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Bobrovitz N, Noël K, Li Z, Cao C, Deveaux G, Selemon A, Clifton DA, Yanes-Lane M, Yan T, Arora RK. SeroTracker-RoB: A decision rule-based algorithm for reproducible risk of bias assessment of seroprevalence studies. Res Synth Methods 2023; 14:414-426. [PMID: 36633513 DOI: 10.1002/jrsm.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
Risk of bias (RoB) assessments are a core element of evidence synthesis but can be time consuming and subjective. We aimed to develop a decision rule-based algorithm for RoB assessment of seroprevalence studies. We developed the SeroTracker-RoB algorithm. The algorithm derives seven objective and two subjective critical appraisal items from the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence studies and implements decision rules that determine study risk of bias based on the items. Decision rules were validated using the SeroTracker seroprevalence study database, which included non-algorithmic RoB judgments from two reviewers. We quantified efficiency as the mean difference in time for the algorithmic and non-algorithmic assessments of 80 randomly selected articles, coverage as the proportion of studies where the decision rules yielded an assessment, and reliability using intraclass correlations comparing algorithmic and non-algorithmic assessments for 2070 articles. A set of decision rules with 61 branches was developed using responses to the nine critical appraisal items. The algorithmic approach was faster than non-algorithmic assessment (mean reduction 2.32 min [SD 1.09] per article), classified 100% (n = 2070) of studies, and had good reliability compared to non-algorithmic assessment (ICC 0.77, 95% CI 0.74-0.80). We built the SeroTracker-RoB Excel Tool, which embeds this algorithm for use by other researchers. The SeroTracker-RoB decision-rule based algorithm was faster than non-algorithmic assessment with complete coverage and good reliability. This algorithm enabled rapid, transparent, and reproducible RoB evaluations of seroprevalence studies and may support evidence synthesis efforts during future disease outbreaks. This decision rule-based approach could be applied to other types of prevalence studies.
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Affiliation(s)
- Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.,Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Kim Noël
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Zihan Li
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Christian Cao
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Deveaux
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Anabel Selemon
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | | | - Tingting Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahul K Arora
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada.,Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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Bergeri I, Whelan MG, Ware H, Subissi L, Nardone A, Lewis HC, Li Z, Ma X, Valenciano M, Cheng B, Al Ariqi L, Rashidian A, Okeibunor J, Azim T, Wijesinghe P, Le LV, Vaughan A, Pebody R, Vicari A, Yan T, Yanes-Lane M, Cao C, Clifton DA, Cheng MP, Papenburg J, Buckeridge D, Bobrovitz N, Arora RK, Van Kerkhove MD. Global SARS-CoV-2 seroprevalence from January 2020 to April 2022: A systematic review and meta-analysis of standardized population-based studies. PLoS Med 2022; 19:e1004107. [PMID: 36355774 PMCID: PMC9648705 DOI: 10.1371/journal.pmed.1004107] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our understanding of the global scale of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains incomplete: Routine surveillance data underestimate infection and cannot infer on population immunity; there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS-CoV-2 seroprevalence studies, standardized to those described in the World Health Organization's Unity protocol (WHO Unity) for general population seroepidemiological studies, to estimate the extent of population infection and seropositivity to the virus 2 years into the pandemic. METHODS AND FINDINGS We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between January 1, 2020 and May 20, 2022. The review protocol is registered with PROSPERO (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies-those aligned with the WHO Unity protocol-were extracted and critically appraised in duplicate, with risk of bias evaluated using a modified Joanna Briggs Institute checklist. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate underascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% low- and middle-income countries [LMICs]) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/subnational scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vaccination was 59.2%, 95% CI [56.1% to 62.2%]. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% [24.6 to 28.8] to 86.7% [84.6% to 88.5%] in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% [8.3% to 11.0%] in June 2020 to 95.9% [92.6% to 97.8%] in December 2021, in European high-income countries [HICs]). After the emergence of Omicron in March 2022, infection-induced seroprevalence rose to 47.9% [41.0% to 54.9%] in Europe HIC and 33.7% [31.6% to 36.0%] in Americas HIC. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0 to 9 years and adults 60+ were at lower risk of seropositivity than adults 20 to 29 (p < 0.001 and p = 0.005, respectively). In a multivariable model using prevaccination data, stringent public health and social measures were associated with lower seroprevalence (p = 0.02). The main limitations of our methodology include that some estimates were driven by certain countries or populations being overrepresented. CONCLUSIONS In this study, we observed that global seroprevalence has risen considerably over time and with regional variation; however, over one-third of the global population are seronegative to the SARS-CoV-2 virus. Our estimates of infections based on seroprevalence far exceed reported Coronavirus Disease 2019 (COVID-19) cases. Quality and standardized seroprevalence studies are essential to inform COVID-19 response, particularly in resource-limited regions.
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Affiliation(s)
| | - Mairead G. Whelan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harriet Ware
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Anthony Nardone
- World Health Organization, Geneva, Switzerland
- Epiconcept, Paris, France
| | - Hannah C. Lewis
- World Health Organization, Geneva, Switzerland
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Zihan Li
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Xiaomeng Ma
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marta Valenciano
- World Health Organization, Geneva, Switzerland
- Epiconcept, Paris, France
| | - Brianna Cheng
- World Health Organization, Geneva, Switzerland
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Lubna Al Ariqi
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Arash Rashidian
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Joseph Okeibunor
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Tasnim Azim
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Pushpa Wijesinghe
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Linh-Vi Le
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Aisling Vaughan
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Andrea Vicari
- World Health Organization, Regional Office for the Americas (Pan American Health Organization), Washington DC, United States of America
| | - Tingting Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mercedes Yanes-Lane
- COVID-19 Immunity Task Force Secretariat, McGill University, Montreal, Canada
| | - Christian Cao
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A. Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Matthew P. Cheng
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Buckeridge
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Rahul K. Arora
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Lewis HC, Ware H, Whelan M, Subissi L, Li Z, Ma X, Nardone A, Valenciano M, Cheng B, Noel K, Cao C, Yanes-Lane M, Herring BL, Talisuna A, Ngoy N, Balde T, Clifton D, Van Kerkhove MD, Buckeridge D, Bobrovitz N, Okeibunor J, Arora RK, Bergeri I. SARS-CoV-2 infection in Africa: a systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021. BMJ Glob Health 2022; 7:e008793. [PMID: 35998978 PMCID: PMC9402450 DOI: 10.1136/bmjgh-2022-008793] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/28/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Estimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on public health and social measures (PHSM) and vaccine strategy. METHODS We searched for seroprevalence studies conducted in Africa published 1 January 2020-30 December 2021 in Medline, Embase, Web of Science and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity seroprevalence protocol. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO. PROSPERO CRD42020183634. RESULTS We identified 56 full texts or early results, reporting 153 distinct seroprevalence studies in Africa. Of these, 97 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% (95% CI 1.0% to 9.2%) in April-June 2020 to 65.1% (95% CI 56.3% to 73.0%) in July-September 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 100:1, ranging from 18:1 to 954:1) and steady over time. Seroprevalence was highly heterogeneous both within countries-urban versus rural (lower seroprevalence for rural geographic areas), children versus adults (children aged 0-9 years had the lowest seroprevalence)-and between countries and African subregions. CONCLUSION We report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and potential protection against COVID-19 severe disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations.
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Affiliation(s)
- Hannah C Lewis
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Harriet Ware
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mairead Whelan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorenzo Subissi
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Zihan Li
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Xiaomeng Ma
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Nardone
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
- Department of Epidemiology, Epiconcept, Paris, France
| | - Marta Valenciano
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
- Department of Epidemiology, Epiconcept, Paris, France
| | - Brianna Cheng
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Kim Noel
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Christian Cao
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mercedes Yanes-Lane
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- COVID-19 Immunity Task Force Secreteriat, McGill University, Montreal, Québec, Canada
| | - Belinda L Herring
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Nsenga Ngoy
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Thierno Balde
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - David Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Maria D Van Kerkhove
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - David Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Okeibunor
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Rahul K Arora
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Isabel Bergeri
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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4
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Duarte N, Yanes-Lane M, Arora RK, Bobrovitz N, Liu M, Bego MG, Yan T, Cao C, Gurry C, Hankins CA, Cheng MP, Gingras AC, Mazer BD, Papenburg J, Langlois MA. Adapting Serosurveys for the SARS-CoV-2 Vaccine Era. Open Forum Infect Dis 2021; 9:ofab632. [PMID: 35103246 PMCID: PMC8755308 DOI: 10.1093/ofid/ofab632] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Population-level immune surveillance, which includes monitoring exposure and assessing vaccine-induced immunity, is a crucial component of public health decision-making during a pandemic. Serosurveys estimating the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in the population played a key role in characterizing SARS-CoV-2 epidemiology during the early phases of the pandemic. Existing serosurveys provide infrastructure to continue immune surveillance but must be adapted to remain relevant in the SARS-CoV-2 vaccine era. Here, we delineate how SARS-CoV-2 serosurveys should be designed to distinguish infection- and vaccine-induced humoral immune responses to efficiently monitor the evolution of the pandemic. We discuss how serosurvey results can inform vaccine distribution to improve allocation efficiency in countries with scarce vaccine supplies and help assess the need for booster doses in countries with substantial vaccine coverage.
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Affiliation(s)
- Nathan Duarte
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Mercedes Yanes-Lane
- COVID-19 Immunity Task Force, Secretariat, McGill University, Montreal, Quebec, Canada
| | - Rahul K Arora
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Liu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mariana G Bego
- COVID-19 Immunity Task Force, Secretariat, McGill University, Montreal, Quebec, Canada
| | - Tingting Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian Cao
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Celine Gurry
- Coalition for Epidemic Preparedness Innovations, Oslo, Norway
| | - Catherine A Hankins
- COVID-19 Immunity Task Force, Secretariat, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Matthew Pellan Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Bruce D Mazer
- COVID-19 Immunity Task Force, Secretariat, McGill University, Montreal, Quebec, Canada
- Division of Allergy and Immunology, Montreal Children’s Hospital, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Canada
- University of Ottawa Center for Infection, Immunity and Inflammation (CI3), Ottawa, Ontario, Canada
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Yanes-Lane M, Ortiz-Brizuela E, Campbell JR, Benedetti A, Churchyard G, Oxlade O, Menzies D. Tuberculosis preventive therapy for people living with HIV: A systematic review and network meta-analysis. PLoS Med 2021; 18:e1003738. [PMID: 34520459 PMCID: PMC8439495 DOI: 10.1371/journal.pmed.1003738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) preventive therapy (TPT) is an essential component of care for people living with HIV (PLHIV). We compared efficacy, safety, completion, and drug-resistant TB risk for currently recommended TPT regimens through a systematic review and network meta-analysis (NMA) of randomized trials. METHODS AND FINDINGS We searched MEDLINE, Embase, and the Cochrane Library from inception through June 9, 2020 for randomized controlled trials (RCTs) comparing 2 or more TPT regimens (or placebo/no treatment) in PLHIV. Two independent reviewers evaluated eligibility, extracted data, and assessed the risk of bias. We grouped TPT strategies as follows: placebo/no treatment, 6 to 12 months of isoniazid, 24 to 72 months of isoniazid, and rifamycin-containing regimens. A frequentist NMA (using graph theory) was carried out for the outcomes of development of TB disease, all-cause mortality, and grade 3 or worse hepatotoxicity. For other outcomes, graphical descriptions or traditional pairwise meta-analyses were carried out as appropriate. The potential role of confounding variables for TB disease and all-cause mortality was assessed through stratified analyses. A total of 6,466 unique studies were screened, and 157 full texts were assessed for eligibility. Of these, 20 studies (reporting 16 randomized trials) were included. The median sample size was 616 (interquartile range [IQR], 317 to 1,892). Eight were conducted in Africa, 3 in Europe, 3 in the Americas, and 2 included sites in multiple continents. According to the NMA, 6 to 12 months of isoniazid were no more efficacious in preventing microbiologically confirmed TB than rifamycin-containing regimens (incidence rate ratio [IRR] 1.0, 95% CI 0.8 to 1.4, p = 0.8); however, 6 to 12 months of isoniazid were associated with a higher incidence of all-cause mortality (IRR 1.6, 95% CI 1.2 to 2.0, p = 0.02) and a higher risk of grade 3 or higher hepatotoxicity (risk difference [RD] 8.9, 95% CI 2.8 to 14.9, p = 0.004). Finally, shorter regimens were associated with higher completion rates relative to longer regimens, and we did not find statistically significant differences in the risk of drug-resistant TB between regimens. Study limitations include potential confounding due to differences in posttreatment follow-up time and TB incidence in the study setting on the estimates of incidence of TB or all-cause mortality, as well as an underrepresentation of pregnant women and children. CONCLUSIONS Rifamycin-containing regimens appear safer and at least as effective as isoniazid regimens in preventing TB and death and should be considered part of routine care in PLHIV. Knowledge gaps remain as to which specific rifamycin-containing regimen provides the optimal balance of efficacy, completion, and safety.
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Affiliation(s)
- Mercedes Yanes-Lane
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
| | - Edgar Ortiz-Brizuela
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jonathon R. Campbell
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- * E-mail:
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6
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Bobrovitz N, Arora RK, Cao C, Boucher E, Liu M, Donnici C, Yanes-Lane M, Whelan M, Perlman-Arrow S, Chen J, Rahim H, Ilincic N, Segal M, Duarte N, Van Wyk J, Yan T, Atmaja A, Rocco S, Joseph A, Penny L, Clifton DA, Williamson T, Yansouni CP, Evans TG, Chevrier J, Papenburg J, Cheng MP. Global seroprevalence of SARS-CoV-2 antibodies: A systematic review and meta-analysis. PLoS One 2021; 16:e0252617. [PMID: 34161316 PMCID: PMC8221784 DOI: 10.1371/journal.pone.0252617] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Many studies report the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. We aimed to synthesize seroprevalence data to better estimate the level and distribution of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making. METHODS In this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to December 31, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. We corrected estimates for imperfect test accuracy with Bayesian measurement error models, conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634. RESULTS We identified 968 seroprevalence studies including 9.3 million participants in 74 countries. There were 472 studies (49%) at low or moderate risk of bias. Seroprevalence was low in the general population (median 4.5%, IQR 2.4-8.4%); however, it varied widely in specific populations from low (0.6% perinatal) to high (59% persons in assisted living and long-term care facilities). Median seroprevalence also varied by Global Burden of Disease region, from 0.6% in Southeast Asia, East Asia and Oceania to 19.5% in Sub-Saharan Africa (p<0.001). National studies had lower seroprevalence estimates than regional and local studies (p<0.001). Compared to Caucasian persons, Black persons (prevalence ratio [RR] 3.37, 95% CI 2.64-4.29), Asian persons (RR 2.47, 95% CI 1.96-3.11), Indigenous persons (RR 5.47, 95% CI 1.01-32.6), and multi-racial persons (RR 1.89, 95% CI 1.60-2.24) were more likely to be seropositive. Seroprevalence was higher among people ages 18-64 compared to 65 and over (RR 1.27, 95% CI 1.11-1.45). Health care workers in contact with infected persons had a 2.10 times (95% CI 1.28-3.44) higher risk compared to health care workers without known contact. There was no difference in seroprevalence between sex groups. Seroprevalence estimates from national studies were a median 18.1 times (IQR 5.9-38.7) higher than the corresponding SARS-CoV-2 cumulative incidence, but there was large variation between Global Burden of Disease regions from 6.7 in South Asia to 602.5 in Sub-Saharan Africa. Notable methodological limitations of serosurveys included absent reporting of test information, no statistical correction for demographics or test sensitivity and specificity, use of non-probability sampling and use of non-representative sample frames. DISCUSSION Most of the population remains susceptible to SARS-CoV-2 infection. Public health measures must be improved to protect disproportionately affected groups, including racial and ethnic minorities, until vaccine-derived herd immunity is achieved. Improvements in serosurvey design and reporting are needed for ongoing monitoring of infection prevalence and the pandemic response.
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Affiliation(s)
- Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rahul Krishan Arora
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christian Cao
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emily Boucher
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Liu
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Claire Donnici
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Mairead Whelan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara Perlman-Arrow
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Judy Chen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Hannah Rahim
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natasha Ilincic
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Segal
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Duarte
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Jordan Van Wyk
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Tingting Yan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Austin Atmaja
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Simona Rocco
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Abel Joseph
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Lucas Penny
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David A. Clifton
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cedric P. Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Timothy Grant Evans
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Matthew P. Cheng
- Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada
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7
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Yanes-Lane M, Trajman A, Bastos ML, Oxlade O, Valiquette C, Rufino N, Fregonese F, Menzies D. Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation. BMC Public Health 2021; 21:177. [PMID: 33478452 PMCID: PMC7819253 DOI: 10.1186/s12889-021-10195-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/07/2021] [Indexed: 02/01/2023] Open
Abstract
Background Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives. Methods In two health clinics in Rio de Janeiro that received the interventions in the trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. Results In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, − 15) but the number starting latent TB infection treatment was sustained (difference -2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment. Conclusion In this follow-up study, we observed a sustained effect of interventions to strengthen the latent TB infection cascade of care on increasing the number of household contacts starting latent TB infection treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10195-z.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Anete Trajman
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada.,Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mayara Lisboa Bastos
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada.,Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Olivia Oxlade
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada.,McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Chantal Valiquette
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathalia Rufino
- Vector Bourne Diseases Department, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Federica Fregonese
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Dick Menzies
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada. .,McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
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8
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Campbell JR, Uppal A, Oxlade O, Fregonese F, Bastos ML, Lan Z, Law S, Oh CE, Russell WA, Sulis G, Winters N, Yanes-Lane M, Brisson M, Laszlo S, Evans TG, Menzies D. Dépistage actif chez les groupes courant un risque accru de contracter le SRAS-CoV-2 au Canada : coûts et ressources humaines nécessaires. CMAJ 2020; 192:E1734-E1746. [DOI: 10.1503/cmaj.201128-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/01/2022] Open
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9
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Yanes-Lane M, Winters N, Fregonese F, Bastos M, Perlman-Arrow S, Campbell JR, Menzies D. Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis. PLoS One 2020; 15:e0241536. [PMID: 33141862 PMCID: PMC7608887 DOI: 10.1371/journal.pone.0241536] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. METHODS We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). RESULTS Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. CONCLUSIONS Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Winters
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | - Federica Fregonese
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mayara Bastos
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Perlman-Arrow
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathon R. Campbell
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Dick Menzies
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
- Division of Respiratory Medicine, Department of Medicine, McGill University, Quebec, Canada
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10
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Díaz-Ortega JL, Ferreira-Guerrero E, Cruz-Hervert LP, Delgado-Sánchez G, Ferreyra-Reyes L, Yanes-Lane M, Mongua-Rodríguez N, Montero-Campos R, Castañeda-Desales D, García-García L. Seroprevalence of measles antibodies and factors associated with susceptibility: a national survey in Mexico using a plaque reduction neutralization test. Sci Rep 2020; 10:17488. [PMID: 33060627 PMCID: PMC7562930 DOI: 10.1038/s41598-020-73618-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
Measles continues to be one of the leading causes of child mortality worldwide, even though a highly effective vaccine has existed for more than 40 years. We aimed to describe the seroprevalence of measles antibodies in Mexico in 2012 and the risk factors associated with susceptibility. A total of 7,785 serum samples were analyzed from the National Health and Nutrition Survey in Mexico. This national survey is representative of the general population, including noninstitutionalized adult, adolescent, and child populations. Antibody titers were classified into protective (> 120 mIU/mL) or susceptible (≤ 120 mIU/mL) levels. The weighted seroprevalence and susceptibility of the overall population were 99.37% (95% CI 99.07–99.58) and 0.63% (95% CI 0.42–0.93), respectively. Among 1-to-4-year-old children, 2.18% (95% CI 1.36–3.48) were susceptible to measles. Among adolescents and young adults, the prevalence of susceptibility was as follows: those 15–19 years of age had a prevalence of 0.22% (95% CI 0.09–0.57), and those 30–39 years of age had a prevalence of 1.17% (95% CI 0.47–2.85). Susceptibility was associated with young age, living in Mexico City, living in crowded households and unknown or nonvaccinated status among 1- to 5-year-old children. Although the overall sample population seroprevalence for measles is above 95%, increased susceptibility among younger children signals the importance of the timely administration of the first vaccine dose at 12 months of age. Furthermore, increased susceptibility among specific subgroups indicates the need to reinforce current vaccination policies, including the immunization of unvaccinated or incompletely vaccinated individuals from 10 to 39 years of age.
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Affiliation(s)
- José Luis Díaz-Ortega
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Luis Pablo Cruz-Hervert
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Deyanira Castañeda-Desales
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, México.
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11
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Campbell JR, Uppal A, Oxlade O, Fregonese F, Bastos ML, Lan Z, Law S, Oh CE, Russell WA, Sulis G, Winters N, Yanes-Lane M, Brisson M, Laszlo S, Evans TG, Menzies D. Active testing of groups at increased risk of acquiring SARS-CoV-2 in Canada: costs and human resource needs. CMAJ 2020; 192:E1146-E1155. [PMID: 32907820 DOI: 10.1503/cmaj.201128] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is largely passive, which impedes epidemic control. We defined active testing strategies for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) for groups at increased risk of acquiring SARS-CoV-2 in all Canadian provinces. METHODS We identified 5 groups who should be prioritized for active RT-PCR testing: contacts of people who are positive for SARS-CoV-2, and 4 at-risk populations - hospital employees, community health care workers and people in long-term care facilities, essential business employees, and schoolchildren and staff. We estimated costs, human resources and laboratory capacity required to test people in each group or to perform surveillance testing in random samples. RESULTS During July 8-17, 2020, across all provinces in Canada, an average of 41 751 RT-PCR tests were performed daily; we estimated this required 5122 personnel and cost $2.4 million per day ($67.8 million per month). Systematic contact tracing and testing would increase personnel needs 1.2-fold and monthly costs to $78.9 million. Conducted over a month, testing all hospital employees would require 1823 additional personnel, costing $29.0 million; testing all community health care workers and persons in long-term care facilities would require 11 074 additional personnel and cost $124.8 million; and testing all essential employees would cost $321.7 million, requiring 25 965 added personnel. Testing the larger population within schools over 6 weeks would require 46 368 added personnel and cost $816.0 million. Interventions addressing inefficiencies, including saliva-based sampling and pooling samples, could reduce costs by 40% and personnel by 20%. Surveillance testing in population samples other than contacts would cost 5% of the cost of a universal approach to testing at-risk populations. INTERPRETATION Active testing of groups at increased risk of acquiring SARS-CoV-2 appears feasible and would support the safe reopening of the economy and schools more broadly. This strategy also appears affordable compared with the $169.2 billion committed by the federal government as a response to the pandemic as of June 2020.
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Affiliation(s)
- Jonathon R Campbell
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Aashna Uppal
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Olivia Oxlade
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Federica Fregonese
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Mayara Lisboa Bastos
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Zhiyi Lan
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Stephanie Law
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Chi Eun Oh
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - W Alton Russell
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Giorgia Sulis
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Nicholas Winters
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Mercedes Yanes-Lane
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Marc Brisson
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Sonia Laszlo
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Timothy G Evans
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Dick Menzies
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que.
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12
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Yanes-Lane M, Dussault C, Linthwaite B, Cox J, Klein MB, Sebastiani G, Lebouché B, Kronfli N. Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review. J Viral Hepat 2020; 27:205-220. [PMID: 31638294 DOI: 10.1111/jvh.13220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Elimination of hepatitis C virus (HCV) among short-term sentenced prison populations will require improved access to HCV care and specific strategies dedicated to linkage upon release. Prison-based HCV care has lagged behind HIV care, but much can be learned from HIV studies. We performed a systematic review to identify individual-, provider- and system-level barriers and facilitators to linkage to HCV and HIV care among released inmates. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials and Embase, and performed a grey literature search for English articles published up to November 2018. Two searches were conducted, one each for HCV and HIV; 323 and 684 unique articles were identified of which two and 27 studies were included, respectively. Facilitators to linkage to HCV care included social support, having an existing primary care provider, and receipt of methadone, whereas barriers included a perceived lack of healthcare information and a lack of specialized linkage to care programs. The principal facilitators to linkage to HIV care included social support, treatment for substance use and mental illness, the provision of education, case management, discharge planning and transportation assistance. Important barriers were unstable housing, age <30 years, HIV-related stigma, poor providers' attitudes and the lack of post-release reintegration assistance. While HCV care-specific studies are needed, much can be learned from linkage to HIV care studies. Ultimately, a multi-pronged approach, addressing several individual-level social determinants of health, and key provider- and system-level barriers may be an appropriate starting point for the development of HCV linkage to care strategies.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV trials Network, Vancouver, British Columbia, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
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13
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Blanco-Guillot F, Castañeda-Cediel ML, Cruz-Hervert P, Ferreyra-Reyes L, Delgado-Sánchez G, Ferreira-Guerrero E, Montero-Campos R, Bobadilla-del-Valle M, Martínez-Gamboa RA, Torres-González P, Téllez-Vazquez N, Canizales-Quintero S, Yanes-Lane M, Mongua-Rodríguez N, Ponce-de-León A, Sifuentes-Osornio J, García-García L. Genotyping and spatial analysis of pulmonary tuberculosis and diabetes cases in the state of Veracruz, Mexico. PLoS One 2018. [PMID: 29534104 PMCID: PMC5849303 DOI: 10.1371/journal.pone.0193911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Genotyping and georeferencing in tuberculosis (TB) have been used to characterize the distribution of the disease and occurrence of transmission within specific groups and communities. Objective The objective of this study was to test the hypothesis that diabetes mellitus (DM) and pulmonary TB may occur in spatial and molecular aggregations. Material and methods Retrospective cohort study of patients with pulmonary TB. The study area included 12 municipalities in the Sanitary Jurisdiction of Orizaba, Veracruz, México. Patients with acid-fast bacilli in sputum smears and/or Mycobacterium tuberculosis in sputum cultures were recruited from 1995 to 2010. Clinical (standardized questionnaire, physical examination, chest X-ray, blood glucose test and HIV test), microbiological, epidemiological, and molecular evaluations were carried out. Patients were considered “genotype-clustered” if two or more isolates from different patients were identified within 12 months of each other and had six or more IS6110 bands in an identical pattern, or < 6 bands with identical IS6110 RFLP patterns and spoligotype with the same spacer oligonucleotides. Residential and health care centers addresses were georeferenced. We used a Jeep hand GPS. The coordinates were transferred from the GPS files to ArcGIS using ArcMap 9.3. We evaluated global spatial aggregation of patients in IS6110-RFLP/ spoligotype clusters using global Moran´s I. Since global distribution was not random, we evaluated “hotspots” using Getis-Ord Gi* statistic. Using bivariate and multivariate analysis we analyzed sociodemographic, behavioral, clinic and bacteriological conditions associated with “hotspots”. We used STATA® v13.1 for all statistical analysis. Results From 1995 to 2010, 1,370 patients >20 years were diagnosed with pulmonary TB; 33% had DM. The proportion of isolates that were genotyped was 80.7% (n = 1105), of which 31% (n = 342) were grouped in 91 genotype clusters with 2 to 23 patients each; 65.9% of total clusters were small (2 members) involving 35.08% of patients. Twenty three (22.7) percent of cases were classified as recent transmission. Moran`s I indicated that distribution of patients in IS6110-RFLP/spoligotype clusters was not random (Moran`s I = 0.035468, Z value = 7.0, p = 0.00). Local spatial analysis showed statistically significant spatial aggregation of patients in IS6110-RFLP/spoligotype clusters identifying “hotspots” and “coldspots”. GI* statistic showed that the hotspot for spatial clustering was located in Camerino Z. Mendoza municipality; 14.6% (50/342) of patients in genotype clusters were located in a hotspot; of these, 60% (30/50) lived with DM. Using logistic regression the statistically significant variables associated with hotspots were: DM [adjusted Odds Ratio (aOR) 7.04, 95% Confidence interval (CI) 3.03–16.38] and attending the health center in Camerino Z. Mendoza (aOR18.04, 95% CI 7.35–44.28). Conclusions The combination of molecular and epidemiological information with geospatial data allowed us to identify the concurrence of molecular clustering and spatial aggregation of patients with DM and TB. This information may be highly useful for TB control programs.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Norma Téllez-Vazquez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Sergio Canizales-Quintero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Norma Mongua-Rodríguez
- Doctorado en Geografía, Universidad Nacional Autónoma de México, Ciudad de México, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
- * E-mail:
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14
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Blanco-Guillot F, Delgado-Sánchez G, Mongua-Rodríguez N, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Yanes-Lane M, Montero-Campos R, Bobadilla-del-Valle M, Torres-González P, Ponce-de-León A, Sifuentes-Osornio J, Garcia-Garcia L. Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0184675. [PMID: 28902922 PMCID: PMC5597214 DOI: 10.1371/journal.pone.0184675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus. Materials and methods We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words “tuberculosis AND transmission” OR “tuberculosis diabetes mellitus” OR “Mycobacterium tuberculosis molecular epidemiology” OR “RFLP-IS6110” OR “Spoligotyping” OR “MIRU-VNTR”. Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used. Results Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40–1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429). Conclusion There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Lourdes Garcia-Garcia
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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15
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Cossío-Torres PE, Padrón-Salas A, Gutiérrez-Mendoza LM, Yanes-Lane M. [Overview of mortality in Mexico through four indicators from 1990 to 2012]. GAC MED MEX 2017; 153:16-25. [PMID: 28128801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To describe the behavior of mortality in Mexico through four indicators from 1990 to 2012. MATERIAL AND METHODS The official mortality and population records of Mexico were used. RESULTS An advance was achieved for children under five years of age, with a decrease in mortality, although there was an increase in the years of potential life lost (YPLL) from 2008 for this age group. For children under one year of age, there was no advance since 2002 in the index of YPLL and in the productive years of life lost (PYLL). Since 2008 there has been an increase in the rates of mortality, YPLL, and PYLL in the group from 10 to 29 years of age. There has been a sustained increase in YPLL in the age group from 40 to 69. CONCLUSIONS It is relevant to evaluate the health policies in Mexico for the different age groups; even though there have been positive results in some of them, these are not across all the age groups, which could put some sectors of the population at risk, such as children and young people from 10 to 29 years of age.
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Affiliation(s)
| | - Aldanely Padrón-Salas
- Departamento de Salud Pública, Universidad Autónoma de San Luis Potosí, San Luís Potosí, S.L.P., México
| | | | - Mercedes Yanes-Lane
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luís Potosí, S.L.P., México
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16
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Báez-Saldaña R, Delgado-Sánchez G, García-García L, Cruz-Hervert LP, Montesinos-Castillo M, Ferreyra-Reyes L, Bobadilla-del-Valle M, Canizales-Quintero S, Ferreira-Guerrero E, Téllez-Vázquez N, Montero-Campos R, Yanes-Lane M, Mongua-Rodriguez N, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A. Isoniazid Mono-Resistant Tuberculosis: Impact on Treatment Outcome and Survival of Pulmonary Tuberculosis Patients in Southern Mexico 1995-2010. PLoS One 2016; 11:e0168955. [PMID: 28030600 PMCID: PMC5193431 DOI: 10.1371/journal.pone.0168955] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
Abstract
Background Isoniazid mono-resistance (IMR) is the most common form of mono-resistance; its world prevalence is estimated to range between 0.0 to 9.5% globally. There is no consensus on how these patients should be treated. Objective To describe the impact of IMR tuberculosis (TB) on treatment outcome and survival among pulmonary TB patients treated under programmatic conditions in Orizaba, Veracruz, Mexico. Materials and Methods We conducted a prospective cohort study of pulmonary TB patients in Southern Mexico. From 1995 to 2010 patients with acid-fast bacilli or culture proven Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. We included patients who harbored isoniazid mono-resistant (IMR) strains and patients with strains susceptible to isoniazid, rifampicin, ethambutol and streptomycin. All patients were treated following Mexican TB Program guidelines. We performed annual follow-up to ascertain treatment outcome, recurrence, relapse and mortality. Results Between 1995 and 2010 1,243 patients with pulmonary TB were recruited; 902/1,243 (72.57%) had drug susceptibility testing; 716 (79.38%) harbored pan-susceptible and 88 (9.75%) IMR strains. Having any contact with a person with TB (adjusted odds ratio (aOR)) 1.85, 95% Confidence interval (CI) 1.15–2.96) and homelessness (adjusted odds ratio (aOR) 2.76, 95% CI 1.08–6.99) were associated with IMR. IMR patients had a higher probability of failure (adjusted hazard ratio (HR) 12.35, 95% CI 3.38–45.15) and death due to TB among HIV negative patients (aHR 3.30. 95% CI 1.00–10.84). All the models were adjusted for socio-demographic and clinical variables. Conclusions The results from our study provide evidence that the standardized treatment schedule with first line drugs in new and previously treated cases with pulmonary TB and IMR produces a high frequency of treatment failure and death due to tuberculosis. We recommend re-evaluating the optimal schedule for patients harboring IMR. It is necessary to strengthen scientific research for the evaluation of alternative treatment schedules in similar settings.
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Affiliation(s)
- Renata Báez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
| | - Luis Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Marlene Montesinos-Castillo
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México, México
| | - Sergio Canizales-Quintero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Téllez-Vázquez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Norma Mongua-Rodriguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México. México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán, Ciudad de México, México
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