scholarly journals Ratio of asymptomatic COVID-19 cases among ascertained SARS-CoV-2 infections in different regions and population groups in 2020: a systematic review and meta-analysis including 130 123 infections from 241 studies

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049752
Author(s):  
Xiao Chen ◽  
Ziyue Huang ◽  
Jingxuan Wang ◽  
Shi Zhao ◽  
Martin Chi-Sang Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Score Test ◽  
Risk Groups ◽  
Asymptomatic Infection ◽  
Control Measures ◽  
Patient Demographics ◽  
Geographical Regions ◽  
Before And After ◽  
Asymptomatic Infections

IntroductionAsymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.MethodsIn this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command ‘metaprop’ was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).ResultsA total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%–29.1%) and 21.7% (16.8%–27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%–68.9%), children (32.1%, 24.2%–40.5%), and studies reporting screening programmes (36.0%, 24.6%–48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%–51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%–71.6%), followed by America (40.0%, 27.4%–53.3%), Europe (28.1%, 19.0%–38.1%) and Asia (18.1%, 13.2%–23.5%).ConclusionWe approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic.

scholarly journals The Rate of Asymptomatic COVID-19 Infection: A Systematic Review and Meta-analysis Including 12,713 Infections from 136 Studies

2020 ◽  
Author(s):  
Xiao C hen ◽  
Ziyue Huang ◽  
Jingxuan Wang ◽  
Shi Zhao ◽  
Martin CS Wong ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Meta Analysis ◽  
Score Test ◽  
Cost Effective ◽  
Asymptomatic Infection ◽  
Control Measures ◽  
Effective Strategies ◽  
Geographical Regions ◽  
Community Transmission ◽  
Asymptomatic Infections

Abstract Background: Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise pandemic control measures of COVID-19. We aimed to estimate the rate of asymptomatic COVID-19 infection from published studies, and compare this rate among different patient groups. Methods: The electronic databases including Medline, Embase, PubMed, and three Chinese electronic databases (The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, and VIP) were searched. Studies with sample size (or number of subjects) not less than 5 were included. The STATA command ‘Metaprop’ was implemented to conduct meta-analysis for the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence intervals (CIs). Results: A total of 12,713 COVID-19 patients in 136 studies were included in the meta-analysis, including 2,785 asymptomatic infections. The overall rate of asymptomatic infection was 15.1% (95% CI: 12.0%-18.4%). Subgroup analysis showed that the rate was significantly higher in pregnant women (36.3%, 95% CI: 15.7%-59.6%), children (29.4%, 17.4%-42.9%), and studies for screening settings (25.3%, 15.4%-36.5%) conducted on or after 01 March 2020 (27.8%, 15.7%-41.7%). In terms of geographical regions, the rate was the highest in Asia (excluding China) (27.4%, 14.3%-42.6%), followed by Europe (22.7%, 6.3%-44.9%), the US (15.9%, 8.9%-24.3%), and China (13.1%, 10.2%-16.3%). Conclusions: High proportion of asymptomatic infection were observed in pregnant women, children, European residents, screening programmes, and in studies conducted in and after March 2020. Our findings help inform the true burden of COVID-19 among different groups of cases, and provide information on cost-effective strategies of identifying and tracing asymptomatic infections.

scholarly journals What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate, serial interval, and asymptomatic infection

2020 ◽  
Author(s):  
Wee Chian Koh ◽  
Lin Naing ◽  
Muhammad Ali Rosledzana ◽  
Mohammad Fathi Alikhan ◽  
Liling Chaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Attack Rate ◽  
Meta Analysis ◽  
Original Data ◽  
Asymptomatic Infection ◽  
Control Measures ◽  
Transmission Risk ◽  
Contact Tracing ◽  
Random Effects Models ◽  
Serial Interval

Background Current SARS-CoV-2 containment measures rely on the capacity to control person-to-person viral transmission. Effective prioritization of these measures can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of three parameters: (i) secondary attack rate (SAR) in various settings, (ii) clinical onset serial interval (SI), and (iii) the proportion of asymptomatic infection. Methods and Findings We searched PubMed, medRxiv, and bioRxiv databases between January 1, 2020, and May 15, 2020, for articles describing SARS-CoV-2 attack rate, SI, and asymptomatic infection. Studies were included if they presented original data for estimating point estimates and 95% confidence intervals of the three parameters. Random effects models were constructed to pool SAR, mean SI, and asymptomatic proportion. Risk ratios were used to examine differences in transmission risk by setting, type of contact, and symptom status of the index case. Publication and related bias were assessed by funnel plots and Egger's meta-regression test for small-study effects. Our search strategy for SAR, SI, and asymptomatic infection identified 459, 572, and 1624 studies respectively. Of these, 20 studies met the inclusion criteria for SAR, 18 studies for SI, and 66 studies for asymptomatic infection. We estimated the pooled household SAR at 15.4% (95% CI: 12.2%, 18.7%) compared to 4.0% (95% CI: 2.8%, 5.2%) in non-household settings. We observed variation across settings; however, the small number of studies limited power to detect associations and sources of heterogeneity. SAR of symptomatic index cases is significantly higher than cases that were symptom-free at diagnosis (RR 2.55, 95% CI: 1.47, 4.45). Adults appear to be more susceptible to transmission than children (RR 1.40, 95% CI: 1.00, 1.96). The pooled mean SI is estimated at 4.87 days (95% CI: 3.98, 5.77). The pooled proportion of cases who had no symptoms at diagnosis is 25.9% (95% CI: 18.8%, 33.1%). Conclusions Based our pooled estimates, 10 infected symptomatic persons living with 100 contacts would result in 15 additional cases in <5 days. To be effective, quarantine of contacts should occur within 3 days of symptom onset. If testing and tracing relies on symptoms, one-quarter of cases would be missed. As such, while aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, control measures should transition to account for SAR variability across settings. Targeted strategies focusing on high-density enclosed settings may be effective without overly restricting social movement.

scholarly journals Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adineh Jafarzadeh ◽  
Alireza Mahboub-Ahari ◽  
Moslem Najafi ◽  
Mahmood Yousefi ◽  
Koustuv Dalal
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Supply And Demand ◽  
Random Effect ◽  
Effect Sizes ◽  
Household Surveys ◽  
Affective Factors ◽  
Urban Households ◽  
Medical Needs ◽  
Geographical Regions

Abstract Background Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates. Methods Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions. Results From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage. Conclusions Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

scholarly journals How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Peter J Gates ◽  
Rae-Anne Hardie ◽  
Magdalena Z Raban ◽  
Ling Li ◽  
Johanna I Westbrook
Keyword(s):  
Systematic Review ◽  
Medication Error ◽  
Medication Errors ◽  
Meta Analysis ◽  
Error Rates ◽  
Prescribing Error ◽  
Before And After ◽  
Actual Harm ◽  
Computer Based ◽  
Wide Scale

Abstract Objective To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. Materials and Methods We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. Results There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. Discussion and Conclusion Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

scholarly journals Evaluating the effectiveness of measures to control the novel coronavirus disease 2019 in Jilin Province, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qinglong Zhao ◽  
Yao Wang ◽  
Meng Yang ◽  
Meina Li ◽  
Zeyu Zhao ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Good Control ◽  
Asymptomatic Infection ◽  
Jilin Province ◽  
Control Measures ◽  
First Case ◽  
Before And After ◽  
Novel Coronavirus ◽  
Reported Data ◽  
And Control

Abstract Background Based on differences in populations and prevention and control measures, the spread of new coronary pneumonia in different countries and regions also differs. This study aimed to calculate the transmissibility of coronavirus disease 2019 (COVID-19), and to evaluate the effectiveness of measures to control the disease in Jilin Province, China. Methods The data of reported COVID-19 cases were collected, including imported and local cases from Jilin Province as of March 14, 2019. A Susceptible–Exposed–Infectious–Asymptomatic–Recovered/Removed (SEIAR) model was developed to fit the data, and the effective reproduction number (Reff) was calculated at different stages in the province. Finally, the effectiveness of the measures was assessed. Results A total of 97 COVID-19 infections were reported in Jilin Province, among which 45 were imported infections (including one asymptomatic infection) and 52 were local infections (including three asymptomatic infections). The model fit the reported data well (R2 = 0.593, P < 0.001). The Reff of COVID-19 before and after February 1, 2020 was 1.64 and 0.05, respectively. Without the intervention taken on February 1, 2020, the predicted cases would have reached a peak of 177,011 on October 22, 2020 (284 days from the first case). The projected number of cases until the end of the outbreak (on October 9, 2021) would have been 17,129,367, with a total attack rate of 63.66%. Based on the comparison between the predicted incidence of the model and the actual incidence, the comprehensive intervention measures implemented in Jilin Province on February 1 reduced the incidence of cases by 99.99%. Therefore, according to the current measures and implementation efforts, Jilin Province can achieve good control of the virus’s spread. Conclusions COVID-19 has a moderate transmissibility in Jilin Province, China. The interventions implemented in the province had proven effective; increasing social distancing and a rapid response by the prevention and control system will help control the spread of the disease.

scholarly journals Movement Patterns and Muscular Function Before and After Onset of Sports-Related Groin Pain: A Systematic Review with Meta-analysis

2016 ◽  
Vol 46 (12) ◽  
pp. 1847-1867 ◽  
Author(s):  
Paulina Kloskowska ◽  
Dylan Morrissey ◽  
Claire Small ◽  
Peter Malliaras ◽  
Christian Barton
Keyword(s):  
Systematic Review ◽  
Groin Pain ◽  
Meta Analysis ◽  
Movement Patterns ◽  
Before And After ◽  
Muscular Function

Global epidemiology of SARS-CoV-2 infection: a systematic review and meta-analysis of standardized population-based seroprevalence studies, Jan 2020-Oct 2021

2021 ◽  
Author(s):  
Isabel Bergeri ◽  
Mairead Whelan ◽  
Harriet Ware ◽  
Lorenzo Subissi ◽  
Anthony Nardone ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Grey Literature ◽  
Population Based ◽  
Control Measures ◽  
Middle Income ◽  
Global Epidemiology ◽  
Using Data ◽  
Demographic Subgroups ◽  
Over Time

Background COVID-19 case data underestimates infection and immunity, especially in low- and middle-income countries (LMICs). We meta-analyzed standardized SARS-CoV-2 seroprevalence studies to estimate global seroprevalence. Objectives/Methods We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence studies aligned with the WHO UNITY protocol published between 2020-01-01 and 2021-10-29. Eligible studies were extracted and critically appraised in duplicate. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate under-ascertainment; meta-analyzed differences in seroprevalence between demographic subgroups; and identified national factors associated with seroprevalence using meta-regression. PROSPERO: CRD42020183634. Results We identified 396 full texts reporting 736 distinct seroprevalence studies (41% LMIC), including 355 low/moderate risk of bias studies with national/sub-national scope in further analysis. By April 2021, global SARS-CoV-2 seroprevalence was 26.1%, 95% CI [24.6-27.6%]. Seroprevalence rose steeply in the first half of 2021 due to infection in some regions (e.g., 18.2% to 45.9% in Africa) and vaccination and infection in others (e.g., 11.3% to 57.4% in the Americas high-income countries), but remained low in others (e.g., 0.3% to 1.6% in the Western Pacific). In 2021 Q1, median seroprevalence to case ratios were 1.9:1 in HICs and 61.9:1 in LMICs. Children 0-9 years and adults 60+ were at lower risk of seropositivity than adults 20-29. In a multivariate model using data pre-vaccination, more stringent public health and social measures were associated with lower seroprevalence. Conclusions Global seroprevalence has risen considerably over time and with regional variation, however much of the global population remains susceptible to SARS-CoV-2 infection. True infections far exceed reported COVID-19 cases. Standardized seroprevalence studies are essential to inform COVID-19 control measures, particularly in resource-limited regions.

scholarly journals Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241536 ◽  
Author(s):  
Mercedes Yanes-Lane ◽  
Nicholas Winters ◽  
Federica Fregonese ◽  
Mayara Bastos ◽  
Sara Perlman-Arrow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Asymptomatic Infection ◽  
Transmission Potential

scholarly journals Effect of electroconvulsive therapy on hippocampal and amygdala volumes: systematic review and meta-analysis

2018 ◽  
Vol 212 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Akihiro Takamiya ◽  
Jun Ku Chung ◽  
Kuo-ching Liang ◽  
Ariel Graff-Guerrero ◽  
Masaru Mimura ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electroconvulsive Therapy ◽  
Animal Studies ◽  
Brain Volume ◽  
Meta Analysis ◽  
Brain Structures ◽  
Volume Increase ◽  
Left Hippocampus ◽  
Before And After ◽  
Underlying Mechanisms

BackgroundElectroconvulsive therapy (ECT) is one of the most effective treatments for depression, although the underlying mechanisms remain unclear. Animal studies have shown that electroconvulsive shock induced neuroplastic changes in the hippocampus.AimsTo summarise volumetric magnetic resonance imaging studies investigating the effects of ECT on limbic brain structures.MethodA systematic review and meta-analysis was conducted to assess volumetric changes of each side of the hippocampus and amygdala before and after ECT. Standardised mean difference (SMD) was calculated.ResultsA total of 8 studies (n = 193) were selected for our analyses. Both right and left hippocampal and amygdala volumes increased after ECT. Meta-regression analyses revealed that age, percentage of those responding and percentage of those in remission were negatively associated with volume increases in the left hippocampus.ConclusionsECT increased brain volume in the limbic structures. The clinical relevance of volume increase needs further investigation.Declaration of interestNone.

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