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Weber S, Didelot A, Agrinier N, Peyrin-Biroulet L, Schvoerer E, Rabaud C, Jeulin H. SARS-CoV-2 seroprevalence in healthcare workers and risk factors. Infect Dis Health 2022; 27:203-210. [PMID: 35644801 PMCID: PMC9110541 DOI: 10.1016/j.idh.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exposure of healthcare workers (HCW) to SARS-CoV-2 is a public health concern. Not only are HCWs particularly exposed to SARS-CoV-2, but their contamination can also weaken the healthcare system. METHODS We analyzed exposure of French University Hospital HCWs to SARS-CoV-2 through history of positive RT-PCR test and SARS-CoV-2 seroprevalence. Potential risk factors, such as age, BMI, having children or not, working in a COVID-19 unit, or smoking were explored. RESULTS From May to June 2020, among the 8960 employees of the University Hospital of Nancy, a serological test was performed in 4696 HCWs. The average (SD) age was 40.4 (11.4) years, and the sample included 3926 women (83.6%). Of the 4696 HCWs, 1050 were smokers (22.4%). Among them, 2231 HCWs had a history of COVID-19 symptoms and/or flu-like syndrome (47.5%) and 238 were seropositive (5.1%). Neither gender, sex, BMI, nor having children were associated with a history of positive RT-PCR test or seropositive status. Previous work in a COVID-19 unit was associated with a history of positive RT-PCR test (p = 0.045), but not with seroprevalence (p = 0.215). As expected, history of COVID-19 clinical manifestations was more frequent in HCWs with positive serology than in HCWs with negative serology (adjusted OR = 1.9, 95%CI [1.4-2.5], p < 0.001). Less expected, smoking was associated with a reduced risk of seropositivity among HCWs (adjusted OR = 0.6, 95%CI [0.4-0.9], p = 0.019). CONCLUSION HCW are patently exposed to SARS-CoV-2. Care to COVID-19 patients was not associated with a higher SARS-CoV-2 seroprevalence. Smoking appears here associated to a lower seroprevalence.
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Affiliation(s)
- Stéphanie Weber
- CHRU-Nancy, Laboratoire de Virologie, Nancy, F-54000, France
| | - Alice Didelot
- CHRU-Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, F-54000, France
| | - Nelly Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U1256 NGERE, Nancy University Hospital, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Evelyne Schvoerer
- CHRU-Nancy, Laboratoire de Virologie, Nancy, F-54000, France; Université de Lorraine, CNRS, LCPME, Nancy, F-54000, France
| | - Christian Rabaud
- CHRU-Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, F-54000, France
| | - Hélène Jeulin
- CHRU-Nancy, Laboratoire de Virologie, Nancy, F-54000, France; Université de Lorraine, CNRS, LCPME, Nancy, F-54000, France.
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Kumar A, Parihar A, Panda U, Parihar DS. Microfluidics-Based Point-of-Care Testing (POCT) Devices in Dealing with Waves of COVID-19 Pandemic: The Emerging Solution. ACS APPLIED BIO MATERIALS 2022; 5:2046-2068. [PMID: 35473316 PMCID: PMC9063993 DOI: 10.1021/acsabm.1c01320] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/11/2022] [Indexed: 02/08/2023]
Abstract
Recent advances in microfluidics-based point-of-care testing (POCT) technology such as paper, array, and beads have shown promising results for diagnosing various infectious diseases. The fast and timely detection of viral infection has proven to be a critical step for deciding the therapeutic outcome in the current COVID-19 pandemic, which in turn not only enhances the patient survival rate but also reduces the disease-associated comorbidities. In the present scenario, rapid, noninvasive detection of the virus using low cost and high throughput microfluidics-based POCT devices embraces the advantages over existing diagnostic technologies, for which a centralized lab facility, expensive instruments, sample pretreatment, and skilled personnel are required. Microfluidic-based multiplexed POCT devices can be a boon for clinical diagnosis in developing countries that lacks a centralized health care system and resources. The microfluidic devices can be used for disease diagnosis and exploited for the development and testing of drug efficacy for disease treatment in model systems. The havoc created by the second wave of COVID-19 led several countries' governments to the back front. The lack of diagnostic kits, medical devices, and human resources created a huge demand for a technology that can be remotely operated with single touch and data that can be analyzed on a phone. Recent advancements in information technology and the use of smartphones led to a paradigm shift in the development of diagnostic devices, which can be explored to deal with the current pandemic situation. This review sheds light on various approaches for the development of cost-effective microfluidics POCT devices. The successfully used microfluidic devices for COVID-19 detection under clinical settings along with their pros and cons have been discussed here. Further, the integration of microfluidic devices with smartphones and wireless network systems using the Internet-of-things will enable readers for manufacturing advanced POCT devices for remote disease management in low resource settings.
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Affiliation(s)
- Avinash Kumar
- Department of Mechanical Engineering,
Indian Institute of Information Technology Design & Manufacturing
Kancheepuram, Chennai 600127, India
| | - Arpana Parihar
- Industrial Waste Utilization, Nano and Biomaterials,
CSIR-Advanced Materials and Processes Research Institute
(AMPRI), Hoshangabad Road, Bhopal, Madhya Pradesh 462026,
India
| | - Udwesh Panda
- Department of Mechanical Engineering,
Indian Institute of Information Technology Design & Manufacturing
Kancheepuram, Chennai 600127, India
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Social Determinants of Health and Distance Learning in Italy in the Era of the SARS-CoV-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095741. [PMID: 35565136 PMCID: PMC9104284 DOI: 10.3390/ijerph19095741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
Objectives: To investigate the experiences by distance learning (DL) method during the first wave of the SARS-CoV-2 pandemic in Italy, and to search for correlations with purported experiences and respective levels of social determinants of health (SDH). Study design and methods: Cross-sectional online survey, investigating various SDH and parents’ attitude towards DL, proposed 6 months after the beginning of the pandemic to a sample population of parents with school-aged children throughout Italy. Results: A total of 3791 questionnaires were analyzed. Non-Italian parents complained more frequently of difficulties in providing support to their children in DL due to poor digital skills (p = 0.01), lack of good-quality digital equipment (p = 0.01), problems with the Italian language (p < 0.001), and a lower level of education (p < 0.001). When parents lived apart, greater difficulties in concentration in children using DL (p = 0.05) and a lower parental capacity to support DL (p = 0.002) were reported. Adequate digital structures appeared related to living in owned compared to rented property, higher levels of parental education, and better familial financial situations. Conclusions: Students from families with financial difficulties and low levels of parental education, or even those living in houses for rent or having separated parents, may be disadvantaged in an educational context since the introduction of DL.
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104
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Petri O, Abazaj E, Daka A, Huti G, Puca E, Brati B. The Epidemiological Situation and Clinical Characteristic Aspect Cause by COVID-19 in Suspected Cases in Albania. Open Access Maced J Med Sci 2022. [DOI: https:/doi.org/10.3889/oamjms.2022.8824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has forcefully entered our lives and profoundly changed the perception and habits of the world population since the December 2019.
AIM: The aims of this study were to presents the epidemiology data and clinical characteristic aspect of patients suspected with COVID-19 and analyzed in the American laboratory in Tirana, Albania from August 2020 to March 2021.
METHODS: This study includes 1205 suspected cases for SARS COVID-19. Professionally trained health workers collected the samples from suspected patients by using synthetic fiber swabs. Double specimens from nasopharyngeal and pharyngeal swabs were collected from each of person. A standard questionnaire about the demographic and clinical data was filled for each person. The software SPSS version 22.0 was used for analyzing all data and also the examination findings.
RESULTS: The prevalence of SARS COVID-19 resulted to be 31.1%. The average age resulted 42.17 ± 18.6. The most predominant positive age resulted the age groups 31–40 years old and 41–50 years old with positivity 17.3% and 16.3%, respectively, with significant association p = 0.01. Male were the most analyzed and affected persons (61.6%) in this study with a strong significant association p = 0.0004. It turned out that more than half of patients refereed at least two symptoms in the same time of analyze and about 1/3 refereed more than three symptoms. We found an association for presence of all typical symptoms with positivity except the temperature. We identified that for all of these symptoms, the p value resulted less than 0.05.
CONCLUSION: SARS COVID-19 in the early stages of the disease is highly contagious. For this reason, the screening of people with symptoms is recommended to determine who should be quarantined and be tested. In this manner, we can decrease the rate of infection and protect healthy people from infection.
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105
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Petri O, Abazaj E, Daka A, Huti G, Puca E, Brati B. The Epidemiological Situation and Clinical Characteristic Aspect Cause by COVID-19 in Suspected Cases in Albania. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has forcefully entered our lives and profoundly changed the perception and habits of the world population since the December 2019.
AIM: The aims of this study were to presents the epidemiology data and clinical characteristic aspect of patients suspected with COVID-19 and analyzed in the American laboratory in Tirana, Albania from August 2020 to March 2021.
METHODS: This study includes 1205 suspected cases for SARS COVID-19. Professionally trained health workers collected the samples from suspected patients by using synthetic fiber swabs. Double specimens from nasopharyngeal and pharyngeal swabs were collected from each of person. A standard questionnaire about the demographic and clinical data was filled for each person. The software SPSS version 22.0 was used for analyzing all data and also the examination findings.
RESULTS: The prevalence of SARS COVID-19 resulted to be 31.1%. The average age resulted 42.17 ± 18.6. The most predominant positive age resulted the age groups 31–40 years old and 41–50 years old with positivity 17.3% and 16.3%, respectively, with significant association p = 0.01. Male were the most analyzed and affected persons (61.6%) in this study with a strong significant association p = 0.0004. It turned out that more than half of patients refereed at least two symptoms in the same time of analyze and about 1/3 refereed more than three symptoms. We found an association for presence of all typical symptoms with positivity except the temperature. We identified that for all of these symptoms, the p value resulted less than 0.05.
CONCLUSION: SARS COVID-19 in the early stages of the disease is highly contagious. For this reason, the screening of people with symptoms is recommended to determine who should be quarantined and be tested. In this manner, we can decrease the rate of infection and protect healthy people from infection.
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106
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Schäfer E, Scheer C, Saljé K, Fritz A, Kohlmann T, Hübner NO, Napp M, Fiedler-Lacombe L, Stahl D, Rauch B, Nauck M, Völker U, Felix S, Lucchese G, Flöel A, Engeli S, Hoffmann W, Hahnenkamp K, Tzvetkov MV. Course of disease and risk factors for hospitalization in outpatients with a SARS-CoV-2 infection. Sci Rep 2022; 12:7249. [PMID: 35508524 PMCID: PMC9065670 DOI: 10.1038/s41598-022-11103-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
We analyzed symptoms and comorbidities as predictors of hospitalization in 710 outpatients in North-East Germany with PCR-confirmed SARS-CoV-2 infection. During the first 3 days of infection, commonly reported symptoms were fatigue (71.8%), arthralgia/myalgia (56.8%), headache (55.1%), and dry cough (51.8%). Loss of smell (anosmia), loss of taste (ageusia), dyspnea, and productive cough were reported with an onset of 4 days. Anosmia or ageusia were reported by only 18% of the participants at day one, but up to 49% between days 7 and 9. Not all participants who reported ageusia also reported anosmia. Individuals suffering from ageusia without anosmia were at highest risk of hospitalization (OR 6.8, 95% CI 2.5–18.1). They also experienced more commonly dyspnea and nausea (OR of 3.0, 2.9, respectively) suggesting pathophysiological connections between these symptoms. Other symptoms significantly associated with increased risk of hospitalization were dyspnea, vomiting, and fever. Among basic parameters and comorbidities, age > 60 years, COPD, prior stroke, diabetes, kidney and cardiac diseases were also associated with increased risk of hospitalization. In conclusion, due to the delayed onset, ageusia and anosmia may be of limited use in differential diagnosis of SARS-CoV-2. However, differentiation between ageusia and anosmia may be useful for evaluating risk for hospitalization.
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Affiliation(s)
- Eik Schäfer
- Department of Clinical Pharmacology, Institute of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University Medicine Greifswald, Greifswald, Germany.,Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Scheer
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Karen Saljé
- Department of Clinical Pharmacology, Institute of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University Medicine Greifswald, Greifswald, Germany
| | - Anja Fritz
- Department of General Pharmacology, Institute of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University Medicine Greifswald, 17489, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- Central Unit for Infection Prevention and Control, University Medicine Greifswald, Greifswald, Germany.,Institute of Hygiene and Environmental Medicine, University of Greifswald, Greifswald, Germany
| | - Matthias Napp
- Departments of Emergency and Acute Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lizon Fiedler-Lacombe
- Independent Trusted Third Party, University Medicine Greifswald, Greifswald, Germany
| | - Dana Stahl
- Independent Trusted Third Party, University Medicine Greifswald, Greifswald, Germany
| | - Bernhard Rauch
- Department of General Pharmacology, Institute of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University Medicine Greifswald, 17489, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Uwe Völker
- Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Felix
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Guglielmo Lucchese
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Engeli
- Department of Clinical Pharmacology, Institute of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Klaus Hahnenkamp
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Mladen V Tzvetkov
- Department of General Pharmacology, Institute of Pharmacology, Center of Drug Absorption and Transport (C_DAT), University Medicine Greifswald, 17489, Greifswald, Germany.
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Hausfater P, Boutolleau D, Lacombe K, Beurton A, Dumont M, Constantin JM, Ghosn J, Combes A, Cury N, Guedj R, Djibré M, Bompard R, Mazerand S, Pourcher V, Gimeno L, Marois C, Teyssou E, Marcelin AG, Hajage D, Tubach F. Cumulative incidence of SARS-CoV-2 infection and associated risk factors among frontline health care workers in Paris: the SEROCOV cohort study. Sci Rep 2022; 12:7211. [PMID: 35508515 PMCID: PMC9068621 DOI: 10.1038/s41598-022-10945-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/30/2022] [Indexed: 12/30/2022] Open
Abstract
With the COVID-19 pandemic, documenting whether health care workers (HCWs) are at increased risk of SARS-CoV-2 contamination and identifying risk factors is of major concern. In this multicenter prospective cohort study, HCWs from frontline departments were included in March and April 2020 and followed for 3 months. SARS-CoV-2 serology was performed at month 0 (M0), M1, and M3 and RT-PCR in case of symptoms. The primary outcome was laboratory-confirmed SARS-CoV-2 infection at M3. Risk factors of laboratory-confirmed SARS-CoV-2 infection at M3 were identified by multivariate logistic regression. Among 1062 HCWs (median [interquartile range] age, 33 [28–42] years; 758 [71.4%] women; 321 [30.2%] physicians), the cumulative incidence of SARS-CoV-2 infection at M3 was 14.6% (95% confidence interval [CI] [12.5; 16.9]). Risk factors were the working department specialty, with increased risk for intensive care units (odds ratio 1.80, 95% CI [0.38; 8.58]), emergency departments (3.91 [0.83; 18.43]) and infectious diseases departments (4.22 [0.92; 18.28]); current smoking was associated with reduced risk (0.36 [0.21; 0.63]). Age, sex, professional category, number of years of experience in the job or department, and public transportation use were not significantly associated with laboratory-confirmed SARS-CoV-2 infection at M3. The rate of SARS-CoV-2 infection in frontline HCWs was 14.6% at the end of the first COVID-19 wave in Paris and occurred mainly early. The study argues for an origin of professional in addition to private life contamination and therefore including HCWs in the first-line vaccination target population. It also highlights that smokers were at lower risk. Trial registration The study has been registered on ClinicalTrials.gov: NCT04304690 first registered on 11/03/2020.
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Affiliation(s)
- Pierre Hausfater
- Emergency Department, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, 83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. .,GRC-14 BIOSFAST, UMR INSERM 1166, IHU ICAN, Sorbonne Université, Paris, France.
| | - David Boutolleau
- INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique (iPLESP), GH AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Sorbonne Université, Paris, France
| | - Karine Lacombe
- Infectious Disease Department, Sorbonne Université Hôpital Saint-Antoine, Paris, France
| | - Alexandra Beurton
- Service de Pneumologie-Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université Inserm UMRS Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Margaux Dumont
- Emergency Department, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, 83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Jean-Michel Constantin
- Department of Anaesthesiology and Critical Care, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpêtrière, GH APHP, Sorbonne Université, Paris, France
| | - Jade Ghosn
- AP-HP, Nord, Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, and Université de Paris, INSERM, UMR 1137 IAME, Paris, France
| | - Alain Combes
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, and Service de Médecine Intensive-Réanimation, Institut de Cardiologie, GH APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Nicolas Cury
- Emergency Department, APHP, Sorbonne Université Hôpital Saint-Antoine, Paris, France
| | - Romain Guedj
- Pediatric Emergency Deparment, APHP Hôpital Armand Trousseau-Sorbonne Université, Faculté de Médecine, Paris, France.,Centre of Research in Epidemiology and Statistics-CRESS, INSERM, Université de Paris, 75004, Paris, France
| | - Michel Djibré
- Service de Médecine Intensive Réanimation, APHP, Sorbonne Université Hôpital Tenon, Paris, France
| | - Rudy Bompard
- Emergency Department, Hôpital Tenon, APHP, Sorbonne Université, Paris, France
| | - Sandie Mazerand
- Service de Médecine Intensive-Réanimation, APHP, Sorbonne Université Hôpital Saint-Antoine, Paris, France
| | - Valérie Pourcher
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies Infectieuses et Tropicales, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, 75013, Paris, France
| | - Linda Gimeno
- APHP, Unité de Recherche Clinique Pitié Salpêtrière Charles Foix, Sorbonne Université, 75013, Paris, France
| | - Clémence Marois
- Unité de Médecine Intensive Réanimation Neurologique, Département de Neurologie, DMU Neurosciences, APHP, Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France
| | - Elisa Teyssou
- INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique (iPLESP), GH AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Sorbonne Université, Paris, France
| | - Anne-Geneviève Marcelin
- INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique (iPLESP), GH AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Sorbonne Université, Paris, France
| | - David Hajage
- APHP, Unité de Recherche Clinique Pitié Salpêtrière Charles Foix, Sorbonne Université, 75013, Paris, France.,Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1422, 75013, Paris, France
| | - Florence Tubach
- APHP, Unité de Recherche Clinique Pitié Salpêtrière Charles Foix, Sorbonne Université, 75013, Paris, France.,Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, CIC-1422, 75013, Paris, France
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108
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Akyıl FT, Önür ST, Sökücü S, Abalı H, Boyracı N, Çayır E, Altın S, Altin S. Lifestyle Changes and Exacerbation Frequency of COPD in Times of the Pandemic. Turk Thorac J 2022; 23:210-217. [PMID: 35579227 PMCID: PMC9450222 DOI: 10.5152/turkthoracj.2022.21165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to analyze chronic obstructive pulmonary disease exacerbation rates and the effect of patients' behavioral changes on the exacerbations during the pandemic. MATERIAL AND METHODS This study was conducted in a reference hospital for chest diseases and patients who were hospitalized with an exacerbation of chronic obstructive pulmonary disease between March 11, 2019, and March 11, 2020, were designated. Patients' chronic obstructive pulmonary disease exacerbations requiring emergency department visits and/or hospitalization were com- pared between the pre-pandemic and pandemic periods. Each patient was surveyed with 25 questions using telemedicine. RESULTS Of all the 256 patients, 203 (79%) were male and the mean age was 66 ± 10 years. Compared to the previous year, emer- gency department visits and hospitalizations in our hospital were significantly lower and less frequent (P < .0001, for both). Smoking habits decreased in 9% of patients, and 60% had hardly spent time outdoors. Only 3 patients reported to spend time indoors. The household mask-use rate while contacting the patient was 50%. As a chronic obstructive pulmonary disease patient, 33% expressed themselves as "feeling better." Overall, 92(36%) patients were recorded not to have any exacerbation, and 34 (13%) to have no attacks of worsening were managed at home. Novel exacerbation risk was found to independently correlate with younger age (odds ratio: 0.944, CI: 0.904-0.986, P = .010) and having more frequent episodes of exacerbation in the pre-pandemic period (odds ratio: 1.2, CI: 1.025-1.405, P = .023). CONCLUSION Chronic obstructive pulmonary disease patients specifically benefited from confinements, restrictions, and lifestyle changes. Further studies are needed to better identify the most critical factors leading to these positive outcomes. A permanent patient management guideline for chronic obstructive pulmonary disease patients could be formulated where the weight of lifestyle factors is elevated.
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Mogensen I, Hallberg J, Björkander S, Du L, Zuo F, Hammarström L, Pan-Hammarström Q, Ekström S, Georgelis A, Palmberg L, Janson C, Bergström A, Melén E, Kull I. Lung function before and after COVID-19 in young adults: A population-based study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:37-42. [PMID: 36647376 PMCID: PMC8966371 DOI: 10.1016/j.jacig.2022.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/14/2022] [Accepted: 03/04/2022] [Indexed: 01/19/2023]
Abstract
Background There is limited evidence on the long-term impact of mild-to-moderate coronavirus disease 2019 (COVID-19) on lung function among young adults. Objectives We aimed to assess whether COVID-19 has a negative impact on lung function in young adults and whether asthma, allergic sensitization, or use of inhaled corticosteroids (ICSs) modifies a potential association. Methods Participants from the population-based BAMSE (Barn, Allergi, Miljö, Stockholm, Epidemiologi) cohort with spirometry assessed before (2016-2019) and after onset of the COVID-19 pandemic (2020-2021) were included. Serum levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor-binding domain-specific IgG, IgM, and/or IgA (determined with ELISA) defined seropositivity. Mean change in lung function (ie, change in FEV1, forced vital capacity [FVC], and FEV1/FVC ratio expressed as percent of predicted [pp]) from before to after onset of the pandemic were compared between the seronegative and seropositive participants. In seropositive participants, change in lung function was assessed in relation to allergic sensitization and self-reported ICS use. Results Of the 853 included participants, 29% (n = 243) were seropositive. There were no differences in change in lung function between the seronegative and seropositive participants (for mean change in FEV1 pp [SD], seropositivity = 0.87% [4.79%] and seronegativity = 1.03% (4.76%) [P = .66] for difference using a t test; FVC pp (SD), seropositivity = 1.34% (4.44%) and seronegativity = 1.29% (4.27%) [P = .87]; and for FEV1/FVC pp (SD), seropositivity = -0.25% (3.13%) and seronegativity = -0.13% (3.15%) [P = .61]). Similar results were observed among participants with asthma (n = 147 [17%]). Among seropositive participants, allergic sensitization or ICS use did not influence lung function. Conclusion We found no evidence of mild-to-moderate COVID-19 affecting lung function long term in a population-based cohort of young adults. Moreover, neither asthma nor allergic sensitization nor ICS use affected the results.
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Key Words
- AU, Arbitrary unit
- Asthma
- BAMSE, Barn, Allergi, Miljö, Stockholm, Epidemiologi
- BMI, Body mass index
- COVID-19
- COVID-19, Coronavirus disease 2019
- FVC, Forced vital capacity
- ICS, Inhaled corticosteroid
- Lung function
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- pp, Percent of predicted
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Affiliation(s)
- Ida Mogensen
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sophia Björkander
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Likun Du
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Fanglei Zuo
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Lennart Hammarström
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | | | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Antonios Georgelis
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Palmberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy, and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Muscogiuri G, Barrea L, Verde L, Vetrani C, Savastano S, Colao A. The "identikit" of subject with obesity and COVID-19 vaccine breakthrough. EXCLI JOURNAL 2022; 21:687-694. [PMID: 35721580 PMCID: PMC9203987 DOI: 10.17179/excli2022-4864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
The mRNA coronavirus disease 2019 (COVID-19) vaccines were highly effective in the prevention of symptomatic COVID-19, hospitalization, severe disease, and death. However, a minority of vaccinated individuals might become infected and experience significant morbidity. Risk factors of COVID-19 vaccine breakthrough in obesity have not been elucidated. Thus, we aimed to portray the subjects with obesity developing COVID-19 vaccine breakthrough despite vaccination. Coronavirus 2019 (COVID-19) mRNA vaccines have been highly effective in preventing symptomatic COVID-19, hospitalization, severe illness and death. However, a minority of vaccinated individuals may become infected and experience considerable morbidity. The risk factors for COVID-19 vaccine breakthrough in obesity have not been elucidated. Therefore, we aimed to depict individuals with obesity who develop COVID-19 vaccine breakthrough despite vaccination. An online questionnaire was distributed to respondents via a snowball sampling method among subjects with obesity belonging to Italian Associations for people living with obesity aged 18 years and above. Two hundred and thirty-five respondents (44.5±14 years; BMI: 33.3±7.2 kg/m2) were included in the study. COVID-19 vaccine breakthrough was noted in 34 % of respondents. A higher prevalence of grade III obesity was detected in subjects with COVID-19 vaccine breakthrough compared to subjects that did not (27.5 % vs 13.5 %; p=0.014). In addition, a significant lower prevalence of respondents that completed third dose were found in respondents with COVID-19 vaccine breakthrough compared with respondents that did not develop it (33.8 % vs 72.9 %; p<0.001). After stratifying respondents with COVID-19 vaccine breakthrough according to the completed doses of vaccine, we found that, although no differences were detected in terms of clinical manifestations of COVID-19, there was a significant higher prevalence of type 2 diabetes and hypertension in respondents that completed third doses compared to respondents that completed first and second doses. In conclusion, COVID-19 vaccine breakthrough was more common in subjects with grade III obesity. The presence of type 2 diabetes and hypertension could counteract the immune potentiating effects of vaccine booster against COVID-19.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Medical School of Naples, Naples, Italy,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy,Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University Medical School of Naples, Naples, Italy,*To whom correspondence should be addressed: Giovanna Muscogiuri, Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Medical School of Naples, Naples, Italy; Tel: +390817463779, FAX: +300817463688, E-mail:
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, 80143 Napoli, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Claudia Vetrani
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Medical School of Naples, Naples, Italy,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinology Unit, University Medical School of Naples, Naples, Italy,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy,Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University Medical School of Naples, Naples, Italy
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111
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Plais H, Labruyère M, Creutin T, Nay P, Plantefeve G, Tapponnier R, Jonas M, Ngapmen NT, Le Guennec L, De Roquetaillade C, Argaud L, Jamme M, Goulenok C, Merouani K, Leclerc M, Sauneuf B, Shidasp S, Stoclin A, Bardet A, Mir O, Ibrahimi N, Llitjos JF. Outcomes of Patients With Active Cancer and COVID-19 in the Intensive-Care Unit: A Multicenter Ambispective Study. Front Oncol 2022; 12:858276. [PMID: 35359407 PMCID: PMC8960921 DOI: 10.3389/fonc.2022.858276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background Several studies report an increased susceptibility to SARS-CoV-2 infection in cancer patients. However, data in the intensive care unit (ICU) are scarce. Research Question We aimed to investigate the association between active cancer and mortality among patients requiring organ support in the ICU. Study Design and Methods In this ambispective study encompassing 17 hospitals in France, we included all adult active cancer patients with SARS-CoV-2 infection requiring organ support and admitted in ICU. For each cancer patient, we included 3 non cancer patients as controls. Patients were matched at the same ratio using the inverse probability weighting approach based on a propensity score assessing the probability of cancer at admission. Mortality at day 60 after ICU admission was compared between cancer patients and non-cancer patients using primary logistic regression analysis and secondary multivariable analyses. Results Between March 12, 2020 and March 8, 2021, 2608 patients were admitted with SARS-CoV-2 infection in our study, accounting for 2.8% of the total population of patients with SARS-CoV-2 admitted in all French ICUs within the same period. Among them, 105 (n=4%) presented with cancer (51 patients had hematological malignancy and 54 patients had solid tumors). 409 of 420 patients were included in the propensity score matching process, of whom 307 patients in the non-cancer group and 102 patients in the cancer group. 145 patients (35%) died in the ICU at day 60, 59 (56%) with cancer and 86 (27%) without cancer. In the primary logistic regression analysis, the odds ratio for death associated to cancer was 2.3 (95%CI 1.24 - 4.28, p=0.0082) higher for cancer patients than for a non-cancer patient at ICU admission. Exploratory multivariable analyses showed that solid tumor (OR: 2.344 (0.87-6.31), p=0.062) and hematological malignancies (OR: 4.144 (1.24-13.83), p=0.062) were independently associated with mortality. Interpretation Patients with cancer and requiring ICU admission for SARS-CoV-2 infection had an increased mortality, hematological malignancy harboring the higher risk in comparison to solid tumors.
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Affiliation(s)
- Henri Plais
- Intensive Care Unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Marie Labruyère
- Department of Intensive Care, Dijon Bourgogne University Hospital, Dijon, France
| | - Thibault Creutin
- Service de Médecine Intensive and Réanimation, APHP-CUP, Hôpital Cochin, Paris, France
| | - Paula Nay
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Gaëtan Plantefeve
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Romain Tapponnier
- Medical Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France
| | - Maud Jonas
- Centre Hospitalier Général de Saint-Nazaire, Service de Médecine Intensive Réanimation, Saint-Nazaire, France
| | | | - Loïc Le Guennec
- Médecine Intensive Réanimation Neurologique, Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles De Roquetaillade
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP, Paris, France
| | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Matthieu Jamme
- Intensive Care Unit, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
| | - Cyril Goulenok
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Karim Merouani
- Medical and Surgical Intensive Care Unit, Alençon Hospital, Alençon, France
| | - Maxime Leclerc
- Intensive Care Unit, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France
| | - Bertrand Sauneuf
- Réanimation - Médecine Intensive, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Sami Shidasp
- Intensive Care Unit, Etampes Hospital, Etampes, France
| | - Annabelle Stoclin
- Intensive Care Unit, Centre Hospitalier de Château-Thierry, Château-Thierry, France
| | - Aurélie Bardet
- Bureau of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France and U1018 INSERM Oncostat, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Olivier Mir
- Gustave-Roussy, Département d'oncologie Médicale, Villejuif, France
| | - Nusaibah Ibrahimi
- Bureau of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France and U1018 INSERM Oncostat, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
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112
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Bayram Z, Musharrafieh U, Bizri AR. Revisiting the potential role of BCG and MMR vaccines in COVID-19. Sci Prog 2022; 105:368504221105172. [PMID: 35848578 PMCID: PMC10450304 DOI: 10.1177/00368504221105172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Despite the development and deployment of effective COVID-19 vaccines, many regions remain poorly covered. Seeking alternative tools for achieving immunity against COVID-19 remains to be of high importance. "Trained immunity" is the nonspecific immune response usually established through administering live attenuated vaccines and is a potential preventive tool against unrelated infections. Evidence regarding a possible protective role for certain live attenuated vaccines against COVID-19 has emerged mainly for those administered as part of childhood vaccination protocols. This review summarizes the relevant literature about the potential impact of Bacille Calmette-Guérin (BCG) and measles, mumps and rubella (MMR) vaccines on COVID-19. Existing available data suggest a potential role for BCG and MMR in reducing COVID-19 casualties and burden. However, more investigation and comparative studies are required for a better understanding of their impact on COVID-19 outcomes.
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Affiliation(s)
| | - Umayya Musharrafieh
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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113
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Raeisi T, Mozaffari H, Sepehri N, Darand M, Razi B, Garousi N, Alizadeh M, Alizadeh S. The negative impact of obesity on the occurrence and prognosis of the 2019 novel coronavirus (COVID-19) disease: a systematic review and meta-analysis. Eat Weight Disord 2022; 27:893-911. [PMID: 34247342 PMCID: PMC8272688 DOI: 10.1007/s40519-021-01269-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality. METHODS The study protocol was registered in PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted from 31 December 2019 to 1 June 2020 to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated to assess the associations. RESULTS The prevalence of obesity was 33% (95% CI 30.0%-35.0%) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR = 2.42, 95% CI 1.58-3.70; moderate certainty) and COVID-19 severity (OR = 1.62, 95% CI 1.48-1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR = 1.75, 95% CI 1.47-2.09; very low certainty), mechanical ventilation (OR = 2.24, 95% CI 1.70-2.94; low certainty), intensive care unit (ICU) admission (OR = 1.75, 95% CI 1.38-2.22; low certainty), and death (OR = 1.23, 95% CI 1.06-1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. CONCLUSION Obesity is associated with COVID-19, need for hospitalization, mechanical ventilation, ICU admission, and death due to COVID-19. LEVEL OF EVIDENCE Level I, systematic reviews and meta-analyses.
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Affiliation(s)
- Tahereh Raeisi
- Department of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada
| | | | - Mina Darand
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahman Razi
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Nazila Garousi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Alizadeh
- Department of Medical Surgical Nursing, Nasibeh Nursing and Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Mortazavi SA, Bevelacqua JJ, Rafiepour P, Ghadimi-Moghadam A, Saraie P, Jooyan N, Mortazavi SH, Javad Mortazavi SM, Welsh JS. Revisiting the Paradox of Smoking: Radioactivity in Tobacco Smoke or Suppressing the SARS-CoV-2 Receptor, Angiotensin-Converting Enzyme 2, via Aryl-Hydrocarbon Receptor Signal? Dose Response 2022; 20:15593258221075111. [PMID: 35392263 PMCID: PMC8980405 DOI: 10.1177/15593258221075111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/01/2022] [Indexed: 11/15/2022] Open
Abstract
Despite current controversies, some reports show a paradoxical mitigating effect associated with smoking in individuals with symptomatic COVID-19 compared to the general population. To explain the potential mechanisms behind the lower number of hospitalized COVID-19 patients, it has been hypothesized that cigarette smoking may reduce the odds of cytokine storm and related severe inflammatory responses through cholinergic-mediated anti-inflammatory mechanisms. Japanese scientists have recently identified a potential mechanism behind the lower numbers of COVID-19 cases amongst smokers compared to non-smokers. However, we believe that this mitigative effect may be due to the relatively high concentration of deposited energy of alpha particles emitted from naturally occurring radionuclides such as Po-210 in cigarette tobacco. Regarding COVID-19, other researchers and our team have previously addressed the anti-inflammatory and immune-modulating effects of low doses of ionizing radiation. MC-simulation using the Geant4 Monte Carlo toolkit shows that the radiation dose absorbed in a spherical cell with a radius of .9 μm for a single 5.5 MeV alpha particle is about 5.1 Gy. This energy deposition may trigger both anti-inflammatory and anti-thrombotic effects which paradoxically lower the risk of hospitalization due to COVID-19 in smokers.
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Affiliation(s)
| | | | - Payman Rafiepour
- Department of Nuclear Engineering, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | | | - Pooya Saraie
- Radiology Department, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Jooyan
- Medical Physics and Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - James S Welsh
- Department of Radiation Oncology Edward Hines Jr VA Hospital Hines, IL, USA
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago, IL, United States
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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27. [PMID: 35426357 DOI: 10.1101/2020.08.19.20177188] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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116
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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27:2001551. [PMID: 35426357 PMCID: PMC9012093 DOI: 10.2807/1560-7917.es.2022.27.15.2001551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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Rodriguez-Morales AJ, León-Figueroa DA, Romaní L, McHugh TD, Leblebicioglu H. Vaccination of children against COVID-19: the experience in Latin America. Ann Clin Microbiol Antimicrob 2022; 21:14. [PMID: 35337354 PMCID: PMC8949833 DOI: 10.1186/s12941-022-00505-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia. .,Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. .,School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia.
| | - Darwin A León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru.,Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru.,Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luccio Romaní
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru.,Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Royal Free Campus, UCL, London, UK
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey
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Nakashita M, Takagi Y, Tanaka H, Nakamura H, Serizawa Y, Ukai T, Azuma K, Chiba H, Terada K, Nakanishi K, Fujikawa T, Saito K, Yamaguchi R, Mitsuhashi Y, Yano K, Shibuma T, Kuzuma A, Tsuda S, Sadamoto T, Ishii Y, Ohara T, Hitomi Y, Hiroshima T, Yamagishi T, Kamiya H, Anita S, Yahata Y, Shimada T, Arima Y, Suzuki M, Sekizuka T, Kuroda M, Sunagawa T. Singing Is a Risk Factor for SARS-CoV-2 Infection: A Case-control Study of Karaoke-related COVID-19 Outbreaks in Two Cities in Hokkaido, Japan, Linked by Whole Genome Analysis. Open Forum Infect Dis 2022; 9:ofac158. [PMID: 35531379 PMCID: PMC8992236 DOI: 10.1093/ofid/ofac158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Singing in an indoor space may increase the risk of SARS-CoV-2 infection. We conducted a case-control study of karaoke-related COVID-19 outbreaks to reveal the risk factors for SARS-CoV-2 infection among individuals who participate in karaoke.
Methods
Cases were defined as people who enjoyed karaoke at a bar and who tested positive for SARS-CoV-2 by RT-PCR between May 16 and July 3, 2020. Controls were defined as people who enjoyed karaoke at the same bar during the same period as the cases and tested negative. Odds ratio (OR) and confidence interval (CI) were calculated. ORs were adjusted by variables with significantly high odds ratio (aOR).
Results
We identified 81 cases, the majority of whom were active elderly individuals (median age: 75 years). Six cases died (case fatality ratio: 7%). Among the cases, 68 (84%) were guests, 18 of whom had visited more than two karaoke bars. A genome analysis conducted in 30 cases showed six types of isolates within four single-nucleotide variations difference. The case-control study revealed that singing (aOR 11.0, 95% CI, 1.2-101.0), not wearing a mask (aOR 3.7, 95% CI 1.2-11.2) and time spent per visit (aOR 1.7, 95% CI 1.1-2.7) were associated with COVID-19 infection.
Conclusions
A karaoke-related COVID-19 outbreak that occurred in two different cities was confirmed by the results of genome analysis. Singing in less-ventilated, indoor and crowded environments increases the risk of acquiring SARS-CoV-2 infection. Wearing a mask and staying for only a short time can reduce the risk of infection during karaoke.
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Affiliation(s)
- Manami Nakashita
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuta Takagi
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | - Haruna Nakamura
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yusuke Serizawa
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomohiko Ukai
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kotaro Azuma
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | - Hiroko Chiba
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | | | | | - Kayoko Saito
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | - Ryo Yamaguchi
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | - Koichi Yano
- Public Health Office, City of Sapporo, Hokkaido, Japan
| | | | - Akemi Kuzuma
- Public Health Office, Otaru City, Hokkaido, Japan
| | | | | | - Yasuhiko Ishii
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Tsukasa Ohara
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Yoshiaki Hitomi
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Takashi Hiroshima
- Hokkaido Government Department of Health and Welfare, Hokkaido, Japan
| | - Takuya Yamagishi
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hajime Kamiya
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Samuel Anita
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuichiro Yahata
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomoe Shimada
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuzo Arima
- Center for Surveillance, Immunization and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuyoshi Sekizuka
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Kuroda
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Center for Field Epidemiology Intelligence, Research, and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
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Stead D, Adeniyi OV, Singata-Madliki M, Abrahams S, Batting J, Jelliman E, Parrish A. Cumulative incidence of SARS-CoV-2 and associated risk factors among healthcare workers: a cross-sectional study in the Eastern Cape, South Africa. BMJ Open 2022; 12:e058761. [PMID: 35304402 PMCID: PMC8935006 DOI: 10.1136/bmjopen-2021-058761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study assesses the cumulative incidence of SARS-CoV-2 infection among healthcare workers (HCWs) during South Africa's first wave and examines the associated demographic, health-related and occupational risk factors for infection. METHODS Multistage cluster sampling was used in a cross-sectional study to recruit 1309 HCWs from two academic hospitals in the Eastern Cape, South Africa over 6 weeks in November and December 2020. Prior test results for SARS-CoV-2 PCR and participants' characteristics were recorded while a blood sample was drawn for detection of IgG antibodies against SARS-CoV-2 nucleocapsid protein. The primary outcome measure was the SARS-CoV-2 cumulative incidence rate, defined as the combined total of positive results for either PCR or IgG antibodies, divided by the total sample. The secondary outcome was significant risk factors associated with infection. RESULTS Of the total participants included in the analysis (n=1295), the majority were women (81.5%), of black race (78.7%) and nurses (44.8%). A total of 390 (30.1%) HCWs had a positive SARS-CoV-2 PCR result and SARS-CoV-2 antibodies were detected in 488 (37.7%), yielding a cumulative incidence of 47.2% (n=611). In the adjusted logistic regression model, being overweight (adjusted OR (aOR)=2.15, 95% CI 1.44 to 3.20), obese (aOR=1.37, 95% CI 1.02 to 1.85) and living with HIV (aOR=1.78, 95% CI 1.38 to 2.08) were independently associated with SARS-CoV-2 infection. There was no significant difference in infection rates between high, medium and low COVID-19 exposure working environments. CONCLUSIONS The high SARS-CoV-2 cumulative incidence in the cohort was surprising this early in the epidemic and probably related to exposure both in and outside the hospitals. To mitigate the impact of SARS-CoV-2 among HCWs, infection prevention and control strategies should target community transmission in addition to screening for HIV and metabolic conditions.
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Affiliation(s)
- David Stead
- Department of Internal Medicine, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
- Internal Medicine, Frere Hospital, East London, Eastern Cape, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
- Department of Family Medicine, Cecilia Makiwane Hospital, Mdantsane, Eastern Cape, South Africa
| | - Mandisa Singata-Madliki
- Department of Public health, University of Fort Hare East London Campus, East London, South Africa
- Obstetrics and Gynaecology, Wits University, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Shareef Abrahams
- Division of Microbiology, Department of Pathology, National Health Laboratory Service, Port Elizabeth, South Africa
| | - Joanne Batting
- Department of Public health, University of Fort Hare East London Campus, East London, South Africa
| | - Eloise Jelliman
- Radiology, Frere Hospital, East London, Eastern Cape, South Africa
| | - Andrew Parrish
- Department of Internal Medicine, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
- Internal Medicine, Frere Hospital, East London, Eastern Cape, South Africa
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Kjøllesdal MKR, Juarez SP, Aradhya S, Indseth T. Understanding the excess COVID-19 burden among immigrants in Norway. J Public Health (Oxf) 2022:6548103. [PMID: 35285905 PMCID: PMC8992298 DOI: 10.1093/pubmed/fdac033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/10/2022] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
We aim to use intermarriage as a measure to disentangle the role of exposure to virus, susceptibility and care in differences in burden of COVID-19, by comparing rates of COVID-19 infections between immigrants married to a native and to another immigrant.
Methods
Using data from the Norwegian emergency preparedness, register participants (N=2 312 836) were linked with their registered partner and categorized based on own and partner’s country of birth. From logistic regressions, odds ratios (OR) of COVID-19 infection (15 June 2020–01 June 2021) and related hospitalization were calculated adjusted for age, sex, municipality, medical risk, occupation, household income, education and crowded housing.
Results
Immigrants were at increased risk of COVID-19 and related hospitalization regardless of their partners being immigrant or not, but immigrants married to a Norwegian-born had lower risk than other immigrants. Compared with intramarried Norwegian-born, odds of COVID-19 infection was higher among persons in couples with one Norwegian-born and one immigrant from Europe/USA/Canada/Oceania (OR 1.42–1.46) or Africa/Asia/Latin-America (OR 1.91–2.01). Odds of infection among intramarried immigrants from Africa/Asia/Latin-America was 4.92. For hospitalization, the corresponding odds were slightly higher.
Conclusion
Our study suggests that the excess burden of COVID-19 among immigrants is explained by differences in exposure and care rather than susceptibility.
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Affiliation(s)
- M K R Kjøllesdal
- Norwegian Institute of Public Health, Health Services Research, 0213 Oslo, Norway
- Norwegian University of Life Sciences, Institute of Public Health Science, 1432 Ås, Norway
| | - S P Juarez
- Stockholm University, Department of Public Health Sciences, SE-106 91 Stockholm, Sweden
| | - S Aradhya
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, SE-106 91 Stockholm, Sweden
| | - T Indseth
- Norwegian Institute of Public Health, Health Services Research, 0213 Oslo, Norway
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Ambrose PA, Goodman WA. Impact of COVID-19 on Patients with Inflammatory Bowel Disease. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2022; 7:37-44. [PMID: 35966234 PMCID: PMC9373928 DOI: 10.14218/jerp.2021.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, in late 2019. Responsible for the ongoing coronavirus disease 2019 (COVID-19) pandemic, SARS-CoV-2 is one of three structurally similar beta-coronaviruses that can cause a strong upregulation of cytokines referred to as cytokine release syndrome (CRS). Unresolved CRS leads to respiratory symptoms, including pneumonia, and in more severe cases, acute respiratory distress syndrome (ARDS). Although COVID-19 is widely known for these hallmark respiratory symptoms, it also impacts the gut, causing gastrointestinal (GI) tract inflammation and diarrhea. COVID-19's GI symptoms may be due to the high intestinal expression of angiotensin converting enzyme-2 receptors, which are for the binding of SARS-CoV-2 viral particles. Reports have shown that SARS-CoV-2 can be passed through fecal matter, with one study finding that 48.1% of COVID-19 patients expressed viral SARS-CoV-2 mRNA in their stool. Given that the GI tract is a target tissue affected by COVID-19, this causes concern for those with underlying GI pathologies, such as inflammatory bowel disease (IBD). Regrettably, there have been only limited studies on the impact of COVID-19 on gut health, and the impact of COVID-19 on intestinal inflammation among IBD patients remains unclear. In particular, questions regarding susceptibility to SARS-CoV-2 infection, clinical impact of COVID-19 on IBD, and the potential influence of age, sex, and immunosuppressant medications are still poorly understood. An improved understanding of these issues is needed to address the unique risks of COVID-19 among IBD patients, as well as the potential impact of SARS-CoV-2 on the host intestinal microbiota.
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Affiliation(s)
| | - Wendy A. Goodman
- Correspondence to: Wendy A. Goodman, Department of Pathology, Case Western Reserve University School of Medicine, OH 44106, USA. Tel: +1 216 368-3920, Fax: +1 216-368-0494,
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Örs ED, Alkan ŞB, Öksüz A. Possible Effect of Astaxanthin on Obesity-related Increased COVID-19
Infection Morbidity and Mortality. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401317666211011105732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract:
Obesity is defined by the World Health Organisation (WHO) as a body mass index
equal to 30 kg/m2 or greater. It is an important and escalating global public health problem.
Obesity is known to cause low-grade chronic inflammation, increasing the burden of noncommunicable
and possibly communicable diseases. There is considerable evidence that obesity is
associated with an increased risk of contracting coronavirus disease 2019 (COVID-19) infection
as well as significantly higher COVID-19 morbidity and mortality. It appears plausible
that controlling the chronic systemic low-grade inflammation associated with obesity may have
a positive impact on the symptoms and the prognosis of COVID-19 disease in obese patients.
Astaxanthin (ASTX) is a naturally occurring carotenoid with anti-inflammatory, antioxidant,
and immunomodulatory activities. As a nutraceutical agent, it is used as a preventative and a
co-treatment in a number of systemic neurological, cardiovascular, and metabolic diseases.
This review article will discuss the pathogenesis of COVID-19 infection and the effect of
ASTX on obesity and obesity-related inflammation. The potential positive impact of ASTX anti-
inflammatory properties in obese COVID-19 patients will be discussed.
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Affiliation(s)
- Elif Didem Örs
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Şenay Burçin Alkan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Abdullah Öksüz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
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Satué-Gracia EM, Vila-Córcoles A, de Diego-Cabanes C, Vila-Rovira A, Torrente-Fraga C, Gómez-Bertomeu F, Hospital-Guardiola I, Ochoa-Gondar O, Martín-Luján F. Susceptibility and risk of SARS-COV-2 infection among middle-aged and older adults in Tarragona area, Spain. MEDICINA CLÍNICA (ENGLISH EDITION) 2022; 158:251-259. [PMID: 35492428 PMCID: PMC9034652 DOI: 10.1016/j.medcle.2021.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022]
Abstract
Objective To analyse susceptibility/risk of suffering COVID-19 among adults with distinct underlying medical conditions. Methods Population-based cohort study involving 79,083 individuals ≥50 years old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (demographic, pre-existing comorbidities, chronic medications and vaccinations history) were established at study start (01/03/2020) and primary outcome was laboratory-confirmed COVID-19 occurred among cohort members throughout 01/03/2020–30/06/2020. Risk of suffering COVID-19 was evaluated by Cox regression, estimating multivariable hazard ratios (HRs) adjusted for age/sex and pre-existing comorbidities. Results Across study period, 536 laboratory-confirmed COVID-19 cases were observed (mean incidence: 39.5 cases per 100,000 persons-week). In multivariable-analysis, increasing age/years (HR: 1.01; 95% CI: 1.00–1.02), nursing-home (HR: 20.19; 95% CI: 15.98–25.51), neurological disease (HR: 1.35; 95% CI: 1.03–1.77), taking diuretics (HR: 1.39; 95% CI: 1.10–1.75), antiplatelet (HR: 1.36; 95% CI: 1.05–1.76) and benzodiazepines (HR: 1.24; 95% CI: 1.00–1.53) increased risk; conversely, taking angiotensin-converting-enzyme inhibitors (HR: 0.78; 95% CI: 0.61–1.00), angiotensin-receptor-blockers (HR: 0.70; 95%CI: 0.51–0.96) and statins (HR: 0.75; 95% CI: 0.58–0.96) were associated with reduced risk. Among community-dwelling individuals, pre-existing cancer, renal and cardiac disease appeared also related with an increased risk, whereas influenza vaccination was associated with reduced risk. Conclusion In a setting with relatively low incidence of COVID-19 across the first wave of pandemic period, increasing age, nursing-home residence and multiple comorbidities appear predisposing for COVID-19 among middle-aged/older adults. Conversely, statins, angiotensin-receptor blockers/inhibitors and influenza vaccination were related with decreased risk.
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Affiliation(s)
- Eva M Satué-Gracia
- Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Unitat de Suport a la Recerca (USR), Camí de Riudoms, 53-55, 43202 Reus (Tarragona), Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Angel Vila-Córcoles
- Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Unitat de Suport a la Recerca (USR), Camí de Riudoms, 53-55, 43202 Reus (Tarragona), Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Cinta de Diego-Cabanes
- Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Centre d'Alta Resolució (CAR) Salou, Tarragona, Spain
| | - Angel Vila-Rovira
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Cristina Torrente-Fraga
- Technology and Informatic Department Camp de Tarragona, Institut Català de la Salut (ICS), Tarragona, Spain
| | - Frederic Gómez-Bertomeu
- Universitary Hospital Joan XXIII, Institut Català de la Salut (ICS), Microbiology Department, Tarragona, Spain
| | - Imma Hospital-Guardiola
- Primary Care Department Camp de Tarragona, Institut Catala de la Salut (ICS), Centre d'Atenció Primària (CAP) Dr. Sarró-Valls Urbà, Tarragona, Spain
| | - Olga Ochoa-Gondar
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
- Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Centre d'Atenció Primària (CAP), Sant Pere i Sant Pau-Tarragona 5, Tarragona, Spain
| | - Francisco Martín-Luján
- Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Unitat de Suport a la Recerca (USR), Camí de Riudoms, 53-55, 43202 Reus (Tarragona), Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
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Diaz Badial P, Bothorel H, Kherad O, Dussoix P, Tallonneau Bory F, Ramlawi M. A new screening tool for SARS-CoV-2 infection based on self-reported patient clinical characteristics: the COV 19-ID score. BMC Infect Dis 2022; 22:187. [PMID: 35209872 PMCID: PMC8867452 DOI: 10.1186/s12879-022-07164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/16/2022] [Indexed: 01/08/2023] Open
Abstract
Background While several studies aimed to identify risk factors for severe COVID-19 cases to better anticipate intensive care unit admissions, very few have been conducted on self-reported patient symptoms and characteristics, predictive of RT-PCR test positivity. We therefore aimed to identify those predictive factors and construct a predictive score for the screening of patients at admission. Methods This was a monocentric retrospective analysis of clinical data from 9081 patients tested for SARS-CoV-2 infection from August 1 to November 30 2020. A multivariable logistic regression using least absolute shrinkage and selection operator (LASSO) was performed on a training dataset (60% of the data) to determine associations between self-reported patient characteristics and COVID-19 diagnosis. Regression coefficients were used to construct the Coronavirus 2019 Identification score (COV19-ID) and the optimal threshold calculated on the validation dataset (20%). Its predictive performance was finally evaluated on a test dataset (20%). Results A total of 2084 (22.9%) patients were tested positive to SARS-CoV-2 infection. Using the LASSO model, COVID-19 was independently associated with loss of smell (Odds Ratio, 6.4), fever (OR, 2.7), history of contact with an infected person (OR, 1.7), loss of taste (OR, 1.5), muscle stiffness (OR, 1.5), cough (OR, 1.5), back pain (OR, 1.4), loss of appetite (OR, 1.3), as well as male sex (OR, 1.05). Conversely, COVID-19 was less likely associated with smoking (OR, 0.5), sore throat (OR, 0.9) and ear pain (OR, 0.9). All aforementioned variables were included in the COV19-ID score, which demonstrated on the test dataset an area under the receiver-operating characteristic curve of 82.9% (95% CI 80.6%–84.9%), and an accuracy of 74.2% (95% CI 74.1%–74.3%) with a high sensitivity (80.4%, 95% CI [80.3%–80.6%]) and specificity (72.2%, 95% CI [72.2%–72.4%]). Conclusions The COV19-ID score could be useful in early triage of patients needing RT-PCR testing thus alleviating the burden on laboratories, emergency rooms, and wards. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07164-1.
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Affiliation(s)
- Pablo Diaz Badial
- Department of Emergency Medicine, La Tour Hospital, 1217, Geneva, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, 1217, Geneva, Switzerland.
| | - Omar Kherad
- Department of Internal Medicine, La Tour Hospital and University of Geneva, 1217, Geneva, Switzerland
| | - Philippe Dussoix
- Department of Emergency Medicine, La Tour Hospital, 1217, Geneva, Switzerland
| | | | - Majd Ramlawi
- Department of Emergency Medicine, La Tour Hospital, 1217, Geneva, Switzerland
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Talaei M, Faustini S, Holt H, Jolliffe DA, Vivaldi G, Greenig M, Perdek N, Maltby S, Bigogno CM, Symons J, Davies GA, Lyons RA, Griffiths CJ, Kee F, Sheikh A, Richter AG, Shaheen SO, Martineau AR. Determinants of pre-vaccination antibody responses to SARS-CoV-2: a population-based longitudinal study (COVIDENCE UK). BMC Med 2022; 20:87. [PMID: 35189888 PMCID: PMC8860623 DOI: 10.1186/s12916-022-02286-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prospective population-based studies investigating multiple determinants of pre-vaccination antibody responses to SARS-CoV-2 are lacking. METHODS We did a prospective population-based study in SARS-CoV-2 vaccine-naive UK adults recruited between May 1 and November 2, 2020, without a positive swab test result for SARS-CoV-2 prior to enrolment. Information on 88 potential sociodemographic, behavioural, nutritional, clinical and pharmacological risk factors was obtained through online questionnaires, and combined IgG/IgA/IgM responses to SARS-CoV-2 spike glycoprotein were determined in dried blood spots obtained between November 6, 2020, and April 18, 2021. We used logistic and linear regression to estimate adjusted odds ratios (aORs) and adjusted geometric mean ratios (aGMRs) for potential determinants of SARS-CoV-2 seropositivity (all participants) and antibody titres (seropositive participants only), respectively. RESULTS Of 11,130 participants, 1696 (15.2%) were seropositive. Factors independently associated with higher risk of SARS-CoV-2 seropositivity included frontline health/care occupation (aOR 1.86, 95% CI 1.48-2.33), international travel (1.20, 1.07-1.35), number of visits to shops and other indoor public places (≥ 5 vs. 0/week: 1.29, 1.06-1.57, P-trend = 0.01), body mass index (BMI) ≥ 25 vs. < 25 kg/m2 (1.24, 1.11-1.39), South Asian vs. White ethnicity (1.65, 1.10-2.49) and alcohol consumption ≥15 vs. 0 units/week (1.23, 1.04-1.46). Light physical exercise associated with lower risk (0.80, 0.70-0.93, for ≥ 10 vs. 0-4 h/week). Among seropositive participants, higher titres of anti-Spike antibodies associated with factors including BMI ≥ 30 vs. < 25 kg/m2 (aGMR 1.10, 1.02-1.19), South Asian vs. White ethnicity (1.22, 1.04-1.44), frontline health/care occupation (1.24, 95% CI 1.11-1.39), international travel (1.11, 1.05-1.16) and number of visits to shops and other indoor public places (≥ 5 vs. 0/week: 1.12, 1.02-1.23, P-trend = 0.01); these associations were not substantially attenuated by adjustment for COVID-19 disease severity. CONCLUSIONS Higher alcohol consumption and lower light physical exercise represent new modifiable risk factors for SARS-CoV-2 infection. Recognised associations between South Asian ethnic origin and obesity and higher risk of SARS-CoV-2 seropositivity were independent of other sociodemographic, behavioural, nutritional, clinical, and pharmacological factors investigated. Among seropositive participants, higher titres of anti-Spike antibodies in people of South Asian ancestry and in obese people were not explained by greater COVID-19 disease severity in these groups.
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Affiliation(s)
- Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hayley Holt
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - David A Jolliffe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Giulia Vivaldi
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Perdek
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sheena Maltby
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carola M Bigogno
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Christopher J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Frank Kee
- Centre for Public Health Research (NI), Queen's University Belfast, Belfast, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Seif O Shaheen
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
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Childhood obesity and risk of SARS-CoV-2 infection. Int J Obes (Lond) 2022; 46:1155-1159. [PMID: 35173279 PMCID: PMC8853122 DOI: 10.1038/s41366-022-01094-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
Objective To estimate the association between childhood obesity and the risk of SARS-CoV-2 infection in a cohort followed from 4 to 12 years of age. Methods The data were obtained from two independent sources: the Longitudinal Childhood Obesity Study (ELOIN) and the epidemiological surveillance system data from the Community of Madrid (Spain), which served to identify the population within the cohort with confirmed SARS-CoV-2 infection. The SARS-CoV-2 registry was cross-checked with the cohort population at 11–12 years of age. A total of 2018 eligible participants were identified in the cohort, who underwent physical examinations at 4, 6, and 9 years of age during which weight, height, and waist circumference were recorded. General obesity (GO) was determined according to the WHO-2007 criteria whereas abdominal obesity (AO) was defined based on the International Diabetes Federation (IDF) criteria. The relative risks (RRs) of infection were estimated using a Poisson regression model and adjusted by sociodemographic variables, physical activity, and perceived health reported by the parents. Results The accumulated incidence of SARS-CoV-2 infection was 8.6% (95% CI: 7.3–9.8). The estimated RR of SARS-CoV-2 infection was 2.53 (95% CI: 1.56–4.10) and 2.56 (95% CI: 1.55–4.21) for children 4–9 years old with stable GO and AO, respectively, compared with those who did not present GO. Conclusions Childhood obesity is an independent risk factor for SARS-CoV-2 infection. This study provides new evidence that indicates that obesity increases the vulnerability of the paediatric population to infectious diseases.
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Labberton AS, Godøy A, Elgersma IH, Strand BH, Telle K, Arnesen T, Nygård KM, Indseth T. SARS-CoV-2 infections and hospitalisations among immigrants in Norway-significance of occupation, household crowding, education, household income and medical risk: a nationwide register study. Scand J Public Health 2022; 50:772-781. [PMID: 35164616 PMCID: PMC9361416 DOI: 10.1177/14034948221075029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: As in other countries, the COVID-19 pandemic has affected Norway’s immigrant
population disproportionately, with significantly higher infection rates and
hospitalisations. The reasons for this are uncertain. Methods: Through the national emergency preparedness register, BeredtC19, we have
studied laboratory-confirmed infections with SARS-CoV-2 and related
hospitalisations in the entire Norwegian population, by birth-country
background for the period 15 June 2020 to 31 March 2021, excluding the first
wave due to limited test capacity and restrictive test criteria.
Straightforward linkage of individual-level data allowed adjustment for
demographics, socioeconomic factors (occupation, household crowding,
education and household income), and underlying medical risk for severe
COVID-19 in regression models. Results: The sample comprised 5.49 million persons, of which 0.91 million were born
outside of Norway, there were 82,532 confirmed cases and 3088
hospitalisations. Confirmed infections in this period (per 100,000):
foreign-born 3140, Norwegian-born with foreign-born parents 4799 and
Norwegian-born with Norwegian-born parent(s) 1011. Hospitalisations (per
100,000): foreign-born 147, Norwegian-born with foreign-born parents 47 and
Norwegian-born with Norwegian-born parent(s) 37. The addition of
socioeconomic and medical factors to the base model (age, sex, municipality
of residence) attenuated excess infection rates by 12.0% and
hospitalisations by 3.8% among foreign-born, and 10.9% and 46.2%,
respectively, among Norwegian-born with foreign parents, compared to
Norwegian-born with Norwegian-born parent(s). Conclusions: There were large differences in infection rates and hospitalisations
by country background, and these do not appear to be fully explained by
socioeconomic and medical factors. Our results may have implications for
health policy, including the targeting of mitigation strategies.
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Affiliation(s)
- Angela S Labberton
- Division for Health Services, Norwegian Institute of Public Health, Norway
| | - Anna Godøy
- Division for Health Services, Norwegian Institute of Public Health, Norway
| | | | - Bjørn Heine Strand
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Kjetil Telle
- Division for Health Services, Norwegian Institute of Public Health, Norway
| | - Trude Arnesen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Karin Maria Nygård
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Thor Indseth
- Division for Health Services, Norwegian Institute of Public Health, Norway
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Vasileiou E, Shi T, Kerr S, Robertson C, Joy M, Tsang R, McGagh D, Williams J, Hobbs R, de Lusignan S, Bradley D, OReilly D, Murphy S, Chuter A, Beggs J, Ford D, Orton C, Akbari A, Bedston S, Davies G, Griffiths LJ, Griffiths R, Lowthian E, Lyons J, Lyons RA, North L, Perry M, Torabi F, Pickett J, McMenamin J, McCowan C, Agrawal U, Wood R, Stock SJ, Moore E, Henery P, Simpson CR, Sheikh A. Investigating the uptake, effectiveness and safety of COVID-19 vaccines: protocol for an observational study using linked UK national data. BMJ Open 2022; 12:e050062. [PMID: 35165107 PMCID: PMC8844955 DOI: 10.1136/bmjopen-2021-050062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The novel coronavirus SARS-CoV-2, which emerged in December 2019, has caused millions of deaths and severe illness worldwide. Numerous vaccines are currently under development of which a few have now been authorised for population-level administration by several countries. As of 20 September 2021, over 48 million people have received their first vaccine dose and over 44 million people have received their second vaccine dose across the UK. We aim to assess the uptake rates, effectiveness, and safety of all currently approved COVID-19 vaccines in the UK. METHODS AND ANALYSIS We will use prospective cohort study designs to assess vaccine uptake, effectiveness and safety against clinical outcomes and deaths. Test-negative case-control study design will be used to assess vaccine effectiveness (VE) against laboratory confirmed SARS-CoV-2 infection. Self-controlled case series and retrospective cohort study designs will be carried out to assess vaccine safety against mild-to-moderate and severe adverse events, respectively. Individual-level pseudonymised data from primary care, secondary care, laboratory test and death records will be linked and analysed in secure research environments in each UK nation. Univariate and multivariate logistic regression models will be carried out to estimate vaccine uptake levels in relation to various population characteristics. VE estimates against laboratory confirmed SARS-CoV-2 infection will be generated using a generalised additive logistic model. Time-dependent Cox models will be used to estimate the VE against clinical outcomes and deaths. The safety of the vaccines will be assessed using logistic regression models with an offset for the length of the risk period. Where possible, data will be meta-analysed across the UK nations. ETHICS AND DISSEMINATION We obtained approvals from the National Research Ethics Service Committee, Southeast Scotland 02 (12/SS/0201), the Secure Anonymised Information Linkage independent Information Governance Review Panel project number 0911. Concerning English data, University of Oxford is compliant with the General Data Protection Regulation and the National Health Service (NHS) Digital Data Security and Protection Policy. This is an approved study (Integrated Research Application ID 301740, Health Research Authority (HRA) Research Ethics Committee 21/HRA/2786). The Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub meets NHS Digital's Data Security and Protection Toolkit requirements. In Northern Ireland, the project was approved by the Honest Broker Governance Board, project number 0064. Findings will be made available to national policy-makers, presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
| | - Ting Shi
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Steven Kerr
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Declan Bradley
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Dermot OReilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Siobhan Murphy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Antony Chuter
- BREATHE - The Health Data Research Hub for Respiratory Health, London, UK
| | - Jillian Beggs
- BREATHE - The Health Data Research Hub for Respiratory Health, London, UK
| | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gareth Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Lucy J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Emily Lowthian
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Laura North
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Malorie Perry
- Vaccine Preventable Disease Programme, Public Health Wales, Cardiff, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Rachael Wood
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | - Sarah Jane Stock
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | | | - Paul Henery
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin R Simpson
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Wellington School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Aziz Sheikh
- The University of Edinburgh, Usher Institute, Edinburgh, UK
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Mondal S, Chaipitakporn C, Kumar V, Wangler B, Gurajala S, Dhaniyala S, Sur S. COVID-19 in New York state: Effects of demographics and air quality on infection and fatality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 807:150536. [PMID: 34628294 PMCID: PMC8461036 DOI: 10.1016/j.scitotenv.2021.150536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 05/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) has had a global impact that has been unevenly distributed among and even within countries. Multiple demographic and environmental factors have been associated with the risk of COVID-19 spread and fatality, including age, gender, ethnicity, poverty, and air quality among others. However, specific contributions of these factors are yet to be understood. Here, we attempted to explain the variability in infection, death, and fatality rates by understanding the contributions of a few selected factors. We compared the incidence of COVID-19 in New York State (NYS) counties during the first wave of infection and analyzed how different demographic and environmental variables associate with the variation observed across the counties. We observed that infection and death rates, two important COVID-19 metrics, to be highly correlated with both being highest in counties located near New York City, considered as one of the epicenters of the infection in the US. In contrast, disease fatality was found to be highest in a different set of counties despite registering a low infection rate. To investigate this apparent discrepancy, we divided the counties into three clusters based on COVID-19 infection, death, or fatality, and compared the differences in the demographic and environmental variables such as ethnicity, age, population density, poverty, temperature, and air quality in each of these clusters. Furthermore, a regression model built on this data reveals PM2.5 and distance from the epicenter are significant risk factors for infection, while disease fatality has a strong association with age and PM2.5. Our results demonstrate that for the NYS, demographic components distinctly associate with specific aspects of COVID-19 burden and also highlight the detrimental impact of poor air quality. These results could help design and direct location-specific control and mitigation strategies.
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Affiliation(s)
- Sumona Mondal
- Department of Mathematics, Clarkson University, Potsdam, NY, USA
| | | | - Vijay Kumar
- Department of Mathematics, Clarkson University, Potsdam, NY, USA
| | - Bridget Wangler
- David D. Reh School of Business, Clarkson University, Potsdam, NY, USA
| | | | - Suresh Dhaniyala
- Department of Mechanical and Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Shantanu Sur
- Department of Biology, Clarkson University, Potsdam, NY, USA.
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130
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Marshall AT, Hackman DA, Baker FC, Breslin FJ, Brown SA, Dick AS, Gonzalez MR, Guillaume M, Kiss O, Lisdahl KM, McCabe CJ, Pelham WE, Sheth C, Tapert SF, Rinsveld AV, Wade NE, Sowell ER. Resilience to COVID-19: Socioeconomic Disadvantage Associated With Positive Caregiver-Youth Communication and Youth Preventative Actions. Front Public Health 2022; 10:734308. [PMID: 35223717 PMCID: PMC8865385 DOI: 10.3389/fpubh.2022.734308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/05/2022] [Indexed: 01/26/2023] Open
Abstract
Socioeconomic disadvantage is associated with larger COVID-19 disease burdens and pandemic-related economic impacts. We utilized the longitudinal Adolescent Brain Cognitive Development Study to understand how family- and neighborhood-level socioeconomic disadvantage relate to disease burden, family communication, and preventative responses to the pandemic in over 6,000 youth-caregiver dyads. Data were collected at three timepoints (May-August 2020). Here, we show that both family- and neighborhood-level disadvantage were associated with caregivers' reports of greater family COVID-19 disease burden, less perceived exposure risk, more frequent caregiver-youth conversations about COVID-19 risk/prevention and reassurance, and greater youth preventative behaviors. Families with more socioeconomic disadvantage may be adaptively incorporating more protective strategies to reduce emotional distress and likelihood of COVID-19 infection. The results highlight the importance of caregiver-youth communication and disease-preventative practices for buffering the economic and disease burdens of COVID-19, along with policies and programs that reduce these burdens for families with socioeconomic disadvantage.
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Affiliation(s)
- Andrew T. Marshall
- The Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States,*Correspondence: Andrew T. Marshall
| | - Daniel A. Hackman
- University of Southern California (USC) Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, United States
| | - Florence J. Breslin
- National Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Sandra A. Brown
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Anthony Steven Dick
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Marybel R. Gonzalez
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mathieu Guillaume
- Graduate School of Education, Stanford University, Stanford, CA, United States
| | - Orsolya Kiss
- Center for Health Sciences, SRI International, Menlo Park, CA, United States
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Connor J. McCabe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - William E. Pelham
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Chandni Sheth
- Department of Psychiatry, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | | | - Natasha E. Wade
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Elizabeth R. Sowell
- The Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States,Elizabeth R. Sowell
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131
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Martínez-Baz I, Trobajo-Sanmartín C, Burgui C, Casado I, Castilla J. Transmission of SARS-CoV-2 infection and risk factors in a cohort of close contacts. Postgrad Med 2022; 134:230-238. [PMID: 35102793 DOI: 10.1080/00325481.2022.2037360] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Many factors might affect SARS-CoV-2 transmission, but their relevance is not well established. The objectives were to assess the secondary attack rate (SAR) and the risk factors for SARS-CoV-2 transmission from confirmed index cases to their close contacts in household and non-household settings. METHODS This cohort study included the close contacts of SARS-CoV-2 infected cases confirmed between May and December 2020 in Navarre, Spain. Epidemiological and clinical variables of the index case and close contacts were collected. The SAR was calculated, and the independent effect of each variable on the transmission risk was evaluated by logistic regression. RESULTS A total of 59,900 close contacts of 20,048 index cases were studied, and 53.6% were household contacts. SAR was 34.9% overall, 46.8% in household contacts and 21.1% in non-household contacts. The risk of transmission was higher in household setting (adjusted odds ratio (aOR) 2.96, 95% CI 2.84-3.07), from symptomatic index cases (aOR 1.50, 95% CI 1.43-1.58), immigrants (aOR 1.44, 95% CI 1.36-1.52), and increased with age. A higher susceptibility of close contacts was associated with 5-14 years of age, immigrants (aOR 1.54), very low or low-income level (aOR 1.27, and aOR, 1.17, respectively), healthcare work (aOR 1.21), and diagnosis of diabetes (aOR 1.14, 95%CI 1.03-1.25), chronic kidney disease (aOR 1.18, 95%CI 1.04-1.35), hypertension (aOR 1.11, 95% CI 1.03-1.19), and severe obesity (aOR 1.18, 95% CI 1.00-1.38). Transmission increased progressively from May to September 2020 as the B.1.177 variant became dominant. CONCLUSION The risk of SARS-CoV-2 infection was considerable among close contacts of infected persons. The higher risk associated with household contacts, immigrants, older index cases, close contacts with lower income level and comorbidities should be considered to address preventive interventions.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
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132
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Puerta JL, Torrego-Ellacuría M, Del Rey-Mejías A, Biénzobas López C. Comorbidities of Primary Care patients with COVID-19 during the first wave of the SARS-CoV-2 pandemic in the Community of Madrid. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:63-70. [PMID: 34889087 PMCID: PMC8790647 DOI: 10.37201/req/114.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recent publications on inpatients with COVID-19 describing their comorbidities and demographic profile exists, but data from large populations requiring only primary care (PC) are scarce. This paper aims to fill this gap and report the prevalence of eight comorbidities (high blood pressure, diabetes mellitus, cancer, cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and chronic heart failure) among patients attending PC during the onset of the SARS-CoV-2 pandemic in the Community of Madrid (CoM), Spain. METHODS This is an observational retrospective study that collects data registered in the CoM between February 25th and May 31st, 2020. Data are divided in two groups: Group-1 (N=339,890) consist of all patients with suspected or proven SARS-CoV-2 infection; and Group-2 is the subgroup (N=48,556, 14.3% of Group-1) of individuals with COVID-19 confirmed by positive RT-PCR test. RESULTS Comparing Group-1 with Group-2, 339,890/48,556 patients, respectively, the main results were as follows: average age (60.9/69.9 years), presence of at least one comorbidity (33.51%/47.69%), high blood pressure (19.74%/32.74%), diabetes mellitus (7.13%/13.75%), cancer (6.56%/10.6%), cardiovascular disease (4.52%/9.26%), asthma (7.98%/6.56%), chronic kidney disease (1.84%/4.41%), chronic obstructive pulmonary disease (2%/4.03%), and chronic heart failure (1.14%/2.77%). High blood pressure and diabetes mellitus were seen to be the most frequent (6.56%/8.38%) association. CONCLUSIONS Patients requiring PC attention during the first wave of the COVID-19 pandemic in the CoM presented with a very high rate of comorbidities, with marked differences among those with or without a confirmed SARS-CoV-2 infection.
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Affiliation(s)
- J L Puerta
- José Luis Puerta, Consejería de Sanidad, Calle de la Aduana, 29, 28013 Madrid. Spain.
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Kjøllesdal M, Skyrud K, Gele A, Arnesen T, Kløvstad H, Diaz E, Indseth T. The correlation between socioeconomic factors and COVID-19 among immigrants in Norway: a register-based study. Scand J Public Health 2022; 50:52-60. [PMID: 33983088 PMCID: PMC8807998 DOI: 10.1177/14034948211015860] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Immigrants in Norway have higher COVID-19 notification and hospitalisation rates than Norwegian-born individuals. The knowledge about the role of socioeconomic factors to explain these differences is limited. We investigate the relationship between socioeconomic indicators at group level and epidemiological data for all notified cases of COVID-19 and related hospitalisations among the 23 largest immigrant groups in Norway. METHODS We used data on all notified COVID-19 cases in Norway up to 15 November 2020, and associated hospitalisations, from the Norwegian Surveillance System for Communicable Diseases and the emergency preparedness register at the Norwegian Institute of Public Health. We report notified COVID-19 cases and associated hospitalisation rates per 100,000 and their correlation to income, education, unemployment, crowded housing and years of residency at the group level. RESULTS Crowded housing and low income at a group level were correlated with rates of both notified cases of COVID-19 (Pearson`s correlation coefficient 0.77 and 0.52) and related hospitalisations (0.72, 0.50). In addition, low educational level and unemployment were correlated with a high number of notified cases. CONCLUSIONS Immigrant groups living in disadvantaged socioeconomic positions are important to target with preventive measures for COVID-19. This must include targeted interventions for low-income families living in overcrowded households.
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Affiliation(s)
- Marte Kjøllesdal
- Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Katrine Skyrud
- Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Abdi Gele
- Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Trude Arnesen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde Kløvstad
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Esperanza Diaz
- Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- Department for Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Thor Indseth
- Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
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Richard A, Wisniak A, Perez-Saez J, Garrison-Desany H, Petrovic D, Piumatti G, Baysson H, Picazio A, Pennacchio F, De Ridder D, Chappuis F, Vuilleumier N, Low N, Hurst S, Eckerle I, Flahault A, Kaiser L, Azman AS, Guessous I, Stringhini S. Seroprevalence of anti-SARS-CoV-2 IgG antibodies, risk factors for infection and associated symptoms in Geneva, Switzerland: a population-based study. Scand J Public Health 2022; 50:124-135. [PMID: 34664529 PMCID: PMC8808008 DOI: 10.1177/14034948211048050] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 01/08/2023]
Abstract
Aims: To assess SARS-CoV-2 seroprevalence over the first epidemic wave in the canton of Geneva, Switzerland, as well as risk factors for infection and symptoms associated with IgG seropositivity. Methods: Between April and June 2020, former participants of a representative survey of the 20-74-year-old population of canton Geneva were invited to participate in the study, along with household members aged over 5 years. Blood samples were tested for anti-SARS-CoV-2 immunoglobulin G. Questionnaires were self-administered. We estimated seroprevalence with a Bayesian model accounting for test performance and sampling design. Results: We included 8344 participants, with an overall adjusted seroprevalence of 7.8% (95% credible interval 6.8-8.9). Seroprevalence was highest among 18-49 year-olds (9.5%), and lowest in 5-9-year-old children (4.3%) and individuals >65 years (4.7-5.4%). Odds of seropositivity were significantly reduced for female retirees and unemployed men compared to employed individuals, and smokers compared to non-smokers. We found no significant association between occupation, level of education, neighborhood income and the risk of being seropositive. The symptom most strongly associated with seropositivity was anosmia/dysgeusia. Conclusions: Anti-SARS-CoV-2 population seroprevalence remained low after the first wave in Geneva. Socioeconomic factors were not associated with seropositivity in this sample. The elderly, young children and smokers were less frequently seropositive, although it is not clear how biology and behaviours shape these differences.
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Affiliation(s)
- Aude Richard
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Institute of Global Health, University of Geneva, Switzerland
| | - Ania Wisniak
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Institute of Global Health, University of Geneva, Switzerland
| | - Javier Perez-Saez
- Institute of Global Health, University of Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Dusan Petrovic
- Division of Primary Care, Geneva University Hospitals, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Switzerland
| | - Giovanni Piumatti
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Faculty of BioMedicine, Università della Svizzera Italiana, Switzerland
| | - Hélène Baysson
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
| | - Attilio Picazio
- Division of Primary Care, Geneva University Hospitals, Switzerland
| | | | - David De Ridder
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
| | - François Chappuis
- Department of Health and Community Medicine, University of Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Geneva University Hospitals, Switzerland
- Department of Medicine, University of Geneva, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, University of Geneva, Switzerland
| | - Isabella Eckerle
- Geneva Center for Emerging Viral Diseases and Laboratory of Virology, Geneva University Hospitals, Switzerland
- Department of Microbiology and Molecular Medicine, University of Geneva, Switzerland
| | - Antoine Flahault
- Institute of Global Health, University of Geneva, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Switzerland
| | - Laurent Kaiser
- Department of Medicine, University of Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases and Laboratory of Virology, Geneva University Hospitals, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Switzerland
| | - Andrew S. Azman
- Institute of Global Health, University of Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Idris Guessous
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care, Geneva University Hospitals, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
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COVID-19 lockdown and housing deprivation across European countries. Soc Sci Med 2022; 298:114839. [PMID: 35228097 PMCID: PMC8861473 DOI: 10.1016/j.socscimed.2022.114839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023]
Abstract
Housing deprivation is a key determinant of the capacity to prevent infection and to recover from a disease because poor housing prevents adequate sheltering during a quarantine. We analyze the degree of housing deprivation faced by households in European countries when COVID-19 lockdown measures were enacted. To do so, we propose a synthetic measure that includes more dimensions than the official Eurostat indicator of severe housing deprivation. We use a fuzzy set approach to measure housing deprivation so that, unlike traditional deprivation approaches, based on a dichotomous variable, we can identify different degrees of housing deprivation for each household in the population. We find similar orderings of housing deprivation dimensions by country with the highest degree of deprivation in the living space dimension and the lowest one in the standard housing or technology deprivation dimension. Nonetheless, housing deprivation levels differ across countries, with Eastern European households being significantly more housing deprived than the rest when the lockdown began. This result shows that the effects of the lockdown on social well-being have not affected all Europeans equally and emphasizes the need for government measures that promote decent housing.
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Pritchard E, Jones J, Vihta KD, Stoesser N, Matthews PPC, Eyre DW, House T, Bell JI, Newton PJN, Farrar J, Crook PD, Hopkins S, Cook D, Rourke E, Studley R, Diamond PI, Peto PT, Pouwels KB, Walker PAS. Monitoring populations at increased risk for SARS-CoV-2 infection in the community using population-level demographic and behavioural surveillance. THE LANCET REGIONAL HEALTH. EUROPE 2022; 13:100282. [PMID: 34927119 PMCID: PMC8665900 DOI: 10.1016/j.lanepe.2021.100282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic is rapidly evolving, with emerging variants and fluctuating control policies. Real-time population screening and identification of groups in whom positivity is highest could help monitor spread and inform public health messaging and strategy. METHODS To develop a real-time screening process, we included results from nose and throat swabs and questionnaires taken 19 July 2020-17 July 2021 in the UK's national COVID-19 Infection Survey. Fortnightly, associations between SARS-CoV-2 positivity and 60 demographic and behavioural characteristics were estimated using logistic regression models adjusted for potential confounders, considering multiple testing, collinearity, and reverse causality. FINDINGS Of 4,091,537 RT-PCR results from 482,677 individuals, 29,903 (0·73%) were positive. As positivity rose September-November 2020, rates were independently higher in younger ages, and those living in Northern England, major urban conurbations, more deprived areas, and larger households. Rates were also higher in those returning from abroad, and working in healthcare or outside of home. When positivity peaked December 2020-January 2021 (Alpha), high positivity shifted to southern geographical regions. With national vaccine roll-out from December 2020, positivity reduced in vaccinated individuals. Associations attenuated as rates decreased between February-May 2021. Rising positivity rates in June-July 2021 (Delta) were independently higher in younger, male, and unvaccinated groups. Few factors were consistently associated with positivity. 25/45 (56%) confirmed associations would have been detected later using 28-day rather than 14-day periods. INTERPRETATION Population-level demographic and behavioural surveillance can be a valuable tool in identifying the varying characteristics driving current SARS-CoV-2 positivity, allowing monitoring to inform public health policy. FUNDING Department of Health and Social Care (UK), Welsh Government, Department of Health (on behalf of the Northern Ireland Government), Scottish Government, National Institute for Health Research.
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Affiliation(s)
- Emma Pritchard
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joel Jones
- Office for National Statistics, Newport, UK
| | - Karina-Doris Vihta
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Department of Engineering, University of Oxford, Oxford, UK
| | - Nicole Stoesser
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Prof Philippa C. Matthews
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - David W. Eyre
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Department of Engineering, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, UK
- IBM Research, Hartree Centre, Sci-Tech Daresbury, UK
| | - John I Bell
- Office of the Regius Professor of Medicine, University of Oxford, Oxford, UK
| | | | | | - Prof Derrick Crook
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Susan Hopkins
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | | | | | | | - Prof Tim Peto
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Koen B. Pouwels
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Prof A. Sarah Walker
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- MRC Clinical Trials Unit at UCL, UCL, London, UK
| | - COVID-19 Infection Survey Team
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Office for National Statistics, Newport, UK
- Department of Engineering, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Mathematics, University of Manchester, Manchester, UK
- IBM Research, Hartree Centre, Sci-Tech Daresbury, UK
- Office of the Regius Professor of Medicine, University of Oxford, Oxford, UK
- Health Improvement Directorate, Public Health England, London, UK
- Wellcome Trust, London, UK
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Clinical Trials Unit at UCL, UCL, London, UK
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Mechanisms contributing to adverse outcomes of COVID-19 in obesity. Mol Cell Biochem 2022; 477:1155-1193. [PMID: 35084674 PMCID: PMC8793096 DOI: 10.1007/s11010-022-04356-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/07/2022] [Indexed: 01/08/2023]
Abstract
A growing amount of epidemiological data from multiple countries indicate an increased prevalence of obesity, more importantly central obesity, among hospitalized subjects with COVID-19. This suggests that obesity is a major factor contributing to adverse outcome of the disease. As it is a metabolic disorder with dysregulated immune and endocrine function, it is logical that dysfunctional metabolism contributes to the mechanisms behind obesity being a risk factor for adverse outcome in COVID-19. Emerging data suggest that in obese subjects, (a) the molecular mechanisms of viral entry and spread mediated through ACE2 receptor, a multifunctional host cell protein which links to cellular homeostasis mechanisms, are affected. This includes perturbation of the physiological renin-angiotensin system pathway causing pro-inflammatory and pro-thrombotic challenges (b) existent metabolic overload and ER stress-induced UPR pathway make obese subjects vulnerable to severe COVID-19, (c) host cell response is altered involving reprogramming of metabolism and epigenetic mechanisms involving microRNAs in line with changes in obesity, and (d) adiposopathy with altered endocrine, adipokine, and cytokine profile contributes to altered immune cell metabolism, systemic inflammation, and vascular endothelial dysfunction, exacerbating COVID-19 pathology. In this review, we have examined the available literature on the underlying mechanisms contributing to obesity being a risk for adverse outcome in COVID-19.
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Miyara M, Tubach F, Pourcher V, Morélot-Panzini C, Pernet J, Haroche J, Lebbah S, Morawiec E, Gorochov G, Caumes E, Hausfater P, Combes A, Similowski T, Amoura Z. Lower Rate of Daily Smokers With Symptomatic COVID-19: A Monocentric Self-Report of Smoking Habit Study. Front Med (Lausanne) 2022; 8:668995. [PMID: 35071251 PMCID: PMC8766759 DOI: 10.3389/fmed.2021.668995] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Identification of prognostic factors in COVID-19 remains a global challenge. The role of smoking is still controversial. Methods: PCR-positive in- and outpatients with symptomatic COVID-19 from a large French University hospital were systematically interviewed for their smoking status, use of e-cigarette, and nicotinic substitutes. The rates of daily smokers in in- and outpatients were compared using the same smoking habit questionnaire to those in the 2019 French general population, after standardisation for sex and age. Results: The inpatient group was composed of 340 patients, median age of 66 years: 203 men (59.7%) and 137 women (40.3%), median age of both 66 years, with a rate of 4.1% daily smokers (CI 95% [2.3-6.9]) (5.4% of men and 2.2% of women). The outpatient group was composed of 139 patients, median age of 44 years: 62 men (44.6%, median age of 43 years) and 77 women (55.4%, median age of 44 years). The daily smoker rate was 6.1% (CI 95% [2.7-11.6], 5.1% of men and 6.8% of women). Amongst inpatients, daily smokers represented 2.2 and 3.4% of the 45 dead patients and of the 29 patients transferred to ICU, respectively. The rate of daily smokers was significantly lower in patients with symptomatic COVID-19, as compared to that in the French general population after standardisation by age and sex, with standardised incidence ratios (SIRs) of 0.24 [0.12-0.48] for outpatients and 0.24 [0.14-0.40] for inpatients. Conclusions: Daily smoker rate in patients with symptomatic COVID-19 is lower as compared to the French general population.
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Affiliation(s)
- Makoto Miyara
- Sorbonne Université, Inserm UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Groupe Hospitalier Universitaire APHP.Sorbonne-université, site Pitié-Salpêtrière, Département d'immunologie, Paris, France
| | - Florence Tubach
- Sorbonne Université, Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP.Sorbonne-Université, site Pitié-Salpêtrière, Département de Santé Publique, Unité de Recherche Clinique Pitié, CIC-1422, Paris, France
| | - Valérie Pourcher
- Sorbonne Université, Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP.Sorbonne-Université, site Pitié-Salpêtrière, Service des maladies infectieuses et tropicales, Paris, France
| | - Capucine Morélot-Panzini
- Sorbonne Université, Inserm, UMRS-1158, APHP, Groupe Hospitalier Universitaire APHP- Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France
| | - Julie Pernet
- Sorbonne Université, GRC-14 BIOSFAST, UMR Inserm 1166, IHU ICAN, Service d'accueil des Urgences, Groupe Hospitalier Universitaire APHP.Sorbonne-université, site Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Sorbonne Université, Inserm UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Groupe Hospitalier Universitaire APHP.Sorbonne-université, site Pitié-Salpêtrière, service de médecine interne 2, Paris, France
| | - Said Lebbah
- Sorbonne Université, Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP.Sorbonne-Université, site Pitié-Salpêtrière, Département de Santé Publique, Unité de Recherche Clinique Pitié, CIC-1422, Paris, France
| | - Elise Morawiec
- APHP, Groupe Hospitalier Universitaire APHP.Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Groupe Hospitalier Universitaire APHP.Sorbonne-université, site Pitié-Salpêtrière, Département d'immunologie, Paris, France
| | - Eric Caumes
- Sorbonne Université, Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP.Sorbonne-Université, site Pitié-Salpêtrière, Service des maladies infectieuses et tropicales, Paris, France
| | - Pierre Hausfater
- Sorbonne Université, GRC-14 BIOSFAST, UMR Inserm 1166, IHU ICAN, Service d'accueil des Urgences, Groupe Hospitalier Universitaire APHP.Sorbonne-université, site Pitié-Salpêtrière, Paris, France
| | - Alain Combes
- Sorbonne Université, Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, APHP. Sorbonne-université, Service de médecine intensive-réanimation, Institut de Cardiologie, site Pitié-Salpêtrière, Paris, France
| | - Thomas Similowski
- Sorbonne Université, Inserm, UMRS-1158, APHP, Groupe Hospitalier Universitaire APHP- Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France
| | - Zahir Amoura
- Sorbonne Université, Inserm UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Groupe Hospitalier Universitaire APHP.Sorbonne-université, site Pitié-Salpêtrière, service de médecine interne 2, Paris, France
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Menozzi R, Valoriani F, Prampolini F, Banchelli F, Boldrini E, Martelli F, Galetti S, Fari' R, Gabriele S, Palumbo P, Forni D, Pantaleoni M, D'Amico R, Pecchi AR. Impact of sarcopenia in SARS-CoV-2 patients during two different epidemic waves. Clin Nutr ESPEN 2022; 47:252-259. [PMID: 35063210 PMCID: PMC8648616 DOI: 10.1016/j.clnesp.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/11/2023]
Abstract
Background Sarcopenia was reported to be associated with poor clinical outcome, higher incidence of community-acquired pneumonia, increased risk of infections and reduced survival in different clinical settings. The aim of our work is to evaluate the prognostic role of sarcopenia in patients with the 2019 novel coronavirus disease (COVID-19). Materials and methods 272 COVID-19 patients admitted to the University Hospital of Modena (Italy) from February 2020 to January 2021 were retrospectively studied. All included patients underwent a chest computed tomography (CT) scan to assess pneumonia during their hospitalization and showed a positive SARS-CoV-2 molecular test. Sarcopenia was defined by skeletal muscle area (SMA) evaluation at the 12th thoracic vertebra (T12). Clinical, laboratory data and adverse clinical outcome (admission to Intensive Care Unit and death) were collected for all patients. Results Prevalence of sarcopenia was high (41.5%) but significantly different in each pandemic wave (57.9% vs 21.6% p < 0.0000). At the multivariate analysis, sarcopenia during the first wave (Hazard Ratio 2.29, 95% confidence intervals 1.17 to 4.49 p = 0.0162) was the only independent prognostic factor for adverse clinical outcome. There were no significant differences in comorbidities and COVID19 severity in terms of pulmonary involvement at lung CT comparing during the first and second wave. Mixed pattern with peripheral and central involvement was found to be dominant in both groups. Conclusion We highlight the prognostic impact of sarcopenia in COVID-19 patients hospitalized during the first wave. T12 SMA could represent a potential tool to identify sarcopenic patients in particular settings. Further studies are needed to better understand the association between sarcopenia and COVID-19.
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Affiliation(s)
- R Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy.
| | - F Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - F Prampolini
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - F Banchelli
- Unit of Clinical Statistics, University Hospital of Modena, Modena, Italy
| | - E Boldrini
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - F Martelli
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - S Galetti
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - R Fari'
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - S Gabriele
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - P Palumbo
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - D Forni
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - M Pantaleoni
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - R D'Amico
- Unit of Clinical Statistics, University Hospital of Modena, Modena, Italy
| | - A R Pecchi
- Department of Radiology, University Hospital of Modena, Modena, Italy
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140
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Jaljaa A, Caminada S, Tosti ME, D'Angelo F, Angelozzi A, Isonne C, Marchetti G, Mazzalai E, Giannini D, Turatto F, De Marchi C, Gatta A, Declich S, Pizzarelli S, Geraci S, Baglio G, Marceca M. Risk of SARS-CoV-2 infection in migrants and ethnic minorities compared with the general population in the European WHO region during the first year of the pandemic: a systematic review. BMC Public Health 2022; 22:143. [PMID: 35057781 PMCID: PMC8771174 DOI: 10.1186/s12889-021-12466-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Migrants and ethnic minorities have suffered a disproportionate impact of the COVID-19 pandemic compared to the general population from different perspectives. Our aim was to assess specifically their risk of infection in the 53 countries belonging to the World Health Organization European Region, during the first year of the pandemic. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42021247326). We searched multiple databases for peer-reviewed literature, published on Medline, Embase, Scisearch, Biosis and Esbiobase in 2020 and preprints from PubMed up to 29/03/2021. We included cross-sectional, case-control, cohort, intervention, case-series, prevalence or ecological studies, reporting the risk of SARS-CoV-2 infection among migrants, refugees, and ethnic minorities. RESULTS Among the 1905 records screened, 25 met our inclusion criteria and were included in the final analysis. We found that migrants and ethnic minorities during the first wave of the pandemic were at increased exposure and risk of infection and were disproportionately represented among COVID-19 cases. However, the impact of COVID-19 on minorities does not seem homogeneous, since some ethnic groups seem to be more at risk than others. Risk factors include high-risk occupations, overcrowded accommodations, geographic distribution, social deprivation, barriers to access to information concerning preventive measures (due to the language barrier or to their marginality), together with biological and genetic susceptibilities. CONCLUSIONS Although mixed methods studies will be required to fully understand the complex interplay between the various biological, social, and cultural factors underlying these findings, the impact of structural determinants of health is evident. Our findings corroborate the need to collect migration and ethnicity-disaggregated data and contribute to advocacy for inclusive policies and programmatic actions tailored to reach migrants and ethnic minorities.
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Affiliation(s)
- Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Elena Tosti
- National Health Institute, National Centre for Global Health, Rome, Italy
| | - Franca D'Angelo
- National Health Institute, National Centre for Global Health, Rome, Italy
| | - Aurora Angelozzi
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Giulia Marchetti
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- National Health Institute, National Centre for Global Health, Rome, Italy
| | - Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Silvia Declich
- National Health Institute, National Centre for Global Health, Rome, Italy
| | - Scilla Pizzarelli
- National Health Institute; Knowledge Service, Documentation and Library, Rome, Italy
| | - Salvatore Geraci
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- Caritas of Rome, Health Area, Rome, Italy
| | - Giovanni Baglio
- Italian Society of Migration Medicine (SIMM), Rome, Italy
- AGENAS, Research and International Relations Office, Rome, Italy
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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141
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Brown C, Wilkins K, Craig-Neil A, Upshaw T, Pinto AD. Reducing Inequities During the COVID-19 Pandemic: A Rapid Review and Synthesis of Public Health Recommendations. Public Health Rev 2022; 42:1604031. [PMID: 35140994 PMCID: PMC8802804 DOI: 10.3389/phrs.2021.1604031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/04/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives: Efforts to contain the COVID-19 pandemic should take into account worsening health inequities. While many public health experts have commented on inequities, no analysis has yet synthesized recommendations into a guideline for practitioners. The objective of this rapid review was to identify the areas of greatest concern and synthesize recommendations. Methods: We conducted a rapid systematic review (PROSPERO: CRD42020178131). We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials databases from December 1, 2019 to April 27, 2020. We included English language peer-reviewed commentaries, editorials, and opinion pieces that addressed the social determinants of health in the context of COVID-19. Results: 338 articles met our criteria. Authors represented 81 countries. Income, housing, mental health, age and occupation were the most discussed social determinants of health. We categorized recommendations into primordial, primary, secondary and tertiary prevention that spoke to the social determinants of COVID-19 and equity. Conclusion: These recommendations can assist efforts to contain COVID-19 and reduce health inequities during the pandemic. Using these recommendations, public health practitioners could support a more equitable pandemic response. Systematic Review Registration: PROSPERO, CRD42020178131.
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Affiliation(s)
- Chloe Brown
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katie Wilkins
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Tara Upshaw
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew David Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
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142
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Rojanaworarit C, Lambert DC, Conigliaro J, Kim EJ. Prevalence and risk characteristics of COVID-19 in outpatients: A cross-sectional study of New York-area clinics. J Med Life 2022; 14:645-650. [PMID: 35027966 PMCID: PMC8742885 DOI: 10.25122/jml-2021-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Outpatients can be at heightened risk of COVID-19 due to interaction between existing non-communicable diseases in outpatients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study measured the magnitude of COVID-19 prevalence and explored related risk characteristics among adult outpatients visiting medicine clinics within a New York state-based tertiary hospital system. Data were compiled from 63,476 adult patients visiting outpatient medicine clinics within a New York-area hospital system between March 1, 2020, and August 28, 2020. The outcome was a clinical diagnosis of COVID-19. Crude and adjusted prevalence ratios (PR) of a COVID-19 were analyzed using univariable and multivariable Poisson regression with robust standard errors. The prevalence of COVID-19 was higher among these outpatients (3.0%) than in the total population in New York State (2.2%) as of August 28, 2020. Multivariable analysis revealed adjusted prevalence ratios significantly greater than one for male sex (PR=1.10), age 40 to 64 compared to <40 (PR=1.19), and racial/ethnic minorities in comparison to White patients (Hispanic: PR=2.76; Black: PR=1.89; and Asian/others: PR=1.56). Nonetheless, factors including the advanced age of ≥65 compared to <40 (PR=0.69) and current smoking compared to non-smoking (PR=0.60) were related to significantly lower prevalence. Therefore, the prevalence of COVID-19 in outpatients was higher than that of the general population. The findings also enabled hypothesis generation that routine clinical measures comprising sex, age, race/ethnicity, and smoking were candidate risk characteristics of COVID-19 in outpatients to be further verified by designs capable of assessing temporal association.
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Affiliation(s)
- Chanapong Rojanaworarit
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA
| | - Douglas Charles Lambert
- Department of General Internal Medicine, Northwell Health, Great Neck, NY, USA.,Section of Obesity Medicine, Northwell Health, Great Neck, NY, USA
| | - Joseph Conigliaro
- Department of General Internal Medicine, Northwell Health, Great Neck, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eun Ji Kim
- Department of General Internal Medicine, Northwell Health, Great Neck, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Feinstein Institutes for Medical Research, Great Neck, NY, USA
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143
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Yang Y, Wang L, Liu J, Fu S, Zhou L, Wang Y. Obesity or increased body mass index and the risk of severe outcomes in patients with COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28499. [PMID: 35029905 PMCID: PMC8735775 DOI: 10.1097/md.0000000000028499] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To assess the effect of obesity or a high body mass index (BMI) on the risk of severe outcomes in patients with coronavirus disease 2019 (COVID-19). METHODS Studies on the relationship between BMI or obesity and COVID-19 since December 2019. The odds ratio (OR) and weighted mean difference (WMD) with their 95% confidence intervals (CIs) were used to assess the effect size. RESULTS BMI was significantly increased in COVID-19 patients with severe illness (WMD: 1.18; 95% CI: 0.42-1.93), who were admitted to an intensive care unit (ICU) (WMD: 1.46; 95% CI: 0.96-1.97), who required invasive mechanical ventilation (IMV) (WMD: 2.70, 95% CI: 1.05-4.35) and who died (WMD: 0.91, 95% CI: 0.02-1.80). In Western countries, obesity (BMI of ≥30 kg/m2) increased the risk of hospitalization (OR: 2.08; 95% CI: 1.22-3.54), admission to an ICU (OR: 1.54; 95% CI: 1.29-1.84), need for IMV (OR: 1.73, 95% CI: 1.38-2.17), and mortality (OR: 1.43; 95% CI: 1.17-1.74) of patients with COVID-19. In the Asian population, obesity (BMI of ≥28 kg/m2) increased the risk of severe illness (OR: 3.14; 95% CI: 1.83-5.38). Compared with patients with COVID-19 and a BMI of <25 kg/m2, those with a BMI of 25-30 kg/m2 and ≥30 kg/m2 had a higher risk of need for IMV (OR: 2.19, 95% CI: 1.30-3.69 and OR: 3.04; 95% CI: 1.76-5.28, respectively). The risk of ICU admission in patients with COVID-19 and a BMI of ≥30 kg/m2 was significantly higher than in those with a BMI of 25-30 kg/m2 (OR: 1.49; 95% CI: 1.00-2.21). CONCLUSION As BMI increased, the risks of hospitalization, ICU admission, and need for IMV increased, especially in COVID-19 patients with obesity. ETHICS AND DISSEMINATION This systematic review and meta-analysis does not require an ethics approval as it does not collect any primary data from patients.
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Affiliation(s)
- Yaxian Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Liting Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Jingfang Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Songbo Fu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, P.R. China
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Liyuan Zhou
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
| | - Yan Wang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China
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Whitaker HJ, Tsang RS, Byford R, Andrews NJ, Sherlock J, Pillai PS, Williams J, Button E, Campbell H, Sinnathamby M, Victor W, Anand S, Linley E, Hewson J, DArchangelo S, Otter AD, Ellis J, Hobbs RF, Howsam G, Zambon M, Ramsay M, Brown KE, de Lusignan S, Amirthalingam G, Bernal JL. Pfizer-BioNTech and Oxford AstraZeneca COVID-19 vaccine effectiveness and immune response among individuals in clinical risk groups. J Infect 2022; 84:675-683. [PMID: 34990709 PMCID: PMC8720678 DOI: 10.1016/j.jinf.2021.12.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 01/30/2023]
Abstract
Background COVID-19 vaccines approved in the UK are highly effective in general population cohorts, however, data on effectiveness amongst individuals with clinical conditions that place them at increased risk of severe disease are limited. Methods We used GP electronic health record data, sentinel virology swabbing and antibody testing within a cohort of 712 general practices across England to estimate vaccine antibody response and vaccine effectiveness against medically attended COVID-19 amongst individuals in clinical risk groups using cohort and test-negative case control designs. Findings There was no reduction in S-antibody positivity in most clinical risk groups, however reduced S-antibody positivity and response was significant in the immunosuppressed group. Reduced vaccine effectiveness against clinical disease was also noted in the immunosuppressed group; after a second dose, effectiveness was moderate (Pfizer: 59.6%, 95%CI 18.0–80.1%; AstraZeneca 60.0%, 95%CI -63.6–90.2%). Interpretation In most clinical risk groups, immune response to primary vaccination was maintained and high levels of vaccine effectiveness were seen. Reduced antibody response and vaccine effectiveness were seen after 1 dose of vaccine amongst a broad immunosuppressed group, and second dose vaccine effectiveness was moderate. These findings support maximising coverage in immunosuppressed individuals and the policy of prioritisation of this group for third doses.
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Affiliation(s)
- Heather J Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK; Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Praveen Sebastian Pillai
- Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Helen Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Sinnathamby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - William Victor
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency (formerly Public Health England)), Manchester M13 9WL, UK
| | - Jacqueline Hewson
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Silvia DArchangelo
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Ashley D Otter
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK; Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Richard Fd Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Gary Howsam
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Maria Zambon
- Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG; Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK.
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145
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Das P, Igoe M, Lenhart S, Luong L, Lanzas C, Lloyd AL, Odoi A. Geographic disparities and determinants of COVID-19 incidence risk in the greater St. Louis Area, Missouri (United States). PLoS One 2022; 17:e0274899. [PMID: 36170339 PMCID: PMC9518888 DOI: 10.1371/journal.pone.0274899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evidence seems to suggest that the risk of Coronavirus Disease 2019 (COVID-19) might vary across communities due to differences in population characteristics and movement patterns. However, little is known about these differences in the greater St Louis Area of Missouri and yet this information is useful for targeting control efforts. Therefore, the objectives of this study were to investigate (a) geographic disparities of COVID-19 risk and (b) associations between COVID-19 risk and socioeconomic, demographic, movement and chronic disease factors in the Greater St. Louis Area of Missouri, USA. METHODS Data on COVID-19 incidence and chronic disease hospitalizations were obtained from the Department of Health and Missouri Hospital Association, respectively. Socioeconomic and demographic data were obtained from the 2018 American Community Survey while population mobility data were obtained from the SafeGraph website. Choropleth maps were used to identify geographic disparities of COVID-19 risk and several sociodemographic and chronic disease factors at the ZIP Code Tabulation Area (ZCTA) spatial scale. Global negative binomial and local geographically weighted negative binomial models were used to investigate associations between ZCTA-level COVID-19 risk and socioeconomic, demographic and chronic disease factors. RESULTS There were geographic disparities found in COVID-19 risk. Risks tended to be higher in ZCTAs with high percentages of the population with a bachelor's degree (p<0.0001) and obesity hospitalizations (p<0.0001). Conversely, risks tended to be lower in ZCTAs with high percentages of the population working in agriculture (p<0.0001). However, the association between agricultural occupation and COVID-19 risk was modified by per capita between ZCTA visits. Areas that had both high per capita between ZCTA visits and high percentages of the population employed in agriculture had high COVID-19 risks. The strength of association between agricultural occupation and COVID-19 risk varied by geographic location. CONCLUSIONS Geographic disparities of COVID-19 risk exist in the St. Louis area and are associated with sociodemographic factors, population movements, and obesity hospitalization risks. The latter is particularly concerning due to the growing prevalence of obesity and the known immunological impairments among obese individuals. Therefore, future studies need to focus on improving our understanding of the relationships between COVID-19 vaccination efficacy, obesity and waning of immunity among obese individuals so as to better guide vaccination regimens and reduce disparities.
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Affiliation(s)
- Praachi Das
- Biomathematics Graduate Program and Department of Mathematics, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Morganne Igoe
- Department of Mathematics, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Suzanne Lenhart
- Department of Mathematics, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Lan Luong
- BJC Healthcare, St. Louis, Missouri, United States of America
| | - Cristina Lanzas
- Department of Population Health and Pathobiology and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Alun L. Lloyd
- Biomathematics Graduate Program and Department of Mathematics, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostics Sciences, University of Tennessee, Knoxville, Tennessee, United States of America
- * E-mail:
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Antonelli M, Penfold RS, Merino J, Sudre CH, Molteni E, Berry S, Canas LS, Graham MS, Klaser K, Modat M, Murray B, Kerfoot E, Chen L, Deng J, Österdahl MF, Cheetham NJ, Drew DA, Nguyen LH, Pujol JC, Hu C, Selvachandran S, Polidori L, May A, Wolf J, Chan AT, Hammers A, Duncan EL, Spector TD, Ourselin S, Steves CJ. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. THE LANCET. INFECTIOUS DISEASES 2022; 22:43-55. [PMID: 34480857 PMCID: PMC8409907 DOI: 10.1016/s1473-3099(21)00460-6] [Citation(s) in RCA: 451] [Impact Index Per Article: 225.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 vaccines show excellent efficacy in clinical trials and effectiveness in real-world data, but some people still become infected with SARS-CoV-2 after vaccination. This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness. METHODS This prospective, community-based, nested, case-control study used self-reported data (eg, on demographics, geographical location, health risk factors, and COVID-19 test results, symptoms, and vaccinations) from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile phone app. For the risk factor analysis, cases had received a first or second dose of a COVID-19 vaccine between Dec 8, 2020, and July 4, 2021; had either a positive COVID-19 test at least 14 days after their first vaccination (but before their second; cases 1) or a positive test at least 7 days after their second vaccination (cases 2); and had no positive test before vaccination. Two control groups were selected (who also had not tested positive for SARS-CoV-2 before vaccination): users reporting a negative test at least 14 days after their first vaccination but before their second (controls 1) and users reporting a negative test at least 7 days after their second vaccination (controls 2). Controls 1 and controls 2 were matched (1:1) with cases 1 and cases 2, respectively, by the date of the post-vaccination test, health-care worker status, and sex. In the disease profile analysis, we sub-selected participants from cases 1 and cases 2 who had used the app for at least 14 consecutive days after testing positive for SARS-CoV-2 (cases 3 and cases 4, respectively). Controls 3 and controls 4 were unvaccinated participants reporting a positive SARS-CoV-2 test who had used the app for at least 14 consecutive days after the test, and were matched (1:1) with cases 3 and 4, respectively, by the date of the positive test, health-care worker status, sex, body-mass index (BMI), and age. We used univariate logistic regression models (adjusted for age, BMI, and sex) to analyse the associations between risk factors and post-vaccination infection, and the associations of individual symptoms, overall disease duration, and disease severity with vaccination status. FINDINGS Between Dec 8, 2020, and July 4, 2021, 1 240 009 COVID Symptom Study app users reported a first vaccine dose, of whom 6030 (0·5%) subsequently tested positive for SARS-CoV-2 (cases 1), and 971 504 reported a second dose, of whom 2370 (0·2%) subsequently tested positive for SARS-CoV-2 (cases 2). In the risk factor analysis, frailty was associated with post-vaccination infection in older adults (≥60 years) after their first vaccine dose (odds ratio [OR] 1·93, 95% CI 1·50-2·48; p<0·0001), and individuals living in highly deprived areas had increased odds of post-vaccination infection following their first vaccine dose (OR 1·11, 95% CI 1·01-1·23; p=0·039). Individuals without obesity (BMI <30 kg/m2) had lower odds of infection following their first vaccine dose (OR 0·84, 95% CI 0·75-0·94; p=0·0030). For the disease profile analysis, 3825 users from cases 1 were included in cases 3 and 906 users from cases 2 were included in cases 4. Vaccination (compared with no vaccination) was associated with reduced odds of hospitalisation or having more than five symptoms in the first week of illness following the first or second dose, and long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals, and vaccinated participants were more likely to be completely asymptomatic, especially if they were 60 years or older. INTERPRETATION To minimise SARS-CoV-2 infection, at-risk populations must be targeted in efforts to boost vaccine effectiveness and infection control measures. Our findings might support caution around relaxing physical distancing and other personal protective measures in the post-vaccination era, particularly around frail older adults and individuals living in more deprived areas, even if these individuals are vaccinated, and might have implications for strategies such as booster vaccinations. FUNDING ZOE, the UK Government Department of Health and Social Care, the Wellcome Trust, the UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, the UK National Institute for Health Research, the UK Medical Research Council, the British Heart Foundation, and the Alzheimer's Society.
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Affiliation(s)
- Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rose S Penfold
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jordi Merino
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Programs in Metabolism, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Programs in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Medical Image Computing, University College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sarah Berry
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kerstin Klaser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc F Österdahl
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nathan J Cheetham
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College London and Guy's and St Thomas' PET Centre, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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147
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Chappell H, Patel R, Driessens C, Tarr AW, Irving WL, Tighe PJ, Jackson HJ, Harvey-Cowlishaw T, Mills L, Shaunak M, Gbesemete D, Leahy A, Lucas JS, Faust SN, de Graaf H. Immunocompromised children and young people are at no increased risk of severe COVID-19. J Infect 2022; 84:31-39. [PMID: 34785268 PMCID: PMC8590622 DOI: 10.1016/j.jinf.2021.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We aimed to prospectively describe the incidence and clinical spectrum of SARS-CoV-2 infection in immunocompromised paediatric patients in the UK. METHODS From March 2020 to 2021 weekly questionnaires were sent to immunocompromised paediatric patients or their parents. Information, including symptom presentation and SARS-CoV-2 PCR test results, was collected from 1527 participants from 46 hospitals. Cross-sectional serology was investigated in February and March 2021. RESULTS Until the end of September 2020, no cases were reported. From September 28th 2020 to March 2021 a total of 38 PCR-detected SARS-CoV-2 infections were reported. Of these, four children were admitted to hospital but none had acute severe COVID-19. Increasing age in association with immunodeficiency increased reporting of SARS-CoV-2 infection. Worsening of fever, cough, and sore throat were associated with participants reporting SARS-CoV-2 infection. Serology data included 452 unvaccinated participants. In those reporting prior positive SARS-CoV-2 PCR, there were detectable antibodies in 9 of 18 (50%). In those with no prior report of infection, antibodies were detected in 32 of 434 (7•4%). CONCLUSIONS This study shows SARS-CoV-2 infections have occurred in immunocompromised children and young people with no increased risk of severe disease. No children died.
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Affiliation(s)
- H Chappell
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
| | - R Patel
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - C Driessens
- NIHR Applied Research Collaboration Wessex, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - A W Tarr
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK; Wolfson Centre for Global Virus Research
| | - W L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK; Wolfson Centre for Global Virus Research
| | - P J Tighe
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - H J Jackson
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - T Harvey-Cowlishaw
- School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - L Mills
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
| | - M Shaunak
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
| | - D Gbesemete
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK
| | - A Leahy
- Paediatric Medicine, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - J S Lucas
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK; Paediatric Medicine, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - S N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK; Paediatric Medicine, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - H de Graaf
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK; Paediatric Medicine, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK.
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148
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Mensah AA, Lacy J, Stowe J, Seghezzo G, Sachdeva R, Simmons R, Bukasa A, O'Boyle S, Andrews N, Ramsay M, Campbell H, Brown K. Evaluation of disease severity during SARS-COV-2 reinfection, January 2020 to April 2021, England: an observational study. J Infect 2022; 84:542-550. [PMID: 35085659 PMCID: PMC8786677 DOI: 10.1016/j.jinf.2022.01.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 12/12/2022]
Abstract
Objective We aimed to look at the burden of disease caused by SARS-COV-2 reinfections and identified potential risk factors for disease severity. Methods We used national surveillance data to collect information on all SARS-CoV-2 primary infection and suspected reinfection cases between January 2020 until early May 2021. Reinfection cases were positive COVID-19 PCR or antigen test, 90 days after their first COVID-19 positive test. We collected information on case demographics, hospital and ICU admission, immunisation status and if individuals were at risk of complication for COVID-19. Results Deaths reported within 28 days of testing positive were 61% (95% confidence interval: 56% to 65%) lower in suspected COVID-19 reinfection than primary infection cases. In the unvaccinated cohort, reinfections were associated with 49% (37% to 58%) lower odds of hospital admission in cases aged 50 to 65 years in the population not identified at risk of complication for COVID-19, and 34% (17% to 48%) in those at risk. ICU admission at reinfection compared to primary infection decreased 76% (55% to 87%). Individuals at risk and those aged below 50 years, who received at least 1 dose of vaccine against COVID-19, were 62% (39% to 74%) and 58% (24% to 77%) less likely to get admitted to hospital at reinfection, respectively. Conclusion Prior SARS-CoV-2 infection was associated with lower odds of dying, and both prior infection and immunisation showed a protective effect against severe disease in selected populations. Older age, sex and underlying comorbidities appeared as principal risk factors for illness severity at reinfection. Funding PHE/UKHSA
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Affiliation(s)
- Anna A Mensah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Joanne Lacy
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | | | - Ruchira Sachdeva
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Ruth Simmons
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Antoaneta Bukasa
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Shennae O'Boyle
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK.
| | - Kevin Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
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149
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Surveillance of COVID-19 outbreaks in prisons in the US South: The role of economic distress in the communities surrounding prison facilities. J Clin Transl Sci 2022; 6:e101. [PMID: 36106130 PMCID: PMC9428667 DOI: 10.1017/cts.2022.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/12/2022] [Accepted: 07/21/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: The US South is the epicenter of the epidemic of mass incarceration. Prisons have experienced substantial challenges in preventing COVID-19. Incarcerated individuals and prison staff are at a high risk for infection due to minimal available preventive measures. Prisons are not closed systems and many staff come from communities in close proximity to the facility. Characteristics of the communities immediately surrounding prisons are an overlooked but critical factor to better understand the role prisons play in pandemics. Methods: We used facility-level COVID-19 data from the COVID Prison Project to identify the number of unique outbreaks between May 2019 and May 2020. We used a county-level composite indicator of economic distress (DCI score) to identify the environment surrounding each prison (2015–2019). We modeled the number of outbreaks to DCI scores using negative binomial regression, adjusting for race/ethnicity (African American and Latino/Hispanic), age (65 and older), and rurality level. Results: Our sample included 570 prisons in 368 counties across 13 Southern states. We found that score was positively and significantly associated with prison COVID-19 outbreaks (aRR, 1.012; p < 0.0001), and rurality was potentially a stronger surrogate measure of economic distress (aRR, 1.35; p, 0.02). Economic stability is a key precursor to physical health. Poorer communities have been disproportionately impacted by the pandemic, and we found that prisons located in these communities were more susceptible to recurring outbreaks. Prison-based disease prevention interventions should consider the impact that the outside world has on the health of incarcerated individuals.
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150
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Clift AK, von Ende A, Tan PS, Sallis HM, Lindson N, Coupland CAC, Munafò MR, Aveyard P, Hippisley-Cox J, Hopewell JC. Smoking and COVID-19 outcomes: an observational and Mendelian randomisation study using the UK Biobank cohort. Thorax 2022; 77:65-73. [PMID: 34580193 PMCID: PMC8483921 DOI: 10.1136/thoraxjnl-2021-217080] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Conflicting evidence has emerged regarding the relevance of smoking on risk of COVID-19 and its severity. METHODS We undertook large-scale observational and Mendelian randomisation (MR) analyses using UK Biobank. Most recent smoking status was determined from primary care records (70.8%) and UK Biobank questionnaire data (29.2%). COVID-19 outcomes were derived from Public Health England SARS-CoV-2 testing data, hospital admissions data, and death certificates (until 18 August 2020). Logistic regression was used to estimate associations between smoking status and confirmed SARS-CoV-2 infection, COVID-19-related hospitalisation, and COVID-19-related death. Inverse variance-weighted MR analyses using established genetic instruments for smoking initiation and smoking heaviness were undertaken (reported per SD increase). RESULTS There were 421 469 eligible participants, 1649 confirmed infections, 968 COVID-19-related hospitalisations and 444 COVID-19-related deaths. Compared with never-smokers, current smokers had higher risks of hospitalisation (OR 1.80, 95% CI 1.26 to 2.29) and mortality (smoking 1-9/day: OR 2.14, 95% CI 0.87 to 5.24; 10-19/day: OR 5.91, 95% CI 3.66 to 9.54; 20+/day: OR 6.11, 95% CI 3.59 to 10.42). In MR analyses of 281 105 White British participants, genetically predicted propensity to initiate smoking was associated with higher risks of infection (OR 1.45, 95% CI 1.10 to 1.91) and hospitalisation (OR 1.60, 95% CI 1.13 to 2.27). Genetically predicted higher number of cigarettes smoked per day was associated with higher risks of all outcomes (infection OR 2.51, 95% CI 1.20 to 5.24; hospitalisation OR 5.08, 95% CI 2.04 to 12.66; and death OR 10.02, 95% CI 2.53 to 39.72). INTERPRETATION Congruent results from two analytical approaches support a causal effect of smoking on risk of severe COVID-19.
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Affiliation(s)
- Ashley K Clift
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, UK
| | - Adam von Ende
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah M Sallis
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carol A C Coupland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jemma C Hopewell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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