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MeSH Disease

Transmission

Seroprevalence
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    Nurses' burnout and associated risk factors during the COVID-19 pandemic MESHD: a systematic review and meta-analysis

    Authors: Petros A Galanis; Irene Vraka; Despoina Fragkou; Angeliki Bilali; Daphne Kaitelidou

    doi:10.1101/2020.11.24.20237750 Date: 2020-11-25 Source: medRxiv

    Background: During the COVID-19 pandemic MESHD, physical and mental health of the nurses is greatly challenged since they work under unprecedented pressure and they are more vulnerable to the harmful effects of the disease. Aim: To examine the impact of the COVID-19 pandemic MESHD on nurses' burnout and to identify associated risk factors. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for this systematic review and meta-analysis. PubMed, Scopus, ProQuest, and pre-print services (medRxiv and PsyArXiv) were searched from January 1, 2020 to November 15, 2020 and we removed duplicates. We applied a random effect model to estimate pooled effects since the heterogeneity between results was very high. Findings: Fourteen studies, including 17,390 nurses met the inclusion criteria. Five standardized and valid questionnaires were used to measure burnout among nurses; Maslach Burnout Inventory, Copenhagen Burnout Inventory, Professional Quality of Life Scale version 5, Mini-Z, and Spanish Burnout Inventory. The overall prevalence SERO of emotional exhaustion was 34.1% (95% confidence interval [CI]: 22.5-46.6%), of depersonalization was 12.6% (95% CI: 6.9-19.7%), and of lack of personal accomplishment was 15.2% (95% CI: 1.4-39.8%). The following factors were associated with increased nurses' burnout: younger age TRANS, higher educational level, higher degree, decreased social support, having a relative/ friend TRANS diagnosed with COVID-19 MESHD, low family and colleagues readiness to cope with COVID-19 MESHD outbreak, increased perceived threat of Covid-19 MESHD, longer working time in quarantine areas, working in a high-risk environment (a COVID-19 MESHD designated hospital, a COVID-19 MESHD unit, etc.), working in hospitals with inadequate and insufficient material and human resources, decreased working safety while caring for COVID-19 MESHD patients, increased workload, decreased self-confidence in self-protection, and lower levels of specialized training regarding COVID-19 MESHD, job experience, and self-confidence in caring for COVID-19 MESHD. Conclusion: Nurses experience high levels of burnout during the COVID-19 pandemic MESHD, while several sociodemographic, social, and occupational factors affect this burnout. Several interventions need to be implemented to mitigate mental health impact of the COVID-19 pandemic MESHD on nurses, e.g. screening for mental health illness and early supportive interventions for high-risk nurses, immediate access to mental health care services, social support to reduce feelings of isolation, sufficient personal protective equipment for all nurses to provide security, etc. Governments, health care organizations, and policy makers should act in this direction to prepare health care systems, individuals, and nurses for a better response against the COVID-19 pandemic MESHD.

    Healthcare workers hospitalized due to COVID-19 MESHD have no higher risk of death MESHD than general population. Data from the Spanish SEMI- COVID-19 MESHD Registry.

    Authors: Jesus Diez-Manglano; Nataya Solis Marquinez; Andrea Alvarez Garcia; Nicolas Alcala Rivera; Irene Maderuelo Riesco; Martin Gerico Aseguinolaza; Jose Luis Beato Perez; Manuel Mendez Bailon; Ane Elbire Laburua-Iturburu Ruiz; Miriam Garcia Gomez; Carmen Martinez Cilleros; Paula Maria Pesqueira Fontan; Lucy Abella Vazquez; Julio Cesar Blazquez Encinar; Ramon Boixeda; Ricardo Gil Sanchez; Andres de la Pena Fernandez; Jose Loureiro Amigo; Joaquin Escobar Sevilla; Marcos Guzman Garcia; Maria Dolores Martin Escalante; Jeffrey Oskar Magallanes Gamboa; Angel Luis Martinez Gonzalez; Carlos Lumbreras Bermejo; Juan Miguel Anton Santos; Saed M. A. Saefan; Mohamed M. Thaivalappil; Abubacker S. Thoyalil; Inayath M. Umar; Zaina Al Kanaani; Abdullatif Al Khal; Einas Al Kuwari; Adeel A. Butt; Peter Coyle; Andrew Jeremijenko; Anvar Hassan Kaleeckal; Ali Nizar Latif; Riyazuddin Mohammad Shaik; Hanan F. Abdul Rahim; Hadi M. Yassine; Gheyath K. Nasrallah; Mohamed G. Al Kuwari; Odette Chaghoury; Hiam Chemaitelly; Laith J Abu-Raddad

    doi:10.1101/2020.11.23.20236810 Date: 2020-11-24 Source: medRxiv

    Aim: To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 MESHD have a worse prognosis than non-healthcare workers (NHCW). Methods: Observational cohort study based on the SEMI- COVID-19 MESHD Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 MESHD in Spain. Patients aged TRANS 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results: As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age TRANS of HCW was 52 (15) years and 62.4% were women. Prevalence SERO of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis HP sepsis MESHD and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p=0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age TRANS, male TRANS sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.219, 95%CI 0.069-0.693, p=0.01). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions: Hospitalized COVID-19 MESHD HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 MESHD in HCW does not carry more clinical severity nor mortality.

    Posttraumatic Stress Disorder MESHD and Associated Factors During the Early Stage of the COVID-19 Pandemic MESHD in Norway

    Authors: Tore Bonsaksen; Trond Heir; Inger Schou-Bredal; Øivind Ekeberg; Laila Skogstad; Tine K. Grimholt

    id:10.20944/preprints202011.0617.v1 Date: 2020-11-24 Source: Preprints.org

    The COVID-19 MESHD outbreak and the sudden lockdown of society in March 2020 had a large impact on people’s daily life and gave rise to concerns for the mental health in the general population. The aim of the study was to examine post- traumatic stress MESHD reactions related to the COVID-19 pandemic MESHD, the prevalence SERO of symptom-defined post- traumatic stress disorder MESHD ( PTSD MESHD), and factors associated with post- traumatic stress MESHD in the Norwegian population during the early stages of the COVID-19 MESHD outbreak. A survey was administered via social media channels, to which a sample of 4527 adults TRANS (≥18 years) responded. Symptom-defined PTSD was measured with the PTSD Checklist for the DSM-5. The items were specifically linked to the COVID-19 pandemic MESHD. We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Associations with PTSD MESHD were examined with single and multiple logistic regression analyses. The prevalence SERO of symptom-defined PTSD MESHD was 12.5% for men and 19.5% for women. PTSD MESHD was associated with lower age TRANS, female TRANS gender TRANS, lack of social support, and a range of pandemic-related variables such as economic concerns, expecting economic loss, having been in quarantine or isolation, being at high-risk for complications from COVID-19 MESHD infection, and having concern for family and close friends TRANS. In conclusion, posttraumatic stress MESHD reactions were common in the Norwegian population in the early stages of the COVID-19 MESHD outbreak. Concerns about finances, health, and family and friends TRANS seem to matter.

    Seroprevalence SERO of SARS-CoV-2 infection MESHD in the craft and manual worker population of Qatar

    Authors: Mohamed H. Al-Thani; Elmoubasher Farag; Roberto Bertollini; Hamad Eid Al Romaihi; Sami Abdeen; Ashraf Abdelkarim; Faisal Daraan; Ahmed Ismail; Nahid Mostafa; Mohamed Sahl; Jinan Suliman; Elias Tayar; Hasan Ali Kasem; Meynard J. A. Agsalog; Bassam K. Akkarathodiyil; Ayat A. Alkhalaf; Mohamed Morhaf M. H. Alakshar; Abdulsalam Ali A. H. Al-Qahtani; Monther H. A. Al-Shedifat; Anas Ansari; Ahmad Ali Ataalla; Sandeep Chougule; Abhilash K. K. V. Gopinathan; Feroz J. Poolakundan; Sanjay U. Ranbhise; Saed M. A. Saefan; Mohamed M. Thaivalappil; Abubacker S. Thoyalil; Inayath M. Umar; Zaina Al Kanaani; Abdullatif Al Khal; Einas Al Kuwari; Adeel A. Butt; Peter Coyle; Andrew Jeremijenko; Anvar Hassan Kaleeckal; Ali Nizar Latif; Riyazuddin Mohammad Shaik; Hanan F. Abdul Rahim; Hadi M. Yassine; Gheyath K. Nasrallah; Mohamed G. Al Kuwari; Odette Chaghoury; Hiam Chemaitelly; Laith J Abu-Raddad

    doi:10.1101/2020.11.24.20237719 Date: 2020-11-24 Source: medRxiv

    Background: Qatar experienced a severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) epidemic that disproportionately affected the craft and manual worker (CMW) population who comprise 60% of the total population. This study aimed to assess the proportions of ever and/or current infection in this population. Methods: A cross-sectional population-based survey was conducted during July 26-September 09, 2020 to assess both anti-SARS-CoV-2 positivity through serological testing SERO and polymerase chain reaction (PCR) positivity through PCR testing. Associations with antibody SERO and PCR positivity were identified through regression analyses. Results: Study included 2,641 participants, 69.3% of whom were <40 years of age TRANS. Anti-SARS-CoV-2 positivity was estimated at 55.3% (95% CI: 53.3-57.3%) and was significantly associated with nationality, geographic location, educational attainment, occupation, presence of symptoms in the two weeks preceding the survey, and previous infection diagnosis. PCR positivity was assessed at 11.3% (95% CI: 9.9-12.8%) and was significantly associated with geographic location, contact with an infected person, and reporting two or more symptoms. Infection positivity ( antibody SERO and/or PCR positive) was assessed at 60.6% (95% CI: 9.9-12.8%). The proportion of antibody SERO-positive CMWs that had a prior SARS-CoV-2 diagnosis was 9.3% (95% CI: 7.9-11.0%). Only seven infections were ever severe and one was ever critical - an infection severity rate of 0.5% (95% CI: 0.2-1.0%). Conclusions: Six in every 10 CMWs have been infected, suggestive of reaching the herd immunity threshold. Infection severity was low with only one in every 200 infections progressing to be severe or critical. Only one in every 10 infections had been previously diagnosed suggestive of mostly asymptomatic TRANS or minimally mild infections.

    On-site rapid molecular testing, mobile sampling teams and eHealth to support primary care physicians during the COVID-19 pandemic MESHD

    Authors: N.N. Cheung; S.A. Boers; S. Kiani deh Kiani; R.W. Jansen; D.O. Mook-Kanamori; L. Janssens; M.C.W. Feltkamp; A.C.M. Kroes; B.C. Mourik; Niels Vandamme; Linos Vandekerckhove; Roser Vento-Tormo; Alexandra Chloe Villani; - Chan Zuckerberg Initiative Single-Cell COVID-19 Consortia

    doi:10.1101/2020.11.20.20234898 Date: 2020-11-23 Source: medRxiv

    Objectives We evaluated the effects of on-site rapid molecular testing at a drive-through sampling facility, deployment of mobile sampling teams and implementation of an online eHealth platform as supportive measures for general practitioners (GPs) during the COVID-19 pandemic MESHD. Methods An eHealth platform was developed that allowed GPs to either refer patients to a drive-through sampling facility or to request a home visit by a sampling team. Nasopharyngeal swab samples from patients marked as urgent (n=333) were tested immediately on-site using a GeneXpert System. Non-urgent samples (n=1,460) were sent once a day to a university hospital laboratory for routine testing. Time stamps starting from referral to the moment of test report sent were recorded to calculate the turnaround time. Results The eHealth platform was rapidly adopted and used by a total of 517 GPs to test 1,793 patients in a period of 13 weeks. On-site rapid molecular testing reduced the median turnaround time to 03h:41m compared to 29h:15m for routine testing. Positive SARS-CoV-2 test results were identified amongst 84/1,477 (5.7%) and 33/316 (10.4%) patients sampled at the drive-through or at home, respectively. In the age category TRANS of >80 years, 80.4% of patients were tested by a mobile sampling team. Conclusions The combination of rapid molecular testing and eHealth reduced the time between referral and results sent back to the GP to less than four hours. In addition, mobile sampling teams helped in reaching non-mobile, elderly TRANS patient populations with a higher prevalence SERO of COVID-19 MESHD.

    At the dawn of winter: comparing COVID-19 MESHDand influenza presentation and trajectory

    Authors: Anat Reiner Benaim; Jonathan Aryeh Sobel; Ronit Almog; Snir Lugassy; Tsviel Ben Shabbat; Alistair Johnson; Danny Eytan; Joachim A. Behar; Yuqing Qiu; Thomas J Ketas; Eric Francomano; P.J. Klasse; Layla Hatem; Lars F Westblade; Heng Wu; Haode Chen; Robert Zuk; Hong Tan; Roxanne Girardin; Alan P Dupuis II; Anne F Payne; John P Moore; Melissa M Cushing; Amy Chadburn; Zhen Zhao; Bram P Prins; John Danesh; Poornima Devineni; Yunling Shi; Kristine E Lynch; Scott L DuVall; Helene Garcon; Lauren Thomann; Jin J Zhou; Bryan R Gorman; Jennifer E Huffman; Christopher J O'Donnell; Philip S Tsao; Jean C Beckham; Saiju Pyarajan; Sumitra Muralidhar; Grant D Huang; Rachel Ramoni; Adriana M Hung; Kyong-Mi Chang; Yan V Sun; Jacob Joseph; Andrew R Leach; Todd L Edwards; Kelly Cho; J Michael Gaziano; Adam S Butterworth; Juan P Casas

    doi:10.1101/2020.11.19.20235077 Date: 2020-11-22 Source: medRxiv

    Background COVID-19 MESHD is a newly recognized illness with a predominantly respiratory presentation. As winter approaches in the northern hemisphere, it is important to characterize the differences in disease presentation and trajectory between COVID-19 MESHD patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment. MethodsData from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and September 1st, 2020. Four groups of patients were defined: COVID-19 MESHD (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292) and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult TRANS patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 hours of hospitalization, and on comorobidity prevalence SERO. Results COVID-19 MESHD patients were overall younger in age TRANS and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 MESHD group compared to influenza and SARI. Severely- and moderately-ill COVID-19 MESHD patients older than 65 years of age TRANS suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood SERO cells and neutrophils were lower among COVID-19 MESHD patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first two days of hospitalization revealed that white blood SERO count, neutrophils percentage and glucose in blood SERO increased among COVID-19 MESHD patients, while decreasing among other patients. ConclusionsThe intrinsic virulence of COVID-19 MESHD appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function and metabolism were uniquely affected by COVID-19 MESHD.

    REACT-1 round 6 updated report: high prevalence SERO of SARS-CoV-2 swab positivity with reduced rate of growth in England at the start of November 2020

    Authors: Steven Riley; Kylie E. C. Ainslie; Oliver Eales; Caroline E. Walters; Haowei Wang; Christina Atchinson; Claudio Fronterre; Peter J. Diggle; Deborah Ashby; Christl A Donnelly; Graham Cooke; Wendy Barclay; Helen Ward; Ara Darzi; Paul Elliott; Peter Judak; Kris Roels; Laurie De Wilde; Peter Van Eenoo; Tim Reyns; Marc Cherlet; Emmie Dumont; Griet Debyser; Ruben t'Kindt; Koen Sandra; Surya Gupta; Nicolas Drouin; Amy Harms; Thomas Hankemeier; Donald Jones; Pankaj Gupta; Cathy Lane; Said El Ouadi; Jean-Baptiste Vincendet; Nick Morrice; S. Oehrle; Nikunj Tanna; Steve Silvester; Sally Hannam; Florian Sigloch; Andrea Bhangu-Uhlmann; Jan Claereboudt; Morteza Razavi; Norman Leigh Anderson; Sven Degroeve; Lize Cuypers; Christophe Stove; Katrien Lagrou; Geert Antoine Martens; Dieter Deforce; Lennart Martens; Hans Vissers; Maarten Dhaenens; Mariano Aizpurua; Romina Zadoff; Carla Marchionatti; Natalia Garcia Escude; Romina Romero; Noelia Iraizos; Emmanuel Ezequiel Valls; Patricia Rearte Carvalho; Jimena Franco; Natali Estrada; Juan Rusconi; Guido Ochoa; Maria Veronica Paz; Patricia Lesch; Maria Fernanda Caracciolo; Maria Eugenia Macaneo; Lia Pocket; Silvana Marquez; Gaston Pellegrino; Jorge Geffner; Rocio Zarlenga; Camila Witteveen; Agustina Venditti; Indira Pichetto Olanda; Juan Mauricio Vargas; Micaela Piani; Daniela Carolina Galnarez; Florencia De la Fuente; Andrea Gamarnik; Maria del Carmen Nigro; Susana Villaroel; Cristina Soler Riera; Leonel Langellotti; Clarisa Taffarel; Jose L Scapellato; Mariano Girasolli; Maximiliano de Zan; Juan Sebastian Riera; Enio Garcia; Mario Rovere; Juan Canela; Agostina Pagella; Cecilia Pampuro; Yanina Miragaya; Silvina Kuperman; Alfonso Raggio; Ramiro Manuel Larrea; Maria Dolores Silveyra; Gabriela Leberzstein; Alejandra Debonis; Juan Molinos; Miguel Gonzalez; Eduardo Perez; Nicolas Kreplak; Susana Pastor Arguello; Luz Gibbons; Fernando Althabe; Eduardo Bergel; Fernando P Polack

    doi:10.1101/2020.11.18.20233932 Date: 2020-11-20 Source: medRxiv

    BackgroundEngland is now in the midst of its second wave of the COVID-19 pandemic MESHD. Multiple regions of the country are at high infection prevalence SERO and all areas experienced rapid recent growth of the epidemic during October 2020. MethodsREACT-1 is a series of community surveys of SARS-CoV-2 RT-PCR swab-positivity in England designed to monitor the spread of the epidemic and thus increase situational awareness. Round 6 of REACT-1 commenced swab-collection on 16th October. A prior interim report included data from 16th to 25th October for 85,971 participants. Here, we report data for the entire round on 160,175 participants with swab results obtained up to 2nd November 2020. ResultsOverall weighted prevalence SERO of infection in the community in England was 1.3% or 130 people per 10,000 infected, up from 60 people per 10,000 in the round 5 report (18th September to 5th October 2020), doubling every 24 days on average since the prior round. The corresponding R number was estimated to be 1.2. Prevalence SERO of infection was highest in North West (2.4%, up from 1.2%), followed by Yorkshire and The Humber (2.3% up from 0.84%), West Midlands (1.6% up from 0.60%), North East (1.5% up from 1.1%), East Midlands (1.3% up from 0.56%), London (0.97%, up from 0.54%), South West (0.80% up from 0.33%), South East (0.69% up from 0.29%), and East of England (0.69% up from 0.30%). Rapid growth in the South observed in the first half of round 6 was no longer apparent in the second half of round 6. We also observed a decline in prevalence SERO in Yorkshire and The Humber during this period. Comparing the first and second halves of round 6, there was a suggestion of decline in weighted prevalence SERO in participants aged TRANS 5 to 12 years and in those aged TRANS 25 to 44 years. While prevalence SERO remained high, in the second half of round 6 there was suggestion of a slight fall HP then rise that was seen nationally and also separately in both the North and the South. ConclusionThe impact of the second national lockdown in England is not yet known. We provide here a detailed description of swab-positivity patterns at national, regional and local scales for the period immediately preceding lockdown, against which future trends in prevalence SERO can be evaluated.

    Global seroprevalence SERO of SARS-CoV-2 antibodies SERO: a systematic review and meta-analysis

    Authors: Niklas Bobrovitz; Rahul Krishan Arora; Christian Cao; Emily Boucher; Michael Liu; Hannah Rahim; Claire Donnici; Natasha Ilincic; Nathan Duarte; Jordan Van Wyk; Tingting Yan; Lucas Penny; Mitchell Segal; Judy Chen; Mairead Whelan; Austin Atmaja; Simona Rocco; Abel Joseph; David Clifton; Tyler Williamson; Cedric P Yansouni; Timothy Evans Grant; Jonathan Chevrier; Jesse Papenburg; Matthew P Cheng

    doi:10.1101/2020.11.17.20233460 Date: 2020-11-18 Source: medRxiv

    BackgroundStudies reporting estimates of the seroprevalence SERO of severe acute respiratory syndrome coronavirus 2 MESHD ( SARS-CoV-2) antibodies SERO have rapidly emerged. We aimed to synthesize seroprevalence SERO data to better estimate the burden of SARS-CoV-2 infection MESHD, identify high-risk groups, and inform public health decision making. MethodsIn this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to August 28, 2020. We included studies that reported a sample size, study date, location, and seroprevalence SERO estimate. Estimates were corrected for imperfect test accuracy with Bayesian measurement error models. We conducted meta-analysis to identify demographic differences in the prevalence SERO of SARS-CoV-2 antibodies SERO, and meta-regression to identify study-level factors associated with seroprevalence SERO. We compared region-specific seroprevalence SERO data to confirmed cumulative incidence. PROSPERO: CRD42020183634. FindingsWe identified 338 seroprevalence SERO studies including 2.3 million participants in 50 countries. Seroprevalence SERO was low in the general population (median 3.2%, IQR 1.0-6.4%) and slightly higher in at-risk populations (median 5.4%, IQR 1.5-18.4%). Median seroprevalence SERO varied by WHO Global Burden of Disease region (p < 0.01), from 1.0% in Southeast Asia, East Asia and Oceania to 18.8% in South Asia. National studies had lower seroprevalence SERO estimates than local (p = 0.02) studies. Compared to White persons, Black persons ( prevalence SERO ratio [RR] 2.34, 95% CI 1.60-3.43) and Asian persons (RR 1.56, 95% CI 1.22-2.01) were more likely to be seropositive. Seroprevalence SERO was higher among people ages TRANS 18-64 compared to 65 and over (RR 1.26, 95% CI 1.04-1.52). Health care workers had a 1.74x (95% CI: 1.18-2.58) higher risk compared to the general population. There was no difference in seroprevalence SERO between sexes. There were 123 studies (36%) at low or moderate risk of bias. Seroprevalence SERO estimates from national studies were median 11.9 (IQR 8.0 - 16.6) times higher than the corresponding SARS-CoV-2 cumulative incidence. InterpretationMost of the population remains susceptible to SARS-CoV-2 infection MESHD. Public health measures must be improved to protect disproportionately affected groups, including non-White people and adults TRANS. Measures taken in SE Asia, E Asia and Oceania, and Latin America and Caribbean may have been more effective in controlling virus transmission TRANS than measures taken in other regions. FundingPublic Health Agency of Canada through the COVID-19 MESHD Immunity Task Force.

    Community prevalence SERO of antibodies to SARS-CoV-2 SERO and correlates of protective immunity in five localities in an Indian metropolitan city

    Authors: Aurnab Ghose; Sankar Bhattacharya; Arun S Karthikeyan; Abhay Machindra Kudale; Joy M Monteiro; Aparna Joshi; Guruprasad R Medigeshi; Gagandeep Kang; Vineeta Bal; Satyajit Rath; L S Shashidhara; Jacob John; Susmita Chaudhuri; Aarti Nagarkar; Rahul Batra; Stuart J D Neil; Michael H Malim; Katie J Doores; Sam T Douthwaite; Gaia Nebbia; Jonathan D Edgeworth; Ali R Awan; - The COVID-19 Genomics UK (COG-UK) consortium

    doi:10.1101/2020.11.17.20228155 Date: 2020-11-18 Source: medRxiv

    BackgroundCurrent testing guidelines for COVID-19 MESHD substantially underestimates the spread of SARS-CoV-2 in dense urban populations. Granular estimates of infection are important for understanding population-level immunity. We examined seroprevalence SERO of anti- SARS-CoV-2 antibodies SERO in Pune city in India and its implication for protective immunity. MethodsSeroprevalence was estimated during July 20-August 5, 2020 from 1659 randomly selected individuals recruited from five administrative Pune sub-wards (combined population 366,984). Prevalence SERO of anti-SARS-CoV-2 spike protein antibodies SERO were estimated and along with correlates of virus neutralisation. FindingsSeropositivity was extensive (51{middle dot}3%; 95%CI 39{middle dot}9-62{middle dot}4) but varied widely in the five localities tested, ranging from 35{middle dot}8% to 66{middle dot}4%. Seropositivity was higher in crowded living conditions in the slums (OR 1{middle dot}91), and was lower in those 65 years or older (OR 0{middle dot}59). The infection-fatality ratio was estimated at 0.28%. Post survey, COVID-19 MESHD incidence was lower in areas noted to have higher seroprevalence SERO. Substantial virus-neutralising activity was observed in seropositive individuals, but with considerable heterogeneity in the immune response and possible age TRANS-dependent diversity in the antibody SERO repertoire. InterpretationDespite crowded living conditions having facilitated widespread transmission TRANS, the variability in seroprevalence SERO in localities that are in geographical proximity indicates a heterogenous spread of infection. Declining infection rates in areas with high seropositivity suggest population-level protection and is supported by substantial neutralising activity in asymptomatically TRANS infected individuals. The heterogeneity in antibody SERO levels and neutralisation capacity indicates the existence of immunological sub-groups of functional interest. FundingPersistent Foundation, Pune, India RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSWe searched the literature (upto 2 Nov 2020), using the terms " seroprevalence SERO", "serosurveillance", "seroepidemiology", "immune response", "seroconversion" and "SARS-CoV-2," without any article type restrictions, and selected only population- or community-level seroprevalence SERO studies for collecting background information. The survey of literature indicated that community serosurveys for SARS-CoV-2 in LICs and LMICs have been limited and have largely reported correlations of seroprevalence SERO with demographic factors. There are no reports of protective immunity-associated characteristics in community surveillance settings from LMIC/LICs. In fact, such studies from the global North are also limited. The existing evidence thus lacks granular details critical to understand community-level heterogeneities, and provides limited epidemiological data without meaningful immunobiological correlates. Added value of this studyThis is the first systematic study (at the time of submission) from a LMIC reporting community SARS-CoV-2 sero-surveillance of high granularity alongside estimation of correlates of immune protection. We estimated seroprevalence SERO as well as serological correlates of protection in a cross-sectional cohort of 1659 asymptomatic TRANS participants from five small urban localities in the metropolitan city of Pune, India. IgG seroprevalence SERO was determined against the receptor-binding-domain (RBD) of the SARS-CoV-2 spike protein, to aid correlation with immune protection since RBD is the predominant target for neutralising antibodies SERO. Large subsets of the sera were also tested for surrogate neutralisation as well as live SARS-CoV-2 virus neutralisation, data not so far reported in community sero-surveillance studies. We identified substantial locality-specific variations in seropositivity levels and infection fatality rates (IFRs), highlighting heterogeneities of infection behaviour even in dense, urban populations often lost in more global analyses. Notably, the incidence of new infections after the sero-sampling period revealed a strong negative association with seropositivity, indicating potential modification of transmission TRANS by community immunity. While RBD-specific antibody SERO levels expectedly showed broad correlation with neutralisation capacities, 30% of individuals showed significant departures from this correlation, again underlining significant immune response heterogeneities. Implications of all the available evidenceHigh seroprevalence SERO in the dense urban localities of the study site, despite a protracted and stringent lockdown, provides a realistic account on transmission TRANS dynamics crucial for public health policies in LMICs. Micro-geographic variability within locales, dominated by sub-optimal living conditions, needs to be acknowledged and used to develop measures designed for people in such socio-economic contexts. The heterogeneity of correlation between RBD seropositivity and neutralising capacity, as well as the complex association with age TRANS encountered in this study open up a plethora HP of research questions into epitope dominance and affinity variations in anti-viral antibodies SERO in asymptomatic TRANS infection.

    COVID-19 MESHD Quarantine Reveals Grade-specific Behavioral Modification of Myopia MESHD Myopia HP: One-Million Chinese Schoolchildren Study

    Authors: Liangde Xu; Yunlong Ma; Jian Yuan; Yaru Zhang; Hong Wang; Guosi Zhang; Changsheng Tu; Xiaoyan Lu; Jing Li; Yichun Xiong; Fukun Chen; Xinting Liu; Zhengbo Xue; Meng Zhou; Wen-Qing Li; Nan Wu; Hao Chen; Jiangfan Chen; Fan Lu; Jianzhong Su; Jia Qu

    doi:10.1101/2020.11.15.20231936 Date: 2020-11-18 Source: medRxiv

    BackgroundHigh prevalence SERO of myopia MESHD myopia HP of adolescent has been a global public health concern. Their risk factors and effective prevention methods for myopia HP myopia MESHD across schoolchildren developmental stages are critically needed but remain uncertain due to the difficulty in implementing intervention measurements under normal life situation. We aimed to study the impact of the COVID-19 MESHD quarantine on myopia HP myopia MESHD development among over one-million schoolchildren. MethodsWe designed the ongoing longitudinal project of Myopic Epidemiology and Intervention Study (MEIS) to biannually examine myopia HP among millions of schoolchildren for ten years in Wenzhou City, Zhejiang Province, China. In the present study, we performed three examinations of myopia HP in 1,305 elementary and high schools for schoolchildren in June 2019, December 2019 and June 2020. We used the normal period (June-December 2019) and COVID-19 MESHD quarantine period (January-June 2020) for comparisons. Myopia HP was defined as an uncorrected visual acuity of 20/25 or less and a spherical equivalent refraction (SER) of -0.5 diopters (D) or less. High myopia HP was defined as an SER of -6.0 D or less. FindingsIn June 2019, 1,001,749 students aged TRANS 7-18 were eligible for examinations. In the 6-month and 12-month follow-up studies, there were 813,755 eligible students (81.2%) and 768,492 eligible students (76.7%), respectively. Among all students, we found that half-year myopia HP progression increased approximate 1.5 times from -0.263 D (95% CI, -0.262 to -0.264) during normal period to -0.39 D (95% CI, -0.389 to -0.391) during COVID-19 MESHD quarantine (P < 0.001). Multivariate Cox regression analysis identified grade rather than age TRANS was significantly associated with myopia HP (Hazard ratio [HR]: 1.10, 95% CI, 1.08 to 1.13; P < 0.001) and high myopia HP (HR: 1.40, 95% CI, 1.35 to 1.46; P < 0.001) after adjustment for other factors. The prevalence SERO, progression, and incidence of myopia and high HP myopia HP could be categorized into two grade groups: I (grades 1-6) and II (grades 7-12). Specifically, COVID-19 MESHD quarantine for 6 months sufficiently increased risk of developing myopia HP (OR: 1.36, 95% CI, 1.33 to 1.40) or high myopia HP (OR: 1.30, 95% CI, 1.22 to 1.39) in Grade Group I, but decreased risk of developing myopia HP (OR: 0.45, 95% CI, 0.43 to 0.48) or high myopia HP (OR: 0.57, 95% CI, 0.54 to 0.59) in Grade Group II. InterpretationThe finding that behavioral modifications for six months during COVID-19 MESHD quarantine sufficiently and grade-specifically modify myopia HP development offers the largest human behavioral intervention data at the one million scale to identify the grade-specific causal factors and effective prevention methods for guiding the formulation of myopia HP prevention and control policies. FundingKey Program of National Natural Science Foundation of China; the National Natural Science Foundation of China; Scientific Research Foundation for Talents of Wenzhou Medical University; Key Research and Development Program of Zhejiang Province. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSMyopia is the most-common refractive error worldwide. Myopia HP with younger onset may result in developing high myopia HP, which is associated with sight-threatening ocular diseases such as maculopathy, retinal detachment HP, opticneuropathy, glaucoma HP, retinal atrophy HP, choroidal neovascularization HP. In light of the increasing prevalence SERO of myopia and high HP myopia HP has been a global public health concern, the impact of COVID-19 MESHD lockdown on myopia HP development has gained substantial attention. We searched PubMed, Google Scholar, and MEDLINE databases for original articles reported between database inception and November 10, 2020, using the following search terms: (coronavirus OR COVID* OR SARS-COV-2 OR lockdown OR quarantine) AND ( myopia HP OR short-sightedness OR refractive error). To date, there was no original study reported to uncover the influence of COVID-19 MESHD quarantine on myopia HP progression. Added value of this studyThis study provides the largest longitudinal intervention data on myopia HP progression in Chinese schoolchildren covering all grades of schoolchildren at one-million scale. COVID-19 MESHD quarantine model uncovers that behavioral modifications for six months may lead to significant increase of overall prevalence SERO of myopia HP associated with their increased screen times and decreased outdoor activity times. Importantly, their effects on developing myopia or high HP myopia HP of students are grade-dependent, which were risk factors for elementary schools period but protective factors for high schools period partly due to reduced school education burden. Implications of all the available evidenceThis one-million schoolchildren myopia HP survey offers evidence that six months behavioral modifications sufficiently and grade-specifically change the progression of myopia and high HP myopia HP. In view of the increased use of electronic devices is an unavoidable trend, effective myopia HP prevention strategy according to grade among students is urgently needed. Since COVID-19 MESHD outbreak is still ongoing and spreading, international collaborate efforts are warranted to uncover the influence of COVID-19 MESHD on myopia HP progression to further substantiate these findings.

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MeSH Disease
Transmission
Seroprevalence


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