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Haowei Y, Mahyuddin N, Bin Nik Ghazali NN, Wang Z, Liu Y, Pan S, Badruddin IA. A critical review of research methodologies for COVID-19 transmission in indoor built environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:3413-3477. [PMID: 38385569 DOI: 10.1080/09603123.2024.2308731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
The Coronavirus Disease 2019 (COVID-19) has caused massive losses for the global economy. Scholars have used different methods to study the transmission mode and influencing factors of the virus to find effective methods to provide people with a healthy built environment. However, these studies arrived at different or even contradictory conclusions. This review presents the main research methodologies utilized in this field, summarizes the main investigation methods, and critically discusses their related conclusions. Data statistical analysis, sample collection, simulation models, and replication transmission scenarios are the main research methods. The summarized conclusion for prevention from all reviewed papers are: adequate ventilation and proper location of return air vents, proper use of personal protective equipment, as well as the reasonable and strict enforcement of policies are the main methods for reducing the transmission. Recommendations including standardized databases, causation clarification, rigorous experiment design, improved simulation accuracy and verification are provided.
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Affiliation(s)
- Yu Haowei
- Centre for Building, Construction & Tropical Architecture (BuCTA), Faculty of Built Environment, University of Malaya, Kuala Lumpur, Malaysia
| | - Norhayati Mahyuddin
- Centre for Building, Construction & Tropical Architecture (BuCTA), Faculty of Built Environment, University of Malaya, Kuala Lumpur, Malaysia
| | - Nik Nazri Bin Nik Ghazali
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Zeyu Wang
- China Nuclear Power Engineering Co. Ltd, Beijing Institute of Nuclear Engineering, Beijing, China
| | - Yiqiao Liu
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Song Pan
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing, China
- Key Laboratory for Comprehensive Energy Saving of Cold Regions Architecture of Ministry of Education, Jilin Jianzhu University, Changchun, PR China
| | - Irfan Anjum Badruddin
- Mechanical Engineering Department, College of Engineering, King Khalid University, Abha, Saudi Arabia
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2
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Chen YH, Fang CT. Achieving COVID-19 zero without lockdown, January 2020 to March 2022: The Taiwan model explained. J Formos Med Assoc 2024; 123 Suppl 1:S8-S16. [PMID: 37714769 DOI: 10.1016/j.jfma.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
Despite never imposing a lockdown, Taiwan achieved COVID-19 zero, with reporting only 56 local coronavirus disease 2019 (COVID-19) cases after testing 126,987 individuals in 2020, and further contained a large outbreak rapidly and successfully in 2021. At the onset of the COVID-19 pandemic, our infectious disease modeling results indicated that testing and contact tracing alone would fail to contain the pandemic. However, by supplementing this approach with general public surgical mask-wearing, the reproduction number (R0) could be suppressed to less than 1. This would effectively contain the virus's spread within Taiwan, particularly when combined with strict border control measures to prevent the overwhelming influx of imported COVID-19 cases and ensure the capacity of the medical and public health systems remains resilient. These modeling results became the theoretical basis behind the highly successful Taiwan model against COVID-19 during 2020-2021, supporting by negative excess mortality, seroepidemiological surveys, and molecular epidemiological analyses. This is a public health triumph demonstrating that a democratic and humane approach to the COVID-19 pandemic is not only feasible but highly effective. It also highlights the crucial role of infectious disease modeling in assisting the formulation of a successful national pandemic response.
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Affiliation(s)
- Yi-Hsuan Chen
- Epidemic Intelligence Center, Taiwan Centers for Disease Control, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Ministry of Health and Welfare and National Taiwan University Infectious Diseases Research and Education Center, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Ministry of Health and Welfare and National Taiwan University Infectious Diseases Research and Education Center, Taipei, Taiwan; Epidemiology Advisor, Taiwan Central Epidemic Command Center for COVID-19, Taipei, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Population Health Research Center, College of Public Health, National Taiwan University, Taipei, Taiwan.
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3
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Chen YY, Yang MH, Lai JZ, Chen JW, Wang YL, Wei ST, Hou SM, Chen CJ, Wu HS. Seroprevalence of Anti-SARS-CoV-2 Remained Extremely Low in Taiwan Until the Vaccination Program Was Implemented. Open Forum Infect Dis 2024; 11:ofad614. [PMID: 38192381 PMCID: PMC10773475 DOI: 10.1093/ofid/ofad614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Background The Taiwanese government made a concerted effort to contain a coronavirus disease 2019 (COVID-19) nosocomial outbreak of variant B.1.429, shortly before universal vaccination program implementation. This study aimed to investigate seroprevalence in the highest-risk regions. Methods Between January and February 2021, we retrieved 10 000 repository serum samples from blood donors to examine for antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) and spike (S) antigens. A positive result was confirmed if anti-N and anti-S antibodies were positive. Overall, 2000 donors residing in the highest-risk district and donating blood in January 2021 were further examined for SARS-CoV-2 RNA. We estimated seroprevalence and compared the epidemic curve between confirmed COVID-19 cases and blood donors with positive antibodies or viral RNA. Results Twenty-one cases with COVID-19 were confirmed in the nosocomial cluster, with an incidence of 1.27/100 000 in the COVID-affected districts. Among 4888 close contacts of the nosocomial cases, 20 (0.4%) became confirmed cases during isolation. Anti-SARS-CoV-2 was detected in 2 of the 10000 blood donors, showing a seroprevalence of 2/10000 (95% CI, 0.55-7.29). None of the 2000 donors who underwent tests for SARS-CoV-2 RNA were positive. The SARS-CoV-2 infection epidemic curve was observed sporadically in blood donors compared with the nosocomial cluster. Conclusions In early 2021, an extremely low anti-SARS-CoV-2 seroprevalence among blood donors was observed. Epidemic control measures through precise close contact tracing, testing, and isolation effectively contained SARS-CoV-2 transmission before universal vaccination program implementation.
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Affiliation(s)
| | | | | | - Jen-Wei Chen
- Taiwan Blood Services Foundation, Taipei, Taiwan
| | | | | | - Sheng-Mou Hou
- Taiwan Blood Services Foundation, Taipei, Taiwan
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | - Ho-Sheng Wu
- Hsinchu Blood Center, Hsinchu, Taiwan
- Taipei Medical University, Taipei, Taiwan
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4
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Zhang D, Guo Y, Liu Z, Xu P, Ma Z, Zhan J. Laboratory investigation on added-value application of the COVID-19 disposable mask in hot mix asphalt (HMA). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 860:160243. [PMID: 36403823 PMCID: PMC9671606 DOI: 10.1016/j.scitotenv.2022.160243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/04/2023]
Abstract
The outbreak of the COVID-19 pandemic has stimulated the demand for disposable masks to an unprecedented level, which also poses a significant risk to the natural environment from the improper treatment or disposal of waste masks. To lower such an environmental risk and maximize the added value of the waste masks, this paper proposed to recycle the waste mask fiber (MF) in combination with the waste cooking oil (WCO) for hot mix asphalt (HMA) application. A series of MF + WCO modified asphalt binders were first designed and fabricated. Their performance properties were then systematically measured. The physical-rheological test results showed that the incorporation of MF can significantly improve the high-temperature rutting resistance performance of asphalt binder. However, it may also lower the asphalt's low-temperature anti-cracking performance. The addition of WCO was found to compensate for this low-temperature performance loss effectively, and the MF5% + WCO3% was identified as the best combination. The Fourier transform infrared (FTIR) spectroscopy test results revealed that the asphalt modified by the MF + WCO involved only a physical modification. The performance test results indicated that the high-temperature permanent deformation resistance and low-temperature anti-cracking of MF5% + WCO3% modified HMA was greatly enhanced, while its moisture stability was slightly reduced but still met the specification requirement. The environmental benefit assessments proved that recycling the waste masks for asphalt paving can provide an enormous added value to pavement engineering in terms of carbon emission reduction and land resource saving.
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Affiliation(s)
- Derun Zhang
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yichen Guo
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ziyang Liu
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Peixin Xu
- School of Civil and Hydraulic Engineering, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Zirong Ma
- Fujian Provincial Transportation Research Institute Co., Ltd., Fuzhou 350005, China
| | - Jun Zhan
- Fujian Communications Planning and Design Institute Co., Ltd., Fuzhou 350000, China
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Sim JY, Chen YC, Hsu WY, Chen WY, Chou Y, Chow JC, Lai YC, Tang HJ, Chen CC, Ho CH, Chang TH. Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1151-1158. [PMID: 35450828 PMCID: PMC9767794 DOI: 10.1016/j.jmii.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND In Taiwan, there were only 799 confirmed COVID-19 cases in 2020. The unique backdrop amidst a pandemic and promotion of nonpharmaceutical interventions generated some distinct changes in the epidemiology of common respiratory pathogens. In this study, we aimed to investigate the dynamic changes in respiratory pathogens in children during 2020. METHODS We performed a retrospective cohort study at a tertiary hospital in southern Taiwan during 2020. Patients aged 0-18 years who visited the pediatric emergency department were enrolled. Children who presented with clinical symptoms (fever or respiratory illness) and received nasopharyngeal swabs for multiplex polymerase chain reaction (PCR) were included in our analysis. We also compared respiratory syncytial virus (RSV) trends from previous years by PCR and lateral flow immunochromatographic assays from 2017 to 2020. RESULTS A total of 120 children were tested. The overall detection rate was 55%. With strengthened restrictions, the detection rate dropped from 70% to 30%. However, non-enveloped viruses (rhinovirus/enterovirus and adenovirus) were in constant circulation. Upon easing prevention measures, the detection rate remained above 60%, and an outbreak of an enveloped virus (RSV and parainfluenza virus) was noted. Compared with 2017-2019, the cyclical RSV epidemic was delayed, with a large surge in late 2020. CONCLUSIONS We observed a constant circulation of non-enveloped viruses when strict nonpharmaceutical interventions were employed and a delayed surge of enveloped viruses during the easing of restrictions. Continuous surveillance and monitoring of the evolutionary dynamics of respiratory viruses is important, while easing restrictions requires balanced judgment.
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Affiliation(s)
- Jun Yi Sim
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Yu-Chin Chen
- Department of Pediatrics, Chi Mei Medical Center, Chiali, Tainan, Taiwan
| | - Wei-Yun Hsu
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Yu Chen
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Yun Chou
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Julie Chi Chow
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Ching Lai
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chi-Chung Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan,Department of Food Science, National Chiayi University, Chiayi, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan,Corresponding author. Department of Pediatrics, Chi Mei Medical Center No.901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan. Fax: +886 6 220 370
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Muacevic A, Adler JR, Almudaiheem A, Almutlaq H, Alqunaibet A, Alseraihi H, Alaswad R, Khoja AT, AlAbdulkareem K, AlSaif F, Abu Saris R. Community-Based Seroprevelance of SARS-CoV-2 in Saudi Arabia. Cureus 2022; 14:e32419. [PMID: 36636543 PMCID: PMC9832282 DOI: 10.7759/cureus.32419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The new coronavirus disease 2019 (COVID-19) is a major global concern. Due to the number of asymptomatic cases that go untested, the actual proportion of those who have been infected is likely to be higher than the reported prevalence. Thus, investigating the exact proportion of those who developed antibodies against the virus through serological surveys is crucial to identify the immune status of the population and direct public health decisions accordingly. Objectives The aim of this study is to estimate the seroprevalence of SARS-CoV-2 in the community and to describe the epidemiological characteristics of the discovered cases. Methods Between July and October 2020, a cross-sectional sero-survey was conducted including a total of 15,873 serum samples collected from seven regions within the kingdom. Using a multistage convenient sampling, people were invited to participate in an interviewer-administrated questionnaire. Afterward, blood samples were collected and seroprevalence was determined using the SARS-CoV-2 virus IgG/IgM antibody detection kits (ELISA). A p-value of <0.05 and 95% CI were used to report the significance. Results The overall seroprevalence of SARS-CoV-2 in the sample was 17.0%, and Makkah region constituted the highest number of reactive cases (33.3%). There was a significant association between all comorbidities and having symptoms except for diabetes. In addition, age, education, nationality, and region were all significant predeterminants of sero-result. Also, contact with a confirmed or suspected case increased the risk of being seropositive by nearly 1.5 times. Conclusion This study estimated the national seroprevalence of SARS-CoV-2 in Saudi Arabia to be 17%. At the time of this study, most of the population did not have the SARS-CoV-2 specific antibodies. This suggests that the population is still below the threshold of herd immunity and emphasizes the importance of mass vaccination programs and abiding by recommended prevention precautions.
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Ssenyange G, Kerfoot M, Zhao M, Farhadian S, Chen S, Peng L, Ren P, Dela Cruz CS, Gupta S, Sutton RE. Development of an efficient reproducible cell-cell transmission assay for rapid quantification of SARS-CoV-2 spike interaction with hACE2. CELL REPORTS METHODS 2022; 2:100252. [PMID: 35757815 PMCID: PMC9213030 DOI: 10.1016/j.crmeth.2022.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/28/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
Efficient quantitative assays for measurement of viral replication and infectivity are indispensable for future endeavors to develop prophylactic or therapeutic antiviral drugs or vaccines against SARS-CoV-2. We developed a SARS-CoV-2 cell-cell transmission assay that provides a rapid and quantitative readout to assess SARS-CoV-2 spike hACE2 interaction in the absence of pseudotyped particles or live virus. We established two well-behaved stable cell lines, which demonstrated a remarkable correlation with standard cell-free viral pseudotyping for inhibition by convalescent sera, small-molecule drugs, and murine anti-spike monoclonal antibodies. The assay is rapid, reliable, and highly reproducible, without a requirement for any specialized research reagents or laboratory equipment and should be easy to adapt for use in most investigative and clinical settings. It can be effectively used or modified for high-throughput screening for compounds and biologics that interfere with virus-cell binding and entry to complement other neutralization assays currently in use.
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Affiliation(s)
- George Ssenyange
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
| | - Maya Kerfoot
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
| | - Min Zhao
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
| | - Shelli Farhadian
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
| | - Sidi Chen
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lei Peng
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Ping Ren
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Charles S. Dela Cruz
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Shaili Gupta
- Department of Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Medicine, Veterans Affairs Healthcare Systems of Connecticut, West Haven, CT 06516, USA
| | - Richard E. Sutton
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Medicine, Veterans Affairs Healthcare Systems of Connecticut, West Haven, CT 06516, USA
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Nguyen HHH, Nguyen QH, Truong DTT, Dao MH, Le TN, Nguyen HT, Nguyen AH, Nguyen TV, Hoang DTN, Hoang LK, Tran TT, Cao TM, Luong QC, Phan LT, Huynh LTK, Nguyen TV, Pham QD. Seroprevalence of SARS-CoV-2 Neutralizing Antibodies among Blood Donors in Ho Chi Minh City, Vietnam, August-November 2020. Am J Trop Med Hyg 2022; 106:891-895. [PMID: 35081510 PMCID: PMC8922498 DOI: 10.4269/ajtmh.21-0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 01/05/2022] [Indexed: 12/27/2022] Open
Abstract
Relatively little is known about the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies and COVID-19-related behaviors in the general population in Vietnam, where the first case of COVID-19 was detected on January 22, 2020. We surveyed a group of 885 blood donors at community blood donation sessions in Ho Chi Minh City from August 27 to November 7, 2020. Blood was collected to test for SARS-CoV-2 IgG antibodies using the plaque reduction neutralization test. We adjusted the seroprevalence by weight for ages 18 to 59 years old obtained from the 2019 population census. The weighted seroprevalence estimate for SARS-CoV-2 neutralizing IgG antibodies was 0.20% (95% CI, 0.05-0.81). Reports of usually or always using a mask in public places were observed at high levels of 28.6% and 67.5%, respectively. The percentages of usually or always washing hands with soap or disinfecting with hand sanitizer after touching items in public places were 48.0% and 37.6%, respectively. Although our findings suggest undocumented exposure to the virus, the seroprevalence of SARS-CoV-2 IgG antibodies among blood donors was low in this city.
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Affiliation(s)
- Hanh Hong Ho Nguyen
- Training Center, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam;,School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam;,Viet-Anh Department, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Quan Hoang Nguyen
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Dung Thi Thuy Truong
- Department for Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Manh Huy Dao
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tu Ngoc Le
- Department for Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hieu Trung Nguyen
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Anh Hoang Nguyen
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thinh Viet Nguyen
- Department for Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Loan Kim Hoang
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tham Thi Tran
- Blood Donation Centre of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thang Minh Cao
- Microbiology and Immunology Department, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Quang Chan Luong
- Department for Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Lan Trong Phan
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Thuong Vu Nguyen
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Quang Duy Pham
- Training Center, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam;,Planning Division, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam,Address correspondence to Quang D. Pham, Training Center– Planning Division, Pasteur Institute of Ho Chi Minh City, 167 Pasteur St., District 3, Ho Chi Minh City, Vietnam. E-mail:
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Huang JH, Chang HT, Liao CH, Chiu KM. Rapid response of a medical center upon the surge of COVID-19 epidemic in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1-5. [PMID: 34866013 PMCID: PMC8609672 DOI: 10.1016/j.jmii.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022]
Abstract
A surge of coronavirus disease (COVID-19) cases emerged in northern Taiwan in mid-May 2021. In spite of over one-year preparedness, the medical system in this area suffered from the crisis. Far Eastern Memorial Hospital (FEMH) responded quickly with decreased total hospitalization cases (about 50%) to free manpower and space. With simple construction work, the in-hospital service capacity increases from 11 negative-pressure ward (1 unit) and 2 negative-pressure ICU (1 unit) beds to over 130 ward (5 units) and 58 ICU beds (4 units) without negative-pressure design within 3 weeks. For a period of time, FEMH takes care of 10% of all intensive care services in Taiwan. The vaccination rate of workers reaches 90% since mid-May. The amount of testing performed during the period, including PCR and rapid tests, comprised of more than 20% of tests performed in New Taipei City. Two hotels for mild/asymptomatic COVID patients were handled by FEMH workers. By mid-July, about one-fifth of COVID-19 cases in New Taipei City received services from the FEMH system. With determined leadership and concerted efforts, combined interventions can increase the capacity of medical care within weeks and help society against the COVID-19 epidemic.
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Affiliation(s)
- Jih-Hsin Huang
- Department of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hou-Tai Chang
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taiwan.
| | - Kuan-Ming Chiu
- Department of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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10
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Chimeddorj B, Mandakh U, Le LV, Bayartsogt B, Deleg Z, Enebish O, Altanbayar O, Magvan B, Gantumur A, Byambaa O, Enebish G, Saindoo BE, Davaadorj M, Amgalanbaatar A, Enkhtugs K, Munkhbayar U, Bayanjargal B, Badamsambuu T, Dashtseren M, Narmandakh Z, Togoo K, Boldbaatar EA, Bat-Erdene A, Mukhtar Y, Shagdarsuren OE, Ganbat M, Batjargal O, Bavuusuren B, Batchuluun B, Zulmunkh G, Byambatsogt G, Nyamdavaa K, Dalkh T, Boldbaatar D, Tseren T, Gantulga D, Damdinbazar O, Vanchin B, Subissi L, Bergeri I, Dambadarjaa D, Pagbajabyn N, Greif G, Erkhembayar R. SARS-CoV-2 seroprevalence in Mongolia: Results from a national population survey. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 17:100317. [PMID: 34841381 PMCID: PMC8609908 DOI: 10.1016/j.lanwpc.2021.100317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/20/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022]
Abstract
Background With the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020, Mongolia implemented rapid emergency measures and did not report local transmission until November 2020. We conducted a national seroprevalence survey to monitor the burden of SARS-CoV-2 in Mongolia in the months surrounding the first local transmission. Methods During October-December 2020, participants were randomly selected using age stratification and invited for interviews and blood samples at local primary health centres. We screened for total SARS-CoV-2 antibodies, followed by two-step quantitative SARS-CoV-2 IgG serology tests for positive samples. Weighted and test-adjusted seroprevalences were estimated. We used chi-square, Fisher's exact and other tests to identify variables associated with seropositivity. Findings A total of 5000 subjects were enrolled. We detected SARS-CoV-2 IgG antibodies in 72 samples. Crude seroprevalence of SARS-CoV-2 antibodies was 1·44% (95%CI,1·21-1·67). Population weighted and test-adjusted seroprevalences were 1·36% (95%CI,1·11-1·63) and 1·45% (95%CI,1·11-1·63), respectively. Age, sex, geographical, and occupational factors were not associated with seropositivity (p>0·05). Symptoms and signs within past 3 months and seropositivity were not associated at the time of the survey (p>0·05). Interpretation SARS-CoV-2 seroprevalence in Mongolia was low in the first year of the pandemic potentially due to strong public health measures, including border restrictions, educational facilities closure, earlier adoption of mask-wearing and others. Our findings suggest large-scale community transmission could not have occurred up to November 2020 in Mongolia. Additional serosurveys are needed to monitor the local pandemic dynamic and estimate how far from herd immunity Mongolia will be following-up with vaccination programme in 2021 and 2022. Funding World Health Organisation, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. Translation Cyrillic and Traditional Mongolian translation of abstract is available on appendix section.
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Affiliation(s)
- Battogtokh Chimeddorj
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Institute of Biomedical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Undram Mandakh
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Linh-Vi Le
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Batzorig Bayartsogt
- Department of Epidemiology and Biostatistics, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Zolzaya Deleg
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyunsuren Enebish
- Department of Planning and Research, Ministry of Health, Ulaanbaatar, Mongolia
| | - Oyunbaatar Altanbayar
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Battur Magvan
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Anuujin Gantumur
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Otgonjargal Byambaa
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gerelmaa Enebish
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Bat-Erdene Saindoo
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mandakhnaran Davaadorj
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Avarzed Amgalanbaatar
- Department of International Cyber Education, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Khangai Enkhtugs
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Usukhbayar Munkhbayar
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Batkhuu Bayanjargal
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Tuyajargal Badamsambuu
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Myagmartseren Dashtseren
- Department of Family Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Zolmunkh Narmandakh
- Department of Immunology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Khongorzul Togoo
- Department of Immunology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkh-Amar Boldbaatar
- Department of Immunology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Ariunzaya Bat-Erdene
- Department of Immunology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Yerkyebulan Mukhtar
- Department of Epidemiology and Biostatistics, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyu-Erdene Shagdarsuren
- Department of Epidemiology and Biostatistics, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mandukhai Ganbat
- Department of Epidemiology and Biostatistics, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Ochbadrakh Batjargal
- Department of Microbiology and Infection Prevention Control, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Bayasgalantai Bavuusuren
- Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Batzaya Batchuluun
- Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gereltsetseg Zulmunkh
- Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Ganbaatar Byambatsogt
- Department of Biochemistry, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Tserendagva Dalkh
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | | | - Byambasuren Vanchin
- Department of Cardiology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | | | - Gregory Greif
- Department of International Cyber Education, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Ryenchindorj Erkhembayar
- Institute of Biomedical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Department of International Cyber Education, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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11
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Chiu WT, Scholl J, Li YCJ, Wu J. So Few COVID-19 Cases in Taiwan: Has Population Immune Health Played a Role? Front Public Health 2021; 9:676750. [PMID: 34195171 PMCID: PMC8236524 DOI: 10.3389/fpubh.2021.676750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wen-Ta Chiu
- AHMC Health System, Alhambra, CA, United States
| | | | - Yu-Chuan Jack Li
- College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jonathan Wu
- AHMC Health System, Alhambra, CA, United States
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12
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Learning from the past: Taiwan's responses to COVID-19 versus SARS. Int J Infect Dis 2021; 110:469-478. [PMID: 34098099 PMCID: PMC8178059 DOI: 10.1016/j.ijid.2021.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate the prevalence of infection prevention behaviors in Taiwan-wearing facemasks and alcohol-based hand hygiene (AHH)-and compare their practice rates during SARS and COVID-19. METHODS We surveyed 2328 Taiwanese from July 29 to August 6, 2020, assessing demographics, information sources, and preventive behaviors during the 2003 SARS outbreaks, 2009 pandemic influenza H1N1, COVID-19, and with post-survey intentions. Characteristics associated with the practice of preventive behaviors in 2020 were identified through logistic regression. RESULTS Preventive behaviors were conscientiously practiced by 70.2% of participants. Compared with 2003 SARS/2009 H1N1, the percentages of facemask use (66.6% vs 99.2% [indoors], P < 0.001) and on-person AHH (44.2% vs 65.4% [hand sanitizers], P < 0.001) significantly increasedduring 2020 COVID-19. Highest adherence to preventive behaviors in 2020 was among females (adjusted odds ratio [aOR], 1.72), those receiving government COVID-19 information (aOR, 1.52), participants recruited from primary-care clinics (aOR, 1.43), and those who practiced AHH during 2003 SARS/2009 H1N1 (aOR, 1.37). CONCLUSIONS Government leadership, healthcare providers risk communication, and public cooperation rapidly mitigated the spread of COVID-19 in Taiwan even before vaccination. Future global efforts must implement such population-based preventive behaviors at a level above the viral-transmission-threshold, particularly in areas with fast-spreading SARS-CoV-2 variants.
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13
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Tseng WP, Wu JL, Wu CC, Kuo KT, Lin CH, Chung MY, Lee YF, Yang BJ, Huang CH, Chen SY, Yu CJ, Chen SC, Hsueh PR. Seroprevalence Surveys for Anti-SARS-CoV-2 Antibody in Different Populations in Taiwan With Low Incidence of COVID-19 in 2020 and Severe Outbreaks of SARS in 2003. Front Immunol 2021; 12:626609. [PMID: 34084161 PMCID: PMC8167053 DOI: 10.3389/fimmu.2021.626609] [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] [Received: 11/06/2020] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Accurate detection of anti-SARS-CoV-2 antibodies provides a more accurate estimation of incident cases, epidemic dynamics, and risk of community transmission. We conducted a cross-sectional seroprevalence study specifically targeting different populations to examine the performance of pandemic control in Taiwan: symptomatic patients with epidemiological risk and negative qRT-PCR test (Group P), frontline healthcare workers (Group H), healthy adult citizens (Group C), and participants with prior virologically-confirmed severe acute respiratory syndrome (SARS) infection in 2003 (Group S). The presence of anti-SARS-CoV-2 total and IgG antibodies in all participants were determined by Roche Elecsys® Anti-SARS-CoV-2 test and Abbott SARS-CoV-2 IgG assay, respectively. Sera that showed positive results by the two chemiluminescent immunoassays were further tested by three anti-SARS-CoV-2 lateral flow immunoassays and line immunoassay (MIKROGEN recomLine SARS-CoV-2 IgG). Between June 29 and July 25, 2020, sera of 2,115 participates, including 499 Group P participants, 464 Group H participants, 1,142 Group C participants, and 10 Group S participants, were tested. After excluding six false-positive samples, SARS-CoV-2 seroprevalence were 0.4, 0, and 0% in Groups P, H, and C, respectively. Cross-reactivity with SARS-CoV-2 antibodies was observed in 80.0% of recovered SARS participants. Our study showed that rigorous exclusion of false-positive testing results is imperative for an accurate estimate of seroprevalence in countries with previous SARS outbreak and low COVID-19 prevalence. The overall SARS-CoV-2 seroprevalence was extremely low among populations of different exposure risk of contracting SARS-CoV-2 in Taiwan, supporting the importance of integrated countermeasures in containing the spread of SARS-CoV-2 before effective COVID-19 vaccines available.
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Affiliation(s)
- Wen-Pin Tseng
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jhong-Lin Wu
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research and Department of Integrated Surgery, Hsinchu Biomedical Science Park Medical Center (National Taiwan University Hospital Hsin-Chu Biomedical Park Branch), Hsinchu, Taiwan
| | - Kuan-Ting Kuo
- Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan
| | - Chien-Hao Lin
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Yi Chung
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Fan Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bey-Jing Yang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, 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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14
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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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15
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Fesler MC, Stricker RB. Pre-Exposure Prophylaxis for COVID-19 in Pregnant Women. Int J Gen Med 2021; 14:279-284. [PMID: 33542646 PMCID: PMC7851576 DOI: 10.2147/ijgm.s295627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Pregnant women are at higher risk for developing severe complications of COVID-19 including preterm delivery, respiratory failure, and death. Although vaccines to prevent COVID-19 are being developed, pregnant women are not included in the current COVID-19 vaccine trials and initially this population may not be eligible for COVID-19 vaccines due to lack of safety testing in pregnancy. As an alternate approach, we discuss the concept of pre-exposure prophylaxis (PrEP) using medications that are approved for use in pregnant women to prevent gestational problems and severe illness in this high-risk population. In particular, the use of hydroxychloroquine PrEP affords a safe and readily available means to avoid COVID-19 complications in pregnancy.
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Affiliation(s)
- Melissa C Fesler
- Alan E. Beer Medical Center for Reproductive Immunology, Los Gatos, CA, USA.,Union Square Medical Associates, San Francisco, CA, USA
| | - Raphael B Stricker
- Alan E. Beer Medical Center for Reproductive Immunology, Los Gatos, CA, USA.,Union Square Medical Associates, San Francisco, CA, USA
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