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Mohanty S, Tita AT, Varner M, Stockwell MS, Newes‐Adeyi G, Battarbee AN, Reichle L, Morrill T, Daugherty M, Mourad M, Silverio Francisco RA, Woodworth K, Wielgosz K, Galang R, Maniatis P, Semenova V, Dawood FS. Association between SARS-CoV-2 infections during pregnancy and preterm live birth. Influenza Other Respir Viruses 2023; 17:e13192. [PMID: 37744991 PMCID: PMC10511836 DOI: 10.1111/irv.13192] [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: 03/08/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
We examined associations between mild or asymptomatic prenatal SARS-CoV-2 infection and preterm live birth in a prospective cohort study. During August 2020-October 2021, pregnant persons were followed with systematic surveillance for RT-PCR or serologically confirmed SARS-CoV-2 infection until pregnancy end. The association between prenatal SARS-CoV-2 infection and preterm birth was assessed using Cox proportional-hazards regression. Among 954 pregnant persons with a live birth, 185 (19%) had prenatal SARS-CoV-2 infection and 123 (13%) had preterm birth. The adjusted hazard ratio for the association between SARS-CoV-2 infection and preterm birth was 1.28 (95% confidence interval 0.82-1.99, p = 0.28), although results did not reach statistical significance.
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Affiliation(s)
- Sarita Mohanty
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Alan T. Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Michael Varner
- Department of Obstetrics and GynecologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Population and Family Health, Mailman School of Public HealthColumbia University Irving Medical CenterNew YorkNew YorkUSA
- New York‐Presbyterian HospitalNew YorkNew YorkUSA
| | | | - Ashley N. Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | | | | | - Mirella Mourad
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Raul A. Silverio Francisco
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kate Woodworth
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Romeo Galang
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Pete Maniatis
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Vera Semenova
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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Egloff C, Roques P, Picone O. Impact of COVID-19 on pregnant women's health: Consequences in obstetrics two years after the pandemic. J Reprod Immunol 2023; 158:103981. [PMID: 37390631 PMCID: PMC10266984 DOI: 10.1016/j.jri.2023.103981] [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: 10/11/2022] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
The pandemic linked to SARS-CoV-2 has profoundly disrupted the health systems and many studies have led to a better understanding of this virus, which is responsible for severe disease, particularly during pregnancy. Pregnancy is a risk factor for severe COVID-19. Term of pregnancy and vaccination status is the main risk factor in addition to classic comorbidities like general population. COVID-19 during pregnancy is responsible for more maternal death, stillbirth, pre-eclampsia spontaneous and induced prematurity. Vaccination is therefore strongly recommended for pregnant patients. In addition, the COVID-19 pandemic has highlighted a psychological and social dimension that should not be neglected in the management of a pregnant patient. Correlation between immunological changes and clinical impact are described in this review. Many conclusions can now be made and are summarized in this article in order to discuss possible future research.
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Affiliation(s)
- Charles Egloff
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Université de Paris, France.
| | - Pierre Roques
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases, (IMVA-HB/IDMIT), Université Paris-Saclay, INSERM, CEA, Fontenay-aux-Roses, Le Kremlin-Bicêtre, France; Virology Unit, Institut Pasteur de Guinée, Conakry, Guinea.
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Université de Paris, France; IAME Inserm, U1137, Paris, France; Groupe de Recherche Contre Les Infections au Cours de la Grossesse(GRIG), Velizy, France.
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Marchand G, Masoud AT, Grover S, King A, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Moir C, Govindan M, Moberly A, Proctor A, Sainz K, Blumrick R. Maternal and neonatal outcomes of COVID-19 vaccination during pregnancy, a systematic review and meta-analysis. NPJ Vaccines 2023; 8:103. [PMID: 37454153 PMCID: PMC10349851 DOI: 10.1038/s41541-023-00698-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is associated with increased pregnancy complications. Despite effective vaccination strategies for the general population, the evidence on the safety and efficacy of Coronavirus disease 2019 (COVID-19) vaccinations in pregnancy is limited due to a lack of well-powered studies. The present study compares the maternal, neonatal, and immunological outcomes between vaccinated pregnant and unvaccinated pregnant women using a systematic review and meta-analysis approach. We included 37 studies with a total of 141,107 pregnant women (36.8% vaccinated) spread across all outcomes. Our evidence indicates a higher rate of cesarean section in the 1898 vaccinated pregnant women compared to the 6180 women who did not receive vaccination (OR = 1.20, CI = (1.05, 1.38), P = 0.007, I2 = 45%). Regarding immunological outcomes, the risk of SARS-CoV-2 infection during pregnancy or postpartum was significantly reduced in 6820 vaccinated pregnant women compared to 17,010 unvaccinated pregnant women (OR = 0.25, CI = 0.13-0.48, P < 0.0001, I2 = 61%), as evident from qualitative assessment indicating significantly higher postpartum antibody titers compared to that observed in both unvaccinated mothers and mothers who have recently recovered from a SARS-CoV-2 infection. Our analysis represents high quality evidence showing that COVID-19 vaccination effectively raises antibody titers against SARS-CoV-2. This may confer protection against infection during pregnancy and the postpartum period. In addition to being protective against SARS-CoV-2, the vaccine was associated with decreased odds of preterm delivery. Furthermore, COVID-19 vaccination may also be associated with higher odds of cesarean section.
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Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA.
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Sandeep Grover
- Center for Human Genetics, Universitatsklinikum Giessen und Marburg, Marburg, Germany
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Atley Moberly
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Anna Proctor
- University of Iowa, College of Public Health, Iowa City, IA, USA
| | - Katelyn Sainz
- Tucson Medical Center, Department of Pediatrics, Tucson, AZ, USA
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Baki Yıldırım S, Yeniay D. Characteristics and Outcomes of Women With Mild and Moderate Forms of COVID-19 Giving Birth During the COVID-19 Pandemic. Cureus 2023; 15:e41397. [PMID: 37546030 PMCID: PMC10401895 DOI: 10.7759/cureus.41397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION We aim to investigate the clinical course and impact of mild and moderate forms of coronavirus disease 2019 (COVID-19) infection on pregnant women. METHOD A retrospective cohort study was conducted on pregnant women who delivered in a hospital with confirmed COVID-19 infection. Demographic features, clinical characteristics, and perinatal outcomes were retrospectively evaluated. RESULTS In total, 157 pregnant women with COVID-19 were hospitalized. In a total of 46 deliveries, three (6.5%) had comorbidities and six (13%) were symptomatic. Myalgia and cough were the leading symptoms. In total, 11 (23.8%) patients received COVID-19 therapy, 41 (90%) had mild disease, and five (10.9%) were transferred to the intensive care unit (ICU). Maternal mortality was observed in two (4.3%) cases. Of the patients, 15 (32.6) had pregnancy complications (preterm delivery) (n = 13, 28.2%), and the cesarean section rate was 91.3%. CONCLUSION The course of COVID-19 was mild in the majority of cases. However, accompanying comorbid conditions may accelerate the return to severe form and cause death.
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Affiliation(s)
- Sema Baki Yıldırım
- Department of Obstetrics and Gynecology, Giresun University, Giresun, TUR
| | - Dilek Yeniay
- Department of Anesthesiology and Reanimation, Giresun Maternity and Child Health Training and Research Hospital, Giresun, TUR
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Dawood FS, Tita A, Stockwell MS, Newes-Adeyi G, Wielgosz K, Gyamfi-Bannerman C, Battarbee A, Reichle L, Thornburg N, Ellington S, Galang RR, Vorwaller K, Vargas CY, Morrill T, Parks M, Powers E, Gibson M, Varner M. Neutralizing Antibody Responses to Messenger RNA Coronavirus Disease 2019 Vaccines Versus Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Pregnant Women and Vaccine-Induced Antibody Transfer to Infants. Open Forum Infect Dis 2023; 10:ofad204. [PMID: 37187508 PMCID: PMC10167992 DOI: 10.1093/ofid/ofad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Background Early coronavirus disease 2019 (COVID-19) vaccine trials excluded pregnant women, resulting in limited data about immunogenicity and maternal-fetal antibody transfer, particularly by gestational timing of vaccination. Methods In this multicenter observational immunogenicity study, pregnant and nonpregnant women receiving COVID-19 vaccines were prospectively enrolled. Participants had sera collected before vaccination, at 14-28 days after each vaccine dose, at delivery (umbilical cord and peripheral), and from their infants at 3 and 6 months. Geometric mean titers (GMTs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ID50 neutralizing antibody (nAb) against D614G-like viruses were compared by participant characteristics. Results Overall, 23 nonpregnant and 85 pregnant participants (trimester of first vaccine dose: 10 first, 47 second, 28 third) were enrolled. Ninety-three percent (76/82 with blood samples) of pregnant participants had detectable SARS-CoV-2 nAb after 2 vaccine doses, but GMTs (95% confidence intervals) were lower in pregnant participants than nonpregnant participants (1722 [1136-2612] vs 4419 [2012-9703]; P = .04). By 3 and 6 months, 28% and 74% of infants, respectively, of vaccinated participants had no detectable nAb to D614G-like viruses. Among the 71 pregnant participants without detectable nAb before vaccination, cord blood GMTs at delivery were 5-fold higher among participants vaccinated during the third versus first trimester, and cord blood nAb titers appeared inversely correlated with weeks since first vaccine dose (R2 = 0.06, P = .06). Conclusions Though most pregnant women develop nAb after 2 doses of mRNA COVID-19 vaccines, this analysis suggests that infant protection from maternal vaccination varies by gestational timing of vaccination and wanes. Additional prevention strategies such as caregiver vaccination may warrant consideration to optimize infant protection.
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Affiliation(s)
- Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alan Tita
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa S Stockwell
- New York–Presbyterian Hospital, New York, New York, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Kristina Wielgosz
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia Gyamfi-Bannerman
- New York–Presbyterian Hospital, New York, New York, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, California, USA
| | - Ashley Battarbee
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Natalie Thornburg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha Ellington
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Romeo R Galang
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelly Vorwaller
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Mickey Parks
- Center for Women's Reproductive Health and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Powers
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie Gibson
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Firestein MR, Shuffrey LC, Hu Y, Kyle M, Hussain M, Bianco C, Hott V, Hyman SP, Kyler M, Rodriguez C, Tejeda Romero M, Tzul Lopez H, Alcántara C, Amso D, Austin J, Bain JM, Barbosa J, Battarbee AN, Bruno A, Ettinger S, Factor-Litvak P, Gilboa S, Goldman S, Gyamfi-Bannerman C, Maniatis P, Marsh R, Morrill T, Mourad M, Muhle R, Newes-Adeyi G, Noble KG, O’Reilly KC, Penn AA, Reichle L, Sania A, Semenova V, Silver WG, Smotrich G, Tita AT, Tottenham N, Varner M, Welch MG, Zork N, Garey D, Fifer WP, Stockwell MS, Monk C, Dawood F, Dumitriu D. Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2 Infection During Pregnancy. JAMA Netw Open 2023; 6:e237396. [PMID: 37036706 PMCID: PMC10087058 DOI: 10.1001/jamanetworkopen.2023.7396] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Importance Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding. Objective To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months. Design, Setting, and Participants This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants. Exposures Maternal symptomatic or asymptomatic SARS-CoV-2 infection. Main Outcomes and Measures Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language. Results Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores. Conclusions and Relevance In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.
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Affiliation(s)
- Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Yunzhe Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Margaret Kyle
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Maha Hussain
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Bianco
- Department of Psychology, Columbia University, New York, New York
| | - Violet Hott
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sabrina P. Hyman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Mia Kyler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Rodriguez
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Melanie Tejeda Romero
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Helen Tzul Lopez
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Dima Amso
- Department of Psychology, Columbia University, New York, New York
| | - Judy Austin
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Jennifer M. Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ashley N. Battarbee
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham
| | - Ann Bruno
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Sharon Ettinger
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Suzanne Gilboa
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sylvie Goldman
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California
| | - Panagiotis Maniatis
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | | | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca Muhle
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | | | - Kimberly G. Noble
- Department of Behavioral Sciences, Teachers College, Columbia University, New York, New York
| | - Kally C. O’Reilly
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Anna A. Penn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Vera Semenova
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy G. Silver
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Grace Smotrich
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Martha G. Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Donna Garey
- Department of Pediatrics, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Fatimah Dawood
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dani Dumitriu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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7
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Feng Q, Cui Q, Xiao Z, Liu Z, Fan S. Maternal and Perinatal Outcomes of SARS-CoV-2 and Variants in Pregnancy. MATERNAL-FETAL MEDICINE 2023. [DOI: 10.1097/fm9.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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8
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Thind P, Vargas CY, Reed C, Wang L, Alba LR, Larson EL, Saiman L, Stockwell MS. Acceptability, Feasibility, and Validity of Detecting Respiratory Pathogens During Acute Respiratory Illness in Participant-Collected Swabs in a Low-Income, Community Sample. Open Forum Infect Dis 2023; 10:ofad068. [PMID: 36879622 PMCID: PMC9985149 DOI: 10.1093/ofid/ofad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Indexed: 02/18/2023] Open
Abstract
Background Community surveillance for acute respiratory illness (ARI) can include unsupervised participant-collected nasal swabs. Little is known about use of self-swabs in low-income populations or among households including extended family members and the validity of self-collected swabs. We assessed the acceptability, feasibility, and validity of unsupervised participant-collected nasal swabs in a low-income, community sample. Methods This was a substudy of a larger prospective community-based ARI surveillance study in 405 households in New York City. Participating household members self-collected swabs on the day of a research home visit for an index case, and for 3-6 subsequent days. Demographics associated with agreement to participate and swab collection were assessed, and index case self-collected versus research staff-collected swab results were compared. Results Most households (n = 292 [89.6%]) agreed to participate, including 1310 members. Being <18 years old, female, and the household reporter or member of the nuclear family (parents and children) were associated with both agreement to participate and self-swab collection. Being born in the United States or immigrating ≥10 years ago was associated with participation, and being Spanish-speaking and having less than a high school education were associated with swab collection. In all, 84.4% collected at least 1 self-swabbed specimen; self-swabbing rates were highest during the first 4 collection days. Concordance between research staff-collected swabs and self-swabs was 88.4% for negative swabs, 75.0% for influenza, and 69.4% for noninfluenza pathogens. Conclusions Self-swabbing was acceptable, feasible, and valid in this low-income, minoritized population. Some differences in participation and swab collection were identified that could be noted by future researchers and modelers.
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Affiliation(s)
- Priyam Thind
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Celibell Y Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Liqun Wang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Luis R Alba
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elaine L Larson
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Infection Prevention and Control, New York–Presbyterian Hospital, New York, New York, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
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9
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Han E, Gyöngyösi M. [Long COVID-A New Challenge in Medicine: Focus on Pregnancy and Breastfeeding]. JOURNAL FUR GYNAKOLOGISCHE ENDOKRINOLOGIE (OSTERREICHISCHE AUSG.) 2023; 33:7-12. [PMID: 36747883 PMCID: PMC9893966 DOI: 10.1007/s41974-023-00250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/05/2023]
Abstract
Long COVID (coronavirus disease) has been described as a new multi-organ disease, which appears to be more prevalent in women than in men. Pregnant and breastfeeding women are a special subgroup of patients to consider with long COVID, as only scarce data have been collected to date. Menstrual changes are commonly observed during or after COVID-19; some studies also attribute slight changes of cycle length to previous inoculation against the virus. Pregnant women who have a symptomatic infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are at a higher risk for adverse outcomes and pregnancy-associated complications. Moreover, more and robust data are required to evaluate vertical transmission. COVID vaccines are the most effective tool against the pandemic, as they prevent infection, but also appear to be able to ease long COVID symptoms. Vaccines have been proven safe and effective in both pregnant and breastfeeding women. This article aims to present current data on long COVID in pregnant and breastfeeding women and elucidate risk factors and possible treatment options.
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Affiliation(s)
- Emilie Han
- Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich
| | - Mariann Gyöngyösi
- Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich
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10
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Wielgosz K, Dawood FS, Stockwell MS, Varner M, Newes-Adeyi G, Ellington S, Vargas C, Bruno AM, Powers E, Morrill T, Reichle L, Battarbee AN, Tita AT. Agreement Between Pregnant Individuals' Self-Report of Coronavirus Disease 2019 (COVID-19) Vaccination and Medical Record Documentation. Obstet Gynecol 2022; 140:989-992. [PMID: 36357976 PMCID: PMC10563869 DOI: 10.1097/aog.0000000000004994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
For public health research such as vaccine uptake or effectiveness assessments, self-reported coronavirus disease 2019 (COVID-19) vaccination status may be a more efficient measure than verifying vaccination status from medical records if agreement between sources is high. We assessed agreement between self-reported and medical record-documented COVID-19 vaccination status among pregnant individuals followed in a cohort during August 2020-October 2021. At end of pregnancy, participants completed questionnaires about COVID-19 vaccine receipt during pregnancy; staff verified vaccination status using medical records. Agreement was assessed between self-reported and medical record vaccination status using Cohen's kappa. There was high agreement between self-reported and medical record vaccination status (Kappa coefficient=0.94, 95% CI 0.91-0.98), suggesting that self-report may be acceptable for ascertaining COVID-19 vaccination status during pregnancy.
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Affiliation(s)
| | | | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Michael Varner
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Celibell Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ann M. Bruno
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Emily Powers
- Department of Obstetrics and Gynecology, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Ashley N. Battarbee
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
| | - Alan T. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL
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11
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Yefet E, Massalha M, Alter A, Gal Harnik A, Hosari Mahamed S, Novick L, Wattad M, Sakas J, Baram S, Weiss A, Iskander R, Peretz A, Rozenberg O, Younis JS, Perlitz Y, Nachum Z. Should pregnant women be screened for SARS-CoV-2 infection? A prospective multicenter cohort study. Int J Gynaecol Obstet 2022; 160:161-166. [PMID: 35842225 PMCID: PMC9349848 DOI: 10.1002/ijgo.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranges from asymptomatic to severe infection. We aimed to compare the prevalence of COVID-19 in asymptomatic pregnant versus nonpregnant women in order to establish recommendations for a COVID-19 screening strategy. METHODS A prospective multicenter cohort study was conducted. Asymptomatic pregnant or nonpregnant women after March 2020 (the time when COVID-19 was first detected in north Israel) were tested for SARS-CoV-2 using nasopharyngeal reverse transcription polymerase chain reaction test, anti-nucleocapsid IgG, and anti-spike IgG. Diagnosis was made if at least one test result was positive. Pregnant women were tested between 34 and 42 weeks, mostly at birth. RESULTS Among the 297 participating women, 152 were pregnant and 145 were nonpregnant. The prevalence of asymptomatic COVID-19 was similar between the groups (4 [2.6%] and 8 [5.5%], respectively; P = 0.2). All women with COVID-19 delivered healthy appropriate-for-gestational-age babies without malformations, at term. CONCLUSIONS The rate of asymptomatic COVID-19 in pregnant women is low and comparable to the rate among nonpregnant women. Pregnancy outcomes are favorable. Future screening programs should consider that one of 25 screened asymptomatic women will be positive.
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Affiliation(s)
- Enav Yefet
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Manal Massalha
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Adi Alter
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael
| | - Amit Gal Harnik
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael
| | | | - Lia Novick
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael
| | - Malak Wattad
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
| | - Jawad Sakas
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael
| | - Shira Baram
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
| | - Amir Weiss
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,Rappaport Faculty of Medicine, TechnionHaifaIsrael
| | - Rula Iskander
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael
| | - Avi Peretz
- Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael,Clinical Microbiology LaboratoryBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael
| | | | - Johnny S. Younis
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Yuri Perlitz
- Department of Obstetrics and GynecologyBaruch Padeh Medical Center Poriya, Affiliated with Azrieli Faculty of MedicinePoriyaIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Zohar Nachum
- Department of Obstetrics and GynecologyEmek Medical CenterAfulaIsrael,Rappaport Faculty of Medicine, TechnionHaifaIsrael
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12
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SARS-CoV-2 incidence, transmission, and reinfection in a rural and an urban setting: results of the PHIRST-C cohort study, South Africa, 2020-21. THE LANCET. INFECTIOUS DISEASES 2022; 22:821-834. [PMID: 35298900 PMCID: PMC8920516 DOI: 10.1016/s1473-3099(22)00069-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND By August, 2021, South Africa had been affected by three waves of SARS-CoV-2; the second associated with the beta variant and the third with the delta variant. Data on SARS-CoV-2 burden, transmission, and asymptomatic infections from Africa are scarce. We aimed to evaluate SARS-CoV-2 burden and transmission in one rural and one urban community in South Africa. METHODS We conducted a prospective cohort study of households in Agincourt, Mpumalanga province (rural site) and Klerksdorp, North West province (urban site) from July, 2020 to August, 2021. We randomly selected households for the rural site from a health and sociodemographic surveillance system and for the urban site using GPS coordinates. Households with more than two members and where at least 75% of members consented to participate were eligible. Midturbinate nasal swabs were collected twice a week from household members irrespective of symptoms and tested for SARS-CoV-2 using real-time RT-PCR (RT-rtPCR). Serum was collected every 2 months and tested for anti-SARS-CoV-2 antibodies. Main outcomes were the cumulative incidence of SARS-CoV-2 infection, frequency of reinfection, symptomatic fraction (percent of infected individuals with ≥1 symptom), the duration of viral RNA shedding (number of days of SARS-CoV-2 RT-rtPCR positivity), and the household cumulative infection risk (HCIR; number of infected household contacts divided by the number of susceptible household members). FINDINGS 222 households (114 at the rural site and 108 at the urban site), and 1200 household members (643 at the rural site and 557 at the urban site) were included in the analysis. For 115 759 nasal specimens from 1200 household members (follow-up 92·5%), 1976 (1·7%) were SARS-CoV-2-positive on RT-rtPCR. By RT-rtPCR and serology combined, 749 of 1200 individuals (62·4% [95% CI 58·1-66·4]) had at least one SARS-CoV-2 infection episode, and 87 of 749 (11·6% [9·4-14·2]) were reinfected. The mean infection episode duration was 11·6 days (SD 9·0; range 4-137). Of 662 RT-rtPCR-confirmed episodes (>14 days after the start of follow-up) with available data, 97 (14·7% [11·9-17·9]) were symptomatic with at least one symptom (in individuals aged <19 years, 28 [7·5%] of 373 episodes symptomatic; in individuals aged ≥19 years, 69 [23·9%] of 289 episodes symptomatic). Among 222 households, 200 (90·1% [85·3-93·7]) had at least one SARS-CoV-2-positive individual on RT-rtPCR or serology. HCIR overall was 23·9% (195 of 817 susceptible household members infected [95% CI 19·8-28·4]). HCIR was 23·3% (20 of 86) for symptomatic index cases and 23·9% (175 of 731) for asymptomatic index cases (univariate odds ratio [OR] 1·0 [95% CI 0·5-2·0]). On multivariable analysis, accounting for age and sex, low minimum cycle threshold value (≤30 vs >30) of the index case (OR 5·3 [2·3-12·4]) and beta and delta variant infection (vs Wuhan-Hu-1, OR 3·3 [1·4-8·2] and 10·4 [4·1-26·7], respectively) were associated with increased HCIR. People living with HIV who were not virally supressed (≥400 viral load copies per mL) were more likely to develop symptomatic illness when infected with SAR-CoV-2 (OR 3·3 [1·3-8·4]), and shed SARS-CoV-2 for longer (hazard ratio 0·4 [95% CI 0·3-0·6]) compared with HIV-uninfected individuals. INTERPRETATION In this study, 565 (85·3%) SARS-CoV-2 infections were asymptomatic and index case symptom status did not affect HCIR, suggesting a limited role for control measures targeting symptomatic individuals. Increased household transmission of beta and delta variants was likely to have contributed to successive waves of SARS-CoV-2 infection, with more than 60% of individuals infected by the end of follow-up. FUNDING US CDC, South Africa National Institute for Communicable Diseases, and Wellcome Trust.
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Carvalho MS, Bastos LS, Fuller T, Cruz OG, Damasceno L, Calvet G, Resende PC, Smith C, Whitworth J, Siqueira M, Brasil P. Incidence of SARS-CoV-2 over four epidemic waves in a low-resource community in Rio de Janeiro, Brazil: A prospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100283. [PMID: 35663637 PMCID: PMC9135359 DOI: 10.1016/j.lana.2022.100283] [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] [Indexed: 01/11/2023]
Abstract
Background Incidence rates of SARS-CoV-2 infections in low-resource communities can inform vaccination strategies and non-pharmaceutical interventions (NPIs). Our objective was to estimate incidence over four epidemic waves in a slum in Rio de Janeiro, a proxy for economically deprived areas in the Global South. Methods Prospective cohort of children and household contacts screened for SARS-CoV-2 by PCR and serology (IgG). The incidence density of PCR positive infections estimated for each wave - the first wave, Zeta, Gamma and Delta - was compared to an index combining NPIs and vaccination coverage. Findings 718 families and 2501 individuals were enrolled, from May 2020 to November 2021. The incidence density of SARS-CoV-2 infection due to the first wave was 2, 3 times that of the other waves. The incidence among children was lower than that of older participants, except in later waves, when vaccination of the elderly reached 90%. Household agglomeration was significantly associated with incidence only during the first wave. Interpretation The incidence of infection greatly exceeded rates reported in similar cohorts. The observed reduction in incidence in the elderly during the Delta variant wave, in spite of the rollback of NPIs, can be attributed to increased vaccine coverage. The high incidence in young people reinforces the importance of vaccination in this age group, a policy that has yet to receive the full support of some sectors of society. Funding UK Medical Research Council, Foundation for the Advancement of Science of the State of Rio de Janeiro, National Council for Scientific and Technological Development.
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Affiliation(s)
- Marilia Sa Carvalho
- Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Trevon Fuller
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | | | - Luana Damasceno
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil
| | - Paola Cristina Resende
- Laboratory of Respiratory Viruses and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Brazil
| | - Chris Smith
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jimmy Whitworth
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marilda Siqueira
- Laboratory of Respiratory Viruses and Measles, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Brazil
| | - Patricia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil,Corresponding author.
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Affiliation(s)
- Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, 1600 Archer Road, Box 100296, Gainesville, Florida, 32610; Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA; Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA.
| | - Denise J Jamieson
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Woodruff Memorial Research Building, 101 Woodruff Circle, Suite 4208, Atlanta, GA 30322, USA
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15
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Cohen C, Kleynhans J, von Gottberg A, McMorrow ML, Wolter N, Bhiman JN, Moyes J, du Plessis M, Carrim M, Buys A, Martinson NA, Kahn K, Tollman S, Lebina L, Wafawanaka F, du Toit J, Xavier Gómez-Olivé F, Dawood FS, Mkhencele T, Sun K, Viboud C, Tempia S. SARS-CoV-2 incidence, transmission and reinfection in a rural and an urban setting: results of the PHIRST-C cohort study, South Africa, 2020-2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.07.20.21260855. [PMID: 34909794 PMCID: PMC8669861 DOI: 10.1101/2021.07.20.21260855] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND By August 2021, South Africa experienced three SARS-CoV-2 waves; the second and third associated with emergence of Beta and Delta variants respectively. METHODS We conducted a prospective cohort study during July 2020-August 2021 in one rural and one urban community. Mid-turbinate nasal swabs were collected twice-weekly from household members irrespective of symptoms and tested for SARS-CoV-2 using real-time reverse transcription polymerase chain reaction (rRT-PCR). Serum was collected every two months and tested for anti-SARS-CoV-2 antibodies. RESULTS Among 115,759 nasal specimens from 1,200 members (follow-up rate 93%), 1976 (2%) were SARS-CoV-2-positive. By rRT-PCR and serology combined, 62% (749/1200) of individuals experienced ≥1 SARS-CoV-2 infection episode, and 12% (87/749) experienced reinfection. Of 662 PCR-confirmed episodes with available data, 15% (n=97) were associated with ≥1 symptom. Among 222 households, 200 (90%) had ≥1 SARS-CoV-2-positive individual. Household cumulative infection risk (HCIR) was 25% (213/856). On multivariable analysis, accounting for age and sex, index case lower cycle threshold value (OR 3.9, 95%CI 1.7-8.8), urban community (OR 2.0,95%CI 1.1-3.9), Beta (OR 4.2, 95%CI 1.7-10.1) and Delta (OR 14.6, 95%CI 5.7-37.5) variant infection were associated with increased HCIR. HCIR was similar for symptomatic (21/110, 19%) and asymptomatic (195/775, 25%) index cases (p=0.165). Attack rates were highest in individuals aged 13-18 years and individuals in this age group were more likely to experience repeat infections and to acquire SARS-CoV-2 infection. People living with HIV who were not virally supressed were more likely to develop symptomatic illness, and shed SARS-CoV-2 for longer compared to HIV-uninfected individuals. CONCLUSIONS In this study, 85% of SARS-CoV-2 infections were asymptomatic and index case symptom status did not affect HCIR, suggesting a limited role for control measures targeting symptomatic individuals. Increased household transmission of Beta and Delta variants, likely contributed to successive waves, with >60% of individuals infected by the end of follow-up. RESEARCH IN CONTEXT Evidence before this study: Previous studies have generated wide-ranging estimates of the proportion of SARS-CoV-2 infections which are asymptomatic. A recent systematic review found that 20% (95% CI 3%-67%) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remained asymptomatic throughout infection and that transmission from asymptomatic individuals was reduced. A systematic review and meta-analysis of 87 household transmission studies of SARS-CoV-2 found an estimated secondary attack rate of 19% (95% CI 16-22). The review also found that household secondary attack rates were increased from symptomatic index cases and that adults were more likely to acquire infection. As of December 2021, South Africa experienced three waves of SARS-CoV-2 infections; the second and third waves were associated with circulation of Beta and Delta variants respectively. SARS-CoV-2 vaccines became available in February 2021, but uptake was low in study sites reaching 5% fully vaccinated at the end of follow up. Studies to quantify the burden of asymptomatic infections, symptomatic fraction, reinfection frequency, duration of shedding and household transmission of SARS-CoV-2 from asymptomatically infected individuals have mostly been conducted as part of outbreak investigations or in specific settings. Comprehensive systematic community studies of SARS-CoV-2 burden and transmission including for the Beta and Delta variants are lacking, especially in low vaccination settings.Added value of this study: We conducted a unique detailed COVID-19 household cohort study over a 13 month period in South Africa, with real time reverse transcriptase polymerase chain reaction (rRT-PCR) testing twice a week irrespective of symptoms and bimonthly serology. By the end of the study in August 2021, 749 (62%) of 1200 individuals from 222 randomly sampled households in a rural and an urban community in South Africa had at least one confirmed SARS-CoV-2 infection, detected on rRT-PCR and/or serology, and 12% (87/749) experienced reinfection. Symptom data were analysed for 662 rRT-PCR-confirmed infection episodes that occurred >14 days after the start of follow-up (of a total of 718 rRT-PCR-confirmed episodes), of these, 15% (n=97) were associated with one or more symptoms. Among symptomatic indvidiausl, 9% (n=9) were hospitalised and 2% (n=2) died. Ninety percent (200/222) of included households, had one or more individual infected with SARS-CoV-2 on rRT-PCR and/or serology within the household. SARS-CoV-2 infected index cases transmitted the infection to 25% (213/856) of susceptible household contacts. Index case ribonucleic acid (RNA) viral load proxied by rRT-PCR cycle threshold value was strongly predictive of household transmission. Presence of symptoms in the index case was not associated with household transmission. Household transmission was four times greater from index cases infected with Beta variant and fifteen times greater from index cases infected with Delta variant compared to wild-type infection. Attack rates were highest in individuals aged 13-18 years and individuals in this age group were more likely to experience repeat infections and to acquire SARS-CoV-2 infection within households. People living with HIV (PLHIV) who were not virally supressed were more likely to develop symptomatic illness when infected with SARS-CoV-2, and shed SARS-CoV-2 for longer when compared to HIV-uninfected individuals.Implications of all the available evidence: We found a high rate of SARS-CoV-2 infection in households in a rural community and an urban community in South Africa, with the majority of infections being asymptomatic in individuals of all ages. Asymptomatic individuals transmitted SARS-CoV-2 at similar levels to symptomatic individuals suggesting that interventions targeting symptomatic individuals such as symptom-based testing and contact tracing of individuals tested because they report symptoms may have a limited impact as control measures. Increased household transmission of Beta and Delta variants, likely contributed to recurrent waves of COVID-19, with >60% of individuals infected by the end of follow-up. Higher attack rates, reinfection and acquisition in adolescents and prolonged SARS-CoV-2 shedding in PLHIV who were not virally suppressed suggests that prioritised vaccination of individuals in these groups could impact community transmission.
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Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N. Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Floidy Wafawanaka
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques du Toit
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatimah S. Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thulisa Mkhencele
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kaiyun Sun
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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