WMJ : official publication of the State Medical Society of Wisconsin最新文献

Introduction: The COVID-19 pandemic created unprecedented opportunities to introduce rapid SARS-CoV-2 antigen testing (RSAT) into kindergarten through 12th grade (K-12) school settings. We evaluated the feasibility and functionality of Sofia Fluorescent Immunoassay Flu + SARS in 1 school district across the 2021-2022 academic year.

Methods: Seven schools in the Oregon School District (Oregon, Wisconsin) were supplied with RSAT analyzers and test kits, along with minimal training of health office staff. We assessed RSAT utilization among schools, rate of invalid results, and comparability to 952 190 reverse transcription-polymerase chain reaction tests performed countywide during the same time period. A feedback survey was distributed to all 13 health office staff to assess respondents' perceptions regarding the feasibility and acceptability of RSAT in the Oregon School District.

Results: Over the school year, 1226 RSATs were performed; SARS-CoV-2 was detected in 103 specimens. Percent positivity was similar to the county level (8.4 vs 9.2%; chi-square = 0.74; P = 0.39). Cross-correlation of weekly positive tests between the Oregon School District and Dane County was maximal with no lag (rs = 0.69; P < 0.001). Health office staff indicated Sofia2 RSAT was easy to perform, and 92.3% reported interest in continuing to utilize RSAT in the upcoming school year.

Conclusions: Implementing a RSAT protocol is feasible and acceptable for monitoring SARS-CoV-2 cases in K-12 school settings. High rates of compliance and confidence in results demonstrate program effectiveness. Continuing to use RSAT in school settings after the urgency of the pandemic subsides could help address future outbreaks of SARS-CoV-2 and other respiratory viruses within schools and in the larger community.

Background: The food manufacturing industry is a critical economic sector and has been a high-risk industry for COVID-19. This analysis aimed to describe COVID-19 cumulative case incidence rates among Wisconsin food manufacturing workers and their worker's compensation utilization.

Methods: This was a descriptive analysis of COVID-19 cases among food manufacturing industry workers in Wisconsin from October 1, 2020, through December 31, 2021.

Results: Occupations with the highest cumulative case incidence rate (per 1000 workers) were Packers and Packagers, Hand (275; 95% CI, 252-300), Packaging and Filling Machine Operators and Tenders (266; 95% CI, 254-277), and Laborers and Freight, Stock and Material Movers, Hand (261; 95% CI, 247-276). Two worker's compensation claims were paid to food manufacturing workers.

Discussion: Wisconsin food manufacturing workers were disproportionately affected by COVID-19, with a high cumulative case incidence rate exceeding that of the manufacturing industry overall, statewide non-institutionalized working-age adults, and the ambulatory health care industry. There was also a disproportionately low use of worker's compensation benefits in Wisconsin compared to the high COVID-19 disease incidence. Improved worker protections for occupational infectious diseases with high risk of transmission are needed as well as improvements to the worker's compensation system.

Introduction: Equitable COVID-19 vaccine access is essential to ending the COVID-19 pandemic. In many instances, COVID-19 vaccination notification and scheduling occurred through online patient portals, for which socially vulnerable populations have limited access. Our objective was to reduce disparities in COVID-19 vaccine access for the Black and socially vulnerable populations unintentionally excluded by our health system's patient portal-driven vaccine outreach through a telephone outreach initiative.

Methods: From February 1, 2021, through April 27, 2021, telephone outreach was directed towards patients aged 65 and older without patient portal access at a large urban academic general internal medicine clinic. Univariate and multivariate analyses between those who did and did not receive telephone outreach were completed to assess the odds of vaccination, accounting for outreach status, sex, age, race/ethnicity, payor status, social vulnerability index, and Elixhauser Comorbidity count.

Results: A total of 1466 patients aged 65 and older without active patient portals were eligible to receive the COVID-19 vaccine. Of these patients, 664 received outreach calls; 382 (57.5%) of them got vaccinated compared to 802 patients who did not receive outreach calls, of which 486 (60.6%) got vaccinated (P = 0.2341). Patients who received outreach calls versus those who did not were more likely to be female, younger, non-Hispanic Black, from high social vulnerability index census tracts, and have higher Elixhauser Comorbidity counts. Logistical analysis revealed an odds ratio (OR) with a nonstatistically significant trend favoring higher vaccination likelihood in the no outreach cohort with univariate analysis with no changes when adjustment was made for age, sex, race/ethnicity, payor, social vulnerability index, and Elixhauser Comorbidity count (univariate analysis: OR 0.88 [95% CI, 0.71-1.09]; model 1: OR 0.89 [95% CI, 0.72 - 1.10]; model 2 - 0.89 (0.72 - 1.11); model 3: OR 0.87 (95% CI, 0.70 -1.09)].

Conclusions: While our telephone outreach initiative was not successful in increasing vaccination rates, lessons learned can help clinicians and health systems as they work to improve health equity. Achieving health equity requires a multifaceted approach engaging not only health systems but also public health and community systems to directly address the pervasive effects of structural racism perpetuating health inequities.

Introduction: Peripheral smear examination is a simple and cost-effective test that is routinely performed while monitoring patients diagnosed with COVID-19. We sought to summarize the peripheral blood morphologic findings in patients with COVID-19 infection.

Methods: A systematic review was conducted using a standardized keyword search on Medline database (PubMed), med RXIV, Google Scholar, EMBASE, and SCOPUS for studies discussing peripheral blood smear or morphologic blood findings in patients diagnosed with COVID-19.

Results: A total of 28 studies were included in the review. Normocytic normochromic anemia was the most frequently encountered red blood cell finding. Neutrophilia was seen in most of the studies. A variety of morphological changes were observed in neutrophils, including pyknotic nuclei, variable shapes, toxic granules, and cytoplasmic vacuolization. Hyposegmented neutrophils, pseudo-Pegler Huet forms, and hypogranular forms were common findings reported by many studies. Lymphopenia was reported by most studies. Lymphocytes showed numerous morphological changes, including reactive forms, Downey forms, increased large granular lymphocytes, and plasmacytoid cells. The presence of giant platelets was seen frequently.

Conclusions: The peripheral blood in COVID-19 shows a spectrum of findings, mostly reactive changes in neutrophils, monocytes, lymphocytes, and platelets. Increased neutrophil/lymphocyte ratio and higher neutrophil counts have been associated with poor prognosis, which potentially could help triage patients, but this needs to be confirmed in larger studies.

Introduction: Since the beginning of the COVID-19 pandemic, the incidence and severity of COVID-19 co-infection in people living with HIV (PLWH) has been an area of investigative research. Clinic databases of PLWH provide opportunities to investigate outcomes of COVID-19 co-infection and efficacy of outreach efforts, which are integral to patient care during health crises.

Methods: All PLWH over 18 years of age who receive care at the Froedtert & Medical College of Wisconsin Adult Infectious Disease Clinic and who had a COVID-19 test performed during May 2020 through March 2021 were included for analysis. All patients received an individualized phone call with COVID-19 testing education and information. Automated data collection and manual chart review were used to acquire information on demographics, outreach efforts, COVID-19 testing results, and COVID-19 clinical course.

Results: Four hundred sixty-two COVID-19 tests completed on 793 PLWH were included, with 40 (8.7%) positive tests and 422 (91.3%) negative tests on a predominantly young, male, and virally suppressed cohort. Most patients had mild to moderate COVID-19 infection (20/27, 74.07%), with 1 patient requiring hospitalization and zero deaths. Three hundred fourteen (39.59%) patients accepted outreach for COVID-19 testing; 171 were tested in our health system, with 72 of those tests occurring within 2 weeks. Outreach efforts demonstrated a statistically significant increase in COVID-19 testing (P < 0.001).

Conclusions: In this largely young, male, virally suppressed cohort of PLWH, most COVID-19 co-infections were associated with mild to moderate disease severity, with 1 hospitalization and zero deaths. Individualized patient outreach efforts were associated with a significant increase in COVID-19 testing, most of which occurred after a single phone call. This outreach process could have utility in other public health arenas, though may be limited by larger patient populations.

Introduction: There is a paucity of studies evaluating vaccine uptake in adults with neurological and musculoskeletal medical conditions. We sought to evaluate the rates of COVID-19 vaccine uptake in patients seen in an outpatient rehabilitation clinic.

Methods: We conducted a retrospective, single center study of adults seen at an outpatient rehabilitation clinic from December 1, 2020, through June 30, 2021, with an active Wisconsin Immunization Registry record. The primary outcome was completion of a COVID-19 primary vaccine series.

Results: Of 1362 patients, 83.3% completed a COVID-19 vaccination series. Younger patients had increased odds of not completing a COVID-19 vaccination series (mean [SD] 46.7 [14.7] vs 54.3 [15.8]; OR 1.03; 95% CI, 1.02-1.04; P < 0.001). Those who identified as non-White (1.88; 95% CI, 1.16-3.04; P = 0.010) or current smoker (1.85, 95% CI, 1.85-2.79; P = 0.004) had increased odds of not completing a COVID-19 vaccination series. Those who resided in rural ZIP codes (1.81; 95% CI, 1.35-2.43; P < 0.001), had not received a 2019-2020 influenza vaccine (5.13; 95% CI, 3.79-6.96; P < 0.001), or had lower comorbidity scores (2.95; 95% CI, 1.98-4.41; P < 0.001) had higher odds of not completing a COVID-19 vaccination series.

Conclusions: There was a high rate of COVID-19 vaccine uptake among patients seen in a rehabilitation clinic, though racial, ethnic, and geographic differences did exist. Further studies are needed to determine why these disparities exist and investigate interventions to increase vaccine uptake in these populations.

Reactive infectious mucocutaneous eruptions (RIME) is a relatively novel terminology describing postinfectious mucocutaneous eruptions that usually affect 2 or more mucosal sites. To our knowledge, we describe the first case of RIME secondary to COVID-19 infection in an elderly 64-year-old immunocompetent male patient. This contrasts with previous case reports that have identified cases of RIME post-COVID-19 infection among the pediatric population and young adults. Our patient had characteristic mucosal involvement and required hospitalization and treatment with systemic steroids. This report also reviews the clinical features, treatment modalities, and outcome of RIME secondary to COVID-19 infection in other published case reports. We emphasize the need for further prospective studies to better elucidate the use of steroids in the management of RIME.