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Pereira FM, Salomão de Araujo A, Catarina Martins Reis A, Santos da Hora A, Pinotti F, Paton RS, Vilas Boas Figueiredo C, Lopes Damasceno C, Carlos dos Santos D, Souza de Santana D, Freitas Sales D, Ariana Andrade Brandão E, da Silva Batista E, Campos de Sousa FS, Santana Menezes G, Silveira dos Santos J, Gomes Lima J, Tadeu Brito J, Dandara dos Santos L, Reboredo L, Santana Santos M, Kelly Astete Gomez M, Freitas da Cruz M, Rosa Ampuero M, Guerra Lemos da Silva M, S. da Paixão Melo M, Ferreira da Silva M, de Jesus Gonçalves dos Santos N, de Souza Pessoa N, Silva de Araujo R, de Macedo Godim T, Fraga de Oliveira Tosta S, Brandão Nardy V, Cristina Faria E, Frederico de Carvalho Dominguez Souza B, Laís Almeida dos Santos J, Wikramaratna P, Giovanetti M, Alcântara LCJ, Lourenço J, Leal e Silva de Mello A. Dynamics and Determinants of SARS-CoV-2 RT-PCR Testing on Symptomatic Individuals Attending Healthcare Centers during 2020 in Bahia, Brazil. Viruses 2022; 14:v14071549. [PMID: 35891528 PMCID: PMC9321627 DOI: 10.3390/v14071549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/01/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 02/05/2023] Open
Abstract
RT-PCR testing data provides opportunities to explore regional and individual determinants of test positivity and surveillance infrastructure. Using Generalized Additive Models, we explored 222,515 tests of a random sample of individuals with COVID-19 compatible symptoms in the Brazilian state of Bahia during 2020. We found that age and male gender were the most significant determinants of test positivity. There was evidence of an unequal impact among socio-demographic strata, with higher positivity among those living in areas with low education levels during the first epidemic wave, followed by those living in areas with higher education levels in the second wave. Our estimated probability of testing positive after symptom onset corroborates previous reports that the probability decreases with time, more than halving by about two weeks and converging to zero by three weeks. Test positivity rates generally followed state-level reported cases, and while a single laboratory performed ~90% of tests covering ~99% of the state's area, test turn-around time generally remained below four days. This testing effort is a testimony to the Bahian surveillance capacity during public health emergencies, as previously witnessed during the recent Zika and Yellow Fever outbreaks.
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Affiliation(s)
- Felicidade Mota Pereira
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Aline Salomão de Araujo
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Ana Catarina Martins Reis
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Anadilton Santos da Hora
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Francesco Pinotti
- Department of Zoology, University of Oxford, Oxford OX1 3SZ, UK; (F.P.); (R.S.P.)
| | - Robert S. Paton
- Department of Zoology, University of Oxford, Oxford OX1 3SZ, UK; (F.P.); (R.S.P.)
| | - Camylla Vilas Boas Figueiredo
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Caroline Lopes Damasceno
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Daiana Carlos dos Santos
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Daniele Souza de Santana
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Danielle Freitas Sales
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Evelyn Ariana Andrade Brandão
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Everton da Silva Batista
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Fulvia Soares Campos de Sousa
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Gabriela Santana Menezes
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Jackeline Silveira dos Santos
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Jaqueline Gomes Lima
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Jean Tadeu Brito
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Lenisa Dandara dos Santos
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Luciana Reboredo
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Maiara Santana Santos
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Marcela Kelly Astete Gomez
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Marcia Freitas da Cruz
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Mariana Rosa Ampuero
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Mariele Guerra Lemos da Silva
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Mariza S. da Paixão Melo
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Marta Ferreira da Silva
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Nadja de Jesus Gonçalves dos Santos
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Núbia de Souza Pessoa
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Ramile Silva de Araujo
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Taiane de Macedo Godim
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | | | - Vanessa Brandão Nardy
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Elaine Cristina Faria
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Breno Frederico de Carvalho Dominguez Souza
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | - Jessica Laís Almeida dos Santos
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
| | | | - Marta Giovanetti
- Laboratório de Flavivírus, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro 21045-900, Brazil;
- Department of Science and Technology for Humans and the Environment, University of Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Luiz Carlos Junior Alcântara
- Laboratório de Flavivírus, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro 21045-900, Brazil;
- Correspondence: (L.C.J.A.); (J.L.)
| | - José Lourenço
- Biosystems and Integrative Sciences Institute, Faculdade de Ciências, 1749-016 Lisboa, Portugal
- Correspondence: (L.C.J.A.); (J.L.)
| | - Arabela Leal e Silva de Mello
- Laboratório Central de Saúde Pública Professor Gonçalo Muniz, Salvador 40295-010, Brazil; (F.M.P.); (A.S.d.A.); (A.C.M.R.); (A.S.d.H.); (C.V.B.F.); (C.L.D.); (D.C.d.S.); (D.S.d.S.); (D.F.S.); (E.A.A.B.); (E.d.S.B.); (F.S.C.d.S.); (G.S.M.); (J.S.d.S.); (J.G.L.); (J.T.B.); (L.D.d.S.); (L.R.); (M.S.S.); (M.K.A.G.); (M.F.d.C.); (M.R.A.); (M.G.L.d.S.); (M.S.d.P.M.); (M.F.d.S.); (N.d.J.G.d.S.); (N.d.S.P.); (R.S.d.A.); (T.d.M.G.); (V.B.N.); (E.C.F.); (B.F.d.C.D.S.); (J.L.A.d.S.); (A.L.e.S.d.M.)
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Pinotti F, Obolski U, Wikramaratna P, Giovanetti M, Paton R, Klenerman P, Thompson C, Gupta S, Lourenço J. Real-time seroprevalence and exposure levels of emerging pathogens in infection-naive host populations. Sci Rep 2021; 11:5825. [PMID: 33712648 PMCID: PMC7954847 DOI: 10.1038/s41598-021-84672-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/08/2020] [Accepted: 02/16/2021] [Indexed: 12/29/2022] Open
Abstract
For endemic pathogens, seroprevalence mimics overall exposure and is minimally influenced by the time that recent infections take to seroconvert. Simulating spatially-explicit and stochastic outbreaks, we set out to explore how, for emerging pathogens, the mix of exponential growth in infection events and a constant rate for seroconversion events could lead to real-time significant differences in the total numbers of exposed versus seropositive. We find that real-time seroprevalence of an emerging pathogen can underestimate exposure depending on measurement time, epidemic doubling time, duration and natural variation in the time to seroconversion among hosts. We formalise mathematically how underestimation increases non-linearly as the host's time to seroconversion is ever longer than the pathogen's doubling time, and how more variable time to seroconversion among hosts results in lower underestimation. In practice, assuming that real-time seroprevalence reflects the true exposure to emerging pathogens risks overestimating measures of public health importance (e.g. infection fatality ratio) as well as the epidemic size of future waves. These results contribute to a better understanding and interpretation of real-time serological data collected during the emergence of pathogens in infection-naive host populations.
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Affiliation(s)
| | - Uri Obolski
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
- Porter School of the Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Marta Giovanetti
- Laboratório de Genética Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Laboratório de Flavivírus, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro, Brazil
| | - Robert Paton
- Department of Zoology, University of Oxford, Oxford, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, Oxford, UK
| | | | - Sunetra Gupta
- Department of Zoology, University of Oxford, Oxford, UK
| | - José Lourenço
- Department of Zoology, University of Oxford, Oxford, UK.
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Müller MA, Meyer B, Corman VM, Al-Masri M, Turkestani A, Ritz D, Sieberg A, Aldabbagh S, Bosch BJ, Lattwein E, Alhakeem RF, Assiri AM, Albarrak AM, Al-Shangiti AM, Al-Tawfiq JA, Wikramaratna P, Alrabeeah AA, Drosten C, Memish ZA. Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. Lancet Infect Dis 2015; 15:629. [PMID: 26008827 DOI: 10.1016/s1473-3099(15)00029-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Müller MA, Meyer B, Corman VM, Al-Masri M, Turkestani A, Ritz D, Sieberg A, Aldabbagh S, Bosch BJ, Lattwein E, Alhakeem RF, Assiri AM, Albarrak AM, Al-Shangiti AM, Al-Tawfiq JA, Wikramaratna P, Alrabeeah AA, Drosten C, Memish ZA. Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. Lancet Infect Dis 2015. [PMID: 25863564 DOI: 10.1016/s1473-30991570090-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Scientific evidence suggests that dromedary camels are the intermediary host for the Middle East respiratory syndrome coronavirus (MERS-CoV). However, the actual number of infections in people who have had contact with camels is unknown and most index patients cannot recall any such contact. We aimed to do a nationwide serosurvey in Saudi Arabia to establish the prevalence of MERS-CoV antibodies, both in the general population and in populations of individuals who have maximum exposure to camels. METHODS In the cross-sectional serosurvey, we tested human serum samples obtained from healthy individuals older than 15 years who attended primary health-care centres or participated in a national burden-of-disease study in all 13 provinces of Saudi Arabia. Additionally, we tested serum samples from shepherds and abattoir workers with occupational exposure to camels. Samples were screened by recombinant ELISA and MERS-CoV seropositivity was confirmed by recombinant immunofluorescence and plaque reduction neutralisation tests. We used two-tailed Mann Whitney U exact tests, χ(2), and Fisher's exact tests to analyse the data. FINDINGS Between Dec 1, 2012, and Dec 1, 2013, we obtained individual serum samples from 10,009 individuals. Anti-MERS-CoV antibodies were confirmed in 15 (0·15%; 95% CI 0·09-0·24) of 10,009 people in six of the 13 provinces. The mean age of seropositive individuals was significantly younger than that of patients with reported, laboratory-confirmed, primary Middle Eastern respiratory syndrome (43·5 years [SD 17·3] vs 53·8 years [17·5]; p=0·008). Men had a higher antibody prevalence than did women (11 [0·25%] of 4341 vs two [0·05%] of 4378; p=0·028) and antibody prevalence was significantly higher in central versus coastal provinces (14 [0·26%] of 5479 vs one [0·02%] of 4529; p=0·003). Compared with the general population, seroprevalence of MERS-CoV antibodies was significantly increased by 15 times in shepherds (two [2·3%] of 87, p=0·0004) and by 23 times in slaughterhouse workers (five [3·6%] of 140; p<0·0001). INTERPRETATION Seroprevalence of MERS-CoV antibodies was significantly higher in camel-exposed individuals than in the general population. By simple multiplication, a projected 44,951 (95% CI 26,971-71,922) individuals older than 15 years might be seropositive for MERS-CoV in Saudi Arabia. These individuals might be the source of infection for patients with confirmed MERS who had no previous exposure to camels. FUNDING European Union, German Centre for Infection Research, Federal Ministry of Education and Research, German Research Council, and Ministry of Health of Saudi Arabia.
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Affiliation(s)
- Marcel A Müller
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Benjamin Meyer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Victor M Corman
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany
| | - Malak Al-Masri
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia
| | - Abdulhafeez Turkestani
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia; Makkah Regional Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Daniel Ritz
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Andrea Sieberg
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Souhaib Aldabbagh
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Berend-J Bosch
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Raafat F Alhakeem
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia
| | - Abdullah M Assiri
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia
| | | | | | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paul Wikramaratna
- Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, Edinburgh, UK
| | | | - Christian Drosten
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.
| | - Ziad A Memish
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia.
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Müller MA, Meyer B, Corman VM, Al-Masri M, Turkestani A, Ritz D, Sieberg A, Aldabbagh S, Bosch BJ, Lattwein E, Alhakeem RF, Assiri AM, Albarrak AM, Al-Shangiti AM, Al-Tawfiq JA, Wikramaratna P, Alrabeeah AA, Drosten C, Memish ZA. Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. Lancet Infect Dis 2015; 15:559-64. [PMID: 25863564 PMCID: PMC7185864 DOI: 10.1016/s1473-3099(15)70090-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Scientific evidence suggests that dromedary camels are the intermediary host for the Middle East respiratory syndrome coronavirus (MERS-CoV). However, the actual number of infections in people who have had contact with camels is unknown and most index patients cannot recall any such contact. We aimed to do a nationwide serosurvey in Saudi Arabia to establish the prevalence of MERS-CoV antibodies, both in the general population and in populations of individuals who have maximum exposure to camels. Methods In the cross-sectional serosurvey, we tested human serum samples obtained from healthy individuals older than 15 years who attended primary health-care centres or participated in a national burden-of-disease study in all 13 provinces of Saudi Arabia. Additionally, we tested serum samples from shepherds and abattoir workers with occupational exposure to camels. Samples were screened by recombinant ELISA and MERS-CoV seropositivity was confirmed by recombinant immunofluorescence and plaque reduction neutralisation tests. We used two-tailed Mann Whitney U exact tests, χ2, and Fisher's exact tests to analyse the data. Findings Between Dec 1, 2012, and Dec 1, 2013, we obtained individual serum samples from 10 009 individuals. Anti-MERS-CoV antibodies were confirmed in 15 (0·15%; 95% CI 0·09–0·24) of 10 009 people in six of the 13 provinces. The mean age of seropositive individuals was significantly younger than that of patients with reported, laboratory-confirmed, primary Middle Eastern respiratory syndrome (43·5 years [SD 17·3] vs 53·8 years [17·5]; p=0·008). Men had a higher antibody prevalence than did women (11 [0·25%] of 4341 vs two [0·05%] of 4378; p=0·028) and antibody prevalence was significantly higher in central versus coastal provinces (14 [0·26%] of 5479 vs one [0·02%] of 4529; p=0·003). Compared with the general population, seroprevalence of MERS-CoV antibodies was significantly increased by 15 times in shepherds (two [2·3%] of 87, p=0·0004) and by 23 times in slaughterhouse workers (five [3·6%] of 140; p<0·0001). Interpretation Seroprevalence of MERS-CoV antibodies was significantly higher in camel-exposed individuals than in the general population. By simple multiplication, a projected 44 951 (95% CI 26 971–71 922) individuals older than 15 years might be seropositive for MERS-CoV in Saudi Arabia. These individuals might be the source of infection for patients with confirmed MERS who had no previous exposure to camels. Funding European Union, German Centre for Infection Research, Federal Ministry of Education and Research, German Research Council, and Ministry of Health of Saudi Arabia.
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Affiliation(s)
- Marcel A Müller
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Benjamin Meyer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Victor M Corman
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany
| | - Malak Al-Masri
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia
| | - Abdulhafeez Turkestani
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia; Makkah Regional Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Daniel Ritz
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Andrea Sieberg
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Souhaib Aldabbagh
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Berend-J Bosch
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Raafat F Alhakeem
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia
| | - Abdullah M Assiri
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia
| | | | | | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paul Wikramaratna
- Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, Edinburgh, UK
| | | | - Christian Drosten
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.
| | - Ziad A Memish
- King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia.
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