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Spinks B, Williams D, Williams D, Lewis R, Bull F, Ogbonna U, Edwards A. Mitigating COVID-19 Burden in People Experiencing Incarceration: A Systematic Review. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:172-197. [PMID: 38579144 DOI: 10.1089/jchc.23.10.0090] [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] [Indexed: 04/07/2024]
Abstract
People experiencing incarceration (PEI) have poorer COVID-19 clinical outcomes compared with the general population. Many interventions were implemented in incarceration facilities to mitigate the burden of COVID-19. This systematic review seeks to analyze the effectiveness of these interventions. Twenty-two studies were included. Reduction of the incarcerated population/interfacility transfers, cohorting of new and infectious incarcerated people, mass asymptomatic testing (despite often low uptake), hygiene measures, and prioritization of PEI in vaccine policy had some evidence of effectiveness at reducing transmission and risk of COVID-19 in incarceration facilities. Visitation suspension had conflicting evidence of effectiveness. Studies were of low or medium quality. Inadequate control of confounding variables limited the reliability and validity of conclusions drawn. Many studies relied on retrospective, third-party data. Higher quality research is required.
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Affiliation(s)
- Bethany Spinks
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Darius Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Denitza Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ruth Lewis
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
- North Wales Centre for Primary Care Research, School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Francesca Bull
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Uju Ogbonna
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Johannesson JM, Glover WA, Petti CA, Veldman TH, Tsalik EL, Taylor DH, Hendren S, Neighbors CE, Tillekeratne LG, Kennedy SW, Harper B, Kibbe WA, Corbie G, Cohen-Wolkowiez M, Woods CW, Lee MJ. Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review. Front Public Health 2023; 11:1237066. [PMID: 37841714 PMCID: PMC10568314 DOI: 10.3389/fpubh.2023.1237066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers. Methods A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery. Results Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them. Conclusion A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery.
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Affiliation(s)
- Jon M. Johannesson
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - William A. Glover
- North Carolina State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, United States
| | - Cathy A. Petti
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Healthspring Global Inc., Bradenton, FL, United States
| | - Timothy H. Veldman
- Duke Global Health Institute, Durham, NC, United States
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, United States
| | - Ephraim L. Tsalik
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Donald H. Taylor
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Stephanie Hendren
- Duke University Medical Center Library, Duke University, Durham, NC, United States
| | - Coralei E. Neighbors
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, United States
| | | | - Scott W. Kennedy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Barrie Harper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Warren A. Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, United States
| | - Giselle Corbie
- Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Christopher W. Woods
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Hubert-Yeargan Center for Global Health, Duke University, Durham, NC, United States
| | - Mark J. Lee
- Department of Pathology, Duke University School of Medicine, Durham, NC, United States
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Hershow RB, Burnett JC, Nicolae L, Marquez N, Everett M, Tyagi E, Williams SP. COVID-19 Burden in Adult Correctional or Detention Facilities and the Surrounding Communities, January 1, 2020-July 20, 2021. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:241-246. [PMID: 37163216 PMCID: PMC10527881 DOI: 10.1089/jchc.22.02.0012] [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] [Indexed: 05/11/2023]
Abstract
We estimated the COVID-19 burden in adult correctional or detention facilities and associated counties by state, facility jurisdiction, and county urbanicity. COVID-19 cumulative incidence (cases per 1,000 persons) for each U.S. correctional or detention facility and people ages 18 years and older in the associated county was estimated between January 1, 2020 and July 20, 2021. Across 46 U.S. states, 1,083 correctional or detention facilities in 718 counties were included. The median COVID-19 incidence rate was higher in facilities than in associated counties for 42 of 46 states and for all facility jurisdictions and county urbanicity categories. COVID-19 burden was higher in most facilities than in associated counties. Implementing COVID-19 mitigation measures in correctional settings is needed to prevent SARS-CoV-2 transmission in facilities and associated counties.
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Affiliation(s)
- Rebecca B. Hershow
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet C. Burnett
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lavinia Nicolae
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC COVID-19 Response, State, Tribal, Local, and Territories Task Force, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neal Marquez
- UCLA Law COVID Behind Bars Data Project, University of California Los Angeles School of Law, Los Angeles, California, USA
| | - Michael Everett
- UCLA Law COVID Behind Bars Data Project, University of California Los Angeles School of Law, Los Angeles, California, USA
| | - Erika Tyagi
- UCLA Law COVID Behind Bars Data Project, University of California Los Angeles School of Law, Los Angeles, California, USA
| | - Samantha P. Williams
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Viloria Winnett A, Porter MK, Romano AE, Savela ES, Akana R, Shelby N, Reyes JA, Schlenker NW, Cooper MM, Carter AM, Ji J, Barlow JT, Tognazzini C, Feaster M, Goh YY, Ismagilov RF. Morning SARS-CoV-2 Testing Yields Better Detection of Infection Due to Higher Viral Loads in Saliva and Nasal Swabs upon Waking. Microbiol Spectr 2022; 10:e0387322. [PMID: 36287073 PMCID: PMC9769854 DOI: 10.1128/spectrum.03873-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 01/10/2023] Open
Abstract
Optimizing specimen collection methods to achieve the most reliable SARS-CoV-2 detection for a given diagnostic sensitivity would improve testing and minimize COVID-19 outbreaks. From September 2020 to April 2021, we performed a household-transmission study in which participants self-collected specimens every morning and evening throughout acute SARS-CoV-2 infection. Seventy mildly symptomatic participants collected saliva, and of those, 29 also collected nasal swab specimens. Viral load was quantified in 1,194 saliva and 661 nasal swab specimens using a high-analytical-sensitivity reverse transcription-quantitative PCR (RT-qPCR) assay. Viral loads in both saliva and nasal swab specimens were significantly higher in morning-collected specimens than in evening-collected specimens after symptom onset. This aspect of the biology of SARS-CoV-2 infection has implications for diagnostic testing. We infer that morning collection would have resulted in significantly improved detection and that this advantage would be most pronounced for tests with low to moderate analytical sensitivity. Collecting specimens for COVID-19 testing in the morning offers a simple and low-cost improvement to clinical diagnostic sensitivity of low- to moderate-analytical-sensitivity tests. IMPORTANCE Our findings suggest that collecting saliva and nasal swab specimens in the morning immediately after waking yields higher SARS-CoV-2 viral loads than collection later in the day. The higher viral loads from morning specimen collection are predicted to significantly improve detection of SARS-CoV-2 in symptomatic individuals, particularly when using moderate- to low-analytical-sensitivity COVID-19 diagnostic tests, such as rapid antigen tests.
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Affiliation(s)
| | | | - Anna E. Romano
- California Institute of Technology, Pasadena, California, USA
| | - Emily S. Savela
- California Institute of Technology, Pasadena, California, USA
| | - Reid Akana
- California Institute of Technology, Pasadena, California, USA
| | - Natasha Shelby
- California Institute of Technology, Pasadena, California, USA
| | | | | | | | | | - Jenny Ji
- California Institute of Technology, Pasadena, California, USA
| | - Jacob T. Barlow
- California Institute of Technology, Pasadena, California, USA
| | - Colten Tognazzini
- City of Pasadena Public Health Department, Pasadena, California, USA
| | - Matthew Feaster
- City of Pasadena Public Health Department, Pasadena, California, USA
| | - Ying-Ying Goh
- City of Pasadena Public Health Department, Pasadena, California, USA
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5
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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [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: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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Kim H, Hughes E, Cavanagh A, Norris E, Gao A, Bondy SJ, McLeod KE, Kanagalingam T, Kouyoumdjian FG. The health impacts of the COVID-19 pandemic on adults who experience imprisonment globally: A mixed methods systematic review. PLoS One 2022; 17:e0268866. [PMID: 35594288 PMCID: PMC9122186 DOI: 10.1371/journal.pone.0268866] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prison setting and health status of people who experience imprisonment increase the risks of COVID-19 infection and sequelae, and other health impacts of the COVID-19 pandemic. OBJECTIVES To conduct a mixed methods systematic review on the impacts of the COVID-19 pandemic on the health of people who experience imprisonment. DATA SOURCES We searched Medline, PsycINFO, Embase, the Cochrane Library, Social Sciences Abstracts, CINAHL, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Sociology Database, Coronavirus Research Database, ERIC, Proquest Dissertations and Theses, Web of Science, and Scopus in October 2021. We reviewed reference lists for included studies. STUDY ELIGIBILITY CRITERIA Original research conducted in or after December 2019 on health impacts of the COVID-19 pandemic on adults in prisons or within three months of release. STUDY APPRAISAL AND SYNTHESIS METHODS We used the Joanna Briggs Institute's Critical Appraisal Checklist for Qualitative Research for qualitative studies and the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data for quantitative studies. We qualitized quantitative data and extracted qualitative data, coded data, and collated similar data into categories. RESULTS We identified 62 studies. People in prisons had disproportionately high rates of COVID-19 infection and COVID-19 mortality. During the pandemic, all-cause mortality worsened, access to health care and other services worsened, and there were major impacts on mental wellbeing and on relationships with family and staff. There was limited evidence regarding key primary and secondary prevention strategies. LIMITATIONS Our search was limited to databases. As the COVID-19 pandemic is ongoing, more evidence will emerge. CONCLUSIONS Prisons and people who experience imprisonment should be prioritized for COVID-19 response and recovery efforts, and an explicit focus on prisons is needed for ongoing public health work including emergency preparedness. PROSPERO REGISTRATION NUMBER 239324.
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Affiliation(s)
- Hannah Kim
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Hughes
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alice Cavanagh
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emily Norris
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Angela Gao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan J. Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Katherine E. McLeod
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tharsan Kanagalingam
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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7
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Buitrago-Garcia D, Ipekci AM, Heron L, Imeri H, Araujo-Chaveron L, Arevalo-Rodriguez I, Ciapponi A, Cevik M, Hauser A, Alam MI, Meili K, Meyerowitz EA, Prajapati N, Qiu X, Richterman A, Robles-Rodriguez WG, Thapa S, Zhelyazkov I, Salanti G, Low N. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: Update of a living systematic review and meta-analysis. PLoS Med 2022; 19:e1003987. [PMID: 35617363 PMCID: PMC9135333 DOI: 10.1371/journal.pmed.1003987] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Debate about the level of asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection continues. The amount of evidence is increasing and study designs have changed over time. We updated a living systematic review to address 3 questions: (1) Among people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) What is the infectiousness of asymptomatic and presymptomatic, compared with symptomatic, SARS-CoV-2 infection? (3) What proportion of SARS-CoV-2 transmission in a population is accounted for by people who are asymptomatic or presymptomatic? METHODS AND FINDINGS The protocol was first published on 1 April 2020 and last updated on 18 June 2021. We searched PubMed, Embase, bioRxiv, and medRxiv, aggregated in a database of SARS-CoV-2 literature, most recently on 6 July 2021. Studies of people with PCR-diagnosed SARS-CoV-2, which documented symptom status at the beginning and end of follow-up, or mathematical modelling studies were included. Studies restricted to people already diagnosed, of single individuals or families, or without sufficient follow-up were excluded. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with a bespoke checklist and modelling studies with a published checklist. All data syntheses were done using random effects models. Review question (1): We included 130 studies. Heterogeneity was high so we did not estimate a mean proportion of asymptomatic infections overall (interquartile range (IQR) 14% to 50%, prediction interval 2% to 90%), or in 84 studies based on screening of defined populations (IQR 20% to 65%, prediction interval 4% to 94%). In 46 studies based on contact or outbreak investigations, the summary proportion asymptomatic was 19% (95% confidence interval (CI) 15% to 25%, prediction interval 2% to 70%). (2) The secondary attack rate in contacts of people with asymptomatic infection compared with symptomatic infection was 0.32 (95% CI 0.16 to 0.64, prediction interval 0.11 to 0.95, 8 studies). (3) In 13 modelling studies fit to data, the proportion of all SARS-CoV-2 transmission from presymptomatic individuals was higher than from asymptomatic individuals. Limitations of the evidence include high heterogeneity and high risks of selection and information bias in studies that were not designed to measure persistently asymptomatic infection, and limited information about variants of concern or in people who have been vaccinated. CONCLUSIONS Based on studies published up to July 2021, most SARS-CoV-2 infections were not persistently asymptomatic, and asymptomatic infections were less infectious than symptomatic infections. Summary estimates from meta-analysis may be misleading when variability between studies is extreme and prediction intervals should be presented. Future studies should determine the asymptomatic proportion of SARS-CoV-2 infections caused by variants of concern and in people with immunity following vaccination or previous infection. Without prospective longitudinal studies with methods that minimise selection and measurement biases, further updates with the study types included in this living systematic review are unlikely to be able to provide a reliable summary estimate of the proportion of asymptomatic infections caused by SARS-CoV-2. REVIEW PROTOCOL Open Science Framework (https://osf.io/9ewys/).
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Affiliation(s)
- Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lucia Araujo-Chaveron
- EHESP French School of Public Health, Paris and Rennes, France
- Institut Pasteur, Paris, France
| | - Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, Fife, Scotland, United Kingdom
| | - Anthony Hauser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Kaspar Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eric A. Meyerowitz
- Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, New York, United States of America
| | | | - Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aaron Richterman
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Shabnam Thapa
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
| | | | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Zhou N, Agathis N, Lees Y, Stevens H, Clark J, Reede D, Kunkel A, Balajee SA. Implementation of a COVID-19 Screening Testing Program in a Rural, Tribal Nation: Experience of the San Carlos Apache Tribe, January-February 2021. Public Health Rep 2022; 137:220-225. [PMID: 35023417 DOI: 10.1177/00333549211061770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected tribal populations, including the San Carlos Apache Tribe. Universal screening testing in a community using rapid antigen tests could allow for near-real-time identification of COVID-19 cases and result in reduced SARS-CoV-2 transmission. Published experiences of such testing strategies in tribal communities are lacking. Accordingly, tribal partners, with support from the Centers for Disease Control and Prevention, implemented a serial testing program using the Abbott BinaxNOW rapid antigen test in 2 tribal casinos and 1 detention center on the San Carlos Apache Indian Reservation for a 4-week pilot period from January to February 2021. Staff members at each setting, and incarcerated adults at the detention center, were tested every 3 or 4 days with BinaxNOW. During the 4-week period, 3834 tests were performed among 716 participants at the sites. Lessons learned from implementing this program included demonstrating (1) the plausibility of screening testing programs in casino and prison settings, (2) the utility of training non-laboratory personnel in rapid testing protocols that allow task shifting and reduce the workload on public health employees and laboratory staff, (3) the importance of building and strengthening partnerships with representatives from the community and public and private sectors, and (4) the need to implement systems that ensure confidentiality of test results and promote compliance among participants. Our experience and the lessons learned demonstrate that a serial rapid antigen testing strategy may be useful in work settings during the COVID-19 pandemic as schools and businesses are open for service.
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Affiliation(s)
- Natsai Zhou
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | - Nickolas Agathis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yvonne Lees
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | - Heidi Stevens
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | - James Clark
- San Carlos Apache Health Corporation, San Carlos Apache Tribe, Peridot, AZ, USA
| | - David Reede
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | - Amber Kunkel
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Arunmozhi Balajee
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marusinec R, Brodie D, Buhain S, Chawla C, Corpuz J, Diaz J, Durbin M, Moss N, Okada R, Sanchez Y, Watkins-Tartt K, Yette E, Chitnis AS. Epidemiology of Coronavirus Disease 2019 at a County Jail-Alameda County, California, March 2020-March 2021. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:50-59. [PMID: 34797241 DOI: 10.1097/phh.0000000000001453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Coronavirus disease 2019 (COVID-19) incidence rates are 2- to 5-fold higher among persons incarcerated in the United States than in the general population. PROGRAM OR POLICY We describe an outbreak investigation of COVID-19 at a jail (jail A) in Alameda County during March 2020-March 2021. IMPLEMENTATION To prevent COVID-19 cases among incarcerated persons and employees, staff at jail A and the county public health department worked to develop and recommend infection control measures implemented by jail A including, but not limited to, face covering use among incarcerated persons and staff; cohorting incarcerated persons at a higher risk of severe COVID-19 in dedicated housing units; quarantining all newly detained individuals for 14 days; and offering testing for all symptomatic incarcerated persons, newly incarcerated persons at day 2 and day 10, and all persons who resided in a housing unit where a COVID-19 case was detected. EVALUATION A total of 571 COVID-19 cases were detected among incarcerated persons at jail A during March 2020-March 2021, which represented a total incidence of 280 per 1000 population, 5 times higher than the rate in Alameda County. Of the 571 cases among incarcerated persons, 557 (98%) were male; 415 (73%) were aged 18 to 40 years; 249 (44%) were Latino; and 180 (32%) were African American; 354 (62%) were not symptomatic; and 220 (39%) had no comorbidities. Less than 2% of infected incarcerated persons were hospitalized, and no deaths were reported. DISCUSSION COVID-19 disproportionately impacted persons incarcerated at jail A, with higher numbers among Latinos and African Americans. Implementation of COVID-19 infection control and testing measures, and collaboration between public health, law enforcement, and health care providers may have, in part, led to reductions in morbidity and mortality associated with COVID-19 at jail A.
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Affiliation(s)
- Rachel Marusinec
- Division of Communicable Disease Control and Prevention (Mss Marusinec, Buhain, and Okada, Mr Corpuz, and Drs Yette and Chitnis), Alameda County Health Care Services Agency (Ms Chawla and Dr Moss), Public Health Department (Dr Moss and Ms Watkins-Tartt), San Leandro, California; Detention and Corrections Unit, Alameda County Sheriff's Office, Dublin, California (Mr Brodie and Ms Sanchez); and Wellpath, Nashville, Tennessee (Ms Diaz and Mr Durbin)
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10
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Ma Q, Liu J, Liu Q, Kang L, Liu R, Jing W, Wu Y, Liu M. Global Percentage of Asymptomatic SARS-CoV-2 Infections Among the Tested Population and Individuals With Confirmed COVID-19 Diagnosis: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2137257. [PMID: 34905008 PMCID: PMC8672238 DOI: 10.1001/jamanetworkopen.2021.37257] [Citation(s) in RCA: 268] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Asymptomatic infections are potential sources of transmission for COVID-19. OBJECTIVE To evaluate the percentage of asymptomatic infections among individuals undergoing testing (tested population) and those with confirmed COVID-19 (confirmed population). DATA SOURCES PubMed, EMBASE, and ScienceDirect were searched on February 4, 2021. STUDY SELECTION Cross-sectional studies, cohort studies, case series studies, and case series on transmission reporting the number of asymptomatic infections among the tested and confirmed COVID-19 populations that were published in Chinese or English were included. DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Random-effects models were used to estimate the pooled percentage and its 95% CI. Three researchers performed the data extraction independently. MAIN OUTCOMES AND MEASURES The percentage of asymptomatic infections among the tested and confirmed populations. RESULTS Ninety-five unique eligible studies were included, covering 29 776 306 individuals undergoing testing. The pooled percentage of asymptomatic infections among the tested population was 0.25% (95% CI, 0.23%-0.27%), which was higher in nursing home residents or staff (4.52% [95% CI, 4.15%-4.89%]), air or cruise travelers (2.02% [95% CI, 1.66%-2.38%]), and pregnant women (2.34% [95% CI, 1.89%-2.78%]). The pooled percentage of asymptomatic infections among the confirmed population was 40.50% (95% CI, 33.50%-47.50%), which was higher in pregnant women (54.11% [95% CI, 39.16%-69.05%]), air or cruise travelers (52.91% [95% CI, 36.08%-69.73%]), and nursing home residents or staff (47.53% [95% CI, 36.36%-58.70%]). CONCLUSIONS AND RELEVANCE In this meta-analysis of the percentage of asymptomatic SARS-CoV-2 infections among populations tested for and with confirmed COVID-19, the pooled percentage of asymptomatic infections was 0.25% among the tested population and 40.50% among the confirmed population. The high percentage of asymptomatic infections highlights the potential transmission risk of asymptomatic infections in communities.
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Affiliation(s)
- Qiuyue Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Liangyu Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Runqing Liu
- School of Health Humanities, Peking University, Beijing, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yu Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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11
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Sah P, Fitzpatrick MC, Zimmer CF, Abdollahi E, Juden-Kelly L, Moghadas SM, Singer BH, Galvani AP. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A 2021; 118:e2109229118. [PMID: 34376550 PMCID: PMC8403749 DOI: 10.1073/pnas.2109229118] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.
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Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Charlotte F Zimmer
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
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12
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Stufano A, Buonvino N, Cagnazzo F, Armenise N, Pontrelli D, Curzio G, De Benedictis L, Lovreglio P. Efficacy of the Measures Adopted to Prevent COVID-19 Outbreaks in an Italian Correctional Facility for Inmates Affected by Chronic Diseases. Front Public Health 2021; 9:694795. [PMID: 34307287 PMCID: PMC8292769 DOI: 10.3389/fpubh.2021.694795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background: COVID-19 outbreaks in prisons and jails may affect both inmates and correctional workers. An observational study has been performed to investigate the efficacy of specific procedures and of a serial testing approach adopted for the COVID-19 prevention in an Italian correctional facility (Bari, Apulia) for inmates affected by chronic diseases. Methods: Two SARS-CoV-2 antigen testing campaigns were carried out for all the prisoners and correctional workers, including correctional officers (CO), administrative staff (AS), correctional health care workers (HCW), and operators working with people completing their sentence outside the prison (OOP). Antigen testing was conducted on nasopharyngeal swab specimens, using a fluorescence immunoassay for the qualitative detection of nucleocapsid SARS-CoV-2 antigen. All subjects positive to the antigen test underwent confirmation by rRT-PCR test. Results: In total, 426 new and residential inmates were tested during the first campaign and 480 during the second campaign. Only two new inmates resulted positive at the first campaign, while no positive cases were observed at the second campaign or outside of the testing campaigns. In total, 367 correctional workers were tested at the first campaign and 325 at the second. At the first, 4 CO and 2 HCW showed positive test results, while no new positive cases were observed at the second. Moreover, 1 CO and 1 HCW resulted positive outside of the testing campaigns for the onset of symptoms while at home. Conclusion: The implementation of a full risk management plan in a correctional facility, including both a strict protocol for the application of preventive measures and a serial testing approach, seems to be able to prevent COVID-19 outbreaks in both inmates and correctional workers.
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Affiliation(s)
- Angela Stufano
- Interdisciplinary Department of Medicine - Section of Occupational Medicine, University of Bari, Bari, Italy
| | - Nicola Buonvino
- U.O.C. Penitentiary Medicine - Department of Territorial Care, Bari Local Health Authority, Bari, Italy
| | - Francesco Cagnazzo
- Interdisciplinary Department of Medicine - Section of Occupational Medicine, University of Bari, Bari, Italy
| | - Nicola Armenise
- U.O.C. Penitentiary Medicine - Department of Territorial Care, Bari Local Health Authority, Bari, Italy
| | - Daniela Pontrelli
- U.O.C. Penitentiary Medicine - Department of Territorial Care, Bari Local Health Authority, Bari, Italy
| | - Giovanna Curzio
- U.O.C. Penitentiary Medicine - Department of Territorial Care, Bari Local Health Authority, Bari, Italy
| | - Leonarda De Benedictis
- Interdisciplinary Department of Medicine - Section of Occupational Medicine, University of Bari, Bari, Italy
| | - Piero Lovreglio
- Interdisciplinary Department of Medicine - Section of Occupational Medicine, University of Bari, Bari, Italy
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Dunne EM, Morgan E, Wells-Moore B, Pierson S, Zakroff S, Haskell L, Link K, Powell J, Holland I, Elgethun K, Ball C, Haugen R, Hahn CG, Carter KK, Starr C. COVID-19 Outbreaks in Correctional Facilities with Work-Release Programs - Idaho, July-November 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:589-594. [PMID: 33886536 PMCID: PMC8061795 DOI: 10.15585/mmwr.mm7016a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
As of April 16, 2021, U.S. correctional and detention facilities reported 399,631 cases of COVID-19 in incarcerated persons, resulting in 2,574 deaths (1). During July 14-November 30, 2020, COVID-19 was diagnosed in 382 persons incarcerated in Idaho correctional facilities with work-release programs. Work-release programs (which place incarcerated persons in community businesses) have social and economic benefits, but might put participants at increased risk for bidirectional transmission of SARS-CoV-2, the virus that causes COVID-19. The Idaho Department of Correction (IDOC) operates 13 state-run correctional facilities, including six low-security facilities dedicated to work-release programs. This report describes COVID-19 outbreaks in five IDOC facilities with work-release programs,* provides the mitigation strategies that IDOC implemented, and describes the collaborative public health response. As of November 30, 2020, 382 outbreak-related COVID-19 cases were identified among incarcerated persons in five Idaho correctional facilities with work-release programs; two outbreaks were linked to food processing plants. Mitigation strategies that helped to control outbreaks in IDOC facilities with work-release programs included isolation of persons with COVID-19, identification and quarantine of close contacts, mass testing of incarcerated persons and staff members, and temporary suspension of work-release programs. Implementation of public health recommendations for correctional and detention facilities with work-release programs, including mass testing and identification of high-risk work sites, can help mitigate SARS-CoV-2 outbreaks. Incarcerated persons participating in work-release should be included in COVID-19 vaccination plans.
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14
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Tsitsilonis OE, Paraskevis D, Lianidou E, Terpos E, Akalestos A, Pierros V, Kostaki EG, Kastritis E, Moutsatsou P, Politou M, Scorilas A, Sphicopoulos T, Thomaidis N, Trougakos IP, Tsakris A, Voulgaris N, Daskalaki CC, Evangelakou Z, Fouki C, Gianniou DD, Gumeni S, Kostopoulos IV, Manola MS, Orologas-Stavrou N, Panteli C, Papanagnou ED, Rousakis P, Sklirou AD, Smilkou S, Stergiopoulou D, Tsiodras S, Dimopoulos MA, Sfikakis PP. SARS-CoV-2 Infection Is Asymptomatic in Nearly Half of Adults with Robust Anti-Spike Protein Receptor-Binding Domain Antibody Response. Vaccines (Basel) 2021; 9:207. [PMID: 33801380 PMCID: PMC7998869 DOI: 10.3390/vaccines9030207] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Between June and November 2020, we assessed plasma antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid protein in 4996 participants (aged 18-82 years, 34.5% men) from the National and Kapodistrian University of Athens. The weighted overall prevalence was 1.6% and monthly prevalence correlated with viral RNA-confirmed SARS-CoV-2 infections in Greece, in the same period. Notably, 49% of seropositive cases reported no history of SARS-CoV-2 infection-related clinical symptoms and 33% were unsuspected of their previous infection. Additionally, levels of anti-SARS-CoV-2 antibodies against the spike-protein receptor-binding domain were similar between symptomatic and asymptomatic individuals, irrespective of age and gender. Using Food and Drug Administration Emergency Use Authorization-approved assays, these results support the need for such studies on pandemic evaluation and highlight the development of robust humoral immune responses even among asymptomatic individuals. The high percentage of unsuspected/asymptomatic active cases, which may contribute to community transmission for more days than that of cases who are aware and self-isolate, underscores the necessity of measures across the population for the efficient control of the pandemic.
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Affiliation(s)
- Ourania E. Tsitsilonis
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, NKUA, 11527 Athens, Greece; (E.G.K.); (C.F.)
| | - Evi Lianidou
- Department of Chemistry, NKUA, 15771 Athens, Greece; (E.L.); (N.T.); (S.S.); (D.S.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, NKUA, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | | | - Vassilios Pierros
- Department of Informatics and Telecommunications, NKUA, 15784 Athens, Greece; (V.P.); (T.S.)
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, NKUA, 11527 Athens, Greece; (E.G.K.); (C.F.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, NKUA, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, School of Medicine, University General Hospital Attikon, NKUA, 12462 Haidari, Greece;
| | - Marianna Politou
- Hematology Laboratory-Blood Bank, Aretaieio Hospital, School of Medicine, NKUA, 11528 Athens, Greece;
| | - Andreas Scorilas
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Thomas Sphicopoulos
- Department of Informatics and Telecommunications, NKUA, 15784 Athens, Greece; (V.P.); (T.S.)
| | - Nikolaos Thomaidis
- Department of Chemistry, NKUA, 15771 Athens, Greece; (E.L.); (N.T.); (S.S.); (D.S.)
| | - Ioannis P. Trougakos
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | | | | | - Christina C. Daskalaki
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Zoi Evangelakou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Christina Fouki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, NKUA, 11527 Athens, Greece; (E.G.K.); (C.F.)
| | - Despoina D. Gianniou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Sentiljana Gumeni
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Ioannis V. Kostopoulos
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Maria S. Manola
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Nikolaos Orologas-Stavrou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Chrysanthi Panteli
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Eleni-Dimitra Papanagnou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Pantelis Rousakis
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Aimilia D. Sklirou
- Department of Biology, National and Kapodistrian University of Athens (NKUA), 15784 Athens, Greece; (A.S.); (I.P.T.); (C.C.D.); (Z.E.); (D.D.G.); (S.G.); (I.V.K.); (M.S.M.); (N.O.-S.); (C.P.); (E.-D.P.); (P.R.); (A.D.S.)
| | - Stavroula Smilkou
- Department of Chemistry, NKUA, 15771 Athens, Greece; (E.L.); (N.T.); (S.S.); (D.S.)
| | | | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, School of Medicine, University Hospital Attikon, NKUA, 12462 Haidari, Greece;
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, NKUA, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko General Hospital, NKUA, 15772 Athens, Greece;
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