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Goh YS, Fong SW, Hor PX, Loh CY, Wang B, Salleh SNM, Ngoh EZX, Lee RTC, Poh XY, Rao S, Chia PY, Ong SWX, Lee TH, Lim C, Teo J, Pada S, Sun LJ, Ong DLS, Somani J, Lee ES, Maurer-Stroh S, Wang CI, Leo YS, Lye DC, Young BE, Ng LFP, Renia L. Variant-specific IgA protects against Omicron infection. J Infect Dis 2023:jiad525. [PMID: 37996071 DOI: 10.1093/infdis/jiad525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The emergence of rapidly evolving SARS-CoV-2 variants, coupled with waning vaccine-induced immunity, has contributed to the rise of vaccine breakthrough infections. It is crucial to understand how vaccine-induced protection is mediated. METHODS We examined two prospective cohorts of mRNA-vaccinated-and-boosted individuals during the Omicron wave of infection in Singapore. RESULTS We found that, individuals, who remain uninfected over the follow-up period, had a higher variant-specific IgA, but not IgG, antibody response at 1-month post booster vaccination, compared with individuals who became infected. CONCLUSIONS We conclude that IgA may have a potential contributory role in protection against Omicron infection.
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Affiliation(s)
- Yun Shan Goh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Siew-Wai Fong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Pei Xiang Hor
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Chiew Yee Loh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Bei Wang
- Singapore Immunology Network, A*STAR, Singapore
| | | | | | - Raphael Tze Chuen Lee
- Bioinformatics Institute, A*STAR, Singapore
- GISAID Global Data Science Initiative (GISAID), Munich, Germany
| | | | - Suma Rao
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean W X Ong
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Clarissa Lim
- National Centre for Infectious Diseases, Singapore
| | - Jefanie Teo
- National Centre for Infectious Diseases, Singapore
| | | | | | | | - Jyoti Somani
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Healthcare Group Polyclinics, Singapore
| | - Sebastian Maurer-Stroh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
- Bioinformatics Institute, A*STAR, Singapore
- GISAID Global Data Science Initiative (GISAID), Munich, Germany
- National Public Health Laboratory, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
- National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool UK
| | - Laurent Renia
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore
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Goh YS, Rouers A, Fong SW, Zhuo NZ, Hor PX, Loh CY, Huang Y, Neo VK, Kam IKJ, Wang B, Ngoh EZX, Salleh SNM, Lee RTC, Pada S, Sun LJ, Ong DLS, Somani J, Lee ES, Maurer-Stroh S, Wang CI, Leo Y, Ren EC, Lye DC, Young BE, Ng LFP, Renia L. Waning of specific antibodies against Delta and Omicron variants five months after a third dose of BNT162b2 SARS-CoV-2 vaccine in elderly individuals. Front Immunol 2022; 13:1031852. [PMID: 36451833 PMCID: PMC9704817 DOI: 10.3389/fimmu.2022.1031852] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/21/2022] [Indexed: 07/30/2023] Open
Abstract
The emergence of new SARS-CoV-2 variants, such as the more transmissible Delta and Omicron variants, has raised concerns on efficacy of the COVID-19 vaccines. Here, we examined the waning of antibody responses against different variants following primary and booster vaccination. We found that antibody responses against variants were low following primary vaccination. The antibody response against Omicron was almost non-existent. Efficient boosting of antibody response against all variants, including Omicron, was observed following a third dose. The antibody response against the variants tested was significantly higher at one month following booster vaccination, compared with two months following primary vaccination, for all individuals, including the low antibody responders identified at two months following primary vaccination. The antibody response, for all variants tested, was significantly higher at four months post booster than at five months post primary vaccination, and the proportion of low responders remained low (6-11%). However, there was significant waning of antibody response in more than 95% of individuals at four months, compared to one month following booster. We also observed a robust memory B cell response following booster, which remained higher at four months post booster than prior to booster. However, the memory B cell responses were on the decline for 50% of individuals at four months following booster. Similarly, while the T cell response is sustained, at cohort level, at four months post booster, a substantial proportion of individuals (18.8 - 53.8%) exhibited T cell response at four months post booster that has waned to levels below their corresponding levels before booster. The findings show an efficient induction of immune response against SARS-CoV-2 variants following booster vaccination. However, the induced immunity by the third BNT162b2 vaccine dose was transient. The findings suggest that elderly individuals may require a fourth dose to provide protection against SARS-CoV-2.
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Affiliation(s)
- Yun Shan Goh
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Angeline Rouers
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Siew-Wai Fong
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Nicole Ziyi Zhuo
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Pei Xiang Hor
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Chiew Yee Loh
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Yuling Huang
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Vanessa Kexin Neo
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Isaac Kai Jie Kam
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Bei Wang
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Eve Zi Xian Ngoh
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Siti Nazihah Mohd Salleh
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Raphael Tze Chuen Lee
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Global Data Science Initiative (GISAID), Munich, Germany
| | - Surinder Pada
- Infectious Diseases, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Louisa Jin Sun
- Infectious Diseases, Alexandra Hospital, Singapore, Singapore
| | | | - Jyoti Somani
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclincs, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | | | - Sebastian Maurer-Stroh
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Global Data Science Initiative (GISAID), Munich, Germany
- National Public Health Laboratory, National Centre for Infectious Diseases (NCID), Singapore, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Cheng-I Wang
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yee‐Sin Leo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases (NCID), Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee Chee Ren
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David C. Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases (NCID), Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Barnaby Edward Young
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases (NCID), Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lisa F. P. Ng
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laurent Renia
- ASTAR Infectious Diseases Labs (ASTAR ID Labs), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
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3
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Goh YS, Fong SW, Rouers A, Chang ZW, Tay MZ, Chavatte JM, Zhuo NZ, Hor PX, Loh CY, Huang Y, Wong JXE, Tan YJ, Lim DRX, Wang B, Ngoh EZX, Salleh SNM, Lee RTC, Pada S, Sun LJ, Ong DLS, Somani J, Lee ES, Maurer-Stroh S, Wang CI, Leo YS, Lin RT, Ren EC, Lye DC, Young BE, Lim PL, Ng LF, Renia L. Heterologous booster vaccination with CoronaVac following prime vaccination with mRNA vaccine. Clin Transl Immunology 2022; 11:e1403. [PMID: 36016852 PMCID: PMC9398778 DOI: 10.1002/cti2.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Despite the high vaccine efficacy of mRNA COVID‐19 vaccines, there are individuals who developed excessive reactogenic and/or allergic responses after the first mRNA dose and were considered ineligible for further mRNA doses. CoronaVac, an inactivated SARS‐CoV‐2 vaccine, is recommended in Singapore as an alternative. Methods Individuals, ineligible for further mRNA vaccines (BNT162b2 or mRNA‐1273) because of excessive reactive responses to prime mRNA vaccination, were recruited and offered two doses of CoronaVac as booster vaccination 38–224 days post their mRNA vaccine dose. Individuals who did not develop any excessive reactive responses after the prime mRNA vaccination were also recruited and given another mRNA vaccine as booster vaccination. Blood samples were collected at days 0, 21 and 90 post first CoronaVac dose and mRNA dose, respectively, for analysis. Results We showed that two CoronaVac booster doses induced specific immunity in these mRNA vaccine‐primed individuals. Although the spike‐specific antibody response was lower, their memory B cell response against the receptor‐binding domain (RBD) of the spike protein was similar, compared with individuals who received two BNT162b2 injections. The spike‐specific memory T cell response also increased following CoronaVac booster doses. However, specific immunity against the Omicron variant was low, similar to individuals with two BNT162b2 doses. Conclusion Our findings showed that while mRNA vaccine‐primed individuals can opt for two subsequent doses of CoronaVac, an additional dose may be necessary to achieve protection, especially against newly emerging immune escape variants such as Omicron.
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Affiliation(s)
- Yun Shan Goh
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Siew-Wai Fong
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Angeline Rouers
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Zi Wei Chang
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Matthew Zirui Tay
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Jean-Marc Chavatte
- National Public Health Laboratory National Centre for Infectious Diseases Singapore City Singapore
| | - Nicole Ziyi Zhuo
- Singapore Immunology Network, Agency for Science Technology and Research (ASTAR) Singapore City Singapore
| | - Pei Xiang Hor
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Chiew Yee Loh
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Yuling Huang
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Joel Xu En Wong
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Yong Jie Tan
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore
| | - Daniel Rui Xiang Lim
- National Public Health Laboratory National Centre for Infectious Diseases Singapore City Singapore
| | - Bei Wang
- Singapore Immunology Network, Agency for Science Technology and Research (ASTAR) Singapore City Singapore
| | - Eve Zi Xian Ngoh
- Singapore Immunology Network, Agency for Science Technology and Research (ASTAR) Singapore City Singapore
| | - Siti Nazihah Mohd Salleh
- Singapore Immunology Network, Agency for Science Technology and Research (ASTAR) Singapore City Singapore
| | - Raphael Tze Chuen Lee
- Bioinformatics Institute, ASTAR Singapore City Singapore.,GISAID Global Data Science Initiative (GISAID) Munich Germany
| | - Surinder Pada
- Ng Teng Fong General Hospital Singapore City Singapore
| | - Louisa Jin Sun
- Infectious Diseases Alexandra Hospital Singapore City Singapore
| | | | - Jyoti Somani
- Division of Infectious Diseases, Department of Medicine, National University Hospital National University Health System Singapore City Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics Singapore City Singapore.,Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore
| | | | | | - Sebastian Maurer-Stroh
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore.,National Public Health Laboratory National Centre for Infectious Diseases Singapore City Singapore.,Bioinformatics Institute, ASTAR Singapore City Singapore.,GISAID Global Data Science Initiative (GISAID) Munich Germany.,Department of Biological Sciences National University of Singapore Singapore City Singapore
| | - Cheng-I Wang
- Singapore Immunology Network, Agency for Science Technology and Research (ASTAR) Singapore City Singapore
| | - Yee-Sin Leo
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.,National Centre for Infectious Diseases (NCID) Singapore City Singapore.,Department of Infectious Diseases Tan Tock Seng Hospital Singapore City Singapore.,Saw Swee Hock School of Public Health National University of Singapore Singapore City Singapore.,Yong Loo Lin School of Medicine National University of Singapore and National University Health System Singapore City Singapore
| | - Raymond Tp Lin
- National Public Health Laboratory National Centre for Infectious Diseases Singapore City Singapore.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Ee Chee Ren
- Singapore Immunology Network, Agency for Science Technology and Research (ASTAR) Singapore City Singapore.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - David C Lye
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.,National Centre for Infectious Diseases (NCID) Singapore City Singapore.,Department of Infectious Diseases Tan Tock Seng Hospital Singapore City Singapore.,Yong Loo Lin School of Medicine National University of Singapore and National University Health System Singapore City Singapore
| | - Barnaby Edward Young
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.,National Centre for Infectious Diseases (NCID) Singapore City Singapore.,Department of Infectious Diseases Tan Tock Seng Hospital Singapore City Singapore
| | - Poh Lian Lim
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.,National Centre for Infectious Diseases (NCID) Singapore City Singapore.,Department of Infectious Diseases Tan Tock Seng Hospital Singapore City Singapore.,Saw Swee Hock School of Public Health National University of Singapore Singapore City Singapore.,Yong Loo Lin School of Medicine National University of Singapore and National University Health System Singapore City Singapore
| | - Lisa Fp Ng
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore.,National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections University of Liverpool Liverpool UK.,Institute of Infection, Veterinary and Ecological Sciences University of Liverpool Liverpool UK
| | - Laurent Renia
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science Technology and Research (A*STAR) Singapore City Singapore.,Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.,School of Biological Sciences Nanyang Technological University Singapore City Singapore
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Mao Y, Tan YR, Thein TL, Chai YAL, Cook AR, Dickens BL, Lew YJ, Lim FS, Lim JT, Sun Y, Sundaram M, Soh A, Tan GSE, Wong FPG, Young B, Zeng K, Chen M, Ong DLS. Identifying COVID-19 cases in outpatient settings. Epidemiol Infect 2021; 149:e92. [PMID: 33814027 PMCID: PMC8060539 DOI: 10.1017/s0950268821000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 01/08/2023] Open
Abstract
Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.
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Affiliation(s)
- Yinan Mao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Yi-Roe Tan
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Tun Linn Thein
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Yi Ann Louis Chai
- National University Hospital, National University Health System, Singapore, Singapore
| | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Borame L. Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yii Jen Lew
- National University Polyclinics, Singapore, Singapore
| | - Fong Seng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yinxiaohe Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | | | - Alexius Soh
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Glorijoy Shi En Tan
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Barnaby Young
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Kangwei Zeng
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Mark Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
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5
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Mittal R, Wong ML, Koh GCH, Ong DLS, Lee YH, Tan MN, Allen PF. Factors affecting dental service utilisation among older Singaporeans eligible for subsidized dental care - a qualitative study. BMC Public Health 2019; 19:1075. [PMID: 31395045 PMCID: PMC6688284 DOI: 10.1186/s12889-019-7422-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization has highlighted the paucity of research into the oral health needs of older adults. In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. Access to a more comprehensive range of subsidized care in the private sector was widened through the government-funded Community Health Assistance Scheme (CHAS) in 2012 and Pioneer Generation (PG) scheme in 2015. Little is known about the attitude to dental service utilization among older adults in Singapore since then. Methods We conducted semi-structured individual interviews with 25 participants above 65 years of age who were eligible for subsidized dental care plans. Participants were recruited from a public teaching hospital and a public primary care clinic in Singapore. The duration of each interview was 15–30 min. Interviews were transcribed verbatim and the transcripts were analyzed thematically using a phenomenological approach. Results Pertinent themes emerged related to four major areas: (a) general awareness towards oral health, (b) life course perspective of oral health, (c) barriers to visit the dentist, (d) shaping dental service utilisation behaviours through provision of financial subsidies for dental care. Most participants perceived a strong relationship between oral health and systemic health. However, there were erroneous traditional beliefs such as oral health is not part of physical health and edentulous participants did not need to visit a dentist. Fear, anxiety, previous negative experience and lack of knowledge were barriers to visiting the dentist. Trust and convenience were considerations for patients when deciding whether to switch from public to private dental services where CHAS/PG were only available. Conclusion Our study provided important insights regarding oral health perceptions and beliefs of older people residing in the community which may affect their dental service utilization. This further highlights the importance of understanding the concerns of this group when implementing healthcare policies for elderly in Singapore. The findings of our study will serve as a baseline for future studies in Singapore and inform studies in other countries that implement targeted schemes for older adults.
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Affiliation(s)
- Rakhi Mittal
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | | | - Yun Hui Lee
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Mei Na Tan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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