Adverse events following vaccination with mRNA COVID-19 vaccines

The deadly COVID-19 virus continues to be a major threat to humankind. COVID-19 vaccinations prevent the virus from spreading and safeguard the general population. The first vaccines to be approved for emergency/conditional use by health organizations are based on mRNA technology. Hesitancy towards mRNA vaccinations has increased among the population globally as a result of the rapid pace at which vaccines are being developed as well as the lack of knowledge regarding the possibility for long-term adverse events. A successful vaccination campaign is dependent on the population’s willingness to be vaccinated as well as the availability of the vaccine in sufficient quantities and appropriate storage conditions. The purpose of the current review is to present a comprehensive update on the present scientific understanding of adverse events that might occur after vaccination with mRNA vaccines

Necrotizing enterocolitis in the neonatal period—morbidity, risk factors, and recommendations for prevention

Necrotizing enterocolitis (NEC) is a highly debilitating gastrointestinal disorder distinguished by intestinal inflammation and necrosis. This specific condition is commonly acknowledged as a common gastrointestinal emergency in neonates, particularly among premature infants who have successfully completed the initial neonatal period. Necrotizing enterocolitis is the leading cause of death related to gastrointestinal disease in premature infants. The aim of the current review is to present an overview of the incidence, risk factors and preventive strategies for necrotizing enterocolitis. Prematurity is identified as the primary prognostic risk factor for NEC. The immaturity of the gastrointestinal tract, namely in terms of its motility, digestion, perfusion, barrier function, and immunological defense, is a significant contributing factor for necrotizing enterocolitis. Potential reductions in the occurrence of NEC could be achieved through modifications in the feeding protocols for vulnerable individuals in neonatal intensive care units (NICUs), such as promoting the utilization of human breast milk and closely monitoring the pace at which feedings are escalated

ADVERSE EVENTS FOLLOWING VACCINATION WITH A VIRAL VECTOR-BASED VACCINE - A CROSS-SECTIONAL STUDY

Background: The effectiveness and safety of recently implemented COVID-19 vaccine platforms are often compared since the launch of the mass vaccination campaign worldwide. The aim of the present study is to assess the prevalence of adverse events (AEs) occurring after vaccination with the two viral vector-based vaccines authorized in the European Union to prevent COVID-19.  Materials and methods: A survey was carried out among adults who have completed vaccination with either of the viral vector-based vaccine approved for use in Bulgaria ChAdOx1-S nCoV-19 vaccine (commonly known as Astra Zeneca or Vaxzevria) or Ad26.COV2S vaccine (commonly known as Janssen or JCOVDEN). For the data analysis, standard descriptive statistics was used. Quantitative variables are presented by the mean and standard deviation (mean ± SD) or median (25th percentile; 75th percentile). Qualitative variables are presented as numbers absolute/relative frequencies totals and percentages. The Kolmogorov-Smirnov test was used to obtain information regarding the distribution of the sampled patients. The chi-square test for independence was used to determine whether differences between observed and theoretical distributions existed.  Results: In total 314 respondents took part in the study. Of them, 273 (86.9%) reported at least one local AE after the first dose of a vaccine, and the prevalence among the ChAdOx1-S vaccine group was significantly higher (88.5%) than in the Ad26.COV2.S vaccine group (59.2%) (Pearson χ2 test=19.942, p=0.000). The most common systemic AEs after administration of a viral vector-based vaccine were chills (77.3% for ChAdOx1-S and 25.9% for Ad26. COV2.S.) fatigue (76.3% for ChAdOx1-S and 25.9% for Ad26.COV2.S.), and headache (62.3% for ChAdOx1-S and 25.9% for Ad26.COV2.S.). Those adverse events appeared significantly more often in participants vaccinated with the ChAdOx1-S vaccine.  Conclusion: The analysis of the collected data proves that although common, AEs following vaccination with vector-based products are classified as mild and usually resolve within 48 hours of dose administration

Changes in the incidence of some respiratory pathogens during the COVID-19 pandemic in Bulgaria

INTRODUCTION: The advent of a novel pathogen, such as SARS-CoV-2, and the subsequent implementation of a range of non-pharmaceutical interventions have resulted in alterations in disease prevalence, particularly in cases transmitted through an airborne mechanism.AIM: The aim of the present study was to analyze the changes in the incidence of influenza and acute respiratory infections (ARIs), varicella (chickenpox), and scarlet fever, which occurred as a result of the spread of COVID-19 in Bulgaria.MATERIALS AND METHODS: Official sources of epidemiological information (NCIPD, NCPHA, etc.) and a set of normative documents for the introduced anti-epidemic measures (AEMs) were used. The analysis of the distribution of varicella and scarlet fever covered the 2012–2022 period, and that of influenza and SARS-CoV-2: 2019–2022.RESULTS: The incidence of varicella in the pre-pandemic period (2012–2019) ranged from 379.11%ooo to 437.54%ooo, and the incidence trend was upward. The addition to the data model for the 2020–2022 period radically changed the trend line to a downward one, with an average rate of decline of 18.5%ooo, although in 2022, with the liberalization of AEMs, there was a rise (388.82%ooo), characteristic for the pre-pandemic period. The incidence of scarlet fever in the 2012–2022 period had a downward trend with an average value of 43.08%ooo and varied from 42.15%ooo in 2012 to 15.62%ooo in 2022, with the lowest indicator in 2021 (2.66%ooo). The most pronounced changes were observed in influenza infection, when no influenza epidemic was registered in 2021.CONCLUSION: The imposed 16 types of AEMs, mainly until February 2022, modeled the epidemic process of the presented respiratory pathogens

Cost Analysis for Patients with Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit

The concept of improving the quality and safety of healthcare is well known. However, a follow-up question is often asked about whether these improvements are cost-effective. The prevalence of nosocomial infections (NIs) in the neonatal intensive care unit (NICU) is approximately 30% in developing countries. Ventilator-associated pneumonia (VAP) is the second most common NI in the NICU. Reducing the incidence of NIs can offer patients better and safer treatment and at the same time can provide cost savings for hospitals and payers. The aim of the study is to assess the direct costs of VAP in the NICU. This is a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. During this period, 107 neonates were ventilated for more than 48 h and included in the study. The costs for the hospital stay are based on the records from the Accounting Database of the setting. The differences directly attributable to VAP are presented both as an absolute value and percentage, based on the difference between the values of the analyzed variables. There are no statistically significant differences between patients with and without VAP in terms of age, sex, APGAR score, time of admission after birth and survival. We confirmed differences between the median birth weight (U = 924, p = 0.045) and average gestational age (t = 2.14, p = 0.035) of the patients in the two study groups. The median length of stay (patient-days) for patients with VAP is 32 days, compared to 18 days for non-VAP patients (U = 1752, p p p = 0.024). Our analysis confirms the results of other studies that the increased length of hospital stays due to VAP results in an increase in hospital costs. VAP is particularly associated with prematurity, low birth weight and prolonged mechanical ventilation

Chest CT diagnostic potential as a tool for early detection of suspected COVID-19 cases in pandemic peaks

Introduction: The emergence of severe acute respiratory syndrome coronavirus disease (COVID-19) in China at the end of 2019 caused a massive global outbreak that has become a major public health issue. Aim: Our aim was to investigate the diagnostic potential of chest CT in screening patients suspected of having COVID-19 in high-prevalence settings. Materials and methods: This is a real-life, prospective, observational study involving 260 patients. All patients received chest CT scan at the emergency department (ED) of Kaspela University Hospital, Plovdiv, Bulgaria and RT-PCR testing for suspected COVID-19 from March 27 to December 31, 2020. COVID-19 likelihood was assessed by assigning each CT scan to a particular category of the COVID-19 Reporting and Data System (CO-RADS). IBM SPSS v. 26 was used to process the data. Results: The male-to-female distribution ratio was 1.4:1 – 150 (57.7%) males vs. 110 (42.3%) females (p=0.014). The median age was 55 yrs (range 46–65 yrs). Discharged patients were 247 (95.0%), the rest died in the COVID-19 intensive care unit. Males were 4.13 times more likely to be diagnosed with CO-RADS≥3 score than females. Increasing age was associated with an increased likelihood of being classified with higher CO-RADS scores. The ROC curves analysis demonstrated that CO-RADS ≥3 was the optimal cutoff for discriminating between a positive and negative PCR (Youden’s index J=0.67), with an AUC of 0.825 (95% CI 0.72-0.93), sensitivity of 91.9% (95% CI 87.7%-95.1%), specificity of 75.0% (95% CI 53.3%-90.2%) and accuracy of 76.4% (95% CI 70.7%-81.4%). Conclusions: The results of this study reveal that a CT examination can provide a quick and accurate diagnosis of patients with suspected COVID-19 infection, whereas the PCR test is time-consuming, and the delay in receiving results can be substantial when the incidence curve begins to grow rapidly

Epidemiological Prognosis of Pertussis Incidence in Bulgaria

Introduction: Epidemiological forecasting facilitates scientifically sound solutions to upcoming theoretical and practical issues, in the development of public health management, in particular of infectious diseases.Aim: To critically analyze the most recent scientific advances in the biosocial nature and methodology of epidemiological forecasting to present a real-life example of pertussis, a disease with shifting epidemiology.Materials and methods: For the prediction of pertussis morbidity the autoregressive integrated moving average (ARIMA) the model was established by utilizing the method of time series analysis to construct a model of overall morbidity using Time series modeller in SPSS v.25. To model pertussis morbidity we obtained official data from the Ministry of Health and the National Center for Infectious and Parasitic Diseases, since the beginning of disease registration from 1903 until 2018. We also analyzed the shifting epidemiology of pertussis.Results: The proper identification procedures we applied indicated ARIMA (3,0,0) model to best fit our original time series of the annual whooping cough morbidity for the 1921-2018 period. The model predicts better morbidity in a one-step forecast. The incidence rate is expected to be stable at about 1.35 per 100,000 in the next three years, which is close to the 2016 level and lower than those in 2017-2018.Conclusion: The ARIMA (3,0,0) model in our study is an adequate tool for presenting the pertussis morbidity trend and is suitable to forecast near-future disease dynamics, with acceptable error tolerance

Surveillance of Nosocomial Infections in a Bulgarian Neonatal Intensive Care Unit

Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality.Aim: To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies.Materials and methods: A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count,  percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses.Results: Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respectively. Nosocomial infections were detected in neonates from all birth weight (BW) classes, but it was low BW and premature neonates that were at major risk to acquire them. The most common infection sites were ventilator-asso-ciated pneumonia (VAP) (67.27%), bloodstream infection (23.64%) and conjunctivitis (9.09%). Major pathogens were Gram-negative such as Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa and Acinetobacter baumannii. In the multivariate logistic regression analysis NIs were strongly associated with intubation, presence of a venous catheter, the duration of antibiotic treatment and increased CRP> 10 mg/l.Conclusions: This report highlights the burden of NIs, identifies the major focus for future NI control and prevention programs

Depression and self-esteem among Afghan school-going adolescents under the Taliban Government: a cross-sectional study

Abstract Background During the period of adolescence, several major developmental changes occur that can have significant impact on an individual’s brain structure and functioning through their entire life. Aims The present study aimed to examine the association between depression and self-esteem alongside specific sociodemographic factors among school-going adolescents living under the rule of Taliban. Methods A cross-sectional survey study was conducted with adolescents (n = 452) from 20 randomly selected public primary, secondary and high schools of Herat province (Afghanistan) out of the 86 schools registered in Herat Education Department. The survey included the Center for Epidemiological Studies-Depression Scale (CES-D) and Rosenberg's Self-Esteem Scale (RSES). Results Two-thirds of adolescents reported depression symptoms (65.3%) and 86.3% reported poor self-esteem. Multiple regression analysis indicated that (i) mother's education level was significantly associated with depression symptoms and (ii) low-income economic status was significantly associated with self-esteem. Conclusion As well as being one of the few studies in Afghanistan, the present study is one of the very few to assess the association between class group, self-esteem, and depression symptoms. These findings may be used by healthcare authorities and school administrators to raise awareness and implement strategies to facilitate self-esteem among school school-going adolescents

Bulgarian General Practitioners’ Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule

The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables—such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs