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Helou M, Zoghbi S, El Osta N, Mina J, Mokhbat J, Husni R. COVID-19 infection and seroconversion rates in healthcare workers in Lebanon: An observational study. Medicine (Baltimore) 2023; 102:e32992. [PMID: 37115042 PMCID: PMC10143398 DOI: 10.1097/md.0000000000032992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 04/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) infection is a recent pandemic. Healthcare workers (HCW) are at high risk of acquiring the infection and transmitting it to others. Seroprevalence for COVID-19 among HCW varies between countries, hospitals in the same country and even among different departments in the same hospital. In this study, we aim to determine the prevalence of severe acute respiratory syndrome coronavirus 2 antibodies and the seroconversion among the HCW in our hospital. A total of 203 HCW were included. The rate of conversion to seropositive was 19.7% in total, with a rate of 13.4% in female versus 25% in male. The seropositivity in the House keeping group was 83%, followed by 45% in the COVID Floor while the seropositivity in the Anesthesia was 4% and the Infection Control 0%. The highest seropositivity rate in the COVID floor, and in the intensive care unit was explained by the long time spent with the patients. While in the inhalation team and the anesthesia, the lower rates of seropositivity was due to the N95 mask wearing the whole time. Seropositivity for COVID-19 in HCW is a major public health concern. Policies should be implemented to better protect HCWs.
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Affiliation(s)
- Mariana Helou
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Sanaa Zoghbi
- Division of Infection Control, Lebanese American University Medical Center, Beirut, Lebanon
| | - Nour El Osta
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Jonathan Mina
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Jacques Mokhbat
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Rola Husni
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
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Jijón S, Al Shafie A, Hassan E, Temime L, Jean K, El-Kassas M. Estimating the risk of incident SARS-CoV-2 infection among healthcare workers in quarantine hospitals: the Egyptian example. Sci Rep 2022; 12:19773. [PMID: 36396799 PMCID: PMC9670048 DOI: 10.1038/s41598-022-23428-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
In response to the COVID-19 epidemic, Egypt established a unique care model based on quarantine hospitals where only externally-referred confirmed COVID-19 patients were admitted, and healthcare workers resided continuously over 1- to 2-week working shifts. Using a mathematical model accounting for the false-negative rates of RT-PCR tests, we computed the incidence rate of SARS-CoV-2 infection among HCWs, while unveiling the proportion of infections remaining undiagnosed despite routine testing. We relied on longitudinal data, including results of routine RT-PCR tests, collected within three Egyptian quarantine hospitals. We estimated an incidence rate (per 100 person-day, PD) of 1.05 (95% CrI 0.58-1.65) at Hospital 1, 1.92 (95% CrI 0.93-3.28) at Hospital 2 and 7.62 (95% CrI 3.47-13.70) at Hospital 3. We found that the risk for an HCW to be infected during a working shift lay within the range of risk levels previously documented in standard healthcare settings for Hospitals 1-2, whereas it was > threefold higher for Hospital 3. This large variation suggests that HCWs from quarantine hospitals may face a high occupational risk of infection, but that, with sufficient infection control measures, this risk can be brought down to levels similar to those observed in standard healthcare settings.
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Affiliation(s)
- Sofía Jijón
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires (MESuRS), Conservatoire National des Arts et Métiers, Paris, France.
- Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France.
- iEES Paris, Sorbonne Université, Campus Pierre et Marie Curie, 4 Place Jussieu, 75005, Paris, France.
| | - Ahmad Al Shafie
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Essam Hassan
- Tropical Medicine Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Laura Temime
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires (MESuRS), Conservatoire National des Arts et Métiers, Paris, France
- Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - Kévin Jean
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires (MESuRS), Conservatoire National des Arts et Métiers, Paris, France
- Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Seroprevalence, correlates and kinetics of SARS-CoV-2 nucleocapsid IgG antibody in healthcare workers and nonclinical staff at a tertiary hospital: A prevaccine census study. PLoS One 2022; 17:e0267619. [PMID: 36301926 PMCID: PMC9612503 DOI: 10.1371/journal.pone.0267619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Healthcare workers and nonclinical staff in medical facilities are perceived to be a high-risk group for acquiring SAR-CoV-2 infection, and more so in countries where COVID-19 vaccination uptake is low. Serosurveillance may best determine the true extent of SARS-CoV-2 infection since most infected HCWs and other staff may be asymptomatic or present with only mild symptoms. Over time, determining the true extent of SARS-CoV-2 infection could inform hospital management and staff whether the preventive measures instituted are effective and valuable in developing targeted solutions. METHODS This was a census survey study conducted at the Aga Khan University Hospital, Nairobi, between November 2020 and February 2021 before the implementation of the COVID-19 vaccination. The SARS-CoV-2 nucleocapsid IgG test was performed using a chemiluminescent assay. RESULTS One thousand six hundred thirty-one (1631) staff enrolled, totalling 60% of the workforce. The overall crude seroprevalence was 18.4% and the adjusted value (for assay sensitivity of 86%) was 21.4% (95% CI; 19.2-23.7). The staff categories with higher prevalence included pharmacy (25.6%), outreach (24%), hospital- based nursing (22.2%) and catering staff (22.6%). Independent predictors of a positive IgG result after adjusting for age, sex and comorbidities included prior COVID-19 like symptoms, odds ratio (OR) 2.0 [95% confidence interval (CI) 1.3-3.0, p = 0.001], a prior positive SARS-CoV-2 PCR result OR 12.0 (CI: 7.7-18.7, p<0.001) and working in a clinical COVID-19 designated area, OR 1.9 (CI 1.1-3.3, p = 0.021). The odds of testing positive for IgG after a positive PCR test were lowest if the antibody test was performed more than 2 months later; OR 0.7 (CI: 0.48-0.95, p = 0.025). CONCLUSIONS The prevalence of anti- SARS-CoV-2 nucleocapsid IgG among HCWs and nonclinical staff was lower than in the general population. Staff working in clinical areas were not at increased risk when compared to staff working in non-clinical areas.
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Kolawole OM, Tomori O, Agbonlahor D, Ekanem E, Bakare R, Abdulsalam N, Okojie O, Braide E, Uzochukwu B, Rafindadi A, Bello S, Shehu S, Gureje O, Lecky M, Onwujekwe O, Onyedum C, Ezike A, Bukbuk D, Ashir G, Anyaehie B, Amazigo U, Habib A, Ufere J, Azodoh N. SARS CoV-2 Seroprevalence in Selected States of High and Low Disease Burden in Nigeria. JAMA Netw Open 2022; 5:e2236053. [PMID: 36219441 PMCID: PMC9554701 DOI: 10.1001/jamanetworkopen.2022.36053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The global impact of COVID-19 has led to an increased need to continuously assess disease surveillance tools. The utility of SARS-CoV-2 serologic tools in determining immunity levels across different age groups and locations in helping to quickly assess the burden of COVID-19 with significant health policy implications is unknown. OBJECTIVE To determine the prevalence of SARS-CoV-2 antibodies with respect to the age group and sex of participants. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey of 4904 individuals across 12 states with high and low COVID-19 disease burden in Nigeria was carried out between June 29 and August 21, 2021. MAIN OUTCOMES AND MEASURES Enzyme-linked immunosorbent assay was used for the detection of specific SARS-CoV-2 immunoglobulin G and immunoglobulin M antibodies, such as the nucleocapsid protein-NCP and spike protein S1. Interviewer-administered questionnaires provided information on participants' history of disease and associated risk factors. RESULTS A total of 4904 individuals participated in the study (3033 were female [61.8%]; mean [SD] age, 26.7 [6.51] years). A high seroprevalence of SARS-CoV-2 (78.9%) was obtained. Seropositivity was consistent across the states surveyed, ranging from 69.8% in Lagos to 87.7% in Borno. There was no association between sex and seropositivity (female, 2414 [79.6%]; male, 1456 [77.8%]; P = .61); however, an association was noted between age and seropositivity, with the peak prevalence observed in participants aged 15 to 19 years (616 [83.6%]; P = .001). Similarly, loss of appetite (751 [82.3%]; P = .04) and smell (309 [84.4%]; P = .01) were associated with seropositivity. CONCLUSIONS AND RELEVANCE In this cross-sectional study, a high SARS-CoV-2 seroprevalence was obtained among the study population during the low level of vaccination at the time of the survey. Thus, there is a need for both an efficacy and antibody neutralization test study to ascertain the efficacy of the antibody detected and the potential for herd immunity in Nigeria.
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Affiliation(s)
- Olatunji Matthew Kolawole
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Oyewale Tomori
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Dennis Agbonlahor
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Ekanem Ekanem
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Rasheed Bakare
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Nasidi Abdulsalam
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Obehi Okojie
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Eka Braide
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Benjamin Uzochukwu
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Abdulmumini Rafindadi
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Shaibu Bello
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Sule Shehu
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Oye Gureje
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Muhammed Lecky
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Obinna Onwujekwe
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Cajetan Onyedum
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Adaobi Ezike
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - David Bukbuk
- Department of Microbiology, Faculty of Science, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Garba Ashir
- Department of Microbiology, Faculty of Science, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Bond Anyaehie
- Department of Physiology, College of Medicine, University of Nigeria, Enugu
| | - Uche Amazigo
- Pan-African Community Initiative on Education and Health, Enugu, Enugu State, Nigeria
| | - Abdulrajak Habib
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
| | - Joy Ufere
- World Health Organization Country Office, Federal Capital Territory, Abuja, Nigeria
| | - Ngozi Azodoh
- Ministerial Expert Advisory Committee on COVID-19-Health Sector Response, Federal Ministry of Health, Abuja, Nigeria
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Mohamad N, Pahrol MA, Shaharudin R, Md Yazin NKR, Osman Y, Toha HR, Mustapa N, Mohamed Z, Mohammad A, Ismail R. Compliance to Infection Prevention and Control Practices Among Healthcare Workers During COVID-19 Pandemic in Malaysia. Front Public Health 2022; 10:878396. [PMID: 35923958 PMCID: PMC9340217 DOI: 10.3389/fpubh.2022.878396] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare workers (HCWs) are at risk of contracting coronavirus disease-2019 (COVID-19) in their workplace. Infection prevention guidelines and standard operating procedures were introduced to reduce risk of exposure and prevent transmission. Safe practices during interaction with patients with COVID-19 are crucial for infection prevention and control (IPC). This study aimed to assess HCWs' compliance to IPC and to determine its association with sociodemographic and organizational factors. A cross-sectional study was conducted between March and April 2021 at public healthcare facilities in the east coast of Peninsular Malaysia. HCWs who were involved with COVID-19-related works were invited to participate in the online survey. The questionnaire was adapted from the World Health Organization (WHO) Interim Guidance: WHO Risk Assessment and Management of Exposure of Healthcare Workers in the Context of COVID-19. Respondents were categorized as compliant or non-compliant to IPC. A total of 600 HCWs involved in COVID-19-related works participated in the survey. Most of them (63.7%) were compliant to IPC as they responded to all items as "always, as recommended" during interaction with patients with COVID-19. The multivariate analysis showed that non-compliance was significantly associated with working in the emergency department (AOR = 3.16; 95% CI = 1.07-9.31), working as laboratory personnel (AOR = 15.13; 95% CI = 1.36-168.44), health attendant (AOR = 4.42; 95% CI = 1.74-11.24), and others (AOR = 3.63; 95% CI = 1.1-12.01), as well as work experience of more than 10 years (AOR = 4.71; 95% CI = 1.28-17.27). The odds of non-compliance among respondents without adequate new norms and personal protective equipment training were 2.02 (95% CI = 1.08-3.81) more than those with adequate training. Although most of the respondents complied to IPC protocols, compliance status differed according to department, work category, and years of service. Ensuring adequate training that will hopefully lead to behavioral change is crucial to prevent breach in IPC and thus minimize the risk of exposure to and transmission of COVID-19 in healthcare facilities.
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Affiliation(s)
- Nadia Mohamad
- Environmental Health Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Muhammad Alfatih Pahrol
- Environmental Health Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Rafiza Shaharudin
- Environmental Health Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | | | - Yelmizaitun Osman
- Occupational and Environmental Health Unit, Kelantan State Health Department, Ministry of Health Malaysia, Kota Bharu, Malaysia
| | - Haidar Rizal Toha
- Occupational and Environmental Health Unit, Johor State Health Department, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Normazura Mustapa
- Occupational and Environmental Health Unit, Melaka State Health Department, Ministry of Health Malaysia, Melaka, Malaysia
| | - Zuraida Mohamed
- Occupational and Environmental Health Unit, Negeri Sembilan State Health Department, Ministry of Health Malaysia, Seremban, Malaysia
| | - Azyyati Mohammad
- Occupational and Environmental Health Unit, Negeri Sembilan State Health Department, Ministry of Health Malaysia, Seremban, Malaysia
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Shah Alam, Malaysia
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Ratovoson R, Raberahona M, Razafimahatratra R, Randriamanantsoa L, Andriamasy EH, Herindrainy P, Razanajatovo N, Andriamandimby SF, Rakotonaivo A, Randrianarisaona F, Dussart P, Heraud JM, de Randria MJDD, Schoenhals M, Randremanana RV. SARS-CoV-2 infection rate in Antananarivo frontline health care workers, Madagascar. Influenza Other Respir Viruses 2022; 16:994-1003. [PMID: 35754109 PMCID: PMC9350202 DOI: 10.1111/irv.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) represent a vulnerable population during epidemic periods. Our cohort study aimed to estimate the risk of infection and associated factors among HCWs during the first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Madagascar. METHODS A prospective cohort study was carried out in three hospitals that oversaw the first cases of COVID-19. Monthly ELISA-based serological tests were conducted, and nasopharyngeal swabs were collected in the case of symptoms linked to COVID-19 for RT-PCR analysis. Survival analyses were used to determine factors associated with SARS-CoV-2 infection. RESULTS The study lasted 7 months from May 2020. We included 122 HCWs, 61.5% of whom were women. The median age was 31.9 years (IQR: 26.4-42.3). In total, 42 (34.4%) had SARS-CoV-2 infections, of which 20 were asymptomatic (47.6%). The incidence of SARS-CoV-2 infection was 9.3% (95% CI [6.5-13.2]) person-months. Sixty-five HCWs presented symptoms, of which 19 were positive by RT-PCR. When adjusted for exposure to deceased cases, infection was more frequent in HCWs younger than 30 years of age (RR = 4.9, 95% CI [1.4-17.2]). CONCLUSION Our results indicate a high incidence of infection with SARS-CoV-2 among HCWs, with a high proportion of asymptomatic cases. Young HCWs are more likely to be at risk than others. Greater awareness among young people is necessary to reduce the threat of infection among HCWs.
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Affiliation(s)
- Rila Ratovoson
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
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Hajissa K, Islam MA, Hassan SA, Zaidah AR, Ismail N, Mohamed Z. Seroprevalence of SARS-CoV-2 Antibodies in Africa: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127257. [PMID: 35742506 PMCID: PMC9223681 DOI: 10.3390/ijerph19127257] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/06/2023]
Abstract
A reliable estimate of SARS-CoV-2-specific antibodies is increasingly important to track the spread of infection and define the true burden of the ongoing COVID-19 pandemic. A systematic review and a meta-analysis were conducted with the objective of estimating the seroprevalence of SARS-CoV-2 infection in Africa. A systematic search of the PubMed, Scopus, Web of Science and Google Scholar electronic databases was conducted. Thirty-five eligible studies were included. Using meta-analysis of proportions, the overall seroprevalence of anti-SARS-CoV-2 antibodies was calculated as 16% (95% CI 13.1-18.9%). Based on antibody isotypes, 14.6% (95% CI 12.2-17.1%) and 11.5% (95% CI 8.7-14.2%) were seropositive for SARS-CoV-2 IgG and IgM, respectively, while 6.6% (95% CI 4.9-8.3%) were tested positive for both IgM and IgG. Healthcare workers (16.3%) had higher seroprevalence than the general population (11.7%), blood donors (7.5%) and pregnant women (5.7%). The finding of this systematic review and meta-analysis (SRMA) may not accurately reflect the true seroprevalence status of SARS-CoV-2 infection in Africa, hence, further seroprevalence studies across Africa are required to assess and monitor the growing COVID-19 burden.
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Affiliation(s)
- Khalid Hajissa
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (K.H.); (S.A.H.); (A.R.Z.); (N.I.)
- Department of Zoology, Faculty of Science and Technology, Omdurman Islamic University, P.O. Box 382, Omdurman 14415, Sudan
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence: or (M.A.I.); (Z.M.)
| | - Siti Asma Hassan
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (K.H.); (S.A.H.); (A.R.Z.); (N.I.)
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Abdul Rahman Zaidah
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (K.H.); (S.A.H.); (A.R.Z.); (N.I.)
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Nabilah Ismail
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (K.H.); (S.A.H.); (A.R.Z.); (N.I.)
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Zeehaida Mohamed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (K.H.); (S.A.H.); (A.R.Z.); (N.I.)
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Correspondence: or (M.A.I.); (Z.M.)
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Müller SA, Wood RR, Hanefeld J, El-Bcheraoui C. Seroprevalence and risk factors of COVID-19 in healthcare workers from 11 African countries: a scoping review and appraisal of existing evidence. Health Policy Plan 2022; 37:505-513. [PMID: 34726740 PMCID: PMC8689910 DOI: 10.1093/heapol/czab133] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022] Open
Abstract
A better understanding of serological data and risk factors for coronavirus disease 2019 (COVID-19) infection in healthcare workers (HCWs) is especially important in African countries where human resources and health services are more constrained. We reviewed and appraised the evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and its risk factors in HCWs in Africa to inform response and preparedness strategies during the SARS-CoV-2 pandemic. We followed the Preferred Reporting Items for systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines in this scoping review. Databases including PubMed, Embase and preprint servers were searched accordingly from the start of the COVID-19 pandemic to 19 April 2021. Our search yielded 12 peer-reviewed and four pre-print articles comprising data on 9223 HCWs from 11 countries in Africa. Seroprevalence varied widely and ranged from 0% to 45.1%. Seropositivity was associated with older age, lower education, working as a nurse/non-clinical HCW or in gynaecology, emergency, outpatient or surgery departments. Asymptomatic rates were high and half of the studies recommended routine testing of HCWs. This scoping review found a varying but often high SARS-CoV-2 seroprevalence in HCWs in 11 African countries and identified certain risk factors. COVID-19 public health strategies for policy and planning should consider these risk factors and the potential for high seroprevalence among HCWs when prioritizing infection prevention and control measures and vaccine deployment.
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Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, Berlin 13353, Germany
| | - Rebekah Ruth Wood
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, Berlin 13353, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, Berlin 13353, Germany
| | - Charbel El-Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, Berlin 13353, Germany
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Malaeb R, Yousef N, Al-Nagdah O, Ali QH, Saeed MAS, Haider A, Zelikova E, Malou N, Guiramand S, Mills C, Luquero F, Porten K. High seroprevalence of antibodies against SARS-CoV-2 among healthcare workers 8 months after the first wave in Aden, Yemen. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000767. [PMID: 36962647 PMCID: PMC10022234 DOI: 10.1371/journal.pgph.0000767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
The true burden of COVID-19 in Yemen is underestimated. The healthcare system is dysfunctional and there is a high shortage of health care workers in the country. Testing for SARS-CoV-2 remains limited and official surveillance data is restricted to those who are severe or highly suspected. In this study, Médecins Sans Frontières (MSF) aimed to conduct serological screening using rapid tests for asymptomatic staff at the MSF Aden Trauma Center to determine the SARS-CoV-2 antibody seropositivity. Four months after the peak of the first wave, we offered all the staff at the MSF Aden Trauma Center PCR if symptomatic, and a baseline SARS-CoV-2 serology screening followed by follow-up screenings. A final round was scheduled four months after the baseline. A rapid serology lateral flow test, NG-Test IgM-IgG was used in all rounds and in the final round, an electrochemiluminescence immunoassay (ECLIA) (Elecsys Anti-SARS-CoV-2 assay). Univariate and multivariate analyses were used to identify risk factors for seropositivity. The level of agreement between the different serology assays used was investigated. Overall 69 out of 356 participants (19.4%, 95% CI 17.9-20.8) tested positive by NG-Test between September and November 2020. A sub-sample of 161 staff members were retested in January 2021. Of these, the NG-Test detected only 13 positive cases, whereas the ECLIA detected 109 positive cases. The adjusted seroprevalence by ECLIA was 59% (95%CI 52.2-65.9). The non-medical staff had significantly lower odds of seropositivity compared to the medical staff (AOR 0.43, 95% CI 0.15-0.7, p<0.001). The positive percent agreement between the two tests was very low (11%). Our results suggest a very high SARS-CoV-2 seroprevalence in healthcare workers in Yemen, highlighting the need for regular testing and rapid vaccination of all healthcare workers in the country.
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Kishk RM, Nemr N, Aly HM, Soliman NH, Hagras AM, Ahmed AAA, Kishk SM, Mostafa Ahmed M, Louis N. Assessment of potential risk factors for coronavirus disease-19 (COVID-19) among health care workers. J Infect Public Health 2021; 14:1313-1319. [PMID: 34281792 PMCID: PMC8265179 DOI: 10.1016/j.jiph.2021.07.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background Understanding COVID-19 infection among health workers and the risk factors for adverse outcomes is important not only for characterizing virus transmission patterns and risk factors for infection, but also for preventing the future infection of health workers and other patients and reducing secondary COVID-19 transmission within health care settings. Our aim was to identify risk factors for infection among health care workers to limit adverse events in health care facilities. Subjects and Methods A total of 336 HCWs from COVID-19 treatment hospitals took part in the study with varying COVID-19 exposure risk depending on job function and working site. All participants were asked about risk factors for COVID-19 infection. Results Among our participants, 42.6% were medical doctors, 28.6% nurses and 7.4% assistant nurses and 21.4% were others. Forty four percent of participants had work experience 5–10 years. More than half of participants received training in Infection Prevention and Control (IPC) (56.8%) about COVID 19; 91% have hand hygiene facilities and 69% admitted availability of PPE. More than half of participants admitted that they always follow IPC measures. Two thirds of participants (66.7%) had close contact with a patient since admission; 42.3% were present in aerosolizing procedures for patients. Forty two percent of participants had respiratory symptom; the most common was sore throat representing (32.4%). The highest frequency of respiratory symptoms was among of nurses and assistant nurses 51%. Frequency of respiratory symptoms was higher among those who contacted the patient directly or for prolonged period compared to those who do not admitted these contacts. Conclusions Risk factors for COVID-19 represented by those who were smokers, nurses and assistant nurses were more liable to catch COVID-19 than doctors as they contacted the patient directly for prolonged period or his/her body fluids, materials or surfaces around him.
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Affiliation(s)
- Rania M Kishk
- Microbiology and Immunology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt.
| | - Nader Nemr
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Hebatalla M Aly
- Public Health, Community, Occupational and Environmental Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Nourhan H Soliman
- Clinical Pathology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Abeer M Hagras
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ali A A Ahmed
- Microbiology and Immunology Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Safaa M Kishk
- Pharmaceutical Medicinal Chemistry Department, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Mona Mostafa Ahmed
- Internal Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Nageh Louis
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
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Mostafa A, El-Sayed MH, El-Meteini M, Saleh A, Omar A, Mansour O, Girgis S, Hafez H, Kandil S. SARS-Co-V2 infection in never, former, and current tobacco/nicotine users: a cohort study of 4040 Egyptian healthcare workers. BMC Public Health 2021; 21:1243. [PMID: 34182960 PMCID: PMC8238378 DOI: 10.1186/s12889-021-11290-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking negatively impacts COVID-19 severity and adverse outcomes. Evidence on whether smoking is associated with SARS-Co-V2 infection and having a positive test is scarce, particularly from low-and middle-income countries, where most of the world's billion smokers live. The inconsistency in relevant findings calls for study designs and analyses to account for possible confounders including background characteristics and pre-existing co-morbidities, to disentangle the specific effect of smoking. In healthcare workers (HCWs) the frequency of exposure to COVID-19 cases adds another layer of risk that was not factored in previous studies. We examined the association of HCWs' tobacco/nicotine use (never, former, and current use) with having a positive SARS-Co-V2 test result and symptoms suggestive of infection, accounting for demographics, exposures, and co-morbidities. METHODS A prospective cohort study of 4040 healthcare workers with baseline and follow-up screening took place during April-June 2020 in 12 healthcare facilities in Cairo, Egypt. Data on demographics, tobacco/nicotine use (manufactured or roll-your-own cigarettes, waterpipe tobacco, and electronic devices), co-morbidities, symptoms, exposures, and SARS-Co-V2 investigations were analyzed. Multinomial and multivariable logistic regression analyses were performed. RESULTS Overall, 270/4040 (6.7, 95%CI: 5.9-7.5) had positive SARS-CoV-2 tests, 479 (11.9%) were current and 79 (2.0%) were former tobacco/nicotine users. The proportion of positive tests was 7.0% (243/3482, 95%CI: 6.1-7.8) among never, 5.1% (4/79, 95%CI: 0.1-10.0) among former, and 4.8% (23/479, 95%CI: 2.9-6.7) among current users. HCWs' SARS-CoV-2 test results did not vary significantly by single/multiple or daily/non-daily tobacco/nicotine use. Compared to never users, former users were more likely to self-report a pre-existing medical condition (ORadjusted1.87, 95%CI: 1.05-3.33, p = 0.033), and to experience symptoms suggestive of COVID-19 (ORadjusted1.76, 95%CI: 1.07-2.90, p = 0.027). After adjustment, former (ORadjusted0.45, 95%CI: 0.11-1.89, p = 0.273) and current (ORadjusted0.65, 95%CI: 0.38-1.09, p = 0.101) tobacco/nicotine use was not associated with HCWs' SARS-CoV-2 positive test results. CONCLUSIONS This is the first report on this association from low- and middle-income countries with high tobacco/nicotine use prevalence. In this HCW cohort, having a positive SARS-CoV-2 test was not associated with tobacco/nicotine use after accounting for demographics, exposures, and co-morbidities. Additional population-based studies could use such preliminary evidence to investigate this controversial association.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, 38 Ramses st., Abbassia square, PO-box 11566, Cairo, Egypt.
| | - Manal H El-Sayed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud El-Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Omar
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ossama Mansour
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Samia Girgis
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala Hafez
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sahar Kandil
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, 38 Ramses st., Abbassia square, PO-box 11566, Cairo, Egypt
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12
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Kobashi Y, Nishikawa Y, Kawamura T, Kodama T, Shimazu Y, Obara D, Zhao T, Tsubokura M. Seroprevalence of SARS-CoV-2 antibodies among hospital staff in rural Central Fukushima, Japan: A historical cohort study. Int Immunopharmacol 2021; 98:107884. [PMID: 34246041 PMCID: PMC8200307 DOI: 10.1016/j.intimp.2021.107884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Performing a cohort-based SARS-CoV-2 antibody assay is crucial for understanding infection status and future decision-making. The objective of this study was to examine consecutive antibody seroprevalence changes among hospital staff, a high-risk population. A two-time survey was performed in May and October 2020 for 545 hospital staff to investigate the changes in the results of the rapid kit test and chemiluminescence immunoassay (CLIA). The seroprevalence of each assay was summarized at both the survey periods. The proportion of seropositive individuals in the CLIA for each survey period and the number of confirmed COVID-19 cases in Central Fukushima were then compared. We chose 515 participants for the analysis. The proportion of IgM seroprevalence in CLIA increased from 0.19% in May to 0.39% in October, and IgG seroprevalence decreased from 0.97% in May to 0.39% in October. The proportion of IgM seroprevalence in the rapid kit test decreased from 7.96% in May to 3.50% in October, and IgG seroprevalence decreased from 7.77% in May to 2.14% in October. The IgG and IgM antibody seroprevalence among hospital staff in rural Central Fukushima decreased; the seroprevalence among hospital staff was consistent with the number of confirmed COVID-19 cases in the Central Fukushima area. Although it is difficult to interpret the results of the antibody assay in a population with a low prior probability, constant follow-up surveys of antibody titers among hospital staff had several merits in obtaining a set of criteria regarding the accuracy of measures against COVID-19 and estimating the COVID-19 infection status among hospital staff.
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Affiliation(s)
- Yurie Kobashi
- Department of General Internal Medicine, Hirata Central Hospital, Hirata, Ishikawa District, Fukushima, Japan; Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.
| | - Yoshitaka Nishikawa
- Department of General Internal Medicine, Hirata Central Hospital, Hirata, Ishikawa District, Fukushima, Japan
| | - Takeshi Kawamura
- Laboratory for Systems Biology and Medicine, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo 153-8904, Japan; Proteomics Laboratory, Isotope Science Center, The University of Tokyo, Tokyo 113-0032, Japan
| | - Tatsuhiko Kodama
- Laboratory for Systems Biology and Medicine, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo 153-8904, Japan
| | - Yuzo Shimazu
- Southern Tohoku Research Institute for Neuroscience, 7-115, Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Daiji Obara
- Department of General Internal Medicine, Hirata Central Hospital, Hirata, Ishikawa District, Fukushima, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of General Internal Medicine, Hirata Central Hospital, Hirata, Ishikawa District, Fukushima, Japan; Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, Debenham L, Llavall AC, Dixit A, Zhou D, Balaji R, Lee SI, Qiu X, Yuan M, Coomar D, Sheikh J, Lawson H, Ansari K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Tiberi S, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Zamora J, Thangaratinam S. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370:m3320. [PMID: 32873575 PMCID: PMC7459193 DOI: 10.1136/bmj.m3320] [Citation(s) in RCA: 1235] [Impact Index Per Article: 308.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). DESIGN Living systematic review and meta-analysis. DATA SOURCES Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 6 October 2020, along with preprint servers, social media, and reference lists. STUDY SELECTION Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. DATA EXTRACTION At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. RESULTS 192 studies were included. Overall, 10% (95% confidence interval 7% to 12%; 73 studies, 67 271 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (41%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to have symptoms (odds ratio 0.28, 95% confidence interval 0.13 to 0.62; I2=42.9%) or report symptoms of fever (0.49, 0.38 to 0.63; I2=40.8%), dyspnoea (0.76, 0.67 to 0.85; I2=4.4%) and myalgia (0.53, 0.36 to 0.78; I2=59.4%). The odds of admission to an intensive care unit (odds ratio 2.13, 1.53 to 2.95; I2=71.2%), invasive ventilation (2.59, 2.28 to 2.94; I2=0%) and need for extra corporeal membrane oxygenation (2.02, 1.22 to 3.34; I2=0%) were higher in pregnant and recently pregnant than non-pregnant reproductive aged women. Overall, 339 pregnant women (0.02%, 59 studies, 41 664 women) with confirmed covid-19 died from any cause. Increased maternal age (odds ratio 1.83, 1.27 to 2.63; I2=43.4%), high body mass index (2.37, 1.83 to 3.07; I2=0%), any pre-existing maternal comorbidity (1.81, 1.49 to 2.20; I2=0%), chronic hypertension (2.0, 1.14 to 3.48; I2=0%), pre-existing diabetes (2.12, 1.62 to 2.78; I2=0%), and pre-eclampsia (4.21, 1.27 to 14.0; I2=0%) were associated with severe covid-19 in pregnancy. In pregnant women with covid-19, increased maternal age, high body mass index, non-white ethnicity, any pre-existing maternal comorbidity including chronic hypertension and diabetes, and pre-eclampsia were associated with serious complications such as admission to an intensive care unit, invasive ventilation and maternal death. Compared to pregnant women without covid-19, those with the disease had increased odds of maternal death (odds ratio 2.85, 1.08 to 7.52; I2=0%), of needing admission to the intensive care unit (18.58, 7.53 to 45.82; I2=0%), and of preterm birth (1.47, 1.14 to 1.91; I2=18.6%). The odds of admission to the neonatal intensive care unit (4.89, 1.87 to 12.81, I2=96.2%) were higher in babies born to mothers with covid-19 versus those without covid-19. CONCLUSION Pregnant and recently pregnant women with covid-19 attending or admitted to the hospitals for any reason are less likely to manifest symptoms such as fever, dyspnoea, and myalgia, and are more likely to be admitted to the intensive care unit or needing invasive ventilation than non-pregnant women of reproductive age. Pre-existing comorbidities, non-white ethnicity, chronic hypertension, pre-existing diabetes, high maternal age, and high body mass index are risk factors for severe covid-19 in pregnancy. Pregnant women with covid-19 versus without covid-19 are more likely to deliver preterm and could have an increased risk of maternal death and of being admitted to the intensive care unit. Their babies are more likely to be admitted to the neonatal unit. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178076. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 1 September 2020 (BMJ 2020;370:m3320), and previous updates can be found as data supplements (https://www.bmj.com/content/370/bmj.m3320/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
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Affiliation(s)
- John Allotey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Magnus Yap
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Tania Kew
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Luke Debenham
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Anushka Dixit
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynaecology, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Mingyang Yuan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Heidi Lawson
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Kehkashan Ansari
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elizabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Asma Khalil
- St George's, University of London, London, UK
| | - Simon Tiberi
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lynne Mofenson
- Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, USA
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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