scholarly journals Epidemiology and transmission dynamics of COVID-19 in two Indian states

2020 ◽  
Author(s):  
Ramanan Laxminarayan ◽  
Brian Wahl ◽  
Shankar Reddy Dudala ◽  
K Gopal ◽  
Chandra Mohan ◽  
...  
Keyword(s):  
Tamil Nadu ◽  
Andhra Pradesh ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Primary Data ◽  
Indian States ◽  
Middle Income ◽  
Time To Death ◽  
Middle Income Countries

Although most COVID-19 cases have occurred in low-resource countries, there is scarce information on the epidemiology of the disease in such settings. Comprehensive SARS-CoV-2 testing and contact-tracing data from the Indian states of Tamil Nadu and Andhra Pradesh reveal stark contrasts from epidemics affecting high-income countries, with 92.1% of cases and 59.7% of deaths occurring among individuals <65 years old. The per-contact risk of infection is 9.0% (95% confidence interval: 7.5-10.5%) in the household and 2.6% (1.6-3.9%) in the community. Superspreading plays a prominent role in transmission, with 5.4% of cases accounting for 80% of infected contacts. The case-fatality ratio is 1.3% (1.0-1.6%), and median time-to-death is 5 days from testing. Primary data are urgently needed from low- and middle-income countries to guide locally-appropriate control measures.

scholarly journals Epidemiology and transmission dynamics of COVID-19 in two Indian states

Science ◽  
2020 ◽  
Vol 370 (6517) ◽  
pp. 691-697 ◽  
Author(s):  
Ramanan Laxminarayan ◽  
Brian Wahl ◽  
Shankar Reddy Dudala ◽  
K. Gopal ◽  
Chandra Mohan B ◽  
...  
Keyword(s):  
Tamil Nadu ◽  
Andhra Pradesh ◽  
Case Fatality ◽  
Control Measures ◽  
Primary Data ◽  
Demographic Differences ◽  
Indian States ◽  
Low Resource ◽  
High Incidence ◽  
Transmission Pathways

Although most cases of coronavirus disease 2019 (COVID-19) have occurred in low-resource countries, little is known about the epidemiology of the disease in such contexts. Data from the Indian states of Tamil Nadu and Andhra Pradesh provide a detailed view into severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission pathways and mortality in a high-incidence setting. Reported cases and deaths have been concentrated in younger cohorts than would be expected from observations in higher-income countries, even after accounting for demographic differences across settings. Among 575,071 individuals exposed to 84,965 confirmed cases, infection probabilities ranged from 4.7 to 10.7% for low-risk and high-risk contact types, respectively. Same-age contacts were associated with the greatest infection risk. Case fatality ratios spanned 0.05% at ages of 5 to 17 years to 16.6% at ages of 85 years or more. Primary data from low-resource countries are urgently needed to guide control measures.

scholarly journals Climate drivers of plague epidemiology in British India, 1898–1949

2020 ◽  
Vol 287 (1928) ◽  
pp. 20200538
Author(s):  
Warren S. D. Tennant ◽  
Mike J. Tildesley ◽  
Simon E. F. Spencer ◽  
Matt J. Keeling
Keyword(s):  
Predictive Models ◽  
Control Measures ◽  
Climate Data ◽  
British India ◽  
Middle Income ◽  
Middle Income Countries ◽  
Complex Interactions ◽  
The World ◽  
Spatio Temporal

Plague, caused by Yersinia pestis infection, continues to threaten low- and middle-income countries throughout the world. The complex interactions between rodents and fleas with their respective environments challenge our understanding of human plague epidemiology. Historical long-term datasets of reported plague cases offer a unique opportunity to elucidate the effects of climate on plague outbreaks in detail. Here, we analyse monthly plague deaths and climate data from 25 provinces in British India from 1898 to 1949 to generate insights into the influence of temperature, rainfall and humidity on the occurrence, severity and timing of plague outbreaks. We find that moderate relative humidity levels of between 60% and 80% were strongly associated with outbreaks. Using wavelet analysis, we determine that the nationwide spread of plague was driven by changes in humidity, where, on average, a one-month delay in the onset of rising humidity translated into a one-month delay in the timing of plague outbreaks. This work can inform modern spatio-temporal predictive models for the disease and aid in the development of early-warning strategies for the deployment of prophylactic treatments and other control measures.

scholarly journals Two cases of cholera O1 in South Batinah, Oman, April 2019: lessons learned

2019 ◽  
Vol 41 ◽  
pp. e2019033
Author(s):  
Zayid K. Al Mayahi ◽  
Nasser Al-Shaqsi ◽  
Hamid A. Elmutashi ◽  
Ali Al-Dhoyani ◽  
Azza Al Hattali ◽  
...  
Keyword(s):  
Infection Control ◽  
Low Income ◽  
Lessons Learned ◽  
Control Measures ◽  
Care Level ◽  
Middle Income ◽  
Primary Care Level ◽  
Middle Income Countries ◽  
Infection Control Measures ◽  
Detection Point

Cholera represents an ongoing threat to many low-income and middle-income countries, but some cases of cholera even occur in high-income countries. Therefore, to prevent or combat cholera outbreaks, it is necessary to maintain the capacity to rapidly detect cholera cases, implement infection control measures, and improve general hygiene in terms of the environment, water, and food. The 2 cases, 1 imported and 1 secondary, described herein are broadly indicative of areas that require improvement. These cases were missed at the primary health care stage, which should be the first detection point even for unusual diseases such as cholera, and the absence of strict infection control practices at the primary care level is believed to contribute to secondary cases of infection. This report also encourages countries to ensure that rapid diagnostic stool tests are available to enable quick detection, as well as to provide information to people travelling to areas where cholera is endemic.

scholarly journals Experiential learnings from the Nipah virus outbreaks in Kerala towards containment of infectious public health emergencies in India

2020 ◽  
Vol 148 ◽  
Author(s):  
Rima R. Sahay ◽  
Pragya D. Yadav ◽  
Nivedita Gupta ◽  
Anita M. Shete ◽  
Chandni Radhakrishnan ◽  
...  
Keyword(s):  
State Government ◽  
Single Case ◽  
Point Of Care ◽  
Nipah Virus ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Hospital Infection Control ◽  
Kerala State

Abstract Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.

scholarly journals Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Nina Droz ◽  
Yingfen Hsia ◽  
Sally Ellis ◽  
Angela Dramowski ◽  
Mike Sharland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Culture ◽  
Case Fatality Rate ◽  
Bacterial Pathogens ◽  
Meta Analysis ◽  
Case Fatality ◽  
Bloodstream Infections ◽  
Fatality Rate ◽  
Middle Income ◽  
Middle Income Countries

Abstract Background Despite a high mortality rate in childhood, there is limited evidence on the causes and outcomes of paediatric bloodstream infections from low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to characterize the bacterial causes of paediatric bloodstream infections in LMICs and their resistance profile. Methods We searched Pubmed and Embase databases between January 1st 1990 and October 30th 2019, combining MeSH and free-text terms for “sepsis” and “low-middle-income countries” in children. Two reviewers screened articles and performed data extraction to identify studies investigating children (1 month-18 years), with at least one blood culture. The main outcomes of interests were the rate of positive blood cultures, the distribution of bacterial pathogens, the resistance patterns and the case-fatality rate. The proportions obtained from each study were pooled using the Freeman-Tukey double arcsine transformation, and a random-effect meta-analysis model was used. Results We identified 2403 eligible studies, 17 were included in the final review including 52,915 children (11 in Africa and 6 in Asia). The overall percentage of positive blood culture was 19.1% [95% CI: 12.0–27.5%]; 15.5% [8.4–24.4%] in Africa and 28.0% [13.2–45.8%] in Asia. A total of 4836 bacterial isolates were included in the studies; 2974 were Gram-negative (63.9% [52.2–74.9]) and 1858 were Gram-positive (35.8% [24.9–47.5]). In Asia, Salmonella typhi (26.2%) was the most commonly isolated pathogen, followed by Staphylococcus aureus (7.7%) whereas in Africa, S. aureus (17.8%) and Streptococcus pneumoniae (16.8%) were predominant followed by Escherichia coli (10.7%). S. aureus was more likely resistant to methicillin in Africa (29.5% vs. 7.9%), whereas E. coli was more frequently resistant to third-generation cephalosporins (31.2% vs. 21.2%), amikacin (29.6% vs. 0%) and ciprofloxacin (36.7% vs. 0%) in Asia. The overall estimate for case-fatality rate among 8 studies was 12.7% [6.6–20.2%]. Underlying conditions, such as malnutrition or HIV infection were assessed as a factor associated with bacteraemia in 4 studies each. Conclusions We observed a marked variation in pathogen distribution and their resistance profiles between Asia and Africa. Very limited data is available on underlying risk factors for bacteraemia, patterns of treatment of multidrug-resistant infections and predictors of adverse outcomes.

scholarly journals Adoption of Information and Communication Technologies for Early Detection of Breast and Cervical Cancers in Low- and Middle-Income Countries

2016 ◽  
Vol 2 (4) ◽  
pp. 222-234 ◽  
Author(s):  
Jessica M. DiCarlo ◽  
Sricharan Gopakumar ◽  
Preet K. Dhillon ◽  
Suneeta Krishnan
Keyword(s):  
Early Detection ◽  
Cancer Prevention ◽  
Information And Communication Technologies ◽  
Cervical Cancer Prevention ◽  
Primary Data ◽  
Middle Income ◽  
Cervical Cancers ◽  
Middle Income Countries ◽  
Information And Communication ◽  
Low And Middle Income

Purpose In response to the growing burden of breast and cervical cancers, low- and middle-income countries (LMICs) are beginning to implement national cancer prevention programs. We reviewed the literature on information and communication technology (ICT) applications in the prevention of breast and cervical cancers in LMICs to examine their potential to enhance cancer prevention efforts. Methods Ten databases of peer-reviewed and gray literature were searched using an automated strategy for English-language articles on the use of mobile health (mHealth) and telemedicine in breast and cervical cancer prevention (screening and early detection) published between 2005 and 2015. Articles that described the rationale for using these ICTs and/or implementation experiences (successes, challenges, and outcomes) were reviewed. Bibliographies of articles that matched the eligibility criteria were reviewed to identify additional relevant references. Results Of the initial 285 citations identified, eight met the inclusion criteria. Of these, four used primary data, two were overviews of ICT applications, and two were commentaries. Articles described the potential for mHealth and telemedicine to address both demand- and supply-side challenges to cancer prevention, such as awareness, access, and cost, in LMICs. However, there was a dearth of evidence to support these hypotheses. Conclusion This review indicates that there are few publications that reflect specifically on the role of mHealth and telemedicine in cancer prevention and even fewer that describe or evaluate interventions. Although articles suggest that mHealth and telemedicine can enhance the implementation and use of cancer prevention interventions, more evidence is needed.

scholarly journals Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries

2017 ◽  
Vol 47 (16) ◽  
pp. 2906-2917 ◽  
Author(s):  
B. Stubbs ◽  
D. Vancampfort ◽  
N. Veronese ◽  
T. Thompson ◽  
M. Fornaro ◽  
...  
Keyword(s):  
Depressive Episode ◽  
Severe Pain ◽  
Meta Analysis ◽  
Primary Data ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Subsyndromal Depression ◽  
Low And Middle Income

BackgroundDepression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.MethodsCommunity-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.ResultsThe prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83–2.55], 1.45 (95% CI 1.22–1.73), and 2.11 (95% CI 1.87–2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54–4.37).ConclusionDepression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

scholarly journals Contact Tracing is Associated with Lower COVID-19 Case Fatality Rates: Evidence from 40 countries

2020 ◽  
Author(s):  
ABDULLAH YALAMAN ◽  
GOKCE BASBUG ◽  
CEYHUN ELGIN ◽  
ALISON P. GALVANI
Keyword(s):  
Panel Data ◽  
Early Detection ◽  
Medical Care ◽  
Regression Models ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Regression Analyses ◽  
Cross Sectional ◽  
Lower Case

Abstract The coronavirus disease (COVID-19) outbreak has killed over 725,000 people since its emergence in late 2019. As of early August 2020, there has been substantial variability in the policies and intensity of diagnostic efforts between countries. In this paper, we quantitatively evaluate the effectiveness of the national contact tracing policy in decreasing case fatality rates of COVID-19 in 40 countries. Our regression analyses indicate that countries that utilize comprehensive contact tracing have significantly lower case fatality rates. The association of contact tracing policy and case fatality rates is robust and observed in regression models using cross-sectional and panel data, even controlling for the number of tests conducted and non-pharmaceutical control measures adopted by governments. Our results suggest that comprehensive contact tracing is instrumental not only to curtailing transmission but also to reducing case fatality rates by early detection and isolation of secondary cases and ultimately diminishing the burden on the healthcare system and speeding the rate at which infected individuals receive the medical care they need to maximize their chance of recovery.

scholarly journals Impact of contact tracing on COVID-19 mortality: An impact evaluation using surveillance data from Colombia

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0246987
Author(s):  
Andres I. Vecino-Ortiz ◽  
Juliana Villanueva Congote ◽  
Silvana Zapata Bedoya ◽  
Zulma M. Cucunuba
Keyword(s):  
Fixed Effects ◽  
Contact Tracing ◽  
Supply Side ◽  
Fixed Effects Model ◽  
Surveillance Strategy ◽  
Middle Income ◽  
The Public ◽  
Middle Income Countries ◽  
The Impact ◽  
Crucial Part

Background Contact tracing is a crucial part of the public health surveillance toolkit. However, it is labor-intensive and costly to carry it out. Some countries have faced challenges implementing contact tracing, and no impact evaluations using empirical data have assessed its impact on COVID-19 mortality. This study assesses the impact of contact tracing in a middle-income country, providing data to support the expansion and optimization of contact tracing strategies to improve infection control. Methods We obtained publicly available data on all confirmed COVID-19 cases in Colombia between March 2 and June 16, 2020. (N = 54,931 cases over 135 days of observation). As suggested by WHO guidelines, we proxied contact tracing performance as the proportion of cases identified through contact tracing out of all cases identified. We calculated the daily proportion of cases identified through contact tracing across 37 geographical units (32 departments and five districts). Further, we used a sequential log-log fixed-effects model to estimate the 21-days, 28-days, 42-days, and 56-days lagged impact of the proportion of cases identified through contact tracing on daily COVID-19 mortality. Both the proportion of cases identified through contact tracing and the daily number of COVID-19 deaths are smoothed using 7-day moving averages. Models control for the prevalence of active cases, second-degree polynomials, and mobility indices. Robustness checks to include supply-side variables were performed. Results We found that a 10 percent increase in the proportion of cases identified through contact tracing is related to COVID-19 mortality reductions between 0.8% and 3.4%. Our models explain between 47%-70% of the variance in mortality. Results are robust to changes of specification and inclusion of supply-side variables. Conclusion Contact tracing is instrumental in containing infectious diseases. Its prioritization as a surveillance strategy will substantially impact reducing deaths while minimizing the impact on the fragile economic systems of lower and middle-income countries. This study provides lessons for other LMIC.

scholarly journals COVID-19 Mortality and Case-Fatality Rates in Sergipe State, Northeast Brazil, From April to June 2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Paulo R. Martins-Filho ◽  
Adriano A. S. Araújo ◽  
Marco A. O. Góes ◽  
Mércia S. F. de Souza ◽  
Lucindo J. Quintans-Júnior ◽  
...  
Keyword(s):  
Time Lag ◽  
Case Series ◽  
Case Fatality ◽  
Population Data ◽  
Population Based ◽  
Population Characteristics ◽  
Northeast Brazil ◽  
Middle Income ◽  
Middle Income Countries ◽  
Case Series Study

Information on how coronavirus disease 2019 (COVID-19) mortality is related to population characteristics in low- and middle-income countries is still limited. We described the deaths from COVID-19 in Sergipe state, Northeast Brazil, from April 2 to June 27, 2020. For this purpose, we conducted a study composed of (i) a case series study of all deaths due to COVID-19 and (ii) a population-based study to verify the behavior of the mortality and case-fatality rates (CFR) related to COVID-19. Data from 605 deaths due to COVID-19 were used to describe the characteristics of individuals with the disease, as well as the differences in gender, age, and comorbidities. Additionally, population data were extracted to estimate the mortality and CFR by population stratum. We also performed an adjusted CFR analysis including a time lag of 14 days between the onset of symptoms and reporting deaths. Of the 605 patients included in this study, 321 (53.1%) were males and the median age was 67.0 years. Most patients (n = 447, 73.9%) who died from COVID-19 had at least one pre-existing clinical condition. The mortality rate was 29.3 deaths per 100,000 inhabitants and the crude CRF was 2.6% (95% CI 2.4–2.8). CFR was higher in males (3.1%, 95% CI 2.8–3.4; p &lt; 0.001) and people aged ≥60 years (14.2%, 95% CI 13.0–15.6; p = 0.042). About 25% of patients died during the first 24-h post-hospital admission. The adjusted CFR for a 14-day time lag was ~2-fold higher than the crude CFR over the study period.

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