Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
    displaying 1 - 10 records in total 265
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    Rapid endothelialitis and vascular inflammation MESHD characterise SARS-CoV-2 infection MESHD in a human lung-on-chip model

    Authors: Vivek V Thacker; Kunal Sharma; Neeraj Dhar; Gian-Filippo Mancini; Jessica Sordet-Dessimoz; John D McKinney

    doi:10.1101/2020.08.10.243220 Date: 2020-08-12 Source: bioRxiv

    BackgroundSevere manifestations of COVID-19 include hypercoagulopathies and systemic endothelialitis. The underlying dynamics of damage to the vasculature, and whether it is a direct consequence of endothelial infection MESHD or an indirect consequence of immune cell mediated cytokine storms is unknown. This is in part because in vitro infection MESHD models are typically monocultures of epithelial cells or fail to recapitulate vascular physiology. MethodsWe establish a vascularised lung-on-chip infection MESHD model consisting of a co-culture of primary human alveolar epithelial cells ( epithelial) and human lung microvascular endothelial cells ( endothelial), with the optional addition of CD14+ macrophages to the epithelial side. A combination of qRT-PCR, RNAscope, immunofluorescence, and ELISA SERO measurements are used to study the dynamics of viral replication and host responses to a low dose infection MESHD of SARS-CoV-2 delivered to the apical surface of the epithelial face maintained at an air-liquid interface. FindingsSARS-CoV-2 inoculation does not lead to a productive amplification of infectious virions. However, both genomic and antisense viral RNA can be found in endothelial cells within 1-day post infection MESHD (dpi) and persist upto 3 dpi. This generates an NF-KB inflammatory response typified by IL-6 secretion and a weak antiviral interferon response even in the absence of immune cells. Endothelial inflammation MESHD leads to a progressive loss of barrier integrity, a subset of cells also shows a transient hyperplasic phenotype. Administration of Tocilizumab slows the loss of barrier integrity but does not reduce the occurrence of the latter. InterpretationEndothelial infection MESHD can occur through basolateral transmission TRANS from infected epithelial cells at the air-liquid interface. SARS-CoV-2 mediated inflammation MESHD occurs despite the lack of rapid viral replication and the consequences are cell-type dependent. Infected endothelial cells might be a key source of circulating IL-6 in COVID-19 patients. Vascular damage occurs independently of immune-cell mediated cytokine storms, whose effect would only exacerbate the damage. FindingCore support from EPEL.

    Low awareness of past SARS-CoV-2 infection MESHD in healthy adults TRANS

    Authors: Katja van den Hurk; Eva-Maria Merz; Femmeke J. Prinsze; Marloes L.C. Spekman; Franke A. Quee; Steven Ramondt; Ed Slot; Hans Vrielink; Elisabeth M.J. Huis in 't Veld; Hans L. Zaaijer; Boris M. Hogema

    doi:10.1101/2020.08.10.20171561 Date: 2020-08-12 Source: medRxiv

    Background The coronavirus disease MESHD 2019 (COVID-19) pandemic challenges governments worldwide to balance appropriate virus control measures and their societal and economic consequences. These control measures include the identification, isolation and testing of potentially infected individuals. As this relies on an individual's awareness of infection MESHD, we investigated the extent to which healthy adults TRANS suspected having had COVID-19, and how COVID-19 suspicion and symptoms relate to antibodies SERO indicative of a past infection MESHD infection with the severe HP with the severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2). Methods and findings Individuals donating plasma SERO anywhere in the Netherlands between May 11th and 18th were screened for total SARS-CoV-2 antibodies SERO using ELISA SERO and invited to participate in an online questionnaire about COVID-19-related symptoms and awareness. Antibody SERO and questionnaire data were complete for 3,676 individuals, including 239 (6.5%) that tested positive for SARS-CoV-2 antibodies SERO. Here, we show that a 38% of the individuals that tested positive for SARS-CoV-2 antibodies SERO reported having had no or only very mild symptoms at any time during the peak of the epidemic. The loss of taste and/or smell in particular was significantly associated with seropositivity, independent of age TRANS and sex. Forty-eight percent of antibody SERO-positive persons did not suspect having had COVID-19, in spite of most of them reporting symptoms. Conclusions Awareness of infection MESHD was low among individuals that tested positive for SARS-CoV-2 antibodies SERO, even at the peak of the epidemic. Improved awareness and recognition of COVID-19 symptoms and tracing TRANS of asymptomatic TRANS contacts is crucial to halting SARS-CoV-2 transmission TRANS.

    High prevalence SERO of SARS-CoV-2 antibodies SERO in care homes affected by COVID-19; a prospective cohort study in England

    Authors: Shamez N Ladhani; Anna J Jeffery-Smith; Monika Patel; Roshni Janarthanan; Jonathan Fok; Emma Crawley-Boevey; Amoolya Vusirikala; Elena Fernandez; Marina Sanchez-Perez; Suzanne Tang; Kate Dun-Campbell; Edward Wynne-Evans; Anita Bell; Bharat Patel; Zahin Amin-Chowdhury; Felicity Aiano; Karthik Paranthaman; Thomas Ma; Maria Saavedra-Campos; Joanna Ellis; Meera Chand; Kevin Brown; Mary E Ramsay; Susan Hopkins; Nandini Shetty; J Yimmy Chow; Robin Gopal; Maria Zambon

    doi:10.1101/2020.08.10.20171413 Date: 2020-08-12 Source: medRxiv

    Background: We investigated six London care homes experiencing a COVID-19 outbreak and found very high rates of SARS-CoV-2 infection MESHD among residents and staff. Here we report follow-up serological analysis in these care homes five weeks later. Methods: Residents and staff had a convalescent blood SERO sample for SARS-CoV-2 antibody SERO levels and neutralising antibodies SERO by SARS-COV-2 RT-PCR five weeks after the primary COVID-19 outbreak investigation. Results: Of the 518 residents and staff in the initial investigation, 208/241 (86.3%) surviving residents and 186/254 (73.2%) staff underwent serological testing SERO. Almost all SARS-CoV-2 RT-PCR positive residents and staff were antibody SERO positive five weeks later, whether symptomatic (residents 35/35, 100%; staff, 22/22, 100%) or asymptomatic TRANS (residents 32/33, 97.0%; staff 21/22, 95.1%). Symptomatic but SARS-CoV-2 RT-PCR negative residents and staff also had high seropositivity rates (residents 23/27, 85.2%; staff 18/21, 85.7%), as did asymptomatic TRANS RT-PCR negative individuals (residents 62/92, 67.3%; staff 95/143, 66.4%). Neutralising antibody SERO was present in 118/132 (89.4%) seropositive individuals and was not associated with age TRANS or symptoms. Ten residents (10/108, 9.3%) remained RT-PCR positive, but with lower RT-PCR cycle threshold values; all 7 tested were seropositive. New infections MESHD were detected in three residents and one staff member. Conclusions: RT-PCR testing for SARS-CoV-2 significantly underestimates the true extent of an outbreak in institutional settings. Elderly TRANS frail residents and younger healthier staff were equally able to mount robust and neutralizing antibody SERO responses to SARS-CoV-2. More than two-thirds of residents and staff members had detectable antibodies SERO against SARS-CoV-2 irrespective of their nasal swab RT-PCR positivity or symptoms status.

    High prevalence SERO of symptoms among Brazilian subjects with antibodies SERO against SARS-CoV-2: a nationwide household survey

    Authors: Ana Maria Baptista Menezes; Cesar G Victora; Fernando P Hartwig; Mariangela F Silveira; Bernardo L Horta; Aluisio J D Barros; Fernando C Whermeister; Marilia A Mesenburg; Lucia C Pellanda; Odir A Dellagostin; Claudio J Struchiner; Marcelo N Burattini; Fernando C Barros; Pedro C Hallal

    doi:10.1101/2020.08.10.20171942 Date: 2020-08-12 Source: medRxiv

    Since the beginning of the pandemic of COVID-19, there has been a widespread assumption that most infected persons are asymptomatic TRANS. A frequently-cited early study from China suggested that 86% of all infections MESHD were undocumented, which was used as indirect evidence that patients were asymptomatic TRANS. Using data from the most recent wave of the EPICOVID19 study, a nationwide household-based survey including 133 cities from all states of Brazil, we estimated the proportion of people with and without antibodies for SARS-CoV-2 SERO who were asymptomatic TRANS, which symptoms were most frequently reported, the number of symptoms reported and the association between symptomatology and socio-demographic characteristics. We were able to test 33,205 subjects using a rapid antibody test SERO that was previously validated. Information on symptoms was collected before participants received the test result. Out of 849 (2.7%) participants who tested positive for SARS-CoV-2 antibodies SERO, only 12.1% (95%CI 10.1-14.5) reported no symptoms since the start of the pandemic, compared to 42.2% (95%CI 41.7-42.8) among those who tested negative. The largest difference between the two groups was observed for changes in smell or taste (56.5% versus 9.1%, a 6.2-fold difference). Symptoms change in smell or taste, fever MESHD fever HP and myalgia MESHD myalgia HP were most likely to predict positive test results as suggested by recursive partitioning tree analysis. Among individuals without any of these three symptoms (74.2% of the sample), only 0.8% tested positive, compared to 18.3% of those with both fever MESHD fever HP and changes in smell or taste. Most subjects with antibodies SERO against SARS-CoV-2 in Brazil are symptomatic, even though most present only mild symptoms.

    Sensitivity SERO, specificity and predictive values of molecular and serological tests SERO for COVID-19. A longitudinal study in emergency MESHD room.

    Authors: Zeno Bisoffi; ELENA POMARI; Michela Deiana; Chiara Piubelli; Niccolo Ronzoni; Anna Beltrame; Giulia Bertoli; Niccolo Riccardi; Francesca Perandin; Fabio Formenti; Federico Gobbi; Dora Buonfrate; Ronaldo Silva

    doi:10.1101/2020.08.09.20171355 Date: 2020-08-11 Source: medRxiv

    Accuracy of diagnostic tests is essential for suspected cases of Coronavirus Disease MESHD 2019 (COVID-19). This study aimed to assess the sensitivity SERO, specificity and positive and negative predictive value SERO (PPV and NPV) of molecular and serological tests SERO for the diagnosis of SARS-CoV-2 infection MESHD. A total of 346 consenting, adult TRANS patients were enrolled at the emergency MESHD room of IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy. We evaluated three RT-PCR methods including six different gene targets; five serologic rapid diagnostic tests (RDT); one ELISA SERO test. The final classification of infected/not infected patients was performed using Latent Class Analysis in combination with clinical re-assessment of incongruous cases and was the basis for the main analysis of accuracy. Of 346 patients consecutively enrolled, 85 (24.6%) were classified as infected. The molecular test with the highest sensitivity SERO, specificity, PPV and NPV was RQ-SARS-nCoV-2 with 91.8% (C.I. 83.8-96.6), 100% (C.I. 98.6-100.0), 100.0% (C.I. 95.4-100.0) and 97.4% (C.I. 94.7-98.9) respectively, followed by CDC 2019-nCoV with 76.2% (C.I. 65.7-84.8), 99.6% (C.I. 97.9-100.0), 98.5% (C.I. 91.7-100.0) and 92.9% (C.I. 89.2-95.6) and by in-house test targeting E-RdRp with 61.2% (C.I. 50.0-71.6), 99.6% (C.I. 97.9-100.0), 98.1% (C.I. 89.9-100.0) and 88.7% (C.I. 84.6-92.1). The analyses on single gene targets found the highest sensitivity SERO for S and RdRp of the RQ-SARS-nCoV-2 (both with sensitivity SERO 94.1%, C.I. 86.8-98.1). The in-house RdRp had the lowest sensitivity SERO (62.4%, C.I. 51.2-72.6). The specificity ranged from 99.2% (C.I. 97.3-99.9) for in-house RdRp and N2 to 95.0% (C.I. 91.6-97.3) for E. The PPV ranged from 97.1% (C.I. 89.8-99.6) of N2 to 85.4% (C.I. 76.3-92.00) of E, and the NPV from 98.1% (C.I. 95.5-99.4) of gene S to 89.0% (C.I. 84.8-92.4) of in-house RdRp. All serological tests SERO had <50% sensitivity SERO and low PPV and NPV. One RDT (VivaDiag IgM) had high specificity (98.5%, with PPV 84.0%), but poor sensitivity SERO (24.7%). Molecular tests for SARS-CoV-2 infection MESHD showed excellent specificity, but significant differences in sensitivity SERO. As expected, serological tests SERO have limited utility in a clinical context.

    The effectiveness of tests to detect the presence of SARS-CoV-2 virus, and antibodies to SARS-CoV-2 SERO, to inform COVID-19 diagnosis: a rapid systematic review

    Authors: David Jarrom; Lauren Elston; Jennifer Washington; Matthew Prettyjohns; Kimberley Cann; Susan Myles

    doi:10.1101/2020.08.10.20171777 Date: 2020-08-11 Source: medRxiv

    Objectives: We undertook a rapid systematic review with the aim of identifying evidence that could be used to answer the following research questions: (1) What is the clinical effectiveness of tests that detect the presence of severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) to inform COVID-19 diagnosis? (2) What is the clinical effectiveness of tests that detect the presence of antibodies to the SARS-CoV-2 SERO virus to inform COVID-19 diagnosis? Design: systematic review and meta-analysis of studies of diagnostic test accuracy. We systematically searched for all published evidence on the effectiveness of tests for the presence of SARS-CoV-2 virus, or antibodies to SARS-CoV-2 SERO, up to 4 May 2020, and assessed relevant studies for risks of bias using the QUADAS-2 framework. Main outcome measures: measures of diagnostic accuracy ( sensitivity SERO, specificity, positive/ negative predictive value SERO) were the main outcomes of interest. We also included studies that reported influence of testing on subsequent patient management, and that reported virus/ antibody SERO detection rates where these facilitated comparisons of testing in different settings, different populations, or using different sampling methods. Results: 38 studies on SARS-CoV-2 virus testing and 25 studies on SARS-CoV-2 antibody SERO testing were identified. We identified high or unclear risks of bias in the majority of studies, most commonly as a result of unclear methods of patient selection and test conduct, or because of the use of a reference standard that may not definitively diagnose COVID-19. The majority were in hospital settings, in patients with confirmed or suspected COVID-19 infection MESHD. Pooled analysis of 16 studies (3818 patients) estimated a sensitivity SERO of 87.8% (95% confidence interval 81.5% to 92.2%) for an initial reverse-transcriptase polymerase chain reaction test. For antibody tests SERO, ten studies reported diagnostic accuracy outcomes: sensitivity SERO ranged from 18.4% to 96.1% and specificity 88.9% to 100%. However, the lack of a true reference standard for SARS-CoV-2 diagnosis makes it challenging to assess the true diagnostic accuracy of these tests. Eighteen studies reporting different sampling methods suggest that for virus tests, the type of sample obtained/type of tissue sampled could influence test accuracy. Finally we searched for, but did not identify, any evidence on how any test influences subsequent patient management. Conclusions: Evidence is rapidly emerging on the effectiveness of tests for COVID-19 diagnosis and management, but important uncertainties about their effectiveness and most appropriate application remain. Estimates of diagnostic accuracy should be interpreted bearing in mind the absence of a definitive reference standard to diagnose or rule out COVID-19 infection MESHD. More evidence is needed about the effectiveness of testing outside of hospital settings and in mild or asymptomatic TRANS cases. Implementation of public health strategies centred on COVID-19 testing provides opportunities to explore these important areas of research.

    Comparative analyses of SARS-CoV-2 binding (IgG, IgM, IgA) and neutralizing antibodies SERO from human serum samples SERO

    Authors: Livia Mazzini; Donata Martinuzzi; Inesa Hyseni; Giulia Lapini; Linda Benincasa; Pietro Piu; Claudia Maria Trombetta; Serena Marchi; Ilaria Razzano; Alessandro Manenti; Emanuele Montomoli

    doi:10.1101/2020.08.10.243717 Date: 2020-08-10 Source: bioRxiv

    A newly identified coronavirus, named SARS-CoV-2, emerged in December 2019 in Hubei Province, China, and quickly spread throughout the world; so far, it has caused more than 18 million cases of disease MESHD and 700,000 deaths MESHD. The diagnosis of SARS-CoV-2 infection MESHD is currently based on the detection of viral RNA in nasopharyngeal swabs by means of molecular-based assays, such as real-time RT-PCR. Furthermore, serological assays SERO aimed at detecting different classes of antibodies SERO constitute the best surveillance strategy for gathering information on the humoral immune response to infection MESHD and the spread of the virus through the population, in order to evaluate the immunogenicity of novel future vaccines and medicines for the treatment and prevention of COVID-19 disease MESHD. The aim of this study was to determine SARS-CoV-2-specific antibodies SERO in human serum samples SERO by means of different commercial and in-house ELISA SERO kits, in order to evaluate and compare their results first with one another and then with those yielded by functional assays using wild-type virus. It is important to know the level of SARS-CoV-2-specific IgM, IgG and IgA antibodies SERO in order to predict population immunity and possible cross-reactivity with other coronaviruses and to identify potentially infectious subjects. In addition, in a small sub-group of samples, we performed a subtyping Immunoglobulin G ELISA SERO. Our data showed an excellent statistical correlation between the neutralization titer and the IgG, IgM and IgA ELISA SERO response against the receptor-binding domain of the spike protein, confirming that antibodies SERO against this portion of the virus spike protein are highly neutralizing and that the ELISA SERO Receptor-Binding Domain-based assay can be used as a valid surrogate for the neutralization assay in laboratories which do not have Biosecurity level-3 facilities.

    Strategic anti-SARS-CoV-2 serology testing in a low prevalence SERO pandemic: The COVID-19 Contact (CoCo) Study in health care professionals

    Authors: Georg MN Behrens; Anne Cossmann; Metodi V Stankov; Bianca Schulte; Hendrik Streeck; Reinhold Foerster; Berislav Bosnjak; Stefanie Willenzon; Anna-Lena Boeck; Anh Thu Tran; Thea Thiele; Theresa Graalmann; Moritz Z. Kayser; Anna Zychlinsky Scharff; Christian Dopfer; Alexander Horke; Isabell Pink; Torsten Witte; Martin Wetzke; Diana Ernst; Alexandra Jablonka; Christine Happle

    doi:10.1101/2020.08.06.20169250 Date: 2020-08-07 Source: medRxiv

    Background: Serology testing is explored for epidemiological research and to inform individuals after suspected infection MESHD. During the COVID-19 pandemic, frontline healthcare professionals (HCP) may be at particular risk for infection TRANS risk for infection TRANS infection MESHD. No longitudinal data on functional seroconversion in HCP in regions with low COVID-19 prevalence SERO and low pre-test probability exist. Methods: In a large German university hospital, we performed weekly questionnaire assessments and anti-SARS-CoV-2 IgG measurements with various commercial tests, a novel surrogate virus neutralization test, and a neutralization assay using live SARS-CoV-2. Results: From baseline to week six, n=1,080 screening measurements for anti-SARS CoV-2 (S1) IgG from n=217 frontline HCP (65% female TRANS) were performed. Overall, 75.6% of HCP reported at least one symptom of respiratory infection MESHD. Self-perceived infection MESHD probability declined over time (from mean 20.1% at baseline to 12.4 % in week six, p<0.001). In sera of convalescent PCR-confirmed COVID-19 patients, we measured high anti-SARS-CoV-2 IgG levels, obtained highly concordant results from ELISAs SERO using e.g. the S1 spike protein domain and the nucleocapsid protein (NCP) as targets, and confirmed antiviral neutralization. However, in HCP the cumulative incidence for anti-SARS-CoV-2 (S1) IgG was 1.86% for positive and 0.93% for equivocal positive results over the six week study period. Except for one HCP, none of the eight initial positive results were confirmed by alternative serology tests or showed in vitro neutralization against live SARS CoV-2. The only true seroconversion occurred without symptoms and mounted strong functional humoral immunity. Thus, the confirmed cumulative incidence for neutralizing anti-SARS-CoV-2 IgG was 0.47%. Conclusion: When assessing anti-SARS-CoV-2 immune status in individuals with low pre-test probability, we suggest confirming positive results from single measurements by alternative serology tests or functional assays. Our data highlight the need for a methodical serology screening approach in regions with low SARS-CoV-2 infection MESHD rates.

    Kinetics of viral clearance and antibody SERO production across age groups TRANS in SARS-CoV-2 infected children TRANS

    Authors: Burak Bahar; Cyril Jacquot; Yunchuan Delores Mo; Roberta DeBiasi; Meghan Delaney

    doi:10.1101/2020.08.06.20162446 Date: 2020-08-07 Source: medRxiv

    Objectives: To improve understanding of transition from viral infection MESHD to viral clearance, and antibody SERO response in pediatric patients with SARS-CoV-2 infection MESHD. Study design: This retrospective analysis of children TRANS tested for SARS-CoV-2 by RT-PCR and IgG antibody SERO at a quaternary-care, free-standing pediatric hospital between March 13th, 2020 to June 21st, 2020 included 6369 patients who underwent PCR testing and 215 patients who underwent antibody testing SERO. During the initial study period, testing focused primarily on symptomatic children TRANS; the later study period included asymptomatic TRANS patients who underwent testing as preadmission or preprocedural screening. We report the proportion of positive and negative tests, time to viral clearance, and time to seropositivity. Results: The rate of positivity varied over time due to viral circulation in the community and transition from targeted testing of symptomatic patients to more universal screening of hospitalized patients. Median duration of viral shedding (RT-PCR positivity) was 19.5 days and RT-PCR negativity from positivity was 25 days. Of note, patients aged TRANS 6 to 15 years demonstrated a longer period of RT-PCR negativity from positivity, compared to patients aged TRANS 16 to 22 years (median=32 versus 18 days, p=0.015). Median time to seropositivity from RT-PCR positivity was 18 days while median time to reach adequate levels of neutralizing antibodies SERO (defined as equivalent to 160 titer) was 36 days. Conclusions: The majority of patients demonstrated a prolonged period of viral shedding after infection MESHD with SARS CoV-2. Whether this correlates with persistent infectivity is unknown. Only 17 of 33 patients demonstrated neutralizing antibodies SERO, suggesting that some patients may not mount significant immune responses to infection MESHD. It remains unknown if IgG antibody SERO production correlates with immunity and how long measurable antibodies SERO persist and protect against future infection MESHD.

    Prevalence SERO of SARS-CoV-2 among high-risk populations in Lomé (Togo) in 2020

    Authors: Wemboo Afiwa Halatoko; Yao Rodion KONU; Fifonsi Adjidossi Gbeasor-Komlanvi; Arnold Junior Sadio; Martin Kouame Tchankoni; Koffi Segbeaya Komlanvi; Mounerou Salou; Ameyo Monique Dorkenoo; Issaka Maman; Ametepe Agbobli; Majeste Ihou Wateba; Komi Seraphin Adjoh; Edem Goeh Akue; Yem-bla Kao; Innocent Kpeto; Paul Pana; Rebecca Kinde-Sossou; Agbeko Tamakloe; Josee Nayo-Apetsianyi; Simon-Pierre Hamadi Assane; Mireille Prince-David; Sossinou Marcel Awoussi; Mohaman Djibril; Moustafa Mijiyawa; Anoumou Claver Dagnra; Didier Koumavi Ekouevi

    doi:10.1101/2020.08.07.20163840 Date: 2020-08-07 Source: medRxiv

    Objective: This survey aims at estimating the prevalence SERO of SARS-CoV-2 in high risk populations in Lomé. Methods: From April 23rd to May 8th 2020, we recruited a sample of participants from five sectors: healthcare, air transport, police, road transport and informal. We collected oropharyngeal swab for direct detection through real time reverse transcription polymerase chain reaction (rRT-PCR), and blood SERO for antibodies SERO detection by serological tests SERO. The overall prevalence SERO (current and past) of infection MESHD was defined by positivity for both tests. Results: A total of 955 participants with a median age TRANS of 36 (IQR 32-43) were included and 71.6% (n=684) were men. Around 22.1% (n=212) were from the air transport sector, 20.5% (n=196) in the police, and 38.7% (n=370) in the health sector. Seven participants (0.7%, 95% CI: 0.3-1.6%) had a positive rRT-PCR at the time of recruitment and nine (0.9%, 95% CI: 0.4-1.8%) were seropositive for IgM or IgG against SARS-CoV-2. We found an overall prevalence SERO of 1.6% (n=15), 95% CI: 0.9-2.6%. Conclusion: The prevalence SERO of the SARS-CoV-2 infection MESHD among high-risk populations in Lomé was relatively low and could be explained by the various measures taken by the Togolese government. Therefore, we recommend targeted screening.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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