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And then the third strategy is based on foreign policy decisions. This is my least favorite. For example, the Biden Administration has donated doses to Canada and Mexico, obviously because they are countries on our borders where we have a self-interest in preventing virus importations.
Is there enough time to deliver the vaccines to make a difference? Well, with India, I must say, it's late. Then you need to give them two doses. You can look at where outbreaks are really emerging like in Nepal or Thailand to target vaccine doses. What more can the United States do to address the global situation?
The United States needs to do a lot more than donating vaccines. The United States needs to support the expansion of vaccine manufacturing both domestically and abroad. It needs to help build that capacity, provide training for personnel, and relax export restrictions on supplies, reagents, and chemicals that go into manufacturing vaccines.
This needs to be a global partnership among the wealthy nations to coordinate all of the responses needed. We need to substantially reduce the burden of disease for humanitarian purposes and reduce transmission of the virus for self-interest to prevent the emergence of variants that could cause outbreaks in the United States. We are already at a point in the United States where we have a surplus of vaccines.
Obviously we expanded eligibility for children 12 to 15 years old, and this will increase our need. To date 1. This needs to be an urgent and collaborative global effort. Can surplus vaccines be used as booster shots later? I believe that is one of the reasons why there has been some reluctance to donate a large number of doses.
Many experts believe we will need them. The question is when. The Biden Administration justifiably has been focused on bringing the pandemic under control in the United States. It does not want to put the United States into a shortage, which I think is reasonable.
But the United States still need to be a global leader in addressing global vaccine inequities. The United States will need to maintain a supply of vaccine for potential booster doses. Now if there is a new variant that is driving the need for additional vaccine doses, we could use the current vaccine as a booster, but we may also need a new vaccine created specifically to target a variant. Pandemic Data Initiative. This is one of the greatest scientific and medical achievements in recent history, but detailed vaccination data reveals that this rollout has not been without its shortcomings.
This demographic data is disappointingly incomplete and rife with sampling biases due to the limited data points for which complete demographic data is available. As we move into , government leaders and public health experts should focus on the collection and dissemination of accurate COVID demographic data as it will be a powerful tool to reduce disease spread and increase vaccine uptake. Reporting frequency, definitions, and even the types of data released have yet to be standardized and mandated by federal agencies.
Even some leaders have stopped pursuing health and data-driven decision-making in the face of surging COVID cases presenting all-time high case numbers in the United States.
Nevertheless, providing antiviral prophylaxis to the patients receiving rituximab-containing therapy could be considered[ 72 ]. In patients with hematological malignancy and resolved hepatitis B receiving rituximab-containing regimens, tenofovir effectively prevents the occurrence of HBVr[ 73 ]. Prophylactic lamivudine may be considered only in the patients without HBV viremia[ 74 ]. Screening tests including HBsAg and anti-HBc with or without anti-HBs in the patients about to start anticancer and immunosuppressive therapy is recommended.
An integrated strategy involving screening the patients at risk, stratifying the patients for risk according to the status of HBV and the type of immunosuppressive agents administered and careful evaluation of the prophylactic therapy could significantly lower the risk of HBVr.
Entecavir or tenofovir are preferred over lamivudine as antiviral therapy for the prophylaxis of HBVr. The optimal duration of prophylactic antiviral therapy remains to be defined. Current international guidelines suggest administration of prophylactic antiviral therapy for at least 6 to 12 mo after the completion of chemotherapy and even longer for rituximab users or patients with high serum HBV DNA levels before the start of chemotherapy.
However, patients with chronic hepatitis B or cirrhosis should continue antiviral therapy regardless of the duration of chemotherapy. Aggressive screening of HBV with adequate antiviral prophylaxis is the optimal strategy for preventing HBVr during chemotherapy and immunosuppressive therapy. Conflict-of-interest statement: The authors declare having no conflict of interest.
Manuscript source: Invited manuscript. Peer-review started: January 29, First decision: March 29, Article in press: June 2, Specialty type: Medicine, research and experimental. Grade A Excellent : 0.
Grade B Very good : 0. National Center for Biotechnology Information , U. World J Clin Cases. Published online Jul Author information Article notes Copyright and License information Disclaimer. Author contributions: Shih CA and Chen WC designed the research study, performed the research and wrote the manuscript; All authors have read and approved the final manuscript. Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
Host factor Younger age and male gender are among the risk factors for HBVr[ 20 ]. Virological factor The extent of HBV replication before the start of chemotherapy and immunosuppressive therapy is an important risk factor for HBVr.
Table 1 Immunosuppressive agent classes and corresponding risks of hepatitis B reactivation. Open in a separate window. Rheumatologic diseases The incidences of HBVr in patients with rheumatologic disease such as rheumatoid arthritis could be up to Inflammatory bowel disease The HBVr rates in patients with inflammatory bowel disease range between 0.
Figure 1. Figure 2. Table 2 Recommendations of international guidelines for treatment and follow-up in different clinical scenarios. Footnotes Conflict-of-interest statement: The authors declare having no conflict of interest. References 1. Hepatitis B reactivation in cancer patients: role of prechemotherapy screening and antiviral prophylaxis.
Clin Adv Hematol Oncol. Hepatitis B virus infection. Pattullo V. Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure. World J Hepatol. Lee WM. N Engl J Med. Practical difficulties in the management of hepatitis B in the Asia-Pacific region. J Gastroenterol Hepatol. Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies treated with anticancer therapy.
World J Gastroenterol. PLoS One. Hepatitis B virus reactivation risk varies with different chemotherapy regimens commonly used in solid tumours.
Equine herpesvirus-1 EHV-1 is an alphaherpesvirus which infects horses, causing respiratory and neurological disease and abortion in pregnant mares. Latency is established in trigeminal ganglia and lymphocytes.
Immunity to EHV-1 lasts between 3 and 6 months.
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