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Caini S, Casalegno JS, Rodrigues AP, Lee V, Cohen C, Huang QS, Bruno Caicedo A, Teirlinck A, Guiomar R, Ang LW, Moyes J, Wood T, de Mora D, Bangert M, Kramer R, Staadegaard L, Heemskerk S, van Summeren J, Meijer A, Paget J. Change in Age profile of Respiratory Syncytial Virus disease over the course of annual epidemics: a multi-national study. J Infect 2024; 88:106154. [PMID: 38583722 DOI: 10.1016/j.jinf.2024.106154] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/16/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES We aimed to study whether the percentwise age distribution of RSV cases changes over time during annual epidemics. METHODS We used surveillance data (2008-2019) from the Netherlands, Lyon (France), Portugal, Singapore, Ecuador, South Africa, and New Zealand. In each country, every season was divided into "epidemic quarters", i.e. periods corresponding to each quartile of RSV cases. Multinomial logistic regression models were fitted to evaluate whether the likelihood of RSV cases being aged <1 or ≥5 years (vs. 1 to <5) changed over time within a season. RESULTS In all countries, RSV cases were significantly more likely to be aged <1 year in the 4th vs. 1st epidemic quarter; the relative risk ratio [RRR] ranged between 1.35 and 2.56. Likewise, RSV cases were significantly more likely to be aged ≥5 years in the 4th vs. 1st epidemic quarter (except in Singapore); the RRR ranged from 1.75 to 6.70. The results did not change when stratifying by level of care or moving the lower cut-off to 6 months. CONCLUSIONS The age profile of RSV cases shifts within a season, with infants and adolescents, adults, and the elderly constituting a higher proportion of cases in the later phases of annual epidemics. These findings may have implications for RSV prevention policies with newly approved vaccines.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
| | - Jean-Sebastien Casalegno
- Virology Department, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, HCL, Lyon, France
| | | | - Vernon Lee
- Ministry of Health, Singapore, Singapore
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Q Sue Huang
- Institute of Environmental Science and Research Limited (ESR), National Centre for Biosecurity and Infectious Disease (NCBID), Upper Hutt, New Zealand
| | - Alfredo Bruno Caicedo
- Instituto Nacional de Investigación en Salud Pública (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador; Universidad Agraria del Ecuador, Guayaquil, Ecuador
| | - Anne Teirlinck
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Research, Bilthoven, the Netherlands
| | - Raquel Guiomar
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Li Wei Ang
- Ministry of Health, Singapore, Singapore
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Tim Wood
- Institute of Environmental Science and Research Limited (ESR), National Centre for Biosecurity and Infectious Disease (NCBID), Upper Hutt, New Zealand
| | - Doménica de Mora
- Instituto Nacional de Investigación en Salud Pública (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador
| | | | | | - Lisa Staadegaard
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Susanne Heemskerk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | | | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Research, Bilthoven, the Netherlands
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
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Ng TM, Ang LW, Heng ST, Kwa ALH, Wu JE, Seah XFV, Lee SY, Seah J, Choo R, Lim PL, Thoon KC, Chlebicki MP, Somani J, Lee TH, Lye DC. Antibiotic utilisation and resistance over the first decade of nationally funded antimicrobial stewardship programmes in Singapore acute-care hospitals. Antimicrob Resist Infect Control 2023; 12:82. [PMID: 37612738 PMCID: PMC10464409 DOI: 10.1186/s13756-023-01289-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the time series of broad-spectrum antibiotic utilisation and incidence of antibiotic-resistant organisms during the implementation of antimicrobial stewardship programmes (ASP) in Singapore. METHODS An observational study was conducted using data from 2011 to 2020 in seven acute-care public hospitals. We applied joinpoint regressions to investigate changes in antibiotic utilisation rate and incidence density of antibiotic-resistant organisms. RESULTS Across the seven hospitals, quarterly broad-spectrum antibiotic utilisation rate remained stable. Half-yearly incidence density of antibiotic-resistant organisms with two joinpoints at first half (H1) of 2012 and second half (H2) of 2014 decreased significantly in the second and third period with a half-yearly percentage change (HPC) of -2.9% and - 0.5%, respectively. Across the five hospitals with complete data, half-yearly broad-spectrum antibiotic utilisation rate with one joinpoint decreased significantly from H1 of 2011 to H2 of 2018 (HPC - 4.0%) and H2 of 2018 to H2 2020 (HPC - 0.5%). Incidence density of antibiotic-resistant organisms decreased significantly in the two joinpoint periods from H1 of 2012 to H2 of 2014 (HPC - 2.7%) and H2 of 2014 to H2 of 2020 (HPC - 1.0%). Ceftriaxone with one joinpoint decreased significantly from H1 of 2011 to H1 of 2014 (HPC - 6.0%) and H1 of 2014 to H2 of 2020 (HPC - 1.8%) and ceftriaxone-resistant E. coli and K. pneumoniae decreased significantly in later periods, from H2 of 2016 to H2 of 2020 (HPC - 2.5%) and H1 of 2012 to H2 of 2015 (HPC - 4.6%) respectively. Anti-pseudomonal antibiotics with one joinpoint decreased significantly from H1 of 2011 to H2 of 2014 (HPC - 4.5%) and H2 of 2014 to H2 of 2020 (HPC - 0.8%) and that of quinolones with one joinpoint at H1 of 2015 decreased significantly in the first period. C. difficile with one joinpoint increased significantly from H1 of 2011 to H1 of 2015 (HPC 3.9%) and decreased significantly from H1 of 2015 to H2 of 2020 (HPC - 4.9%). CONCLUSIONS In the five hospitals with complete data, decrease in broad-spectrum antibiotic utilisation rate was followed by decrease in incidence density of antibiotic-resistant organisms. ASP should continue to be nationally funded as a key measure to combat antimicrobial resistance in acute care hospitals.
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Affiliation(s)
- Tat Ming Ng
- Tan Tock Seng Hospital, Singapore, Singapore.
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
| | | | - Andrea Lay-Hoon Kwa
- Singapore General Hospital, Singapore, Singapore
- Duke- National University of Singapore Medical School, Singapore, Singapore
| | - Jia En Wu
- National University Hospital, Singapore, Singapore
| | | | | | | | - Robin Choo
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Poh Lian Lim
- Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
| | - Koh Cheng Thoon
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke- National University of Singapore Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | | | - Jyoti Somani
- National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Tau Hong Lee
- Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
| | - David C Lye
- Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Yong Loo Lin School of Medicine, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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Ng TM, Heng ST, Chua BH, Ang LW, Tan SH, Tay HL, Yap MY, Quek J, Teng CB, Young BE, Lin R, Ang B, Lee TH, Lye DC. Sustaining Antimicrobial Stewardship in a High-Antibiotic Resistance Setting. JAMA Netw Open 2022; 5:e2210180. [PMID: 35503216 PMCID: PMC9066280 DOI: 10.1001/jamanetworkopen.2022.10180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE There is a lack of studies comparing the intended and unintended consequences of prospective review and feedback (PRF) with computerized decision support systems (CDSS), especially in the longer term in antimicrobial stewardship. OBJECTIVE To examine the outcomes associated with the sequential implementation of PRF and CDSS and changes to these interventions with long-term use of antibiotics for and incidence of multidrug resistant organisms (MDROs) and other unintended outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used an interrupted time series with segmented regression analysis of data from January 2007 to December 2018. Data were extracted from the electronic medical records of patients admitted at a large university teaching hospital with high rates of antibiotic resistance in Singapore. Data were analyzed from June 2019 to June 2020. EXPOSURES PRF of piperacillin-tazobactam and carbapenems (intervention 1, April 2009), with the addition of hospital-wide CDSS (intervention 2, April 2011), and lifting of CDSS for half of the hospital wards for 6 months (intervention 3, March 2017). MAIN OUTCOMES AND MEASURES Monthly antimicrobial use was measured in defined daily doses (DDDs) per 1000 patient-days. The monthly incidence of MDROs was calculated as number of clinical isolates detected per 1000 inpatient-days over a 6-month period. Unintended outcomes examined included in-hospital mortality and age-adjusted length of stay (LOS). RESULTS The number of inpatients increased from 56 263 in 2007 to 63 572 in 2018. During the same period, the mean monthly patient days increased from 33 929 in 2007 to 45 603 in 2018, and the proportion of patients older than 65 years increased from 45.5% in 2007 to 56.6% in 2018. After intervention 1, there were 0.33 (95% CI, 0.18 to 0.48) more DDDs per 1000 patient-days per month of piperacillin-tazobactam and carbapenems and -11.05 (95% CI, -15.55 to -6.55) fewer DDDs per 1000 patient-days per month for other broad-spectrum antibiotics. After intervention 2, there were -0.22 (95% CI, -0.33 to -0.10) fewer DDDs per 1000 patient-days per month of piperacillin-tazobactam and carbapenems and -2.10 (95% CI, -3.13 to -1.07) fewer DDDs per 1000 patient-days per month for other broad-spectrum antibiotics. After intervention 3, use of piperacillin-tazobactam and carbapenem increased by 0.28 (95% CI, 0.02 to 0.55) DDDs per 1000 patient-days per month. After intervention 2, incidence of Clostridioides difficile decreased (estimate, -0.02 [95% CI, -0.03 to -0.01] cases per 1000 patient-days per month). CONCLUSIONS AND RELEVANCE In this cohort study, concurrent PRF and CDSS were associated with limiting the use of piperacillin-tazobactam and carbapenems while reducing use of other antibiotics.
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Affiliation(s)
- Tat Ming Ng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shi Thong Heng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Hou Chua
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - Sock Hoon Tan
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hui Lin Tay
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Min Yi Yap
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jason Quek
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Christine B. Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Barnaby E. Young
- Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ray Lin
- Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Brenda Ang
- Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tau Hong Lee
- Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David C. Lye
- Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Chia PY, Ong SWX, Chiew CJ, Ang LW, Chavatte JM, Mak TM, Cui L, Kalimuddin S, Chia WN, Tan CW, Chai LYA, Tan SY, Zheng S, Lin RTP, Wang L, Leo YS, Lee VJ, Lye DC, Young BE. Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine breakthrough infections: a multicentre cohort study. Clin Microbiol Infect 2022; 28:612.e1-612.e7. [PMID: 34826623 DOI: 10.1101/2021.1107.1128.21261295v21261291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/16/2021] [Accepted: 11/06/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Highly effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed but variants of concerns are worrisome, especially B.1.617.2 (Delta) which has rapidly spread across the world. We aim to study if vaccination alters virological and serological kinetics in breakthrough infections. METHODS We conducted a multicentre retrospective cohort study of patients in Singapore who had received a licensed mRNA vaccine and been admitted to hospital with B.1.617.2 SARS-CoV-2 infection. We compared clinical features, virological and serological kinetics (anti-nucleocapsid, anti-spike and surrogate virus neutralization titres) between fully vaccinated and unvaccinated individuals. RESULTS Out of 218 individuals with B.1.617.2 infection, 84 received an mRNA vaccine of which 71 were fully vaccinated, 130 were unvaccinated and four received a non-mRNA vaccine. Despite significantly older age in the vaccine breakthrough group, only 2.8% (2/71) developed severe COVID-19 requiring oxygen supplementation compared with 53.1% (69/130) in the unvaccinated group (p < 0.001). Odds of severe COVID-19 following vaccination were significantly lower (adjusted odds ratio 0.07 95% CI 0.015-0.335, p 0.001). PCR cycle threshold values were similar between vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals. Early, robust boosting of anti-spike protein antibodies was observed in vaccinated patients; however, these titres were significantly lower against B.1.617.2 than the wildtype vaccine strain. DISCUSSION The mRNA vaccines are highly effective at preventing symptomatic and severe COVID-19 associated with B.1.617.2 infection. Vaccination is associated with faster decline in viral RNA load and a robust serological response. Vaccination remains a key strategy for control of the COVID-19 pandemic.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore; Ministry of Health, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Tze-Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore
| | - Shirin Kalimuddin
- Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wan Ni Chia
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Chee Wah Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Linfa Wang
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Chia PY, Ong SWX, Chiew CJ, Ang LW, Chavatte JM, Mak TM, Cui L, Kalimuddin S, Chia WN, Tan CW, Chai LYA, Tan SY, Zheng S, Lin RTP, Wang L, Leo YS, Lee VJ, Lye DC, Young BE. Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine breakthrough infections: a multicentre cohort study. Clin Microbiol Infect 2022. [PMID: 34826623 DOI: 10.1101/2021.07.28.21261295] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [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] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Highly effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed but variants of concerns are worrisome, especially B.1.617.2 (Delta) which has rapidly spread across the world. We aim to study if vaccination alters virological and serological kinetics in breakthrough infections. METHODS We conducted a multicentre retrospective cohort study of patients in Singapore who had received a licensed mRNA vaccine and been admitted to hospital with B.1.617.2 SARS-CoV-2 infection. We compared clinical features, virological and serological kinetics (anti-nucleocapsid, anti-spike and surrogate virus neutralization titres) between fully vaccinated and unvaccinated individuals. RESULTS Out of 218 individuals with B.1.617.2 infection, 84 received an mRNA vaccine of which 71 were fully vaccinated, 130 were unvaccinated and four received a non-mRNA vaccine. Despite significantly older age in the vaccine breakthrough group, only 2.8% (2/71) developed severe COVID-19 requiring oxygen supplementation compared with 53.1% (69/130) in the unvaccinated group (p < 0.001). Odds of severe COVID-19 following vaccination were significantly lower (adjusted odds ratio 0.07 95% CI 0.015-0.335, p 0.001). PCR cycle threshold values were similar between vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals. Early, robust boosting of anti-spike protein antibodies was observed in vaccinated patients; however, these titres were significantly lower against B.1.617.2 than the wildtype vaccine strain. DISCUSSION The mRNA vaccines are highly effective at preventing symptomatic and severe COVID-19 associated with B.1.617.2 infection. Vaccination is associated with faster decline in viral RNA load and a robust serological response. Vaccination remains a key strategy for control of the COVID-19 pandemic.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore; Ministry of Health, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Tze-Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore
| | - Shirin Kalimuddin
- Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wan Ni Chia
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Chee Wah Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Linfa Wang
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Chia PY, Ong SWX, Chiew CJ, Ang LW, Chavatte JM, Mak TM, Cui L, Kalimuddin S, Chia WN, Tan CW, Chai LYA, Tan SY, Zheng S, Lin RTP, Wang L, Leo YS, Lee VJ, Lye DC, Young BE. Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine breakthrough infections: a multicentre cohort study. Clin Microbiol Infect 2022; 28:612.e1-612.e7. [PMID: 34826623 PMCID: PMC8608661 DOI: 10.1016/j.cmi.2021.11.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 72.5] [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: 07/25/2021] [Revised: 10/16/2021] [Accepted: 11/06/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Highly effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed but variants of concerns are worrisome, especially B.1.617.2 (Delta) which has rapidly spread across the world. We aim to study if vaccination alters virological and serological kinetics in breakthrough infections. METHODS We conducted a multicentre retrospective cohort study of patients in Singapore who had received a licensed mRNA vaccine and been admitted to hospital with B.1.617.2 SARS-CoV-2 infection. We compared clinical features, virological and serological kinetics (anti-nucleocapsid, anti-spike and surrogate virus neutralization titres) between fully vaccinated and unvaccinated individuals. RESULTS Out of 218 individuals with B.1.617.2 infection, 84 received an mRNA vaccine of which 71 were fully vaccinated, 130 were unvaccinated and four received a non-mRNA vaccine. Despite significantly older age in the vaccine breakthrough group, only 2.8% (2/71) developed severe COVID-19 requiring oxygen supplementation compared with 53.1% (69/130) in the unvaccinated group (p < 0.001). Odds of severe COVID-19 following vaccination were significantly lower (adjusted odds ratio 0.07 95% CI 0.015-0.335, p 0.001). PCR cycle threshold values were similar between vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals. Early, robust boosting of anti-spike protein antibodies was observed in vaccinated patients; however, these titres were significantly lower against B.1.617.2 than the wildtype vaccine strain. DISCUSSION The mRNA vaccines are highly effective at preventing symptomatic and severe COVID-19 associated with B.1.617.2 infection. Vaccination is associated with faster decline in viral RNA load and a robust serological response. Vaccination remains a key strategy for control of the COVID-19 pandemic.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore; Ministry of Health, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Tze-Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore
| | - Shirin Kalimuddin
- Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wan Ni Chia
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Chee Wah Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Linfa Wang
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore; Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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7
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Tay MZ, Ang LW, Wei WE, Lee VJM, Leo YS, Toh MPHS. Health-seeking behavior of COVID-19 cases during the first eight weeks of the outbreak in Singapore: differences between local community and imported cases and having visits to single or multiple healthcare providers. BMC Public Health 2022; 22:239. [PMID: 35123440 PMCID: PMC8817635 DOI: 10.1186/s12889-022-12637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background COVID-19 is a novel pandemic affecting almost all countries leading to lockdowns worldwide. In Singapore, locally-acquired cases emerged after the first wave of imported cases, and these two groups of cases may have different health-seeking behavior affecting disease transmission. We investigated differences in health-seeking behavior between locally-acquired cases and imported cases, and within the locally-acquired cases, those who saw single versus multiple healthcare providers. Methods We conducted a retrospective study of 258 patients who were diagnosed with COVID-19 from 23 January to 17 March 2020. Variables related to health-seeking behavior included number of visits prior to hospitalization, timing of the first visit, duration from symptom onset to admission, and places where the cases had at least one visit. Results Locally-acquired cases had longer duration from onset of symptoms to hospital admission (median 6 days, interquartile range [IQR] 4–9) than imported cases (median 4 days, IQR 2–7) (p < 0.001). Singapore residents were more likely to have at least one visit to private clinics and/or government-subsidized public clinics than non-residents (84.0% vs. 58.7%, p < 0.001). Among locally-acquired cases, those who sought care from a single healthcare provider had fewer visits before their hospital admissions compared with those who went to multiple providers (median 2 vs. 3, p = 0.001). Conclusion Our study indicates the need to encourage individuals to seek medical attention early on in their patient journey, particularly from the same healthcare provider. This in turn, would facilitate early detection and isolation, hence limiting local transmission and enabling better control of the COVID-19 outbreak.
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Ang LW, Gao Q, Cui L, Farwin A, Toh MPHS, Boudville IC, Chen MIC, Chow A, Lin RTP, Lee VJM, Leo YS. Prevalence of measles antibodies among migrant workers in Singapore: a serological study to identify susceptible population subgroups. BMC Infect Dis 2022; 22:88. [PMID: 35078426 PMCID: PMC8787927 DOI: 10.1186/s12879-022-07066-2] [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: 07/06/2021] [Accepted: 01/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background In 2019, two clusters of measles cases were reported in migrant worker dormitories in Singapore. We conducted a seroprevalence study to measure the level of susceptibility to measles among migrant workers in Singapore. Methods Our study involved residual sera of migrant workers from seven Asian countries (Bangladesh, China, India, Indonesia, Malaysia, Myanmar and the Philippines) who had participated in a survey between 2016 and 2019. Immunoglobulin G (IgG) antibody levels were first measured using a commercial enzyme-linked immunosorbent assay (ELISA) test kit. Those with equivocal or negative IgG results were further evaluated using plaque reduction neutralization test (PRNT). Results A total of 2234 migrant workers aged 20–49 years were included in the study. The overall prevalence of measles IgG antibodies among migrant workers from the seven Asian countries was 90.5% (95% confidence interval 89.2–91.6%). The country-specific seroprevalence ranged from 80.3 to 94.0%. The seroprevalence was significantly higher among migrant workers born in 1965–1989 than those born in 1990–1999 (95.3% vs. 86.6%, p < 0.0005), whereas there was no significant difference by gender (90.8% in men vs. 89.9% in women, p = 0.508). 195 out of 213 samples with equivocal or negative ELISA results were tested positive using PRNT. Conclusion The IgG seroprevalence in migrant workers was below the herd immunity threshold of 95% for measles. Sporadic outbreaks may occur in susceptible individuals due to high transmissibility of measles virus. Seroprevalence surveys can help identify susceptible subgroups for vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07066-2.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore. .,Public Health Group, Ministry of Health, Singapore, Singapore.
| | - Qi Gao
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
| | - Aysha Farwin
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Matthias Paul Han Sim Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Irving Charles Boudville
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Mark I-Cheng Chen
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Public Health Group, Ministry of Health, Singapore, Singapore
| | - Angela Chow
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - Raymond Tzer-Pin Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Vernon Jian Ming Lee
- Public Health Group, Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yee Sin Leo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
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9
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Ang LW, Gao Q, Cui L, Farwin A, Toh MPHS, Boudville IC, Chen MIC, Chow A, Lin RTP, Lee VJM, Leo YS. Seroprevalence of IgG antibodies against diphtheria antitoxin among migrant workers in Singapore, 2016-2019. BMC Public Health 2022; 22:111. [PMID: 35033034 PMCID: PMC8761332 DOI: 10.1186/s12889-022-12528-y] [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: 07/20/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022] Open
Abstract
Background Since the last local case of diphtheria in 1992, there had not been any case in Singapore until an autochthonous case was reported in 2017. This fatal diphtheria case of a migrant worker raised concerns about the potential re-emergence of locally transmitted toxigenic diphtheria in Singapore. We conducted a seroprevalence study to assess the immunity levels to diphtheria among migrant workers in Singapore. Methods Residual sera from migrant workers who hailed from Bangladesh, China, India, Indonesia, Malaysia, Myanmar and the Philippines were tested for anti-diphtheria toxoid immunoglobulin G (IgG) antibodies. These migrant workers previously participated in a survey between 2016 and 2019 and had provided blood samples as part of the survey procedure. Results A total of 2176 migrant workers were included in the study. Their overall mean age was 27.1 years (standard deviation 5.0), range was 20–43 years. The proportion having at least basic protection against diphtheria (antitoxin titres ≥ 0.01 IU/ml) ranged from 77.9% (95% confidence interval [CI] 72.8 – 82.3%) among migrant workers from Bangladesh to 96.7% (95% CI 92.5 – 98.6%) in those hailing from Malaysia. The proportion showing full protection (antitoxin titres ≥ 0.10 IU/ml) ranged from 10.1% (95% CI 6.5 – 15.4%) in Chinese workers to 23.0% (95% CI 17.1 – 30.3%) in Malaysian workers. There were no significant differences in the proportion with at least basic protection across birth cohorts, except for those from Bangladesh where the seroprevalence was significantly lower in younger migrant workers born after 1989. Conclusions The proportions having at least basic protection against diphtheria in migrant workers from five out of seven Asian countries (India, Indonesia, Malaysia, Myanmar and the Philippines) were higher than 85%, the threshold for diphtheria herd immunity. Seroprevalence surveys should be conducted periodically to assess the level of immunity against diphtheria and other vaccine preventable diseases in migrant worker population, so that appropriate interventions such as booster vaccination can be implemented proactively to prevent sporadic outbreaks. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12528-y.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore. .,Public Health Group, Ministry of Health, Singapore, Singapore.
| | - Qi Gao
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
| | - Aysha Farwin
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Matthias Paul Han Sim Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Irving Charles Boudville
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Mark I-Cheng Chen
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Public Health Group, Ministry of Health, Singapore, Singapore
| | - Angela Chow
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - Raymond Tzer-Pin Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Vernon Jian Ming Lee
- Public Health Group, Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yee Sin Leo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
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10
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Lim ZC, Hoo GS, Ang JH, Teng CB, Ang LW, Lee CC, Leo YS, Law HL, Ng OT, Wong CS. Safety and effectiveness of switching to Abacavir/Lamivudine plus rilpivirine for maintenance therapy in virologically suppressed HIV-1 individuals in Singapore (SEALS). AIDS Res Ther 2021; 18:80. [PMID: 34724931 PMCID: PMC8561921 DOI: 10.1186/s12981-021-00402-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/26/2020] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and tolerability of an antiretroviral regimen are important considerations for selection of HIV-1 infection maintenance therapy. Abacavir/lamivudine plus rilpivirine (ABC/3TC + RPV) has been shown in international studies to be effective and well-tolerated in virologically suppressed individuals. This study evaluated the effectiveness and safety of switching to ABC/3TC + RPV as maintenance therapy in virologically suppressed HIV-1 infected individuals in Singapore. METHODS In this retrospective, single-centre study, we included individuals who were prescribed ABC/3TC + RPV, had HIV-1 viral load (VL) < 50 copies/ml immediately pre-switch, and had no documented history of resistance mutations or virologic failure to any of the components. The follow-up period was 48 ± 12 weeks. The primary outcome was the proportion of individuals who maintained virologic suppression of HIV-1 VL < 50 copies/ml at the end of follow-up period based on on-treatment analysis. The secondary outcomes were the resistance profiles associated with virologic failure, changes in immunologic and metabolic parameters, and the safety profile of ABC/3TC + RPV. RESULTS A total of 222 individuals were included in the study. The primary outcome was achieved in 197 individuals [88.8%, 95% confidence interval: 83.7-92.4%]. There were 21 individuals (9.5%) who discontinued treatment for non-virologic reasons. The remaining 4 individuals experienced virologic failure, of whom, 3 of these individuals had developed emergent antiretroviral resistance and had HIV-1 VL > 500 copies/ml at the end of the 48 ± 12 weeks follow-up period. The remaining individual experienced sustained low level viremia and subsequently achieved viral suppression without undergoing resistance testing. A total of 49 adverse events were observed in 31 out of 222 individuals (14.0%), which led to 13 individuals discontinuing therapy. Neuropsychiatric adverse events were most commonly observed (53.1%). A statistically significant increase in CD4 was observed (p < 0.01), with a median absolute change of 31 cells/uL (interquartile range: - 31.50 to 140.75). No significant changes in lipid profiles were detected. CONCLUSION ABC/3TC + RPV is a safe and effective switch option for maintenance therapy in virologically suppressed HIV-1 individuals with in Singapore.
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Affiliation(s)
- Z C Lim
- Department of Pharmacy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - G S Hoo
- Department of Pharmacy, National Centre of Infectious Diseases, Singapore, Singapore.
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.
| | - J H Ang
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - C B Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - L W Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - C C Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Y S Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - H L Law
- Department of Pharmacy, National Centre of Infectious Diseases, Singapore, Singapore
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - O T Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - C S Wong
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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11
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Ong SWX, Chiew CJ, Ang LW, Mak TM, Cui L, Toh MPHS, Lim YD, Lee PH, Lee TH, Chia PY, Maurer-Stroh S, Lin RTP, Leo YS, Lee VJ, Lye DC, Young BE. Clinical and Virological Features of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants of Concern: A Retrospective Cohort Study Comparing B.1.1.7 (Alpha), B.1.351 (Beta), and B.1.617.2 (Delta). Clin Infect Dis 2021; 75:e1128-e1136. [PMID: 34423834 PMCID: PMC8522361 DOI: 10.1093/cid/ciab721] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [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: 07/01/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The impact of SARS-CoV-2 variants of concern (VOCs) on disease severity is unclear. In this retrospective study, we compared the outcomes of patients infected with B.1.1.7, B.1.351, and B.1.617.2 with wild-type strains from early 2020. METHODS National surveillance data from January to May 2021 were obtained and outcomes in relation to VOCs were explored. Detailed patient-level data from all patients with VOC infection admitted to our center between December 2020 and May 2021 were analyzed. Clinical outcomes were compared with a cohort of 846 patients admitted from January to April 2020. RESULTS A total of 829 patients in Singapore in the study period were infected with these 3 VOCs. After adjusting for age and sex, B.1.617.2 was associated with higher odds of oxygen requirement, intensive care unit admission, or death (adjusted odds ratio [aOR], 4.90; 95% confidence interval [CI]: 1.43-30.78). Of these patients, 157 were admitted to our center. After adjusting for age, sex, comorbidities, and vaccination, the aOR for pneumonia with B.1.617.2 was 1.88 (95% CI: .95-3.76) compared with wild-type. These differences were not seen with B.1.1.7 and B.1.351. Vaccination status was associated with decreased severity. B.1.617.2 was associated with significantly lower polymerase chain reaction cycle threshold (Ct) values and longer duration of Ct value ≤30 (median duration 18 days for B.1.617.2, 13 days for wild-type). CONCLUSIONS B.1.617.2 was associated with increased severity of illness, and with lower Ct values and longer viral shedding. These findings provide impetus for the rapid implementation of vaccination programs.
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Affiliation(s)
- Sean Wei Xiang Ong
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore, Singapore,Ministry of Health, Singapore, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Matthias Paul H S Toh
- National Centre for Infectious Diseases, Singapore, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Pei Hua Lee
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tau Hong Lee
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Bioinformatics Institute, Agency for Science, Technology and Research, Singapore, Singapore,A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore,Department of Biological Sciences, National University of Singapore, Singapore
| | - Raymond T P Lin
- National Centre for Infectious Diseases, Singapore, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vernon J Lee
- Ministry of Health, Singapore, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Barnaby Edward Young
- Correspondence: Barnaby Young, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442 ()
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12
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Ang LW, Toh MPHS, Boudville IC, Wong CS, Archuleta S, Lee V, Chow A, Leo YS. Epidemiological factors associated with the absence of previous HIV testing among HIV-positive persons in Singapore, 2012-2017. BMJ Open 2021; 11:e050133. [PMID: 34404712 PMCID: PMC8372883 DOI: 10.1136/bmjopen-2021-050133] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess the temporal trend and identify risk factors associated with the absence of previous HIV testing prior to their diagnosis among HIV-positive persons in Singapore. STUDY DESIGN Cross-sectional. SETTING AND PARTICIPANTS We analysed data of HIV-positive persons infected via sexual transmission, who were notified to the National HIV Registry in 2012-2017. OUTCOMES Epidemiological factors associated with the absence of HIV testing prior to diagnosis were determined separately for two groups of HIV-positive persons: early and late stages of HIV infection at diagnosis. RESULTS 2188 HIV-positive persons with information on HIV testing history and CD4 cell count were included in the study. The median age at HIV diagnosis was 40 years (IQR 30-51). Nearly half (45.1%) had never been tested for HIV prior to their diagnosis. The most common reason cited for no previous HIV testing was 'not necessary to test' (73.7%). The proportion diagnosed at late-stage HIV infection was significantly higher among HIV-positive persons who had never been tested for HIV (63.9%) compared with those who had undergone previous HIV tests (29.0%). Common risk factors associated with no previous HIV testing in multivariable logistic regression analysis stratified by stage of HIV infection were: older age at HIV diagnosis, lower educational level, detection via medical care and HIV infection via heterosexual transmission. In the stratified analysis for persons diagnosed at early-stage of HIV infection, in addition to the four risk factors, women and those of Malay ethnicity were also less likely to have previous HIV testing prior to their diagnosis. CONCLUSION Targeted prevention efforts and strategies are needed to raise the level of awareness of HIV/AIDS and to encourage early and regular screening among the at-risk groups by making HIV testing more accessible.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | | | - Chen Seong Wong
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Vernon Lee
- National University of Singapore, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Nanyang Technological University, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Nanyang Technological University, Singapore
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13
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Staadegaard L, Caini S, Wangchuk S, Thapa B, de Almeida WAF, de Carvalho FC, Fasce RA, Bustos P, Kyncl J, Novakova L, Caicedo AB, de Mora Coloma DJ, Meijer A, Hooiveld M, Huang QS, Wood T, Guiomar R, Rodrigues AP, Lee VJM, Ang LW, Cohen C, Moyes J, Larrauri A, Delgado-Sanz C, Demont C, Bangert M, Dückers M, van Summeren J, Paget J. Defining the seasonality of respiratory syncytial virus around the world: National and subnational surveillance data from 12 countries. Influenza Other Respir Viruses 2021; 15:732-741. [PMID: 34255934 PMCID: PMC8542954 DOI: 10.1111/irv.12885] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary. Objectives The main objective of this study was to contribute to a better understanding of RSV seasonality by examining the GERi multi‐country surveillance dataset. Methods RSV seasons were included in the analysis if they contained ≥100 cases. Seasonality was determined using the “average annual percentage” method. Analyses were performed at a subnational level for the United States and Brazil. Results We included 601 425 RSV cases from 12 countries. Most temperate countries experienced RSV epidemics in the winter, with a median duration of 10–21 weeks. Not all epidemics fit this pattern in a consistent manner, with some occurring later or in an irregular manner. More variation in timing was observed in (sub)tropical countries, and we found substantial differences in seasonality at a subnational level. No association was found between the timing of the epidemic and the dominant RSV subtype. Conclusions Our findings suggest that geographical location or climatic characteristics cannot be used as a definitive predictor for the timing of RSV epidemics and highlight the need for (sub)national data collection and analysis.
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Affiliation(s)
- Lisa Staadegaard
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Saverio Caini
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Sonam Wangchuk
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Binay Thapa
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | | | | | - Rodrigo A Fasce
- Subdepartamento Enfermedades Virales, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Patricia Bustos
- Sección Virus Respiratorios, Subdepartamento Enfermedades Virales, Instituto de Salud Publica de Chile, Santiago, Chile
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic.,Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ludmila Novakova
- National Reference Laboratory for Influenza and Other Respiratory Viruses, National Institute of Public Health, Prague, Czech Republic
| | - Alfredo Bruno Caicedo
- Universidad Agraria del Ecuador, Guayaquil, Ecuador.,Instituto Nacional de Investigación en Salud Pública (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador
| | - Domenica Joseth de Mora Coloma
- Instituto Nacional de Investigación en Salud Pública (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador
| | - Adam Meijer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mariëtte Hooiveld
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Q Sue Huang
- Institute of Environmental Science and Research Limited (ESR), National Centre for Biosecurity and Infectious Disease (NCBID), Upper Hutt, New Zealand
| | - Tim Wood
- Institute of Environmental Science and Research Limited (ESR), National Centre for Biosecurity and Infectious Disease (NCBID), Upper Hutt, New Zealand
| | - Raquel Guiomar
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | | | | | - Li Wei Ang
- Ministry of Health, Singapore.,National Centre for Infectious Diseases, Singapore
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Concepción Delgado-Sanz
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | | | - Michel Dückers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | | | - John Paget
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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14
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Lee IR, Thein TL, Ang LW, Ding Y, Lim JJ, Bok CF, Mukherjee S, Titin C, Kalimuddin S, Archuleta S, Lye DC. Cefazolin versus ceftriaxone as definitive treatment for Klebsiella pneumoniae bacteraemia: a retrospective multicentre study in Singapore. J Antimicrob Chemother 2021; 76:1303-1310. [PMID: 33501978 DOI: 10.1093/jac/dkab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ceftriaxone is the preferred treatment for bacteraemia caused by non-MDR (antibiotic-susceptible) Klebsiella pneumoniae. Excessive and widespread ceftriaxone use creates selection pressure for ESBLs. Cefazolin is an alternative, although there are theoretical concerns that SHV-1 β-lactamase in K. pneumoniae may inactivate cefazolin in an inoculum-dependent manner. OBJECTIVES In this retrospective study, we investigated the outcomes in K. pneumoniae bacteraemia patients treated with IV cefazolin versus IV ceftriaxone as definitive therapy. METHODS A total of 917 patients infected with K. pneumoniae from 1 January to 31 December 2016 in three public acute care hospitals in Singapore were screened for study eligibility. Consecutive unique episodes of monomicrobial bacteraemia caused by cefazolin- and/or ceftriaxone-susceptible K. pneumoniae were analysed (n = 284). RESULTS There were 143 patients (50.4%) in the cefazolin group and 141 patients (49.6%) in the ceftriaxone group. Demographics, baseline illness severity and risk factors for healthcare-associated bacteraemia were comparable in the two treatment groups. The primary outcome of 28 day all-cause mortality was not significantly different between the cefazolin and ceftriaxone groups (10.5% versus 7.1%, P = 0.403). Both in the crude analysis and using a multivariable logistic regression model with inverse probability weighting based on propensity score, cefazolin treatment was not associated with increased risk of 28 day mortality (OR 1.51 with ceftriaxone as the reference group, 95% CI 0.67-3.53; adjusted OR 1.55, 95% CI 0.33-7.40). CONCLUSIONS Cefazolin may be a ceftriaxone-sparing alternative treatment for antibiotic-susceptible K. pneumoniae bacteraemia. This observation may provide sufficient clinical equipoise for a randomized controlled trial.
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Affiliation(s)
- I Russel Lee
- National Centre for Infectious Diseases, Singapore
| | | | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | - Ying Ding
- National Centre for Infectious Diseases, Singapore
| | | | | | - Shilpa Mukherjee
- Division of Infectious Diseases, National University Hospital, National University Health System, Singapore
| | - Christina Titin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Sophia Archuleta
- Division of Infectious Diseases, National University Hospital, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
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15
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Ang LW, Toh MPHS, Wong CS, Boudville IC, Archuleta S, Lee VJM, Leo YS, Chow A. Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection. Medicine (Baltimore) 2021; 100:e26507. [PMID: 34190180 PMCID: PMC8257899 DOI: 10.1097/md.0000000000026507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Chen Seong Wong
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Vernon Jian Ming Lee
- National University of Singapore, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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16
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Zhang JJY, Lee KS, Ong CW, Chan MY, Ang LW, Leo YS, Chen MI, Lye DCB, Young BE. Diagnostic performance of COVID-19 serological assays during early infection: A systematic review and meta-analysis of 11 516 samples. Influenza Other Respir Viruses 2021; 15:529-538. [PMID: 33609075 PMCID: PMC8013346 DOI: 10.1111/irv.12841] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The use of coronavirus disease 2019 (COVID-19) serological testing to diagnose acute infection or determine population seroprevalence relies on understanding assay accuracy during early infection. We aimed to evaluate the diagnostic performance of serological testing in COVID-19 by providing summary sensitivity and specificity estimates with time from symptom onset. METHODS A systematic search of Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed was performed up to May 13, 2020. All English language, original peer-reviewed publications reporting the diagnostic performance of serological testing vis-à-vis virologically confirmed SARS-CoV-2 infection were included. RESULTS Our search yielded 599 unique publications. A total of 39 publications reporting 11 516 samples from 8872 human participants met eligibility criteria for inclusion in our study. Pooled percentages of IgM and IgG seroconversion by Day 7, 14, 21, 28 and after Day 28 were 37.5%, 73.3%, 81.3%, 72.3% and 73.3%, and 35.4%, 80.6%, 93.3%, 84.4% and 98.9%, respectively. By Day 21, summary estimate of IgM sensitivity was 0.872 (95% CI: 0.784-0.928) and specificity 0.973 (95% CI: 0.938-0.988), while IgG sensitivity was 0.913 (95% CI: 0.823-0.959) and specificity 0.960 (95% CI: 0.919-0.980). On meta-regression, IgM and IgG test accuracy was significantly higher at Day 14 using enzyme-linked immunosorbent assay (ELISA) compared to other methods. CONCLUSIONS Serological assays offer imperfect sensitivity for the diagnosis of acute SARS-CoV-2 infection. Estimates of population seroprevalence during or shortly after an outbreak will need to adjust for the delay between infection, symptom onset and seroconversion.
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Affiliation(s)
- John J. Y. Zhang
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health SciencesUniversity of BristolBristolUK
| | - Chee Wui Ong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Mae Yee Chan
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Li Wei Ang
- National Centre for Infectious DiseasesSingaporeSingapore
| | - Yee Sin Leo
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- National Centre for Infectious DiseasesSingaporeSingapore
- Tan Tock Seng HospitalSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Mark I‐Cheng Chen
- National Centre for Infectious DiseasesSingaporeSingapore
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - David Chien Boon Lye
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- National Centre for Infectious DiseasesSingaporeSingapore
- Tan Tock Seng HospitalSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Barnaby Edward Young
- National Centre for Infectious DiseasesSingaporeSingapore
- Tan Tock Seng HospitalSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
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17
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Gan SH, KhinMar KW, Ang LW, Lim LKY, Sng LH, Wang YT, Chee CBE. Recurrent Tuberculosis Disease in Singapore. Open Forum Infect Dis 2021; 8:ofab340. [PMID: 34307732 PMCID: PMC8297698 DOI: 10.1093/ofid/ofab340] [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: 03/15/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background Previously treated (ie, recurrent) tuberculosis (TB) cases account for approximately 7%-8% of incident TB globally and in Singapore. Molecular fingerprinting has enabled the differentiation of these patients into relapsed or reinfection cases. Methods Patient demographics, disease characteristics, and treatment information were obtained from the national TB notification registry and TB Control Unit. We performed a retrospective, case-control study to evaluate factors associated with recurrent TB disease in Singapore citizens and permanent residents with culture-positive TB from 2006 to 2013 and who developed a second episode of culture-positive TB up to 2016 using multivariable logistic regression analyses. Results Ninety-one cases with culture-positive first and recurrent TB disease episodes were identified. Recurrent TB was associated with age ≥60 years (adjusted odds ratio [aOR], 1.98 [95% confidence interval {CI}, 1.09-3.61), male sex (aOR, 2.29 [95% CI, 1.22-4.51]), having concomitant pulmonary and extrapulmonary TB (aOR, 3.10 [95% CI, 1.59-6.10]) and extrapulmonary TB alone (aOR, 3.82 [95% CI, 1.12-13.31]), and was less likely in non-Malays (aOR, 0.52 [95% CI, .27-.99]). DNA fingerprinting results for both episodes in 49 cases differentiated these into 28 relapsed and 21 reinfection cases. Relapse was associated with having concomitant pulmonary and extrapulmonary TB (aOR, 9.24 [95% CI, 2.50-42.42]) and positive sputum acid-fast bacilli smear (aOR, 3.95 [95% CI, 1.36-13.10]). Conclusions Relapse and reinfection contributed to 57% and 43%, respectively, of recurrent TB in Singapore. Our study highlights the underappreciated association of concomitant pulmonary and extrapulmonary TB as a significant risk factor for disease relapse.
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Affiliation(s)
- Suay Hong Gan
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | | | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | - Leo K Y Lim
- National Centre for Infectious Diseases, Singapore
| | - Li Hwei Sng
- Department of Pathology, Singapore General Hospital, Singapore
| | - Yee Tang Wang
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
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18
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Dalan R, Ang LW, Tan WYT, Fong SW, Tay WC, Chan YH, Renia L, Ng LFP, Lye DC, Chew DEK, Young BE. The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study. Eur Heart J Cardiovasc Pharmacother 2021; 7:e48-e51. [PMID: 32766831 PMCID: PMC7454507 DOI: 10.1093/ehjcvp/pvaa098] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Siew-Wai Fong
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore
| | | | - Yi-Hao Chan
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Laurent Renia
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Lisa F P Ng
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Yong Loo Lin School of Medicine, Singapore
| | - Daniel E K Chew
- Department of Endocrinology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Yong Loo Lin School of Medicine, Singapore
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19
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Ang LW, Ng OT, Boudville IC, Leo YS, Wong CS. An observational study of the prevalence of metabolic syndrome in treatment-experienced people living with HIV in Singapore. PLoS One 2021; 16:e0252320. [PMID: 34077481 PMCID: PMC8171957 DOI: 10.1371/journal.pone.0252320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/24/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background While the use of combination antiretroviral therapy (cART) has conferred significant reduction in morbidity and mortality, there are growing concerns about the metabolic complications of antiretroviral regimens in HIV-infected patients. The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) among people living with HIV (PLHIV) in Singapore. Methods We conducted a retrospective study using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. Treatment-experienced PLHIV on follow-up during 2015–2017 were included. MetS was defined as having three or more of the following five abnormalities: hypertriglyceridemia, HDL hypocholesterolemia, hypertension, obesity, and diabetes. Results A total of 2,231 PLHIV were included in this study. 93.9% were men, and the median age at latest follow-up was 48 years. The median duration of HIV infection and duration of exposure to cART was 6.8 years and 5.7 years, respectively. All had been exposed to nucleoside reverse transcriptase inhibitors (NRTIs) as the first line of treatment, 93.9% to non-NRTIs, 28.6% to protease inhibitors (PIs) and 12.8% to integrase strand transfer inhibitors. The most common metabolic abnormality among PLHIV was HDL hypocholesterolemia (60.2%) followed by hypertriglyceridemia (45.5%). Of all the 2,231 individuals, 68.8% had at least one component of MetS. The overall prevalence of MetS was 23.6% (95% confidence interval 21.9%–25.4%). Of the 526 with MetS, the most common combination was HDL hypocholesterolemia, hypertriglyceridemia and hypertension (51.0%), followed by HDL hypocholesterolemia, hypertriglyceridemia, hypertension and diabetes (25.1%). Compared with PLHIV without MetS, a significantly higher proportion of those with MetS were ever on protease inhibitors (33.5% vs. 27.1%). Conclusion MetS is common in PLHIV. In view of the progressive aging of HIV-infected population and long-term use of cART, regular monitoring for metabolic abnormalities, surveillance of drug effects and behavioural interventions are needed to optimize management and prevention of metabolic disorders in PLHIV.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
- * E-mail:
| | - Oon Tek Ng
- Department of Infectious Diseases, 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
| | - Irving Charles Boudville
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Yee Sin Leo
- Department of Infectious Diseases, 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, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Seong Wong
- Department of Infectious Diseases, 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
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20
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Young BE, Wei WE, Fong SW, Mak TM, Anderson DE, Chan YH, Pung R, Heng CS, Ang LW, Zheng AKE, Lee B, Kalimuddin S, Pada S, Tambyah PA, Parthasarathy P, Tan SY, Sun L, Smith GJ, Lin RTP, Leo YS, Renia L, Wang LF, Ng LF, Maurer-Stroh S, Lye DC, Lee VJ. Association of SARS-CoV-2 clades with clinical, inflammatory and virologic outcomes: An observational study. EBioMedicine 2021; 66:103319. [PMID: 33840632 PMCID: PMC8027908 DOI: 10.1016/j.ebiom.2021.103319] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/30/2020] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Host determinants of severe coronavirus disease 2019 include advanced age, comorbidities and male sex. Virologic factors may also be important in determining clinical outcome and transmission rates, but limited patient-level data is available. METHODS We conducted an observational cohort study at seven public hospitals in Singapore. Clinical and laboratory data were collected and compared between individuals infected with different SARS-CoV-2 clades. Firth's logistic regression was used to examine the association between SARS-CoV-2 clade and development of hypoxia, and quasi-Poisson regression to compare transmission rates. Plasma samples were tested for immune mediator levels and the kinetics of viral replication in cell culture were compared. FINDINGS 319 patients with PCR-confirmed SARS-CoV-2 infection had clinical and virologic data available for analysis. 29 (9%) were infected with clade S, 90 (28%) with clade L/V, 96 (30%) with clade G (containing D614G variant), and 104 (33%) with other clades 'O' were assigned to lineage B.6. After adjusting for age and other covariates, infections with clade S (adjusted odds ratio (aOR) 0·030 (95% confidence intervals (CI): 0·0002-0·29)) or clade O (B·6) (aOR 0·26 (95% CI 0·064-0·93)) were associated with lower odds of developing hypoxia requiring supplemental oxygen compared with clade L/V. Patients infected with clade L/V had more pronounced systemic inflammation with higher concentrations of pro-inflammatory cytokines, chemokines and growth factors. No significant difference in the severity of clade G infections was observed (aOR 0·95 (95% CI: 0·35-2·52). Though viral loads were significantly higher, there was no evidence of increased transmissibility of clade G, and replicative fitness in cell culture was similar for all clades. INTERPRETATION Infection with clades L/V was associated with increased severity and more systemic release of pro-inflammatory cytokines. Infection with clade G was not associated with changes in severity, and despite higher viral loads there was no evidence of increased transmissibility.
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Affiliation(s)
- Barnaby E Young
- National Centre for Infectious Diseases, Singapore; Deaprtment of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Wycliffe E Wei
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore; Singapore Ministry of Health, Singapore
| | - Siew-Wai Fong
- A*STAR ID Labs, Agency for Science, Technology and Research (A*STAR), Singapore; Singapore Immunology Network, A*STAR, Singapore; Department of Biological Science, National University of Singapore, Singapore
| | - Tze-Minn Mak
- National Centre for Infectious Diseases, Singapore
| | | | - Yi-Hao Chan
- Singapore Immunology Network, A*STAR, Singapore; Singapore Immunology Network, A*STAR, Singapore
| | - Rachael Pung
- Singapore Ministry of Health, Singapore; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | | | - Bernett Lee
- Singapore Immunology Network, A*STAR, Singapore
| | - Shirin Kalimuddin
- Duke NUS Medical School, Singapore; Singapore General Hospital of Singapore, Singapore
| | | | - Paul A Tambyah
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore; Deaprtment of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Laurent Renia
- Singapore Immunology Network, A*STAR, Singapore; Singapore Immunology Network, A*STAR, Singapore
| | | | - Lisa Fp Ng
- Singapore Immunology Network, A*STAR, Singapore; Singapore Immunology Network, A*STAR, Singapore
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Deaprtment of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vernon J Lee
- Singapore Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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21
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Staadegaard L, Caini S, Wangchuk S, Thapa B, de Almeida WAF, de Carvalho FC, Njouom R, Fasce RA, Bustos P, Kyncl J, Novakova L, Caicedo AB, de Mora Coloma DJ, Meijer A, Hooiveld M, Huang S, Wood T, Guiomar R, Rodrigues AP, Danilenko D, Stolyarov K, Lee VJM, Ang LW, Cohen C, Moyes J, Larrauri A, Delgado-Sanz C, Le MQ, Hoang PVM, Demont C, Bangert M, van Summeren J, Dückers M, Paget J. The Global Epidemiology of RSV in Community and Hospitalized Care: Findings From 15 Countries. Open Forum Infect Dis 2021; 8:ofab159. [PMID: 34337092 PMCID: PMC8320297 DOI: 10.1093/ofid/ofab159] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/25/2021] [Indexed: 12/19/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is one of the leading causes of acute respiratory tract infections. To optimize control strategies, a better understanding of the global epidemiology of RSV is critical. To this end, we initiated the Global Epidemiology of RSV in Hospitalized and Community care study (GERi). Methods Focal points from 44 countries were approached to join GERi and share detailed RSV surveillance data. Countries completed a questionnaire on the characteristics of their surveillance system. Results Fifteen countries provided granular surveillance data and information on their surveillance system. A median (interquartile range) of 1641 (552–2415) RSV cases per season were reported from 2000 and 2020. The majority (55%) of RSV cases occurred in the <1-year-olds, with 8% of cases reported in those aged ≥65 years. Hospitalized cases were younger than those in community care. We found no age difference between RSV subtypes and no clear pattern of dominant subtypes. Conclusions The high number of cases in the <1-year-olds indicates a need to focus prevention efforts in this group. The minimal differences between RSV subtypes and their co-circulation implies that prevention needs to target both subtypes. Importantly, there appears to be a lack of RSV surveillance data in the elderly.
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Affiliation(s)
- Lisa Staadegaard
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Saverio Caini
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Sonam Wangchuk
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Binay Thapa
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | | | | | - Richard Njouom
- Service de Virologie, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Rodrigo A Fasce
- Subdepartamento Enfermedades Virales, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Patricia Bustos
- Sección Virus Respiratorios, Subdepartamento Enfermedades Virales, Instituto de Salud Publica de Chile, Santiago, Chile
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic.,Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ludmila Novakova
- National Reference Laboratory for Influenza and Other Respiratory Viruses, National Institute of Public Health, Prague, Czech Republic
| | - Alfredo Bruno Caicedo
- Instituto Nacional de Investigación en Salud Pública (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador.,Universidad Agraria del Ecuador, Guayaquil, Ecuador
| | - Domenica Joseth de Mora Coloma
- Instituto Nacional de Investigación en Salud Pública (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador
| | - Adam Meijer
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mariëtte Hooiveld
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Sue Huang
- Institute of Environmental Science and Research Limited (ESR), National Centre for Biosecurity and Infectious Disease (NCBID), Upper Hutt, New Zealand
| | - Tim Wood
- Institute of Environmental Science and Research Limited (ESR), National Centre for Biosecurity and Infectious Disease (NCBID), Upper Hutt, New Zealand
| | - Raquel Guiomar
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | | | - Daria Danilenko
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russian Federation
| | - Kirill Stolyarov
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russian Federation
| | | | - Li Wei Ang
- Ministry of Health, Singapore.,National Centre for Infectious Diseases, Singapore
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Concepción Delgado-Sanz
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Mai Quynh Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | - Michel Dückers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands.,Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - John Paget
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
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22
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See YP, Young BE, Ang LW, Ooi XY, Chan CP, Looi WL, Yeo SC, Lye DC. Risk Factors for Development of Acute Kidney Injury in COVID-19 Patients: A Retrospective Observational Cohort Study. Nephron Clin Pract 2021; 145:256-264. [PMID: 33780937 PMCID: PMC8089436 DOI: 10.1159/000514064] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/22/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) in coronavirus infection disease (COVID-19) is associated with disease severity. We aimed to evaluate risk factors associated with AKI beyond COVID-19 severity. METHODS A retrospective observational study of COVID-19 patients admitted to a tertiary hospital in Singapore. Logistic regression was used to evaluate associations between risk factors and AKI (based on Kidney Disease Improving Global Outcomes criteria). Dominance analysis was performed to evaluate the relative importance of individual factors. RESULTS Seven hundred seven patients were included. Median age was 46 years (interquartile range [IQR]: 29-57) and 57% were male with few comorbidities (93%, Charlson Comorbidity Index [CCI] <1). AKI occurred in 57 patients (8.1%); 39 were in AKI stage 1 (68%), 9 in stage 2 (16%), and 9 in stage 3 (16%). Older age (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI]: 1.01-1.07), baseline use of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (aOR 2.86; 95% CI: 1.20-6.83), exposure to vancomycin (aOR 5.84; 95% CI: 2.10-16.19), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (aOR 3.04; 95% CI: 1.15-8.05), and severe COVID-19 with hypoxia (aOR 13.94; 95% CI: 6.07-31.98) were associated with AKI in the multivariable logistic regression model. The 3 highest ranked predictors were severe COVID-19 with hypoxia, vancomycin exposure, and age, accounting for 79.6% of the predicted variance (41.6, 23.1, and 14.9%, respectively) on dominance analysis. CONCLUSION Severe COVID-19 is independently associated with increased risk of AKI beyond premorbid conditions and age. Appropriate avoidance of vancomycin and NSAIDs are potentially modifiable means to prevent AKI in patients with COVID-19.
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Affiliation(s)
- Yong Pey See
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Barnaby Edward Young
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Disease, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Li Wei Ang
- National Centre for Infectious Disease, Singapore, Singapore
| | - Xi Yan Ooi
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chi Peng Chan
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wan Limm Looi
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - David Chien Lye
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Disease, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore
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23
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Ang LW, Low C, Wong CS, Boudville IC, Toh MPHS, Archuleta S, Lee VJM, Leo YS, Chow A, Lin RTP. Epidemiological factors associated with recent HIV infection among newly-diagnosed cases in Singapore, 2013-2017. BMC Public Health 2021; 21:430. [PMID: 33653290 PMCID: PMC7927232 DOI: 10.1186/s12889-021-10478-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/01/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Early diagnosis is crucial in securing optimal outcomes in the HIV care cascade. Recent HIV infection (RHI) serves as an indicator of early detection in the course of HIV infection. Surveillance of RHI is important in uncovering at-risk groups in which HIV transmission is ongoing. The study objectives are to estimate the proportion of RHI among persons newly-diagnosed in 2013–2017, and to elucidate epidemiological factors associated with RHI in Singapore. Methods As part of the National HIV Molecular Surveillance Programme, residual plasma samples of treatment-naïve HIV-1 positive individuals were tested using the biotinylated peptide-capture enzyme immunoassay with a cutoff of normalized optical density ≤ 0.8 for evidence of RHI. A recent infection testing algorithm was applied for the classification of RHI. We identified risk factors associated with RHI using logistic regression analyses. Results A total of 701 newly-diagnosed HIV-infected persons were included in the study. The median age at HIV diagnosis was 38 years (interquartile range, 28–51). The majority were men (94.2%), and sexual route was the predominant mode of HIV transmission (98.3%). Overall, 133/701 (19.0, 95% confidence interval [CI] 16.2–22.0%) were classified as RHI. The proportions of RHI in 2015 (31.1%) and 2017 (31.0%) were significantly higher than in 2014 (11.2%). A significantly higher proportion of men having sex with men (23.4, 95% CI 19.6–27.6%) had RHI compared with heterosexual men (11.1, 95% CI 7.6–15.9%). Independent factors associated with RHI were: age 15–24 years (adjusted odds ratio [aOR] 4.18, 95% CI 1.69–10.31) compared with ≥55 years; HIV diagnosis in 2015 (aOR 2.36, 95% CI 1.25–4.46) and 2017 (aOR 2.52, 95% CI 1.32–4.80) compared with 2013–2014; detection via voluntary testing (aOR 1.91, 95% CI 1.07–3.43) compared with medical care; and self-reported history of HIV test(s) prior to diagnosis (aOR 1.72, 95% CI 1.06–2.81). Conclusion Although there appears to be an increasing trend towards early diagnosis, persons with RHI remain a minority in Singapore. The strong associations observed between modifiable behaviors (voluntary testing and HIV testing history) and RHI highlight the importance of increasing the accessibility to HIV testing for at-risk groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10478-5.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.
| | - Carmen Low
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
| | - Chen Seong Wong
- National HIV Programme, National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Irving Charles Boudville
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Matthias Paul Han Sim Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sophia Archuleta
- National HIV Programme, National Centre for Infectious Diseases, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Vernon Jian Ming Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Communicable Diseases Division, Ministry of Health, Singapore, Singapore
| | - Yee Sin Leo
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Angela Chow
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - Raymond Tzer-Pin Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
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24
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Ang LW, Choy CY, Ng OT, Leo YS, Wong CS. Hepatitis C virus infection in HIV-infected men in Singapore, 2006-2018: incidence and associated factors. Sex Health 2021; 18:221-231. [PMID: 34148565 DOI: 10.1071/sh20197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022]
Abstract
Background The epidemiology of hepatitis C virus (HCV) infection in people living with HIV has been evolving, with increasing evidence of permucosal (sexual) transmission identified predominantly in HIV-positive men who have sex with men (MSM). The aim of this study was to estimate the incidence rate and elucidate epidemiological factors associated with HCV infection among HIV-infected men in Singapore from 2006 to 2018. METHODS A retrospective cohort study was conducted using a clinical database maintained by the Clinical HIV Program at the National Centre for Infectious Diseases, Singapore. Factors associated with incident HCV infections were identified using Cox proportional hazards regression analyses. RESULTS Among 1348 HIV-infected male patients who were HCV seronegative at baseline, 64 (4.7%) subsequently tested positive for HCV, giving an incidence of 0.88 per 100 person-years of follow-up (PYFU) (95% confidence interval (CI) 0.69-1.13). The incidence rate of HCV seroconversion increased from 0.33 (95% CI 0.12-0.71) per 100 PYFU in 2010-2012 to 1.93 (95% CI 1.36-2.67) in 2016-2018. Independent factors associated with incident HCV infection were younger age groups at HIV diagnosis versus ≥45 years, HIV acquisition via MSM or via both sexual contact and intravenous drug use versus heterosexual transmission, HIV diagnosis in later periods versus 2006-2009, and recent syphilis acquisition. CONCLUSIONS An increasing trend of incident HCV infection was seen in HIV-infected men, particularly for MSM. Preventive and behavioural interventions should be targeted at HIV-infected individuals engaged in high-risk sexual behaviour.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Corresponding author.
| | - Chiaw Yee Choy
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore
| | - Oon Tek Ng
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Yee Sin Leo
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore; and Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, 117597, Singapore; and Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore
| | - Chen Seong Wong
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442, Singapore; and Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore; and Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
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25
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Lwin MO, Lu J, Sheldenkar A, Panchapakesan C, Tan YR, Yap P, Chen MI, Chow VT, Thoon KC, Yung CF, Ang LW, Ang BS. Effectiveness of a Mobile-Based Influenza-Like Illness Surveillance System (FluMob) Among Health Care Workers: Longitudinal Study. JMIR Mhealth Uhealth 2020; 8:e19712. [PMID: 33284126 PMCID: PMC7752531 DOI: 10.2196/19712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/29/2020] [Accepted: 10/30/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Existing studies have suggested that internet-based participatory surveillance systems are a valid sentinel for influenza-like illness (ILI) surveillance. However, there is limited scientific knowledge on the effectiveness of mobile-based ILI surveillance systems. Previous studies also adopted a passive surveillance approach and have not fully investigated the effectiveness of the systems and their determinants. OBJECTIVE The aim of this study was to assess the efficiency of a mobile-based surveillance system of ILI, termed FluMob, among health care workers using a targeted surveillance approach. Specifically, this study evaluated the effectiveness of the system for ILI surveillance pertaining to its participation engagement and surveillance power. In addition, we aimed to identify the factors that can moderate the effectiveness of the system. METHODS The FluMob system was launched in two large hospitals in Singapore from April 2016 to March 2018. A total of 690 clinical and nonclinical hospital staff participated in the study for 18 months and were prompted via app notifications to submit a survey listing 18 acute respiratory symptoms (eg, fever, cough, sore throat) on a weekly basis. There was a period of study disruption due to maintenance of the system and the end of the participation incentive between May and July of 2017. RESULTS On average, the individual submission rate was 41.4% (SD 24.3%), with a rate of 51.8% (SD 26.4%) before the study disruption and of 21.5% (SD 30.6%) after the disruption. Multivariable regression analysis showed that the adjusted individual submission rates were higher for participants who were older (<30 years, 31.4% vs 31-40 years, 40.2% [P<.001]; 41-50 years, 46.0% [P<.001]; >50 years, 39.9% [P=.01]), ethnic Chinese (Chinese, 44.4% vs non-Chinese, 34.7%; P<.001), and vaccinated against flu in the past year (vaccinated, 44.6% vs nonvaccinated, 34.4%; P<.001). In addition, the weekly ILI incidence was 1.07% on average. The Pearson correlation coefficient between ILI incidence estimated by FluMob and that reported by Singapore Ministry of Health was 0.04 (P=.75) with all data and was 0.38 (P=.006) including only data collected before the study disruption. Health care workers with higher risks of ILI and influenza such as women, non-Chinese, allied health staff, those who had children in their households, not vaccinated against influenza, and reported allergy demonstrated higher surveillance correlations. CONCLUSIONS Mobile-based ILI surveillance systems among health care workers can be effective. However, proper operation of the mobile system without major disruptions is vital for the engagement of participants and the persistence of surveillance power. Moreover, the effectiveness of the mobile surveillance system can be moderated by participants' characteristics, which highlights the importance of targeted disease surveillance that can reduce the cost of recruitment and engagement.
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Affiliation(s)
- May Oo Lwin
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Jiahui Lu
- School of New Media and Communication, Tianjin University, Tianjin, China
| | - Anita Sheldenkar
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Chitra Panchapakesan
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yi-Roe Tan
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Peiling Yap
- The International Digital Health & Artificial Intelligence Research Collaborative (I-DAIR), Graduate Institute of Geneva, Geneva, Switzerland
| | - Mark I Chen
- National Centre for Infectious Diseases, Singapore, Singapore
| | | | | | - Chee Fu Yung
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Brenda Sp Ang
- National Centre for Infectious Diseases, Singapore, Singapore
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26
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Zhang JJY, Lee KS, Ang LW, Leo YS, Young BE. Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Clin Infect Dis 2020; 71:2199-2206. [PMID: 32407459 PMCID: PMC7239203 DOI: 10.1093/cid/ciaa576] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic spread globally in the beginning of 2020. At present, predictors of severe disease and the efficacy of different treatments are not well understood. We conducted a systematic review and meta-analysis of all published studies up to 15 March 2020, which reported COVID-19 clinical features and/or treatment outcomes. Forty-five studies reporting 4203 patients were included. Pooled rates of intensive care unit (ICU) admission, mortality, and acute respiratory distress syndrome (ARDS) were 10.9%, 4.3%, and 18.4%, respectively. On meta-regression, ICU admission was predicted by increased leukocyte count (P < .0001), alanine aminotransferase (P = .024), and aspartate transaminase (P = .0040); elevated lactate dehydrogenase (LDH) (P < .0001); and increased procalcitonin (P < .0001). ARDS was predicted by elevated LDH (P < .0001), while mortality was predicted by increased leukocyte count (P = .0005) and elevated LDH (P < .0001). Treatment with lopinavir-ritonavir showed no significant benefit in mortality and ARDS rates. Corticosteroids were associated with a higher rate of ARDS (P = .0003).
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Affiliation(s)
- John J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Yee Sin Leo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Centre for Infectious Diseases, Singapore
- 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, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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27
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Young BE, Fong SW, Chan YH, Mak TM, Ang LW, Anderson DE, Lee CYP, Amrun SN, Lee B, Goh YS, Su YCF, Wei WE, Kalimuddin S, Chai LYA, Pada S, Tan SY, Sun L, Parthasarathy P, Chen YYC, Barkham T, Lin RTP, Maurer-Stroh S, Leo YS, Wang LF, Renia L, Lee VJ, Smith GJD, Lye DC, Ng LFP. Effects of a major deletion in the SARS-CoV-2 genome on the severity of infection and the inflammatory response: an observational cohort study. Lancet 2020; 396:603-611. [PMID: 32822564 PMCID: PMC7434477 DOI: 10.1016/s0140-6736(20)31757-8] [Citation(s) in RCA: 308] [Impact Index Per Article: 77.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with a 382-nucleotide deletion (∆382) in the open reading frame 8 (ORF8) region of the genome have been detected in Singapore and other countries. We investigated the effect of this deletion on the clinical features of infection. METHODS We retrospectively identified patients who had been screened for the ∆382 variant and recruited to the PROTECT study-a prospective observational cohort study conducted at seven public hospitals in Singapore. We collected clinical, laboratory, and radiological data from patients' electronic medical records and serial blood and respiratory samples taken during hospitalisation and after discharge. Individuals infected with the ∆382 variant were compared with those infected with wild-type SARS-CoV-2. Exact logistic regression was used to examine the association between the infection groups and the development of hypoxia requiring supplemental oxygen (an indicator of severe COVID-19, the primary endpoint). Follow-up for the study's primary endpoint is completed. FINDINGS Between Jan 22 and March 21, 2020, 278 patients with PCR-confirmed SARS-CoV-2 infection were screened for the ∆382 deletion and 131 were enrolled onto the study, of whom 92 (70%) were infected with the wild-type virus, ten (8%) had a mix of wild-type and ∆382-variant viruses, and 29 (22%) had only the ∆382 variant. Development of hypoxia requiring supplemental oxygen was less frequent in the ∆382 variant group (0 [0%] of 29 patients) than in the wild-type only group (26 [28%] of 92; absolute difference 28% [95% CI 14-28]). After adjusting for age and presence of comorbidities, infection with the ∆382 variant only was associated with lower odds of developing hypoxia requiring supplemental oxygen (adjusted odds ratio 0·07 [95% CI 0·00-0·48]) compared with infection with wild-type virus only. INTERPRETATION The ∆382 variant of SARS-CoV-2 seems to be associated with a milder infection. The observed clinical effects of deletions in ORF8 could have implications for the development of treatments and vaccines. FUNDING National Medical Research Council Singapore.
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Affiliation(s)
- Barnaby E 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
| | - Siew-Wai Fong
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore; Department of Biological Sciences, National University of Singapore, Singapore
| | - Yi-Hao Chan
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore
| | | | - Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | | | - Cheryl Yi-Pin Lee
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore
| | - Siti Naqiah Amrun
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore
| | - Yun Shan Goh
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore
| | - Yvonne C F Su
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wycliffe E Wei
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Shirin Kalimuddin
- Duke-NUS Medical School, National University of Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Louis Yi Ann Chai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Health System, Singapore
| | - Surinder Pada
- Department of Medicine, Infectious Diseases Service, Ng Teng Fong General Hospital, Singapore
| | - Seow Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore
| | | | | | | | - Timothy Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Sebastian Maurer-Stroh
- National Centre for Infectious Diseases, Singapore; Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore; Department of Biological Sciences, National University of Singapore, Singapore; Global Initiative on Sharing All Influenza Data, Munich, Germany
| | - 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; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lin-Fa Wang
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Laurent Renia
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore
| | - Vernon J Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Ministry of Health, Singapore
| | - Gavin J D Smith
- Duke-NUS Medical School, National University of Singapore, Singapore.
| | - David Chien 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; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lisa F P Ng
- Infectious Diseases Horizontal Technology Centre, Agency for Science, Technology, and Research, Singapore; Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore.
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28
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Young BE, Ong SWX, Ng LFP, Anderson DE, Chia WN, Chia PY, Ang LW, Mak TM, Kalimuddin S, Chai LYA, Pada S, Tan SY, Sun L, Parthasarathy P, Fong SW, Chan YH, Tan CW, Lee B, Rötzschke O, Ding Y, Tambyah P, Low JGH, Cui L, Barkham T, Lin RTP, Leo YS, Renia L, Wang LF, Lye DC. Viral dynamics and immune correlates of COVID-19 disease severity. Clin Infect Dis 2020; 73:e2932-e2942. [PMID: 32856707 PMCID: PMC7499509 DOI: 10.1093/cid/ciaa1280] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [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: 05/23/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Key knowledge gaps remain in the understanding of viral dynamics and immune response of SARS-CoV-2 infection. Methods We evaluated these characteristics and established their association with clinical severity in a prospective observational cohort study of 100 patients with PCR-confirmed SARS-CoV-2 infection (mean age 46 years, 56% male, 38% with comorbidities). Respiratory samples (n=74) were collected for viral culture, serum samples for measurement of IgM/IgG levels (n=30), and plasma samples for levels of inflammatory cytokines and chemokines (n=81). Disease severity was correlated with results from viral culture, serologic testing, and immune markers. Results 57 (57%) patients developed viral pneumonia, of whom 20 (20%) required supplemental oxygen including 12 (12%) invasive mechanical ventilation. Viral culture from respiratory samples was positive for 19 of 74 patients (26%). No virus was isolated when the PCR cycle threshold (Ct) value was >30 or >14 days after symptom onset. Seroconversion occurred at a median of 12.5 days (IQR 9-18) for IgM and 15.0 days (IQR 12-20) for IgG; 54/62 patients (87.1%) sampled at day 14 or later seroconverted. Severe infections were associated with earlier seroconversion and higher peak IgM and IgG levels. Levels of IP-10, HGF, IL-6, MCP-1, MIP-1α, IL-12p70, IL-18, VEGF-A, PDGF-BB and IL-1RA significantly correlated with disease severity. Conclusion We found virus viability was associated with lower PCR Ct value in early illness. A stronger antibody response was associated with disease severity. The overactive proinflammatory immune signatures offers targets for host-directed immunotherapy which should be evaluated in randomised controlled trials.
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Affiliation(s)
- Barnaby E Young
- National Centre for Infectious Diseases, Singapore.,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.,Tan Tock Seng Hospital, Singapore
| | - Lisa F P Ng
- Infection Diseases Horizontal Technology Centre (ID HTC), Agency for Science, Technology and Research, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | | | | | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | - Tze-Minn Mak
- National Centre for Infectious Diseases, Singapore
| | - Shirin Kalimuddin
- Duke-NUS Medical School, Singapore.,Singapore General Hospital, Singapore
| | - Louis Yi Ann Chai
- National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | - Siew-Wai Fong
- Infection Diseases Horizontal Technology Centre (ID HTC), Agency for Science, Technology and Research, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore.,Department of Biological Science, National University of Singapore, Singapore
| | - Yi-Hao Chan
- Infection Diseases Horizontal Technology Centre (ID HTC), Agency for Science, Technology and Research, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Chee Wah Tan
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Olaf Rötzschke
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Ying Ding
- National Centre for Infectious Diseases, Singapore
| | - Paul Tambyah
- National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jenny G H Low
- Duke-NUS Medical School, Singapore.,Singapore General Hospital, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore
| | - Timothy Barkham
- Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Laurent Renia
- Infection Diseases Horizontal Technology Centre (ID HTC), Agency for Science, Technology and Research, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Singapore.,Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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29
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Ang LW, Wong CS, Ng OT, Leo YS. Incidence of syphilis among HIV-infected men in Singapore, 2006-2017: temporal trends and associated risk factors. Sex Transm Infect 2020; 96:293-299. [PMID: 31371448 PMCID: PMC7279196 DOI: 10.1136/sextrans-2019-054163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/13/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE There have been recent reports globally on substantial increase in syphilis diagnoses particularly among high-risk men. The aim of this study was to assess temporal trends of incident syphilis and associated risk factors among HIV-infected men in Singapore. METHODS We conducted retrospective cohort analysis using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. HIV-infected men with a negative syphilis result at baseline who had undergone at least one subsequent test in 2006-2017 were included. Factors associated with incident syphilis were investigated using Cox proportional hazards regression analyses. RESULTS A total of 1069 HIV-infected men were tested for syphilis at least once following their negative baseline test during the 12-year period, and they contributed 4284 person-years of follow-up (PYFU). There were 266 cases of incident syphilis, giving an overall incidence of 6.21 per 100 PYFU (95% CI 5.49-7.00). The incidence of syphilis per 100 PYFU increased from 1.21 (95% CI 0.33 to 3.10) in 2010 to 26.04 (95% CI 19.97 to 33.40) in 2017. In the multivariable model, risk factors for syphilis seroconversion were: age 15-24 years at HIV diagnosis (adjusted HR (aHR) 1.64, 95% CI 1.05 to 2.56) versus ≥45 years, being Chinese (aHR 1.82, 95% CI 1.01 to 3.29) versus Indian and other minority ethnic groups, men having sex with men (MSM) (aHR 3.29, 95% CI 2.22 to 4.87) versus heterosexuals, and HIV diagnosis in later periods of 2009-2011 (aHR 1.96, 95% CI 1.41 to 2.74), 2012-2014 (aHR 3.96, 95% CI 2.68 to 5.83) and 2015-2017 (aHR 7.94, 95% CI 4.52 to 13.95) versus 2006-2008. CONCLUSION The annual incidence rate of syphilis in HIV-infected men was on the rise, and it was consistently higher among MSM than in heterosexual men. The findings supported regular screening for syphilis and enhanced behavioural interventions in Singapore.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Chen Seong Wong
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Oon Tek Ng
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Yee Sin Leo
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
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30
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Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, Ng OT, Marimuthu K, Ang LW, Mak TM, Lau SK, Anderson DE, Chan KS, Tan TY, Ng TY, Cui L, Said Z, Kurupatham L, Chen MIC, Chan M, Vasoo S, Wang LF, Tan BH, Lin RTP, Lee VJM, Leo YS, Lye DC. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA 2020; 323:1488-1494. [PMID: 32125362 PMCID: PMC7054855 DOI: 10.1001/jama.2020.3204] [Citation(s) in RCA: 1329] [Impact Index Per Article: 332.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China. OBJECTIVE To report the initial experience in Singapore with the epidemiologic investigation of this outbreak, clinical features, and management. DESIGN, SETTING, AND PARTICIPANTS Descriptive case series of the first 18 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection at 4 hospitals in Singapore from January 23 to February 3, 2020; final follow-up date was February 25, 2020. EXPOSURES Confirmed SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES Clinical, laboratory, and radiologic data were collected, including PCR cycle threshold values from nasopharyngeal swabs and viral shedding in blood, urine, and stool. Clinical course was summarized, including requirement for supplemental oxygen and intensive care and use of empirical treatment with lopinavir-ritonavir. RESULTS Among the 18 hospitalized patients with PCR-confirmed SARS-CoV-2 infection (median age, 47 years; 9 [50%] women), clinical presentation was an upper respiratory tract infection in 12 (67%), and viral shedding from the nasopharynx was prolonged for 7 days or longer among 15 (83%). Six individuals (33%) required supplemental oxygen; of these, 2 required intensive care. There were no deaths. Virus was detectable in the stool (4/8 [50%]) and blood (1/12 [8%]) by PCR but not in urine. Five individuals requiring supplemental oxygen were treated with lopinavir-ritonavir. For 3 of the 5 patients, fever resolved and supplemental oxygen requirement was reduced within 3 days, whereas 2 deteriorated with progressive respiratory failure. Four of the 5 patients treated with lopinavir-ritonavir developed nausea, vomiting, and/or diarrhea, and 3 developed abnormal liver function test results. CONCLUSIONS AND RELEVANCE Among the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore, clinical presentation was frequently a mild respiratory tract infection. Some patients required supplemental oxygen and had variable clinical outcomes following treatment with an antiretroviral agent.
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Affiliation(s)
- Barnaby Edward Young
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
| | - Shirin Kalimuddin
- Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Jenny G. Low
- Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | | | - Oon-Tek Ng
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases,
Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases,
Singapore
| | | | | | | | - Thean Yen Tan
- Duke-NUS Medical School, Singapore
- Changi General Hospital, Singapore
| | | | - Lin Cui
- National Centre for Infectious Diseases,
Singapore
| | | | | | - Mark I-Cheng Chen
- National Centre for Infectious Diseases,
Singapore
- Saw Swee Hock School of Public Health,
Singapore
| | - Monica Chan
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Boon Huan Tan
- Lee Kong Chian School of Medicine,
Singapore
- DSO National Laboratories, Singapore
| | | | | | - Yee-Sin Leo
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
- Yong Loo Lin School of Medicine, Singapore
- Saw Swee Hock School of Public Health,
Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
- Yong Loo Lin School of Medicine, Singapore
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31
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Ang LW, Mak TM, Cui L, Leo YS, Lee VJM, Lin RTP. Characterisation of respiratory syncytial virus activity in children and adults presenting with acute respiratory illness at primary care clinics in Singapore, 2014-2018. Influenza Other Respir Viruses 2020; 14:412-419. [PMID: 32090482 PMCID: PMC7298310 DOI: 10.1111/irv.12730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/01/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important respiratory pathogen that affects people of all ages. OBJECTIVES We examined the patterns of RSV circulation in 2014-2018, and investigated their age-specific differences in tropical Singapore. METHODS Nasopharyngeal and/or throat swabs were taken from outpatient attendees for the national influenza virological surveillance among those who presented with acute respiratory illness in the community. Specimens tested negative for influenza were then tested for RSV and other respiratory pathogens. RESULTS Among 8436 influenza-negative specimens tested during the five-year period, 5.8% (95% confidence interval 5.3%-6.3%) were positive for RSV. The peak of RSV activity occurred around middle of the year. The age-specific proportion of RSV detections showed a reverse J-shaped pattern; RSV positivity was the highest in young children ≤2 years of age (10.9%), followed by those aged 3-5 years (6.4%) and persons aged ≥65 years (5.3%), while the nadir was observed in the age group of 15-24 years (1.2%). RSV type A was predominantly circulating in children ≤5 years of age from 2014 to 2015 and 2017, whereas in 2016, they were more affected by type B. CONCLUSION Respiratory syncytial virus was more frequently detected among the two age groups that have been recommended for influenza vaccination; persons ≥65 years of age and children 6 months to <5 years of age. Characterisation of RSV activity in the community helps to better inform public health policies for effective prevention and control interventions.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore City, Singapore.,Public Health Group, Ministry of Health, Singapore City, Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore City, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore City, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore City, Singapore
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32
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Ng Y, Chua LAV, Cui L, Ang LW, Tee NWS, Lin RTP, Ma S, Lee VJM. Seroprevalence of vaccine-preventable diseases among children and adolescents in Singapore: Results from the National Paediatric Seroprevalence Survey 2018. Int J Infect Dis 2019; 92:234-240. [PMID: 31843668 DOI: 10.1016/j.ijid.2019.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The Ministry of Health (MOH), Singapore, conducted the National Paediatric Seroprevalence Survey 2018 (NPSS 2018) to estimate the latest immunity levels against measles, rubella, varicella, diphtheria, tetanus and hepatitis B, and the seroprevalence of chronic hepatitis B virus (HBV) carriage in children and adolescents in Singapore. METHODS The survey involved prospective collection of residual sera from 1,200 children and adolescents aged 1-17 years in two public acute hospitals. Enzyme-linked immunosorbent assays (EIA) or plague reduction neutralisation tests (PRNT) were used to determine the seroprevalence of the vaccine-preventable diseases. RESULTS Overall prevalence of measles and rubella antibodies among Singaporean children and adolescents aged 1-17 years were 98.2% (95% CI: 91.2-98.8%) and 94.8% (95% CI: 93.4-95.9%) respectively. 97.1% (95% CI: 96.0-97.9%) of subjects had at least basic protection against diphtheria, while 89.3% (95% CI: 87.5-91.0%) were protected against tetanus. The prevalence of chronic HBV carriage was 0.4% (95% CI: 0.2-1.0%), while 45.7% (95% CI: 42.9-48.5%) were immune against HBV. The seroprevalence for varicella antibodies was 52.9% (95% CI: 50.1-55.7%). Concordance between vaccination status and seroprevalence was observed for measles, rubella, diphtheria and tetanus. CONCLUSION Singapore's children and adolescents are well-protected against measles, rubella, diphtheria and tetanus. Continual efforts in ensuring high vaccination coverage should be sustained.
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Affiliation(s)
- Yixiang Ng
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
| | - Lily Ai Vee Chua
- Epidemiology and Disease Control Division, Ministry of Health, Singapore.
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Nancy Wen Sim Tee
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Raymond Tzer Pin Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Stefan Ma
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
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33
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Caini S, Kusznierz G, Garate VV, Wangchuk S, Thapa B, de Paula Júnior FJ, Ferreira de Almeida WA, Njouom R, Fasce RA, Bustos P, Feng L, Peng Z, Araya JL, Bruno A, de Mora D, Barahona de Gámez MJ, Pebody R, Zambon M, Higueros R, Rivera R, Kosasih H, Castrucci MR, Bella A, Kadjo HA, Daouda C, Makusheva A, Bessonova O, Chaves SS, Emukule GO, Heraud JM, Razanajatovo NH, Barakat A, El Falaki F, Meijer A, Donker GA, Huang QS, Wood T, Balmaseda A, Palekar R, Arévalo BM, Rodrigues AP, Guiomar R, Lee VJM, Ang LW, Cohen C, Treurnicht F, Mironenko A, Holubka O, Bresee J, Brammer L, Le MTQ, Hoang PVM, El Guerche-Séblain C, Paget J. The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st century. PLoS One 2019; 14:e0222381. [PMID: 31513690 PMCID: PMC6742362 DOI: 10.1371/journal.pone.0222381] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [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: 02/07/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022] Open
Abstract
We describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000–2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- * E-mail:
| | - Gabriela Kusznierz
- National Institute of Respiratory Diseases "Emilio Coni", Santa Fe, Argentina
| | | | - Sonam Wangchuk
- Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Binay Thapa
- Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | | | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Rodrigo A. Fasce
- Sub-Department of Viral Diseases, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Patricia Bustos
- Sub-Department of Viral Diseases, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Luzhao Feng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Jenny Lara Araya
- National Influenza Center, Ministry of Health, San José, Costa Rica
| | - Alfredo Bruno
- National Institute of Public Health Research (INSPI), National Reference Centre for Influenza and Other Respiratory Viruses, Guayaquil, Ecuador
- Agricultural University of Ecuador, Guayaquil, Ecuador
| | - Doménica de Mora
- National Institute of Public Health Research (INSPI), National Reference Centre for Influenza and Other Respiratory Viruses, Guayaquil, Ecuador
| | | | | | - Maria Zambon
- Public Health England, London, England, United Kingdom
| | - Rocio Higueros
- National Influenza Center, Ministry of Health, Guatemala City, Guatemala
| | | | | | - Maria Rita Castrucci
- National Influenza Center, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Hervé A. Kadjo
- Department of Epidemic Virus, Institut Pasteur, Abidjan, Côte d'Ivoire
| | - Coulibaly Daouda
- Service of Epidemiological Diseases Surveillance, National Institute of Public Hygiene, Abidjan, Côte d'Ivoire
| | - Ainash Makusheva
- National Center of Expertise, Committee of Public Health Protection, Ministry of Health, Astana, Kazakhstan
| | - Olga Bessonova
- National Center of Expertise, Committee of Public Health Protection, Ministry of Health, Uralsk City, Kazakhstan
| | - Sandra S. Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Gideon O. Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jean-Michel Heraud
- National Influenza Center, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Norosoa H. Razanajatovo
- National Influenza Center, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Amal Barakat
- National Influenza Center, Institut National d'Hygiène, Ministry of Health, Rabat, Morocco
| | - Fatima El Falaki
- National Influenza Center, Institut National d'Hygiène, Ministry of Health, Rabat, Morocco
| | - Adam Meijer
- National Institute for Public Health and the Environment, Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Bilthoven, The Netherlands
| | - Gé A. Donker
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Q. Sue Huang
- Institute of Environmental Science and Research, Weillngton, New Zealand
| | - Tim Wood
- Institute of Environmental Science and Research, Weillngton, New Zealand
| | - Angel Balmaseda
- National Influenza Center, Ministry of Health, Managua, Nicaragua
| | - Rakhee Palekar
- Pan American Health Organization, Washington, District of Columbia, United States of America
| | | | - Ana Paula Rodrigues
- Department of epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Raquel Guiomar
- National Influenza Reference Laboratory, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | | | - Li Wei Ang
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - Cheryl Cohen
- 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
| | - Florette Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Alla Mironenko
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases, National Academy of Medical Science of Ukraine, Department of Respiratory and other Viral Infections, Kyiv, Ukraine
| | - Olha Holubka
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases, National Academy of Medical Science of Ukraine, Department of Respiratory and other Viral Infections, Kyiv, Ukraine
| | - Joseph Bresee
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lynnette Brammer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mai T. Q. Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Clotilde El Guerche-Séblain
- Global Vaccine Epidemiology and Modeling Department (VEM), Franchise Epidemiologist, Sanofi Pasteur, Lyon, France
| | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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34
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Tan LK, Low SL, Sun H, Shi Y, Liu L, Lam S, Tan HH, Ang LW, Wong WY, Chua R, Teo D, Ng LC, Cook AR. Force of Infection and True Infection Rate of Dengue in Singapore: Implications for Dengue Control and Management. Am J Epidemiol 2019; 188:1529-1538. [PMID: 31062837 PMCID: PMC6670050 DOI: 10.1093/aje/kwz110] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 11/02/2017] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 12/23/2022] Open
Abstract
National data on dengue notifications do not capture all dengue infections and do not reflect the true intensity of disease transmission. To assess the true dengue infection rate and disease control efforts in Singapore, we conducted age-stratified serosurveys among residents after a 2013 outbreak that was the largest dengue outbreak on record. The age-weighted prevalence of dengue immunoglobulin G among residents was 49.8% (95% confidence interval: 48.4, 51.1) in 2013 and 48.6% (95% confidence interval: 47.0, 50.0) in 2017; prevalence increased with age. Combining these data with those from previous serosurveys, the year-on-year estimates of the dengue force of infection from 1930 to 2017 revealed a significant decrease from the late 1960s to the mid-1990s, after which the force of infection remained stable at approximately 10 per 1,000 persons per year. The reproduction number (R0) had also declined since the 1960s. The reduction in dengue transmission may be attributed to the sustained national vector program and partly to a change in the age structure of the population. The improved estimated ratio of notified cases to true infections, from 1:14 in 2005–2009 to 1:6 in 2014–2017, signifies that the national notification system, which relies on diagnosed cases, has improved over time. The data also suggest that the magnitudes of dengue epidemics cannot be fairly compared across calendar years and that the current disease control program remains applicable.
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Affiliation(s)
- Li Kiang Tan
- Environmental Health Institute, National Environment Agency, Singapore
| | - Swee Ling Low
- Environmental Health Institute, National Environment Agency, Singapore
| | - Haoyang Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yuan Shi
- Environmental Health Institute, National Environment Agency, Singapore
| | - Lilac Liu
- Environmental Health Institute, National Environment Agency, Singapore
| | - Sally Lam
- Blood Services Group, Health Sciences Authority, Singapore
| | - Hwee Huang Tan
- Blood Services Group, Health Sciences Authority, Singapore
| | - Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
| | - Wing Yan Wong
- Environmental Health Institute, National Environment Agency, Singapore
| | - Rachel Chua
- Environmental Health Institute, National Environment Agency, Singapore
| | - Diana Teo
- Blood Services Group, Health Sciences Authority, Singapore
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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35
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Choy CY, Ang LW, Ng OT, Leo YS, Wong CS. Factors Associated with Hepatitis B and C Co-Infection among HIV-Infected Patients in Singapore, 2006-2017. Trop Med Infect Dis 2019; 4:tropicalmed4020087. [PMID: 31137801 PMCID: PMC6631379 DOI: 10.3390/tropicalmed4020087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/26/2019] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022] Open
Abstract
Co-infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) with human immunodeficiency virus (HIV) is associated with increased risk of hepatic complications and mortality. A retrospective study to estimate the proportion of HBV and HCV co-infections in Singapore was conducted using a clinical database. We included 3065 patients who were seen under the Clinical HIV Programme at the largest referral centre for HIV care between 2006 and 2017 and were tested for both HBV and HCV. Factors associated with HIV-HBV and HIV-HCV co-infections were determined using logistic regressions. The majority (86.3%) of HIV-infected patients were mono-infected, while 7.2% were co-infected with HBV, 6.0% with HCV, and 0.5% were co-infected with both HBV and HCV. The most common HCV genotype was GT1 (63%). Factors significantly associated with HBV co-infection in the multivariable model were: Aged 30–49 years and 50–69 years at HIV diagnosis, male gender, and HIV transmission through intravenous drug use (IDU). Independent factors associated with HCV co-infection were: Malay ethnicity, HIV transmission through IDU, and HIV diagnosis between 2006 and 2008. Behavioural risk factors such as IDU, as well as epidemiologic differences associated with co-infection, should inform further studies and interventions aimed at reducing viral hepatitis infection among HIV-infected individuals.
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Affiliation(s)
- Chiaw Yee Choy
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308422, Singapore.
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | - Li Wei Ang
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308422, Singapore.
- Public Health Group, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore.
| | - Oon Tek Ng
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308422, Singapore.
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore.
| | - Yee Sin Leo
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308422, Singapore.
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore.
| | - Chen Seong Wong
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308422, Singapore.
- Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore.
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36
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Ang LW, Cui L, Mak TM, Ng Y, Leo YS, Lee VJM, Lin RTP. Differential age-specific distribution of influenza virus types and subtypes in tropical Singapore, 2011 to 2017. J Med Virol 2019; 91:1415-1422. [PMID: 30927452 DOI: 10.1002/jmv.25473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/26/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/06/2022]
Abstract
Surveillance and reporting of epidemiological features of seasonal influenza mostly are aggregates across all-ages. We investigated age-specific differences in distribution of influenza virus (sub)types in tropical Singapore, using laboratory-confirmed virological data collected under the national influenza surveillance programme from 2011 to 2017. The proportion of influenza-positive specimens from outpatients with influenza-like illness was used as an indicator of influenza activity in the community. The highest influenza positivity for age groups of 5 to 14 years and 15 to 64 years coincided in the same month in 5 out of the 7 years under study. Influenza positivity was lowest in young children <5 years of age compared with older age groups. Influenza A(H3N2) was most prevalent in the community except in 2012 when a predominance of influenza B was observed. The dominant virus (sub)type varied across the years in children <5 years and 5 to 14 years of age. Influenza A(H3N2) was the predominant circulating virus subtype among elderly persons aged ≥65 years during the 7-year period, and among adults aged 15 to 64 years since 2013. Knowledge about the age-specific differences in distribution of influenza virus (sub)types helps to facilitate better understanding of seasonal epidemics and to inform targeted strategies in prevention and control of influenza virus transmission.
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Affiliation(s)
- Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore.,Public Health Group, Ministry of Health, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Tze Minn Mak
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Yixiang Ng
- Public Health Group, Ministry of Health, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
| | | | - Raymond Tzer-Pin Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
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37
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Caini S, Spreeuwenberg P, Kusznierz GF, Rudi JM, Owen R, Pennington K, Wangchuk S, Gyeltshen S, Ferreira de Almeida WA, Pessanha Henriques CM, Njouom R, Vernet MA, Fasce RA, Andrade W, Yu H, Feng L, Yang J, Peng Z, Lara J, Bruno A, de Mora D, de Lozano C, Zambon M, Pebody R, Castillo L, Clara AW, Matute ML, Kosasih H, Nurhayati, Puzelli S, Rizzo C, Kadjo HA, Daouda C, Kiyanbekova L, Ospanova A, Mott JA, Emukule GO, Heraud JM, Razanajatovo NH, Barakat A, El Falaki F, Huang SQ, Lopez L, Balmaseda A, Moreno B, Rodrigues AP, Guiomar R, Ang LW, Lee VJM, Venter M, Cohen C, Badur S, Ciblak MA, Mironenko A, Holubka O, Bresee J, Brammer L, Hoang PVM, Le MTQ, Fleming D, Séblain CEG, Schellevis F, Paget J. Distribution of influenza virus types by age using case-based global surveillance data from twenty-nine countries, 1999-2014. BMC Infect Dis 2018; 18:269. [PMID: 29884140 PMCID: PMC5994061 DOI: 10.1186/s12879-018-3181-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 02/07/2017] [Accepted: 05/30/2018] [Indexed: 11/23/2022] Open
Abstract
Background Influenza disease burden varies by age and this has important public health implications. We compared the proportional distribution of different influenza virus types within age strata using surveillance data from twenty-nine countries during 1999-2014 (N=358,796 influenza cases). Methods For each virus, we calculated a Relative Illness Ratio (defined as the ratio of the percentage of cases in an age group to the percentage of the country population in the same age group) for young children (0-4 years), older children (5-17 years), young adults (18-39 years), older adults (40-64 years), and the elderly (65+ years). We used random-effects meta-analysis models to obtain summary relative illness ratios (sRIRs), and conducted meta-regression and sub-group analyses to explore causes of between-estimates heterogeneity. Results The influenza virus with highest sRIR was A(H1N1) for young children, B for older children, A(H1N1)pdm2009 for adults, and (A(H3N2) for the elderly. As expected, considering the diverse nature of the national surveillance datasets included in our analysis, between-estimates heterogeneity was high (I2>90%) for most sRIRs. The variations of countries’ geographic, demographic and economic characteristics and the proportion of outpatients among reported influenza cases explained only part of the heterogeneity, suggesting that multiple factors were at play. Conclusions These results highlight the importance of presenting burden of disease estimates by age group and virus (sub)type. Electronic supplementary material The online version of this article (10.1186/s12879-018-3181-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands.
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands
| | - Gabriela F Kusznierz
- Instituto Nacional de Enfermedades Respiratorias "Dr. Emilio Coni", Santa Fe, Argentina
| | - Juan Manuel Rudi
- Instituto Nacional de Enfermedades Respiratorias "Dr. Emilio Coni", Santa Fe, Argentina
| | - Rhonda Owen
- Vaccine Preventable Diseases Surveillance Section, Health Policy Protection branch, Office for Health Protection, Department of Health, Woden, Canberra, Australia
| | - Kate Pennington
- Vaccine Preventable Diseases Surveillance Section, Health Policy Protection branch, Office for Health Protection, Department of Health, Woden, Canberra, Australia
| | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Sonam Gyeltshen
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | | | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Rodrigo A Fasce
- Sección Virus Respiratorios, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Winston Andrade
- Sección Virus Respiratorios, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Yang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhibin Peng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jenny Lara
- National Influenza Center, Ministry of Health, San José, Costa Rica
| | - Alfredo Bruno
- Instituto Nacional de Investigacion en Salud Publica (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador
| | - Doménica de Mora
- Instituto Nacional de Investigacion en Salud Publica (INSPI), Centro de Referencia Nacional de Influenza y otros Virus Respiratorios, Guayaquil, Ecuador
| | - Celina de Lozano
- National Influenza Center, Ministry of Health, San Salvador, El Salvador
| | - Maria Zambon
- Respiratory Virus Unit, Public Health England, London, Colindale, UK
| | - Richard Pebody
- Respiratory Diseases Department, Public Health England, London, Colindale, UK
| | - Leticia Castillo
- National Influenza Center, Ministry of Health, Guatemala City, Guatemala
| | - Alexey W Clara
- US Centers for Disease Control, Central American Region, Guatemala City, Guatemala
| | | | | | - Nurhayati
- US Naval Medical Research Unit No.2, Jakarta, Indonesia
| | - Simona Puzelli
- National Influenza Center, National Institute of Health, Rome, Italy
| | - Caterina Rizzo
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Herve A Kadjo
- Department of Epidemic Virus, Institut Pasteur, Abidjan, Côte d'Ivoire
| | - Coulibaly Daouda
- Service of Epidemiological Diseases Surveillance, National Institute of Public Hygiene, Abidjan, Côte d'Ivoire
| | - Lyazzat Kiyanbekova
- National Center of Expertise, Committee of Consumer Right Protection, Astana, Kazakhstan
| | - Akerke Ospanova
- Zonal Virology Laboratory, National Center of Expertise, Committee of Consumer Right Protection, Astana, Kazakhstan
| | - Joshua A Mott
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya.,US Public Health Service, Rockville, Maryland, USA
| | - Gideon O Emukule
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | - Jean-Michel Heraud
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | | | - Amal Barakat
- National Influenza Center, Institut National d'Hygiène, Ministry of Health, Rabat, Morocco
| | - Fatima El Falaki
- National Influenza Center, Institut National d'Hygiène, Ministry of Health, Rabat, Morocco
| | - Sue Q Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Liza Lopez
- Institute of Environmental Science and Research, Wellington, New Zealand
| | - Angel Balmaseda
- National Influenza Center, Ministry of Health, Managua, Nicaragua
| | - Brechla Moreno
- National Influenza Center, IC Gorgas, Panama City, Panama
| | - Ana Paula Rodrigues
- Department of epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Raquel Guiomar
- National Influenza Reference Laboratory, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, Singapore
| | | | - Marietjie Venter
- Global Disease Detection, US-CDC, Pretoria, South Africa.,Zoonoses Research Center, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Alla Mironenko
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases National Academy of Medical Science of Ukraine, Reiv, Ukraine
| | - Olha Holubka
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases National Academy of Medical Science of Ukraine, Reiv, Ukraine
| | - Joseph Bresee
- Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Brammer
- Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - François Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands
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38
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Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, Cohen C, Gran JM, Schanzer D, Cowling BJ, Wu P, Kyncl J, Ang LW, Park M, Redlberger-Fritz M, Yu H, Espenhain L, Krishnan A, Emukule G, van Asten L, Pereira da Silva S, Aungkulanon S, Buchholz U, Widdowson MA, Bresee JS. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet 2018; 391:1285-1300. [PMID: 29248255 PMCID: PMC5935243 DOI: 10.1016/s0140-6736(17)33293-2] [Citation(s) in RCA: 1558] [Impact Index Per Article: 259.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015. METHODS We estimated country-specific influenza-associated respiratory excess mortality rates (EMR) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data. To extrapolate estimates to countries without data, we divided countries into three analytic divisions for three age groups (<65 years, 65-74 years, and ≥75 years) using WHO Global Health Estimate (GHE) respiratory infection mortality rates. We calculated mortality rate ratios (MRR) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates. To calculate death estimates for individual countries within each age-specific analytic division, we multiplied randomly selected mean annual EMRs by the country's MRR and population. Global 95% credible interval (CrI) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year. We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods. FINDINGS EMR-contributing countries represented 57% of the global population. The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years, 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years, and 17·9 to 223·5 per 100 000 for people older than 75 years. We estimated that 291 243-645 832 seasonal influenza-associated respiratory deaths (4·0-8·8 per 100 000 individuals) occur annually. The highest mortality rates were estimated in sub-Saharan Africa (2·8-16·5 per 100 000 individuals), southeast Asia (3·5-9·2 per 100 000 individuals), and among people aged 75 years or older (51·3-99·4 per 100 000 individuals). For 92 countries, we estimated that among children younger than 5 years, 9243-105 690 influenza-associated respiratory deaths occur annually. INTERPRETATION These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated. FUNDING None.
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Affiliation(s)
- A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Katherine M Roguski
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David J Muscatello
- Department of Biostatistics and Bioinformatics, University of New South Wales, Sydney, NSW, Australia
| | | | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Jon Michael Gran
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Norway; Domain for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Dena Schanzer
- Infection Disease Prevention and Control Branch, Public Health Agency Canada, Ottawa, ON, Canada
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
| | - Li Wei Ang
- Department of Infectious Diseases Epidemiology, Ministry of Health, Singapore
| | - Minah Park
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Laura Espenhain
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Gideon Emukule
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Liselotte van Asten
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Susana Pereira da Silva
- Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Suchunya Aungkulanon
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Udo Buchholz
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | | | - Joseph S Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tan S, Lin Y, Foo K, Koh HF, Tow C, Zhang Y, Ang LW, Cui L, Badaruddin H, Ooi PL, Lin RTP, Cutter J. Group B Streptococcus Serotype III Sequence Type 283 Bacteremia Associated with Consumption of Raw Fish, Singapore. Emerg Infect Dis 2018; 22:1970-1973. [PMID: 27767904 PMCID: PMC5088028 DOI: 10.3201/eid2211.160210] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We conducted a retrospective study of 40 case-patients and 58 controls as part of a nationwide investigation of a group B Streptococcus outbreak in Singapore in 2015. Eating a Chinese-style raw fish dish (yusheng) was a major risk factor for bacteremia, particularly caused by serotype III sequence type 283.
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40
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Ang LW, Kam YW, Lin C, Krishnan PU, Tay J, Ng LC, James L, Lee VJM, Goh KT, Ng LFP, Lin RTP. Seroprevalence of antibodies against chikungunya virus in Singapore resident adult population. PLoS Negl Trop Dis 2017; 11:e0006163. [PMID: 29281644 PMCID: PMC5760101 DOI: 10.1371/journal.pntd.0006163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/09/2018] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives We determined the seroprevalence of chikungunya virus (CHIKV) infection in the adult resident population in Singapore following local outbreaks of chikungunya fever (CHIKF) in 2008–2009. Methods Our cross-sectional study involved residual sera from 3,293 adults aged 18–79 years who had participated in the National Health Survey in 2010. Sera were tested for IgG antibodies against CHIKV and dengue virus (DENV) and neutralizing antibodies against CHIKV. Results The prevalence of CHIKV-neutralizing antibodies among Singapore residents aged 18–79 years was 1.9% (95% confidence interval: 1.4%– 2.3%). The CHIKV seroprevalence was highest in the elderly aged 70–79 years at 11.5%, followed by those aged 30–39 years at 3.1%. Men had significantly higher CHIKV seroprevalence than women (2.5% versus 1.3%, p = 0.01). Among the three main ethnic groups, Indians had the highest seroprevalence (3.5%) compared to Chinese (1.6%) and Malays (0.7%) (p = 0.02 and p = 0.01, respectively). Multivariable logistic regression identified adults aged 30–39 years and 70–79 years, men, those of Indian ethnicity and ethnic minority groups, and residence on ground floor of public and private housing apartments as factors that were significantly associated with a higher likelihood of exposure to CHIKV. The overall prevalence of anti-DENV IgG antibodies was 56.8% (95% CI: 55.1%– 58.5%), while 1.5% (95% CI: 1.1%– 2.0%) of adults possessed both neutralizing antibodies against CHIKV and IgG antibodies against DENV. Conclusions Singapore remains highly susceptible to CHIKV infection. There is a need to maintain a high degree of vigilance through disease surveillance and vector control. Findings from such serological study, when conducted on a regular periodic basis, could supplement surveillance to provide insights on CHIKV circulation in at-risk population. The prevalence of neutralizing antibodies against chikungunya virus (CHIKV) was low at 1.9% among resident adults in Singapore after local outbreaks in 2008–2009. Adults aged 30–39 years and 70–79 years, men, those of Indian ethnicity and ethnic minority groups, and residence on ground floor of public and private housing apartments were significantly associated with a higher likelihood of exposure to CHIKV.
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Affiliation(s)
- Li Wei Ang
- Public Health Group, Ministry of Health, Singapore
- * E-mail:
| | - Yiu Wing Kam
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Cui Lin
- Public Health Group, Ministry of Health, Singapore
| | - Prabha Unny Krishnan
- Public Health Group, Ministry of Health, Singapore
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - Joanne Tay
- Public Health Group, Ministry of Health, Singapore
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
| | - Lyn James
- Public Health Group, Ministry of Health, Singapore
| | | | - Kee Tai Goh
- Public Health Group, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lisa F. P. Ng
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore
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Ang LW, Yap J, Lee V, Chng WQ, Jaufeerally FR, Lam CSP, Cutter J, Yeo KK, Ma S. Influenza-Associated Hospitalizations for Cardiovascular Diseases in the Tropics. Am J Epidemiol 2017; 186:202-209. [PMID: 28338806 DOI: 10.1093/aje/kwx001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
Influenza is a major cause of mortality and morbidity. We aimed to examine the influenza-associated hospitalization rates and proportions for cardiovascular disease (CVD) in tropical Singapore. Hospital admissions for ischemic heart disease (IHD), congestive heart failure (CHF), and overall CVD were obtained from the national inpatient database for the period of 2010-2014. We used, as the key indicator of influenza virus activity, the overall proportion of specimens from outpatients with influenza-like illness in the community that tested positive for influenza as part of the national influenza surveillance program. The annual influenza-associated hospitalization rates per 100,000 person-years ranged from 9.5 to 12.2 for IHD, 7.7 to 9.1 for CHF, and 15.8 to 19.2 for overall CVD. The influenza-associated hospitalization rates increased with increasing age. Influenza was significantly associated with excess hospitalizations in elderly persons aged ≥80 years, with an excess hospitalization rate per 100,000 person-years of 242.7 for IHD (P = 0.02), 271.8 for CHF (P = 0.01), and 497.2 for overall CVD (P < 0.001). In the tropics, influenza accounts for excess cardiovascular-related hospitalizations, especially in the elderly.
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42
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Ang LW, Cutter J, James L, Goh KT. Epidemiological characteristics associated with uptake of pneumococcal vaccine among older adults living in the community in Singapore: Results from the National Health Surveillance Survey 2013. Scand J Public Health 2017; 46:175-181. [PMID: 28701087 DOI: 10.1177/1403494817720105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS In Singapore, pneumococcal vaccination is recommended for the elderly (i.e. those ≥65 years of age) and people with chronic medical conditions. We investigated epidemiological characteristics associated with the uptake of pneumococcal vaccine based on a nationally representative cross-sectional sample of community-living adults aged ≥50 years. METHODS The data were obtained from the National Health Surveillance Survey (NHSS) 2013. Associations between pneumococcal vaccination and sociodemographic and health-related variables were analysed using univariable and multivariable logistic regression models. RESULTS Among 3672 respondents aged ≥50 years in the NHSS, 7.8% had taken the pneumococcal vaccination. A higher level of education and higher monthly household income were sociodemographic characteristics independently associated with pneumococcal vaccine uptake. Health-related characteristics predictive of pneumococcal vaccine uptake were better self-rated health and having a regular family doctor/general practitioner. Among those who responded to the two questions on vaccinations, 3.9% had been vaccinated against both seasonal influenza and pneumococcal infection, while 11.1% had taken only seasonal influenza vaccination in the past year. CONCLUSIONS There is a need to boost pneumococcal vaccination coverage among community-dwelling older adults. These findings provide insights into reviewing and tailoring public-health strategies and programmes to increase vaccine uptake in at-risk population groups.
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Affiliation(s)
- Li Wei Ang
- 1 Public Health Group, Ministry of Health, Singapore
| | | | - Lyn James
- 1 Public Health Group, Ministry of Health, Singapore
| | - Kee Tai Goh
- 1 Public Health Group, Ministry of Health, Singapore.,2 Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Nandar K, Ang LW, Tey J, James L, Kyi Win KM, Chee C, Ng OT, Cutter JL, Wang YT. Epidemiology of tuberculosis and HIV coinfections in Singapore, 2000-2014. HIV Med 2017; 19:59-64. [PMID: 28675626 DOI: 10.1111/hiv.12529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Abstract
Cross-matching of records between Singapore's tuberculosis and HIV registries showed that 3.3% of individuals with tuberculosis (TB) were coinfected with HIV (2000-2014), the TB incidence among individuals with HIV infection was 1.65 per 100 person-years, and 53% of coinfections were diagnosed within 1 month of each other. The findings supported joint prevention programmes for early diagnosis and treatment.
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Affiliation(s)
| | - L W Ang
- Ministry of Health, Singapore
| | - J Tey
- Ministry of Health, Singapore
| | - L James
- Ministry of Health, Singapore
| | | | - Cbe Chee
- Tan Tock Seng Hospital, Singapore
| | - O T Ng
- Tan Tock Seng Hospital, Singapore
| | | | - Y T Wang
- Tan Tock Seng Hospital, Singapore
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Caini S, Huang QS, Ciblak MA, Kusznierz G, Owen R, Wangchuk S, Henriques CMP, Njouom R, Fasce RA, Yu H, Feng L, Zambon M, Clara AW, Kosasih H, Puzelli S, Kadjo HA, Emukule G, Heraud JM, Ang LW, Venter M, Mironenko A, Brammer L, Mai LTQ, Schellevis F, Plotkin S, Paget J. Epidemiological and virological characteristics of influenza B: results of the Global Influenza B Study. Influenza Other Respir Viruses 2016; 9 Suppl 1:3-12. [PMID: 26256290 PMCID: PMC4549097 DOI: 10.1111/irv.12319] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [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] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Literature on influenza focuses on influenza A, despite influenza B having a large public health impact. The Global Influenza B Study aims to collect information on global epidemiology and burden of disease of influenza B since 2000. METHODS Twenty-six countries in the Southern (n = 5) and Northern (n = 7) hemispheres and intertropical belt (n = 14) provided virological and epidemiological data. We calculated the proportion of influenza cases due to type B and Victoria and Yamagata lineages in each country and season; tested the correlation between proportion of influenza B and maximum weekly influenza-like illness (ILI) rate during the same season; determined the frequency of vaccine mismatches; and described the age distribution of cases by virus type. RESULTS The database included 935 673 influenza cases (2000-2013). Overall median proportion of influenza B was 22·6%, with no statistically significant differences across seasons. During seasons where influenza B was dominant or co-circulated (>20% of total detections), Victoria and Yamagata lineages predominated during 64% and 36% of seasons, respectively, and a vaccine mismatch was observed in ≈25% of seasons. Proportion of influenza B was inversely correlated with maximum ILI rate in the same season in the Northern and (with borderline significance) Southern hemispheres. Patients infected with influenza B were usually younger (5-17 years) than patients infected with influenza A. CONCLUSION Influenza B is a common disease with some epidemiological differences from influenza A. This should be considered when optimizing control/prevention strategies in different regions and reducing the global burden of disease due to influenza.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Q Sue Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | | | - Gabriela Kusznierz
- Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni, Santa Fe, Argentina
| | - Rhonda Owen
- Department of Health and Ageing, Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Woden, ACT, Australia
| | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | | | - Richard Njouom
- Service de Virologie, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Rodrigo A Fasce
- Sección de Virus Respiratorios y Exantemáticos, Instituto de Salud Pública de Chile, Santiago de Chile, Chile
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maria Zambon
- Respiratory Virus Unit, Public Health England, Colindale, UK
| | - Alexey W Clara
- US Centers for Disease Control, Central American Region, Guatemala City, Guatemala
| | - Herman Kosasih
- US Naval Medical Research Unit No. 2, Jakarta, Indonesia
| | - Simona Puzelli
- National Influenza Center, Istituto Superiore Sanità, Rome, Italy
| | - Herve A Kadjo
- Respiratory Viruses Unit, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Gideon Emukule
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jean-Michel Heraud
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, Singapore
| | - Marietjie Venter
- Global Disease Detection, US-CDC, Pretoria, South Africa.,Zoonoses Research Unit, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Alla Mironenko
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases National Academy of Medical Science of Ukraine, Kiev, Ukraine
| | - Lynnette Brammer
- Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - François Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Ang LW, Tien WS, Lin RTP, Cui L, Cutter J, James L, Goh KT. Characterization of influenza activity based on virological surveillance of influenza-like illness in tropical Singapore, 2010-2014. J Med Virol 2016; 88:2069-2077. [PMID: 27152935 DOI: 10.1002/jmv.24566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/10/2022]
Abstract
Singapore is situated in the tropics where the seasonality of influenza is not as well defined as that of temperate countries. We examined the circulation of influenza viruses in the community in terms of the characteristics of influenza activity. We reviewed laboratory-confirmed virological data collected between 2010 and 2014 under the national influenza surveillance programme. Influenza activity was measured by the proportion of specimens from outpatients with influenza-like illness tested positive for influenza virus based on 4-weekly moving interval. Seasonal epidemics occurred around the end of previous year or the beginning and middle of the year. Increases in influenza positivity were more pronounced when there was a change in the predominant circulating influenza virus type/subtype to influenza A(H3N2). Influenza epidemics lasted about 12 weeks on average, with longer duration when there was a change in the predominant influenza type/subtype and especially when it was associated with influenza A(H3N2). Continuous influenza surveillance is important as it could provide early warning of imminent surges in virus transmission, and allow for timely implementation of public health prevention and control interventions to minimize influenza-associated disease burden. J. Med. Virol. 88:2069-2077, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore.
| | - Wee Siong Tien
- Communicable Diseases Division, Ministry of Health, Singapore
| | | | - Lin Cui
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Jeffery Cutter
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Lyn James
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
| | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Ang LW, Lim C, Lee VJM, Ma S, Tiong WW, Ooi PL, Lin RTP, James L, Cutter J. Influenza-associated hospitalizations, Singapore, 2004-2008 and 2010-2012. Emerg Infect Dis 2015; 20:1652-60. [PMID: 25275710 PMCID: PMC4193272 DOI: 10.3201/eid2010.131768] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Studies of influenza-associated hospitalizations in tropical settings are lacking. To increase understanding of the effect of influenza in Singapore, we estimated the age-specific influenza-associated hospitalizations for pneumonia and influenza during 2004-2008 and 2010-2012. The rate of hospitalization was 28.3/100,000 person-years during 2004-2008 and 29.6/100,000 person-years during 2010-2012. The age-specific influenza-associated hospitalization rates followed a J-shaped pattern: rates in persons >75 years of age and in children <6 months of age were >47 times and >26 times higher, respectively, than those for persons 25-44 years of age. Across all ages during these 2 study periods, ≈12% of the hospitalizations for pneumonia and influenza were attributable to influenza. The rates and proportions of hospitalizations for influenza, particularly among the very young and the elderly, are considerable in Singapore and highlight the importance of vaccination in protecting populations at risk.
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Ang LW, Cutter J, James L, Goh KT. Seroprevalence of past dengue virus infection among children and adolescents in Singapore. J Med Virol 2015; 87:2159-62. [PMID: 26058712 DOI: 10.1002/jmv.24287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/08/2022]
Abstract
We conducted a pediatric seroprevalence study of dengue virus (DENV) infection in Singapore, a dengue endemic city-state. Residual sera from 1,200 Singapore residents aged 1-17 years seen in two hospitals between 2008 and 2010 were tested for anti-DENV IgG antibodies. The overall seroprevalence was 10.4% (95%CI: 8.7-12.1%). There had been a marked decline in seroprevalence in the 15-19-year age group over the last three decades, while the prevalence in the 1-5-year olds (12.6%) was significantly higher than that of the 1996-1997 pediatric survey (0.8%). The overall dengue seroprevalence in children and adolescents remained low.
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Affiliation(s)
- Li Wei Ang
- Epidemiology & Disease Control Division, Ministry of Health, Singapore
| | - Jeffery Cutter
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Lyn James
- Epidemiology & Disease Control Division, Ministry of Health, Singapore
| | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Ang LW, Tay J, Phoon MC, Hsu JP, Cutter J, James L, Goh KT, Chow VTK. Seroepidemiology of Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 Infections among Children and Adolescents in Singapore, 2008-2010. PLoS One 2015; 10:e0127999. [PMID: 26011735 PMCID: PMC4444285 DOI: 10.1371/journal.pone.0127999] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/21/2015] [Indexed: 01/21/2023] Open
Abstract
Coxsackieviruses A6 (CV-A6) and A16 (CV-A16) and Enterovirus 71 (EV-A71) have caused periodic epidemics of hand, foot and mouth disease (HFMD) among children in Singapore. We conducted a cross-sectional study to estimate the seroprevalence of these enteroviruses among Singapore children and adolescents. The study was conducted between August 2008 and July 2010. It involved 700 Singapore residents aged 1-17 years whose residual sera were obtained following the completion of routine biochemical investigations in two public acute-care hospitals. The levels of neutralizing antibodies (NtAb) against CV-A6, CV-A16 and EV-A71 were analyzed by the microneutralization test. The age-specific geometric mean titer (GMT) of antibodies against each of the three enteroviruses and the 95% confidence intervals (CI) were calculated. The seroprevalence of CV-A6 and CV-A16 was high at 62.7% (95% CI: 59.1-66.2%) and 60.6% (95% CI: 56.9-64.1%), respectively. However, the seroprevalence of EV-A71 was significantly lower at 29.3% (95% CI: 26.0-32.8%). About 89.7% of the children and adolescents had been infected by at least one of the three enteroviruses by 13-17 years of age. About half (52.3%) were seropositive for two or all three enteroviruses, while only 16.1% had no NtAb against any of the three enteroviruses. High NtAb levels were observed in the younger age groups. CV-A6 and CV-A16 infections are very common among Singapore children and adolescents, while EV-A71 infections are less common. Infection is continually acquired from early childhood to adolescent age.
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Affiliation(s)
- Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Joanne Tay
- Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Meng Chee Phoon
- Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore
| | - Jung Pu Hsu
- Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore
| | - Jeffery Cutter
- Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Lyn James
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
| | - Vincent Tak-Kwong Chow
- Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore
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Chua YX, Ang LW, Low C, James L, Cutter JL, Goh KT. An epidemiological assessment towards elimination of rubella and congenital rubella syndrome in Singapore. Vaccine 2015; 33:3150-7. [PMID: 25887085 DOI: 10.1016/j.vaccine.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/17/2014] [Revised: 03/10/2015] [Accepted: 04/01/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In line with regional and global goals for the elimination of rubella and congenital rubella syndrome (CRS), we reviewed the epidemiological situation in Singapore, based on surveillance reports on rubella and CRS, national immunization coverage and seroprevalence surveys. The aim of our review was to identify current gaps and steps taken to achieve the targets set by the World Health Organization (WHO) Western Pacific Regional Office (WPRO). METHODS Epidemiological data on clinical and laboratory-confirmed rubella cases, including CRS, notified to the Communicable Diseases Division, Ministry of Health, Singapore, from 2003 to 2013 were collated and analyzed. Vaccination coverage against rubella was obtained from the National Immunization Registry and School Health Services of the Health Promotion Board. The changing prevalence of rubella was determined from periodic serological surveys. FINDINGS The incidence of indigenous rubella cases per million population decreased from 37.2 in 2008 to 7.6 in 2013 and there had been no indigenous case of CRS in 2012 and 2013. Therapeutic abortions performed due to rubella infections had become uncommon. The annual measles, mumps, and rubella (MMR) vaccination coverage in childhood population remained high ranging from 93% to 96%. The overall susceptibility to rubella in women aged 18-44 years had reduced significantly from 15.8% in 2004 to 11.0% in 2010. The prevalence of IgG antibody against rubella among Singapore children aged 1-17 years was maintained at 87.3% in 2008-2010. CONCLUSION All available data indicated that Singapore has made good progress towards the elimination of rubella and CRS. It has attained the targets set by the WHO WPRO for 2015. In preparation for verification of rubella elimination, an enhanced surveillance system has been implemented to ensure that all reported cases are laboratory confirmed, and genotyping of rubella virus strains isolated is carried out to provide evidence for interruption of endemic transmission.
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Affiliation(s)
- Ying Xian Chua
- National Healthcare Group, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Li Wei Ang
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Constance Low
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Lyn James
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | | | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Ang LW, James L, Goh KT. Prevalence of diphtheria and tetanus antibodies among adults in Singapore: a national serological study to identify most susceptible population groups. J Public Health (Oxf) 2015; 38:99-105. [PMID: 25678536 DOI: 10.1093/pubmed/fdv011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In view of waning antitoxin titres over time after the last vaccine dose against diphtheria and tetanus, we determined the immunity levels in adults to identify most susceptible groups for protection in Singapore. METHODS Our study involved residual sera from 3293 adults aged 18-79 who had participated in a national health survey in 2010. IgG antibody levels were determined using commercial enzyme-linked immunosorbent assay. RESULTS Overall, 92.0% (95% confidence interval [CI]: 91.1-92.9%) had at least basic protection against diphtheria (antibody levels ≥0.01 IU/ml), while 71.4% (95% CI: 69.8-72.9%) had at least short-term protection against tetanus (antibody levels >0.1 IU/ml). The seroprevalence declined significantly with age for both diseases; the drop was most marked in the 50- to 59-year age group for diphtheria and 60- to 69-year age group for tetanus. There was a significant difference in seroprevalence by residency for diphtheria (92.8% among Singapore citizens versus 87.1% among permanent residents; P = 0.001). The seroprevalence for tetanus was significantly higher among males (83.2%) than females (62.4%) (P < 0.0005). CONCLUSIONS It may be of value to consider additional vaccination efforts to protect older adults at higher risk for exposure against diphtheria and tetanus, particularly those travelling to areas where diphtheria is endemic or epidemic.
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Affiliation(s)
- L W Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore 169854, Singapore
| | - L James
- Epidemiology and Disease Control Division, Ministry of Health, Singapore 169854, Singapore
| | - K T Goh
- Communicable Diseases Division, Ministry of Health, Singapore 169854, Singapore Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597, Singapore
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