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Baumgart SWL, McLachlan A, Kenny H, McKew G, Maddocks S, Chen SCA, Kok J. Deisolation in the Healthcare Setting Following Recent COVID-19 Infection. Viruses 2024; 16:1131. [PMID: 39066294 PMCID: PMC11281359 DOI: 10.3390/v16071131] [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: 05/22/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Deisolation of persons infected with SARS-CoV-2, the virus that causes COVID-19, presented a substantial challenge for healthcare workers and policy makers, particularly during the early phases of the pandemic. Data to guide deisolation of SARS-CoV-2-infected patients remain limited, and the risk of transmitting and acquiring infection has changed with the evolution of SARS-CoV-2 variants and population immunity from previous vaccination or infection, or both. AIMS This review examines the evidence to guide the deisolation of SARS-CoV-2-infected inpatients within the hospital setting when clinically improving and also of healthcare workers with COVID-19 prior to returning to work. METHODS A review was performed using relevant search terms in Medline, EMBASE, Google Scholar, and PubMed. RESULTS AND DISCUSSION The evidence is reviewed with regards to the nature of SARS-CoV-2 transmission, the role of testing to guide deisolation, and the impact of SARS-CoV-2-specific immunity. A paradigm and recommendations are proposed to guide deisolation for inpatients and return to work for healthcare workers.
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Affiliation(s)
- Samuel W. L. Baumgart
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
| | - Aidan McLachlan
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
| | - Hayden Kenny
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
| | - Genevieve McKew
- Department of Infectious Diseases and Microbiology, Concord Hospital, Concord, NSW 2137, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Susan Maddocks
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia;
| | - Sharon C.-A. Chen
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia;
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology—Public Health, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145, Australia;
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology—Public Health, Westmead Hospital, Westmead, NSW 2145, Australia
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Bouhadfane M, Monfardini E, Loundou A, Roy P, Martin F, Boufercha R, Bajon F, Beque C, Villa A, Lehucher-Michel MP. Correlation between unproven therapies and delayed return-to-work for COVID-19-infected healthcare workers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2024; 79:45-56. [PMID: 38767268 DOI: 10.1080/19338244.2024.2353264] [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: 12/07/2023] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
The objective of this study is to investigate factors influencing the time to return to work (RTW) of HealthCare Workers (HCW) infected with COVID-19 during the initial wave of the pandemic in a southern French university hospital. Data collection of 170 HCW (between March 16 to June 1, 2020) included demographic and professional information, clinical profiles, comorbidities, medical management, therapies and RT-PCR results. The mean time to RTW was 15.6 days. Multivariate analyses revealed that the time to RTW was shorter among laboratory and emergency workers, while it was longer for HCW aged 40 to 49 years, at higher risk of severe illness, with a delayed negative SARS-CoV-2 PCR or those treated with azithromycin and/or hydroxychloroquine. This study highlights diverse factors affecting HCW RTW post-COVID-19 infection, underscoring the importance of exercising caution in administering unproven therapies to HCW during the early stages of a novel infectious pandemic.
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Affiliation(s)
| | | | | | - Pierre Roy
- APHM, Service de Médecine et Santé au Travail, Marseille, France
| | - Françoise Martin
- APHM, Service de Médecine et Santé au Travail, Marseille, France
| | - Rafika Boufercha
- APHM, Service de Médecine et Santé au Travail, Marseille, France
| | - Florence Bajon
- APHM, Service de Médecine et Santé au Travail, Marseille, France
| | - Christine Beque
- APHM, Service de Médecine et Santé au Travail, Marseille, France
| | - Antoine Villa
- APHM, Service de Médecine et Santé au Travail, Marseille, France
- Aix-Marseille Université, CEReSS, Marseille, France
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Aninagyei E, Ayivor-Djanie R, Gyamfi J, Owuani T, Ameke SL, Kpeli GS, Agbogli HK, Essandoh P, Duedu KO. Faecal shedding of SARS-CoV-2 from patients with asymptomatic and mild COVID-19 without gastrointestinal symptoms in Ghana. BMC Res Notes 2024; 17:130. [PMID: 38730439 PMCID: PMC11084030 DOI: 10.1186/s13104-024-06790-z] [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: 09/13/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE In this study, we sought to determine whether faecal shedding occurs among SARS-COV-2 positive Ghanaians, as reported elsewhere. Hence we assayed for SARS-COV-2 in the stools of 48 SARS-COV-2 confirmed patients at the Ho Municipal Hospital in Ghana. RESULTS Of the 48 COVID-19 patients, 45 (93.8%) had positive tests for SARS-CoV-2 faecal shedding. About 60% reported no respiratory symptoms, while only 2% (1 patient) reported gastrointestinal (GI) symptoms in the form of nausea. Other symptoms reported included headache (57.9%), weakness (57.9%), cough (52.6%), blocked/runny nose (47.4%), fever (31.6%), sore throat (31.6%), and shortness of breath (21.1%). One person complained of nausea (5.3%) Semi-quantitative comparison of the SARS COV-2 viral loads in matched respiratory and faecal samples using the cycle threshold (CT) values revealed no statistical differences. Furthermore, the duration between collection of respiratory and faecal samples did not have any direct influence on the differences in the CT values. This suggests that treatment and use of sewage for environmental surveillance of SARS COV-2 could be a potential public health countermeasure.
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Affiliation(s)
- Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Reuben Ayivor-Djanie
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
- UHAS COVID-19 Centre, University of Health and Allied Sciences, Ho, Ghana
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Legon, Ghana
| | - Jones Gyamfi
- UHAS COVID-19 Centre, University of Health and Allied Sciences, Ho, Ghana
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Theodore Owuani
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | | | - Grace Semabia Kpeli
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
- UHAS COVID-19 Centre, University of Health and Allied Sciences, Ho, Ghana
| | - Hubert Kwame Agbogli
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
- UHAS COVID-19 Centre, University of Health and Allied Sciences, Ho, Ghana
| | - Priscilla Essandoh
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
- UHAS COVID-19 Centre, University of Health and Allied Sciences, Ho, Ghana
| | - Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana.
- UHAS COVID-19 Centre, University of Health and Allied Sciences, Ho, Ghana.
- College of Life Sciences, Birmingham City University, City South Campus, Birmingham, UK.
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Folkes M, Castro-Gutierrez V, Lundy L, Bajón-Fernández Y, Soares A, Jeffrey P, Hassard F. Campus source to sink wastewater surveillance of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). CURRENT RESEARCH IN MICROBIAL SCIENCES 2024; 6:100240. [PMID: 38774836 PMCID: PMC11106825 DOI: 10.1016/j.crmicr.2024.100240] [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] [Indexed: 05/24/2024] Open
Abstract
Wastewater-based surveillance (WBS) offers an aggregate, and cost-effective approach for tracking infectious disease outbreak prevalence within communities, that provides data on community health complementary to individual clinical testing. This study reports on a 16-month WBS initiative on a university campus in England, UK, assessing the presence of SARS-CoV-2 in sewers from large buildings, downstream sewer locations, raw wastewater, partially treated and treated effluents. Key findings include the detection of the Alpha (B.1.1.7) variant in wastewater, with 70 % of confirmed campus cases correlating with positive wastewater samples. Notably, ammonium nitrogen (NH4-N) levels showed a positive correlation (ρ = 0.543, p < 0.01) with virus levels at the large building scale, a relationship not observed at the sewer or wastewater treatment works (WWTW) levels due to dilution. The WWTW was compliant to wastewater standards, but the secondary treatment processes were not efficient for virus removal as SARS-CoV-2 was consistently detected in treated discharges. Tools developed through WBS can also be used to enhance traditional environmental monitoring of aquatic systems. This study provides a detailed source-to-sink evaluation, emphasizing the critical need for the widespread application and improvement of WBS. It showcases WBS utility and reinforces the ongoing challenges posed by viruses to receiving water quality.
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Affiliation(s)
- M. Folkes
- Cranfield University, College Road, Cranfield, Bedfordshire, MK43 0AL, UK
| | - V.M. Castro-Gutierrez
- Center for Research on Environmental Pollution (CICA), Universidad de Costa Rica, Montes de Oca, 11501, Costa Rica
| | - L. Lundy
- Department of Natural Sciences, Middlesex University, NW4 4BT, UK
| | - Y. Bajón-Fernández
- Cranfield University, College Road, Cranfield, Bedfordshire, MK43 0AL, UK
| | - A. Soares
- Cranfield University, College Road, Cranfield, Bedfordshire, MK43 0AL, UK
| | - P. Jeffrey
- Cranfield University, College Road, Cranfield, Bedfordshire, MK43 0AL, UK
| | - F. Hassard
- Cranfield University, College Road, Cranfield, Bedfordshire, MK43 0AL, UK
- Institute for Nanotechnology and Water Sustainability, College of Science, Engineering and Technology, University of South Africa, Johannesburg, South Africa
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5
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Teoh Z, Conrey S, McNeal M, Burrell A, Burke RM, Mattison CP, McMorrow M, Thornburg N, Payne DC, Morrow AL, Staat MA. Factors Associated With Prolonged Respiratory Virus Detection From Polymerase Chain Reaction of Nasal Specimens Collected Longitudinally in Healthy Children in a US Birth Cohort. J Pediatric Infect Dis Soc 2024; 13:189-195. [PMID: 38366142 DOI: 10.1093/jpids/piae009] [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: 11/08/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort. METHODS Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression. RESULTS From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not. CONCLUSIONS Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding.
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Affiliation(s)
- Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shannon Conrey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison Burrell
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel M Burke
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P Mattison
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Meredith McMorrow
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie Thornburg
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ardythe L Morrow
- Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Allen Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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6
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Liu W, Gong F, Zheng X, Pei L, Wang X, Yang S, Zhao S, Yang Z, Lin J, Jing F, Shang H, Bi Y, Wei D, Chen E, Chen Y. Factors associated with prolonged viral shedding of SARS-CoV-2 Omicron variant infection in Shanghai: A multicenter, retrospective, observational study. J Med Virol 2023; 95:e29342. [PMID: 38130170 DOI: 10.1002/jmv.29342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
Shanghai has faced an unprecedented COVID-19 pandemic with the BA.2.2 strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infection. Comprehensive insights into its epidemiology, clinical manifestations, and viral shedding dynamics are currently limited. This study encompasses 208373 COVID-19 patients that were infected with the Omicron BA.2.2 sub-lineage in Shanghai, China. Demographic information, clinical symptoms, vaccination status, isolation status, as well as viral shedding time (VST) were recorded. Among the COVID-19 patients included in this study, 187124 were asymptomatic and 21249 exhibited mild symptoms. The median VST was 8.3 days. The common clinical symptoms included fever, persistent cough, phlegm, sore throat, and gastrointestinal symptoms. Factors such as advanced age, presence of comorbidities, mild symptomatology, and delayed isolation correlated with extended VST. Conversely, female gender and administration of two or three vaccine doses correlated with a reduction in VST. This investigation offers an in-depth characterization and analytical perspective on Shanghai's recent COVID-19 surge. Prolonged viral shedding of SARS-CoV-2 was observed in elderly, male, symptomatic patients, and those with comorbidity. Female, individuals with two or three vaccine doses, as well as those isolated early, shows an effective reduced VST.
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Affiliation(s)
- Wenbin Liu
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangchen Gong
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangtao Zheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Pei
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanzhi Zhao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingsheng Lin
- Department of Disciplinary Development and Planning, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Jing
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanbing Shang
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Wei
- Research Laboratory of Clinical Virology, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Integration von SARS-CoV-2 als Erreger von Infektionen in der endemischen Situation in die Empfehlungen der KRINKO „Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten“. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1279-1301. [PMID: 37861707 DOI: 10.1007/s00103-023-03776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
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8
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Geubbels ELPE, Backer JA, Bakhshi-Raiez F, van der Beek RFHJ, van Benthem BHB, van den Boogaard J, Broekman EH, Dongelmans DA, Eggink D, van Gaalen RD, van Gageldonk A, Hahné S, Hajji K, Hofhuis A, van Hoek AJ, Kooijman MN, Kroneman A, Lodder W, van Rooijen M, Roorda W, Smorenburg N, Zwagemaker F, de Keizer NF, van Walle I, de Roda Husman AM, Ruijs C, van den Hof S. The daily updated Dutch national database on COVID-19 epidemiology, vaccination and sewage surveillance. Sci Data 2023; 10:469. [PMID: 37474530 PMCID: PMC10359398 DOI: 10.1038/s41597-023-02232-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/12/2023] [Indexed: 07/22/2023] Open
Abstract
The Dutch national open database on COVID-19 has been incrementally expanded since its start on 30 April 2020 and now includes datasets on symptoms, tests performed, individual-level positive cases and deaths, cases and deaths among vulnerable populations, settings of transmission, hospital and ICU admissions, SARS-CoV-2 variants, viral loads in sewage, vaccinations and the effective reproduction number. This data is collected by municipal health services, laboratories, hospitals, sewage treatment plants, vaccination providers and citizens and is cleaned, analysed and published, mostly daily, by the National Institute for Public Health and the Environment (RIVM) in the Netherlands, using automated scripts. Because these datasets cover the key aspects of the pandemic and are available at detailed geographical level, they are essential to gain a thorough understanding of the past and current COVID-19 epidemiology in the Netherlands. Future purposes of these datasets include country-level comparative analysis on the effect of non-pharmaceutical interventions against COVID-19 in different contexts, such as different cultural values or levels of socio-economic disparity, and studies on COVID-19 and weather factors.
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Affiliation(s)
- E L P E Geubbels
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - J A Backer
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - F Bakhshi-Raiez
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands
| | - R F H J van der Beek
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - B H B van Benthem
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - J van den Boogaard
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- The network of regional epidemiological consultants (REC), Bilthoven, the Netherlands
| | | | - D A Dongelmans
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D Eggink
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - R D van Gaalen
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - A van Gageldonk
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - S Hahné
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - K Hajji
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - A Hofhuis
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - A J van Hoek
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M N Kooijman
- Centre of Information Services and CIO office, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - A Kroneman
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W Lodder
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M van Rooijen
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W Roorda
- GGD GHOR Nederland, Utrecht, the Netherlands
| | - N Smorenburg
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - F Zwagemaker
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - N F de Keizer
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, the Netherlands
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, the Netherlands
| | - I van Walle
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - A M de Roda Husman
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - C Ruijs
- GGD GHOR Nederland, Utrecht, the Netherlands
| | - S van den Hof
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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9
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Gao Y, Zhao Y, Zhang X, Tian J, Guyatt G, Hao Q. Comparing SARS-CoV-2 testing positivity rates and COVID-19 impact among different isolation strategies: a rapid systematic review and a modelling study. EClinicalMedicine 2023; 61:102058. [PMID: 37360963 PMCID: PMC10285308 DOI: 10.1016/j.eclinm.2023.102058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Background The optimal isolation duration for patients with COVID-19 remains unclear. To support an update of World Health Organization (WHO)'s Living Clinical management guidelines for COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2022.2), this rapid systematic review and modelling study addresses the effects of different isolation periods for preventing onward transmission leading to hospitalisation and death among secondary cases. Methods We searched the WHO COVID-19 database for studies up to Feb 27, 2023. We included clinical studies of any design with COVID-19 patients confirmed by PCR test or rapid antigen test addressing the impact of any isolation strategy on preventing the spread of COVID-19. There were no restrictions on publication language, publication status, age of patients, severity of COVID-19, variants of SARS-COV-2, comorbidity of patients, isolation location, or co-interventions. We performed random-effects meta-analyses to summarise testing rates of persistent test positivity rates after COVID-19 infection. We performed pre-specified subgroup analyses by symptom status and meta-regression analyses for the proportion of fully vaccinated patients. We developed a model to compare the effects of three isolation strategies on onward transmission leading to hospitalisation and death. The three isolation strategies were (1) 5-day isolation, with no test to release; (2) removal of isolation based on a negative test; and (3) 10-day isolation, with no test to release. The model incorporates estimates of test positivity rates, effective reproduction number, isolation adherence, false negative rate, and hospitalisation rates or case fatality rates. To assess the impact of varying isolation adherence and false negative rates on rapid antigen testing, we conducted some sensitivity analyses. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. The protocol is registered with PROSPERO (CRD42022348626). Findings Fifteen studies addressing persistent test positivity rates including 4188 patients proved eligible. Asymptomatic patients (27.1%, 95% CI: 15.8%-40.0%) had a significantly lower rapid antigen test positive rate than symptomatic patients (68.1%, 95% CI: 40.6%-90.3%) on day 5. The rapid antigen test positive rate was 21.5% (95% CI: 0-64.1%; moderate certainty) on day 10. Our modelling study suggested that the risk difference (RD) for asymptomatic patients between 5-day isolation and 10-day isolation in hospitalisations (23 more hospitalisations of secondary cases per 10,000 patients isolated, 95% uncertainty interval (UI) 14 more to 33 more) and mortality (5 more per 10,000 patients, 95% UI 1 to 9 more) of secondary cases proved very small (very low certainty). For symptomatic patients, the potential impact of 5- versus 10-day isolation was much greater in hospitalisations (RD 186 more per 10,000 patients, 95% UI 113 more to 276 more; very low certainty) and mortality (RD 41 more per 10,000 patients, 95% UI 11 more to 73 more; very low certainty). There may be little or no difference between removing isolation based on a negative antigen test and 10-day isolation in the onward transmission leading to hospitalisation or death, but the average isolation period (mean difference -3 days) will be shorter for the removal of isolation based on a negative antigen test (moderate certainty). Interpretation 5 days versus 10 days of isolation in asymptomatic patients may result in a small amount of onward transmission and negligible hospitalisation and mortality; however, in symptomatic patients, the level of onward transmission is concerning and may lead to high hospitalisation and death rates. The evidence is, however, very uncertain. Funding This work was done in collaboration with WHO.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Zhang
- Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Qiukui Hao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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10
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Opsteen S, Files JK, Fram T, Erdmann N. The role of immune activation and antigen persistence in acute and long COVID. J Investig Med 2023; 71:545-562. [PMID: 36879504 PMCID: PMC9996119 DOI: 10.1177/10815589231158041] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/09/2023] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
In late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered the global coronavirus disease 2019 (COVID-19) pandemic. Although most infections cause a self-limited syndrome comparable to other upper respiratory viral pathogens, a portion of individuals develop severe illness leading to substantial morbidity and mortality. Furthermore, an estimated 10%-20% of SARS-CoV-2 infections are followed by post-acute sequelae of COVID-19 (PASC), or long COVID. Long COVID is associated with a wide variety of clinical manifestations including cardiopulmonary complications, persistent fatigue, and neurocognitive dysfunction. Severe acute COVID-19 is associated with hyperactivation and increased inflammation, which may be an underlying cause of long COVID in a subset of individuals. However, the immunologic mechanisms driving long COVID development are still under investigation. Early in the pandemic, our group and others observed immune dysregulation persisted into convalescence after acute COVID-19. We subsequently observed persistent immune dysregulation in a cohort of individuals experiencing long COVID. We demonstrated increased SARS-CoV-2-specific CD4+ and CD8+ T-cell responses and antibody affinity in patients experiencing long COVID symptoms. These data suggest a portion of long COVID symptoms may be due to chronic immune activation and the presence of persistent SARS-CoV-2 antigen. This review summarizes the COVID-19 literature to date detailing acute COVID-19 and convalescence and how these observations relate to the development of long COVID. In addition, we discuss recent findings in support of persistent antigen and the evidence that this phenomenon contributes to local and systemic inflammation and the heterogeneous nature of clinical manifestations seen in long COVID.
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Affiliation(s)
- Skye Opsteen
- Division of Infectious Diseases, Department
of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob K Files
- Division of Infectious Diseases, Department
of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tim Fram
- Division of Infectious Diseases, Department
of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathan Erdmann
- Division of Infectious Diseases, Department
of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Mendes-Correa MC, Salomão MC, Ghilardi F, Tozetto-Mendoza TR, Santos Villas-Boas L, de Paula AV, Paiao HGO, da Costa AC, Leal FE, Ferraz ADBC, Sales FCS, Claro IM, Ferreira NE, Pereira GM, da Silva AR, Freire W, Espinoza EPS, Manuli ER, Romano CM, de Jesus JG, Sabino EC, Witkin SS. SARS-CoV-2 Detection and Culture in Different Biological Specimens from Immunocompetent and Immunosuppressed COVID-19 Patients Infected with Two Different Viral Strains. Viruses 2023; 15:1270. [PMID: 37376568 DOI: 10.3390/v15061270] [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: 04/05/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction-The dynamics of SARS-CoV-2 shedding and replication in humans remain incompletely understood. Methods-We analyzed SARS-CoV-2 shedding from multiple sites in individuals with an acute COVID-19 infection by weekly sampling for five weeks in 98 immunocompetent and 25 immunosuppressed individuals. Samples and culture supernatants were tested via RT-PCR for SARS-CoV-2 to determine viral clearance rates and in vitro replication. Results-A total of 2447 clinical specimens were evaluated, including 557 nasopharyngeal swabs, 527 saliva samples, 464 urine specimens, 437 anal swabs and 462 blood samples. The SARS-CoV-2 genome sequences at each site were classified as belonging to the B.1.128 (ancestral strain) or Gamma lineage. SARS-CoV-2 detection was highest in nasopharyngeal swabs regardless of the virus strain involved or the immune status of infected individuals. The duration of viral shedding varied between clinical specimens and individual patients. Prolonged shedding of potentially infectious virus varied from 10 days up to 191 days, and primarily occurred in immunosuppressed individuals. Virus was isolated in culture from 18 nasal swab or saliva samples collected 10 or more days after onset of disease. Conclusions-Our findings indicate that persistent SARS-CoV-2 shedding may occur in both competent or immunosuppressed individuals, at multiple clinical sites and in a minority of subjects is capable of in vitro replication.
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Affiliation(s)
- Maria Cássia Mendes-Correa
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-010, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Matias Chiarastelli Salomão
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-010, Brazil
- Rua Peixoto Gomide, 645, Sao Paulo 01409-002, Brazil
| | - Fábio Ghilardi
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Tania Regina Tozetto-Mendoza
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Lucy Santos Villas-Boas
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Anderson Vicente de Paula
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Heuder Gustavo Oliveira Paiao
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Antonio Charlys da Costa
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Fábio E Leal
- Faculdade de Medicina da, Universidade Municipal de Sao Caetano do Sul, São Paulo 09521-160, Brazil
- Programa de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro 20230-130, Brazil
| | | | - Flavia C S Sales
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Ingra M Claro
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Noely E Ferreira
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Geovana M Pereira
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Almir Ribeiro da Silva
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Wilton Freire
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Evelyn Patricia Sánchez Espinoza
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Erika R Manuli
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade de Medicina da, Universidade Municipal de Sao Caetano do Sul, São Paulo 09521-160, Brazil
| | - Camila M Romano
- Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-010, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Jaqueline G de Jesus
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Ester C Sabino
- Departamento de Molestias Infecciosas e Parasitarias, Aculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, n. 470, São Paulo 05403-000, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade de Medicina da, Universidade Municipal de Sao Caetano do Sul, São Paulo 09521-160, Brazil
| | - Steven S Witkin
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA
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12
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Wu Y, Guo Z, Yuan J, Cao G, Wang Y, Gao P, Liu J, Liu M. Duration of viable virus shedding and polymerase chain reaction positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract: a systematic review and meta-analysis. Int J Infect Dis 2023; 129:228-235. [PMID: 36804640 PMCID: PMC9937726 DOI: 10.1016/j.ijid.2023.02.011] [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: 09/02/2022] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES To assess the duration of viable virus shedding and polymerase chain reaction (PCR) positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract. METHODS We systematically searched PubMed, Cochrane, and Web of Science for original articles reporting the duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract from November 11, 2021 to December 11, 2022. This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42022357349). We used the DerSimonian-Laird random-effects meta-analyses to obtain the pooled value and the 95% confidence intervals. RESULTS We included 29 studies and 230,227 patients. The pooled duration of viable virus shedding of the SARS-CoV-2 Omicron variant in the upper respiratory tract was 5.16 days (95% CI: 4.18-6.14), and the average duration of PCR positivity was 10.82 days (95% CI: 10.23-11.42). The duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in symptomatic patients was slightly higher than that in asymptomatic patients, but the difference was not significant (P >0.05). CONCLUSION The current study improves our understanding of the status of the literature on the duration of viable virus shedding and PCR positivity of Omicron in the upper respiratory tract. Our findings have implications for pandemic control strategies and infection control measures.
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Affiliation(s)
- Yu Wu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Zirui Guo
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Jie Yuan
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Guiying Cao
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Yaping Wang
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Peng Gao
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatics, School of Public Health, Peking University, Beijing, China.
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13
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Tsang TK, Huang X, Wang C, Chen S, Yang B, Cauchemez S, Cowling BJ. The effect of variation of individual infectiousness on SARS-CoV-2 transmission in households. eLife 2023; 12:82611. [PMID: 36880191 PMCID: PMC9991055 DOI: 10.7554/elife.82611] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Quantifying variation of individual infectiousness is critical to inform disease control. Previous studies reported substantial heterogeneity in transmission of many infectious diseases including SARS-CoV-2. However, those results are difficult to interpret since the number of contacts is rarely considered in such approaches. Here, we analyze data from 17 SARS-CoV-2 household transmission studies conducted in periods dominated by ancestral strains, in which the number of contacts was known. By fitting individual-based household transmission models to these data, accounting for number of contacts and baseline transmission probabilities, the pooled estimate suggests that the 20% most infectious cases have 3.1-fold (95% confidence interval: 2.2- to 4.2-fold) higher infectiousness than average cases, which is consistent with the observed heterogeneity in viral shedding. Household data can inform the estimation of transmission heterogeneity, which is important for epidemic management.
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Affiliation(s)
- Tim K Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
- Laboratory of Data Discovery for HealthHong KongChina
| | - Xiaotong Huang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - Can Wang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - Sijie Chen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - Bingyi Yang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong KongHong KongChina
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut PasteurParisFrance
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14
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Martínez-López J, De la Cruz J, Gil-Manso R, Alegre A, Ortiz J, Llamas P, Martínez Y, Hernández-Rivas JÁ, González-Gascón I, Benavente C, Estival Monteliu P, Jiménez-Yuste V, Canales M, Bastos M, Kwon M, Valenciano S, Callejas-Charavia M, López-Jiménez J, Herrera P, Duarte R, Núñez Martín-Buitrago L, Sanchez Godoy P, Jacome Yerovi C, Martínez-Barranco P, García Roa M, Escolano Escobar C, Matilla A, Rosado Sierra B, Aláez-Usón MC, Quiroz-Cervantes K, Martínez-Chamorro C, Pérez-Oteyza J, Martos-Martinez R, Herráez R, González-Santillana C, Del Campo JF, Alonso A, de la Fuente A, Pascual A, Bustelos-Rodriguez R, Sebrango A, Ruiz E, Marcheco-Pupo EA, Grande C, Cedillo Á, Lumbreras C, Arroyo Barea A, Casas-Rojo JM, Calbacho M, Diez-Martín JL, García-Suárez J. COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study. Cancers (Basel) 2023; 15:1497. [PMID: 36900296 PMCID: PMC10001264 DOI: 10.3390/cancers15051497] [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: 11/30/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/05/2023] Open
Abstract
Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February-June 2020; n = 769 (66%)) and later (July 2020-February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11-0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01-3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22-0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81-1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.
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Affiliation(s)
- Joaquín Martínez-López
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - Javier De la Cruz
- Research Institute, Hospital Universitario 12 de Octubre, imas12, 28041 Madrid, Spain
| | - Rodrigo Gil-Manso
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - Adrián Alegre
- Hematology Department, Hospital Universitario de La Princesa, IIS-HUP, 28006 Madrid, Spain
| | - Javier Ortiz
- Hematology Department, Hospital Universitario de La Princesa, IIS-HUP, 28006 Madrid, Spain
| | - Pilar Llamas
- Hematology Department, Hospital Fundación Jiménez Díaz, Health Research Institute IIS-FJD, 28040 Madrid, Spain
| | - Yolanda Martínez
- Hematology Department, Hospital Fundación Jiménez Díaz, Health Research Institute IIS-FJD, 28040 Madrid, Spain
| | | | | | - Celina Benavente
- Hematology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | | | | | - Miguel Canales
- Hematology Department, Clínica Universidad de Navarra, 28027 Madrid, Spain
| | - Mariana Bastos
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28223 Madrid, Spain
| | - Mi Kwon
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28223 Madrid, Spain
| | - Susana Valenciano
- Hematology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | - Marta Callejas-Charavia
- Hematology Department, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
| | - Javier López-Jiménez
- Hematology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Pilar Herrera
- Hematology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Rafael Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain
| | | | - Pedro Sanchez Godoy
- Hematology Department, Hospital Universitario Severo Ochoa, 28911 Madrid, Spain
| | | | | | - María García Roa
- Hematology Department, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
| | | | - Arturo Matilla
- Hematology Department, Hospital Central de la Defensa Gómez Ulla, 28047 Madrid, Spain
| | - Belén Rosado Sierra
- Hematology Department, Hospital Universitario Rey Juan Carlos, Móstoles, 28933 Madrid, Spain
| | | | | | - Carmen Martínez-Chamorro
- Hematology Department, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - Jaime Pérez-Oteyza
- Hematology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | - Rafael Martos-Martinez
- Hematology Department, Hospital Universitario General de Villalba, Villalba, 28400 Madrid, Spain
| | - Regina Herráez
- Hematology Department, Hospital Universitario Infanta Sofía, San Sebastián de Los Reyes, 28702 Madrid, Spain
| | | | | | - Arancha Alonso
- Hematology Department, Hospital Ruber, 28006 Madrid, Spain
| | - Adolfo de la Fuente
- Hematology Department, MD Anderson Cancer Center Madrid, 28033 Madrid, Spain
| | - Adriana Pascual
- Hematology Department, Hospital Universitario Infanta Elena, Valdemoro, 28340 Madrid, Spain
| | | | - Ana Sebrango
- Hematology Department, Hospital Universitario de Torrejón, 28850 Madrid, Spain
| | - Elena Ruiz
- Hematology Department, Hospital Universitario del Tajo, Aranjuez, 28300 Madrid, Spain
| | | | - Carlos Grande
- Hematology Department, Clínica Universidad de Navarra, 28027 Madrid, Spain
| | - Ángel Cedillo
- Asociación Madrileña de Hematología y Hemoterapia (AMHH), 28040 Madrid, Spain
| | - Carlos Lumbreras
- Internal Medicine Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Andrés Arroyo Barea
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - José Manuel Casas-Rojo
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, 28980 Madrid, Spain
| | - Maria Calbacho
- Hematology Department, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense, CNIO-ISCIII, CIBERONC, 28041 Madrid, Spain
| | - José Luis Diez-Martín
- Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28223 Madrid, Spain
| | - Julio García-Suárez
- Hematology Department, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
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15
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Keske Ş, Güney-Esken G, Vatansever C, Beşli Y, Kuloğlu ZE, Nergiz Z, Barlas T, Şencanlı Ö, Kuşkucu MA, Palaoğlu E, Can F, Önder Ergönül. Duration of infectious shedding of SARS-CoV-2 Omicron variant and its relation with symptoms. Clin Microbiol Infect 2023; 29:221-224. [PMID: 35853589 PMCID: PMC9287585 DOI: 10.1016/j.cmi.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES SARS-CoV-2 infections with Omicron variants have a high capability of human-to-human transmission. Nevertheless, the duration of isolation for mild cases was shortened to 5 to 7 days. We aimed to detect the duration of viral shedding among healthcare workers (HCWs) with Omicron by using viral culture. METHODS We prospectively included newly diagnosed nonsevere, symptomatic SARS-CoV-2 positive HCWs. Nasopharyngeal swab samples were obtained consecutively on days 5, 7,10, and 14 of onset of symptoms. The samples were examined by nucleic acid amplification test and viral culture. RESULTS In total, 55 non-severe patients with SARS-CoV-2 Omicron variant were included. The mean age of the population was 34 years (range, 23 to 54) and 78% (43/55) were female. The PCR positivity rate on days 5, 7, 10, and 14 was 96.4% (53/55), 87.3% (48/55), 74.545% (41/55), and 41.8% (23/55) consecutively, whereas the viral culture positivity rates were 83% (44/53), 52% (26/50), 13.5% (7/52), and 8% (4/50). Among the patients who became symptom-free, the viral culture positivity rates were 100% (4/4), 58% (7/12), 11% (3/27), and 5% (2/41). DISCUSSION We showed that among the SARS-CoV-2 Omicron variant infected patients, viral shedding continues for ≥10 days in 13.5% of all cases and 11% in symptom-free cases. The decision for cessation of isolation according to the presence of symptoms could be reconsidered until further studies disapprove of our results. Meanwhile, the infected HCWs who give care to high-risk patients for severe COVID-19 might extend their isolations ≤10 days after the onset of symptoms, regardless of their symptoms.
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Affiliation(s)
- Şiran Keske
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey; Koç University-Isbank Center for Infectious Diseases, Turkey.
| | | | - Cansel Vatansever
- Koç University-Isbank Center for Infectious Diseases, Turkey; Department of Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Yeşim Beşli
- Department of Medical Microbiology, VKV American Hospital, Istanbul, Turkey
| | - Zeynep Ece Kuloğlu
- Koç University-Isbank Center for Infectious Diseases, Turkey; Department of Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Zeliş Nergiz
- Koç University-Isbank Center for Infectious Diseases, Turkey; Department of Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Tayfun Barlas
- Koç University-Isbank Center for Infectious Diseases, Turkey
| | - Özgür Şencanlı
- Department of Occupational Medicine, VKV American Hospital, Istanbul, Turkey
| | | | - Erhan Palaoğlu
- Department of Medical Microbiology, VKV American Hospital, Istanbul, Turkey
| | - Füsun Can
- Koç University-Isbank Center for Infectious Diseases, Turkey; Department of Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Önder Ergönül
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey; Koç University-Isbank Center for Infectious Diseases, Turkey.
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Armas F, Chandra F, Lee WL, Gu X, Chen H, Xiao A, Leifels M, Wuertz S, Alm EJ, Thompson J. Contextualizing Wastewater-Based surveillance in the COVID-19 vaccination era. ENVIRONMENT INTERNATIONAL 2023; 171:107718. [PMID: 36584425 PMCID: PMC9783150 DOI: 10.1016/j.envint.2022.107718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
SARS-CoV-2 wastewater-based surveillance (WBS) offers a tool for cost-effective oversight of a population's infections. In the past two years, WBS has proven to be crucial for managing the pandemic across different geographical regions. However, the changing context of the pandemic due to high levels of COVID-19 vaccination warrants a closer examination of its implication towards SARS-CoV-2 WBS. Two main questions were raised: 1) Does vaccination cause shedding of viral signatures without infection? 2) Does vaccination affect the relationship between wastewater and clinical data? To answer, we review historical reports of shedding from viral vaccines in use prior to the COVID-19 pandemic including for polio, rotavirus, influenza and measles infection and provide a perspective on the implications of different COVID-19 vaccination strategies with regard to the potential shedding of viral signatures into the sewershed. Additionally, we reviewed studies that looked into the relationship between wastewater and clinical data and how vaccination campaigns could have affected the relationship. Finally, analyzing wastewater and clinical data from the Netherlands, we observed changes in the relationship concomitant with increasing vaccination coverage and switches in dominant variants of concern. First, that no vaccine-derived shedding is expected from the current commercial pipeline of COVID-19 vaccines that may confound interpretation of WBS data. Secondly, that breakthrough infections from vaccinated individuals contribute significantly to wastewater signals and must be interpreted in light of the changing dynamics of shedding from new variants of concern.
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Affiliation(s)
- Federica Armas
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Franciscus Chandra
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Wei Lin Lee
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Xiaoqiong Gu
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Hongjie Chen
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Amy Xiao
- Department of Biological Engineering, Massachusetts Institute of Technology, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology
| | - Mats Leifels
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Stefan Wuertz
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore; School of Civil and Environmental Engineering, Nanyang Technological University, Singapore
| | - Eric J Alm
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Department of Biological Engineering, Massachusetts Institute of Technology, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Janelle Thompson
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore; Asian School of the Environment, Nanyang Technological University, Singapore.
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17
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Arslan A, Sahbudak Bal Z, Yildirim Arslan S, Bilen NM, Guner Ozenen G, Yazıcı Özkaya P, Yurtseven A, Çiçek C, Durusoy İR, Ozkinay F, Kurugol Z. The longitudinal evaluation of COVID-19 in pediatric patients and the impact of delta variant. J Trop Pediatr 2022; 69:6972188. [PMID: 36611014 DOI: 10.1093/tropej/fmac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pediatric patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) displayed milder symptoms than adults. However, they play an important role in case numbers and virus transmission. Therefore, we aimed to determine the epidemiological features of all pediatric patients infected with SARS-CoV-2 and put forth case numbers longitudinally throughout the delta variant dominant period. METHODS A retrospective study was conducted at a university hospital and included patients between 0 and18 years old with a SARS-CoV-2 polymerase chain reaction (PCR) positive result, including inpatients and outpatients. Epidemiological and clinical features were recorded from electronic files, and telephone visits were performed between March 2020 and December 2021. RESULTS During the study period, 3175 coronavirus disease 2019 (COVID-19) pediatric patients were admitted to our hospital with a mean age of 10.61 ± 4.6 years. Of the 1815 patients who could be interviewed, 85.7% reported at least one symptom. Before the delta variant period, 0-4 years aged children were more commonly infected, while school-aged children and adolescents were more common, and the rate of pediatric cases to all COVID-19 cases increased to 35.8% after the delta variant became dominant. Symptomatic cases were significantly higher before the delta variant (87.8% vs. 84.06%, p = 0.016). The hospitalization rate was higher before the delta variant (p < 0.001), whereas PICU admission showed no statistical difference. CONCLUSIONS The frequency of school-aged children and adolescents raised with the impact of both school openings and the delta variant, and the rate of pediatric cases increased in total COVID-19 patient numbers.
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Affiliation(s)
- Asli Arslan
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Zumrut Sahbudak Bal
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Sema Yildirim Arslan
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Nimet Melis Bilen
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Gizem Guner Ozenen
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Pınar Yazıcı Özkaya
- Division of Pediatric İntensive Care Unit, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Ali Yurtseven
- Division of Emergency Medicine, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Candan Çiçek
- Department of Microbiology, Medical School of Ege University, Izmir 35100, Turkey
| | - İsabel Raika Durusoy
- Department of Public Health, Medical School of Ege University, Izmir 35100, Turkey
| | - Ferda Ozkinay
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Zafer Kurugol
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
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18
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Valenzuela-Fernández A, Cabrera-Rodriguez R, Ciuffreda L, Perez-Yanes S, Estevez-Herrera J, González-Montelongo R, Alcoba-Florez J, Trujillo-González R, García-Martínez de Artola D, Gil-Campesino H, Díez-Gil O, Lorenzo-Salazar JM, Flores C, Garcia-Luis J. Nanomaterials to combat SARS-CoV-2: Strategies to prevent, diagnose and treat COVID-19. Front Bioeng Biotechnol 2022; 10:1052436. [PMID: 36507266 PMCID: PMC9732709 DOI: 10.3389/fbioe.2022.1052436] [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: 09/23/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the associated coronavirus disease 2019 (COVID-19), which severely affect the respiratory system and several organs and tissues, and may lead to death, have shown how science can respond when challenged by a global emergency, offering as a response a myriad of rapid technological developments. Development of vaccines at lightning speed is one of them. SARS-CoV-2 outbreaks have stressed healthcare systems, questioning patients care by using standard non-adapted therapies and diagnostic tools. In this scenario, nanotechnology has offered new tools, techniques and opportunities for prevention, for rapid, accurate and sensitive diagnosis and treatment of COVID-19. In this review, we focus on the nanotechnological applications and nano-based materials (i.e., personal protective equipment) to combat SARS-CoV-2 transmission, infection, organ damage and for the development of new tools for virosurveillance, diagnose and immune protection by mRNA and other nano-based vaccines. All the nano-based developed tools have allowed a historical, unprecedented, real time epidemiological surveillance and diagnosis of SARS-CoV-2 infection, at community and international levels. The nano-based technology has help to predict and detect how this Sarbecovirus is mutating and the severity of the associated COVID-19 disease, thereby assisting the administration and public health services to make decisions and measures for preparedness against the emerging variants of SARS-CoV-2 and severe or lethal COVID-19.
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Affiliation(s)
- Agustín Valenzuela-Fernández
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Romina Cabrera-Rodriguez
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Laura Ciuffreda
- Research Unit, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Silvia Perez-Yanes
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Judith Estevez-Herrera
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | | | - Julia Alcoba-Florez
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Rodrigo Trujillo-González
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Departamento de Análisis Matemático, Facultad de Ciencias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Helena Gil-Campesino
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Oscar Díez-Gil
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - José M. Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Carlos Flores
- Research Unit, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Health Sciences, University of Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Jonay Garcia-Luis
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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19
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Early Negativization of SARS-CoV-2 Infection by Nasal Spray of Seawater plus Additives: The RENAISSANCE Open-Label Controlled Clinical Trial. Pharmaceutics 2022; 14:pharmaceutics14112502. [PMID: 36432693 PMCID: PMC9696981 DOI: 10.3390/pharmaceutics14112502] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background: COVID-19 is an asymptomatic condition in 40% of cases, and most symptomatic patients present with mild/moderate disease not requiring hospitalization or intensive care, especially during the Omicron wave, when the hospitalization rate was estimated to be 0.3%. The main port of entry for SARS-CoV-2 in the human body is the nasal cavity and the upper respiratory tract is affected since the early stages of the infection. Nasal irrigation or aerosol by isotonic or hypertonic saline solution is a traditional therapeutic approach for respiratory or nasal inflammation, also featured by prophylactic properties against upper respiratory infections. Methods: We conducted a prospective open-label controlled study to assess the superiority of an already existing medication (Tonimer Lab Panthexyl 800)-a sterile hypertonic solution containing seawater, xylitol, panthenol and lactic acid-to reduce the viral shedding time in patients affected by asymptomatic or mild COVID-19. COVID-19 patients (N = 108) were split into two groups: a treatment arm (50 participants receiving standard of care plus nasal spray 3 times/day with Tonimer Lab Panthexyl 800) and a control arm (58 participants receiving standard of care but nasal spray with Tonimer Lab Panthexyl 800). The two groups, both testing initially positive for SARS-CoV-2 at real-time PCR (RT-PCR) on nasal swab, were followed up over time to assess the daily number of positive swab tests turning negative (study endpoint). Treatment effectiveness at various time lags since the first positive RT-PCR swab test was measured by rate of events in the experimental arm (EER) and in the control arm (CER), absolute risk increase (ARI) = (EER - CER), and number needed to treat (NNT) = (1/ARI). To investigate the endpoint, we used logistic and Cox regression models, expressing the result as odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (95%CI), respectively. The symptoms recorded with a modified COVID-Q questionnaire at both diagnosis and first negative antigenic swab test were compared in each group (treated versus controls) by exact symmetry test. Results: During the first five days of treatment, COVID-19 patients treated with Tonimer Lab Panthexyl 800 were more likely to become negative two days before controls. According to NNT, four subjects had to be treated for five days to achieve the study endpoint in one individual. The negativization rate in patients treated with Tonimer Lab Panthexyl 800 was significantly higher than patients' treated with standard of care alone (OR = 7.39, 95%CI: 1.83-29.8; HR = 6.12, 95%CI: 1.76-21.32). There was no evidence of side effects. Conclusions: Nasal spray with Tonimer Lab Panthexyl 800 was effective against SARS-CoV-2, stopping viral shedding in the treatment arm two days before the control group. This treatment should be continued for at least five days after the first positive swab test for SARS-CoV-2.
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20
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Raymenants J, Duthoo W, Stakenborg T, Verbruggen B, Verplanken J, Feys J, Van Duppen J, Hanifa R, Marchal E, Lambrechts A, Maes P, André E, Van den Wijngaert N, Peumans P. Exhaled breath SARS-CoV-2 shedding patterns across variants of concern. Int J Infect Dis 2022; 123:25-33. [PMID: 35932968 PMCID: PMC9349369 DOI: 10.1016/j.ijid.2022.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We performed exhaled breath (EB) and nasopharyngeal (NP) quantitative polymerase chain reaction (qPCR) and NP rapid antigen testing (NP RAT) of SARS-CoV-2 infections with different variants. METHODS We included immuno-naïve alpha-infected (n = 11) and partly boosted omicron-infected patients (n = 8) as high-risk contacts. We compared peak NP and EB qPCR cycle time (ct) values between cohorts (Wilcoxon-Mann-Whitney test). Test positivity was compared for three infection phases using Cochran Q test. RESULTS Peak median NP ct was 11.5 (interquartile range [IQR] 10.1-12.1) for alpha and 12.2 (IQR 11.1-15.3) for omicron infections. Peak median EB ct was 25.2 (IQR 24.5-26.9) and 28.3 (IQR 26.4-30.8) for alpha and omicron infections, respectively. Distributions did not differ between cohorts for NP (P = 0.19) or EB (P = 0.09). SARS-CoV-2 shedding peaked on day 1 in EB (confidence interval [CI] 0.0 - 4.5) and day 3 in NP (CI 1.5 - 6.0). EB qPCR positivity equaled NP qPCR positivity on D0-D1 (P = 0.44) and D2-D6 (P = 1.0). It superseded NP RAT positivity on D0-D1 (P = 0.003) and D2-D6 (P = 0.008). It was inferior to both on D7-D10 (P < 0.001). CONCLUSION Peak EB and nasopharynx shedding were comparable across variants. EB qPCR positivity matched NP qPCR and superseded NP RAT in the first week of infection.
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Affiliation(s)
- Joren Raymenants
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000, Leuven, Belgium; Department of general internal medicine, University Hospitals Leuven, 3000, Leuven, Belgium.
| | - Wout Duthoo
- Imec Solutions department, imec, 3001, Leuven, Belgium
| | - Tim Stakenborg
- Life Science Technologies department, imec, 3001, Leuven, Belgium
| | | | - Julien Verplanken
- Enabling Digital Transformations department, imec, 9000, Ghent, Belgium
| | - Jos Feys
- Department of Clinical and Epidemiological Virology (Rega Institute), 3000, Leuven, Belgium
| | - Joost Van Duppen
- Life Science Technologies department, imec, 3001, Leuven, Belgium
| | - Rabea Hanifa
- Life Science Technologies department, imec, 3001, Leuven, Belgium
| | | | | | | | - Emmanuel André
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000, Leuven, Belgium; Department of laboratory medicine, University Hospitals Leuven, 3000, Leuven, Belgium
| | | | - Peter Peumans
- Life Science Technologies department, imec, 3001, Leuven, Belgium
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21
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Prasek SM, Pepper IL, Innes GK, Slinski S, Ruedas M, Sanchez A, Brierley P, Betancourt WQ, Stark ER, Foster AR, Betts-Childress ND, Schmitz BW. Population level SARS-CoV-2 fecal shedding rates determined via wastewater-based epidemiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156535. [PMID: 35688254 PMCID: PMC9172256 DOI: 10.1016/j.scitotenv.2022.156535] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 05/21/2023]
Abstract
Wastewater-based epidemiology (WBE) has been utilized as an early warning tool to anticipate disease outbreaks, especially during the COVID-19 pandemic. However, COVID-19 disease models built from wastewater-collected data have been limited by the complexities involved in estimating SARS-CoV-2 fecal shedding rates. In this study, wastewater from six municipalities in Arizona and Florida with distinct demographics were monitored for SARS-CoV-2 RNA between September 2020 and December 2021. Virus concentrations with corresponding clinical case counts were utilized to estimate community-wide fecal shedding rates that encompassed all infected individuals. Analyses suggest that average SARS-CoV-2 RNA fecal shedding rates typically occurred within a consistent range (7.53-9.29 log10 gc/g-feces); and yet, were unique to each community and influenced by population demographics. Age, ethnicity, and socio-economic factors may have influenced shedding rates. Interestingly, populations with median age between 30 and 39 had the greatest fecal shedding rates. Additionally, rates remained relatively constant throughout the pandemic provided conditions related to vaccination and variants were unchanged. Rates significantly increased in some communities when the Delta variant became predominant. Findings in this study suggest that community-specific shedding rates may be appropriate in model development relating wastewater virus concentrations to clinical case counts.
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Affiliation(s)
- Sarah M Prasek
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Ian L Pepper
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Gabriel K Innes
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Stephanie Slinski
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Martha Ruedas
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Ana Sanchez
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Paul Brierley
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA
| | - Walter Q Betancourt
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Erika R Stark
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Aidan R Foster
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Nick D Betts-Childress
- Water & Energy Sustainable Technology (WEST) Center, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85745, USA
| | - Bradley W Schmitz
- Yuma Center of Excellence for Desert Agriculture (YCEDA), University of Arizona, 6425 W. 8(th) St., Yuma, AZ 85364, USA.
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22
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Kleynhans J, Walaza S, Martinson NA, Neti M, von Gottberg A, Bhiman JN, Toi D, Amoako DG, Buys A, Ndlangisa K, Wolter N, Genade L, Maloma L, Chewparsad J, Lebina L, de Gouveia L, Kotane R, Tempia S, Cohen C. Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Adult Index Cases With and Without Human Immunodeficiency Virus in South Africa, 2020-2021: A Case-Ascertained, Prospective, Observational Household Transmission Study. Clin Infect Dis 2022; 76:e71-e81. [PMID: 35925613 PMCID: PMC9384657 DOI: 10.1093/cid/ciac640] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In South Africa, 19% of adults are living with human immunodeficiency virus (HIV; LWH). Few data on the influence of HIV on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) household transmission are available. METHODS We performed a case-ascertained, prospective household transmission study of symptomatic adult index SARS-CoV-2 cases LWH and not living with HIV (NLWH) and their contacts from October 2020 to September 2021. Households were followed up 3 times a week for 6 weeks to collect nasal swabs for SARS-CoV-2 testing. We estimated household cumulative infection risk (HCIR) and duration of SARS-CoV-2 positivity (at a cycle threshold value <30 as proxy for high viral load). RESULTS HCIR was 59% (220 of 373), not differing by index HIV status (60% LWH vs 58% NLWH). HCIR increased with index case age (35-59 years: adjusted OR [aOR], 3.4; 95% CI, 1.5-7.8 and ≥60 years: aOR, 3.1; 95% CI, 1.0-10.1) compared with 18-34 years and with contacts' age, 13-17 years (aOR, 7.1; 95% CI, 1.5-33.9) and 18-34 years (aOR, 4.4; 95% CI, 1.0-18.4) compared with <5 years. Mean positivity was longer in cases LWH (adjusted hazard ratio, 0.4; 95% CI, .1-.9). CONCLUSIONS Index HIV status was not associated with higher HCIR, but cases LWH had longer positivity duration. Adults aged >35 years were more likely to transmit and individuals aged 13-34 to be infected SARS-CoV-2 in the household. As HIV infection may increase transmission, health services must maintain HIV testing and antiretroviral therapy initiation.
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Affiliation(s)
- Jackie Kleynhans
- Correspondence: J. Kleynhans, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Modderfontein Road, Sandringham, 2192, Johannesburg, South Africa ()
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa,Center for TB Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mzimasi Neti
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dylan Toi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Daniel G Amoako
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kedibone Ndlangisa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leisha Genade
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Maloma
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Juanita Chewparsad
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa,Africa Health Research Institute, Durban, South Africa
| | - Linda de Gouveia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Retshidisitswe Kotane
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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23
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Shao J, Fan R, Hu J, Zhang T, Lee C, Huang X, Wang F, Liang H, Jin Y, Jiang Y, Gu Y, Huang G. Clinical Progression and Outcome of Hospitalized Patients Infected with SARS-CoV-2 Omicron Variant in Shanghai, China. Vaccines (Basel) 2022; 10:vaccines10091409. [PMID: 36146487 PMCID: PMC9503563 DOI: 10.3390/vaccines10091409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Studies on the Omicron variant infection have generally been restricted to descriptions of its initial clinical and epidemiological characteristics. We investigated the timeline-related progression and clinical outcome in hospitalized individuals with the Omicron variant. Methods: We conducted a retrospective, single-centered study including 226 laboratory-confirmed cases with the Omicron variant between 6 April and 11 May 2022 in Shanghai, China. The final date of follow-up was 30 May 2022. Results: Among 226 enrolled patients, the median age was 52 years, and 118 (52.2%) were female. The duration from onset of symptoms to hospitalization was 3 days (interquartile range (IQR): 2–4 days) for symptomatic patients. Cough occurred in 168 patients (74.3%). The median interval to negative reverse-transcriptase PCR tests of nasopharynx swab was 10 days ((IQR): 8–13 days). No radiographic progressions were found in 196 patients on the 7th day after onset of symptoms. The median duration of fever in all participants was 5 days (IQR: 4–6 days). The median PCR conversion time of Paxlovid-treated patients was 8 days (IQR: 7–10 days) compared with that of a traditional Chinese herb medicine lianhuaqingwen (10 days, IQR: 8–13 days) (p = 0.00056). Booster vaccination can significantly decrease the severity of Omicron infection when compared with unvaccinated patients (p = 0.009). In multivariate logistic analysis, erythrocyte sedimentation rate (ESR) (OR = 1.05) was independently related to the severity of the infection. Conclusions: The majority of clinical symptoms of Omicron infection were not severe. Early and aggressive administration of Paxlovid can significantly reduce the PCR conversion time. Booster vaccination should also be highly recommended in the population over 14 years old.
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Affiliation(s)
- Jiasheng Shao
- Department of Infectious Diseases and Immunology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201899, China
| | - Rong Fan
- Genomics, Biotechnology Center, Center for Molecular and Cellular Bioengineering, Technische Universität, 01307 Dresden, Germany
| | - Jianrong Hu
- Department of Respiratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201899, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Catherine Lee
- College of Public Health, University of Georgia, Athens, GA 30602, USA
| | - Xuyuan Huang
- Department of Urology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China
| | - Fei Wang
- Department of Intensive Care Unit, Jiading District Central Hospital, Shanghai 201899, China
| | - Haiying Liang
- Department of Respiratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201899, China
| | - Ye Jin
- Department of Respiratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201899, China
| | - Ying Jiang
- Department of Respiratory Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201899, China
| | - Yanhua Gu
- Department of Nursing, Jiading District Central Hospital, Shanghai 201899, China
| | - Gang Huang
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
- Correspondence: ; Tel.: +86-021-65881330
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24
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Verkerke HP, Damhorst GL, Graciaa DS, McLendon K, O'Sick W, Robichaux C, Cheedarla N, Potlapalli S, Wu SC, Harrington KRV, Webster A, Kraft C, Rostad CA, Waggoner JJ, Gandhi NR, Guarner J, Auld SC, Neish A, Roback JD, Lam WA, Shah NS, Stowell SR. Nucleocapsid Antigenemia Is a Marker of Acute SARS-CoV-2 Infection. J Infect Dis 2022; 226:1577-1587. [PMID: 35877413 PMCID: PMC9384592 DOI: 10.1093/infdis/jiac225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 01/07/2023] Open
Abstract
Detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is essential for diagnosis, treatment, and infection control. Polymerase chain reaction (PCR) fails to distinguish acute from resolved infections, as RNA is frequently detected after infectiousness. We hypothesized that nucleocapsid in blood marks acute infection with the potential to enhance isolation and treatment strategies. In a retrospective serosurvey of inpatient and outpatient encounters, we categorized samples along an infection timeline using timing of SARS-CoV-2 testing and symptomatology. Among 1860 specimens from 1607 patients, the highest levels and frequency of antigenemia were observed in samples from acute SARS-CoV-2 infection. Antigenemia was higher in seronegative individuals and in those with severe disease. In our analysis, antigenemia exhibited 85.8% sensitivity and 98.6% specificity as a biomarker for acute coronavirus disease 2019 (COVID-19). Thus, antigenemia sensitively and specifically marks acute SARS-CoV-2 infection. Further study is warranted to determine whether antigenemia may aid individualized assessment of active COVID-19.
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Affiliation(s)
- Hans P Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
| | - Daniel S Graciaa
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kaleb McLendon
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William O'Sick
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Narayanaiah Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sindhu Potlapalli
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shang Chuen Wu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin R V Harrington
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Andrew Webster
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jesse J Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA.,Emory Healthcare, Atlanta, Georgia, USA.,Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Neel R Gandhi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sara C Auld
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wilbur A Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA.,Department of Pediatrics and Center for Childhood Infections and Vaccines, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - N Sarita Shah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Sean R Stowell
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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25
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Schwellnus M, Adami PE, Bougault V, Budgett R, Clemm HH, Derman W, Erdener U, Fitch K, Hull JH, McIntosh C, Meyer T, Pedersen L, Pyne DB, Reier-Nilsen T, Schobersberger W, Schumacher YO, Sewry N, Soligard T, Valtonen M, Webborn N, Engebretsen L. International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections. Br J Sports Med 2022; 56:bjsports-2022-105759. [PMID: 35863871 DOI: 10.1136/bjsports-2022-105759] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.
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Affiliation(s)
- Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee Research Centre, Pretoria, South Africa
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco, Monaco Principality
| | - Valerie Bougault
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Hege Havstad Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Wayne Derman
- International Olympic Committee Research Centre, Pretoria, South Africa
- Institute of Sport and Exercise Medicine (ISEM), Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Uğur Erdener
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Ken Fitch
- School of Human Science; Sports, Exercise and Health, University of Western Australia, Perth, Western Australia, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London (UCL), London, UK
| | | | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Tonje Reier-Nilsen
- The Norwegian Olympic Sports Centre, Oslo, Norway
- Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Wolfgang Schobersberger
- Institute for Sports Medicine, Alpine Medicine & Health Tourism (ISAG), University Hospital - Tirol Kliniken Innsbruck and Private University UMIT Tirol, Hall, Austria
| | | | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee Research Centre, Pretoria, South Africa
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | | | - Nick Webborn
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Brighton, UK
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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26
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Castro-Gutierrez V, Hassard F, Vu M, Leitao R, Burczynska B, Wildeboer D, Stanton I, Rahimzadeh S, Baio G, Garelick H, Hofman J, Kasprzyk-Hordern B, Kwiatkowska R, Majeed A, Priest S, Grimsley J, Lundy L, Singer AC, Di Cesare M. Monitoring occurrence of SARS-CoV-2 in school populations: A wastewater-based approach. PLoS One 2022; 17:e0270168. [PMID: 35714109 PMCID: PMC9205509 DOI: 10.1371/journal.pone.0270168] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/03/2022] [Indexed: 01/12/2023] Open
Abstract
Clinical testing of children in schools is challenging, with economic implications limiting its frequent use as a monitoring tool of the risks assumed by children and staff during the COVID-19 pandemic. Here, a wastewater-based epidemiology approach has been used to monitor 16 schools (10 primary, 5 secondary and 1 post-16 and further education) in England. A total of 296 samples over 9 weeks have been analysed for N1 and E genes using qPCR methods. Of the samples returned, 47.3% were positive for one or both genes with a detection frequency in line with the respective local community. WBE offers a low cost, non-invasive approach for supplementing clinical testing and can provide longitudinal insights that are impractical with traditional clinical testing.
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Affiliation(s)
- Victor Castro-Gutierrez
- Cranfield University, Bedfordshire, United Kingdom
- Environmental Pollution Research Center (CICA), University of Costa Rica, Montes de Oca, Costa Rica
| | | | - Milan Vu
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Rodrigo Leitao
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Beata Burczynska
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Dirk Wildeboer
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Isobel Stanton
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Shadi Rahimzadeh
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, United Kingdom
| | - Hemda Garelick
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Jan Hofman
- Water Innovation & Research Centre, Department of Chemical Engineering, University of Bath, Bath, United Kingdom
| | - Barbara Kasprzyk-Hordern
- Water Innovation & Research Centre, Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Rachel Kwiatkowska
- School of Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Field Services, National Infection Service, Public Health England, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College Faculty of Medicine, London, United Kingdom
| | - Sally Priest
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Jasmine Grimsley
- Joint Biosecurity Centre, Department for Health and Social Care, London, United Kingdom
| | - Lian Lundy
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Andrew C. Singer
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Mariachiara Di Cesare
- Institute of Public Health and Wellbeing, University of Essex, Colchester, United Kingdom
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27
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Powers KA, Sullivan KM, Zadrozny SL, Shook-Sa BE, Byrnes R, Bogojevich DA, Lauen DL, Thompson P, Robinson WR, Gordon-Larsen P, Aiello AE. North Carolina public school teachers' contact patterns and mask use within and outside of school during the prevaccine phase of the COVID-19 pandemic. Am J Infect Control 2022; 50:608-617. [PMID: 34971715 PMCID: PMC8714247 DOI: 10.1016/j.ajic.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Teachers are central to school-associated transmission networks, but little is known about their behavioral patterns during the COVID-19 pandemic. METHODS We conducted a cross-sectional survey of 700 North Carolina public school teachers in 4 districts open to in-person learning in November-December 2020 (pre-COVID-19 vaccines). We assessed indoor and outdoor time spent, numbers of people encountered at <6 feet ("close contacts"), and mask use by teachers and those around them at specific locations on the most recent weekday and weekend day. RESULTS Nearly all respondents reported indoor time at home (98%) and school (94%) on the most recent weekday, while 62% reported indoor time at stores, 18% at someone else's home, and 17% at bars/restaurants. Responses were similar for the most recent weekend day, excepting school (where 5% reported indoor time). Most teachers (>94%) reported wearing masks inside school, stores, and salons; intermediate percentages (∼50%-85%) inside places of worship, bars/restaurants, and recreational settings; and few (<25%) in their or others' homes. Approximately half reported daily close contact with students. CONCLUSIONS As schools reopened in the COVID-19 pandemic, potential transmission opportunities arose through close contacts within and outside of school, along with suboptimal mask use by teachers and/or those around them. Our granular estimates underscore the importance of multilayered mitigation strategies and can inform interventions and mathematical models addressing school-associated transmission.
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Affiliation(s)
- Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Kristin M Sullivan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sabrina L Zadrozny
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rosemary Byrnes
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David A Bogojevich
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Douglas L Lauen
- Department of Public Policy, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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28
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Pitak-Arnnop P, Tangmanee C, Meningaud JP, Neff A. Prolonged viral shedding identified from external splints and intranasal packings in immediately cured COVID-19 patients with nasal fractures: A retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:287-291. [PMID: 35413460 PMCID: PMC8994412 DOI: 10.1016/j.jormas.2022.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Our aim was to measure and compare prolonged viral shedding (PVS) identified from external splints (ES) and intranasal packings (IP) for isolated nasal fracture (INF) repair in immediately cured asymptomatic vs. mildly symptomatic COVID-19 patients (AS-COVID vs. MS-COVID). METHODS We designed a retrospective cohort study and enroled a sample of post-AS-COVID and post-MS-COVID patients, whose INF were treated at a German level 1 trauma centre. The primary predictor variable was COVID severity presurgery (AS-COVD vs. MS-COVID). The main outcome variable was PVS detected in ES/IP. Other study variables were separated into demographic, clinical, and operative. Descriptive, bi- and multivariate statistics were computed, and statistical significance was set at P≤ 0.05. RESULTS The study sample comprised 15 INF patients (53.3% females; 46.7% post-AS-COVID) with a mean age of 42.2 ± 22.7 years (range, 18-85). 13.3% ES and 53.3% IP were contaminated with SARS-CoV-2. However, only IP-contamination between the two cohorts reached statistical significance (P= 0.01; odds ratio, 0.02; 95% confidence interval, 0 to 0.47; Pearson's r= 0.73; post hoc power = 87.4%). Multiple linear regression models refuted the associations between PVS and the other parameters (i.e. age, gender, time to treatment, length of hospital stay, lengths of ES/IP placement). CONCLUSIONS Despite a relative low sample size, our findings suggest PVS via endonasal materials removed from cured COVID-19 patients, especially those healed from MS-COVID. This PVS may trigger re-infection and surgical site infections and/or transmission to other humans, and thereby, requires further investigations.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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29
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Wright J, Driver EM, Bowes DA, Johnston B, Halden RU. Comparison of high-frequency in-pipe SARS-CoV-2 wastewater-based surveillance to concurrent COVID-19 random clinical testing on a public U.S. university campus. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 820:152877. [PMID: 34998780 PMCID: PMC8732902 DOI: 10.1016/j.scitotenv.2021.152877] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 05/14/2023]
Abstract
Wastewater-based epidemiology (WBE) is utilized globally as a tool for quantifying the amount of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within communities, yet the efficacy of community-level wastewater monitoring has yet to be directly compared to random Coronavirus Disease of 2019 (COVID-19) clinical testing; the best-supported method of virus surveillance within a single population. This study evaluated the relationship between SARS-CoV-2 RNA in raw wastewater and random COVID-19 clinical testing on a large university campus in the Southwestern United States during the Fall 2020 semester. Daily composites of wastewater (24-hour samples) were collected three times per week at two campus locations from 16 August 2020 to 1 January 2021 (n = 95) and analyzed by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) targeting the SARS-CoV-2 E gene. Campus populations were estimated using campus resident information and anonymized, unique user Wi-Fi connections. Resultant trends of SARS-CoV-2 RNA levels in wastewater were consistent with local and nationwide pandemic trends showing peaks in infections at the start of the Fall semester in mid-August 2020 and mid-to-late December 2020. A strong positive correlation (r = 0.71 (p < 0.01); n = 15) was identified between random COVID-19 clinical testing and WBE surveillance methods, suggesting that wastewater surveillance has a predictive power similar to that of random clinical testing. Additionally, a comparative cost analysis between wastewater and clinical methods conducted here show that WBE was more cost effective, providing data at 1.7% of the total cost of clinical testing ($6042 versus $338,000, respectively). We conclude that wastewater monitoring of SARS-CoV-2 performed in tandem with random clinical testing can strengthen campus health surveillance, and its economic advantages are maximized when performed routinely as a primary surveillance method, with random clinical testing reserved for an active outbreak situation.
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Affiliation(s)
- Jillian Wright
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; OneWaterOneHealth, The Arizona State University Foundation, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA
| | - Erin M Driver
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Devin A Bowes
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; OneWaterOneHealth, The Arizona State University Foundation, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; School for Engineering of Matter, Transport, and Energy, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Bridger Johnston
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Rolf U Halden
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; School for Engineering of Matter, Transport, and Energy, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; School for Sustainable Engineering and the Built Environment, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; Global Futures Laboratory, Arizona State University, 800 S. Cady Mall, Tempe, AZ 85281, USA.
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30
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Yan H, Ding Y, Guo W. Epidemiological, Radiographical, and Laboratorial Characteristics of Chinese Asymptomatic Cases With COVID-19: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:808471. [PMID: 35433622 PMCID: PMC9008196 DOI: 10.3389/fpubh.2022.808471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/11/2022] [Indexed: 12/23/2022] Open
Abstract
The comprehensive understanding of the characteristics of asymptomatic cases are helpful for the identification and management of patients with asymptomatic COVID-19 infection. Four electronic databases were searched from December 1, 2019 to February 8, 2022 for relevant articles. Data synthesis, subgroup analysis, and sensitivity analysis were performed on the included studies. I2 and Q tests were applied to evaluate heterogeneity across studies. The risk of publication bias was assessed and visualized using a funnel plot. A total of 45 studies consisting of 2,655 patients with no symptoms at the screening point were included. Pooled results showed that in China, 65% of initial no-symptoms COVID-19 patients did not present any COVID-19-related symptom during follow-up or by end of disease course (asymptomatic infections). High proportions of initial no-symptoms COVID-19 patients (76%) and patients with asymptomatic infection (55%) had abnormal CT features at the screening point. High proportion of patients with asymptomatic infection had been detected Ig G+ (72%) and/or Ig M+ (57%) at the screening point. The chest CT scan and SARS-CoV-2-specific antibody testing could serve as effective supplementary methods to identify asymptomatic cases in the early stage of SARS-CoV-2 infection. However, the chest CT scan and the SARS-CoV-2-specific IgM and IgG testing should not replace reverse transcription–polymerase chain reaction (RT-PCR) for screening in asymptomatic patients. The combination of repeated RT-PCR, chest CT scans, and the SARS-CoV-2-specific IgM and IgG testing should be performed for those highly suspected SARS-CoV-2 infections.
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Affiliation(s)
- Haohao Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yudan Ding
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, China
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31
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Long SM, Chern A, Cooley V, Chung S, Feit NZ, Craney A, Simon MS, Tassler AB. Temporal Dynamics of Nasopharyngeal and Tracheal SARS-CoV-2 Cycle Thresholds in COVID-19 Patients with Tracheostomy. Clin Infect Dis 2022; 75:1649-1651. [PMID: 35442449 PMCID: PMC9047213 DOI: 10.1093/cid/ciac316] [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: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
In this study of 45 patients with COVID-19 undergoing tracheostomy, nasopharyngeal and tracheal cycle threshold (Ct) values were analyzed. Ct values rose to 37.9 by the time of tracheostomy and remained >35 postoperatively, demonstrating that persistent test positivity may not be associated with persistent transmissible virus in this population.
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Affiliation(s)
- Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York USA
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York USA
| | - Victoria Cooley
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York USA
| | - Sei Chung
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York USA
| | - Noah Z Feit
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA
| | - Arryn Craney
- Clinical Molecular and Microbiology, Orlando Health Regional Medical Center, Orlando, Florida USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York USA
| | - Matthew S Simon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York USA
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA
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32
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Tam I, McNamara C, Dunbar J, O'Connor K, Manzano G, Cabana MD, Hametz PA. SARS-CoV-2 Gastrointestinal Shedding in Hospitalized Children. Hosp Pediatr 2022; 12:e78-e85. [PMID: 35028670 DOI: 10.1542/hpeds.2021-006304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus that can cause gastrointestinal (GI) symptoms, with studies demonstrating detection of stool viral RNA weeks after respiratory tract clearance. It is unknown if children who test negative for SARS-CoV-2 on a nasopharyngeal (NP) swab may be shedding the virus in their stool. OBJECTIVE To measure the prevalence of SARS-CoV-2 stool shedding in children with positive and negative SARS-CoV-2 NP polymerase chain reactions (PCR) tests, and to determine clinical factors associated with GI shedding. METHODS In this cross-sectional study, we enrolled hospitalized patients 0 to 21 years old with a positive or a negative SARS-CoV-2 NP PCR test who had respiratory and/or GI symptoms. Participants were surveyed, and stool samples were sent for viral PCR testing. Fisher's exact test was used to evaluate bivariate associations of stool PCR test positivity with categorical variables. RESULTS Sixty-seven patients were consented; 34 patients did not provide stool samples so 33 patients were included: 17 NP-positive and 16 NP-negative for SARS-CoV-2. Eight of the 17 NP-positive patients had a positive stool PCR test for SARS-CoV-2, while none of the 16 SARS-CoV-2 NP-negative patients had a positive result (P < .01). For the 17 SARS-CoV-2 NP-positive patients, GI symptoms were associated with a positive stool PCR test (P = .05) for SARS-CoV-2, but this association was not found for all 33 patients (P = .11). No associations were found with patients in an immunocompromised state or those with a comorbid condition, fever and/or chills, respiratory symptoms, headache and/or myalgias, or anosmia and/or ageusia. CONCLUSIONS SARS-CoV-2 GI shedding is common and associated with GI symptoms in NP-positive children, with 47% having positive stool PCRs for SARS-CoV-2. GI shedding was not demonstrated in SARS-CoV-2 NP-negative children.
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33
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Ceccarelli M, Marino A, Cosentino F, Moscatt V, Celesia BM, Gussio M, Bruno R, Rullo EV, Nunnari G, Cacopardo BS. Post-infectious ST elevation myocardial infarction following a COVID-19 infection: A case report. Biomed Rep 2022; 16:10. [PMID: 34987794 DOI: 10.3892/br.2021.1493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022] Open
Abstract
Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has been shown to increase the risk of thrombotic events due to a hypercoagulable state caused by several factors. The case of a 59-year-old woman affected by hypertension and metabolic disorders, treated for a COVID-19 infection who developed cardiac symptoms during the first days of hospitalization is reported. Electrocardiogram analysis and cardiac-ultrasound confirmed ST-segment elevation myocardial infarction (STEMI) diagnosis, thus the patient underwent percutaneous coronary intervention, which was successful. This case highlights a possible association between respiratory infection, particularly SARS-CoV-2 infection, and cardiovascular events, in particular Acute Coronary Syndrome. The association between these phenomena seems related to a range of factors, including a proinflammatory state and the hypoxemia. Moreover, the association amongst SARS-CoV-2 and cardiovascular diseases may be also linked to long-term sequelae. Thus, further studies are required to better understand the multifaceted and severe complications of this disease.
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Affiliation(s)
- Manuela Ceccarelli
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy
| | - Andrea Marino
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy
| | - Federica Cosentino
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy.,Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-I98124 Messina, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy.,Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-I98124 Messina, Italy
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy
| | - Maria Gussio
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy
| | - Roberto Bruno
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-I98124 Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-I98124 Messina, Italy
| | - Bruno Santi Cacopardo
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, I-95122 Catania, Sicily, Italy
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34
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Castro-Gutierrez V, Hassard F, Vu M, Leitao R, Burczynska B, Wildeboer D, Stanton I, Rahimzadeh S, Baio G, Garelick H, Hofman J, Kasprzyk-Hordern B, Kwiatkowska R, Majeed A, Priest S, Grimsley J, Lundy L, Singer AC, Di Cesare M. Monitoring occurrence of SARS-CoV-2 in school populations: A wastewater-based approach. PLoS One 2022. [PMID: 35714109 DOI: 10.1101/2021.03.25.21254231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Clinical testing of children in schools is challenging, with economic implications limiting its frequent use as a monitoring tool of the risks assumed by children and staff during the COVID-19 pandemic. Here, a wastewater-based epidemiology approach has been used to monitor 16 schools (10 primary, 5 secondary and 1 post-16 and further education) in England. A total of 296 samples over 9 weeks have been analysed for N1 and E genes using qPCR methods. Of the samples returned, 47.3% were positive for one or both genes with a detection frequency in line with the respective local community. WBE offers a low cost, non-invasive approach for supplementing clinical testing and can provide longitudinal insights that are impractical with traditional clinical testing.
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Affiliation(s)
- Victor Castro-Gutierrez
- Cranfield University, Bedfordshire, United Kingdom
- Environmental Pollution Research Center (CICA), University of Costa Rica, Montes de Oca, Costa Rica
| | | | - Milan Vu
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Rodrigo Leitao
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Beata Burczynska
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Dirk Wildeboer
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Isobel Stanton
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Shadi Rahimzadeh
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, United Kingdom
| | - Hemda Garelick
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Jan Hofman
- Water Innovation & Research Centre, Department of Chemical Engineering, University of Bath, Bath, United Kingdom
| | - Barbara Kasprzyk-Hordern
- Water Innovation & Research Centre, Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Rachel Kwiatkowska
- School of Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Field Services, National Infection Service, Public Health England, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College Faculty of Medicine, London, United Kingdom
| | - Sally Priest
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Jasmine Grimsley
- Joint Biosecurity Centre, Department for Health and Social Care, London, United Kingdom
| | - Lian Lundy
- Department of Natural Science, School of Science and Technology, Middlesex University, London, United Kingdom
| | - Andrew C Singer
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Mariachiara Di Cesare
- Institute of Public Health and Wellbeing, University of Essex, Colchester, United Kingdom
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35
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Gastrointestinal viral shedding in children with SARS-CoV-2: a systematic review and meta-analysis. World J Pediatr 2022; 18:582-588. [PMID: 35665477 PMCID: PMC9166206 DOI: 10.1007/s12519-022-00553-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/12/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has different manifestations in pediatric cases. It is assumed that they might present more gastrointestinal symptoms with a different viral shedding pattern in gastrointestinal samples. In this systematic review and meta-analysis, we aimed to evaluate the viral shedding pattern in gastrointestinal specimens of children with COVID-19. METHODS We searched all published studies in English language in PubMed, Web of Science, and Scopus, up to date as of October 2021. Our search included the term "severe acute respiratory syndrome coronavirus 2, COVID-19, SARS-CoV-2, novel coronavirus, or coronavirus; and shed, excrete, secret, or carriage; and stool or rectal; and children or pediatrics". We included studies evaluating SARS-CoV-2 shedding in gastrointestinal specimens, including rectal swabs and stool samples of children with COVID-19 infection. We excluded duplicated data, case reports, and studies without original data. RESULTS Twelve studies met the eligibility criteria for the qualitative synthesis, 10 of which were included in the meta-analysis. The pooled prevalence of gastrointestinal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in children with COVID-19 was 86% (95% confidence interval 73%-96%, I2 = 62.28%). After respiratory specimen had become negative, 72% (43/60) had persistent shedding in gastrointestinal specimens. The gastrointestinal RNA had a positive test result for more than 70 days after symptoms onset. CONCLUSIONS Gastrointestinal shedding of SARS-CoV-2 might occur in a substantial portion of children and might persist long after negative respiratory testing. Further research is recommended to find the role of SARS-CoV-2 gastrointestinal shedding in transmission in children.
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Parrella R, Marra A, Scarano F, Manzillo E, Esposito V, Punzi R, Fragranza F, D'Agnano V, Cazzola M, Bianco A. [Corticosteroids and delayed conversion of SARS-CoV-2 RNA nasopharyngeal swabs in hospitalized patients with COVID 19 pneumonia]. Arch Bronconeumol 2021; 58:55-58. [PMID: 34866749 PMCID: PMC8627005 DOI: 10.1016/j.arbres.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Roberto Parrella
- UOC Malattie Infettive ad Indirizzo Respiratorio, Cotugno Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Alberto Marra
- Dipartimento Malattie Infettive e Urgenze Infettivologiche, Cotugno Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Francesco Scarano
- UOC Malattie Infettive ad Indirizzo Respiratorio, Cotugno Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Elio Manzillo
- UOC Malattie Infettive e dell'Immigrazione, Cotugno Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Vincenzo Esposito
- UOC Malattie Infettive e Medicina di Genere, Cotugno Hospital AORN Ospedali dei Colli, Napoli, Italy
| | - Rodolfo Punzi
- UOC Malattie Infettive ad Indirizzo Epato-Oncologico e dei Trapianti, Cotugno Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Fiorentino Fragranza
- UOC Anestesia, Rianimazione e Terapia Intensiva, Cotugno Hospital, AORN Ospedali dei Colli, Napoli, Italy
| | - Vito D'Agnano
- Dipartimento di Scienze Mediche Traslazionali, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Mario Cazzola
- Dipartimento di Medicina Sperimentale, University of Rome "Tor Vergata", Roma, Italy
| | - Andrea Bianco
- Dipartimento di Scienze Mediche Traslazionali, University of Campania "L. Vanvitelli", Napoli, Italy
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37
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Julin CH, Robertson AH, Hungnes O, Tunheim G, Bekkevold T, Laake I, Aune IF, Killengreen MF, Strand TR, Rykkvin R, Dorenberg DH, Stene-Johansen K, Berg ES, Bodin JE, Oftung F, Steens A, Næss LM. Household Transmission of SARS-CoV-2: A Prospective Longitudinal Study Showing Higher Viral Load and Increased Transmissibility of the Alpha Variant Compared to Previous Strains. Microorganisms 2021; 9:2371. [PMID: 34835495 PMCID: PMC8622435 DOI: 10.3390/microorganisms9112371] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
We studied the secondary attack rate (SAR), risk factors, and precautionary practices of household transmission in a prospective, longitudinal study. We further compared transmission between the Alpha (B.1.1.7) variant and non-Variant of Concern (non-VOC) viruses. From May 2020 throughout April 2021, we recruited 70 confirmed COVID-19 cases with 146 household contacts. Participants donated biological samples eight times over 6 weeks and answered questionnaires. SARS-CoV-2 infection was detected by real-time RT-PCR. Whole genome sequencing and droplet digital PCR were used to establish virus variant and viral load. SARS-CoV-2 transmission occurred in 60% of the households, and the overall SAR for household contacts was 50%. The SAR was significantly higher for the Alpha variant (78%) compared with non-VOC viruses (43%) and was associated with a higher viral load. SAR was higher in household contacts aged ≥40 years (69%) than in younger contacts (40-47%), and for contacts of primary cases with loss of taste/smell. Children had lower viral loads and were more often asymptomatic than adults. Sleeping separately from the primary case reduced the risk of transmission. In conclusion, we found substantial household transmission, particularly for the Alpha variant. Precautionary practices seem to reduce SAR, but preventing household transmission may become difficult with more contagious variants, depending on vaccine use and effectiveness.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lisbeth Meyer Næss
- Division of Infection Control, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway; (C.H.J.); (A.H.R.); (O.H.); (G.T.); (T.B.); (I.L.); (I.F.A.); (M.F.K.); (T.R.S.); (R.R.); (D.H.D.); (K.S.-J.); (E.S.B.); (J.E.B.); (F.O.); (A.S.)
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38
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Lin DY, Gu Y, Zeng D, Janes HE, Gilbert PB. Evaluating Vaccine Efficacy Against SARS-CoV-2 Infection. Clin Infect Dis 2021; 74:544-552. [PMID: 34260716 PMCID: PMC8406869 DOI: 10.1093/cid/ciab630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Indexed: 12/31/2022] Open
Abstract
Although interim results from several large, placebo-controlled, phase 3 trials demonstrated high vaccine efficacy (VE) against symptomatic coronavirus disease 2019 (COVID-19), it is unknown how effective the vaccines are in preventing people from becoming asymptomatically infected and potentially spreading the virus unwittingly. It is more difficult to evaluate VE against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than against symptomatic COVID-19 because infection is not observed directly but rather is known to occur between 2 antibody or reverse-transcription polymerase chain reaction (RT-PCR) tests. Additional challenges arise as community transmission changes over time and as participants are vaccinated on different dates because of staggered enrollment of participants or crossover of placebo recipients to the vaccine arm before the end of the study. Here, we provide valid and efficient statistical methods for estimating potentially waning VE against SARS-CoV-2 infection with blood or nasal samples under time-varying community transmission, staggered enrollment, and blinded or unblinded crossover. We demonstrate the usefulness of the proposed methods through numerical studies that mimic the BNT162b2 phase 3 trial and the Prevent COVID U study. In addition, we assess how crossover and the frequency of diagnostic tests affect the precision of VE estimates.
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Affiliation(s)
- Dan-Yu Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yu Gu
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Holly E Janes
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, Washington, USA
| | - Peter B Gilbert
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, Washington, USA
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39
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Busa F, Bardanzellu F, Pintus MC, Fanos V, Marcialis MA. COVID-19 and School: To Open or Not to Open, That Is the Question. The First Review on Current Knowledge. Pediatr Rep 2021; 13:257-278. [PMID: 34205837 PMCID: PMC8293384 DOI: 10.3390/pediatric13020035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has led to an unprecedented closure of schools in terms of duration. The option of school closure, SARS-CoV-2 initially being poorly known, was influenced by the epidemiological aspects of the influenza virus. However, school closure is still under debate and seems unsupported by sure evidence of efficacy in the COVID-19 era. The aim of our narrative review is to discuss the available literature on SARS-CoV-2 spread among children and adolescents, in the school setting, trying to explain why children appear less susceptible to severe disease and less involved in viral spreading. We also tried to define the efficacy of school closure, through an overview of the effects of the choices made by the various countries, trying to identify which preventive measures could be effective for a safe reopening. Finally, we focused on the psychological aspects of such a prolonged closure for children and adolescents. SARS-CoV-2, children, COVID-19, influenza, and school were used as key words in our literature research, updated to 29 March 2021. To our knowledge, this is the first review summarizing the whole current knowledge on SARS-CoV-2 spreading among children and adolescents in the school setting, providing a worldwide overview in such a pandemic context.
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Affiliation(s)
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4,500, 09042 Monserrato, Italy; (F.B.); (M.C.P.); (V.F.); (M.A.M.)
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