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Lucien MAB, Pierre K, Jean-Denis G, Rigodon J, Worrell CM, Couture A, Flynn A, Calderon MC, Codina LF, Vicari AS, Marseille S, Jean Baptiste KT, Fouche B, Joseph G, Journel I, Rendel K, Grant-Greene Y, Jean-Charles NP, Lafontant D, Amouzou S, Pierre W, Clement MGR, Juin S, Boncy J, Dely P. Epidemiology and risk factors related to severity of clinical manifestations of COVID-19 in outpatients: A retrospective study in Haiti. PLoS One 2022; 17:e0274760. [PMID: 36129879 PMCID: PMC9491605 DOI: 10.1371/journal.pone.0274760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Haiti’s first COVID-19 cases were confirmed on March 18, 2020, and subsequently spread throughout the country. The objective of this study was to describe clinical manifestations of COVID-19 in Haitian outpatients and to identify risk factors for severity of clinical manifestations. Methods We conducted a retrospective study of COVID-19 outpatients diagnosed from March 18-August 4, 2020, using demographic, epidemiological, and clinical data reported to the Ministry of Health (MoH). We used univariate and multivariate analysis, including multivariable logistic regression, to explore the risk factors and specific symptoms related to persons with symptomatic COVID-19 and the severity of symptomatic COVID-19 disease. Results Of 5,389 cases reported to MOH during the study period, 1,754 (32.5%) were asymptomatic. Amongst symptomatic persons 2,747 (75.6%) had mild COVID-19 and 888 (24.4%) had moderate-to-severe disease; the most common symptoms were fever (69.6%), cough (51.9%), and myalgia (45.8%). The odds of having moderate-to-severe disease were highest among persons with hypertension (aOR = 1.72, 95% Confidence Interval [CI] (1.34, 2.20), chronic pulmonary disease (aOR = 3.93, 95% CI (1.93, 8.17)) and tuberculosis (aOR = 3.44, 95% CI (1.35, 9.14)) compared to persons without those conditions. The odds of having moderate-to-severe disease increased with age but was also seen among children aged 0–4 years (OR: 1.73, 95% CI (0.93, 3.08)), when using 30–39 years old as the reference group. All of the older age groups, 50–64 years, 65–74 years, 75–84 years, and 85+ years, had significantly higher odds of having moderate-to-severe COVID-19 compared with ages 30–39 years. Diabetes was associated with elevated odds of moderate-to-severe disease in bivariate analysis (OR = 2.17, 95% CI (1.58,2.98) but, this association did not hold in multivariable analyses (aOR = 1.22,95%CI (0.86,1.72)). Conclusion These findings from a resource-constrained country highlight the importance of surveillance systems to track emerging infections and their risk factors. In addition to co-morbidities described elsewhere, tuberculosis was a risk factor for moderate-to-severe COVID-19 disease.
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Affiliation(s)
- Mentor Ali Ber Lucien
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Katilla Pierre
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | - Gladzdin Jean-Denis
- Pan American Health Organization, World Health Organization (PAHO/WHO), Port-au-Prince, Haiti
| | - Jonas Rigodon
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
- * E-mail:
| | - Caitlin M. Worrell
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexia Couture
- COVID-19 International Task Force Emergency Response Capacity Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aspen Flynn
- COVID-19 International Task Force Emergency Response Capacity Team, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mauricio Cerpa Calderon
- Pan American Health Organization, World Health Organization (PAHO/WHO), Port-au-Prince, Haiti
| | - Luis Felipe Codina
- Pan American Health Organization, World Health Organization (PAHO/WHO), Port-au-Prince, Haiti
| | - Andrea S. Vicari
- Pan American Health Organization, World Health Organization (PAHO/WHO), Washington, DC, United States of America
| | - Samson Marseille
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | | | | | - Gerard Joseph
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Ito Journel
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Kenold Rendel
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | | | | | - Donald Lafontant
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | - Senou Amouzou
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | - Wilnique Pierre
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
| | | | - Stanley Juin
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Jacques Boncy
- National Public Health Laboratory (LNSP)/ Ministry of Public Health and Population (MSPP), Port au Prince, Haiti
| | - Patrick Dely
- Directorate of Epidemiology, Laboratories and Research (DELR)/MSPP, Port au Prince, Haiti
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Burnett E, Juin S, Esona MD, Desormeaux AM, Aliabadi N, Pierre M, Andre-Alboth J, Leshem E, Etheart MD, Patel R, Dely P, Fitter D, Jean-Denis G, Kalou M, Katz MA, Bowen MD, Grant-Greene Y, Boncy J, Parashar UD, Joseph GA, Tate JE. Effectiveness of monovalent rotavirus vaccine against hospitalizations due to all rotavirus and equine-like G3P[8] genotypes in Haiti 2014-2019. Vaccine 2021; 39:4458-4462. [PMID: 34187708 PMCID: PMC8474148 DOI: 10.1016/j.vaccine.2021.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rotavirus vaccines are effective in preventing severe rotavirus. Haiti introduced 2-dose monovalent (G1P[8]) rotavirus vaccine recommended for infants at 6 and 10 weeks of age in 2014. We calculated the effectiveness of rotavirus vaccine against hospitalization for acute gastroenteritis in Haiti. METHODS We enrolled children 6-59 months old admitted May 2014-September 2019 for acute watery diarrhea at any sentinel surveillance hospital. Stool was tested for rotavirus using enzyme immunoassay (EIA) and genotyped with multiplex one-step RT-PCR assay and Sanger sequencing for stratification by genotype. We used a case-negative design where cases were children positive for rotavirus and controls were negative for rotavirus. Only children eligible for vaccination were included and a child was considered vaccinated if vaccine was given ≥ 14 days before enrollment. We used unconditional logistic regression to calculate odds ratios and calculated 2-dose and 1-dose vaccine effectiveness (VE) as (1 - odds ratio) * 100. RESULTS We included 129 (19%) positive cases and 543 (81%) negative controls. Among cases, 77 (60%) were positive for equine-like G3P[8]. Two doses of rotavirus vaccine were 66% (95% CI: 44, 80) effective against hospitalizations due to any strain of rotavirus and 64% (95% CI: 33, 81) effective against hospitalizations due to the equine-like G3P[8] genotype. CONCLUSIONS These findings are comparable to other countries in the Americas region. To the best of our knowledge, this is the first VE estimate both against the equine-like G3P[8] genotype and from a Caribbean country. Overall, these results support rotavirus vaccine use and demonstrate the importance of complete vaccination.
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Affiliation(s)
| | | | | | | | | | | | - Jocelyn Andre-Alboth
- Ministry of Public Health and Population - Laboratoire National de Sante Publique, Port-au-Prince, Haiti
| | - Eyal Leshem
- Division of Viral Diseases, NCIRD, CDC, USA; Sheba Medical Center and Tel Aviv University, Tel Aviv, Israel
| | | | | | - Patrick Dely
- Ministry of Public Health and Population - Directorate of Epidemiology, Laboratory and Research (DELR), Port-au-Prince, Haiti
| | | | | | | | | | | | | | - Jacques Boncy
- Ministry of Public Health and Population - Laboratoire National de Sante Publique, Port-au-Prince, Haiti
| | | | - Gerard A Joseph
- Ministry of Public Health and Population - Laboratoire National de Sante Publique, Port-au-Prince, Haiti
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Lucien MAB, Canarie MF, Kilgore PE, Jean-Denis G, Fénélon N, Pierre M, Cerpa M, Joseph GA, Maki G, Zervos MJ, Dely P, Boncy J, Sati H, Rio AD, Ramon-Pardo P. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. Int J Infect Dis 2021; 104:250-254. [PMID: 33434666 PMCID: PMC7796801 DOI: 10.1016/j.ijid.2020.12.087] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [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: 09/10/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal.
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Affiliation(s)
- Mentor Ali Ber Lucien
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti.
| | - Michael F Canarie
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul E Kilgore
- Eugene Applebaum School of Pharmacy, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | - Gerard A Joseph
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Gina Maki
- The Global Health Initiative, Henry Ford Health System, Detroit, Michigan, USA
| | - Marcus J Zervos
- The Global Health Initiative, Henry Ford Health System, Detroit, Michigan, USA
| | - Patrick Dely
- Direction d'Épidémiologie, de Laboratoire et de Recherches, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Hatim Sati
- Pan American Health Organization, AMR Special Program, Washington DC, USA
| | - Ana Del Rio
- Pan American Health Organization, AMR Special Program, Washington DC, USA
| | - Pilar Ramon-Pardo
- Pan American Health Organization, AMR Special Program, Washington DC, USA
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