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Stanke Z, Spouge JL. Estimating age-stratified transmission and reproduction numbers during the early exponential phase of an epidemic: A case study with COVID-19 data. Epidemics 2023; 44:100714. [PMID: 37595401 PMCID: PMC10528737 DOI: 10.1016/j.epidem.2023.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/07/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
In a pending pandemic, early knowledge of age-specific disease parameters, e.g., susceptibility, infectivity, and the clinical fraction (the fraction of infections coming to clinical attention), supports targeted public health responses like school closures or sequestration of the elderly. The earlier the knowledge, the more useful it is, so the present article examines an early phase of many epidemics, exponential growth. Using age-stratified COVID-19 case counts collected in Canada, China, Israel, Italy, the Netherlands, and the United Kingdom before April 23, 2020, we present a linear analysis of the exponential phase that attempts to estimate the age-specific disease parameters given above. Some combinations of the parameters can be estimated by requiring that they change smoothly with age. The estimation yielded: (1) the case susceptibility, defined for each age-group as the product of susceptibility to infection and the clinical fraction; (2) the mean number of transmissions of infection per contact within each age-group; and (3) the reproduction number of infection within each age-group, i.e., the diagonal of the age-stratified next-generation matrix. Our restriction to data from the exponential phase indicates the combinations of epidemic parameters that are intrinsically easiest to estimate with early age-stratified case counts. For example, conclusions concerning the age-dependence of case susceptibility appeared more robust than corresponding conclusions about infectivity. Generally, the analysis produced some results consistent with conclusions confirmed much later in the COVID-19 pandemic. Notably, our analysis showed that in some countries, the reproduction number of infection within the half-decade 70-75 was unusually large compared to other half-decades. Our analysis therefore could have anticipated that without countermeasures, COVID-19 would spread rapidly once seeded in homes for the elderly.
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Affiliation(s)
- Zachary Stanke
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - John L Spouge
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA.
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2
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Tormos R, Fonseca i Casas P, Garcia-Alamino JM. In-person school reopening and the spread of SARS-CoV-2 during the second wave in Spain. Front Public Health 2022; 10:990277. [PMID: 36311601 PMCID: PMC9608566 DOI: 10.3389/fpubh.2022.990277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/16/2022] [Indexed: 01/26/2023] Open
Abstract
We investigate the effects of school reopening on the evolution of COVID-19 infections during the second wave in Spain studying both regional and age-group variation within an interrupted time-series design. Spain's 17 Autonomous Communities reopened schools at different moments in time during September 2020. We find that in-person school reopening correlates with a burst in infections in almost all those regions. Data from Spanish regions gives a further leverage: in some cases, pre-secondary and secondary education started at different dates. The analysis of those cases does not allow to conclude whether reopening one educational stage had an overall stronger impact than the other. To provide a plausible mechanism connecting school reopening with the burst in contagion, we study the Catalan case in more detail, scrutinizing the interrupted time-series patterns of infections among age-groups and the possible connections between them. The stark and sudden increase in contagion among older children (10-19) just after in-person school reopening appears to drag the evolution of other age-groups according to Granger causality. This might be taken as an indirect indication of household transmission from offspring to parents with important societal implications for the aggregate dynamics of infections.
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Affiliation(s)
- Raül Tormos
- Centre d'Estudis d'Opinió - Generalitat de Catalunya, Barcelona, Spain
- Department of Law and Political Science, Open University of Catalonia, Barcelona, Spain
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3
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Lacomba‐Trejo L, Schoeps K, Valero‐Moreno S, del Rosario C, Montoya‐Castilla I. Teachers' Response to Stress, Anxiety and Depression During COVID-19 Lockdown: What Have We Learned From the Pandemic? THE JOURNAL OF SCHOOL HEALTH 2022; 92:864-872. [PMID: 35610141 PMCID: PMC9347633 DOI: 10.1111/josh.13192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND As a result of national lockdown due to the COVID-19 outbreak, teachers were forced to suspend their classes and replace them with online teaching and home schooling. Additional stressors such as competing family responsibility have increased their worries and mental health problems. The aim of this study was to determine the impact of COVID-19-related worries on teachers' emotional symptoms, considering the mediating role of several protective factors. METHODS A total of 614 Chilean teachers (94.60% women) participated in this study using a cross-sectional design and incidental sampling method. Self-report data was collected assessing emotional symptoms, COVID-19-related worries, life satisfaction, affect balance, and resilience. Descriptive analyses, Pearson's correlations, hierarchical regressions, and mediation models were conducted. RESULTS The results indicated that emotional symptoms were associated with prepandemic physical and mental health problems, higher levels of worries and negative affect, as well as lower levels of life satisfaction and resilience. Results from the mediation models showed that the negative impact of COVID-19-related worries on emotional symptoms was alleviated by affect balance and resilience. CONCLUSIONS These findings highlight the importance of addressing the risk and protective factors for teachers' mental health during exceptional situations such as the ongoing pandemic.
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Affiliation(s)
- Laura Lacomba‐Trejo
- Department of Personality, Assessment and Psychological TreatmentsUniversitat de ValènciaValenciaSpain, Valencia
| | - Konstanze Schoeps
- Department of Personality, Assessment and Psychological TreatmentsUniversitat de ValènciaValenciaSpain, Valencia
| | - Selene Valero‐Moreno
- Department of Developmental and Educational PsychologyUniversitat de ValènciaValenciaSpain, Valencia
| | | | - Inmaculada Montoya‐Castilla
- Department of Personality, Assessment and Psychological TreatmentsUniversitat de ValènciaValenciaSpain, Valencia
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4
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Keeling MJ, Moore SE. An assessment of the vaccination of school-aged children in England against SARS-CoV-2. BMC Med 2022; 20:196. [PMID: 35581585 PMCID: PMC9113775 DOI: 10.1186/s12916-022-02379-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Children and young persons are known to have a high number of close interactions, often within the school environment, which can facilitate rapid spread of infection; yet for SARS-CoV-2, it is the elderly and vulnerable that suffer the greatest health burden. Vaccination, initially targeting the elderly and vulnerable before later expanding to the entire adult population, has been transformative in the control of SARS-CoV-2 in England. However, early concerns over adverse events and the lower risk associated with infection in younger individuals means that the expansion of the vaccine programme to those under 18 years of age needs to be rigorously and quantitatively assessed. METHODS Here, using a bespoke mathematical model matched to case and hospital data for England, we consider the potential impact of vaccinating 12-17 and 5-11-year-olds. This analysis is reported from an early model (generated in June 2021) that formed part of the evidence base for the decisions in England, and a later model (from November 2021) that benefits from a richer understanding of vaccine efficacy, greater knowledge of the Delta variant wave and uses data on the rate of vaccine administration. For both models, we consider the population wide impact of childhood vaccination as well as the specific impact on the age groups targeted for vaccination. RESULTS Projections from June suggested that an expansion of the vaccine programme to those 12-17 years old could generate substantial reductions in infection, hospital admission and deaths in the entire population, depending on population behaviour following the relaxation of control measures. The benefits within the 12-17-year-old cohort were less marked, saving between 660 and 1100 (95% PI (prediction interval) 280-2300) hospital admissions and between 22 and 38 (95% PI 9-91) deaths depending on assumed population behaviour. For the more recent model, the benefits within this age group are reduced, saving on average 630 (95% PI 300-1300) hospital admissions and 11 (95% PI 5-28) deaths for 80% vaccine uptake, while the benefits to the wider population represent a reduction of 8-10% in hospital admissions and deaths. The vaccination of 5-11-year-olds is projected to have a far smaller impact, in part due to the later roll-out of vaccines to this age group. CONCLUSIONS Vaccination of 12-170-year-olds and 5-11-year-olds is projected to generate a reduction in infection, hospital admission and deaths for both the age groups involved and the population in general. For any decision involving childhood vaccination, these benefits needs to be balanced against potential adverse events from the vaccine, the operational constraints on delivery and the potential for diverting resources from other public health campaigns.
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Affiliation(s)
- Matt J Keeling
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK.
| | - Sam E Moore
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
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5
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Lopez Bernal J, Panagiotopoulos N, Byers C, Garcia Vilaplana T, Boddington N, Zhang XS, Charlett A, Elgohari S, Coughlan L, Whillock R, Logan S, Bolt H, Sinnathamby M, Letley L, MacDonald P, Vivancos R, Edeghere O, Anderson C, Paranthaman K, Cottrell S, McMenamin J, Zambon M, Dabrera G, Ramsay M, Saliba V. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020. Euro Surveill 2022; 27. [PMID: 35426357 DOI: 10.1101/2020.08.19.20177188] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
BackgroundHouseholds appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.AimWe aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.MethodsA prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.ResultsWe included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31-43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.ConclusionsRates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.
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Affiliation(s)
- Jamie Lopez Bernal
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Chloe Byers
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | | | - Nicki Boddington
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Xu-Sheng Zhang
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Suzanne Elgohari
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Laura Coughlan
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Rosie Whillock
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Sophie Logan
- Field Services Division, Public Health England, London, United Kingdom
| | - Hikaru Bolt
- Field Services Division, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Pauline MacDonald
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Roberto Vivancos
- Field Services Division, Public Health England, London, United Kingdom
| | - Obaghe Edeghere
- Field Services Division, Public Health England, London, United Kingdom
| | | | | | | | | | - Maria Zambon
- TARGET Department, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- TARGET Department, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
| | - Vanessa Saliba
- Immunisation and Countermeasures Department, Public Health England, London, United Kingdom
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6
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Kousi T, Vivacqua D, Dalal J, James A, Câmara DCP, Botero Mesa S, Chimbetete C, Impouma B, Williams GS, Mboussou F, Mlanda T, Bukhari A, Keiser O, Abbate JL, Hofer CB. COVID-19 pandemic in Africa’s island nations during the first 9 months: a descriptive study of variation in patterns of infection, severe disease, and response measures. BMJ Glob Health 2022; 7:bmjgh-2021-006821. [PMID: 35277427 PMCID: PMC8919133 DOI: 10.1136/bmjgh-2021-006821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
The geographic and economic characteristics unique to island nations create a different set of conditions for, and responses to, the spread of a pandemic compared with those of mainland countries. Here, we aimed to describe the initial period of the COVID-19 pandemic, along with the potential conditions and responses affecting variation in the burden of infections and severe disease burden, across the six island nations of the WHO’s Africa region: Cabo Verde, Comoros, Madagascar, Mauritius, São Tomé e Príncipe and Seychelles. We analysed the publicly available COVID-19 data on confirmed cases and deaths from the beginning of the pandemic through 29 November 2020. To understand variation in the course of the pandemic in these nations, we explored differences in their economic statuses, healthcare expenditures and facilities, age and sex distributions, leading health risk factors, densities of the overall and urban populations and the main industries in these countries. We also reviewed the non-pharmaceutical response measures implemented nationally. We found that the burden of SARS-CoV-2 infection was reduced by strict early limitations on movement and biased towards nations where detection capacity was higher, while the burden of severe COVID-19 was skewed towards countries that invested less in healthcare and those that had older populations and greater prevalence of key underlying health risk factors. These findings highlight the need for Africa’s island nations to invest more in healthcare and in local testing capacity to reduce the need for reliance on border closures that have dire consequences for their economies.
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Affiliation(s)
- Timokleia Kousi
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Daniela Vivacqua
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jyoti Dalal
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- HACE: Data Changing Child Labor, Manchester, UK
| | - Ananthu James
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Daniel Cardoso Portela Câmara
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Sara Botero Mesa
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Cleophas Chimbetete
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Newlands Clinic, Harare, Zimbabwe
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Franck Mboussou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Tamayi Mlanda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Arish Bukhari
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olivia Keiser
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Jessica Lee Abbate
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- World Health Organization Regional Office for Africa, Brazzaville, Congo
- Geomatys, Montpellier, France
- UMI TransVIHMI (Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier), Montpellier, France
| | - Cristina Barroso Hofer
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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7
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Tagarro A, Cobos-Carrascosa E, Villaverde S, Sanz-Santaeufemia FJ, Grasa C, Soriano-Arandes A, Hernanz A, Navarro ML, Pino R, Epalza C, Batista R, Rizo J, Iglesias-Bouzas MI, Rodríguez-Molino P, Villanueva-Medina S, Carrasco-Colom J, Alonso-Cadenas JA, Mellado MJ, Herrero B, Melendo S, De La Torre M, Calleja L, Calvo C, Urretavizcaya-Martínez M, Astigarraga I, Menasalvas A, Penin M, Neth O, Berzosa A, De Ceano-Vivas M, Vidal P, Romero I, González R, García ML, Mesa JM, Ballesteros Á, Bernardino M, Moraleda C. Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children. Eur J Pediatr 2022; 181:1105-1115. [PMID: 34738173 PMCID: PMC8568563 DOI: 10.1007/s00431-021-04306-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022]
Abstract
We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.
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Affiliation(s)
- Alfredo Tagarro
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain. .,Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain. .,Pediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
| | - Elena Cobos-Carrascosa
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | - Serena Villaverde
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | | | - Carlos Grasa
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Antoni Soriano-Arandes
- grid.411083.f0000 0001 0675 8654Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Alicia Hernanz
- grid.410526.40000 0001 0277 7938Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- grid.410526.40000 0001 0277 7938Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Pino
- grid.411160.30000 0001 0663 8628Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Cristina Epalza
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain ,grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rosa Batista
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Jana Rizo
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - María-Isabel Iglesias-Bouzas
- grid.411107.20000 0004 1767 5442Paediatric Intensive Care Unit, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Paula Rodríguez-Molino
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Sara Villanueva-Medina
- grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jaime Carrasco-Colom
- grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María-José Mellado
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Blanca Herrero
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Susana Melendo
- grid.411083.f0000 0001 0675 8654Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Mercedes De La Torre
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Lourdes Calleja
- grid.411107.20000 0004 1767 5442Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Cristina Calvo
- grid.81821.320000 0000 8970 9163Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | | | - Itziar Astigarraga
- Department of Pediatrics, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, OsakidetzaBarakaldo, Spain
| | - Ana Menasalvas
- grid.411372.20000 0001 0534 3000Paediatrics Department, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain
| | - María Penin
- grid.411336.20000 0004 1765 5855Paediatrics Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Olaf Neth
- grid.411109.c0000 0000 9542 1158Paediatrics Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Arantxa Berzosa
- grid.411068.a0000 0001 0671 5785Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María De Ceano-Vivas
- grid.81821.320000 0000 8970 9163Emergency Pediatrics Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Paula Vidal
- grid.411050.10000 0004 1767 4212Paediatrics Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Isabel Romero
- Paediatrics Department, Hospitales HM, Madrid, Spain
| | - Raúl González
- Paediatrics Department, Hospital Universitario Sant Joan, Comunidad Valenciana, AlacantAlicante, Spain
| | - María Luz García
- grid.411361.00000 0001 0635 4617Paediatrics Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Juan-Miguel Mesa
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Álvaro Ballesteros
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
| | - María Bernardino
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Cinta Moraleda
- grid.144756.50000 0001 1945 5329Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain ,grid.144756.50000 0001 1945 5329Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain
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8
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Rees EM, Waterlow NR, Lowe R, Kucharski AJ. Estimating the duration of seropositivity of human seasonal coronaviruses using seroprevalence studies. Wellcome Open Res 2021; 6:138. [PMID: 34708157 PMCID: PMC8517721 DOI: 10.12688/wellcomeopenres.16701.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The duration of immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still uncertain, but it is of key clinical and epidemiological importance. Seasonal human coronaviruses (HCoV) have been circulating for longer and, therefore, may offer insights into the long-term dynamics of reinfection for such viruses. Methods: Combining historical seroprevalence data from five studies covering the four circulating HCoVs with an age-structured reverse catalytic model, we estimated the likely duration of seropositivity following seroconversion. Results: We estimated that antibody persistence lasted between 0.9 (95% Credible interval: 0.6 - 1.6) and 3.8 (95% CrI: 2.0 - 7.4) years. Furthermore, we found the force of infection in older children and adults (those over 8.5 [95% CrI: 7.5 - 9.9] years) to be higher compared with young children in the majority of studies. Conclusions: These estimates of endemic HCoV dynamics could provide an indication of the future long-term infection and reinfection patterns of SARS-CoV-2.
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Affiliation(s)
- Eleanor M. Rees
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Naomi R. Waterlow
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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9
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Marchant E, Todd C, James M, Crick T, Dwyer R, Brophy S. Primary school staff perspectives of school closures due to COVID-19, experiences of schools reopening and recommendations for the future: A qualitative survey in Wales. PLoS One 2021; 16:e0260396. [PMID: 34855789 DOI: 10.1101/2020.11.06.20227108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/10/2021] [Indexed: 05/25/2023] Open
Abstract
School closures due to the COVID-19 global pandemic are likely to have a range of negative consequences spanning the domains of child development, education and health, in addition to the widening of inequalities and inequities. Research is required to improve understanding of the impact of school closures on the education, health and wellbeing of pupils and school staff, the challenges posed during face-to-face reopening and importantly to identify how the impacts of these challenges can be addressed going forward to inform emerging policy and practice. This qualitative study aimed to reflect on the perspectives and experiences of primary school staff (pupils aged 3-11) in Wales regarding school closures and the initial face-to-face reopening of schools and to identify recommendations for the future. A total of 208 school staff completed a national online survey through the HAPPEN primary school network, consisting of questions about school closures (March to June 2020), the phased face-to-face reopening of schools (June to July 2020) and a return to face-to-face education. Thematic analysis of survey responses highlighted that primary school staff perceive that gaps in learning, health and wellbeing have increased and inequalities have widened during school closures. Findings from this study identified five recommendations; (i) prioritise the health and wellbeing of pupils and staff; (ii) focus on enabling parental engagement and support; (iii) improve digital competence amongst pupils, teachers and parents; (iv) consider opportunities for smaller class sizes and additional staffing; and (v) improve the mechanism of communication between schools and families, and between government and schools.
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Affiliation(s)
- Emily Marchant
- Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Charlotte Todd
- Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Michaela James
- Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Tom Crick
- Department of Education & Childhood Studies, Faculty of Humanities and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Russell Dwyer
- St Thomas Community Primary School, Swansea, United Kingdom
| | - Sinead Brophy
- Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
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10
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Rees EM, Waterlow NR, Lowe R, Kucharski AJ. Estimating the duration of seropositivity of human seasonal coronaviruses using seroprevalence studies. Wellcome Open Res 2021; 6:138. [PMID: 34708157 PMCID: PMC8517721 DOI: 10.12688/wellcomeopenres.16701.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The duration of immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still uncertain, but it is of key clinical and epidemiological importance. Seasonal human coronaviruses (HCoV) have been circulating for longer and, therefore, may offer insights into the long-term dynamics of reinfection for such viruses. Methods: Combining historical seroprevalence data from five studies covering the four circulating HCoVs with an age-structured reverse catalytic model, we estimated the likely duration of seropositivity following seroconversion. Results: We estimated that antibody persistence lasted between 0.9 (95% Credible interval: 0.6 - 1.6) and 3.8 (95% CrI: 2.0 - 7.4) years. Furthermore, we found the force of infection in older children and adults (those over 8.5 [95% CrI: 7.5 - 9.9] years) to be higher compared with young children in the majority of studies. Conclusions: These estimates of endemic HCoV dynamics could provide an indication of the future long-term infection and reinfection patterns of SARS-CoV-2.
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Affiliation(s)
- Eleanor M. Rees
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Naomi R. Waterlow
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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11
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Head JR, Andrejko KL, Remais JV. Model-based assessment of SARS-CoV-2 Delta variant transmission dynamics within partially vaccinated K-12 school populations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.08.20.21262389. [PMID: 34462757 PMCID: PMC8404896 DOI: 10.1101/2021.08.20.21262389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We examined school reopening policies amidst rising transmission of the highly transmissible Delta variant, accounting for vaccination among individuals aged 12 years and older, with the goal of characterizing risk to students and teachers under various within-school non-pharmaceutical interventions (NPIs) combined with specific vaccination coverage levels. METHODS We developed an individual-based transmission model to simulate transmission of the Delta variant of SARS-CoV-2 among a synthetic population, representative of Bay Area cities. We parameterized the model using community contact rates from vaccinated households ascertained from a household survey of Bay Area families with children conducted between February - April, 2021. INTERVENTIONS AND OUTCOMES We evaluated the additional infections in students and teachers/staff resulting over a 128-day semester from in-school instruction compared to remote instruction when various NPIs (mask use, cohorts, and weekly testing of students/teachers) were implemented in schools, across various community-wide vaccination coverages (50%, 60%, 70%), and student (≥12 years) and teacher/staff vaccination coverages (50% - 95%). We quantified the added benefit of universal masking over masking among unvaccinated students and teachers, across varying levels of vaccine effectiveness (45%, 65%, 85%), and compared results between Delta and Alpha variant circulation. RESULTS The Delta variant sharply increases the risk of within-school COVID-transmission when compared to the Alpha variant. In our highest risk scenario (50% community and within-school vaccine coverage, no within-school NPIs, and predominant circulation of the Delta variant), we estimated that an elementary school could see 33-65 additional symptomatic cases of COVID-19 over a four-month semester (depending on the relative susceptibility of children <10 years). In contrast, under the Bay Area reopening plan (universal mask use, community and school vaccination coverage of 70%), we estimated excess symptomatic infection attributable to school reopening among 2.0-9.7% of elementary students (8-36 excess symptomatic cases per school over the semester), 3.0% of middle school students (13 cases per school) and 0.4% of high school students (3 cases per school). Excess rates among teachers attributable to reopening were similar. Achievement of lower risk tolerances, such as <5 excess infections per 1,000 students or teachers, required a cohort approach in elementary and middle school populations. In the absence of NPIs, increasing the vaccination coverage of community members from 50% to 70% or elementary teachers from 70% to 95% reduced the estimated excess rate of infection among elementary school students attributable to school transmission by 24% and 41%, respectively. We estimated that with 70% coverage of the eligible community and school population with a vaccine that is ≤65% effective, universal masking can avert more cases than masking of unvaccinated persons alone. CONCLUSIONS Amidst circulation of the Delta variant, our findings demonstrated that schools are not inherently low risk, yet can be made so with high community vaccination coverages and universal masking. Vaccination of adult community members and teachers protects unvaccinated elementary and middle school children. Elementary and middle schools that can support additional interventions, such as cohorts and testing, should consider doing so, particularly if additional studies find that younger children are equally as susceptible as adults to the Delta variant of SARS-CoV-2. LIMITATIONS We did not consider the effect of social distancing in classrooms, or variation in testing frequency, and considerable uncertainty remains in key transmission parameters.
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Affiliation(s)
- Jennifer R. Head
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Kristin L. Andrejko
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Justin V. Remais
- Center for Computational Biology, College of Engineering, University of California, Berkeley, Berkeley, California, United States
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12
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Ulyte A, Radtke T, Abela IA, Haile SR, Blankenberger J, Jung R, Capelli C, Berger C, Frei A, Huber M, Schanz M, Schwarzmueller M, Trkola A, Fehr J, Puhan MA, Kriemler S. Variation in SARS-CoV-2 seroprevalence across districts, schools and classes: baseline measurements from a cohort of primary and secondary school children in Switzerland. BMJ Open 2021; 11:e047483. [PMID: 34312201 PMCID: PMC8316698 DOI: 10.1136/bmjopen-2020-047483] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/05/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To determine the variation in SARS-CoV-2 seroprevalence in school children and the relationship with self-reported symptoms. DESIGN Baseline measurements of a longitudinal cohort study (Ciao Corona) from June to July 2020. SETTING 55 schools stratified by district in the canton of Zurich, Switzerland. PARTICIPANTS 2585 children (1339 girls; median age: 11 years, age range: 6-16 years), attending grades 1-2, 4-5 and 7-8. MAIN OUTCOME MEASURES Variation in seroprevalence of SARS-CoV-2 in children across 12 cantonal districts, schools and grades, assessed using Luminex-based test of four epitopes for IgG, IgA and IgM (Antibody Coronavirus Assay,ABCORA 2.0). Clustering of cases within classes. Association of seropositivity and symptoms. Comparison with seroprevalence in adult population, assessed using Luminex-based test of IgG and IgA (Sensitive Anti-SARS-CoV-2 Spike Trimer Immunoglobulin Serological test). RESULTS Overall seroprevalence was 2.8% (95% CI 1.5% to 4.1%), ranging from 1.0% to 4.5% across districts. Seroprevalence in grades 1-2 was 3.8% (95% CI 2.0% to 6.1%), in grades 4-5 was 2.4% (95% CI 1.1% to 4.2%) and in grades 7-8 was 1.5% (95% CI 0.5% to 3.0%). At least one seropositive child was present in 36 of 55 (65%) schools and in 44 (34%) of 131 classes where ≥5 children and ≥50% of children within the class were tested. 73% of children reported COVID-19-compatible symptoms since January 2020, with the same frequency in seropositive and seronegative children for all symptoms. Seroprevalence of children and adults was similar (3.2%, 95% credible interval (CrI) 1.7% to 5.0% vs 3.6%, 95% CrI 1.7% to 5.4%). The ratio of confirmed SARS-CoV-2 cumulative incidence-to-seropositive cases was 1:89 in children and 1:12 in adults. CONCLUSIONS SARS-CoV-2 seroprevalence was low in children and similar to that in adults by the end of June 2020. Very low ratio of diagnosed-to-seropositive children was observed. We did not detect clustering of SARS-CoV-2-seropositive children within classes, but the follow-up of this study will shed more light on transmission within schools. TRIAL REGISTRATION NUMBER NCT04448717.
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Affiliation(s)
- Agne Ulyte
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Irene Alma Abela
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Jacob Blankenberger
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Ruedi Jung
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Celine Capelli
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | | | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Merle Schanz
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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13
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Rees EM, Waterlow NR, Lowe R, Kucharski AJ. Estimating the duration of seropositivity of human seasonal coronaviruses using seroprevalence studies. Wellcome Open Res 2021; 6:138. [PMID: 34708157 PMCID: PMC8517721 DOI: 10.12688/wellcomeopenres.16701.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The duration of immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still uncertain, but it is of key clinical and epidemiological importance. Seasonal human coronaviruses (HCoV) have been circulating for longer and, therefore, may offer insights into the long-term dynamics of reinfection for such viruses. Methods: Combining historical seroprevalence data from five studies covering the four circulating HCoVs with an age-structured reverse catalytic model, we estimated the likely duration of seropositivity following seroconversion. Results: We estimated that antibody persistence lasted between 0.9 (95% Credible interval: 0.6 - 1.6) and 3.8 (95% CrI: 2.0 - 7.4) years. Furthermore, we found the force of infection in older children and adults (those over 8.5 [95% CrI: 7.5 - 9.9] years) to be higher compared with young children in the majority of studies. Conclusions: These estimates of endemic HCoV dynamics could provide an indication of the future long-term infection and reinfection patterns of SARS-CoV-2.
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Affiliation(s)
- Eleanor M. Rees
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Naomi R. Waterlow
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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14
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Siebach MK, Piedimonte G, Ley SH. COVID-19 in childhood: Transmission, clinical presentation, complications and risk factors. Pediatr Pulmonol 2021; 56:1342-1356. [PMID: 33721405 PMCID: PMC8137603 DOI: 10.1002/ppul.25344] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/09/2021] [Accepted: 02/19/2021] [Indexed: 01/10/2023]
Abstract
Children less than 18 years of age account for an estimated 2%-5% of reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases globally. Lower prevalence of coronavirus disease 2019 (COVID-19) among children, in addition to higher numbers of mild and asymptomatic cases, continues to provide challenges in determining appropriate prevention and treatment courses. Here, we summarize the current evidence on the transmission, clinical presentation, complications and risk factors in regard to SARS-CoV-2 in children, and highlight crucial gaps in knowledge going forward. Based on current evidence, children are rarely the primary source of secondary transmission in the household or in child care and school settings and are more likely to contract the virus from an adult household member. Higher transmission rates are observed in older children (10-19 years old) compared with younger children ( <10 years old). While increasing incidence of COVID-19 in neonates raises the suspicion of vertical transmission, it is unlikely that breast milk is a vehicle for transmission from mother to infant. The vast majority of clinical cases of COVID-19 in children are mild, but there are rare cases that have developed complications such as multisystem inflammatory syndrome in children, which often presents with severe cardiac symptoms requiring intensive care. Childhood obesity is associated with a higher risk of infection and a more severe clinical presentation. Although immediate mortality rates among children are low, long-term respiratory, and developmental implications of the disease remain unknown in this young and vulnerable population.
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Affiliation(s)
- Melissa K. Siebach
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
- Department of Tropical MedicineTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Giovanni Piedimonte
- Departments of Pediatrics, Biochemistry, and Molecular BiologyTulane University School of MedicineNew OrleansLouisianaUSA
| | - Sylvia H. Ley
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
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15
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Abstract
There is a lack of clarity regarding management of COVID-19 infection in children. This review aims to summarize the key clinical presentations and management of Pediatric COVID-19. The Medline database was searched for seminal articles and guidelines on COVID-19 presentation and management in children less than 18 years of age. COVID-19 has a lower incidence (15% of reported cases worldwide), causes milder disease with lower need for intensive care admission and lower mortality rate (00.7%) in children compared with adults. Multisystem inflammatory syndrome is a rare but severe complication in children. Majority of patients require supportive care including adequate hydration, nutrition and antipyretics. Supplemental oxygen therapy should be given in moderate to severe cases with all precautions to prevent air-borne COVID-19 spread. Steroids may be helpful in severe cases. Anticoagulation is indicated in moderate to severe cases with risk factors. More data on the efficacy and safety of antivirals and immunomodulators in children is needed.
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Affiliation(s)
- Puneet Kaur Sahi
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. Correspondence to: Dr Puneet Kaur Sahi, Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110 002, India.
| | - Urmila Jhamb
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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16
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Holden TM, Richardson RA, Arevalo P, Duffus WA, Runge M, Whitney E, Wise L, Ezike NO, Patrick S, Cobey S, Gerardin J. Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.14.21255476. [PMID: 33907762 PMCID: PMC8077585 DOI: 10.1101/2021.04.14.21255476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. Methods We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. Results By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50-80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. Conclusions Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission.
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Affiliation(s)
- Tobias M Holden
- Northwestern University Feinberg School of Medicine,
Chicago IL
| | - Reese A.K. Richardson
- Department of Chemical and Biological Engineering,
Northwestern University, Evanston IL
| | - Philip Arevalo
- Department of Ecology and Evolutionary Biology, University
of Chicago, Chicago IL
| | - Wayne A. Duffus
- Center for Preparedness and Response, Division of State and
Local Readiness, Centers for Disease Control and Prevention, Atlanta GA
- Illinois Department of Public Health, Springfield IL
| | - Manuela Runge
- Department of Preventive Medicine and Institute for Global
Health, Northwestern University, Chicago IL
| | - Elena Whitney
- Department of Ecology and Evolutionary Biology, University
of Chicago, Chicago IL
| | - Leslie Wise
- Illinois Department of Public Health, Springfield IL
| | | | - Sarah Patrick
- Illinois Department of Public Health, Springfield IL
| | - Sarah Cobey
- Department of Ecology and Evolutionary Biology, University
of Chicago, Chicago IL
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global
Health, Northwestern University, Chicago IL
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17
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Shi KW, Huang YH, Quon H, Ou-Yang ZL, Wang C, Jiang SC. Quantifying the risk of indoor drainage system in multi-unit apartment building as a transmission route of SARS-CoV-2. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 762:143056. [PMID: 33268249 PMCID: PMC7560110 DOI: 10.1016/j.scitotenv.2020.143056] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 05/05/2023]
Abstract
The COVID-19 pandemic has had a profound impact on human society. The isolation of SARS-CoV-2 from patients' feces on human cell line raised concerns of possible transmission through human feces including exposure to aerosols generated by toilet flushing and through the indoor drainage system. Currently, routes of transmission, other than the close contact droplet transmission, are still not well understood. A quantitative microbial risk assessment was conducted to estimate the health risks associated with two aerosol exposure scenarios: 1) toilet flushing, and 2) faulty connection of a floor drain with the building's main sewer pipe. SARS-CoV-2 data were collected from the emerging literature. The infectivity of the virus in feces was estimated based on a range of assumption between viral genome equivalence and infectious unit. The human exposure dose was calculated using Monte Carlo simulation of viral concentrations in aerosols under each scenario and human breathing rates. The probability of COVID-19 illness was generated using the dose-response model for SARS-CoV-1, a close relative of SARS-CoV-2, that was responsible for the SARS outbreak in 2003. The results indicate the median risks of developing COVID-19 for a single day exposure is 1.11 × 10-10 and 3.52 × 10-11 for toilet flushing and faulty drain scenario, respectively. The worst case scenario predicted the high end of COVID-19 risk for the toilet flushing scenario was 5.78 × 10-4 (at 95th percentile). The infectious viral loads in human feces are the most sensitive input parameter and contribute significantly to model uncertainty.
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Affiliation(s)
- Kuang-Wei Shi
- School of Environment, Tsinghua University, Beijing, China
| | - Yen-Hsiang Huang
- Civil and Environmental Engineering, University of California, Irvine, USA
| | - Hunter Quon
- Civil and Environmental Engineering, University of California, Irvine, USA
| | - Zi-Lu Ou-Yang
- School of Environment, Tsinghua University, Beijing, China
| | - Chengwen Wang
- School of Environment, Tsinghua University, Beijing, China.
| | - Sunny C Jiang
- Civil and Environmental Engineering, University of California, Irvine, USA.
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18
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Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to "flatten the curve" of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20-40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5-10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.
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Affiliation(s)
- Ari R. Joffe
- Division of Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- John Dossetor Health Ethics Center, University of Alberta, Edmonton, AB, Canada
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19
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Yang J, Zheng W, Shi H, Yan X, Dong K, You Q, Zhong G, Gong H, Chen Z, Jit M, Viboud C, Ajelli M, Yu H. Who should be prioritized for COVID-19 vaccination in China? A descriptive study. BMC Med 2021; 19:45. [PMID: 33563270 PMCID: PMC7872877 DOI: 10.1186/s12916-021-01923-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND All countries are facing decisions about which population groups to prioritize for access to COVID-19 vaccination after the first vaccine products have been licensed, at which time supply shortages are inevitable. Our objective is to define the key target populations, their size, and priority for a COVID-19 vaccination program in the context of China. METHODS On the basis of utilitarian and egalitarian principles, we define and estimate the size of tiered target population groups for a phased introduction of COVID-19 vaccination, considering evolving goals as vaccine supplies increase, detailed information on the risk of illness and transmission, and past experience with vaccination during the 2009 influenza pandemic. Using publicly available data, we estimated the size of target population groups, and the number of days needed to vaccinate 70% of the target population. Sensitivity analyses considered higher vaccine coverages and scaled up vaccine delivery relative to the 2009 pandemic. RESULTS Essential workers, including staff in the healthcare, law enforcement, security, nursing homes, social welfare institutes, community services, energy, food and transportation sectors, and overseas workers/students (49.7 million) could be prioritized for vaccination to maintain essential services in the early phase of a vaccination program. Subsequently, older adults, individuals with underlying health conditions and pregnant women (563.6 million) could be targeted for vaccination to reduce the number of individuals with severe COVID-19 outcomes, including hospitalizations, critical care admissions, and deaths. In later stages, the vaccination program could be further extended to target adults without underlying health conditions and children (784.8 million), in order to reduce symptomatic infections and/or to stop virus transmission. Given 10 million doses administered per day, and a two-dose vaccination schedule, it would take 1 week to vaccinate essential workers but likely up to 7 months to vaccinate 70% of the overall population. CONCLUSIONS The proposed framework is general but could assist Chinese policy-makers in the design of a vaccination program. Additionally, this exercise could be generalized to inform other national and regional strategies for use of COVID-19 vaccines, especially in low- and middle-income countries.
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Affiliation(s)
- Juan Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wen Zheng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Huilin Shi
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xuemei Yan
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Kaige Dong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Qian You
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Guangjie Zhong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Hui Gong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Zhiyuan Chen
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Special Administrative Region, Hong Kong, China
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Marco Ajelli
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
- Department of infectious diseases, Huashan Hospital, Fudan University, Shanghai, China.
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20
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Viner RM, Bonell C, Drake L, Jourdan D, Davies N, Baltag V, Jerrim J, Proimos J, Darzi A. Reopening schools during the COVID-19 pandemic: governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure. Arch Dis Child 2021; 106:111-113. [PMID: 32747375 PMCID: PMC7401577 DOI: 10.1136/archdischild-2020-319963] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Research Programme, University College London Institute of Child Health, London, UK
| | - Christopher Bonell
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Lesley Drake
- Partnership for Child Development, Imperial College London, London, UK
| | - Didier Jourdan
- Faculty of Education, Université Blaise-Pascal, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
| | - Nicolette Davies
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - John Jerrim
- UCL Institute of Education, University College London Institute of Education, London, UK
| | - Jenny Proimos
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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21
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Spoulou V, Noni M, Koukou D, Kossyvakis A, Michos A. Clinical characteristics of COVID-19 in neonates and young infants. Eur J Pediatr 2021; 180:3041-3045. [PMID: 33786658 PMCID: PMC8009690 DOI: 10.1007/s00431-021-04042-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 01/03/2023]
Abstract
We report the clinical characteristics and management of fourteen neonates and very young infants with COVID-19. Although all presented with mild symptoms and did not require specific treatment, most of them had abnormal laboratory and radiological findings. Ten infants presented with neutropenia and/or monocytosis but none with lymphopenia. Transient hypertriglyceridemia and/or prolonged viral shedding were detected in 9 patients.Conclusion: Based to our experience, COVID-19 is mild in very young infants and might have distinct laboratory findings. What is Known: • SARS-CoV-2 in infants is a mild disease. • The period of transmission is approximately 2 weeks. What is New: • Very young age is not a risk factor for severe COVID-19 but could be associated with prolonged viral shedding. • Neutropenia and monocytosis are distinct characteristics of COVID-19 in very young infants.
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Affiliation(s)
- Vana Spoulou
- 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Maria Noni
- 1st Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Koukou
- 1st Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Kossyvakis
- National Reference Laboratory for Influenza and other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Athanasios Michos
- 1st Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
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22
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Li X, Xu W, Dozier M, He Y, Kirolos A, Lang Z, Song P, Theodoratou E. The role of children in the transmission of SARS-CoV2: updated rapid review. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201101] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Lee B, Hanley JP, Nowak S, Bates JHT, Hébert-Dufresne L. Modeling the impact of school reopening on SARS-CoV-2 transmission using contact structure data from Shanghai. BMC Public Health 2020; 20:1713. [PMID: 33198707 PMCID: PMC7667656 DOI: 10.1186/s12889-020-09799-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mathematical modeling studies have suggested that pre-emptive school closures alone have little overall impact on SARS-CoV-2 transmission, but reopening schools in the background of community contact reduction presents a unique scenario that has not been fully assessed. METHODS We adapted a previously published model using contact information from Shanghai to model school reopening under various conditions. We investigated different strategies by combining the contact patterns observed between different age groups during both baseline and "lockdown" periods. We also tested the robustness of our strategy to the assumption of lower susceptibility to infection in children under age 15 years. RESULTS We find that reopening schools for all children would maintain a post-intervention R0 < 1 up to a baseline R0 of approximately 3.3 provided that daily contacts among children 10-19 years are reduced to 33% of baseline. This finding was robust to various estimates of susceptibility to infection in children relative to adults (up to 50%) and to estimates of various levels of concomitant reopening in the rest of the community (up to 40%). However, full school reopening without any degree of contact reduction in the school setting returned R0 virtually back to baseline, highlighting the importance of mitigation measures. CONCLUSIONS These results, based on contact structure data from Shanghai, suggest that schools can reopen with proper precautions during conditions of extreme contact reduction and during conditions of reasonable levels of reopening in the rest of the community.
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Affiliation(s)
- Benjamin Lee
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
- Translational Global Infectious Diseases Research Center, University of Vermont, Burlington, VT, USA.
| | - John P Hanley
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Translational Global Infectious Diseases Research Center, University of Vermont, Burlington, VT, USA
| | - Sarah Nowak
- Translational Global Infectious Diseases Research Center, University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jason H T Bates
- Translational Global Infectious Diseases Research Center, University of Vermont, Burlington, VT, USA
- Department of Computer Science, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA
| | - Laurent Hébert-Dufresne
- Translational Global Infectious Diseases Research Center, University of Vermont, Burlington, VT, USA
- Department of Computer Science, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA
- Vermont Complex Systems Center, University of Vermont, Burlington, VT, USA
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24
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Teoh CW, Gaudreault-Tremblay MM, Blydt-Hansen TD, Goldberg A, Arora S, Feber J, Langlois V, Ruhl M, Phan V, Morgan C, Acott P, Hamiwka L. Management of Pediatric Kidney Transplant Patients During the COVID-19 Pandemic: Guidance From the Canadian Society of Transplantation Pediatric Group. Can J Kidney Health Dis 2020; 7:2054358120967845. [PMID: 33240516 PMCID: PMC7672730 DOI: 10.1177/2054358120967845] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF THE PROGRAM To provide guidance on the management of pediatric kidney transplant patients during the COVID-19 pandemic. SOURCES OF INFORMATION Program-specific documents, preexisting, and related to COVID-19; documents from provincial, national, and international kidney transplant societies/agencies and organ procurement agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. METHODS Challenges in the care of pediatric kidney transplant patients during the COVID-19 pandemic were highlighted within the Canadian Society of Transplantation (CST) Pediatric Group. It identified pediatric kidney transplant nephrologists (including a pediatric nephrologist ethicist) across the country and formed a workgroup. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via e-mail and virtual meetings. Disagreements were resolved by consensus. The document was reviewed by the CST Kidney Transplant Working Group, by the Canadian Society of Nephrology (CSN) COVID-19 Rapid Response Team (RRT), and an infectious disease expert. The suggestions were presented at an interactive webinar sponsored by CSN in collaboration with the CST and Canadian Association of Pediatric Nephrologists (CAPN), and attended by pediatric kidney health care professionals for further peer input. Final revisions were made based on feedback received. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity. KEY FINDINGS We identified 8 key areas of pediatric kidney transplant care that may be affected by the COVID-19 pandemic: (1) transplant activity, (2) outpatient clinic activity, (3) monitoring, (4) multidisciplinary care, (5) medications (immunosuppression and others), (6) patient/family education/support, (7) school and employment, and (8) management of pediatric kidney transplant patients who are COVID-19 positive. We make specific suggestions for each of these areas. LIMITATIONS A full systematic review of available literature was not undertaken for the sake of expediency in development of this guideline. There is a paucity of literature to support evidence-based recommendations at this time. Instead, these guidelines were formulated based on expert opinion derived from available knowledge/experience and are subject to the biases associated with this level of evidence. The parallel review process that was created to expedite the publication of this work may not be as robust as standard arms' length peer review processes. IMPLICATIONS These recommendations are meant to serve as a guide to pediatric kidney transplant directors, clinicians, and administrators for providing the best patient care in the context of limited resources while protecting patients and health care providers wherever possible by limiting exposure to COVID-19. We recognize that recommendations may not be applicable to all provincial/local health authority practices and that they may not be delivered to all patients given the time and resource constraints affecting the individual provincial/local health jurisdiction.
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Affiliation(s)
- Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | | | - Tom D. Blydt-Hansen
- Division of Nephrology, BC Children’s Hospital, Vancouver, Canada
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
| | - Aviva Goldberg
- Division of Nephrology, The Children’s Hospital of Winnipeg, MB, Canada
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Steven Arora
- Division of Nephrology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Janusz Feber
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- Department of Paediatrics, University of Ottawa, ON, Canada
| | - Valerie Langlois
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | - Michelle Ruhl
- Division of Nephrology, Jim Pattison Children’s Hospital, Saskatoon, SK, Canada
- Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Veronique Phan
- Division of Nephrology, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Paediatrics, University de Montreal, QC, Canada
| | - Catherine Morgan
- Division of Nephrology, Stollery Children’s Hospital, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, Canada
| | - Philip Acott
- Division of Nephrology, IWK Health Centre, Halifax, NS, Canada
- Department of Paediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lorraine Hamiwka
- Division of Nephrology, Alberta Children’s Hospital, Calgary, Canada
- Department of Paediatrics, University of Calgary, AB, Canada
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25
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Dingens AS, Crawford KHD, Adler A, Steele SL, Lacombe K, Eguia R, Amanat F, Walls AC, Wolf CR, Murphy M, Pettie D, Carter L, Qin X, King NP, Veesler D, Krammer F, Dickerson JA, Chu HY, Englund JA, Bloom JD. Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak. Nat Commun 2020; 11:4378. [PMID: 32873791 PMCID: PMC7463158 DOI: 10.1038/s41467-020-18178-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/07/2020] [Indexed: 11/09/2022] Open
Abstract
Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases as of April 2, 2020. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. Here, to better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screen 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children have neutralizing activity, including one that neutralized at a dilution > 1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.
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Affiliation(s)
- Adam S Dingens
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Katharine H D Crawford
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA
- Medical Scientist Training Program, University of Washington, Seattle, WA, 98195, USA
| | - Amanda Adler
- Division of Infectious Disease, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Sarah L Steele
- Division of Infectious Disease, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Kirsten Lacombe
- Division of Infectious Disease, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Rachel Eguia
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Fatima Amanat
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Alexandra C Walls
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA
| | - Caitlin R Wolf
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, 98195, USA
| | - Michael Murphy
- Institute for Protein Design, University of Washington, Seattle, WA, 98195, USA
| | - Deleah Pettie
- Institute for Protein Design, University of Washington, Seattle, WA, 98195, USA
| | - Lauren Carter
- Institute for Protein Design, University of Washington, Seattle, WA, 98195, USA
| | - Xuan Qin
- Division of Infectious Disease, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Neil P King
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA
- Institute for Protein Design, University of Washington, Seattle, WA, 98195, USA
| | - David Veesler
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jane A Dickerson
- Division of Infectious Disease, Seattle Children's Hospital, Seattle, WA, 98105, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, 98195, USA
| | - Janet A Englund
- Division of Infectious Disease, Seattle Children's Hospital, Seattle, WA, 98105, USA.
- Department of Pediatrics, University of Washington, Seattle, WA, 98195, USA.
| | - Jesse D Bloom
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
- Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA.
- Howard Hughes Medical Institute, Seattle, WA, 98103, USA.
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26
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Idele P, Anthony D, You D, Luo C, Mofenson L. The evolving picture of SARS-CoV-2 and COVID-19 in children: critical knowledge gaps. BMJ Glob Health 2020; 5:e003454. [PMID: 32938610 PMCID: PMC7496567 DOI: 10.1136/bmjgh-2020-003454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - David Anthony
- Office of Research, UNICEF, Florence, Toscana, Italy
| | - Danzhen You
- Data & Analytics, UNICEF, New York, New York, USA
| | - Chewe Luo
- HIV/AIDS Section, UNICEF, New York, New York, USA
| | - Lynne Mofenson
- Research Programme, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, District of Columbia, USA
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27
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Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, Seth S, Egan C, Hardwick HE, Halpin S, Girvan M, Donohue C, Pritchard M, Patel LB, Ladhani S, Sigfrid L, Sinha IP, Olliaro PL, Nguyen-Van-Tam JS, Horby PW, Merson L, Carson G, Dunning J, Openshaw PJM, Baillie JK, Harrison EM, Docherty AB, Semple MG. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ 2020; 370:m3249. [PMID: 32960186 PMCID: PMC7488201 DOI: 10.1136/bmj.m3249] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). DESIGN Prospective observational cohort study with rapid data gathering and near real time analysis. SETTING 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). PARTICIPANTS 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. MAIN OUTCOME MEASURES Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. RESULTS Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. CONCLUSIONS Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). STUDY REGISTRATION ISRCTN66726260.
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Affiliation(s)
- Olivia V Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK
| | - Karl A Holden
- Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Lance Turtle
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Infectious diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Louisa Pollock
- Paediatric Infectious Diseases, Royal Hospital for Children, Glasgow, UK
| | - Cameron J Fairfield
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sohan Seth
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK
| | - Conor Egan
- Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK
| | - Hayley E Hardwick
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Sophie Halpin
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Michelle Girvan
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Chloe Donohue
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Mark Pritchard
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Latifa B Patel
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, Colindale, UK
- Paediatric Infectious Disease, St George's Hospital, London, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ian P Sinha
- Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Piero L Olliaro
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
- United Kingdom Department of Health and Social Care, London, UK
| | - Peter W Horby
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Merson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gail Carson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jake Dunning
- National Infection Service, Public Health England, [A: Where?]
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Malcolm G Semple
- Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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28
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Silva-Filho JC, Melo CGFD, Oliveira JLD. The influence of ABO blood groups on COVID-19 susceptibility and severity: A molecular hypothesis based on carbohydrate-carbohydrate interactions. Med Hypotheses 2020; 144:110155. [PMID: 33254482 PMCID: PMC7395945 DOI: 10.1016/j.mehy.2020.110155] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022]
Abstract
The world is experiencing one of the most difficult moments in history with the COVID-19 pandemic, a disease caused by SARS-CoV-2, a new type of coronavirus. Virus infectivity is mediated by the binding of Spike transmembrane glycoprotein to specific protein receptors present on cell host surface. Spike is a homotrimer that emerges from the virion, each monomer containing two subunits named S1 and S2, which are related to cell recognition and membrane fusion, respectively. S1 is subdivided in domains S1A (or NTD) and S1B (or RBD), with experimental and in silico studies suggesting that the former binds to sialic acid-containing glycoproteins, such as CD147, whereas the latter binds to ACE2 receptor. Recent findings indicate that the ABO blood system modulates susceptibility and progression of infection, with type-A individuals being more susceptible to infection and/or manifestation of a severe condition. Seeking to understand the molecular mechanisms underlying this susceptibility, we carried out an extensive bibliographic survey on the subject. Based on this survey, we hypothesize that the correlation between the ABO blood system and susceptibility to SARS-CoV-2 infection can be presumably explained by the modulation of sialic acid-containing receptors distribution on host cell surface induced by ABO antigens through carbohydrate-carbohydrate interactions, which could maximize or minimize the virus Spike protein binding to the host cell. This model could explain previous sparse observations on the molecular mechanism of infection and can direct future research to better understand of COVID-19 pathophysiology.
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29
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Van Damme W, Dahake R, Delamou A, Ingelbeen B, Wouters E, Vanham G, van de Pas R, Dossou JP, Ir P, Abimbola S, Van der Borght S, Narayanan D, Bloom G, Van Engelgem I, Ag Ahmed MA, Kiendrébéogo JA, Verdonck K, De Brouwere V, Bello K, Kloos H, Aaby P, Kalk A, Al-Awlaqi S, Prashanth NS, Muyembe-Tamfum JJ, Mbala P, Ahuka-Mundeke S, Assefa Y. The COVID-19 pandemic: diverse contexts; different epidemics-how and why? BMJ Glob Health 2020; 5:e003098. [PMID: 32718950 PMCID: PMC7392634 DOI: 10.1136/bmjgh-2020-003098] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
It is very exceptional that a new disease becomes a true pandemic. Since its emergence in Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has spread to nearly all countries of the world in only a few months. However, in different countries, the COVID-19 epidemic takes variable shapes and forms in how it affects communities. Until now, the insights gained on COVID-19 have been largely dominated by the COVID-19 epidemics and the lockdowns in China, Europe and the USA. But this variety of global trajectories is little described, analysed or understood. In only a few months, an enormous amount of scientific evidence on SARS-CoV-2 and COVID-19 has been uncovered (knowns). But important knowledge gaps remain (unknowns). Learning from the variety of ways the COVID-19 epidemic is unfolding across the globe can potentially contribute to solving the COVID-19 puzzle. This paper tries to make sense of this variability-by exploring the important role that context plays in these different COVID-19 epidemics; by comparing COVID-19 epidemics with other respiratory diseases, including other coronaviruses that circulate continuously; and by highlighting the critical unknowns and uncertainties that remain. These unknowns and uncertainties require a deeper understanding of the variable trajectories of COVID-19. Unravelling them will be important for discerning potential future scenarios, such as the first wave in virgin territories still untouched by COVID-19 and for future waves elsewhere.
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Affiliation(s)
- Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology and Centre for Population, University of Antwerp, Antwerpen, Belgium
- Centre for Health Systems Research and Development, University of the Free State-Bloemfontein Campus, Bloemfontein, Free State, South Africa
| | - Guido Vanham
- Biomedical Department, Institute of Tropical Medicine, Antwerpen, Belgium
- Biomedical Department, University of Antwerp, Antwerpen, Belgium
| | - Remco van de Pas
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Gerald Bloom
- Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
| | - Ian Van Engelgem
- European Commission Directorate General for Civil Protection and Humanitarian Aid Operations, Kinshasa, Democratic Republic of Congo
| | | | - Joël Arthur Kiendrébéogo
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Public Health, University of Ouagadougou Health Sciences Training and Research Unit, Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Kéfilath Bello
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peter Aaby
- INDEPTH Network, Bandim Health Project, Bissau, Guinea-Bissau
| | - Andreas Kalk
- Bureau GIZ à Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Sameh Al-Awlaqi
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - N S Prashanth
- Health Equity Cluster, Institute of Public Health, Bengaluru, India
| | | | - Placide Mbala
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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30
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Dingens AS, Crawford KHD, Adler A, Steele SL, Lacombe K, Eguia R, Amanat F, Walls AC, Wolf CR, Murphy M, Pettie D, Carter L, Qin X, King NP, Veesler D, Krammer F, Dickerson JA, Chu HY, Englund JA, Bloom JD. Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.26.20114124. [PMID: 32511483 PMCID: PMC7273251 DOI: 10.1101/2020.05.26.20114124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Children are strikingly underrepresented in COVID-19 case counts1-3. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases1. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults1,4-7. To better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screened 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈ 1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children had neutralizing activity, including one that neutralized at a dilution >1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.
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Affiliation(s)
- Adam S. Dingens
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Katharine H. D. Crawford
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
- Medical Scientist Training Program, University of Washington, Seattle, WA 98195, USA
| | - Amanda Adler
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Sarah L. Steele
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Kirsten Lacombe
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Rachel Eguia
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Fatima Amanat
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexandra C. Walls
- Department of Biochemistry, University of Washington, Seattle, WA 98195, USA
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA
| | - Michael Murphy
- Institute for Protein Design, University of Washington, Seattle, WA 98195, USA
| | - Deleah Pettie
- Institute for Protein Design, University of Washington, Seattle, WA 98195, USA
| | - Lauren Carter
- Institute for Protein Design, University of Washington, Seattle, WA 98195, USA
| | - Xuan Qin
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Neil P. King
- Department of Biochemistry, University of Washington, Seattle, WA 98195, USA
- Institute for Protein Design, University of Washington, Seattle, WA 98195, USA
| | - David Veesler
- Department of Biochemistry, University of Washington, Seattle, WA 98195, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jane A. Dickerson
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA
| | - Janet A. Englund
- Division of Infectious Disease, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Jesse D. Bloom
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
- Howard Hughes Medical Institute, Seattle, WA 98103, USA
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