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Listening to the Voices of Health Care Workers During the COVID-19 Pandemic: A Qualitative Study Providing In-Depth Insights Into Ethical and Individual Challenges
Get PDFIn their daily practice, health care workers (HCWs) experience the effects of tensions between professional ethos and work realities, which can lead to ethical dilemmas. We aim to explore the ethical dilemmas that affected HCWs in Germany during the COVID-19 pandemic and to understand these in the context of the German health system. Between April and December 2022, we interviewed HCWs from various levels of care and key informants responsible for decisions related to HCWs in Germany. Three themes were identified in the data analyzed from 78 participants. The first highlighted the potency of pre-existing health system problems during the COVID-19 pandemic. The second captured the ethical dilemmas that were described as having arisen due to the tension between professional ethos and structural constraints. The third included factors related to increasing or diminishing the implications of ethical dilemmas. A lack of opportunities for HCWs to participate in political and managerial decisions was suggested to result in policies that do not meet the needs of HCWs and patients. Positive interpersonal interactions were described as helpful when coping with dilemmatic decision-making situations. In order to avoid negative consequences caused by unresolved ethical dilemmas, including moral distress, among HCWs, staff shortages and decision-making in the German health system urgently need to be addressed. HCWs’ working conditions regularly evoke ethical dilemmas, particularly during public health emergencies. Together with HCWs, decision-makers must develop new models for working in health care settings that are in line with HCWs’ professional ethos.Peer Reviewe
Understanding vaccination behavior of healthcare workers in German hospitals—results from the OKaPII study
No full textHintergrund:
Das Potenzial der Influenza-Impfung zur Verhinderung der Erkrankung und Weiterverbreitung des Virus wird im klinischen Setting nicht ausgeschöpft. Ein Verständnis von Impfverhalten ist notwendig, um wirksame Maßnahmen zur Steigerung der Impfquote ergreifen zu können.
Methodik:
OKaPII ist eine jährliche, deutschlandweite Onlinebefragung von Klinikpersonal zur Influenza-Impfung. Es wurden Unterschiede im Impfverhalten nach Alter, Geschlecht und Beruf sowie im Wissen zwischen Ärzteschaft und Pflege getestet. Zusammenhänge zwischen psychologischen Determinanten und Impfverhalten wurden bei Ärzteschaft und Pflege mittels Regressionsanalysen identifiziert.
Ergebnisse:
An der Befragung (17.04.–15.05.2023) nahmen 15.312 Mitarbeitende aus 115 Kliniken teil. In der Saison 2022/2023 waren 58,7 % des befragten Klinikpersonals gegen Influenza geimpft (Pflege: 51,1 %; Ärzteschaft: 80,7 %). Die Impfentscheidung von Ärzteschaft und Pflegepersonal hing u. a. signifikant mit der Wahrnehmung der Impfung als gemeinschaftliche Maßnahme (Pflege: OR = 1,94; Ärzteschaft: OR = 1,89) sowie dem Vertrauen in die Sicherheit der Impfung (Pflege: OR = 1,90; Ärzteschaft: OR = 1,78) zusammen. Von den Wissensitems wurden 87,2 % von der Ärzteschaft und 62 % von der Pflege richtig beantwortet.
Diskussion:
Es bestehen deutliche Unterschiede in den Impfquoten zwischen Berufsgruppen in deutschen Kliniken. Impflücken bestehen seit Jahren, insb. bei Pflegekräften. Zielgruppengerechte Interventionen sollten den Schutzgedanken vulnerabler Personen und das Vertrauen in die Sicherheit der Impfung fördern. Verstärkte Aufklärung, v. a. zu Sicherheitsfragen der Impfung, kann die Impfentscheidung positiv beeinflussen. Es sollten Möglichkeiten geschaffen werden, die Impfung trotz Zeitnot am Arbeitsplatz wahrzunehmen.Background:
Influenza vaccination coverage in Germany is generally low. Even in hospitals, the demand for influenza vaccination is lacking although it has the potential to prevent the spread of the influenza virus and diseases. To take effective actions, a deeper understanding of vaccination behavior of healthcare workers is crucial.
Methods:
OKaPII is an annual German-wide online survey of clinical staff on influenza vaccination. Differences in vaccination behavior were tested for occupation, sex, and age, and differences in knowledge were tested between physicians and nurses. We used logistic regressions to analyze associations between psychological determinants and vaccination behavior among physicians and nursing staff.
Results:
From 115 clinics, 15,312 employees participated in the survey (17 April to 15 May 2023). In the 2022/23 season, 58.7% of the participants were vaccinated against influenza. The vaccination coverage was 80.7% for physicians and 51.1% for nursing staff . The vaccination behavior of physicians and nursing staff was significantly associated with collective responsibility and confidence in vaccination safety. Of the knowledge items, 87.2% were answered correctly by physicians and 62% by nursing staff.
Discussion:
We identified significant differences in vaccine uptake between occupational groups in German hospitals. Low vaccination coverage has existed for years, especially among nursing staff. Tailored interventions should promote the idea of protecting vulnerable people and confidence in the safety of vaccination. Increased education, especially on vaccination safety issues, can have a positive impact on the decision to vaccinate. Possibilities to get vaccinated despite time constraints in the workplace should be provided.Peer Reviewe
Outpatient Health Service Utilization Among Adults with Diabetes, Hypertension and Cardiovascular Disease During the COVID-19 Pandemic – Results of Population-Based Surveys in Germany from 2019 to 2021
Get PDFPurpose: Fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and lockdown measures may have an impact on health care utilization particularly for people with chronic diseases. We investigated changes in outpatient utilization behavior in pandemic phases among people with selected chronic diseases in Germany.
Methods: The nationwide population-based telephone surveys German Health Update (GEDA) 2019/2020 (April 2019 to September 2020) and GEDA 2021 (July to December 2021) covered 4 out of 7 pandemic phases from the pre-pandemic to the 4th pandemic wave. Data on hypertension, diabetes and major cardiovascular diseases (CVD) in the past 12 months and visiting a general practitioner (GP) or a specialist (excluding dentist) in the past 4 weeks was collected using a standardized questionnaire. Proportions and odds ratios were derived from logistic regression models adjusted for age, sex, education and federal states.
Results: Among 27,967 participants aged ≥ 16 years, 8,449, 2,497 and 1,136 individuals had hypertension, diabetes and major CVD. Participants with these chronic diseases visited a GP or specialist significantly more often than the overall study population, irrespective of pandemic phases. Compared to the pre-pandemic phase, a significant reduction in specialist-visiting was found in the first pandemic wave among people with hypertension (34.3% vs 24.1%), diabetes (39.5% vs 25.5%) and major CVD (41.9% vs 25.6%). GP-visiting was lower only among people with hypertension (53.0% vs 46.0%). No difference in GP or specialist visiting was found in the 4th pandemic wave compared to the pre-pandemic phase.
Conclusion: The observed decrease particularly in specialist utilization among people with the selected chronic diseases at the beginning of the pandemic was not observed for the second half of 2021 despite the ongoing pandemic. Further studies are required to examine whether the temporary changes in the utilization of ambulatory health care have affected the disease management of people with chronic diseases.Peer Reviewe
Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study
Get PDFBackground:
There have been declines in global immunisation coverage due to the COVID-19 pandemic. Recovery has begun but is geographically variable. This disruption has led to under-immunised cohorts and interrupted progress in reducing vaccine-preventable disease burden. There have, so far, been few studies of the effects of coverage disruption on vaccine effects. We aimed to quantify the effects of vaccine-coverage disruption on routine and campaign immunisation services, identify cohorts and regions that could particularly benefit from catch-up activities, and establish if losses in effect could be recovered.
Methods:
For this modelling study, we used modelling groups from the Vaccine Impact Modelling Consortium from 112 low-income and middle-income countries to estimate vaccine effect for 14 pathogens. One set of modelling estimates used vaccine-coverage data from 1937 to 2021 for a subset of vaccine-preventable, outbreak-prone or priority diseases (ie, measles, rubella, hepatitis B, human papillomavirus [HPV], meningitis A, and yellow fever) to examine mitigation measures, hereafter referred to as recovery runs. The second set of estimates were conducted with vaccine-coverage data from 1937 to 2020, used to calculate effect ratios (ie, the burden averted per dose) for all 14 included vaccines and diseases, hereafter referred to as full runs. Both runs were modelled from Jan 1, 2000, to Dec 31, 2100. Countries were included if they were in the Gavi, the Vaccine Alliance portfolio; had notable burden; or had notable strategic vaccination activities. These countries represented the majority of global vaccine-preventable disease burden. Vaccine coverage was informed by historical estimates from WHO–UNICEF Estimates of National Immunization Coverage and the immunisation repository of WHO for data up to and including 2021. From 2022 onwards, we estimated coverage on the basis of guidance about campaign frequency, non-linear assumptions about the recovery of routine immunisation to pre-disruption magnitude, and 2030 endpoints informed by the WHO Immunization Agenda 2030 aims and expert consultation. We examined three main scenarios: no disruption, baseline recovery, and baseline recovery and catch-up.
Findings:
We estimated that disruption to measles, rubella, HPV, hepatitis B, meningitis A, and yellow fever vaccination could lead to 49 119 additional deaths (95% credible interval [CrI] 17 248–134 941) during calendar years 2020–30, largely due to measles. For years of vaccination 2020–30 for all 14 pathogens, disruption could lead to a 2·66% (95% CrI 2·52–2·81) reduction in long-term effect from 37 378 194 deaths averted (34 450 249–40 241 202) to 36 410 559 deaths averted (33 515 397–39 241 799). We estimated that catch-up activities could avert 78·9% (40·4–151·4) of excess deaths between calendar years 2023 and 2030 (ie, 18 900 [7037–60 223] of 25 356 [9859–75 073]).
Interpretation:
Our results highlight the importance of the timing of catch-up activities, considering estimated burden to improve vaccine coverage in affected cohorts. We estimated that mitigation measures for measles and yellow fever were particularly effective at reducing excess burden in the short term. Additionally, the high long-term effect of HPV vaccine as an important cervical-cancer prevention tool warrants continued immunisation efforts after disruption.
Funding:
The Vaccine Impact Modelling Consortium, funded by Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.
Translations:
For the Arabic, Chinese, French, Portguese and Spanish translations of the abstract see Supplementary Materials section.Peer Reviewe
Effectiveness and duration of protection of primary and booster immunisation against meningococcal serogroup C disease with meningococcal conjugate C and ACWY vaccines: Systematic review
Get PDFObjectives:
To estimate vaccine effectiveness (VE) and duration of protection of single primary and booster immunisation with meningococcal C (MenC) and ACWY (MenACWY) conjugate vaccines in preventing MenC invasive meningococcal disease (IMD).
Methods:
We performed a systematic review on studies of VE and immunogenicity (rSBA/hSBA titers) of participants aged 12–23 months for primary and 6–18 years for booster immunisation (last search: 18 August 2023). Risk of bias and certainty of evidence were evaluated (PROSPERO: CRD42020178773).
Results:
We identified 10 studies. Two studies reported VE of primary immunisation with MenC vaccines ranging between 90% (74.9 – 96.1) and 84.1% (41.5 – 95.7) for periods of 2 and 7 years, respectively. Eight studies reported immunogenicity of primary immunisation with MenC and/or MenACWY vaccines, of which two reported -in addition- on booster immunisation. The percentage of participants with protective rSBA titers was high after primary immunisation but waned over the following 6 years. A single booster at the age of 7 years or older seems to prolong protection for several years.
Conclusions:
A single dose of MenC or MenACWY vaccine at 12–23 months of age provides robust protection against MenC IMD. Data on booster immunisation are sparse, but indicate prolonged protection for three years at least.Peer Reviewe
Antimicrobial susceptibility prediction from genomes: a dream come true?
Get PDFGenome-based diagnostics provides relevant information to guide patient treatment and support pathogen and resistance surveillance. Recently, Coll et al. introduced a curated database for predicting antimicrobial resistance (AMR) from Enterococcus faecium genomics data, offering excellent predictive values for susceptibility to important antimicrobials. Challenges to predict resistance to last-resort antimicrobials remain.Peer Reviewe
How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by “fomite-borne risk assessment”
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SUMMARY
In healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of contamination, infectious dose (ID), virulence, hygiene practices, and patient vulnerability. This review attempts to close a gap in previous reviews on persistence/tenacity by only including articles (n = 171) providing quantitative data on re-cultivable pathogens from fomites for a better translation into clinical settings. We have therefore introduced the new term “replication capacity” (RC). The RC is affected by the degree of contamination, surface material, temperature, relative humidity, protein load, organic soil, UV-light (sunlight) exposure, and pH value. In general, investigations into surface RC are mainly performed in vitro using reference strains with high inocula. In vitro data from studies on 14 Gram-positive, 26 Gram-negative bacteria, 18 fungi, 4 protozoa, and 37 viruses. It should be regarded as a worst-case scenario indicating the upper bounds of risks when using such data for clinical decision-making. Information on RC after surface contamination could be seen as an opportunity to choose the most appropriate infection prevention and control (IPC) strategies. To help with decision-making, pathogens characterized by an increased nosocomial risk for transmission from inanimate surfaces (“fomite-borne”) are presented and discussed in this systematic review. Thus, the review offers a theoretical basis to support local risk assessments and IPC recommendations.Peer Reviewe
Different populations of A(H1N1)pdm09 viruses in a patient with hemolytic-uremic syndrome
Get PDFRespiratory viral infections may have different impacts ranging from infection without symptoms to severe disease or even death though the reasons are not well characterized.
A patient (age group 5–15 years) displaying symptoms of hemolytic uremic syndrome died one day after hospitalization. qPCR, next generation sequencing, virus isolation, antigenic characterization, resistance analysis was performed and virus replication kinetics in well-differentiated airway cells were determined.
Autopsy revealed hemorrhagic pneumonia as major pathological manifestation. Lung samples harbored a large population of A(H1N1)pdm09 viruses with the polymorphism H456H/Y in PB1 polymerase. The H456H/Y viruses replicated much faster to high viral titers than upper respiratory tract viruses in vitro. H456H/Y-infected air-liquid interface cultures of differentiated airway epithelial cells did reflect a more pronounced loss of ciliated cells. A different pattern of virus quasispecies was found in the upper airway samples where substitution S263S/F (HA1) was observed.
The data support the notion that viral quasispecies had evolved locally in the lung to support high replicative fitness. This change may have initiated further pathogenic processes leading to rapid dissemination of inflammatory mediators followed by development of hemorrhagic lung lesions and fatal outcome.Peer Reviewe
Correction: A seroprevalence study indicates a high proportion of clinically undiagnosed MPXV infections in men who have sex with men in Berlin, Germany
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RIBAP: a comprehensive bacterial core genome annotation pipeline for pangenome calculation beyond the species level
No full textMicrobial pangenome analysis identifies present or absent genes in prokaryotic genomes. However, current tools are limited when analyzing species with higher sequence diversity or higher taxonomic orders such as genera or families. The Roary ILP Bacterial core Annotation Pipeline (RIBAP) uses an integer linear programming approach to refine gene clusters predicted by Roary for identifying core genes. RIBAP successfully handles the complexity and diversity of Chlamydia, Klebsiella, Brucella, and Enterococcus genomes, outperforming other established and recent pangenome tools for identifying all-encompassing core genes at the genus level. RIBAP is a freely available Nextflow pipeline at github.com/hoelzer-lab/ribap and zenodo.org/doi/10.5281/zenodo.10890871.Peer Reviewe