scholarly journals Optimizing Benefits of Testing Key Workers for Infection with SARS-CoV-2: A Mathematical Modeling Analysis

2020 ◽  
Author(s):  
Frank G Sandmann ◽  
Peter J White ◽  
Mary Ramsay ◽  
Mark Jit
Keyword(s):  
Asymptomatic Infection ◽  
Transmission Risk ◽  
Decision Analytic Model ◽  
Analytic Model ◽  
Healthcare Staff ◽  
Rt Pcr ◽  
Modeling Analysis ◽  
Household Members ◽  
Increasing Risk ◽  
The Impact

Abstract Background Internationally, key workers such as healthcare staff are advised to stay at home if they or household members experience coronavirus disease 2019 (COVID-19)–like symptoms. This potentially isolates/quarantines many staff without SARS-CoV-2, while not preventing transmission from staff with asymptomatic infection. We explored the impact of testing staff on absence durations from work and transmission risks to others. Methods We used a decision-analytic model for 1000 key workers to compare the baseline strategy of (S0) no RT-PCR testing of workers to testing workers (S1) with COVID-19–like symptoms in isolation, (S2) without COVID-19–like symptoms but in household quarantine, and (S3) all staff. We explored confirmatory re-testing scenarios of repeating all initial tests, initially positive tests, initially negative tests, or no re-testing. We varied all parameters, including the infection rate (0.1–20%), proportion asymptomatic (10–80%), sensitivity (60–95%), and specificity (90–100%). Results Testing all staff (S3) changes the risk of workplace transmission by −56.9 to +1.0 workers/1000 tests (with reductions throughout at RT-PCR sensitivity ≥65%), and absences by −0.5 to +3.6 days/test but at heightened testing needs of 989.6–1995.9 tests/1000 workers. Testing workers in household quarantine (S2) reduces absences the most by 3.0–6.9 days/test (at 47.0–210.4 tests/1000 workers), while increasing risk of workplace transmission by 0.02–49.5 infected workers/1000 tests (which can be minimized when re-testing initially negative tests). Conclusions Based on optimizing absence durations or transmission risk, our modeling suggests testing staff in household quarantine or all staff, depending on infection levels and testing capacities.

scholarly journals Risk Groups for SARS-CoV-2 Infection among Healthcare Workers: Community Versus Hospital Transmission

2021 ◽  
Vol 13 (3) ◽  
pp. 724-729
Author(s):  
Fatihan Pınarlık ◽  
Zeliha Genç ◽  
Mahir Kapmaz ◽  
Süda Tekin ◽  
Önder Ergönül
Keyword(s):  
Healthcare Workers ◽  
Risk Groups ◽  
Rt Pcr ◽  
Increased Risk ◽  
Study Results ◽  
Hospital Infection Control ◽  
Household Members ◽  
Increasing Risk ◽  
Antibody Levels ◽  
Hospital Transmission

Background: We aimed to detect the risk factors for SARS-CoV-2 infection among healthcare workers (HCWs) in 2020 before the vaccination era. Methods: We surveyed SARS-CoV-2 infection among the HCWs in a hospital through screening for antibody levels and the detection of viral RNA by RT-PCR between May 2020 and December 2020. Occupational and non-occupational potential predictors of disease were surveyed for the HCWs included in this study. Results: Among 1925 personnel in the hospital, 1732 were included to the study with a response rate of 90%. The overall infection rate of HCWs was 16.3% at the end of 2020, before vaccinations started. In the multivariate analysis, being janitorial staff (OR: 2.24, CI: 1.21–4.14, p = 0.011), being a medical secretary (OR: 4.17, CI: 2.12–8.18, p < 0.001), having at least one household member with a COVID-19 diagnosis (OR: 8.98, CI: 6.64–12.15, p < 0.001), and number of household members > 3 (OR: 1.67, CI: 1.26–2.22, p < 0.001) were found to be significantly associated with SARS-CoV-2 infection. Conclusions: Medical secretaries and janitorial staff were under increased risk of SARS-CoV-2 infection. The community-hospital gradient can explain the mode of transmission for infection among HCWs. In the setting of this study, community measures were less strict, whereas hospital infection control was adequate and provided necessary personal protective equipment. Increasing risk in larger households and households with diagnosed COVID-19 patient indicates the community-acquired transmission of the infection.

scholarly journals Alitretinoin for the treatment of severe chronic hand eczema

2010 ◽  
Vol 14 (Suppl 1) ◽  
pp. 39-45
Author(s):  
M Paulden ◽  
M Rodgers ◽  
S Griffin ◽  
R Slack ◽  
S Duffy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Supportive Care ◽  
Time Horizon ◽  
Hand Eczema ◽  
Decision Analytic Model ◽  
Topical Steroids ◽  
Analytic Model ◽  
Chronic Hand Eczema ◽  
The Impact

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of alitretinoin for the treatment of adults with severe chronic hand eczema refractory to topical steroid treatment in accordance with the licensed indication, based upon the evidence submission from Basilea Pharmaceuticals Ltd to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The clinical evidence came from a single placebo-controlled randomised controlled trial of daily treatment with alitretinoin for 12–24 weeks, with follow-up for a further 24 weeks, in patients with severe chronic hand eczema (CHE) unresponsive to topical steroids. A statistically significantly greater proportion of patients using alitretinoin achieved the primary end point of clear or almost clear hands by week 24 than did those with placebo. Dose-dependent headache was the most commonly reported adverse event in patients treated with alitretinoin. Serious adverse events were rare, but alitretinoin was associated with increases in both total cholesterol and triglycerides, which has implications for risks of future cardiovascular events. The manufacturer submitted a de novo decision analytic model to estimate, over a time horizon of 3 years, the cost-effectiveness of alitretinoin versus the other relevant comparators identified by NICE. In response to the points of clarification put to it by the ERG regarding the initial submission, the manufacturer provided additional evidence and a revised decision analytic model with a ‘placebo’ arm. In the manufacturer’s original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were £8614 per quality-adjusted life-year (QALY) versus ciclosporin, –£469 per QALY versus psoralen + UVA (with alitretinoin dominant) and £10,612 per QALY versus azathioprine. These ICERs decreased as the time horizon was extended in sensitivity analyses. In patients with hyperkeratotic CHE and in women of child-bearing potential, the ICER remained below £20,000. When the health-related quality of life (HRQoL) values used in the model were replaced with those derived from an alternative study, these ICERs increased significantly (to £22,312 per QALY for alitretinoin versus azathioprine). In the revised model, alitretinoin was reported to have an ICER of £12,931 per QALY gained versus supportive care (placebo). However, the model underestimates the costs of treatment associated with alitretinoin. The manufacturer assumed that patients receiving alitretinoin visited the dermatologist every 4 weeks and ceased treatment as soon as they responded to it. If, in practice, patients would receive treatment for longer than this, then the manufacturer’s model will have significantly underestimated the costs to the NHS. Additional analyses undertaken by the ERG produced ICERs close to £30,000 per QALY gained for alitretinoin versus supportive care. This was largely due to uncertainty surrounding the impact of alitretinoin on HRQoL. The placebo-controlled trials conducted to date have established that alitretinoin can be efficacious for the treatment of severe CHE refractory to topical steroids, but longer term follow-up of trials or the implementation of registries is required to better establish the longer term efficacy or safety of alitretinoin. NICE recommended the use of alitretinoin for patients with severe CHE and a Dermatology Life Quality Index (DLQI) score of at least 15. Treatment was recommended to be stopped as soon as an adequate response was observed, or if CHE remained severe at 12 weeks, or if response was inadequate at 24 weeks.

scholarly journals Canine SARS-CoV-2 infection

2020 ◽  
Author(s):  
Thomas HC Sit ◽  
Christopher J Brackman ◽  
Sin Ming Ip ◽  
Karina WS Tam ◽  
Pierra YT Law ◽  
...  
Keyword(s):  
Hong Kong ◽  
Amino Acid ◽  
Respiratory Disease ◽  
Asymptomatic Infection ◽  
Viral Sequence ◽  
Rt Pcr ◽  
Viral Loads ◽  
Nasal Swabs ◽  
Household Members ◽  
Negative Gene

Abstract SARS-CoV-2 emerged in Wuhan in December 2019 and has caused the pandemic respiratory disease, COVID-19. Following what is presumed to be an initial zoonotic transmission event, the virus is now spreading efficient in humans. Very little is known about the susceptibility of domestic mammals kept as pets to this virus. Samples were collected over a 13-day period from a 17 year-old neutered male Pomeranian in Hong Kong SA that was taken into isolation after two members of the household tested positive for the virus. Nasal swabs were consistently positive on the five occasions the dog was tested using quantitative RT- PCR with viral loads between 7.5xE2 to 2.6 x10E4 RNA copies per mL of sample. The dog remained asymptomatic. Cultures attempted on three RT-PCR positive nasal samples were negative. Gene sequences from samples from two household members were identical. The viral sequence from the dog differed at three nucleotide positions; two of these resulted in amino acid changes but their significance is yet to be determined. Seroconversion was not detected but this was expected given the asymptomatic infection and low virus load. The evidence suggests that this is an instance of human-to-animal transmission of SARS-COV-2. It is likely that we could see similar events in other infected households. We do not have information yet on whether this virus can cause illness in dogs but no specific signs were seen in this dog. Whether infected dogs could transmit the virus to other animals or back to humans remains unknown. In this case it did not appear to have occurred.

scholarly journals A prospective study of asymptomatic SARS-CoV-2 infection among individuals involved in academic research under limited operations during the COVID-19 pandemic

2021 ◽  
Author(s):  
Audrey Pettifor ◽  
Bethany L DiPrete ◽  
Bonnie E Shook-Sa ◽  
Lakshmanane Premkumar ◽  
Kriste Kuczynski ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Academic Research ◽  
Asymptomatic Infection ◽  
Transmission Risk ◽  
Future Research ◽  
Rt Pcr ◽  
Serological Tests ◽  
Kaplan Meier ◽  
Asymptomatic Individuals ◽  
A Prospective Study

Background: Early in the pandemic, transmission risk from asymptomatic infection was unclear making it imperative to monitor infection in workplace settings. Further, data on SARS-CoV-2 seroprevalence within university populations has been limited. Methods: We performed a longitudinal study of University research employees on campus July-December 2020. We conducted questionnaires on COVID-19 risk factors, RT-PCR testing, and SARS-CoV-2 serology using an in-house spike RBD assay, laboratory-based Spike NTD assay, and standard nucleocapsid platform assay. We estimated prevalence and cumulative incidence of seroconversion with 95% confidence intervals using the inverse of the Kaplan-Meier estimator. Results: 910 individuals were included in this analysis. At baseline, 6.2% (95% CI 4.29-8.19) were seropositive using the spike RBD assay; four (0.4%) were seropositive using the nucleocapsid assay, and 44 (4.8%) using the Spike NTD assay. Cumulative incidence was 3.61% (95% CI: 2.04-5.16). Six asymptomatic individuals had positive RT-PCR results. Conclusions: Prevalence and incidence of SARS-CoV-2 infections was low; however differences in target antigens of serological tests provided different estimates. Future research on appropriate methods of serological testing in unvaccinated and vaccinated populations is needed. Frequent RT-PCR testing of asymptomatic individuals is required to detect acute infections, and repeated serosurveys are beneficial for monitoring subclinical infection.

scholarly journals Predictors of SARS CoV-2 Infection Among Healthcare Workers: The Impact of Community-Hospital Gradient

2021 ◽  
Author(s):  
Fatihan Pinarlik ◽  
Zeliha Akbulut ◽  
Mahir Kapmaz ◽  
Suda Tekin ◽  
Onder Ergonul
Keyword(s):  
Healthcare Workers ◽  
Community Hospital ◽  
Increased Risk ◽  
Study Results ◽  
Hospital Infection Control ◽  
Household Members ◽  
Increasing Risk ◽  
Polymerase Chain ◽  
Antibody Levels ◽  
The Impact

Aim: We aimed to detect the risk factors for SARS-CoV-2 infection among healthcare workers (HCWs) in 2020, before vaccination era. Methods: We surveyed the SARS-CoV-2 infection among the HCWs in a hospital by screening of antibody levels and detection of viral RNA by reverse transcription polymerase chain reaction (RT-PCR) between May 2020 to December 2020. Occupational and non-occupational potential predictors of disease were surveyed for the HCWs included in this study. Results: Among 1925 personnel in the hospital, 1732 were included to the study with the response rate of 90%. Overall seroprevalence was 15% at the end of 2020, before vaccinations started. In multivariate analysis, being janitorial staff (OR:2.24, CI:1.21-4.14, p=0.011), being medical secretary (OR: 4.17, CI: 2.12-8.18, p<0.001), having at least one household member with COVID-19 diagnosis (OR:8.98, CI: 6.64-12.15, p<0.001) and number of household members >3 (OR:1.67, CI:1.26-2.22, p<0.001) were found to be significantly associated with SARS-CoV-2 infection. Conclusion: By the end of 2020, just before the era of vaccination and variants, seroprevalence was 15% among HCWs. Medical secretary and janitorial staff were under increased risk of SARS-CoV-2 infection. Community-hospital gradient can explain the mode of transmission for infection among HCWs. In the setting of this study, community measures were less strict, whereas hospital infection control was adequate and provided necessary personal protective equipment. Increasing risk in larger households and households with diagnosed COVID-19 patient indicates community acquired transmission of the infection.

scholarly journals Reducing COVID-19 quarantine with SARS-CoV-2 testing: a simulation study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050473
Author(s):  
Bo Peng ◽  
Wen Zhou ◽  
Rowland W Pettit ◽  
Patrick Yu ◽  
Peter G Matos ◽  
...  
Keyword(s):  
Optimal Strategies ◽  
Cost Effective ◽  
Transmission Risk ◽  
Sensitivity Analyses ◽  
Rt Pcr ◽  
Viral Loads ◽  
Reverse Transcription Pcr ◽  
Highly Sensitive ◽  
Antigen Tests ◽  
The Impact

ObjectiveTo evaluate the effectiveness of SARS-CoV-2 testing on shortening the duration of quarantines for COVID-19 and to identify the most effective choices of testing schedules.DesignWe performed extensive simulations to evaluate the performance of quarantine strategies when one or more SARS-CoV-2 tests were administered during the quarantine. Simulations were based on statistical models for the transmissibility and viral loads of SARS-CoV-2 infections and the sensitivities of available testing methods. Sensitivity analyses were performed to evaluate the impact of perturbations in model assumptions on the outcomes of optimal strategies.ResultsWe found that SARS-CoV-2 testing can effectively reduce the length of a quarantine without compromising safety. A single reverse transcription-PCR (RT-PCR) test performed before the end of quarantine can reduce quarantine duration to 10 days. Two tests can reduce the duration to 8 days, and three highly sensitive RT-PCR tests can justify a 6-day quarantine. More strategic testing schedules and longer quarantines are needed if tests are administered with less-sensitive RT-PCR tests or antigen tests. Shorter quarantines can be used for applications that tolerate a residual postquarantine transmission risk comparable to a 10-day quarantine.ConclusionsTesting could substantially reduce the length of isolation, reducing the physical and mental stress caused by lengthy quarantines. With increasing capacity and lowered costs of SARS-CoV-2 tests, test-assisted quarantines could be safer and more cost-effective than 14-day quarantines and warrant more widespread use.

scholarly journals Detection of diarrhoea associated rotavirus and co-infection with diarrhoeagenic pathogens in the Littoral region of Cameroon using ELISA, RT-PCR and Luminex xTAG GPP assays

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rahinatou N. Ghapoutsa ◽  
Maurice Boda ◽  
Rashi Gautam ◽  
Valantine Ngum Ndze ◽  
Akongnwi E. Mugyia ◽  
...  
Keyword(s):  
Demographic Data ◽  
Laboratory Diagnosis ◽  
Epidemiological Studies ◽  
Sub Saharan Africa ◽  
Rt Pcr ◽  
Mortality And Morbidity ◽  
Vaccine Introduction ◽  
Littoral Region ◽  
Rotavirus Vaccines ◽  
The Impact

Abstract Background Despite the global roll-out of rotavirus vaccines (RotaTeq/Rotarix / ROTAVAC/Rotasiil), mortality and morbidity due to group A rotavirus (RVA) remains high in sub-Saharan Africa, causing 104,000 deaths and 600,000 hospitalizations yearly. In Cameroon, Rotarix™ was introduced in March 2014, but, routine laboratory diagnosis of rotavirus infection is not yet a common practice, and vaccine effectiveness studies to determine the impact of vaccine introduction have not been done. Thus, studies examining RVA prevalence post vaccine introduction are needed. The study aim was to determine RVA prevalence in severe diarrhoea cases in Littoral region, Cameroon and investigate the role of other diarrheagenic pathogens in RVA-positive cases. Methods We carried out a study among hospitalized children < 5 years of age, presenting with acute gastroenteritis in selected hospitals of the Littoral region of Cameroon, from May 2015 to April 2016. Diarrheic stool samples and socio-demographic data including immunization and breastfeeding status were collected from these participating children. Samples were screened by ELISA (ProSpecT™ Rotavirus) for detection of RVA antigen and by gel-based RT-PCR for detection of the VP6 gene. Co-infection was assessed by multiplexed molecular detection of diarrheal pathogens using the Luminex xTAG GPP assay. Results The ELISA assay detected RVA antigen in 54.6% (71/130) of specimens, with 45, positive by VP6 RT-PCR and 54, positive using Luminex xTAG GPP. Luminex GPP was able to detect all 45 VP6 RT-PCR positive samples. Co-infections were found in 63.0% (34/54) of Luminex positive RVA infections, with Shigella (35.3%; 12/34) and ETEC (29.4%; 10/34) detected frequently. Of the 71 ELISA positive RVA cases, 57.8% (41/71) were fully vaccinated, receiving two doses of Rotarix. Conclusion This study provides insight on RVA prevalence in Cameroon, which could be useful for post-vaccine epidemiological studies, highlights higher than expected RVA prevalence in vaccinated children hospitalized for diarrhoea and provides the trend of RVA co-infection with other enteric pathogens. RVA genotyping is needed to determine circulating rotavirus genotypes in Cameroon, including those causing disease in vaccinated children.

scholarly journals COVID-19 among the inhabitants of the slums in the city of Buenos Aires: a population-based study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044592
Author(s):  
Alejandro Macchia ◽  
Daniel Ferrante ◽  
Gabriel Battistella ◽  
Javier Mariani ◽  
Fernán González Bernaldo de Quirós
Keyword(s):  
Incidence Rate ◽  
Buenos Aires ◽  
Reporting System ◽  
Incidence Rates ◽  
Health Reporting ◽  
Rt Pcr ◽  
Slum Dwellers ◽  
Integrated Health ◽  
The Impact ◽  
The City

ObjectiveTo summarise the unfolding of the COVID-19 epidemic among slum dwellers and different social strata in the city of Buenos Aires during the first 20 weeks after the first reported case.DesignObservational study using a time-series analysis. Natural experiment in a big city.SettingPopulation of the city of Buenos Aires and the integrated health reporting system records of positive RT-PCR for COVID-19 tests.ParticipantsRecords from the Argentine Integrated Health Reporting System for all persons with suspected and RT-PCR-confirmed diagnosis of COVID-19 between 31 January and 14 July 2020.OutcomesTo estimate the effects of living in a slum on the standardised incidence rate of COVID-19, corrected Poisson regression models were used. Additionally, the impact of socioeconomic status was performed using an ecological analysis at the community level.ResultsA total of 114 052 people were tested for symptoms related with COVID-19. Of these, 39 039 (34.2%) were RT-PCR positive. The incidence rates for COVID-19 towards the end of the 20th week were 160 (155 to 165) per 100 000 people among the inhabitants who did not reside in the slums (n=2 841 997) and 708 (674 to 642) among slums dwellers (n=233 749). Compared with the better-off socioeconomic quintile (1.00), there was a linear gradient on incidence rates: 1.36 (1.25 to 1.46), 1.61 (1.49 to 1.74), 1.86 (1.72 to 2.01), 2.94 (2.74 to 3.16) from Q2 to Q5, respectively. Slum dwellers were associated with an incidence rate of 14.3 (13.4 to 15.4).ConclusionsThe distribution of the epidemic is socially conditioned. Slum dwellers are at a much higher risk than the rest of the community. Slum dwellers should not be considered just another risk category but an entirely different reality that requires policies tailored to their needs.

scholarly journals Household transmission and incidence of positive SARS-CoV-2 RT-PCR in symptomatic healthcare workers, clinical course and outcome: a French hospital experience

2020 ◽  
pp. oemed-2020-106866
Author(s):  
Evguenia Krastinova ◽  
Valérie Garrait ◽  
Marie-Thérèse Lecam ◽  
André Coste ◽  
Emmanuelle Varon ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Current Smoker ◽  
Infection Rates ◽  
Rt Pcr ◽  
Living Situation ◽  
Household Transmission ◽  
Occupational Profile ◽  
Household Members ◽  
French Hospital ◽  
At Home

ObjectivesAlthough healthcare workers (HCWs) have been particularly affected by SARS-CoV-2, detailed data remain scarce. In this study, we investigated infection rates, clinical characteristics, occupational exposure and household transmission among all symptomatic HCWs screened by SARS-CoV-2 RT-PCR between 17 March (French lockdown) and 20 April.MethodsSARS-CoV-2 RT-PCR was proposed to symptomatic (new cough or dyspnoea) HCWs at Creteil Hospital in one of the Parisian suburbs most severely affected by COVID-19. Data on occupational profile, living situation and household, together with self–isolation and mask use at home were collected, as well as the number of cases in the household.ResultsThe incidence rate of symptomatic SARS-CoV-2 was estimated to be 5% (110/2188). A total of 110 (35%) of the 314 HCWs tested positive and 9 (8%) were hospitalised. On multivariate analysis, factors independently associated with positive RT-PCR were occupational profile with direct patient facing (OR 3.1, 95% CI 1.1 to 8.8), p<0.03), and presence of anosmia (OR 5.7, 95% CI 3.1 to 10.6), p<0.0001). Being a current smoker was associated with negative RT-PCR (OR 0.3, 95% CI 0.1 to 0.7), p=0.005). Transmission from HCWs to household members was reported in 9 (14%) cases, and 2 deaths occurred. Overall, self-isolation was possible in 52% of cases, but only 31% of HCWs were able to wear a mask at home.ConclusionThis is the first study to report infection rates among HCWs during the peak of the SARS-CoV-2 epidemic in France and the lockdown period, highlighting the risk related to occupational profile and household transmission.

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