Systematic review on digitals tools used for contact tracing of COVID-19 patients: interim results

Background

Contact tracing is a public health intervention implemented in synergy with other measures, such as testing, physical distancing, and vaccination, to curb the COVID-19 pandemic. Digital solutions have been developed worldwide to enhance the contact tracing process. The aim of the study was to evaluate the effectiveness and impact of tracking COVID-19 patients using digital tools.

Methods

A systematic literature review was performed on eight online databases to identify observational studies on digital contact tracing, published 2020-2021, in English. Studies identified through the ‘Population Health Information Research Infrastructure’ project were also included. An ad hoc form has been deployed for data extraction of relevant information. Quality assessment of the included studies will be performed using validated tools.

Results

Over 8000 records were identified, of which 27 met the inclusion criteria: 16 modelling and 11 population-based studies. A study was based on GPS technology, four were Bluetooth-based, and others used digital technologies and manual tracing. The uptake rate of the tools ranged 19-100% across the studies. Most studies compared digital contact tracing with other strategies (e.g., no intervention, lockdown). Digital contact tracing was associated with improved identification of contact persons (9 studies), reduction of the effective reproduction number or covid-19 infections (8 studies), and increased effectiveness in combination with other containment measures (9 studies). Security and privacy issues were considered in 8 studies.

Conclusions

Digital contact tracing contributes in reducing further transmission, especially with sufficient population uptake of the applications and in combination with other public health measures. However, its deployment has been limited by security and privacy issues. Further studies are required to investigate the combined impact of digital and conventional contact tracing and enhance privacy and security.

Setting targets for population health improvements: Trends in perinatal health in Europe over the past five years

Background

The Euro-Peristat network documented disparities in perinatal outcomes between countries in Europe in its reports published every 5 years, but trend analyses were limited because data were not collected annually.

Methods

Using the Euro-Peristat PHIRI protocol, we estimated rates and assessed trends between 2015 and 2019 for preterm birth, stillbirth, neonatal mortality and caesarean delivery. Country-specific relative risks (RR) for year, modelled as a continuous variable, were estimated and random effects meta-analysis used to generate pooled RRs. Heterogeneity was measured with the I2 statistic (percentage of variability in estimates due to heterogeneity rather than sampling error).

Results

Stillbirth rates ≥24 weeks of gestational age (GA) varied in 2019 from <2.5 per 1000 births in Denmark, Estonia, Finland and Slovenia to over 4 per 1000 in Belgium, Cyprus, UK Wales and Lithuania. Preterm birth rates ranged from <6% in Lithuania, Finland, Latvia, Estonia and Denmark to 8% or more in Portugal, Belgium, UK Scotland and Cyprus. Fewer than 20% of births were by caesarean in Norway, the Netherlands, Finland, Estonia in comparison to one-third in Cyprus, Ireland, Italy, UK Scotland. Trends over time differed between countries and were not related to the level of the indicator: the pooled RR by year for preterm birth was 0.99 [0.99; 1.00] with five countries having significant decreases and three countries having increases. Caesarean section rates were stable overall (RR: 1.00 [0.99; 1.01]RR:1.00, 95% CI: 0.99-1.01), but with high heterogeneity (I2=99%); in six countries rates increased significantly, whereas in nine rates decreased between 2015 and 2019.

Conclusions

European countries have varying rates and trends of the principal perinatal health indicators. Investigation of policies in high-performing countries could provide guidance for improvement elsewhere.

Birth defects and associated antenatal care factors related with 1st trimester of pregnancy

Background

Ultrasound (US) can help monitor normal fetal development and screen for any potential problems. The prenatal detection of fetal anomalies allows for optimal perinatal management.

Aim

The aim was to assess congenital anomalies at births and their associated antenatal care factors.

Methods

Data source - Health Care Monitoring Datalink (HCMD), including two data sources: Medical Birth Register and ambulatory care data provided by public and private health care providers about US. Screening was detected by specific manipulation code: 50694 - routine US screening in the 1st trimester of pregnancy. All singleton birth in 2018 (n = 12955) were included in the data analysis. OR (odds ratio) were calculated. Multiple regression model was adjusted for mother age, gestational age, living area and antenatal care factors.

Results

The mean mother age was 30.3 (SD 5.4) and gestational age 39.3 (SD 1.8). The use of ICD-10 code O28 - abnormal findings on antenatal screening of mother - was observed in a small number of cases. 2.4% (n = 305) abnormal findings on antenatal screening of mother were detected at ambulatory care visits. From these cases 7.5% (n = 23) were diagnosed congenital anomalies at birth. Totally 2.8% (n = 362) of births were registered congenital anomalies. Congenital anomalies at birth have higher and statistically significant odds of invasive diagnostic methods in pregnancy (OR = 2.0; 95%CI 1.2-3.6; p < 0.01) and abnormal findings on US screening (OR = 2.6; 95%CI 1.7-4.2; p < 0.001). Slightly higher frequency of congenital anomalies at birth but not statistically significant (p > 0.05) were observed for 1st trimester genetic screening (OR = 1.5), preterm deliveries (OR = 1.4) and living in urban area (OR = 1.3).

Conclusions

Pregnancy outcome as congenital anomalies at birth related with higher maternal screening examinations prenatally. Further studies are needed to analyze the efficiency of US examinations for early prenatal detection of congenital anomalies.

Key messages

Impact of COVID-19 on maternal and neonatal outcomes: a population-based cohort study in Latvia

Introduction

Coronavirus disease (COVID-19) has affected many pregnant women worldwide. Pregnant women with COVID-19 infection belong to a vulnerable group with concerns about the effect of the disease on maternal and neonatal health.

Objectives

To assess association of COVID-19 on maternal and neonatal outcomes in Latvia.

Methods

Data source was Medical Birth Register. A total of 17206 birth data for 2021 were included in the data analysis.

Results

2.1% (n = 358) women with COVID-19 (U07.1; U07.2) during pregnancy or delivery. COVID-19 infection was related to the following conditions during pregnancy - gestation diabetes (10.6% to 4.6%; p < 0.001); placental abruption (1.7% to 0.6%; p < 0.05). Birth outcomes for COVID-19 infected women showed that infection has led to the increased caesarean section (27.7% to 22.0%; p < 0.01), preterm birth (12.8% to 5.3%; p < 0.001); low birth weight ≤2499g rate (10.1% to 3.9%; p < 0.001); stillbirths (2.8% to 0.4%; p < 0.001) and newborn infections specific to the perinatal period (P35-P39) (9.5% to 5.2%; p < 0.05). Increased BMI (8.9% to 6.8%), fetal distress (3.9% to 2.4%); preeclampsia, eclampsia (3.2% to 2.1%), hypertension (2.8% to 2.0%), gestational hypertension (5.0% to 3.8%) more frequently were observed among COVID-19 infected patients but the difference was not statistically significant. COVID-19 associated with higher odds (adjusted by mother age, multiple births, gestational age, mode of delivery) of gestational diabetes (ORadj 2.3; 95%CI 1.7-3.4; p < 0.001), newborn infections specific to the perinatal period (ORadj 1.7; 95%CI 1.2-2.4; p < 0.01) and stillbirth (ORadj 4.0; 95%CI 1.9-8.2; p < 0.001).

Conclusions

COVID- 19 during pregnancy is associated with higher risk of adverse maternal and perinatal outcomes. The study results of short-term pregnancy outcomes show importance of implementation of all recommended COVID-19 prophylactic measures by public health specialists and clinicians during antenatal care.

Key messages