COVID-19 vaccination and liver disease

Various vaccines against severe acute respiratory syndrome coronavirus 2 have been developed in response to the coronavirus disease 2019(COVID-19)global pandemic,several of which are highly effective in preventing COVID-19 in the general population.Patients with chronic liver diseases(CLDs),particularly those with liver cirrhosis,are considered to be at a high risk for severe COVID-19 and death.Given the increased rates of disease severity and mortality in patients with liver disease,there is an urgent need to understand the efficacy of vaccination in this population.However,the data regarding efficacy and safety of COVID-19 vaccination in patients with CLDs is limited.Indeed,several organ-specific or systemic immune-mediated side effects following COVID-19 vaccination,including liver injury similar to autoimmune hepatitis,have been recently reported.Although the number of cases of vaccine-related liver injury is increasing,its frequency,clinical course,and mechanism remain unclear.Here,we review the current findings on COVID-19 vaccination and liver disease,focusing on:(1)The impact of COVID-19 in patients with CLD;(2)The efficacy,safety,and risk-benefit profiles of COVID-19 vaccines in patients with CLD;and(3)Liver injury following COVID-19 vaccination.

Prevalence of and risk factors for tuberculosis among healthcare workers in Chinese tuberculosis facilities

Background:China is one of 22 countries with a high tuberculosis(TB)burden in the world.Healthcare workers(HCWs)have a high risk of contracting Mycobacterium tuberculosis infection due to insufficient infection control practices.We conducted a cross-sectional study to explore the prevalence of TB and its associated risk factors among HCWs in Chinese TB facilities.Methods:Two hundred and forty-one TB facilities employing a total of 9663 HCWs were selected from 12 provinces in China to represent healthcare settings at the provincial,prefectural,and county levels.Structured questionnaires were used to collect information on TB infection control practices and HCWs in those facilities.Data was double entered into EpiData 3.1;TB prevalence and associated risk factors were analyzed using SPSS 21.0 with bivariate and multivariate regression models.Results:The results showed that 71 HCWs had been diagnosed with TB,accounting for a prevalence of 760/100000.The multivariate analysis showed that associated risk factors included belonging to the age group of 51 years and above(aOR:6.17,95%CI:1.35-28.28),being a nurse(aOR=3.09,95%CI:1.15-8.32),implementation of 0-9 items of management measures(aOR=2.57,95%CI:1.37-4.80),and implementation of 0-1 items of ventilation measures(aOR=2.42,95%CI:1.31-4.47).Conclusion:This was the first national large sampling survey on TB prevalence among HCWs in China.It was found that the implementation of TB infection control practices in some facilities was poor.The TB prevalence in HCWs was higher than that in the general population.Therefore,TB infection control practices in Chinese medical facilities should be strengthened.

Total and cause-specific mortality attributable to cold spells in China:A multicity and multicounty study

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events,but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden.We collected daily data on climate,sociodemo-graphic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March 2014-2018.A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors.Twelve definitions of cold spells were used.Multi-meta regression analysis was applied to pool the impacts over different regions.Cold spells were significantly associated with all-cause mortality at lag 0-21(CRR:1.38,95%CI:1.21,1.57).In addition to respiratory diseases and cir-culatory system diseases,digestive,endocrine and nervous system diseases and injury were also affected by cold spells.The magnitude of the impacts of cold spells on mortality varied among the diseases investigated,with the highest risk estimate found for influenza and pneumonia(CRR:2.00,95%CI:1.45,2.76)and the lowest estimate found for injury(CRR:1.26,95%CI:1.09,1.46).The fraction of all-cause mortality attributable to cold spells was 2.31%(95%CI:0.90%,3.46%).Among the regional differences,the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone,with attributable fractions of 2.85%(95%CI:1.23%,4.11%)and 3.36%(95%CI:0.55%,5.35%),respectively.Cold spells increased mortality from a range of diseases.Women,older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts.The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.