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Van der Heyden J, Leclercq V, Duysburgh E, Cornelissen L, Desombere I, Roukaerts I, Gisle L. Prevalence of SARS-CoV-2 antibodies and associated factors in the adult population of Belgium: a general population cohort study between March 2021 and April 2022. Arch Public Health 2024; 82:72. [PMID: 38750563 PMCID: PMC11094959 DOI: 10.1186/s13690-024-01298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND This study assessed seroprevalence trends of SARS-CoV-2 antibodies in the Belgian adult population between March 2021 and April 2022, and explored factors associated with seropositivity and seroreversion among the vaccinated and unvaccinated population. METHODS A prospective longitudinal surveillance study was conducted within a random sample of the general population (18 + years) in Belgium, selected from the national register through a multistage sampling design. Participants provided a saliva sample and completed a survey questionnaire on three occasions: at baseline and in two follow-up waves. Outcome variables included (1) seropositivity, defined as the presence of SARS-CoV-2 antibodies, assessed with a semi-quantitative measure of anti-RBD (Receptor Binding Domain) IgG ELISA and (2) seroreversion, defined as passing from a positive to a negative antibody test between two measurements. Trends in SARS-CoV-2 antibody prevalence were assessed using binary logistic regression with contrasts applying post-stratification. Potential determinants of seropositivity were assessed through multilevel logistic regressions. RESULTS In total 6,178 valid observations were obtained from 2,768 individuals. SARS-CoV-2 antibody prevalence increased from 25.1% in the beginning of the study period to 92.3% at the end. Among the vaccinated population, factors significantly associated with higher seropositivity rates were being younger, having a bachelor diploma, living with others, having had a vaccine in the last 3 months and having received a nucleic-acid vaccine or a combination. Lower seropositivity rates were observed among vaccinated people with a neurological disease and transplant patients. Factors significantly associated with higher seropositivity rates among the unvaccinated population were having non-O blood type and being non-smoker. Among vaccinated people, the seroreversion rate was much lower (0.3%) in those who had received their latest vaccine in the last 3 months compared to those who had received their latest vaccine more than 3 months ago (2.7%) (OR 0.13; 95%CI 0.04-0.42). CONCLUSIONS The rapid increase in antibody seropositivity in the general adult population in Belgium during the study period was driven by the vaccination campaign which ran at full speed during this period. Among vaccinated people, seropositivity varied in function of the time since last vaccine, the type of vaccine, sociodemographic features and health status.
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Affiliation(s)
- Johan Van der Heyden
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium.
| | - Victoria Leclercq
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
| | - Els Duysburgh
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
| | - Laura Cornelissen
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
| | | | | | - Lydia Gisle
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
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Van Herck M, Pagen DME, van Bilsen CJA, Brinkhues S, Konings K, den Heijer CDJ, Mujakovic S, Ter Waarbeek HLG, Burtin C, Janssen DJA, Hoebe CJPA, Spruit MA, Dukers-Muijrers NHTM. Impact of post-COVID-19 condition on health status and activities of daily living: the PRIME post-COVID study. Thorax 2024; 79:457-464. [PMID: 38499346 DOI: 10.1136/thorax-2023-220504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/28/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To assess health and activities of daily living (ADL) in SARS-CoV-2-positive adults with and without post-COVID-19 condition (PCC) and compare this with negative tested individuals. Furthermore, different PCC case definitions were compared with SARS-CoV-2-negative individuals. METHODS All adults tested PCR positive for SARS-CoV-2 at the Public Health Service South Limburg (Netherlands) between June 2020 and November 2021 (n=41 780) and matched PCR negative individuals (2:1, on age, sex, year-quarter test, municipality; n=19 875) were invited by email. Health (five-level EuroQol five-dimension (EQ5D) index and EuroQol visual analogue scale (EQVAS)) and ADL impairment were assessed. PCC classification was done using the WHO case definition and five other common definitions. RESULTS In total, 8409 individuals (6381 SARS-CoV-2 positive; 53±15 years; 57% female; 9 (7-11) months since test) were included. 39.4% of positives had PCC by the WHO case definition (EQVAS: 71±20; EQ5D index: 0.800±0.191; ADL impairment: 30 (10-70)%) and perceived worse health and more ADL impairment than negatives, that is, difference of -8.50 points (95% CI -9.71 to -7.29; p<0.001) for EQVAS, which decreased by 1.49 points (95% CI 0.86 to 2.12; p<0.001) in individuals with PCC for each comorbidity present, and differences of -0.065 points (95% CI -0.074 to -0.056; p<0.001) for EQ5D index, and +16.72% (95% CI 15.01 to 18.43; p<0.001) for ADL impairment. Health and ADL impairment were similar in negatives and positives without PCC. Replacing the WHO case definition with other PCC definitions yielded comparable results. CONCLUSIONS Individuals with PCC have substantially worse health and more ADL impairment than negative controls, irrespective of the case definition. Authorities should inform the public about the associated burden of PCC and enable adequate support.
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Affiliation(s)
- Maarten Van Herck
- Department of Research and Education, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
- REVAL, Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Demi M E Pagen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Céline J A van Bilsen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Stephanie Brinkhues
- Department of Knowledge & Innovation, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Kevin Konings
- Department of Process & Information Management, Communication & Automation, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Casper D J den Heijer
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Suhreta Mujakovic
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Henriëtte L G Ter Waarbeek
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Chris Burtin
- REVAL, Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Daisy J A Janssen
- Department of Research and Education, Ciro, Horn, The Netherlands
- Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Social Medicine, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, The Netherlands
- Department of Health Promotion, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Verheul MK, Kaczorowska J, Hofstee MI, Schepp RM, Smits GP, Wessels Beljaars D, Kuijer M, Schuin W, Middelhof I, Wong D, van Hagen CCE, Vos ERA, Nicolaie MA, de Melker HE, van Binnendijk RS, van der Klis FRM, den Hartog G. Protective mucosal SARS-CoV-2 antibodies in the majority of the general population in the Netherlands. Mucosal Immunol 2024:S1933-0219(24)00027-8. [PMID: 38553008 DOI: 10.1016/j.mucimm.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
Antibodies to SARS-CoV-2 on the mucosal surfaces of the respiratory tract are understood to contribute to protection against SARS-CoV-2 infection. We aimed to describe the prevalence, levels, and functionality of mucosal antibodies in the general Dutch population. Nasal samples were collected from 778 randomly selected participants, 1-90 years of age, nested within the nationwide prospective SARS-CoV-2 PIENTER corona serosurvey in the Netherlands. Spike-specific immunoglobulin (Ig)G was detected in the nasal samples of 94.6% (in case of the wild-type S1 variant) and 94.9% (Omicron BA.1) of the individuals, whereas 44.2% and 62.7% of the individuals were positive for wild-type and Omicron BA.1 S1 IgA, respectively. The lowest prevalence of mucosal antibodies was observed in children under 12 years of age. The prevalence and levels of IgA and IgG were higher in individuals with a history of SARS-CoV-2 infection. Mucosal antibodies inhibited the binding of Wuhan, Delta, and Omicron BA.1 receptor binding domain to human angiotensin-converting enzyme 2 in 94.4%, 95.4%, and 92.6% of the participants, respectively. Higher levels of mucosal antibodies were associated with a lower risk of future infection.
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Affiliation(s)
- Marije K Verheul
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Joanna Kaczorowska
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Marloes I Hofstee
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rutger M Schepp
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Gaby P Smits
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Dewi Wessels Beljaars
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Marjan Kuijer
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Wendy Schuin
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Irene Middelhof
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Denise Wong
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Cheyenne C E van Hagen
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Eric R A Vos
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M Alina Nicolaie
- Department of Statistics, Data Science and Modelling, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Robert S van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Gerco den Hartog
- Centre for Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Laboratory of Medical Immunology, Radboudumc, Nijmegen, The Netherlands.
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van Hagen CCE, Huiberts AJ, Mutubuki EN, de Melker HE, Vos ERA, van de Wijgert JHHM, van den Hof S, Knol MJ, van Hoek AJ. Health-related quality of life during the COVID-19 pandemic: The impact of restrictive measures using data from two Dutch population-based cohort studies. PLoS One 2024; 19:e0300324. [PMID: 38498510 PMCID: PMC10947685 DOI: 10.1371/journal.pone.0300324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES We describe health-related quality of life during the COVID-19 pandemic in the general Dutch population and correlations with restrictive measures. METHODS Data were obtained from 18-85 year-old participants of two population-based cohort studies (February 2021-July 2022): PIENTER Corona (n = 8,019) and VASCO (n = 45,413). Per cohort, mean scores of mental and physical health and health utility from the SF-12 were calculated by age group, sex and presence of a medical risk condition. Spearman correlations with stringency of measures were calculated. RESULTS Both cohorts showed comparable results. Participants <30 years had lowest health utility and mental health score, and highest physical health score. Health utility and mental health score increased with age (up to 79 years), while physical health score decreased with age. Women and participants with a medical risk condition scored lower than their counterparts. Fluctuations were small over time but most pronounced among participants <60 years, and correlated weakly, but mostly positively with measure stringency. CONCLUSIONS During the Dutch COVID-19 epidemic, health utility and mental health scores were lower and fluctuated strongest among young adults compared to older adults. In our study population, age, sex and presence of a medical risk condition seemed to have more impact on health scores than stringency of COVID-19 non-pharmaceutical interventions.
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Affiliation(s)
- Cheyenne C. E. van Hagen
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Anne J. Huiberts
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Elizabeth N. Mutubuki
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Hester E. de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Eric R. A. Vos
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Janneke H. H. M. van de Wijgert
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Susan van den Hof
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Mirjam J. Knol
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
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Klinkenberg D, Backer J, de Keizer N, Wallinga J. Projecting COVID-19 intensive care admissions for policy advice, the Netherlands, February 2020 to January 2021. Euro Surveill 2024; 29:2300336. [PMID: 38456214 PMCID: PMC10986673 DOI: 10.2807/1560-7917.es.2024.29.10.2300336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024] Open
Abstract
BackgroundModel projections of coronavirus disease 2019 (COVID-19) incidence help policymakers about decisions to implement or lift control measures. During the pandemic, policymakers in the Netherlands were informed on a weekly basis with short-term projections of COVID-19 intensive care unit (ICU) admissions.AimWe aimed at developing a model on ICU admissions and updating a procedure for informing policymakers.MethodThe projections were produced using an age-structured transmission model. A consistent, incremental update procedure integrating all new surveillance and hospital data was conducted weekly. First, up-to-date estimates for most parameter values were obtained through re-analysis of all data sources. Then, estimates were made for changes in the age-specific contact rates in response to policy changes. Finally, a piecewise constant transmission rate was estimated by fitting the model to reported daily ICU admissions, with a changepoint analysis guided by Akaike's Information Criterion.ResultsThe model and update procedure allowed us to make weekly projections. Most 3-week prediction intervals were accurate in covering the later observed numbers of ICU admissions. When projections were too high in March and August 2020 or too low in November 2020, the estimated effectiveness of the policy changes was adequately adapted in the changepoint analysis based on the natural accumulation of incoming data.ConclusionThe model incorporates basic epidemiological principles and most model parameters were estimated per data source. Therefore, it had potential to be adapted to a more complex epidemiological situation with the rise of new variants and the start of vaccination.
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Affiliation(s)
- Don Klinkenberg
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jantien Backer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Jacco Wallinga
- Leiden University Medical Centre, Leiden, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Boldea O, Alipoor A, Pei S, Shaman J, Rozhnova G. Age-specific transmission dynamics of SARS-CoV-2 during the first 2 years of the pandemic. PNAS NEXUS 2024; 3:pgae024. [PMID: 38312225 PMCID: PMC10837015 DOI: 10.1093/pnasnexus/pgae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
During its first 2 years, the SARS-CoV-2 pandemic manifested as multiple waves shaped by complex interactions between variants of concern, non-pharmaceutical interventions, and the immunological landscape of the population. Understanding how the age-specific epidemiology of SARS-CoV-2 has evolved throughout the pandemic is crucial for informing policy decisions. In this article, we aimed to develop an inference-based modeling approach to reconstruct the burden of true infections and hospital admissions in children, adolescents, and adults over the seven waves of four variants (wild-type, Alpha, Delta, and Omicron BA.1) during the first 2 years of the pandemic, using the Netherlands as the motivating example. We find that reported cases are a considerable underestimate and a generally poor predictor of true infection burden, especially because case reporting differs by age. The contribution of children and adolescents to total infection and hospitalization burden increased with successive variants and was largest during the Omicron BA.1 period. However, the ratio of hospitalizations to infections decreased with each subsequent variant in all age categories. Before the Delta period, almost all infections were primary infections occurring in naive individuals. During the Delta and Omicron BA.1 periods, primary infections were common in children but relatively rare in adults who experienced either reinfections or breakthrough infections. Our approach can be used to understand age-specific epidemiology through successive waves in other countries where random community surveys uncovering true SARS-CoV-2 dynamics are absent but basic surveillance and statistics data are available.
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Affiliation(s)
- Otilia Boldea
- Department of Econometrics and OR, Tilburg School of Economics and Management, Tilburg University, Tilburg 5037 AB, The Netherlands
| | - Amir Alipoor
- Department of Econometrics and OR, Tilburg School of Economics and Management, Tilburg University, Tilburg 5037 AB, The Netherlands
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
- Columbia Climate School, Columbia University, New York, NY 10025, USA
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
- Center for Complex Systems Studies (CCSS), Utrecht University, Utrecht 3584 CE, The Netherlands
- Faculdade de Ciências, Universidade de Lisboa, Lisbon PT1749-016, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisbon PT1749-016, Portugal
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Alshehri SS, Minhaji BI, Pasha MR, Fouda D, Joseph J, Ahmed N. Characteristics and Outcomes of Children With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Admitted to a Quaternary Hospital: A Single-Center Experience. Cureus 2024; 16:e52532. [PMID: 38371066 PMCID: PMC10870100 DOI: 10.7759/cureus.52532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives In the setting of the recent global pandemic, children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) presented to our hospital with a variety of symptoms ranging from mild to severe disease including multiorgan dysfunction. Our objective was to study the clinical profile, risk factors, complications, and outcomes in pediatric patients admitted to our center with SARS-CoV-2 infection. Methods This retrospective observational study was conducted at a large quaternary center in Riyadh between May 2020 and September 2021. The study population was comprised of children between 0 and ≤14 years with SARS-CoV-2 suspicion or positivity. Results One hundred and fifty-six children were included in the study, the majority of whom were 1-10 years old. One hundred and twenty of them (76.93%) were SARS-CoV-2 positive. Fifty-nine patients (37.18%) were labelled as multisystem inflammatory syndrome in children (MIS-C) based on clinical and lab criteria, of whom 35 (22.44%) tested SARS-CoV-2 positive. Hematological disease was found to be the most common comorbidity, followed by neurological and chronic lung diseases. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Eighty patients (51%) required pediatric intensive care unit (PICU) admission (length of stay: 5-12 days), among whom 32 (40%) required ventilation, 26 (32.5%) needed hemodynamic support, and three patients (3.75%) underwent continuous renal replacement therapy (CRRT). The overall mortality rate was 4.5% (seven patients) among the studied population. The most frequent lab abnormalities were found to be elevated serum ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels. Ninety-one percent received antibiotics, and prophylactic anticoagulant was used in 32%. In the MIS-C subset, 80.5% received steroids, 71.43% intravenous immunoglobulin (IVIG), and 5.17% (three patients) tocilizumab. Conclusion The SARS-CoV-2 infection presented with a range of severity among our cohort of children; however, most of the patients responded well to appropriate supportive treatment. A slight male preponderance was noted. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Inflammatory markers such as ESR, CRP, serum ferritin, and LDH levels were found to be elevated in nearly all patients. Raised serum lactate and serum creatinine and lymphopenia were of significant note in patients with MIS-C. Higher mortality rates were observed in patients with MIS-C and those requiring respiratory support. In addition to these two factors, the presence of comorbidities and the need for CRRT were associated with prolonged PICU length of stay.
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Affiliation(s)
- Saleh S Alshehri
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Bushra I Minhaji
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Mohsina R Pasha
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Dina Fouda
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, SAU
| | - Jency Joseph
- Nursing Administration, King Saud Medical City, Riyadh, SAU
| | - Nehad Ahmed
- Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, SAU
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Recanatini C, GeurtsvanKessel CH, Pas SD, Broens EM, Maas M, van Mansfeld R, Mutsaers-van Oudheusden AJG, van Rijen M, Schippers EF, Stegeman A, Tami A, Veldkamp KE, Visser H, Voss A, Wegdam-Blans MCA, Wertheim HFL, Wever PC, Koopmans MPG, Kluytmans JAJW, Kluytmans-van den Bergh MFQ. Seroprevalence of SARS-CoV-2 antibodies among healthcare workers in Dutch hospitals after the 2020 first wave: a multicentre cross-sectional study with prospective follow-up. Antimicrob Resist Infect Control 2023; 12:137. [PMID: 38031155 PMCID: PMC10688070 DOI: 10.1186/s13756-023-01324-x] [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: 04/22/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND We aimed to estimate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and describe its determinants and associated symptoms among unvaccinated healthcare workers (HCWs) after the first wave of the pandemic. METHODS HCWs from 13 Dutch hospitals were screened for antibodies against the spike protein of SARS-CoV-2 in June-July 2020 and after three months. Participants completed a retrospective questionnaire on determinants for occupational and community exposure to SARS-CoV-2 and symptoms suggestive of COVID-19 experienced since January 2020. The seroprevalence was calculated per baseline characteristic and symptom at baseline and after follow-up. Adjusted odds ratios (aOR) for seropositivity were determined using logistic regression. RESULTS Among 2328 HCWs, 323 (13.9%) were seropositive at enrolment, 49 of whom (15%) reported no previous symptoms suggestive of COVID-19. During follow-up, only 1% of the tested participants seroconverted. Seroprevalence was higher in younger HCWs compared to the mid-age category (aOR 1.53, 95% CI 1.07-2.18). Nurses (aOR 2.21, 95% CI 1.34-3.64) and administrative staff (aOR 1.87, 95% CI 1.02-3.43) had a higher seroprevalence than physicians. The highest seroprevalence was observed in HCWs in the emergency department (ED) (aOR 1.79, 95% CI 1.10-2.91), the lowest in HCWs in the intensive, high, or medium care units (aOR 0.47, 95% CI 0.31-0.71). Chronic respiratory disease, smoking, and having a dog were independently associated with a lower seroprevalence, while HCWs with diabetes mellitus had a higher seroprevalence. In a multivariable model containing all self-reported symptoms since January 2020, altered smell and taste, fever, general malaise/fatigue, and muscle aches were positively associated with developing antibodies, while sore throat and chills were negatively associated. CONCLUSIONS The SARS-CoV-2 seroprevalence in unvaccinated HCWs of 13 Dutch hospitals was 14% in June-July 2020 and remained stable after three months. A higher seroprevalence was observed in the ED and among nurses, administrative and young staff, and those with diabetes mellitus, while a lower seroprevalence was found in HCWs in intensive, high, or medium care, and those with self-reported lung disease, smokers, and dog owners. A history of altered smell or taste, fever, muscle aches and fatigue were independently associated with the presence of SARS-CoV-2 antibodies in unvaccinated HCWs.
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Affiliation(s)
- Claudia Recanatini
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | - Suzan D Pas
- Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Els M Broens
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Martje Maas
- Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Miranda van Rijen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Emile F Schippers
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - Arjan Stegeman
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hannah Visser
- Department of Internal Medicine, Beatrix Hospital, Gorinchem, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolijn C A Wegdam-Blans
- Catharina Hospital, Eindhoven, The Netherlands
- Hospital St. Jans Gasthuis, Weert, The Netherlands
- Department of Medical Microbiology, Stichting PAMM, Veldhoven, The Netherlands
| | - Heiman F L Wertheim
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Marion P G Koopmans
- Viroscience Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolein F Q Kluytmans-van den Bergh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands
- Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands
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9
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Vaughan A, Duffell E, Freidl GS, Lemos DS, Nardone A, Valenciano M, Subissi L, Bergeri I, K Broberg E, Penttinen P, Pebody R, Keramarou M. Systematic review of seroprevalence of SARS-CoV-2 antibodies and appraisal of evidence, prior to the widespread introduction of vaccine programmes in the WHO European Region, January-December 2020. BMJ Open 2023; 13:e064240. [PMID: 37931969 PMCID: PMC10632881 DOI: 10.1136/bmjopen-2022-064240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/04/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES Systematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes. DESIGN A systematic review of the literature. DATA SOURCES We searched MEDLINE, EMBASE and the preprint servers MedRxiv and BioRxiv in the WHO 'COVID-19 Global literature on coronavirus disease' database using a predefined search strategy. Articles were supplemented with unpublished WHO-supported Unity-aligned seroprevalence studies and other studies reported directly to WHO Regional Office for Europe and European Centre for Disease Prevention and Control. ELIGIBILITY CRITERIA Studies published before the widespread implementation of COVID-19 vaccination programmes in January 2021 among the general population and blood donors, at national and regional levels. DATA EXTRACTION AND SYNTHESIS At least two independent researchers extracted the eligible studies; a third researcher resolved any disagreements. Study risk of bias was assessed using a quality scoring system based on sample size, sampling and testing methodologies. RESULTS In total, 111 studies from 26 countries published or conducted between 1 January 2020 and 31 December 2020 across the WHO European Region were included. A significant heterogeneity in implementation was noted across the studies, with a paucity of studies from the east of the Region. Sixty-four (58%) studies were assessed to be of medium to high risk of bias. Overall, SARS-CoV-2 seropositivity prior to widespread community circulation was very low. National seroprevalence estimates after circulation started ranged from 0% to 51.3% (median 2.2% (IQR 0.7-5.2%); n=124), while subnational estimates ranged from 0% to 52% (median 5.8% (IQR 2.3%-12%); n=101), with the highest estimates in areas following widespread local transmission. CONCLUSIONS The low levels of SARS-CoV-2 antibody in most populations prior to the start of vaccine programmes underlines the critical importance of targeted vaccination of priority groups at risk of severe disease, while maintaining reduced levels of transmission to minimise population morbidity and mortality.
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Affiliation(s)
- Aisling Vaughan
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Erika Duffell
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Gudrun S Freidl
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Diogo Simão Lemos
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | | | | | - Eeva K Broberg
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Maria Keramarou
- European Centre for Disease Prevention and Control, Solna, Sweden
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10
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Tancredi S, Chiolero A, Wagner C, Haller ML, Chocano-Bedoya P, Ortega N, Rodondi N, Kaufmann L, Lorthe E, Baysson H, Stringhini S, Michel G, Lüdi C, Harju E, Frank I, Imboden M, Witzig M, Keidel D, Probst-Hensch N, Amati R, Albanese E, Corna L, Crivelli L, Vincentini J, Gonseth Nusslé S, Bochud M, D'Acremont V, Kohler P, Kahlert CR, Cusini A, Frei A, Puhan MA, Geigges M, Kaufmann M, Fehr J, Cullati S. Seroprevalence trends of anti-SARS-CoV-2 antibodies and associated risk factors: a population-based study. Infection 2023; 51:1453-1465. [PMID: 36870034 PMCID: PMC9985433 DOI: 10.1007/s15010-023-02011-0] [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: 11/15/2022] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE We aimed to assess the seroprevalence trends of SARS-CoV-2 antibodies in several Swiss cantons between May 2020 and September 2021 and investigate risk factors for seropositivity and their changes over time. METHODS We conducted repeated population-based serological studies in different Swiss regions using a common methodology. We defined three study periods: May-October 2020 (period 1, prior to vaccination), November 2020-mid-May 2021 (period 2, first months of the vaccination campaign), and mid-May-September 2021 (period 3, a large share of the population vaccinated). We measured anti-spike IgG. Participants provided information on sociodemographic and socioeconomic characteristics, health status, and adherence to preventive measures. We estimated seroprevalence with a Bayesian logistic regression model and the association between risk factors and seropositivity with Poisson models. RESULTS We included 13,291 participants aged 20 and older from 11 Swiss cantons. Seroprevalence was 3.7% (95% CI 2.1-4.9) in period 1, 16.2% (95% CI 14.4-17.5) in period 2, and 72.0% (95% CI 70.3-73.8) in period 3, with regional variations. In period 1, younger age (20-64) was the only factor associated with higher seropositivity. In period 3, being aged ≥ 65 years, with a high income, retired, overweight or obese or with other comorbidities, was associated with higher seropositivity. These associations disappeared after adjusting for vaccination status. Seropositivity was lower in participants with lower adherence to preventive measures, due to a lower vaccination uptake. CONCLUSIONS Seroprevalence sharply increased over time, also thanks to vaccination, with some regional variations. After the vaccination campaign, no differences between subgroups were observed.
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Affiliation(s)
- Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland.
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- School of Population and Global Health, McGill University, Montreal, Canada
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cornelia Wagner
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
| | - Moa Lina Haller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patricia Chocano-Bedoya
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Natalia Ortega
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Kaufmann
- Cantonal Public Health Service of the Canton of Neuchâtel, Neuchâtel, Switzerland
| | - Elsa Lorthe
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Gisela Michel
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Chantal Lüdi
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Erika Harju
- Department Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Clinical Trial Unit, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Irene Frank
- Clinical Trial Unit, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Melissa Witzig
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Laurie Corna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Julia Vincentini
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Semira Gonseth Nusslé
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases, Cantonal Hospital of Grisons, Chur, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Geigges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Route Des Arsenaux 41, 1700, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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11
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Backer JA, van de Kassteele J, El Fakiri F, Hens N, Wallinga J. Contact patterns of older adults with and without frailty in the Netherlands during the COVID-19 pandemic. BMC Public Health 2023; 23:1829. [PMID: 37730628 PMCID: PMC10510272 DOI: 10.1186/s12889-023-16725-1] [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: 05/08/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, social distancing measures were imposed to protect the population from exposure, especially older adults and people with frailty, who have the highest risk for severe outcomes. These restrictions greatly reduced contacts in the general population, but little was known about behaviour changes among older adults and people with frailty themselves. Our aim was to quantify how COVID-19 measures affected the contact behaviour of older adults and how this differed between older adults with and without frailty. METHODS In 2021, a contact survey was carried out among people aged 70 years and older in the Netherlands. A random sample of persons per age group (70-74, 75-79, 80-84, 85-89, and 90 +) and gender was invited to participate, either during a period with stringent (April 2021) or moderate (October 2021) measures. Participants provided general information on themselves, including their frailty, and they reported characteristics of all persons with whom they had face-to-face contact on a given day over the course of a full week. RESULTS In total, 720 community-dwelling older adults were included (overall response rate of 15%), who reported 16,505 contacts. During the survey period with moderate measures, participants without frailty had significantly more contacts outside their household than participants with frailty. Especially for females, frailty was a more informative predictor of the number of contacts than age. During the survey period with stringent measures, participants with and without frailty had significantly lower numbers of contacts compared to the survey period with moderate measures. The reduction of the number of contacts was largest for the eldest participants without frailty. As they interact mostly with adults of a similar high age who are likely frail, this reduction of the number of contacts indirectly protects older adults with frailty from SARS-CoV-2 exposure. CONCLUSIONS The results of this study reveal that social distancing measures during the COVID-19 pandemic differentially affected the contact patterns of older adults with and without frailty. The reduction of contacts may have led to the direct protection of older adults in general but also to the indirect protection of older adults with frailty.
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Affiliation(s)
- Jantien A Backer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Jan van de Kassteele
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Fatima El Fakiri
- Public Health Service of Amsterdam (GGD), Amsterdam, the Netherlands
| | - Niel Hens
- UHasselt, Data Science Institute and I-BioStat, Hasselt, Belgium
- University of Antwerp, Vaccine and Infectious Disease Institute, Antwerp, Belgium
| | - Jacco Wallinga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Leiden University Medical Center, Leiden, the Netherlands
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12
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Wit FW, Reiss P, Rijnders B, Rokx C, Roukens A, Brinkman K, van der Valk M. COVID-19 in people with HIV in the Netherlands. AIDS 2023; 37:1671-1681. [PMID: 37199566 PMCID: PMC10399951 DOI: 10.1097/qad.0000000000003597] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/03/2023] [Accepted: 12/20/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We investigated occurrence of and risk factors for severe COVID-19 outcomes in people with HIV (PWH) in the Netherlands. DESIGN An ongoing prospective nationwide HIV cohort study. METHODS COVID-19 diagnoses and outcomes with other relevant medical information were prospectively collected from electronic medical records in all HIV treatment centers in the Netherlands, from the start of the COVID-19 epidemic until December 31, 2021. Risk factors for COVID-19 related hospitalization and death were investigated using multivariable logistic regression, including demographics, HIV-related factors, and comorbidities. RESULTS The cohort comprises 21 289 adult PWH, median age 51.2 years, 82% male, 70% were of Western origin, 12.0% were of sub-Saharan African and 12.6% Latin American/Caribbean origin, 96.8% had HIV-RNA less than 200 copies/ml, median CD4 + cell count 690 (IQR 510-908) cells/μl. Primary SARS-CoV-2 infections were registered in 2301 individuals, of whom 157 (6.8%) required hospitalization and 27 (1.2%) ICU admission. Mortality rates were 13 and 0.4% among hospitalized and nonhospitalized individuals, respectively. Independent risk factors for severe outcomes (COVID-19-related hospitalization and death) were higher age, having multiple comorbidities, a CD4 + cell count less than 200 cells/μl, uncontrolled HIV replication, and prior AIDS diagnosis. Migrants from sub-Saharan Africa, Latin America, and the Caribbean were at an increased risk of severe outcomes independently of other risk factors. CONCLUSION In our national cohort of PWH, risk of severe COVID-19 outcomes was increased in individuals with uncontrolled HIV replication, low CD4 + cell count, and prior AIDS diagnosis, independently of general risk factors such as higher age, comorbidity burden and migrants originating from non-Western countries.
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Affiliation(s)
- Ferdinand W.N.M. Wit
- Stichting HIV Monitoring
- Amsterdam University Medical Centers, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection & Immunity Institute, Amsterdam
| | - Peter Reiss
- Stichting HIV Monitoring
- Amsterdam University Medical Centers, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection & Immunity Institute, Amsterdam
| | - Bart Rijnders
- Erasmus University Medical Center, Departments of Internal Medicine & Medical Microbiology, Rotterdam
| | - Casper Rokx
- Erasmus University Medical Center, Departments of Internal Medicine & Medical Microbiology, Rotterdam
| | - Anna Roukens
- Leiden University Medical Center, Department of Internal Medicine, Leiden
| | - Kees Brinkman
- Onze Lieve Vrouwe Gasthuis, Department of Internal Medicine, Amsterdam, Netherlands
| | - Marc van der Valk
- Stichting HIV Monitoring
- Amsterdam University Medical Centers, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection & Immunity Institute, Amsterdam
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13
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Backer JA, Bogaardt L, Beutels P, Coletti P, Edmunds WJ, Gimma A, van Hagen CCE, Hens N, Jarvis CI, Vos ERA, Wambua J, Wong D, van Zandvoort K, Wallinga J. Dynamics of non-household contacts during the COVID-19 pandemic in 2020 and 2021 in the Netherlands. Sci Rep 2023; 13:5166. [PMID: 36997550 PMCID: PMC10060924 DOI: 10.1038/s41598-023-32031-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
The COVID-19 pandemic was in 2020 and 2021 for a large part mitigated by reducing contacts in the general population. To monitor how these contacts changed over the course of the pandemic in the Netherlands, a longitudinal survey was conducted where participants reported on their at-risk contacts every two weeks, as part of the European CoMix survey. The survey included 1659 participants from April to August 2020 and 2514 participants from December 2020 to September 2021. We categorized the number of unique contacted persons excluding household members, reported per participant per day into six activity levels, defined as 0, 1, 2, 3-4, 5-9 and 10 or more reported contacts. After correcting for age, vaccination status, risk status for severe outcome of infection, and frequency of participation, activity levels increased over time, coinciding with relaxation of COVID-19 control measures.
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Affiliation(s)
- Jantien A Backer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - Laurens Bogaardt
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Pietro Coletti
- UHasselt, Data Science Institute and I-BioStat, Hasselt, Belgium
| | - W John Edmunds
- London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Gimma
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Niel Hens
- University of Antwerp, Antwerp, Belgium
- UHasselt, Data Science Institute and I-BioStat, Hasselt, Belgium
| | | | - Eric R A Vos
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - James Wambua
- UHasselt, Data Science Institute and I-BioStat, Hasselt, Belgium
| | - Denise Wong
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Jacco Wallinga
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
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14
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Dekker MM, Coffeng LE, Pijpers FP, Panja D, de Vlas SJ. Reducing societal impacts of SARS-CoV-2 interventions through subnational implementation. eLife 2023; 12:80819. [PMID: 36880190 PMCID: PMC10023153 DOI: 10.7554/elife.80819] [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: 06/06/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
To curb the initial spread of SARS-CoV-2, many countries relied on nation-wide implementation of non-pharmaceutical intervention measures, resulting in substantial socio-economic impacts. Potentially, subnational implementations might have had less of a societal impact, but comparable epidemiological impact. Here, using the first COVID-19 wave in the Netherlands as a case in point, we address this issue by developing a high-resolution analysis framework that uses a demographically stratified population and a spatially explicit, dynamic, individual contact-pattern based epidemiology, calibrated to hospital admissions data and mobility trends extracted from mobile phone signals and Google. We demonstrate how a subnational approach could achieve similar level of epidemiological control in terms of hospital admissions, while some parts of the country could stay open for a longer period. Our framework is exportable to other countries and settings, and may be used to develop policies on subnational approach as a better strategic choice for controlling future epidemics.
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Affiliation(s)
- Mark M Dekker
- Department of Information and Computing Sciences, Utrecht UniversityUtrechtNetherlands
- Centre for Complex Systems Studies, Utrecht UniversityUtrechtNetherlands
- PBL Netherlands Environmental Assessment AgencyThe HagueNetherlands
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center RotterdamRotterdamNetherlands
| | - Frank P Pijpers
- Statistics NetherlandsThe HagueNetherlands
- Korteweg-de Vries Institute for Mathematics, University of AmsterdamAmsterdamNetherlands
| | - Debabrata Panja
- Department of Information and Computing Sciences, Utrecht UniversityUtrechtNetherlands
- Centre for Complex Systems Studies, Utrecht UniversityUtrechtNetherlands
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center RotterdamRotterdamNetherlands
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Atkinson A, Albert A, McClymont E, Andrade J, Beach L, Bolotin S, Boucoiran I, Bullard J, Charlton C, Crane J, Dougan S, Forest JC, German GJ, Giguère Y, Girouard G, Hankins C, Krajden M, Lang A, Levett P, Minion J, Neudorf C, Poliquin V, Robinson JL, Scott H, Stein DR, Tran V, Zahariadis G, Zhou HY, Money D. Canadian SARS-CoV-2 serological survey using antenatal serum samples: a retrospective seroprevalence study. CMAJ Open 2023; 11:E305-E313. [PMID: 37015743 PMCID: PMC10079308 DOI: 10.9778/cmajo.20220045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Insufficient data on the rate and distribution of SARS-CoV-2 infection in Canada has presented a substantial challenge to the public health response to the COVID-19 pandemic. Our objective was to assess SARS-CoV-2 seroprevalence in a representative sample of pregnant people throughout Canada, across multiple time points over 2 years of the pandemic, to describe the seroprevalence and show the ability of this process to provide prevalence estimates. METHODS This Canadian retrospective serological surveillance study used existing serological prenatal samples across 10 provinces over multiple time periods: Feb. 3-21, 2020; Aug. 24-Sept. 11, 2020; Nov. 16-Dec. 4, 2020; Nov. 15-Dec. 3, 2021; and results from the province of British Columbia during a period in which the SARS-CoV-2 B.1.1.529 (Omicron) variant was predominant, from Nov. 15, 2021, to June 11, 2022. Age and postal code administrative data allowed for comparison with concurrent polymerase chain reactivity (PCR)-positive results collected by Statistics Canada and the Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg) project. RESULTS Seropositivity in antenatal serum as early as February 2020 indicates SARS-CoV-2 transmission before the World Health Organization's declaration of the pandemic. Seroprevalence in our sample of pregnant people was 1.84 to 8.90 times higher than the recorded concurrent PCR-positive prevalence recorded among females aged 20-49 years in November-December 2020. Overall seropositivity in our sample of pregnant people was low at the end of 2020, increasing to 15% in 1 province by the end of 2021. Seroprevalence among pregnant people in BC during the Omicron period increased from 5.8% to 43% from November 2021 to June 2022. INTERPRETATION These results indicate widespread vulnerability to SARS-CoV-2 infection before vaccine availability in Canada. During the time periods sampled, public health tracking systems were under-reporting infections, and seroprevalence results during the Omicron period indicate extensive community spread of SARS-CoV-2 infection.
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Affiliation(s)
- Andrea Atkinson
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Arianne Albert
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Elisabeth McClymont
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Janice Andrade
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Lori Beach
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Shelly Bolotin
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Isabelle Boucoiran
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jared Bullard
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Carmen Charlton
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Joan Crane
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Shelley Dougan
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jean-Claude Forest
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Greg J German
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Yves Giguère
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Gabriel Girouard
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Catherine Hankins
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Mel Krajden
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Amanda Lang
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Paul Levett
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jessica Minion
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Cory Neudorf
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Vanessa Poliquin
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jason L Robinson
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Heather Scott
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Derek R Stein
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Vanessa Tran
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - George Zahariadis
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Hong Y Zhou
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Deborah Money
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
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16
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Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
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Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
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17
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Michielin G, Arefi F, Puhach O, Bellon M, Sattonnet-Roche P, L'Huillier AG, Eckerle I, Meyer B, Maerkl SJ. Clinical sensitivity and specificity of a high-throughput microfluidic nano-immunoassay combined with capillary blood microsampling for the identification of anti-SARS-CoV-2 Spike IgG serostatus. PLoS One 2023; 18:e0283149. [PMID: 36952463 PMCID: PMC10035827 DOI: 10.1371/journal.pone.0283149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES We evaluate the diagnostic performance of dried blood microsampling combined with a high-throughput microfluidic nano-immunoassay (NIA) for the identification of anti-SARS-CoV-2 Spike IgG seropositivity. METHODS We conducted a serological study among 192 individuals with documented prior SARS-CoV-2 infection and 44 SARS-CoV-2 negative individuals. Participants with prior SARS-CoV-2 infection had a long interval of 11 months since their qRT-PCR positive test. Serum was obtained after venipuncture and tested with an automated electrochemiluminescence anti-SARS-CoV-2 S total Ig reference assay, a commercial ELISA anti-S1 IgG assay, and the index test NIA. In addition, 109 participants from the positive cohort and 44 participants from the negative cohort participated in capillary blood collection using three microsampling devices: Mitra, repurposed glucose test strips, and HemaXis. Samples were dried, shipped by regular mail, extracted, and measured with NIA. RESULTS Using serum samples, we achieve a clinical sensitivity of 98·33% and specificity of 97·62% on NIA, affirming the high performance of NIA in participants 11 months post infection. Combining microsampling with NIA, we obtain a clinical sensitivity of 95·05% using Mitra, 61·11% using glucose test strips, 83·16% using HemaXis, and 91·49% for HemaXis after automated extraction, without any drop in specificity. DISCUSSION High sensitivity and specificity was demonstrated when testing micro-volume capillary dried blood samples using NIA, which is expected to facilitate its use in large-scale studies using home-based sampling or samples collected in the field.
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Affiliation(s)
- Grégoire Michielin
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fatemeh Arefi
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Olha Puhach
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathilde Bellon
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pascale Sattonnet-Roche
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Isabella Eckerle
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals & Faculty of Medicine, Université de Genève, Geneva, Switzerland
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Sebastian J Maerkl
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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18
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The importance of sustained compliance with physical distancing during COVID-19 vaccination rollout. COMMUNICATIONS MEDICINE 2022; 2:146. [DOI: 10.1038/s43856-022-00207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background
Increasing vaccination coverage against SARS-CoV-2 enabled relaxation of lockdowns in many countries in Europe. As the vaccination rollouts progressed, the public health authorities were seeking recommendations on the continuation of physical distancing measures during ongoing vaccination rollouts. Compliance with these measures was declining while more transmissible virus variants have emerged.
Methods
We used a SARS-CoV-2 transmission model to investigate the feedback between compliance, infection incidence, and vaccination coverage. We quantified our findings in terms of cumulative number of new hospitalisations three and six months after the start of vaccination.
Results
Our results suggest that the combination of fast waning compliance in non-vaccinated individuals, low compliance in vaccinated individuals, low vaccine efficacy against infection and more transmissible virus variants may result in a higher cumulative number of new hospitalisations than in a situation without vaccination. These adverse effects can be alleviated by deploying behavioural interventions that should preferably target both vaccinated and non-vaccinated individuals. The choice of the most appropriate intervention depends on vaccination rate and vaccine efficacy against infection.
Conclusions
Supplementary behavioural interventions aiming to boost compliance to physical distancing measures can improve the outcome of vaccination programmes, until vaccination coverage is sufficiently high. For optimal results, these interventions should be selected based on the vaccine efficacy against infection and expected vaccination rate. While we considered the dynamics of SARS-CoV-2, the qualitative effects of the interplay between infectious disease spread and behavior on the outcomes of a vaccination programme can be used as guidance in a future similar pandemic.
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19
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High Prevalence of Undocumented SARS-CoV-2 Infections in the Pediatric Population of the Tyrolean District of Schwaz. Viruses 2022; 14:v14102294. [PMID: 36298849 PMCID: PMC9609860 DOI: 10.3390/v14102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
Complementing the adult seroprevalence data collected at the time of the rapid SARS-CoV-2 mass vaccination in the district of Schwaz in 2021, we set out to establish the seroprevalence of SARS-CoV-2 among the pediatric population of the district. A total of 369 children, mean age 9.9 (SD 3.4), participated in the study, answering a structured questionnaire on the history of SARS-CoV-2 infection, household contacts, symptoms and history of vaccination. We determined binding and neutralizing antibody levels using plasma samples provided. We estimated the overall prevalence of SARS-CoV-2 infection in the general pediatric population at the time of the study using the census data from Statistik Austria and daily reports of officially confirmed cases. Excluding study participants who reported a history of PCR-confirmed infection, the age-standardized seroprevalence of previously unknown SARS-CoV-2 infection among the general pediatric population of the district was 27% (95% CI: 26.1–27.8). Adding this to the officially documented cases, the true overall prevalence was 32.8% (95% CI: 31.9–33.6) in contrast to the officially documented 8.0% (95% CI: 7.5–8.5) by June 2021. This translated into a proportion of 75.7% (95% CI: 74.4–77.0) of cases being officially undocumented, suggesting a high extent of silent SARS-CoV-2 infections in the pediatric population and possibly silent transmission.
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20
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Pluss O, Campbell H, Pezzi L, Morales I, Roell Y, Quandelacy TM, Arora RK, Boucher E, Lamb MM, Chu M, Bärnighausen T, Jaenisch T. Limitations introduced by a low participation rate of SARS-CoV-2 seroprevalence data. Int J Epidemiol 2022; 52:32-43. [PMID: 36164817 PMCID: PMC9619459 DOI: 10.1093/ije/dyac178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There has been a large influx of COVID-19 seroprevalence studies, but comparability between the seroprevalence estimates has been an issue because of heterogeneities in testing platforms and study methodology. One potential source of heterogeneity is the response or participation rate. METHODS We conducted a review of participation rates (PR) in SARS-CoV-2 seroprevalence studies collected by SeroTracker and examined their effect on the validity of study conclusions. PR was calculated as the count of participants for whom the investigators had collected a valid sample, divided by the number of people invited to participate in the study. A multivariable beta generalized linear model with logit link was fitted to determine if the PR of international household and community-based seroprevalence studies was associated with the factors of interest, from 1 December 2019 to 10 March 2021. RESULTS We identified 90 papers based on screening and were able to calculate the PR for 35 out of 90 papers (39%), with a median PR of 70% and an interquartile range of 40.92; 61% of the studies did not report PR. CONCLUSIONS Many SARS-CoV-2 seroprevalence studies do not report PR. It is unclear what the median PR rate would be had a larger portion not had limitations in reporting. Low participation rates indicate limited representativeness of results. Non-probabilistic sampling frames were associated with higher participation rates but may be less representative. Standardized definitions of participation rate and data reporting necessary for the PR calculations are essential for understanding the representativeness of seroprevalence estimates in the population of interest.
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Affiliation(s)
- Olivia Pluss
- Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Harlan Campbell
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Laura Pezzi
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), Marseille, France
| | - Ivonne Morales
- Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany,Heidelberg Institute for Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Yannik Roell
- Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Talia M Quandelacy
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Rahul Krishan Arora
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Emily Boucher
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Molly M Lamb
- Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA,Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - May Chu
- Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Till Bärnighausen
- Heidelberg Institute for Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Jaenisch
- Corresponding author. Department of Epidemiology and Center for Global Health, Colorado School of Public Health, 13199 East Montview Boulevard, Suite 310, Mail Stop A090, Aurora, CO 80045, USA. E-mail:
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21
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McDonald SA, Lagerweij GR, de Boer P, de Melker HE, Pijnacker R, Mughini Gras L, Kretzschmar ME, den Hartog G, van Gageldonk-Lafeber AB, van den F S, Wallinga J. The estimated disease burden of acute COVID-19 in the Netherlands in 2020, in disability-adjusted life-years. Eur J Epidemiol 2022; 37:1035-1047. [PMID: 35951278 PMCID: PMC9366822 DOI: 10.1007/s10654-022-00895-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
The impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires hospital and/or ICU admission, results in prolonged and chronic illness, or leads to premature death. We aimed to quantify the total disease burden of acute COVID-19 in the Netherlands in 2020 using the disability-adjusted life-years (DALY) measure, and to investigate how burden varies between age-groups and occupations. Using standard methods and diverse data sources (mandatory notifications, population-level seroprevalence, hospital and ICU admissions, registered COVID-19 deaths, and the literature), we estimated years of life lost (YLL), years lived with disability, DALY and DALY per 100,000 population due to COVID-19, excluding post-acute sequelae, stratified by 5-year age-group and occupation category. The total disease burden due to acute COVID-19 was 286,100 (95% CI: 281,700-290,500) DALY, and the per-capita burden was 1640 (95% CI: 1620-1670) DALY/100,000, of which 99.4% consisted of YLL. The per-capita burden increased steeply with age, starting from 60 to 64 years, with relatively little burden estimated for persons under 50 years old. SARS-CoV-2 infection and associated premature mortality was responsible for a considerable direct health burden in the Netherlands, despite extensive public health measures. DALY were much higher than for other high-burden infectious diseases, but lower than estimated for coronary heart disease. These findings are valuable for informing public health decision-makers regarding the expected COVID-19 health burden among population subgroups, and the possible gains from targeted preventative interventions.
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Affiliation(s)
- Scott A McDonald
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Giske R Lagerweij
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Pieter de Boer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Roan Pijnacker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Lapo Mughini Gras
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mirjam E Kretzschmar
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gerco den Hartog
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arianne B van Gageldonk-Lafeber
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Susan van den F
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jacco Wallinga
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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22
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Schoot Uiterkamp MHH, Gösgens M, Heesterbeek H, van der Hofstad R, Litvak N. The role of inter-regional mobility in forecasting SARS-CoV-2 transmission. JOURNAL OF THE ROYAL SOCIETY, INTERFACE 2022; 19:20220486. [PMID: 36043288 PMCID: PMC9428544 DOI: 10.1098/rsif.2022.0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this paper, we present a method to forecast the spread of SARS-CoV-2 across regions with a focus on the role of mobility. Mobility has previously been shown to play a significant role in the spread of the virus, particularly between regions. Here, we investigate under which epidemiological circumstances incorporating mobility into transmission models yields improvements in the accuracy of forecasting, where we take the situation in The Netherlands during and after the first wave of transmission in 2020 as a case study. We assess the quality of forecasting on the detailed level of municipalities, instead of on a nationwide level. To model transmissions, we use a simple mobility-enhanced SEIR compartmental model with subpopulations corresponding to the Dutch municipalities. We use commuter information to quantify mobility, and develop a method based on maximum likelihood estimation to determine the other relevant parameters. We show that taking inter-regional mobility into account generally leads to an improvement in forecast quality. However, at times when policies are in place that aim to reduce contacts or travel, this improvement is very small. By contrast, the improvement becomes larger when municipalities have a relatively large amount of incoming mobility compared with the number of inhabitants.
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Affiliation(s)
| | - Martijn Gösgens
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans Heesterbeek
- Department of Population Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Remco van der Hofstad
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Nelly Litvak
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
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Sugiyama A, Okada F, Abe K, Imada H, Ouoba S, E B, Hussain MRA, Ohisa M, Ko K, Nagashima S, Akita T, Yamazaki S, Yokozaki M, Kishita E, Tanaka J. A longitudinal study of anti-SARS-CoV-2 antibody seroprevalence in a random sample of the general population in Hiroshima in 2020. Environ Health Prev Med 2022; 27:30. [PMID: 35793938 PMCID: PMC9283912 DOI: 10.1265/ehpm.22-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This longitudinal study aimed to determine chronological changes in the seroprevalence of prior SARS-CoV-2 infection, including asymptomatic infections in Hiroshima Prefecture, Japan. METHODS A stratified random sample of 7,500 residents from five cities of Hiroshima Prefecture was selected to participate in a three-round survey from late 2020 to early 2021, before the introduction of the COVID-19 vaccine. The seroprevalence of anti-SARS-CoV-2 antibodies was calculated if at least two of four commercially available immunoassays were positive. Then, the ratio between seroprevalence and the prevalence of confirmed COVID-19 cases in Hiroshima was calculated and compared to the results from other prefectures where the Ministry of Health, Labour and Welfare conducted a survey by using the same reagents at almost the same period. RESULTS The numbers of participants in the first, second, and third rounds of the survey were 3025, 2396, and 2351, respectively and their anti-SARS-CoV-2 antibodies seroprevalences were 0.03% (95% confidence interval: 0.00-0.10%), 0.08% (0.00-0.20%), and 0.30% (0.08-0.52%), respectively. The ratio between the seroprevalence and the prevalence of confirmed COVID-19 cases in Hiroshima was 1.2, which was smaller than that in similar studies in other prefectures. CONCLUSIONS The seroprevalence of anti-SARS-CoV-2 antibodies in Hiroshima increased tenfold in a half year. The difference between seroprevalence and the prevalence of confirmed COVID-19 cases in Hiroshima was smaller than that in other prefectures, suggesting that asymptomatic patients were more actively detected in Hiroshima.
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Affiliation(s)
- Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Fumie Okada
- Hiroshima Prefecture Health and Welfare Bureau
| | - Kanon Abe
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Hirohito Imada
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Serge Ouoba
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Unité de Recherche Clinique de Nanoro (URCN), Institut de Recherche en Science de la Santé (IRSS)
| | - Bunthen E
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Payment Certification Agency, Ministry of Health
| | - Md Razeen Ashraf Hussain
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Masayuki Ohisa
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Shintaro Nagashima
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Shinichi Yamazaki
- Division of Clinical Laboratory Medicine, Hiroshima University Hospital
| | - Michiya Yokozaki
- Division of Clinical Laboratory Medicine, Hiroshima University Hospital
| | | | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
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24
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Prevalence of SARS-CoV-2 antibodies and risk factors in the pandemic epicentre of Catalonia. Sci Rep 2022; 12:9169. [PMID: 35654922 PMCID: PMC9163094 DOI: 10.1038/s41598-022-13290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/09/2022] [Indexed: 11/14/2022] Open
Abstract
To define the seroprevalence of antibodies against SARS-CoV-2 in the municipality of Vilanova del Camí (in the region of Conca d'Ódena, Barcelona, Spain) and to know the risk factors associated with positive seroprevalence. Cross-sectional descriptive study. The population of Vilanova del Camí had the opportunity to voluntarily attend two screenings (October and December 2020) for antibodies against the nucleocapsid protein of SARS-CoV-2 using a Rapid Diagnostic Test (RDT) (Salocor (Salofa Oy). Participants in the screening signed an informed consent form. From the 3,610 attendees at the screening, 2,170 patients were randomly selected. The relationship between antibody test results and other demographic (sex, age, morbidity index) and clinical (diagnoses, smoking and drugs) variables was analysed. The prevalence of antibodies against SARS-CoV-2 was 9.6% (95% CI of 8.4% to 10.9%) and was similar for men and women but increased with age. Among complex chronic patients, 14.3% had antibodies against SARS-CoV-2, and among patients with advanced chronic disease, 25% had antibodies against SARS-CoV-2. Age, AMG (Adjusted Morbidity Groups) index, COVID-19 diagnosis and contact with a COVID-19 case were risk factors for positive seroprevalence. A higher seroprevalence was detected in the October screening (12.16%) than in the December screening (8.38%). In the December screening, obesity was a risk factor for positive seroprevalence. This study demonstrates the high seroprevalence of antibodies against SARS-CoV-2 in the pandemic epicentre of Catalonia.
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Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, Spijker R, Hooft L, Emperador D, Domen J, Tans A, Janssens S, Wickramasinghe D, Lannoy V, Horn SRA, Van den Bruel A. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19. Cochrane Database Syst Rev 2022; 5:CD013665. [PMID: 35593186 PMCID: PMC9121352 DOI: 10.1002/14651858.cd013665.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND COVID-19 illness is highly variable, ranging from infection with no symptoms through to pneumonia and life-threatening consequences. Symptoms such as fever, cough, or loss of sense of smell (anosmia) or taste (ageusia), can help flag early on if the disease is present. Such information could be used either to rule out COVID-19 disease, or to identify people who need to go for COVID-19 diagnostic tests. This is the second update of this review, which was first published in 2020. OBJECTIVES To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19. SEARCH METHODS We undertook electronic searches up to 10 June 2021 in the University of Bern living search database. In addition, we checked repositories of COVID-19 publications. We used artificial intelligence text analysis to conduct an initial classification of documents. We did not apply any language restrictions. SELECTION CRITERIA Studies were eligible if they included people with clinically suspected COVID-19, or recruited known cases with COVID-19 and also controls without COVID-19 from a single-gate cohort. Studies were eligible when they recruited people presenting to primary care or hospital outpatient settings. Studies that included people who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards. DATA COLLECTION AND ANALYSIS Pairs of review authors independently selected all studies, at both title and abstract, and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and assessed risk of bias using the QUADAS-2 checklist, and resolved disagreements by discussion with a third review author. Analyses were restricted to prospective studies only. We presented sensitivity and specificity in paired forest plots, in receiver operating characteristic (ROC) space and in dumbbell plots. We estimated summary parameters using a bivariate random-effects meta-analysis whenever five or more primary prospective studies were available, and whenever heterogeneity across studies was deemed acceptable. MAIN RESULTS We identified 90 studies; for this update we focused on the results of 42 prospective studies with 52,608 participants. Prevalence of COVID-19 disease varied from 3.7% to 60.6% with a median of 27.4%. Thirty-five studies were set in emergency departments or outpatient test centres (46,878 participants), three in primary care settings (1230 participants), two in a mixed population of in- and outpatients in a paediatric hospital setting (493 participants), and two overlapping studies in nursing homes (4007 participants). The studies did not clearly distinguish mild COVID-19 disease from COVID-19 pneumonia, so we present the results for both conditions together. Twelve studies had a high risk of bias for selection of participants because they used a high level of preselection to decide whether reverse transcription polymerase chain reaction (RT-PCR) testing was needed, or because they enrolled a non-consecutive sample, or because they excluded individuals while they were part of the study base. We rated 36 of the 42 studies as high risk of bias for the index tests because there was little or no detail on how, by whom and when, the symptoms were measured. For most studies, eligibility for testing was dependent on the local case definition and testing criteria that were in effect at the time of the study, meaning most people who were included in studies had already been referred to health services based on the symptoms that we are evaluating in this review. The applicability of the results of this review iteration improved in comparison with the previous reviews. This version has more studies of people presenting to ambulatory settings, which is where the majority of assessments for COVID-19 take place. Only three studies presented any data on children separately, and only one focused specifically on older adults. We found data on 96 symptoms or combinations of signs and symptoms. Evidence on individual signs as diagnostic tests was rarely reported, so this review reports mainly on the diagnostic value of symptoms. Results were highly variable across studies. Most had very low sensitivity and high specificity. RT-PCR was the most often used reference standard (40/42 studies). Only cough (11 studies) had a summary sensitivity above 50% (62.4%, 95% CI 50.6% to 72.9%)); its specificity was low (45.4%, 95% CI 33.5% to 57.9%)). Presence of fever had a sensitivity of 37.6% (95% CI 23.4% to 54.3%) and a specificity of 75.2% (95% CI 56.3% to 87.8%). The summary positive likelihood ratio of cough was 1.14 (95% CI 1.04 to 1.25) and that of fever 1.52 (95% CI 1.10 to 2.10). Sore throat had a summary positive likelihood ratio of 0.814 (95% CI 0.714 to 0.929), which means that its presence increases the probability of having an infectious disease other than COVID-19. Dyspnoea (12 studies) and fatigue (8 studies) had a sensitivity of 23.3% (95% CI 16.4% to 31.9%) and 40.2% (95% CI 19.4% to 65.1%) respectively. Their specificity was 75.7% (95% CI 65.2% to 83.9%) and 73.6% (95% CI 48.4% to 89.3%). The summary positive likelihood ratio of dyspnoea was 0.96 (95% CI 0.83 to 1.11) and that of fatigue 1.52 (95% CI 1.21 to 1.91), which means that the presence of fatigue slightly increases the probability of having COVID-19. Anosmia alone (7 studies), ageusia alone (5 studies), and anosmia or ageusia (6 studies) had summary sensitivities below 50% but summary specificities over 90%. Anosmia had a summary sensitivity of 26.4% (95% CI 13.8% to 44.6%) and a specificity of 94.2% (95% CI 90.6% to 96.5%). Ageusia had a summary sensitivity of 23.2% (95% CI 10.6% to 43.3%) and a specificity of 92.6% (95% CI 83.1% to 97.0%). Anosmia or ageusia had a summary sensitivity of 39.2% (95% CI 26.5% to 53.6%) and a specificity of 92.1% (95% CI 84.5% to 96.2%). The summary positive likelihood ratios of anosmia alone and anosmia or ageusia were 4.55 (95% CI 3.46 to 5.97) and 4.99 (95% CI 3.22 to 7.75) respectively, which is just below our arbitrary definition of a 'red flag', that is, a positive likelihood ratio of at least 5. The summary positive likelihood ratio of ageusia alone was 3.14 (95% CI 1.79 to 5.51). Twenty-four studies assessed combinations of different signs and symptoms, mostly combining olfactory symptoms. By combining symptoms with other information such as contact or travel history, age, gender, and a local recent case detection rate, some multivariable prediction scores reached a sensitivity as high as 90%. AUTHORS' CONCLUSIONS Most individual symptoms included in this review have poor diagnostic accuracy. Neither absence nor presence of symptoms are accurate enough to rule in or rule out the disease. The presence of anosmia or ageusia may be useful as a red flag for the presence of COVID-19. The presence of cough also supports further testing. There is currently no evidence to support further testing with PCR in any individuals presenting only with upper respiratory symptoms such as sore throat, coryza or rhinorrhoea. Combinations of symptoms with other readily available information such as contact or travel history, or the local recent case detection rate may prove more useful and should be further investigated in an unselected population presenting to primary care or hospital outpatient settings. The diagnostic accuracy of symptoms for COVID-19 is moderate to low and any testing strategy using symptoms as selection mechanism will result in both large numbers of missed cases and large numbers of people requiring testing. Which one of these is minimised, is determined by the goal of COVID-19 testing strategies, that is, controlling the epidemic by isolating every possible case versus identifying those with clinically important disease so that they can be monitored or treated to optimise their prognosis. The former will require a testing strategy that uses very few symptoms as entry criterion for testing, the latter could focus on more specific symptoms such as fever and anosmia.
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Affiliation(s)
- Thomas Struyf
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jacqueline Dinnes
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Clare Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Julie Domen
- Department of Primary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Anouk Tans
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | | | | | - Sebastiaan R A Horn
- Department of Primary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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van den Hoogen LL, Verheul MK, Vos ERA, van Hagen CCE, van Boven M, Wong D, Wijmenga-Monsuur AJ, Smits G, Kuijer M, van Rooijen D, Bogaard-van Maurik M, Zutt I, van Vliet J, Wolf J, van der Klis FRM, de Melker HE, van Binnendijk RS, den Hartog G. SARS-CoV-2 Spike S1-specific IgG kinetic profiles following mRNA or vector-based vaccination in the general Dutch population show distinct kinetics. Sci Rep 2022; 12:5935. [PMID: 35396570 PMCID: PMC8990276 DOI: 10.1038/s41598-022-10020-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/30/2022] [Indexed: 12/21/2022] Open
Abstract
mRNA- and vector-based vaccines are used at a large scale to prevent COVID-19. We compared Spike S1-specific (S1) IgG antibodies after vaccination with mRNA-based (Comirnaty, Spikevax) or vector-based (Janssen, Vaxzevria) vaccines, using samples from a Dutch nationwide cohort. In adults 18-64 years old (n = 2412), the median vaccination interval between the two doses was 77 days for Vaxzevria (interquartile range, IQR: 69-77), 35 days (28-35) for Comirnaty and 33 days (28-35) for Spikevax. mRNA vaccines induced faster inclines and higher S1 antibodies compared to vector-based vaccines. For all vaccines, one dose resulted in boosting of S1 antibodies in adults with a history of SARS-CoV-2 infection. For Comirnaty, two to four months following the second dose (n = 196), S1 antibodies in adults aged 18-64 years old (436 BAU/mL, IQR: 328-891) were less variable and median concentrations higher compared to those in persons ≥ 80 years old (366, 177-743), but differences were not statistically significant (p > 0.100). Nearly all participants seroconverted following COVID-19 vaccination, including the aging population. These data confirm results from controlled vaccine trials in a general population, including vulnerable groups.
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Affiliation(s)
- Lotus L van den Hoogen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Marije K Verheul
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Eric R A Vos
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cheyenne C E van Hagen
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Denise Wong
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Alienke J Wijmenga-Monsuur
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Marjan Kuijer
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Debbie van Rooijen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Marjan Bogaard-van Maurik
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Ilse Zutt
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Jeffrey van Vliet
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Janine Wolf
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Fiona R M van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Robert S van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Gerco den Hartog
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
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27
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Herrera-Esposito D, de Los Campos G. Age-specific rate of severe and critical SARS-CoV-2 infections estimated with multi-country seroprevalence studies. BMC Infect Dis 2022; 22:311. [PMID: 35351016 DOI: 10.1101/2021.07.29.21261282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/11/2022] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Knowing the age-specific rates at which individuals infected with SARS-CoV-2 develop severe and critical disease is essential for designing public policy, for infectious disease modeling, and for individual risk evaluation. METHODS In this study, we present the first estimates of these rates using multi-country serology studies, and public data on hospital admissions and mortality from early to mid-2020. We combine these under a Bayesian framework that accounts for the high heterogeneity between data sources and their respective uncertainties. We also validate our results using an indirect method based on infection fatality rates and hospital mortality data. RESULTS Our results show that the risk of severe and critical disease increases exponentially with age, but much less steeply than the risk of fatal illness. We also show that our results are consistent across several robustness checks. CONCLUSION A complete evaluation of the risks of SARS-CoV-2 for health must take non-fatal disease outcomes into account, particularly in young populations where they can be 2 orders of magnitude more frequent than deaths.
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Affiliation(s)
- Daniel Herrera-Esposito
- Laboratorio de Neurociencias, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay.
- Centro Interdisciplinario de Ciencia de Datos y Aprendizaje Automático, Universidad de la República, Montevideo, Uruguay.
| | - Gustavo de Los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
- Institute for Quantitative Health Science and Engineering, East Lansing, MI, USA
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28
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Herrera-Esposito D, de Los Campos G. Age-specific rate of severe and critical SARS-CoV-2 infections estimated with multi-country seroprevalence studies. BMC Infect Dis 2022; 22:311. [PMID: 35351016 PMCID: PMC8962942 DOI: 10.1186/s12879-022-07262-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background Knowing the age-specific rates at which individuals infected with SARS-CoV-2 develop severe and critical disease is essential for designing public policy, for infectious disease modeling, and for individual risk evaluation. Methods In this study, we present the first estimates of these rates using multi-country serology studies, and public data on hospital admissions and mortality from early to mid-2020. We combine these under a Bayesian framework that accounts for the high heterogeneity between data sources and their respective uncertainties. We also validate our results using an indirect method based on infection fatality rates and hospital mortality data. Results Our results show that the risk of severe and critical disease increases exponentially with age, but much less steeply than the risk of fatal illness. We also show that our results are consistent across several robustness checks. Conclusion A complete evaluation of the risks of SARS-CoV-2 for health must take non-fatal disease outcomes into account, particularly in young populations where they can be 2 orders of magnitude more frequent than deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07262-0.
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Affiliation(s)
- Daniel Herrera-Esposito
- Laboratorio de Neurociencias, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay. .,Centro Interdisciplinario de Ciencia de Datos y Aprendizaje Automático, Universidad de la República, Montevideo, Uruguay.
| | - Gustavo de Los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.,Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA.,Institute for Quantitative Health Science and Engineering, East Lansing, MI, USA
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29
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Smagul M, Esmagambetova A, Nusupbaeva G, Kirpicheva U, Kasabekova L, Nukenova G, Saliev T, Fakhradiyev I, Tanabayeva S, Zhussupov B. Sero‐prevalence of SARS‐CoV‐2 in certain cities of Kazakhstan. Health Sci Rep 2022; 5:e562. [PMID: 35317419 PMCID: PMC8921938 DOI: 10.1002/hsr2.562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 12/25/2022] Open
Abstract
Background and Aims Seroprevalence studies are needed to determine the cumulative prevalence of SARS‐CoV‐2 infection and to develop pandemic mitigation strategies. Despite the constant monitoring and surveillance, the true level of infection in the population of Kazakhstan remains unknown. The aim of this study was to determine the sero‐prevalence of SARS‐CoV‐2 in the main cities of Kazakhstan. Methods The research was conducted as a cluster‐randomized cross‐sectional national household study in three cities of Kazakhstan. The study covered the period: from October 24, 2020, to January 11, 2021. A total of 5739 people took part in the study. All participants agreed to be tested for antibodies to IgM/IgG. Demographic characteristics were analyzed. The presence of symptoms of respiratory diseases and the results of polymerase chain reaction (PCR) testing were determined. The antibodies to the SARS‐CoV‐2 virus were detected using the method of enzyme‐linked immunosorbent assay (ELISA). Results There was significant geographic variability with a higher prevalence of IgG/IgM antibodies to SARS‐CoV‐2 in Almaty 57.0%, in Oskemen 60.7% than in Kostanay 39.4%. There were no significant differences in prevalence between men and women (p ≥ 0.05). In Almaty, only 19% of participants with antibodies reported the presence of respiratory symptoms during a pandemic. At the same time, the percentage of patients with antibodies who had respiratory symptoms was 36% in Oskemen and 27% in Kostanay. Conclusion The findings indicate that despite reasonable level of seroprevalence, the country has not yet reached the baseline minimum of herd immunity scores. The prevalence estimates for asymptomatic or subclinical forms of the disease ranged from 64% to 81%. Thus, given that almost half of the population of Kazakhstan remains vulnerable, the importance of preventive strategies such as social distancing, the use of medical masks, and vaccination to protect the population from the transmission of SARS‐CoV‐2 is highly critical.
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Affiliation(s)
- Manar Smagul
- “Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring” Branch of the National Center for Public Health of the Ministry of Healthcare of the Republic of Kazakhstan Nur‐Sultan Republic of Kazakhstan
| | - Aizhan Esmagambetova
- Committee of Sanitary and Epidemiological Control of the Ministry of Healthcare of the Republic of Kazakhstan Nur‐Sultan Republic of Kazakhstan
| | - Gauhar Nusupbaeva
- “Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring” Branch of the National Center for Public Health of the Ministry of Healthcare of the Republic of Kazakhstan Nur‐Sultan Republic of Kazakhstan
| | - Ulyana Kirpicheva
- “Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring” Branch of the National Center for Public Health of the Ministry of Healthcare of the Republic of Kazakhstan Nur‐Sultan Republic of Kazakhstan
| | - Lena Kasabekova
- “Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring” Branch of the National Center for Public Health of the Ministry of Healthcare of the Republic of Kazakhstan Nur‐Sultan Republic of Kazakhstan
| | - Gauhar Nukenova
- “Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring” Branch of the National Center for Public Health of the Ministry of Healthcare of the Republic of Kazakhstan Nur‐Sultan Republic of Kazakhstan
| | - Timur Saliev
- S. D. Asfendiyarov Kazakh National Medical University Almaty Republic of Kazakhstan
| | - Ildar Fakhradiyev
- S. D. Asfendiyarov Kazakh National Medical University Almaty Republic of Kazakhstan
| | - Shynar Tanabayeva
- S. D. Asfendiyarov Kazakh National Medical University Almaty Republic of Kazakhstan
| | - Baurzhan Zhussupov
- S. D. Asfendiyarov Kazakh National Medical University Almaty Republic of Kazakhstan
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Piler P, Thon V, Andrýsková L, Doležel K, Kostka D, Pavlík T, Dušek L, Pikhart H, Bobák M, Matic S, Klánová J. Nationwide increases in anti-SARS-CoV-2 IgG antibodies between October 2020 and March 2021 in the unvaccinated Czech population. COMMUNICATIONS MEDICINE 2022; 2:19. [PMID: 35603283 PMCID: PMC9053194 DOI: 10.1038/s43856-022-00080-0] [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] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/24/2022] [Indexed: 01/13/2023] Open
Abstract
Background The aim of the nationwide prospective seroconversion (PROSECO) study was to investigate the dynamics of anti-SARS-CoV-2 IgG antibodies in the Czech population. Here we report on baseline prevalence from that study. Methods The study included the first 30,054 persons who provided a blood sample between October 2020 and March 2021. Seroprevalence was compared between calendar periods, previous RT-PCR results and other factors. Results The data show a large increase in seropositivity over time, from 28% in October/November 2020 to 43% in December 2020/January 2021 to 51% in February/March 2021. These trends were consistent with government data on cumulative viral antigenic prevalence in the population captured by PCR testing - although the seroprevalence rates established in this study were considerably higher. There were only minor differences in seropositivity between sexes, age groups and BMI categories, and results were similar between test providing laboratories. Seropositivity was substantially higher among persons with history of symptoms (76% vs. 34%). At least one third of all seropositive participants had no history of symptoms, and 28% of participants with antibodies against SARS-CoV-2 never underwent PCR testing. Conclusions Our data confirm the rapidly increasing prevalence in the Czech population during the rising pandemic wave prior to the beginning of vaccination. The difference between our results on seroprevalence and PCR testing suggests that antibody response provides a better marker of past infection than the routine testing program.
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Affiliation(s)
- Pavel Piler
- grid.10267.320000 0001 2194 0956RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
| | - Vojtěch Thon
- grid.10267.320000 0001 2194 0956RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
| | - Lenka Andrýsková
- grid.10267.320000 0001 2194 0956RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
| | - Kamil Doležel
- QualityLab Association, Evropská 846/176a, Prague, Czech Republic
| | - David Kostka
- grid.436106.6Health Insurance Company of the Ministry of the Interior of the Czech Republic, Vinohradská 2577/178, 130 00 Prague, Czech Republic
| | - Tomáš Pavlík
- grid.10267.320000 0001 2194 0956Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic ,grid.486651.80000 0001 2231 0366Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 4, 128 01 Prague, Czech Republic
| | - Ladislav Dušek
- grid.10267.320000 0001 2194 0956Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic ,grid.486651.80000 0001 2231 0366Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 4, 128 01 Prague, Czech Republic
| | - Hynek Pikhart
- grid.10267.320000 0001 2194 0956RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic ,grid.83440.3b0000000121901201Department of Epidemiology & Public Health, University College London, 1 – 19 Torrington Place, London, WC1E 6BT UK
| | - Martin Bobák
- grid.10267.320000 0001 2194 0956RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic ,grid.83440.3b0000000121901201Department of Epidemiology & Public Health, University College London, 1 – 19 Torrington Place, London, WC1E 6BT UK
| | - Srdan Matic
- World Health Organization (WHO), Country Office in the Czech Republic, Rytířská 31, 110 00 Prague, Czech Republic
| | - Jana Klánová
- grid.10267.320000 0001 2194 0956RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
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van den Hoogen LL, Smits G, van Hagen CC, Wong D, Vos ER, van Boven M, de Melker HE, van Vliet J, Kuijer M, Woudstra L, Wijmenga-Monsuur AJ, GeurtsvanKessel CH, Stoof SP, Reukers D, Wijsman LA, Meijer A, Reusken CB, Rots NY, van der Klis FR, van Binnendijk RS, den Hartog G. Seropositivity to Nucleoprotein to detect mild and asymptomatic SARS-CoV-2 infections: A complementary tool to detect breakthrough infections after COVID-19 vaccination? Vaccine 2022; 40:2251-2257. [PMID: 35287986 PMCID: PMC8904156 DOI: 10.1016/j.vaccine.2022.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/14/2022] [Accepted: 03/03/2022] [Indexed: 12/17/2022]
Abstract
Background Methods Results Conclusions
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Costa JPD, Meireles P, Rodrigues PNS, Barros H. Incidence of SARS-CoV-2 infection in a cohort of workers from the University of Porto, Portugal. Infect Dis (Lond) 2022; 54:441-447. [PMID: 35129057 DOI: 10.1080/23744235.2022.2035429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Repeated serosurveys in the same population provide more accurate estimates of the frequency of SARS-CoV-2 infection and more comparable data over time than notified cases. We aimed to estimate the incidence of SARS-CoV-2 infection, identify associated factors, and assess time trends in the ratio of serological/molecular diagnosis in a cohort of university workers. METHODS Participants had a serological rapid test for SARS-CoV-2 immunoglobulins M and G, and completed a questionnaire, in May-July 2020 (n = 3628) and November 2020-January 2021 (n = 2661); 1960 participated in both evaluations and provided data to compute the incidence proportion and the incidence rate. Crude and adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) were computed using generalized linear models with Poisson regression. RESULTS The incidence rate was 1.8/100 person-months (95% CI: 1.5-2.0), and the 6 months' cumulative incidence was 10.7%. The serological/molecular diagnosis ratio was 10:1 in the first evaluation and 3:1 in the second. Considering newly identified seropositive cases at the first (n = 69) and second evaluation (n = 202), 29.0% and 9.4% never reported symptoms, respectively, 14.5% and 33.3% reported contact with a confirmed case and 82.6%, and 46.0% never had a molecular test. Males (aIRR: 0.61; 95% CI: 0.44-0.85) and 'high-skilled white-collar' workers (aIRR: 0.74, 95% CI: 0.53-1.04) had lower risk of infection. CONCLUSION University workers presented a high SARS-CoV-2 incidence while restrictive measures were in place. The time decrease in the proportion of undiagnosed cases reflected the increased access and awareness to testing, but opportunities continued to be missed, even in the presence of COVID-19-like symptoms.
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Affiliation(s)
- Joana Pinto da Costa
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Paula Meireles
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Pedro N S Rodrigues
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Quantitative analysis of mRNA-1273 COVID-19 vaccination response in immunocompromised adult hematology patients. Blood Adv 2022; 6:1537-1546. [PMID: 35114690 PMCID: PMC8816838 DOI: 10.1182/bloodadvances.2021006917] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/18/2022] [Indexed: 12/01/2022] Open
Abstract
Immunochemotherapy does not preclude adequate antibody responses in hematology patients, except when B cells are absent or dysfunctional. During the pandemic, COVID-19 vaccination should not be delayed in hematology patients.
Vaccination guidelines for patients treated for hematological diseases are typically conservative. Given their high risk for severe COVID-19, it is important to identify those patients that benefit from vaccination. We prospectively quantified serum immunoglobulin G (IgG) antibodies to spike subunit 1 (S1) antigens during and after 2-dose mRNA-1273 (Spikevax/Moderna) vaccination in hematology patients. Obtaining S1 IgG ≥ 300 binding antibody units (BAUs)/mL was considered adequate as it represents the lower level of S1 IgG concentration obtained in healthy individuals, and it correlates with potent virus neutralization. Selected patients (n = 723) were severely immunocompromised owing to their disease or treatment thereof. Nevertheless, >50% of patients obtained S1 IgG ≥ 300 BAUs/mL after 2-dose mRNA-1273. All patients with sickle cell disease or chronic myeloid leukemia obtained adequate antibody concentrations. Around 70% of patients with chronic graft-versus-host disease (cGVHD), multiple myeloma, or untreated chronic lymphocytic leukemia (CLL) obtained S1 IgG ≥ 300 BAUs/mL. Ruxolitinib or hypomethylating therapy but not high-dose chemotherapy blunted responses in myeloid malignancies. Responses in patients with lymphoma, patients with CLL on ibrutinib, and chimeric antigen receptor T-cell recipients were low. The minimal time interval after autologous hematopoietic cell transplantation (HCT) to reach adequate concentrations was <2 months for multiple myeloma, 8 months for lymphoma, and 4 to 6 months after allogeneic HCT. Serum IgG4, absolute B- and natural killer–cell number, and number of immunosuppressants predicted S1 IgG ≥ 300 BAUs/mL. Hematology patients on chemotherapy, shortly after HCT, or with cGVHD should not be precluded from vaccination. This trial was registered at Netherlands Trial Register as #NL9553.
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Richard A, Wisniak A, Perez-Saez J, Garrison-Desany H, Petrovic D, Piumatti G, Baysson H, Picazio A, Pennacchio F, De Ridder D, Chappuis F, Vuilleumier N, Low N, Hurst S, Eckerle I, Flahault A, Kaiser L, Azman AS, Guessous I, Stringhini S. Seroprevalence of anti-SARS-CoV-2 IgG antibodies, risk factors for infection and associated symptoms in Geneva, Switzerland: a population-based study. Scand J Public Health 2022; 50:124-135. [PMID: 34664529 PMCID: PMC8808008 DOI: 10.1177/14034948211048050] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 01/08/2023]
Abstract
Aims: To assess SARS-CoV-2 seroprevalence over the first epidemic wave in the canton of Geneva, Switzerland, as well as risk factors for infection and symptoms associated with IgG seropositivity. Methods: Between April and June 2020, former participants of a representative survey of the 20-74-year-old population of canton Geneva were invited to participate in the study, along with household members aged over 5 years. Blood samples were tested for anti-SARS-CoV-2 immunoglobulin G. Questionnaires were self-administered. We estimated seroprevalence with a Bayesian model accounting for test performance and sampling design. Results: We included 8344 participants, with an overall adjusted seroprevalence of 7.8% (95% credible interval 6.8-8.9). Seroprevalence was highest among 18-49 year-olds (9.5%), and lowest in 5-9-year-old children (4.3%) and individuals >65 years (4.7-5.4%). Odds of seropositivity were significantly reduced for female retirees and unemployed men compared to employed individuals, and smokers compared to non-smokers. We found no significant association between occupation, level of education, neighborhood income and the risk of being seropositive. The symptom most strongly associated with seropositivity was anosmia/dysgeusia. Conclusions: Anti-SARS-CoV-2 population seroprevalence remained low after the first wave in Geneva. Socioeconomic factors were not associated with seropositivity in this sample. The elderly, young children and smokers were less frequently seropositive, although it is not clear how biology and behaviours shape these differences.
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Affiliation(s)
- Aude Richard
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Institute of Global Health, University of Geneva, Switzerland
| | - Ania Wisniak
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Institute of Global Health, University of Geneva, Switzerland
| | - Javier Perez-Saez
- Institute of Global Health, University of Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Dusan Petrovic
- Division of Primary Care, Geneva University Hospitals, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Switzerland
| | - Giovanni Piumatti
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Faculty of BioMedicine, Università della Svizzera Italiana, Switzerland
| | - Hélène Baysson
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
| | - Attilio Picazio
- Division of Primary Care, Geneva University Hospitals, Switzerland
| | | | - David De Ridder
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
| | - François Chappuis
- Department of Health and Community Medicine, University of Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Geneva University Hospitals, Switzerland
- Department of Medicine, University of Geneva, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, University of Geneva, Switzerland
| | - Isabella Eckerle
- Geneva Center for Emerging Viral Diseases and Laboratory of Virology, Geneva University Hospitals, Switzerland
- Department of Microbiology and Molecular Medicine, University of Geneva, Switzerland
| | - Antoine Flahault
- Institute of Global Health, University of Geneva, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Switzerland
| | - Laurent Kaiser
- Department of Medicine, University of Geneva, Switzerland
- Geneva Center for Emerging Viral Diseases and Laboratory of Virology, Geneva University Hospitals, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals, Switzerland
| | - Andrew S. Azman
- Institute of Global Health, University of Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Idris Guessous
- Division of Primary Care, Geneva University Hospitals, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care, Geneva University Hospitals, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Switzerland
- Department of Health and Community Medicine, University of Geneva, Switzerland
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Flegr J, Flegr P, Příplatová L. The effects of 105 biological, socioeconomic, behavioral, and environmental factors on the risk of SARS-CoV-2 infection and a severe course of COVID-19: a prospective, explorative cohort study. Biol Methods Protoc 2022; 7:bpac030. [PMCID: PMC9750789 DOI: 10.1093/biomethods/bpac030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 12/16/2022] Open
Abstract
Abstract
The confirmed number of SARS-CoV-2 infections up to 18 October 2022 is 626 million worldwide, but information about factors affecting the probability of infection or a severe course of COVID-19 remains insufficient and often speculative. Only a small number of factors have been rigorously examined, mostly by retrospective or cross-sectional studies.
We ran a preregistered study on 5164 Internet users who shared information with us about their exposure to 105 risk factors and reported being COVID-19 negative before the beginning of the fourth wave of COVID-19 in the Czech Republic. After the fourth wave, in which 709 (13.7%) of participants were infected, we used a partial Kendall test controlled for sex, age, and urbanization to compare the risk of infection and a severe course of the disease in subjects who initially did and did not report exposure to particular risk factors.
After the correction for multiple tests, we identified 13 factors – including male sex, lower age, blood group B, and larger household size – that increased the risk of infection and 16 factors – including mask-wearing, borreliosis in the past, use of vitamin D supplements, or rooibos drinking – that decreased it. We also identified 23 factors that increased the risk of a severe course of COVID-19 and 12 factors that decreased the risk.
This preregistered longitudinal study is of explorative nature. Therefore, although the observed effects were strong and remained highly significant even after correction for multiple tests, it will be necessary to confirm their existence in future independent studies.
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Affiliation(s)
- Jaroslav Flegr
- Division of Biology, Faculty of Science, Charles University , Prague 128 00, Czech Republic
| | - Pavel Flegr
- Faculty of Electrical Engineering, Czech Technical University in Prague , Prague 166 27, Czech Republic
| | - Lenka Příplatová
- Division of Biology, Faculty of Science, Charles University , Prague 128 00, Czech Republic
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Coyer L, Boyd A, Schinkel J, Agyemang C, Galenkamp H, Koopman ADM, Leenstra T, Moll van Charante EP, van den Born BJH, Lok A, Verhoeff A, Zwinderman AH, Jurriaans S, van Vught LA, Stronks K, Prins M. SARS-CoV-2 antibody prevalence and correlates of six ethnic groups living in Amsterdam, the Netherlands: a population-based cross-sectional study, June-October 2020. BMJ Open 2022; 12:e052752. [PMID: 34992110 PMCID: PMC8739540 DOI: 10.1136/bmjopen-2021-052752] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES It has been suggested that ethnic minorities have been disproportionally affected by the COVID-19. We aimed to determine whether prevalence and correlates of past SARS-CoV-2 exposure varied between six ethnic groups in Amsterdam, the Netherlands. DESIGN, SETTING, PARTICIPANTS Participants aged 25-79 years enrolled in the Healthy Life in an Urban Setting population-based prospective cohort (n=16 889) were randomly selected within ethnic groups and invited to participate in a cross-sectional COVID-19 seroprevalence substudy. OUTCOME MEASURES We tested participants for SARS-CoV-2-specific antibodies and collected information on SARS-CoV-2 exposures. We estimated prevalence and correlates of SARS-CoV-2 exposure within ethnic groups using survey-weighted logistic regression adjusting for age, sex and calendar time. RESULTS Between 24 June and 9 October 2020, we included 2497 participants. Adjusted SARS-CoV-2 seroprevalence was comparable between ethnic Dutch (24/498; 5.1%, 95% CI 2.8% to 7.4%), South-Asian Surinamese (22/451; 4.9%, 95% CI 2.2% to 7.7%), African Surinamese (22/400; 8.3%, 95% CI 3.1% to 13.6%), Turkish (30/408; 7.9%, 95% CI 4.4% to 11.4%) and Moroccan (32/391; 7.2%, 95% CI 4.2% to 10.1%) participants, but higher among Ghanaians (95/327; 26.3%, 95% CI 18.5% to 34.0%). 57.1% of SARS-CoV-2-positive participants did not suspect or were unsure of being infected, which was lowest in African Surinamese (18.2%) and highest in Ghanaians (90.5%). Correlates of SARS-CoV-2 exposure varied across ethnic groups, while the most common correlate was having a household member suspected of infection. In Ghanaians, seropositivity was associated with older age, larger household sizes, living with small children, leaving home to work and attending religious services. CONCLUSIONS No remarkable differences in SARS-CoV-2 seroprevalence were observed between the largest ethnic groups in Amsterdam after the first wave of infections. The higher infection seroprevalence observed among Ghanaians, which passed mostly unnoticed, warrants wider prevention efforts and opportunities for non-symptom-based testing.
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Affiliation(s)
- Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam UMC, location AMC, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Anitra D M Koopman
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Tjalling Leenstra
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Health Promotion and Healthcare Innovation, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Jurriaans
- Department of Medical Microbiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke A van Vught
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental Molecular Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Diseases, Amsterdam UMC, location AMC, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, The Netherlands
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Ohm M, Knol MJ, Vos ERA, Bogaard MJM, van Rooijen DM, Sanders EAM, de Melker HE, van der Klis FRM, Berbers GAM. Seroprevalence of meningococcal ACWY antibodies across the population in the Netherlands: Two consecutive surveys in 2016/17 and 2020. Vaccine 2022; 40:59-66. [PMID: 34839991 DOI: 10.1016/j.vaccine.2021.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Meningococcal serogroup C (MenC) vaccination was introduced for 14-month-olds in the Netherlands in 2002, alongside a mass campaign for 1-18 year-olds. Due to an outbreak of serogroup W disease, MenC vaccination was replaced for MenACWY vaccination in 2018, next to introduction of a booster at 14 years of age and a catch-up campaign for 14-18 year-olds. We assessed meningococcal ACWY antibodies across the Dutch population in 2016/17 and 2020. METHODS In a nationwide cross-sectional serosurvey in 2016/17, sera from participants aged 0-89 years (n = 6886) were tested for MenACWY-polysaccharide-specific (PS) serum IgG concentrations, and functional MenACWY antibody titers were determined in subsets. Moreover, longitudinal samples collected in 2020 (n = 1782) were measured for MenACWY-PS serum IgG concentrations. RESULTS MenC antibody levels were low, except in recently vaccinated 14-23 month-olds and individuals who were vaccinated as teenagers in 2002, with seroprevalence of 59% and 20-46%, respectively. Meningococcal AWY antibody levels were overall low both in 2016/17 and in 2020. Naturally-acquired MenW immunity was limited in 2020 despite the recent serogroup W outbreak. CONCLUSIONS This study demonstrates waning of MenC immunity 15 years after a mass campaign in the Netherlands. Furthermore, it highlights the lack of meningococcal AWY immunity across the population and underlines the importance of the recently introduced MenACWY (booster) vaccination.
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Affiliation(s)
- Milou Ohm
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands.
| | - Eric R A Vos
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Marjan J M Bogaard
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Debbie M van Rooijen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, the Netherlands
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Piler P, Thon V, Andrýsková L, Doležel K, Kostka D, Pavlík T, Dušek L, Pikhart H, Bobák M, Matic S, Klánová J. Nationwide increases in anti-SARS-CoV-2 IgG antibodies between October 2020 and March 2021 in the unvaccinated Czech population. COMMUNICATIONS MEDICINE 2022. [PMID: 35603283 DOI: 10.1038/s43856-022-00080-0.pmid:35603283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The aim of the nationwide prospective seroconversion (PROSECO) study was to investigate the dynamics of anti-SARS-CoV-2 IgG antibodies in the Czech population. Here we report on baseline prevalence from that study. METHODS The study included the first 30,054 persons who provided a blood sample between October 2020 and March 2021. Seroprevalence was compared between calendar periods, previous RT-PCR results and other factors. RESULTS The data show a large increase in seropositivity over time, from 28% in October/November 2020 to 43% in December 2020/January 2021 to 51% in February/March 2021. These trends were consistent with government data on cumulative viral antigenic prevalence in the population captured by PCR testing - although the seroprevalence rates established in this study were considerably higher. There were only minor differences in seropositivity between sexes, age groups and BMI categories, and results were similar between test providing laboratories. Seropositivity was substantially higher among persons with history of symptoms (76% vs. 34%). At least one third of all seropositive participants had no history of symptoms, and 28% of participants with antibodies against SARS-CoV-2 never underwent PCR testing. CONCLUSIONS Our data confirm the rapidly increasing prevalence in the Czech population during the rising pandemic wave prior to the beginning of vaccination. The difference between our results on seroprevalence and PCR testing suggests that antibody response provides a better marker of past infection than the routine testing program.
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Affiliation(s)
- Pavel Piler
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
| | - Vojtěch Thon
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
| | - Lenka Andrýsková
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
| | - Kamil Doležel
- QualityLab Association, Evropská 846/176a, Prague, Czech Republic
| | - David Kostka
- Health Insurance Company of the Ministry of the Interior of the Czech Republic, Vinohradská 2577/178, 130 00 Prague, Czech Republic
| | - Tomáš Pavlík
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 4, 128 01 Prague, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 4, 128 01 Prague, Czech Republic
| | - Hynek Pikhart
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
- Department of Epidemiology & Public Health, University College London, 1 - 19 Torrington Place, London, WC1E 6BT UK
| | - Martin Bobák
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
- Department of Epidemiology & Public Health, University College London, 1 - 19 Torrington Place, London, WC1E 6BT UK
| | - Srdan Matic
- World Health Organization (WHO), Country Office in the Czech Republic, Rytířská 31, 110 00 Prague, Czech Republic
| | - Jana Klánová
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, 611 37 Brno, Czech Republic
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Vos ERA, van Boven M, den Hartog G, Backer JA, Klinkenberg D, van Hagen CCE, Boshuizen H, van Binnendijk RS, Mollema L, van der Klis FRM, de Melker HE. Associations Between Measures of Social Distancing and Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity: A Nationwide Population-based Study in the Netherlands. Clin Infect Dis 2021. [PMID: 33772265 DOI: 10.1093/cid/ciab264.pmid:33772265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
UNLABELLED This large, nationwide, population-based, seroepidemiological study provides evidence of the effectiveness of physical distancing (>1.5 m) and indoor group size reductions in reducing severe acute respiratory syndrome coronavirus 2 infection. Additionally, young adults may play an important role in viral spread, contrary to children up until age 12 years with whom close contact is permitted. CLINICAL TRIALS REGISTRATION NTR8473.
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Affiliation(s)
- Eric R A Vos
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Michiel van Boven
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Gerco den Hartog
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jantien A Backer
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Don Klinkenberg
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Cheyenne C E van Hagen
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hendriek Boshuizen
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Robert S van Binnendijk
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Liesbeth Mollema
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Fiona R M van der Klis
- Immunology of Infectious Diseases and Vaccines, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hester E de Melker
- Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Dorp CHV, Goldberg EE, Hengartner N, Ke R, Romero-Severson EO. Estimating the strength of selection for new SARS-CoV-2 variants. Nat Commun 2021; 12:7239. [PMID: 34907182 PMCID: PMC8671537 DOI: 10.1038/s41467-021-27369-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/10/2021] [Indexed: 01/15/2023] Open
Abstract
Controlling the SARS-CoV-2 pandemic becomes increasingly challenging as the virus adapts to human hosts through the continual emergence of more transmissible variants. Simply observing that a variant is increasing in frequency is relatively straightforward, but more sophisticated methodology is needed to determine whether a new variant is a global threat and the magnitude of its selective advantage. We present two models for quantifying the strength of selection for new and emerging variants of SARS-CoV-2 relative to the background of contemporaneous variants. These methods range from a detailed model of dynamics within one country to a broad analysis across all countries, and they include alternative explanations such as migration and drift. We find evidence for strong selection favoring the D614G spike mutation and B.1.1.7 (Alpha), weaker selection favoring B.1.351 (Beta), and no advantage of R.1 after it spreads beyond Japan. Cutting back data to earlier time horizons reveals that uncertainty is large very soon after emergence, but that estimates of selection stabilize after several weeks. Our results also show substantial heterogeneity among countries, demonstrating the need for a truly global perspective on the molecular epidemiology of SARS-CoV-2.
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Affiliation(s)
- Christiaan H van Dorp
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Emma E Goldberg
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos, NM, USA
- New Mexico Consortium, Los Alamos, NM, USA
| | - Nick Hengartner
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos, NM, USA
- New Mexico Consortium, Los Alamos, NM, USA
| | - Ruian Ke
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos, NM, USA
- New Mexico Consortium, Los Alamos, NM, USA
| | - Ethan O Romero-Severson
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos, NM, USA.
- New Mexico Consortium, Los Alamos, NM, USA.
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Rotee ILM, Ong DSY, Koeleman JGM, Vos ERA, Tramper-Stranders GA. Trends in SARS-CoV-2 seroprevalence amongst urban paediatric patients compared with a nationwide cohort in the Netherlands. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100045. [PMID: 35262026 PMCID: PMC8501184 DOI: 10.1016/j.jcvp.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives The extent of SARS-CoV-2 infection amongst children and their role in transmission remains unclear. Therefore, we aimed to estimate the SARS-CoV-2 antibody seroprevalence amongst children who presented to our hospital for non-COVID-19-related morbidity during the first and second epidemic wave in 2020 and compared these to the general Dutch paediatric population. Methods We collected residual plasma samples from all paediatric patients (1 month-17 years of age) visiting our clinic or emergency room, who had blood drawing for various medical reasons. Samples were analysed for the presence of total antibodies against SARS-CoV-2 by Wantai ELISA. The seroprevalence in two separate periods (July-Sep 2020, and Oct-Dec 2020) was compared to regional and national data (PIENTER-Corona study, September 2020), and associations with co-morbidities were assessed. Results A total of 209 samples in period 1 and 240 samples in period 2 were collected (median age 7.1 years, IQR 1.5–13.5). SARS-CoV-2 antibodies were detected in 4.1% and 13.8%, respectively (p< 0.001). Seroprevalence was higher compared to national paediatric data, but did not differ with regional estimates. Most children with SARS-CoV-2 antibodies were seen in the outpatient clinic for general paediatric problems with no differences in medical reasons for presentation between the two periods. Conclusions These data confirm a rapid three-fold increase in SARS-CoV-2 seroprevalence in paediatric patients in the second half of 2020 with a trend towards a higher seroprevalence compared to randomly-selected children in a nationwide study. Underlying morbidity in children might not play an important role in acquiring SARS-CoV-2 infection.
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Affiliation(s)
- I L M Rotee
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Netherlands
| | - D S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Netherlands.,Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - J G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Netherlands
| | - E R A Vos
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - G A Tramper-Stranders
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Netherlands.,Department of Neonatology, Sophia Children's Hospital, Erasmus Medical Center Rotterdam, Netherlands
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Maltezou HC, Krumbholz B, Mavrouli M, Tseroni M, Gamaletsou MN, Botsa E, Anastassopoulou C, Gikas A, Fournarakou E, Kavieri M, Koureli A, Mandilara D, Marinopoulou A, Theodorikakou A, Tsiahris P, Zarzali A, Pournaras S, Lourida A, Elefsiniotis I, Vrioni G, Sipsas NV, Tsakris A. A study of the evolution of the third COVID-19 pandemic wave in the Athens metropolitan area, Greece, through two cross-sectional seroepidemiological surveys: March, June 2021. J Med Virol 2021; 94:1465-1472. [PMID: 34812522 PMCID: PMC9011894 DOI: 10.1002/jmv.27465] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/22/2022]
Abstract
We studied the third coronavirus disease 2019 (COVID‐19) pandemic wave in Athens metropolitan area (3 738 901 inhabitants) through two seroepidemiological surveys. Persons presenting in 12 healthcare facilities across Athens in March and June 2021 were studied (764 and 901, respectively). Immunoglobulin G antibodies against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike protein were measured by a chemiluminescent microparticle immunoassay. In March the seroprevalence rate was 11.6%, meaning that 435 208 residents of Athens had evidence of immunity. The respective values in June were 55.7% and 2 082 568 residents. The highest seroprevalence rates attributed to SARS‐CoV‐2 infection were recorded in persons <18 years (16.3% in March and 31.6% in June), while immunity was mainly vaccine‐induced in persons 18–64 years and >65 years. Infection‐attributed immunity also increased in older‐age groups. Wide ranges in seroprevalence rates were noted across areas in March and June. The highest seroprevalence rates were recorded in Piraeus (47.2%) and West Attica (37.5%). However, the highest increase (>5 times) occurred in Piraeus and the South Section of Athens, which are among the most densely populated areas in Athens. In both study periods, history of COVID‐19 or febrile episode, and having a cohabitant with COVID‐19 were associated with increased risk for seropositivity among unvaccinated persons (p values <0.001 for all). Residing in Piraeus, the South Section or West Attica was associated with increased risk for seropositivity in June (p values <0.001). Wide heterogeneity in seroprevalence rates was found across areas in Athens, which is mainly attributed to population density. The impact of population mobility and socioeconomic status should be explored.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | | | - Maria Mavrouli
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tseroni
- Directorate of Epidemiological Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Maria N Gamaletsou
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Evanthia Botsa
- First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Dionysia Mandilara
- Academic Department of Internal Medicine, General Oncology Hospital of Kifisia "Agioi Anargyroi", National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - Spyridon Pournaras
- Laboratory of Clinical Microbiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Lourida
- Infection Control Committee, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine, General Oncology Hospital of Kifisia "Agioi Anargyroi", National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Bajos N, Counil E, Franck JE, Jusot F, Pailhé A, Spire A, Martin C, Lydie N, Slama R, Meyer L, Warszawski J. Social inequalities and dynamics of the early COVID-19 epidemic: a prospective cohort study in France. BMJ Open 2021; 11:e052888. [PMID: 34764173 PMCID: PMC8587531 DOI: 10.1136/bmjopen-2021-052888] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Although social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented. DESIGN Random population-based prospective cohort. SETTING From May to June 2020 in France. PARTICIPANTS Adults included in the Epidémiologie et Conditions de Vie cohort (n=77 588). MAIN OUTCOME MEASURES Self-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown). RESULTS In all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak. CONCLUSION The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.
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Affiliation(s)
- Nathalie Bajos
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences sociales, politique, santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
| | | | - Jeanna-Eve Franck
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences sociales, politique, santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
| | | | | | - Alexis Spire
- Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - Sciences sociales, politique, santé, IRIS (UMR 8156 CNRS - EHESS - U997 INSERM), Aubervilliers, France
| | | | | | - Remy Slama
- University Grenoble Alpes, INSERM, CNRS, Institute for Advanced Biosciences, Grenoble, France
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Inferring the COVID-19 infection fatality rate in the community-dwelling population: a simple Bayesian evidence synthesis of seroprevalence study data and imprecise mortality data. Epidemiol Infect 2021. [PMCID: PMC8632419 DOI: 10.1017/s0950268821002405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Abstract
Estimating the coronavirus disease-2019 (COVID-19) infection fatality rate (IFR) has proven to be particularly challenging –and rather controversial– due to the fact that both the data on deaths and the data on the number of individuals infected are subject to many different biases. We consider a Bayesian evidence synthesis approach which, while simple enough for researchers to understand and use, accounts for many important sources of uncertainty inherent in both the seroprevalence and mortality data. With the understanding that the results of one's evidence synthesis analysis may be largely driven by which studies are included and which are excluded, we conduct two separate parallel analyses based on two lists of eligible studies obtained from two different research teams. The results from both analyses are rather similar. With the first analysis, we estimate the COVID-19 IFR to be 0.31% [95% credible interval (CrI) of (0.16%, 0.53%)] for a typical community-dwelling population where 9% of the population is aged over 65 years and where the gross-domestic-product at purchasing-power-parity (GDP at PPP) per capita is $17.8k (the approximate worldwide average). With the second analysis, we obtain 0.32% [95% CrI of (0.19%, 0.47%)]. Our results suggest that, as one might expect, lower IFRs are associated with younger populations (and may also be associated with wealthier populations). For a typical community-dwelling population with the age and wealth of the United States we obtain IFR estimates of 0.43% and 0.41%; and with the age and wealth of the European Union, we obtain IFR estimates of 0.67% and 0.51%.
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Thamm R, Buttmann-Schweiger N, Fiebig J, Poethko-Müller C, Prütz F, Sarganas G, Neuhauser H. [Seroprevalence of SARS-CoV-2 among children and adolescents in Germany-an overview]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1483-1491. [PMID: 34731291 PMCID: PMC8563819 DOI: 10.1007/s00103-021-03448-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/06/2021] [Indexed: 01/26/2023]
Abstract
Hintergrund SARS-CoV-2-Antikörperstudien ergänzen und erweitern die Erkenntnisse aus der Meldestatistik laborbestätigter COVID-19-Fälle um Informationen zu unentdeckten Fällen. Ziel der Arbeit Der vorliegende Beitrag fasst bisherige Ergebnisse zur SARS-CoV-2-Prävalenz aus seroepidemiologischen Studien in Deutschland zusammen, die sich auf Kinder und Jugendliche konzentrieren, und ergänzt die bereits vorliegende Übersicht zur Seroprävalenz bei Erwachsenen und speziell bei Blutspendenden in Deutschland. Material und Methoden Die Ergebnisse der Übersichtsarbeit beruhen auf einer fortlaufenden systematischen Recherche in Studienregistern, Literaturdatenbanken, von Preprint-Veröffentlichungen und Medienberichten seroepidemiologischer Studien in Deutschland sowie deren Ergebnissen. Ergebnisse Mit Stand 17.09.2021 sind uns 16 deutsche seroepidemiologische Studien, die sich auf Kinder und Jugendliche konzentrieren, bekannt geworden. Für 9 dieser Studien liegen Ergebnisse vor. Für fast alle untersuchten Settings lag die SARS-CoV-2-Seroprävalenz für Kinder im Kita- und Grundschulalter in der ersten COVID-19-Welle deutlich unter 1 % und für Jugendliche unter 2 %. Im Verlauf der Pandemie wurden höhere Seroprävalenzen von bis zu 8 % für Kinder im Grundschulalter ermittelt. Diskussion Ergebnisse von SARS-CoV-2-Antikörperstudien bei Kindern und Jugendlichen in Deutschland liegen bislang erst in geringem Umfang und basierend auf lokal-regionalen, nichtrepräsentativen Stichproben vor. In künftigen Studien gilt es, einerseits abzuschätzen, welcher Anteil der Kinder und Jugendlichen bereits eine Infektion hatte oder geimpft ist. Zum anderen gilt es, die Verbreitung körperlicher und psychischer Beeinträchtigungen im Nachgang einer Infektion zu untersuchen.
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Affiliation(s)
- Roma Thamm
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Nina Buttmann-Schweiger
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Julia Fiebig
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Christina Poethko-Müller
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Franziska Prütz
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Giselle Sarganas
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Hannelore Neuhauser
- Abteilung Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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El Rifay AS, Mahmoud SH, Marouf MA, Gomaa MR, El Taweel A, Abo Shama NM, GabAllah M, Abd El Dayem SM, Kandeil A, Mostafa A, El‐Shesheny R, Kayali G, Ali MA. Determinants of having severe acute respiratory syndrome coronavirus 2 neutralizing antibodies in Egypt. Influenza Other Respir Viruses 2021; 15:750-756. [PMID: 34264010 PMCID: PMC8446982 DOI: 10.1111/irv.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Reported laboratory-confirmed COVID-19 cases underestimate the true burden of disease as cases without laboratory confirmation, and asymptomatic and mild cases are missed by local surveillance systems. Population-based seroprevalence studies can provide better estimates of burden of disease by taking into account infections that were missed by surveillance systems. Additionally, little is known about the determinants of seroconversion in community settings. METHODS We conducted a cross-sectional serologic survey among 888 participants in Egypt. RESULTS Neutralizing antibodies were detected in 30% of study volunteers. Age and educational level were associated with being seropositive as people older than 70 years and people with graduate degrees had lower seroprevalence. Self-reporting cases having COVID-19-related symptoms such as fever, malaise, headache, dyspnea, dry cough, chest pain, diarrhea, and loss of taste or smell were all associated with having antibodies. Fever and loss of taste or smell were strong predictors with odds ratios of 2.1 (95% confidence interval: 1.3-3.5) and 4.5 (95% confidence interval: 2.6-7.8), respectively. CONCLUSIONS Our results can guide COVID-19 prevention and control policies and assist in determining the immunity level in some Egyptian communities.
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Affiliation(s)
- Amira S. El Rifay
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
- Child Health DepartmentNational Research CentreGizaEgypt
| | - Sara H. Mahmoud
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Mohamed A. Marouf
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Mokhtar R. Gomaa
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Ahmed El Taweel
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Noura M. Abo Shama
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Mohamed GabAllah
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | | | - Ahmed Kandeil
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Ahmed Mostafa
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Rabeh El‐Shesheny
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
| | - Ghazi Kayali
- Department of Epidemiology, Human Genetics, and Environmental SciencesUniversity of TexasHoustonTexasUSA
- Life Sciences DivisionHuman LinkDubaiUnited Arab Emirates
| | - Mohamed A. Ali
- Centre of Scientific Excellence for Influenza VirusesNational Research CentreGizaEgypt
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47
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Keuning MW, Grobben M, de Groen AEC, Berman-de Jong EP, Bijlsma MW, Cohen S, Felderhof M, de Groof F, Molanus D, Oeij N, Rijpert M, van Eijk HWM, Koen G, van der Straten K, Oomen M, Visser R, Linty F, Steenhuis M, Vidarsson G, Rispens T, Plötz FB, van Gils MJ, Pajkrt D. Saliva SARS-CoV-2 Antibody Prevalence in Children. Microbiol Spectr 2021; 9:e0073121. [PMID: 34523985 PMCID: PMC8557814 DOI: 10.1128/spectrum.00731-21] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 patients produce circulating and mucosal antibodies. In adults, specific saliva antibodies have been detected. Nonetheless, seroprevalence is routinely investigated, while little attention has been paid to mucosal antibodies. We therefore assessed SARS-CoV-2-specific antibody prevalence in serum and saliva in children in the Netherlands. We assessed SARS-CoV-2 antibody prevalence in serum and saliva of 517 children attending medical services in the Netherlands (irrespective of COVID-19 exposure) from April to October 2020. The prevalence of SARS-CoV-2 spike (S), receptor binding domain (RBD), and nucleocapsid (N)-specific IgG and IgA were evaluated with an exploratory Luminex assay in serum and saliva and with the Wantai SARS-CoV-2 RBD total antibody enzyme-linked immunosorbent assay in serum. Using the Wantai assay, the RBD-specific antibody prevalence in serum was 3.3% (95% confidence interval [CI]. 1.9 to 5.3%). With the Luminex assay, we detected heterogeneity between antibodies for S, RBD, and N antigens, as IgG and IgA prevalence ranged between 3.6 and 4.6% in serum and between 0 and 4.4% in saliva. The Luminex assay also revealed differences between serum and saliva, with SARS-CoV-2-specific IgG present in saliva but not in serum for 1.5 to 2.7% of all children. Using multiple antigen assays, the IgG prevalence for at least two out of three antigens (S, RBD, or N) in serum or saliva can be calculated as 3.8% (95% CI, 2.3 to 5.6%). Our study displays the heterogeneity of the SARS-CoV-2 antibody response in children and emphasizes the additional value of saliva antibody detection and the combined use of different antigens. IMPORTANCE Comprehending humoral immunity to SARS-CoV-2, including in children, is crucial for future public health and vaccine strategies. Others have suggested that mucosal antibody measurement could be an important and more convenient tool to evaluate humoral immunity compared to circulating antibodies. Nonetheless, seroprevalence is routinely investigated, while little attention has been paid to mucosal antibodies. We show the heterogeneity of SARS-CoV-2 antibodies, in terms of both antigen specificity and differences between circulating and mucosal antibodies, emphasizing the additional value of saliva antibody detection next to detection of antibodies in serum.
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Affiliation(s)
- Maya W. Keuning
- Department of Pediatric Infectious Diseases, Rheumatology, & Immunology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marloes Grobben
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute of Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne-Elise C. de Groen
- Department of Pediatric Infectious Diseases, Rheumatology, & Immunology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eveline P. Berman-de Jong
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Merijn W. Bijlsma
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie Cohen
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariet Felderhof
- Department of Pediatrics, Flevoziekenhuis, Almere, The Netherlands
| | - Femke de Groof
- Department of Pediatrics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Daniel Molanus
- Department of Pediatrics, Amstellandziekenhuis, Amstelveen, The Netherlands
| | - Nadia Oeij
- Department of Pediatrics, Amstellandziekenhuis, Amstelveen, The Netherlands
| | - Maarten Rijpert
- Department of Pediatrics, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Hetty W. M. van Eijk
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute of Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerrit Koen
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute of Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karlijn van der Straten
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute of Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Melissa Oomen
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute of Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Remco Visser
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Federica Linty
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
- Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo Rispens
- Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands
| | - Frans B. Plötz
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute of Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Rheumatology, & Immunology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Williams A, Branscome H, Khatkar P, Mensah GA, Al Sharif S, Pinto DO, DeMarino C, Kashanchi F. A comprehensive review of COVID-19 biology, diagnostics, therapeutics, and disease impacting the central nervous system. J Neurovirol 2021; 27:667-690. [PMID: 34581996 PMCID: PMC8477646 DOI: 10.1007/s13365-021-00998-6] [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] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/17/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023]
Abstract
The ongoing COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly transmissible disease. SARS-CoV-2 is estimated to have infected over 153 million people and to have caused over 3.2 million global deaths since its emergence in December 2019. SARS-CoV-2 is the seventh coronavirus known to infect humans, and like other coronaviruses, SARS-CoV-2 infection is characterized by a variety of symptoms including general flu-like symptoms such as a fever, sore throat, fatigue, and shortness of breath. Severe cases often display signs of pneumonia, lymphopenia, acute kidney injury, cardiac injury, cytokine storms, lung damage, acute respiratory distress syndrome (ARDS), multiple organ failure, sepsis, and death. There is evidence that around 30% of COVID-19 cases have central nervous system (CNS) or peripheral nervous system (PNS) symptoms along with or in the absence of the previously mentioned symptoms. In cases of CNS/PNS impairments, patients display dizziness, ataxia, seizure, nerve pain, and loss of taste and/or smell. This review highlights the neurological implications of SARS-CoV-2 and provides a comprehensive summary of the research done on SARS-CoV-2 pathology, diagnosis, therapeutics, and vaccines up to May 5.
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Affiliation(s)
- Anastasia Williams
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Heather Branscome
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
- American Type Culture Collection (ATCC), Manassas, VA, USA
| | - Pooja Khatkar
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Gifty A Mensah
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Sarah Al Sharif
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Daniel O Pinto
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
- Immunology Core, Malaria Biologics Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Catherine DeMarino
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, School of Systems Biology, George Mason University, Manassas, VA, USA.
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49
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Cheval B, Sieber S, Maltagliati S, Millet GP, Formánek T, Chalabaev A, Cullati S, Boisgontier MP. Muscle strength is associated with COVID-19 hospitalization in adults 50 years of age or older. J Cachexia Sarcopenia Muscle 2021; 12:1136-1143. [PMID: 34363345 PMCID: PMC8426913 DOI: 10.1002/jcsm.12738] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Weak muscle strength has been associated with a wide range of adverse health outcomes. Yet, whether individuals with weaker muscle strength are more at risk for hospitalization due to severe COVID-19 is still unclear. The objective of this study was to investigate the independent association between muscle strength and COVID-19 hospitalization. METHODS Data from adults 50 years of age or older were analysed using logistic models adjusted for several chronic conditions, body-mass index, age, and sex. Hand-grip strength was repeatedly measured between 2004 and 2017 using a handheld dynamometer. COVID-19 hospitalization during the lockdown was self-reported in summer 2020 and was used as an indicator of COVID-19 severity. RESULTS The study was based on the Survey of Health, Ageing and Retirement in Europe (SHARE) and included 3600 older adults (68.8 ± 8.8 years, 2044 female), among whom 316 were tested positive for the severe acute respiratory syndrome coronavirus 2 (8.8%), and 83 (2.3%) were hospitalized due to COVID-19. Results showed that higher grip strength was associated with a lower risk of COVID-19 hospitalization [adjusted odds ratio (OR) per increase of 1 standard deviation in grip strength = 0.64, 95% confidence interval (95% CI) = 0.45-0.87, P = 0.015]. Results also showed that age (OR for a 10 -year period = 1.70, 95% CI = 1.32-2.20, P < 0.001) and obesity (OR = 2.01, 95% CI = 1.00-3.69, P = 0.025) were associated with higher risk of COVID-19 hospitalization. Sensitivity analyses using different measurements of grip strength as well as robustness analyses based on rare-events logistic regression and a different sample of participants (i.e. COVID-19 patients) were consistent with the main results. CONCLUSIONS Muscle strength is an independent risk factor for COVID-19 severity in adults 50 years of age or older.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective SciencesUniversity of GenevaGenevaSwitzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of PsychologyUniversity of GenevaGenevaSwitzerland
| | - Stefan Sieber
- Swiss NCCR ‘LIVES—Overcoming Vulnerability: Life Course Perspectives’University of GenevaGenevaSwitzerland
| | | | | | - Tomáš Formánek
- Department of Public Mental HealthNational Institute of Mental HealthKlecanyCzech Republic
- EpiCentre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | | | - Stéphane Cullati
- Population Health LaboratoryUniversity of FribourgFribourgSwitzerland
- Department of Readaptation and GeriatricsUniversity of GenevaGenevaSwitzerland
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences, Faculty of Health SciencesUniversity of OttawaOttawaOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
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50
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van Dorp CH, Goldberg EE, Hengartner N, Ke R, Romero-Severson EO. Estimating the strength of selection for new SARS-CoV-2 variants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.29.21254233. [PMID: 33821289 PMCID: PMC8020992 DOI: 10.1101/2021.03.29.21254233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Controlling the SARS-CoV-2 pandemic becomes increasingly challenging as the virus adapts to human hosts through the continual emergence of more transmissible variants. Simply observing that a variant is increasing in frequency is relatively straightforward, but more sophisticated methodology is needed to determine whether a new variant is a global threat and the magnitude of its selective advantage. We present three methods for quantifying the strength of selection for new and emerging variants of SARS-CoV-2 relative to the background of contemporaneous variants. These methods range from a detailed model of dynamics within one country to a broad analysis across all countries, and they include alternative explanations such as migration and drift. We find evidence for strong selection favoring the D614G spike mutation and B.1.1.7 (Alpha), weaker selection favoring B.1.351 (Beta), and no advantage of R.1 after it spreads beyond Japan. Cutting back data to earlier time horizons reveals large uncertainty very soon after emergence, but that estimates of selection stabilize after several weeks. Our results also show substantial heterogeneity among countries, demonstrating the need for a truly global perspective on the molecular epidemiology of SARS-CoV-2.
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Affiliation(s)
- Christiaan H. van Dorp
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos NM, USA
| | - Emma E. Goldberg
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos NM, USA
- New Mexico Consortium, Los Alamos NM, USA
| | - Nick Hengartner
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos NM, USA
- New Mexico Consortium, Los Alamos NM, USA
| | - Ruian Ke
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos NM, USA
- New Mexico Consortium, Los Alamos NM, USA
| | - Ethan O. Romero-Severson
- Theoretical Biology and Biophysics (T-6), Los Alamos National Laboratory, Los Alamos NM, USA
- New Mexico Consortium, Los Alamos NM, USA
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