RSS 1.0Downstate School of Public Health
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Graduating into Lower Risk: Chlamydia and Trichomonas Prevalance among Community College Students and GraduatesBackground: Community colleges enable youth from economically disadvantaged and minority populations to access college and may enable social mobility including improved health outcomes. However, educational health disparities studies rarely assess the health outcomes for community college graduates. Methods: Chlamydia and trichomonas prevalence were assessed with nucleic acid based tests in a nationally representative sample of 6233 high school graduates (ages 18–25) from five educational levels: young adults without post-secondary credentials who were not enrolled in college, community college students, 4-year college students, associate’s degree, and bachelor’s degree. To reduce confounding between educational attainment and STI status, we used full matching to balance on 22 measures of demographics, socioeconomic status, educational factors, and sexual risk-taking. Estimates of associations between educational attainment and STI status were obtained from multivariate regression in the full (n=6233) and matched (n=1655) samples. Results:Four-year college students (adjusted incidence rate ratio (IRR) = 0.41, 95% CI [0.27, 0.61], p Conclusions: Community college students come from populations with greater health risks than 4-year college students, but community college graduation may reduce the likelihood of chlamydia infection. STI interventions can meet the needs of young adults who access college through community college by partnering with community college health clinics to encourage continued STI prevention, testing, and treatment after the intervention ends. Public health studies that use inclusive educational attainment measures that incorporate sub-baccalaureate credentials will better capture health disparities.
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Confidence Disparities: Pre-course Coding Confidence Predicts Greater Statistics Intentions and Perceived Achievement in a Project-Based Introductory Statistics CourseSelf-efficacy is associated with a range of educational outcomes, including science and math degree attainment. Project-based statistics courses have the potential to increase students’ math self-efficacy because projects may represent a mastery experience, but students enter courses with preexisting math self-efficacy. This study explored associations between pre-course math confidence and coding confidence with post-course statistical intentions and perceived achievement among students in a project-based statistics course at 28 private and public colleges and universities between fall 2018 and winter 2020 (n = 801) using multilevel mixed-effects multivariate linear regression within multiply imputed data with a cross-validation approach (testing n = 508 at 20 colleges/universities). We found that pre-course coding confidence was associated with, respectively, 9 points greater post-course statistical intentions and 10 points greater perceived achievement on a scale 0–100 (0.09, 95% confidence interval (0.02, 0.17), p = 0.02; 0.10, 95% CI (0.01, 0.19), p = 0.04), and that minoritized students have greater post-course statistical intentions than nonminoritized students. These results concur with past research showing the potential effectiveness of the project-based approach for increasing the interest of minoritized students in statistics. Pre-course interventions to increase coding confidence such as pre-college coding experiences may improve students’ post-course motivations and perceived achievement in a project-based course. Supplementary materials for this article are available online.
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Quantification of HIV-1 RNA Among Men Who Have Sex With Men Using an At-Home Self-Collected Dried Blood Spot Specimen: Feasibility StudyBackground: Suboptimal antiretroviral therapy (ART) adherence and disengagement in care present significant public health challenges because of the increased probability of HIV transmission. In the United States, men who have sex with men (MSM) continue to be disproportionately affected by HIV, highlighting a critical need to engage high-risk MSM living with HIV who are not engaged or retained in care. Objective: The aim of the study was to assess the feasibility of at-home blood self-collection and laboratory quantification of HIV-1 RNA viral load (VL) to report laboratory-based VL outcomes and compare self-reported and laboratory-reported VL. Methods: Between 2016 and 2017, 766 US HIV-positive MSM enrolled in a Web-based behavioral intervention were invited to participate in an at-home dried blood spot (DBS) collection study using HemaSpot-HF kits (Spot On Sciences, Inc, Austin, TX) for laboratory-quantified VL. Results: Of those invited to participate, 72.3% (554/766) enrolled in the DBS study. Most (79.2%, 439/554) men enrolled reported attempting to collect their blood, 75.5% (418/554) of participants mailed a DBS specimen to the research laboratory, and 60.8% (337/554) had an adequate blood sample for VL testing. Of the 337 specimens tested for VL by the laboratory, 52.5% (177/337) had detectable VL (median: 3508 copies/mL; range: 851-1,202,265 copies/mL). Most men (83.9%, 135/161) who returned a DBS specimen with laboratory-quantified detectable VL self-reported an undetectable VL during their last clinical visit. Conclusions: Home collection of DBS samples from HIV-positive MSM is feasible and has the potential to support clinical VL monitoring. Discrepant laboratory HIV-1 RNA values and self-reported VL indicate a need to address perceived VL status, especially in the era of treatment as prevention. Most participants were willing to use an at-home DBS kit in the future, signaling an opportunity to engage high-risk MSM in long-term HIV care activities.
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Adaptation of a Group-Based HIV RISK Reduction Intervention to a Mobile App for Young Sexual Minority MenThere is a dearth of evidence-based HIV prevention interventions for very young men who have sex with men (YMSM) ages 13-18 years, at high risk for HIV. We adapted the MyPEEPS intervention-an evidence-based, group-level intervention-to individual-level delivery by a mobile application. We used an expert panel review, in-depth interviews with YMSM (n = 40), and weekly meetings with the investigative team and the software development company to develop the mobile app. The expert panel recommended changes to the intervention in the following areas: (1) biomedical interventions, (2) salience of intervention content, (3) age group relevance, (4) technical components, and (5) stigma content. Interview findings reflected current areas of focus for the intervention and recommendations of the expert panel for new content. In regular meetings with the software development firm, guiding principles included development of dynamic content, while maintaining fidelity of the original curriculum and shortening intervention content for mobile delivery.
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COVID-19 Vaccine Effectiveness Against Omicron Infection and HospitalizationObjectives: This study aimed to provide real-world evidence on coronavirus disease 2019 vaccine effectiveness (VE) against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years. Methods: We used the test-negative study design and linked provincial databases to estimate BNT162b2 vaccine effectiveness against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years between January 2 and August 27, 2022 in Ontario. We used multivariable logistic regression to estimate VE by time since the latest dose, compared with unvaccinated children, and we evaluated VE by dosing interval. Results: We included 6284 test-positive cases and 8389 test-negative controls. VE against symptomatic infection declined from 24% (95% confidence interval [CI], 8% to 36%) 14 to 29 days after a first dose and 66% (95% CI, 60% to 71%) 7 to 29 days after 2 doses. VE was higher for children with dosing intervals of ≥56 days (57% [95% CI, 51% to 62%]) than 15 to 27 days (12% [95% CI, -11% to 30%]) and 28 to 41 days (38% [95% CI, 28% to 47%]), but appeared to wane over time for all dosing interval groups. VE against severe outcomes was 94% (95% CI, 57% to 99%) 7 to 29 days after 2 doses and declined to 57% (95%CI, -20% to 85%) after ≥120 days. Conclusions: In children aged 5 to 11 years, 2 doses of BNT162b2 provide moderate protection against symptomatic Omicron infection within 4 months of vaccination and good protection against severe outcomes. Protection wanes more rapidly for infection than severe outcomes. Overall, longer dosing intervals confer higher protection against symptomatic infection, however protection decreases and becomes similar to shorter dosing interval starting 90 days after vaccination.
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Age, period, and cohort effects on asthma prevalence in Canadian adults, 1994–2011Purpose: To examine the age, period, and cohort effects on asthma prevalence among Canadian adults from 1994/1995 to 2010/2011. Methods: Using data from the National Population Health Survey, 13,616 Canadian adults were followed for 16 years. Age was limited to 18-80 years during follow-up. Modified Poisson regression models with generalized estimating equations were used to estimate age, period, and cohort effects on asthma and active asthma prevalence after accounting for sociodemographic factors. Model-based standardization was performed to estimate standardized rates. Results: Overall asthma prevalence increased from 5% in 1994/1995 to 11% in 2010/2011; decreasing from 12% for 20-year-olds to 6% for 50-60-year-olds and then increased to 8% for 80-year-olds. Individuals aged 20 years had the steepest increase in prevalence between 1994/1995 and 2010/2011. Active asthma prevalence increased from 5% in 1994/1995 to 8% in 2010/2011; decreasing from 8% for 20-year-olds to 5% for 50-60-year-olds and then increased to 6% for 80-year-olds. Conclusions: Our findings suggest the presence of age, period, and cohort effects on prevalence of asthma overall and presence of age and period effects on active asthma prevalence in Canadian adults.
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Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping reviewBackground: Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. Objectives: We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. Methods: We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. Results: We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. Conclusions: We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.
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Are Indigenous Determinants of Health Associated with Self-Reported Health Professional-Diagnosed Anxiety Disorders Among Canadian First Nations Adults?: Findings from the 2012 Aboriginal Peoples SurveyWe estimated the prevalence of self-reported health professional-diagnosed anxiety disorders among Canadian First Nations adults living off-reserve, and assessed the relationship between anxiety disorders and Indigenous determinants of health (Status Indian, residential school attendance, knowledge of Indigenous language, and participation in traditional activities) using the 2012 Aboriginal Peoples Survey. Multivariable logistic regression models were performed using bootstrap weights. The prevalence of anxiety disorders was 14.5% among off-reserve First Nations adults. There was an increased odds of anxiety disorders among those participating in traditional activities compared to their counterparts (aOR 1.46, 95% CI 1.12-1.90). No association was found between anxiety disorders and other Indigenous determinants of health. There is a high prevalence of self-reported anxiety among First Nations adults living off-reserve. However, further studies are warranted to identify and assess the role of Indigenous determinants of health for anxiety disorders and other prevalent mental health conditions in this population.
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The effect of gestational diabetes mellitus on the risk of asthma in offspringPurpose: To examine the effect of maternal gestational diabetes mellitus on the risk of asthma in the offspring. Methods: This cohort study used data from 19,933 children in the National Longitudinal Survey of Children and Youth (NLSCY), 1994/1995-2008/2009, Canada. Children were followed until the first-time report of having health professional-diagnosed asthma (hereafter incident asthma), loss to follow-up, or end of the NLSCY follow-up, whichever occurred first. As a surrogate for Cox proportional hazards regression, pooled logistic regression models, crude and adjusted for potential confounders, were fitted to estimate the effect of gestational diabetes mellitus on the risk of asthma in the offspring. Results: Among the 19,933 children, 1,178 (5.9%) had mothers with gestational diabetes mellitus. The median duration of follow-up was 4 (interquartile range: 4) years. A total of 1639 children in the cohort had reported incident asthma during the follow-up, and 119 of them had mothers with gestational diabetes mellitus. The adjusted hazard ratio for the association between gestational diabetes mellitus and incident asthma in offspring was 1.25 (95% confidence interval [CI] 1.03, 1.51). Conclusions: Our findings suggest that gestational diabetes mellitus increases the risk of asthma in the offspring.
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Havens of Risks or Resources? A Study of Two Latino Neighborhoods in New York CityResearch has been mixed on the potential risks and resources that ethnic enclaves may confer upon residents: whereas some authors characterize racial and ethnic minority neighborhoods through the lens of segregation and risk, others argue that these minority neighborhoods are ethnic enclaves that can improve the availability of resources to residents. In this study, we sought to assess two predominantly Latino New York City neighborhoods (one enclave neighborhood and one comparison) in the areas of structural resources (e.g., grocers, parks), cultural resources (e.g., botanicas, hair salons), and risks (e.g., empty lots, bars) by street-level coding in 20 census tracts (streets N = 202). We used Poisson generalized linear models to assess whether enclave status of a neighborhood predicted the numbers of risks and resources on streets within those neighborhoods. Enclave status did not predict the number of risks (Rate ratio = 1.08(0.83, 1.42), χ (2)(1, N = 202) = 0.35, p = n. s.) or cultural resources (Rate ratio = 0.87(0.54, 1.40), χ (2)(1, N = 202) = 0.34, p = n. s.), yet it was associated with a higher number of structural resources (Rate ratio = 1.90(1.48, 2.43), χ (2)(1, N = 202) = 25.74, p < 0.001). The results suggest that while living in an ethnic enclave may not reduce risks, it may help residents cope with those risks through an increased number of structural resources. These findings support theories that conceptualize ethnic enclaves as neighborhoods where greater resources are available to residents. The focus on resources within this work was instrumental, as no difference would have been found if a solely risk-focused approach had been employed.
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Acculturation as a Moderator of HIV Risk Behavior Correlates Among Latino Men Who Have Sex with MenAcculturation is associated with increased sexual risk behaviors among heterosexual Latinos, but its influence among Latino gay, bisexual, and other men who have sex with men (MSM) remains less clear. Elements of acculturation may create distinct lived experiences among sexual minority Latinos, moderating how beneficial and adverse influences contribute to their sexual risk behaviors. Latino MSM living in New York City (n = 412) were recruited using a modified time-space venue- and web-based sampling method. Negative binomial regression models estimated associations between indicators of acculturation (i.e., language use, nativity status, ethnic identification), sexual minority stressors (i.e., internalized homophobia, sexual orientation-based discrimination), peer condom use norms, and the number of serodiscordant condomless anal intercourse (SDCAI) encounters. Acculturation indicators were then tested as simultaneous moderators of the influence of each predictor variable on the outcome. The association between internalized homophobia and SDCAI was significant only among English language speakers (aIRR = 3.05 [2.13, 4.37]) and those born outside of the U.S. (foreign-born = 0, aIRR = 0.17 [0.08, 0.36]). Sexual orientation-based discrimination and SDCAI were also positively associated among both English-speaking (aIRR = 1.82 [1.22, 2.72]) and foreign-born men (aIRR = 0.34 [0.14, 0.84]). Stronger ethnic identification also moderated the protective effects of peer condom use norms on SDCAI (aIRR = 0.28 [0.15, 0.52]). Results suggest that different dimensions of acculturation help shape how both stressors and protective factors influence HIV risk among Latino MSM. Future research is needed to examine the mechanisms through which these differences in acculturation may act on sexual risk behaviors among Latino MSM.
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Deterrents and motivators of HIV testing among young Black men who have sex with men in North CarolinaIn the United States (US), young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV. Delayed and infrequent HIV testing has been associated with the increased likelihood of YBMSM to be infected, yet unaware. Despite increased efforts to provide HIV testing to YBMSM in the US, HIV testing remains underutilized by YBMSM in the South. To develop strategies to increase HIV testing, this study sought to understand the factors that affect HIV testing utilization among YBMSM. Twenty-two HIV-positive and HIV-negative YBMSM aged 22-33 in North Carolina participated in semistructured interviews. Qualitative thematic analysis revealed that deterrents and motivators to HIV testing spanned individual, social, and structural levels. Deterrents included a low perceived risk of HIV, fear of receiving an HIV-positive test result, lack of HIV testing locations, healthcare provider mistreatment and privacy concerns due to intersectional stigma. Motivators of HIV testing included health maintenance, social support, and increased access to HIV testing. The findings from this study contribute to ongoing research that aims to address inconsistent HIV testing and late HIV diagnosis among YBMSM. Interventions to address intersectional stigma in community and healthcare settings can enhance utilization of HIV prevention services .
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Disparities in substance use disorder treatment use and perceived need by sexual identity and gender among adults in the United StatesBackground: Substance use disorder (SUD) treatment use is low in the United States. We assessed differences in treatment use and perceived need by sexual identity (i.e., lesbian, gay, bisexual, heterosexual) and gender among adults with a past-year SUD. Methods: We pooled data from the 2015-2019 National Survey on Drug Use and Health for adults (18+) who met past-year DSM-IV SUD criteria and self-reported sexual identity (n = 21,926). Weighted multivariable logistic regressions estimated odds of past-year: 1) any SUD treatment; 2) specialty SUD treatment; 3) perceived SUD treatment need by sexual identity, stratified by gender and adjusted for socio-demographics. Results: Any past-year SUD treatment use was low among adult men (heterosexual [10.4 %], gay [15.5 %], and bisexual [7.1 %]) and women (heterosexual [9.9 %], gay/lesbian [11.9 %], and bisexual [13.2 %]). Patterns were similar for specialty SUD treatment and perceived treatment need. Adjusted odds of any SUD treatment use were higher among gay men (aOR = 1.65 [95 % Confidence Interval 1.10-2.46]) and bisexual women (aOR = 1.31 [1.01-1.69]) than their heterosexual peers. Compared to their heterosexual counterparts, adjusted odds of perceived SUD treatment need were higher among bisexual women (aOR = 1.65 [1.22-2.25]), gay men (aOR = 1.76 [1.09-2.84]), and bisexual men (aOR = 2.39 [1.35-4.24]). Conclusions: Most adults with SUD did not receive treatment. Gay men and bisexual women were more likely to receive treatment and reported higher perceived SUD treatment need than heterosexual peers. Facilitating treatment access and engagement is needed to reduce unmet needs among marginalized people who perceive SUD treatment need.
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Daily cannabis use, cannabis use disorder, and any medical cannabis use among US adults: Associations within racial, ethnic, and sexual minoritized identities in a changing policy contextDifferences in cannabis use patterns among racial, ethnic and sexual minoritized identity subgroups have been attributed to marginalized identity stressors. However, associations at the intersection of these minoritized identities remain underexplored in a changing medical cannabis law (MCL) context. We estimated medical cannabis and daily cannabis use, and cannabis use disorder (CUD) by intersecting racial, ethnic and sexual minoritized identity subgroups. We included 189,800 adults in the 2015-2019 National Survey on Drug Use and Health identifying as non-Hispanic white, non-Hispanic Black, or Hispanic and self-reported heterosexual, gay/lesbian, or bisexual sexual identity. We estimated the adjusted odds of past-year: (a) any medical cannabis, (b) daily cannabis use (i.e., 300 + days/year), and (c) DSM-5-proxy CUD by sexual identity, stratified by race and ethnicity. Cannabis measures were higher among sexual minoritized groups than heterosexual adults across racial and ethnic subgroups. Bisexual adults had higher odds of any medical cannabis use than their heterosexual counterparts: non-Hispanic white (6.4% vs. 1.8%; aOR = 2.6, 95% CI = [2.5-3.5]), non-Hispanic Black (4.1% vs. 1.7%; aOR = 2.7, 95% CI = [1.6-4.5]), and Hispanic adults (5.3% vs. 1.8 %; aOR = 2.6, 95% CI = [1.9-3.3]). We found heterogeneous associations with state MCL status across subgroups stratified by race and ethnicity. Bisexual adults in MCL states had higher odds of any medical cannabis use among non-Hispanic white (aOR = 2.0, 95% CI = [1.4-2.9]) and Hispanic (aOR = 3.6, 95% CI = [1.2-10.2]) adults compared to their non-MCL counterparts, but this was marginal among non-Hispanic Black bisexual adults (aOR = 1.6, 95% CI = [1.0-2.6]). Studies should assess intended and unintended cannabis policy effects among racial, ethnic, and sexual identity subgroups.
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Predictors of Past-Year Health Care Utilization Among Young Men Who Have Sex with Men Using Andersen's Behavioral Model of Health Service UsePurpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersen's behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctor's offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSM's health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.
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Knowledge Assessment of Diabetic Patients: A Cross Sectional StudyTwo hundred and sixteen diabetic patients were interviewed using a purpose made questionnaire ro assess their knowledge on diabetes mellitus (DM. The mean age of the subjects was 47.06 * 13.28 years. and they were Ahosn to have diabetes for 5.74 g 4.68 years. Family history f DM was found in 44.44% and 87.50% were members of Diabetic Association of Bangladesh (DAB). A considerable number of the patients interviewed were quire unaware about the symptoms of DM (20.37%). prohibited foods (5.55%). restricted foods (13.88%). non-restricted foods (53.70%). ideal body weight (59.72%), relationship benceen body weight and diabetes control (56.01%), importance of exercise in diabetes control (4.16%) and Itypoglwaenda (82.87%). They were equally unaware of the fact that diabetes can affect eve 137.68%). kidney (51.85%). bean (64.81%), brain (93.51%)and skin (leg ulcer) (59.25%1. About 81.94% did not know lion' to control DM. Out of 216 cases. 72.22% attended basic information session in large group once during their enrollment in DAB. The difference in knowledge between the groups who attended the ...ion and those vita did not was found to be insignificant with the exception of knowledge about non-restricted food and kidney and heart complications (p..0511. p=.036 and p=.010 respectively). A sub-group of 106 (49.07%) cases were on insulin: among then, 2830% lacked the skill to inject insulin and 44.33% did not have the knowledge about when and how to change doses of insulin. Among the study group. SMBG was very poor (7.87%). This study found that the blo•ledge attained by the diabetic patients regarding their disease is not satisfactory and needs Pother improwntent by more effective methods of continuous education.
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Pneumococcal disease burden and vaccination coverage in older adults: where does Canada stand?Prevention of vaccine-preventable infectious diseases in aging adult population is imperative for healthy aging. Here we reflect on where Canada stands with regard to vaccine-preventable pneumococcal diseases in older adults, specifically the continuing high disease burden, current evidence on effectiveness and observed impact of pneumococcal vaccines, and suboptimal vaccine uptake in older adults. The need for ongoing strong disease surveillance is emphasized, and the implications of a lack of adult vaccine registry are also discussed.
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A multiprovincial retrospective analysis of the incidence of myocarditis or pericarditis after mRNA vaccination compared to the incidence after SARS-CoV-2 infectionObjective: To compare myocarditis/pericarditis risk after COVID-19 mRNA vaccination versus SARS-CoV-2 infection, and to assess if myocarditis/pericarditis risk varies by vaccine dosing interval. Methods: In this retrospective cohort study, we used linked databases in Quebec, Ontario, and British Columbia between January 26, 2020, and September 9, 2021. We included individuals aged 12 or above who received an mRNA vaccine as the second dose or were SARS-CoV-2-positive by RT-PCR. The outcome was hospitalization/emergency department visit for myocarditis/pericarditis within 21 days of exposure. We calculated age- and sex-stratified incidence ratios (IRs) of myocarditis/pericarditis following mRNA vaccination versus SARS-CoV-2 infection. We also calculated myocarditis/pericarditis incidence by vaccine type, homologous/heterologous schedule, and dosing interval. We pooled province-specific estimates using meta-analysis. Results: Following 18,860,817 mRNA vaccinations and 860,335 SARS-CoV-2 infections, we observed 686 and 160 myocarditis/pericarditis cases, respectively. Myocarditis/pericarditis incidence was lower after vaccination than infection (IR [BNT162b2/SARS-CoV-2], 0.14; 95%CI, 0.07-0.29; IR [mRNA-1273/SARS-CoV-2], 0.28; 95%CI, 0.20-0.39). Within the vaccinated cohort, myocarditis/pericarditis incidence was lower with longer dosing intervals; IR (56 or more days/15-30 days) was 0.28 (95%CI, 0.19-0.41) for BNT162b2 and 0.26 (95%CI, 0.18-0.38) for mRNA-1273. Conclusion: Myocarditis/pericarditis risk was lower after mRNA vaccination than SARS-CoV-2 infection, and with longer intervals between primary vaccine doses.
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Infection with influenza A(H1N1)pdm09 during the first wave of the 2009 pandemic: Evidence from a longitudinal seroepidemiologic study in Dhaka, BangladeshBackground: We determined influenza A(H1N1)pdm09 antibody levels before and after the first wave of the pandemic in an urban community in Dhaka, Bangladesh. Methods: We identified a cohort of households by stratified random sampling. We collected baseline serum specimens during July-August 2009, just prior to the initial wave of the 2009 pandemic in this community and a second specimen during November 2009, after the pandemic peak. Paired sera were tested for antibodies against A(H1N1)pdm09 virus using microneutralization assay and hemagglutinin inhibition (HI) assay. A fourfold increase in antibody titer by either assay with a titer of ≥40 in the convalescent sera was considered a seroconversion. At baseline, an HI titer of ≥40 was considered seropositive. We collected information on clinical illness from weekly home visits. Results: We tested 779 paired sera from the participants. At baseline, before the pandemic wave, 1% overall and 3% of persons >60 years old were seropositive. After the first wave of the pandemic, 211 (27%) individuals seroconverted against A(H1N1)pdm09. Children aged 5-17 years had the highest proportion (37%) of seroconversion. Among 264 (34%) persons with information on clinical illness, 191 (72%) had illness >3 weeks prior to collection of the follow-up sera and 73 (38%) seroconverted. Sixteen (22%) of these 73 seroconverted participants reported no clinical illness. Conclusion: After the first pandemic wave in Dhaka, one in four persons were infected by A(H1N1)pdm09 virus and the highest burden of infection was among the school-aged children. Seroprevalence studies supplement traditional surveillance systems to estimate infection burden.
