OBJECTIVE: Vaccine hesitancy has been a public health issue for some time now, but gained more attention during COVID-19 pandemic. This systematic review aimed to estimate the prevalence of COVID-19 vaccination hesitancy and identify factors affecting it among adolescents. MATERIALS AND METHODS: The preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P 2020) was used. A search was performed in PubMed/ MEDLINE, EMBASE, Google Scholar, Herdin, and Cochrane databases on September 2023 using the key words: (COVID-19 OR SARS-COV OR corona virus) AND (Vaccination OR immunization) AND (adolescence OR teenagers OR youth) AND (hesitancy OR acceptance). Observational studies which determined the prevalence or risk factors for COVID-19 vaccine hesitancy among adolescents aged 10-19 years old were included. RESULTS: There were 5 good quality cross-sectional studies included. The prevalence of adolescents who did not want to be vaccinated ranged between 8.4% and 61.0%; while the prevalence of being unsure if they want to be vaccinated was between 31.6% and 88.0%. Factors associated with vaccine hesitancy included being economically disadvantaged, not having influenza vaccination, worrying about its effectiveness and safety, and low perceived necessity. CONCLUSION There is good quality evidence that COVID-19 vaccine hesitancy exists among adolescents. It is recommended that health workers should conduct information and education campaigns to iterate the effectiveness, safety, and misconceptions about of COVID-19 vaccination. Vaccination programs should also reach out to economically disadvantaged adolescents, and tapping parents and social media may be an effective strategy to improve vaccination acceptance among adolescents.
COVID-19 ; SARS-COV ; Severe acute respiratory syndrome-related coronavirus ; Vaccination ; Immunization ; Adolescent ; Adolescence ; Teenagers ; Youth

Objective: To determine incidence, predictors, and impact of liver injury among hospitalized COVID-19 patients Methods: This is a retrospective cohort study of hospitalized COVID-19 patients at the University of the PhilippinesPhilippine General Hospital. Liver injury (LI) was defined as ALT elevation above institutional cut-off (>50 u/L) and was classified as mild (>1x to 3x ULN), moderate (>3x to 5x ULN), or severe (>5x ULN). Significant liver injury (SLI) was defined as moderate to severe LI. Univariate analysis of SLI predictors was performed. The impact of LI on clinical outcomes was determined and adjusted for known predictors -age, sex, and comorbidities. Results: Of the 1,131 patients, 565 (50.04%) developed LI. SLI was associated with male sex, alcohol use, chronic liver disease, increasing COVID-19 severity, high bilirubin, AST, LDH, CRP, and low lymphocyte count and albumin. An increasing degree of LI correlated with ICU admission. Only severe LI was associated with the risk of invasive ventilation (OR: 3.54, p=0.01) and mortality (OR: 2.76, p=0.01). Severe LI, male sex, cardiovascular disease, and malignancy were associated with longer hospital stay among survivors. Conclusion The liver injury occurred commonly among COVID-19 patients and was associated with important clinicodemographic characteristics. Severe liver injury increases the risk of adverse outcomes among hospitalized patients.
Liver injury ; Coronavirus disease-19 ; Severe Acute Respiratory Syndrome Coronavirus-2 ; Clinical outcomes

INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.
Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Disease Outbreaks ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care/statistics & numerical data* ; Patient Admission/trends* ; Pediatrics ; Retrospective Studies ; Severe Acute Respiratory Syndrome/epidemiology* ; Singapore/epidemiology*

An epidemic of acute respiratory syndrome in humans, which appeared in Wuhan, China in December 2019, was caused by a novel coronavirus (SARS-CoV-2). This disease was named as "Coronavirus Disease 2019" (COVID-19). SARS-CoV-2 was first identified as an etiological pathogen of COVID-19, belonging to the species of severe acute respiratory syndrome-related coronaviruses (SARSr-CoV). The speed of both the geographical transmission and the sudden increase in numbers of cases is much faster than SARS and Middle East respiratory syndrome (MERS). COVID-19 is the first global pandemic caused by a coronavirus, which outbreaks in 211 countries/territories/areas. The vaccine against COVID-19, regarded as an effective prophylactic strategy for control and prevention, is being developed in about 90 institutions worldwide. The experiences and lessons encountered in the previous SARS and MERS vaccine research can be used for reference in the development of COVID-19 vaccine. The present paper hopes to provide some insights for COVID-19 vaccines researchers.
Betacoronavirus ; immunology ; Biomedical Research ; Coronavirus Infections ; epidemiology ; immunology ; prevention & control ; virology ; Humans ; Internationality ; Middle East Respiratory Syndrome Coronavirus ; immunology ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; immunology ; prevention & control ; virology ; SARS Virus ; immunology ; Severe Acute Respiratory Syndrome ; immunology ; Viral Vaccines ; immunology

The ongoing outbreak of the coronavirus disease 2019 (COVID-19) as named by the World Health Organization has millions of confirmed cases around the world and has claimed hundreds of thousands of lives. The virus was named SARS-CoV-2 in February by International Committee on Taxonomy of Viruses. COVID-19 presents as fever, dry cough, dyspnea, headache and pneumonia. In a small subset of severe cases, the disease quickly progresses to respiratory failure and even death. Since the 21st century, there have been three major outbreaks caused by human coronaviruses, including the severe acute respiratory syndrome (SARS) that broke out in 2003, the Middle East respiratory syndrome (MERS) in 2012, and the recent pandemic of COVID-19. Since 2003, significant progress has been made in the study of SARS-CoV and MERS-CoV concerning their natural origins, pathogenesis, antiviral development and vaccine design. Since SARS-CoV-2 and SARS-CoV are closely related, previous findings on SARS-CoV are highly relevant to a better understanding as well as diagnosis, treatment, prevention and control of SARS-CoV-2. In this review, we highlight recent progresses in the field; compare the biological characteristics of SARS-CoV and SARS-CoV-2; summarize the urgently-needed diagnostic, treatment, prevention and control options; and provide future perspectives for the outcome of the outbreak and research questions to be answered, including some of the difficulties in vaccine development. Hopefully, our comments and suggestions would prove useful for the control of the SARS-CoV-2 epidemic in China and the world.
Antiviral Agents ; pharmacology ; therapeutic use ; Betacoronavirus ; drug effects ; immunology ; pathogenicity ; Coronavirus Infections ; diagnosis ; prevention & control ; therapy ; virology ; Humans ; Middle East Respiratory Syndrome Coronavirus ; drug effects ; immunology ; pathogenicity ; Pandemics ; prevention & control ; Pneumonia, Viral ; diagnosis ; prevention & control ; therapy ; virology ; SARS Virus ; drug effects ; immunology ; pathogenicity ; Severe Acute Respiratory Syndrome ; diagnosis ; prevention & control ; therapy ; virology ; Viral Vaccines

Adenosine Monophosphate ; analogs & derivatives ; therapeutic use ; Adult ; Aged ; Alanine ; analogs & derivatives ; therapeutic use ; Anti-Arrhythmia Agents ; therapeutic use ; Arrhythmias, Cardiac ; diagnosis ; epidemiology ; Coronavirus Infections ; diagnosis ; drug therapy ; epidemiology ; Echocardiography ; Electrocardiography ; methods ; statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Male ; Pandemics ; statistics & numerical data ; Pneumonia, Viral ; diagnosis ; drug therapy ; epidemiology ; Sampling Studies ; Severe Acute Respiratory Syndrome ; diagnosis ; epidemiology ; Singapore ; Treatment Outcome

OBJECTIVES: To develop a new Chinese medicine (CM)-based drug and to evaluate its safety and effect for suppressing acute respiratory distress syndrome (ARDS) in COVID-19 patients. METHODS: A putative ARDS-suppressing drug Keguan-1 was first developed and then evaluated by a randomized, controlled two-arm trial. The two arms of the trial consist of a control therapy (alpha interferon inhalation, 50 µg twice daily; and lopinavir/ritonavir, 400 and 100 mg twice daily, respectively) and a testing therapy (control therapy plus Keguan-1 19.4 g twice daily) by random number table at 1:1 ratio with 24 cases each group. After 2-week treatment, adverse events, time to fever resolution, ARDS development, and lung injury on newly diagnosed COVID-19 patients were assessed. RESULTS: An analysis of the data from the first 30 participants showed that the control arm and the testing arm did not exhibit any significant differences in terms of adverse events. Based on this result, the study was expanded to include a total of 48 participants (24 cases each arm). The results show that compared with the control arm, the testing arm exhibited a significant improvement in time to fever resolution (P=0.035), and a significant reduction in the development of ARDS (P=0.048). CONCLUSIONS Keguan-1-based integrative therapy was safe and superior to the standard therapy in suppressing the development of ARDS in COVID-19 patients. (Trial registration No. NCT04251871 at www.clinicaltrials.gov ).
Administration, Inhalation ; Adult ; China ; Coronavirus Infections ; diagnosis ; drug therapy ; mortality ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Integrative Medicine ; Interferon-alpha ; administration & dosage ; Lopinavir ; administration & dosage ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnosis ; drug therapy ; mortality ; Risk Assessment ; Severe Acute Respiratory Syndrome ; diagnosis ; drug therapy ; mortality ; Severity of Illness Index ; Survival Rate

Betacoronavirus ; Coronavirus Infections ; epidemiology ; transmission ; Disease Outbreaks ; Humans ; Pandemics ; Pneumonia, Viral ; epidemiology ; transmission ; Severe Acute Respiratory Syndrome ; epidemiology

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVID-19), SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review. Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19, SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients' manifestations in early chest CT including lesion patterns, distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0. Results A total of 24 studies were included, composing of 10 studies of COVID-19, 5 studies of MERS and 9 studies of SARS. The included CT exams were 147, 40, and 122 respectively. For the early CT features of the 3 pneumonias, the basic lesion pattern with respect to "mixed ground glass opacity (GGO) and consolidation, GGO mainly, or consolidation mainly" was similar among the 3 groups (=7.966, >0.05). There were no significant differences on the lesion distribution (=13.053, >0.05) and predominate involvement of the subpleural area of bilateral lower lobes (=4.809, >0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (=23.509, <0.05). The proportions of crazy-paving pattern (=23.037, <0.001), organizing pneumonia pattern (<0.05) and pleural effusions (<0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias, the fibrotic changes were more frequent in SARS than COVID-19 and MERS (=6.275, <0.05). For other imaging signs, only the MERS pneumonia demonstrated tree-in-buds, cavitation, and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (=22.412, <0.05). No pneumothorax, pneumomediastinum and lymphadenopathy was present for each group. Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns, including GGO and consolidation, bilateral distribution, and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SARS only. MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.
Betacoronavirus ; Coronavirus Infections ; diagnostic imaging ; Humans ; Lung ; diagnostic imaging ; Middle East Respiratory Syndrome Coronavirus ; Pandemics ; Pneumonia, Viral ; diagnostic imaging ; SARS Virus ; Severe Acute Respiratory Syndrome ; diagnostic imaging ; Tomography, X-Ray Computed

This article evaluates the potential influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women on the development of coronavirus disease 2019 in neonates and discusses the possibility of mother-to-child vertical transmission of SARS-CoV-2. With reference to related articles published up to now and the information on official websites, a retrospective review was performed for the clinical manifestations and laboratory examination results of the neonates born to the mothers with infection during pregnancy during the epidemics of severe acute respiratory syndrome and Middle East respiratory syndrome and after the outbreak of SARS-CoV-2 infection since December 2019. Based on the limited data, there is no conclusive evidence for mother-to-child vertical transmission of coronavirus disease 2019, and more cases need to be collected for further evaluation.
Betacoronavirus ; Child ; Coronavirus Infections ; Female ; Humans ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Pandemics ; Pneumonia, Viral ; Pregnancy ; Pregnancy Complications, Infectious ; Pregnancy Outcome ; Retrospective Studies ; Severe Acute Respiratory Syndrome