Herpes zoster related hospitalisation after inactivated (CoronaVac) and mRNA (BNT162b2) SARS-CoV-2 vaccination: a self-controlled case series and nested case-control study

BACKGROUND: Stimulation of immunity by vaccination may elicit adverse events. There is currently inconclusive evidence on the relationship between herpes zoster related hospitalization and COVID-19 vaccination. This study aimed to evaluate the effect of inactivated virus (CoronaVac, Sinovac) and mRNA (BNT162b2, BioNTech/Fosun Pharma) COVID-19 vaccine on the risk of herpes zoster related hospitalization. METHODS: Self-controlled case series (SCCS) analysis was conducted using the data from the electronic health records in Hospital Authority and COVID-19 vaccination records in the Department of Health in Hong Kong. We conducted the SCCS analysis including patients with a first primary diagnosis of herpes zoster in the hospital inpatient setting between February 23 and July 31, 2021. A confirmatory analysis by nested case-control method was also conducted. Each herpes zoster case was randomly matched with ten controls according to sex, age, Charlson comorbidity index, and date of hospital admission. Conditional Poisson regression and logistic regression models were used to assess the potential excess rates of herpes zoster after vaccination. FINDINGS: From February 23 to July 31, 2021, a total of 16 and 27 patients were identified with a first primary hospital diagnosis of herpes zoster within 28 days after CoronaVac and BNT162b2 vaccinations. The incidence of herpes zoster was 7.9 (95% Confidence interval [CI]: 5.2–11.5) for CoronaVac and 7.1 (95% CI: 4.1–11.5) for BNT162b2 per 1,000,000 doses administered. In SCCS analysis, CoronaVac vaccination was associated with significantly higher risk of herpes zoster within 14 days after first dose (adjusted incidence rate ratio [aIRR]=2.67, 95% CI: 1.08–6.59) but not in other periods afterwards compared to the baseline period. Regarding BNT162b2 vaccination, a significantly increased risk of herpes zoster was observed after first dose up to 14 days after second dose (0-13 days after first dose: aIRR=5.23, 95% CI: 1.61–17.03; 14–27 days after first dose: aIRR=5.82, 95% CI: 1.62–20.91; 0-13 days after second dose: aIRR=5.14, 95% CI: 1.29–20.47). Using these relative rates, we estimated that there has been an excess of approximately 5 and 7 cases of hospitalization as a result of herpes zoster after every 1,000,000 doses of CoronaVac and BNT162b2 vaccination, respectively. The findings in the nested case control analysis showed similar results. INTERPRETATION: We identified an increased risk of herpes zoster related hospitalization after CoronaVac and BNT162b2 vaccinations. However, the absolute risks of such adverse event after CoronaVac and BNT162b2 vaccinations were very low. In locations where COVID-19 is prevalent, the protective effects on COVID-19 from vaccinations will greatly outweigh the potential side effects of vaccination. FUNDING: The project was funded by Research Grant from the Food and Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref. No.COVID19F01). FTTL (Francisco Tsz Tsun Lai) and ICKW (Ian Chi Kei Wong)’s posts were partly funded by D^{2}4H; hence this work was partly supported by AIR@InnoHK administered by Innovation and Technology Commission

Waist circumference and waist-to-height ratio of Hong Kong Chinese children

<p>Abstract</p> <p>Background</p> <p>Central body fat is a better predictor than overall body fat for cardiovascular (CV) risk factors in both adults and children. Waist circumference (WC) has been used as a proxy measure of central body fat. Children at high CV risk may be identified by WC measurements. Waist-to-height ratio (WHTR) has been proposed as an alternative, conveniently age-independent measure of CV risk although WHTR percentiles have not been reported. We aim to provide age- and sex-specific reference values for WC and WHTR in Hong Kong Chinese children.</p> <p>Methods</p> <p>Cross sectional study in a large representative sample of 14,842 children aged 6 to 18 years in 2005/6. Sex-specific descriptive statistics for whole-year age groups and smoothed percentile curves of WC and WHTR were derived and presented.</p> <p>Results</p> <p>WC increased with age, although less after age 14 years in girls. WHTR decreased with age (particularly up to age 14). WHTR correlated less closely than WC with BMI (r = 0.65, 0.59 cf. 0.93, 0.91, for boys and girls respectively).</p> <p>Conclusion</p> <p>Reference values and percentile curves for WC and WHRT of Chinese children and adolescents are provided. Both WC and WHTR are age dependent. Since the use of WHRT does not obviate the need for age-related reference standards, simple WC measurement is a more convenient method for central fat estimation than WHRT.</p

Clinical evaluation of deep learning and atlas-based auto-contouring for head and neck radiation therapy

202403 bcvcVersion of RecordOthersHong Kong Polytechnic UniversityPublishedC

Initial treatment with lansoprazole in young dyspeptic patients with negative urea breath test result: A randomized controlled trial with 12-month follow-up

INTRODUCTION: Although empirical antisecretory drug therapy is recommended to young dyspeptic patients without alarming features, the effectiveness of this approach remains undetermined. We evaluated the long-term effects of an initial 12-wk course of lansoprazole in young dyspeptic patients without Helicobacter pylori (H. pylori) infection. METHODS: Patients who were less than 45 yr and presented with at least 3 months of dyspepsia in the absence of alarming features were eligible. They were offered 13C-urea breath test (UBT) to determine H. pylori status and all symptomatic patients with negative UBT were randomized to receive lansoprazole 30 mg daily or placebo for 12 wk. Those who had previous endoscopy or positive UBT were excluded. Primary end point was the proportion of patients with treatment failure, defined as worsening of global dyspeptic symptom, while on study medication. Patients were followed up for 26 wk for global dyspeptic symptom as determined by 7-point Likert scale. Quality-of-life assessment (SF-36), need of endoscopy, and utilization of other health-care services were monitored for 52 wk. RESULTS: A total of 157 dyspeptic patients were randomized. At the end of 12-wk treatment, the proportion of patients with treatment failure was similar in the lansoprazole (33.3%) and placebo (30.3%) groups (P = 0.74). Patients' global assessment of their dyspeptic symptom was comparable at all time points measured. There was also no significant difference in the SF-36 mental and physical summary scales. At the end of 52 wk, there was no difference in the proportion of patients who underwent endoscopy, had additional medical consultations, or used other nonstudy medications between the two groups. CONCLUSION: Lansoprazole is not effective in the initial management of young dyspeptic patients without H. pylori infection. © 2007 by Am. Coll. of Gastroenterology.link_to_subscribed_fulltex

Reduction of hepatitis B core related antigen by long term nucleoside nucleotide analogue therapy and its correlation with intrahepatic HBV DNA reduction

Topic 11 - Hepatitis B: no. 1282Conference Theme: New Horizons from East to west in HepatologyThis journal suppl. entitled: Conference Abstracts: 24th Annual Conference of APASL, March 12-15, 2015, Istanbul, TurkeyOBJECTIVE: We aimed to investigate the reduction of hepatitis B corerelated antigen (HBcrAg) in patients with long term nucleoside/ nucleotide analogue (NA) therapy. METHODS: Forty-three patients (median age: 43 years, range: 24–63 years) who had been on continuous (median follow-up duration: 10 years; range 5–12 years) NA therapy, including lamivudine, adefovir, telbivudine, entecavir, and tenofovir, were recruited. All patients had liver biopsies at baseline and at the last follow-up. HBcrAg (detection limit: 3 log U/mL) were measured using a Lumipulse HBcrAg assay (Fujirebio, Japan). Intrahepatic total HBV DNA (ihHBV-DNA) and covalently closed circular DNA (cccDNA) were assayed by real-time PCR. RESULTS: At baseline, the median levels of HBcrAg, ihHBV-DNA, and cccDNA were 6.7 log U/mL, 286 copies/cell, and 7.3 copies/cell, respectively. Baseline level of HBcrAg correlated positively with that of ihHBV-DNA (r = 0.568, P\0.0001), and cccDNA (r = 0.559, P\0.0001). At the time of last biopsy, 12 (28 %) patients had undetectable HBcrAg (median: 3.8; range:\3–5.7 log U/mL). All patients had detectable ihHBV-DNA (median: 0.35 copies/cell), and 21 (49 %) patients had undetectable cccDNA. The median logarithmic reductions of HBcrAg, ihHBV-DNA, and cccDNA were 2.7 log U/mL, 2.81 log copies/cell, and 2.94 log copies/cell, respectively. There was a positive correlation between the logarithmic reduction of HBcrAg and ihHBV-DNA (r = 0.550, P\0.001) and cccDNA (r = 0.419, P = 0.005). CONCLUSION: The marked reduction of HBcrAg, together with the reduction in ihHBV-DNA and cccDNA, further supports the effectiveness of long-term nucleoside/tide analogue therapy in potentially eradicating HBV from chronic carriersLink_to_subscribed_fulltex

Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: Results of a randomized double-blind trial

Background & Aims: The gastric safety of cyclooxgenase-2 inhibitors and prophylactic antisecretory therapy in high-risk arthritis patients is unclear. We studied the ulcer incidence and factors predicting ulcer recurrence in a prospective, double-blinded trial. Methods: We studied patients who presented with nonsteroidal anti-inflammatory drug-associated ulcer bleeding. After ulcer healing, patients who were negative for Helicobacter pylori were randomly assigned to celecoxib 200 mg twice a day plus omeprazole placebo once daily or diclofenac 75 mg twice daily plus omeprazole 20 mg once daily for 6 months. Patients underwent endoscopy if they developed recurrent bleeding. Those without recurrent events underwent endoscopy at their last follow-up visit. Results: Two hundred eighty-seven patients were enrolled; 24 had recurrent gastrointestinal complications. Among 259 patients without events, 222 underwent endoscopy (116 received celecoxib and 106 received diclofenac plus omeprazole). The probability of recurrent ulcers in 6 months was 18.7% in the celecoxib group and 25.6% in the diclofenac plus omeprazole group (difference, -6.7%; 95% CI: -17.8% to 3.9%) (P = 0.21). Combining bleeding and endoscopic ulcers, 24.1% in the celecoxib group and 32.3% in the diclofenac plus omeprazole group had recurrent ulcers in 6 months (difference, -8.2%; 95% CI: -19.5% to 2.9%) (P = 0.15). Treatment-induced significant dyspepsia (hazard ratio, 5.3; 95% CI: 2.6-10.8), age ≥75 (hazard ratio, 2.0; 95% CI: 1.1-3.5), and comorbidity (hazard ratio, 2.1; 95% CI: 1.2-3.7) independently predicted ulcer recurrence. Conclusions: Among patients with previous ulcer bleeding, neither celecoxib nor diclofenac plus omeprazole adequately prevents ulcer recurrence. Treatment-induced significant dyspepsia is an indication for endoscopic evaluation.link_to_subscribed_fulltex

Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis

Background: Current guidelines recommend that patients at risk for ulcer disease who require treatment for arthritis receive nonsteroidal antiinflammatory drugs (NSAIDs) that are selective for cyclooxygenase-2 or the combination of a nonselective NSAID with a proton-pump inhibitor. We assessed whether celecoxib would be similar to diclofenac plus omeprazole in reducing the risk of recurrent ulcer bleeding in patients at high risk for bleeding. Methods: We studied patients who used NSAIDs for arthritis and who presented with ulcer bleeding. After their ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 200 mg of celecoxib twice daily plus daily placebo or 75 mg of diclofenac twice daily plus 20 mg of omeprazole daily for six months. The end end point was recurrent ulcer bleeding. Results: In the intention-to-treat analysis, which included 287 patients (144 receiving celecoxib and 143 receiving diclofenac plus omeprazole), recurrent ulcer bleeding occurred in 7 patients receiving celecoxib and 9 receiving diclofenac plus omeprazole. The probability of recurrent bleeding during the six-month period was 4.9 percent (95 percent confidence interval, 3.1 to 6.7) for patients who received celecoxib and 6.4 percent (95 percent confidence interval, 4.3 to 8.4) for patients who received diclofenac plus omeprazole (difference, - 1.5 percentage points; 95 percent confidence interval for the difference, -6.8 to 3.8). Renal adverse events, including hypertension, peripheral edema, and renal failure, occurred in 24.3 percent of the patients receiving celecoxib and 30.8 percent of those receiving diclofenac plus omeprazole. Conclusions: Among patients with a recent history of ulcer bleeding, treatment with celecoxib was as effective as treatment with diclofenac plus omeprazole, with respect to the prevention of recurrent bleeding. Renal toxic effects are common in high-risk patients receiving celecoxib or diclofenac plus omeprazole. Copyright © 2002 Massachusetts Medical Society.link_to_subscribed_fulltex

Long-term outcome of Helicobacter pylori-negative idiopathic bleeding ulcers: A prospective cohort study

Background & Aims: Helicobacter pylori-negative idiopathic ulcers are increasingly recognized. The secular trend and long-term outcome of this condition are unknown. Methods: We prospectively studied consecutive patients with bleeding gastroduodenal ulcers from January to December 2000. The incidence and etiology of ulcers during this period were compared with that between September 1997 and August 1998. H pylori-negative idiopathic ulcers were defined as negative tests for H pylori, no exposure to analgesics within 4 weeks, and absence of other risk factors for ulcers. After the ulcers had healed, patients with H pylori-negative idiopathic ulcers and patients with H pylori ulcers who received eradication therapy were followed up for 12 months without anti-ulcer drugs. Results: Six hundred thirty-eight patients had bleeding ulcers: 213 (33.4%) were H pylori ulcers, and 120 (18.8%) were H pylori-negative idiopathic ulcers (vs 480 [50.3%] H pylori ulcers and 40 [4.2%] H pylori-negative idiopathic ulcers in 1997-1998; P <. 001). H pylori-negative idiopathic ulcers accounted for 16.1% of patients who were admitted for bleeding and 42.4% of patients who bled while in the hospital (P <. 0001); 28.3% of patients with H pylori-negative idiopathic ulcers had histologic evidence of past H pylori infection. The probability of recurrent ulcer complications in 12 months was 13.4% (95% CI: 7.3%-19.5%) in patients with H pylori-negative idiopathic ulcers and 2.5% (95% CI: 0.4%-4.6%) in patients with H pylori ulcers who received eradication therapy (P =. 0002). Conclusions: The incidence of H pylori-negative idiopathic bleeding ulcers is rising. These ulcers are prone to recurrent complications. © 2005 by the American Gastroenterological Association.link_to_subscribed_fulltex

Screening of occult HBV infection in blood donors in Hong Kong using nucleic acid testing

This journal suppl. entitled: Abstracts of the 43 Annual Meeting of the European Association for the Study of the LiverSession 05D. Viral Hepatitis – D) Hepatitis B – Clinical (Except Therapy)BACKGROUND AND AIMS: Post-transfusion hepatitis B infection can still occur with HBsAg-negative blood donors. This is believed to be caused by occult HBV infection, defined by detectable HBV DNA in HBsAg-negative subjects. We aimed to determine the prevalence of occult HBV infection in blood donors in Hong Kong with high endemicity for chronic hepatitis B. PATIENTS AND METHODS: From January 2006 to September 2007, we prospectively collected serum samples from 10,000 blood donors at the Hong Kong Red Cross Transfusion Service. Sera were screened by the Cobas TaqScreen MPX Test in the s201 system (Roche diagnostics). In subjects with initial positive results, occult HBV status was confirmed by the Artus HBV PCR [lower limit of detection (LLOD): 6.4 copies/mL] (Qiagen), Cobas TaqMan (LLOD: 69.8 copies/mL) (Roche diagnostics), and an in-house real-time PCR tests (LLOD: 26 copies/mL). Genuine HBV DNA positive result was defined as having 2 out of 3 positive HBV DNA signals by the Artus test. RESULTS: We identified 61 HBsAg-negative, s201-positive cases. Artus HBV test revealed that 43 cases had 2 consecutive negative PCR signal, while 7 cases had only 1 positive PCR result out of 3 tests. Eleven cases had 2 positive HBV DNA results out of 3 tests (range: 0.7−53.9 copies/mL). Thus 11 out of 10,000 donors (0.11%) had confirmed occult HBV infection. Six samples were tested with Cobas TaqMan test and in-house real-time PCR. HBV DNA was undetectable in all 6 samples by the Cobas TaqMan test and detectable in 1 sample by the in-house real-time PCR test. At the time of writing, 5 subjects (3 male, 2 female) underwent liver biopsies. One female subject had normal histology and the other female had mild necroinflammation. Two male subjects had mild to moderate fibrosis, and one male subject had moderate steatosis. CONCLUSIONS: The prevalence of occult HBV infection was 0.11% among blood donors in Hong Kong. Due to the extremely low HBV DNA levels in these subjects, it is difficult to accurately diagnose occult HBV infection. Liver histology however showed that some subjects had developed fibrosis and other mild hepatic changes.Link_to_subscribed_fulltex

Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding

BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel. Copyright © 2005 Massachusetts Medical Society.link_to_subscribed_fulltex