Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.

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Demographic and Clinical Characteristics of Early Travel-Associated COVID-19 Cases

Frontiers in Public Health ◽

10.3389/fpubh.2020.573925 ◽

2020 ◽

Vol 8 ◽

Author(s):

Reham M. Marei ◽

Mohamed M. Emara ◽

Omar M. Elsaied ◽

Gheyath K. Nasrallah ◽

Tawanda Chivese ◽

...

Keyword(s):

Clinical Data ◽

Clinical Symptoms ◽

Age Groups ◽

The Elderly ◽

World Health ◽

Female Ratio ◽

Younger Age ◽

The Mean ◽

Health Organization ◽

Male To Female

Background: SARS-CoV-2 continues to claim hundreds of thousands of people's lives. It mostly affects the elderly and those with chronic illness but can also be fatal in younger age groups. This article is the first comprehensive analysis of the epidemiological and clinical outcomes of the travel-associated SARS-CoV-2 cases until April 19, 2020.Methods: Demographic and clinical data of travel-associated SARS-CoV-2 cases were collected for the period between January 16, 2020 and April 19, 2020. More than one hundred and eighty databases were searched, including the World Health Organization (WHO) database, countries' ministries websites, and official media sites. Demographic and clinical data were extracted and analyzed.Results: A total of 1,186 cases from 144 countries meeting the inclusion criteria were reported and included in the analysis. The mean age of the cases was 44 years, with a male to female ratio of 1.6:1. Travel-associated cases originated from more than 40 countries, with China, Italy, and Iran reporting the highest numbers at 208, 225, and 155, respectively. Clinical symptoms varied between patients, with some reporting symptoms during the flights (117 cases; 9.87%). A total of 312 (26.31%) cases were hospitalized, of which 50 cases (4.22%) were fatal.Conclusion: Major gaps exist in the epidemiology and clinical spectrum of the COVID-19 travel-associated cases due to a lack of reporting and sharing data of many counties. The identification and implementation of methodologies for measuring traveler's risk to coronavirus would help in minimizing the spread of the virus, especially in the next waves.

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Air-travel related TB incident follow up – effectiveness and outcomes: a systematic review

European Respiratory Journal ◽

10.1183/13993003.00013-2020 ◽

2020 ◽

pp. 2000013

Author(s):

Laura Maynard-Smith ◽

Colin Stewart Brown ◽

Ross Jeremy Harris ◽

Peter Hodkinson ◽

Surinder Tamne ◽

...

Keyword(s):

Meta Analysis ◽

Positive Tuberculin Skin Test ◽

Air Travel ◽

World Health ◽

Contact Tracing ◽

Cochrane Library ◽

Publication Date ◽

Single Positive ◽

Latent Tb ◽

Health Organization

BackgroundThe World Health Organization (WHO) recommends following up passengers following possible exposure to a case of infectious tuberculosis (TB) during air travel. This is known to be time consuming and difficult, and increasingly so with higher numbers of flights and passengers to and from countries with high TB endemicity each year.ObjectivesThis paper systematically reviews the literature on contact tracing investigations following a plane exposure to active pulmonary TB. Evidence for in-flight transmission was assessed by reviewing the positive results of contacts without prior risk factors for latent TB.Data sources & EligibilityA search of Medline, EMBASE, BIOSIS, Cochrane Library and Database of Systematic Reviews was carried out, with no restrictions on study design, index case characteristics, duration of flight or publication date.ResultsTwenty-two papers were included, with a total of 469 index cases and 15 889 contacts. Only 26.4% of all contacts identified completed screening following exposure. The yield of either a single positive tuberculin skin test (TST) or a TST conversion attributable to in-flight transmission is between 0.19% (95%CI 0.13–0.27) and 0.74% (95%CI 0.61–0.88) of all contacts identified (0.00%, 95%CI 0.00–0.00 and 0.13%, 95%CI 0.00–0.61 in random effects meta-analysis).LimitationsThe main limitation is heterogeneity of reporting.Conclusions and implications of key findingsThe evidence behind the criteria for initiating investigations is weak and it has been widely demonstrated that active screening of contacts is labour intensive and unlikely to be effective. Based on our findings, formal comprehensive contact tracing may be of limited utility following a plane exposure.

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Organization of restrictive quarantine measures to prevent especially dangerous infections

Spravočnik vrača obŝej praktiki (Journal of Family Medicine) ◽

10.33920/med-10-2005-01 ◽

2020 ◽

pp. 6-11

Author(s):

Petr Ilyin

Keyword(s):

Infectious Diseases ◽

Clinical Symptoms ◽

International Health ◽

World Health ◽

The World ◽

History Of ◽

Entire History ◽

Health Organization ◽

Former Ussr ◽

Health Regulations

Especially dangerous infections (EDIs) belong to the conditionally labelled group of infectious diseases that pose an exceptional epidemic threat. They are highly contagious, rapidly spreading and capable of affecting wide sections of the population in the shortest possible time, they are characterized by the severity of clinical symptoms and high mortality rates. At the present stage, the term "especially dangerous infections" is used only in the territory of the countries of the former USSR, all over the world this concept is defined as "infectious diseases that pose an extreme threat to public health on an international scale." Over the entire history of human development, more people have died as a result of epidemics and pandemics than in all wars combined. The list of especially dangerous infections and measures to prevent their spread were fixed in the International Health Regulations (IHR), adopted at the 22nd session of the WHO's World Health Assembly on July 26, 1969. In 1970, at the 23rd session of the WHO's Assembly, typhus and relapsing fever were excluded from the list of quarantine infections. As amended in 1981, the list included only three diseases represented by plague, cholera and anthrax. However, now annual additions of new infections endemic to different parts of the earth to this list take place. To date, the World Health Organization (WHO) has already included more than 100 diseases in the list of especially dangerous infections.

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The study of Iranian children and adolescents’ physical activity: a systematic review and meta-analysis

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2020-0302 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Adel Alizadeh ◽

Reza Negarandeh ◽

Fahimehe Bagheri Amiri ◽

Zahra Yazdani

Keyword(s):

Physical Activity ◽

Children And Adolescents ◽

Meta Analysis ◽

World Health ◽

Chi Square ◽

The Status ◽

Newcastle Ottawa Scale ◽

Health Organization ◽

Iranian Children

Abstract Objectives This systematic and meta-analysis review was conducted to determine the status of Iranian children and adolescents’ physical activity. Content All the related articles which were published in the major databases, including Pubmed, Scopus, Web of Science, Embase, Magiran, SID from the beginning of 2010 to the end of 2019, were reviewed by researchers. The Newcastle-Ottawa scale was also used to evaluate the quality of articles. Moreover, I 2 index and chi-square were used to assess the heterogeneity between the results. Summary 490 articles were found as a result of the search in the selected international and local databases, where finally, 10 articles were included into the meta-analysis after the elimination of the duplicated articles and applying inclusion and exclusion criteria. The results indicated that 29.5% of the girls were considered active according to WHO criteria (16.1–42.8: 95% CI) and also 20.5% of the boys (7.3–33.7: 95% CI). Outlook Overall, this study’s findings showed that a large percentage of Iranian children and adolescents do not achieve the level of physical activity recommended by the World Health Organization. This can lead to undesirable consequences for this group of population that is considered as the human capital of any country; consequently, it seems necessary to take basic measures at the micro and macro levels in order to reduce such problems in the society.

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A living WHO guideline on drugs to prevent covid-19

BMJ ◽

10.1136/bmj.n526 ◽

2021 ◽

pp. n526

Author(s):

François Lamontagne ◽

Thomas Agoritsas ◽

Reed Siemieniuk ◽

Bram Rochwerg ◽

Jessica Bartoszko ◽

...

Keyword(s):

Systematic Review ◽

Guideline Development ◽

Meta Analysis ◽

World Health ◽

Policy And Practice ◽

Assessment Development ◽

Research Priority ◽

Health Organization ◽

Almost All ◽

Drug Interventions

Abstract Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. Recommendation The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the new recommendation The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

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Identification of determinants of healthy ageing in Italy: results from the national survey IDAGIT

Ageing and Society ◽

10.1017/s0144686x20001671 ◽

2020 ◽

pp. 1-21

Author(s):

Erika Guastafierro ◽

Ilaria Rocco ◽

Rui Quintas ◽

Barbara Corso ◽

Nadia Minicuci ◽

...

Keyword(s):

Neurological Diseases ◽

Public Health Problem ◽

The Elderly ◽

Factor Loading ◽

Healthy Ageing ◽

World Health ◽

Italian Population ◽

Social Environments ◽

Ageing Model ◽

Health Organization

Abstract Healthy ageing is a public health problem globally. In Europe, the dependency ratio of the elderly is expected to increase by 21.6 per cent to 51.2 per cent in 2070. The World Health Organization (WHO) study on healthy ageing started in 2002 as a concept whereby all people of all ages should be able to live in a healthy, safe and socially inclusive way. The aim of this study is to present preliminary results of the project Identification of Determinants of Healthy Ageing in Italy (IDAGIT) that aimed to collect data on the active and healthy ageing of the Italian population aged over 18 using the conceptual framework of the WHO's ageing model. To link the determinants of the IDAGIT studies to those of the WHO model, we performed a confirmatory factor analysis which reported these variables as significant (in order of factor loading): smoking, cognition score, comorbidity, outdoor built environment, participation, working expertise and income. Considering comorbidity, 83.8 per cent of the sample declared not having any chronic diseases or to have only one, and regarding neurological diseases, only nine people had received a diagnosis of stroke. Regarding gender, the personal determinants and physical and social environments did not result in statistically significant differences, whereas we found statistical differences between the aged groups in all variables analysed. These results provide a first bio-psycho-social perspective on ageing in the Italian population.

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Implicações do uso do Aparelho de Amplificação Sonora Individual na qualidade de vida de idosos

CoDAS ◽

10.1590/2317-1782/20172016241 ◽

2017 ◽

Vol 29 (5) ◽

Cited By ~ 2

Author(s):

Camila Zorzetto Carniel ◽

Juliana Cristina Ferreira de Sousa ◽

Carla Dias da Silva ◽

Carla Aparecida de Urzedo Fortunato-Queiroz ◽

Miguel Ângelo Hyppolito ◽

...

Keyword(s):

Quality Of Life ◽

World Health Organization ◽

The Elderly ◽

World Health ◽

World Health Organization Quality ◽

Hearing Handicap ◽

Organization Quality ◽

Health Organization ◽

Post Hoc

RESUMO Objetivo Avaliar, por meio de questionários padronizados, a qualidade de vida de idosos com deficiência auditiva diagnosticada que utilizam ou não a prótese auditiva (AASI) e de idosos sem queixa auditiva. Método Trata-se de um estudo transversal, com amostra não probabilística, distribuída em três grupos divididos da seguinte forma: 30 idosos com perda auditiva diagnosticada e com indicação para uso do aparelho de amplificação sonora individual (AASI), mas que ainda não faziam uso da prótese; 30 idosos com deficiência auditiva que usavam o AASI; e 30 idosos sem queixa auditiva. Os participantes completaram um questionário que investigava dados sociodemográficos e familiares, o Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) e o World Health Organization Quality of Life - versão breve (WHOQOL-Breve). Além das análises descritivas dos dados, foram realizados testes para comparação dos três grupos, aplicando-se a análise de variância (ANOVA) e o teste post hoc de Bonferroni. Resultados Os três grupos se diferenciaram significativamente em todos os domínios de qualidade de vida. O grupo de idosos com perda auditiva diagnosticada e com indicação para uso do AASI apresentou menores escores que o grupo de idosos com deficiência auditiva que usavam o AASI e que o grupo de referência. O grupo com AASI apresentou os melhores resultados de qualidade de vida. Conclusão A perda auditiva afeta a qualidade de vida do idoso. O uso efetivo da prótese auditiva é benéfico a esta população, melhorando suas condições de vida e saúde.

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Elder Abuse

10.1093/obo/9780195396607-0309 ◽

2021 ◽

Keyword(s):

Criminal Justice ◽

Older People ◽

Elder Abuse ◽

Evolutionary Process ◽

The Elderly ◽

World Health ◽

Private Space ◽

Positive Treatment ◽

Justice Model ◽

Health Organization

Criminological concerns with the victimization of the elderly has developed parallel to, and independently of, the elder abuse debate. Criminologists have traditionally been concerned with the commission of acts against the older person in public as opposed to private space. A further hindrance to criminological enquiry is the practice of defining elder abuse in terms of victim needs, rather than of basic human rights. There has been no neat evolutionary process from positive treatment of the elderly, attributed to some golden age in the past to their increasing present victimization rates globally. Elder victimization is a long way from the simplistic notions of “granny battering.” There is general agreement among scholars that older people regularly suffer victimization in private space—in the household and in care institutions. They regularly experience multiple forms of abuse. One can attribute some of these experiences to major social changes as declining family support for older people diminishes and the proportion of young to old decreases. The World Health Organization (WHO) states that as the global population ages, the number of people aged sixty years and older is estimated to reach 1.2 billion worldwide by 2025. More pointedly, the longevity is also inextricably linked to the maltreatment of the global old. In particular, we have seen offenders apprehended in transgressions against the young, women, and ethnic minorities but have yet to see an active criminal justice response concerned with the experience of elder victimization. The discipline’s reluctance to recognize elder victimization is associated with it commonly being labeled as victimization by intimates, and to be understood through the lenses of psychology and psychiatry rather than through a criminal justice model. Care and individual needs of the elderly have been the traditional focus, rather than social justice, reason, and rights. Justice and rights involve choice and free will. Older people are not simply passive recipients of other people’s actions—they resist their victimization and often fight back. This article is a critical exposition of the sources available on elders abused as part of a larger account of the experience of older people worldwide. In particular, the reader is reminded that this article is limited due to publishing word constraints. Therefore, it provides a balanced, limited overview of the major literature and research available in the Western context. More pointedly, the literature cited here is intended to reflect on recent scholarship considered to have the potential of adding to the debate in criminology and elder victimization. Given that the study of elder abuse is still in its infancy in the discipline of criminology, this article is therefore necessarily interdisciplinary.

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