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O'Brien SF, Asamoah-Boaheng M, Grunau B, Krajden M, Buckeridge DL, Goldfarb DM, Anderson M, Germain M, Brown P, Stein DR, Kandola K, Tipples G, Awadalla P, Lang A, Behl L, Fitzpatrick T, Drews SJ. Canada's approach to SARS-CoV-2 sero-surveillance: Lessons learned for routine surveillance and future pandemics. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:558-566. [PMID: 38981961 DOI: 10.17269/s41997-024-00901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/24/2024] [Indexed: 07/11/2024]
Abstract
SETTING In Canada's federated healthcare system, 13 provincial and territorial jurisdictions have independent responsibility to collect data to inform health policies. During the COVID-19 pandemic (2020-2023), national and regional sero-surveys mostly drew upon existing infrastructure to quickly test specimens and collect data but required cross-jurisdiction coordination and communication. INTERVENTION There were 4 national and 7 regional general population SARS-CoV-2 sero-surveys. Survey methodologies varied by participant selection approaches, assay choices, and reporting structures. We analyzed Canadian pandemic sero-surveillance initiatives to identify key learnings to inform future pandemic planning. OUTCOMES Over a million samples were tested for SARS-CoV-2 antibodies from 2020 to 2023 but siloed in 11 distinct datasets. Most national sero-surveys had insufficient sample size to estimate regional prevalence; differences in methodology hampered cross-regional comparisons of regional sero-surveys. Only four sero-surveys included questionnaires. Sero-surveys were not directly comparable due to different assays, sampling methodologies, and time-frames. Linkage to health records occurred in three provinces only. Dried blood spots permitted sample collection in remote populations and during stay-at-home orders. IMPLICATIONS To provide timely, high-quality information for public health decision-making, routine sero-surveillance systems must be adaptable, flexible, and scalable. National capability planning should include consortiums for assay design and validation, defined mechanisms to improve test capacity, base documents for data linkage and material transfer across jurisdictions, and mechanisms for real-time communication of data. Lessons learned will inform incorporation of a robust sero-survey program into routine surveillance with strategic sampling and capacity to adapt and scale rapidly as a part of a comprehensive national pandemic response plan.
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Affiliation(s)
- Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, ON, Canada.
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Michael Asamoah-Boaheng
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Mel Krajden
- Public Health Laboratory, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David L Buckeridge
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Maureen Anderson
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
- Ministry of Health, Government of Saskatchewan, Regina, SK, Canada
| | - Marc Germain
- Affaires médicales et innovation, Héma-Québec, Québec, QC, Canada
| | - Patrick Brown
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Derek R Stein
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kami Kandola
- Government of Northwest Territories, Yellowknife, NT, Canada
| | - Graham Tipples
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, University of Toronto, Toronto, ON, Canada
| | - Amanda Lang
- Roy Romanow Provincial Laboratory, Saskatchewan Health Authority, Regina, SK, Canada
| | - Lesley Behl
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tiffany Fitzpatrick
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Services, Edmonton, AB, Canada
- Division of Diagnostics and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
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Li C, Zhang C, Chen J, Chen Y, Ying Z, Hu Y, Song H, Fu P, Zeng X. The Time-Varying Impact of COVID-19 on the Acute Kidney Disorders: A Historical Matched Cohort Study and Mendelian Randomization Analysis. HEALTH DATA SCIENCE 2024; 4:0159. [PMID: 39011273 PMCID: PMC11246837 DOI: 10.34133/hds.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/04/2024] [Indexed: 07/17/2024]
Abstract
Background: This study aimed to explore the time-varying impact of COVID-19 on acute kidney disorders, including acute kidney injury and other acute kidney diseases. Methods: From the UK Biobank, 10,121 participants with COVID-19 were matched with up to 3 historically unexposed controls by age, sex, Townsend deprivation index, and the status of hospitalization or receiving critical care. We investigated the association between COVID-19 and incidence of acute kidney disorders, within the first 4 weeks after infection, using conditional and time-varying Cox proportional hazard regression. In addition, one-sample Mendelian randomization, utilizing the polygenic risk score for COVID-19 as an instrumental variable, was conducted to explore the potential causality of the association. Results: In the matched cohort study, we observed a significant association between COVID-19 and acute kidney disorders predominantly within the first 3 weeks. The impact of COVID-19 was time dependent, peaking in the second week (hazard ratio, 12.77; 95% confidence interval, 5.93 to 27.70) and decreasing by the fourth week (hazard ratio, 2.28; 95% confidence interval, 0.75 to 6.93). In subgroup analyses, only moderate to severe COVID-19 cases were associated with acute worsening of renal function in a time-dependent pattern. One-sample Mendelian randomization analyses further showed that COVID-19 might exert a "short-term" causal effect on the risk of acute kidney disorders, primarily confined to the first week after infection. Conclusions: The risk of acute kidney disorders following COVID-19 demonstrates a time-varying pattern. Hazard effects were observed only in patients with moderate or severe but not mild COVID-19.
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Affiliation(s)
- Chunyang Li
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
| | - Chao Zhang
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
| | - Jie Chen
- Department of Core Laboratory, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Yilong Chen
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
| | - Zhiye Ying
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
| | - Yao Hu
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
| | - Huan Song
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ping Fu
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoxi Zeng
- Division of Nephrology, West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Med-X Center for Informatics, Sichuan University, Chengdu 610065, China
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Dvořák M, Kubáň P. Automated analyses of dried blood spots collected by volumetric microsampling devices. Anal Chim Acta 2024; 1310:342718. [PMID: 38811137 DOI: 10.1016/j.aca.2024.342718] [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: 02/05/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Dried blood spot (DBS) sampling on cellulose cards suffers from varying blood haematocrit levels and from chromatographic effects, which have a direct impact on quantitative DBS analyses. Commercial volumetric microsampling devices were, therefore, introduced to mitigate these effects, however, these devices are not compatible with automated DBS processing systems and must be processed manually. RESULTS Capillary electrophoresis (CE) instruments use fused-silica (FS) capillaries for precise and accurate liquid handling as well as for injection, separation, and quantitative analyses of liquid samples. These inherent features of an Agilent 7100 CE instrument were employed for the automated processing (elution and homogenization) of DBSs collected by hemaPEN® volumetric devices (2.74 μL of capillary blood per spot). The hemaPEN® samples were processed directly in CE vials by consecutive transfers of 56 μL of methanol and 14 μL of deionized water through the FS capillary in a sequence of 39 DBSs with repeatability of the liquid transfers better than 1.4 %. The resulting DBS eluates were homogenized by a quick air flush through the capillary and analyzed by the same capillary and CE instrument. Creatinine was selected as a clinically relevant model analyte and its endogenous concentrations in DBSs were determined by CE with capacitively coupled contactless conductivity detection (CE-C4D) in a background electrolyte solution consisting of 50 mM acetic acid and 0.1 % (v/v) Tween 20 (pH 3.0). The overall repeatability of the automated DBS processing and CE-C4D analyses of 39 DBSs was ≤7.1 % (peak areas) and ≤0.6 % (migration times), the calibration curve was linear in the 25-500 μM range (R2 = 0.9993) and covered all endogenous blood creatinine levels, the limit of detection was 5.0 μM, and sample throughput was >12 DBSs per hour. DBS ageing for 60 days and varying blood haematocrit levels (20-70 %) did not affect creatinine quantitative results (≤6.9 % for peak areas). Inter-capillary and inter-instrument repeatability was ≤7.7 % (peak areas) and ≤3.4 % (migration times) and demonstrated an excellent transferability of the proposed analytical concept among laboratories. SIGNIFICANCE AND NOVELTY This contribution is the first-ever report on the use of a single off-the-shelf analytical instrument for fully automated analyses of DBSs collected by commercial volumetric microsampling devices and holds great promise for future unmanned quantitative DBS analyses.
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Affiliation(s)
- Miloš Dvořák
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic
| | - Pavel Kubáň
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic.
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Bean DJ, Monroe J, Liang YM, Borberg E, Senussi Y, Swank Z, Chalise S, Walt D, Weinberg J, Sagar M. Heterotypic immunity from prior SARS-CoV-2 infection but not COVID-19 vaccination associates with lower endemic coronavirus incidence. Sci Transl Med 2024; 16:eado7588. [PMID: 38865483 DOI: 10.1126/scitranslmed.ado7588] [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: 02/19/2024] [Accepted: 05/07/2024] [Indexed: 06/14/2024]
Abstract
Immune responses from prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccination mitigate disease severity, but they do not fully prevent subsequent infections, especially from genetically divergent strains. We examined the incidence of and immune differences against human endemic coronaviruses (eCoVs) as a proxy for response against future genetically heterologous coronaviruses (CoVs). We assessed differences in symptomatic eCoV and non-CoV respiratory disease incidence among those with known prior SARS-CoV-2 infection or previous COVID-19 vaccination but no documented SARS-CoV-2 infection or neither exposure. Retrospective cohort analyses suggest that prior SARS-CoV-2 infection, but not previous COVID-19 vaccination alone, associates with a lower incidence of subsequent symptomatic eCoV infection. There was no difference in non-CoV incidence, implying that the observed difference was eCoV specific. In a second cohort where both cellular and humoral immunity were measured, those with prior SARS-CoV-2 spike protein exposure had lower eCoV-directed neutralizing antibodies, suggesting that neutralization is not responsible for the observed decreased eCoV disease. The three groups had similar cellular responses against the eCoV spike protein and nucleocapsid antigens. However, CD8+ T cell responses to the nonstructural eCoV proteins nsp12 and nsp13 were higher in individuals with previous SARS-CoV-2 infection as compared with the other groups. This association between prior SARS-CoV-2 infection and decreased incidence of eCoV disease may therefore be due to a boost in CD8+ T cell responses against eCoV nsp12 and nsp13, suggesting that incorporation of nonstructural viral antigens in a future pan-CoV vaccine may improve vaccine efficacy.
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Affiliation(s)
- David J Bean
- Department of Virology, Immunology and Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Janet Monroe
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Yan Mei Liang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Ella Borberg
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
| | - Yasmeen Senussi
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
| | - Zoe Swank
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
| | - Sujata Chalise
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
| | - David Walt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02215, USA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Manish Sagar
- Department of Virology, Immunology and Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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Arbel Y, Arbel Y, Kerner A, Kerner M. Can COVID-19 herd immunity be achieved at a city level? PLoS One 2024; 19:e0299574. [PMID: 38809902 PMCID: PMC11135690 DOI: 10.1371/journal.pone.0299574] [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: 08/04/2023] [Accepted: 02/12/2024] [Indexed: 05/31/2024] Open
Abstract
We propose a new approach to estimate the vaccination rates required to achieve herd immunity against SARS-COV2 virus at a city level. Based on information obtained from the Israeli Ministry of Health, we estimate two separate quadratic models, one for each dose of the BNT162b2 mRNA Pfizer vaccine. The dependent variable is the scope of morbidity, expressed as the number of cases per 10,000 persons. The independent variables are the first and second vaccination rates and their squares. The outcomes corroborate that herd immunity is achieved in the case that 71 percent of the urban population is vaccinated, and the minimum anticipated scope of morbidity is approximately 5 active COVID-19 cases per 10,000 persons, compared to 53-67 cases per 10,000 persons for zero vaccination rate. Findings emphasize the importance of vaccinations and demonstrate that urban herd immunity may be defined as a situation in which people continue to interact, yet the COVID-19 spread is contained. This, in turn, might prevent the need for lockdowns or other limitations at the city level.
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Affiliation(s)
- Yuval Arbel
- Sir Harry Solomon School of Economics and Management, Western Galilee College, Acre, Israel
| | - Yifat Arbel
- Department of Mathematics, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Kerner
- Faculty of Social Sciences, Banking and Finance Program, Bar Ilan University, Ramat Gan, Israel
| | - Miryam Kerner
- The Ruth and Bruce Rapoport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Dermatology, Emek Medical Center, Afula, Israel
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Stanley HB, Pereda-Campos V, Mantel M, Rouby C, Daudé C, Aguera PE, Fornoni L, Hummel T, Weise S, Mignot C, Konstantinidis I, Garefis K, Ferdenzi C, Pierron D, Bensafi M. Identification of the needs of individuals affected by COVID-19. COMMUNICATIONS MEDICINE 2024; 4:83. [PMID: 38724573 PMCID: PMC11082167 DOI: 10.1038/s43856-024-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The optimal management of COVID-19 symptoms and their sequelae remains an important area of clinical research. Policy makers have little scientific data regarding the effects on the daily life of affected individuals and the identification of their needs. Such data are needed to inform effective care policy. METHODS We studied 639 people with COVID-19 resident in France via an online questionnaire. They reported their symptoms, effects on daily life, and resulting needs, with particular focus on olfaction. RESULTS The results indicate that a majority of participants viewed their symptoms as disabling, with symptoms affecting their physical and mental health, social and professional lives. 60% of the individuals reported having unmet medical, psychological and socio-professional support needs. Finally, affected individuals were concerned about the risk and invasiveness of possible treatments as shown by a preference for non-invasive intervention over surgery to cure anosmia. CONCLUSIONS It is important that policy makers take these needs into consideration in order to assist affected individuals to regain a normal quality of life.
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Affiliation(s)
- Halina B Stanley
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France.
| | - Veronica Pereda-Campos
- Équipe de Médecine Evolutive Faculté de chirurgie dentaire-UMR5288, CNRS/Université Paul-Sabatier Toulouse III, Toulouse, 31400, France
| | - Marylou Mantel
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France
- Équipe de Médecine Evolutive Faculté de chirurgie dentaire-UMR5288, CNRS/Université Paul-Sabatier Toulouse III, Toulouse, 31400, France
| | - Catherine Rouby
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France
| | - Christelle Daudé
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France
| | - Pierre-Emmanuel Aguera
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France
| | - Lesly Fornoni
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinlaryngology, Technische Universität Dresden, Dresden, Germany
| | - Susanne Weise
- Smell & Taste Clinic, Department of Otorhinlaryngology, Technische Universität Dresden, Dresden, Germany
| | - Coralie Mignot
- Smell & Taste Clinic, Department of Otorhinlaryngology, Technische Universität Dresden, Dresden, Germany
| | - Iordanis Konstantinidis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Garefis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Camille Ferdenzi
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France
| | - Denis Pierron
- Équipe de Médecine Evolutive Faculté de chirurgie dentaire-UMR5288, CNRS/Université Paul-Sabatier Toulouse III, Toulouse, 31400, France
| | - Moustafa Bensafi
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, NEUROPOP, F-69500, Bron, France.
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7
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Hunter SR, Zola A, Ho E, Kallen M, Adjei-Danquah E, Achenbach C, Smith GR, Gershon R, Reed DR, Schalet B, Parma V, Dalton PH. Using SCENTinel® to predict SARS-CoV-2 infection: insights from a community sample during dominance of Delta and Omicron variants. Front Public Health 2024; 12:1322797. [PMID: 38660364 PMCID: PMC11041634 DOI: 10.3389/fpubh.2024.1322797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Based on a large body of previous research suggesting that smell loss was a predictor of COVID-19, we investigated the ability of SCENTinel®, a newly validated rapid olfactory test that assesses odor detection, intensity, and identification, to predict SARS-CoV-2 infection in a community sample. Methods Between April 5, 2021, and July 5, 2022, 1,979 individuals took one SCENTinel® test, completed at least one physician-ordered SARS-CoV-2 PCR test, and endorsed a list of self-reported symptoms. Results Among the of SCENTinel® subtests, the self-rated odor intensity score, especially when dichotomized using a previously established threshold, was the strongest predictor of SARS-CoV-2 infection. SCENTinel® had high specificity and negative predictive value, indicating that those who passed SCENTinel® likely did not have a SARS-CoV-2 infection. Predictability of the SCENTinel® performance was stronger when the SARS-CoV-2 Delta variant was dominant rather than when the SARS-CoV-2 Omicron variant was dominant. Additionally, SCENTinel® predicted SARS-CoV-2 positivity better than using a self-reported symptom checklist alone. Discussion These results indicate that SCENTinel® is a rapid assessment tool that can be used for population-level screening to monitor abrupt changes in olfactory function, and to evaluate spread of viral infections like SARS-CoV-2 that often have smell loss as a symptom.
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Affiliation(s)
| | - Anne Zola
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Emily Ho
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael Kallen
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Chad Achenbach
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - G. Randy Smith
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Richard Gershon
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Benjamin Schalet
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Valentina Parma
- Monell Chemical Senses Center, Philadelphia, PA, United States
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Eltayeb A, Al-Sarraj F, Alharbi M, Albiheyri R, Mattar EH, Abu Zeid IM, Bouback TA, Bamagoos A, Uversky VN, Rubio-Casillas A, Redwan EM. Intrinsic factors behind long COVID: IV. Hypothetical roles of the SARS-CoV-2 nucleocapsid protein and its liquid-liquid phase separation. J Cell Biochem 2024; 125:e30530. [PMID: 38349116 DOI: 10.1002/jcb.30530] [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: 09/09/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
When the SARS-CoV-2 virus infects humans, it leads to a condition called COVID-19 that has a wide spectrum of clinical manifestations, from no symptoms to acute respiratory distress syndrome. The virus initiates damage by attaching to the ACE-2 protein on the surface of endothelial cells that line the blood vessels and using these cells as hosts for replication. Reactive oxygen species levels are increased during viral replication, which leads to oxidative stress. About three-fifths (~60%) of the people who get infected with the virus eradicate it from their body after 28 days and recover their normal activity. However, a large fraction (~40%) of the people who are infected with the virus suffer from various symptoms (anosmia and/or ageusia, fatigue, cough, myalgia, cognitive impairment, insomnia, dyspnea, and tachycardia) beyond 12 weeks and are diagnosed with a syndrome called long COVID. Long-term clinical studies in a group of people who contracted SARS-CoV-2 have been contrasted with a noninfected matched group of people. A subset of infected people can be distinguished by a set of cytokine markers to have persistent, low-grade inflammation and often self-report two or more bothersome symptoms. No medication can alleviate their symptoms efficiently. Coronavirus nucleocapsid proteins have been investigated extensively as potential drug targets due to their key roles in virus replication, among which is their ability to bind their respective genomic RNAs for incorporation into emerging virions. This review highlights basic studies of the nucleocapsid protein and its ability to undergo liquid-liquid phase separation. We hypothesize that this ability of the nucleocapsid protein for phase separation may contribute to long COVID. This hypothesis unlocks new investigation angles and could potentially open novel avenues for a better understanding of long COVID and treating this condition.
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Affiliation(s)
- Ahmed Eltayeb
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal Al-Sarraj
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mona Alharbi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Raed Albiheyri
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Centre of Excellence in Bionanoscience Research, King Abdulaziz University, Jeddah, Saudi Arabia
- Immunology Unit, King Fahad Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ehab H Mattar
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Isam M Abu Zeid
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Thamer A Bouback
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Atif Bamagoos
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vladimir N Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Research Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Moscow Region, Russia
| | - Alberto Rubio-Casillas
- Autlan Regional Hospital, Health Secretariat, Autlan, Jalisco, Mexico
- Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan, Jalisco, Mexico
| | - Elrashdy M Redwan
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Centre of Excellence in Bionanoscience Research, King Abdulaziz University, Jeddah, Saudi Arabia
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9
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Petrick LM, Niedzwiecki MM, Dolios G, Guan H, Tu P, Wright RO, Wright RJ. Effects of storage temperature and time on metabolite profiles measured in dried blood spots, dried blood microsamplers, and plasma. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169383. [PMID: 38101622 PMCID: PMC10842436 DOI: 10.1016/j.scitotenv.2023.169383] [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: 07/21/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
The practical advantages of capillary whole blood collection over venipuncture plasma collection for human exposome research are well known. However, before epidemiologists, clinicians, and public health researchers employ these microvolume sample collections, a rigorous evaluation of pre-analytical storage conditions is needed to develop protocols that maximize sample stability and reliability over time. Therefore, we performed a controlled experiment of dried whole blood collected on 10 μL Mitra microsamplers (DBM), 5-mm punches of whole blood from a dried blood spot (DBS), and 10 μL of plasma, and evaluated the effects of storage conditions at 4 °C, -20 °C, or -80 °C for up to 6 months on the resulting metabolite profiles measured with untargeted liquid chromatography-high resolution mass spectrometry (LC-HRMS). At -80 °C storage conditions, metabolite profiles from DBS, DBM, and plasma showed similar stability. While DBS and DBM metabolite profiles remained similarly stable at -20 °C storage, plasma profiles showed decreased stability at -20 °C compared to -80 °C storage. At refrigerated temperatures (4 °C), metabolite profiles collected on DBM were more stable than plasma or DBS, particularly for lipid classes. These results inform robust capillary blood sample storage protocols for DBM and DBS at potentially warmer temperatures than -80 °C, which may facilitate blood collections for populations outside of a clinical setting.
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Affiliation(s)
- Lauren M Petrick
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Institute for Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Bert Strassburger Metabolic Center, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Megan M Niedzwiecki
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Institute for Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georgia Dolios
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haibin Guan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peijun Tu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Institute for Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Institute for Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Macaluso M, Rothenberg ME, Ferkol T, Kuhnell P, Kaminski HJ, Kimberlin DW, Benatar M, Chehade M. Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey. JMIR Public Health Surveill 2024; 10:e48430. [PMID: 38354030 PMCID: PMC10868638 DOI: 10.2196/48430] [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: 04/23/2023] [Revised: 09/20/2023] [Accepted: 12/15/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). OBJECTIVE This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. METHODS US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. RESULTS Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. CONCLUSIONS Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.
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Affiliation(s)
- Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Marc E Rothenberg
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Thomas Ferkol
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Pierce Kuhnell
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Henry J Kaminski
- Department of Neurology and Rehabilitation Medicine, George Washington University, Washington, DC, United States
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, United States
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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11
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Seabra SG, Merca F, Pereira B, Fonseca I, Carvalho AC, Brito V, Alves D, Libin P, Martins MRO, Miranda MNS, Pingarilho M, Pimentel V, Abecasis AB. Serological screening in a large-scale municipal survey in Cascais, Portugal, during the first waves of the COVID-19 pandemic: lessons for future pandemic preparedness efforts. Front Public Health 2024; 12:1326125. [PMID: 38371240 PMCID: PMC10869482 DOI: 10.3389/fpubh.2024.1326125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Background Serological surveys for SARS-CoV-2 were used early in the COVID-19 pandemic to assess epidemiological scenarios. In the municipality of Cascais (Portugal), serological testing combined with a comprehensive socio-demographic, clinical and behavioral questionnaire was offered to residents between May 2020 and beginning of 2021. In this study, we analyze the factors associated with adherence to this municipal initiative, as well as the sociodemographic profile and chronic diseases clinical correlates associated to seropositivity. We aim to contribute with relevant information for future pandemic preparedness efforts. Methods This was a cross-sectional study with non-probabilistic sampling. Citizens residing in Cascais Municipality went voluntarily to blood collection centers to participate in the serological survey. The proportion of participants, stratified by socio-demographic variables, was compared to the census proportions to identify the groups with lower levels of adherence to the survey. Univariate and multivariate logistic regression were used to identify socio-demographic, clinical and behavioral factors associated with seropositivity. Results From May 2020 to February 2021, 19,608 participants (9.2% of the residents of Cascais) were included in the study. Based on the comparison to census data, groups with lower adherence to this survey were men, the youngest and the oldest age groups, individuals with lower levels of education and unemployed/inactive. Significant predictors of a reactive (positive) serological test were younger age, being employed or a student, and living in larger households. Individuals with chronic diseases generally showed lower seroprevalence. Conclusion The groups with low adherence to this voluntary study, as well as the socio-economic contexts identified as more at risk of viral transmission, may be targeted in future pandemic situations. We also found that the individuals with chronic diseases, perceiving higher risk of serious illness, adopted protective behaviors that limited infection rates, revealing that health education on preventive measures was effective for these patients.
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Affiliation(s)
- Sofia G. Seabra
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Francisco Merca
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
- Artificial Intelligence Research Lab, Vrije Universiteit Brussels (VUB), Pleinlaan 2, Brussel, Belgium
| | - Bernardo Pereira
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Ivo Fonseca
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | | | - Vera Brito
- Câmara Municipal de Cascais, Cascais, Portugal
| | - Daniela Alves
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Pieter Libin
- Artificial Intelligence Research Lab, Vrije Universiteit Brussels (VUB), Pleinlaan 2, Brussel, Belgium
- Interuniversity Institute of Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Mafalda N. S. Miranda
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, Lisbon, Portugal
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12
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Chervo TC, Elkin EP, Nugent JR, Valice E, Amsden LB, Ergas IJ, Munneke JR, Flores M, Saelee GN, Hsiao CA, Schapiro JM, Quesenberry CP, Corley DA, Habel LA, Kushi LH, Skarbinski J. Relative contribution of COVID-19 vaccination and SARS-CoV-2 infection to population-level seroprevalence of SARS-CoV-2 spike antibodies in a large integrated health system. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.31.24301674. [PMID: 38352327 PMCID: PMC10863028 DOI: 10.1101/2024.01.31.24301674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background Understanding the relative contributions of SARS-CoV-2 infection-induced and vaccine- induced seroprevalence is key to measuring overall population-level seroprevalence and help guide policy decisions. Methods Using a series of six population-based cross-sectional surveys conducted among persons aged ≥7 years in a large health system with over 4.5 million members between May 2021 and April 2022, we combined data from the electronic health record (EHR), an electronic survey and SARS-CoV-2 spike antibody binding assay, to assess the relative contributions of infection and vaccination to population- level SARS-CoV-2 seroprevalence. EHR and survey data were incorporated to determine spike antibody positivity due to SARS-CoV-2 infection and COVID-19 vaccination. We used sampling and non-response weighting to create population-level estimates. Results We enrolled 4,319 persons over six recruitment waves. SARS-CoV-2 spike antibody seroprevalence increased from 83.3% (CI 77.0-88.9) in May 2021 to 93.5% (CI 89.5-97.5) in April 2022. By April 2022, 68.5% (CI 61.9-74.3) of the population was seropositive from COVID-19 vaccination only, 13.9% (10.7-17.9) from COVID-19 vaccination and prior diagnosed SARS-CoV-2 infection, 8.2% (CI 4.5- 14.5) from prior diagnosed SARS-CoV-2 infection only and 2.9% (CI 1.1-7.6) from prior undiagnosed SARS-CoV-2 infection only. We found high agreement (≥97%) between EHR and survey data for ascertaining COVID-19 vaccination and SARS-CoV-2 infection status. Conclusions By April 2022, 93.5% of persons had detectable SARS-CoV-2 spike antibody, predominantly from COVID-19 vaccination. In this highly vaccinated population and over 18 months into the pandemic, SARS-CoV-2 infection without COVID-19 vaccination was a small contributor to overall population-level seroprevalence. Article summary By April 2022, >93% of people had antibodies to SARS-CoV-2 with COVID-19 vaccination as the main driver of overall population-level seroprevalence in our healthcare system. SARS-CoV-2 infection without vaccination made a small contribution to population-level seroprevalence in our healthcare system.
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13
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Berman A, Iglesias M, Khanna R, Beaulieu T. The association between COVID-19 infection and incident atrial fibrillation: results from a retrospective cohort study using a large US commercial insurance database. Open Heart 2023; 10:e002399. [PMID: 37989491 PMCID: PMC10661058 DOI: 10.1136/openhrt-2023-002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND We sought to examine a 1-year incidence of atrial fibrillation (AF) among patients with SARS-CoV-2 virus (COVID-19) in comparison to those with non-COVID-19 acute upper respiratory infection (AURI). METHODS Patients with a diagnosis of COVID-19 (in any setting) between April 2020 and June 2021 were identified in Optum Clinformatics. Two comparator cohorts were constructed: an 'AURI pandemic' cohort (AURI diagnosis between April 2020 and June 2021) and an 'AURI prepandemic' cohort (AURI diagnosis between January 2018 and December 2018). One-year incidence of AF was compared among: COVID-19 versus AURI pandemic cohort; COVID-19 versus AURI prepandemic cohort; and AURI pandemic versus AURI prepandemic cohort. For each comparison, we applied a matching weights technique to balance covariates. Logistic regression was used to compare the odds of incident AF among the matched cohorts. RESULTS When comparing the matched COVID-19 (n=102 227) cohort with the AURI pandemic (n=102 101) cohort, higher incidence of AF was observed among the COVID-19 cohort (2.2% vs 1.2%; p<0.001; OR 1.83; 95% CI 1.72 to 1.95). Similar findings were observed for the COVID-19 (n=169 687) versus AURI prepandemic (n=169 486) comparison (2.7% vs 1.6%; p<0.001; OR 1.70; 95% CI 1.63 to 1.78). When comparing the AURI pandemic (n=1 26 392) versus AURI prepandemic (n=1 26 394) cohort, no significant differences in incident AF were observed (1.1% vs 1.2%; p=0.133; OR 0.95, 95% CI 0.90 to 1.01). CONCLUSION Patients diagnosed with COVID-19 were found to be at a higher risk of incident AF as compared with those with AURI. Timely diagnosis and appropriate treatment of AF may potentially mitigate the burden of AF conferred by COVID-19.
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Affiliation(s)
- Adam Berman
- Baptist Heart, Mississippi Baptist Health Systems, Jackson, Mississippi, USA
| | - Maximiliano Iglesias
- Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, California, USA
| | - Rahul Khanna
- MedTech Epidemiology & Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Tara Beaulieu
- MedTech Epidemiology & Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
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14
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Bean DJ, Monroe J, Liang YM, Borberg E, Senussi Y, Swank Z, Chalise S, Walt D, Weinberg J, Sagar M. Heterotypic responses against nsp12/nsp13 from prior SARS-CoV-2 infection associates with lower subsequent endemic coronavirus incidence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.23.563621. [PMID: 37961343 PMCID: PMC10634759 DOI: 10.1101/2023.10.23.563621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Immune responses from prior SARS-CoV-2 infection and COVID-19 vaccination do not prevent re-infections and may not protect against future novel coronaviruses (CoVs). We examined the incidence of and immune differences against human endemic CoVs (eCoV) as a proxy for response against future emerging CoVs. Assessment was among those with known SARS-CoV-2 infection, COVID-19 vaccination but no documented SARS-CoV-2 infection, or neither exposure. Retrospective cohort analyses suggest that prior SARS-CoV-2 infection, but not COVID-19 vaccination alone, protects against subsequent symptomatic eCoV infection. CD8+ T cell responses to the non-structural eCoV proteins, nsp12 and nsp13, were significantly higher in individuals with previous SARS-CoV-2 infection as compared to the other groups. The three groups had similar cellular responses against the eCoV spike and nucleocapsid, and those with prior spike exposure had lower eCoV-directed neutralizing antibodies. Incorporation of non-structural viral antigens in a future pan-CoV vaccine may improve protection against future heterologous CoV infections.
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Affiliation(s)
- David J. Bean
- Department of Virology, Immunology and Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Janet Monroe
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Yan Mei Liang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Ella Borberg
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Yasmeen Senussi
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Zoe Swank
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Sujata Chalise
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - David Walt
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Manish Sagar
- Department of Virology, Immunology and Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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15
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Karkanitsa M, Li Y, Valenti S, Spathies J, Kelly S, Hunsberger S, Yee L, Croker JA, Wang J, Alfonso AL, Faust M, Mehalko J, Drew M, Denson JP, Putman Z, Fathi P, Ngo TB, Siripong N, Baus HA, Petersen B, Ford EW, Sundaresan V, Josyula A, Han A, Giurgea LT, Rosas LA, Bean R, Athota R, Czajkowski L, Klumpp-Thomas C, Cervantes-Medina A, Gouzoulis M, Reed S, Graubard B, Hall MD, Kalish H, Esposito D, Kimberly RP, Reis S, Sadtler K, Memoli MJ. Dynamics of SARS-CoV-2 Seroprevalence in a Large US population Over a Period of 12 Months. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.20.23297329. [PMID: 37904956 PMCID: PMC10614993 DOI: 10.1101/2023.10.20.23297329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Due to a combination of asymptomatic or undiagnosed infections, the proportion of the United States population infected with SARS-CoV-2 was unclear from the beginning of the pandemic. We previously established a platform to screen for SARS-CoV-2 positivity across a representative proportion of the US population, from which we reported that almost 17 million Americans were estimated to have had undocumented infections in the Spring of 2020. Since then, vaccine rollout and prevalence of different SARS-CoV-2 variants have further altered seropositivity trends within the United States population. To explore the longitudinal impacts of the pandemic and vaccine responses on seropositivity, we re-enrolled participants from our baseline study in a 6- and 12- month follow-up study to develop a longitudinal antibody profile capable of representing seropositivity within the United States during a critical period just prior to and during the initiation of vaccine rollout. Initial measurements showed that, since July 2020, seropositivity elevated within this population from 4.8% at baseline to 36.2% and 89.3% at 6 and 12 months, respectively. We also evaluated nucleocapsid seropositivity and compared to spike seropositivity to identify trends in infection versus vaccination relative to baseline. These data serve as a window into a critical timeframe within the COVID-19 pandemic response and serve as a resource that could be used in subsequent respiratory illness outbreaks.
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Affiliation(s)
- Maria Karkanitsa
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Yan Li
- Joint Program in Survey Methodology, Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD 20742
| | - Shannon Valenti
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Jacquelyn Spathies
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science (BEPS), NIBIB, NIH, Bethesda MD 20894
| | - Sophie Kelly
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science (BEPS), NIBIB, NIH, Bethesda MD 20894
| | - Sally Hunsberger
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD 20894
| | - Laura Yee
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), NIH, MD 20894
| | - Jennifer A. Croker
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jing Wang
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD 21702
| | - Andrea Lucia Alfonso
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Mondreakest Faust
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Jennifer Mehalko
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Matthew Drew
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - John-Paul Denson
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Zoe Putman
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Parinaz Fathi
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Tran B. Ngo
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Nalyn Siripong
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Holly Ann Baus
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda MD 20894
| | - Brian Petersen
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Eric W. Ford
- Department of Health Care Organization, and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vanathi Sundaresan
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Aditya Josyula
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Alison Han
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Luca T. Giurgea
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Luz Angela Rosas
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Rachel Bean
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Rani Athota
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Lindsay Czajkowski
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Carleen Klumpp-Thomas
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD 20850
| | | | - Monica Gouzoulis
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Susan Reed
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
| | - Barry Graubard
- Division of Cancer Epidemiology & Genetics, Biostatistics Branch, NCI, NIH, Bethesda, MD 20894
| | - Matthew D. Hall
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD 20850
| | - Heather Kalish
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science (BEPS), NIBIB, NIH, Bethesda MD 20894
| | - Dominic Esposito
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702
| | - Robert P. Kimberly
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven Reis
- Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA 15213
| | - Kaitlyn Sadtler
- Section on Immunoengineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda MD 20894
| | - Matthew J Memoli
- LID Clinical Studies Unit, Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD 20894
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16
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Kost GJ. The Impact of Repeating COVID-19 Rapid Antigen Tests on Prevalence Boundary Performance and Missed Diagnoses. Diagnostics (Basel) 2023; 13:3223. [PMID: 37892044 PMCID: PMC10606553 DOI: 10.3390/diagnostics13203223] [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: 09/06/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
A prevalence boundary (PB) marks the point in prevalence in which the false omission rate, RFO = FN/(TN + FN), exceeds the tolerance limit for missed diagnoses. The objectives were to mathematically analyze rapid antigen test (RAgT) performance, determine why PBs are breeched, and evaluate the merits of testing three times over five days, now required by the US Food and Drug Administration for asymptomatic persons. Equations were derived to compare test performance patterns, calculate PBs, and perform recursive computations. An independent July 2023 FDA-NIH-university-commercial evaluation of RAgTs provided performance data used in theoretical calculations. Tiered sensitivity/specificity comprise the following: tier (1) 90%, 95%; tier (2) 95%, 97.5%; and tier (3) 100%, ≥99%. Repeating a T2 test improves the PB from 44.6% to 95.2% (RFO 5%). In the FDA-NIH-university-commercial evaluation, RAgTs generated a sensitivity of 34.4%, which improved to 55.3% when repeated, and then improved to 68.5% with the third test. With RFO = 5%, PBs are 7.37/10.46/14.22%, respectively. PB analysis suggests that RAgTs should achieve a clinically proven sensitivity of 91.0-91.4%. When prevalence exceeds PBs, missed diagnoses can perpetuate virus transmission. Repeating low-sensitivity RAgTs delays diagnosis. In homes, high-risk settings, and hotspots, PB breaches may prolong contagion, defeat mitigation, facilitate new variants, and transform outbreaks into endemic disease. Molecular diagnostics can help avoid these potential vicious cycles.
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Affiliation(s)
- Gerald J. Kost
- Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA;
- Point-of-Care Testing Center for Teaching and Research (POCT•CTR), Knowledge Optimization, Davis, CA 95616, USA
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17
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Zendt M, Bustos Carrillo FA, Kelly S, Saturday T, DeGrange M, Ginigeme A, Wu L, Callier V, Ortega-Villa A, Faust M, Chang-Rabley E, Bugal K, Kenney H, Khil P, Youn JH, Osei G, Regmi P, Anderson V, Bosticardo M, Daub J, DiMaggio T, Kreuzburg S, Pala F, Pfister J, Treat J, Ulrick J, Karkanitsa M, Kalish H, Kuhns DB, Priel DL, Fink DL, Tsang JS, Sparks R, Uzel G, Waldman MA, Zerbe CS, Delmonte OM, Bergerson JRE, Das S, Freeman AF, Lionakis MS, Sadtler K, van Doremalen N, Munster V, Notarangelo LD, Holland SM, Ricotta EE. Characterization of the antispike IgG immune response to COVID-19 vaccines in people with a wide variety of immunodeficiencies. SCIENCE ADVANCES 2023; 9:eadh3150. [PMID: 37824621 PMCID: PMC10569702 DOI: 10.1126/sciadv.adh3150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
Research on coronavirus disease 2019 vaccination in immune-deficient/disordered people (IDP) has focused on cancer and organ transplantation populations. In a prospective cohort of 195 IDP and 35 healthy volunteers (HV), antispike immunoglobulin G (IgG) was detected in 88% of IDP after dose 2, increasing to 93% by 6 months after dose 3. Despite high seroconversion, median IgG levels for IDP never surpassed one-third that of HV. IgG binding to Omicron BA.1 was lowest among variants. Angiotensin-converting enzyme 2 pseudo-neutralization only modestly correlated with antispike IgG concentration. IgG levels were not significantly altered by receipt of different messenger RNA-based vaccines, immunomodulating treatments, and prior severe acute respiratory syndrome coronavirus 2 infections. While our data show that three doses of coronavirus disease 2019 vaccinations induce antispike IgG in most IDP, additional doses are needed to increase protection. Because of the notably reduced IgG response to Omicron BA.1, the efficacy of additional vaccinations, including bivalent vaccines, should be studied in this population.
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Affiliation(s)
- Mackenzie Zendt
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Fausto A. Bustos Carrillo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
- Office of Data Science and Emerging Technologies, Office of Science Management and Operations, NIAID, NIH, Rockville, MD, USA
| | - Sophie Kelly
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH, Bethesda, MD, USA
| | | | - Maureen DeGrange
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Anita Ginigeme
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
- Medical Science and Computing LLC, Rockville, MD, USA
| | - Lurline Wu
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Viviane Callier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Ana Ortega-Villa
- Biostatistics Research Branch, Division of Clinical Research, NIAID, NIH, Rockville, MD, USA
| | | | - Emma Chang-Rabley
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kara Bugal
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Heather Kenney
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Pavel Khil
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Jung-Ho Youn
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Gloria Osei
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Pravesh Regmi
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Victoria Anderson
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marita Bosticardo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Janine Daub
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Thomas DiMaggio
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Samantha Kreuzburg
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Francesca Pala
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Justina Pfister
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jennifer Treat
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jean Ulrick
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Heather Kalish
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH, Bethesda, MD, USA
| | - Douglas B. Kuhns
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Debra L. Priel
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Danielle L. Fink
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - John S. Tsang
- Department of Immunobiology and Yale Center for Systems and Engineering Immunology, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT,USA
| | - Rachel Sparks
- Laboratory of Immune System Biology, DIR, NIAID, NIH, Bethesda, MD,USA
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Meryl A. Waldman
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Christa S. Zerbe
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ottavia M. Delmonte
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jenna R. E. Bergerson
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Sanchita Das
- Division of Laboratory Medicine, NIH Clinical Center, Bethesda, MD,USA
| | - Alexandra F. Freeman
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Michail S. Lionakis
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kaitlyn Sadtler
- Section for Immunoengineering, NIBIB, NIH, Bethesda, MD, USA
| | | | | | - Luigi D. Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Emily E. Ricotta
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
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18
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Zhang R, Tai J, Pei S. Ensemble inference of unobserved infections in networks using partial observations. PLoS Comput Biol 2023; 19:e1011355. [PMID: 37549190 PMCID: PMC10434926 DOI: 10.1371/journal.pcbi.1011355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/17/2023] [Accepted: 07/12/2023] [Indexed: 08/09/2023] Open
Abstract
Undetected infections fuel the dissemination of many infectious agents. However, identification of unobserved infectious individuals remains challenging due to limited observations of infections and imperfect knowledge of key transmission parameters. Here, we use an ensemble Bayesian inference method to infer unobserved infections using partial observations. The ensemble inference method can represent uncertainty in model parameters and update model states using all ensemble members collectively. We perform extensive experiments in both model-generated and real-world networks in which individuals have differential but unknown transmission rates. The ensemble method outperforms several alternative approaches for a variety of network structures and observation rates, despite that the model is mis-specified. Additionally, the computational complexity of this algorithm scales almost linearly with the number of nodes in the network and the number of observations, respectively, exhibiting the potential to apply to large-scale networks. The inference method may support decision-making under uncertainty and be adapted for use for other dynamical models in networks.
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Affiliation(s)
- Renquan Zhang
- School of Mathematical Sciences, Dalian University of Technology, Dalian, China
| | - Jilei Tai
- School of Mathematical Sciences, Dalian University of Technology, Dalian, China
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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19
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Moravčík O, Dvořák M, Kubáň P. Autonomous capillary electrophoresis processing and analysis of dried blood spots for high-throughput determination of uric acid. Anal Chim Acta 2023; 1267:341390. [PMID: 37257961 DOI: 10.1016/j.aca.2023.341390] [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: 03/23/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
A new set-up for fully autonomous and high-throughput capillary electrophoresis (CE) analyses of dried blood spot (DBS) samples is presented. The DBS samples were prepared by collecting exactly 5 μL of capillary blood from a finger-prick onto a pre-punched DBS disc in a disposable plastic CE vial and by in-vial blood drying. The vials with the DBS samples were then loaded into a commercial CE instrument for a fully unmanned sample processing and analysis. A fused-silica capillary of the CE instrument was first used for the transfer of 100 μL of elution solvent to each vial, in-vial DBS elution, and in-vial eluate homogenization. The same capillary was also used for at-line injection, separation, and selective analysis of the resulting eluates. Novel CE sequences were tailor-programmed for consecutive processing and analyses of multiple DBSs, which facilitated a fully autonomous determination of uric acid with a throughput of 240 DBS samples per day (24 h). The presented analytical protocol (using 100 μm i. d./30 cm capillary; 30 mM 2-(N-morpholino)-ethanesulfonic acid, 30 mM l-histidine, and 30 μM cetyltrimethylammonium bromide background electrolyte solution; and UV detection at 292 nm) provided excellent precision at endogenous and spiked uric acid concentrations with RSD values of peak areas below 3.2%. Calibration curves were linear over the 33.3 - 1200 μM range (R2 better than 0.998), limits of detection and quantification in the original capillary blood were 10 and 33.3 μM, respectively, and were well below the uric acid clinical range (140-420 μM). The stability of uric acid in DBS samples stored at laboratory temperature for up to 2 months was also excellent demonstrating less than a 4.2% decrease in uric acid concentrations. The actual set-up might thus be highly attractive for clinical subjects and laboratories because it is minimally invasive and requires minimum intervention from laboratory staff.
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Affiliation(s)
- Ondrej Moravčík
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic; Faculty of Science, Department of Chemistry, Masaryk University, Kamenice 5, CZ-62500, Brno, Czech Republic
| | - Miloš Dvořák
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic
| | - Pavel Kubáň
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic.
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20
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Tartof SY, Xie F, Yadav R, Wernli KJ, Martin ET, Belongia EA, Gaglani M, Zimmerman RK, Talbot HK, Thornburg N, Flannery B. Prior SARS-CoV-2 infection and COVID-19 vaccine effectiveness against outpatient illness during widespread circulation of SARS-CoV-2 Omicron variant, US Flu VE network. Influenza Other Respir Viruses 2023; 17:e13143. [PMID: 37246146 PMCID: PMC10209645 DOI: 10.1111/irv.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND We estimated combined protection conferred by prior SARS-CoV-2 infection and COVID-19 vaccination against COVID-19-associated acute respiratory illness (ARI). METHODS During SARS-CoV-2 Delta (B.1.617.2) and Omicron (B.1.1.529) variant circulation between October 2021 and April 2022, prospectively enrolled adult patients with outpatient ARI had respiratory and filter paper blood specimens collected for SARS-CoV-2 molecular testing and serology. Dried blood spots were tested for immunoglobulin-G antibodies against SARS-CoV-2 nucleocapsid (NP) and spike protein receptor binding domain antigen using a validated multiplex bead assay. Evidence of prior SARS-CoV-2 infection also included documented or self-reported laboratory-confirmed COVID-19. We used documented COVID-19 vaccination status to estimate vaccine effectiveness (VE) by multivariable logistic regression by prior infection status. RESULTS Four hundred fifty-five (29%) of 1577 participants tested positive for SARS-CoV-2 infection at enrollment; 209 (46%) case-patients and 637 (57%) test-negative patients were NP seropositive, had documented previous laboratory-confirmed COVID-19, or self-reported prior infection. Among previously uninfected patients, three-dose VE was 97% (95% confidence interval [CI], 60%-99%) against Delta, but not statistically significant against Omicron. Among previously infected patients, three-dose VE was 57% (CI, 20%-76%) against Omicron; VE against Delta could not be estimated. CONCLUSIONS Three mRNA COVID-19 vaccine doses provided additional protection against SARS-CoV-2 Omicron variant-associated illness among previously infected participants.
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Affiliation(s)
- Sara Y. Tartof
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
- Department of Health Systems ScienceKaiser Permanente Bernard J. Tyson School of MedicinePasadenaCaliforniaUSA
| | - Fagen Xie
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Ruchi Yadav
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Emily T. Martin
- University of Michigan School of Public HealthAnn ArborMichiganUSA
| | | | - Manjusha Gaglani
- Baylor Scott & White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
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21
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García-Carreras B, Hitchings MDT, Johansson MA, Biggerstaff M, Slayton RB, Healy JM, Lessler J, Quandelacy T, Salje H, Huang AT, Cummings DAT. Accounting for assay performance when estimating the temporal dynamics in SARS-CoV-2 seroprevalence in the U.S. Nat Commun 2023; 14:2235. [PMID: 37076502 PMCID: PMC10115837 DOI: 10.1038/s41467-023-37944-5] [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: 10/04/2022] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
Reconstructing the incidence of SARS-CoV-2 infection is central to understanding the state of the pandemic. Seroprevalence studies are often used to assess cumulative infections as they can identify asymptomatic infection. Since July 2020, commercial laboratories have conducted nationwide serosurveys for the U.S. CDC. They employed three assays, with different sensitivities and specificities, potentially introducing biases in seroprevalence estimates. Using models, we show that accounting for assays explains some of the observed state-to-state variation in seroprevalence, and when integrating case and death surveillance data, we show that when using the Abbott assay, estimates of proportions infected can differ substantially from seroprevalence estimates. We also found that states with higher proportions infected (before or after vaccination) had lower vaccination coverages, a pattern corroborated using a separate dataset. Finally, to understand vaccination rates relative to the increase in cases, we estimated the proportions of the population that received a vaccine prior to infection.
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Affiliation(s)
- Bernardo García-Carreras
- Department of Biology, University of Florida, Gainesville, FL, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
| | - Matt D T Hitchings
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Michael A Johansson
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Biggerstaff
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel B Slayton
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica M Healy
- COVID-19 Response, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Justin Lessler
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Carolina Population Center, Chapel Hill, NC, USA
| | | | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Angkana T Huang
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
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22
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Liang Y, Buchanan BC, Khanthaphixay B, Zhou A, Quirk G, Worobey M, Yoon JY. Sensitive SARS-CoV-2 salivary antibody assays for clinical saline gargle samples using smartphone-based competitive particle immunoassay platforms. Biosens Bioelectron 2023; 229:115221. [PMID: 36958205 PMCID: PMC10008095 DOI: 10.1016/j.bios.2023.115221] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
Antibody assay for SARS-CoV-2 has become increasingly important to track latent and asymptomatic infections, check the individual's immune status, and confirm vaccine efficacy and durability. However, current SARS-CoV-2 antibody assays require invasive blood collection, requiring a remote laboratory and a trained phlebotomist. Direct detection of SARS-CoV-2 antibodies from clinical saline gargle samples has been considered challenging due to the smaller number of antibodies in such specimens and the high limit of detection of currently available rapid tests. This work demonstrates simple and non-invasive methods for detecting SARS-CoV-2 salivary antibodies. Competitive particle immunoassays were developed on a paper microfluidic chip using the receptor-binding domain (RBD) antigens on spike proteins. Using a smartphone, they were monitored by counting the captured fluorescent particles or evaluating the capillary flow velocities. The limit of detection (LOD), cross-binding between alpha- and omicron-strains, and the effect of angiotensin-converting enzyme 2 (ACE2) presence were investigated. LODs were 1-5 ng/mL in both 10% and 1% saliva. Clinical saline gargle samples were assayed using both methods, showing a statistical difference between virus-negative and virus-positive samples, although the assays targeted antibodies. Only a small number of virus-positive samples were antibody-negative. The high assay sensitivity detected a small number of antibodies developed even during the early phase of infections. Overall, this work demonstrates the ability to detect SARS-CoV-2 salivary IgG antibodies on simple, cost-effective, portable platforms towards mitigating SARS-CoV-2 and potentially other respiratory viruses.
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Affiliation(s)
- Yan Liang
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ, 85721, United States
| | - Bailey C Buchanan
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, United States
| | - Bradley Khanthaphixay
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, United States
| | - Avory Zhou
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, United States
| | - Grace Quirk
- Department of Ecology and Evolutionary Biology, The University of Arizona, Tucson, AZ, 85721, United States
| | - Michael Worobey
- Department of Ecology and Evolutionary Biology, The University of Arizona, Tucson, AZ, 85721, United States
| | - Jeong-Yeol Yoon
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ, 85721, United States; Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, 85721, United States.
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23
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Bayer DM, Fay MP, Graubard BI. Confidence intervals for prevalence estimates from complex surveys with imperfect assays. Stat Med 2023; 42:1822-1867. [PMID: 36866590 DOI: 10.1002/sim.9701] [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: 05/19/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
There are established methods for estimating disease prevalence with associated confidence intervals for complex surveys with perfect assays, or simple random sample surveys with imperfect assays. We develop and study methods for the complicated case of complex surveys with imperfect assays. The new methods use the melding method to combine gamma intervals for directly standardized rates and established adjustments for imperfect assays by estimating sensitivity and specificity. One of the new methods appears to have at least nominal coverage in all simulated scenarios. We compare our new methods to established methods in special cases (complex surveys with perfect assays or simple surveys with imperfect assays). In some simulations, our methods appear to guarantee coverage, while competing methods have much lower than nominal coverage, especially when overall prevalence is very low. In other settings, our methods are shown to have higher than nominal coverage. We apply our method to a seroprevalence survey of SARS-CoV-2 in undiagnosed adults in the United States between May and July 2020.
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Affiliation(s)
- Damon M Bayer
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.,Department of Statistics, University of California, Irvine, Irvine, California, USA
| | - Michael P Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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24
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Atkinson A, Albert A, McClymont E, Andrade J, Beach L, Bolotin S, Boucoiran I, Bullard J, Charlton C, Crane J, Dougan S, Forest JC, German GJ, Giguère Y, Girouard G, Hankins C, Krajden M, Lang A, Levett P, Minion J, Neudorf C, Poliquin V, Robinson JL, Scott H, Stein DR, Tran V, Zahariadis G, Zhou HY, Money D. Canadian SARS-CoV-2 serological survey using antenatal serum samples: a retrospective seroprevalence study. CMAJ Open 2023; 11:E305-E313. [PMID: 37015743 PMCID: PMC10079308 DOI: 10.9778/cmajo.20220045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Insufficient data on the rate and distribution of SARS-CoV-2 infection in Canada has presented a substantial challenge to the public health response to the COVID-19 pandemic. Our objective was to assess SARS-CoV-2 seroprevalence in a representative sample of pregnant people throughout Canada, across multiple time points over 2 years of the pandemic, to describe the seroprevalence and show the ability of this process to provide prevalence estimates. METHODS This Canadian retrospective serological surveillance study used existing serological prenatal samples across 10 provinces over multiple time periods: Feb. 3-21, 2020; Aug. 24-Sept. 11, 2020; Nov. 16-Dec. 4, 2020; Nov. 15-Dec. 3, 2021; and results from the province of British Columbia during a period in which the SARS-CoV-2 B.1.1.529 (Omicron) variant was predominant, from Nov. 15, 2021, to June 11, 2022. Age and postal code administrative data allowed for comparison with concurrent polymerase chain reactivity (PCR)-positive results collected by Statistics Canada and the Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg) project. RESULTS Seropositivity in antenatal serum as early as February 2020 indicates SARS-CoV-2 transmission before the World Health Organization's declaration of the pandemic. Seroprevalence in our sample of pregnant people was 1.84 to 8.90 times higher than the recorded concurrent PCR-positive prevalence recorded among females aged 20-49 years in November-December 2020. Overall seropositivity in our sample of pregnant people was low at the end of 2020, increasing to 15% in 1 province by the end of 2021. Seroprevalence among pregnant people in BC during the Omicron period increased from 5.8% to 43% from November 2021 to June 2022. INTERPRETATION These results indicate widespread vulnerability to SARS-CoV-2 infection before vaccine availability in Canada. During the time periods sampled, public health tracking systems were under-reporting infections, and seroprevalence results during the Omicron period indicate extensive community spread of SARS-CoV-2 infection.
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Affiliation(s)
- Andrea Atkinson
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Arianne Albert
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Elisabeth McClymont
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Janice Andrade
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Lori Beach
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Shelly Bolotin
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Isabelle Boucoiran
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jared Bullard
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Carmen Charlton
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Joan Crane
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Shelley Dougan
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jean-Claude Forest
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Greg J German
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Yves Giguère
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Gabriel Girouard
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Catherine Hankins
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Mel Krajden
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Amanda Lang
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Paul Levett
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jessica Minion
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Cory Neudorf
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Vanessa Poliquin
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Jason L Robinson
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Heather Scott
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Derek R Stein
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Vanessa Tran
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - George Zahariadis
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Hong Y Zhou
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
| | - Deborah Money
- Department of Obstetrics & Gynecology (Atkinson, McClymont, Money), University of British Columbia; Women's Health Research Institute (Albert, Andrade, Money); Department of Pediatrics (McClymont), University of British Columbia, Vancouver, BC; Department of Pathology (Beach), Dalhousie University, Halifax, NS; Dalla Lana School of Public Health (Bolotin), University of Toronto; Public Health Ontario (Bolotin, Tran), Toronto, Ont.; Department of Obstetrics & Gynecology and School of Public Health (Boucoiran), Université de Montréal, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases (Bullard, Stein), University of Manitoba, Winnipeg, Man.; Department of Laboratory Medicine & Pathology (Charlton, H.Y. Zhou), University of Alberta; Public Health Laboratory (ProvLab), Alberta Precision Laboratories (Charlton, R. Zhuo), Edmonton, Alta.; Department of Obstetrics & Gynecology (Crane), Memorial University of Newfoundland, St. John's, NL; Department of Medical Microbiology and Infectious Diseases (Desnoyers, Girouard), Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB; Better Outcomes Network & Registry Ontario (Dougan), Ont.; CHU de Québec-Université Laval Research Center and Departement of Molecular Biology, Medical Biochemistry, and Pathology (Forest, Giguère), Université Laval, Quebec City, Que.; Health PEI (German, Robinson), Charlottetown, PEI; Department of Laboratory Medicine & Pathobiology (German, Tran), University of Toronto, Toronto, Ont.; Department of Epidemiology, Biostatistics, and Occupational Health (Hankins), McGill University, Montreal, Que.; Department of Pathology & Laboratory Medicine (Krajden, Levett), University of British Columbia, Vancouver, BC; Department of Pathology & Laboratory Medicine (Lang, Minion) and Department of Community Health & Epidemiology (Neudorf), University of Saskatchewan, Saskatoon, Sask.; Department of Obstetrics, Gynecology & Reproductive Sciences (Poliquin), University of Manitoba, Winnipeg, Man.; Department of Obstetrics & Gynecology (Scott), Dalhousie University, Halifax, NS; Cadham Provincial Laboratory (Stein), Manitoba Health, Winnipeg, Man.; Department of Laboratory Medicine (Zahariadis), Memorial University of Newfoundland, St. John's, NL
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25
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Mangel M. Operational analysis for COVID-19 testing: Determining the risk from asymptomatic infections. PLoS One 2023; 18:e0281710. [PMID: 36780871 PMCID: PMC9925232 DOI: 10.1371/journal.pone.0281710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
Testing remains a key tool for managing health care and making health policy during the coronavirus pandemic, and it will probably be important in future pandemics. Because of false negative and false positive tests, the observed fraction of positive tests-the surface positivity-is generally different from the fraction of infected individuals (the incidence rate of the disease). In this paper a previous method for translating surface positivity to a point estimate for incidence rate, then to an appropriate range of values for the incidence rate consistent with the model and data (the test range), and finally to the risk (the probability of including one infected individual) associated with groups of different sizes is illustrated. The method is then extended to include asymptomatic infections. To do so, the process of testing is modeled using both analysis and Monte Carlo simulation. Doing so shows that it is possible to determine point estimates for the fraction of infected and symptomatic individuals, the fraction of uninfected and symptomatic individuals, and the ratio of infected asymptomatic individuals to infected symptomatic individuals. Inclusion of symptom status generalizes the test range from an interval to a region in the plane determined by the incidence rate and the ratio of asymptomatic to symptomatic infections; likelihood methods can be used to determine the contour of the rest region. Points on this contour can be used to compute the risk (defined as the probability of including one asymptomatic infected individual) in groups of different sizes. These results have operational implications that include: positivity rate is not incidence rate; symptom status at testing can provide valuable information about asymptomatic infections; collecting information on time since putative virus exposure at testing is valuable for determining point estimates and test ranges; risk is a graded (rather than binary) function of group size; and because the information provided by testing becomes more accurate with more tests but at a decreasing rate, it is possible to over-test fixed spatial regions. The paper concludes with limitations of the method and directions for future work.
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Affiliation(s)
- Marc Mangel
- Department of Biology, University of Bergen, Bergen, Norway,Department of Applied Mathematics, University of California Santa Cruz, Santa Cruz, CA, United States of America,Puget Sound Institute, University of Washington Tacoma, Tacoma, WA, United States of America,* E-mail:
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26
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Leveraging CTSA hubs for rapid, large-scale, high-impact research: A case study during a global public health emergency. J Clin Transl Sci 2023; 7:e13. [PMID: 36755544 PMCID: PMC9879899 DOI: 10.1017/cts.2022.484] [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: 06/29/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
As the COVID-19 pandemic took hold in the USA in early 2020, it became clear that knowledge of the prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic individuals could inform public health policy decisions and provide insight into the impact of the infection on vulnerable populations. Two Clinical and Translational Science Award (CTSA) Hubs and the National Institutes of Health (NIH) set forth to conduct a national seroprevalence survey to assess the infection's rate of spread. This partnership was able to quickly design and launch the project by leveraging established research capacities, prior experiences in large-scale, multisite studies and a highly skilled workforce of CTSA hubs and unique experimental capabilities at the NIH to conduct a diverse prospective, longitudinal observational cohort of 11,382 participants who provided biospecimens and participant-reported health and behavior data. The study was completed in 16 months and benefitted from transdisciplinary teamwork, information technology innovations, multimodal communication strategies, and scientific partnership for rigor in design and analytic methods. The lessons learned by the rapid implementation and dissemination of this national study is valuable in guiding future multisite projects as well as preparation for other public health emergencies and pandemics.
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27
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Ryšavá L, Dorazilová J, Dvořák M, Sedláček P, Vojtová L, Kubáň P. Fully soluble polymeric foams for in-vial dried blood spot collection and analysis of acidic drugs by capillary electrophoresis. Anal Chim Acta 2023; 1241:340793. [PMID: 36657868 DOI: 10.1016/j.aca.2023.340793] [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: 10/24/2022] [Revised: 12/16/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
Polymeric foams tailor-made of polyvinylpyrrolidone (PVP) and carboxymethylcellulose/oxidized 6-carboxycellulose (CMC07/OC) composite were proposed as suitable sorbents for the collection and analysis of dried blood spots (DBSs). The PVP and CMC07/OC foams were easy to prepare, enabled collection of minute volumes of capillary blood, and blood drying at ambient temperature. The resulting foams were prepared as small porous discs with uniform dimensions (approx. 6 × 3 mm) and were fully soluble in aqueous solutions. The DBSs were formed in standard capillary electrophoresis (CE) vials fitted with the soluble foam discs and enabled the direct in-vial DBS processing and at-line analysis by CE. The DBSs were pretreated with a simple process, which involved a complete dissolution of the foam disc in an acidic solution and a simultaneous hollow fiber liquid-phase microextraction (HF-LPME) in one step. The complete solubility of the foam disc with the DBS served for a quantitative transfer of all blood components into the eluate and a nearly exhaustive HF-LPME of target analytes, whereas the blood matrix and the polymeric foam components were efficiently retained by the organic solvent impregnated in the walls of the HF. The suitability of the PVP and CMC07/OC foams for the collection and the direct analysis of DBSs was demonstrated by the HF-LPME/CE determination of model acidic drugs (warfarin, ibuprofen, naproxen, ketoprofen, and diclofenac) at therapeutically relevant concentrations. Repeatability of the analytical method was better than 8.1% (RSD), extraction recoveries ranged from 70 to 99% (for PVP foam), calibration curves were linear over two orders of magnitude (R2 higher than 0.9991), and limits of detection were less than 44 μg/L (for concentrations in undiluted capillary blood). The soluble polymeric foams exhibited non-significant variations in analyte concentrations for DBSs prepared from blood samples with different hematocrit levels and for aged DBSs (less than 9.2%), moreover, they outperformed standard DBS sampling devices in terms of sample pretreatment time and extraction recovery.
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Affiliation(s)
- Lenka Ryšavá
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic; Institute of Food Science and Biotechnology, Faculty of Chemistry, Brno University of Technology, Purkyňova 118, CZ-61200, Brno, Czech Republic
| | - Jana Dorazilová
- Central European Institute of Technology, Advanced Biomaterials, Brno University of Technology, Purkyňova 656/123, CZ-612 00, Brno, Czech Republic
| | - Miloš Dvořák
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic
| | - Petr Sedláček
- Institute of Physical and Applied Chemistry, Faculty of Chemistry, Brno University of Technology, Purkyňova 118, CZ-61200, Brno, Czech Republic
| | - Lucy Vojtová
- Central European Institute of Technology, Advanced Biomaterials, Brno University of Technology, Purkyňova 656/123, CZ-612 00, Brno, Czech Republic
| | - Pavel Kubáň
- Institute of Analytical Chemistry of the Czech Academy of Sciences, Veveří 97, CZ-60200, Brno, Czech Republic.
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Axfors C, Pezzullo AM, Contopoulos-Ioannidis DG, Apostolatos A, Ioannidis JPA. Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies. J Glob Health 2023; 13:06004. [PMID: 36655924 PMCID: PMC9850866 DOI: 10.7189/jogh.13.06004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Debate exists about whether extra protection of elderly and other vulnerable individuals is feasible in COVID-19. We aimed to assess the relative infection rates in the elderly vs the non-elderly and, secondarily, in children vs adults. Methods We performed a systematic review and meta-analysis of seroprevalence studies conducted in the pre-vaccination era. We identified representative national studies without high risk of bias through SeroTracker and PubMed searches (last updated May 17, 2022). We noted seroprevalence estimates for children, non-elderly adults, and elderly adults, using cut-offs of 20 and 60 years (or as close to these ages, if they were unavailable) and compared them between different age groups. Results We included 38 national seroprevalence studies from 36 different countries comprising 826 963 participants. Twenty-six of these studies also included pediatric populations and twenty-five were from high-income countries. The median ratio of seroprevalence in elderly vs non-elderly adults (or non-elderly in general, if pediatric and adult population data were not offered separately) was 0.90-0.95 in different analyses, with large variability across studies. In five studies (all in high-income countries), we observed significant protection of the elderly with a ratio of <0.40, with a median of 0.83 in high-income countries and 1.02 elsewhere. The median ratio of seroprevalence in children vs adults was 0.89 and only one study showed a significant ratio of <0.40. The main limitation of our study is the inaccuracies and biases in seroprevalence studies. Conclusions Precision shielding of elderly community-dwelling populations before the availability of vaccines was indicated in some high-income countries, but most countries failed to achieve any substantial focused protection. Registration Open Science Framework (available at: https://osf.io/xvupr).
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA,Department for Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Angelo Maria Pezzullo
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA,Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Despina G Contopoulos-Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA,Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Alexandre Apostolatos
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - John PA Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA,Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, California, USA
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Tartof SY, Xie F, Yadav R, Wernli KJ, Martin ET, Belongia EA, Gaglani M, Zimmerman RK, Talbot HK, Thornburg N, Flannery B. Prior SARS-CoV-2 Infection and COVID-19 Vaccine Effectiveness against Outpatient Illness during Widespread Circulation of SARS-CoV-2 Omicron Variant, US Flu VE Network. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.10.23284397. [PMID: 36711929 PMCID: PMC9882409 DOI: 10.1101/2023.01.10.23284397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background We estimated combined protection conferred by prior SARS-CoV-2 infection and COVID-19 vaccination against COVID-19-associated acute respiratory illness (ARI). Methods During SARS-CoV-2 Delta (B.1.617.2) and Omicron (B.1.1.529) variant circulation between October 2021 and April 2022, prospectively enrolled adult patients with outpatient ARI had respiratory and filter paper blood specimens collected for SARS-CoV-2 molecular testing and serology. Dried blood spots were tested for immunoglobulin-G antibodies against SARS-CoV-2 nucleocapsid (NP) and spike protein receptor binding domain antigen using a validated multiplex bead assay. Evidence of prior SARS-CoV-2 infection also included documented or self-reported laboratory-confirmed COVID-19. We used documented COVID-19 vaccination status to estimate vaccine effectiveness (VE) by multivariable logistic regression by prior infection status. Results 455 (29%) of 1577 participants tested positive for SARS-CoV-2 infection at enrollment; 209 (46%) case-patients and 637 (57%) test-negative patients were NP seropositive, had documented previous laboratory-confirmed COVID-19, or self-reported prior infection. Among previously uninfected patients, three-dose VE was 97% (95% confidence interval [CI], 60%- 99%) against Delta, but not statistically significant against Omicron. Among previously infected patients, three-dose VE was 57% (CI, 20%-76%) against Omicron; VE against Delta could not be estimated. Conclusions Three mRNA COVID-19 vaccine doses provided additional protection against SARS-CoV-2 Omicron variant-associated illness among previously infected participants.
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Affiliation(s)
- Sara Y. Tartof
- Kaiser Permanente Southern California, Department of Research & Evaluation,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Fagen Xie
- Kaiser Permanente Southern California, Department of Research & Evaluation
| | - Ruchi Yadav
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen J. Wernli
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Emily T. Martin
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA,Texas A&M University College of Medicine, Temple, TX, USA
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Michielin G, Arefi F, Puhach O, Bellon M, Sattonnet-Roche P, L'Huillier AG, Eckerle I, Meyer B, Maerkl SJ. Clinical sensitivity and specificity of a high-throughput microfluidic nano-immunoassay combined with capillary blood microsampling for the identification of anti-SARS-CoV-2 Spike IgG serostatus. PLoS One 2023; 18:e0283149. [PMID: 36952463 PMCID: PMC10035827 DOI: 10.1371/journal.pone.0283149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES We evaluate the diagnostic performance of dried blood microsampling combined with a high-throughput microfluidic nano-immunoassay (NIA) for the identification of anti-SARS-CoV-2 Spike IgG seropositivity. METHODS We conducted a serological study among 192 individuals with documented prior SARS-CoV-2 infection and 44 SARS-CoV-2 negative individuals. Participants with prior SARS-CoV-2 infection had a long interval of 11 months since their qRT-PCR positive test. Serum was obtained after venipuncture and tested with an automated electrochemiluminescence anti-SARS-CoV-2 S total Ig reference assay, a commercial ELISA anti-S1 IgG assay, and the index test NIA. In addition, 109 participants from the positive cohort and 44 participants from the negative cohort participated in capillary blood collection using three microsampling devices: Mitra, repurposed glucose test strips, and HemaXis. Samples were dried, shipped by regular mail, extracted, and measured with NIA. RESULTS Using serum samples, we achieve a clinical sensitivity of 98·33% and specificity of 97·62% on NIA, affirming the high performance of NIA in participants 11 months post infection. Combining microsampling with NIA, we obtain a clinical sensitivity of 95·05% using Mitra, 61·11% using glucose test strips, 83·16% using HemaXis, and 91·49% for HemaXis after automated extraction, without any drop in specificity. DISCUSSION High sensitivity and specificity was demonstrated when testing micro-volume capillary dried blood samples using NIA, which is expected to facilitate its use in large-scale studies using home-based sampling or samples collected in the field.
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Affiliation(s)
- Grégoire Michielin
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fatemeh Arefi
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Olha Puhach
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathilde Bellon
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pascale Sattonnet-Roche
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Isabella Eckerle
- Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals & Faculty of Medicine, Université de Genève, Geneva, Switzerland
| | - Benjamin Meyer
- Centre for Vaccinology, Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Sebastian J Maerkl
- Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Chudik A, Pesaran MH, Rebucci A. Social Distancing, Vaccination and Evolution of COVID-19 Transmission Rates in Europe. IMF ECONOMIC REVIEW 2023; 71:474-508. [PMCID: PMC9439281 DOI: 10.1057/s41308-022-00181-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper provides estimates of COVID-19 transmission rates and explains their evolution for selected European countries since the start of the pandemic taking account of changes in voluntary and government mandated social distancing, incentives to comply, vaccination and the emergence of new variants. Evidence based on panel data modeling indicates that the diversity of outcomes that we document may have resulted from the nonlinear interaction of mandated and voluntary social distancing and the economic incentives that governments provided to support isolation. The importance of these factors declined over time, with vaccine uptake driving heterogeneity in country experiences in 2021. Our approach also allows us to identify the basic reproduction number, \documentclass[12pt]{minimal}
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\begin{document}$${\mathcal{R}}_{0}$$\end{document}R0, which is precisely estimated around 5, which is much larger than the values in the range of 2.4–3.9 assumed in the extant literature.
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Affiliation(s)
| | - M. Hashem Pesaran
- University of Southern California, Los Angeles, USA
- Trinity College, Cambridge, UK
| | - Alessandro Rebucci
- Carey Business School, Johns Hopkins University, Baltimore, USA
- CEPR, London, UK
- NBER, Boston, USA
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Outcomes of lung cancer surgery in patients with COVID-19 history: a single center cohort study. Gen Thorac Cardiovasc Surg 2023; 71:175-181. [PMID: 36103107 PMCID: PMC9471024 DOI: 10.1007/s11748-022-01871-x] [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: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) can irreversibly damage the lungs and could possibly increase the risk of surgical treatment of lung cancer. The study aimed to assess the relationship between preoperative COVID-19 and complications and early outcomes of lung cancer surgery. METHODS This single-center cohort study included 444 patients who underwent lobectomy or segmentectomy for primary lung cancer from January 1, 2019 to December 31, 2021. The exclusion criteria were pneumonectomy, extended resection, and wedge resection. The groups of patients with (n = 72) and without (n = 372) the history of COVID-19 prior to surgery were compared. The groups were similar in terms of distribution of baseline, surgical and histopathological characteristics. The primary endpoint was the incidence of postoperative complications. Secondary endpoints were outcomes at discharge and at 90 days. RESULTS The incidence of postoperative complications did not differ between the groups of patients with and without COVID-19 history (30.6% vs 29.3%, p = 0.831). Outcomes at discharge and at 90 days after surgery did not differ between the groups. Among the patients with and without prior COVID-19, 97.2 and 99.5% were alive at discharge (p = 0.125), and 97.2% and 98.1% ninety days after surgery (p = 0.644), respectively. Patients with COVID-19 history more often required re-drainage (6.9% v 2.2%, p = 0.044) and reoperation (5.6 v 1.3%, p = 0.042). CONCLUSIONS COVID-19 history is not related to the general incidence of complications, outcomes at discharge from the hospital, and at 90-days after surgery.
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Xu Q, Milanez-Almeida P, Martins AJ, Radtke AJ, Hoehn KB, Oguz C, Chen J, Liu C, Tang J, Grubbs G, Stein S, Ramelli S, Kabat J, Behzadpour H, Karkanitsa M, Spathies J, Kalish H, Kardava L, Kirby M, Cheung F, Preite S, Duncker PC, Kitakule MM, Romero N, Preciado D, Gitman L, Koroleva G, Smith G, Shaffer A, McBain IT, McGuire PJ, Pittaluga S, Germain RN, Apps R, Schwartz DM, Sadtler K, Moir S, Chertow DS, Kleinstein SH, Khurana S, Tsang JS, Mudd P, Schwartzberg PL, Manthiram K. Adaptive immune responses to SARS-CoV-2 persist in the pharyngeal lymphoid tissue of children. Nat Immunol 2023; 24:186-199. [PMID: 36536106 PMCID: PMC10777159 DOI: 10.1038/s41590-022-01367-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022]
Abstract
Most studies of adaptive immunity to SARS-CoV-2 infection focus on peripheral blood, which may not fully reflect immune responses at the site of infection. Using samples from 110 children undergoing tonsillectomy and adenoidectomy during the COVID-19 pandemic, we identified 24 samples with evidence of previous SARS-CoV-2 infection, including neutralizing antibodies in serum and SARS-CoV-2-specific germinal center and memory B cells in the tonsils and adenoids. Single-cell B cell receptor (BCR) sequencing indicated virus-specific BCRs were class-switched and somatically hypermutated, with overlapping clones in the two tissues. Expanded T cell clonotypes were found in tonsils, adenoids and blood post-COVID-19, some with CDR3 sequences identical to previously reported SARS-CoV-2-reactive T cell receptors (TCRs). Pharyngeal tissues from COVID-19-convalescent children showed persistent expansion of germinal center and antiviral lymphocyte populations associated with interferon (IFN)-γ-type responses, particularly in the adenoids, and viral RNA in both tissues. Our results provide evidence for persistent tissue-specific immunity to SARS-CoV-2 in the upper respiratory tract of children after infection.
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Affiliation(s)
- Qin Xu
- Cell Signaling and Immunity Section, Laboratory of Immune System Biology (LISB), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Andrew J Martins
- Multiscale Systems Biology Section, LISB, NIAID, NIH, Bethesda, MD, USA
| | - Andrea J Radtke
- Center for Advanced Tissue Imaging, LISB, NIAID, NIH, Bethesda, MD, USA
| | - Kenneth B Hoehn
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Cihan Oguz
- NIAID Collaborative Bioinformatics Resource (NCBR), NIAID, NIH, Bethesda, MD, USA
- Axle Informatics, Bethesda, MD, USA
| | - Jinguo Chen
- Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Can Liu
- Multiscale Systems Biology Section, LISB, NIAID, NIH, Bethesda, MD, USA
| | - Juanjie Tang
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Gabrielle Grubbs
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Sydney Stein
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center (CC), NIH, Bethesda, MD, USA
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Sabrina Ramelli
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center (CC), NIH, Bethesda, MD, USA
| | - Juraj Kabat
- Center for Advanced Tissue Imaging, LISB, NIAID, NIH, Bethesda, MD, USA
| | - Hengameh Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Maria Karkanitsa
- Laboratory of Immuno-Engineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH, Bethesda, MD, USA
| | - Jacquelyn Spathies
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, NIBIB, NIH, Bethesda, MD, USA
| | - Heather Kalish
- Trans-NIH Shared Resource on Biomedical Engineering and Physical Science, NIBIB, NIH, Bethesda, MD, USA
| | - Lela Kardava
- B-cell Immunology Section, Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Martha Kirby
- National Human Genome Research Institute (NHGRI), NIH, Bethesda, MD, USA
| | - Foo Cheung
- Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Silvia Preite
- Cell Signaling and Immunity Section, Laboratory of Immune System Biology (LISB), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | | | - Nahir Romero
- Division of Otolaryngology, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Diego Preciado
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
- Division of Otolaryngology, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Lyuba Gitman
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
- Division of Otolaryngology, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Grace Smith
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, MD, USA
| | - Arthur Shaffer
- Lymphoid Malignancies Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD, USA
| | - Ian T McBain
- Cell Signaling and Immunity Section, Laboratory of Immune System Biology (LISB), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Peter J McGuire
- National Human Genome Research Institute (NHGRI), NIH, Bethesda, MD, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), NIH, Bethesda, MD, USA
| | - Ronald N Germain
- Center for Advanced Tissue Imaging, LISB, NIAID, NIH, Bethesda, MD, USA
- Lymphocyte Biology Section, LISB, NIAID, NIH, Bethesda, MD, USA
| | - Richard Apps
- Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - Kaitlyn Sadtler
- Laboratory of Immuno-Engineering, National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH, Bethesda, MD, USA
| | - Susan Moir
- B-cell Immunology Section, Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Daniel S Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center (CC), NIH, Bethesda, MD, USA
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD, USA
| | - Steven H Kleinstein
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - John S Tsang
- Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
- Multiscale Systems Biology Section, LISB, NIAID, NIH, Bethesda, MD, USA
| | - Pamela Mudd
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
- Division of Otolaryngology, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Pamela L Schwartzberg
- Cell Signaling and Immunity Section, Laboratory of Immune System Biology (LISB), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA.
- National Human Genome Research Institute (NHGRI), NIH, Bethesda, MD, USA.
| | - Kalpana Manthiram
- Cell Signaling and Immunity Section, Laboratory of Immune System Biology (LISB), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA.
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Pezzullo AM, Axfors C, Contopoulos-Ioannidis DG, Apostolatos A, Ioannidis JPA. Age-stratified infection fatality rate of COVID-19 in the non-elderly population. ENVIRONMENTAL RESEARCH 2023; 216:114655. [PMID: 36341800 PMCID: PMC9613797 DOI: 10.1016/j.envres.2022.114655] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 05/02/2023]
Abstract
The largest burden of COVID-19 is carried by the elderly, and persons living in nursing homes are particularly vulnerable. However, 94% of the global population is younger than 70 years and 86% is younger than 60 years. The objective of this study was to accurately estimate the infection fatality rate (IFR) of COVID-19 among non-elderly people in the absence of vaccination or prior infection. In systematic searches in SeroTracker and PubMed (protocol: https://osf.io/xvupr), we identified 40 eligible national seroprevalence studies covering 38 countries with pre-vaccination seroprevalence data. For 29 countries (24 high-income, 5 others), publicly available age-stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.034% (interquartile range (IQR) 0.013-0.056%) for the 0-59 years old population, and 0.095% (IQR 0.036-0.119%) for the 0-69 years old. The median IFR was 0.0003% at 0-19 years, 0.002% at 20-29 years, 0.011% at 30-39 years, 0.035% at 40-49 years, 0.123% at 50-59 years, and 0.506% at 60-69 years. IFR increases approximately 4 times every 10 years. Including data from another 9 countries with imputed age distribution of COVID-19 deaths yielded median IFR of 0.025-0.032% for 0-59 years and 0.063-0.082% for 0-69 years. Meta-regression analyses also suggested global IFR of 0.03% and 0.07%, respectively in these age groups. The current analysis suggests a much lower pre-vaccination IFR in non-elderly populations than previously suggested. Large differences did exist between countries and may reflect differences in comorbidities and other factors. These estimates provide a baseline from which to fathom further IFR declines with the widespread use of vaccination, prior infections, and evolution of new variants.
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Affiliation(s)
- Angelo Maria Pezzullo
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Sezione di Igiene, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Despina G Contopoulos-Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexandre Apostolatos
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA.
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Vachon CM, Norman AD, Prasad K, Jensen D, Schaeferle GM, Vierling KL, Sherden M, Majerus MR, Bews KA, Heinzen EP, Hebl A, Yost KJ, Kennedy RB, Theel ES, Ghosh A, Fries M, Wi CI, Juhn YJ, Sampathkumar P, Morice WG, Rocca WA, Tande AJ, Cerhan JR, Limper AH, Ting HH, Farrugia G, Carter RE, Finney Rutten LJ, Jacobson RM, St. Sauver J. Rates of Asymptomatic COVID-19 Infection and Associated Factors in Olmsted County, Minnesota, in the Prevaccination Era. Mayo Clin Proc Innov Qual Outcomes 2022; 6:605-617. [PMID: 36277251 PMCID: PMC9578336 DOI: 10.1016/j.mayocpiqo.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective To estimate rates and identify factors associated with asymptomatic COVID-19 in the population of Olmsted County during the prevaccination era. Patients and Methods We screened first responders (n=191) and Olmsted County employees (n=564) for antibodies to SARS-CoV-2 from November 1, 2020 to February 28, 2021 to estimate seroprevalence and asymptomatic infection. Second, we retrieved all polymerase chain reaction (PCR)-confirmed COVID-19 diagnoses in Olmsted County from March 2020 through January 2021, abstracted symptom information, estimated rates of asymptomatic infection and examined related factors. Results Twenty (10.5%; 95% CI, 6.9%-15.6%) first responders and 38 (6.7%; 95% CI, 5.0%-9.1%) county employees had positive antibodies; an additional 5 (2.6%) and 10 (1.8%) had prior positive PCR tests per self-report or medical record, but no antibodies detected. Of persons with symptom information, 4 of 20 (20%; 95% CI, 3.0%-37.0%) first responders and 10 of 39 (26%; 95% CI, 12.6%-40.0%) county employees were asymptomatic. Of 6020 positive PCR tests in Olmsted County with symptom information between March 1, 2020, and January 31, 2021, 6% (n=385; 95% CI, 5.8%-7.1%) were asymptomatic. Factors associated with asymptomatic disease included age (0-18 years [odds ratio {OR}, 2.3; 95% CI, 1.7-3.1] and >65 years [OR, 1.40; 95% CI, 1.0-2.0] compared with ages 19-44 years), body mass index (overweight [OR, 0.58; 95% CI, 0.44-0.77] or obese [OR, 0.48; 95% CI, 0.57-0.62] compared with normal or underweight) and tests after November 20, 2020 ([OR, 1.35; 95% CI, 1.13-1.71] compared with prior dates). Conclusion Asymptomatic rates in Olmsted County before COVID-19 vaccine rollout ranged from 6% to 25%, and younger age, normal weight, and later tests dates were associated with asymptomatic infection.
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Affiliation(s)
- Celine M. Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Aaron D. Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Kavita Prasad
- Integrative Medicine, Zumbro Valley Health Center, Mayo Clinic, Rochester, MN
| | - Dan Jensen
- Department of Health, Housing and Human Services Administration, Olmsted County Public Health, Mayo Clinic, Rochester, MN
| | - Gavin M. Schaeferle
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Kristy L. Vierling
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Meaghan Sherden
- Department of Epidemiology, Surveillance and Preparedness Team, Olmsted County Public Health, Mayo Clinic, Rochester, MN
| | | | - Katherine A. Bews
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ethan P. Heinzen
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Amy Hebl
- Department of Human Resources, Olmsted County, Mayo Clinic, Rochester, MN
| | - Kathleen J. Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Richard B. Kennedy
- Vaccine Research Group, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Mayo Clinic, Rochester, MN
| | - Aditya Ghosh
- Department of Internal Medicine, Northeast Georgia Medical Center, Gainesville, GA
| | | | - Chung-Il Wi
- Department of Precision Population Science Lab, Mayo Clinic, Rochester, MN
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Priya Sampathkumar
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - William G. Morice
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN
| | - Walter A. Rocca
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Neurology and Women’s Health Research Center, Mayo Clinic, Rochester, MN
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - James R. Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Andrew H. Limper
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Henry H. Ting
- Department of Cardiology, Emory University, Atlanta, GA
| | - Gianrico Farrugia
- Division of Gastroenterology & Hepatology, Department of Medicine, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | | | - Robert M. Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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Wojtera B, Singh N, Iankovitch S, Post L, Ahmed AA, Abouzid M. Changes in psychological distress among Polish medical university teachers during the COVID-19 pandemic. PLoS One 2022; 17:e0278311. [PMID: 36454976 PMCID: PMC9714882 DOI: 10.1371/journal.pone.0278311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Our study aims to update knowledge about psychological distress and its changes in the Polish group of academic medical teachers after two years of a global pandemic. During the coronavirus disease, teachers were challenged to rapidly transition into remote teaching and adapt new assessment and evaluation systems for students, which might have been a completely novel situation that was not addressed before, especially in medical universities in Poland. We conducted a cross-sectional study at Poznan University of Medical Sciences from March to April 2022. The questionnaire included self-reported information on anxiety, stress, and depression. We found that post-pandemic levels of anxiety, stress, and depression have significantly (p<0.001) improved compared to initial levels at the beginning of coronavirus disease. In multivariate models, females had higher odds of improving levels of anxiety (OR = 0.46; 95% CI = -1.58-(-0.03); p = 0.04), stress (OR = 0.36; 95% CI = -1.83-(-0.22); p = 0.01), and depression (OR = 0.0.37; 95% CI = -1.58-(-0.12); p = 0.03). Anxiety, stress, or depression were not significantly associated with years of experience, the number of taught subjects, and weekly teaching hours, but only with the academic work during COVID-19 (Spearman ranxiety = 0.37, rstress = 0.32, rdepression = 0.37, p<0.001). For the virtual learning concerns, 79% of teachers reported that students might engage less; and it was correlated with higher weekly teaching hours (r = 0.19, p<0.05). Even though only 29.8% reported cheating as a concern, it was correlated with a higher number of taught subjects (r = 0.2, p<0.05). Levels of anxiety, stress, and depression have improved as time passed, not affecting teachers' academic performance. Concerns about virtual learning have been raised, suggesting it may be conjoined with classroom learning but not as an alternative. Universities should highlight the importance of seeking psychological support and provide essential programs to employees. Teachers' coping skills with psychological distress should be further studied.
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Affiliation(s)
| | - Nisha Singh
- Poznan University of Medical Sciences, Poznan, Poland
| | | | - Lilly Post
- Poznan University of Medical Sciences, Poznan, Poland
| | - Alhassan Ali Ahmed
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail: (MA); (AAA)
| | - Mohamed Abouzid
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail: (MA); (AAA)
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Abstract
OBJECTIVES To quantify the burden of death that COVID-19 contributes relative to the top three causes of death for all countries. DESIGN We performed uncertainty analyses and created contour plots for COVID-19 mortality to place the number of COVID-19 deaths in context relative to the top three causes of death in each country, across a plausible range of values for two key parameters: case fatality rate and magnitude of under-reporting. SETTING All countries that have reported COVID-19 cases to the WHO and are included in the Global Burden of Disease Study by the Institute of Health Metrics and Evaluation. MAIN OUTCOMES AND MEASURES Monthly number of deaths caused by COVID-19 and monthly number of deaths caused by the top three causes of death for every country. RESULTS For countries that were particularly hard hit during the outbreak in 2020, most combinations of model parameters resulted in COVID-19 ranking within the top three causes of death. For countries not as hard hit on a per-capita basis, such as China and India, COVID-19 did not rank higher than the third leading cause of death at any combination of the model parameters within the given ranges. Up-to-date ranking of COVID-19 deaths relative to the top three causes of death for all countries globally is provided in an interactive online application. CONCLUSIONS Estimating the country-level burden of death that COVID-19 contributes relative to the top three causes of death is feasible through contour graphs, even when the actual number of deaths or cases is unknown. This method can help convey importance by placing the magnitude of COVID-related deaths in context relative to more familiar causes of death by communicating when COVID-related deaths rank among the top three causes of death.
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Affiliation(s)
- Eunice Y S Chan
- Department of Anesthesia and Perioperative Medicine, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Davy Cheng
- Department of Anesthesia and Perioperative Medicine, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Janet Martin
- Department of Anesthesia and Perioperative Medicine, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Buckner CM, Kardava L, El Merhebi O, Narpala SR, Serebryannyy L, Lin BC, Wang W, Zhang X, Lopes de Assis F, Kelly SE, Teng IT, McCormack GE, Praiss LH, Seamon CA, Rai MA, Kalish H, Kwong PD, Proschan MA, McDermott AB, Fauci AS, Chun TW, Moir S. Interval between prior SARS-CoV-2 infection and booster vaccination impacts magnitude and quality of antibody and B cell responses. Cell 2022; 185:4333-4346.e14. [PMID: 36257313 PMCID: PMC9513331 DOI: 10.1016/j.cell.2022.09.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 01/26/2023]
Abstract
SARS-CoV-2 mRNA booster vaccines provide protection from severe disease, eliciting strong immunity that is further boosted by previous infection. However, it is unclear whether these immune responses are affected by the interval between infection and vaccination. Over a 2-month period, we evaluated antibody and B cell responses to a third-dose mRNA vaccine in 66 individuals with different infection histories. Uninfected and post-boost but not previously infected individuals mounted robust ancestral and variant spike-binding and neutralizing antibodies and memory B cells. Spike-specific B cell responses from recent infection (<180 days) were elevated at pre-boost but comparatively less so at 60 days post-boost compared with uninfected individuals, and these differences were linked to baseline frequencies of CD27lo B cells. Day 60 to baseline ratio of BCR signaling measured by phosphorylation of Syk was inversely correlated to days between infection and vaccination. Thus, B cell responses to booster vaccines are impeded by recent infection.
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Affiliation(s)
- Clarisa M. Buckner
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lela Kardava
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Omar El Merhebi
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sandeep R. Narpala
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Leonid Serebryannyy
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bob C. Lin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wei Wang
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xiaozhen Zhang
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Felipe Lopes de Assis
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sophie E.M. Kelly
- Bioengineering and Physical Sciences Shared Resource, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - I-Ting Teng
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Genevieve E. McCormack
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lauren H. Praiss
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Catherine A. Seamon
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - M. Ali Rai
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Heather Kalish
- Bioengineering and Physical Sciences Shared Resource, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter D. Kwong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Michael A. Proschan
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Adrian B. McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Anthony S. Fauci
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tae-Wook Chun
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA,Corresponding author
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Gordon‐Lipkin EM, Marcum CS, Kruk S, Thompson E, Kelly SEM, Kalish H, Bellusci L, Khurana S, Sadtler K, McGuire PJ. Comprehensive profiling of the human viral exposome in households containing an at-risk child with mitochondrial disease during the 2020-2021 COVID-19 pandemic. Clin Transl Med 2022; 12:e1100. [PMID: 36336785 PMCID: PMC9637669 DOI: 10.1002/ctm2.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Viral infection is a major cause of morbidity in children with mitochondrial disease (MtD). As a result, families with children with MtD are highly adherent to risk mitigation behaviours (RMBs) advised by the Centers for Disease Control and Prevention during the COVID-19 pandemic that can modulate infection risk. METHODS Deep serologic phenotyping of viral infections was performed via home-based sampling by combining SARS-CoV-2 serologic testing and phage display immunoprecipitation and sequencing. Samples were collected approximately 1 year apart (October 2020 to April 2021 and October 2021 to March 2022) on households containing a child with MtD. RESULTS In contrast to our first collection in 2020-2021, SARS-CoV-2 antibody profiles for all participants in 2021-2022 were marked by greater isotype diversity and the appearance of neutralizing antibodies. Besides SARS-CoV-2, households (N = 15) were exposed to >38 different respiratory and gastrointestinal viruses during the study, averaging five viral infections per child with MtD. Regarding clinical outcomes, children with MtD (N = 17) experienced 34 episodes of illness resulting in 6 hospitalizations, with some children experiencing multiple episodes. Neurologic events following illness were recorded in five patients. Infections were identified via clinical testing in only seven cases. Viral exposome profiles were consistent with clinical testing and even identified infections not captured by clinical testing. CONCLUSIONS Despite reported adherence to RMBs during the COVID-19 pandemic by families with a child with MtD, viral infection was pervasive. Not all infections resulted in illness in the child with MtD, suggesting that some were subclinical or asymptomatic. However, selected children with MtD did experience neurologic events. Our studies emphasize that viral infections are inexorable, emphasizing the need for further understanding of host-pathogen interactions through broad serologic surveillance.
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Affiliation(s)
- Eliza M. Gordon‐Lipkin
- Metabolism, Infection and Immunity SectionNational Human Genome Research InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Christopher S. Marcum
- Data Science PolicyNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Shannon Kruk
- Metabolism, Infection and Immunity SectionNational Human Genome Research InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Elizabeth Thompson
- Metabolism, Infection and Immunity SectionNational Human Genome Research InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Sophie E. M. Kelly
- Trans‐NIH Shared Resource on Biomedical Engineering and Physical ScienceNational Institute of Biomedical Imaging and BioengineeringNational Institutes of HealthBethesdaMarylandUSA
| | - Heather Kalish
- Trans‐NIH Shared Resource on Biomedical Engineering and Physical ScienceNational Institute of Biomedical Imaging and BioengineeringNational Institutes of HealthBethesdaMarylandUSA
| | - Lorenza Bellusci
- Division of Viral ProductsCenter for Biologics Evaluation and ResearchFood and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Surender Khurana
- Division of Viral ProductsCenter for Biologics Evaluation and ResearchFood and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Kaitlyn Sadtler
- Section on ImmunoengineeringNational Institute of Biomedical Imaging and BioengineeringNational Institutes of HealthBethesdaMarylandUSA
| | - Peter J. McGuire
- Metabolism, Infection and Immunity SectionNational Human Genome Research InstituteNational Institutes of HealthBethesdaMarylandUSA
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40
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A population-based cohort study of sex and risk of severe outcomes in covid-19. Eur J Epidemiol 2022; 37:1159-1169. [PMID: 36301399 PMCID: PMC9607822 DOI: 10.1007/s10654-022-00919-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022]
Abstract
There is a male sex disadvantage in morbidity and mortality due to COVID-19. Proposed explanations to this disparity include gender-related health behaviors, differential distribution of comorbidities and biological sex differences. In this study, we investigated the association between sex and risk of severe COVID-19 while adjusting for comorbidities, socioeconomic factors, as well as unmeasured factors shared by cohabitants which are often left unadjusted. We conducted a total-population-based cohort study (n = 1,854,661) based on individual-level register data. Cox models was used to estimate the associations between sex and risk for severe COVID-19. We additionally used a within-household design and conditional Cox models aiming to account for unmeasured factors shared by cohabitants. A secondary aim was to compare the risk of COVID-19 related secondary outcomes between men and women hospitalized due to COVID-19 using logistic regression. Men were at higher risk for hospitalization (HR = 1.63;95%CI = 1.57–1.68), ICU admission (HR = 2.63;95%CI = 2.38–2.91) and death (HR = 1.81;95%CI = 1.68–1.95) due to COVID-19, based on fully adjusted models. However, the effect of sex varied significantly across age groups: Among people in their 50s, men had > four times higher risk of COVID-19 death. The within-household design did not provide any further explanation to the sex disparity. Among patients hospitalized due to COVID-19, men had an increased risk for viral pneumonia, acute respiratory distress syndrome, acute respiratory insufficiency, acute kidney injury, and sepsis which persisted in fully adjusted models. Recognition of the combined effect of sex and age on COVID-19 outcomes has implications for policy strategies to reduce the adverse effects of the disease.
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Mudd P, Romero N, Behzadpour H, Xu Q, Rana MS, Gitman L, Preciado D, Karkanitsa M, Spathies J, Sadtler K, Kalish H, Schwartzberg PL, Manthiram K. Examining multi‐level immune response to determine prevalence of
COVID
‐19 in pediatric tonsillectomy. Laryngoscope 2022. [PMID: 36102311 PMCID: PMC9538220 DOI: 10.1002/lary.30382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Pamela Mudd
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Nahir Romero
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Hengameh Behzadpour
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
| | - Qin Xu
- National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Maryland USA
| | - Md Sohel Rana
- Division of Surgery Children's National Hospital Washington DC USA
| | - Lyuba Gitman
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Diego Preciado
- Division of Pediatric Otolaryngology Children's National Hospital Washington DC USA
- Department of Surgery, Division of Otolaryngology The George Washington University Washington DC USA
| | - Maria Karkanitsa
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Jacquelyn Spathies
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Kaitlyn Sadtler
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Heather Kalish
- Trans‐NIH Shared Resource on Biomedical Engineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Bethesda Maryland USA
| | - Pamela L. Schwartzberg
- National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Maryland USA
| | - Kalpana Manthiram
- National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda Maryland USA
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42
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Pesaran MH, Yang CF. Matching theory and evidence on Covid-19 using a stochastic network SIR model. JOURNAL OF APPLIED ECONOMETRICS (CHICHESTER, ENGLAND) 2022; 37:1204-1229. [PMID: 35942053 PMCID: PMC9348038 DOI: 10.1002/jae.2904] [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: 11/11/2020] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 06/15/2023]
Abstract
This paper develops an individual-based stochastic network SIR model for the empirical analysis of the Covid-19 pandemic. It derives moment conditions for the number of infected and active cases for single as well as multigroup epidemic models. These moment conditions are used to investigate the identification and estimation of the transmission rates. The paper then proposes a method that jointly estimates the transmission rate and the magnitude of under-reporting of infected cases. Empirical evidence on six European countries matches the simulated outcomes once the under-reporting of infected cases is addressed. It is estimated that the number of actual cases could be between 4 to 10 times higher than the reported numbers in October 2020 and declined to 2 to 3 times in April 2021. The calibrated models are used in the counterfactual analyses of the impact of social distancing and vaccination on the epidemic evolution and the timing of early interventions in the United Kingdom and Germany.
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Affiliation(s)
- M. Hashem Pesaran
- University of Southern CaliforniaLos AngelesCaliforniaUSA
- Trinity College, CambridgeUK
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43
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Sparks R, Lau WW, Liu C, Han KL, Vrindten KL, Sun G, Cox M, Andrews SF, Bansal N, Failla LE, Manischewitz J, Grubbs G, King LR, Koroleva G, Leimenstoll S, Snow L, Chen J, Tang J, Mukherjee A, Sellers BA, Apps R, McDermott AB, Martins AJ, Bloch EM, Golding H, Khurana S, Tsang JS. Influenza vaccination and single cell multiomics reveal sex dimorphic immune imprints of prior mild COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.17.22271138. [PMID: 35233581 PMCID: PMC8887138 DOI: 10.1101/2022.02.17.22271138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Viral infections can have profound and durable functional impacts on the immune system. There is an urgent need to characterize the long-term immune effects of SARS-CoV-2 infection given the persistence of symptoms in some individuals and the continued threat of novel variants. Here we use systems immunology, including longitudinal multimodal single cell analysis (surface proteins, transcriptome, and V(D)J sequences) from 33 previously healthy individuals after recovery from mild, non-hospitalized COVID-19 and 40 age- and sex-matched healthy controls with no history of COVID-19 to comparatively assess the post-infection immune status (mean: 151 days after diagnosis) and subsequent innate and adaptive responses to seasonal influenza vaccination. Identification of both sex-specific and -independent temporally stable changes, including signatures of T-cell activation and repression of innate defense/immune receptor genes (e.g., Toll-like receptors) in monocytes, suggest that mild COVID-19 can establish new post-recovery immunological set-points. COVID-19-recovered males had higher innate, influenza-specific plasmablast, and antibody responses after vaccination compared to healthy males and COVID-19-recovered females, partly attributable to elevated pre-vaccination frequencies of a GPR56 expressing CD8+ T-cell subset in male recoverees that are "poised" to produce higher levels of IFNγ upon inflammatory stimulation. Intriguingly, by day 1 post-vaccination in COVID-19-recovered subjects, the expression of the repressed genes in monocytes increased and moved towards the pre-vaccination baseline of healthy controls, suggesting that the acute inflammation induced by vaccination could partly reset the immune states established by mild COVID-19. Our study reveals sex-dimorphic immune imprints and in vivo functional impacts of mild COVID-19 in humans, suggesting that prior COVID-19, and possibly respiratory viral infections in general, could change future responses to vaccination and in turn, vaccines could help reset the immune system after COVID-19, both in an antigen-agnostic manner.
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Affiliation(s)
- Rachel Sparks
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,These authors contributed equally
| | - William W. Lau
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,These authors contributed equally
| | - Can Liu
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,Graduate Program in Biological Sciences, University of Maryland, College Park, MD, USA,These authors contributed equally
| | - Kyu Lee Han
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Kiera L. Vrindten
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Guangping Sun
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,Division of Intramural Research, NIAID, NIH, Bethesda, MD, USA
| | - Milann Cox
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | | | - Neha Bansal
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Laura E. Failla
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Jody Manischewitz
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Gabrielle Grubbs
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Lisa R. King
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Galina Koroleva
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - LaQuita Snow
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA
| | | | - Jinguo Chen
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | - Juanjie Tang
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | | | | | - Richard Apps
- NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA
| | | | - Andrew J. Martins
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hana Golding
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, USA
| | - John S. Tsang
- Multiscale Systems Biology Section, Laboratory of Immune System Biology, NIAID, NIH, Bethesda, MD, USA,NIH Center for Human Immunology, NIAID, NIH, Bethesda, MD, USA,Correspondence:
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44
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Buckner CM, Kardava L, Merhebi OE, Narpala SR, Serebryannyy L, Lin BC, Wang W, Zhang X, de Assis FL, Kelly SE, Teng IT, McCormack GE, Praiss LH, Seamon CA, Rai MA, Kalish H, Kwong PD, Proschan MA, McDermott AB, Fauci AS, Chun TW, Moir S. Recent SARS-CoV-2 infection abrogates antibody and B-cell responses to booster vaccination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.08.30.22279344. [PMID: 36093348 PMCID: PMC9460969 DOI: 10.1101/2022.08.30.22279344] [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] [Indexed: 11/25/2022]
Abstract
SARS-CoV-2 mRNA booster vaccines provide protection from severe disease, eliciting strong immunity that is further boosted by previous infection. However, it is unclear whether these immune responses are affected by the interval between infection and vaccination. Over a two-month period, we evaluated antibody and B-cell responses to a third dose mRNA vaccine in 66 individuals with different infection histories. Uninfected and post-boost but not previously infected individuals mounted robust ancestral and variant spike-binding and neutralizing antibodies, and memory B cells. Spike-specific B-cell responses from recent infection were elevated at pre-boost but comparatively less so at 60 days post-boost compared to uninfected individuals, and these differences were linked to baseline frequencies of CD27 lo B cells. Day 60 to baseline ratio of BCR signaling measured by phosphorylation of Syk was inversely correlated to days between infection and vaccination. Thus, B-cell responses to booster vaccines are impeded by recent infection.
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Affiliation(s)
- Clarisa M. Buckner
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
- These authors contributed equally
| | - Lela Kardava
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
- These authors contributed equally
| | - Omar El Merhebi
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Sandeep R. Narpala
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Leonid Serebryannyy
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bob C. Lin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wei Wang
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Xiaozhen Zhang
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Felipe Lopes de Assis
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Sophie E.M. Kelly
- Bioengineering and Physical Sciences Shared Resource, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - I-Ting Teng
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Genevieve E. McCormack
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Lauren H. Praiss
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Catherine A. Seamon
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda 20892 MD, USA
| | - M. Ali Rai
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Heather Kalish
- Bioengineering and Physical Sciences Shared Resource, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter D. Kwong
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Michael A. Proschan
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Adrian B. McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Anthony S. Fauci
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Tae-Wook Chun
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda 20892 MD, USA
- Lead contact
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45
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Joung SY, Ebinger JE, Sun N, Liu Y, Wu M, Tang AB, Prostko JC, Frias EC, Stewart JL, Sobhani K, Cheng S. Awareness of SARS-CoV-2 Omicron Variant Infection Among Adults With Recent COVID-19 Seropositivity. JAMA Netw Open 2022; 5:e2227241. [PMID: 35976645 PMCID: PMC9386542 DOI: 10.1001/jamanetworkopen.2022.27241] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Some individuals who were infected by the SARS-CoV-2 Omicron variant may have been completely unaware of their infectious status while the virus was actively transmissible. OBJECTIVE To examine awareness of infectious status among individuals during the recent Omicron variant surge in a diverse and populous urban region of Los Angeles County. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed the records of adult employees and patients of an academic medical center who were enrolled in a longitudinal COVID-19 serological study in Los Angeles County, California. These participants had 2 or more serial anti-nucleocapsid IgG (IgG-N) antibody measurements at least 1 month apart, with the first occurring after the end of a regional Delta variant surge (September 15, 2021) and a subsequent one occurring after the start of a regional Omicron variant surge (December 15, 2021). Adults with evidence of new SARS-CoV-2 infection occurring during the Omicron variant surge period through May 4, 2022, were included in the present study sample. EXPOSURES Recent Omicron variant infection as evidenced by SARS-CoV-2 seroconversion. MAIN OUTCOMES AND MEASURES Awareness of recent SARS-CoV-2 infection was ascertained from review of self-reported health updates, medical records, and COVID-19 testing data. RESULTS Of the 210 participants (median [range] age, 51 (23-84) years; 136 women [65%]) with serological evidence of recent Omicron variant infection, 44% (92) demonstrated awareness of any recent Omicron variant infection and 56% (118) reported being unaware of their infectious status. Among those who were unaware, 10% (12 of 118) reported having had any symptoms, which they attributed to a common cold or other non-SARS-CoV-2 infection. In multivariable analyses that accounted for demographic and clinical characteristics, participants who were health care employees of the medical center were more likely than nonemployees to be aware of their recent Omicron variant infection (adjusted odds ratio, 2.46; 95% CI, 1.30-4.65). CONCLUSIONS AND RELEVANCE Results of this study suggest that more than half of adults with recent Omicron variant infection were unaware of their infectious status and that awareness was higher among health care employees than nonemployees, yet still low overall. Unawareness may be a highly prevalent factor associated with rapid person-to-person transmission within communities.
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Affiliation(s)
- Sandy Y. Joung
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nancy Sun
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yunxian Liu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Min Wu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Amber B. Tang
- David Geffen School of Medicine, UCLA (University of California, Los Angeles)
| | - John C. Prostko
- Applied Research and Technology, Abbott Diagnostics, Abbott Park, Illinois
| | - Edwin C. Frias
- Applied Research and Technology, Abbott Diagnostics, Abbott Park, Illinois
| | - James L. Stewart
- Applied Research and Technology, Abbott Diagnostics, Abbott Park, Illinois
| | - Kimia Sobhani
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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46
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Rennert L, Ma Z, McMahan CS, Dean D. Effectiveness and protection duration of Covid-19 vaccines and previous infection against any SARS-CoV-2 infection in young adults. Nat Commun 2022; 13:3946. [PMID: 35803915 PMCID: PMC9263799 DOI: 10.1038/s41467-022-31469-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/19/2022] [Indexed: 12/12/2022] Open
Abstract
Data on effectiveness and protection duration of Covid-19 vaccines and previous infection against general SARS-CoV-2 infection in general populations are limited. Here we evaluate protection from Covid-19 vaccination (primary series) and previous infection in 21,261 university students undergoing repeated surveillance testing between 8/8/2021-12/04/2021, during which B.1.617 (delta) was the dominant SARS-CoV-2 variant. Estimated mRNA-1273, BNT162b2, and AD26.COV2.S effectiveness against any SARS-CoV-2 infection is 75.4% (95% CI: 70.5-79.5), 65.7% (95% CI: 61.1-69.8), and 42.8% (95% CI: 26.1-55.8), respectively. Among previously infected individuals, protection is 72.9% when unvaccinated (95% CI: 66.1-78.4) and increased by 22.1% with full vaccination (95% CI: 15.8-28.7). Statistically significant decline in protection is observed for mRNA-1273 (P < .001), BNT162b2 (P < .001), but not Ad26.CoV2.S (P = 0.40) or previous infection (P = 0.12). mRNA vaccine protection dropped 29.7% (95% CI: 17.9-41.6) six months post- vaccination, from 83.2% to 53.5%. We conclude that the 2-dose mRNA vaccine series initially offers strong protection against general SARS-CoV-2 infection caused by the delta variant in young adults, but protection substantially decreases over time. These findings indicate that vaccinated individuals may still contribute to community spread. While previous SARS-CoV-2 infection consistently provides moderately strong protection against repeat infection from delta, vaccination yields a substantial increase in protection.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
| | - Zichen Ma
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Christopher S McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | - Delphine Dean
- Department of Bioengineering, Clemson University, Clemson, SC, USA
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47
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Mohammed T, Brewer JVV, Pyatt M, Whitbourne SB, Gaziano JM, Edson C, Holodniy M. Evaluation of Independent Self-Collected Blood Specimens for COVID-19 Antibody Detection among the US Veteran Population. Diagn Microbiol Infect Dis 2022; 104:115770. [PMID: 35985109 PMCID: PMC9287846 DOI: 10.1016/j.diagmicrobio.2022.115770] [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: 04/22/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022]
Abstract
Feasibility of home blood sample collection methods for the presence of SARS-CoV-2 antibodies from VA Million Veteran Program (MVP) participants was tested to determine COVID-19 infection or vaccination status. Participants (n = 312) were randomly assigned to self-collect blood specimens using the Neoteryx Mitra Clamshell (n = 136) or Tasso-SST (n = 176) and asked to rate their experience. Mitra tip blood was eluted and Tasso tubes were centrifuged. All samples were stored at -80 °C until tested with InBios SCoV-2 Detect™ IgG ELISA, BioRad Platelia SARS-CoV-2 Total Ab Assay, Abbott SARS-CoV-2 IgG and AdviseDx SARS-CoV-2 IgG II assays. Participants rated both devices equally. The Abbott assay had the highest sensitivity (87% Mitra, 98% Tasso-SST) for detecting known COVID infection and/or vaccination. The InBios assay with Tasso-SST had the best sensitivity (97%) and specificity (80%) for detecting known COVID-19 infection and/or vaccination. Veterans successfully collected their own specimens with no strong preference for either device.
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Affiliation(s)
- Tseli Mohammed
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
| | - Jessica V V Brewer
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Mary Pyatt
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Connor Edson
- VHA Public Health Reference Laboratory (PHRL), Palo Alto, CA, USA
| | - Mark Holodniy
- VHA Public Health Reference Laboratory (PHRL), Palo Alto, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA
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Liu YE, LeBoa C, Rodriguez M, Sherif B, Trinidad C, del Rosario M, Allen S, Clifford C, Redding J, Chen WT, Rosas LG, Morales C, Chyorny A, Andrews JR. COVID-19 Preventive Measures in Northern California Jails: Perceived Deficiencies, Barriers, and Unintended Harms. Front Public Health 2022; 10:854343. [PMID: 35774562 PMCID: PMC9237366 DOI: 10.3389/fpubh.2022.854343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Carceral facilities are high-risk settings for COVID-19 transmission. Little is known about the hidden burden of infection or practical barriers to infection control in these settings, especially in jails. There is also limited research on the mental health impacts of the pandemic among people living and working in carceral facilities. Methods Between July 8, 2020 and April 30, 2021, we performed SARS-CoV-2 rapid antibody testing and administered a questionnaire among residents and staff of four Northern California jails. We utilized multivariable logistic regression, adjusting for demographic and carceral characteristics, to analyze factors associated with prior infection, including perceived likelihood of prior infection and access to new masks. We additionally assessed the implementation of, perceptions toward, and impacts of COVID-19 policies in practice. We engaged stakeholder representatives, including incarcerated individuals, to guide study design, procedures, and results interpretation. Results We enrolled 788 jail residents and 380 jail staff. Nearly half of residents and two-thirds of staff who were antibody-positive had not previously tested positive for COVID-19. Among residents without a prior COVID-19 diagnosis, antibody positivity was significantly associated with perceived likelihood of prior infection (adjusted OR = 8.9; 95% CI, 3.6–22.0). Residents who had flu-like illness in jail cited inadequate responses to reported illness and deterrents to symptom reporting, including fears of medical isolation and perceptions of medical neglect. Residents also disclosed deficient access to face masks, which was associated with antibody positivity (adjusted OR = 13.8, 95% CI, 1.8–107.0). Worsened mental health was pervasive among residents, attributed not only to fear of COVID-19 and unsanitary jail conditions but also to intensified isolation and deprivation due to pandemic restrictions on in-person visitation, programs, and recreation time. Conclusion Carceral settings present significant challenges to maintaining infection control and human rights. Custody officials should work diligently to transform the conditions of medical isolation, which could mitigate deterrents to symptom reporting. Furthermore, they should minimize use of restrictive measures like lockdowns and suspension of visitation that exacerbate the mental health harms of incarceration. Instead, custody officials should ensure comprehensive implementation of other preventive strategies like masking, testing, and vaccination, in conjunction with multisector efforts to advance decarceration.
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Affiliation(s)
- Yiran E. Liu
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford, CA, United States
- Cancer Biology Graduate Program, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Yiran E. Liu
| | - Christopher LeBoa
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford, CA, United States
| | - Marcela Rodriguez
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Beruk Sherif
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Chrisele Trinidad
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael del Rosario
- Division of Correctional Health Services, San Mateo County Health, Redwood City, CA, United States
| | - Sophie Allen
- Stanford Law School, Stanford, CA, United States
- Department of Sociology, Stanford School of Humanities and Sciences, Stanford, CA, United States
| | | | - Jennifer Redding
- Santa Clara County Office of the Public Defender, San Jose, CA, United States
| | - Wei-ting Chen
- Office of Community Engagement, Stanford University School of Medicine, Stanford, CA, United States
| | - Lisa G. Rosas
- Office of Community Engagement, Stanford University School of Medicine, Stanford, CA, United States
| | - Carlos Morales
- Division of Correctional Health Services, San Mateo County Health, Redwood City, CA, United States
| | - Alexander Chyorny
- Division of Custody Health, Department of Medicine, Santa Clara Valley Health and Hospital System, San Jose, CA, United States
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford, CA, United States
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49
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Lewin A, De Serres G, Grégoire Y, Perreault J, Drouin M, Fournier MJ, Tremblay T, Beaudoin J, Boivin A, Goyette G, Finzi A, Bazin R, Germain M, Delage G, Renaud C. Seroprevalence of SARS-CoV-2 antibodies among blood donors in Québec: an update from a serial cross-sectional study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:385-393. [PMID: 35380364 PMCID: PMC8982303 DOI: 10.17269/s41997-022-00622-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
Objectives We previously estimated the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies following the first pandemic wave at 2.23% in Québec, Canada. Following the much bigger second wave in fall 2020 and early 2021, we estimated the seroprevalence of anti-SARS-CoV-2 in Québec during the first months of 2021. Methods Blood samples from regular, asymptomatic (for ≥ 14 days) donors were collected between January 25, 2021 and March 11, 2021. Anti-SARS-CoV-2 seropositivity was assessed using an enzyme-linked immunosorbent assay that captures antibodies directed against the receptor binding domain of the SARS-CoV-2 spike (and hence cannot discriminate between infection- and vaccine-induced seropositivity). Seroprevalence estimates were adjusted for regional distribution, age, and sex. Results Samples from 7924 eligible donors were analyzed, including 620 (7.8%) vaccinated donors and 7046 (88.9%) unvaccinated donors (vaccination status unknown for 258 (3.3%) donors). Overall, median age was 51 years; 46.4% of donors were female. The adjusted seroprevalence was 10.5% (95% CI = 9.7–11.3) in the unvaccinated population and 14.7% (95% CI = 13.8–15.6) in the overall population. Seroprevalence gradually decreased with age and was higher among donors who self-identified as having a racial/ethnic background other than white, both in the overall and in the unvaccinated populations. Conclusion The seroprevalence of SARS-CoV-2 antibodies significantly increased in Québec since spring 2020, with younger persons and ethnic minorities being disproportionately affected. When compared with the cumulative incidence rate reported by public health authorities (i.e., 3.3% as of March 11, 2021), these results suggest that a substantial proportion of infections remain undetected despite improvements in access to COVID-19 testing. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-022-00622-y.
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Affiliation(s)
- Antoine Lewin
- Affaires Médicales et Innovation, Héma-Québec, Montréal, QC, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Québec, QC, Canada.,Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Yves Grégoire
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada
| | - Josée Perreault
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada
| | - Mathieu Drouin
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada
| | | | - Tony Tremblay
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada
| | - Julie Beaudoin
- Qualité et développement, Héma-Québec, Montréal, QC, Canada
| | - Amélie Boivin
- Affaires Médicales et Innovation, Héma-Québec, Montréal, QC, Canada
| | - Guillaume Goyette
- Centre de Recherche du CHUM, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Andrés Finzi
- Centre de Recherche du CHUM, Montréal, QC, Canada.,Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Renée Bazin
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada
| | - Marc Germain
- Affaires Médicales et Innovation, Héma-Québec, Québec, QC, Canada
| | - Gilles Delage
- Affaires Médicales et Innovation, Héma-Québec, Montréal, QC, Canada
| | - Christian Renaud
- Affaires Médicales et Innovation, Héma-Québec, Montréal, QC, Canada.
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50
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Lee J. Age, Sex, and Race/Ethnicity in Clinical Outcomes Among Patients Hospitalized With COVID-19, 2020. Front Med (Lausanne) 2022; 9:850536. [PMID: 35646954 PMCID: PMC9133563 DOI: 10.3389/fmed.2022.850536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic revealed the disproportionate risk of poor clinical outcomes among population subgroups. The study investigates length of stay (LOS), intensive care unit (ICU) admission, and in-hospital death across age, sex, and race among patients hospitalized with COVID-19. A pooled cross-sectional study analyzed hospital discharge data of state-licensed hospitals in Texas from April to December 2020. Of 98,879 patients, males accounted for 52.3%. The age distribution was 31.9% for the 65-79 age group, 29.6% for those aged 50-64, and 16.3% for those older than 79. Whites constituted the largest proportion (42.6%), followed by Hispanics (36.2%) and Blacks (13.1%). Higher in-hospital death rates were found among patients aged 80 and over (Adjusted Risk Ratio (aRR) 1.12, 95%CI 1.11-1.13) and patients aged 65-79 (aRR 1.08, 95%CI 1.07-1.09) compared to patients aged 19 and below. Hispanics (aRR 1.03, 95%CI 1.02-1.03) and other minorities (aRR 1.02, 95%CI 1.02-1.03) exhibited higher in-hospital death rates than whites, and these patients also had longer LOS and higher ICU admission rates. Patients aged 65-79, 50-64, and 80 and over all had longer hospital stays and higher ICU admission rates. Males experienced poor health outcomes in all assessed outcomes. Findings showed that disparities in clinical outcomes among population subgroups existed and remained throughout 2020. While the nation has to continue practicing public health measures to minimize the harm caused by the novel virus, serious consideration must be given to improving the health of marginalized populations during and beyond the pandemic.
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Affiliation(s)
- Jusung Lee
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, United States
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