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Waite LL, Nahhas A, Irvahn J, Garden G, Kerfonta CM, Killelea E, Ferng W, Cummins JJ, Mereness R, Austin T, Jones S, Olson N, Wilson M, Isaac B, Pepper CA, Koolhof IS, Armstrong J. COVID-19 passenger screening to reduce travel risk and translocation of disease. Epidemiol Infect 2024; 152:e36. [PMID: 38326275 PMCID: PMC10945944 DOI: 10.1017/s0950268824000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
Aviation passenger screening has been used worldwide to mitigate the translocation risk of SARS-CoV-2. We present a model that evaluates factors in screening strategies used in air travel and assess their relative sensitivity and importance in identifying infectious passengers. We use adapted Monte Carlo simulations to produce hypothetical disease timelines for the Omicron variant of SARS-CoV-2 for travelling passengers. Screening strategy factors assessed include having one or two RT-PCR and/or antigen tests prior to departure and/or post-arrival, and quarantine length and compliance upon arrival. One or more post-arrival tests and high quarantine compliance were the most important factors in reducing pathogen translocation. Screening that combines quarantine and post-arrival testing can shorten the length of quarantine for travelers, and variability and mean testing sensitivity in post-arrival RT-PCR and antigen tests decrease and increase with the greater time between the first and second post-arrival test, respectively. This study provides insight into the role various screening strategy factors have in preventing the translocation of infectious diseases and a flexible framework adaptable to other existing or emerging diseases. Such findings may help in public health policy and decision-making in present and future evidence-based practices for passenger screening and pandemic preparedness.
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Affiliation(s)
| | - Ahmad Nahhas
- The Boeing Company, Arlington, Virginia, United States
| | - Jan Irvahn
- The Boeing Company, Arlington, Virginia, United States
| | - Grace Garden
- The Boeing Company, Arlington, Virginia, United States
| | | | | | - William Ferng
- The Boeing Company, Arlington, Virginia, United States
| | | | | | - Thomas Austin
- The Boeing Company, Arlington, Virginia, United States
| | - Stephen Jones
- The Boeing Company, Arlington, Virginia, United States
| | - Nels Olson
- The Boeing Company, Arlington, Virginia, United States
| | - Mark Wilson
- The Boeing Company, Arlington, Virginia, United States
| | - Benson Isaac
- The Boeing Company, Arlington, Virginia, United States
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Towett G, Snead RS, Grigoryan K, Marczika J. Geographical and practical challenges in the implementation of digital health passports for cross-border COVID-19 pandemic management: a narrative review and framework for solutions. Global Health 2023; 19:98. [PMID: 38066568 PMCID: PMC10709942 DOI: 10.1186/s12992-023-00998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
The rapid global spread of infectious diseases, epitomized by the recent COVID-19 pandemic, has highlighted the critical need for effective cross-border pandemic management strategies. Digital health passports (DHPs), which securely store and facilitate the sharing of critical health information, including vaccination records and test results, have emerged as a promising solution to enable safe travel and access to essential services and economic activities during pandemics. However, the implementation of DHPs faces several significant challenges, both related to geographical disparities and practical considerations, necessitating a comprehensive approach for successful global adoption. In this narrative review article, we identify and elaborate on the critical geographical and practical barriers that hinder global adoption and the effective utilization of DHPs. Geographical barriers are complex, encompassing disparities in vaccine access, regulatory inconsistencies, differences across countries in data security and users' privacy policies, challenges related to interoperability and standardization, and inadequacies in technological infrastructure and limited access to digital technologies. Practical challenges include the possibility of vaccine contraindications and breakthrough infections, uncertainties surrounding natural immunity, and limitations of standard tests in assessing infection risk. To address geographical disparities and enhance the functionality and interoperability of DHPs, we propose a framework that emphasizes international collaboration to achieve equitable access to vaccines and testing resources. Furthermore, we recommend international cooperation to establish unified vaccine regulatory frameworks, adopting globally accepted standards for data privacy and protection, implementing interoperability protocols, and taking steps to bridge the digital divide. Addressing practical challenges requires a meticulous approach to assessing individual risk and augmenting DHP implementation with rigorous health screenings and personal infection prevention measures. Collectively, these initiatives contribute to the development of robust and inclusive cross-border pandemic management strategies, ultimately promoting a safer and more interconnected global community in the face of current and future pandemics.
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Anzai A, Yamasaki S, Bleichrodt A, Chowell G, Nishida A, Nishiura H. Epidemiological impact of travel enhancement on the inter-prefectural importation dynamics of COVID-19 in Japan, 2020. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:21499-21513. [PMID: 38124607 DOI: 10.3934/mbe.2023951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Mobility restrictions were widely practiced to reduce contact with others and prevent the spatial spread of COVID-19 infection. Using inter-prefectural mobility and epidemiological data, a statistical model was devised to predict the number of imported cases in each Japanese prefecture. The number of imported cases crossing prefectural borders in 2020 was predicted using inter-prefectural mobility rates based on mobile phone data and prevalence estimates in the origin prefectures. The simplistic model was quantified using surveillance data of cases with an inter-prefectural travel history. Subsequently, simulations were carried out to understand how imported cases vary with the mobility rate and prevalence at the origin. Overall, the predicted number of imported cases qualitatively captured the observed number of imported cases over time. Although Hokkaido and Okinawa are the northernmost and the southernmost prefectures, respectively, they were sensitive to differing prevalence rate in Tokyo and Osaka and the mobility rate. Additionally, other prefectures were sensitive to mobility change, assuming that an increment in the mobility rate was seen in all prefectures. Our findings indicate the need to account for the weight of an inter-prefectural mobility network when implementing countermeasures to restrict human movement. If the mobility rates were maintained lower than the observed rates, then the number of imported cases could have been maintained at substantially lower levels than the observed, thus potentially preventing the unnecessary spatial spread of COVID-19 in late 2020.
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Affiliation(s)
- Asami Anzai
- Graduate School of Medicine, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Amanda Bleichrodt
- School of Public Health, Georgia State University, 140 Decatur St., Atlanta, GA 30303, USA
| | - Gerardo Chowell
- School of Public Health, Georgia State University, 140 Decatur St., Atlanta, GA 30303, USA
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
- Tokyo Center for Infectious Disease Control and Prevention, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto 606-8501, Japan
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Xu J, Wang Z, Moghadas SM. Modelling the effect of travel-related policies on disease control in a meta-population structure. J Math Biol 2023; 87:55. [PMID: 37688625 DOI: 10.1007/s00285-023-01990-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/15/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
Travel restrictions, while delaying the spread of an emerging disease from the source, could inflict substantial socioeconomic burden. Travel-related policies, such as quarantine and testing of travelers, may be considered as alternative strategies to mitigate the negative impact of travel bans. We developed a meta-population, delay-differential model to evaluate a strategy that combines testing of travelers prior to departure from the source of infection with quarantine and testing at exit from quarantine in the destination population. Our results, based on early parameter estimates of SARS-CoV-2 infection, indicate that testing travelers at exit from quarantine is more effective in delaying case importation than testing them before departure or upon arrival. We show that a 1-day quarantine with an exit test could outperform a longer, 3-day quarantine without testing in delaying the outbreak peak. Rapid, large-scale testing capacities with short turnaround times provide important means of detecting infectious cases and reducing case importation, while shortening quarantine duration for travelers at destination.
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Affiliation(s)
- Jingjing Xu
- Agent-Based Modelling Laboratory, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Zhen Wang
- Agent-Based Modelling Laboratory, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
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Chu V, Newman DG. Exercise Effect on Mental Health in Isolating or Quarantining Adults. Aerosp Med Hum Perform 2023; 94:686-695. [PMID: 37587629 DOI: 10.3357/amhp.6073.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
INTRODUCTION: In response to coronavirus disease 2019 (COVID-19), travelers are typically subject to quarantine, which is often associated with poorer mental health (MH). While the protective benefits of community-based exercise are widely recognized, the degree to which this extends to the confined setting is unknown. This systematic review aims to evaluate the effect of exercise on MH in isolating or quarantining adults.METHODS: A literature search of Ovid MEDLINE, APA PsycInfo, and the Cochrane Database of Systematic Reviews limited to January 2019-September 2021 inclusive yielded five eligible studies.RESULTS: Data comprised a total of 2755 college and university students, most of whom were confined. Depending on the scale used, 24.9-76.7% of respondents demonstrated impaired MH, which improved with physical activity (PA), especially when regular and moderate or vigorous. The frequency, duration, and participants of exercise increased as lockdown progressed. One study showed that while sleep, diet, and PA all have an impact on MH, PA was the factor most strongly correlated with MH.DISCUSSION: Physical fitness should be optimized before and maintained during quarantine while exercise space and equipment should be accessible. Importantly, the sustainability of persistent quarantine must be considered given the pervasiveness of COVID-19.Chu V, Newman DG. Exercise effect on mental health in isolating or quarantining adults. Aerosp Med Hum Perform. 2023; 94(9):686-695.
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Hong J, Park AK, Radnaabaatar M, Kim EJ, Kim DW, Jung J. The Impact of Entry Restrictions on the Spread of Severe Acute Respiratory Syndrome Coronavirus Variants Between 2021 and 2022. J Korean Med Sci 2023; 38:e223. [PMID: 37463690 DOI: 10.3346/jkms.2023.38.e223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/25/2023] [Indexed: 07/20/2023] Open
Abstract
To contain the surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the South Korean government has implemented non-pharmacological interventions as well as border restrictions. The efficacy of entry restrictions should be evaluated to facilitate their preparation for new variants of SARS-CoV-2. This study explored the impact of border policy changes on overseas entrants and local cases of SARS-CoV-2 variants. Data from the Korea Disease Control and Prevention Agency randomly collected between April 11, 2021 and August 20, 2022 were evaluated using the Granger causality model. The results showed that the outbreak gap of delta variants between international and domestic cases was 10 weeks, while that of omicron variants was approximately 2 weeks, meaning that the quarantine policy helped contain delta variants rather than more transmissible variants. It is recommended that countries implement quarantine policies based on particular purposes accounting for the specific features of different variants to avoid potential negative impacts on the economy.
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Affiliation(s)
- Jinwook Hong
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Ae Kyung Park
- Division of Emerging Infectious Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Munkhzul Radnaabaatar
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Eun-Jin Kim
- Division of Emerging Infectious Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Dong Wook Kim
- Department of Information and Statistics, Research Institute of Natural Science, Gyeongsang National University, Jinju, Korea
- Department of Bio & Medical Bigdata (BK21 Plus), Gyeongsang National University, Jinju, Korea.
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
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Lim NWH, Lim JT, Dickens BL. Border Control for Infectious Respiratory Disease Pandemics: A Modelling Study for H1N1 and Four Strains of SARS-CoV-2. Viruses 2023; 15:978. [PMID: 37112958 PMCID: PMC10144227 DOI: 10.3390/v15040978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Post-pandemic economic recovery relies on border control for safe cross-border movement. Following the COVID-19 pandemic, we investigate whether effective strategies generalize across diseases and variants. For four SARS-CoV-2 variants and influenza A-H1N1, we simulated 21 strategy families of varying test types and frequencies, quantifying expected transmission risk, relative to no control, by strategy family and quarantine length. We also determined minimum quarantine lengths to suppress relative risk below given thresholds. SARS-CoV-2 variants showed similar relative risk across strategy families and quarantine lengths, with at most 2 days' between-variant difference in minimum quarantine lengths. ART-based and PCR-based strategies showed comparable effectiveness, with regular testing strategies requiring at most 9 days. For influenza A-H1N1, ART-based strategies were ineffective. Daily ART testing reduced relative risk only 9% faster than without regular testing. PCR-based strategies were moderately effective, with daily PCR (0-day delay) testing requiring 16 days for the second-most stringent threshold. Viruses with high typical viral loads and low transmission risk given low viral loads, such as SARS-CoV-2, are effectively controlled with moderate-sensitivity tests (ARTs) and modest quarantine periods. Viruses with low typical viral loads and substantial transmission risk at low viral loads, such as influenza A-H1N1, require high-sensitivity tests (PCR) and longer quarantine periods.
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Affiliation(s)
- Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore 12 Science Drive 2, #10-01, Singapore 117549, Singapore; (N.W.-H.L.); (B.L.D.)
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University Experimental Medicine Building, 59 Nanyang Drive, Singapore 636921, Singapore
| | - Borame Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore 12 Science Drive 2, #10-01, Singapore 117549, Singapore; (N.W.-H.L.); (B.L.D.)
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Chuan BC, Zulkufli NS, Rajesvaran C, Yon R, Khee SL. Lessons from the Lab: SARS-CoV-2 Detection Rate amongst the Vaccinated Travel Lane and Non-Vaccinated Travel Lane Travellers into Malaysia. Malays J Med Sci 2023; 30:153-160. [PMID: 37102055 PMCID: PMC10125236 DOI: 10.21315/mjms2023.30.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/09/2022] [Indexed: 04/28/2023] Open
Abstract
Background The vaccinated travel lane (VTL) between Malaysia and Singapore was implemented to facilitate travelling between countries without the need for quarantine. Objectives i) Observe the rate of positive SARS-CoV-2 test results amongst inbound international travellers; ii) Explore possible factors associated with the outcome of test results between VTL and non-VTL travellers. Method This is a retrospective cross-sectional study involving air travellers arriving in Malaysia via the Kuala Lumpur International Airport (KLIA) or Kuala Lumpur International Airport 2 (KLIA2) who were tested for SARS-CoV-2 by reverse transcriptase polymerase chain reaction (RT-PCR) from 29 November 2021 to 15 March 2022. Subject demographics and RT-PCR results were retrieved from the laboratory information system and statistically analysed. Results Out of 118,902 travellers, mostly were Malaysian nationals (62.7%) and VTL travellers (68.2%) with a median age of 35 years old. A total of 699 (0.6%) of travellers tested positive on arrival, out of which 70.2% had cycle threshold (Ct) values > 30 (70.8% of VTL and 70.0% of non-VTL cohorts). Non-VTL travellers were 4.5 times more likely to test positive compared with VTL travellers (1.25% versus 0.28%; P < 0.001). Conclusion Tighter entry requirements including vaccination status and testing frequency, the use of sensitive detection methods on arrival and similar public health policies between countries may have contributed to the VTL being a safe and cost-effective mode of travel.
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Affiliation(s)
- Beh Chun Chuan
- BP Clinical Lab Sdn Bhd, Temasya@Glenmarie, Selangor, Malaysia
| | | | | | - Rohaizat Yon
- BP Clinical Lab Sdn Bhd, Temasya@Glenmarie, Selangor, Malaysia
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Hu H, Xiong S, Zhang X, Liu S, Gu L, Zhu Y, Xiang D, Skitmore M. The COVID-19 pandemic in various restriction policy scenarios based on the dynamic social contact rate. Heliyon 2023; 9:e14533. [PMID: 36945346 PMCID: PMC10017169 DOI: 10.1016/j.heliyon.2023.e14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
The social contact rate has influenced the transmission of COVID-19, with more social contact resulting in more contagion cases. We chose 18 countries with the most confirmed cases in the first 200 days after the Wuhan lockdown. This was the first study using the dynamic social contact rate to simulate the epidemic under diverse restriction policies over 500 days since the COVID-19 outbreak. The developed General Dynamic Model suggested that the probability of contagion ranged from 12.52% to 39.39% in the epidemic. The geometric mean of the social contact rates differed from 18.21% to 96.00% between countries. The restriction policies in developed economies were 3.5 times more efficient than in developing economies. We compare the effectiveness of different policies for disease prevention and discuss the influence of policy adjustment frequency for each country. Maintaining the tightest restriction or alternate tightening and loosening restrictions was recommended, with each having an average 72.45% and 79.78% reduction in maximum active cases, respectively.
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Affiliation(s)
- Hui Hu
- Economic Development Research Centre, Wuhan University, Hubei, China
- Health Economics and Management Centre, Wuhan University, Hubei, China
- School of Economics & Management, Wuhan University, Hubei, China
| | - Shuaizhou Xiong
- School of Economics & Management, Wuhan University, Hubei, China
| | - Xiaoling Zhang
- Department of Public and International Affairs, City University of Hong Kong, Kowloon, Hong Kong
- School of Energy and Environment, City University of Hong Kong, Kowloon, Hong Kong
- Shenzhen Research Institute, City University of Hong Kong, Shenzhen, China
| | - Shuzhou Liu
- School of Mathematics and Physics, China University of Geosciences, Hubei, China
| | - Lin Gu
- RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
- Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
| | - Yuqi Zhu
- School of Economics & Management, Wuhan University, Hubei, China
| | - Dongjin Xiang
- School of Mathematics and Physics, China University of Geosciences, Hubei, China
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Lou J, Lim NWH, Cai CGX, Dickens BSL, Huynh VA, Wee HL. Cost benefit analysis of alternative testing and quarantine policies for travelers for infection control: A case study of Singapore during the COVID-19 pandemic. Front Public Health 2023; 11:1101986. [PMID: 36908469 PMCID: PMC9996245 DOI: 10.3389/fpubh.2023.1101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Background Border control mitigates local infections but bears a heavy economic cost, especially for tourism-reliant countries. While studies have supported the efficacy of border control in suppressing cross-border transmission, the trade-off between costs from imported and secondary cases and from lost economic activities has not been studied. This case study of Singapore during the COVID-19 pandemic aims to understand the impacts of varying quarantine length and testing strategies on the economy and health system. Additionally, we explored the impact of permitting unvaccinated travelers to address emerging equity concerns. We assumed that community transmission is stable and vaccination rates are high enough that inbound travelers are not dissuaded from traveling. Methods The number of travelers was predicted considering that longer quarantine reduces willingness to travel. A micro-simulation model predicted the number of COVID-19 cases among travelers, the resultant secondary cases, and the probability of being symptomatic in each group. The incremental net monetary benefit (INB) of Singapore was quantified under each border-opening policy compared to pre-opening status, based on tourism receipts, cost/profit from testing and quarantine, and cost and health loss due to COVID-19 cases. Results Compared to polymerase chain reaction (PCR), rapid antigen test (ART) detects fewer imported cases but results in fewer secondary cases. Longer quarantine results in fewer cases but lower INB due to reduced tourism receipts. Assuming the proportion of unvaccinated travelers is small (8% locally and 24% globally), allowing unvaccinated travelers will accrue higher INB without exceeding the intensive care unit (ICU) capacity. The highest monthly INB from all travelers is $2,236.24 m, with 46.69 ICU cases per month, achieved with ARTs at pre-departure and on arrival without quarantine. The optimal policy in terms of highest INB is robust under changes to various model assumptions. Among all cost-benefit components, the top driver for INB is tourism receipts. Conclusions With high vaccination rates locally and globally alongside stable community transmission, opening borders to travelers regardless of vaccination status will increase economic growth in the destination country. The caseloads remain manageable without exceeding ICU capacity, and costs of cases are offset by the economic value generated from travelers.
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Affiliation(s)
- Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Vinh Anh Huynh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Vilches TN, Rafferty E, Wells CR, Galvani AP, Moghadas SM. Economic evaluation of COVID-19 rapid antigen screening programs in the workplace. BMC Med 2022; 20:452. [PMID: 36424587 PMCID: PMC9686464 DOI: 10.1186/s12916-022-02641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diagnostic testing has been pivotal in detecting SARS-CoV-2 infections and reducing transmission through the isolation of positive cases. We quantified the value of implementing frequent, rapid antigen (RA) testing in the workplace to identify screening programs that are cost-effective. METHODS To project the number of cases, hospitalizations, and deaths under alternative screening programs, we adapted an agent-based model of COVID-19 transmission and parameterized it with the demographics of Ontario, Canada, incorporating vaccination and waning of immunity. Taking into account healthcare costs and productivity losses associated with each program, we calculated the incremental cost-effectiveness ratio (ICER) with quality-adjusted life year (QALY) as the measure of effect. Considering RT-PCR testing of only severe cases as the baseline scenario, we estimated the incremental net monetary benefits (iNMB) of the screening programs with varying durations and initiation times, as well as different booster coverages of working adults. RESULTS Assuming a willingness-to-pay threshold of CDN$30,000 per QALY loss averted, twice weekly workplace screening was cost-effective only if the program started early during a surge. In most scenarios, the iNMB of RA screening without a confirmatory RT-PCR or RA test was comparable or higher than the iNMB for programs with a confirmatory test for RA-positive cases. When the program started early with a duration of at least 16 weeks and no confirmatory testing, the iNMB exceeded CDN$1.1 million per 100,000 population. Increasing booster coverage of working adults improved the iNMB of RA screening. CONCLUSIONS Our findings indicate that frequent RA testing starting very early in a surge, without a confirmatory test, is a preferred screening program for the detection of asymptomatic infections in workplaces.
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Affiliation(s)
- Thomas N Vilches
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Ellen Rafferty
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Chad R Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada.
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Wells CR, Gokcebel S, Pandey A, Galvani AP, Townsend JP. Testing for COVID-19 is Much More Effective When Performed Immediately Prior to Social Mixing. Int J Public Health 2022; 67:1604659. [PMID: 35967267 PMCID: PMC9363582 DOI: 10.3389/ijph.2022.1604659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To quantify the utility of RT-PCR and rapid antigen tests in preventing post-arrival transmission based on timing of the pre-departure test. Methods: We derived analytical expressions to compute post-arrival transmission when no test is performed, and when either an RT-PCR or any of 18 rapid antigen tests is performed at specified times before arrival. We determined the diagnostic sensitivity of the rapid antigen tests by propagating their RT-PCR percent positive agreement onto known RT-PCR diagnostic sensitivity. Results: Depending on the rapid antigen test used, conducting a rapid antigen test immediately before departure reduces post-arrival transmission between 37.4% (95% CrI: 28.2%-40.7%) and 46.7% (95% CrI:40.0%-49.3%), compared to a 31.1% (95% CrI: 26.3%-33.5%) reduction using an RT-PCR 12 h before arrival. Performance of each rapid antigen test differed by diagnostic sensitivity over the course of disease. However, these differences were smaller than those engendered by testing too early. Conclusion: Testing closer to arrival-ideally on the day of arrival-is more effective at reducing post-arrival transmission than testing earlier. Rapid antigen tests perform the best in this application due to their short turnaround time.
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Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Senay Gokcebel
- Yale School of Public Health, New Haven, CT, United States
- Grinnell College, Grinnell, IA, United States
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Jeffrey P. Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
- Program in Microbiology, Yale University, New Haven, CT, United States
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Wells CR, Pandey A, Gokcebel S, Krieger G, Donoghue AM, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and serial testing for variants of SARS-CoV-2 with benefits of vaccination and boosting on consequent control of COVID-19. PNAS NEXUS 2022; 1:pgac100. [PMID: 35909795 PMCID: PMC9335027 DOI: 10.1093/pnasnexus/pgac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
Quarantine and serial testing strategies for a disease depend principally on its incubation period and infectiousness profile. In the context of COVID-19, these primary public health tools must be modulated with successive SARS CoV-2 variants of concern that dominate transmission. Our analysis shows that (1) vaccination status of an individual makes little difference to the determination of the appropriate quarantine duration of an infected case, whereas vaccination coverage of the population can have a substantial effect on this duration, (2) successive variants can challenge disease control efforts by their earlier and increased transmission in the disease time course relative to prior variants, and (3) sufficient vaccine boosting of a population substantially aids the suppression of local transmission through frequent serial testing. For instance, with Omicron, increasing immunity through vaccination and boosters-for instance with 100% of the population is fully immunized and at least 24% having received a third dose-can reduce quarantine durations by up to 2 d, as well as substantially aid in the repression of outbreaks through serial testing. Our analysis highlights the paramount importance of maintaining high population immunity, preferably by booster uptake, and the role of quarantine and testing to control the spread of SARS CoV-2.
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Affiliation(s)
- Chad R Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT 06520, USA
| | - Senay Gokcebel
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA,Department of Biochemistry, Grinnell College, Grinnell, IA 50112, USA
| | - Gary Krieger
- NewFields E&E, Boulder, CO 80301, USA,Skaggs School of Pharmacy and Pharmaceutical Science, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - A Michael Donoghue
- Group HSE, BHP Group Ltd, 171 Collins Street, Melbourne, VIC 3000, Australia
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL 32610, USA
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT 06520, USA
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14
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Seetah K, Moots H, Pickel D, Van Cant M, Cianciosi A, Mordecai E, Cullen M, Maldonado Y. Global Health Needs Modernized Containment Strategies to Prepare for the Next Pandemic. Front Public Health 2022; 10:834451. [PMID: 35769777 PMCID: PMC9234159 DOI: 10.3389/fpubh.2022.834451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19 continues to be a public health crisis, while severely impacting global financial markets causing significant economic and social hardship. As with any emerging disease, pharmaceutical interventions required time, emphasizing the initial and continuing need for non-pharmaceutical interventions. We highlight the role of anthropological and historical perspectives to inform approaches to non-pharmaceutical interventions for future preparedness. The National Academy of Medicine, a not-for-profit, non-governmental US-based medical watchdog organization, published a key document early in the COVID-19 pandemic which points to inadequate quarantine and containment infrastructure as a significant obstacle to an effective pandemic response. In considering how to implement effective quarantine policies and infrastructure, we argue that it is essential to take a longitudinal approach to assess interventions that have been effective in past pandemics while simultaneously addressing and eliminating the negative socio-historical legacies of ineffective quarantine practices. Our overview reinforces the need for social equity and compassion when implementing containment.
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Affiliation(s)
- Krish Seetah
- Department of Anthropology, Stanford, CA, United States
- Center for Innovation in Global Health, Stanford University, Stanford, CA, United States
- Center for Population Health Sciences, Stanford School of Medicine, Stanford University, Stanford, CA, United States
- Woods Institute for the Environment, Stanford, CA, United States
| | - Hannah Moots
- Department of Human Genetics, Oriental Institute Museum, University of Chicago, Chicago, IL, United States
| | - David Pickel
- Department of Classics, Stanford University, Stanford, CA, United States
| | - Marit Van Cant
- Department of Anthropology, Stanford, CA, United States
- Belgian American Educational Foundation (B.A.E.F), New Haven, CT, United States
| | - Alessandra Cianciosi
- Department of Anthropology, Stanford, CA, United States
- Amsterdam School of Historical Studies, University of Amsterdam, Amsterdam, Netherlands
| | - Erin Mordecai
- Department of Biology, Stanford University, Stanford, CA, United States
| | - Mark Cullen
- Center for Population Health Sciences, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Yvonne Maldonado
- Faculty Development and Diversity, Global Health and Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, CA, United States
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15
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A Testing and Quarantine Algorithm for Individual International Travelers Using Published Data on WHO-Approved Vaccines and Bayes’ Theorem. Vaccines (Basel) 2022; 10:vaccines10060902. [PMID: 35746509 PMCID: PMC9230962 DOI: 10.3390/vaccines10060902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023] Open
Abstract
Policies such as border closures and quarantines have been widely used during the COVID-19 pandemic. Policy modifications and updates, however, must be adjusted as global vaccination rates increase. We calculated the risks of individual travelers based on their expected transmission and benchmarked them against that of an unvaccinated traveler quarantined for 14 days without testing. All individuals with a negative preboarding test can be released with a negative arrival test, when both tests have a sensitivity ≥ 90% and a specificity ≥ 97%, performance characteristics that could be accomplished by rapid antigen tests. This assumption is valid for an incidence rate up to 0.1 (prior to testing) and effective reproduction number (Rt) up to 4 in the arrival country. In a sensitivity analysis scenario where the incidence rate is 0.4 and Rt is 16, a negative preboarding test and a negative arrival test, both with a sensitivity ≥ 98% and a specificity ≥ 97%, can ensure that a traveler has a lower expected transmission than an unvaccinated person who is quarantined for 14 days. In most cases, fully vaccinated travelers (with or without booster) and a negative preboarding test can be released with a negative rapid antigen test upon arrival, allowing travelers to depart the airport within 30 min.
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16
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Blanford JI, Jong NBD, Schouten SE, Friedrich AW, Araújo-Soares V. Navigating travel in Europe during the pandemic: from mobile apps, certificates and quarantine to traffic-light system. J Travel Med 2022; 29:6520892. [PMID: 35134215 PMCID: PMC9155998 DOI: 10.1093/jtm/taac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/14/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ever since 2020, travelling has become complex, and increasingly so as the COVID-19 pandemic continues. To reopen Europe safely, a consensus of travel measures has been agreed between countries to enable movement between countries with as few restrictions as possible. However, communication of these travel measures and requirements for entry are not always clear and easily available. The aim of this study was to assess the availability, accessibility and harmonization of current travel information available in Europe. METHODS We performed a systematic documental analysis of online publicly available information and synthesized travel entry requirements for all countries in the European Union and Schengen Area (N = 31). For each country we assessed entry requirements, actions after entry, how risk was assessed, and how accessible the information was. RESULTS We found varying measures implemented across Europe for entry and a range of exemptions and restrictions, some of which were consistent between countries. Information was not always easy to find taking on average 10 clicks to locate. Twenty-one countries required pre-travel forms to be completed. Forty apps were in use, 11 serving as digital certification checkers. All countries required some form of COVID-19 certification for entry with some exemptions (e.g. children). Nineteen percent (n = 6) of countries used the ECDC risk assessment system; 80% (n = 25) defined their own. Forty-eight percent (n = 15) of countries used a traffic-light system with 2-5 risk classifications. CONCLUSION A comprehensive set of measures has been developed to enable continued safe travel in Europe. However further refinements and coordination is needed to align travel measures throughout the EU to minimize confusion and maximize adherence to requested measures. We recommend that, along with developing travel measures based on a common set of rules, a standard approach is taken to communicate what these measures are.
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Affiliation(s)
- Justine I Blanford
- Faculty of Geoinformation Science and Earth Observation, University of Twente, Enschede, the Netherlands
| | - Nienke Beerlage-de Jong
- Section of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Stephanie E Schouten
- Section of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Alex W Friedrich
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Vera Araújo-Soares
- Section of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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17
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Cao Z, Qiu Z, Tang F, Liang S, Wang Y, Long H, Chen C, Zhang B, Zhang C, Wang Y, Tang K, Tang J, Chen J, Yang C, Xu Y, Yang Y, Xiao S, Tian D, Jiang G, Du X. Drivers and forecasts of multiple waves of the coronavirus disease 2019 pandemic: a systematic analysis based on an interpretable machine learning framework. Transbound Emerg Dis 2022; 69:e1584-e1594. [PMID: 35192224 DOI: 10.1111/tbed.14492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become a global pandemic and continues to prevail with multiple rebound waves in many countries. The driving factors for the spread of COVID-19 and their quantitative contributions, especially to rebound waves, are not well studied. Multidimensional time-series data, including policy, travel, medical, socioeconomic, environmental, mutant and vaccine related data, were collected from 39 countries up to June 30, 2021, and an interpretable machine learning framework (XGBoost model with Shapley Additive explanation interpretation) was used to systematically analyze the effect of multiple factors on the spread of COVID-19, using the daily effective reproduction number as an indicator. Based on a model of the pre-vaccine era, policy-related factors were shown to be the main drivers of the spread of COVID-19, with a contribution of 60.81%. In the post-vaccine era, the contribution of policy-related factors decreased to 28.34%, accompanied with an increase in the contribution of travel-related factors, such as domestic flights, and contributions emerged for mutant-related (16.49%) and vaccine-related (7.06%) factors. For single-peak countries, the dominant ones were policy-related factors during both the rising and fading stages, with overall contributions of 33.7% and 37.7%, respectively. For double-peak countries, factors from the rebound stage contributed 45.8% and policy-related factors showed the greatest contribution in both the rebound (32.6%) and fading (25.0%) stages. For multiple-peak countries, the Delta variant, domestic flights (current month) and the daily vaccination population are the three greatest contributors (8.12%, 7.59% and 7.26%, respectively). Forecasting models to predict the rebound risk were built based on these findings, with accuracies of 0.78 and 0.81 for the pre- and post-vaccine eras, respectively. These findings quantitatively demonstrate the systematic drivers of the spread of COVID-19, and the framework proposed in this study will facilitate the targeted prevention and control of the ongoing COVID-19 pandemic. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zicheng Cao
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Zekai Qiu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Feng Tang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,Foshan Center for Disease Control and Prevention, Foshan, 528010, P.R. China
| | - Shiwen Liang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,Fujian Provincial Center for Disease Control and Prevention, Fuzhou, 350001, P.R. China
| | - Yinghan Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,Clinical research center, Second Affiliated Hospital of Kunming Medical University, Kunming, 650033, P.R. China
| | - Haoyu Long
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Cai Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China
| | - Bing Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Chi Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Yaqi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Kang Tang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Jing Tang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Junhong Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Chunhui Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Yuzhe Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Yulin Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Shenglan Xiao
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Dechao Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Guozhi Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China
| | - Xiangjun Du
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, 510275, P.R. China.,School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P.R. China.,Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-sen University, Guangzhou, 510030, P.R. China
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