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Savela ES, Viloria Winnett A, Romano AE, Porter MK, Shelby N, Akana R, Ji J, Cooper MM, Schlenker NW, Reyes JA, Carter AM, Barlow JT, Tognazzini C, Feaster M, Goh YY, Ismagilov RF. Quantitative SARS-CoV-2 Viral-Load Curves in Paired Saliva Samples and Nasal Swabs Inform Appropriate Respiratory Sampling Site and Analytical Test Sensitivity Required for Earliest Viral Detection. J Clin Microbiol 2022; 60:e0178521. [PMID: 34911366 PMCID: PMC8849374 DOI: 10.1128/jcm.01785-21] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [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: 08/24/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022] Open
Abstract
Early detection of SARS-CoV-2 infection is critical to reduce asymptomatic and presymptomatic transmission, curb the spread of variants, and maximize treatment efficacy. Low-analytical-sensitivity nasal-swab testing is commonly used for surveillance and symptomatic testing, but the ability of these tests to detect the earliest stages of infection has not been established. In this study, conducted between September 2020 and June 2021 in the greater Los Angeles County, California, area, initially SARS-CoV-2-negative household contacts of individuals diagnosed with COVID-19 prospectively self-collected paired anterior-nares nasal-swab and saliva samples twice daily for viral-load quantification by high-sensitivity reverse-transcription quantitative PCR (RT-qPCR) and digital-RT-PCR assays. We captured viral-load profiles from the incidence of infection for seven individuals and compared diagnostic sensitivities between respiratory sites. Among unvaccinated persons, testing saliva with a high-analytical-sensitivity assay detected infection up to 4.5 days before viral loads in nasal swabs reached concentrations detectable by low-analytical-sensitivity nasal-swab tests. For most participants, nasal swabs reached higher peak viral loads than saliva but were undetectable or at lower loads during the first few days of infection. High-analytical-sensitivity saliva testing was most reliable for earliest detection. Our study illustrates the value of acquiring early (within hours after a negative high-sensitivity test) viral-load profiles to guide the appropriate analytical sensitivity and respiratory site for detecting earliest infections. Such data are challenging to acquire but critical to designing optimal testing strategies with emerging variants in the current pandemic and to respond to future viral pandemics.
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Affiliation(s)
- Emily S. Savela
- California Institute of Technology, Pasadena, California, USA
| | | | - Anna E. Romano
- California Institute of Technology, Pasadena, California, USA
| | | | - Natasha Shelby
- California Institute of Technology, Pasadena, California, USA
| | - Reid Akana
- California Institute of Technology, Pasadena, California, USA
| | - Jenny Ji
- California Institute of Technology, Pasadena, California, USA
| | | | | | | | | | - Jacob T. Barlow
- California Institute of Technology, Pasadena, California, USA
| | - Colten Tognazzini
- City of Pasadena Public Health Department, Pasadena, California, USA
| | - Matthew Feaster
- City of Pasadena Public Health Department, Pasadena, California, USA
| | - Ying-Ying Goh
- City of Pasadena Public Health Department, Pasadena, California, USA
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Reukers DFM, van Boven M, Meijer A, Rots N, Reusken C, Roof I, van Gageldonk-Lafeber AB, van der Hoek W, van den Hof S. High Infection Secondary Attack Rates of Severe Acute Respiratory Syndrome Coronavirus 2 in Dutch Households Revealed by Dense Sampling. Clin Infect Dis 2022; 74:52-58. [PMID: 33822007 PMCID: PMC8083540 DOI: 10.1093/cid/ciab237] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Indoor environments are considered one of the main settings for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Households in particular represent a close-contact environment with high probability of transmission between persons of different ages and roles in society. METHODS Households with a laboratory-confirmed SARS-CoV-2 positive case in the Netherlands (March-May 2020) were included. At least 3 home visits were performed during 4-6 weeks of follow-up, collecting naso- and oropharyngeal swabs, oral fluid, feces and blood samples from all household members for molecular and serological analyses. Symptoms were recorded from 2 weeks before the first visit through to the final visit. Infection secondary attack rates (SAR) were estimated with logistic regression. A transmission model was used to assess household transmission routes. RESULTS A total of 55 households with 187 household contacts were included. In 17 households no transmission took place; in 11 households all persons were infected. Estimated infection SARs were high, ranging from 35% (95% confidence interval [CI], 24%-46%) in children to 51% (95% CI, 39%-63%) in adults. Estimated transmission rates in the household were high, with reduced susceptibility of children compared with adolescents and adults (0.67; 95% CI, .40-1.1). CONCLUSION Estimated infection SARs were higher than reported in earlier household studies, presumably owing to our dense sampling protocol. Children were shown to be less susceptible than adults, but the estimated infection SAR in children was still high. Our results reinforce the role of households as one of the main multipliers of SARS-CoV-2 infection in the population.
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Affiliation(s)
- Daphne F M Reukers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nynke Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Chantal Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Inge Roof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan van den Hof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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de Gier B, Andeweg S, Backer JA, Hahné SJ, van den Hof S, de Melker HE, Knol MJ. Vaccine effectiveness against SARS-CoV-2 transmission to household contacts during dominance of Delta variant (B.1.617.2), the Netherlands, August to September 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34738514 PMCID: PMC8569927 DOI: 10.2807/1560-7917.es.2021.26.44.2100977] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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] [Indexed: 12/05/2022]
Abstract
We estimated SARS-CoV-2 vaccine effectiveness against onward transmission by comparing secondary attack rates among household members for vaccinated and unvaccinated index cases, based on source and contact tracing data collected when the Delta variant was dominant. Effectiveness of full vaccination of the index case against transmission to unvaccinated and fully vaccinated household contacts, respectively, was 63% (95% confidence interval (CI): 46–75) and 40% (95% CI: 20–54), in addition to the direct protection of vaccination of contacts against infection.
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Affiliation(s)
- Brechje de Gier
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Stijn Andeweg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jantien A Backer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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- The members of this group (in addition to the named authors) are listed under Investigators
| | - Susan Jm Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Susan van den Hof
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mirjam J Knol
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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de Gier B, Andeweg S, Joosten R, Ter Schegget R, Smorenburg N, van de Kassteele J, Hahné SJ, van den Hof S, de Melker HE, Knol MJ. Vaccine effectiveness against SARS-CoV-2 transmission and infections among household and other close contacts of confirmed cases, the Netherlands, February to May 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34355689 PMCID: PMC8343550 DOI: 10.2807/1560-7917.es.2021.26.31.2100640] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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] [Indexed: 11/20/2022]
Abstract
Several studies report high effectiveness of COVID-19 vaccines against SARS-CoV-2 infection and severe disease, however an important knowledge gap is the vaccine effectiveness against transmission (VET). We present estimates of the VET to household and other close contacts in the Netherlands, from February to May 2021, using contact monitoring data. The secondary attack rate among household contacts was lower for fully vaccinated than unvaccinated index cases (11% vs 31%), with an adjusted VET of 71% (95% confidence interval: 63–77).
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Affiliation(s)
- Brechje de Gier
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Stijn Andeweg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rosa Joosten
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Naomi Smorenburg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jan van de Kassteele
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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- The members of the group are listed under Investigators
| | - Susan Jm Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Susan van den Hof
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mirjam J Knol
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Abstract
The Chinese government stresses healthcare reform to improve the health of all residents in urban and rural areas. However, much research showed that inequities still existed in health status and health services utilization in China, especially in economically disadvantaged areas. Southwest China's Yunnan Province is an ethnic frontier region with lagging economic development. This study analyzed health equity among rural residents with various socio-economic and demographic statuses in Yunnan Province. Research on this area concerns rural residents. Our study was based on a household study sample consisting of 27,395 participants from six counties in Yunnan. For all participants, data on demographic and socio-economic characteristics, and health status were collected. The chi-square test and logistic regression were used to analyze factors influencing health. The concentration index was used to evaluate health equity. For all respondents, the 2-week prevalence, the prevalence of chronic diseases, and the required hospitalization rate were 7.3, 12.8, and 9.2%, respectively. After adjusting the age proportion of the sixth population census of Yunnan Province, the 2-week prevalence was 7.1%, the prevalence of chronic disease was 10.7%, and the hospitalization rate was 8.4%. The concentration indexes (CIs) reflecting health equity among the respondents with different incomes and educational levels were negative. There was health inequity among respondents with different incomes and educational levels. The respondents with lower incomes and educational levels had worse health. The common influencing factors included gender, age, ethnicity, occupation, marriage status, and the number of family members. Females, the aged, ethnic minorities, farmers, and the divorced or widowed had worse health status than the control groups. Larger numbers of family members correlated with better health. The respondents with lower incomes or educational levels had higher chronic disease prevalences. The associations between the 2-week prevalence, required hospitalization rate, and age were U-shaped; the lowest age group and the highest age group had higher rates. In conclusion, more attention should be paid to females, the aged, ethnic minorities, farmers, the divorced or widowed, residents with low income and low educational level, and those with chronic diseases.
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Affiliation(s)
- Xiao-Mei Li
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jing Kou
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Yu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yuan-Yuan Xiao
- School of Public Health, Kunming Medical University, Kunming, China
| | - Qiong Meng
- School of Public Health, Kunming Medical University, Kunming, China
| | - Li-Ping He
- School of Public Health, Kunming Medical University, Kunming, China
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Reach G, Consoli SM, Halimi S, Colas C, Duclos M, Fontaine P, Martineau C, Avril C, Tourette-Turgis C, Pucheu S, Brunet O. The multinational second Diabetes, Attitudes, Wishes and Needs study: results of the French survey. Patient Prefer Adherence 2015; 9:289-97. [PMID: 25709415 PMCID: PMC4334344 DOI: 10.2147/ppa.s68941] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The second Diabetes, Attitudes, Wishes and Needs (DAWN2™) multinational cross-sectional study was aimed at generating insights to facilitate innovative efforts by people with diabetes (PWD), family members (FMs), and health care professionals (HCPs) to improve self-management and psychosocial support in diabetes. Here, the French data from the DAWN2™ study are described. METHODS In France, 500 PWD (80 with type 1 diabetes [T1] and 420 with type 2 diabetes [T2]), 120 FMs, and 288 HCPs were recruited. The questionnaires assessed the impact of diabetes on quality of life and mood, self-management, attitudes/beliefs, and care/support. RESULTS Diabetes negatively impacted the emotional well-being of 59% of people with T1 versus 45% of people with T2 (P<0.05) and about half of FMs. A high level of distress was felt by about half of PWD and FMs. About half of HCPs reported assessing depression in their patients. Sixty-two percent of FMs considered managing diabetes to be a burden. Hypoglycemia was a source of concern for 64% of people with T1 and 73% of FMs of insulin users. About two-thirds of non-insulin-medicated people with T2 agreed to start insulin if prescribed, while half of HCPs preferred to delay insulin initiation. A discrepancy between HCPs' perceptions of their interactions with their patients and PWD's recollection of these interactions with regard to patients' personal needs and distress was also observed. CONCLUSION While distress remains under-assessed by HCPs, the negative impact of diabetes on the lives of PWD and FMs clearly induces distress on both groups. These findings provide new understanding of barriers precluding optimal management of diabetes. Developing strategies to overcome these barriers is now warranted.
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Affiliation(s)
- Gérard Reach
- Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, Bobigny, Paris, France
- EA 3412, CRNH-IDF, Paris 13 University, Sorbonne Paris Cité, Bobigny, Paris, France
- Correspondence: Gérard Reach, Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital APHP, 125 rue de Stalingrad, 93000 Bobigny, France, Tel +33 1 4895 5158, Fax +33 1 4895 5560, Email
| | - Silla M Consoli
- Paris Descartes University, Paris Sorbonne Cité, Faculty of Medicine, Paris, France
- University Service of Adult and Elderly Psychiatry, European Georges-Pompidou Hospital, Paris, France
| | - Serge Halimi
- Department of Diabetology, Endocrinology and Nutrition, Joseph Fourier University and CHU Grenoble, Grenoble, France
| | - Claude Colas
- Department of Diabetology, Hôtel-Dieu Hospital, Paris, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, Montpied Hospital, Clermont-Ferrand, France
- Department of Human Nutrition, Centre de Recherche en Nutrition Humaine, Institut National de la Recherche Agronomique, Clermont-Ferrand, France
- Department of Human Nutrition, University of Auvergne, Clermont-Ferrand, France
| | - Pierre Fontaine
- Department of Endocrinology, Diabetes and Metabolic Diseases, Huriez Hospital, Lille 2 University, Lille, France
| | | | | | | | - Sylvie Pucheu
- University Service of Adult and Elderly Psychiatry, European Georges-Pompidou Hospital, Paris, France
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