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López-Peñalver RS, Cañas-Cañas R, Casaña-Mohedo J, Benavent-Cervera JV, Fernández-Garrido J, Juárez-Vela R, Pellín-Carcelén A, Gea-Caballero V, Andreu-Fernández V. Predictive potential of SARS-CoV-2 RNA concentration in wastewater to assess the dynamics of COVID-19 clinical outcomes and infections. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 886:163935. [PMID: 37164095 PMCID: PMC10164651 DOI: 10.1016/j.scitotenv.2023.163935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Abstract
Coronavirus disease 2019 - caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -, has triggered a worldwide pandemic resulting in 665 million infections and over 6.5 million deaths as of December 15, 2022. The development of different epidemiological tools have helped predict new outbreaks and assess the behavior of clinical variables in different health contexts. In this study, we aimed to monitor concentrations of SARS-CoV-2 in wastewater as a tool to predict the progression of clinical variables during Waves 3, 5, and 6 of the pandemic in the Spanish city of Xátiva from September 2020 to March 2022. We estimated SARS-CoV-2 RNA concentrations in 195 wastewater samples using the RT-PCR Diagnostic Panel validated by the Center for Disease Control and Prevention. We also compared the trends of several clinical variables (14-day cumulative incidence, positive cases, hospital cases and stays, critical cases and stays, primary care visits, and deaths) for each study wave against wastewater SARS-CoV-2 RNA concentrations using Pearson's product-moment correlations, a two-sided Mann-Whitney U test, and a cross-correlation analysis. We found strong correlations between SARS-CoV-2 concentrations with 14-day cumulative incidence and positive cases over time. Wastewater RNA concentrations showed strong correlations with these variables one and two weeks in advance. There were significant correlations with hospitalizations and critical care during Wave 3 and Wave 6; cross-correlations were stronger for hospitalization stays one week before during Wave 6. No association between vaccination percentages and wastewater viral concentrations was observed. Our findings support wastewater SARS-CoV-2 concentrations as a potential surveillance tool to anticipate infection and epidemiological data such as 14-day cumulative incidence, hospitalizations, and critical care stays. Public health authorities could use this epidemiological tool on a similar population as an aid for health care decision-making during an epidemic outbreak.
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Affiliation(s)
- Raimundo Seguí López-Peñalver
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain; Global Omnium, Valencia, Spain
| | | | - Jorge Casaña-Mohedo
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain; Faculty of Health Sciences, Universidad Católica de Valencia San Vicente Mártir, 46001, Valencia, Spain
| | | | - Julio Fernández-Garrido
- Consellería de Sanidad Universal y Salud Pública, Generalitat Valenciana, Department of Nursing, University of Valencia, 46001 Jaume Roig St, Valencia, Spain
| | - Raúl Juárez-Vela
- Faculty of Health Sciences, La Rioja University, 26006 Logroño, Spain
| | - Ana Pellín-Carcelén
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain
| | - Vicente Andreu-Fernández
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain; Biosanitary Research Institute, Valencian International University (VIU), 46002, Valencia, Spain.
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2
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Baldanti F, Ganguly NK, Wang G, Möckel M, O’Neill LA, Renz H, dos Santos Ferreira CE, Tateda K, Van Der Pol B. Choice of SARS-CoV-2 diagnostic test: challenges and key considerations for the future. Crit Rev Clin Lab Sci 2022; 59:445-459. [PMID: 35289222 PMCID: PMC8935452 DOI: 10.1080/10408363.2022.2045250] [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] [Indexed: 01/27/2023]
Abstract
A plethora of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tests are available, each with different performance specifications, detection methods, and targets. This narrative review aims to summarize the diagnostic technologies available and how they are best selected to tackle SARS-CoV-2 infection as the pandemic evolves. Seven key settings have been identified where diagnostic tests are being deployed: symptomatic individuals presenting for diagnostic testing and/or treatment of COVID-19 symptoms; asymptomatic individuals accessing healthcare for planned non-COVID-19-related reasons; patients needing to access emergency care (symptom status unknown); patients being discharged from healthcare following hospitalization for COVID-19; healthy individuals in both single event settings (e.g. airports, restaurants, hotels, concerts, and sporting events) and repeat access settings (e.g. workplaces, schools, and universities); and vaccinated individuals. While molecular diagnostics remain central to SARS-CoV-2 testing strategies, we have offered some discussion on the considerations for when other tools and technologies may be useful, when centralized/point-of-care testing is appropriate, and how the various additional diagnostics can be deployed in differently resourced settings. As the pandemic evolves, molecular testing remains important for definitive diagnosis, but increasingly widespread point-of-care testing is essential to the re-opening of society.
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Affiliation(s)
- Fausto Baldanti
- Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Guiqiang Wang
- The Center for Liver Diseases, Peking University First Hospital, Beijing, China
| | - Martin Möckel
- Charité – Universitätsmedizin, Berlin, Germany,CONTACT Martin Möckel Departments of Emergency Medicine and Chest Pain Units CVK/CCM, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Luke A. O’Neill
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH, Giessen, Germany,Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Barbara Van Der Pol
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Chen Y, Liu F, Lee LP. Quantitative and ultrasensitive in situ immunoassay technology for SARS-CoV-2 detection in saliva. SCIENCE ADVANCES 2022; 8:eabn3481. [PMID: 35613342 PMCID: PMC9132547 DOI: 10.1126/sciadv.abn3481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/11/2022] [Indexed: 05/26/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has become an immense global health crisis. However, the lack of efficient and sensitive on-site testing methods limits early detection for timely isolation and intervention. Here, we present a quantitative and ultrasensitive in situ immunoassay technology for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in saliva (QUIT SARS-CoV-2). Our nanoporous membrane resonator generates a rapid oscillating flow to purify and concentrate fully intact SARS-CoV-2 virus in saliva by 40-fold for in situ detection of viral antigens based on chemiluminescent immunoassay within 20 min. This method can not only achieve a detection sensitivity below 100 copies/ml of virus, comparable to the bench-top PCR equipment; it can also improve detection specificity via direct monitoring of viral loads. The integrated portable QUIT SARS-CoV-2 system, which enables rapid and accurate on-site viral screening with a high-throughput sample pooling strategy, can be performed in primary care settings and substantially improve the detection and prevention of COVID-19.
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Affiliation(s)
- Yuchao Chen
- WellSIM Biomedical Technologies Inc., 626 Bancroft Way, Suite A, Berkeley, CA, USA
| | - Fei Liu
- WellSIM Biomedical Technologies Inc., 626 Bancroft Way, Suite A, Berkeley, CA, USA
| | - Luke P. Lee
- Harvard Medical School, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Bioengineering and Department of Electrical Engineering and Computer Science, University of California at Berkeley, Berkeley, CA, USA
- Institute of Quantum Biophysics, Department of Biophysics, Sungkyunkwan University, Suwon, Gyeonggi-do, Korea
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4
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Radišić V, Ždraljević M, Perić S, Mladenović B, Ralić B, Jovanović DR, Berisavac I. Is there a difference between GBS triggered by COVID-19 and those of other origins? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:54. [PMID: 35601875 PMCID: PMC9107584 DOI: 10.1186/s41983-022-00486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/22/2022] [Indexed: 01/08/2023] Open
Abstract
Background Since the outbreak of the coronavirus disease 2019 (COVID-19), an increasing number of Guillain–Barré syndrome (GBS) cases following the infection has been reported. The aim of our study was to detect patients with GBS treated in our hospital over a 1-year period and to compare the characteristics and outcomes of those triggered by COVID-19 with the rest of GBS patients. Our prospective study included 29 patients who were diagnosed with GBS from March 2020 to March 2021. Based on the preceding event, patients were stratified as post-COVID-19 and non-COVID-19. The GBS disability scale (GDS) was used to assess functional disability. Results We identified 10 (34.5%) patients with post-COVID-19 GBS and 19 (65.5%) patients with non-COVID-19 GBS. The median time from the preceding event to the symptoms onset was longer in post-COVID-19 than in non-COVID-19 GBS patients (p = 0.04). However, the time from the symptom onset to the nadir did not differ (p = 0.12). GDS at admission, as well as at nadir, did not differ between these two groups. The level of proteinorrachia was higher in post-COVID-19 GBS patients (p = 0.035). The most frequent subtype of GBS in both groups was acute inflammatory demyelinating polyneuropathy (AIDP). GDS score at discharge (p = 0.56) did not differ between two study groups. Conclusions There was no difference in clinical and electrophysiological features, disease course, and outcome in post-COVID-19 compared with non-COVID-19 GBS patients.
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5
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De R, Dutta S. Role of the Microbiome in the Pathogenesis of COVID-19. Front Cell Infect Microbiol 2022; 12:736397. [PMID: 35433495 PMCID: PMC9009446 DOI: 10.3389/fcimb.2022.736397] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/28/2022] [Indexed: 12/12/2022] Open
Abstract
The ongoing pandemic coronavirus disease COVID-19 is caused by the highly contagious single-stranded RNA virus, SARS-coronavirus 2 (SARS-CoV-2), which has a high rate of evolution like other RNA viruses. The first genome sequences of SARS-CoV-2 were available in early 2020. Subsequent whole-genome sequencing revealed that the virus had accumulated several mutations in genes associated with viral replication and pathogenesis. These variants showed enhanced transmissibility and infectivity. Soon after the first outbreak due to the wild-type strain in December 2019, a genetic variant D614G emerged in late January to early February 2020 and became the dominant genotype worldwide. Thereafter, several variants emerged, which were found to harbor mutations in essential viral genes encoding proteins that could act as drug and vaccine targets. Numerous vaccines have been successfully developed to assuage the burden of COVID-19. These have different rates of efficacy, including, although rarely, a number of vaccinated individuals exhibiting side effects like thrombosis. However, the recent emergence of the Britain strain with 70% more transmissibility and South African variants with higher resistance to vaccines at a time when several countries have approved these for mass immunization has raised tremendous concern regarding the long-lasting impact of currently available prophylaxis. Apart from studies addressing the pathophysiology, pathogenesis, and therapeutic targets of SARS-CoV-2, analysis of the gut, oral, nasopharyngeal, and lung microbiome dysbiosis has also been undertaken to find a link between the microbiome and the pathogenesis of COVID-19. Therefore, in the current scenario of skepticism regarding vaccine efficacy and challenges over the direct effects of currently available drugs looming large, investigation of alternative therapeutic avenues based on the microbiome can be a rewarding finding. This review presents the currently available understanding of microbiome dysbiosis and its association with cause and consequence of COVID-19. Taking cues from other inflammatory diseases, we propose a hypothesis of how the microbiome may be influencing homeostasis, pro-inflammatory condition, and the onset of inflammation. This accentuates the importance of a healthy microbiome as a protective element to prevent the onset of COVID-19. Finally, the review attempts to identify areas where the application of microbiome research can help in reducing the burden of the disease.
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Affiliation(s)
- Rituparna De
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkota, India
- Division of Immunology, National Institute of Cholera and Enteric Diseases, Kolkota, India
| | - Shanta Dutta
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkota, India
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Kotwa JD, Jamal AJ, Mbareche H, Yip L, Aftanas P, Barati S, Bell NG, Bryce E, Coomes E, Crowl G, Duchaine C, Faheem A, Farooqi L, Hiebert R, Katz K, Khan S, Kozak R, Li AX, Mistry HP, Mozafarihashjin M, Nasir JA, Nirmalarajah K, Panousis EM, Paterson A, Plenderleith S, Powis J, Prost K, Schryer R, Taylor M, Veillette M, Wong T, Zoe Zhong X, McArthur AG, McGeer AJ, Mubareka S. Surface and Air Contamination With Severe Acute Respiratory Syndrome Coronavirus 2 From Hospitalized Coronavirus Disease 2019 Patients in Toronto, Canada, March-May 2020. J Infect Dis 2022; 225:768-776. [PMID: 34850051 DOI: 10.1101/2021.05.17.21257122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/24/2021] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND We determined the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in air and on surfaces in rooms of patients hospitalized with coronavirus disease 2019 (COVID-19) and investigated patient characteristics associated with SARS-CoV-2 environmental contamination. METHODS Nasopharyngeal swabs, surface, and air samples were collected from the rooms of 78 inpatients with COVID-19 at 6 acute care hospitals in Toronto from March to May 2020. Samples were tested for SARS-CoV-2 ribonucleic acid (RNA), cultured to determine potential infectivity, and whole viral genomes were sequenced. Association between patient factors and detection of SARS-CoV-2 RNA in surface samples were investigated. RESULTS Severe acute respiratory syndrome coronavirus 2 RNA was detected from surfaces (125 of 474 samples; 42 of 78 patients) and air (3 of 146 samples; 3 of 45 patients); 17% (6 of 36) of surface samples from 3 patients yielded viable virus. Viral sequences from nasopharyngeal and surface samples clustered by patient. Multivariable analysis indicated hypoxia at admission, polymerase chain reaction-positive nasopharyngeal swab (cycle threshold of ≤30) on or after surface sampling date, higher Charlson comorbidity score, and shorter time from onset of illness to sampling date were significantly associated with detection of SARS-CoV-2 RNA in surface samples. CONCLUSIONS The infrequent recovery of infectious SARS-CoV-2 virus from the environment suggests that the risk to healthcare workers from air and near-patient surfaces in acute care hospital wards is likely limited.
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Affiliation(s)
| | | | | | - Lily Yip
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | | | | | - Elizabeth Bryce
- Division of Medical Microbiology and Infection Prevention, Vancouver Coastal Health, Vancouver, British Colombia, Canada
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Colombia, Canada
| | - Eric Coomes
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Caroline Duchaine
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université de Laval, Québec City, Québec, Canada
- Départment de Biochimie, de Microbiologie et de Bio-Informatique, Faculté des Sciences et de Génie, Université de Laval, Québec City, Québec, Canada
| | - Amna Faheem
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Ryan Hiebert
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Saman Khan
- Sinai Health System, Toronto, Ontario, Canada
| | - Robert Kozak
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Angel X Li
- Sinai Health System, Toronto, Ontario, Canada
| | | | | | - Jalees A Nasir
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- Department of Biochemistry and Biomedical Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Emily M Panousis
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- Department of Biochemistry and Biomedical Science, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | - Karren Prost
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Renée Schryer
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Marc Veillette
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université de Laval, Québec City, Québec, Canada
| | - Titus Wong
- Division of Medical Microbiology and Infection Prevention, Vancouver Coastal Health, Vancouver, British Colombia, Canada
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Colombia, Canada
| | | | - Andrew G McArthur
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- Department of Biochemistry and Biomedical Science, McMaster University, Hamilton, Ontario, Canada
| | - Allison J McGeer
- Sinai Health System, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samira Mubareka
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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7
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Di Gioia CC, Artusi N, Xotta G, Bonsano M, Sisto UG, Tecchiolli M, Orso D, Cominotto F, Amore G, Meduri S, Copetti R. Lung ultrasound in ruling out COVID-19 pneumonia in the ED: a multicentre prospective sensitivity study. Emerg Med J 2022; 39:199-205. [PMID: 34937709 PMCID: PMC8704061 DOI: 10.1136/emermed-2020-210973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/13/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Early diagnosis of COVID-19 has a crucial role in confining the spread among the population. Lung ultrasound (LUS) was included in the diagnostic pathway for its high sensitivity, low costs, non-invasiveness and safety. We aimed to test the sensitivity of LUS to rule out COVID-19 pneumonia (COVIDp) in a population of patients with suggestive symptoms. METHODS Multicentre prospective observational study in three EDs in Northeastern Italy during the first COVID-19 outbreak. A convenience sample of 235 patients admitted to the ED for symptoms suggestive COVIDp (fever, cough or shortness of breath) from 17 March 2020 to 26 April 2020 was enrolled. All patients underwent a sequential assessment involving: clinical examination, LUS, CXR and arterial blood gas. The index test under investigation was a standardised protocol of LUS compared with a pragmatic composite reference standard constituted by: clinical gestalt, real-time PCR test, radiological and blood gas results. Of the 235 enrolled patients, 90 were diagnosed with COVIDp according to the reference standard. RESULTS Among the patients with suspected COVIDp, the prevalence of SARS-CoV-2 was 38.3%. The sensitivity of LUS for diagnosing COVIDp was 85.6% (95% CI 76.6% to 92.1%); the specificity was 91.7% (95% CI 86.0% to 95.7%). The positive predictive value and the negative predictive value were 86.5% (95%CI 78.8% to 91.7%) and 91.1% (95% CI 86.1% to 94.4%) respectively. The diagnostic accuracy of LUS for COVIDp was 89.4% (95% CI 84.7% to 93.0%). The positive likelihood ratio was 10.3 (95% CI 6.0 to 17.9), and the negative likelihood ratio was 0.16 (95% CI 0.1 to 0.3). CONCLUSION In a population with high SARS-CoV-2 prevalence, LUS has a high sensitivity (and negative predictive value) enough to rule out COVIDp in patients with suggestive symptoms. The role of LUS in diagnosing patients with COVIDp is perhaps even more promising. Nevertheless, further research with adequately powered studies is needed. TRIAL REGISTRATION NUMBER NCT04370275.
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Affiliation(s)
- Carmine Cristiano Di Gioia
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Nicola Artusi
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Giovanni Xotta
- Department of Emergency Medicine, University of Verona, Verona, Veneto, Italy
| | - Marco Bonsano
- Department of Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Ugo Giulio Sisto
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Marzia Tecchiolli
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Friuli-Venezia Giulia, Italy
| | - Franco Cominotto
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Giulia Amore
- Department of Emergency Medicine, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
| | - Stefano Meduri
- Department of Radiology, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
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8
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Science M, Bolotin S, Silverman M, Nadarajah J, Maguire B, Parekh RS, McGeer A, Schwartz KL, Alexander L, Allen U, Ariyarajah A, Castellani L, Cohn RD, Downing M, Katz K, Kazmi K, Leis JA, Liu D, Pernica JM, Schneiderman JE, Sumaida M, Campigotto A. SARS-CoV-2 antibodies in Ontario health care workers during and after the first wave of the pandemic: a cohort study. CMAJ Open 2021; 9:E929-E939. [PMID: 34642255 PMCID: PMC8513603 DOI: 10.9778/cmajo.20210044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Health care workers have a critical role in the pandemic response to COVID-19 and may be at increased risk of infection. The objective of this study was to assess the seroprevalence of SARS-CoV-2 immunoglobulin G (IgG) antibodies among health care workers during and after the first wave of the pandemic. METHODS We conducted a prospective multicentre cohort study involving health care workers in Ontario, Canada, to detect IgG antibodies against SARS-CoV-2. Blood samples and self-reported questionnaires were obtained at enrolment, at 6 weeks and at 12 weeks. A community hospital, tertiary care pediatric hospital and a combined adult-pediatric academic health centre enrolled participants from Apr. 1 to Nov. 13, 2020. Predictors of seropositivity were evaluated using a multivariable logistic regression, adjusted for clustering by hospital site. RESULTS Among the 1062 health care workers participating, the median age was 40 years, and 834 (78.5%) were female. Overall, 57 (5.4%) were seropositive at any time point (2.5% when participants with prior infection confirmed by polymerase chain reaction testing were excluded). Seroprevalence was higher among those who had a known unprotected exposure to a patient with COVID-19 (p < 0.001) and those who had been contacted by public health because of a nonhospital exposure (p = 0.003). Providing direct care to patients with COVID-19 or working on a unit with a COVID-19 outbreak was not associated with higher seroprevalence. In multivariable logistic regression, presence of symptomatic contacts in the household was the strongest predictor of seropositivity (adjusted odds ratio 7.15, 95% confidence interval 5.42-9.41). INTERPRETATION Health care workers exposed to household risk factors were more likely to be seropositive than those not exposed, highlighting the need to emphasize the importance of public health measures both inside and outside of the hospital.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont.
| | - Shelly Bolotin
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Michael Silverman
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jeya Nadarajah
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Bryan Maguire
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Rulan S Parekh
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Allison McGeer
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kevin L Schwartz
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Laura Alexander
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Upton Allen
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Archchun Ariyarajah
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Lucas Castellani
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Ronald D Cohn
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Mark Downing
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kevin Katz
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Kescha Kazmi
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jerome A Leis
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Derek Liu
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jeffrey M Pernica
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Jane E Schneiderman
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Maya Sumaida
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont
| | - Aaron Campigotto
- Division of Infectious Diseases (Science, Allen, Kazmi, Liu, Sumaida), Department of Paediatrics, The Hospital for Sick Children; Public Health Ontario (Science, Bolotin, Schwartz); Dalla Lana School of Public Health (Bolotin, Ariyarajah), University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Silverman), Department of Medicine and Department of Epidemiology and Biostatistics (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Nadarajah), Markham Stouffville Hospital, Markham, Ont.; Department of Medicine (Nadarajah, Parekh, Leis), University of Toronto; SickKids Research Institute (Maguire, Schneiderman), The Hospital for Sick Children; Division of Nephrology (Parekh), Department of Pediatrics, The Hospital for Sick Children and University of Toronto; Department of Laboratory Medicine and Pathobiology (McGeer, Katz, Campigotto), University of Toronto; Lunenfeld-Tanenbaum Research Institute (McGeer), Sinai Health System, Toronto; Division of Infectious Diseases (Schwartz, Downing), Department of Medicine, Unity Health Toronto; Occupational Health and Safety (Alexander), The Hospital for Sick Children, Toronto, Ont.; Division of Infection Prevention and Control (Castellani), Sault Area Hospital, Sudbury, Ont.; Departments of Paediatrics and Molecular Genetics (Cohn), University of Toronto; Department of Paediatrics (Cohn), The Hospital for Sick Children; Division of Infection Prevention and Control (Katz), North York General Hospital; Division of Infectious Diseases (Leis), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Pediatrics (Pernica), McMaster University, Hamilton, Ont.; Division of Microbiology (Campigotto), Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ont.
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9
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Kunjumon B, Wachtel EV, Lumba R, Quan M, Remon J, Louie M, Verma S, Moffat MA, Kouba I, Bennett TA, Mejia CMD, Mally PV, Lin X, Hanna N. Breast Milk and Breastfeeding of Infants Born to SARS-CoV-2 Positive Mothers: A Prospective Observational Cohort Study. Am J Perinatol 2021; 38:1209-1216. [PMID: 34182576 DOI: 10.1055/s-0041-1731451] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE There are limited published data on the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus from mothers to newborns through breastfeeding or from breast milk. The World Health Organization released guidelines encouraging mothers with suspected or confirmed COVID-19 to breastfeed as the benefits of breastfeeding outweighs the possible risk of transmission. The objective of this study was to determine if SARS-CoV-2 was present in the breast milk of lactating mothers who had a positive SARS-CoV-2 nasopharyngeal swab test prior to delivery, and the clinical outcomes for their newborns. STUDY DESIGN This was a single-center, observational, prospective cohort study. Maternal-newborn dyads that delivered at New York University Langone Hospital Brooklyn with confirmed maternal SARS-CoV-2 positive screen test at the time of admission were recruited for the study. Breast milk samples were collected during postpartum hospitalization and tested for the presence of SARS-CoV-2 genes N1 and N2 by two-step reverse transcription polymerase chain reaction. Additionally, the clinical characteristics of the maternal newborn dyad, results of nasopharyngeal SARS-CoV-2 testing, and neonatal follow-up data were collected. RESULTS A total of 19 mothers were included in the study and their infants who were all fed breast milk. Breast milk samples from 18 mothers tested negative for SARS-CoV-2, and 1 was positive for SARS-CoV-2 RNA. The infant who ingested the breast milk that tested positive had a negative nasopharyngeal test for SARS-CoV-2, and had a benign clinical course. There was no evidence of significant clinical infection during the hospital stay or from outpatient neonatal follow-up data for all the infants included in this study. CONCLUSION In a small cohort of SARS-CoV-2 positive lactating mothers giving birth at our institution, most of their breast milk samples (95%) contained no detectable virus, and there was no evidence of COVID-19 infection in their breast milk-fed neonates. KEY POINTS · Breast milk may rarely contain detectable SARS-CoV-2 RNA and was not detected in asymptomatic mothers.. · Breast milk with detectable SARS-CoV-2 RNA from a symptomatic mother had no clinical significance for her infant.. · Breast feeding with appropriate infection control instructions appears to be safe in mother with COVID infection..
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Affiliation(s)
- Bgee Kunjumon
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Elena V Wachtel
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Rishi Lumba
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Michelle Quan
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Juan Remon
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Moi Louie
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Sourabh Verma
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Michael A Moffat
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Insaf Kouba
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York City, New York
| | - Terri-Ann Bennett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York City, New York.,Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York City, New York
| | - Claudia Manzano De Mejia
- Department of Pediatrics, New York University Long Island School of Medicine, New York City, New York
| | - Pradeep V Mally
- Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Xinhua Lin
- Department of Pediatrics, New York University Long Island School of Medicine, New York City, New York
| | - Nazeeh Hanna
- Department of Pediatrics, New York University Long Island School of Medicine, New York City, New York
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10
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Zaffina S, Lanteri P, Gilardi F, Garbarino S, Santoro A, Vinci MR, Carsetti R, Scorpecci A, Raponi M, Magnavita N, Camisa V. Recurrence, Reactivation, or Inflammatory Rebound of SARS-CoV-2 Infection With Acute Vestibular Symptoms: A Case Report and Revision of Literature. Front Hum Neurosci 2021; 15:666468. [PMID: 34456694 PMCID: PMC8385757 DOI: 10.3389/fnhum.2021.666468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases.
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Affiliation(s)
- Salvatore Zaffina
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Lanteri
- Department of Diagnostics and Applied Technology, Neurophysiopathology Centre, Fondazione IRCCS, Istituto Neurologico “Carlo Besta”, Milan, Italy
| | | | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Genoa, Italy
| | - Annapaola Santoro
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Rosaria Vinci
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Carsetti
- Department of Laboratories, Unit of Diagnostic Immunology and Immunology Research Area, Unit of B-Cell Pathophysiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Scorpecci
- Audiology and Otosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Nicola Magnavita
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Camisa
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Iglesias Gómez R, Méndez R, Palanques-Pastor T, Ballesta-López O, Borrás Almenar C, Megías Vericat JE, López-Briz E, Font-Noguera I, Menéndez Villanueva R, Román Iborra JA, Poveda Andrés JL. Baricitinib against severe COVID-19: effectiveness and safety in hospitalised pretreated patients. Eur J Hosp Pharm 2021; 29:e41-e45. [PMID: 34321249 PMCID: PMC8326024 DOI: 10.1136/ejhpharm-2021-002741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/05/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To analyse the effectiveness and safety of baricitinib for severe COVID-19 in cytokine storm syndrome based on its potential role as an anti-inflammatory immunomodulator and inhibitor of viral endocytosis. Methods This was an observational retrospective study of hospitalised patients treated with baricitinib for severe COVID-19. Outcomes were clinical improvement on an ordinal scale of 1–8 on day 1 of baricitinib compared with day 14 (where 8=death and 1=not hospitalised with no limitations of activities), overall survival, time to recovery since baricitinib treatment started (days until hospital discharge) and laboratory parameters related to COVID-19 poor prognosis. Adverse events related to baricitinib during the admission period were also reported. Results Forty-three patients (70% men, mean age 70 years (IQR 54–79)) treated with baricitinib daily for 6 days (IQR 5–7) were included. Thirty-six patients were treated with corticosteroids (84%). Clinical improvement was 3 points (IQR 1–4) in patients on an ordinal scale of 4–6, overall survival was 100% at day 30 and day 60 with a mean time to recovery of 12 days (IQR 9–25) from start of baricitinib treatment. No adverse events of interest were found and all poor prognosis risk factors improved at day 14: interleukin-6, C-reactive protein, ferritin, lymphocytes, platelets and D-dimers. Conclusions Patients treated with baricitinib for severe COVID-19 showed improvements in clinical and analytical values without relevant adverse events and 100% overall survival. Clinical randomised trials are needed to confirm the clinical benefit of baricitinib.
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Affiliation(s)
| | - Raúl Méndez
- Pneumology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | | | - Eduardo López-Briz
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isabel Font-Noguera
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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12
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Salido RA, Cantú VJ, Clark AE, Leibel SL, Foroughishafiei A, Saha A, Hakim A, Nouri A, Lastrella AL, Castro-Martínez A, Plascencia A, Kapadia B, Xia B, Ruiz C, Marotz CA, Maunder D, Lawrence ES, Smoot EW, Eisner E, Crescini ES, Kohn L, Vargas LF, Chacón M, Betty M, Machnicki M, Wu MY, Baer NA, Belda-Ferre P, Hoff PD, Seaver P, Ostrander RT, Tsai R, Sathe S, Aigner S, Morgan SC, Ngo TT, Barber T, Cheung W, Carlin AF, Yeo GW, Laurent LC, Fielding-Miller R, Knight R. Comparison of heat-inactivated and infectious SARS-CoV-2 across indoor surface materials shows comparable RT-qPCR viral signal intensity and persistence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2021:2021.07.16.452756. [PMID: 34312621 PMCID: PMC8312891 DOI: 10.1101/2021.07.16.452756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Environmental monitoring in public spaces can be used to identify surfaces contaminated by persons with COVID-19 and inform appropriate infection mitigation responses. Research groups have reported detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on surfaces days or weeks after the virus has been deposited, making it difficult to estimate when an infected individual may have shed virus onto a SARS-CoV-2 positive surface, which in turn complicates the process of establishing effective quarantine measures. In this study, we determined that reverse transcription-quantitative polymerase chain reaction (RT-qPCR) detection of viral RNA from heat-inactivated particles experiences minimal decay over seven days of monitoring on eight out of nine surfaces tested. The properties of the studied surfaces result in RT-qPCR signatures that can be segregated into two material categories, rough and smooth, where smooth surfaces have a lower limit of detection. RT-qPCR signal intensity (average quantification cycle (Cq)) can be correlated to surface viral load using only one linear regression model per material category. The same experiment was performed with infectious viral particles on one surface from each category, with essentially identical results. The stability of RT-qPCR viral signal demonstrates the need to clean monitored surfaces after sampling to establish temporal resolution. Additionally, these findings can be used to minimize the number of materials and time points tested and allow for the use of heat-inactivated viral particles when optimizing environmental monitoring methods.
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Affiliation(s)
- Rodolfo A Salido
- These authors contributed equally
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Victor J Cantú
- These authors contributed equally
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Alex E Clark
- Division of Infectious Diseases and Global Public Health, Department of Medicine; University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - Sandra L Leibel
- Department of Pediatrics, University of California San Diego, La Jolla, CA
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
| | - Anahid Foroughishafiei
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Anushka Saha
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Abbas Hakim
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Alhakam Nouri
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Alma L Lastrella
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Anelizze Castro-Martínez
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Ashley Plascencia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Bhavika Kapadia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Bing Xia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Christopher Ruiz
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Clarisse A Marotz
- Department of Pediatrics, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Daniel Maunder
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Elijah S Lawrence
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Elizabeth W Smoot
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Emily Eisner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Evelyn S Crescini
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Laura Kohn
- Herbert Wertheim School of Public Health, University of California, San Diego 9500 Gilman Drive, La Jolla, CA 92093
| | - Lizbeth Franco Vargas
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Marisol Chacón
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Maryann Betty
- Department of Pediatrics, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
- Rady Children's Hospital, San Diego, CA
| | - Michal Machnicki
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Min Yi Wu
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Nathan A Baer
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Pedro Belda-Ferre
- Department of Pediatrics, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Peter De Hoff
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, USA
| | - Phoebe Seaver
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - R Tyler Ostrander
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Rebecca Tsai
- Department of Pediatrics, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Shashank Sathe
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
- Dept of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA
| | - Stefan Aigner
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
- Dept of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA
| | - Sydney C Morgan
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, USA
| | - Toan T Ngo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Tom Barber
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
| | - Willi Cheung
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA
- San Diego State University, San Diego, CA
| | - Aaron F Carlin
- Division of Infectious Diseases and Global Public Health, Department of Medicine; University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - Gene W Yeo
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Dept of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA
| | - Louise C Laurent
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, USA
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health, University of California, San Diego 9500 Gilman Drive, La Jolla, CA 92093
- Co-corresponding authors
| | - Rob Knight
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA
- Co-corresponding authors
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13
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Landry SA, Barr JJ, MacDonald MI, Subedi D, Mansfield D, Hamilton GS, Edwards BA, Joosten SA. Viable virus aerosol propagation by positive airway pressure circuit leak and mitigation with a ventilated patient hood. Eur Respir J 2021; 57:13993003.03666-2020. [PMID: 33303543 DOI: 10.1183/13993003.03666-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/24/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a major feature of the COVID-19 pandemic. Evidence suggests patients can auto-emit aerosols containing viable viruses; these aerosols could be further propagated when patients undergo certain treatments, including continuous positive airway pressure (PAP) therapy. Our aim was to assess 1) the degree of viable virus propagated from PAP circuit mask leak and 2) the efficacy of a ventilated plastic canopy to mitigate virus propagation. METHODS Bacteriophage phiX174 (108 copies·mL-1) was nebulised into a custom PAP circuit. Mask leak was systematically varied at the mask interface. Plates containing Escherichia coli host quantified viable virus (via plaque forming unit) settling on surfaces around the room. The efficacy of a low-cost ventilated headboard created from a tarpaulin hood and a high-efficiency particulate air (HEPA) filter was tested. RESULTS Mask leak was associated with virus contamination in a dose-dependent manner (χ2=58.24, df=4, p<0.001). Moderate mask leak (≥21 L·min-1) was associated with virus counts equivalent to using PAP with a vented mask. The highest frequency of viruses was detected on surfaces <1 m away; however, viable viruses were recorded up to 3.86 m from the source. A plastic hood with HEPA filtration significantly reduced viable viruses on all plates. HEPA exchange rates ≥170 m3·h-1 eradicated all evidence of virus contamination. CONCLUSIONS Mask leak from PAP may be a major source of environmental contamination and nosocomial spread of infectious respiratory diseases. Subclinical mask leak levels should be treated as an infectious risk. Low-cost patient hoods with HEPA filtration are an effective countermeasure.
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Affiliation(s)
- Shane A Landry
- Dept of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Australia
| | - Jeremy J Barr
- School of Biological Sciences, Monash University, Clayton, Australia
| | | | - Dinesh Subedi
- School of Biological Sciences, Monash University, Clayton, Australia
| | - Darren Mansfield
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Monash Partners - Epworth, Victoria, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Monash Partners - Epworth, Victoria, Australia
| | - Bradley A Edwards
- Dept of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Monash Partners - Epworth, Victoria, Australia
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14
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Tang X, Musa SS, Zhao S, He D. Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review. Front Public Health 2021; 9:663045. [PMID: 34178920 PMCID: PMC8226004 DOI: 10.3389/fpubh.2021.663045] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022] Open
Abstract
As the pandemic continues, individuals with re-detectable positive (RP) SARS-CoV-2 viral RNA among recovered COVID-19 patients have raised public health concerns. It is imperative to investigate whether the cases with re-detectable positive (RP) SARS-CoV-2 might cause severe infection to the vulnerable population. In this work, we conducted a systematic review of recent literature to investigate reactivation and reinfection among the discharged COVID-19 patients that are found positive again. Our study, consisting more than a total of 113,715 patients, indicates that the RP-SARS-CoV-2 scenario occurs plausibly due to reactivation, reinfection, viral shedding, or testing errors. Nonetheless, we observe that previously infected individuals have significantly lower risk of being infected for the second time, indicating that reactivation or reinfection of SARS-CoV-2 likely have relatively less impact in the general population than the primary infection.
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Affiliation(s)
- Xiujuan Tang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Salihu S Musa
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China.,Department of Mathematics, Kano University of Science and Technology, Wudil, Nigeria
| | - Shi Zhao
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China
| | - Daihai He
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China
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15
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Mardian Y, Kosasih H, Karyana M, Neal A, Lau CY. Review of Current COVID-19 Diagnostics and Opportunities for Further Development. Front Med (Lausanne) 2021; 8:615099. [PMID: 34026773 PMCID: PMC8138031 DOI: 10.3389/fmed.2021.615099] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a critical role in addressing the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Rapid and accurate diagnostic tests are imperative for identifying and managing infected individuals, contact tracing, epidemiologic characterization, and public health decision making. Laboratory testing may be performed based on symptomatic presentation or for screening of asymptomatic people. Confirmation of SARS-CoV-2 infection is typically by nucleic acid amplification tests (NAAT), which requires specialized equipment and training and may be particularly challenging in resource-limited settings. NAAT may give false-negative results due to timing of sample collection relative to infection, improper sampling of respiratory specimens, inadequate preservation of samples, and technical limitations; false-positives may occur due to technical errors, particularly contamination during the manual real-time polymerase chain reaction (RT-PCR) process. Thus, clinical presentation, contact history and contemporary phyloepidemiology must be considered when interpreting results. Several sample-to-answer platforms, including high-throughput systems and Point of Care (PoC) assays, have been developed to increase testing capacity and decrease technical errors. Alternatives to RT-PCR assay, such as other RNA detection methods and antigen tests may be appropriate for certain situations, such as resource-limited settings. While sequencing is important to monitor on-going evolution of the SARS-CoV-2 genome, antibody assays are useful for epidemiologic purposes. The ever-expanding assortment of tests, with varying clinical utility, performance requirements, and limitations, merits comparative evaluation. We herein provide a comprehensive review of currently available COVID-19 diagnostics, exploring their pros and cons as well as appropriate indications. Strategies to further optimize safety, speed, and ease of SARS-CoV-2 testing without compromising accuracy are suggested. Access to scalable diagnostic tools and continued technologic advances, including machine learning and smartphone integration, will facilitate control of the current pandemic as well as preparedness for the next one.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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16
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Chen L, Zhang G, Liu L, Li Z. Emerging biosensing technologies for improved diagnostics of COVID-19 and future pandemics. Talanta 2021; 225:121986. [PMID: 33592734 PMCID: PMC7733602 DOI: 10.1016/j.talanta.2020.121986] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/25/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
Diagnostic tools play significant roles in the fight against COVID-19 and other pandemics. Existing tests, such as RT-qPCR, have limitations including long assay time, low throughput, inadequate sensitivity, and suboptimal portability. Emerging biosensing technologies hold the promise to develop tests that are rapid, highly sensitive, and suitable for point-of-care testing, which could significantly facilitate the testing of COVID-19. Despite that, practical applications of such biosensors in pandemics have yet to be achieved. In this review, we consolidate the newly developed diagnostic tools for COVID-19 using emerging biosensing technologies and discuss their application promise. In particular, we present nucleic acid tests and antibody tests of COVID-19 based on both conventional and emerging biosensing methods. We then provide perspectives on the existing challenges and potential solutions.
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Affiliation(s)
- Linzhe Chen
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
| | - Guoliang Zhang
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Longqi Liu
- BGI-Shenzhen, Shenzhen, 518083, China,Corresponding author
| | - Zida Li
- Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China,Corresponding author. Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
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17
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Ren X, Ren X, Lou J, Wang Y, Huang Q, Shi Y, Deng Y, Li X, Lu L, Yan S, Wang Y, Luo L, Zeng X, Yao X, Jin Y. A systematic review and meta-analysis of discharged COVID-19 patients retesting positive for RT-PCR. EClinicalMedicine 2021; 34:100839. [PMID: 33898952 PMCID: PMC8052132 DOI: 10.1016/j.eclinm.2021.100839] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND With the increased number of patients discharged after having COVID-19, more and more studies have reported cases whose retesting was positive (RP) during the convalescent period, which brings a new public health challenge to the world. METHODS We searched PubMed, Web of Science, The Cochrane Library, CNKI, WanFang and VIP from December 1, 2019 to December 31, 2020. The included studies were assessed using JBI critical appraisal tools and Newcastle-Ottawa Scale. The RP rate of discharge patients was analyzed by a meta-analysis. We adhered to PRISMA reporting guideline. FINDINGS We have included 117 studies with 2669 RP participants after discharge. The methodological quality of 66 case reports were low to high, 42 case series and 3 cohort study were moderate to high, 3 case-control studies were moderate and 3 cross-sectional studies were low to moderate. The clinical manifestations of most RP patients were mild or asymptomatic, and CT imaging and laboratory examinations were usually normal. The existing risk factors suggest that more attention should be paid to sever patients, elderly patients, and patients with co-morbidities. The summary RP rate was 12·2% (95% CI 10·6-13·7) with high heterogeneity (I2 = 85%). INTERPRETATION To date, the causes and risk factors of RP result in discharged patients are not fully understood. High-quality etiological and clinical studies are needed to investigate these issues to further help us to make strategies to control and prevent its occurrence.
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Affiliation(s)
- Xiangying Ren
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- College of Nursing and Health, Henan University, Kaifeng, Henan, China
| | - Xiangge Ren
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jiaao Lou
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- College of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Yongbo Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuexian Shi
- School of Nursing, Peking University, Beijing, China
| | - Yuqing Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Thyroid Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Nephrology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liye Lu
- Yongnian District maternity and childcare hospital, Xinming Road No.28. Yongnian District, HanDan, Hebei, China
| | - Siyu Yan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yunyun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lisha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiantao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Corresponding authors.
| | - Xiaomei Yao
- Center for clinical practice guideline conduction and evaluation, Children's Hospital of Fudan University, Shanghai, China
- Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Corresponding author at: Center for clinical practice guideline conduction and evaluation, Children's Hospital of Fudan University, Shanghai, China.
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Corresponding authors.
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18
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Persistence of SARS-CoV-2 viral RNA in nasopharyngeal swabs after death. J Infect 2021; 82:e3-e5. [PMID: 33609587 PMCID: PMC7889030 DOI: 10.1016/j.jinf.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022]
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19
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Lee L, Liu F, Chen Y, Roma G. Quantitative and Ultrasensitive In-situ Immunoassay Technology for SARS-CoV-2 Detection in Saliva. RESEARCH SQUARE 2021. [PMID: 33469572 PMCID: PMC7814831 DOI: 10.21203/rs.3.rs-138025/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has become an immense global health crisis. However, the lack of efficient and sensitive on-site testing methods limits early detection for timely isolation and intervention. Here, we present a Quantitative and Ultrasensitive in-situ Immunoassay Technology for SARS-CoV-2 detection in saliva (QUIT SARS-CoV-2). Our nanoporous membrane resonator generates a rapid oscillating flow to purify and concentrate SARS-CoV-2 virus in saliva by 40 folds for in-situ detection of viral antigens based on chemiluminescent immunoassay within 20 min. This method achieved a detection sensitivity below 100 copies/mL viral load, comparable to the bench-top PCR equipment. The portable QUIT SARS-CoV-2 system, allowing rapid and accurate on-site viral screen with high-throughput sample pooling strategy, can be performed at the primary care settings and substantially improve the detection and prevention of COVID-19.
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20
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Gidari A, Nofri M, Saccarelli L, Bastianelli S, Sabbatini S, Bozza S, Camilloni B, Fusco-Moffa I, Monari C, De Robertis E, Mencacci A, Francisci D. Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature. Eur J Clin Microbiol Infect Dis 2021; 40:1-12. [PMID: 33037944 PMCID: PMC7547550 DOI: 10.1007/s10096-020-04057-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022]
Abstract
Can a patient diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) be infected again? This question is still unsolved. We tried to analyze local and literature cases with a positive respiratory swab after recovery. We collected data from symptomatic patients diagnosed with SARS-CoV-2 infection in the Italian Umbria Region that, after recovery, were again positive for SARS-CoV-2 in respiratory tract specimens. Samples were also assessed for infectivity in vitro. A systematic review of similar cases reported in the literature was performed. The study population was composed of 9 patients during a 4-month study period. Among the new positive samples, six were inoculated in Vero-E6 cells and showed no growth and negative molecular test in culture supernatants. All patients were positive for IgG against SARS-CoV-2 nucleoprotein and/or S protein. Conducting a review of the literature, 1350 similar cases have been found. The presumptive reactivation occurred in 34.5 days on average (standard deviation, SD, 18.7 days) after COVID-19 onset, when the 5.6% of patients presented fever and the 27.6% symptoms. The outcome was favorable in 96.7% of patients, while the 1.1% of them were still hospitalized at the time of data collection and the 2.1% died. Several hypotheses have been formulated to explain new positive respiratory samples after confirmed negativity. According to this study, the phenomenon seems to be due to the prolonged detection of SARS-CoV-2 RNA traces in respiratory samples of recovered patients. The failure of the virus to replicate in vitro suggests its inability to replicate in vivo.
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Affiliation(s)
- Anna Gidari
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy.
| | - Marco Nofri
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Luca Saccarelli
- Department of Anesthesiology, Intensive Care and Pain therapy Center, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Sabrina Bastianelli
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Samuele Sabbatini
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Silvia Bozza
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Barbara Camilloni
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Igino Fusco-Moffa
- Department of Prevention, Local Health Unit Umbria 1, Travel Medicine Unit, Perugia, Italy
| | - Claudia Monari
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Department of Anesthesiology, Intensive Care and Pain therapy Center, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Antonella Mencacci
- Department of Medicine, Medical Microbiology Section, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Department of Medicine, Clinic of Infectious Diseases, "Santa Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
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21
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Recurrence of SARS-CoV-2 viral RNA in recovered COVID-19 patients: a narrative review. Eur J Clin Microbiol Infect Dis 2020; 40:13-25. [PMID: 33113040 PMCID: PMC7592450 DOI: 10.1007/s10096-020-04088-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Many studies have shown that re-positive tests for SARS-CoV-2 by RT-PCR in recovered COVID-19 patients are very common. We aim to conduct this review to summarize the clinical and epidemiological characteristics of these patients and discuss the potential explanations for recurrences, the contagiousness of re-detectable positive SARS-CoV-2 virus, and the management of COVID-19 patients after discharge from hospital. The proportion of re-positive tests in discharged COVID-19 patients varied from 2.4 to 69.2% and persisted from 1 to 38 days after discharge, depending on population size, age of patients, and type of specimens. Currently, several causes of re-positive tests for SARS-CoV-2 in recovered COVID-19 patients are suggested, including false-negative, false-positive RT-PCR tests; reactivation; and re-infection with SARS-CoV-2, but the mechanism leading to these re-positive cases is still unclear. The prevention of re-positive testing in discharged patients is a fundamental measure to control the spread of the pandemic. In order to reduce the percentage of false-negative tests prior to discharge, we recommend performing more than two tests, according to the standard sampling and microbiological assay protocol. In addition, specimens should be collected from multiple body parts if possible, to identify SARS-CoV-2 viral RNA before discharge. Further studies should be conducted to develop novel assays that target a crucial region of the RNA genome in order to improve its sensitivity and specificity.
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