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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: 26] [Impact Index Per Article: 26.0] [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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Ergoren MC, Akan G, Volkan E, Kandemis E, Evren EU, Evren H, Volkan E, Tuncel G, Suer K, Sanlidag T. The "vaccine" hubbub: Viral load comparisons of SARS-CoV-2 Delta and Omicron variants against different vaccine-booster vaccine combinations. J Med Virol 2023; 95:e28309. [PMID: 36377303 DOI: 10.1002/jmv.28309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
There is a significant body of evidence showing that efficient vaccination schemes against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is helping control the coronavirus disease 2019 (COVID-19) pandemic. However, this goal cannot be achieved without real world data highlighting the impact of vaccines against viral spread. In this study, we have aimed at differentially investigating the impact of COVID-19 vaccines (CoronaVac, Pfizer/BioNTech, Astra/Zeneca Oxford, Janssen) used in North Cyprus in limiting the viral load of Delta and Omicron variants of SARS-COV-2. We have utilized real-time quantitative polymerase chain reaction cycle threshold values (Ct values) as a proxy of viral load of the two SARS-CoV-2 variants. Our results indicate that the administration of at least two doses of the messenger RNA-based Pfizer/BioNTech vaccine leads to the lowest viral load (highest Ct values) obtained for both Omicron and Delta variants. Interestingly, regardless of the vaccine type used, our study revealed that Delta variant produced significantly higher viral loads (lower Ct values) compared with the Omicron variant, where the latter was more commonly associated with younger patients. Viral spread is a crucial factor that can help determine the future of the pandemic. Thus, prioritizing vaccines that will play a role in not only preventing severe disease but also in limiting viral load and spread may contribute to infection control strategies.
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Affiliation(s)
- Mahmut C Ergoren
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Gokce Akan
- DESAM Research Institute, Near East University, Nicosia, Cyprus
| | - Ender Volkan
- Department of Microbiology, Faculty of Pharmacy, Cyprus International University, Nicosia, Cyprus.,Department of Microbiology, Biotechnology Research Center, Cyprus International University, Nicosia, Cyprus
| | - Emine Kandemis
- Department of Medical Biology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Emine U Evren
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Hakan Evren
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Eliz Volkan
- Department of Psychology, Faculty of Arts and Sciences, Cyprus International University, Nicosia, Cyprus
| | - Gulten Tuncel
- DESAM Research Institute, Near East University, Nicosia, Cyprus
| | - Kaya Suer
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Tamer Sanlidag
- DESAM Research Institute, Near East University, Nicosia, Cyprus
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Ergoren MC, Komurcu K, Tuncel G, Akan G, Ozverel CS, Dalkan C, Kalayci M, Sanlıdag T. Impact of SARS-CoV-2 Delta and Omicron variants on viral burden and cycle threshold in BNT162b2-vaccinated 12-18 years group. Braz J Microbiol 2022; 53:1937-1940. [PMID: 36050578 PMCID: PMC9436458 DOI: 10.1007/s42770-022-00820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022] Open
Abstract
The SARS-CoV-2 pandemic continues to impact the medical, economic, social, and political areas worldwide. Although it has been claimed that children are the most responsible for the outbreaks as of September 2021, the statistics showed controversary. Although it showed no difference in viral load and Ct values between symptomatic children and symptomatic adults, or between asymptomatic children and asymptomatic adults, the molecular mechanism remains unclear. Here, we aimed to investigate the effects of different strains on infection by comparing viral load levels in pediatric patients aged 12–18 years, infected with different variants of SARS-CoV-2, and vaccinated with full-dose BNT162b2. In this retrospective study, a total of 200 patients aged 12–18 years, who were diagnosed with COVID-19 in our hospital, and vaccinated with full-dose BNT162b2, were analyzed according to their gender, age, viral load, and cycle threshold values. Viral RNA levels were evaluated using Ct values, a semi-quantitative proxy of viral load. While the findings did not show a significant difference between gender and age (P = 0.886 and P = 0.897, respectively), a significant difference was found between the Ct and viral load (P < 0.0001). In conclusion, SARS-CoV-2 viral load was higher in cases infected with SARS-CoV-2 Delta variant than SARS-CoV-2 Omicron variant (mean Ct = 23.05 ± 4.06, viral load = 7.8 × 105 copies/ml and mean Ct = 28.04 ± 3.02, viral load = 7.8 × 103 copies/ml, respectively). These findings indicated that the Delta variant had high viral load and our result could be one of the causes the Delta variant was more effective in the pandemic severity than the other variants in the October–December periods when the Delta variant was dominant in Northern Cyprus. During the same period, the severity of the disease was higher, with higher hospitalization and death rates.
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Affiliation(s)
- Mahmut Cerkez Ergoren
- Department of Medical Genetics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus.
| | - Kubra Komurcu
- Department of Medical Genetics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Gulten Tuncel
- DESAM Research Institute, Near East University, Nicosia, Cyprus
| | - Gokce Akan
- DESAM Research Institute, Near East University, Nicosia, Cyprus
| | - Cenk Serhan Ozverel
- Department of Medical Sciences, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Ceyhun Dalkan
- Department of Pediatrics, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Melis Kalayci
- DESAM Research Institute, Near East University, Nicosia, Cyprus
| | - Tamer Sanlıdag
- DESAM Research Institute, Near East University, Nicosia, Cyprus
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The impact of COVID-19 on the molecular epidemiology of seasonal viral respiratory infections, Cyprus. J Infect 2022; 84:e105-e107. [PMID: 35398407 PMCID: PMC8990445 DOI: 10.1016/j.jinf.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022]
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Baddal B, Bostanci A, Suer K, Sanlidag T. SARS-CoV-2 was already in circulation in Northern Cyprus in the prepandemic period. J Infect 2021; 83:e25-e26. [PMID: 33662407 PMCID: PMC7917476 DOI: 10.1016/j.jinf.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Buket Baddal
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus.
| | - Aysegul Bostanci
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Kaya Suer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
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Baddal B, Sanlidag T, Uzun B, Uzun Ozsahin D. The use of double border-screening strategy in the surveillance and prevention of COVID-19. J Infect Public Health 2021; 14:757-758. [PMID: 34022733 PMCID: PMC8005380 DOI: 10.1016/j.jiph.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/14/2021] [Accepted: 03/21/2021] [Indexed: 01/24/2023] Open
Affiliation(s)
- Buket Baddal
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus; DESAM Institute, Near East University, Nicosia, Cyprus.
| | | | - Berna Uzun
- DESAM Institute, Near East University, Nicosia, Cyprus; Department of Mathematics, Near East University, Nicosia, Cyprus
| | - Dilber Uzun Ozsahin
- DESAM Institute, Near East University, Nicosia, Cyprus; Department of Biomedical Engineering, Near East University, Nicosia, Cyprus
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A Method by Disposable Medical Hydrogel to Reduce Water Vapor in Goggles. Aesthetic Plast Surg 2020; 44:1940-1943. [PMID: 32789539 DOI: 10.1007/s00266-020-01908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
In this letter, we describe a method about disposable medical hydrogel recommended inside surgical masks to reduce the water vapor in the goggles. The introduction is as follows.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Letter to the Editor.
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