Objective: To identify the acceptance of the vaccine based on factors influencing the vaccination program and the side effects from vaccinated people. Methods: A cross-sectional online survey of 1 529 Bangladeshi adults (≥18 years) was conducted between 17 April, 2021 and 26 April, 2021. Statistical analysis of the data included Chi-square test and multinomial logistic regression analysis. Results: In total, 67.04% of the participants were willing to accept a COVID-19 vaccine, and 45.00% of them in our study had already received. Overall Bangladeshi people were more likely to accept COVID-19 vaccine if the vaccine reduces risk of infectious disease and has no associated health risk after receiving it. Among the respondents, religions, education level, living area (urban), belif that vaccines protect against infectious diseases and vaccines do not have health-related risk and vaccination was significantly associated with the acceptance of COVID-19 vaccines. Conversely, people’s perception on development of natural immunity rather than receiving vaccines was also positively reflected. More than half (57.41%) reported minor side effects such as fever, muscle pain and headache after getting vaccine shots. Conclusions: This study revealed that the acceptance rate was influenced by socio-demographic and health-related characteristics and people are not afraid of this vaccine if they faced minor side effects after receiving it. These findings might help the government and policymakers of Bangladesh to implement necessary steps to accomplish this vaccination program effectively.

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Objective: To define the alert levels for the total number of COVID-19 cases derived by using quantile functions to monitor COVID-19 outbreaks via an exponentially weighted moving-average (EWMA) control chart based on the first hitting time of the total number of COVID-19 cases following a symmetric logistic growth curve. Methods: The cumulative distribution function of the time for the total number of COVID-19 cases was used to construct a quantile function for classifying COVID-19 alert levels. The EWMA control chart control limits for monitoring a COVID-19 outbreak were formulated by applying the delta method and the sample mean and variance method. Samples were selected from countries and region including Thailand, Singapore, Vietnam, and Hong Kong to generate the total number of COVID-19 cases from February 15, 2020 to December 16, 2020, all of which followed symmetric patterns. A comparison of the two methods was made by applying them to a EWMA control chart based on the first hitting time for monitoring the COVID-19 outbreak in the sampled countries and region. Results: The optimal first hitting times for the EWMA control chart for monitoring COVID-19 outbreaks in Thailand, Singapore, Vietnam, and Hong Kong were approximately 280, 208, 286, and 298 days, respectively. Conclusions: The findings show that the sample mean and variance method can detect the first hitting time better than the delta method. Moreover, the COVID-19 alert levels can be defined into four stages for monitoring COVID-19 situation, which help the authorities to enact policies that monitor, control, and protect the population from a COVID-19 outbreak.

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Rationale: Hepatitis C in the pediatric population is a large health burden globally. With its diverse genotypes as well as genotypic subtypes, there is a discrepancy in the genotypes used in research compared to their prevalence. HCV genotype 6 which is endemic to South China and Southeast Asia comprises approximately one-third of all HCV infections worldwide, but make up a minority of cases studied in HCV research. Patient concerns: We report a case of HCV-6 seen in an 11-year-old Burmese immigrant to the U.S. and describe the new direct acting antiviral treatment guidelines for pediatrics with HCV genotype 6. Interventions: The patient completed a 12-week course of ledipasvir/sofosbuvir (90 mg/400 mg), per FDA weight-based recommendations for treatment-naive HCV genotypes 4-6, without any complications. Outcomes: The patient was treated successfully with an undetectable HCV viral load one month after treatment completion. Lessons: HCV-6, although previously uncommon in the U.S., is becoming more prevalent. Updated guidelines include the use of direct acting antivirals, which have been proven effective for HCV-6. Lessons on barriers to care in the immigrant population as well as the value of HCV genotyping are also discussed.

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Objective: To describe the prevalence of antiphospholipid antibodies in coronavirus disease-19 (COVID-19) and to find potential associations between antiphospholipid antibody positivity and clinical outcomes. Methods: From September to November 2020, clinical and laboratory data were collected from 50 COVID-19 patients hospitalized at Saiful Anwar General Hospital in Malang, Indonesia. Antiphospholipid antibodies were measured by finding IgM anti-β2 glycoprotein, lupus anticoagulant, and IgM/IgG anticardiolipin. Clinical characteristics, thrombotic events, ICU admission, and mortality during hospitalization were recorded. Disease severity was defined by the Guidelines for the Prevention and Control of COVID-19, Indonesia. Results: Among 50 patients, 5 patients (10.0%) were positive for antiphospholipid antibodies: 4 patients (80.0%) had IgM anti-β2 glycoprotein and 1 patient had IgG anti-cardiolipin (20.0%) and IgM anti-cardiolipin (20.0%), none of lupus anticoagulant was detected. Antiphospholipid antibodies were associated with anosmia (OR 8.1; 95% CI 1.1-57.9; P=0.018), nausea and vomiting (OR 12.4; 95% CI 1.2-122.6; P=0.010), diarrhea (OR 9.8; 95% CI 1.3-70.9; P=0.010), cardiovascular disease (OR 1.4; 95% CI 1.0-1.9; P=0.001), chronic kidney disease (OR 12.0; 95% CI 1.6-90.1; P=0.05), acute coronary syndrome (OR 29.3; 95% CI 2.0-423.7; P=0.001), moderate (OR 0.11; 95% CI 0.01-1.10; P=0.031) and severe (OR 18.5; 95% CI 1.8-188.4; P=0.002) disease severity, and in-hospital mortality (OR 8.1; 95% CI 1.1-57.9; P=0.018). However, there is no correlation between the presence of antiphospholipid antibody and ICU admission. Conclusions: In summary, the prevalence of antiphospholipid antibodies in COVID-19 patients is low, mainly against IgM anticardiolipin, and is associated with an acute coronary syndrome, gastrointestinal manifestations, moderate and severe disease severity, and increased risk of mortality.

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Objective: To identify the predictors of mortality among in-hospital melioidosis patients. Methods: A total of 453 patients in Hospital Sultanah Bahiyah, Kedah, and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis were retrospectively included in the study. Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis. The analysis was performed using STATA/SE 14.0. Results: A total of 50.11% (227/453) of the patients died at the hospital, and a majority (86.75%, 393/453) of cases were bacteremic. The logistic regression estimated that the bacteremic type of melioidosis, low platelet count, abnormal white blood cell counts, and increased urea value were predictors of mortality. The results showed that bacteremic melioidosis increased the risk of death by 4.39 times (OR 4.39, 95% CI 1.83-10.55, P=0.001) compared to non-bacteremic melioidosis. Based on laboratory test, the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease [high white blood cell (>10×10⁹/L): OR 2.43, 95% CI 1.41-4.17, P<0.001; low white blood cell (<4×10⁹/L): OR 3.82, 95% CI 1.09-13.34, P=0.036; low platelet (<100×10⁹/L): OR 4.19, 95% CI 1.89-9.30, P<0.001; high urea (>7 800 μmol/L): OR 5.53, 95% CI 2.50-12.30, P<0.001; and low level of urea (<2 500 μmol/L): OR 3.52, 95% CI 1.71-7.23, P=0.001). Conclusions: Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.

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Human T-cell lymphotropic virus type 1 (HTLV-1) is associated with the development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). It has been reported that the HTLV-1 proteins (specifically TAX and HBZ) can modulate FOXp3, resulting in an immune imbalance that can favor the progression of HAM/TSP. This review aims to summarize the literature in order to clarify the relationship between the expression of HTLV-1 mRNAs and/or viral proteins (TAX and HBZ) with the expression of mRNA and/or protein FOXp3 and their correlation with HAM/ TSP development. This systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The search strategy was performed on the Medical Literature Analysis and Retrieval System Online and Latin American and Caribbean Literature in Health Sciences Platform using subject descriptors. After screening, six articles were included in this review. The studies suggested that TAX and HBZ have a directly proportional correlation with FOXp3 in individuals with HAM/TSP, which also presented an increased expression of FOXp3 compared to asymptomatic controls and/or healthy donors. This systematic review indicates that TAX and HBZ can interact with FOXp3 and that interaction may influence HAM/ TSP development.

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