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Silveira MF, Mesenburg MA, Dellagostin OA, de Oliveira NR, Maia MA, Santos FD, Vale A, Menezes AMB, Victora GD, Victora CG, Barros AJ, Vidaletti LP, Hartwig FP, Barros FC, Hallal PC, Horta BL. Time-dependent decay of detectable antibodies against SARS-CoV-2: A comparison of ELISA with two batches of a lateral-flow test. Braz J Infect Dis 2021; 25:101601. [PMID: 34391693 PMCID: PMC8339571 DOI: 10.1016/j.bjid.2021.101601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/28/2021] [Accepted: 07/10/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Large-scale epidemiological studies of seroprevalence of antibodies against SARS-CoV-2 often rely on point-of-care tests that provide immediate results to participants. Yet, little is known on how long rapid tests remain positive after the COVID-19 episode, or how much variability exists across different brands and even among batches of the same test. METHODS In November 2020, we assessed the sensitivity of three tests applied to 133 individuals with a previous positive PCR result between April and October. All subjects provided finger prick blood samples for two batches (A and B) of the Wondfo lateral-flow IgG/IgM test, and dried blood spot samples for the S-UFRJ ELISA test. RESULTS Overall sensitivity levels were 92.5% (95% CI 86.6-96.3), 63.2% (95% CI 54.4-71.4) and 33.8% (95% CI 25.9-42.5) for the S-UFRJ test, Wondfo A and Wondfo B tests, respectively. There was no evidence of a decline in the positivity of S-UFRJ with time since the diagnosis, but the two Wondfo batches showed sharp reductions to as low as 41.9% and 19.4%, respectively, for subjects with a positive PCR in June or earlier. Positive results for batch B of the rapid test were 35% to 54% lower than for batch A at any given month of diagnosis. INTERPRETATION Whereas the ELISA test showed high sensitivity and stability of results over the five months of the study, both batches of the rapid test showed substantial declines, with one of the batches consistently showing lower sensitivity levels than the other. ELISA tests based on dried-blood spots are an inexpensive alternative to rapid lateral-flow tests in large-scale epidemiological studies. FUNDING The study was funded by the "Todos Pela Saúde" initiative, Instituto Serrapilheira, Brazilian Ministry of Health, Brazilian Collective Health Association (ABRASCO) and the JBS S.A. initiative 'Fazer o Bem Faz Bem'.
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Affiliation(s)
| | - Marilia A Mesenburg
- Universidade Federal de Pelotas, Pelotas, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | | | - Mara Ac Maia
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | | | - André Vale
- Universidade Federal do Rio de Janeiro, Rio de Janeiro,RJ, Brazil.
| | | | - Gabriel D Victora
- Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, United States.
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Kline D, Li Z, Chu Y, Wakefield J, Miller WC, Norris Turner A, Clark SJ. Estimating seroprevalence of SARS-CoV-2 in Ohio: A Bayesian multilevel poststratification approach with multiple diagnostic tests. Proc Natl Acad Sci U S A 2021; 118:e2023947118. [PMID: 34172581 PMCID: PMC8255994 DOI: 10.1073/pnas.2023947118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Globally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 59 million people and killed more than 1.39 million. Designing and monitoring interventions to slow and stop the spread of the virus require knowledge of how many people have been and are currently infected, where they live, and how they interact. The first step is an accurate assessment of the population prevalence of past infections. There are very few population-representative prevalence studies of SARS-CoV-2 infections, and only two states in the United States-Indiana and Connecticut-have reported probability-based sample surveys that characterize statewide prevalence of SARS-CoV-2. One of the difficulties is the fact that tests to detect and characterize SARS-CoV-2 coronavirus antibodies are new, are not well characterized, and generally function poorly. During July 2020, a survey representing all adults in the state of Ohio in the United States collected serum samples and information on protective behavior related to SARS-CoV-2 and coronavirus disease 2019 (COVID-19). Several features of the survey make it difficult to estimate past prevalence: 1) a low response rate; 2) a very low number of positive cases; and 3) the fact that multiple poor-quality serological tests were used to detect SARS-CoV-2 antibodies. We describe a Bayesian approach for analyzing the biomarker data that simultaneously addresses these challenges and characterizes the potential effect of selective response. The model does not require survey sample weights; accounts for multiple imperfect antibody test results; and characterizes uncertainty related to the sample survey and the multiple imperfect, potentially correlated tests.
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Affiliation(s)
- David Kline
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210;
| | - Zehang Li
- Department of Statistics, University of California, Santa Cruz, CA 95064
| | - Yue Chu
- Department of Sociology, The Ohio State University, Columbus, OH 43210
| | - Jon Wakefield
- Department of Statistics, University of Washington, Seattle, WA 98195
- Department of Biostatistics, University of Washington, Seattle, WA 98195
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210
| | - Abigail Norris Turner
- Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH 43210
| | - Samuel J Clark
- Department of Sociology, The Ohio State University, Columbus, OH 43210;
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Hallal PC, Silveira MF, Menezes AMB, Horta BL, Barros AJD, Pellanda LC, Victora GD, Dellagostin OA, Struchiner CJ, Burattini MN, Mesenburg MA, Jacques N, Vidaletti LP, Ambros EL, Berlezi EM, Schirmer H, Renner JDP, Collares K, Ikeda MLR, Ardenghi TM, Gasperi PD, Hartwig FP, Barros FC, Victora CG. Slow Spread of SARS-CoV-2 in Southern Brazil Over a 6-Month Period: Report on 8 Sequential Statewide Serological Surveys Including 35 611 Participants. Am J Public Health 2021; 111:1542-1550. [PMID: 34185552 DOI: 10.2105/ajph.2021.306351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over 6 months in the Brazilian State of Rio Grande do Sul (population 11.3 million), based on 8 serological surveys. Methods. In each survey, 4151 participants in round 1 and 4460 participants in round 2 were randomly sampled from all state regions. We assessed presence of antibodies against SARS-CoV-2 using a validated lateral flow point-of-care test; we adjusted figures for the time-dependent decay of antibodies. Results. The SARS-CoV-2 antibody prevalence increased from 0.03% (95% confidence interval [CI] = 0.00%, 0.34%; 1 in every 3333 individuals) in mid-April to 1.89% (95% CI = 1.36%, 2.54%; 1 in every 53 individuals) in early September. Prevalence was similar across gender and skin color categories. Older adults were less likely to be infected than younger participants. The proportion of the population who reported leaving home daily increased from 21.4% (95% CI = 20.2%, 22.7%) to 33.2% (95% CI = 31.8%, 34.5%). Conclusions. SARS-CoV-2 infection increased slowly during the first 6 months in the state, differently from what was observed in other Brazilian regions. Future survey rounds will continue to document the spread of the pandemic.
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Affiliation(s)
- Pedro C Hallal
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Mariângela F Silveira
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Ana M B Menezes
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Bernardo L Horta
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Aluísio J D Barros
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Lúcia C Pellanda
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Gabriel D Victora
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Odir A Dellagostin
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Claudio J Struchiner
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Marcelo N Burattini
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Marilia A Mesenburg
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Nadege Jacques
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Luís Paulo Vidaletti
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Emanuele L Ambros
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Evelise M Berlezi
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Helena Schirmer
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Jane D P Renner
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Kaue Collares
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Maria Letícia R Ikeda
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Thiago M Ardenghi
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Patricia de Gasperi
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Fernando P Hartwig
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Fernando C Barros
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
| | - Cesar G Victora
- Pedro C. Hallal, Mariângela F. Silveira, Ana M. B. Menezes, Bernardo L. Horta, Aluísio J. D. Barros, Nadege Jacques, Luís Paulo Vidaletti, Fernando P. Hartwig, Fernando C. Barros, and Cesar G. Victora are with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Brazil. Lúcia C. Pellanda and Helena Schirmer are with the Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil. Gabriel D. Victora is with the Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY. Odir A. Dellagostin is with the Postgraduate Program in Biotechnology, Universidade Federal de Pelotas. Claudio J. Struchiner is with the Fundação Getúlio Vargas, Rio de Janeiro, Brazil. Marcelo N. Burattini is with the Universidade Federal de São Paulo, Brazil. Marilia A. Mesenburg is with the Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, and the Universidade Federal de Ciências de Saúde de Porto Alegre. Emanuele L. Ambros is with the Secretaria Municipal de Saúde de Uruguaiana, Brazil. Evelise M. Berlezi is with the Universidade de Ijuí, Brazil. Jane D. P. Renner is with the Universidade de Santa Cruz do Sul, Brazil. Kaue Collares is with the Universidade de Passo Fundo, Brazil. Maria Letícia R. Ikeda is with the Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil. Thiago M. Ardenghi is with the Universidade Federal de Santa Maria, Brazil. Patricia de Gasperi is with the Universidade de Caxias do Sul, Brazil
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Barros FC, Hartwig FP, Barros AJD, Menezes AMB, Horta BL, Struchiner CJ, Vidaletti LP, Silveira MF, Mesenburg MA, Delagostin OA, Hallal PC, Victora CG. COVID-19 and social distancing among children and adolescents in Brazil. Rev Saude Publica 2021; 55:42. [PMID: 34190899 PMCID: PMC8225319 DOI: 10.11606/s1518-8787.2021055003832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May-June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0-9 and 10-19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2-3.6) among children 0-9 years, 2.2% (1.8-2.6) among adolescents 10-19 years, and 3.0% (2.7-3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9-73.8) of families with children, 60.8% (59.6-61.9) for adolescents, and 57.4% (56.9-57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5-82.9), 70.6% (69.6-61.9), and 65.1% (64.7-65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.
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Affiliation(s)
- Fernando C Barros
- Universidade Católica de PelotasPelotasRSBrasilUniversidade Católica de Pelotas. Curso de Pós-Graduação em Saúde no Ciclo Vital. Pelotas, RS, Brasil
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Fernando P Hartwig
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Aluísio J D Barros
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Ana M B Menezes
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Bernardo L Horta
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Cláudio J Struchiner
- Fundação Getúlio VargasEscola de Matemática AplicadaRio de JaneiroRJBrasilFundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil
| | - Luis Paulo Vidaletti
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Mariangela F Silveira
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Marilia A Mesenburg
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
- Universidade Federal de Ciências da Saúde de Porto AlegreFaculdade de MedicinaPorto AlegreRSBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre. Faculdade de Medicina. Porto Alegre, RS, Brasil
| | - Odir A Delagostin
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Pedro C Hallal
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
| | - Cesar G Victora
- Universidade Federal de PelotasFaculdade de MedicinaDepartamento de Medicina SocialPelotasRSBrasilUniversidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Pelotas, RS, Brasil
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55
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Donalisio MR. A beacon for the COVID-19 epidemic control in Brasil: seroepidemiological population-based surveys. Rev Assoc Med Bras (1992) 2021; 67:3-5. [PMID: 34161477 DOI: 10.1590/1806-9282.67.01.20200512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Maria Rita Donalisio
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas - Campinas (SP), Brasil
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56
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Barchuk A, Skougarevskiy D, Titaev K, Shirokov D, Raskina Y, Novkunkskaya A, Talantov P, Isaev A, Pomerantseva E, Zhikrivetskaya S, Barabanova L, Volkov V. Seroprevalence of SARS-CoV-2 antibodies in Saint Petersburg, Russia: a population-based study. Sci Rep 2021; 11:12930. [PMID: 34155259 PMCID: PMC8217236 DOI: 10.1038/s41598-021-92206-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/04/2021] [Indexed: 01/08/2023] Open
Abstract
Properly conducted serological survey can help determine infection disease true spread. This study aims to estimate the seroprevalence of SARS-CoV-2 antibodies in Saint Petersburg, Russia accounting for non-response bias. A sample of adults was recruited with random digit dialling, interviewed and invited for anti-SARS-CoV-2 antibodies. The seroprevalence was corrected with the aid of the bivariate probit model that jointly estimated individual propensity to agree to participate in the survey and seropositivity. 66,250 individuals were contacted, 6,440 adults agreed to be interviewed and blood samples were obtained from 1,038 participants between May 27 and June 26, 2020. Naïve seroprevalence corrected for test characteristics was 9.0% (7.2-10.8) by CMIA and 10.5% (8.6-12.4) by ELISA. Correction for non-response decreased estimates to 7.4% (5.7-9.2) and 9.1% (7.2-10.9) for CMIA and ELISA, respectively. The most pronounced decrease in bias-corrected seroprevalence was attributed to the history of any illnesses in the past 3 months and COVID-19 testing. Seroconversion was negatively associated with smoking status, self-reported history of allergies and changes in hand-washing habits. These results suggest that even low estimates of seroprevalence can be an overestimation. Serosurvey design should attempt to identify characteristics that are associated both with participation and seropositivity.
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Affiliation(s)
- Anton Barchuk
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa, 1, St. Petersburg, Russia, 191187.
- N.N. Petrov National Research Medical Center of Oncology, Pesochny, Leningradskaya Ulitsa, 68, St. Petersburg, Russia, 197758.
- Health Sciences, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Dmitriy Skougarevskiy
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa, 1, St. Petersburg, Russia, 191187
| | - Kirill Titaev
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa, 1, St. Petersburg, Russia, 191187
| | - Daniil Shirokov
- Clinic "Scandinavia" (LLC Ava-Peter), Ilyushina Ulitsa, 4-1, St. Petersburg, Russia, 197372
- ITMO University, Kronverksky Prospekt, 49, St. Petersburg, Russia, 197101
| | - Yulia Raskina
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa, 1, St. Petersburg, Russia, 191187
| | - Anastasia Novkunkskaya
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa, 1, St. Petersburg, Russia, 191187
| | - Petr Talantov
- The Russian Academy of Sciences Commission for Counteracting the Falsification of Scientific Research, Leingradsky Prospekt, 14, Moscow, Russia, 119991
| | - Artur Isaev
- Human Stem Cells Institute, Ulitsa Gubkina, 3-2, Moscow, Russia, 119333
| | - Ekaterina Pomerantseva
- Center of Genetics and Reproductive Medicine GENETICO LLC, Ulitsa Gubkina, 3-1, Moscow, Russia, 119333
| | - Svetlana Zhikrivetskaya
- Center of Genetics and Reproductive Medicine GENETICO LLC, Ulitsa Gubkina, 3-1, Moscow, Russia, 119333
| | - Lubov Barabanova
- Clinic "Scandinavia" (LLC Ava-Peter), Ilyushina Ulitsa, 4-1, St. Petersburg, Russia, 197372
| | - Vadim Volkov
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa, 1, St. Petersburg, Russia, 191187
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Oliveira EA, Colosimo EA, Simões E Silva AC, Mak RH, Martelli DB, Silva LR, Martelli-Júnior H, Oliveira MCL. Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:559-568. [PMID: 34119027 PMCID: PMC8192298 DOI: 10.1016/s2352-4642(21)00134-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
Background COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. Methods We did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. Findings Of the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14·2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7·6%) died in hospital (at a median 6 days [IQR 3–15] after hospital admission), 10 041 (86·5%) patients were discharged from the hospital, 369 (3·2%) were in hospital at the time of analysis, and 317 (2·7%) were missing information on outcome. The estimated probability of death was 4·8% during the first 10 days after hospital admission, 6·7% during the first 20 days, and 8·1% at the end of follow-up. Probability of discharge was 54·1% during the first 10 days, 78·4% during the first 20 days, and 92·0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2·36 [95% CI 1·94–2·88]) or adolescents aged 12–19 years (2·23 [1·84–2·71]) relative to children aged 2–11 years; those of Indigenous ethnicity (3·36 [2·15–5·24]) relative to those of White ethnicity; those living in the Northeast region (2·06 [1·68–2·52]) or North region (1·55 [1·22–1·98]) relative to those in the Southeast region; and those with one (2·96 [2·52–3·47]), two (4·96 [3·80–6·48]), or three or more (7·28 [4·56–11·6]) pre-existing medical conditions relative to those with none. Interpretation Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil. Funding National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.
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Affiliation(s)
- Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert H Mak
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, La Jolla, CA, USA
| | - Daniella B Martelli
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros, Montes Claros, Brazil
| | - Ludmila R Silva
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros, Montes Claros, Brazil
| | - Maria Christina L Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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Gonçalves MR, Dos Reis RCP, Tólio RP, Pellanda LC, Schmidt MI, Katz N, Mengue SS, Hallal PC, Horta BL, Silveira MF, Umpierre RN, Bastos-Molina CG, Souza da Silva R, Duncan BB. Social Distancing, Mask Use, and Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Brazil, April-June 2020. Emerg Infect Dis 2021; 27:2135-2143. [PMID: 34087090 PMCID: PMC8314805 DOI: 10.3201/eid2708.204757] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We assessed the associations of social distancing and mask use with symptomatic, laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in Porto Alegre, Brazil. We conducted a population-based case-control study during April–June 2020. Municipal authorities furnished case-patients, and controls were taken from representative household surveys. In adjusted logistic regression analyses of 271 case-patients and 1,396 controls, those reporting moderate to greatest adherence to social distancing had 59% (odds ratio [OR] 0.41, 95% CI 0.24–0.70) to 75% (OR 0.25, 95% CI 0.15–0.42) lower odds of infection. Lesser out-of-household exposure (vs. going out every day all day) reduced odds from 52% (OR 0.48, 95% CI 0.29–0.77) to 75% (OR 0.25, 95% CI 0.18–0.36). Mask use reduced odds of infection by 87% (OR 0.13, 95% CI 0.04–0.36). In conclusion, social distancing and mask use while outside the house provided major protection against symptomatic infection.
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Assunção AÁ, Maia EG, Jardim R, de Araújo TM. Incidence of Reported Flu-Like Syndrome Cases in Brazilian Health Care Workers in 2020 (March to June). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115952. [PMID: 34206062 PMCID: PMC8198595 DOI: 10.3390/ijerph18115952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/10/2023]
Abstract
Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, FS corresponds to a suspected case of COVID-19. The manuscript analyzed cases of FS in five Brazilian states, estimating the incidence rates of cases of FS and clinical and epidemiological characteristics. Registered cases (March to June 2020) totaled about 1,100,000 cases of FS. HCWs represented 17% of the registers, whose incidence was 20.41/100 vs. 2.15/100 in the GC. FS cases in HCWs concentrated the highest percentages in the age group of 30 to 49 years (65.15%) and among the nursing staff (46.86%). This study was the first interstate evaluation in Brazil to estimate suspected cases of FS by COVID-19 in HCWs. In order to control the spread of viral respiratory infections in HCWs, including COVID-19, it is necessary to review the management of health information to identify who they are, how many they are, and to what situations these workers are most frequently exposed, as well as in what professions they have. This information can guide specific, practical, and far-reaching actions.
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Affiliation(s)
- Ada Ávila Assunção
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil
- Correspondence:
| | - Emanuella Gomes Maia
- Departamento de Ciências da Saúde, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil;
| | - Renata Jardim
- Departamento de Educação e Saúde, Universidade Federal de Sergipe, Lagarto 49100-000, Brazil;
| | - Tânia Maria de Araújo
- Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana 44036-900, Brazil;
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Sughayer MA, Mansour A, Al Nuirat A, Souan L, Ghanem M, Siag M. Dramatic rise in seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors: The evolution of a pandemic. Int J Infect Dis 2021; 107:116-120. [PMID: 33892190 PMCID: PMC8057684 DOI: 10.1016/j.ijid.2021.04.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Seroprevalence studies of SARS-CoV-2 antibodies are useful in assessing the epidemiological status in the community, and the degree of spread. OBJECTIVE To study the seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors in Jordan, at various points of time and as the pandemic evolves in the community. METHODS In total, 1374 blood donor samples, from three groups, were tested for SARS-CoV-2 total immunoglobulin antibodies. In the first group, samples from 734 individuals (from donations made between January and June 2020) were tested in June. In the second group, 348 individuals were tested in September 2020. The third group of 292 individuals was tested in February 2021. A qualitative assay was used for testing (specificity 99.8%, sensitivity 100%). RESULTS The first two groups, from January-June and September 2020, when confirmed Covid-19 cases numbered between several hundred and 3000, showed a seroprevalence rate of 0% (95% CI 0.00-0.51%). The third group (early February 2021), when the number of confirmed cases had reached 100 times that of September 2020, revealed a seroprevalence of 27.4% (95% CI 22.5-32.9%). CONCLUSIONS A dramatic rise in seroprevalence of SARS-CoV-2 antibodies was seen among healthy blood donors in Jordan, in parallel with widespread intracommunity transmission of the disease. This information is useful for assessing the degree of herd immunity, and provides for better understanding of the pandemic.
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Affiliation(s)
- Maher A Sughayer
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan.
| | - Asem Mansour
- Department of Radiology, and CEO, King Hussein Cancer Center, Jordan
| | - Abeer Al Nuirat
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Lina Souan
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mohammad Ghanem
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Siag
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
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Altawalah H, Alfouzan W, Dhar R, Alali W, Bastaki H, Al-Fadalah T, Al-Ghimlas F, Rabaan AA, Ezzikouri S. Severe acute respiratory syndrome coronavirus 2 seroprevalence survey among 10,256 workers in Kuwait. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100017. [PMID: 35262005 PMCID: PMC8091725 DOI: 10.1016/j.jcvp.2021.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global pandemic. Seroprevalence surveillance is urgently needed to estimate and monitor the growing burden of coronavirus disease 2019 (COVID-19). The aim of this study is to estimate the seroprevalence of SARS-CoV-2 infection among worker population residing in areas under lockdown in Kuwait and investigated their risk factors associated with a positive status. From April 18 to May 10, 2020 a randomly sampled, worker-based survey was conducted in 7 governorate in Kuwait (Ahmadi, Farwaniya, Hawali, Asma, Jahra, and Mubarak Alkabeer) among 10,256 workers. SARS-CoV-2 IgG and IgM antibodies was assessed using a commercially point-of-care lateral flow immunoassay (Biozek medical COVID-19 IgG/IgM Rapid Test Cassette). We estimated an overall seroprevalence (IgG or IgM positive) of 5.9% (95% CI: 5.4-6.3). Notably, SARS-CoV-2 seropositivity was significantly higher in males (6.2%) than females (1.9%) ( p < 0.001). Furthermore, the seroprevalence was significantly different by age group, governorate, and nationality of the workers. These results highlighted that the relatively low prevalence of anti-SARS-CoV-2 antibodies in hotspot areas in a specific population. Thus, we emphasize to repeat the serosurvey in the general population to assess the magnitude of viral spread and monitor the growing burden of COVID-19 in Kuwait.
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Affiliation(s)
- Haya Altawalah
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
- Virology Unit, Yacoub Behbehani center, Sabah Hospital, Ministry of Health, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
- Laboratory Medicine, Farwania Hospital, Ministry of Health, Kuwait
| | - Rita Dhar
- Laboratory Medicine, Farwania Hospital, Ministry of Health, Kuwait
| | - Walid Alali
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Kuwait University, Kuwait
- Jahra Hospital, Ministry of Health, Kuwait
| | - Hamad Bastaki
- Department of Public health, Ministry of Health, Kuwait
| | - Talal Al-Fadalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait
| | | | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, Casablanca 20360, Morocco
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Prakash O, Solanki B, Sheth J, Oza D, Kadam M, Vyas S, Shukla A, Pethani J, Tiwari H. Population-based seropositivity for IgG antibodies against SARS-CoV-2 in Ahmedabad city. J Family Med Prim Care 2021; 10:2363-2368. [PMID: 34322439 PMCID: PMC8284215 DOI: 10.4103/jfmpc.jfmpc_2062_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023] Open
Abstract
CONTEXT Ahmedabad city with approximately 7 million population was one of the earliest cities to witness the high case load of COVID-19 pandemic in India. A population-based sero-survey was ideally suited in Ahmedabad to guide the public health response for managing COVID-19 pandemic. OBJECTIVES To study the percentage sero-positivity for SARS-CoV-2 to understand the pandemic status and deriving conclusions for guiding the public health measures for managing the COVID-19 pandemic. SETTINGS AND DESIGN Population-based cross-sectional sero-surveillance. METHODS AND MATERIAL Large scale sero-surveillance with population-based stratified sampling covering more than 10,000 samples from general population of Ahmedabad was carried out during second half of August 2020. The seropositivity was correlated and compared with various demographic factors and other parameters for valid and precise predictions on the immunity status of the population. RESULTS With 2,396 samples positive for IgG antibodies from a total of 10,310 samples, the seropositivity against COVID-19 in the general population of Ahmedabad is around 23.24%. The seropositivity has increasing trend with increasing age and is significantly higher among females (25.37%) than males (21.81%). The zone wise positivity ranged from 11.74% to 33.14%. This closely correlates with the cases recorded so far, higher for those zones with high current or past cases. CONCLUSIONS Seropositivity of 23.24% in general population indicate the overall current level of protection. Since effective vaccine is not yet available, it is required to continue emphasis on the public health preventive measures for controlling and managing the COVID-19 pandemic.
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Affiliation(s)
- Om Prakash
- Deputy Municipal Commissioner, AMC, Gujarat, India
| | | | - Jay Sheth
- Community Medicine, AMC MET Medical College, Gujarat, India
| | | | - Mina Kadam
- Microbiology, AMC MET Medical College, Gujarat, India
| | - Sheetal Vyas
- Community Medicine, AMC MET Medical College, Gujarat, India
| | - Aparajita Shukla
- Community Medicine, NHL Municipal Medical College, Gujarat, India
| | | | - Hemant Tiwari
- Community Medicine, NHL Municipal Medical College, Gujarat, India
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Lee K, Jo S, Lee J. Seroprevalence of SARS-CoV-2 antibodies in South Korea. J Korean Stat Soc 2021; 50:891-904. [PMID: 34054312 PMCID: PMC8142885 DOI: 10.1007/s42952-021-00131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
In 2020, Korea Disease Control and Prevention Agency reported three rounds of surveys on seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in South Korea. SARS-CoV-2 is the virus which inflicts the coronavirus disease 2019 (COVID-19). We analyze the seroprevalence surveys using a Bayesian method with an informative prior distribution on the seroprevalence parameter, and the sensitivity and specificity of the diagnostic test. We construct the informative prior of the sensitivity and specificity of the diagnostic test using the posterior distribution obtained from the clinical evaluation data. The constraint of the seroprevalence parameter induced from the known confirmed coronavirus 2019 cases can be imposed naturally in the proposed Bayesian model. We also prove that the confidence interval of the seroprevalence parameter based on the Rao's test can be the empty set, while the Bayesian method renders interval estimators with coverage probability close to the nominal level. As of the 30th of October 2020, the95 % credible interval of the estimated SARS-CoV-2 positive population does not exceed 318, 685, approximately 0.62 % of the Korean population. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s42952-021-00131-7.
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Affiliation(s)
- Kwangmin Lee
- Department of Statistics, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 Republic of Korea
| | - Seongil Jo
- Department of Statistics, Inha University, 100 Inha-ro, Nam-Gu, Incheon, Republic of Korea
| | - Jaeyong Lee
- Department of Statistics, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 Republic of Korea
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Seroprevalence of SARS-CoV-2 antibodies in the poorest region of Brazil: results from a population-based study. Epidemiol Infect 2021; 149:e130. [PMID: 34001292 PMCID: PMC8160491 DOI: 10.1017/s0950268821001163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Population-based seroprevalence studies on coronavirus disease 2019 (COVID-19) in low- and middle-income countries are lacking. We investigated the seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibodies in Sergipe state, Northeast Brazil, using rapid IgM−IgG antibody test and fluorescence immunoassay. The seroprevalence was 9.3% (95% CI 8.5–10.1), 10.2% (95% CI 9.2–11.3) for women and 7.9% (IC 95% 6.8–9.1) for men (P = 0.004). We found a decline in the prevalence of SARS-CoV-2 antibodies according to age, but the differences were not statistically significant: 0–19 years (9.9%; 95% CI 7.8–12.5), 20–59 years (9.3%; 95% CI 8.4–10.3) and ≥60 years (9.0%; 95% CI 7.5–10.8) (P = 0.517). The metropolitan area had a higher seroprevalence (11.7%, 95% CI 10.3–13.2) than outside municipalities (8.0%, 95% CI 7.2–8.9) (P < 0.001). These findings highlight the importance of serosurveillance to estimate the real impact of the COVID-19 outbreak and thereby provide data to better understand the spread of the virus, as well as providing information to guide stay-at-home measures and other policies. In addition, these results may be useful as basic data to follow the progress of COVID-19 outbreak as social restriction initiatives start to be relaxed in Brazil.
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Abdella S, Riou S, Tessema M, Assefa A, Seifu A, Blachman A, Abera A, Moreno N, Irarrazaval F, Tollera G, Browning D, Tasew G. Prevalence of SARS-CoV-2 in urban and rural Ethiopia: Randomized household serosurveys reveal level of spread during the first wave of the pandemic. EClinicalMedicine 2021; 35:100880. [PMID: 34124630 PMCID: PMC8176122 DOI: 10.1016/j.eclinm.2021.100880] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The spread of SARS-CoV-2 in Sub-Saharan Africa is poorly understood and to date has generally been characterised by a lower number of declared cases and deaths as compared to other regions of the world. Paucity of reliable information, with insights largely derived from limited RT-PCR testing in high-risk and urban populations, has been one of the biggest barriers to understanding the course of the pandemic and informed policy-making. Here we estimate seroprevalence of anti-SARS-CoV-2 antibodies in Ethiopia during the first wave of the pandemic. METHODS We undertook a population-based household seroprevalence serosurvey based on 1856 participants in Ethiopia, in the capital city Addis Ababa, and in Jimma, a middle-sized town in the Oromia region, and its rural surroundings (districts of Seka and Mana), between 22 July and 02 September 2020. We tested one random participant per household for anti-SARS-CoV-2 antibodies using a high specificity rapid diagnostic tests (RDTs) and evaluated population seroprevalence using a Bayesian logistic regression model taking into account test performance as well as age and sex of the participants. FINDINGS In total, 2304 random households were visited, with 1856 individuals consenting to participate. This produced a sample of 956 participants in Addis Ababa and 900 participants in Jimma. IgG prevalence was estimated at 1.9% (95% CI 0.4-3.7%), and combined IgM/IgG prevalence at 3.5% (95% CI 1.7-5.4%) for Addis Ababa in early August 2020, with higher prevalence in central sub-cities. Prevalence in Jimma town was lower at 0.5% (95% CI 0-1.8%) for IgG and 1.6% (95%CI 0-4.1%) for IgM/IgG, while in rural Jimma IgG prevalence was 0.2% and IgM/IgG 0.4% in early September. INTERPRETATION More than four months after the first cases were detected in Ethiopia, Addis Ababa displayed a prevalence under 5% and likely as low as 2%, while rural Jimma displayed a prevalence of 0.2%. A 2% seroprevalence figure for the capital translated to a number of cases at least five times larger than those reported for the country as a whole. At the same time, it contrasts with significantly higher seroprevalence figures in large cities in Europe and America only two to three months after the first cases. This population-based seroepidemiological study thus provides evidence of a slower spread of SARS-CoV-2 in the Ethiopian population during the first wave of the pandemic and does not appear to support the notion that lower case numbers were simply a reflection of limited testing and surveillance. FUNDING Schmidt Family Foundation, Joachim Hertz Foundation, Nespresso, Peet's and Smuckers.
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Affiliation(s)
- Saro Abdella
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | - Samuel Riou
- Enveritas, 24 Innis Lane, Old Greenwich, CT, USA
| | - Masresha Tessema
- Nutrition and Food Sciences Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | - Albab Seifu
- Enveritas, 24 Innis Lane, Old Greenwich, CT, USA
| | | | - Adugna Abera
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | | | | | - Getachew Tollera
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Gulelle Arbegnoch street, Addis Ababa, Ethiopia
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Ioannidis JPA. Reconciling estimates of global spread and infection fatality rates of COVID-19: An overview of systematic evaluations. Eur J Clin Invest 2021; 51:e13554. [PMID: 33768536 PMCID: PMC8250317 DOI: 10.1111/eci.13554] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/21/2021] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Estimates of community spread and infection fatality rate (IFR) of COVID-19 have varied across studies. Efforts to synthesize the evidence reach seemingly discrepant conclusions. METHODS Systematic evaluations of seroprevalence studies that had no restrictions based on country and which estimated either total number of people infected and/or aggregate IFRs were identified. Information was extracted and compared on eligibility criteria, searches, amount of evidence included, corrections/adjustments of seroprevalence and death counts, quantitative syntheses and handling of heterogeneity, main estimates and global representativeness. RESULTS Six systematic evaluations were eligible. Each combined data from 10 to 338 studies (9-50 countries), because of different eligibility criteria. Two evaluations had some overt flaws in data, violations of stated eligibility criteria and biased eligibility criteria (eg excluding studies with few deaths) that consistently inflated IFR estimates. Perusal of quantitative synthesis methods also exhibited several challenges and biases. Global representativeness was low with 78%-100% of the evidence coming from Europe or the Americas; the two most problematic evaluations considered only one study from other continents. Allowing for these caveats, four evaluations largely agreed in their main final estimates for global spread of the pandemic and the other two evaluations would also agree after correcting overt flaws and biases. CONCLUSIONS All systematic evaluations of seroprevalence data converge that SARS-CoV-2 infection is widely spread globally. Acknowledging residual uncertainties, the available evidence suggests average global IFR of ~0.15% and ~1.5-2.0 billion infections by February 2021 with substantial differences in IFR and in infection spread across continents, countries and locations.
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Affiliation(s)
- John P. A. Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta‐Research Innovation Center at Stanford (METRICS)Stanford UniversityStanfordCAUSA
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Dramatic rise in seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors: The evolution of a pandemic. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES : IJID : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR INFECTIOUS DISEASES 2021. [PMID: 33892190 DOI: 10.1016/j.ijid.2021.04.059.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Seroprevalence studies of SARS-CoV-2 antibodies are useful in assessing the epidemiological status in the community, and the degree of spread. OBJECTIVE To study the seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors in Jordan, at various points of time and as the pandemic evolves in the community. METHODS In total, 1374 blood donor samples, from three groups, were tested for SARS-CoV-2 total immunoglobulin antibodies. In the first group, samples from 734 individuals (from donations made between January and June 2020) were tested in June. In the second group, 348 individuals were tested in September 2020. The third group of 292 individuals was tested in February 2021. A qualitative assay was used for testing (specificity 99.8%, sensitivity 100%). RESULTS The first two groups, from January-June and September 2020, when confirmed Covid-19 cases numbered between several hundred and 3000, showed a seroprevalence rate of 0% (95% CI 0.00-0.51%). The third group (early February 2021), when the number of confirmed cases had reached 100 times that of September 2020, revealed a seroprevalence of 27.4% (95% CI 22.5-32.9%). CONCLUSIONS A dramatic rise in seroprevalence of SARS-CoV-2 antibodies was seen among healthy blood donors in Jordan, in parallel with widespread intracommunity transmission of the disease. This information is useful for assessing the degree of herd immunity, and provides for better understanding of the pandemic.
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Pasqualotto AC, Pereira PDC, Lana DFD, Schwarzbold AV, Ribeiro MS, Riche CVW, Castro CPP, Korsack PL, Ferreira PEB, Domingues GDC, Ribeiro GT, Carneiro M, Caurio CFB, Vasconcellos ICDS, Knebel LM, Zamberlan L, Stolz AP, Vilanova M, Watte G, Kalil AN. COVID-19 seroprevalence in military police force, Southern Brazil. PLoS One 2021; 16:e0249672. [PMID: 33886596 PMCID: PMC8061934 DOI: 10.1371/journal.pone.0249672] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background Limited data is available regarding the frequency of COVID-19 in populations that are highly exposed to SARS-CoV-2. In this cross-section study we evaluated COVID-19 seroprevalence in military police forces of 10 major cities in Rio Grande do Sul, South of Brazil. Methods Sampling was randomly performed in clusters, in respect to the number of professionals at service per city and military unit. Research subjects were evaluated on July 23, 2020 (first wave peak in Brazil). Clinical information was obtained, and venous blood was taken for ELISA testing (IgA, and IgG antibodies). Sample size consisted of 1,592 military workers (33.6% of study population). They were mostly man (81.2%) and young (median 34 years-old). Most had been asymptomatic (75.3%) during pandemic, and 27.5% reported close contact with COVID-19 cases (after a median time of 21 days). Antibodies were detected in 3.3% of the participants, mostly IgA (2.7%), and IgG (1.7%). After 3 weeks, 66.7% of IgA and IgG results turned negative, in addition to 78.3% and 100% of borderline IgA and IgG results, respectively. Conclusion The seroprevalence of COVID-19 amongst military police was at least 3.4 higher than the findings of other studies performed in the general population, in the same cities and dates. Most detectable antibodies were of IgA class, which implies recent exposure. Asymptomatic people were more prone to have negative antibody titters in the second run.
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Affiliation(s)
- Alessandro C. Pasqualotto
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, UFCSPA, Porto Alegre, Brazil
- * E-mail:
| | | | - Daiane F. Dalla Lana
- Universidade Federal de Ciencias da Saude de Porto Alegre, UFCSPA, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | | - Marcelo Carneiro
- Universidade de Santa Cruz do Sul, UNISC, Santa Cruz do Sul, Brazil
| | - Cassia Ferreira B. Caurio
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, UFCSPA, Porto Alegre, Brazil
| | - Izadora Clezar da S. Vasconcellos
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, UFCSPA, Porto Alegre, Brazil
| | | | | | | | | | - Guilherme Watte
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, UFCSPA, Porto Alegre, Brazil
| | - Antonio N. Kalil
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, UFCSPA, Porto Alegre, Brazil
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69
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Shinde S, Ranade P, Watve M. Evaluating alternative hypotheses to explain the downward trend in the indices of the COVID-19 pandemic death rate. PeerJ 2021; 9:e11150. [PMID: 33976966 PMCID: PMC8063871 DOI: 10.7717/peerj.11150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/03/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the ongoing Covid-19 pandemic, in the global data on the case fatality ratio (CFR) and other indices reflecting death rate, there is a consistent downward trend from mid-April to mid-November. The downward trend can be an illusion caused by biases and limitations of data or it could faithfully reflect a declining death rate. A variety of explanations for this trend are possible, but a systematic analysis of the testable predictions of the alternative hypotheses has not yet been attempted. METHODOLOGY We state six testable alternative hypotheses, analyze their testable predictions using public domain data and evaluate their relative contributions to the downward trend. RESULTS We show that a decline in the death rate is real; changing age structure of the infected population and evolution of the virus towards reduced virulence are the most supported hypotheses and together contribute to major part of the trend. The testable predictions from other explanations including altered testing efficiency, time lag, improved treatment protocols and herd immunity are not consistently supported, or do not appear to make a major contribution to this trend although they may influence some other patterns of the epidemic. CONCLUSION The fatality of the infection showed a robust declining time trend between mid April to mid November. Changing age class of the infected and decreasing virulence of the pathogen were found to be the strongest contributors to the trend.
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Affiliation(s)
- Sonali Shinde
- Department of Biodiversity, Abasaheb Garware College, Pune, Pune, Maharashtra, India
| | - Pratima Ranade
- Department of Biodiversity, Abasaheb Garware College, Pune, Pune, Maharashtra, India
| | - Milind Watve
- Independent Researcher, Pune, Maharashtra, India
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70
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Conte DD, Carvalho JMA, de Souza Luna LK, Faíco-Filho KS, Perosa AH, Bellei N. Comparative analysis of three point-of-care lateral flow immunoassays for detection of anti-SARS-CoV-2 antibodies: data from 100 healthcare workers in Brazil. Braz J Microbiol 2021; 52:1161-1165. [PMID: 33871824 PMCID: PMC8053894 DOI: 10.1007/s42770-021-00498-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
Since the coronavirus disease 2019 (COVID-19) pandemic, Brazil has the third-highest number of confirmed cases and the second-highest number of recovered patients. SARS-CoV-2 detection by real-time RT-PCR is the gold standard but requires a certified laboratory infrastructure with high-cost equipment and trained personnel. However, for large-scale testing, diagnostics should be fast, cost-effective, widely available, and deployed for the community, such as serological tests based on lateral flow immunoassay (LFIA) for IgM/IgG detection. We evaluated three different commercial point-of-care (POC) LFIAs for anti-SARS-CoV-2 IgM and IgG detection in capillary whole blood of 100 healthcare workers (HCW) from São Paulo university hospital previously tested by RT-PCR: (1) COVID-19 IgG/IgM BIO (Bioclin, Brazil), (2) Diagnostic Kit for IgM/IgG Antibody to Coronavirus (SARS-CoV-2) (Livzon, China), and (3) SARS-CoV-2 Antibody Test (Wondfo, China). A total of 84 positives and 16 negatives HCW were tested. The data was also analyzed by the number of days post symptoms (DPS) in three groups: <30 (n=26), 30–59 (n=42), and >59 (n=16). The observed sensibility was 85.71%, 47.62%, and 44.05% for Bioclin, Wondfo, and Livzon, respectively, with a specificity of 100% for all LFIA. Bioclin was more sensitive (p<0.01), regardless of the DPS. Thus, the Bioclin may be used as a POC test to monitor SARS-CoV-2 seroconversion in HCW.
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Affiliation(s)
- Danielle Dias Conte
- Department of Medicine, Discipline of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Luciano Kleber de Souza Luna
- Department of Medicine, Discipline of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil. .,Laboratório de Virologia Clínica, Universidade Federal de São Paulo, Rua Pedro de Toledo, 781 - Vila Clementino, São Paulo, SP, 04039-032, Brazil.
| | - Klinger Soares Faíco-Filho
- Department of Medicine, Discipline of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Helena Perosa
- Universidade Federal de São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Nancy Bellei
- Department of Medicine, Discipline of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
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71
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Francisco RDS, Benites LF, Lamarca AP, de Almeida LGP, Hansen AW, Gularte JS, Demoliner M, Gerber AL, de C Guimarães AP, Antunes AKE, Heldt FH, Mallmann L, Hermann B, Ziulkoski AL, Goes V, Schallenberger K, Fillipi M, Pereira F, Weber MN, de Almeida PR, Fleck JD, Vasconcelos ATR, Spilki FR. Pervasive transmission of E484K and emergence of VUI-NP13L with evidence of SARS-CoV-2 co-infection events by two different lineages in Rio Grande do Sul, Brazil. Virus Res 2021; 296:198345. [PMID: 33631222 PMCID: PMC7898980 DOI: 10.1016/j.virusres.2021.198345] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/24/2022]
Abstract
Emergence of novel SARS-CoV-2 lineages are under the spotlight of the media, scientific community and governments. Recent reports of novel variants in the United Kingdom, South Africa and Brazil (B.1.1.28-E484K) have raised intense interest because of a possible higher transmission rate or resistance to the novel vaccines. Nevertheless, the spread of B.1.1.28 (E484K) and other variants in Brazil is still unknown. In this work, we investigated the population structure and genomic complexity of SARS-CoV-2 in Rio Grande do Sul, the southernmost state in Brazil. Most samples sequenced belonged to the B.1.1.28 (E484K) lineage, demonstrating its widespread dispersion. We were the first to identify two independent events of co-infection caused by the occurrence of B.1.1.28 (E484K) with either B.1.1.248 or B.1.91 lineages. Also, clustering analysis revealed the occurrence of a novel cluster of samples circulating in the state (named VUI-NP13L) characterized by 12 lineage-defining mutations. In light of the evidence for E484K dispersion, co-infection and emergence of VUI-NP13 L in Rio Grande do Sul, we reaffirm the importance of establishing strict and effective social distancing measures to counter the spread of potentially more hazardous SARS-CoV-2 strains.
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Affiliation(s)
| | - L Felipe Benites
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Alessandra P Lamarca
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Brazil
| | - Luiz G P de Almeida
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Brazil
| | - Alana Witt Hansen
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | | | - Meriane Demoliner
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Alexandra L Gerber
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Brazil
| | - Ana Paula de C Guimarães
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Brazil
| | | | - Fagner Henrique Heldt
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Larissa Mallmann
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Bruna Hermann
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Ana Luiza Ziulkoski
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Vyctoria Goes
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | | | - Micheli Fillipi
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Francini Pereira
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Matheus Nunes Weber
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | | | - Juliane Deise Fleck
- Laboratório de Microbiologia Molecular,Universidade Feevale, Rio Grande do Sul, Brazil
| | - Ana Tereza R Vasconcelos
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Brazil.
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Chvatal-Medina M, Mendez-Cortina Y, Patiño PJ, Velilla PA, Rugeles MT. Antibody Responses in COVID-19: A Review. Front Immunol 2021; 12:633184. [PMID: 33936045 PMCID: PMC8081880 DOI: 10.3389/fimmu.2021.633184] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide as a severe pandemic. Although its seroprevalence is highly variable among territories, it has been reported at around 10%, but higher in health workers. Evidence regarding cross-neutralizing response between SARS-CoV and SARS-CoV-2 is still controversial. However, other previous coronaviruses may interfere with SARS-CoV-2 infection, since they are phylogenetically related and share the same target receptor. Further, the seroconversion of IgM and IgG occurs at around 12 days post onset of symptoms and most patients have neutralizing titers on days 14-20, with great titer variability. Neutralizing antibodies correlate positively with age, male sex, and severity of the disease. Moreover, the use of convalescent plasma has shown controversial results in terms of safety and efficacy, and due to the variable immune response among individuals, measuring antibody titers before transfusion is mostly required. Similarly, cellular immunity seems to be crucial in the resolution of the infection, as SARS-CoV-2-specific CD4+ and CD8+ T cells circulate to some extent in recovered patients. Of note, the duration of the antibody response has not been well established yet.
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Affiliation(s)
- Mateo Chvatal-Medina
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Pablo J. Patiño
- Grupo Inmunodeficiencias Primarias, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Paula A. Velilla
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Maria T. Rugeles
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Spielberger BD, Goerne T, Geweniger A, Henneke P, Elling R. Intra-Household and Close-Contact SARS-CoV-2 Transmission Among Children - a Systematic Review. Front Pediatr 2021; 9:613292. [PMID: 33898355 PMCID: PMC8062727 DOI: 10.3389/fped.2021.613292] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/01/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction: The outbreak of the novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a range of emergency measures worldwide. Early in the pandemic, children were suspected to act as drivers of the COVID-19 spread in the population, which was based on experiences with influenza virus and other respiratory pathogens. Consequently, closures of schools and kindergartens were implemented in many countries around the world, alongside with other non-pharmaceutical interventions for transmission control. Given the grave and multifaceted consequences of contact restriction measures for children, it is crucial to better understand the effect size of these incisive actions for the COVID-19 pandemic. Therefore, we systematically review the current evidence on transmission of SARS-CoV-2 to and by children. Data Sources: PubMed and preprints uploaded on medRxiv. Study Selection: Original research articles, case reports, brief communications, and commentaries were included into the analysis. Each title or abstract was independently reviewed to identify relevant articles. Studies in other languages than English were not included. Data Extraction: Two reviewers independently reviewed the selected studies. Extracted data included citation of each study, type of healthcare setting, location of the study, characteristics of patient population, and reported outcomes. Results: Data on transmission of SARS-CoV-2 on or by children is scarce. Several studies show a lower seropositivity of children compared to adults, suggesting a lower susceptibility of especially younger children. Most insight currently comes from household studies suggesting, that children are predominantly infected by their household contacts. The contagiousness however, seems to be comparable between children and adults, based on our meta-analysis of included studies. Conclusions: Larger and systematic studies are urgently needed to better understand the age dependent patterns of SARS-CoV-2 transmission and thereby design more effective non-pharmaceutical interventions to reduce disease transmission.
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Affiliation(s)
- Benedikt D. Spielberger
- Center for Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Tessa Goerne
- Center for Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center – University of Freiburg, Freiburg, Germany
| | - Anne Geweniger
- Center for Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Philipp Henneke
- Center for Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center – University of Freiburg, Freiburg, Germany
| | - Roland Elling
- Center for Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center – University of Freiburg, Freiburg, Germany
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Byambasuren O, Dobler CC, Bell K, Rojas DP, Clark J, McLaws ML, Glasziou P. Comparison of seroprevalence of SARS-CoV-2 infections with cumulative and imputed COVID-19 cases: Systematic review. PLoS One 2021; 16:e0248946. [PMID: 33798211 PMCID: PMC8018669 DOI: 10.1371/journal.pone.0248946] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/08/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Accurate seroprevalence estimates of SARS-CoV-2 in different populations could clarify the extent to which current testing strategies are identifying all active infection, and hence the true magnitude and spread of the infection. Our primary objective was to identify valid seroprevalence studies of SARS-CoV-2 infection and compare their estimates with the reported, and imputed, COVID-19 case rates within the same population at the same time point. METHODS We searched PubMed, Embase, the Cochrane COVID-19 trials, and Europe-PMC for published studies and pre-prints that reported anti-SARS-CoV-2 IgG, IgM and/or IgA antibodies for serosurveys of the general community from 1 Jan to 12 Aug 2020. RESULTS Of the 2199 studies identified, 170 were assessed for full text and 17 studies representing 15 regions and 118,297 subjects were includable. The seroprevalence proportions in 8 studies ranged between 1%-10%, with 5 studies under 1%, and 4 over 10%-from the notably hard-hit regions of Gangelt, Germany; Northwest Iran; Buenos Aires, Argentina; and Stockholm, Sweden. For seropositive cases who were not previously identified as COVID-19 cases, the majority had prior COVID-like symptoms. The estimated seroprevalences ranged from 0.56-717 times greater than the number of reported cumulative cases-half of the studies reported greater than 10 times more SARS-CoV-2 infections than the cumulative number of cases. CONCLUSIONS The findings show SARS-CoV-2 seroprevalence is well below "herd immunity" in all countries studied. The estimated number of infections, however, were much greater than the number of reported cases and deaths in almost all locations. The majority of seropositive people reported prior COVID-like symptoms, suggesting that undertesting of symptomatic people may be causing a substantial under-ascertainment of SARS-CoV-2 infections.
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Affiliation(s)
| | - Claudia C. Dobler
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Katy Bell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Diana Patricia Rojas
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health & Medicine, James Cook University, North Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
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Kuwelker K, Zhou F, Blomberg B, Lartey S, Brokstad KA, Trieu MC, Bansal A, Madsen A, Krammer F, Mohn KG, Tøndel C, Linchausen DW, Cox RJ, Langeland N. Attack rates amongst household members of outpatients with confirmed COVID-19 in Bergen, Norway: A case-ascertained study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 3:100014. [PMID: 33871470 PMCID: PMC8009692 DOI: 10.1016/j.lanepe.2020.100014] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Households studies reflect the natural spread of SARS-CoV-2 in immunologically naive populations with limited preventive measures to control transmission.We hypothesise that seropositivity provides more accurate household attack rates than RT-PCR. Here, we investigated the importance of age in household transmission dynamics. METHODS We enroled 112 households (291 participants) in a case-ascertained study in Bergen, Norway from 28th February to 4th April 2020, collecting demographic and clinical data from index patients and household members. SARS-CoV-2-specific antibodies were measured in sera collected 6-8 weeks after index patient nasopharyngeal testing to define household attack rates. FINDINGS The overall attack rate was 45% (95% CI 38-53) assessed by serology, and 47% when also including seronegative RT-PCR positives. Serology identified a higher number of infected household members than RT-PCR. Attack rates were equally high in children (48%) and young adults (42%). The attack rate was 16% in asymptomatic household members and 42% in RT-PCR negative contacts. Older adults had higher antibody titres than younger adults. The risk of household transmission was higher when the index patient had fever (aOR 3.31 [95% CI 1.52-7.24]; p = 0.003) or dyspnoea (aOR 2.25 [95% CI 1.80-4.62]; p = 0.027) during acute illness. INTERPRETATION Serological assays provide more sensitive and robust estimates of household attack rates than RT-PCR. Children are equally susceptible to infection as young adults. Negative RT-PCR or lack of symptoms are not sufficient to rule out infection in household members. FUNDING Helse Vest (F-11628), Trond Mohn Foundation (TMS2020TMT05).
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Affiliation(s)
- Kanika Kuwelker
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- National Advisory Unit for Tropical Infectious Diseases (KK, BB, NL) Haukeland University Hospital, N-5021 Bergen, Norway
| | - Fan Zhou
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science (NL, BB), University of Bergen, N-5021 Bergen, Norway
- National Advisory Unit for Tropical Infectious Diseases (KK, BB, NL) Haukeland University Hospital, N-5021 Bergen, Norway
| | - Sarah Lartey
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Karl Albert Brokstad
- Broeglemann Research Laboratory (KAB), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Department of Safety, Chemistry and Biomedical Laboratory Sciences (KAB), Western Norway University of Applied Sciences, Bergen N-5020, Norway
| | - Mai Chi Trieu
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Amit Bansal
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Anders Madsen
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Florian Krammer
- Department of Microbiology (FK), Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Kristin Gi Mohn
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Department of Medicine (KGIM), Haukeland University Hospital, N-5021 Bergen, Norway
| | - Camilla Tøndel
- Department of Paediatrics (CT), Haukeland University Hospital, N-5021 Bergen, Norway
| | | | - Rebecca J Cox
- Influenza Centre (KK, RJC, FZ, SL, MCT, AM, KGIM), Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Department of Microbiology (RJC), Haukeland University Hospital, N-5021 Bergen, Norway
| | - Nina Langeland
- Department of Clinical Science (NL, BB), University of Bergen, N-5021 Bergen, Norway
- National Advisory Unit for Tropical Infectious Diseases (KK, BB, NL) Haukeland University Hospital, N-5021 Bergen, Norway
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Feehan AK, Fort D, Velasco C, Burton JH, Garcia-Diaz J, Price-Haywood EG, Sapp E, Pevey D, Seoane L. The importance of anosmia, ageusia and age in community presentation of symptomatic and asymptomatic SARS-CoV-2 infection in Louisiana, USA; a cross-sectional prevalence study. Clin Microbiol Infect 2021; 27:633.e9-633.e16. [PMID: 33421576 PMCID: PMC7787079 DOI: 10.1016/j.cmi.2020.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE While many seroprevalence studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been performed, few are demographically representative. This investigation focused on defining the nature and frequency of symptomatic and asymptomatic SARS-CoV-2 infection in a representative, cross-sectional sample of communities in Louisiana, USA. METHODS A sample of 4778 adults from New Orleans and Baton Rouge, Louisiana were given a survey of symptoms and co-morbidities, nasopharyngeal swab to test for active infection (PCR), and blood draw to test for past infection (IgG). Odds ratios, cluster analysis, quantification of virus and antibody, and linear modelling were used to understand whether certain symptoms were associated with a positive test, how symptoms grouped together, whether virus or antibody varied by symptom status, and whether being symptomatic was different across the age span. RESULTS Reported anosmia/ageusia was strongly associated with a positive test; 40.6% (93/229) tested positive versus 4.8% (218/4549) positivity in those who did not report anosmia/ageusia (OR 13.6, 95% CI 10.1-18.3). Of the people who tested positive, 47.3% (147/311) were completely asymptomatic. Symptom presentation clustered into three groups; low/no symptoms (0.4 ± 0.9, mean ± SD), highly symptomatic (7.5 ± 1.9) or moderately symptomatic (4.0 ± 1.5). Quantity of virus was lower in the asymptomatic versus symptomatic group (cycle number 23.3 ± 8.3 versus 17.3 ± 9.0; p < 0.001). Modelling the probability of symptoms showed changes with age; the highest probability of reporting symptoms was 64.6% (95% CI 50.4-76.5) at age 29 years, which decreased to a probability of 49.3% (95% CI 36.6-62.0) at age 60 years and only 25.1% (95% CI 5.0-68.1) at age 80 years. CONCLUSION Anosmia/ageusia can be used to differentiate SARS-CoV-2 infection from other illnesses, and, given the high ratio of asymptomatic individuals, contact tracing should include those without symptoms. Regular testing in congregant settings of those over age 60 years may help mitigate asymptomatic spread.
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Affiliation(s)
- Amy K Feehan
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA.
| | - Daniel Fort
- Ochsner Clinic Foundation, New Orleans, LA, USA
| | | | | | - Julia Garcia-Diaz
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA
| | - Eric Sapp
- Public Democracy, Arlington, VA, USA
| | - Dawn Pevey
- Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Leonardo Seoane
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA; Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA
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Dupraz J, Butty A, Duperrex O, Estoppey S, Faivre V, Thabard J, Zuppinger C, Greub G, Pantaleo G, Pasquier J, Rousson V, Egger M, Steiner-Dubuis A, Vassaux S, Masserey E, Bochud M, Gonseth Nusslé S, D'Acremont V. Prevalence of SARS-CoV-2 in Household Members and Other Close Contacts of COVID-19 Cases: A Serologic Study in Canton of Vaud, Switzerland. Open Forum Infect Dis 2021; 8:ofab149. [PMID: 34307723 PMCID: PMC8083624 DOI: 10.1093/ofid/ofab149] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background Research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within households and other close settings using serological testing is scarce. Methods We invited coronavirus disease 2019 (COVID-19) cases diagnosed between February 27 and April 1, 2020, in Canton of Vaud, Switzerland, to participate, along with household members and other close contacts. Anti-SARS-CoV-2 immunoglobulin G antibodies were measured using a Luminex immunoassay. We estimated factors associated with serological status using generalized estimating equations. Results Overall, 219 cases, 302 household members, and 69 other close contacts participated between May 4 and June 27, 2020. More than half of household members (57.2%; 95% CI, 49.7%-64.3%) had developed a serologic response to SARS-CoV-2, while 19.0% (95% CI, 10.0%-33.2%) of other close contacts were seropositive. After adjusting for individual and household characteristics, infection risk was higher in household members aged ≥65 years than in younger adults (adjusted odds ratio [aOR], 3.63; 95% CI, 1.05-12.60) and in those not strictly adhering to simple hygiene rules like hand washing (aOR, 1.80; 95% CI, 1.02-3.17). The risk was lower when more than 5 people outside home were met during semiconfinement, compared with none (aOR, 0.35; 95% CI, 0.16-0.74). Individual risk of household members to be seropositive was lower in large households (22% less per each additional person). Conclusions During semiconfinement, household members of a COVID-19 case were at very high risk of getting infected, 3 times more than close contacts outside home. This highlights the need to provide clear messages on protective measures applicable at home. For elderly couples, who were especially at risk, providing external support for daily basic activities is essential.
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Affiliation(s)
- Julien Dupraz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Audrey Butty
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Olivier Duperrex
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sandrine Estoppey
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Vincent Faivre
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julien Thabard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claire Zuppinger
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Swiss Vaccine Research Institute, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Malik Egger
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Amélie Steiner-Dubuis
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sophie Vassaux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Eric Masserey
- Cantonal Medical Office, Department of Health and Social Action, Canton of Vaud, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Semira Gonseth Nusslé
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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Moshe M, Daunt A, Flower B, Simmons B, Brown JC, Frise R, Penn R, Kugathasan R, Petersen C, Stockmann H, Ashby D, Riley S, Atchison C, Taylor GP, Satkunarajah S, Naar L, Klaber R, Badhan A, Rosadas C, Marchesin F, Fernandez N, Sureda-Vives M, Cheeseman H, O'Hara J, Shattock R, Fontana G, Pallett SJC, Rayment M, Jones R, Moore LSP, Ashrafian H, Cherapanov P, Tedder R, McClure M, Ward H, Darzi A, Elliott P, Cooke GS, Barclay WS. SARS-CoV-2 lateral flow assays for possible use in national covid-19 seroprevalence surveys (React 2): diagnostic accuracy study. BMJ 2021; 372:n423. [PMID: 33653694 PMCID: PMC7921617 DOI: 10.1136/bmj.n423] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate the performance of new lateral flow immunoassays (LFIAs) suitable for use in a national coronavirus disease 2019 (covid-19) seroprevalence programme (real time assessment of community transmission 2-React 2). DESIGN Diagnostic accuracy study. SETTING Laboratory analyses were performed in the United Kingdom at Imperial College, London and university facilities in London. Research clinics for finger prick sampling were run in two affiliated NHS trusts. PARTICIPANTS Sensitivity analyses were performed on sera stored from 320 previous participants in the React 2 programme with confirmed previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Specificity analyses were performed on 1000 prepandemic serum samples. 100 new participants with confirmed previous SARS-CoV-2 infection attended study clinics for finger prick testing. INTERVENTIONS Laboratory sensitivity and specificity analyses were performed for seven LFIAs on a minimum of 200 serum samples from participants with confirmed SARS-CoV-2 infection and 500 prepandemic serum samples, respectively. Three LFIAs were found to have a laboratory sensitivity superior to the finger prick sensitivity of the LFIA currently used in React 2 seroprevalence studies (84%). These LFIAs were then further evaluated through finger prick testing on participants with confirmed previous SARS-CoV-2 infection: two LFIAs (Surescreen, Panbio) were evaluated in clinics in June-July 2020 and the third LFIA (AbC-19) in September 2020. A spike protein enzyme linked immunoassay and hybrid double antigen binding assay were used as laboratory reference standards. MAIN OUTCOME MEASURES The accuracy of LFIAs in detecting immunoglobulin G (IgG) antibodies to SARS-CoV-2 compared with two reference standards. RESULTS The sensitivity and specificity of seven new LFIAs that were analysed using sera varied from 69% to 100%, and from 98.6% to 100%, respectively (compared with the two reference standards). Sensitivity on finger prick testing was 77% (95% confidence interval 61.4% to 88.2%) for Panbio, 86% (72.7% to 94.8%) for Surescreen, and 69% (53.8% to 81.3%) for AbC-19 compared with the reference standards. Sensitivity for sera from matched clinical samples performed on AbC-19 was significantly higher with serum than finger prick at 92% (80.0% to 97.7%, P=0.01). Antibody titres varied considerably among cohorts. The numbers of positive samples identified by finger prick in the lowest antibody titre quarter varied among LFIAs. CONCLUSIONS One new LFIA was identified with clinical performance suitable for potential inclusion in seroprevalence studies. However, none of the LFIAs tested had clearly superior performance to the LFIA currently used in React 2 seroprevalence surveys, and none showed sufficient sensitivity and specificity to be considered for routine clinical use.
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Affiliation(s)
- Maya Moshe
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Anna Daunt
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Barnaby Flower
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Bryony Simmons
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Jonathan C Brown
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Rebecca Frise
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Rebecca Penn
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Ruthiran Kugathasan
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Claire Petersen
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Helen Stockmann
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Steven Riley
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Christina Atchison
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Graham P Taylor
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Sutha Satkunarajah
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Lenny Naar
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Robert Klaber
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Anjna Badhan
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Federica Marchesin
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Natalia Fernandez
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Macià Sureda-Vives
- Synthetic Biology Group, London Institute of Medical Sciences, Imperial College London, London, UK
| | - Hannah Cheeseman
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Jessica O'Hara
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Robin Shattock
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Gianluca Fontana
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Scott J C Pallett
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Rachael Jones
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Luke S P Moore
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Cherapanov
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Chromatin Structure and Mobile DNA Laboratory, Francis Crick Institute, London, UK
| | - Richard Tedder
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Myra McClure
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Helen Ward
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Ara Darzi
- Institute for Global Health Innovation, Imperial College London, London, UK
| | - Paul Elliott
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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Cavataio J, Schnell S. Interpreting SARS-CoV-2 seroprevalence, deaths, and fatality rate - Making a case for standardized reporting to improve communication. Math Biosci 2021; 333:108545. [PMID: 33460673 PMCID: PMC7810031 DOI: 10.1016/j.mbs.2021.108545] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 01/12/2023]
Abstract
The SARS-CoV-2 virus has spread across the world, testing each nation's ability to understand the state of the pandemic in their country and control it. As we looked into the epidemiological data to uncover the impact of the COVID-19 pandemic, we discovered that critical metadata is missing which is meant to give context to epidemiological parameters. In this review, we identify key metadata for the COVID-19 fatality rate after a thorough analysis of mathematical models, serology-informed studies and determinants of causes of death for the COVID-19 pandemic. In doing so, we find reasons to establish a set of standard-based guidelines to record and report the data from epidemiological studies. Additionally, we discuss why standardizing nomenclature is be a necessary component of these guidelines to improve communication and reproducibility. The goal of establishing these guidelines is to facilitate the interpretation of COVID-19 epidemiological findings and data by the general public, health officials, policymakers and fellow researchers. Our suggestions may not address all aspects of this issue; rather, they are meant to be the foundation for which experts can establish and encourage future guidelines throughout the appropriate communities.
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Affiliation(s)
- Joseph Cavataio
- Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Santiago Schnell
- Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA.
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80
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Gomaa MR, El Rifay AS, Shehata M, Kandeil A, Nabil Kamel M, Marouf MA, GabAllah M, El Taweel A, Kayed AE, Kutkat O, Moatasim Y, Mahmoud SH, Abo Shama NM, El Sayes M, Mostafa A, El-Shesheny R, McKenzie PP, Webby RJ, Kayali G, Ali MA. Incidence, household transmission, and neutralizing antibody seroprevalence of Coronavirus Disease 2019 in Egypt: Results of a community-based cohort. PLoS Pathog 2021; 17:e1009413. [PMID: 33705496 PMCID: PMC7987187 DOI: 10.1371/journal.ppat.1009413] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
SARS-CoV-2 virus is transmitted in closed settings to people in contact with COVID-19 patients such as healthcare workers and household contacts. However, household person-to-person transmission studies are limited. Households participating in an ongoing cohort study of influenza incidence and prevalence in rural Egypt were followed. Baseline enrollment was done from August 2015 to March 2017. The study protocol was amended in April 2020 to allow COVID-19 incidence and seroprevalence studies. A total of 290 households including 1598 participants were enrolled and followed from April to October 2020 in four study sites. When a participant showed respiratory illness symptoms, a serum sample and a nasal and an oropharyngeal swab were obtained. Swabs were tested by RT-PCR for SARS-CoV-2 infection. If positive, the subject was followed and swabs collected on days three, six, nine, and 14 after the first swab day and a serum sample obtained on day 14. All subjects residing with the index case were swabbed following the same sampling schedule. Sera were collected from cohort participants in October 2020 to assess seroprevalence. Swabs were tested by RT-PCR. Sera were tested by Microneutralization Assay to measure the neutralizing antibody titer. Incidence of COVID-19, household secondary attack rate, and seroprevalence in the cohort were determined. The incidence of COVID-19 was 6.9% and the household secondary attack rate was 89.8%. Transmission within households occurred within two-days of confirming the index case. Infections were asymptomatic or mild with symptoms resolving within 10 days. The majority developed a neutralizing antibody titer by day 14 post onset. The overall seroprevalence among cohort participants was 34.8%. These results suggest that within-household transmission is high in Egypt. Asymptomatic or mild illness is common. Most infections seroconvert and have a durable neutralizing antibody titer.
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Affiliation(s)
- Mokhtar R. Gomaa
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Amira S. El Rifay
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Mahmoud Shehata
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Ahmed Kandeil
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Mina Nabil Kamel
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Mohamed A. Marouf
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Mohamed GabAllah
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Ahmed El Taweel
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Ahmed E. Kayed
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Omnia Kutkat
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Yassmin Moatasim
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Sara H. Mahmoud
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Noura M. Abo Shama
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Mohamed El Sayes
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Ahmed Mostafa
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Rabeh El-Shesheny
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
| | - Pamela P. McKenzie
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Richard J. Webby
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Ghazi Kayali
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas, Houston, Texas, United States of America
- Human Link, Dubai, United Arab Emirates
| | - Mohamed A. Ali
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
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Rollins N, Minckas N, Jehan F, Lodha R, Raiten D, Thorne C, Van de Perre P, Ververs M, Walker N, Bahl R, Victora CG. A public health approach for deciding policy on infant feeding and mother-infant contact in the context of COVID-19. LANCET GLOBAL HEALTH 2021; 9:e552-e557. [PMID: 33631131 PMCID: PMC7906661 DOI: 10.1016/s2214-109x(20)30538-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/16/2020] [Accepted: 12/10/2020] [Indexed: 01/22/2023]
Abstract
The COVID-19 pandemic has raised concern about the possibility and effects of mother–infant transmission of SARS-CoV-2 through breastfeeding and close contact. The insufficient available evidence has resulted in differing recommendations by health professional associations and national health authorities. We present an approach for deciding public health policy on infant feeding and mother–infant contact in the context of COVID-19, or for future emerging viruses, that balances the risks that are associated with viral infection against child survival, lifelong health, and development, and also maternal health. Using the Lives Saved Tool, we used available data to show how different public health approaches might affect infant mortality. Based on existing evidence, including population and survival estimates, the number of infant deaths in low-income and middle-income countries due to COVID-19 (2020–21) might range between 1800 and 2800. By contrast, if mothers with confirmed SARS-CoV-2 infection are recommended to separate from their newborn babies and avoid or stop breastfeeding, additional deaths among infants would range between 188 000 and 273 000.
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Affiliation(s)
- Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
| | - Nicole Minckas
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Daniel Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, INSERM, Etablissement Français du Sang, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Mija Ververs
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neff Walker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Heck TG, Frantz RZ, Frizzo MN, François CHR, Ludwig MS, Mesenburg MA, Buratti GP, Franz LBB, Berlezi EM. Insufficient social distancing may contribute to COVID-19 outbreak: The case of Ijuí city in Brazil. PLoS One 2021; 16:e0246520. [PMID: 33596229 PMCID: PMC7888680 DOI: 10.1371/journal.pone.0246520] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease that emerged in 2019 (COVID-19) is highly contagious and has given way to a global pandemic. A present COVID-19 has high transmission rates worldwide, including in small Brazilian cities such as Ijuí. Located in the northwest part of the state of Rio Grande do Sul (RS) and with a population of 83,475, Ijuí was selected as the site of a population-based survey involving 2,222 subjects, from April to June 2020. Subjects were tested for the presence of antibodies against coronavirus (SARS-CoV-2) and answered questions regarding social distance adherence (SDA), daily preventive routines (DPR), comorbidities, and sociodemographic characteristics. In parallel, the local government registered the official COVID-19 cases in Ijuí, as well as the mobile social distancing index (MSDI). In this study, we demonstrate that there was a decrease in the levels of SDA, DPR and MSDI before the beginning of COVID-19 community transmission in Ijuí. Furthermore, we provide predictions for the number of COVID-19 cases, hospitalizations, and deaths in the city. We conclude that insufficient social distancing, as evidenced by different methods, may be related to the rapid increase of COVID-19 cases in Ijuí. Our study predicts an approaching outbreak of COVID-19 in Ijuí through community spread, which could be avoided or attenuated with increased levels of social distancing among the population.
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Affiliation(s)
- Thiago Gomes Heck
- Research Group in Physiology, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Postgraduate Program in Integral Attention to Health, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Medicine Course, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Postgraduate Program in Mathematical and Computational Modeling, Ijuí, RS, Brazil
| | - Rafael Z. Frantz
- Postgraduate Program in Mathematical and Computational Modeling, Ijuí, RS, Brazil
- Department of Exact Sciences and Engineering, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
| | - Matias Nunes Frizzo
- Research Group in Physiology, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Postgraduate Program in Integral Attention to Health, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Medicine Course, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
| | - Carlos Henrique Ramires François
- Medicine Course, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
| | - Mirna Stela Ludwig
- Research Group in Physiology, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Postgraduate Program in Integral Attention to Health, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Medicine Course, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
| | - Marilia Arndt Mesenburg
- Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul State, Brazil
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul State, Brazil
| | - Giovano Pereira Buratti
- Postgraduate Program in Integral Attention to Health, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
| | - Lígia Beatriz Bento Franz
- Postgraduate Program in Integral Attention to Health, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Research Group in Human Aging, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
| | - Evelise Moraes Berlezi
- Postgraduate Program in Integral Attention to Health, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Medicine Course, Department of Life Sciences, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
- Research Group in Human Aging, Regional University of Northwestern Rio Grande do Sul State, Ijuí, Rio Grande do Sul State, Brazil
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83
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Abstract
Reliable antibody testing against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to uncover the population-wide spread of coronavirus disease 2019 (COVID-19), which is critical for making informed healthcare and economic decisions. Here we review different types of antibody tests available for SARS-CoV-2 and their application for population-scale testing. Biases because of varying test accuracy, results of ongoing large-scale serological studies, and use of antibody testing for monitoring development of herd immunity are summarized. Although current SARS-CoV-2 antibody testing efforts have generated valuable insights, the accuracy of serological tests and the selection criteria for the tested cohorts need to be evaluated carefully.
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Affiliation(s)
- Thomas Vogl
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Sigal Leviatan
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
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84
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Stein C, Cousin E, Machado ÍE, Felisbino-Mendes MS, Passos VMDA, Sousa TMD, Schmidt MI, Gallagher J, Naghavi M, Duncan BB. The COVID-19 Pandemic in Brazil: Institute for Health Metrics and Evaluation projections and observed evolution, May-August, 2020. ACTA ACUST UNITED AC 2021; 30:e2020680. [PMID: 33566896 DOI: 10.1590/s1679-49742021000100017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the Institute for Health Metrics and Evaluation (IHME) projections for the COVID-19 pandemic in Brazil and the Brazilian states, present their accuracy and discuss their implications. METHODS The IHME projections from May to August 2020 for Brazil and selected states were compared with the ensuing reported number of cumulative deaths. RESULTS The pandemic was projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The mean error in the cumulative number of deaths at 2, 4 and 6 weeks after the projections were made was 13%, 18% and 22%, respectively. CONCLUSION Short and medium-term projections provide important and sufficiently accurate data to inform health managers, elected officials, and society at large. After following an arduous course up until August, the pandemic is projected to decline steadily although slowly, with ~400 deaths/day still occurring in early December.
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Affiliation(s)
- Caroline Stein
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brasil
| | - Ewerton Cousin
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, Estados Unidos
| | - Ísis Eloah Machado
- Universidade Federal de Ouro Preto, Departamento de Medicina de Família, Saúde Mental e Coletiva, Ouro Preto, MG, Brasil
| | | | | | - Tatiane Moraes de Sousa
- Fundação Instituto Oswaldo Cruz, Departamento de Endemias Samuel Pessoa, Rio de Janeiro, RJ, Brasil
| | - Maria Inês Schmidt
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Social, Porto Alegre, RS, Brasil
| | - John Gallagher
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, Estados Unidos
| | - Mohsen Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, Estados Unidos
| | - Bruce B Duncan
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Social, Porto Alegre, RS, Brasil
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85
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Mugunga JC, Tyagi K, Bernal-Serrano D, Correa N, Iberico M, Kateera F, Leandre F, Murray M, Suffrin JCD, Hedt-Gauthier B. SARS-CoV-2 serosurveys in low-income and middle-income countries. Lancet 2021; 397:353-355. [PMID: 33516323 PMCID: PMC7906745 DOI: 10.1016/s0140-6736(21)00188-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Jean Claude Mugunga
- Partners In Health, Boston, MA 02474, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; University of Global Health Equity, Boston, MA, USA.
| | - Kartik Tyagi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Bernal-Serrano
- Partners In Health, Boston, MA 02474, USA; Instituto Tecnológico y de Estudios Superiores de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | | | | | | | - Fernet Leandre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Megan Murray
- Partners In Health, Boston, MA 02474, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
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86
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Caramelli B, Escalante-Rojas MC, Chauhan HKC, Siciliano RF, Bittencourt MS, Micelli AC. The "false-positive" conundrum: IgA reference level overestimates the seroprevalence of antibodies to SARS-CoV-2. J Glob Health 2021; 11:05001. [PMID: 33604032 PMCID: PMC7882210 DOI: 10.7189/jogh.11.05001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background On 12 June 2020, Brazil reached the second position worldwide in the number of COVID-19 cases. Authorities increased the number of tests performed, including the identification of antibodies to SARS-CoV-2 (IgG, IgA, and IgM). There was an overflooding of the market with several tests, and the presence of possible false-positive results became a challenge. The purpose of this study was to describe the seroprevalence and immunoglobulin blood levels in a group of asymptomatic individuals using the reference levels provided by the manufacturer. Methods Levels of IgG and IgA antibodies to SARS-CoV-2 were determined in blood serum by the same ELISA (enzyme-linked immunoassay) test. Patients must be free of symptoms. Results From 20 to 22 May 2020, 938 individuals were tested. There were 441 (47%) men, age 53 years (interquartile range (IQR) = 39-63.2). The sample included 335 (35.7%) subjects aged ≥60 years old. Subjects with a positive test were 54 (5.8%) for IgG and 96 (10.2%) for IgA and 42 (4.5%) for both IgG and IgA. The prevalence of IgG and IgA positive test was not different in men and women and not different in individuals under 60 and over 60 years of age. Conversely, analysing only individuals with positive tests, the levels of IgG in positive subjects were significantly higher than those with an IgA positive test, 3.00 (IQR = 1.68-5.65), and 1.95 (IQR = 1.40-3.38), respectively; P = 0.017. Additionally, individuals with isolated IgA positive tests had significantly lower levels of IgA than those with both IgA and IgG positive tests: 1.95 (IQR = 1.60-2.40) and 3.15 (IQR = 2.20-3.90), respectively, P = 0.005. These latter data suggest that IgA shows a deviation of the distribution to the left in comparison to IgG distribution data. Indeed, many subjects reported as IgA positive had immunoglobulin levels slightly elevated. Conclusions In conclusion, we strongly suggest caution in the interpretation of IgA test results. This recommendation is more important for those with positive IgA just above the reference level.
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Affiliation(s)
| | | | | | | | - Marcio S Bittencourt
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil; Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
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87
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Khawaja S, Asif M, Naz Mukry S, Sultan Shamsi T. Possible correlation of electrochemiluminescence based numerical cut off index value with concentration of anti-SARS-CoV-2 antibody: Is it worth reporting? J Public Health Res 2021; 10:2079. [PMID: 33708750 PMCID: PMC7941051 DOI: 10.4081/jphr.2021.2079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Many laboratories are reporting a numerical cutoff index value (COI) value for most anti-SARS-CoV-2 qualitative tests. These numerical values in patients' report ultimately created great confusion in the public and physicians, therefore this study was designed to evaluate the correlation of electrochemiluminescence (ECLIA) based numerical COI values with quantitative ELISA of anti-SARS-CoV-2 antibody. Design and Methods: Two hundred and twenty-eight (228) recovered COVID-19 patients were included; their serum samples were analyzed by quantitative ELISA and ECLIA for anti-SARSCOV- 2 antibodies. Results: One hundred and seventy-three (75.8%) patients tested positive by ECLIA and ELISA assay and thirty-seven (6.2%) were tested negative by both methods. A weak positive correlation (r=0.37) was found between numerical COI value of ECLIA with ELISA concentration, which was statistically significant with p<0.001. All values were dispersed on scatter plot and there was no significant linear relationship between ECLIA and ELISA assay. Conclusions: As both testing techniques are base upon the same immunological phenomena of detecting antibodies against nucleocapsid protein. We suggest that COI values are not meant to describe the immunity level of the individuals thus the physicians should not consider it as a quantitative value for antibody levels in COVID-19 patients.
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Affiliation(s)
| | - Mohammad Asif
- Department of Haematology, National Institute of Blood disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - Samina Naz Mukry
- Department of Haematology, National Institute of Blood disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - Tahir Sultan Shamsi
- Department of Haematology, National Institute of Blood disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
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88
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Ioannidis JPA. Infection fatality rate of COVID-19 inferred from seroprevalence data. Bull World Health Organ 2021; 99:19-33F. [PMID: 33716331 PMCID: PMC7947934 DOI: 10.2471/blt.20.265892] [Citation(s) in RCA: 197] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To estimate the infection fatality rate of coronavirus disease 2019 (COVID-19) from seroprevalence data. METHODS I searched PubMed and preprint servers for COVID-19 seroprevalence studies with a sample size ≥ 500 as of 9 September 2020. I also retrieved additional results of national studies from preliminary press releases and reports. I assessed the studies for design features and seroprevalence estimates. I estimated the infection fatality rate for each study by dividing the cumulative number of COVID-19 deaths by the number of people estimated to be infected in each region. I corrected for the number of immunoglobin (Ig) types tested (IgG, IgM, IgA). FINDINGS I included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118-500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people younger than 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%. CONCLUSION The infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients and other factors. The inferred infection fatality rates tended to be much lower than estimates made earlier in the pandemic.
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Affiliation(s)
- John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Road, Stanford, California 94305, United States of America
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89
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Abstract
OBJECTIVE To estimate the infection fatality rate of coronavirus disease 2019 (COVID-19) from seroprevalence data. METHODS I searched PubMed and preprint servers for COVID-19 seroprevalence studies with a sample size ≥ 500 as of 9 September 2020. I also retrieved additional results of national studies from preliminary press releases and reports. I assessed the studies for design features and seroprevalence estimates. I estimated the infection fatality rate for each study by dividing the cumulative number of COVID-19 deaths by the number of people estimated to be infected in each region. I corrected for the number of immunoglobin (Ig) types tested (IgG, IgM, IgA). FINDINGS I included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118-500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people younger than 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%. CONCLUSION The infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients and other factors. The inferred infection fatality rates tended to be much lower than estimates made earlier in the pandemic.
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Affiliation(s)
- John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Road, Stanford, California 94305, United States of America
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90
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Anna F, Goyard S, Lalanne AI, Nevo F, Gransagne M, Souque P, Louis D, Gillon V, Turbiez I, Bidard FC, Gobillion A, Savignoni A, Guillot-Delost M, Dejardin F, Dufour E, Petres S, Richard-Le Goff O, Choucha Z, Helynck O, Janin YL, Escriou N, Charneau P, Perez F, Rose T, Lantz O. High seroprevalence but short-lived immune response to SARS-CoV-2 infection in Paris. Eur J Immunol 2020; 51:180-190. [PMID: 33259646 PMCID: PMC7753614 DOI: 10.1002/eji.202049058] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 12/22/2022]
Abstract
Although the COVID‐19 pandemic peaked in March/April 2020 in France, the prevalence of infection is barely known. Using high‐throughput methods, we assessed herein the serological response against the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) of 1847 participants working in three sites of an institution in Paris conurbation. In May–July 2020, 11% (95% confidence interval [CI]: 9.7–12.6) of serums were positive for IgG against the SARS‐CoV‐2 N and S proteins, and 9.5% (95% CI: 8.2–11.0) were neutralizer in pseudo‐typed virus assays. The prevalence of seroconversion was 11.6% (95% CI: 10.2–13.2) when considering positivity in at least one assay. In 5% of RT‐qPCR positive individuals, no systemic IgGs were detected. Among immune individuals, 21% had been asymptomatic. Anosmia (loss of smell) and ageusia (loss of taste) occurred in 52% of the IgG‐positive individuals and in 3% of the negative ones. In contrast, 30% of the anosmia–ageusia cases were seronegative, suggesting that the true prevalence of infection may have reached 16.6%. In sera obtained 4–8 weeks after the first sampling, anti‐N and anti‐S IgG titers and neutralization activity in pseudo‐virus assay declined by 31%, 17%, and 53%, resulting thus in half‐life of 35, 87, and 28 days, respectively. The population studied is representative of active workers in Paris. The short lifespan of the serological systemic responses suggests an underestimation of the true prevalence of infection.
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Affiliation(s)
| | - Sophie Goyard
- Unit of Lymphocyte Cell Biology, Immunology Department, Institut Pasteur, Paris, France.,INSERM 1221, Institut Pasteur, Paris, France
| | - Ana Ines Lalanne
- Laboratoire d'Immunologie Clinique, Institut Curie, Paris, France.,Centre d'Investigation Clinique en Biothérapie (CIC-BT1428), Institut Curie, Paris, France
| | | | - Marion Gransagne
- Innovation Laboratory: Vaccines, Institut Pasteur, Paris, France
| | - Philippe Souque
- Unit of Molecular Virology and Vaccinology, Virology Department, Institut Pasteur, Paris, France
| | - Delphine Louis
- Laboratoire d'Immunologie Clinique, Institut Curie, Paris, France.,Centre d'Investigation Clinique en Biothérapie (CIC-BT1428), Institut Curie, Paris, France
| | - Véronique Gillon
- Direction of the Clinical Research, Institut Curie, Paris, France
| | - Isabelle Turbiez
- Direction of the Clinical Research, Institut Curie, Paris, France
| | - François-Clément Bidard
- Centre d'Investigation Clinique en Biothérapie (CIC-BT1428), Institut Curie, Paris, France.,Medical Oncology Department, Institut Curie, Paris, France.,UVSQ, Paris-Saclay University, Saint-Cloud, France
| | | | | | - Maude Guillot-Delost
- Centre d'Investigation Clinique en Biothérapie (CIC-BT1428), Institut Curie, Paris, France.,INSERM U932, PSL University, Institut Curie, Paris, France
| | - François Dejardin
- Production and Purification of Recombinant Proteins Technological Platform, Institut Pasteur, Paris, France
| | - Evelyne Dufour
- Production and Purification of Recombinant Proteins Technological Platform, Institut Pasteur, Paris, France
| | - Stéphane Petres
- Production and Purification of Recombinant Proteins Technological Platform, Institut Pasteur, Paris, France
| | | | - Zaineb Choucha
- Innovation Laboratory: Vaccines, Institut Pasteur, Paris, France
| | - Olivier Helynck
- Unit of Chemistry and Biocatalysis, Institut Pasteur, CNRS UMR 3523, Paris, France
| | - Yves L Janin
- Unit of Chemistry and Biocatalysis, Institut Pasteur, CNRS UMR 3523, Paris, France
| | - Nicolas Escriou
- Innovation Laboratory: Vaccines, Institut Pasteur, Paris, France
| | - Pierre Charneau
- Theravectys, Paris, France.,Unit of Molecular Virology and Vaccinology, Virology Department, Institut Pasteur, Paris, France
| | - Franck Perez
- Cell Biology and Cancer Unit, Institut Curie, CNRS UMR 144, PSL Research University, Paris, France
| | - Thierry Rose
- Unit of Lymphocyte Cell Biology, Immunology Department, Institut Pasteur, Paris, France.,INSERM 1221, Institut Pasteur, Paris, France
| | - Olivier Lantz
- Laboratoire d'Immunologie Clinique, Institut Curie, Paris, France.,Centre d'Investigation Clinique en Biothérapie (CIC-BT1428), Institut Curie, Paris, France.,INSERM U932, PSL University, Institut Curie, Paris, France
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91
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SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings. Pathology 2020; 52:801-808. [PMID: 32888706 PMCID: PMC7437539 DOI: 10.1016/j.pathol.2020.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
As the SARS-CoV-2 pandemic unfolds across the globe, consistent themes are emerging with regard to aspects of SARS-CoV-2 infection and its associated disease entities in children. Overall, children appear to be less frequently infected by, and affected by, SARS-CoV-2 virus and the clinical disease COVID-19. Large epidemiological studies have revealed children represent less than 2% of the total confirmed COVID-19 cases, of whom the majority experience minimal or mild disease that do not require hospitalisation. Children do not appear to be major drivers of SARS-CoV-2 transmission, with minimal secondary virus transmission demonstrated within families, schools and community settings. There are several postulated theories regarding the relatively low SARS-CoV-2 morbidity and mortality seen in children, which largely relate to differences in immune responses compared to adults, as well as differences in angiotensin converting enzyme 2 distribution that potentially limits viral entry and subsequent inflammation, hypoxia and tissue injury. The recent emergence of a multisystem inflammatory syndrome bearing temporal and serological plausibility for an immune-mediated SARS-CoV-2-related disease entity is currently under investigation. This article summarises the current available data regarding SARS-CoV-2 and the paediatric population, including the spectrum of disease in children, the role of children in virus transmission, and host-virus factors that underpin the unique aspects of SARS-CoV-2 pathogenicity in children.
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92
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Lai CC, Wang JH, Hsueh PR. Population-based seroprevalence surveys of anti-SARS-CoV-2 antibody: An up-to-date review. Int J Infect Dis 2020; 101:314-322. [PMID: 33045429 PMCID: PMC7546669 DOI: 10.1016/j.ijid.2020.10.011] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 01/12/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic. However, the majority of currently available data are restricted to laboratory-confirmed cases for symptomatic patients, and the SARS-CoV-2 infection can manifest as an asymptomatic or mild disease. Therefore, the true extent of the burden of COVID-19 may be underestimated. Improved serological detection of specific antibodies against SARS-CoV-2 could help estimate the true numbers of infections. This article comprehensively reviews the associated literature and provides updated information regarding the seroprevalence of the anti-SARS-CoV-2 antibody. The seroprevalence can vary across different sites and the seroprevalence can increase with time during longitudinal follow-up. Although healthcare workers (HCWs), especially those caring for COVID-19 patients, are considered as a high-risk group, the seroprevalence in HCWs wearing adequate personal protective equipment is thought to be no higher than that in other groups. With regard to sex, no statistically significant difference has been found between male and female subjects. Some, but not all, studies have shown that children have a lower risk than other age groups. Finally, seroprevalence can vary according to different populations, such as pregnant women and hemodialysis patients; however, limited studies have examined these associations. Furthermore, the continued surveillance of seroprevalence is warranted to estimate and monitor the growing burden of COVID-19.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Jui-Hsiang Wang
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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93
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Meyerowitz-Katz G, Merone L. A systematic review and meta-analysis of published research data on COVID-19 infection fatality rates. Int J Infect Dis 2020; 101:138-148. [PMID: 33007452 PMCID: PMC7524446 DOI: 10.1016/j.ijid.2020.09.1464] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
An important unknown during the coronavirus disease-2019 (COVID-19) pandemic has been the infection fatality rate (IFR). This differs from the case fatality rate (CFR) as an estimate of the number of deaths and as a proportion of the total number of cases, including those who are mild and asymptomatic. While the CFR is extremely valuable for experts, IFR is increasingly being called for by policy makers and the lay public as an estimate of the overall mortality from COVID-19. METHODS Pubmed, Medline, SSRN, and Medrxiv were searched using a set of terms and Boolean operators on 25/04/2020 and re-searched on 14/05/2020, 21/05/2020 and 16/06/2020. Articles were screened for inclusion by both authors. Meta-analysis was performed in Stata 15.1 by using the metan command, based on IFR and confidence intervals extracted from each study. Google/Google Scholar was used to assess the grey literature relating to government reports. RESULTS After exclusions, there were 24 estimates of IFR included in the final meta-analysis, from a wide range of countries, published between February and June 2020. The meta-analysis demonstrated a point estimate of IFR of 0.68% (0.53%-0.82%) with high heterogeneity (p < 0.001). CONCLUSION Based on a systematic review and meta-analysis of published evidence on COVID-19 until July 2020, the IFR of the disease across populations is 0.68% (0.53%-0.82%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents a completely unbiased point estimate. It is likely that, due to age and perhaps underlying comorbidities in the population, different places will experience different IFRs due to the disease. Given issues with mortality recording, it is also likely that this represents an underestimate of the true IFR figure. More research looking at age-stratified IFR is urgently needed to inform policymaking on this front.
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Affiliation(s)
| | - Lea Merone
- James Cook University, Australia; Tropical Public Health Service, Cairns, Australia
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94
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Picon RV, Carreno I, da Silva AA, Mossmann M, Laste G, Domingues GDC, Heringer LFF, Gheno BR, Alvarenga LL, Conte M. Coronavirus disease 2019 population-based prevalence, risk factors, hospitalization, and fatality rates in southern Brazil. Int J Infect Dis 2020; 100:402-410. [PMID: 32949778 PMCID: PMC7493765 DOI: 10.1016/j.ijid.2020.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To assess population-based prevalence, risk factors, hospitalization, and infection fatality rates (IFR) associated with COVID-19. METHODS We conducted two household surveys among the non-institutionalized adult population from May 30 to June 17, 2020, in Lajeado, an 84,000-inhabitant industrial city in southern Brazil. Primary outcome was prevalence of SARS-CoV-2 infection. Secondary outcomes were COVID-19-related hospitalizations and deaths occurring up to June 20, 2020. We summarized prevalence rates across surveys with meta-analysis. We assessed age-range IFR and hospitalization rate and regressed these rates over age strata using nonlinear (exponential) coefficients of determination (R2). RESULTS Summarized overall prevalence was 3.40% (95% CI, 2.74-4.18), 34% lower in older adults ≥60 years. Prevalence was 14.3 and 5.4 times higher among household contacts and meat-precessing plant (MPP) workers, respectively. IFR ranged from 0.08% (0.06-0.11) to 4.63% (2.93-7.84) in individuals 20-39 years and ≥60 years, respectively. R2 for hospitalization rate and IFR over age were 0.98 and 0.93 (both p-values <0.0001), respectively. CONCLUSIONS This is the first population-based study in Brazil to estimate COVID-19 prevalence, hospitalization, and fatality rates per age stratum. Rates were largely age-dependent. Household contacts and MPP workers are at higher risk of infection. Our findings are valuable for health-policy making and resource allocation to mitigate the pandemic.
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Affiliation(s)
- Rafael V Picon
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil; Graduate Program in Medical Sciences, UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil.
| | - Ioná Carreno
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil; Nursing School, UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - André Anjos da Silva
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil; Graduate Program in Medical Sciences, UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Márcio Mossmann
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Gabriela Laste
- Graduate Program in Medical Sciences, UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil; Nursing School, UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Guilherme de Campos Domingues
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Lara Faria Fernandes Heringer
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Brenda Rodrigues Gheno
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Leticia Leão Alvarenga
- School of Medicine, Universidade do Vale do Taquari - UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
| | - Magali Conte
- Nursing School, UNIVATES, Av. Avelino Talini, 171 - Universitário, Lajeado, RS, 95914-014, Brazil
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95
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Hallal PC, Hartwig FP, Horta BL, Silveira MF, Struchiner CJ, Vidaletti LP, Neumann NA, Pellanda LC, Dellagostin OA, Burattini MN, Victora GD, Menezes AMB, Barros FC, Barros AJD, Victora CG. SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys. Lancet Glob Health 2020; 8:e1390-e1398. [PMID: 32979314 PMCID: PMC7511212 DOI: 10.1016/s2214-109x(20)30387-9] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Population-based data on COVID-19 are essential for guiding policies. There are few such studies, particularly from low or middle-income countries. Brazil is currently a hotspot for COVID-19 globally. We aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence by city and according to sex, age, ethnicity group, and socioeconomic status, and compare seroprevalence estimates with official statistics on deaths and cases. METHODS In this repeated cross-sectional study, we did two seroprevalence surveys in 133 sentinel cities in all Brazilian states. We randomly selected households and randomly selected one individual from all household members. We excluded children younger than 1 year. Presence of antibodies against SARS-CoV-2 was assessed using a lateral flow point-of-care test, the WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech, Guangzhou, China), using two drops of blood from finger prick samples. This lateral-flow assay detects IgG and IgM isotypes that are specific to the SARS-CoV-2 receptor binding domain of the spike protein. Participants also answered short questionnaires on sociodemographic information (sex, age, education, ethnicity, household size, and household assets) and compliance with physical distancing measures. FINDINGS We included 25 025 participants in the first survey (May 14-21) and 31 165 in the second (June 4-7). For the 83 (62%) cities with sample sizes of more than 200 participants in both surveys, the pooled seroprevalence increased from 1·9% (95% CI 1·7-2·1) to 3·1% (2·8-3·4). City-level prevalence ranged from 0% to 25·4% in both surveys. 11 (69%) of 16 cities with prevalence above 2·0% in the first survey were located in a stretch along a 2000 km of the Amazon river in the northern region. In the second survey, we found 34 cities with prevalence above 2·0%, which included the same 11 Amazon cities plus 14 from the northeast region, where prevalence was increasing rapidly. Prevalence levels were lower in the south and centre-west, and intermediate in the southeast, where the highest level was found in Rio de Janeiro (7·5% [4·2-12·2]). In the second survey, prevalence was similar in men and women, but an increased prevalence was observed in participants aged 20-59 years and those living in crowded conditions (4·4% [3·5-5·6] for those living with households with six or more people). Prevalence among Indigenous people was 6·4% (4·1-9·4) compared with 1·4% (1·2-1·7) among White people. Prevalence in the poorest socioeconomic quintile was 3·7% (3·2-4·3) compared with 1·7% (1·4-2·2) in the wealthiest quintile. INTERPRETATION Antibody prevalence was highly heterogeneous by country region, with rapid initial escalation in Brazil's north and northeast. Prevalence is strongly associated with Indigenous ancestry and low socioeconomic status. These population subgroups are unlikely to be protected if the policy response to the pandemic by the national government continues to downplay scientific evidence. FUNDING Brazilian Ministry of Health, Instituto Serrapilheira, Brazilian Collective Health Association, and the JBS Fazer o Bem Faz Bem.
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Affiliation(s)
- Pedro C Hallal
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando P Hartwig
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Mariângela F Silveira
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Luís P Vidaletti
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Lucia C Pellanda
- Fundação Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil
| | - Odir A Dellagostin
- Postgraduate Programme in Biotechnology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Marcelo N Burattini
- Universidade Federal de São Paulo, São Paulo, Brazil; Universidade de São Paulo, São Paulo, Brazil
| | - Gabriel D Victora
- Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY, USA
| | - Ana M B Menezes
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil; Universidade Católica de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
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96
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De Boni RB, Balanzá-Martínez V, Mota JC, Cardoso TDA, Ballester P, Atienza-Carbonell B, Bastos FI, Kapczinski F. Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic. J Med Internet Res 2020; 22:e22835. [PMID: 33038075 PMCID: PMC7641648 DOI: 10.2196/22835] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Essential workers have been shown to present a higher prevalence of positive screenings for anxiety and depression during the COVID-19 pandemic. Individuals from countries with socioeconomic inequalities may be at increased risk for mental health disorders. OBJECTIVE We aimed to assess the prevalence and predictors of depression, anxiety, and their comorbidity among essential workers in Brazil and Spain during the COVID-19 pandemic. METHODS A web survey was conducted between April and May 2020 in both countries. The main outcome was a positive screening for depression only, anxiety only, or both. Lifestyle was measured using a lifestyle multidimensional scale adapted for the COVID-19 pandemic (Short Multidimensional Inventory Lifestyle Evaluation-Confinement). A multinomial logistic regression model was performed to evaluate the factors associated with depression, anxiety, and the presence of both conditions. RESULTS From the 22,786 individuals included in the web survey, 3745 self-reported to be essential workers. Overall, 8.3% (n=311), 11.6% (n=434), and 27.4% (n=1027) presented positive screenings for depression, anxiety, and both, respectively. After adjusting for confounding factors, the multinomial model showed that an unhealthy lifestyle increased the likelihood of depression (adjusted odds ratio [AOR] 4.00, 95% CI 2.72-5.87), anxiety (AOR 2.39, 95% CI 1.80-3.20), and both anxiety and depression (AOR 8.30, 95% CI 5.90-11.7). Living in Brazil was associated with increased odds of depression (AOR 2.89, 95% CI 2.07-4.06), anxiety (AOR 2.81, 95%CI 2.11-3.74), and both conditions (AOR 5.99, 95% CI 4.53-7.91). CONCLUSIONS Interventions addressing lifestyle may be useful in dealing with symptoms of common mental disorders during the strain imposed among essential workers by the COVID-19 pandemic. Essential workers who live in middle-income countries with higher rates of inequality may face additional challenges. Ensuring equitable treatment and support may be an important challenge ahead, considering the possible syndemic effect of the social determinants of health.
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Affiliation(s)
- Raquel Brandini De Boni
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Jurema Correa Mota
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Pedro Ballester
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | | | - Francisco I Bastos
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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97
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Pedersen OB, Nissen J, Dinh KM, Schwinn M, Kaspersen KA, Boldsen JK, Didriksen M, Dowsett J, Sørensen E, Thørner LW, Larsen MAH, Grum-Schwensen B, Sækmose S, Paulsen IW, Frisk NLS, Brodersen T, Vestergaard LS, Rostgaard K, Mølbak K, Skov RL, Erikstrup C, Ullum H, Hjalgrim H. SARS-CoV-2 infection fatality rate among elderly retired Danish blood donors - A cross-sectional study. Clin Infect Dis 2020; 73:e2962-e2969. [PMID: 33103182 PMCID: PMC7665387 DOI: 10.1093/cid/ciaa1627] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the vast majority of individuals succumbing to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are elderly, infection fatality rate (IFR) estimates for the age group 70 years older are still scarce. To this end we assessed SARS-CoV-2 seroprevalence among retired blood donors and combined it with national COVID-19 survey data to provide reliable population-based IFR estimates for this age group. METHODS We identified 60,926 retired blood donors age 70 years or older in the rosters of three region-wide Danish blood banks and invited them to fill in a questionnaire on COVID-19 related symptoms and behaviours. Among 24,861 (40.8%) responders, we invited a random sample of 3,200 individuals for blood testing. Overall, 1,201 (37.5%) individuals were tested for SARS-CoV-2 antibodies (Wantai) and compared to 1,110 active blood donors age 17-69 years. Seroprevalence 95% confidence intervals (CI) were adjusted for assay sensitivity and specificity. RESULTS Among retired (age 70 years or older) and active (age 17-69 years) blood donors, adjusted seroprevalences were 1.4% (95% CI: 0.3%-2.5%) and 2.5% (95% CI: 1.3%-3.8%), respectively. Using available population data on COVID-19 related fatalities, IFRs for patients age 70 years or older and for 17-69 years were estimated at 5.4% (95% CI: 2.7%-6.4%) and 0.083% (95% CI: 0.054%-0.18%), respectively. Only 52.4% of SARS-CoV-2 seropositive retired blood donors reported having been sick since the start of the pandemic. CONCLUSION COVID-19 IFR in the age group above 69 years is estimated to be 65 times as high as the IFR for people age 18-69 years.
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Affiliation(s)
- Ole Birger Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen
| | - Janna Nissen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Khoa Manh Dinh
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Schwinn
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joseph Dowsett
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Wegner Thørner
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Susanne Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | | | | | - Thorsten Brodersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | | | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kåre Mølbak
- Infection Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Robert Leo Skov
- Infection Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Haematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen
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98
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Flower B, Atchison C. SARS-CoV-2 antibody seroprevalence in patients receiving dialysis in the USA. Lancet 2020; 396:1308-1309. [PMID: 32987009 PMCID: PMC7518795 DOI: 10.1016/s0140-6736(20)32006-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 10/26/2022]
Affiliation(s)
- Barnaby Flower
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London W2 1NY, UK.
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99
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Martínez-Baz I, Trobajo-Sanmartín C, Arregui I, Navascués A, Adelantado M, Indurain J, Fresán U, Ezpeleta C, Castilla J. Influenza Vaccination and Risk of SARS-CoV-2 Infection in a Cohort of Health Workers. Vaccines (Basel) 2020; 8:E611. [PMID: 33076405 PMCID: PMC7712321 DOI: 10.3390/vaccines8040611] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Vaccines may induce positive non-specific immune responses to other pathogens. This study aims to evaluate if influenza vaccination in the 2019-2020 season had any effect on the risk of SARS-CoV-2 confirmed infection in a cohort of health workers. During the first SARS-CoV-2 epidemic wave in Spain, between March and May 2020, a cohort of 11,201 health workers was highly tested by RT-qPCR and/or rapid antibody test when the infection was suspected. Later in June, 8665 of them were tested for total antibodies in serum. A total of 890 (7.9%) health workers were laboratory-confirmed for SARS-CoV-2 infection by any type of test, while no case of influenza was detected. The adjusted odds ratio between 2019-2020 influenza vaccination and SARS-CoV-2 confirmed infection was the same (1.07; 95% CI, 0.92-1.24) in both comparisons of positive testers with all others (cohort design) and with negative testers (test-negative design). Among symptomatic patients tested by RT-qPCR, the comparison of positive cases and negative controls showed an adjusted odds ratio of 0.86 (95% CI, 0.68-1.08). These results suggest that influenza vaccination does not significantly modify the risk of SARS-CoV-2 infection. The development of specific vaccines against SARS-CoV-2 is urgent.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra–IdiSNA, 31003 Pamplona, Spain; (I.M.-B.); (U.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Camino Trobajo-Sanmartín
- Clinical Microbiology Department, Complejo Hospitalario de Navarra–IdiSNA, 31008 Pamplona, Spain; (C.T.-S.); (I.A.); (A.N.); (M.A.); (J.I.); (C.E.)
| | - Irati Arregui
- Clinical Microbiology Department, Complejo Hospitalario de Navarra–IdiSNA, 31008 Pamplona, Spain; (C.T.-S.); (I.A.); (A.N.); (M.A.); (J.I.); (C.E.)
| | - Ana Navascués
- Clinical Microbiology Department, Complejo Hospitalario de Navarra–IdiSNA, 31008 Pamplona, Spain; (C.T.-S.); (I.A.); (A.N.); (M.A.); (J.I.); (C.E.)
| | - Marta Adelantado
- Clinical Microbiology Department, Complejo Hospitalario de Navarra–IdiSNA, 31008 Pamplona, Spain; (C.T.-S.); (I.A.); (A.N.); (M.A.); (J.I.); (C.E.)
| | - Juan Indurain
- Clinical Microbiology Department, Complejo Hospitalario de Navarra–IdiSNA, 31008 Pamplona, Spain; (C.T.-S.); (I.A.); (A.N.); (M.A.); (J.I.); (C.E.)
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra–IdiSNA, 31003 Pamplona, Spain; (I.M.-B.); (U.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Carmen Ezpeleta
- Clinical Microbiology Department, Complejo Hospitalario de Navarra–IdiSNA, 31008 Pamplona, Spain; (C.T.-S.); (I.A.); (A.N.); (M.A.); (J.I.); (C.E.)
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra–IdiSNA, 31003 Pamplona, Spain; (I.M.-B.); (U.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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100
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Ejazi SA, Ghosh S, Ali N. Antibody detection assays for COVID-19 diagnosis: an early overview. Immunol Cell Biol 2020; 99:21-33. [PMID: 32864735 DOI: 10.1111/imcb.12397] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
The ongoing pandemic of coronavirus disease 2019 (COVID-19) has not only commenced a global health emergency but also agitated various aspects of humanity. During this period of crisis, researchers over the world have ramped their efforts to constrain the disease in all possible ways, whether it is vaccination, therapy or diagnosis. Because the spread of the disease has not yet elapsed, sharing the ongoing research findings could be the key to disease control and management. An early and efficient diagnosis could leverage the outcome until a successful vaccine is developed. Both in-house and commercial kits are the preferred molecular tests being used worldwide in the COVID-19 diagnosis. However, the limitation of high prices and lengthy procedures impede their use for mass testing. Keeping the constant rise of infection in mind, the search for an alternative test that is cost-effective, simple and suitable for large-scale testing and surveillance is the need of the hour. One such alternative could be immunological tests. In the last few months, a deluge of immunological rapid tests have been developed and validated across the globe. The objective of this review is to share the diagnostic performance of various immunological assays reported so far in severe acute respiratory syndrome coronavirus 2 case detection. We consolidate the studies (published and preprints) related to serological tests such as chemiluminescence, enzyme-linked and lateral flow-based point-of-care tests in COVID-19 diagnosis and update the current scenario. This review aims to be an add-on in COVID-19 research and will contribute to congregation of the evidence for decision making.
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Affiliation(s)
- Sarfaraz Ahmad Ejazi
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, West Bengal, India
| | - Sneha Ghosh
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, West Bengal, India.,Department of Biochemistry, Ballygunge Science College, University of Calcutta, Kolkata, West Bengal, India
| | - Nahid Ali
- Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, West Bengal, India
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