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Do TV, Manabe T, Vu GV, Nong VM, Fujikura Y, Phan D, Pham TT, Do CD, Doan TT, Nguyen NT, Nguyen TQ, Dong TV, Luong CQ, Manabe H, Kambayashi D, Hoang AV, Vu NV, Trinh GK, Do SN, Kamiya T, Ohara H, Nguyen CV, Dang TQ, Kudo K, Dao CX. Clinical characteristics and mortality risk among critically ill patients with COVID-19 owing to the B.1.617.2 (Delta) variant in Vietnam: A retrospective observational study. PLoS One 2023; 18:e0279713. [PMID: 36662716 PMCID: PMC9858045 DOI: 10.1371/journal.pone.0279713] [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: 08/13/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND SARS-CoV-2 Delta variant caused a large number of COVID-19 cases in many countries, including Vietnam. Understanding mortality risk factors is crucial for the clinical management of severe COVID-19. METHODS We conducted a retrospective study at an intensive care center in Ho Chi Minh City that urgently built by Bach Mai Hospital during the COVID-19 outbreak in Vietnam, when the Delta variant predominated. Participants were laboratory-confirmed patients with SARS-CoV-2 infection, admitted in August 2021. Data on patients' demographic and clinical characteristics, radiographic and laboratory findings, treatment, and clinical time course were compared between survivors and non-survivors. Risk factors to mortality were assessed using logistic regression. RESULTS Among 504 eligible COVID-19 patients, case fatality was 52.2%. Unvaccinated patients accounted for 61.2% of non-survivors and 43.6% of survivors (p < 0.001). The time from onset to hospital admission was 8 days in non-survivors and 7 days in survivors (p = 0.004). Among non-survivors, 90.2% developed acute respiratory distress syndrome (ARDS). Oxygen therapy was administered for all patients, but antiviral agent was given to 51.7% of non-survivors. 54.2% of non-survivors tested positive for the bacterial infection using blood culture. The risk factors for mortality were diabetes mellitus, respiration rate, oxygen saturation, vaccination status, time from onset to admission, and older age. CONCLUSIONS Critical patients with COVID-19 owing to the Delta variant in Vietnam had delayed hospital admission, leading to ARDS and death. Early availability of vaccines and preventing bacterial infections are crucial for reducing mortality of COVID-19, especially in low- and middle-income countries.
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Affiliation(s)
- Thanh Van Do
- Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Toshie Manabe
- Nagoya City University Graduate School of Medicine, Nagoya city, Aichi, Japan
- Nagoya City University West Medical Center, Nagoya city, Aichi, Japan
| | - Giap Van Vu
- Hanoi Medical University, Hanoi, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Vuong Minh Nong
- Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Yuji Fujikura
- Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Dung Phan
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Thach The Pham
- Intensive Care Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Cuong Duy Do
- Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Tra Thu Doan
- Center for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | | | | | - Thanh Van Dong
- Outpatient Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | - Dan Kambayashi
- Nagoya City University Graduate School of Medicine, Nagoya city, Aichi, Japan
- Showa Pharmaceutical University, Machidashi, Tokyo, Japan
| | - Anh Viet Hoang
- Training and Direction of Healthcare Activities Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Nhan Van Vu
- Training and Direction of Healthcare Activities Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Giang Kim Trinh
- Training and Direction of Healthcare Activities Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Son Ngoc Do
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Takeshi Kamiya
- Nagoya City University Graduate School of Medicine, Nagoya city, Aichi, Japan
| | - Hirotaka Ohara
- Nagoya City University Graduate School of Medicine, Nagoya city, Aichi, Japan
- Nagoya City University West Medical Center, Nagoya city, Aichi, Japan
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Quoc Dang
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Koichiro Kudo
- Yurin Hospital, Tokyo, Japan
- Waseda University, Organization for Regional-Interregional Studies, Tokyo, Japan
| | - Co Xuan Dao
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam
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Su YCF, Ma JZJ, Ou TP, Pum L, Krang S, Raftery P, Kinzer MH, Bohl J, Ieng V, Kab V, Patel S, Sar B, Ying WF, Jayakumar J, Horm VS, Boukli N, Yann S, Troupin C, Heang V, Garcia-Rivera JA, Sengdoeurn Y, Heng S, Lay S, Chea S, Darapheak C, Savuth C, Khalakdina A, Ly S, Baril L, Manning JE, Simone-Loriere E, Duong V, Dussart P, Sovann L, Smith GJD, Karlsson EA. Genomic epidemiology of SARS-CoV-2 in Cambodia, January 2020 to February 2021. Virus Evol 2022; 9:veac121. [PMID: 36654682 PMCID: PMC9838690 DOI: 10.1093/ve/veac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/05/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The first case of coronavirus disease 2019 (COVID-19) in Cambodia was confirmed on 27 January 2020 in a traveller from Wuhan. Cambodia subsequently implemented strict travel restrictions, and although intermittent cases were reported during the first year of the COVID-19 pandemic, no apparent widespread community transmission was detected. Investigating the routes of severe acute respiratory coronavirus 2 (SARS-CoV-2) introduction into the country was critical for evaluating the implementation of public health interventions and assessing the effectiveness of social control measures. Genomic sequencing technologies have enabled rapid detection and monitoring of emerging variants of SARS-CoV-2. Here, we detected 478 confirmed COVID-19 cases in Cambodia between 27 January 2020 and 14 February 2021, 81.3 per cent in imported cases. Among them, fifty-four SARS-CoV-2 genomes were sequenced and analysed along with representative global lineages. Despite the low number of confirmed cases, we found a high diversity of Cambodian viruses that belonged to at least seventeen distinct PANGO lineages. Phylogenetic inference of SARS-CoV-2 revealed that the genetic diversity of Cambodian viruses resulted from multiple independent introductions from diverse regions, predominantly, Eastern Asia, Europe, and Southeast Asia. Most cases were quickly isolated, limiting community spread, although there was an A.23.1 variant cluster in Phnom Penh in November 2020 that resulted in a small-scale local transmission. The overall low incidence of COVID-19 infections suggests that Cambodia's early containment strategies, including travel restrictions, aggressive testing and strict quarantine measures, were effective in preventing large community outbreaks of COVID-19.
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Affiliation(s)
- Yvonne C F Su
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Jordan Z J Ma
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Tey Putita Ou
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
- Ecole Doctorale GAIA, University of Montpelier, 641 Av. du Doyen Gaston Giraud, Montpellier 34000, France
| | - Leakhena Pum
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Sidonn Krang
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Philomena Raftery
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Michael H Kinzer
- United States Centers for Disease Control and Prevention, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Jennifer Bohl
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
- International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia
| | - Vanra Ieng
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Vannda Kab
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Sarika Patel
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Borann Sar
- United States Centers for Disease Control and Prevention, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Wong Foong Ying
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Jayanthi Jayakumar
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
| | - Viseth Srey Horm
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Narjis Boukli
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Sokhoun Yann
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Cecile Troupin
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Vireak Heang
- Sequencing Mini-Platform, Institut Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
- Naval Medical Research Unit TWO, Lot#: 80, 289 Samdach Penn Nout, Phnom Penh 120407, Cambodia
| | - Jose A Garcia-Rivera
- Naval Medical Research Unit TWO, Lot#: 80, 289 Samdach Penn Nout, Phnom Penh 120407, Cambodia
| | - Yi Sengdoeurn
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Seng Heng
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Sreyngim Lay
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Sophana Chea
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | - Chau Darapheak
- National Institute for Public Health, Lot#: 80, 289 Samdach Penn Nouth St (289), Phnom Penh 120407, Cambodia
| | - Chin Savuth
- National Institute for Public Health, Lot#: 80, 289 Samdach Penn Nouth St (289), Phnom Penh 120407, Cambodia
| | - Asheena Khalakdina
- World Health Organization Country Office, 5 - St 205, Phnom Penh 12355, Cambodia
| | - Sowath Ly
- Epidemiology and Public Health Unit, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Laurence Baril
- Direction, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Jessica E Manning
- Laboratory of Malaria and Vector Research, US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
| | | | - Veasna Duong
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Philippe Dussart
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
| | - Ly Sovann
- Communicable Disease Control Department, Ministry of Health, 80, 289 Samdach Penn Nouth St. (289), Phnom Penh 120407, Cambodia
| | - Gavin J D Smith
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Rd 169857, Singapore
- Centre for Outbreak Preparedness, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- SingHealth Duke-NUS Global Health Institute, SingHealth Duke-NUS Academic Medical Centre, 8 College Rd 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Erik A Karlsson
- Virology Unit, World Health Organization COVID-19 Global Referral Laboratory, Institute Pasteur du Cambodge, 5 Preah Monivong Blvd (93), Phnom Penh 12201, Cambodia
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Luo W, Liu Z, Zhou Y, Zhao Y, Li YE, Masrur A, Yu M. Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method. JMIR Public Health Surveill 2022; 8:e35840. [PMID: 35861674 PMCID: PMC9364972 DOI: 10.2196/35840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/19/2022] [Accepted: 07/19/2022] [Indexed: 12/18/2022] Open
Abstract
Background The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA. Objective The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19. Methods We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages. Results We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between –0.05 and –1.46 due to the assistance of continuous restrictions. However, 58.6% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic. Conclusions The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19.
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Affiliation(s)
- Wei Luo
- Department of Geography, National University of Singapore, Singapore, Singapore
| | - Zhaoyin Liu
- Department of Geography, National University of Singapore, Singapore, Singapore
| | - Yuxuan Zhou
- Department of Geography, National University of Singapore, Singapore, Singapore
| | - Yumin Zhao
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore, Singapore
| | - Yunyue Elita Li
- Department of Earth, Atmospheric, and Planetary Sciences, Purdue University, West Lafayette, IN, United States
| | - Arif Masrur
- Department of Geography, Pennsylvania State University, State College, PA, United States
| | - Manzhu Yu
- Department of Geography, Pennsylvania State University, State College, PA, United States
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