Prevalence of risk behaviors and correlates of SARS-CoV-2 positivity among in-school contacts of confirmed cases in a Georgia school district in the pre-vaccine era, December 2020–January 2021

Background There is a continuing risk for COVID-19 transmission in school settings while transmission is ongoing in the community, particularly among unvaccinated populations. To ensure that schools continue to operate safely and to inform implementation of prevention strategies, it is imperative to gain better understanding of the risk behaviors of staff and students. This secondary analysis describes the prevalence of COVID-19 risk behaviors in an exposed population of students and school staff in the pre-vaccine era and identifies associations between these behaviors and testing positive for SARS-CoV-2. Methods From December 2020–January 2021, school staff and students exposed to confirmed COVID-19 cases in a Georgia school district were tested for SARS-CoV-2 and surveyed regarding risk behaviors in and out of school. Prevalence of risk behaviors was described by age group and school level, and associations with SARS-CoV-2 positivity were identified using chi squared tests. Results Overall, 717 students and 79 school staff participated in the investigation; SARS-CoV-2 positivity was 9.2%. In the 2 weeks prior to COVID-19 exposure, 24% of participants reported unmasked indoor time at school, 40% attended social gatherings with non-household members, and 71% visited out-of-school indoor locations, including 19% who ate indoors in restaurants. Frequencies of risk behaviors increased by age. Among students, 17% participated in school sports, of whom 86% participated without a mask. SARS-CoV-2 positivity was significantly associated with school sports and unmasked time in sports. Among K-5 students, positivity was associated with exposure to a teacher index case. Conclusions This analysis highlights the high prevalence of risk behaviors in an unvaccinated population exposed to COVID-19 in school and identifies an association between student sports participation and SARS-CoV-2 positivity. These findings illustrate the importance of school-level prevention measures to reduce SARS-CoV-2 transmission, including limiting close-contact indoor sports and promoting consistent mask use in unvaccinated individuals. Future research could explore the role of community vaccination programs as a strategy to reduce COVID-19 transmission and introductions into school settings.

Exploratory Case Study of Suicide among a Sample of 9/11 Survivors

Background: Previous research has found higher than expected suicide mortality among rescue/recovery workers (RRWs) enrolled in the World Trade Center Health Registry (WTCHR). Whether any enrollee suicides are related to the decedents’ experiences on 9/11 is unknown. We abstracted medical examiner file data to learn more about 9/11-related circumstances of suicides among WTCHR enrollees. Methods: We identified 35 enrollee suicide cases that occurred in New York City using linked vital records data. We reviewed medical examiner files on each case, abstracting demographic and circumstantial data. We also reviewed survey data collected from each case at WTCHR enrollment (2003–2004) and available subsequent surveys to calculate descriptive statistics. Results: Cases were mostly non-Hispanic White (66%), male (83%), and middle-aged (median 58 years). Nineteen decedents (54%) were RRWs, and 32% of them worked at the WTC site for >90 days compared to 18% of the RRW group overall. In the medical examiner files of two cases, accounts from family mentioned 9/11-related circumstances, unprompted. All deaths occurred during 2004–2018, ranging from one to four cases per year. Leading mechanisms were hanging/suffocation (26%), firearm (23%), and jump from height (23%). Sixty percent of the cases had depression mentioned in the files, but none mentioned posttraumatic stress disorder. Conclusions: RRWs may be at particular risk for suicide, as those who worked at the WTC site for long periods appeared to be more likely to die by suicide than other RRWs. Mental health screening and treatment must continue to be prioritized for the 9/11-exposed population. More in-depth investigations of suicides can elucidate the ongoing impacts of 9/11.

Evaluation of Cytogenetic Alterations of Toxic Gas Exposed Population of Bhopal Having Chronic Kidney Disease

The industrial disaster of Bhopal in 1984 resulted in widespread morbidity and mortality in the vicinity of the industry and required long-term surveillance for chronic health effects in those affected by the leakage of gas. Although few cytogenetic studies were undertaken to assess genetic damage in survivors of the disaster, no studies are available on cytogenetic damage of toxic gas-exposed populations having chronic kidney disease (CKD). Thus, the present study aimed to evaluate cytogenetic alterations in chronic kidney disease patients who were exposed to leaked gas and to compare it with those who were not exposed to the leaked gas. The cytogenetic alterations were evaluated through chromosomal aberration analysis and micronuclei assay. The study included 608 study participants divided into four groups based on the history of exposure to the leaked gas and the presence or absence of CKD. The results of the study showed no statistically significant difference in cytogenetic damage between gas-exposed and non-exposed patients of CKD. However, significantly higher cytogenetic damage was observed among gas-exposed participants having CKD as compared to gas-exposed participants free from CKD. Thus, to conclude though the cytogenetic alterations were observed in an exposed group it cannot be solely attributed to the gas exposure and the role of other confounders must also be studied.

A Model for Calculating the Spatial Coverage of Audible Disaster Warnings Using GTFS Realtime Data

In the event of a large-scale disaster, the dissemination of audible disaster warning information via sirens is effective in ensuring a rapid response. Sirens can be installed not only on fixed towers, but also on public transport and other vehicles passing through residential areas, and at spots where residents congregate, to increase area coverage. Although models to calculate the spatial coverage of audible information delivered from fixed sirens have been constructed, no general-purpose model has been developed to assess the delivery from vehicles. In this study, we focused on the General Transit Feed Specification (GTFS), which is an open format for geospatial information on public transport. We conducted a spatial analysis using a geographic information system (GIS) on the basis of the acquired bus location information. We developed a model to calculate the spatial coverage of the audible information delivery for overlapping hazard maps and population. Assuming a flood occurred in the vicinity of Brisbane Central Station, Queensland, Australia, we confirmed that the developed model was capable of characterizing the time-series changes in the exposed population in the target area. Since the GTFS format is currently distributed across various countries, this assessment model is considered to be highly versatile and widely applicable.

The Parental Pesticide and Offspring’s Epigenome Study: Towards an Integrated Use of Human Biomonitoring of Exposure and Effect Biomarkers

In Morocco, due to the lack of education and the presence of a counterfeit market, pesticides constitute a major problem to be addressed by occupational and environmental health agencies. This paper aims to introduce the PaPOE (Parental Pesticides and Offspring Epigenome) prospective study and its goals, to motivate the study rationale and design, and to examine comprehensively whether multi-residue exposure to commonly used pesticides could induce epigenetic alterations through the oxidative stress pathway. The PaPOE project includes a cross-sectional study assessing the occupational exposure among 300 farmworkers in Meknes, and initiates a birth cohort of 1000 pregnant women. Data and biological samples are collected among farmworkers, and throughout pregnancy, and at birth. Oxidative stress biomarkers include Glutathione, Malondialdehyde, and 8-OHdG. Global and gene-specific DNA methylation is assessed. The study began enrollment in 2019 and is ongoing. As of 30 June 2021, 300 farmworkers and 125 pregnant women have enrolled. The results are expected to showcase the importance of biomonitoring for understanding individual risks, and to identify a number of regions where DNA methylation status is altered in the pesticides-exposed population, paving the way for an integrated biomonitoring system in Morocco and Africa to assess environmental exposures and their long-term health consequences.

PP259 Invisible Resilience: The Value Of Medical Technology In Reducing Population And Health Systems’ Vulnerability To COVID-19.

IntroductionCOVID-19 has exposed population and health systems’ vulnerability to a highly infectious disease. People with diabetes have a higher risk of COVID-19 hospitalization and death than those without. Medicines that control blood glucose reduce this risk. We quantified COVID-19 hospital admissions and deaths averted by diabetes medicines in the UK during the March-May 2020 wave.MethodsWe estimated COVID-19 hospital and intensive care unit (ICU) admissions averted and COVID-19 hospital deaths avoided by diabetes medicines, considering a counterfactual where those medicines were not available. We used published UK-data sources on diabetes prevalence, proportion of patients achieving diabetes control with medicines, COVID-19 infection risk, probabilities for COVID-19 hospital admission, subsequent ICU admission and hospital death. We calculated the relative risk reduction of controlled vs. uncontrolled diabetes on COVID-19 hospital or ICU admission (71% and 66%, respectively), and hospital death (38%) from the UK Open Safely data.ResultsDiabetes medicines are estimated to have averted 17,417 hospital admissions, 2,752 ICU-admissions and 438 hospital deaths due to COVID-19 compared to a counterfactual where those medicines had not been available in the UK.ConclusionsEffective medicines to control diabetes contribute to population and health systems resilience against COVID-19. Health technology assessment and policy makers should recognize that adoption and usage of health technology reduces societies’ vulnerability to similar shocks.

Frequency and antibiotic resistance of Helicobacter pullorum among exposed and non-exposed population

Background: Helicobacter pullorum can infect the intestinal tracts of both humans and avian species. This study aimed to assess the frequency and antibiotic resistance of H. pullorum isolated from workers in the poultry slaughterhouses, farms, and markets as exposed population and healthy people who referred to the hospital as non-exposed population by culture method and polymerase chain reaction (PCR) test. Methods: Two hundred healthy individuals, including 100 individuals from exposed population and 100 from non-exposed population were selected in Semnan. Fresh stool samples were examined by conventional culture method and biochemical tests. PCR test with 16S rRNA gene was employed to confirm the H. pullorum isolates. Antibiotic resistance test was done using the disk diffusion method and various antimicrobial agents. Results: Generally, 17 (17%) samples from exposed population and 12 (12%) samples from non-exposed population were H. pullorum positive by culture method and biochemical tests. However, PCR test could confirm 10 (10%) and 7 (7%) samples from exposed and non-exposed populations, respectively. Therefore, the frequency of H. pullorum was determined to be 9.5%. Antibiotic resistance test could reveal that most of the isolates were resistant to ciprofloxacin (84.2%), whereas resistance to colistin and fosfomycin was found to be 15.8%. Conclusion: The present study illustrated that H. pullorum can be present among healthy population with the low frequency rate. Moreover, it was indicated that the frequency of this food-borne pathogen is high in the exposed population. Therefore, there is a high demand for good observation for slaughter hygiene and implementation of routine surveillance in the poultry farms and markets.

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide versus dolutegravir /abacavir/lamivudine in antiretroviral-naïve adults (SYMTRI): a multicenter randomized open-label study (PReEC/RIS-57)

Background D/C/F/TAF is the reference for combination therapy based on protease inhibitors due to its efficacy, tolerability, and convenience. Head-to-head randomized comparisons between D/C/F/TAF and combination therapy based on integrase inhibitors in antiretroviral-naïve patients are lacking. Methods Adult (>18 y) HIV-infected antiretroviral-naïve patients (HLA B5701– and HBV-negative), with VL ≥500 c/mL, were centrally randomized to initiate D/C/F/TAF or DTG/3TC/ABC after stratifying by viral load and CD4 count. Clinical and analytical assessments were performed at weeks 0, 4, 12, 24, and 48. The primary endpoint was VL <50 c/mL at week 48 in the ITT-exposed population (FDA snapshot analysis, 10% non-inferiority margin). Results Between September 2018 and 2019, 316 patients were randomized and 306 patients were included in the ITT-exposed analysis (151 D/C/F/TAF and 155 DTG/3TC/ABC). Almost all (94%) participants were male and their median age was 35 years. 40% had a baseline VL >100,000 copies/mL, and 13% had <200 CD4 cells/μL. Median weight was 73 kg and median BMI 24 kg/m 2. At 48 weeks, 79% (D/C/F/TAF) vs 82% (DTG/3TC/ABC) had VL <50 c/mL (difference –2.4%, 95%CI –11.3 to 6.6). 8% vs 4% experienced virologic failure but no RAMs emerged. 4% vs 6% had drug discontinuation due to adverse events. In the per protocol analysis, 94% vs 96% patients had VL <50 c/mL (difference –2%, 95%CI –8.1 to 3.5). There were no differences in CD4 cell count or weight changes. Conclusions We could not demonstrate the non-inferiority of D/C/F/TAF relative to DTG/ABC/3TC as initial ART, although both regimens were similarly well tolerated.