1
|
de Jesus Á, Ernesto R, Massinga A, Nhacolo F, Munguambe K, Timana A, Nhacolo A, Messa A, Massora S, Escola V, Enosse S, Gunjamo R, Funzamo C, Mwenda J, Okeibunor J, Garcia‐Basteiro A, Guinovart C, Mayor A, Mandomando I. High SARS-CoV-2 Exposure in Rural Southern Mozambique After Four Waves of COVID-19: Community-Based Seroepidemiological Surveys. Influenza Other Respir Viruses 2024; 18:e13332. [PMID: 38838093 PMCID: PMC11150860 DOI: 10.1111/irv.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/08/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Mozambique was one of many African countries with limited testing capacity for SARS-CoV-2. Serosurveys, an alternative to estimate the real exposure to understand the epidemiology and transmission dynamics, have been scarce in Mozambique. Herein, we aimed to estimate the age-specific seroprevalence of SARS-CoV-2 in the general population of the Manhiça District, at four time points, for evaluating dynamics of exposure and the impact of vaccination. METHODS We conducted four community-based seroepidemiological surveys separated by 3 months between May 2021 and June 2022 to assess the prevalence of SARS-CoV-2 antibodies. An age-stratified (0-19, 20-39, 40-59, and ≥ 60 years) sample of 4810 individuals was randomly selected from demographic surveillance database, and their blood samples were analyzed using WANTAI SARS-CoV-2 IgG + IgM ELISA. Nasopharyngeal swabs from a subsample of 2209 participants were also assessed for active infection by RT-qPCR. RESULTS SARS-CoV-2 seroprevalence increased from 27.6% in the first survey (May 2021) to 63.6%, 91.2%, and 91.1% in the second (October 2021), third (January 2022), and fourth (May 2022) surveys, respectively. Seroprevalence in individuals < 18 years, who were not eligible for vaccination, increased from 23.1% in the first survey to 87.1% in the fourth. The prevalence of active infection was below 10.1% in all surveys. CONCLUSIONS A high seroprevalence to SARS-CoV-2 was observed in the study population, including individuals not eligible for vaccination at that time, particularly after circulation of the highly transmissible Delta variant. These data are important to inform decision making on the vaccination strategies in the context of pandemic slowdown in Mozambique.
Collapse
Affiliation(s)
- Áuria de Jesus
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Rita Ernesto
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | | | | | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- Faculdade de MedicinaUniversidade Eduardo Mondlane (UEM)MaputoMozambique
| | - Alcido Timana
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Arsénio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Augusto Messa
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Sérgio Massora
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Valdemiro Escola
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Sónia Enosse
- Instituto Nacional de Saúde (INS)Ministério da SaúdeMarracuene‐MaputoMozambique
| | - Rufino Gunjamo
- Instituto Nacional de Saúde (INS)Ministério da SaúdeMarracuene‐MaputoMozambique
| | - Carlos Funzamo
- Mozambique Country OfficeWorld Health OrganizationMaputoMozambique
| | - Jason M. Mwenda
- Regional Office for Africa (AFRO)World Health OrganizationBrazzavilleRepublic of Congo
| | - Joseph Okeibunor
- Regional Office for Africa (AFRO)World Health OrganizationBrazzavilleRepublic of Congo
| | - Alberto Garcia‐Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobal, Hospital Clínic–Universitat de BarcelonaBarcelonaSpain
- Amsterdam Institute for Global Health and DevelopmentAcademic Medical CentreAmsterdamThe Netherlands
| | | | - Alfredo Mayor
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobal, Hospital Clínic–Universitat de BarcelonaBarcelonaSpain
- Department of Physiologic Sciences, Faculty of MedicineUniversidade Eduardo MondlaneMaputoMozambique
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- Instituto Nacional de Saúde (INS)Ministério da SaúdeMarracuene‐MaputoMozambique
- ISGlobal, Hospital Clínic–Universitat de BarcelonaBarcelonaSpain
| |
Collapse
|
2
|
Sachathep K, Duong YT, Reid G, Dokubo EK, Shang JD, Ndongmo CB, Gabriel E, Tharp G, Dimite LE, N'Dir A, Okpu G, Ogollah FM, Nguafack D, Ntse MC, Hrusa G, Yuengling K, Tebbenhoff M, René E, Françoise NS, Felicity NT, Okomo MC, Bissek ACZK, Harris TG. Seroprevalence of SARS-CoV-2 in 10 Regional Capitals of Cameroon, October-December 2020. Influenza Other Respir Viruses 2024; 18:e13267. [PMID: 38532666 DOI: 10.1111/irv.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 01/22/2024] [Accepted: 02/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Cameroon was among the most affected African countries during the first wave of the COVID-19 pandemic; however, the true prevalence of SARS-CoV-2 remains unknown. METHODS From October to December 2020, we conducted a cross-sectional, age-stratified SARS-CoV-2 seroepidemiological survey at 30 purposively selected community-based sites across Cameroon's 10 regional capitals, sampling 10,000 individuals aged 5 years or older. We employed a parallel SARS-CoV-2 antibody testing algorithm (WANTAI ELISA and Abbott Architect) to improve both the positive predictive value and negative predictive value of seroprevalence. RESULTS The overall weighted and adjusted seroprevalence of SARS-CoV-2 antibodies across the 10 urban capitals of Cameroon was 10.5% (95% CI: 9.1%-12.0%) among participants aged ≥5 years. Of the 9332 participants, 730 males (13.1%, 95% CI: 11.5%-14.9%) had SARS-CoV-2 antibodies compared to 293 females (8.0%, 95% CI: 6.8%-9.3%). Among those who reported a comorbidity at the time of testing, 15.8% (95% CI: 12.8%-19.4%) were seropositive. We estimated that over 2 million SARS-CoV-2 infections occurred in the 10 regional capitals of Cameroon between October and December 2020, compared to 21,160 cases officially reported at that time translating to one laboratory-confirmed case being reported for every 110 SARS-CoV-2 infections across the 10 urban capitals. CONCLUSION This study's findings point to extensive and under-reported circulation of SARS-CoV-2 in Cameroon-an almost 100-fold more cases compared to the number of cases reported to the World Health Organization. This finding highlights the importance of conducting serosurveys, especially in settings where access to testing may be limited and to repeat such surveys as part of pandemic tracking.
Collapse
Affiliation(s)
- Karampreet Sachathep
- ICAP at Columbia University, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
| | - Yen T Duong
- ICAP at Columbia University, New York, New York, USA
| | - Giles Reid
- ICAP at Columbia University, New York, New York, USA
| | - Emily Kainne Dokubo
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Centers for Disease Control and Prevention, Yaoundé, Cameroon
| | - Judith D Shang
- US Centers for Disease Control and Prevention, Yaoundé, Cameroon
| | - Clement B Ndongmo
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Centers for Disease Control and Prevention, Yaoundé, Cameroon
| | | | - G Tharp
- Department of Sociomedical Sciences, Mailman School of Public Health, New York, New York, USA
| | - Laura Eno Dimite
- US Centers for Disease Control and Prevention, Yaoundé, Cameroon
| | - Adama N'Dir
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Centers for Disease Control and Prevention, Yaoundé, Cameroon
| | - Gordon Okpu
- US Centers for Disease Control and Prevention, Yaoundé, Cameroon
| | | | | | | | - Gili Hrusa
- ICAP at Columbia University, New York, New York, USA
| | | | - Megan Tebbenhoff
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | | | | | | | | | - Tiffany G Harris
- ICAP at Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| |
Collapse
|
3
|
Nanque LM, Jensen AM, Diness A, Nielsen S, Cabral C, Cawthorne D, Martins JSD, Ca EJC, Jensen K, Martins CL, Rodrigues A, Fisker AB. Effect of distributing locally produced cloth facemasks on COVID-19-like illness and all-cause mortality-a cluster-randomised controlled trial in urban Guinea-Bissau. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002901. [PMID: 38349910 PMCID: PMC10863890 DOI: 10.1371/journal.pgph.0002901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
Facemasks have been employed to mitigate the spread of SARS-CoV-2. The community effect of providing cloth facemasks on COVID-19 morbidity and mortality is unknown. In a cluster randomised trial in urban Bissau, Guinea-Bissau, clusters (geographical areas with an average of 19 houses), were randomised to an intervention or control arm using computer-generated random numbers. Between 20 July 2020 and 22 January 2021, trial participants (aged 10+ years) living in intervention clusters (n = 90) received two 2-layer cloth facemasks, while facemasks were only distributed later in control clusters (n = 91). All participants received information on COVID-19 prevention. Trial participants were followed through a telephone interview for COVID-19-like illness (3+ symptoms), care seeking, and mortality for 4 months. End-of-study home visits ensured full mortality information and distribution of facemasks to the control group. Individual level information on outcomes by trial arm was compared in logistic regression models with generalised estimating equation-based correction for cluster. Facemasks use was mandated. Facemask use in public areas was assessed by direct observation. We enrolled 39,574 trial participants among whom 95% reported exposure to groups of >20 persons and 99% reported facemasks use, with no difference between trial arms. Observed use was substantially lower (~40%) with a 3%, 95%CI: 0-6% absolute difference between control and intervention clusters. Half of those wearing a facemask wore it correctly. Few participants (532, 1.6%) reported COVID-19-like illness; proportions did not differ by trial arm: Odds Ratio (OR) = 0.81, 95%CI: 0.57-1.15. 177 (0.6%) participants reported consultations and COVID-19-like illness (OR = 0.83, 95%CI: 0.56-1.24); 89 participants (0.2%) died (OR = 1.34, 95%CI: 0.89-2.02). Hence, though trial participants were exposed to many people, facemasks were mostly not worn or not worn correctly. Providing facemasks and messages about correct use did not substantially increase their use and had limited impact on morbidity and mortality. Trial registration: clinicaltrials.gov: NCT04471766.
Collapse
Affiliation(s)
- Line M. Nanque
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Andreas M. Jensen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Arthur Diness
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| | - Carlos Cabral
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Dylan Cawthorne
- The Maersk Mc-Kinney Moller Institute, SDU Drone Center, University of Southern Denmark, Odense, Denmark
- Engineers Without Borders Denmark, Copenhagen, Denmark
| | | | - Elsi J. C. Ca
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Kjeld Jensen
- The Maersk Mc-Kinney Moller Institute, SDU Drone Center, University of Southern Denmark, Odense, Denmark
- Engineers Without Borders Denmark, Copenhagen, Denmark
| | | | | | - Ane B. Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Institute of Clinical Research, Bandim Health Project, Research Unit OPEN, Odense University Hospital/ University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Rabarison JH, Rakotondramanga JM, Ratovoson R, Masquelier B, Rasoanomenjanahary AM, Dreyfus A, Garchitorena A, Rasambainarivo F, Razanajatovo NH, Andriamandimby SF, Metcalf CJ, Lacoste V, Heraud JM, Dussart P. Excess mortality associated with the COVID-19 pandemic during the 2020 and 2021 waves in Antananarivo, Madagascar. BMJ Glob Health 2023; 8:e011801. [PMID: 37495370 PMCID: PMC10373673 DOI: 10.1136/bmjgh-2023-011801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/17/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION COVID-19-associated mortality remains difficult to estimate in sub-Saharan Africa because of the lack of comprehensive systems of death registration. Based on death registers referring to the capital city of Madagascar, we sought to estimate the excess mortality during the COVID-19 pandemic and calculate the loss of life expectancy. METHODS Death records between 2016 and 2021 were used to estimate weekly excess mortality during the pandemic period. To infer its synchrony with circulation of SARS-CoV-2, a cross-wavelet analysis was performed. Life expectancy loss due to the COVID-19 pandemic was calculated by projecting mortality rates using the Lee and Carter model and extrapolating the prepandemic trends (1990-2019). Differences in life expectancy at birth were disaggregated by cause of death. RESULTS Peaks of excess mortality in 2020-21 were associated with waves of COVID-19. Estimates of all-cause excess mortality were 38.5 and 64.9 per 100 000 inhabitants in 2020 and 2021, respectively, with excess mortality reaching ≥50% over 6 weeks. In 2021, we quantified a drop of 0.8 and 1.0 years in the life expectancy for men and women, respectively attributable to increased risks of death beyond the age of 60 years. CONCLUSION We observed high excess mortality during the pandemic period, in particular around the peaks of SARS-CoV-2 circulation in Antananarivo. Our study highlights the need to implement death registration systems in low-income countries to document true toll of a pandemic.
Collapse
Affiliation(s)
| | | | - Rila Ratovoson
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bruno Masquelier
- Universite Catholique de Louvain Centre de recherche en demographie et societes, Louvain la neuve, Belgium
| | | | - Anou Dreyfus
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Andres Garchitorena
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- UMR 224 MIVEGEC, IRD, Montpellier, France
| | - Fidisoa Rasambainarivo
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Mahaliana Labs SARL, Antananarivo, Madagascar
| | | | | | - C Jessica Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | | | - Jean-Michel Heraud
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Institut Pasteur de Dakar, Dakar, Senegal
| | | |
Collapse
|
5
|
Fisker AB, Martins JSD, Nanque LM, Jensen AM, Ca EJC, Nielsen S, Martins CL, Rodrigues A. Oral Polio Vaccine to Mitigate the Risk of Illness and Mortality During the Coronavirus Disease 2019 Pandemic: A Cluster-Randomized Trial in Guinea-Bissau. Open Forum Infect Dis 2022; 9:ofac470. [PMID: 36193229 PMCID: PMC9494416 DOI: 10.1093/ofid/ofac470] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Oral polio vaccine (OPV) may improve resistance to non-polio-infections. We tested whether OPV reduced the risk of illness and mortality before coronavirus disease 2019 (COVID-19) vaccines were available.
Methods
During the early COVID-19 pandemic, houses in urban Guinea-Bissau were randomized 1:1 to intervention or control. Residents aged 50+ years were invited to participate. Participants received bivalent OPV (single dose) or nothing. Rates of mortality, admissions, and consultation for infections (primary composite outcome) during 6 months of follow-up were compared in Cox proportional hazards models adjusted for age and residential area. Secondary outcomes included mortality, admissions, consultations, and symptoms of infection.
Results
We followed 3726 participants (OPV, 1580; control, 2146) and registered 66 deaths, 97 admissions, and 298 consultations for infections. OPV did not reduce the risk of the composite outcome overall (hazard ratio [HR] = 0.97; 95% confidence interval [CI], .79–1.18). OPV reduced the risk in males (HR = 0.71; 95% CI, .51–.98) but not in females (HR = 1.18; 95% CI, .91–1.52) (P for same effect = .02). OPV also reduced the risk in Bacillus Calmette-Guérin scar-positive (HR = 0.70; 95% CI, .49–.99) but not in scar-negative participants (HR = 1.13; 95% CI, .89–1.45) (P = .03). OPV had no overall significant effect on mortality (HR = 0.96; 95% CI, .59–1.55), admissions (HR = 0.76; 95% CI, .49–1.17) or recorded consultations (HR = 0.99; 95% CI, .79–1.25), but the OPV group reported more episodes with symptoms of infection (6050 episodes; HR = 1.10 [95% CI, 1.03–1.17]).
Conclusions
In line with previous studies, OPV had beneficial nonspecific effects in males.
Collapse
Affiliation(s)
- Ane B Fisker
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | | | - Line M Nanque
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | - Andreas M Jensen
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | - Elsi J C Ca
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | | | | |
Collapse
|