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Domènech-Montoliu S, Pac-Sa MR, Sala-Trull D, Del Rio-González A, Sanchéz-Urbano M, Satorres-Martinez P, Blasco-Gari R, Casanova-Suarez J, Gil-Fortuño M, López-Diago L, Notari-Rodríguez C, Pérez-Olaso Ó, Romeu-Garcia MA, Ruiz-Puig R, Aleixandre-Gorriz I, Domènech-León C, Arnedo-Pena A. Underreporting of Cases in the COVID-19 Outbreak of Borriana (Spain) during Mass Gathering Events in March 2020: A Cross-Sectional Study. EPIDEMIOLOGIA 2024; 5:499-510. [PMID: 39189253 PMCID: PMC11348374 DOI: 10.3390/epidemiologia5030034] [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: 06/25/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024] Open
Abstract
Determining the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many locations during the first wave of the COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana (Valencia Community, Spain) in March 2020, a cross-sectional study was performed in June 2020 querying the public health register. Logistic regression models were used. Of a total of 468 symptomatic COVID-19 cases diagnosed in the outbreak through anti-SARS-CoV-2 serology, 36 cases were reported (7.7%), resulting in an underreporting proportion of 92.3% (95% confidence interval [CI], 89.5-94.6%), with 13 unreported cases for every reported case. Only positive SARS-CoV-2 polymerase chain reaction cases were predominantly reported due to a limited testing capacity and following a national protocol. Significant factors associated with underreporting included no medical assistance for COVID-19 disease, with an adjusted odds ratio [aOR] of 10.83 (95% CI 2.49-47.11); no chronic illness, aOR = 2.81 (95% CI 1.28-6.17); middle and lower social classes, aOR = 3.12 (95% CI 1.42-6.85); younger age, aOR = 0.97 (95% CI 0.94-0.99); and a shorter duration of illness, aOR = 0.98 (95% CI 0.97-0.99). To improve the surveillance of future epidemics, new approaches are recommended.
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Affiliation(s)
| | - Maria Rosario Pac-Sa
- Public Health Center, 12003 Castelló de la Plana, Spain; (M.R.P.-S.); (M.A.R.-G.)
| | - Diego Sala-Trull
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | | | - Manuel Sanchéz-Urbano
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Paloma Satorres-Martinez
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Roser Blasco-Gari
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | | | - Maria Gil-Fortuño
- Microbiology Service University Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (Ó.P.-O.)
| | - Laura López-Diago
- Clinical Analysis Service University Hospital de la Plana, 12540 Vila-Real, Spain; (L.L.-D.); (I.A.-G.)
| | - Cristina Notari-Rodríguez
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Óscar Pérez-Olaso
- Microbiology Service University Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (Ó.P.-O.)
| | | | - Raquel Ruiz-Puig
- Emergency Service University Hospital de la Plana, 12540 Vila-Real, Spain; (D.S.-T.); (M.S.-U.); (P.S.-M.); (R.B.-G.); (C.N.-R.); (R.R.-P.)
| | - Isabel Aleixandre-Gorriz
- Clinical Analysis Service University Hospital de la Plana, 12540 Vila-Real, Spain; (L.L.-D.); (I.A.-G.)
| | - Carmen Domènech-León
- Department of Medicine, University CEU Cardenal Herrera, 12006 Castelló de la Plana, Spain;
| | - Alberto Arnedo-Pena
- Public Health Center, 12003 Castelló de la Plana, Spain; (M.R.P.-S.); (M.A.R.-G.)
- Department of Health Science, Public University Navarra, 31006 Pamplona, Spain
- Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Krishnan J, Woods CW, Holodniy M, Nicholson BP, Marconi VC, Ammons MCB, Jinadatha C, Pyarajan S, Wang-Rodriguez J, Garcia AP, Battles JK. Nationwide Genomic Surveillance and Response to COVID-19: The VA SeqFORCE and SeqCURE Consortiums. Fed Pract 2023; 40:S44-S47. [PMID: 38577303 PMCID: PMC10988620 DOI: 10.12788/fp.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background The US Department of Veterans Affairs (VA) has dedicated significant resources toward countering the COVID-19 pandemic. Sequencing for Research Clinical and Epidemiology (SeqFORCE) and Sequencing Collaborations United for Research and Epidemiology (SeqCURE) were developed as clinical and research consortiums, respectively, focused on the genetic COVID-19 surveillance. Observations Through genetic sequencing, VA SeqFORCE and SeqCURE collaborations contributed to the COVID-19 pandemic response and scientific understanding. Future directions for each program include the assessment of the unique impact of COVID-19 on the veteran population, as well as the adaptation of these programs to future infectious disease threats. We foresee the use of these established platforms beyond infectious diseases. Conclusions VA SeqFORCE and SeqCURE were established as clinical and research programs dedicated to sequencing COVID-19 as part of ongoing clinical and surveillance efforts. In the future, we anticipate that having these programs embedded within the largest integrated health care system in the US will enable the study of pathogens and pandemics beyond COVID-19 and at an unprecedented scale. The investment in these programs will form an integral part of our nation's response to emerging infectious diseases, with future applications to precision medicine and beyond.
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Affiliation(s)
- Jay Krishnan
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, North Carolina
| | - Christopher W. Woods
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, North Carolina
| | - Mark Holodniy
- Public Health National Program Office, Department of Veterans Affairs, Washington, DC
- Stanford University, California
| | - Bradly P. Nicholson
- Durham Veterans Affairs Medical Center, North Carolina
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia
| | - Mary Cloud B. Ammons
- Idaho Veterans Research and Education Foundation & Boise Veterans Affairs Medical Center
| | - Chetan Jinadatha
- Central Texas Veterans Health Care System, Temple
- Texas A&M University School of Medicine, Bryan
| | - Saiju Pyarajan
- Center for Data and Computational Sciences, Veterans Affairs Boston Healthcare System, Massachusetts
| | - Jessica Wang-Rodriguez
- National Pathology and Laboratory Medicine Service, Department of Veterans Affairs, Washington, DC
| | - Amanda P. Garcia
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
| | - Jane K. Battles
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
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