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Yang J, Triendl H, Soltan AAS, Prakash M, Clifton DA. Addressing label noise for electronic health records: insights from computer vision for tabular data. BMC Med Inform Decis Mak 2024; 24:183. [PMID: 38937744 PMCID: PMC11212446 DOI: 10.1186/s12911-024-02581-5] [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: 01/26/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
The analysis of extensive electronic health records (EHR) datasets often calls for automated solutions, with machine learning (ML) techniques, including deep learning (DL), taking a lead role. One common task involves categorizing EHR data into predefined groups. However, the vulnerability of EHRs to noise and errors stemming from data collection processes, as well as potential human labeling errors, poses a significant risk. This risk is particularly prominent during the training of DL models, where the possibility of overfitting to noisy labels can have serious repercussions in healthcare. Despite the well-documented existence of label noise in EHR data, few studies have tackled this challenge within the EHR domain. Our work addresses this gap by adapting computer vision (CV) algorithms to mitigate the impact of label noise in DL models trained on EHR data. Notably, it remains uncertain whether CV methods, when applied to the EHR domain, will prove effective, given the substantial divergence between the two domains. We present empirical evidence demonstrating that these methods, whether used individually or in combination, can substantially enhance model performance when applied to EHR data, especially in the presence of noisy/incorrect labels. We validate our methods and underscore their practical utility in real-world EHR data, specifically in the context of COVID-19 diagnosis. Our study highlights the effectiveness of CV methods in the EHR domain, making a valuable contribution to the advancement of healthcare analytics and research.
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Affiliation(s)
- Jenny Yang
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England.
| | | | - Andrew A S Soltan
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
- Oxford Cancer & Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Department of Oncology, University of Oxford, Oxford, England
| | - Mangal Prakash
- Work done at Exscientia, Currently Independent Researcher, Reading, United Kingdom
| | - David A Clifton
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
- Oxford-Suzhou Centre for Advanced Research (OSCAR), Suzhou, China
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2
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Lima TE, Ferraz MVF, Brito CAA, Ximenes PB, Mariz CA, Braga C, Wallau GL, Viana IFT, Lins RD. Determination of prognostic markers for COVID-19 disease severity using routine blood tests and machine learning. AN ACAD BRAS CIENC 2024; 96:e20230894. [PMID: 38922277 DOI: 10.1590/0001-376520242023089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/22/2024] [Indexed: 06/27/2024] Open
Abstract
The need for the identification of risk factors associated to COVID-19 disease severity remains urgent. Patients' care and resource allocation can be potentially different and are defined based on the current classification of disease severity. This classification is based on the analysis of clinical parameters and routine blood tests, which are not standardized across the globe. Some laboratory test alterations have been associated to COVID-19 severity, although these data are conflicting partly due to the different methodologies used across different studies. This study aimed to construct and validate a disease severity prediction model using machine learning (ML). Seventy-two patients admitted to a Brazilian hospital and diagnosed with COVID-19 through RT-PCR and/or ELISA, and with varying degrees of disease severity, were included in the study. Their electronic medical records and the results from daily blood tests were used to develop a ML model to predict disease severity. Using the above data set, a combination of five laboratorial biomarkers was identified as accurate predictors of COVID-19 severe disease with a ROC-AUC of 0.80 ± 0.13. Those biomarkers included prothrombin activity, ferritin, serum iron, ATTP and monocytes. The application of the devised ML model may help rationalize clinical decision and care.
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Affiliation(s)
- Tayná E Lima
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Matheus V F Ferraz
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
- Universidade Federal de Pernambuco, Departamento de Química Fundamental, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-560 Recife, PE, Brazil
| | - Carlos A A Brito
- Universidade Federal de Pernambuco, Hospital das Clínicas, Av. Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil
| | - Pamella B Ximenes
- Hospital dos Servidores Públicos do Estado de Pernambuco, Av. Conselheiro Rosa e Silva, s/n, Espinheiro, 52020-020 Recife, PE, Brazil
| | - Carolline A Mariz
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Parasitologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Cynthia Braga
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Parasitologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Gabriel L Wallau
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Entomologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Isabelle F T Viana
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Roberto D Lins
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Virologia, Av. Professor Moraes Rego, s/n, Cidade Universitária, 50740-465 Recife, PE, Brazil
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3
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Theel ES, Kirby JE, Pollock NR. Testing for SARS-CoV-2: lessons learned and current use cases. Clin Microbiol Rev 2024; 37:e0007223. [PMID: 38488364 PMCID: PMC11237512 DOI: 10.1128/cmr.00072-23] [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] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThe emergence and worldwide dissemination of SARS-CoV-2 required both urgent development of new diagnostic tests and expansion of diagnostic testing capacity on an unprecedented scale. The rapid evolution of technologies that allowed testing to move out of traditional laboratories and into point-of-care testing centers and the home transformed the diagnostic landscape. Four years later, with the end of the formal public health emergency but continued global circulation of the virus, it is important to take a fresh look at available SARS-CoV-2 testing technologies and consider how they should be used going forward. This review considers current use case scenarios for SARS-CoV-2 antigen, nucleic acid amplification, and immunologic tests, incorporating the latest evidence for analytical/clinical performance characteristics and advantages/limitations for each test type to inform current debates about how tests should or should not be used.
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Affiliation(s)
- Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - James E. Kirby
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nira R. Pollock
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
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4
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Yang J, Clifton L, Dung NT, Phong NT, Yen LM, Thy DBX, Soltan AAS, Thwaites L, Clifton DA. Mitigating machine learning bias between high income and low-middle income countries for enhanced model fairness and generalizability. Sci Rep 2024; 14:13318. [PMID: 38858466 PMCID: PMC11164855 DOI: 10.1038/s41598-024-64210-5] [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: 02/29/2024] [Accepted: 06/06/2024] [Indexed: 06/12/2024] Open
Abstract
Collaborative efforts in artificial intelligence (AI) are increasingly common between high-income countries (HICs) and low- to middle-income countries (LMICs). Given the resource limitations often encountered by LMICs, collaboration becomes crucial for pooling resources, expertise, and knowledge. Despite the apparent advantages, ensuring the fairness and equity of these collaborative models is essential, especially considering the distinct differences between LMIC and HIC hospitals. In this study, we show that collaborative AI approaches can lead to divergent performance outcomes across HIC and LMIC settings, particularly in the presence of data imbalances. Through a real-world COVID-19 screening case study, we demonstrate that implementing algorithmic-level bias mitigation methods significantly improves outcome fairness between HIC and LMIC sites while maintaining high diagnostic sensitivity. We compare our results against previous benchmarks, utilizing datasets from four independent United Kingdom Hospitals and one Vietnamese hospital, representing HIC and LMIC settings, respectively.
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Affiliation(s)
- Jenny Yang
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, England.
| | - Lei Clifton
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | | | | | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
| | | | - Andrew A S Soltan
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, England
- Nuffield Department of Population Health, University of Oxford, Oxford, England
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Ho Chi Minh, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
| | - David A Clifton
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, England
- Oxford-Suzhou Centre for Advanced Research (OSCAR), Suzhou, China
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5
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Fogaça MBT, Crispim GJB, Saavedra DP, Lopes-Luz L, da Silva LA, de Camargo BR, Guimarães RA, Nagata T, Ribeiro BM, Bührer-Sékula S. An indirect ELISA for detecting anti-SARS-CoV-2 antibodies in human sera using a baculovirus-expressed recombinant nucleocapsid antigen. Biologicals 2024; 86:101769. [PMID: 38759304 DOI: 10.1016/j.biologicals.2024.101769] [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: 12/07/2023] [Revised: 03/20/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
This study focuses on the development and initial assessment of an indirect IgG enzyme-linked immunosorbent assay (ELISA) specifically designed to detect of anti-SARS-CoV-2 antibodies. The unique aspect of this ELISA method lies in its utilization of a recombinant nucleocapsid (N) antigen, produced through baculovirus expression in insect cells. Our analysis involved 292 RT-qPCR confirmed positive serum samples and 54 pre-pandemic healthy controls. The process encompassed cloning, expression, and purification of the SARS-CoV-2 N gene in insect cells, with the resulted purified protein employed in our ELISA tests. Statistical analysis yielded an Area Under the Curve of 0.979, and the optimized cut-off exhibited 92 % sensitivity and 94 % specificity. These results highlight the ELISA's potential for robust and reliable serological detection of SARS-CoV-2 antibodies. Further assessments, including a larger panel size, reproducibility tests, and application in diverse populations, could enhance its utility as a valuable biotechnological solution for diseases surveillance.
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Affiliation(s)
- Matheus Bernardes Torres Fogaça
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | | | - Djairo Pastor Saavedra
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Leonardo Lopes-Luz
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil
| | - Leonardo Assis da Silva
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Brenda Rabello de Camargo
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Rafael Alves Guimarães
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil
| | - Tatsuya Nagata
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Bergmann Morais Ribeiro
- Departamento de Biologia Celular, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Samira Bührer-Sékula
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, 74605-050, Brazil; Innovation Hub in Point of Care Technologies, Universidade Federal de Goiás-Merck S/A. Alliance, 74690-900, Goiânia, GO, Brazil.
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6
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Zhang X, Hou X, Feng W. Trace detection of canine distemper virus based on Michelson-interferometer sensing probe. JOURNAL OF BIOPHOTONICS 2024; 17:e202300329. [PMID: 37703422 DOI: 10.1002/jbio.202300329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Abstract
A single-mode-fiber (SMF)-multimode-fiber (MMF)-tri-core-fiber (TCF) Michelson probe structure is proposed for trace detection of canine distemper virus (CDV). One end of the TCF is cut flat and fused with the multimode fiber, and the other end is coated with a silver film to enhance the reflection, and an optic-fiber sensing probe with SMF-MMF-TCF structure is obtained. The (PDDA/PSS)3 multilayer film is modified on the surface of the fiber by layer-by-layer self-assembly method as a polyelectrolyte binder to immobilize CDV antibodies to form a (PDDA/PSS)3 /CDV antibody composite membrane for specific detection of CDV antigens. The response-recovery test of the sensor is performed to verify its repeatability. The detection limit, the sensitivity, and the linear fitting degree for CDV antigen are 0.1236 pg/mL, 1.1776 dB/(pg/mL), and 0.9899, respectively. At the same time, the stability, selectivity, and clinical samples of the sensors were also verified.
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Affiliation(s)
- Xinyu Zhang
- School of Science, Chongqing University of Technology, Chongqing, China
| | - Xiangyu Hou
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Wenlin Feng
- School of Science, Chongqing University of Technology, Chongqing, China
- Chongqing Key Laboratory of Green Energy Materials Technology and Systems, Chongqing, China
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7
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Yan VKC, Cheng FWT, Chui CSL, Lai FTT, Wong CKH, Li X, Wan EYF, Wong JSC, Chan EWY, Wong ICK, Kwan MYW, Ip P. Effectiveness of BNT162b2 and CoronaVac vaccines in preventing SARS-CoV-2 Omicron infections, hospitalizations, and severe complications in the pediatric population in Hong Kong: a case-control study. Emerg Microbes Infect 2023; 12:2185455. [PMID: 36852582 PMCID: PMC10026771 DOI: 10.1080/22221751.2023.2185455] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Severe COVID-19 appears to be disproportionately more common in children and adolescents since the emergence of Omicron. More evidence regarding vaccine effectiveness (VE) is urgently needed to assist policymakers in making decisions and minimize vaccine hesitancy among the public. This was a case-control study in the pediatric population using data extracted from the electronic health records database in Hong Kong. Individuals aged 3-17 with COVID-19 confirmed by polymerase chain reaction were included in the study. Each case was matched with up to 10 controls based on age, gender, and index date (within 3 calendar days). The VE of BNT162b2 and CoronaVac in preventing COVID-19, hospitalizations, and severe outcomes were estimated using conditional logistic regression adjusted by patients' comorbidities and medication history during the outbreak from January to August 2022. A total of 36,434 COVID-19 cases, 2231 COVID-19-related hospitalizations, and 1918 severe COVID-19 cases were matched to 109,004, 21,788, and 18,823 controls, respectively. Compared to the unvaccinated group, three doses of BNT162b2 or CoronaVac was associated with reduced risk of infection [VE: BNT162b2: 56.0% (95% CI: 49.6-61.6), CoronaVac: 39.4% (95% CI: 25.6-50.6)], hospitalization [VE: BNT162b2: 58.9% (95% CI: 36.1-73.6), CoronaVac: 51.7% (11.6-73.6)], and severe outcomes [VE: BNT162b2: 60.2% (95% CI: 33.7-76.1), CoronaVac: 42.2% (95% CI: -6.2-68.6)]. Our findings showed that three doses of BNT162b2 or CoronaVac was effective in preventing COVID-19, hospitalizations, and severe outcomes among the pediatric population during Omicron-dominant pandemic, which was further enhanced after a booster dose.
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Affiliation(s)
- Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Franco Wing Tak Cheng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Celine Sze Ling Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Joshua Sung Chih Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, People's Republic of China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Laboratory of Data Discovery for Health (D24H), , Hong Kong Science and Technology Park, Sha Tin, Hong Kong, People's Republic of China
- Aston Pharmacy School, Aston University, Birmingham, UK
| | - Mike Yat Wah Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, People's Republic of China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
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8
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Yang J, El-Bouri R, O’Donoghue O, Lachapelle AS, Soltan AAS, Eyre DW, Lu L, Clifton DA. Deep reinforcement learning for multi-class imbalanced training: applications in healthcare. Mach Learn 2023; 113:2655-2674. [PMID: 38708086 PMCID: PMC11065699 DOI: 10.1007/s10994-023-06481-z] [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: 01/12/2023] [Revised: 08/15/2023] [Accepted: 10/17/2023] [Indexed: 05/07/2024]
Abstract
With the rapid growth of memory and computing power, datasets are becoming increasingly complex and imbalanced. This is especially severe in the context of clinical data, where there may be one rare event for many cases in the majority class. We introduce an imbalanced classification framework, based on reinforcement learning, for training extremely imbalanced data sets, and extend it for use in multi-class settings. We combine dueling and double deep Q-learning architectures, and formulate a custom reward function and episode-training procedure, specifically with the capability of handling multi-class imbalanced training. Using real-world clinical case studies, we demonstrate that our proposed framework outperforms current state-of-the-art imbalanced learning methods, achieving more fair and balanced classification, while also significantly improving the prediction of minority classes. Supplementary Information The online version contains supplementary material available at 10.1007/s10994-023-06481-z.
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Affiliation(s)
- Jenny Yang
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
| | - Rasheed El-Bouri
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
| | - Odhran O’Donoghue
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
| | - Alexander S. Lachapelle
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
| | - Andrew A. S. Soltan
- Oxford Cancer & Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, England
- London Medical Imaging and AI Centre for Value Based Healthcare, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - David W. Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Lei Lu
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
| | - David A. Clifton
- Institute of Biomedical Engineering, Dept. Engineering Science, University of Oxford, Oxford, England
- Oxford-Suzhou Centre for Advanced Research (OSCAR), Suzhou, China
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9
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Çalişkan E, Öztürk CE, Öksüz Ş, Ince N, Yekenkurul D, Kahraman G, Duran P, Şahin İ. Monitoring of antibody levels in healthcare workers after inactivated coronavirus disease 19 vaccination. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20220766. [PMID: 38055449 DOI: 10.1590/1806-9282.20220766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Because of the coronavirus disease 19 pandemic, studies on vaccination are being conducted in our country as well as across the world. In this study, the antibody levels in healthcare workers vaccinated with two doses of inactivated vaccine and the factors affecting these levels were investigated. METHODS Randomly selected volunteers from healthcare workers, who had been vaccinated with two doses of inactivated vaccine in January to February 2021, were included in the study. Blood samples were drawn twice, 1 month and 6 months after the second dose vaccine (CoronaVac:Sinovac Life Science Co, Ltd, Beijing, China). The antibody levels were determined by the chemiluminescence microparticle immunoassay method using kits for quantitative detection of immunoglobulin class G antibodies to severe acute respiratory syndrome coronavirus 2. RESULTS The mean antibody levels of 129 volunteers were 1232.5 (min: 103 to max: 7151) AU/mL in the first month and 403.5 (min: 23 to max: 4963) AU/mL in the sixth month. According to the survey results, 91 (71%) volunteers had not been diagnosed with coronavirus disease 19 before vaccination. The antibody levels 1 month and 6 months after the second dose of vaccination were significantly higher in those who had been diagnosed with coronavirus disease 19 before vaccination than in those who had not. It was found that age, gender, fast food, or healthy nutrition had no effect on antibody levels. CONCLUSION Vaccines are very important both to protect against coronavirus disease 19 and to experience only a mild form of the disease. Immunoglobulin class G levels formed after vaccination may be affected by many factors and may decrease over time.
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Affiliation(s)
- Emel Çalişkan
- Düzce University, Health Practice and Research Center, Department of Medical Microbiology - Düzce, Turkey
| | - Cihadiye Elif Öztürk
- Arel University, Medical Faculty, Department of Clinical Microbiology and Infection Disease - İstanbul, Turkey
| | - Şükrü Öksüz
- Düzce University, Health Practice and Research Center, Department of Medical Microbiology - Düzce, Turkey
| | - Nevin Ince
- Düzce University, Health Practice and Research Center, Department of Clinical Microbiology and Infection Disease - Düzce, Turkey
| | - Dilek Yekenkurul
- Düzce University, Health Practice and Research Center, Department of Clinical Microbiology and Infection Disease - Düzce, Turkey
| | - Gözde Kahraman
- Düzce University, Health Practice and Research Center, Department of Medical Microbiology - Düzce, Turkey
| | - Pelin Duran
- Düzce University, Health Practice and Research Center, Department of Medical Microbiology - Düzce, Turkey
| | - İdris Şahin
- Düzce University, Health Practice and Research Center, Department of Medical Microbiology - Düzce, Turkey
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10
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Charron B, Delorme A, Dubois C, Hojjat Jodaylami M, Masson JF. Influence of bovine and human serum albumin on the binding kinetics of biomolecular interactions. Analyst 2023; 148:5525-5533. [PMID: 37791739 DOI: 10.1039/d3an01117h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Bovine serum albumin (BSA) containing buffers are the standard blocking buffer in biosensing, yet human serum is the intended application for most clinical sensors. However, the effect of human serum albumin (HSA) on binding assays remains underexplored. A simple and well-studied assay (human IgG/goat anti-human IgG) was investigated with a surface plasmon resonance (SPR) sensor to address this fundamental question in sensing. Calibrations were performed with buffers containing various concentrations of bovine or human serum albumin, as well as full and diluted bovine or IgG-depleted human serum. It was found that HSA or human serum, but not BSA or bovine serum, significantly affected the SPR shift and binding constants of the assay. Interestingly, large differences were also observed depending on whether the animal or human antibody was immobilized on the SPR chip for detection, highlighting that matrix protein/analyte/receptor interactions play a significant role in the response. We find that the interaction of soluble HSA with human IgG interferes with the recognition region, affecting the binding constant, and thus results obtained in BSA are not necessarily applicable to clinical samples or in vivo conditions. We also clearly demonstrate why a minimum dilution of 1 : 10 is often required in SPR assays to remove most background effects. Taken together, these results show that: (1) BSA does not affect the binding constant between antibodies and thus serves its purpose well when only surface blocking is intended, (2) HSA is an adequate surrogate for human serum in assay optimization, and (3) blocking buffers should be prepared with HSA in the optimization steps of assays to be translated to human blood or serum.
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Affiliation(s)
- Benjamin Charron
- Département de chimie, Quebec center for advanced materials (QCAM), Regroupement québécois sur les matériaux de pointe (RQMP), and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, CP. 6128 Succ. Centre-Ville, Montréal, Qc, H3C 3J7, Canada.
| | - Alexandre Delorme
- Département de chimie, Quebec center for advanced materials (QCAM), Regroupement québécois sur les matériaux de pointe (RQMP), and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, CP. 6128 Succ. Centre-Ville, Montréal, Qc, H3C 3J7, Canada.
| | - Caroline Dubois
- Département de chimie, Quebec center for advanced materials (QCAM), Regroupement québécois sur les matériaux de pointe (RQMP), and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, CP. 6128 Succ. Centre-Ville, Montréal, Qc, H3C 3J7, Canada.
| | - Maryam Hojjat Jodaylami
- Département de chimie, Quebec center for advanced materials (QCAM), Regroupement québécois sur les matériaux de pointe (RQMP), and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, CP. 6128 Succ. Centre-Ville, Montréal, Qc, H3C 3J7, Canada.
| | - Jean-Francois Masson
- Département de chimie, Quebec center for advanced materials (QCAM), Regroupement québécois sur les matériaux de pointe (RQMP), and Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, CP. 6128 Succ. Centre-Ville, Montréal, Qc, H3C 3J7, Canada.
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11
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Feler J, Chuck C, Anderson M, Poggi J, Sweeney J, Moldovan K, Jayaraman MV, McTaggart R, Torabi R. Dual antiplatelet use in the management of COVID-19 associated acute ischemic stroke reocclusion. Interv Neuroradiol 2023; 29:540-547. [PMID: 35549746 PMCID: PMC10549714 DOI: 10.1177/15910199221097484] [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: 02/25/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
INTRO SARS-CoV-2 (COVID-19) infection is associated with acute ischemic stroke (AIS), which may be due to a prothrombotic state. Early reports have suggested high rates of reocclusion following mechanical thrombectomy (MT) with poor radiographic and clinical outcomes. We report our early experience using intra-procedural antithrombotics to address SARS-CoV-2 reocclusion. METHODS We identified 6 patients that experienced early reocclusion after MT for COVID-19-associated AIS through retrospective chart review abstracting their basic demographics, COVID-19 status, and stroke management. All these patients were treated after reocclusion with aspirin and cangrelor intra-procedurally, the latter of which was converted to ticagrelor post-procedurally. Some patients additionally received argatroban infusion intraprocedurally. RESULTS Mean age was 54. There were 3 post-procedural and 3 intra-procedural re-occlusions. After repeat thrombectomy and treatment with aspirin and cangrelor, those with post-procedure reocclusion did not show further reocclusion, while those with intra-procedural reocclusion showed radiographic improvement with intraprocedural cangrelor administration. Outcomes for these patients were poor, with a median mRS of 4. Two patients developed petechial hemorrhage of their stroke which was managed conservatively, and one developed a retroperitoneal hemorrhage from femoral access requiring transfusion. There were no patients who developed new parenchymal hematomas. CONCLUSION COVID-19 AIS may be associated with a hypercoagulable state which risks malignant reocclusion complicating MT. We found antithrombotic treatment periprocedural cangrelor with or without argatroban transitioned to oral aspirin with ticagrelor to be a viable method for management of these patients.
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Affiliation(s)
- Joshua Feler
- Department of Neurosurgery, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Carlin Chuck
- Department of Neurosurgery, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Matthew Anderson
- Department of Neurosurgery, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Jonathan Poggi
- Department of Neurosurgery, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Joseph Sweeney
- Department of Hematology-Oncology, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Krisztina Moldovan
- Department of Interventional Radiology, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Mahesh V. Jayaraman
- Department of Interventional Radiology, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Ryan McTaggart
- Department of Interventional Radiology, Brown University, The Warren Alpert Medical School, Providence, RI, USA
| | - Radmehr Torabi
- Department of Neurosurgery, Brown University, The Warren Alpert Medical School, Providence, RI, USA
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12
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Zhang WW, Li CX, Cao SJ, Wang YY, Lu ZX, Sun JL, Jing MX. A network meta-analysis of risk factors of infection among close contacts of COVID-19. Heliyon 2023; 9:e20861. [PMID: 37860512 PMCID: PMC10582502 DOI: 10.1016/j.heliyon.2023.e20861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
Objective We aimed to use network meta-analysis to compare the impact of infection risk factors of close contacts with COVID-19, identify the most influential factors and rank their subgroups. It can provide a theoretical basis for the rapid and accurate tracking and management of close contacts. Methods We searched nine databases from December 1, 2019 to August 2, 2023, which only took Chinese and English studies into consideration. Odd ratios (ORs) were calculated from traditional meta-estimated secondary attack rates (SARs) for different risk factors, and risk ranking of these risk factors was calculated by the surface under the cumulative ranking curve (SUCRA). Results 25 studies with 152647 participants identified. Among all risk factors, the SUCRA of type of contact was 69.6 % and ranked first. Among six types of contact, compared with transportation contact, medical contact, social contact and other, daily contact increased risk of infection by 12.11 (OR: 12.11, 95 % confidence interval (CI): 6.51-22.55), 7.76 (OR: 7.76, 95 % CI: 4.09-14.73), 4.65 (OR: 4.65, 95 % CI: 2.66-8.51) and 8.23 OR: 8.23, 95 % CI: 4.23-16.01) times, respectively. Overall, SUCRA ranks from highest to lowest as daily contact (94.7 %), contact with pollution subjects (78.4 %), social contact (60.8 %), medical contact (31.8 %), other (27.9 %), transportation contact (6.4 %). Conclusion The type of contact had the greatest impact on COVID-19 close contacts infection among the risk factors we included. Daily contact carried the greatest risk of infection among six types of contact, followed by contact with pollution subjects, social contact, other, medical contact and transportation contact. The results can provide scientific basis for rapid assess the risk of infection among close contacts based on fewer risk factors and pay attention to high-risk close contacts during management, thereby reducing tracking and management costs.
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Affiliation(s)
- Wei-wen Zhang
- Department of Preventive Medicine, School of Medicine, Shihezi University. Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, PR China
| | - Chen-xi Li
- Oncological Department of Oral & Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, 830054, PR China
| | - Shu-jing Cao
- Department of Preventive Medicine, School of Medicine, Shihezi University. Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, PR China
| | - Yu-yuan Wang
- Department of Preventive Medicine, School of Medicine, Shihezi University. Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, PR China
| | - Ze-xi Lu
- Department of Preventive Medicine, School of Medicine, Shihezi University. Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, PR China
| | - Jia-lin Sun
- Department of Preventive Medicine, School of Medicine, Shihezi University. Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, PR China
| | - Ming -xia Jing
- Department of Preventive Medicine, School of Medicine, Shihezi University. Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, PR China
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13
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Papagiannis D, Perlepe G, Tendolouri T, Karakitsiou P, Damagka G, Kalaitzi A, Alevra S, Malli F, Gourgoulianis KI. Proportion of Respiratory Syncytial Virus, SARS-CoV-2, Influenza A/B, and Adenovirus Cases via Rapid Tests in the Community during Winter 2023-A Cross Sectional Study. Diseases 2023; 11:122. [PMID: 37754318 PMCID: PMC10529898 DOI: 10.3390/diseases11030122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Respiratory infections constitute a major reason for infants and children seeking medical advice and visiting health facilities, thus remaining a significant public threat with high morbidity and mortality. The predominant viruses causing viral respiratory infections are influenza A and B viruses (Flu-A, Flu-B), respiratory syncytial virus (RSV), adenovirus and coronaviruses. We aimed to record the proportion of RSV, SARS-CoV-2, influenza A/B and adenovirus cases with rapid antigen tests and validate the results with RT-PCR assays of upper respiratory specimens with a wide range of viral loads and (co)-infection patterns in children. Clinical samples were collected from early symptomatic children (presenting with fever and/or cough and/or headache within 5-7 days). The surveillance program was conducted in five private pediatric dispensaries and one pediatric care unit, from 10 January 2023 to 30 March 2023 in central Greece. The total sample of specimens collected was 784 young children and infants, of which 383 (48.8%) were female and 401 were male (51.2%). The mean age of participants was 7.3 + 5.5 years. The sensitivity of the FLU A & B test was 91.15% (95% CI: 84.33-95.67%), and the specificity was 98.96% (95% CI: 97.86-99.58%). The sensitivity and specificity of the adenovirus and RSV test was {92.45% (95% CI: 81.79-97.91%), 99.32% (95% CI: 98.41-99.78%)} and {92.59% (95% CI: 75.71-99.09%), 99.47% (95% CI: 98.65-99.86%)} respectively. Lastly, the sensitivity of the SARS-CoV-2 test was 100.00% (95% CI: 79.41-100.00%) and the specificity was 99.74% (95% CI: 99.06-99.97%). We recorded a proportion of 14.3% and 3.44% for influenza A and B, respectively, followed by a proportion of 6.9% for adenovirus, a proportion of 3.7% for RSV, and finally, a proportion of 2.3% for SARS-CoV-2. The combination of a new multiple rapid test with multiple antigens will probably be a useful tool with a financial impact for health systems targeting the early detection and appropriate treatment of respiratory infections in emergency departments in primary health care facilities.
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Affiliation(s)
- Dimitrios Papagiannis
- Public Health & Vaccines Laboratory, Department of Nursing, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
| | - Garifallia Perlepe
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece; (G.P.); (K.I.G.)
| | - Theodora Tendolouri
- MD Private Sector of Greek Health System, Kanouta 1 Str. Trikala Thessaly, 42100 Trikala, Greece;
| | - Polyxeni Karakitsiou
- MD Private Sector of Greek Health System, Annas Komninis 1-3 Str. Trikala Thessaly, 42100 Trikala, Greece;
| | - Georgia Damagka
- MD Private Sector of Greek Health System, Lefkosias Str. 3 Larissa Thessaly, 41335 Larissa, Greece;
| | - Anna Kalaitzi
- Pediatric Department, General Hospital of Larissa, Tsakalof 1 Str. Larissa Thessaly, 41221 Larissa, Greece; (A.K.); (S.A.)
| | - Sofia Alevra
- Pediatric Department, General Hospital of Larissa, Tsakalof 1 Str. Larissa Thessaly, 41221 Larissa, Greece; (A.K.); (S.A.)
| | - Foteini Malli
- Respiratory Disorders Laboratory, Department of Nursing, University of Thessaly, 41110 Larissa, Greece;
| | - Konstantinos I. Gourgoulianis
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece; (G.P.); (K.I.G.)
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14
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Yang J, Soltan AAS, Eyre DW, Clifton DA. Algorithmic fairness and bias mitigation for clinical machine learning with deep reinforcement learning. NAT MACH INTELL 2023; 5:884-894. [PMID: 37615031 PMCID: PMC10442224 DOI: 10.1038/s42256-023-00697-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/27/2023] [Indexed: 08/25/2023]
Abstract
As models based on machine learning continue to be developed for healthcare applications, greater effort is needed to ensure that these technologies do not reflect or exacerbate any unwanted or discriminatory biases that may be present in the data. Here we introduce a reinforcement learning framework capable of mitigating biases that may have been acquired during data collection. In particular, we evaluated our model for the task of rapidly predicting COVID-19 for patients presenting to hospital emergency departments and aimed to mitigate any site (hospital)-specific and ethnicity-based biases present in the data. Using a specialized reward function and training procedure, we show that our method achieves clinically effective screening performances, while significantly improving outcome fairness compared with current benchmarks and state-of-the-art machine learning methods. We performed external validation across three independent hospitals, and additionally tested our method on a patient intensive care unit discharge status task, demonstrating model generalizability.
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Affiliation(s)
- Jenny Yang
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Andrew A. S. Soltan
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - David W. Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David A. Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Oxford-Suzhou Centre for Advanced Research, Suzhou, China
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15
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Kilgour KM, Turner BL, Daniele M, Menegatti S. One-Step Quantification of anti-Covid-19 Antibodies via Dual Affinity Ratiometric Quenching Assays. Anal Chem 2023. [PMID: 37368953 DOI: 10.1021/acs.analchem.3c01266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
The global pandemic caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of people and paralyzed healthcare systems worldwide. Developing rapid and accurate tests to detect and quantify anti-SARS-CoV-2 antibodies in complex fluids is critical to (i) track and address the spread of SARS-CoV-2 variants with different virulence and (ii) support the industrial manufacturing and clinical administration of anti-SARS-CoV-2 therapeutic antibodies. Conventional immunoassays, such as lateral flow, ELISA, and surface plasmon resonance (SPR), are either qualitative or, when quantitative, are laborious and expensive and suffer from high variability. Responding to these challenges, this study evaluates the performance of the Dual-Affinity Ratiometric Quenching (DARQ) assay for the quantification of anti-SARS-CoV-2 antibodies in bioprocess harvests and intermediate fractions (i.e., a Chinese hamster ovary (CHO) cell culture supernatant and a purified eluate) and human fluids (i.e., saliva and plasma). Monoclonal antibodies targeting the SARS-CoV-2 nucleocapsid as well as the spike protein of the delta and omicron variants are adopted as model analytes. Additionally, conjugate pads loaded with dried protein were studied as an at-line quantification method that can be used in clinical or manufacturing laboratories. Our results indicate that the DARQ assay is a highly reproducible (coefficient of variation ∼0.5-3%) and rapid (<10 min) test, whose sensitivity (∼0.23-2.5 ng/mL), limit of detection (23-250 ng/mL), and dynamic range (70-1300 ng/mL) are independent of sample complexity, thus representing a valuable tool for monitoring anti-SARS-CoV-2 antibodies.
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Affiliation(s)
- Katie M Kilgour
- Department of Chemical & Biomolecular Engineering, North Carolina State University, 911 Partners Way, Raleigh, North Carolina 27695, United States
| | - Brendan L Turner
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Raleigh, North Carolina 27695, United States
| | - Michael Daniele
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Raleigh, North Carolina 27695, United States
- Department of Electrical & Computer Engineering, North Carolina State University, 890 Oval Drive, Raleigh, North Carolina 27695, United States
| | - Stefano Menegatti
- Department of Chemical & Biomolecular Engineering, North Carolina State University, 911 Partners Way, Raleigh, North Carolina 27695, United States
- Biomanufacturing Training and Education Center (BTEC), 850 Oval Drive, Raleigh, North Carolina 27606, United States
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16
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Symeonidou E, Dimitriadou A, Morsi-Yeroyannis A, Sidiropoulou MS, Gkoutziotis I, Petras P, Mpallas K. COVID-19 related acute necrotizing encephalopathy presenting in the early postoperative period. Arch Clin Cases 2023; 10:78-85. [PMID: 37293685 PMCID: PMC10246599 DOI: 10.22551/2023.39.1002.10246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgA), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.
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Affiliation(s)
- Elissavet Symeonidou
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | | | - Antonios Morsi-Yeroyannis
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | | | - Ioannis Gkoutziotis
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | - Panagiotis Petras
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | - Konstantinos Mpallas
- 5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece
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17
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Bernardes WPDOS, Santos TG, Fernandes NMGS, de Souza Silva TB, Westin M, Simões TC, Fernandes E Silva E, Alves BM, Molina I, de Carvalho Melo M, Monte-Neto RLD, da Silva-Pereira RA, Alves PA, Fonseca CT. Comparison of diagnostic performance of RT-qPCR, RT-LAMP and IgM/IgG rapid tests for detection of SARS-CoV-2 among healthcare workers in Brazil. J Infect Public Health 2023; 16:1081-1088. [PMID: 37210925 DOI: 10.1016/j.jiph.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND COVID-19 has become a major public health problem after the outbreak caused by SARS-CoV-2 virus. Great efforts to contain COVID-19 transmission have been applied worldwide. In this context, accurate and fast diagnosis is essential. METHODS In this prospective study, we evaluated the clinical performance of three different RNA-based molecular tests - RT-qPCR (Charité protocol), RT-qPCR (CDC (USA) protocol) and RT-LAMP - and one rapid test for detecting anti-SARS-CoV-2 IgM and IgG antibodies. RESULTS Our results demonstrate that RT-qPCR using the CDC (USA) protocol is the most accurate diagnostic test among those evaluated, while oro-nasopharyngeal swabs are the most appropriate biological sample. RT-LAMP was the RNA-based molecular test with lowest sensitivity while the serological test presented the lowest sensitivity among all evaluated tests, indicating that the latter test is not a good predictor of disease in the first days after symptoms onset. Additionally, we observed higher viral load in individuals who reported more than 3 symptoms at the baseline. Nevertheless, viral load had not impacted the probability of testing positive for SARS-CoV-2. CONCLUSION Our data indicates that RT-qPCR using the CDC (USA) protocol in oro-nasopharyngeal swabs samples should be the method of choice to diagnosis COVID-19.
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Affiliation(s)
| | - Thais Garcia Santos
- Grupo de Pesquisa em Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Nubia Monteiro Gonçalves Soares Fernandes
- Grupo de Pesquisa em Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Thais Bárbara de Souza Silva
- Grupo de Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Mateus Westin
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Taynãna César Simões
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Eduardo Fernandes E Silva
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | | | - Israel Molina
- Grupo de Pesquisa em Triatomíneos e Epidemiologia da Doença de Chagas, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | | | - Rubens Lima do Monte-Neto
- Grupo de Pesquisa em Biotecnologia Aplicada ao Estudo de Patógenos (BAP), Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Rosiane A da Silva-Pereira
- Grupo de Pesquisa em Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Augusto Alves
- Grupo de Imunologia de Doenças Virais, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Cristina Toscano Fonseca
- Grupo de Pesquisa em Biologia e Imunologia de Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.
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18
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Lim NWH, Lim JT, Dickens BL. Border Control for Infectious Respiratory Disease Pandemics: A Modelling Study for H1N1 and Four Strains of SARS-CoV-2. Viruses 2023; 15:v15040978. [PMID: 37112958 PMCID: PMC10144227 DOI: 10.3390/v15040978] [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: 03/22/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Post-pandemic economic recovery relies on border control for safe cross-border movement. Following the COVID-19 pandemic, we investigate whether effective strategies generalize across diseases and variants. For four SARS-CoV-2 variants and influenza A-H1N1, we simulated 21 strategy families of varying test types and frequencies, quantifying expected transmission risk, relative to no control, by strategy family and quarantine length. We also determined minimum quarantine lengths to suppress relative risk below given thresholds. SARS-CoV-2 variants showed similar relative risk across strategy families and quarantine lengths, with at most 2 days' between-variant difference in minimum quarantine lengths. ART-based and PCR-based strategies showed comparable effectiveness, with regular testing strategies requiring at most 9 days. For influenza A-H1N1, ART-based strategies were ineffective. Daily ART testing reduced relative risk only 9% faster than without regular testing. PCR-based strategies were moderately effective, with daily PCR (0-day delay) testing requiring 16 days for the second-most stringent threshold. Viruses with high typical viral loads and low transmission risk given low viral loads, such as SARS-CoV-2, are effectively controlled with moderate-sensitivity tests (ARTs) and modest quarantine periods. Viruses with low typical viral loads and substantial transmission risk at low viral loads, such as influenza A-H1N1, require high-sensitivity tests (PCR) and longer quarantine periods.
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Affiliation(s)
- Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University Experimental Medicine Building, 59 Nanyang Drive, Singapore 636921, Singapore
| | - Borame Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore 12 Science Drive 2, #10-01, Singapore 117549, Singapore
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19
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Lai FTT, Fan M, Huang C, Chui CSL, Wan EYF, Li X, Wong CKH, Cheung CL, Wong ICK, Chan EWY. Effectiveness of BNT162b2 after extending the primary series dosing interval in children and adolescents aged 5-17. Nat Commun 2023; 14:1845. [PMID: 37012238 PMCID: PMC10068718 DOI: 10.1038/s41467-023-37556-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
Extended intervals between the first and second doses of mRNA Covid-19 vaccines may reduce the risk of myocarditis in children and adolescents. However, vaccine effectiveness after this extension remains unclear. To examine this potential variable effectiveness, we conducted a population-based nested case-control study of children and adolescents aged 5-17 years who had received two doses of BNT162b2 in Hong Kong. From January 1 to August 15, 2022, 5396 Covid-19 cases and 202 Covid-19 related hospitalizations were identified and matched with 21,577 and 808 controls, respectively. For vaccine recipients with extended intervals [≥28 days, adjusted odds ratio 0.718, 95% Confidence Interval: 0.619, 0.833] there was a 29.2%-reduced risk of Covid-19 infection compared to those with regular intervals (21-27 days). If the threshold was set at eight weeks, the risk reduction was estimated at 43.5% (aOR 0.565, 95% CI: 0.456, 0.700). In conclusion, longer dosing intervals for children and adolescents should be considered.
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Affiliation(s)
- Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Shatin, Hong Kong
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Caige Huang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Shatin, Hong Kong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Shatin, Hong Kong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Shatin, Hong Kong
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Shatin, Hong Kong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Ching-Lung Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Shatin, Hong Kong.
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Yang J, Soltan AAS, Eyre DW, Yang Y, Clifton DA. An adversarial training framework for mitigating algorithmic biases in clinical machine learning. NPJ Digit Med 2023; 6:55. [PMID: 36991077 PMCID: PMC10050816 DOI: 10.1038/s41746-023-00805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
Machine learning is becoming increasingly prominent in healthcare. Although its benefits are clear, growing attention is being given to how these tools may exacerbate existing biases and disparities. In this study, we introduce an adversarial training framework that is capable of mitigating biases that may have been acquired through data collection. We demonstrate this proposed framework on the real-world task of rapidly predicting COVID-19, and focus on mitigating site-specific (hospital) and demographic (ethnicity) biases. Using the statistical definition of equalized odds, we show that adversarial training improves outcome fairness, while still achieving clinically-effective screening performances (negative predictive values >0.98). We compare our method to previous benchmarks, and perform prospective and external validation across four independent hospital cohorts. Our method can be generalized to any outcomes, models, and definitions of fairness.
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Affiliation(s)
- Jenny Yang
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England.
| | - Andrew A S Soltan
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, England
| | - David W Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Yang Yang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
- Oxford-Suzhou Centre for Advanced Research (OSCAR), Suzhou, China
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21
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Cai CGX, Lim NWH, Huynh VA, Ananthakrishnan A, Dabak SV, Dickens BSL, Faradiba D, KC S, Morton A, Park M, Rachatan C, Sittimart M, Wee HL, Lou J, Teerawattananon Y. Economic Analysis of Border Control Policies during COVID-19 Pandemic: A Modelling Study to Inform Cross-Border Travel Policy between Singapore and Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4011. [PMID: 36901023 PMCID: PMC10001629 DOI: 10.3390/ijerph20054011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
With countries progressing towards high COVID-19 vaccination rates, strategies for border reopening are required. This study focuses on Thailand and Singapore, two countries that share significant tourism visitation, to illustrate a framework for optimizing COVID-19 testing and quarantine policies for bilateral travel with a focus on economic recovery. The timeframe is the month of October 2021, when Thailand and Singapore were preparing to reopen borders for bilateral travel. This study was conducted to provide evidence for the border reopening policy decisions. Incremental net benefit (INB) compared to the pre-opening period was quantified through a willingness-to-travel model, a micro-simulation COVID-19 transmission model and an economic model accounting for medical and non-medical costs/benefits. Multiple testing and quarantine policies were examined, and Pareto optimal (PO) policies and the most influential components were identified. The highest possible INB for Thailand is US $125.94 million, under a PO policy with no quarantine but with antigen rapid tests (ARTs) pre-departure and upon arrival to enter both countries. The highest possible INB for Singapore is US $29.78 million, under another PO policy with no quarantine on both sides, no testing to enter Thailand, and ARTs pre-departure and upon arrival to enter Singapore. Tourism receipts and costs/profits of testing and quarantine have greater economic impacts than that from COVID-19 transmission. Provided healthcare systems have sufficient capacity, great economic benefits can be gained for both countries by relaxing border control measures.
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Affiliation(s)
- Celestine Grace Xueting Cai
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Vinh Anh Huynh
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Aparna Ananthakrishnan
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Dian Faradiba
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Sarin KC
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Alec Morton
- Department of Management Science, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, UK
| | - Minah Park
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Chayapat Rachatan
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Manit Sittimart
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
- Department of Pharmacy, Faculty of Science, NUS, 18 Science Drive 4, Singapore 117559, Singapore
| | - Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 12 Science Drive 2, #10-01, Singapore 117549, Singapore
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
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SARS-CoV-2 Omicron (B.1.1.529) Variant: A Challenge with COVID-19. Diagnostics (Basel) 2023; 13:diagnostics13030559. [PMID: 36766664 PMCID: PMC9913917 DOI: 10.3390/diagnostics13030559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there have been multiple peaks of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus virus 2) infection, mainly due to the emergence of new variants, each with a new set of mutations in the viral genome, which have led to changes in the pathogenicity, transmissibility, and morbidity. The Omicron variant is the most recent variant of concern (VOC) to emerge and was recognized by the World Health Organization (WHO) on 26 November 2021. The Omicron lineage is phylogenetically distinct from earlier variants, including the previously dominant Delta SARS-CoV-2 variant. The reverse transcription-polymerase chain reaction (RT-PCR) test, rapid antigen assays, and chest computed tomography (CT) scans can help diagnose the Omicron variant. Furthermore, many agents are expected to have therapeutic benefits for those infected with the Omicron variant, including TriSb92, molnupiravir, nirmatrelvir, and their combination, corticosteroids, and interleukin-6 (IL-6) receptor blockers. Despite being milder than previous variants, the Omicron variant threatens many lives, particularly among the unvaccinated, due to its higher transmissibility, pathogenicity, and infectivity. Mounting evidence has reported the most common clinical manifestations of the Omicron variant to be fever, runny nose, sore throat, severe headache, and fatigue. This review summarizes the essential features of the Omicron variant, including its history, genome, transmissibility, clinical manifestations, diagnosis, management, and the effectiveness of existing vaccines against this VOC.
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23
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Mouliou DS. The Deceptive COVID-19: Lessons from Common Molecular Diagnostics and a Novel Plan for the Prevention of the Next Pandemic. Diseases 2023; 11:diseases11010020. [PMID: 36810534 PMCID: PMC9944891 DOI: 10.3390/diseases11010020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The COVID-19 pandemic took place during the years 2020-2022 and the virus, named SARS-CoV-2, seems likely to have resulted in an endemic disease. Nevertheless, widespread COVID-19 has given rise to several major molecular diagnostics' facts and concerns that have emerged during the overall management of this disease and the subsequent pandemic. These concerns and lessons are undeniably critical for the prevention and control of future infectious agents. Furthermore, most populaces were introduced to several new public health maintenance strategies, and again, some critical events arose. The purpose of this perspective is to thoroughly analyze all these issues and the concerns, such as the molecular diagnostics' terminologies, their role, as well as the quantity and quality issues with a molecular diagnostics' test result. Furthermore, it is speculated that society will be more vulnerable in the future and prone to emerging infectious diseases; thus, a novel preventive medicine's plan for the prevention and control of future (re)emerging infectious diseases is presented, so as to aid the early prevention of future epidemics and pandemics.
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Miyadahira MY, Brizot MDL, Alexander N, Cerdeira Sabino E, Campos de Oliveira da Silva L, Hoshida MS, da Silva Sousa Oliveira AM, Silva Farche AC, Pulcineli Vieira Francisco R, Mayaud P. Monitoring SARS-CoV-2 seroprevalence over time among pregnant women admitted to delivery units: Suitability for surveillance. PLoS One 2023; 18:e0280109. [PMID: 36603011 DOI: 10.1371/journal.pone.0280109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To determine SARS-CoV-2 seroprevalence over time and risk factors among pregnant women at delivery in São Paulo, Brazil; and to evaluate the suitability of pregnant women as a sentinel population for SARS-CoV-2 serosurveillance. METHODS Unselected consecutive pregnant women presenting at the labor ward of a single large hospital between July 20th 2020 to February 21st 2021 were enrolled and tested for SARS-CoV-2 serology using two assays: the rapid chromatic Wondfo One Step (for total IgA and IgG detection) and Roche Elecsys assay (detecting anti-nucleoprotein [N] IgG). SARS-CoV-2 seroprevalence was computed as smooth spline function over time with 95% confidence intervals (CI). Risk factors were evaluated for positivity by each assay. We compared timepoint seroprevalence by the two assays with four concomitant community household surveys (HHS), in which the Roche assay was used, to determine the sensitivity and relevance of the pregnant women population as sentinel population. RESULTS Overall SARS-CoV-2 seroprevalence was 28.9% (221/763) by Roche and 17.9% (137/763) by Wondfo. Reported symptoms experienced during pregnancy were all significantly correlated with being SARS-CoV-2 seropositive at delivery with any assay (with odds-ratios ranging from 3.0 [95% CI: 2.1-4.3] for coryza to 22.8 [95% CI: 12.3-46.6] for ageusia). Seropositivity by either assay was high in women at delivery in the early period of the pandemic (June 2020), compared with seropositivity in women from the concomitant HHS: 44.1% (95% CI: 21.8-66.4) for Roche, 54.1% (30.9-78.5) for Wondfo, versus 11.4% (95% CI: 9.2-13.6) for HHS. For later periods (October 2020 and January 2021), the seropositivity in women at delivery measured by Roche corresponded well with the prevalence found among women in the HHS using the same assay, whilst prevalence measured by Wondfo dropped. CONCLUSIONS Women at delivery represent a highly exposed and readily accessible population for sentinel surveillance of emerging infections such as SARS-CoV-2.
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Affiliation(s)
- Mariana Yumi Miyadahira
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Neal Alexander
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical da FMUSP, São Paulo, Brazil
| | | | - Mara Sandra Hoshida
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Laboratório de Investigação Médica- LIM 57, Hospital das Clínicas da FMUSP, São Paulo, Brazil
| | - Ana Maria da Silva Sousa Oliveira
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Claudia Silva Farche
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
- Hospital Universitário da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Philippe Mayaud
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Lou J, Lim NWH, Cai CGX, Dickens BSL, Huynh VA, Wee HL. Cost benefit analysis of alternative testing and quarantine policies for travelers for infection control: A case study of Singapore during the COVID-19 pandemic. Front Public Health 2023; 11:1101986. [PMID: 36908469 PMCID: PMC9996245 DOI: 10.3389/fpubh.2023.1101986] [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: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Background Border control mitigates local infections but bears a heavy economic cost, especially for tourism-reliant countries. While studies have supported the efficacy of border control in suppressing cross-border transmission, the trade-off between costs from imported and secondary cases and from lost economic activities has not been studied. This case study of Singapore during the COVID-19 pandemic aims to understand the impacts of varying quarantine length and testing strategies on the economy and health system. Additionally, we explored the impact of permitting unvaccinated travelers to address emerging equity concerns. We assumed that community transmission is stable and vaccination rates are high enough that inbound travelers are not dissuaded from traveling. Methods The number of travelers was predicted considering that longer quarantine reduces willingness to travel. A micro-simulation model predicted the number of COVID-19 cases among travelers, the resultant secondary cases, and the probability of being symptomatic in each group. The incremental net monetary benefit (INB) of Singapore was quantified under each border-opening policy compared to pre-opening status, based on tourism receipts, cost/profit from testing and quarantine, and cost and health loss due to COVID-19 cases. Results Compared to polymerase chain reaction (PCR), rapid antigen test (ART) detects fewer imported cases but results in fewer secondary cases. Longer quarantine results in fewer cases but lower INB due to reduced tourism receipts. Assuming the proportion of unvaccinated travelers is small (8% locally and 24% globally), allowing unvaccinated travelers will accrue higher INB without exceeding the intensive care unit (ICU) capacity. The highest monthly INB from all travelers is $2,236.24 m, with 46.69 ICU cases per month, achieved with ARTs at pre-departure and on arrival without quarantine. The optimal policy in terms of highest INB is robust under changes to various model assumptions. Among all cost-benefit components, the top driver for INB is tourism receipts. Conclusions With high vaccination rates locally and globally alongside stable community transmission, opening borders to travelers regardless of vaccination status will increase economic growth in the destination country. The caseloads remain manageable without exceeding ICU capacity, and costs of cases are offset by the economic value generated from travelers.
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Affiliation(s)
- Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nigel Wei-Han Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Vinh Anh Huynh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Fu H, Sun L, Zhu J. Detection of Antibody versus Antigen, Optimal Option of Different Serological Assays Based Tests for COVID-19 Diagnosis: A Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:23-36. [PMID: 36824236 PMCID: PMC9941426 DOI: 10.18502/ijph.v52i1.11662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/11/2022] [Indexed: 01/19/2023]
Abstract
Background In this study, the diagnostic efficacy of antigen test and antibody test were assessed. Additionally, the difference of sensitivity, specificity, and diagnostic odds ratio were compared concerning efficacy of antibody test versus antigen test for Corona Virus Disease 2019 (COVID-19) diagnosis. Methods Online databases were searched for full-text publications and STATA software was used for data pooling and analysis before Sep 1st, 2022. Forrest plot was used to show the pooled sensitivity, specificity and diagnostic odds ratio. Combined receiver operating characteristic (ROC) curve was used to show the area of under curve of complex data. Results Overall, 25 studies were included. The sensitivity (0.68, 95% CI: 0.53-0.80) and specificity (0.99, 95% CI: 0.98-0.99) in antibody or antigen was calculated. The time point of test lead to heterogeneity. The area under curve (AUC) was 0.98 (95% CI: 0.96-0.99), and the diagnostic odds ratio (DOR) was 299.54 (95% CI: 135.61-661.64). Subgroup analysis indicated antibody test with sensitivity (0.59, 95% CI: 0.44-0.73) and specificity (0.98, 95% CI: 0.95-0.99) and antigen test with sensitivity of 0.77 (95% CI: 0.53-0.91) and specificity of 0.99 (95% CI: 0.98-1.00). Higher AUC and DOR were proved in antigen test. Conclusion The present study compared the efficacy of antibody test versus antigen test for COVID-19 diagnosis. Better diagnostic efficacy, lower heterogeneity, and less publication bias of rapid antigen testing was suggested in this study. This study would help us to make better strategy about choosing rapid and reliable testing method in diagnosis of the COVID-19 disease.
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Affiliation(s)
- Haiyan Fu
- Department of Clinical Laboratory, Yantaishan Hospital, Yantai 264001, Shandong Province, PR China
| | - Lin Sun
- Department of Clinical Laboratory, Yantaishan Hospital, Yantai 264001, Shandong Province, PR China
| | - Jingwei Zhu
- Department of Clinical Laboratory, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong Province, PR China,Corresponding Author:
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Rostami S, Haghjooy Javanmard S, Nokhodian Z, Kassaian N, Zamani A, Tahvilian Z, Nasri P, Nasirian M, Ataei B. SARS-CoV-2 Seroprevalence among Health-Care Workers in Isfahan, Iran. Adv Biomed Res 2023; 12:31. [PMID: 37057248 PMCID: PMC10086646 DOI: 10.4103/abr.abr_201_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 04/15/2023] Open
Abstract
Background Health-care workers (HCWs) are in the frontline for fighting the coronavirus disease 2019 (COVID-19) pandemic and are at higher risk of acquiring the infection. Therefore, the defining immunity status among HCWs helps mitigate the exposure risk. In this study, we investigated the anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) and also the associated risk factors in the HCWs working in Isfahan University of Medical Sciences COVID-19 referral hospitals. Materials and Methods In a cross-sectional study, demographics, COVID-19 symptoms during the past 2 weeks, and health-care details were collected from 200 consenting health workers of COVID-center-hospitals of Isfahan University of Medical Sciences from 23 October to 21 December 2020. The recombinant SARS-CoV2 nucleocapsid protein enzyme-linked immunosorbent assay-based IgM, and IgG antibody tests were evaluated. Data were analyzed using Chi-square and independent-t-student tests, and P < 0.05 was considered significant. Results One hundred and forty-one women and 59 men with a mean age of 36.4 ± 7.77 years participated in the study. IgG Ab and IgM Ab were positive in 77 (38.5%) and 12 (6%) of samples, respectively, and both antibodies were detected in 9 (4.5%). Higher ages, direct contact with the patients with COVID-19, muscle pain, loss of taste and smell, fever, and cough were the factors associated with antibody seropositivity against SARS-CoV2. Conclusion This study demonstrated that the prevalence of HCWs with antibodies against SARS-CoV-2 is relatively high in Isfahan University referral hospitals. The development of safety protocols and screening and vaccination strategies in the frontline HCWs must be implemented to reduce the burden of infection.
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Affiliation(s)
- Soodabeh Rostami
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zary Nokhodian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Zary Nokhodian, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Nazila Kassaian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Zamani
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Tahvilian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parto Nasri
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nasirian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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The Seroprevalence and Seropositivity of SARS-CoV-2 among Healthcare Workers during the Third Pandemic Wave. Antibodies (Basel) 2022; 12:antib12010002. [PMID: 36648886 PMCID: PMC9844358 DOI: 10.3390/antib12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Due to the unclear protective role of produced antibodies and the need for seroepidemiologic studies, we surveyed the COVID-19 seroprevalence among healthcare professionals who had direct or indirect contact with COVID-19 patients. METHODS From 19 October 2020 to 17 February 2021, 300 healthcare workers were enrolled and tested for serum antibodies in this prospective cohort study. Demographic information, risk factors, and infection history were collected. Anti- SARS-CoV-2 IgG and IgM antibody titers were determined to estimate the seroconversion rate. RESULTS During the first and second phases of the study, the positive seroconversion rates were 31.7 and 26.6%, respectively. In seronegative individuals, sixteen (10.6%) new cases of COVID-19 and five (6.3%) reinfections were identified. Among those with a positive antibody level, forty-one (36.9%) healthcare workers reported no symptoms in the preceding months. There was no association between occupational exposure and an increased probability of seroconversion. CONCLUSIONS The seropositivity rate and the rate of asymptomatic individuals with seroconversion was remarkable and could be an indicator of a high infection rate among healthcare workers.
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Andrade Belitardo EMM, Nery N, Aguilar Ticona JP, Portilho MM, Mello IO, Ribeiro GS, Reis MG, Costa F, Cummings DAT, Ko AI, Fofana MO. Reliable estimation of SARS-CoV-2 anti-spike protein IgG titers from single dilution optical density values in serologic surveys. Diagn Microbiol Infect Dis 2022; 104:115807. [PMID: 36162285 PMCID: PMC9428330 DOI: 10.1016/j.diagmicrobio.2022.115807] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/25/2022] [Accepted: 08/28/2022] [Indexed: 11/28/2022]
Abstract
Reliable and scalable seroepidemiology methods are needed to estimate SARS-CoV-2 incidence and monitor the dynamics of population-level immunity as the pandemic evolves. We aimed to evaluate the reliability of SARS-CoV-2 normalized ELISA optical density (nOD) at a single dilution compared to titers derived from serial dilutions. We conducted serial serosurveys within a community-based cohort in Salvador, Brazil. Anti-S IgG ELISA (Euroimmun AG) was performed with 5 serial 3-fold dilutions of paired sera from 54 participants. Changes in nOD reliably predicted increases and decreases in titers (98.1% agreement, κ = 95.8%). Fitting the relationship between nOD and interpolated titers to a log-log curve yields highly accurate predictions of titers (r2 = 0.995) and changes in titers (r2 = 0.975), using only 1 to 2 dilutions. This approach can significantly reduce the time, labor and resources needed for large-scale serosurveys to ascertain population-level changes in exposure and immunity.
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Affiliation(s)
| | - Nivison Nery
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | | | - Iago O Mello
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Federico Costa
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Albert I Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Mariam O Fofana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
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Jones Ritten C, Thunström L, Cherry T, Wulfhorst JD. Frequent mandatory COVID-19 testing may increase risky behavior. PNAS NEXUS 2022; 1:pgac247. [PMID: 36712346 PMCID: PMC9802369 DOI: 10.1093/pnasnexus/pgac247] [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: 08/25/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Mandatory surveillance testing programs are popular policies aimed to control SARS-CoV-2 and may be considered for future epidemics. However, if people believe that testing lowers their risk of infection, such policies could increase risky behavior and may even cause increased pathogen spread. Using data from two US universities, we find that frequent mandatory testing is associated with greater participation in events linked to COVID-19 spread. Women seem to be driving this association, and mediation analyses suggest this is partly due to women's higher perception of COVID-related health risks. Our results show the potential for adverse effects from epidemic control policies, both on average and across population subgroups. Undertaking mitigation measures to reduce such unintended consequences may therefore be important.
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Affiliation(s)
| | - Linda Thunström
- Department of Economics, University of Wyoming, Laramie, WY 82071, USA
| | - Todd Cherry
- Department of Economics, University of Wyoming, Laramie, WY 82071, USA
| | - J D Wulfhorst
- Department of Natural Resources and Society, University of Idaho, Moscow, ID 83844, USA
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31
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Dowran R, Damavandi AR, Azad TM. Reinfection and reactivation of SARS-CoV-2. Future Virol 2022. [PMID: 36176508 PMCID: PMC9514089 DOI: 10.2217/fvl-2021-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/31/2022] [Indexed: 11/21/2022]
Abstract
As the cases of SARS-CoV-2 infection escalates, the essence of in-depth knowledge around acquired immunity and emergence of reinfection and reactivation have to be captured. While being a rare phenomenon, reinfection occurs as the result of diminishing protection conferred by antibodies, especially IgG. Reactivation is more concerned with the role of various elements including shedding lingering viral RNA for a prolonged time and incomplete resolution of infection along with the insight of dormant viral exosomes’ role. The concept of testing positive after two consecutive negative results requires proper discrimination of reinfection from reactivation. In this review, we summarized the current evidence for possible mechanisms leading to viral reactivation or test re-positivity. We also pointed out risk factors associated with both reinfection and reactivation.
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Affiliation(s)
- Razieh Dowran
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Student Scientific Association of Virology, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmasoud Rayati Damavandi
- Student Scientific Association of Virology, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Leon‐Sicairos N, Angulo‐Zamudio UA, Pacheco‐Avila M, Medina‐Ramirez I, Velazquez‐Roman J, Angulo‐Rocha J, Martínez‐Villa FA, Flores‐Villaseñor H, Martinez‐Garcia JJ, Sanchez‐Cuen J, Garzon‐Lopez O, Guel‐Gomez M, Cuen‐Diaz HM, Barajas‐Olivas MF, Campos‐Romero A, Alcántar‐Fernández J, Esparza MAL, Canizalez‐Roman A. Epidemiological and clinical characteristics of pregnant women and neonates with COVID-19 in Northwest Mexico. Am J Reprod Immunol 2022; 88:e13583. [PMID: 35661465 PMCID: PMC9348056 DOI: 10.1111/aji.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The SARS-CoV-2 virus, which causes COVID-19, has spread quickly worldwide, causing millions of cases and thousands of deaths. Some risk factors in the general population are related to the development of severe COVID-19 or death, but in pregnant women and neonates, the information is limited. OBJECTIVE To determine the epidemiological and clinical characteristics of pregnant women and neonates diagnosed with COVID-19 by RT-PCR and serological tests, and analyze the relationship between the influenza vaccination and COVID-19 symptoms in infected pregnant women in Sinaloa state. METHODS We collected samples from 116 pregnant women and 84 neonates from the Women´s Hospital of Sinaloa. They were diagnosed with COVID-19 by RT-PCR and serological tests (IgG), and sociodemographic, clinical and laboratory parameters were recorded. RESULTS A total of 11.2% (13/116) of the pregnant women were RT-PCR+, 25% (29/116) were IgG+ and 4.3% (5/116) were positive for both tests. Symptoms such as rhinorrhea (P = .04), cough (P = .02) and polypnea (P = .04) in pregnant women were related to COVID-19, also leukocyte index was higher in pregnant women with COVID-19 (P = .03), but the associations were lost after the Bonferroni correction. No laboratory parameters or underlying diseases were associated with COVID-19, and most infected pregnant women had mild cases. We found an association between the influenza vaccine and less common COVID-19 symptoms in pregnant women who were infected (P = .01). A total of 7.2% (6/84) of neonates were RT-PCR+, 35.7% (30/84) were IgG+, and there were no symptoms or underlying diseases associated with neonates who were infected. In conclusion, this work demonstrated that some symptoms were related to COVID-19, most pregnant women and neonates had mild cases, and the influenza vaccine could decrease the severity of COVID-19 cases in pregnant women.
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Affiliation(s)
- Nidia Leon‐Sicairos
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- Pediatric Hospital of SinaloaCuliacanSinaloaMexico
| | | | | | | | | | | | | | - Hector Flores‐Villaseñor
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- The Sinaloa State Public Health LaboratorySecretariat of HealthCuliacanSinaloaMexico
| | - Jesus J. Martinez‐Garcia
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- Pediatric Hospital of SinaloaCuliacanSinaloaMexico
| | - Jaime Sanchez‐Cuen
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
| | | | | | | | | | | | | | | | - Adrian Canizalez‐Roman
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- The Women's Hospital, Secretariat of HealthCuliacanSinaloaMexico
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Michel M, Malergue F, Ait Belkacem I, Bourgoin P, Morange PE, Arnoux I, Miloud T, Million M, Tissot-Dupont H, Mege JL, Vitte J, Busnel JM. A rapid, easy, and scalable whole blood monocyte CD169 assay for outpatient screening during SARS-CoV-2 outbreak, and potentially other emerging disease outbreaks. SAGE Open Med 2022; 10:20503121221115483. [PMID: 35959245 PMCID: PMC9358337 DOI: 10.1177/20503121221115483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: The COVID-19 corona virus disease outbreak is globally challenging health
systems and societies. Its diagnosis relies on molecular methods, with
drawbacks revealed by mass screening. Upregulation of neutrophil CD64 or
monocyte CD169 has been abundantly reported as markers of bacterial or acute
viral infection, respectively. We evaluated the sensitivity of an easy,
one-step whole blood flow cytometry assay to measure these markers within
10 min, as a potential screening test for COVID-19 patients. Methods: Patients (n = 177) with confirmed severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection were tested on 10 µL blood and
results were compared with reverse transcriptase-quantitative polymerase
chain reaction (RT-qPCR). Results: We observed 98% and 100% sensitivity in early-stage (n = 52)
and asymptomatic patients (n = 9), respectively. Late-stage
patients, who presented for a second control RT-qPCR, were negative for both
assays in most cases. Conversely, neutrophil CD64 expression was unchanged
in 75% of cases, without significant differences between groups. Conclusion: Monocyte CD169 evaluation was highly sensitive for detecting SARS-CoV-2
infection in first-presentation patients; and it returns to basal level upon
infection clearance. The potential ease of fingerprick collection, minimal
time-to-result, and low cost rank this biomarker measurement as a potential
viral disease screening tool, including COVID-19. When the virus prevalence
in the tested population is usually low (1%−10%), such an approach could
increase the testing capacity 10 to 100-fold, with the same limited
molecular testing resources, which could focus on confirmation purposes
only.
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Affiliation(s)
- Moïse Michel
- Aix-Marseille University, Marseille, France.,APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France
| | | | | | | | | | - Isabelle Arnoux
- APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France
| | | | - Matthieu Million
- APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Hervé Tissot-Dupont
- APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille University, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Joana Vitte
- Aix-Marseille University, Marseille, France.,APHM Hôpitaux Universitaires de Marseille, Hôpital Timone, Marseille, France.,IHU Méditerranée Infection, Marseille, France
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Wells CR, Gokcebel S, Pandey A, Galvani AP, Townsend JP. Testing for COVID-19 is Much More Effective When Performed Immediately Prior to Social Mixing. Int J Public Health 2022; 67:1604659. [PMID: 35967267 PMCID: PMC9363582 DOI: 10.3389/ijph.2022.1604659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To quantify the utility of RT-PCR and rapid antigen tests in preventing post-arrival transmission based on timing of the pre-departure test.Methods: We derived analytical expressions to compute post-arrival transmission when no test is performed, and when either an RT-PCR or any of 18 rapid antigen tests is performed at specified times before arrival. We determined the diagnostic sensitivity of the rapid antigen tests by propagating their RT-PCR percent positive agreement onto known RT-PCR diagnostic sensitivity.Results: Depending on the rapid antigen test used, conducting a rapid antigen test immediately before departure reduces post-arrival transmission between 37.4% (95% CrI: 28.2%–40.7%) and 46.7% (95% CrI:40.0%–49.3%), compared to a 31.1% (95% CrI: 26.3%–33.5%) reduction using an RT-PCR 12 h before arrival. Performance of each rapid antigen test differed by diagnostic sensitivity over the course of disease. However, these differences were smaller than those engendered by testing too early.Conclusion: Testing closer to arrival—ideally on the day of arrival—is more effective at reducing post-arrival transmission than testing earlier. Rapid antigen tests perform the best in this application due to their short turnaround time.
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Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Senay Gokcebel
- Yale School of Public Health, New Haven, CT, United States
- Grinnell College, Grinnell, IA, United States
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States
| | - Jeffrey P. Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
- Program in Microbiology, Yale University, New Haven, CT, United States
- *Correspondence: Jeffrey P. Townsend,
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SARS-CoV-2 Seroprevalence among Healthcare Workers after the First and Second Pandemic Waves. Viruses 2022; 14:v14071535. [PMID: 35891515 PMCID: PMC9322964 DOI: 10.3390/v14071535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The Grand Hôpital de Charleroi is a large non-academic Belgian hospital that treated a large number of COVID-19 inpatients. In the context of this pandemic, all professions-combined healthcare workers (HCWs), and not only direct caregivers, are a frontline workforce in contact with suspected and confirmed COVID-19 cases and seem to be a high-risk group for exposure. The aim of our study was to estimate the prevalence of anti-SARS-CoV-2 antibodies in HCWs in our hospital after the first and second pandemic waves and to characterize the distribution of this seroprevalence in relation to various criteria. Methods: At the end of the two recruitment periods, a total of 4008 serological tests were performed in this single-center cross-sectional study. After completing a questionnaire including demographic and personal data, possible previous COVID-19 diagnostic test results and/or the presence of symptoms potentially related to COVID-19, the study participants underwent blood sampling and serological testing using DiaSorin’s LIAISON® SARS-CoV-2 S1/S2 IgG test for the first phase and LIAISON® SARS-CoV-2 TrimericS IgG test for the second phase of this study. Results: In total, 302 study participants (10.72%) in the first round of the study and 404 (33.92%) in the second round were positive for SARS-CoV-2-IgG antibodies. The prevalence of seropositivity observed after the second wave was 3.16 times higher than after the first wave. We confirmed that direct, prolonged, and repeated contact with patients or their environment was a predominant seroconversion factor, but more unexpectedly, that this was the case for all HCWs and not only caregivers. Finally, the notion of high-risk contact seemed more readily identifiable in one’s workplace than in one’s private life. Conclusions: Our study confirmed that HCWs are at a significantly higher risk of contracting COVID-19 than the general population, and suggests that repeated contacts with at-risk patients, regardless of the HCWs’ professions, represents the most important risk factor for seroconversion (Clinicaltrials.gov number, NCT04723290).
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Fischer T, El Baz Y, Scanferla G, Graf N, Waldeck F, Kleger GR, Frauenfelder T, Bremerich J, Kobbe SS, Pagani JL, Schindera S, Conen A, Wildermuth S, Leschka S, Strahm C, Waelti S, Dietrich TJ, Albrich WC. Comparison of temporal evolution of computed tomography imaging features in COVID-19 and influenza infections in a multicenter cohort study. Eur J Radiol Open 2022; 9:100431. [PMID: 35765661 PMCID: PMC9226197 DOI: 10.1016/j.ejro.2022.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To compare temporal evolution of imaging features of coronavirus disease 2019 (COVID-19) and influenza in computed tomography and evaluate their predictive value for distinction. Methods In this retrospective, multicenter study 179 CT examinations of 52 COVID-19 and 44 influenza critically ill patients were included. Lung involvement, main pattern (ground glass opacity, crazy paving, consolidation) and additional lung and chest findings were evaluated by two independent observers. Additional findings and clinical data were compared patient-wise. A decision tree analysis was performed to identify imaging features with predictive value in distinguishing both entities. Results In contrast to influenza patients, lung involvement remains high in COVID-19 patients > 14 days after the diagnosis. The predominant pattern in COVID-19 evolves from ground glass at the beginning to consolidation in later disease. In influenza there is more consolidation at the beginning and overall less ground glass opacity (p = 0.002). Decision tree analysis yielded the following: Earlier in disease course, pleural effusion is a typical feature of influenza (p = 0.007) whereas ground glass opacities indicate COVID-19 (p = 0.04). In later disease, particularly more lung involvement (p < 0.001), but also less pleural (p = 0.005) and pericardial (p = 0.003) effusion favor COVID-19 over influenza. Regardless of time point, less lung involvement (p < 0.001), tree-in-bud (p = 0.002) and pericardial effusion (p = 0.01) make influenza more likely than COVID-19. Conclusions This study identified differences in temporal evolution of imaging features between COVID-19 and influenza. These findings may help to distinguish both diseases in critically ill patients when laboratory findings are delayed or inconclusive. Decision tree analysis helps to distinguish COVID-19 and Influenza. Pleural effusion is a typical feature of influenza in early disease. Ground glass opacities indicate COVID-19 in early disease. Lung involvement remains high in COVID-19 patients > 14 days after the diagnosis. Pleural and pericardial effusion favor influenza over COVID-19 in later disease.
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Key Words
- COPD, Chronic obstructive pulmonary disease
- COVID-19
- COVID-19, Coronavirus disease 2019
- CT, Computed tomography
- Computed tomography
- GGO, Ground glass opacity
- HIV, Human immunodeficiency virus
- HSCT, Haematopoietic stem cell transplantation
- ICC, Intraclass correlation coefficient
- ICU, Intensive care unit
- IQR, Interquartile range
- Influenza
- Lung
- PCR, Polymerase chain reaction
- Pneumonia
- SD, Standard deviation
- SOT, Solid organ transplantation
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Affiliation(s)
- Tim Fischer
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Yassir El Baz
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Giulia Scanferla
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Nicole Graf
- Clinical Trials Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frederike Waldeck
- Division of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gian-Reto Kleger
- Division of Intensive Care, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Jens Bremerich
- Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Sabine Schmidt Kobbe
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jean-Luc Pagani
- Adult Intensive Care Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Anna Conen
- Department of Infectious Diseases and Infection Prevention, Cantonal Hospital Aarau, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Carol Strahm
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Stephan Waelti
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis. Lancet 2022; 399:2351-2380. [PMID: 35405084 PMCID: PMC8993157 DOI: 10.1016/s0140-6736(22)00484-6] [Citation(s) in RCA: 148] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Timely, accurate, and comprehensive estimates of SARS-CoV-2 daily infection rates, cumulative infections, the proportion of the population that has been infected at least once, and the effective reproductive number (Reffective) are essential for understanding the determinants of past infection, current transmission patterns, and a population's susceptibility to future infection with the same variant. Although several studies have estimated cumulative SARS-CoV-2 infections in select locations at specific points in time, all of these analyses have relied on biased data inputs that were not adequately corrected for. In this study, we aimed to provide a novel approach to estimating past SARS-CoV-2 daily infections, cumulative infections, and the proportion of the population infected, for 190 countries and territories from the start of the pandemic to Nov 14, 2021. This approach combines data from reported cases, reported deaths, excess deaths attributable to COVID-19, hospitalisations, and seroprevalence surveys to produce more robust estimates that minimise constituent biases. METHODS We produced a comprehensive set of global and location-specific estimates of daily and cumulative SARS-CoV-2 infections through Nov 14, 2021, using data largely from Johns Hopkins University (Baltimore, MD, USA) and national databases for reported cases, hospital admissions, and reported deaths, as well as seroprevalence surveys identified through previous reviews, SeroTracker, and governmental organisations. We corrected these data for known biases such as lags in reporting, accounted for under-reporting of deaths by use of a statistical model of the proportion of excess mortality attributable to SARS-CoV-2, and adjusted seroprevalence surveys for waning antibody sensitivity, vaccinations, and reinfection from SARS-CoV-2 escape variants. We then created an empirical database of infection-detection ratios (IDRs), infection-hospitalisation ratios (IHRs), and infection-fatality ratios (IFRs). To estimate a complete time series for each location, we developed statistical models to predict the IDR, IHR, and IFR by location and day, testing a set of predictors justified through published systematic reviews. Next, we combined three series of estimates of daily infections (cases divided by IDR, hospitalisations divided by IHR, and deaths divided by IFR), into a more robust estimate of daily infections. We then used daily infections to estimate cumulative infections and the cumulative proportion of the population with one or more infections, and we then calculated posterior estimates of cumulative IDR, IHR, and IFR using cumulative infections and the corrected data on reported cases, hospitalisations, and deaths. Finally, we converted daily infections into a historical time series of Reffective by location and day based on assumptions of duration from infection to infectiousness and time an individual spent being infectious. For each of these quantities, we estimated a distribution based on an ensemble framework that captured uncertainty in data sources, model design, and parameter assumptions. FINDINGS Global daily SARS-CoV-2 infections fluctuated between 3 million and 17 million new infections per day between April, 2020, and October, 2021, peaking in mid-April, 2021, primarily as a result of surges in India. Between the start of the pandemic and Nov 14, 2021, there were an estimated 3·80 billion (95% uncertainty interval 3·44-4·08) total SARS-CoV-2 infections and reinfections combined, and an estimated 3·39 billion (3·08-3·63) individuals, or 43·9% (39·9-46·9) of the global population, had been infected one or more times. 1·34 billion (1·20-1·49) of these infections occurred in south Asia, the highest among the seven super-regions, although the sub-Saharan Africa super-region had the highest infection rate (79·3 per 100 population [69·0-86·4]). The high-income super-region had the fewest infections (239 million [226-252]), and southeast Asia, east Asia, and Oceania had the lowest infection rate (13·0 per 100 population [8·4-17·7]). The cumulative proportion of the population ever infected varied greatly between countries and territories, with rates higher than 70% in 40 countries and lower than 20% in 39 countries. There was no discernible relationship between Reffective and total immunity, and even at total immunity levels of 80%, we observed no indication of an abrupt drop in Reffective, indicating that there is not a clear herd immunity threshold observed in the data. INTERPRETATION COVID-19 has already had a staggering impact on the world up to the beginning of the omicron (B.1.1.529) wave, with over 40% of the global population infected at least once by Nov 14, 2021. The vast differences in cumulative proportion of the population infected across locations could help policy makers identify the transmission-prevention strategies that have been most effective, as well as the populations at greatest risk for future infection. This information might also be useful for targeted transmission-prevention interventions, including vaccine prioritisation. Our statistical approach to estimating SARS-CoV-2 infection allows estimates to be updated and disseminated rapidly on the basis of newly available data, which has and will be crucially important for timely COVID-19 research, science, and policy responses. FUNDING Bill & Melinda Gates Foundation, J Stanton, T Gillespie, and J and E Nordstrom.
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Preoperative monocytosis is predictable at diagnosis for RT-PCR negative COVİD-19 paediatric cardiac surgery patients. Cardiol Young 2022; 32:883-887. [PMID: 34365984 DOI: 10.1017/s104795112100319x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Other markers investigated in this population have gained importance in the diagnosis of the disease since the course of COVID-19 disease is atypical in the paediatric population and PCR may be misleading. The leukocyte profile is one of these biochemical tests. Children did not have lymphopenia in hemogram count, whereas relatively neutropenia and monocytosis were detected, unlike the adult population. The reason why children do not have lymphopenia is thought to be due to the fact that the thymus is more active in the first years of life.Two-hundred and four patients operated in our paediatric cardiac surgery clinic from 11March, 2020 to 1 April, 2021 were retrospectively examined and 11 patients with preoperative asymptomatic and PCR (-), but with PCR (+) in the post-operative period (patients with incubation period or false PCR negativity) were included in our study. Patients requiring emergency operation and operated from PCR (+) patients in the preoperative period were excluded from the study.The neutrophil ratio in the lymphocytic series of 7 patients out of 11 patients was slightly below the normal range in the preoperative period, the lymphocyte ratio of 3 patients was slightly above the normal range, and the relative monocyte ratio of 10 patients was slightly above the normal range.We think that evaluating the leukocyte profile combined with RT-PCR will give more accurate results in the diagnosis of incubation period and false RT-PCR negative patients. In addition, we believe that the algorithms for non-complex paediatric cardiac surgery procedures and timing in the paediatric population with a better course of COVID-19 disease with a positive post-operative course.
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Anti-SARS-CoV-2 Titers Predict the Severity of COVID-19. Viruses 2022; 14:v14051089. [PMID: 35632830 PMCID: PMC9143418 DOI: 10.3390/v14051089] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 is associated with a wide spectrum of disease, ranging from asymptomatic infection to acute respiratory distress syndrome. Some biomarkers may predict disease severity. Among them, the anti-SARS-CoV-2 antibody response has been related to severe disease. The aim of this study was to assess the correlation between the anti-SARS-CoV-2 serological response and COVID-19 outcome. Demographic, clinical, and biological data from nasopharyngeal-PCR confirmed COVID-19 hospitalized patients were prospectively collected between April and August 2020 at our institution. All patients had serial weekly serology testing for a maximum of three blood samples or until discharge. Two different serological assays were used: a chemiluminescent assay and an in-house developed Luminex immunoassay. Kinetics of the serological response and correlation between the antibody titers and outcome were assessed. Among the 70 patients enrolled in the study, 22 required invasive ventilation, 29 required non-invasive ventilation or oxygen supplementation, and 19 did not require any oxygen supplementation. Median duration of symptoms upon admission for the three groups were 13, 8, and 9 days, respectively. Antibody titers gradually increased for up to 3 weeks since the onset of symptoms for patients requiring oxygen supplementation with significantly higher antibody titers for patients requiring invasive ventilation. Antibody titers on admission were also significantly higher in severely ill patients and serology performed well in predicting the necessity of invasive ventilation (AUC: 0.79, 95% CI: 0.67–0.9). Serology testing at admission may be a good indicator to identify severe COVID-19 patients who will require invasive mechanical ventilation.
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An olfactory self-test effectively screens for COVID-19. COMMUNICATIONS MEDICINE 2022; 2:34. [PMID: 35603293 PMCID: PMC9053292 DOI: 10.1038/s43856-022-00095-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/18/2022] [Indexed: 01/05/2023] Open
Abstract
Background Key to curtailing the COVID-19 pandemic are wide-scale screening strategies. An ideal screen is one that would not rely on transporting, distributing, and collecting physical specimens. Given the olfactory impairment associated with COVID-19, we developed a perceptual measure of olfaction that relies on smelling household odorants and rating them online. Methods Each participant was instructed to select 5 household items, and rate their perceived odor pleasantness and intensity using an online visual analogue scale. We used this data to assign an olfactory perceptual fingerprint, a value that reflects the perceived difference between odorants. We tested the performance of this real-time tool in a total of 13,484 participants (462 COVID-19 positive) from 134 countries who provided 178,820 perceptual ratings of 60 different household odorants. Results We observe that olfactory ratings are indicative of COVID-19 status in a country, significantly correlating with national infection rates over time. More importantly, we observe indicative power at the individual level (79% sensitivity and 87% specificity). Critically, this olfactory screen remains effective in participants with COVID-19 but without symptoms, and in participants with symptoms but without COVID-19. Conclusions The current odorant-based olfactory screen adds a component to online symptom-checkers, to potentially provide an added first line of defense that can help fight disease progression at the population level. The data derived from this tool may allow better understanding of the link between COVID-19 and olfaction. From early on in the COVID-19 pandemic, a symptom associated with infection was rapid and often complete loss of the sense of smell. This rendered smell testing a potentially helpful tool in large-scale screening for SARS-CoV-2 infection. We built an online tool (smelltracker.org) that enables assessment of the sense of smell using commonly available household odorants. Initial use by 13,484 participants (462 COVID-19 positive) from 134 countries corroborated that SARS-CoV-2 infection is associated with impaired smell. Moreover, the tool detected infection in the absence of any other symptoms, including subjective loss in smell. Use of this tool may provide an added instrument for screening SARS-CoV-2 infection, and the data generated by the tool may provide for deeper understanding of the brain mechanisms involved with loss of smell associated with COVID-19. Snitz et al. develop a web-based olfactory screening tool for COVID-19, which relies on users smelling household odorants. Based on data from participants in 134 countries, the authors report that olfactory ratings are indicative of COVID-19 status.
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Vyas JM, Castle AC, Bourgouin PP, Turbett SE. Case 9-2022: A 56-Year-Old Woman with Fever, Myalgias, Diarrhea, and Cough. N Engl J Med 2022; 386:1166-1174. [PMID: 35320647 DOI: 10.1056/nejmcpc2115846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jatin M Vyas
- From the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Alison C Castle
- From the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Patrick P Bourgouin
- From the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
| | - Sarah E Turbett
- From the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.M.V., A.C.C., S.E.T.), Radiology (P.P.B.), and Pathology (S.E.T.), Harvard Medical School - both in Boston
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Arbaciauskaite S, Babakhani P, Sandetskaya N, Vitkus D, Jancoriene L, Karosiene D, Karciauskaite D, Zablockiene B, Kuhlmeier D. Self-Sampled Gargle Water Direct RT-LAMP as a Screening Method for the Detection of SARS-CoV-2 Infections. Diagnostics (Basel) 2022; 12:diagnostics12040775. [PMID: 35453823 PMCID: PMC9030430 DOI: 10.3390/diagnostics12040775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022] Open
Abstract
We assessed the viability of self-sampled gargle water direct RT-LAMP (LAMP) for detecting SARS-CoV-2 infections by estimating its sensitivity with respect to the gold standard indirect RT-PCR of paired oro-nasopharyngeal swab samples. We also assessed the impact of symptom onset to test time (STT)—i.e., symptom days at sampling, on LAMP. In addition, we appraised the viability of gargle water self-sampling versus oro-nasopharyngeal swab sampling, by comparing paired indirect RT-PCR results. 202 oro-nasopharyngeal swab and paired self-sampled gargle water samples were collected from hospital patients with COVID-19 associated symptoms. LAMP, indirect and direct RT-PCR were performed on all gargle water samples, and indirect RT-PCR was performed on all oro-nasopharyngeal samples. LAMP presented a sensitivity of 80.8% (95% CI: 70.8–90.8%) for sample pairs with sub-25 Ct oro-nasopharyngeal indirect RT-PCR results, and 77.6% (66.2–89.1%) sensitivity for sub-30 Ct samples with STT ≤ 7 days. STT, independently of Ct value, correlated negatively with LAMP performance. 80.7% agreement was observed between gargle water and oro-nasopharyngeal indirect RT-PCR results. In conclusion, LAMP presents an acceptable sensitivity for low Ct and low STT samples. Gargle water may be considered as a viable sampling method, and LAMP as a screening method, especially for symptomatic persons with low STT values.
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Affiliation(s)
- Skaiste Arbaciauskaite
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology IZI, Perlickstraße 1, 04103 Leipzig, Germany; (N.S.); (D.K.)
- Institute of Cell Biology and Neurobiology, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Correspondence:
| | - Pouya Babakhani
- Department of Computer Science, University of Bath, Claverton Down, Bath BA2 7AY, UK;
| | - Natalia Sandetskaya
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology IZI, Perlickstraße 1, 04103 Leipzig, Germany; (N.S.); (D.K.)
| | - Dalius Vitkus
- Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, M.K. Ciurlionio 21, LT-03101 Vilnius, Lithuania; (D.V.); (D.K.)
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Santariskiu 14, LT-08406 Vilnius, Lithuania;
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, M.K. Ciurlionio 21, LT-03101 Vilnius, Lithuania; (L.J.); (B.Z.)
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu 14, LT-08406 Vilnius, Lithuania
| | - Dovile Karosiene
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Santariskiu 14, LT-08406 Vilnius, Lithuania;
| | - Dovile Karciauskaite
- Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, M.K. Ciurlionio 21, LT-03101 Vilnius, Lithuania; (D.V.); (D.K.)
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Santariskiu 14, LT-08406 Vilnius, Lithuania;
| | - Birute Zablockiene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, M.K. Ciurlionio 21, LT-03101 Vilnius, Lithuania; (L.J.); (B.Z.)
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Santariskiu 14, LT-08406 Vilnius, Lithuania
| | - Dirk Kuhlmeier
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology IZI, Perlickstraße 1, 04103 Leipzig, Germany; (N.S.); (D.K.)
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Ziauddeen N, Gurdasani D, O’Hara ME, Hastie C, Roderick P, Yao G, Alwan NA. Characteristics and impact of Long Covid: Findings from an online survey. PLoS One 2022; 17:e0264331. [PMID: 35259179 PMCID: PMC8903286 DOI: 10.1371/journal.pone.0264331] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/06/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Long Covid is a public health concern that needs defining, quantifying, and describing. We aimed to explore the initial and ongoing symptoms of Long Covid following SARS-CoV-2 infection and describe its impact on daily life. METHODS We collected self-reported data through an online survey using convenience non-probability sampling. The survey enrolled adults who reported lab-confirmed (PCR or antibody) or suspected COVID-19 who were not hospitalised in the first two weeks of illness. This analysis was restricted to those with self-reported Long Covid. Univariate comparisons between those with and without confirmed COVID-19 infection were carried out and agglomerative hierarchical clustering was used to identify specific symptom clusters, and their demographic and functional correlates. RESULTS We analysed data from 2550 participants with a median duration of illness of 7.6 months (interquartile range (IQR) 7.1-7.9). 26.5% reported lab-confirmation of infection. The mean age was 46.5 years (standard deviation 11 years) with 82.8% females and 79.9% of participants based in the UK. 89.5% described their health as good, very good or excellent before COVID-19. The most common initial symptoms that persisted were exhaustion, chest pressure/tightness, shortness of breath and headache. Cognitive dysfunction and palpitations became more prevalent later in the illness. Most participants described fluctuating (57.7%) or relapsing symptoms (17.6%). Physical activity, stress, and sleep disturbance commonly triggered symptoms. A third (32%) reported they were unable to live alone without any assistance at six weeks from start of illness. 16.9% reported being unable to work solely due to COVID-19 illness. 37.0% reported loss of income due to illness, and 64.4% said they were unable to perform usual activities/duties. Acute systems clustered broadly into two groups: a majority cluster (n = 2235, 88%) with cardiopulmonary predominant symptoms, and a minority cluster (n = 305, 12%) with multisystem symptoms. Similarly, ongoing symptoms broadly clustered in two groups; a majority cluster (n = 2243, 88.8%) exhibiting mainly cardiopulmonary, cognitive symptoms and exhaustion, and a minority cluster (n = 283, 11.2%) exhibiting more multisystem symptoms. Belonging to the more severe multisystem cluster was associated with more severe functional impact, lower income, younger age, being female, worse baseline health, and inadequate rest in the first two weeks of the illness, with no major differences in the cluster patterns when restricting analysis to the lab-confirmed subgroup. CONCLUSION This is an exploratory survey of Long Covid characteristics. Whilst this is a non-representative population sample, it highlights the heterogeneity of persistent symptoms, and the significant functional impact of prolonged illness following confirmed or suspected SARS-CoV-2 infection. To study prevalence, predictors and prognosis, research is needed in a representative population sample using standardised case definitions.
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Affiliation(s)
- Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Margaret E. O’Hara
- Patient contributor, Long Covid Support: www.longcovid.org, London, United Kingdom
| | - Claire Hastie
- Patient contributor, Long Covid Support: www.longcovid.org, London, United Kingdom
| | - Paul Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Guiqing Yao
- Department of Health Science, University of Leicester, Leicester, United Kingdom
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Ochola L, Ogongo P, Mungai S, Gitaka J, Suliman S. Performance Evaluation of Lateral Flow Assays for Coronavirus Disease-19 Serology. Clin Lab Med 2022; 42:31-56. [PMID: 35153047 PMCID: PMC8563367 DOI: 10.1016/j.cll.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic, caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has undoubtedly resulted in significant morbidities, mortalities, and economic disruptions across the globe. Affordable and scalable tools to monitor the transmission dynamics of the SARS-CoV-2 virus and the longevity of induced antibodies will be paramount to monitor and control the pandemic as multiple waves continue to rage in many countries. Serologic assays detect humoral responses to the virus, to determine seroprevalence in target populations, or induction of antibodies at the individual level following either natural infection or vaccination. With multiple vaccines rolling out globally, serologic assays to detect anti-SARS-CoV-2 antibodies will be important tools to monitor the development of herd immunity. To address this need, serologic lateral flow assays (LFAs), which can be easily implemented for both population surveillance and home use, will be vital to monitor the evolution of the pandemic and inform containment measures. Such assays are particularly important for monitoring the transmission dynamics and durability of immunity generated by natural infections and vaccination, particularly in resource-limited settings. In this review, we discuss considerations for evaluating the accuracy of these LFAs, their suitability for different use cases, and implementation opportunities.
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Affiliation(s)
- Lucy Ochola
- Department of Tropical and Infectious Diseases, Institute of Primate Research, National Museums of Kenya, PO Box 24481, Nairobi 00502, Kenya
| | - Paul Ogongo
- Department of Tropical and Infectious Diseases, Institute of Primate Research, National Museums of Kenya, PO Box 24481, Nairobi 00502, Kenya; Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Samuel Mungai
- Directorate of Research and Innovation, Mount Kenya University, PO Box 342-01000, Thika, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, PO Box 342-01000, Thika, Kenya
| | - Sara Suliman
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Marando M, Tamburello A, Gianella P, Taylor R, Bernasconi E, Fusi-Schmidhauser T. Diagnostic sensitivity of RT-PCR assays on nasopharyngeal specimens for detection of SARS-CoV-2 infection: A Systematic Review and Meta-Analysis. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:139-147. [PMID: 35872685 PMCID: PMC9272971 DOI: 10.22088/cjim.13.0.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 10/31/2022]
Abstract
Background Reverse transcription polymerase chain reaction (RT-PCR) is the current standard of reference in the diagnosis of SARS-CoV-2 infection. In outpatient clinical practice, nasopharyngeal swab RT-PCR testing is still the most common procedure. The purpose of this systematic review and meta-analysis was to evaluate the sensitivity of RT-PCR nasopharyngeal assays. Methods We searched three databases, including PubMed/MEDLINE, EMBASE, and Cochrane Library, using a comprehensive strategy. Studies investigating the sensitivity of SARS-CoV-2 RT-PCR nasopharyngeal assays in adults were included. Two reviewers extracted data and assessed trial quality independently. Pooled sensitivity and its confidence interval were computed using the meta package in R. Results Thirteen studies were found eligible for the inclusion in the systematic review. Out of these, 25 different sub-studies were identified and included in the meta-analysis, which reported the sensitivities of 25 different nasopharyngeal RT-PCR assays. Finally, the overall pooled sensitivity resulted 89% (95% CI, 85.4 to 91.8%). Conclusion Our study suggests that RT-PCR assays on nasopharyngeal specimens have a substantial sensitivity for diagnosing SARS-CoV-2 infection.
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Affiliation(s)
- Marco Marando
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Adriana Tamburello
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Pietro Gianella
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland,Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Rebecca Taylor
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Enos Bernasconi
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland,Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Tanja Fusi-Schmidhauser
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
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The Prognostic Value of an RT-PCR Test for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Is Contingent on Timing across Disease Time Course in addition to Assay Sensitivity. J Mol Diagn 2022; 24:101-103. [PMID: 34974875 PMCID: PMC8717055 DOI: 10.1016/j.jmoldx.2021.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 01/12/2023] Open
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Cederstrom V, Erickson H, Leatherman J. Acute Hypoxemic Respiratory Failure with High Clinical Suspicion of COVID-19 Despite Negative PCR: a Case for Empiric Corticosteroids and Role of Serum Antibody in Diagnosis. J Gen Intern Med 2022; 37:232-235. [PMID: 34704203 PMCID: PMC8547287 DOI: 10.1007/s11606-021-07177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Vannesa Cederstrom
- Internal Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Heidi Erickson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - James Leatherman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
- University of Minnesota, Minneapolis, MN, USA.
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Yokoyama R, Kurano M, Nakano Y, Morita Y, Ohmiya H, Kishi Y, Okada J, Qian C, Xia F, He F, Zheng L, Yu Y, Mizoguchi M, Higurashi Y, Harada S, Jubishi D, Okamoto K, Moriya K, Kodama T, Yatomi Y. Association of the Serum Levels of the Nucleocapsid Antigen of SARS-CoV-2 With the Diagnosis, Disease Severity, and Antibody Titers in Patients With COVID-19: A Retrospective Cross-Sectional Study. Front Microbiol 2021; 12:791489. [PMID: 34956158 PMCID: PMC8696188 DOI: 10.3389/fmicb.2021.791489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Several types of laboratory tests for COVID-19 have been established to date; however, the clinical significance of the serum SARS-CoV-2 nucleocapsid (N) antigen levels remains to be fully elucidated. In the present study, we attempted to elucidate the usefulness and clinical significance of the serum N antigen levels. Methods: We measured the serum N antigen levels in 391 serum samples collected from symptomatic patients with a confirmed diagnosis of COVID-19 and 96 serum samples collected from patients with non-COVID-19, using a fully automated chemiluminescence immunoassay analyzer. Results: Receiver operating characteristic analysis identified the optimal cutoff value of the serum N antigen level (cutoff index, based on Youden’s index) as 0.255, which yielded a sensitivity and specificity for the diagnosis of COVID-19 of 91.0 and 81.3%, respectively. The serum N antigen levels were significantly higher in the patient groups with moderate and severe COVID-19 than with mild disease. Moreover, a significant negative correlation was observed between the serum N antigen levels and the SARS-CoV-2 IgG antibody titers, especially in patients with severe COVID-19. Conclusion: Serum N antigen testing might be useful both for the diagnosis of COVID-19 and for obtaining a better understanding of the clinical features of the disease.
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Affiliation(s)
- Rin Yokoyama
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Kurano
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Nakano
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshifumi Morita
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroko Ohmiya
- Sales and Marketing Division, Business Planning Department, Medical and Biological Laboratories Co., Ltd., Tokyo, Japan
| | - Yoshiro Kishi
- Sales and Marketing Division, Business Planning Department, Medical and Biological Laboratories Co., Ltd., Tokyo, Japan
| | - Jun Okada
- Sales and Marketing Division, Business Planning Department, Medical and Biological Laboratories Co., Ltd., Tokyo, Japan
| | - Chungen Qian
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics and Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Fuzhen Xia
- Reagent R and D Center, Shenzhen YHLO Biotech Co., Ltd., Guangdong, China
| | - Fan He
- Reagent R and D Center, Shenzhen YHLO Biotech Co., Ltd., Guangdong, China
| | - Liang Zheng
- Reagent R and D Center, Shenzhen YHLO Biotech Co., Ltd., Guangdong, China
| | - Yi Yu
- Reagent R and D Center, Shenzhen YHLO Biotech Co., Ltd., Guangdong, China
| | - Miyuki Mizoguchi
- Department of Infection Control and Prevention, The University of Tokyo, Tokyo, Japan
| | - Yoshimi Higurashi
- Department of Infection Control and Prevention, The University of Tokyo, Tokyo, Japan
| | - Sohei Harada
- Department of Infection Control and Prevention, The University of Tokyo, Tokyo, Japan
| | - Daisuke Jubishi
- Department of Infection Control and Prevention, The University of Tokyo, Tokyo, Japan
| | - Koh Okamoto
- Department of Infection Control and Prevention, The University of Tokyo, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, The University of Tokyo, Tokyo, Japan
| | - Tatsuhiko Kodama
- Laboratory for Systems Biology and Medicine, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Navarro-Carrera P, Roces-Álvarez P, Ramos-Ramos JC, Montero D, Losantos I, Díaz-Pollán B, García Bujalance S. Characteristics of patients with suspected COVID-19 pneumonia and repeatedly negative RT-PCR. Access Microbiol 2021; 3:000279. [PMID: 35024549 PMCID: PMC8749149 DOI: 10.1099/acmi.0.000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Challenges remain and there are still a sufficient number of cases with epidemiological, clinical features and radiological data suggestive of COVID-19 pneumonia that persist negative in their RT-PCR results. The aim of the study was to define the distinguishing characteristics between patients developing a serological response to SARS-CoV-2 and those who did not. Methods RT-PCR tests used were TaqPath 2019-nCoV Assay Kit v1 (ORF-1ab, N and S genes) from Thermo Fisher Diagnostics and SARS-COV-2 Kit (N and E genes) from Vircell. Serological response was tested using the rapid SARS-CoV2 IgG/IgM Test Cassette from T and D Diagnostics Canada and CMC Medical Devices and Drugs, S.L, CE. Results In this cross-sectional study, we included a cohort of 52 patients recruited from 31 March 2020 to 23 April 2020. Patients with positive serology had an older average age (73.29) compared to those who were negative (54.82) (P<0.05). Sat02 in 27 of 34 patients with positive serology were below 94% (P<0.05). There was a frequency of 1.5% negative SARS-CoV-2 RT-PCRs during the study period concurring with 36.7% of positivity. Conclusion Clinical features and other biomarkers in a context of a positive serology can be considered crucial for diagnosis.
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Affiliation(s)
- Paula Navarro-Carrera
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Patricia Roces-Álvarez
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Juan Carlos Ramos-Ramos
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Dolores Montero
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Itsaso Losantos
- Section of Biostatistics- IdiPAZ, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Beatriz Díaz-Pollán
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
| | - Silvia García Bujalance
- Department of Clinical Microbiology and Parasitology, Hospital Universitario La Paz-H. Carlos III, 28046 Madrid, Spain
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50
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Slynko A. Assessing the accuracy of an imperfect dichotomous test in a multiple testing context. Math Biosci 2021; 343:108729. [PMID: 34762905 DOI: 10.1016/j.mbs.2021.108729] [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: 08/20/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
In this paper we address the situation where a well-established, but invasive, expensive or time-consuming diagnostic test may be replaced by multiple repetitions of a different diagnostic test which is known to be imperfect but less invasive or expensive. With an imperfect diagnostic test repeated several times on the same patient, we first introduce the sensitivity and specificity of that test for any given number of test repetitions. We also derive the corresponding asymptotic limits for sensitivity and specificity as the number n of test repetitions increases. Given those limits, we then derive sharp upper bounds for the differences between the sensitivity and specificity, obtained for a given number n of test repetitions, and the corresponding asymptotic limit. Specifically, we provide exact rates for the convergence of the empirical sensitivities and specificities. Our analysis is motivated, among other things, by the current discussion on rapid SARS-CoV-2 testing where the real-time polymerase chain reaction (RT-PCR) test may be replaced with a sequence of rapid lateral-flow antigen tests.
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