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Chaurasia S, Rudraprasad D, Senagari JR, Reddy SL, Kandhibanda S, Mohamed A, Basu S, Garg P, Joseph J. Clinical Utility of COVID-19 Real Time-Polymerase Chain Reaction Testing of Ocular Tissues of Non-COVID-19 Cornea Donors Deemed Suitable for Corneal Retrieval and Transplantation. Cornea 2022; 41:238-242. [PMID: 34852410 DOI: 10.1097/ico.0000000000002874] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence of SARS-CoV-2 in human postmortem ocular tissues of asymptomatic donors and its implications on our eye banking protocols. METHODS The expression of SARS-CoV-2 RNA was assessed by reverse transcription-polymerase chain reaction in corneal rims and conjunctival tissues from 100 donors who were found suitable for transplantation as per the donor screening guidelines of the Global Alliance of Eye Bank Associations. The donor's clinical history and cause of death were assessed for secondary analysis. RESULTS Of 200 ocular tissues (100 corneal and 100 conjunctival) from the same 1 eye of 100 surgical-intended donors, between September 2020 and April 2021, the overall positivity rate for SARS-CoV-2 was ∼1% (2/200). Both the ocular samples that tested positive were conjunctival biopsies (2/100, 2%), whereas corneal samples were negative (0/100, 0%) in both donors. The causes of donor death were trauma in 51 donors, suicide in 33, cardiac arrest in 7, electric shock in 5, metabolic cause in 2, malignancy in 1, and snake bite in 1. None of the donors had a medical history suggestive of COVID infection or possible contact. None of the recipients from the donors were reported to have any systemic adverse event after keratoplasty until the follow-up of 6 weeks. CONCLUSIONS The overall prevalence of SARS-CoV-2 was 1% (2% for conjunctival and 0% for corneal samples, P value = 0.5) in the donors who were found suitable for cornea recovery and transplantation. The findings of exceptionally low positive rates in our samples validate the criticality of history-based donor screening and do not support the necessity of postmortem PCR testing as a criterion for procurement and subsequent use for corneal transplantation.
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Affiliation(s)
- Sunita Chaurasia
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Ramayamma International Eye Bank, LV Prasad Eye Institute, Hyderabad, India
| | | | | | | | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India; and
| | - Sayan Basu
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Center for Ocular Regeneration, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Prashant Garg
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India
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Armocida B, Zamagni G, Magni E, Monasta L, Comar M, Zanotta N, Cason C, Argentini G, Urriza M, Cassone A, Vascotto F, Buzzetti R, Barbi E, Del Pin M, Pani P, Knowles A, Carletti C, Concina F, Milinco M, Ronfani L. Clinical, anamnestic, and sociodemographic predictors of positive SARS-CoV-2 testing in children: A cross sectional study in a tertiary hospital in Italy. PLoS One 2022; 17:e0262923. [PMID: 35077483 PMCID: PMC8789147 DOI: 10.1371/journal.pone.0262923] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/07/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We aimed to identify clinical, anamnestic, and sociodemographic characteristics associated with a positive swab for SARS-CoV2, and to provide a predictive score to identify at risk population in children aged 2-14 years attending school and tested for clinical symptoms of COVID-19. DESIGN Cross sectional study. SETTING Outpatient clinic of the IRCCS Burlo Garofolo, a maternal and child health tertiary care hospital and research centre in Italy. DATA COLLECTION AND ANALYSIS Data were collected through a predefined form, filled out by parents, and gathered information on sociodemographic characteristics, and specific symptoms, which were analysed to determine their association with a positive SARS-CoV-2 swab. The regression coefficients of the variables included in the multivariate analysis were further used in the calculation of a predictive score of the positive or negative test. RESULTS Between September 20th and December 23rd 2020, from 1484 children included in the study, 127 (8.6%) tested positive. In the multivariate analysis, the variables retained by the model were the presence of contact with a cohabiting, non-cohabiting or unspecified symptomatic case (respectively OR 37.2, 95% CI 20.1-68.7; 5.1, 95% CI 2.7-9.6; 15.6, 95% CI 7.3-33.2); female sex (OR 1.49, 95% CI 1.0-2.3); age (6-10 years old: OR 3.2, 95% CI 1.7-6.1 p<0.001; >10 years old: OR 4.8, 95% CI 2.7-8.8 p<0.001); fever (OR 3.9, 95% CI 2.3-6.4); chills (OR 1.9, 95% CI 1.1-3.3); headache (OR 1.45, 95% CI 0.9-2.4); ageusia (OR 1.3, 95% CI 0.5-4.0); sore throat (OR 0.48, 95% CI 0.3-0.8); earache (OR 0.4, 95% CI 0.1-1.3); rhinorrhoea (OR 0.8, 95% CI 0.5-1.3); and diarrhoea (OR 0.52, 95% CI 0.2-1.1). The predictive score based on these variables generated 93% sensitivity and 99% negative predictive value. CONCLUSIONS The timely identification of SARS-CoV2 cases among children is useful to reduce the dissemination of the disease and its related burden. The predictive score may be adopted in a public health perspective to rapidly identify at risk children.
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Affiliation(s)
- Benedetta Armocida
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Elena Magni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Manola Comar
- Unit of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Nunzia Zanotta
- Unit of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Carolina Cason
- Unit of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giorgia Argentini
- Medical Direction, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marianela Urriza
- Medical Direction, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Andrea Cassone
- Health Professions Direction, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Fulvia Vascotto
- Health Professions Direction, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Department of Pediatrics, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Paola Pani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Alessandra Knowles
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Claudia Carletti
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Federica Concina
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Mariarosa Milinco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Trieste, Italy
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Saad Menezes MC, Santinelli Pestana DV, Ferreira JC, Ribeiro de Carvalho CR, Felix MC, Marcilio IO, da Silva KR, Junior VC, Marchini JF, Alencar JC, Gomez LMG, Mauá DD, Souza HP. Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test. Viruses 2022; 14:v14020175. [PMID: 35215772 PMCID: PMC8874612 DOI: 10.3390/v14020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/08/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023] Open
Abstract
Identification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (−) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(−) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).
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Affiliation(s)
- Maria Clara Saad Menezes
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
- Correspondence:
| | - Diego Vinicius Santinelli Pestana
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Juliana Carvalho Ferreira
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Carlos Roberto Ribeiro de Carvalho
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Marcelo Consorti Felix
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Izabel Oliva Marcilio
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Katia Regina da Silva
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Vilson Cobello Junior
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Julio Flavio Marchini
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Julio Cesar Alencar
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Luz Marina Gomez Gomez
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Denis Deratani Mauá
- Institute of Mathematics and Statistics, Universidade de São Paulo, São Paulo 05508-090, Brazil;
| | - Heraldo Possolo Souza
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Emergency USP COVID-19 Group
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - HCFMUSP COVID-19 Study Group
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
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Halperin SA, Ye L, MacKinnon-Cameron D, Smith B, Cahn PE, Ruiz-Palacios GM, Ikram A, Lanas F, Lourdes Guerrero M, Muñoz Navarro SR, Sued O, Lioznov DA, Dzutseva V, Parveen G, Zhu F, Leppan L, Langley JM, Barreto L, Gou J, Zhu T. Final efficacy analysis, interim safety analysis, and immunogenicity of a single dose of recombinant novel coronavirus vaccine (adenovirus type 5 vector) in adults 18 years and older: an international, multicentre, randomised, double-blinded, placebo-controlled phase 3 trial. Lancet 2022; 399:237-248. [PMID: 34953526 PMCID: PMC8700283 DOI: 10.1016/s0140-6736(21)02753-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Ad5-nCoV vaccine is a single-dose adenovirus type 5 (Ad5) vectored vaccine expressing the SARS-CoV-2 spike protein that was well-tolerated and immunogenic in phase 1 and 2 studies. In this study, we report results on the final efficacy and interim safety analyses of the phase 3 trial. METHODS This double-blind, randomised, international, placebo-controlled, endpoint-case driven, phase 3, clinical trial enrolled adults aged 18 years older at study centres in Argentina, Chile, Mexico, Pakistan, and Russia. Participants were eligible for the study if they had no unstable or severe underlying medical or psychiatric conditions; had no history of a laboratory-confirmed SARS-CoV-2 infection; were not pregnant or breastfeeding; and had no previous receipt of an adenovirus-vectored, coronavirus, or SARS-CoV-2 vaccine. After informed consent was obtained, 25 mL of whole blood was withdrawn from all eligible participants who were randomised in a 1:1 ratio to receive a single intramuscular dose of 0·5 mL placebo or a 0·5 mL dose of 5 × 1010 viral particle (vp)/mL Ad5-nCoV vaccine; study staff and participants were blinded to treatment allocation. All participants were contacted weekly by email, telephone, or text message to self-report any symptoms of COVID-19 illness, and laboratory testing for SARS-CoV-2 was done for all participants with any symptoms. The primary efficacy objective evaluated Ad5-nCoV in preventing symptomatic, PCR-confirmed COVID-19 infection occurring at least 28 days after vaccination in all participants who were at least 28 days postvaccination on Jan 15, 2021. The primary safety objective evaluated the incidence of any serious adverse events or medically attended adverse events postvaccination in all participants who received a study injection. This trial is closed for enrolment and is registered with ClinicalTrials.gov (NCT04526990). FINDINGS Study enrolment began on Sept 22, 2020, in Pakistan, Nov 6, 2020, in Mexico, Dec 2, 2020, in Russia and Chile, and Dec 17, 2020, in Argentina; 150 endpoint cases were reached on Jan 15, 2021, triggering the final primary efficacy analysis. One dose of Ad5-nCoV showed a 57·5% (95% CI 39·7-70·0, p=0·0026) efficacy against symptomatic, PCR-confirmed, COVID-19 infection at 28 days or more postvaccination (21 250 participants; 45 days median duration of follow-up [IQR 36-58]). In the primary safety analysis undertaken at the time of the efficacy analysis (36 717 participants), there was no significant difference in the incidence of serious adverse events (14 [0·1%] of 18 363 Ad5-nCoV recipients and 10 [0·1%] of 18 354 placebo recipients, p=0·54) or medically attended adverse events (442 [2·4%] of 18 363 Ad5-nCoV recipients and 411 [2·2%] of 18 354 placebo recipients, p=0·30) between the Ad5-nCoV or placebo groups, or any serious adverse events considered related to the study product (none in both Ad5-nCoV and placebo recipients). In the extended safety cohort, 1004 (63·5%) of 1582 of Ad5-nCoV recipients and 729 (46·4%) of 1572 placebo recipients reported a solicited systemic adverse event (p<0·0001), of which headache was the most common (699 [44%] of Ad5-nCoV recipients and 481 [30·6%] of placebo recipients; p<0·0001). 971 (61·3%) of 1584 Ad5-nCoV recipients and 314 (20·0%) of 1573 placebo recipients reported an injection-site adverse event (p<0·0001), of which pain at the injection site was the most frequent; reported by 939 (59%) Ad5-nCoV recipients and 303 (19%) placebo recipients. INTERPRETATION One dose of Ad5-nCoV is efficacious and safe in healthy adults aged 18 years and older. FUNDING CanSino Biologics and the Beijing Institute of Biotechnology.
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada.
| | - Lingyun Ye
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | - Bruce Smith
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | | | | | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Dmitry A Lioznov
- Federal State Budgetary Institution, Smorodintsev Research Institute of Influenza, St Petersburg, Russia
| | | | | | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Laura Leppan
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | | | | | - Tao Zhu
- CanSino Biologics, Tianjin, China
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5
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Satlin MJ, Zucker J, Baer BR, Rajan M, Hupert N, Schang LM, Pinheiro LC, Shen Y, Sobieszczyk ME, Westblade LF, Goyal P, Wells MT, Sepulveda JL, Safford MM. Changes in SARS-CoV-2 viral load and mortality during the initial wave of the pandemic in New York City. PLoS One 2021; 16:e0257979. [PMID: 34797838 PMCID: PMC8604305 DOI: 10.1371/journal.pone.0257979] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
Public health interventions such as social distancing and mask wearing decrease the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they decrease the viral load of infected patients and whether changes in viral load impact mortality from coronavirus disease 2019 (COVID-19). We evaluated 6923 patients with COVID-19 at six New York City hospitals from March 15-May 14, 2020, corresponding with the implementation of public health interventions in March. We assessed changes in cycle threshold (CT) values from reverse transcription-polymerase chain reaction tests and in-hospital mortality and modeled the impact of viral load on mortality. Mean CT values increased between March and May, with the proportion of patients with high viral load decreasing from 47.7% to 7.8%. In-hospital mortality increased from 14.9% in March to 28.4% in early April, and then decreased to 8.7% by May. Patients with high viral loads had increased mortality compared to those with low viral loads (adjusted odds ratio 2.34). If viral load had not declined, an estimated 69 additional deaths would have occurred (5.8% higher mortality). SARS-CoV-2 viral load steadily declined among hospitalized patients in the setting of public health interventions, and this correlated with decreases in mortality.
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Affiliation(s)
- Michael J. Satlin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
- * E-mail:
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Benjamin R. Baer
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, United States of America
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States of America
- Cornell Institute for Disease and Disaster Preparedness, New York, New York, United States of America
| | - Luis M. Schang
- College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Yanhan Shen
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, United States of America
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lars F. Westblade
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Martin T. Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, United States of America
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, United States of America
| | - Jorge L. Sepulveda
- Department of Pathology, George Washington University, Washington, DC, United States of America
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
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6
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Rodriguez-Paredes MB, Vallejo-Janeta PA, Morales-Jadan D, Freire-Paspuel B, Ortiz-Prado E, Henriquez-Trujillo AR, Rivera-Olivero IA, Jaramillo T, Lozada T, Garcia-Bereguiain MA. COVID-19 Community Transmission and Super Spreaders in Rural Villages from Manabi Province in the Coastal Region of Ecuador Assessed by Massive Testing of Community-Dwelling Population. Am J Trop Med Hyg 2021; 106:121-126. [PMID: 34788738 PMCID: PMC8733526 DOI: 10.4269/ajtmh.21-0582] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Neglected rural communities in Latin America are highly vulnerable to COVID-19 due to a poor health infrastructure and limited access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Manabí is a province of the Coastal Region of Ecuador characterized by a high prevalence of rural population living under poverty conditions. In the current study, we present the retrospective analysis of the results of a massive SARS-CoV-2 testing operation in nonhospitalized populations from Manabí carried out from August to September 2020. A total of 4,003 people from 15 cantons were tested for SARS-CoV-2 by reverse-transcriptase quantitative polymerase chain reaction, resulting in an overall infection rate of 16.13% for SARS-CoV-2, with several communities > 30%. Moreover, 29 SARS-CoV-2 super-spreader community-dwelling individuals with viral loads above 108 copies/mL were found. These results support that uncontrolled COVID-19 community transmission was happening in Manabí during the first semester of COVID-19 pandemic. This report endorses the utility of massive SARS-CoV-2 testing among asymptomatic population for control and surveillance of COVID-19.
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Affiliation(s)
- Maria Belén Rodriguez-Paredes
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
- “UDLA-COVID-19 Team,” Universidad de Las Américas, Quito, Ecuador
| | - Paolo Alexander Vallejo-Janeta
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
- “UDLA-COVID-19 Team,” Universidad de Las Américas, Quito, Ecuador
| | | | | | | | | | | | | | - Tannya Lozada
- Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Miguel Angel Garcia-Bereguiain
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
- Address correspondence to Miguel Angel Garcia-Bereguiain, One Health Research Group, Universidad de Las Américas, Quito, Ecuador. E-mail:
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Bager P, Wohlfahrt J, Fonager J, Rasmussen M, Albertsen M, Michaelsen TY, Møller CH, Ethelberg S, Legarth R, Button MSF, Gubbels S, Voldstedlund M, Mølbak K, Skov RL, Fomsgaard A, Krause TG. Risk of hospitalisation associated with infection with SARS-CoV-2 lineage B.1.1.7 in Denmark: an observational cohort study. Lancet Infect Dis 2021; 21:1507-1517. [PMID: 34171231 PMCID: PMC8219488 DOI: 10.1016/s1473-3099(21)00290-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The more infectious SARS-CoV-2 lineage B.1.1.7 rapidly spread in Europe after December, 2020, and a concern that B.1.1.7 could cause more severe disease has been raised. Taking advantage of Denmark's high RT-PCR testing and whole genome sequencing capacities, we used national health register data to assess the risk of COVID-19 hospitalisation in individuals infected with B.1.1.7 compared with those with other SARS-CoV-2 lineages. METHODS We did an observational cohort study of all SARS-CoV-2-positive cases confirmed by RT-PCR in Denmark, sampled between Jan 1 and March 24, 2021, with 14 days of follow-up for COVID-19 hospitalisation. Cases were identified in the national COVID-19 surveillance system database, which includes data from the Danish Microbiology Database (RT-PCR test results), the Danish COVID-19 Genome Consortium, the National Patient Registry, the Civil Registration System, as well as other nationwide registers. Among all cases, COVID-19 hospitalisation was defined as first admission lasting longer than 12 h within 14 days of a sample with a positive RT-PCR result. The study population and main analysis were restricted to the proportion of cases with viral genome data. We calculated the risk ratio (RR) of admission according to infection with B.1.1.7 versus other co-existing lineages with a Poisson regression model with robust SEs, adjusted a priori for sex, age, calendar time, region, and comorbidities. The contribution of each covariate to confounding of the crude RR was evaluated afterwards by a stepwise forward inclusion. FINDINGS Between Jan 1 and March 24, 2021, 50 958 individuals with a positive SARS-CoV-2 test and at least 14 days of follow-up for hospitalisation were identified; 30 572 (60·0%) had genome data, of whom 10 544 (34·5%) were infected with B.1.1.7. 1944 (6·4%) individuals had a COVID-19 hospitalisation and of these, 571 (29·4%) had a B.1.1.7 infection and 1373 (70·6%) had an infection with other SARS-CoV-2 lineages. Although the overall number of hospitalisations decreased during the study period, the proportion of individuals infected with B.1.1.7 increased from 3·5% to 92·1% per week. B.1.1.7 was associated with a crude RR of hospital admission of 0·79 (95% CI 0·72-0·87; p<0·0001) and an adjusted RR of 1·42 (95% CI 1·25-1·60; p<0·0001). The adjusted RR was increased in all strata of age and calendar period-the two covariates with the largest contribution to confounding of the crude RR. INTERPRETATION Infection with SARS-CoV-2 lineage B.1.1.7 was associated with an increased risk of hospitalisation compared with that of other lineages in an analysis adjusted for covariates. The overall effect on hospitalisations in Denmark was lessened due to a strict lockdown, but our findings could support hospital preparedness and modelling of the projected impact of the epidemic in countries with uncontrolled spread of B.1.1.7. FUNDING None.
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Affiliation(s)
- Peter Bager
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jannik Fonager
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Rasmussen
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Mads Albertsen
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | | | - Camilla Holten Møller
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Ethelberg
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Rebecca Legarth
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Sophie Gubbels
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Kåre Mølbak
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark; Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert Leo Skov
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Fomsgaard
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra Grove Krause
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
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Reddy MM, Zaman K, Mishra SK, Yadav P, Kant R. Differences in age distribution in first and second waves of COVID-19 in eastern Uttar Pradesh, India. Diabetes Metab Syndr 2021; 15:102327. [PMID: 34731821 PMCID: PMC8556065 DOI: 10.1016/j.dsx.2021.102327] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 01/11/2023]
Abstract
Comparison of first and second waves of Coronavirus disease (COVID-19) showed varied differences including the peak and time distribution. Contrary to published reports of comparing two waves in India wherein the younger age group was affected more in the second wave in India; a secondary data analysis of around 0.5 million real-time reverse transcription-polymerase chain reaction tests conducted in COVID-19 diagnostic laboratory in eastern Uttar Pradesh, India showed an increase in positivity rate in older age groups in the second wave. The positivity rate among symptomatic cases was found to be three times higher in second wave compare to the first wave. Higher positivity rates were seen across older age groups, with a shift of 11 years in the mean age of positivity in the second wave compared to the first.
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Affiliation(s)
- Mahendra M Reddy
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, Uttar Pradesh, India.
| | - Kamran Zaman
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, Uttar Pradesh, India.
| | - Shailendra Kumar Mishra
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, Uttar Pradesh, India.
| | - Priyanka Yadav
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, Uttar Pradesh, India.
| | - Rajni Kant
- Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur, Uttar Pradesh, India.
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9
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Hyams C, Marlow R, Maseko Z, King J, Ward L, Fox K, Heath R, Tuner A, Friedrich Z, Morrison L, Ruffino G, Antico R, Adegbite D, Szasz-Benczur Z, Garcia Gonzalez M, Oliver J, Danon L, Finn A. Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalisations in people aged at least 80 years: a test-negative, case-control study. Lancet Infect Dis 2021; 21:1539-1548. [PMID: 34174190 PMCID: PMC8221734 DOI: 10.1016/s1473-3099(21)00330-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND On Dec 8, 2020, deployment of the first SARS-CoV-2 vaccination authorised for UK use (BNT162b2 mRNA vaccine) began, followed by an adenoviral vector vaccine ChAdOx1 nCoV-19 on Jan 4, 2021. Care home residents and staff, frontline health-care workers, and adults aged 80 years and older were vaccinated first. However, few data exist regarding the effectiveness of these vaccines in older people with many comorbidities. In this post-implementation evaluation of two COVID-19 vaccines, we aimed to determine the effectiveness of one dose in reducing COVID-19-related admissions to hospital in people of advanced age. METHODS This prospective test-negative case-control study included adults aged at least 80 years who were admitted to hospital in two NHS trusts in Bristol, UK with signs and symptoms of respiratory disease. Patients who developed symptoms before receiving their vaccine or those who received their vaccine after admission to hospital were excluded, as were those with symptoms that started more than 10 days before hospital admission. We did logistic regression analysis, controlling for time (week), sex, index of multiple deprivations, and care residency status, and sensitivity analyses matched for time and sex using a conditional logistic model adjusting for index of multiple deprivations and care residency status. This study is registered with ISRCTN, number 39557. FINDINGS Between Dec 18, 2020, and Feb 26, 2021, 466 adults were eligible (144 test-positive and 322 test-negative). 18 (13%) of 135 people with SARS-CoV-2 infection and 90 (34%) of 269 controls received one dose of BNT162b2. The adjusted vaccine effectiveness was 71·4% (95% CI 46·5-90·6). Nine (25%) of 36 people with COVID-19 infection and 53 (59%) of 90 controls received one dose of ChAdOx1 nCoV-19. The adjusted vaccine effectiveness was 80·4% (95% CI 36·4-94·5). When BNT162b2 effectiveness analysis was restricted to the period covered by ChAdOx1 nCoV-19, the estimate was 79·3% (95% CI 47·0-92·5). INTERPRETATION One dose of either BNT162b2 or ChAdOx1 nCoV-19 resulted in substantial risk reductions of COVID-19-related hospitalisation in people aged at least 80 years. FUNDING Pfizer.
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Affiliation(s)
- Catherine Hyams
- Population Health Sciences, University of Bristol, Bristol, UK; Academic Respiratory Unit, Southmead Hospital, Bristol, UK
| | - Robin Marlow
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Zandile Maseko
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
| | - Jade King
- Clinical Research and Imaging Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lana Ward
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Kazminder Fox
- Clinical Research and Imaging Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Robyn Heath
- Clinical Research and Imaging Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Anabella Tuner
- Clinical Research and Imaging Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Leigh Morrison
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | | | - Rupert Antico
- Population Health Sciences, University of Bristol, Bristol, UK
| | - David Adegbite
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Jennifer Oliver
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Leon Danon
- Engineering Mathematics, University of Bristol, Bristol, UK
| | - Adam Finn
- Population Health Sciences, University of Bristol, Bristol, UK; Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
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10
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Shrotri M, Krutikov M, Palmer T, Giddings R, Azmi B, Subbarao S, Fuller C, Irwin-Singer A, Davies D, Tut G, Lopez Bernal J, Moss P, Hayward A, Copas A, Shallcross L. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. Lancet Infect Dis 2021; 21:1529-1538. [PMID: 34174193 PMCID: PMC8221738 DOI: 10.1016/s1473-3099(21)00289-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effectiveness of SARS-CoV-2 vaccines in older adults living in long-term care facilities is uncertain. We investigated the protective effect of the first dose of the Oxford-AstraZeneca non-replicating viral-vectored vaccine (ChAdOx1 nCoV-19; AZD1222) and the Pfizer-BioNTech mRNA-based vaccine (BNT162b2) in residents of long-term care facilities in terms of PCR-confirmed SARS-CoV-2 infection over time since vaccination. METHODS The VIVALDI study is a prospective cohort study that commenced recruitment on June 11, 2020, to investigate SARS-CoV-2 transmission, infection outcomes, and immunity in residents and staff in long-term care facilities in England that provide residential or nursing care for adults aged 65 years and older. In this cohort study, we included long-term care facility residents undergoing routine asymptomatic SARS-CoV-2 testing between Dec 8, 2020 (the date the vaccine was first deployed in a long-term care facility), and March 15, 2021, using national testing data linked within the COVID-19 Datastore. Using Cox proportional hazards regression, we estimated the relative hazard of PCR-positive infection at 0-6 days, 7-13 days, 14-20 days, 21-27 days, 28-34 days, 35-48 days, and 49 days and beyond after vaccination, comparing unvaccinated and vaccinated person-time from the same cohort of residents, adjusting for age, sex, previous infection, local SARS-CoV-2 incidence, long-term care facility bed capacity, and clustering by long-term care facility. We also compared mean PCR cycle threshold (Ct) values for positive swabs obtained before and after vaccination. The study is registered with ISRCTN, number 14447421. FINDINGS 10 412 care home residents aged 65 years and older from 310 LTCFs were included in this analysis. The median participant age was 86 years (IQR 80-91), 7247 (69·6%) of 10 412 residents were female, and 1155 residents (11·1%) had evidence of previous SARS-CoV-2 infection. 9160 (88·0%) residents received at least one vaccine dose, of whom 6138 (67·0%) received ChAdOx1 and 3022 (33·0%) received BNT162b2. Between Dec 8, 2020, and March 15, 2021, there were 36 352 PCR results in 670 628 person-days, and 1335 PCR-positive infections (713 in unvaccinated residents and 612 in vaccinated residents) were included. Adjusted hazard ratios (HRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days after the first vaccine dose to 0·44 (95% CI 0·24-0·81) at 28-34 days and 0·38 (0·19-0·77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (adjusted HR 0·32, 95% CI 0·15-0·66) and BNT162b2 (0·35, 0·17-0·71) vaccines at 35-48 days. Mean PCR Ct values were higher for infections that occurred at least 28 days after vaccination than for those occurring before vaccination (31·3 [SD 8·7] in 107 PCR-positive tests vs 26·6 [6·6] in 552 PCR-positive tests; p<0·0001). INTERPRETATION Single-dose vaccination with BNT162b2 and ChAdOx1 vaccines provides substantial protection against infection in older adults from 4-7 weeks after vaccination and might reduce SARS-CoV-2 transmission. However, the risk of infection is not eliminated, highlighting the ongoing need for non-pharmaceutical interventions to prevent transmission in long-term care facilities. FUNDING UK Government Department of Health and Social Care.
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Affiliation(s)
- Madhumita Shrotri
- UCL Institute of Health Informatics, UCL, London, UK; Public Health England, London, UK
| | | | - Tom Palmer
- UCL Institute for Global Health, UCL, London, UK
| | | | - Borscha Azmi
- UCL Institute of Health Informatics, UCL, London, UK
| | | | | | | | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology & Healthcare, UCL, London, UK; Health Data Research UK, London, UK
| | - Andrew Copas
- UCL Institute for Global Health, UCL, London, UK
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11
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Shrotri M, Krutikov M, Palmer T, Giddings R, Azmi B, Subbarao S, Fuller C, Irwin-Singer A, Davies D, Tut G, Lopez Bernal J, Moss P, Hayward A, Copas A, Shallcross L. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. Lancet Infect Dis 2021. [PMID: 34174193 DOI: 10.1101/2021.03.26.21254391] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The effectiveness of SARS-CoV-2 vaccines in older adults living in long-term care facilities is uncertain. We investigated the protective effect of the first dose of the Oxford-AstraZeneca non-replicating viral-vectored vaccine (ChAdOx1 nCoV-19; AZD1222) and the Pfizer-BioNTech mRNA-based vaccine (BNT162b2) in residents of long-term care facilities in terms of PCR-confirmed SARS-CoV-2 infection over time since vaccination. METHODS The VIVALDI study is a prospective cohort study that commenced recruitment on June 11, 2020, to investigate SARS-CoV-2 transmission, infection outcomes, and immunity in residents and staff in long-term care facilities in England that provide residential or nursing care for adults aged 65 years and older. In this cohort study, we included long-term care facility residents undergoing routine asymptomatic SARS-CoV-2 testing between Dec 8, 2020 (the date the vaccine was first deployed in a long-term care facility), and March 15, 2021, using national testing data linked within the COVID-19 Datastore. Using Cox proportional hazards regression, we estimated the relative hazard of PCR-positive infection at 0-6 days, 7-13 days, 14-20 days, 21-27 days, 28-34 days, 35-48 days, and 49 days and beyond after vaccination, comparing unvaccinated and vaccinated person-time from the same cohort of residents, adjusting for age, sex, previous infection, local SARS-CoV-2 incidence, long-term care facility bed capacity, and clustering by long-term care facility. We also compared mean PCR cycle threshold (Ct) values for positive swabs obtained before and after vaccination. The study is registered with ISRCTN, number 14447421. FINDINGS 10 412 care home residents aged 65 years and older from 310 LTCFs were included in this analysis. The median participant age was 86 years (IQR 80-91), 7247 (69·6%) of 10 412 residents were female, and 1155 residents (11·1%) had evidence of previous SARS-CoV-2 infection. 9160 (88·0%) residents received at least one vaccine dose, of whom 6138 (67·0%) received ChAdOx1 and 3022 (33·0%) received BNT162b2. Between Dec 8, 2020, and March 15, 2021, there were 36 352 PCR results in 670 628 person-days, and 1335 PCR-positive infections (713 in unvaccinated residents and 612 in vaccinated residents) were included. Adjusted hazard ratios (HRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days after the first vaccine dose to 0·44 (95% CI 0·24-0·81) at 28-34 days and 0·38 (0·19-0·77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (adjusted HR 0·32, 95% CI 0·15-0·66) and BNT162b2 (0·35, 0·17-0·71) vaccines at 35-48 days. Mean PCR Ct values were higher for infections that occurred at least 28 days after vaccination than for those occurring before vaccination (31·3 [SD 8·7] in 107 PCR-positive tests vs 26·6 [6·6] in 552 PCR-positive tests; p<0·0001). INTERPRETATION Single-dose vaccination with BNT162b2 and ChAdOx1 vaccines provides substantial protection against infection in older adults from 4-7 weeks after vaccination and might reduce SARS-CoV-2 transmission. However, the risk of infection is not eliminated, highlighting the ongoing need for non-pharmaceutical interventions to prevent transmission in long-term care facilities. FUNDING UK Government Department of Health and Social Care.
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Affiliation(s)
- Madhumita Shrotri
- UCL Institute of Health Informatics, UCL, London, UK; Public Health England, London, UK
| | | | - Tom Palmer
- UCL Institute for Global Health, UCL, London, UK
| | | | - Borscha Azmi
- UCL Institute of Health Informatics, UCL, London, UK
| | | | | | | | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology & Healthcare, UCL, London, UK; Health Data Research UK, London, UK
| | - Andrew Copas
- UCL Institute for Global Health, UCL, London, UK
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12
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Nakagama Y, Komase Y, Candray K, Nakagama S, Sano F, Tsuchida T, Kunishima H, Imai T, Shintani A, Nitahara Y, Kaku N, Kido Y. Serological Testing Reveals the Hidden COVID-19 Burden among Health Care Workers Experiencing a SARS-CoV-2 Nosocomial Outbreak. Microbiol Spectr 2021; 9:e0108221. [PMID: 34550021 PMCID: PMC8557877 DOI: 10.1128/spectrum.01082-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022] Open
Abstract
We describe the results of testing health care workers, from a tertiary care hospital in Japan that had experienced a coronavirus disease 2019 (COVID-19) outbreak during the first peak of the pandemic, for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody seroconversion. Using two chemiluminescent immunoassays and a confirmatory surrogate virus neutralization test, serological testing revealed that a surprising 42% of overlooked COVID-19 diagnoses (27/64 cases) occurred when case detection relied solely on SARS-CoV-2 nucleic acid amplification testing (NAAT). Our results suggest that the NAAT-positive population is only the tip of the iceberg and the portion left undetected might potentially have led to silent transmissions and triggered the spread. A questionnaire-based risk assessment was further indicative of exposures to specific aerosol-generating procedures (i.e., noninvasive ventilation and airway suctioning) having mediated transmission and served as the origins of the outbreak. Our observations are supportive of a multitiered testing approach, including the use of serological diagnostics, in order to accomplish exhaustive case detection along the whole COVID-19 spectrum. IMPORTANCE We describe the results of testing frontline health care workers, from a hospital in Japan that had experienced a COVID-19 outbreak, for SARS-CoV-2-specific antibodies. Antibody testing revealed that a surprising 42% of overlooked COVID-19 diagnoses occurred when case detection relied solely on PCR-based viral detection. COVID-19 clusters have been continuously striking the health care system around the globe. Our findings illustrate that such clusters are lined with hidden infections eluding detection with diagnostic PCR and that the cluster burden in total is more immense than actually recognized. The mainstays of diagnosing infectious diseases, including COVID-19, generally consist of two approaches, one aiming to detect molecular fragments of the invading pathogen and the other to measure immune responses of the host. Considering antibody testing as one trustworthy option to test our way through the pandemic can aid in the exhaustive case detection of COVID-19 patients with variable presentations.
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Affiliation(s)
- Yu Nakagama
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yuko Komase
- Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Katherine Candray
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Sachie Nakagama
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Fumiaki Sano
- Department of Hematology and Oncology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Tomoya Tsuchida
- Division of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yuko Nitahara
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Natsuko Kaku
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasutoshi Kido
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
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13
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Miller EM, Law EA, Ajeen R, Karasik J, Mendoza C, Abernathy H, Garrett H, King E, Wallace J, Zelek M, Edwards JK, Xiong K, Beatty C, Fleischauer AT, Ciccone EJ, Shook-Sa BE, Aiello AE, Boyce RM. SARS-CoV-2 infection in central North Carolina: Protocol for a population-based longitudinal cohort study and preliminary participant results. PLoS One 2021; 16:e0259070. [PMID: 34695156 PMCID: PMC8544868 DOI: 10.1371/journal.pone.0259070] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
Public health surveillance systems likely underestimate the true prevalence and incidence of SARS-CoV-2 infection due to limited access to testing and the high proportion of subclinical infections in community-based settings. This ongoing prospective, observational study aimed to generate accurate estimates of the prevalence and incidence of, and risk factors for, SARS-CoV-2 infection among residents of a central North Carolina county. From this cohort, we collected survey data and nasal swabs every two weeks and venous blood specimens every month. Nasal swabs were tested for the presence of SARS-CoV-2 virus (evidence of active infection), and serum specimens for SARS-CoV-2-specific antibodies (evidence of prior infection). As of June 23, 2021, we have enrolled a total of 153 participants from a county with an estimated 76,285 total residents. The anticipated study duration is at least 24 months, pending the evolution of the pandemic. Study data are being shared on a monthly basis with North Carolina state health authorities and future analyses aim to compare study data to state-wide metrics over time. Overall, the use of a probability-based sampling design and a well-characterized cohort will enable collection of critical data that can be used in planning and policy decisions for North Carolina and may be informative for other states with similar demographic characteristics.
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Affiliation(s)
- Elyse M. Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Elle A. Law
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Rawan Ajeen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jaclyn Karasik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Carmen Mendoza
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Haley Abernathy
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Haley Garrett
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Elise King
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - John Wallace
- North Carolina Institute of Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Michael Zelek
- Chatham County Public Health Department, Pittsboro, NC, United States of America
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Khou Xiong
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Cherese Beatty
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Aaron T. Fleischauer
- Division of State and Local Readiness, United States Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Epidemiology Branch, North Carolina Department of Health and Human Services, Raleigh, NC, United States of America
| | - Emily J. Ciccone
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Bonnie E. Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ross M. Boyce
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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14
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Feitosa NM, da Costa Rodrigues B, Petry AC, Nocchi KJCV, de Moraes Brindeiro R, Zilberberg C, Monteiro-de-Barros C, Mury FB, de Souza-Menezes J, Nepomuceno-Silva JL, da Silva ML, de Medeiros MJ, de Souza Gestinari R, da Silva de Alvarenga A, Pozzobon APB, Silva CAO, das Graças Dos Santos D, Silvestre DH, de Sousa GF, de Almeida JF, da Silva JN, Brandão LM, de Oliveira Drummond L, Neto LRG, de Mello Carpes R, Dos Santos RC, Portal TM, Tanuri A, Nunes-da-Fonseca R. Molecular testing and analysis of disease spreading during the emergence of COVID-19 in Macaé, the Brazilian National Capital of Oil. Sci Rep 2021; 11:20121. [PMID: 34635707 PMCID: PMC8505656 DOI: 10.1038/s41598-021-99475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/12/2021] [Accepted: 09/21/2021] [Indexed: 01/12/2023] Open
Abstract
The Brazilian strategy to overcome the spread of COVID-19 has been particularly criticized due to the lack of a national coordinating effort and an appropriate testing program. Here, a successful approach to control the spread of COVID-19 transmission is described by the engagement of public (university and governance) and private sectors (hospitals and oil companies) in Macaé, state of Rio de Janeiro, Brazil, a city known as the National Oil Capital. In 2020 between the 17th and 38th epidemiological week, over two percent of the 206,728 citizens were subjected to symptom analysis and RT-qPCR testing by the Federal University of Rio de Janeiro, with positive individuals being notified up to 48 h after swab collection. Geocodification and spatial cluster analysis were used to limit COVID-19 spreading in Macaé. Within the first semester after the outbreak of COVID-19 in Brazil, Macaé recorded 1.8% of fatalities associated with COVID-19 up to the 38th epidemiological week, which was at least five times lower than the state capital (10.6%). Overall, considering the successful experience of this joint effort of private and public engagement in Macaé, our data suggest that the development of a similar strategy countrywise could have contributed to a better control of the COVID-19 spread in Brazil. Quarantine decree by the local administration, comprehensive molecular testing coupled to scientific analysis of COVID-19 spreading, prevented the catastrophic consequences of the pandemic as seen in other populous cities within the state of Rio de Janeiro and elsewhere in Brazil.
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Affiliation(s)
- Natália Martins Feitosa
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Bruno da Costa Rodrigues
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Ana Cristina Petry
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Keity Jaqueline Chagas Vilela Nocchi
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Rodrigo de Moraes Brindeiro
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-902, Brazil
| | - Carla Zilberberg
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Cintia Monteiro-de-Barros
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Flavia Borges Mury
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Jackson de Souza-Menezes
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - José Luciano Nepomuceno-Silva
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Manuela Leal da Silva
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Marcio José de Medeiros
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Raquel de Souza Gestinari
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Alessandra da Silva de Alvarenga
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Allan Pierre Bonetti Pozzobon
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Carina Azevedo Oliveira Silva
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Daniele das Graças Dos Santos
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Diego Henrique Silvestre
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Graziele Fonseca de Sousa
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Janimayri Forastieri de Almeida
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Jhenifer Nascimento da Silva
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Layza Mendes Brandão
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Leandro de Oliveira Drummond
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Lupis Ribeiro Gomes Neto
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Raphael de Mello Carpes
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Renata Coutinho Dos Santos
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Taynan Motta Portal
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-902, Brazil.
| | - Rodrigo Nunes-da-Fonseca
- Instituto de Biodiversidade e Sustentabilidade-NUPEM, Universidade Federal do Rio de Janeiro (UFRJ), Av. São José do Barreto 764, Macaé, 27965-550, Brazil.
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15
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Sweeney-Reed CM, Wolff D, Hörnschemeyer S, Faßhauer H, Haase A, Schomburg D, Niggel J, Kabesch M, Apfelbacher C. Feasibility of a surveillance programme based on gargle samples and pool testing to prevent SARS-CoV-2 outbreaks in schools. Sci Rep 2021; 11:19521. [PMID: 34593887 PMCID: PMC8484445 DOI: 10.1038/s41598-021-98849-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/27/2021] [Accepted: 09/15/2021] [Indexed: 01/12/2023] Open
Abstract
School closures have a negative impact on physical and mental well-being, and education, of children and adolescents. A surveillance programme to detect asymptomatic SARS-CoV-2 infection could allow schools to remain open, while protecting the vulnerable. We assessed the feasibility of a programme employing gargle samples and pool testing of individually extracted RNA using rRT-qPCR in a primary and a secondary school in Germany, based on programme logistics and acceptance. Twice a week, five participants per class were selected to provide samples, using an algorithm weighted by a risk-based priority score to increase likelihood of case detection. The positive response rate was 54.8% (550 of 1003 pupils). Logistics evaluation revealed the rate-limiting steps: completing the regular pre-test questionnaire and handing in the samples. Acceptance questionnaire responses indicated strong support for research into developing a surveillance programme and a positive evaluation of gargle tests. Participation was voluntary. As not all pupils participated, individual reminders could lead to participant identification. School-wide implementation of the programme for infection monitoring purposes would enable reminders to be given to all school pupils to address these steps, without compromising participant anonymity. Such a programme would provide a feasible means to monitor asymptomatic respiratory tract infection in schools.
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Affiliation(s)
- Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Dept. of Neurology, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Germany.
- Center for Behavioral Brain Sciences, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Doreen Wolff
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Sarah Hörnschemeyer
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Henriette Faßhauer
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Antonia Haase
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Schomburg
- Institute of Biometry und Medical Informatics (IBMI), Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jakob Niggel
- University of Regensburg, Regensburg, Germany
- MaganaMed GmbH, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
- Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John and University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John and University of Regensburg, Regensburg, Germany
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16
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Antwi-Amoabeng D, Beutler BD, Chahal G, Mahboob S, Gullapalli N, Tedja R, Madhani-Lovely F, Rowan C. Ensuring trust in COVID-19 data: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26972. [PMID: 34477127 PMCID: PMC8415935 DOI: 10.1097/md.0000000000026972] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 08/01/2021] [Indexed: 01/05/2023] Open
Abstract
There are no standardized methods for collecting and reporting coronavirus disease-2019 (COVID-19) data. We aimed to compare the proportion of patients admitted for COVID-19-related symptoms and those admitted for other reasons who incidentally tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Retrospective cohort studyData were sampled twice weekly between March 26 and June 6, 2020 from a "COVID-19 dashboard," a system-wide administrative database that includes the number of hospitalized patients with a positive SARS-CoV-2 polymerase chain reaction test. Patient charts were subsequently reviewed and the principal reason for hospitalization abstracted.Data collected during a statewide lockdown revealed that 92 hospitalized patients had positive SARS-CoV-2 test results. Among these individuals, 4.3% were hospitalized for reasons other than COVID-19-related symptoms but were incidentally found to be SARS-CoV-2-positive. After the lockdown was suspended, the total inpatient census of SARS-CoV-2-positive patients increased to 128, 20.3% of whom were hospitalized for non-COVID-19-related complaints.In the absence of a statewide lockdown, there was a significant increase in the proportion of patients admitted for non-COVID-19-related complaints who were incidentally found to be SARS-CoV-2-positive. In order to ensure data integrity, coding should distinguish between patients with COVID-19-related symptoms and asymptomatic patients carrying the SARS-CoV-2 virus.
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Affiliation(s)
- Daniel Antwi-Amoabeng
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
| | - Bryce D. Beutler
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
| | - Gurpreet Chahal
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
| | - Sumaiya Mahboob
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
| | - Rudy Tedja
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
- Department of Pulmonary and Critical Care Medicine, Renown Health, Reno, NV
- Department of Infection Prevention, Renown Health, Reno, NV
| | - Farah Madhani-Lovely
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
- Department of Pulmonary and Critical Care Medicine, Renown Health, Reno, NV
| | - Chris Rowan
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV
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17
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Vaishya R, Malani A, Sharma H, Vaish A, Singh SK. COVID vaccination provided protection from severe disease despite low Cycle threshold (Ct) values. Diabetes Metab Syndr 2021; 15:102281. [PMID: 34530382 PMCID: PMC8434748 DOI: 10.1016/j.dsx.2021.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Raju Vaishya
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
| | - Arpita Malani
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
| | - Himani Sharma
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
| | - Abhishek Vaish
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
| | - Sujeet Kumar Singh
- National Centre for Disease Contgrol, Shamnath Marg, Delhi 110054, India.
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18
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Ranzani OT, Hitchings MDT, Dorion M, D'Agostini TL, de Paula RC, de Paula OFP, Villela EFDM, Torres MSS, de Oliveira SB, Schulz W, Almiron M, Said R, de Oliveira RD, Vieira da Silva P, de Araújo WN, Gorinchteyn JC, Andrews JR, Cummings DAT, Ko AI, Croda J. Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study. BMJ 2021; 374:n2015. [PMID: 34417194 PMCID: PMC8377801 DOI: 10.1136/bmj.n2015] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [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] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To estimate the effectiveness of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech), against symptomatic covid-19 in the elderly population of São Paulo state, Brazil during widespread circulation of the gamma variant. DESIGN Test negative case-control study. SETTING Community testing for covid-19 in São Paulo state, Brazil. PARTICIPANTS 43 774 adults aged ≥70 years who were residents of São Paulo state and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 29 April 2021. 26 433 cases with symptomatic covid-19 and 17 622 test negative controls with covid-19 symptoms were formed into 13 283 matched sets, one case with to up to five controls, according to age, sex, self-reported race, municipality of residence, previous covid-19 status, and date of RT-PCR test (±3 days). INTERVENTION Vaccination with a two dose regimen of CoronaVac. MAIN OUTCOME MEASURES RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. RESULTS Adjusted vaccine effectiveness against symptomatic covid-19 was 24.7% (95% confidence interval 14.7% to 33.4%) at 0-13 days and 46.8% (38.7% to 53.8%) at ≥14 days after the second dose. Adjusted vaccine effectiveness against hospital admissions was 55.5% (46.5% to 62.9%) and against deaths was 61.2% (48.9% to 70.5%) at ≥14 days after the second dose. Vaccine effectiveness ≥14 days after the second dose was highest for the youngest age group (70-74 years)-59.0% (43.7% to 70.2%) against symptomatic disease, 77.6% (62.5% to 86.7%) against hospital admissions, and 83.9% (59.2% to 93.7%) against deaths-and declined with increasing age. CONCLUSIONS Vaccination with CoronaVac was associated with a reduction in symptomatic covid-19, hospital admissions, and deaths in adults aged ≥70 years in a setting with extensive transmission of the gamma variant. Vaccine protection was, however, low until completion of the two dose regimen, and vaccine effectiveness was observe to decline with increasing age among this elderly population.
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Affiliation(s)
- Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Matt D T Hitchings
- Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Murilo Dorion
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | | | | | | | - Wade Schulz
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Almiron
- Pan American Health Organization, Brasília, DF, Brazil
| | - Rodrigo Said
- Pan American Health Organization, Brasília, DF, Brazil
| | | | | | - Wildo Navegantes de Araújo
- Pan American Health Organization, Brasília, DF, Brazil
- Universidade de Brasília, Brasília, DF, Brazil
- National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, MS, Brazil
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19
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Chung H, He S, Nasreen S, Sundaram ME, Buchan SA, Wilson SE, Chen B, Calzavara A, Fell DB, Austin PC, Wilson K, Schwartz KL, Brown KA, Gubbay JB, Basta NE, Mahmud SM, Righolt CH, Svenson LW, MacDonald SE, Janjua NZ, Tadrous M, Kwong JC. Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study. BMJ 2021; 374:n1943. [PMID: 34417165 PMCID: PMC8377789 DOI: 10.1136/bmj.n1943] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [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] [Accepted: 08/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). DESIGN Test negative design study. SETTING Ontario, Canada between 14 December 2020 and 19 April 2021. PARTICIPANTS 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. INTERVENTIONS BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. MAIN OUTCOME MEASURES Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. RESULTS Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. CONCLUSIONS Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.
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Affiliation(s)
| | | | | | - Maria E Sundaram
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah A Buchan
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Sarah E Wilson
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | | | | | - Deshayne B Fell
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Peter C Austin
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Bruyère and Ottawa Hospital Research Institutes, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kevin L Schwartz
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
| | - Kevin A Brown
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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20
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Bamji AN. Infection with SARS-CoV-2 is not the same as covid-19. BMJ 2021; 374:n1896. [PMID: 34340969 DOI: 10.1136/bmj.n1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Bhoyar RC, Senthivel V, Jolly B, Imran M, Jain A, Divakar MK, Scaria V, Sivasubbu S. An optimized, amplicon-based approach for sequencing of SARS-CoV-2 from patient samples using COVIDSeq assay on Illumina MiSeq sequencing platforms. STAR Protoc 2021; 2:100755. [PMID: 34368787 PMCID: PMC8326003 DOI: 10.1016/j.xpro.2021.100755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sequencing of SARS-CoV-2 genomes is crucial for understanding the genetic epidemiology of the COVID-19 pandemic. It is also critical for understanding the evolution of the virus and also for the rapid development of diagnostic tools. The present protocol is a modification of the Illumina COVIDSeq test. We describe an amplicon-based next-generation sequencing approach with short turnaround time, adapted for bench-top sequencers like MiSeq, iSeq, and MiniSeq. For complete details on the use and execution of this protocol, please refer to Bhoyar et al. (2021).
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Affiliation(s)
- Rahul C. Bhoyar
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
| | - Vigneshwar Senthivel
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Bani Jolly
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Mohamed Imran
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Abhinav Jain
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Mohit Kumar Divakar
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Vinod Scaria
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
- Corresponding author
| | - Sridhar Sivasubbu
- CSIR- Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, Delhi, 110025, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
- Corresponding author
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22
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Kostoulas P, Eusebi P, Hartnack S. Diagnostic Accuracy Estimates for COVID-19 Real-Time Polymerase Chain Reaction and Lateral Flow Immunoassay Tests With Bayesian Latent-Class Models. Am J Epidemiol 2021; 190:1689-1695. [PMID: 33823529 PMCID: PMC8083455 DOI: 10.1093/aje/kwab093] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 01/19/2023] Open
Abstract
Our objective was to estimate the diagnostic accuracy of real-time polymerase chain reaction (RT-PCR) and lateral flow immunoassay (LFIA) tests for coronavirus disease 2019 (COVID-19), depending on the time after symptom onset. Based on the cross-classified results of RT-PCR and LFIA, we used Bayesian latent-class models, which do not require a gold standard for the evaluation of diagnostics. Data were extracted from studies that evaluated LFIA (immunoglobulin G (IgG) and/or immunoglobulin M (IgM)) assays using RT-PCR as the reference method. The sensitivity of RT-PCR was 0.68 (95% probability interval (PrI): 0.63, 0.73). IgG/M sensitivity was 0.32 (95% PrI :0.23; 0.41) for the first week and increased steadily. It was 0.75 (95% PrI: 0.67; 0.83) and 0.93 (95% PrI: 0.88; 0.97) for the second and third weeks after symptom onset, respectively. Both tests had a high to absolute specificity, with higher point median estimates for RT-PCR specificity and narrower probability intervals. The specificity of RT-PCR was 0.99 (95% PrI: 0.98; 1.00). and the specificity of IgG/IgM was 0.97 (95% PrI: 0.92, 1.00), 0.98 (95% PrI: 0.95, 1.00) and 0.98 (95% PrI: 0.94, 1.00) for the first, second, and third weeks after symptom onset. The diagnostic accuracy of LFIA varies with time after symptom onset. Bayesian latent-class models provide a valid and efficient alternative for evaluating the rapidly evolving diagnostics for COVID-19, under various clinical settings and different risk profiles.
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Affiliation(s)
- Polychronis Kostoulas
- Correspondence to Dr. Polychronis Kostoulas, Laboratory of Epidemiology and Artificial Intelligence, Faculty of Public and One Health, School of Health Sciences, University of Thessaly, Karditsa, Terma Mavromichali, GR-43100, Greece (e-mail: )
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23
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Simpson CR, Robertson C, Vasileiou E, Moore E, McCowan C, Agrawal U, Stagg HR, Docherty A, Mulholland R, Murray JLK, Ritchie LD, McMenamin J, Sheikh A. Temporal trends and forecasting of COVID-19 hospitalisations and deaths in Scotland using a national real-time patient-level data platform: a statistical modelling study. Lancet Digit Health 2021; 3:e517-e525. [PMID: 34238721 PMCID: PMC8257056 DOI: 10.1016/s2589-7500(21)00105-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As the COVID-19 pandemic continues, national-level surveillance platforms with real-time individual person-level data are required to monitor and predict the epidemiological and clinical profile of COVID-19 and inform public health policy. We aimed to create a national dataset of patient-level data in Scotland to identify temporal trends and COVID-19 risk factors, and to develop a novel statistical prediction model to forecast COVID-19-related deaths and hospitalisations during the second wave. METHODS We established a surveillance platform to monitor COVID-19 temporal trends using person-level primary care data (including age, sex, socioeconomic status, urban or rural residence, care home residence, and clinical risk factors) linked to data on SARS-CoV-2 RT-PCR tests, hospitalisations, and deaths for all individuals resident in Scotland who were registered with a general practice on Feb 23, 2020. A Cox proportional hazards model was used to estimate the association between clinical risk groups and time to hospitalisation and death. A survival prediction model derived from data from March 1 to June 23, 2020, was created to forecast hospital admissions and deaths from October to December, 2020. We fitted a generalised additive spline model to daily SARS-CoV-2 cases over the previous 10 weeks and used this to create a 28-day forecast of the number of daily cases. The age and risk group pattern of cases in the previous 3 weeks was then used to select a stratified sample of individuals from our cohort who had not previously tested positive, with future cases in each group sampled from a multinomial distribution. We then used their patient characteristics (including age, sex, comorbidities, and socioeconomic status) to predict their probability of hospitalisation or death. FINDINGS Our cohort included 5 384 819 people, representing 98·6% of the entire estimated population residing in Scotland during 2020. Hospitalisation and death among those testing positive for SARS-CoV-2 between March 1 and June 23, 2020, were associated with several patient characteristics, including male sex (hospitalisation hazard ratio [HR] 1·47, 95% CI 1·38-1·57; death HR 1·62, 1·49-1·76) and various comorbidities, with the highest hospitalisation HR found for transplantation (4·53, 1·87-10·98) and the highest death HR for myoneural disease (2·33, 1·46-3·71). For those testing positive, there were decreasing temporal trends in hospitalisation and death rates. The proportion of positive tests among older age groups (>40 years) and those with at-risk comorbidities increased during October, 2020. On Nov 10, 2020, the projected number of hospitalisations for Dec 8, 2020 (28 days later) was 90 per day (95% prediction interval 55-125) and the projected number of deaths was 21 per day (12-29). INTERPRETATION The estimated incidence of SARS-CoV-2 infection based on positive tests recorded in this unique data resource has provided forecasts of hospitalisation and death rates for the whole of Scotland. These findings were used by the Scottish Government to inform their response to reduce COVID-19-related morbidity and mortality. FUNDING Medical Research Council, National Institute for Health Research Health Technology Assessment Programme, UK Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK, Scottish Government Director General Health and Social Care.
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Affiliation(s)
- Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand; Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Eleftheria Vasileiou
- Usher Institute, The University of Edinburgh, Edinburgh, UK; HDR UK BREATHE Hub, Edinburgh, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Helen R Stagg
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK; HDR UK BREATHE Hub, Edinburgh, UK
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24
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Girgis SA, Hafez HM, Elarab HE, Sherif B, Sabry MH, Afifi I, Hassan FE, Reda A, Elsayed S, Mahmoud A, Habeb P, Habil IS, Hussein RS, Mossad IM, Mansour O, Omar A, Saleh AM, El-Meteini M. SARS-CoV-2 PCR positivity rate and seroprevalence of related antibodies among a sample of patients in Cairo: Pre-wave 2 results of a screening program in a university hospital. PLoS One 2021; 16:e0254581. [PMID: 34265021 PMCID: PMC8282003 DOI: 10.1371/journal.pone.0254581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Research has revealed that asymptomatic and pre-symptomatic infections are important contributors to the transmission of SARS-CoV-2 in populations. In Egypt, the true prevalence of infections is veiled due to the low number of screening tests. The aim of this study was to determine the SARS-CoV-2 PCR positivity rate as well the seroprevalence of the SARS-CoV-2 antibodies before the ultimate development of a second wave of the epidemic in Cairo, Egypt. METHODS Our study was carried out between May 5 and the end of October 2020. It included all patients requiring admission to Ain Shams University hospitals. An interview questionnaire was used to collect demographic and clinical data. Laboratory tests for all participants included RT-PCR and total antibody assay for SARS-CoV-2. RESULTS A total of 4,313 subjects were enrolled in our study, with females representing 56% of the sample. Adults and middle-aged individuals represented around 60% of the study sample. The positivity rate of SARS-CoV-2 PCR was 3.84% (95% CI 3.29-4.48), and the SARS-CoV-2 antibody seroprevalence was 29.82% (95% CI: 28.16-31.51). Males showed a higher risk for getting the COVID-19 infection, while middle-age group had significantly higher antibody seroprevalence rates. CONCLUSION SARS-CoV-2 infection imposes a high burden on the community as detected by high seroprevalence rates.
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Affiliation(s)
- Samia A. Girgis
- Professor of Clinical Pathology, Faculty of Medicine Director of Infection Control Unit and Vice Director of Ain Shams University Hospitals, Cairo, Egypt
| | - Hala M. Hafez
- Professor of Clinical Pathology, Faculty of Medicine, Head of Clinical Microbiology Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Hoda Ezz Elarab
- Department of Clinical Pathology, Ain Shams University Hospitals, Cairo, Egypt
| | - Basma Sherif
- Department of Clinical Pathology, Ain Shams University Hospitals, Cairo, Egypt
| | - Moshira H. Sabry
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Iman Afifi
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | | | - Amira Reda
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Shaimaa Elsayed
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Asmaa Mahmoud
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Petra Habeb
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Ihab S. Habil
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha S. Hussein
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Isis M. Mossad
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ossama Mansour
- Vice Dean of Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Omar
- Dean of Faculty of Medicine and chairman of board of Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
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25
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David A, Scott L, Jugwanth S, Gededzha M, Kahamba T, Zwane N, Mampeule N, Sanne I, Stevens W, Mayne ES. Operational characteristics of 30 lateral flow immunoassays used to identify COVID-19 immune response. J Immunol Methods 2021; 496:113096. [PMID: 34242653 PMCID: PMC8259047 DOI: 10.1016/j.jim.2021.113096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
Serology or antibody tests for COVID-19 are designed to detect antibodies (mainly Immunoglobulin M (IgM) and Immunoglobulin G (IgG) produced in response to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) infection. In this study, 30 lateral flow immunoassays were tested using serum or plasma from patients with confirmed SARS CoV-2 infection. Negative serological controls were accessed from a well-characterised bank of sera which were stored prior to February 2020. Operational characteristics and ease of use of the assays are reported. 4/30 (13%) of kits (Zheihang Orient Gene COVID-19 IgG/IgM, Genrui Novel Coronavirus (2019-nCoV) IgG/IgM, Biosynex COVID-19 BSS IgG/IgM, Boson Biotech 2019-nCoV IgG/IgM) were recommended for SAHPRA approval based on kit sensitivity. Of these, only the Orientgene was recommended by SAHPRA in August 2020 for use within the approved national testing algorithm while the remaining three received limited authorization for evaluation. All kits evaluated work on the same basic principle of immunochromatography with minor differences noted in the shape and colour of cartridges, the amount of specimen volume required and the test duration. Performance of the lateral flow tests were similar to sensitivities and specificities reported in other studies. The cassettes of the majority of kits evaluated (90%) detected both IgG and IgM. Only 23% of kits evaluated contained all consumables required for point-of-care testing. The study highlights the need for thorough investigation of kits prior to implementation.
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Affiliation(s)
- Anura David
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sarika Jugwanth
- National Health Laboratory Services, Johannesburg, South Africa; Department of Immunology, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Maemu Gededzha
- National Health Laboratory Services, Johannesburg, South Africa; Department of Immunology, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Trish Kahamba
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Nontobeko Zwane
- Department of Immunology, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Nakampe Mampeule
- National Health Laboratory Services, Johannesburg, South Africa; Department of Immunology, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Ian Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical, Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wendy Stevens
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; National Health Laboratory Services, Johannesburg, South Africa
| | - Elizabeth S Mayne
- National Health Laboratory Services, Johannesburg, South Africa; Department of Immunology, Faculty of Health Sciences, University of Witwatersrand, South Africa.
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26
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White EM, Saade EA, Yang X, Canaday DH, Blackman C, Santostefano CM, Nanda A, Feifer RA, Mor V, Rudolph JL, Gravenstein S. SARS-CoV-2 antibody detection in skilled nursing facility residents. J Am Geriatr Soc 2021; 69:1722-1728. [PMID: 33544876 PMCID: PMC8013911 DOI: 10.1111/jgs.17061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/08/2021] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS-CoV-2 infection. DESIGN Retrospective analysis of SNF electronic health records. SETTING Qualitative SARS-CoV-2 antibody test results were available from 81 SNFs in 16 states. PARTICIPANTS Six hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2. MEASUREMENTS Presence of SARS-CoV-2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non-cases. RESULTS Among 397 residents with PCR-confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7-14 days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15-30 days; in 182 of 219 (83.1%) tested within 31-60 days; and in 110 of 124 (88.7%) tested after 60 days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7-14 days of their first PCR test; in 41 of 81 (50.6%) tested within 15-30 days; in 65 of 148 (43.9%) tested within 31-60 days; and in 9 of 34 (26.5%) tested after 60 days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies. CONCLUSIONS These findings suggest that vulnerable older adults can mount an antibody response to SARS-CoV-2, and that antibodies are most likely to be detected within 15-30 days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS-CoV-2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS-CoV-2 prevalence remains high.
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Affiliation(s)
- Elizabeth M. White
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Elie A. Saade
- Case Western Reserve University School of MedicineDivision of Infectious Diseases and HIV MedicineClevelandOhioUSA
- Louis Stokes Veterans Administration Medical CenterClevelandOhioUSA
| | - Xiaofei Yang
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - David H. Canaday
- Case Western Reserve University School of MedicineDivision of Infectious Diseases and HIV MedicineClevelandOhioUSA
- Louis Stokes Veterans Administration Medical CenterClevelandOhioUSA
| | | | - Christopher M. Santostefano
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Aman Nanda
- Division of Geriatrics and Palliative MedicineBrown University Alpert Medical SchoolProvidenceRhode IslandUSA
| | | | - Vincent Mor
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Providence Veterans Administration Medical Center Research ServiceProvidenceRhode IslandUSA
| | - James L. Rudolph
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Providence Veterans Administration Medical Center Research ServiceProvidenceRhode IslandUSA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Division of Geriatrics and Palliative MedicineBrown University Alpert Medical SchoolProvidenceRhode IslandUSA
- Providence Veterans Administration Medical Center Research ServiceProvidenceRhode IslandUSA
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27
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Kissler SM, Fauver JR, Mack C, Olesen SW, Tai C, Shiue KY, Kalinich CC, Jednak S, Ott IM, Vogels CBF, Wohlgemuth J, Weisberger J, DiFiori J, Anderson DJ, Mancell J, Ho DD, Grubaugh ND, Grad YH. Viral dynamics of acute SARS-CoV-2 infection and applications to diagnostic and public health strategies. PLoS Biol 2021; 19:e3001333. [PMID: 34252080 PMCID: PMC8297933 DOI: 10.1371/journal.pbio.3001333] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [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: 01/14/2021] [Revised: 07/22/2021] [Accepted: 06/21/2021] [Indexed: 02/04/2023] Open
Abstract
SARS-CoV-2 infections are characterized by viral proliferation and clearance phases and can be followed by low-level persistent viral RNA shedding. The dynamics of viral RNA concentration, particularly in the early stages of infection, can inform clinical measures and interventions such as test-based screening. We used prospective longitudinal quantitative reverse transcription PCR testing to measure the viral RNA trajectories for 68 individuals during the resumption of the 2019-2020 National Basketball Association season. For 46 individuals with acute infections, we inferred the peak viral concentration and the duration of the viral proliferation and clearance phases. According to our mathematical model, we found that viral RNA concentrations peaked an average of 3.3 days (95% credible interval [CI] 2.5, 4.2) after first possible detectability at a cycle threshold value of 22.3 (95% CI 20.5, 23.9). The viral clearance phase lasted longer for symptomatic individuals (10.9 days [95% CI 7.9, 14.4]) than for asymptomatic individuals (7.8 days [95% CI 6.1, 9.7]). A second test within 2 days after an initial positive PCR test substantially improves certainty about a patient's infection stage. The effective sensitivity of a test intended to identify infectious individuals declines substantially with test turnaround time. These findings indicate that SARS-CoV-2 viral concentrations peak rapidly regardless of symptoms. Sequential tests can help reveal a patient's progress through infection stages. Frequent, rapid-turnaround testing is needed to effectively screen individuals before they become infectious.
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Affiliation(s)
- Stephen M. Kissler
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Joseph R. Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Christina Mack
- Real World Solutions, IQVIA, Durham, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Scott W. Olesen
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Caroline Tai
- Real World Solutions, IQVIA, Durham, North Carolina, United States of America
| | - Kristin Y. Shiue
- Real World Solutions, IQVIA, Durham, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Chaney C. Kalinich
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Sarah Jednak
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Isabel M. Ott
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Chantal B. F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jay Wohlgemuth
- Quest Diagnostics, San Juan Capistrano, California, United States of America
| | - James Weisberger
- Bioreference Laboratories, Elmwood Park, New Jersey, United States of America
| | - John DiFiori
- Hospital for Special Surgery, New York, New York, United States of America
- National Basketball Association, New York, New York, United States of America
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, United States of America
| | - Jimmie Mancell
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - David D. Ho
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Yonatan H. Grad
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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28
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Roland M, Ben Abdelhafidh L, Déom V, Vanbiervliet F, Coppieters Y, Racapé J. SARS-CoV-2 screening among people living in homeless shelters in Brussels, Belgium. PLoS One 2021; 16:e0252886. [PMID: 34129635 PMCID: PMC8205130 DOI: 10.1371/journal.pone.0252886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates. Methods A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms. Results We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic. Conclusion This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.
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Affiliation(s)
| | | | | | | | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Judith Racapé
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Chair of Health and Precarity, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- * E-mail:
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Tso CF, Garikipati A, Green-Saxena A, Mao Q, Das R. Correlation of Population SARS-CoV-2 Cycle Threshold Values to Local Disease Dynamics: Exploratory Observational Study. JMIR Public Health Surveill 2021; 7:e28265. [PMID: 33999831 PMCID: PMC8176948 DOI: 10.2196/28265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite the limitations in the use of cycle threshold (CT) values for individual patient care, population distributions of CT values may be useful indicators of local outbreaks. OBJECTIVE We aimed to conduct an exploratory analysis of potential correlations between the population distribution of cycle threshold (CT) values and COVID-19 dynamics, which were operationalized as percent positivity, transmission rate (Rt), and COVID-19 hospitalization count. METHODS In total, 148,410 specimens collected between September 15, 2020, and January 11, 2021, from the greater El Paso area were processed in the Dascena COVID-19 Laboratory. The daily median CT value, daily Rt, daily count of COVID-19 hospitalizations, daily change in percent positivity, and rolling averages of these features were plotted over time. Two-way scatterplots and linear regression were used to evaluate possible associations between daily median CT values and outbreak measures. Cross-correlation plots were used to determine whether a time delay existed between changes in daily median CT values and measures of community disease dynamics. RESULTS Daily median CT values negatively correlated with the daily Rt values (P<.001), the daily COVID-19 hospitalization counts (with a 33-day time delay; P<.001), and the daily changes in percent positivity among testing samples (P<.001). Despite visual trends suggesting time delays in the plots for median CT values and outbreak measures, a statistically significant delay was only detected between changes in median CT values and COVID-19 hospitalization counts (P<.001). CONCLUSIONS This study adds to the literature by analyzing samples collected from an entire geographical area and contextualizing the results with other research investigating population CT values.
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de la Matta M, Delgado-Sánchez JM, Gutiérrez GM, López Romero JL, Martínez Gómez MM, Domínguez Blanco A. Utility of preoperative polymerase chain reaction testing during SARS-CoV-2 pandemic: The challenge of evolving incidence. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:346-352. [PMID: 34147408 PMCID: PMC8188388 DOI: 10.1016/j.redare.2020.10.002] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/15/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Due to its high transmissibility, measures aimed at reducing the spread of SARS CoV2 have become mandatory. Different organizations have recommended performing polymerase chain reaction tests (PCR) as part of the preoperative screening of surgical patients. We aimed to determine the performance of PCR testing to detect asymptomatic carriers. METHODS Observational study carried out at a tertiary care center. We compared the results of preoperative real-time reverse-transcription-PCR test (RT-PCR) performed on a cohort of patients pending surgery with the results we would have expected assuming the epidemiological data released by government offices. RESULTS We registered no positives in the 2,722 preoperative RT-PCR tests performed in our health care area between epidemiological Weeks 18 to 21, meaning a cumulative incidence trending to zero. Assuming public epidemiological data, the probabilistic projection of potential asymptomatic individuals ranged from 0.27 × 10e-4 (according to official data of new cases diagnosed by PCR) to 4.69 × 10e-4 if we assumed cases confirmed by IgG test in our province. Assuming a RT-PCR sensitivity of 95%, to obtain a positive result we should perform 38,461 and 2,028 tests respectively. CONCLUSIONS In scenarios of very low prevalence and despite high sensitivity scores, indiscriminate preoperative RT-PCR screening is of a questionable effectiveness for detecting asymptomatic carriers. Our findings evidence the difficulty of establishing reliable predictive models for the episodic and rapidly evolving incidence of infections such as has characterized the SARS CoV2 pandemic.
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Affiliation(s)
- M de la Matta
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - J M Delgado-Sánchez
- Departamento de Matemática Aplicada I, Escuela Técnica Superior de Arquitectura, Universidad de Sevilla, Sevilla, Spain
| | - G M Gutiérrez
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L López Romero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M M Martínez Gómez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Domínguez Blanco
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Kumar A, Kunjukutty R, Thaha A, Srikumar S, Madhusoodanan H, David S, Biswas L, Sathyapalan D. Universal screening for SARS-CoV-2 in pregnant women using a combination of antigen and RT-PCR testing. Infez Med 2021; 29:294-296. [PMID: 34061799] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Not available.
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Affiliation(s)
- Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Radhamany Kunjukutty
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Ameena Thaha
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Saranya Srikumar
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Haritha Madhusoodanan
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Sachin David
- Department of Molecular Biology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Lalitha Biswas
- Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
| | - Dipu Sathyapalan
- Department of Infectious Disease, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, India
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Chapleau RR, Christian M, Connors B, Premo C, Chao TC, Rodriguez J, Huntsberger S, Meyer J, Javorina A, Reynolds K, Riddle D, Lisanby M, Starr C. Early Identification of SARS-CoV-2 Emergence in the Department of Defense via Retrospective Analysis of 2019-2020 Upper Respiratory Illness Samples. MSMR 2021; 28:2-5. [PMID: 34379377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first U.S. case of non-travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was detected in late February 2020 in California, but the prevailing delay in diagnostic testing and initial stringent testing criteria made it difficult to identify those who could have acquired the virus through community spread. The emergence of the virus in the western Pacific region in late 2019 and the global distribution of Department of Defense (DoD) personnel present the risk that DoD members may have been exposed and contracted the virus earlier then U.S. detections. Here, a retrospective study from residual samples collected from a global DoD Respiratory Surveillance Program was conducted to establish a tentative timeline of when this virus began circulating in the DoD population. Quantitative real-time reverse-transcription polymerase chain reaction testing for SARS-CoV-2 was performed and the specimen collection dates of positive results were compared to the dates of the first infections previously identified in respective states and counties. Twenty-four positive samples were identified out of approximately 7,000 tested. Although this retrospective testing found early cases in 8 locations, there were no results indicative of circulation before late February.
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Lin EE, Akaho EH, Sobilo A, Blatz AM, Otto WR, John ARO. Concordance of Upper and Lower Respiratory Tract Samples for SARS-CoV-2 in Pediatric Patients: Research Letter. Anesthesiology 2021; 134:970-972. [PMID: 33819338 PMCID: PMC8202764 DOI: 10.1097/aln.0000000000003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Elaina E. Lin
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elikplim H. Akaho
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anna Sobilo
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison M. Blatz
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - William R. Otto
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Audrey R. Odom John
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Wang J, Bao A, Gu J, He X, Wu Z, Qiao B, Chen Z, Xiong L, Zhang Y, Zheng H, Li F, Zhao Z, Mei S, Tong Y. A retrospective analysis of 12,400 SARS-CoV-2 RNA tests in patients with COVID-19 in Wuhan. Medicine (Baltimore) 2021; 100:e25916. [PMID: 34011059 PMCID: PMC8137137 DOI: 10.1097/md.0000000000025916] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
The outbreak and widely spread of coronavirus disease 2019 (COVID-19) has become a global public health concern. COVID-19 has caused an unprecedented and profound impact on the whole world, and the prevention and control of COVID-19 is a global public health challenge remains to be solved. The retrospective analysis of the large scale tests of SARS-CoV-2 RNA may indicate some important information of this pandemic. We selected 12400 SARS-CoV-2 tests detected in Wuhan in the first semester of 2020 and made a systematic analysis of them, in order to find some beneficial clue for the consistent prevention and control of COVID-19.SARS-CoV-2 RNA was detected in suspected COVID-19 patients with real-time fluorescence quantitative PCR (RT-qPCR). The patients' features including gender, age, type of specimen, source of patients, and the dynamic changes of the clinical symptoms were recorded and statistically analyzed. Quantitative and qualitive statistical analysis were carried out after laboratory detection.The positive rate of SARS-CoV-2 was 33.02% in 12,400 suspected patients' specimens in Wuhan at the first months of COVID-19 epidemics. SARS-CoV-2 RT-qPCR test of nasopharyngeal swabs might produce 4.79% (594/12400) presumptive results. The positive rate of SARS-CoV-2 RNA was significantly different between gender, age, type of specimen, source of patients, respectively (P < .05). The median window period from the occurrence of clinical symptom or close contact with COVID-19 patient to the first detection of positive PCR was 2 days (interquartile range, 1-4 days). The median interval time from the first SARS-CoV-2 positive to the turning negative was 14 days (interquartile range, 8-19.25 days).This study reveals the comprehensive characteristics of the SARS-CoV-2 RNA detection from multiple perspectives, and it provides important clues and may also supply useful suggestions for future work of the prevention and treatment of COVID-19.
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Affiliation(s)
- Jingwei Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Anyu Bao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Jian Gu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Xiaoyun He
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Zegang Wu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Bin Qiao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Zhen Chen
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Liang Xiong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Yan Zhang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Hongyun Zheng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Feng Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Zhijun Zhao
- Clinical Laboratory Center & Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Siqing Mei
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
| | - Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan
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Salerno S, Zhao Z, Prabhu Sankar S, Salvatore M, Gu T, Fritsche LG, Lee S, Lisabeth LD, Valley TS, Mukherjee B. Patterns of repeated diagnostic testing for COVID-19 in relation to patient characteristics and outcomes. J Intern Med 2021; 289:726-737. [PMID: 33253457 PMCID: PMC7753604 DOI: 10.1111/joim.13213] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Whilst the COVID-19 diagnostic test has a high false-negative rate, not everyone initially negative is re-tested. Michigan Medicine, a primary regional centre, provided an ideal setting for studying testing patterns during the first wave of the pandemic. OBJECTIVES To identify the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was associated with downstream outcomes amongst positive cases. METHODS Characteristics, test results, and health outcomes for patients presenting for a COVID-19 diagnostic test were collected. We examined whether patient characteristics differed with repeated testing and estimated a false-negative rate for the test. We then studied repeated testing patterns in patients with severe COVID-19-related outcomes. RESULTS Patient age, sex, body mass index, neighbourhood poverty levels, pre-existing type 2 diabetes, circulatory, kidney, and liver diseases, and cough, fever/chills, and pain symptoms 14 days prior to a first test were associated with repeated testing. Amongst patients with a positive result, age (OR: 1.17; 95% CI: (1.05, 1.34)) and pre-existing kidney diseases (OR: 2.26; 95% CI: (1.41, 3.68)) remained significant. Hospitalization (OR: 7.88; 95% CI: (5.15, 12.26)) and ICU-level care (OR: 6.93; 95% CI: (4.44, 10.92)) were associated with repeated testing. The estimated false-negative rate was 23.8% (95% CI: (19.5%, 28.5%)). CONCLUSIONS Whilst most patients were tested once and received a negative result, a meaningful subset underwent multiple rounds of testing. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.
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Affiliation(s)
- S. Salerno
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Z. Zhao
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - S. Prabhu Sankar
- Rogel Cancer CenterUniversity of Michigan MedicineAnn ArborMIUSA
- Data Office for Clinical and Translational ResearchUniversity of MichiganAnn ArborMIUSA
| | - M. Salvatore
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - T. Gu
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - L. G. Fritsche
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
- Rogel Cancer CenterUniversity of Michigan MedicineAnn ArborMIUSA
- Center for Statistical GeneticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - S. Lee
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
- Graduate School of Data ScienceSeoul National UniversitySeoulSouth Korea
| | - L. D. Lisabeth
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - T. S. Valley
- Division of Pulmonary and Critical Care Medicine and Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMIUSA
| | - B. Mukherjee
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
- Rogel Cancer CenterUniversity of Michigan MedicineAnn ArborMIUSA
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
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Lewis NM, Hershow RB, Chu VT, Wu K, Milne AT, LaCross N, Hill M, Risk I, Hersh AL, Kirking HL, Tate JE, Vallabhaneni S, Dunn AC. Factors Associated with Participation in Elementary School-Based SARS-CoV-2 Testing - Salt Lake County, Utah, December 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:557-559. [PMID: 33857064 PMCID: PMC8344994 DOI: 10.15585/mmwr.mm7015e1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fan Z, Yao B, Ding Y, Zhao J, Xie M, Zhang K. Entropy-driven amplified electrochemiluminescence biosensor for RdRp gene of SARS-CoV-2 detection with self-assembled DNA tetrahedron scaffolds. Biosens Bioelectron 2021; 178:113015. [PMID: 33493896 PMCID: PMC7817442 DOI: 10.1016/j.bios.2021.113015] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 12/24/2022]
Abstract
Dependable, specific and rapid diagnostic methods for severe acute respiratory syndrome β-coronavirus (SARS-CoV-2) detection are needed to promote public health interventions for coronavirus disease 2019 (COVID-19). Herein, we have established an entropy-driven amplified electrochemiluminescence (ECL) strategy to detect the RNA-dependent RNA polymerase (RdRp) gene of SARS-CoV-2 known as RdRp-COVID which as the target for SARS-CoV-2 plays an essential role in the diagnosis of COVID-19. For the construction of the sensors, DNA tetrahedron (DT) is modified on the surface of the electrode to furnish robust and programmable scaffolds materials, upon which target DNA-participated entropy-driven amplified reaction is efficiently conducted to link the Ru (bpy)32+ modified S3 to the linear ssDNA at the vertex of the tetrahedron and eventually present an "ECL on" state. The rigid tetrahedral structure of the DT probe enhances the ECL intensity and avoids the cross-reactivity between single-stranded DNA, thus increasing the sensitivity of the assays. The enzyme-free entropy-driven reaction prevents the use of expensive enzyme reagents and facilitates the realization of large-scale screening of SARS-CoV-2 patients. Our DT-based ECL sensor has demonstrated significant specificity and high sensitivity for SARS-CoV-2 with a limit of detection (LOD) down to 2.67 fM. Additionally, our operational method has achieved the detection of RdRp-COVID in human serum samples, which supplies a reliable and feasible sensing platform for the clinical bioanalysis.
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Affiliation(s)
- Zhenqiang Fan
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China
| | - Bo Yao
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China; Key Laboratory of Flexible Electronics (KLOFE) & Institute of Advanced Materials (IAM), Jiangsu National Synergetic Innovation Center for Advanced Materials (SICAM), Nanjing Tech University (NanjingTech), 30 South Puzhu Road, Nanjing, 211816, PR China
| | - Yuedi Ding
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China
| | - Jing Zhao
- Center for Molecular Recognition and Biosensing, School of Life Sciences, Shanghai University, Shanghai, 200444, PR China
| | - Minhao Xie
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China; Department of Radiopharmaceuticals, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
| | - Kai Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, 214063, China.
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Shi JC, Yu ZJ, He GQ, Chen W, Ye XC, Wu ZX, Zhu XQ, Pan JZ, Jiang XG. Epidemiological Features of 105 Patients Infected with the COVID-19. J Natl Med Assoc 2021; 113:212-217. [PMID: 33268103 PMCID: PMC7581504 DOI: 10.1016/j.jnma.2020.09.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate and evaluate the clinical features of patients infected with the 2019 novel coronavirus (COVID-19) outside of Wuhan. METHODS 105 patients admitted to our hospital with clinical- and laboratory-confirmed COVID-19 infection were studied. Data were collected from January 17, 2020 to March 5, 2020. RESULTS 105 patients (57 male and 48 female) were confirmed to have COVID-19 infection. Among the 105 patients, 55 (52%) had made short trips to Wuhan during the two weeks before the onset of illness, and these were the first-generation confirmed cases. An exact date of close contact with someone in Wenzhou with confirmed or suspected COVID-19 infection from Wuhan (the second-generation confirmed cases) could be provided by 38 (36%) patients. Of the remaining patients, six (6%; the third-generation confirmed cases) were familial clusters of the second-generation confirmed cases, three (3%) had no definite epidemiological features, and 16 (15%) were from the same location as for the case report. CONCLUSION Due to the infectiousness of COVID-19, patients with infections should be diagnosed and treated as early as possible after developing fever symptoms or showing other clinical characteristics or imaging features. With respect to high-risk cases, we must focus on any complications that arise and take effective measures to treat them immediately. This will significantly improve the prognosis of patients with severe infections.
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Affiliation(s)
- Ji-Chan Shi
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Zhi-Jie Yu
- Department of Hematology, Wenzhou Key Laboratory of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Gui-Qing He
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Wei Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin-Chun Ye
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Zheng-Xing Wu
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Xiao-Qu Zhu
- Department of Infectious Disease, Wenzhou Hospital of Traditional Chinese Medicine, China
| | - Jiao-Zhi Pan
- Departments of Infectious Diseases, Yongjia People's Hospital, Wenzhou, Zhejiang, China
| | - Xian-Gao Jiang
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang, China.
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Abu-Raddad LJ, Chemaitelly H, Ayoub HH, Al Kanaani Z, Al Khal A, Al Kuwari E, Butt AA, Coyle P, Jeremijenko A, Kaleeckal AH, Latif AN, Owen RC, Rahim HFA, Al Abdulla SA, Al Kuwari MG, Kandy MC, Saeb H, Ahmed SNN, Al Romaihi HE, Bansal D, Dalton L, Al-Thani MH, Bertollini R. Characterizing the Qatar advanced-phase SARS-CoV-2 epidemic. Sci Rep 2021; 11:6233. [PMID: 33737535 PMCID: PMC7973743 DOI: 10.1038/s41598-021-85428-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [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: 09/01/2020] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
The overarching objective of this study was to provide the descriptive epidemiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Qatar by addressing specific research questions through a series of national epidemiologic studies. Sources of data were the centralized and standardized national databases for SARS-CoV-2 infection. By July 10, 2020, 397,577 individuals had been tested for SARS-CoV-2 using polymerase-chain-reaction (PCR), of whom 110,986 were positive, a positivity cumulative rate of 27.9% (95% CI 27.8-28.1%). As of July 5, case severity rate, based on World Health Organization (WHO) severity classification, was 3.4% and case fatality rate was 1.4 per 1,000 persons. Age was by far the strongest predictor of severe, critical, or fatal infection. PCR positivity of nasopharyngeal/oropharyngeal swabs in a national community survey (May 6-7) including 1,307 participants was 14.9% (95% CI 11.5-19.0%); 58.5% of those testing positive were asymptomatic. Across 448 ad-hoc testing campaigns in workplaces and residential areas including 26,715 individuals, pooled mean PCR positivity was 15.6% (95% CI 13.7-17.7%). SARS-CoV-2 antibody prevalence was 24.0% (95% CI 23.3-24.6%) in 32,970 residual clinical blood specimens. Antibody prevalence was only 47.3% (95% CI 46.2-48.5%) in those who had at least one PCR positive result, but 91.3% (95% CI 89.5-92.9%) among those who were PCR positive > 3 weeks before serology testing. Qatar has experienced a large SARS-CoV-2 epidemic that is rapidly declining, apparently due to growing immunity levels in the population.
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Affiliation(s)
- Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Houssein H Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hatoun Saeb
- Primary Health Care Corporation, Doha, Qatar
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Abu-Raddad LJ, Chemaitelly H, Ayoub HH, Al Kanaani Z, Al Khal A, Al Kuwari E, Butt AA, Coyle P, Jeremijenko A, Kaleeckal AH, Latif AN, Owen RC, Rahim HFA, Al Abdulla SA, Al Kuwari MG, Kandy MC, Saeb H, Ahmed SNN, Al Romaihi HE, Bansal D, Dalton L, Al-Thani MH, Bertollini R. Characterizing the Qatar advanced-phase SARS-CoV-2 epidemic. Sci Rep 2021; 11:6233. [PMID: 33737535 DOI: 10.1101/2020.07.16.20155317] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/26/2021] [Indexed: 05/23/2023] Open
Abstract
The overarching objective of this study was to provide the descriptive epidemiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Qatar by addressing specific research questions through a series of national epidemiologic studies. Sources of data were the centralized and standardized national databases for SARS-CoV-2 infection. By July 10, 2020, 397,577 individuals had been tested for SARS-CoV-2 using polymerase-chain-reaction (PCR), of whom 110,986 were positive, a positivity cumulative rate of 27.9% (95% CI 27.8-28.1%). As of July 5, case severity rate, based on World Health Organization (WHO) severity classification, was 3.4% and case fatality rate was 1.4 per 1,000 persons. Age was by far the strongest predictor of severe, critical, or fatal infection. PCR positivity of nasopharyngeal/oropharyngeal swabs in a national community survey (May 6-7) including 1,307 participants was 14.9% (95% CI 11.5-19.0%); 58.5% of those testing positive were asymptomatic. Across 448 ad-hoc testing campaigns in workplaces and residential areas including 26,715 individuals, pooled mean PCR positivity was 15.6% (95% CI 13.7-17.7%). SARS-CoV-2 antibody prevalence was 24.0% (95% CI 23.3-24.6%) in 32,970 residual clinical blood specimens. Antibody prevalence was only 47.3% (95% CI 46.2-48.5%) in those who had at least one PCR positive result, but 91.3% (95% CI 89.5-92.9%) among those who were PCR positive > 3 weeks before serology testing. Qatar has experienced a large SARS-CoV-2 epidemic that is rapidly declining, apparently due to growing immunity levels in the population.
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Affiliation(s)
- Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics On HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Houssein H Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hatoun Saeb
- Primary Health Care Corporation, Doha, Qatar
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Meltzer DO, Best TJ, Zhang H, Vokes T, Arora VM, Solway J. Association of Vitamin D Levels, Race/Ethnicity, and Clinical Characteristics With COVID-19 Test Results. JAMA Netw Open 2021; 4:e214117. [PMID: 33739433 PMCID: PMC7980095 DOI: 10.1001/jamanetworkopen.2021.4117] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 10/20/2020] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open
Abstract
Importance Deficient (ie, <20 ng/mL) or insufficient (ie, 20 to <30 ng/mL) 25-hydroxyvitamin D (also known as calcifediol) levels are more common in Black individuals than White individuals and are associated with increased coronavirus disease 2019 (COVID-19) risk. Whether COVID-19 risk is associated with differences in vitamin D levels of 30 ng/mL or greater is not known. Objective To examine whether COVID-19 test results are associated with differences in vitamin D levels of 30 ng/mL or greater, including for White individuals and for Black individuals. Design, Setting, and Participants This retrospective cohort study was conducted at an academic medical center in Chicago, Illinois. Participants included individuals with data on vitamin D level within 365 days before COVID-19 testing, which was conducted from March 3 to December 30, 2020. Data were analyzed from September 11, 2020, to February 5, 2021. Exposures The last vitamin D level before COVID-19 testing was categorized as less than 20 ng/mL (ie, deficient), 20 to less than 30 ng/mL (ie, insufficient), 30 to less than 40 ng/mL, or 40 ng/mL or greater. Treatment was defined by vitamin D type and dose 14 days before COVID-19 testing and treatment changes after last vitamin D level. Main Outcomes and Measures The main outcome was a positive result for COVID-19 in polymerase chain reaction testing. Multivariable analyses tested whether previously measured vitamin D level was associated with having test results positive for COVID-19 in White individuals and in Black individuals, controlling for months and treatment changes since the vitamin D level was measured, as well as demographic characteristics and comorbidity indicators. Results A total of 4638 individuals (mean [SD] age 52.8 [19.5] years; 3205 [69%] women) had data for a vitamin D level within 1 year before COVID-19 testing, including 2288 (49%) Black individuals, 1999 (43%) White individuals, and 351 individuals (8%) who were another race/ethnicity (eg, Asian, Mideast Indian, >1 race). Stratified by vitamin D level, 1251 individuals (27%) had less than 20 ng/mL, 1267 individuals (27%) had 20 to less than 30 ng/mL, 1023 individuals (22%) had 30 to less than 40 ng/mL, and 1097 individuals (24%) had 40 ng/mL or greater. Lower vitamin D levels were more common in Black individuals (<20 ng/mL: 829 of 2288 Black individuals [36%]) than White individuals (<20 ng/mL: 315 of 1999 White individuals [16%]). A total of 333 individuals (7%) had test results positive for COVID-19, including 102 White individuals (5%) and 211 Black individuals (9%). Multivariate analysis controlling for time since last vitamin D level measurement was used to estimate the outcomes associated with levels 14 days before COVID-19 testing. A positive test result for COVID-19 was not significantly associated with vitamin D levels in White individuals but was associated with vitamin D levels in Black individuals (compared with ≥40 ng/mL: <20 ng/mL incidence rate ratio [IRR], 2.55 [95% CI, 1.26-5.15]; P = .009; 20 to <30 ng/mL IRR, 1.69 [95% CI, 0.75-3.84]; P = .21; 30 to <40 ng/mL IRR, 2.64 [95% CI, 1.24-5.66]; P = .01). Stratified by vitamin D level, estimated COVID-19 positivity rates in Black individuals were 9.72% (95% CI, 6.74%-13.41%) for individuals with a vitamin D level less than 20 ng/mL, 6.47% (95% CI, 3.33%-10.28%) for individuals with a vitamin D level of 20 to less than 30 ng/mL, 10.10% (95% CI, 6.00%-15.47%) for individuals with a vitamin D level of 30 to less than 40 ng/mL, and 3.82% (95% CI, 1.78%-6.68%) for individuals with a vitamin D level of 40 ng/mL or higher. Multivariate analysis in individuals with a vitamin D level of 30 ng/mL or greater found that the IRR of a positive COVID-19 test result was 0.97 (95% CI, 0.94-0.99; P = .008) per 1-ng/mL increase in vitamin D overall and 0.95 (95% CI, 0.91-0.98; P = .003) per 1-ng/mL increase in vitamin D in Black individuals. Conclusions and Relevance In this single-center retrospective cohort study, COVID-19 risk increased among Black individuals with vitamin D level less than 40 ng/mL compared with those with 40 ng/mL or greater and decreased with increasing levels among individuals with levels greater than 30 ng/mL. No significant associations were noted for White individuals. Randomized clinical trials should examine whether increasing vitamin D level to greater than 40 ng/mL affects COVID-19 risk.
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Affiliation(s)
| | | | - Hui Zhang
- The University of Chicago, Chicago, Illinois
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Libin PJK, Willem L, Verstraeten T, Torneri A, Vanderlocht J, Hens N. Assessing the feasibility and effectiveness of household-pooled universal testing to control COVID-19 epidemics. PLoS Comput Biol 2021; 17:e1008688. [PMID: 33690626 PMCID: PMC7943003 DOI: 10.1371/journal.pcbi.1008688] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/16/2020] [Accepted: 01/09/2021] [Indexed: 12/19/2022] Open
Abstract
Outbreaks of SARS-CoV-2 are threatening the health care systems of several countries around the world. The initial control of SARS-CoV-2 epidemics relied on non-pharmaceutical interventions, such as social distancing, teleworking, mouth masks and contact tracing. However, as pre-symptomatic transmission remains an important driver of the epidemic, contact tracing efforts struggle to fully control SARS-CoV-2 epidemics. Therefore, in this work, we investigate to what extent the use of universal testing, i.e., an approach in which we screen the entire population, can be utilized to mitigate this epidemic. To this end, we rely on PCR test pooling of individuals that belong to the same households, to allow for a universal testing procedure that is feasible with the limited testing capacity. We evaluate two isolation strategies: on the one hand pool isolation, where we isolate all individuals that belong to a positive PCR test pool, and on the other hand individual isolation, where we determine which of the individuals that belong to the positive PCR pool are positive, through an additional testing step. We evaluate this universal testing approach in the STRIDE individual-based epidemiological model in the context of the Belgian COVID-19 epidemic. As the organisation of universal testing will be challenging, we discuss the different aspects related to sample extraction and PCR testing, to demonstrate the feasibility of universal testing when a decentralized testing approach is used. We show through simulation, that weekly universal testing is able to control the epidemic, even when many of the contact reductions are relieved. Finally, our model shows that the use of universal testing in combination with stringent contact reductions could be considered as a strategy to eradicate the virus.
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Affiliation(s)
- Pieter J. K. Libin
- Interuniversity Institute of Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
- Artificial Intelligence Lab, Department of computer science, Vrije Universiteit Brussel, Brussels, Belgium
- KU Leuven – University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
| | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Timothy Verstraeten
- Artificial Intelligence Lab, Department of computer science, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Torneri
- Interuniversity Institute of Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Joris Vanderlocht
- Interuniversity Institute of Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Niel Hens
- Interuniversity Institute of Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Patrucco F, Carriero A, Falaschi Z, Paschè A, Gavelli F, Airoldi C, Bellan M, Sainaghi PP, Solidoro P, Balbo PE. COVID-19 Diagnosis in Case of Two Negative Nasopharyngeal Swabs: Association between Chest CT and Bronchoalveolar Lavage Results. Radiology 2021; 298:E152-E155. [PMID: 33399508 PMCID: PMC7903987 DOI: 10.1148/radiol.2020203776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/07/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023]
Abstract
See also the editorial by Little in this issue.
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Affiliation(s)
- Filippo Patrucco
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Alessandro Carriero
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Zeno Falaschi
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Alessio Paschè
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Francesco Gavelli
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Chiara Airoldi
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Mattia Bellan
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Pier Paolo Sainaghi
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
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Mwananyanda L, Gill CJ, MacLeod W, Kwenda G, Pieciak R, Mupila Z, Lapidot R, Mupeta F, Forman L, Ziko L, Etter L, Thea D. Covid-19 deaths in Africa: prospective systematic postmortem surveillance study. BMJ 2021; 372:n334. [PMID: 33597166 PMCID: PMC7887952 DOI: 10.1136/bmj.n334] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To directly measure the fatal impact of coronavirus disease 2019 (covid-19) in an urban African population. DESIGN Prospective systematic postmortem surveillance study. SETTING Zambia's largest tertiary care referral hospital. PARTICIPANTS Deceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death. MAIN OUTCOME MEASURE Postmortem nasopharyngeal swabs were tested via reverse transcriptase quantitative polymerase chain reaction (PCR) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Deaths were stratified by covis-19 status, location, age, sex, and underlying risk factors. RESULTS 372 participants were enrolled between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%) according to the recommended cycle threshold value of <40 and in 70/364 (19.2%) when expanded to any level of PCR detection. The median age at death among people with a positive test for SARS-CoV-2 was 48 (interquartile range 36-72) years, and 69% (n=48) were male. Most deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death. Among the 19/70 people who died in hospital, six were tested before death. Among the 52/70 people with data on symptoms, 44/52 had typical symptoms of covid-19 (cough, fever, shortness of breath), of whom only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53) of people who died were aged under 60 years. The five most common comorbidities among people who died with covid-19 were tuberculosis (22; 31%), hypertension (19; 27%), HIV/AIDS (16; 23%), alcohol misuse (12; 17%), and diabetes (9; 13%). CONCLUSIONS Contrary to expectations, deaths with covid-19 were common in Lusaka. Most occurred in the community, where testing capacity is lacking. However, few people who died at facilities were tested, despite presenting with typical symptoms of covid-19. Therefore, cases of covid-19 were under-reported because testing was rarely done not because covid-19 was rare. If these data are generalizable, the impact of covid-19 in Africa has been vastly underestimated.
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Affiliation(s)
- Lawrence Mwananyanda
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
- Right To Care – Zambia
- Contributed equally
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
- Contributed equally
| | - William MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | - Rachel Pieciak
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Zachariah Mupila
- ZPRIME Molecular Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Rotem Lapidot
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Francis Mupeta
- Division of Internal Medicine, Infectious Diseases Section, University Teaching Hospital, Lusaka, Zambia
| | - Leah Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Luunga Ziko
- Division of Internal Medicine, Infectious Diseases Section, University Teaching Hospital, Lusaka, Zambia
| | - Lauren Etter
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Donald Thea
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
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Ferreira VH, Chruscinski A, Kulasingam V, Pugh TJ, Dus T, Wouters B, Oza A, Ierullo M, Ku T, Majchrzak-Kita B, Humar ST, Bahinskaya I, Pinzon N, Zhang J, Heisler LE, Krzyzanowski PM, Lam B, Lungu IM, Manase D, Pace KM, Mashouri P, Brudno M, Garrels M, Mazzulli T, Cybulsky M, Humar A, Kumar D. Prospective observational study and serosurvey of SARS-CoV-2 infection in asymptomatic healthcare workers at a Canadian tertiary care center. PLoS One 2021; 16:e0247258. [PMID: 33592074 PMCID: PMC7886177 DOI: 10.1371/journal.pone.0247258] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/02/2020] [Accepted: 02/03/2021] [Indexed: 01/01/2023] Open
Abstract
Health care workers (HCWs) are at higher risk for SARS-CoV-2 infection and may play a role in transmitting the infection to vulnerable patients and members of the community. This is particularly worrisome in the context of asymptomatic infection. We performed a cross-sectional study looking at asymptomatic SARS-CoV-2 infection in HCWs. We screened asymptomatic HCWs for SARS-CoV-2 via PCR. Complementary viral genome sequencing was performed on positive swab specimens. A seroprevalence analysis was also performed using multiple assays. Asymptomatic health care worker cohorts had a combined swab positivity rate of 29/5776 (0.50%, 95%CI 0.32–0.75) relative to a comparative cohort of symptomatic HCWs, where 54/1597 (3.4%) tested positive for SARS-CoV-2 (ratio of symptomatic to asymptomatic 6.8:1). SARS-CoV-2 seroprevalence among 996 asymptomatic HCWs with no prior known exposure to SARS-CoV-2 was 1.4–3.4%, depending on assay. A novel in-house Coronavirus protein microarray showed differing SARS-CoV-2 protein reactivities and helped define likely true positives vs. suspected false positives. Our study demonstrates the utility of routine screening of asymptomatic HCWs, which may help to identify a significant proportion of infections.
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Affiliation(s)
| | | | | | - Trevor J. Pugh
- University Health Network, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Tamara Dus
- University Health Network, Toronto, Ontario, Canada
| | - Brad Wouters
- University Health Network, Toronto, Ontario, Canada
| | - Amit Oza
- University Health Network, Toronto, Ontario, Canada
| | | | - Terrance Ku
- University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Bernard Lam
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ilinca M. Lungu
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Dorin Manase
- University Health Network Digital, Toronto, Ontario, Canada
| | - Krista M. Pace
- University Health Network Digital, Toronto, Ontario, Canada
| | | | - Michael Brudno
- University Health Network Digital, Toronto, Ontario, Canada
| | | | | | | | - Atul Humar
- University Health Network, Toronto, Ontario, Canada
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Shah B, Dande V, Rao S, Prabhu S, Bodhanwala M. Outcome of Covid-19 Positive Newborns Presenting to a Tertiary Care Hospital. Indian Pediatr 2021; 58:177-179. [PMID: 33632951 PMCID: PMC7926062] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Neonatal data regarding SARS-CoV-2 is sparse from India. On review of hospital records from April- August, 2020, 18/423 (4.25%) neonates were SARS-CoV-2 RT-PCR positive. 15 (83.3%) neonates recovered and 3 (16.6%) succumbed. Only 50% of the positive babies had positive mothers/ caretakers, a contact could not be traced in others.
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Affiliation(s)
- Bhavya Shah
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Vaidehi Dande
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Sudha Rao
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
| | - Sanjay Prabhu
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Minnie Bodhanwala
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
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Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial mortality. Some specialists proposed chloroquine (CQ) and hydroxychloroquine (HCQ) for treating or preventing the disease. The efficacy and safety of these drugs have been assessed in randomized controlled trials. OBJECTIVES To evaluate the effects of chloroquine (CQ) or hydroxychloroquine (HCQ) for 1) treating people with COVID-19 on death and time to clearance of the virus; 2) preventing infection in people at risk of SARS-CoV-2 exposure; 3) preventing infection in people exposed to SARS-CoV-2. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Current Controlled Trials (www.controlled-trials.com), and the COVID-19-specific resources www.covid-nma.com and covid-19.cochrane.org, for studies of any publication status and in any language. We performed all searches up to 15 September 2020. We contacted researchers to identify unpublished and ongoing studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) testing chloroquine or hydroxychloroquine in people with COVID-19, people at risk of COVID-19 exposure, and people exposed to COVID-19. Adverse events (any, serious, and QT-interval prolongation on electrocardiogram) were also extracted. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility of search results, extracted data from the included studies, and assessed risk of bias using the Cochrane 'Risk of bias' tool. We contacted study authors for clarification and additional data for some studies. We used risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CIs). We performed meta-analysis using a random-effects model for outcomes where pooling of effect estimates was appropriate. MAIN RESULTS 1. Treatment of COVID-19 disease We included 12 trials involving 8569 participants, all of whom were adults. Studies were from China (4); Brazil, Egypt, Iran, Spain, Taiwan, the UK, and North America (each 1 study); and a global study in 30 countries (1 study). Nine were in hospitalized patients, and three from ambulatory care. Disease severity, prevalence of comorbidities, and use of co-interventions varied substantially between trials. We found potential risks of bias across all domains for several trials. Nine trials compared HCQ with standard care (7779 participants), and one compared HCQ with placebo (491 participants); dosing schedules varied. HCQ makes little or no difference to death due to any cause (RR 1.09, 95% CI 0.99 to 1.19; 8208 participants; 9 trials; high-certainty evidence). A sensitivity analysis using modified intention-to-treat results from three trials did not influence the pooled effect estimate. HCQ may make little or no difference to the proportion of people having negative PCR for SARS-CoV-2 on respiratory samples at day 14 from enrolment (RR 1.00, 95% CI 0.91 to 1.10; 213 participants; 3 trials; low-certainty evidence). HCQ probably results in little to no difference in progression to mechanical ventilation (RR 1.11, 95% CI 0.91 to 1.37; 4521 participants; 3 trials; moderate-certainty evidence). HCQ probably results in an almost three-fold increased risk of adverse events (RR 2.90, 95% CI 1.49 to 5.64; 1394 participants; 6 trials; moderate-certainty evidence), but may make little or no difference to the risk of serious adverse events (RR 0.82, 95% CI 0.37 to 1.79; 1004 participants; 6 trials; low-certainty evidence). We are very uncertain about the effect of HCQ on time to clinical improvement or risk of prolongation of QT-interval on electrocardiogram (very low-certainty evidence). One trial (22 participants) randomized patients to CQ versus lopinavir/ritonavir, a drug with unknown efficacy against SARS-CoV-2, and did not report any difference for clinical recovery or adverse events. One trial compared HCQ combined with azithromycin against standard care (444 participants). This trial did not detect a difference in death, requirement for mechanical ventilation, length of hospital admission, or serious adverse events. A higher risk of adverse events was reported in the HCQ-and-azithromycin arm; this included QT-interval prolongation, when measured. One trial compared HCQ with febuxostat, another drug with unknown efficacy against SARS-CoV-2 (60 participants). There was no difference detected in risk of hospitalization or change in computed tomography (CT) scan appearance of the lungs; no deaths were reported. 2. Preventing COVID-19 disease in people at risk of exposure to SARS-CoV-2 Ongoing trials are yet to report results for this objective. 3. Preventing COVID-19 disease in people who have been exposed to SARS-CoV-2 One trial (821 participants) compared HCQ with placebo as a prophylactic agent in the USA (around 90% of participants) and Canada. Asymptomatic adults (66% healthcare workers; mean age 40 years; 73% without comorbidity) with a history of exposure to people with confirmed COVID-19 were recruited. We are very uncertain about the effect of HCQ on the primary outcomes, for which few events were reported: 20/821 (2.4%) developed confirmed COVID-19 at 14 days from enrolment, and 2/821 (0.2%) were hospitalized due to COVID-19 (very low-certainty evidence). HCQ probably increases the risk of adverse events compared with placebo (RR 2.39, 95% CI 1.83 to 3.11; 700 participants; 1 trial; moderate-certainty evidence). HCQ may result in little or no difference in serious adverse events (no RR: no participants experienced serious adverse events; low-certainty evidence). One cluster-randomized trial (2525 participants) compared HCQ with standard care for the prevention of COVID-19 in people with a history of exposure to SARS-CoV-2 in Spain. Most participants were working or residing in nursing homes; mean age was 49 years. There was no difference in the risk of symptomatic confirmed COVID-19 or production of antibodies to SARS-CoV-2 between the two study arms. AUTHORS' CONCLUSIONS HCQ for people infected with COVID-19 has little or no effect on the risk of death and probably no effect on progression to mechanical ventilation. Adverse events are tripled compared to placebo, but very few serious adverse events were found. No further trials of hydroxychloroquine or chloroquine for treatment should be carried out. These results make it less likely that the drug is effective in protecting people from infection, although this is not excluded entirely. It is probably sensible to complete trials examining prevention of infection, and ensure these are carried out to a high standard to provide unambiguous results.
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Affiliation(s)
- Bhagteshwar Singh
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Hannah Ryan
- Department of Clinical Pharmacology, Royal Liverpool University Hospital, Liverpool, UK
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tom Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Nakajima M, Yamamoto Y, Kaszynski RH, Yamauchi Y, Yamamoto K, Nakajima Y, Goto H, Yamaguchi Y, Ide T, Maeda Y, Tajiri Y. A comparison on the percentage of polymerase chain reaction positivity for SARS-CoV-2 between Public Health Center referrals and direct walk-in patients: A single center retrospective analysis in Tokyo. J Infect Chemother 2021; 27:852-856. [PMID: 33593668 PMCID: PMC7862890 DOI: 10.1016/j.jiac.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
Introduction The Public Health Center (PHC)—known as hokenjo in Japan—assume a crucial role in disease control. Coronavirus disease 2019 (COVID-19) is one of many designated infectious diseases monitored by the agency. During the present pandemic, patients who suspected COVID-19 were instructed to call the Coronavirus Consultation Center in the PHC prior to visiting the hospital. The aim of this study was to elucidate the differences in polymerase chain reaction (PCR) positivity between PHC referrals and direct walk-in patients. Methods The present was a single-center, retrospective cohort study conducted at the Tokyo Metropolitan Hospital from March to September, 2020. Patients who received a PCR test for SARS-CoV-2 were included and categorized into the PHC referral or direct walk-in groups. The outcomes included the total number of patients undergoing PCR tests and the percentage of PCR positivity in each group. Results We identified 1680 patients (781 PHC referred and 899 direct walk-in groups). The percentage of PCR positivity did not significantly differ between the PHC referral and direct walk-in groups during the first wave (30.5% vs. 29.2%; p = 0.78). PCR positivity was significantly higher in the PHC referral group than the direct walk-in group during the second wave (30.1% vs. 23.1%; p = 0.051) and entire study period (30.2% vs. 24.7%; p = 0.011). Conclusions Despite health authority recommendations, the number of direct walk-in patients were higher than PHC referral patients. The percentage of PCR positivity was significantly higher in the PHC referral group than in the direct walk-in group.
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Affiliation(s)
- Mikio Nakajima
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan; Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, 181-8611, Tokyo, Japan.
| | - Yasuhiro Yamamoto
- Department of Pediatrics, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Richard H Kaszynski
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Yuko Yamauchi
- Department of Infectious Diseases, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Kazuo Yamamoto
- Department of Pulmonary Medicine, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Yasushi Nakajima
- Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Hideaki Goto
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, 181-8611, Tokyo, Japan.
| | - Takafumi Ide
- Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Yoshiharu Maeda
- Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
| | - Yasuhito Tajiri
- Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, 150-0013, Tokyo, Japan.
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Franco D, Gonzalez C, Abrego LE, Carrera JP, Diaz Y, Caicedo Y, Moreno A, Chavarria O, Gondola J, Castillo M, Valdespino E, Gaitán M, Martínez-Mandiche J, Hayer L, Gonzalez P, Lange C, Molto Y, Mojica D, Ramos R, Mastelari M, Cerezo L, Moreno L, Donnelly CA, Pascale JM, Faria NR, Lopez-Verges S, Martinez AA. Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama. Emerg Infect Dis 2021; 27:612-615. [PMID: 33496228 PMCID: PMC7853578 DOI: 10.3201/eid2702.203767] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We report an epidemiologic analysis of 4,210 cases of infection with severe acute respiratory syndrome coronavirus 2 and genetic analysis of 313 new near-complete virus genomes in Panama during March 9-April 16, 2020. Although containment measures reduced R0 and Rt, they did not interrupt virus spread in the country.
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50
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Abstract
This cohort study assesses the risk of household transmission of SARS-CoV-2 and the associated risk factors among exposed household members.
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Affiliation(s)
- Joshua P. Metlay
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer S. Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander E. Soltoff
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katrina A. Armstrong
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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