiographs taken at the time of admission suggested the diagnosis. Treatment with antibiotics and drainage of empyema resulted in a good outcome in the majority of cases.

Co-abuse of opiates and benzodiazepines

The objective of the study was to assess what differences exist between individuals who are dependent on opiates and benzodiazepines and compare to those who are dependent on opiates. A questionnaire was compiled and administered to patients who had been consecutively admitted to an inpatient drug treatment unit. The prevalence of benzodiazepine dependency was 54 per cent [n = 34]. Patients dependent on benzodiazepines and opiates were significantly older, had been admitted for methadone stabilisation and were more likely to have been prescribed a methadone maintenance programme prior to admission. They had used heroin longer, benzodiazepines more frequently, at larger doses for a longer duration of time and tended to use more drugs in general. They were found to be more psychologically vulnerable than those not dependent on benzodiazepines as they were significantly more likely to have described a past experience of depression and a past episode of deliberate self harm.

A comparison between gastrointestinal blood loss caused by tilcotil (Ro 12-0068) and aspirin in normal volunteers

An open crossover study was carried out in 6 normal volunteers to measure faecal blood loss caused by tilcotil (Ro 12-0068), a new anti-inflammatory drug, compared with that caused by enteric-coated aspirin. Subjects were allocated at random to receive either single doses of 20 mg tilcotil daily or 900 mg aspirin 4-times daily, reducing to a maximum tolerated dose, over a period of 2 weeks before being crossed over to the alternative medication for a further 2 weeks. Faecal specimens passed during 4 consecutive days in a run-in-period of 1 week, in each treatment period, and in the 2 weeks after the finish of drug therapy were analyzed for blood using a radioactive labelling method. The results showed that faecal blood loss was lower and it did not produce any haematological or biochemical abnormalities or any increase in urinary N-acetyl-beta-glucosaminidase activity indicative of renal damage. It is suggested that the method described provides a simple and reliable means of comparing faecal blood loss with different anti-inflammatory drugs.