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Ristić M, Vuković V, Patić A, Marković M, Petrović V. Seroepidemiology of SARS-CoV-2 Virus in Healthcare Workers before Circulation of the Omicron Sublineages BA.4/BA.5 in Vojvodina, Serbia. Vaccines (Basel) 2022; 10:vaccines10122168. [PMID: 36560578 PMCID: PMC9783630 DOI: 10.3390/vaccines10122168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Healthcare workers (HCWs) are a vulnerable and critical population in the ongoing response to the SARS-CoV-2 pandemic. We aimed to estimate the seroprevalence in HCWs considering all of their previous contacts with the SARS-CoV-2 virus and/or the immunity acquired through their immunization against COVID-19 before the advent of the Omicron variants BA.4/BA.5. Serum samples were collected from 28 March to 10 June 2022. We covered 25% out of all the people who worked in some of the government healthcare centers (primary, secondary, and tertiary level) across the entire Autonomous Province of Vojvodina (Northern Serbia). Two serological tests (Anti-SARS-CoV-2 QuantiVac ELISA and LIAISON® SARS-CoV-2 TrimericS) were used to detect anti-spike IgG antibodies. The overall prevalence of the SARS-CoV-2 antibody among the 6936 HCWs was 92.96% [95% CI 92.33−93.55]. Regarding the type of serological test, there was a statistically significant (p = 0.0079) difference of the seropositivity obtained by the LIAISON® SARS-CoV-2 TrimericS (93.87%, 95% CI 92.97−94.69) and Anti-SARS-CoV-2 QuantiVac ELISA (92.23%, 95% CI 91.34−93.06) tests. Seropositivity to SARS-CoV-2 significantly (p < 0.0001) increased with the number of SARS-CoV-2 infections combined with the number of doses of the SARS-CoV-2 vaccines received. A vast majority of the HCWs in Vojvodina had detectable levels of antibodies to the spike protein of SARS-CoV-2, but despite this high seropositivity, it is unknown whether this herd immunity among HCWs is protective against the new variants of concern. Further research should evaluate the rates of reinfections and the associated severity of COVID-19 caused by the Omicron sublineages and/or new variants of SARS-CoV-2 among HCWs.
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Affiliation(s)
- Mioljub Ristić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
- Correspondence: (M.R.); (V.V.); Tel.: +381-21-4897-884 (M.R.)
| | - Vladimir Vuković
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
- Correspondence: (M.R.); (V.V.); Tel.: +381-21-4897-884 (M.R.)
| | - Aleksandra Patić
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Miloš Marković
- Department of Immunology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Vladimir Petrović
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
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Puchades A, Daniel R, Geen J, Peden J, Lewis H, Nnoaham K. SARS-CoV-2 sero-prevalence in the workforces of three large workplaces in South Wales: a sero-epidemiological study. BMC Public Health 2022; 22:162. [PMID: 35073884 PMCID: PMC8785373 DOI: 10.1186/s12889-021-12478-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sero-prevalence studies quantify the proportion of a population that has antibodies against SARS-CoV-2, and can be used to identify the extent of the COVID-19 pandemic at a population level. The aim of the study was to assess the sero-prevalence of SARS-CoV-2 antibodies in the workforce at three workplaces: a food factory, non-food factory and call-centre. METHODS Nine hundred ninety-three participants were recruited from three workplaces in South Wales. Participants completed a questionnaire and had a lateral flow point-of-care SARS-CoV-2 antibody test administered by a healthcare professional. The data were analysed using multivariable logistic regression, both using complete records only and following multiple imputation. RESULTS The sero-prevalence of SARS-CoV-2 antibodies ranged from 4% (n = 17/402) in the non-food factory to 10% (n = 28/281) in the food factory (OR 2.93; 95% CI 1.26 to 6.81). After taking account of confounding factors evidence of a difference remained (cOR comparing food factory to call centre (2.93; 95% CI 1.26 to 6.81) and non-food factory (3.99; 95% CI 1.97 to 8.08) respectively). The SARS-CoV-2 antibody prevalence also varied between roles within workplaces. People working in office based roles had a 2.23 times greater conditional odds (95% CI 1.02 to 4.87) of being positive for SARS-CoV-2 antibodies than those working on the factory floor. CONCLUSION The sero-prevalence of SARS-CoV-2 antibodies varied by workplace and work role. Whilst it is not possible to state whether these differences are due to COVID-19 transmission within the workplaces, it highlights the importance of considering COVID-19 transmission in a range of workplaces and work roles.
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Affiliation(s)
- Alice Puchades
- Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK.
| | - Rhian Daniel
- Division of Population Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - John Geen
- Clinical Biochemistry Department, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, CF47 9DT, UK
| | - Jo Peden
- Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Heather Lewis
- Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Kelechi Nnoaham
- Cwm Taf Morgannwg University Health Board, Navigation Park, Unit 3 Ynysmeurig House, Abercynon, CF45 4SN, UK
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SARS-CoV-2 IgG Surveillance in Asymptomatic Blood Donors and Health Workers. Adv Med 2021; 2021:2404170. [PMID: 34977259 PMCID: PMC8717046 DOI: 10.1155/2021/2404170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
MATERIALS AND METHODS 2085 blood donors were allowed to donate blood only after fulfilling all the criteria laid down by the FDA of India with additional history of excluding COVID-19 suspects. IgG antibody testing was performed by chemiluminescence, and results were noted along with their reactive status. Their reactive status was analyzed with donor information to get an idea of the risk parameters for COVID-19. Medical healthcare workers in whom the study was carried out were 560, out of which 114 had worked in COVID-19 duties and 446 had worked in non-COVID-19 emergencies areas. COVID-19 area duties were further subdivided into triage, holding area, isolation, and COVID-19-related duties. The samples were run on architect i2000 and evaluated for their plasma immunoglobulin G. RESULTS Amongst the asymptomatic blood donors, 1.9% was found to be COVID-19 IgG antibody positive. It was observed that maximum COVID-19 IgG positivity (57.1%) was seen in the age group 18-29 years followed by 26.2% in the age group 30-39 years. Donors in the age group 40-49 years showed antibody positivity of 16.7%, and no antibody-positive donors were found above 50 years of age. COVID-19 IgG positivity was maximum in replacement donors (61.9%) followed by family donors (28.6%) and least involuntary donors (0.6%) Blood donors who showed high IgG positivity were mainly of labor class. Antibody IgG testing on medical healthcare workers showed 2.3% positivity. The healthcare workers who were posted in COVID-19 duties showed 4.8% positivity in the holding area (waiting area with the treatment of patients till their RT PCR report comes) and 5.7% in other COVID-19 areas related to laboratory work. Healthcare workers doing duties in COVID-19 areas showed 2.7% positivity, while those doing duties in non-COVID-19 emergency areas showed a positivity of 2.2%. CONCLUSION Our study shows that the prevalence of detectable antibodies was low in the general population in India and many patients were asymptomatic as seen in the blood donors, especially the labor class. Maximum exposure was present in young healthy males of labor class who remained asymptomatic. The healthcare workers were more exposed to COVID-19 as compared to the general population probably due to lack of precaution and awareness. Those doing non-COVID-19 duties were also exposed appreciably and needed to take all the precautions required for COVID-19 duties.
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Shields A, Faustini SE, Perez-Toledo M, Jossi S, Aldera E, Allen JD, Al-Taei S, Backhouse C, Bosworth A, Dunbar LA, Ebanks D, Emmanuel B, Garvey M, Gray J, Kidd IM, McGinnell G, McLoughlin DE, Morley G, O'Neill J, Papakonstantinou D, Pickles O, Poxon C, Richter M, Walker EM, Wanigasooriya K, Watanabe Y, Whalley C, Zielinska AE, Crispin M, Wraith DC, Beggs AD, Cunningham AF, Drayson MT, Richter AG. SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax 2020; 75:1089-1094. [PMID: 32917840 PMCID: PMC7462045 DOI: 10.1136/thoraxjnl-2020-215414] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers. DESIGN A cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020. SETTING University Hospitals Birmingham NHS Foundation Trust (UHBFT), UK. PARTICIPANTS 545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded. INTERVENTION Participants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked. MAIN OUTCOME MEASURE Proportion of participants demonstrating infection and positive SARS-CoV-2 serology. RESULTS The point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02). CONCLUSIONS AND RELEVANCE We identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.
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Affiliation(s)
- Adrian Shields
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sian E Faustini
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sian Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Erin Aldera
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - Saly Al-Taei
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Claire Backhouse
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andrew Bosworth
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lyndsey A Dunbar
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Daniel Ebanks
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Beena Emmanuel
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Mark Garvey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Joanna Gray
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - I Michael Kidd
- Public Health England Midlands and East Region, Birmingham, UK
| | - Golaleh McGinnell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dee E McLoughlin
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gabriella Morley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Joanna O'Neill
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Oliver Pickles
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Charlotte Poxon
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Megan Richter
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Eloise M Walker
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Kasun Wanigasooriya
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Yasunori Watanabe
- School of Biological Sciences, University of Southampton, Southampton, UK
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, UK
| | - Celina Whalley
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, NIHR Biomedical Research Centre, Birmingham, UK
| | - Andrew D Beggs
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mark T Drayson
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, NIHR Biomedical Research Centre, Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers: A Living Rapid Review. Ann Intern Med 2020; 173:120-136. [PMID: 32369541 PMCID: PMC7240841 DOI: 10.7326/m20-1632] [Citation(s) in RCA: 391] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health care workers (HCWs) are at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PURPOSE To examine the burden of SARS-CoV-2, SARS-CoV-1, and Middle East respiratory syndrome (MERS)-CoV on HCWs and risk factors for infection, using rapid and living review methods. DATA SOURCES Multiple electronic databases, including the WHO database of publications on coronavirus disease and the medRxiv preprint server (2003 through 27 March 2020, with ongoing surveillance through 24 April 2020), and reference lists. STUDY SELECTION Studies published in any language reporting incidence of or outcomes associated with coronavirus infections in HCWs and studies on the association between risk factors (demographic characteristics, role, exposures, environmental and administrative factors, and personal protective equipment [PPE] use) and HCW infections. New evidence will be incorporated on an ongoing basis by using living review methods. DATA EXTRACTION One reviewer abstracted data and assessed methodological limitations; verification was done by a second reviewer. DATA SYNTHESIS 64 studies met inclusion criteria; 43 studies addressed burden of HCW infections (15 on SARS-CoV-2), and 34 studies addressed risk factors (3 on SARS-CoV-2). Health care workers accounted for a significant proportion of coronavirus infections and may experience particularly high infection incidence after unprotected exposures. Illness severity was lower than in non-HCWs. Depression, anxiety, and psychological distress were common in HCWs during the coronavirus disease 2019 outbreak. The strongest evidence on risk factors was on PPE use and decreased infection risk. The association was most consistent for masks but was also observed for gloves, gowns, eye protection, and handwashing; evidence suggested a dose-response relationship. No study evaluated PPE reuse. Certain exposures (such as involvement in intubations, direct patient contact, or contact with bodily secretions) were associated with increased infection risk. Infection control training was associated with decreased risk. LIMITATION There were few studies on risk factors for SARS-CoV-2, the studies had methodological limitations, and streamlined rapid review methods were used. CONCLUSION Health care workers experience significant burdens from coronavirus infections, including SARS-CoV-2. Use of PPE and infection control training are associated with decreased infection risk, and certain exposures are associated with increased risk. PRIMARY FUNDING SOURCE World Health Organization.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
| | - David I Buckley
- Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon (D.I.B., R.F.)
| | - Shelley Selph
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon (D.I.B., R.F.)
| | - Annette M Totten
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
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Pérez-Cameo C, Marín-Lahoz J. Serosurveys and convalescent plasma in COVID-19. EClinicalMedicine 2020; 23:100370. [PMID: 32632410 PMCID: PMC7252163 DOI: 10.1016/j.eclinm.2020.100370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Cristina Pérez-Cameo
- Emergency Department; Hospital Universitari Vall d'Hebron; Passeig de la Vall d'Hebron 119-129; 08035 Barcelona (SPAIN)
| | - Juan Marín-Lahoz
- Neurology Department and Emergency Department; Hospital de la Santa Creu I Sant Pau; C/ Mas Casanovas 90; 08041 Barcelona (SPAIN)
- Corresponding author.
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Turlington M, Chun A, Tomar S, Eggler A, Grum-Tokars V, Jacobs J, Daniels JS, Dawson E, Saldanha A, Chase P, Baez-Santos YM, Lindsley CW, Hodder P, Mesecar AD, Stauffer SR. Discovery of N-(benzo[1,2,3]triazol-1-yl)-N-(benzyl)acetamido)phenyl) carboxamides as severe acute respiratory syndrome coronavirus (SARS-CoV) 3CLpro inhibitors: identification of ML300 and noncovalent nanomolar inhibitors with an induced-fit binding. Bioorg Med Chem Lett 2013; 23:6172-7. [PMID: 24080461 PMCID: PMC3878165 DOI: 10.1016/j.bmcl.2013.08.112] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 12/22/2022]
Abstract
Herein we report the discovery and SAR of a novel series of SARS-CoV 3CLpro inhibitors identified through the NIH Molecular Libraries Probe Production Centers Network (MLPCN). In addition to ML188, ML300 represents the second probe declared for 3CLpro from this collaborative effort. The X-ray structure of SARS-CoV 3CLpro bound with a ML300 analog highlights a unique induced-fit reorganization of the S2-S4 binding pockets leading to the first sub-micromolar noncovalent 3CLpro inhibitors retaining a single amide bond.
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Affiliation(s)
- Mark Turlington
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt Specialized Chemistry Center for Probe Development (MLPCN), Nashville, TN 37232, USA
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Liu W, Han XN, Tang F, Borsboom GJJM, Yang H, Cao WC, de Vlas SJ. No evidence of over-reporting of SARS in mainland China. Trop Med Int Health 2009; 14 Suppl 1:46-51. [DOI: 10.1111/j.1365-3156.2009.02300.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen WQ, Ling WH, Lu CY, Hao YT, Lin ZN, Ling L, Huang J, Li G, Yan GM. Which preventive measures might protect health care workers from SARS? BMC Public Health 2009; 9:81. [PMID: 19284644 PMCID: PMC2666722 DOI: 10.1186/1471-2458-9-81] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 03/13/2009] [Indexed: 12/02/2022] Open
Abstract
Background Despite the use of a series of preventive measures, a high incidence of severe acute respiratory syndrome (SARS) was observed among health care workers (HCWs) during the SARS epidemic. This study aimed to determine which preventive measures may have been effective in protecting HCWs from infection, and which were not effective. Methods A retrospective study was performed among 758 'frontline' health care workers who cared for SARS patients at the Second Affiliated Hospital and the Third Affiliated Hospital of Sun Yat-sen University. The HCWs with IgG against SARS and those without IgG against SARS were respectively defined as the "case group" and the "control group", and logistic regression was conducted to explore the risk factors for SARS infection in HCWs. Results After adjusting for age, gender, marital status, educational level, professional title, and the department in which an individual worked, the results of a multivariate logistic regression analysis indicated that incidence of SARS among HCWs was significantly and positively associated with: performing tracheal intubations for SARS patients, methods used for air ventilation in wards, avoiding face-to-face interaction with SARS patients, the number of pairs of gloves worn by HCWs, and caring for serious SARS cases. Conclusion Some measures, particularly good air ventilation in SARS wards, may be effective in minimizing or preventing SARS transmission among HCWs in hospitals.
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Affiliation(s)
- Wei-Qing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Road II, Guangzhou, PR China.
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TUAN P, HORBY P, DINH P, MAI L, ZAMBON M, SHAH J, HUY V, BLOOM S, GOPAL R, COMER J, PLANT A. SARS transmission in Vietnam outside of the health-care setting. Epidemiol Infect 2006; 135:392-401. [PMID: 16870029 PMCID: PMC2870589 DOI: 10.1017/s0950268806006996] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2006] [Indexed: 12/18/2022] Open
Abstract
To evaluate the risk of transmission of SARS coronavirus outside of the health-care setting, close household and community contacts of laboratory-confirmed SARS cases were identified and followed up for clinical and laboratory evidence of SARS infection. Individual- and household-level risk factors for transmission were investigated. Nine persons with serological evidence of SARS infection were identified amongst 212 close contacts of 45 laboratory-confirmed SARS cases (secondary attack rate 4.2%, 95% CI 1.5-7). In this cohort, the average number of secondary infections caused by a single infectious case was 0.2. Two community contacts with laboratory evidence of SARS coronavirus infection had mild or sub-clinical infection, representing 3% (2/65) of Vietnamese SARS cases. There was no evidence of transmission of infection before symptom onset. Physically caring for a symptomatic laboratory-confirmed SARS case was the only independent risk factor for SARS transmission (OR 5.78, 95% CI 1.23-24.24).
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Affiliation(s)
- P. A. TUAN
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - P. HORBY
- World Health Organization, Hanoi, Vietnam
- *Author for correspondence: Dr P. Horby, Medical Epidemiologist, Communicable Disease Surveillance and Response, World Health Organization, 63 Tran Hung Dao Street, Hoan Kiem District, Hanoi, Vietnam. ()
| | - P. N. DINH
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - L. T. Q. MAI
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - M. ZAMBON
- Health Protection Agency, London, UK
| | - J. SHAH
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - S. BLOOM
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R. GOPAL
- Health Protection Agency, London, UK
| | - J. COMER
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A. PLANT
- Curtin University of Technology, Australia
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Muller MP, Richardson SE, McGeer A, Dresser L, Raboud J, Mazzulli T, Loeb M, Louie M. Early diagnosis of SARS: lessons from the Toronto SARS outbreak. Eur J Clin Microbiol Infect Dis 2006; 25:230-7. [PMID: 16586072 PMCID: PMC7087683 DOI: 10.1007/s10096-006-0127-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The clinical presentation of SARS is nonspecific and diagnostic tests do not provide accurate results early in the disease course. Initial diagnosis remains reliant on clinical assessment. To identify features of the clinical assessment that are useful in SARS diagnosis, the exposure status and the prevalence and timing of symptoms, signs, laboratory and radiographic findings were determined for all adult patients admitted with suspected SARS during the Toronto SARS outbreak. Findings were compared between patients with laboratory-confirmed SARS and those in whom SARS was excluded by laboratory or public health investigation. Of 364 cases, 273 (75%) had confirmed SARS, 30 (8%) were excluded, and 61 (17%) remained indeterminate. Among confirmed cases, exposure occurred in the healthcare environment (80%) or in the households of affected patients (17%); community or travel-related cases were rare (<3%). Fever occurred in 97% of patients by the time of admission. Respiratory findings including cough, dyspnea and pulmonary infiltrates evolved later and were present in only 59, 37 and 68% of patients, respectively, at admission. Direct exposure, fever on the first day of illness, and elevated temperature, pulmonary infiltrates, lymphopenia and thrombocytopenia at admission were associated with confirmed cases. Rhinorrhea, sore throat, and an elevated neutrophil count at admission were associated with excluded cases. In the absence of fever or significant exposure, SARS is unlikely. Other clinical, laboratory and radiographic findings further raise or lower the likelihood of SARS and provide a rational basis for estimating the likelihood of SARS and directing initial management.
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Affiliation(s)
- M P Muller
- Department of Microbiology, Mount Sinai Hospital, 600 University Avenue, M5G 1X5 Toronto, Canada.
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12
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Che XY, Di B, Zhao GP, Wang YD, Qiu LW, Hao W, Wang M, Qin PZ, Liu YF, Chan KH, Cheng VCC, Yuen KY. A patient with asymptomatic severe acute respiratory syndrome (SARS) and antigenemia from the 2003-2004 community outbreak of SARS in Guangzhou, China. Clin Infect Dis 2006; 43:e1-5. [PMID: 16758408 PMCID: PMC7108013 DOI: 10.1086/504943] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 03/18/2006] [Indexed: 01/08/2023] Open
Abstract
An asymptomatic case of severe acute respiratory syndrome (SARS) occurred early in 2004, during a community outbreak of SARS in Guangzhou, China. This was the first time that a case of asymptomatic SARS was noted in an individual with antigenemia and seroconversion. The asymptomatic case patient and the second index case patient with SARS in the 2003-2004 outbreak both worked in the same restaurant, where they served palm civets, which were found to carry SARS-associated coronaviruses. Epidemiological information and laboratory findings suggested that the findings for the patient with asymptomatic infection, together with the findings from previously reported serological analyses of handlers of wild animals and the 4 index case patients from the 2004 community outbreak, reflected a likely intermediate phase of animal-to-human transmission of infection, rather than a case of human-to-human transmission. This intermediate phase may be a critical stage for virus evolution and disease prevention.
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Affiliation(s)
- Xiao-yan Che
- Center of Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou
- Reprints or correspondence: Dr. Xiao-yan Che, Center of Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, People's Republic of China ()
| | - Biao Di
- Center for Disease Control and Prevention of Guangzhou, Guangzhou
| | - Guo-ping Zhao
- Laboratory of Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai
- Dr. Guo-ping Zhao, Laboratory of Disease and Health Genomics, Chinese National Human Genome Center at Shanghai, Shanghai 201203, People's Republic of China ()
| | - Ya-di Wang
- Center of Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou
| | - Li-wen Qiu
- Center of Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou
| | - Wei Hao
- Center of Laboratory, Zhujiang Hospital, Southern Medical University, Guangzhou
| | - Ming Wang
- Center for Disease Control and Prevention of Guangzhou, Guangzhou
| | - Peng-zhe Qin
- Center for Disease Control and Prevention of Guangzhou, Guangzhou
| | - Yu-fei Liu
- Center for Disease Control and Prevention of Guangzhou, Guangzhou
| | - Kwok-hong Chan
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Vincent C. C. Cheng
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Kwok-yung Yuen
- Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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13
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Wong SS, Yuen KY. Nasopharyngeal detection of severe acute respiratory syndrome-associated coronavirus RNA in health-care workers. Chest 2006; 129:12-3. [PMID: 16424407 PMCID: PMC7130424 DOI: 10.1378/chest.129.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Samson S.Y. Wong
- Hong Kong SAR
- Department of Microbiology, the University of Hong Kong
| | - Kwok-yung Yuen
- Hong Kong SAR
- Department of Microbiology, the University of Hong Kong
- Correspondence to: Kwok-yung Yuen, MD, Department of Microbiology, the University of Hong Kong, University Pathology Building, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, Hong Kong SAR
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