scholarly journals Broadening symptom criteria improves early case identification in SARS-CoV-2 contacts

2021 ◽  
pp. 2102308
Author(s):  
Hamish Houston ◽  
Seran Hakki ◽  
Timesh D Pillay ◽  
Kieran Madon ◽  
Nieves Derqui-Fernandez ◽  
...  
Keyword(s):  
Sore Throat ◽  
Contact Tracing ◽  
Training Dataset ◽  
Likelihood Ratios ◽  
Case Definitions ◽  
Appetite Loss ◽  
Case Identification ◽  
Time To Detection ◽  
Prospective Longitudinal ◽  
Symptom Criteria

IntroductionThe success of case isolation and contact tracing for the control of SARS-CoV-2 transmission depends on the accuracy and speed of case identification. We assessed whether inclusion of additional symptoms alongside three canonical symptoms (CS) - fever; cough; loss or change in smell or taste – could improve case definitions and accelerate case identification in SARS-CoV-2 contacts.MethodsTwo prospective longitudinal London-based cohorts of community SARS-CoV-2 contacts, recruited within 5 days of exposure, provided independent training and test datasets. Infected and uninfected contacts completed daily symptom diaries from the earliest possible time-points. Diagnostic information gained by adding symptoms to the CS was quantified using likelihood ratios and AUC-ROC. Improvements in sensitivity and time-to-detection were compared to penalties in terms of specificity and number-needed-to-test.ResultsOf 529 contacts within two cohorts, 164 (31%) developed PCR-confirmed infection and 365 (69%) remained uninfected. In the training dataset (n=168), 29% of infected contacts did not report the CS. Four symptoms (sore throat, muscle aches, headache and appetite loss) were identified as early-predictors (EP) which added diagnostic value to the CS. The broadened symptom criterion “≥1 of the CS, or ≥2 of the EP” identified PCR-positive contacts in the test dataset on average 2 days earlier after exposure (p=0.07) than “≥1 of the CS”, with only modest reduction in specificity (5.7%).ConclusionsBroadening symptom criteria to include individuals with at least 2 of muscle aches, headache, appetite loss and sore throat identifies more infections and reduces time-to-detection, providing greater opportunities to prevent SARS-CoV-2 transmission.

scholarly journals Performance of case definitions and clinical predictors for influenza surveillance among patients followed in a rural cohort in Senegal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mamadou Aliou Barry ◽  
Florent Arinal ◽  
Cheikh Talla ◽  
Boris Gildas Hedible ◽  
Fatoumata Diene Sarr ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Sore Throat ◽  
Predictive Value ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Influenza Virus Infection ◽  
Nasal Discharge ◽  
Age Group ◽  
Case Definitions

Abstract Background Influenza is a major cause of morbidity and mortality in Africa. However, a lack of epidemiological data remains for this pathology, and the performances of the influenza-like illness (ILI) case definitions used for sentinel surveillance have never been evaluated in Senegal. This study aimed to i) assess the performance of three different ILI case definitions, adopted by the WHO, USA-CDC (CDC) and European-CDC (ECDC) and ii) identify clinical factors associated with a positive diagnosis for Influenza in order to develop an algorithm fitted for the Senegalese context. Methods All 657 patients with a febrile pathological episode (FPE) between January 2013 and December 2016 were followed in a cohort study in two rural villages in Senegal, accounting for 1653 FPE observations with nasopharyngeal sampling and influenza virus screening by rRT-PCR. For each FPE, general characteristics and clinical signs presented by patients were collected. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for the three ILI case definitions were assessed using PCR result as the reference test. Associations between clinical signs and influenza infection were analyzed using logistic regression with generalized estimating equations. Sore throat, arthralgia or myalgia were missing for children under 5 years. Results WHO, CDC and ECDC case definitions had similar sensitivity (81.0%; 95%CI: 77.0–85.0) and NPV (91.0%; 95%CI: 89.0–93.1) while the WHO and CDC ILI case definitions had the highest specificity (52.0%; 95%CI: 49.1–54.5) and PPV (32.0%; 95%CI: 30.0–35.0). These performances varied by age groups. In children < 5 years, the significant predictors of influenza virus infection were cough and nasal discharge. In patients from 5 years, cough, nasal discharge, sore throat and asthenia grade 3 best predicted influenza infection. The addition of “nasal discharge” as a symptom to the WHO case definition decreased sensitivity but increased specificity, particularly in the pediatric population. Conclusion In summary, all three definitions studies (WHO, ECDC & CDC) have similar performance, even by age group. The revised WHO ILI definition could be chosen for surveillance purposes for its simplicity. Symptomatic predictors of influenza virus infection vary according the age group.

scholarly journals Asian Countries Response and Management against the COVID-19 Pandemic

2020 ◽  
Author(s):  
Shipra Agarwal
Keyword(s):  
Contact Tracing ◽  
Asian Countries ◽  
Social Distancing ◽  
Case Identification ◽  
Disease Spreading ◽  
Novel Coronavirus ◽  
Restrictive Measures

Restrictive measures like social distancing, lockdown, case identification, isolation, contact tracing, and quarantine of exposed people were revealed to the most efficient actions to control the disease spreading. This presents an overview of the presently obtainable information on the strategies and management of this novel coronavirus

scholarly journals Global lessons and Potential strategies in combating COVID-19 pandemic in Ethiopia: Systematic Review

2020 ◽  
Author(s):  
Yimam Getaneh ◽  
Ajanaw Yizengaw ◽  
Sisasy Adane ◽  
Kidist Zealiyas ◽  
Zelalem Abate ◽  
...  
Keyword(s):  
Public Health ◽  
Early Detection ◽  
Public Awareness ◽  
Rapid Test ◽  
International Travel ◽  
Mitigation Strategies ◽  
World Health ◽  
Contact Tracing ◽  
Reference List ◽  
Case Definitions

AbstractBackgroundCoronavirus disease 2019 (COVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). In the absence of treatment for this virus, there is an urgent need to find alternative public health strategies to control the spread. Here, we have conducted an online search for all relevant public health interventions for COVID-19. We then characterize and summarize the global COVID-19 pandemic situation and recommend potential mitigation strategies in the context of Ethiopia.MethodsInitial search of Pub Med central and Google scholar was undertaken followed by analysis of the text words; COVID-19,SARS-CoV-2, Global lessons and Pandemic; A second search using all identified keywords including COVID-19, Epidemiology, Sociocultural, Ethiopia; thirdly, the reference list of all identified reports and articles were searched. Accordingly, of the 1,402 articles, 39 were included in the analysis for this review.ResultCountries COVID-19 mitigation strategies widely varied. The most common global COVID-19 mitigation strategies include; whole of government approach including individual, community and environmental measures, detecting and isolating cases, contact tracing and quarantine, social and physical distancing measures including for mass gatherings and international travel measures. Models revealed that, social and physical distancing alone could prevent the pandemic from 60-95%, if timely and effectively implemented. Moreover, detecting and isolation of cases were found to be crucial while access to testing was found to the global challenge. Individual measures including proper hand washing were also reported to be effective measures in preventing the pandemic. Asymptomatic cases of COVID-19 ranged from 25% to 80% and as a result, countries are revising the case definition for early detection of mild symptomatic cases of COVID-19 with inclusion of Chills, Muscle pain and new loss of taste or smell in addition to Cough, Shortness of breath, Fever and Sore throat. Global reports also revealed that the incubation period of COVID-19 could go to 24 days. Ethiopia is also unique in the aspects of sociocultural prospects while more than 99.3% of the population has a religion. Moreover, 69% of the population is under the age of 29 years old and the health policy in the country focused on prevention and primary health care. All these could be potential entries and opportunities to combat COVID-19 pandemic in the context of Ethiopia.ConclusionWhile recommendations may change depending on the level of outbreak, we conclude that in Most countries have benefited from early interventions and in setups like Africa including Ethiopia where health system capability is limited, community engagement supported by local evidence with strict implementation of social and physical distancing measures is mandatory. Active involvement of religious Institutions and mobilizing youth could be entry to increase public awareness in mitigating COVID-19. Community level case detection could enhance early identification of cases which could be implemented through the health extension program. Isolation and quarantine beyond 14 days could help identify long term carriers of COVID-19. Validation and use of rapid test kits could be vital to increase access for testing. Revision of case definitions for COVID-19 could be important for early detection and identification of mild symptomatic cases.

scholarly journals Antibiotics Used in Covid-19 And Mucormycosis (Black Fungus)

2021 ◽  
Vol 9 (12) ◽  
pp. 1641-1648
Author(s):  
Mr. Chintale Deepak Baliram
Keyword(s):  
Homology Modeling ◽  
Current Knowledge ◽  
Viral Evolution ◽  
Unknown Origin ◽  
International Committee ◽  
Control Measures ◽  
Contact Tracing ◽  
Case Identification ◽  
Health Authorities ◽  
Novel Coronavirus

Abstract: Background: In late December 2019, Chinese health authorities reported an outbreak of pneumonia of unknown origin in Wuhan, Hubei Province. Summary: A few days later, the genome of a novel coronavirus was released. org/t/novel2019-coronavirus-genome/319; Wuhan- Hu-1, GenBank accession No. MN908947) and made publicly available to the scientific community. This novel coronavirus was provisionally named 2019-nCoV, now SARS-CoV-2 according to the Coronavirus Study Group of the International Committee on Taxonomy of Viruses. SARS-CoV-2 belongs to the Coronaviridae family, Betacoronavirus genus, subgenus Sarbecovirus. Since its discovery, the virus has spread globally, causing thousands of deaths and having an enormous impact on our health systems and economies. In this review, we summarize the current knowledge about the epidemiology, phylogenesis, homology modeling, and molecular diagnostics of SARS-CoV-2. Phylogenetic analysis is essential to understand viral evolution, whereas homology modeling is important for vaccine strategies and therapies. Highly sensitive and specific diagnostic assays are key to case identification, contact tracing, identification of the animal source, and implementation of control measures. Keywords: COVID-19 · SARS-CoV-2 · Pandemic · Phylogenesis · Protein modeling · Real-time polymerase chain reaction

scholarly journals Validation of the electronic prescription as a method of measurement of treatment adherence in hypertension

2015 ◽  
Author(s):  
Emilio Marquez-Contreras ◽  
Lourdes López García-Ramos ◽  
Nieves Martell-Claros ◽  
Vicente F Gil-Guillen ◽  
Sara Márquez-Rivero ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Medication Possession Ratio ◽  
Daily Practice ◽  
Adherence Rate ◽  
Likelihood Ratios ◽  
Electronic Prescription ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Prospective Longitudinal ◽  
Electronic Prescriptions

Background. The diagnosis of non-adherence is complex and there are no completely reliable methods that can be used widely in daily practice. The aim of this study was to validate electronic prescriptions as a method of measuring treatment adherence in patients with mild-moderate hypertension. Methods. We conducted a prospective, longitudinal, multicenter study in primary care centers. The study involved 120 patients treated for hypertension and included in the electronic prescription program of the centers. Five visits were made: initial, 6, 12, 18 and 24 months. Adherence was measured using an electronic monitor [medication event monitoring system (MEMS)] and through the electronic prescription program. We calculated the adherence rate (AR) using the MEMS and the electronic prescriptions, with the Medication Possession Ratio (MPR). Adherent patients were considered to be those whose AR was 80-100%. To validate the electronic prescription, its data were compared to the pill count by MEMS (Method of certainty). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and positive (LR+) and negative (LR-) likelihood ratios were calculated. The Kappa concordance index and the area under the ROC curve were also determined. Results. The study was completed by 108 patients (mean age 61.06 years, SD 9.08). Adherence was 77.4% by MEMS (95% CI: 66.8-88%) and 80.4% (95% CI=70.3-90.5) by MPR. At 24 months the sensitivity was 87%, specificity 93.7%, PPV 80%, NPV 96.1%, LR+ 13.8 and LR- 0.1. The K was 0.782 and the AUC was 0.903 (95% CI: 0.817-0.989). Therapeutic complexity was associated with pharmacological non-adherence (OR=1.35, p<0.01). Discussion. The electronic prescription was an excellent method to measure non-adherence in hypertensive patients included in this program for over two years. Therapeutic simplicity improved treatment adherence.

scholarly journals Pooling of Nasopharyngeal Swab Specimens for SARS-CoV-2 detection by RT-PCR

2020 ◽  
Author(s):  
Ignacio Torres ◽  
Eliseo Albert ◽  
David Navarro
Keyword(s):  
Large Population ◽  
Rdrp Gene ◽  
Contact Tracing ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Case Identification ◽  
E Gene ◽  
Sample Pooling ◽  
Community Transmission ◽  
Pcr Targeting

ABSTRACTSystematic testing of large population groups by RT-PCR is mandatory to Covid-19 case identification and contact tracing in order to minimize the likelyhood of resurgence in contagion. Sample pooling for RT-PCR has been effectively used to detect community transmission of SARS CoV-2. Nevertheless, this procedure may decrease the sensitivity of RT-PCR assays due to specimen dilution. We evaluated the efficacy of this strategy for diagnosis of Covid-19 using a sensitive commercially-available RT-PCR targeting SARS CoV-2 E and RdRp genes in a single reaction. A total of 20 mini-pools containing either 5 (n=10) or 10 (n=10) nasopharyngeal exudates collected in universal transport medium were made, each of which including a unique positive NP specimen. Positive specimens yielding CT <32 for the E gene (6 out of 10) or <35.2 for the RdRP gene (7 out of 10) were detected in mini-pools of both sizes. In contrast, most NP samples displaying CTs > 35.8 for the E gene or 35.7 for the RdRP gene remained undetected in mini-pools of 5 specimens (3/4 and 2/3, respectively) or in mini-pools of 10 samples (4/4 and 3/3, respectively.

scholarly journals Implementation of a COVID-19 surveillance programme for healthcare workers in a teaching hospital in an upper-middle-income country

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249394
Author(s):  
Kim Sui Wan ◽  
Peter Seah Keng Tok ◽  
Kishwen Kanna Yoga Ratnam ◽  
Nuraini Aziz ◽  
Marzuki Isahak ◽  
...  
Keyword(s):  
High Risk ◽  
Sore Throat ◽  
Healthcare Worker ◽  
Teaching Hospital ◽  
Healthcare Workers ◽  
Contact Tracing ◽  
Risk Category ◽  
Cross Sectional ◽  
Middle Income ◽  
Surveillance Programme

Introduction The reporting of Coronavirus Disease 19 (COVID-19) mortality among healthcare workers highlights their vulnerability in managing the COVID-19 pandemic. Some low- and middle-income countries have highlighted the challenges with COVID-19 testing, such as inadequate capacity, untrained laboratory personnel, and inadequate funding. This article describes the components and implementation of a healthcare worker surveillance programme in a designated COVID-19 teaching hospital in Malaysia. In addition, the distribution and characteristics of healthcare workers placed under surveillance are described. Material and methods A COVID-19 healthcare worker surveillance programme was implemented in University Malaya Medical Centre. The programme involved four teams: contact tracing, risk assessment, surveillance and outbreak investigation. Daily symptom surveillance was conducted over fourteen days for healthcare workers who were assessed to have low-, moderate- and high-risk of contracting COVID-19. A cross-sectional analysis was conducted for data collected over 24 weeks, from the 6th of March 2020 to the 20th of August 2020. Results A total of 1,174 healthcare workers were placed under surveillance. The majority were females (71.6%), aged between 25 and 34 years old (64.7%), were nursing staff (46.9%) and had no comorbidities (88.8%). A total of 70.9% were categorised as low-risk, 25.7% were moderate-risk, and 3.4% were at high risk of contracting COVID-19. One-third (35.2%) were symptomatic, with the sore throat (23.6%), cough (19.8%) and fever (5.0%) being the most commonly reported symptoms. A total of 17 healthcare workers tested positive for COVID-19, with a prevalence of 0.3% among all the healthcare workers. Risk category and presence of symptoms were associated with a positive COVID-19 test (p<0.001). Fever (p<0.001), cough (p = 0.003), shortness of breath (p = 0.015) and sore throat (p = 0.002) were associated with case positivity. Conclusion COVID-19 symptom surveillance and risk-based assessment have merits to be included in a healthcare worker surveillance programme to safeguard the health of the workforce.

scholarly journals Importance of adequate COVID-19 case definitions in the SARS-CoV-2 pandemic

2021 ◽  
Author(s):  
Isaac Núñez ◽  
Yanink Caro-Vega ◽  
Pablo F. Belaunzarán-Zamudio
Keyword(s):  
Mexico City ◽  
Open Data ◽  
Case Definition ◽  
Contact Tracing ◽  
Suspected Case ◽  
Case Definitions ◽  
Probable Case ◽  
Mexican Government ◽  
Antigen Tests ◽  
Low Sensitivity

Background: Epidemiologic case definitions serve a myriad of purposes during a pandemic, including contact tracing and monitoring disease trends. It is unknown how any COVID-19 case definition fares against the current gold standard of molecular or antigen tests. Methods: We calculated the diagnostic properties of five COVID-19 definitions (three of the Mexican government and two of the WHO) using open data of suspected COVID-19 cases in Mexico City from March 24th 2020 until January 31st 2021. Results: All 1,632,420 people included in the analysis met the WHO suspected case definition (sensitivity 100%, specificity 0%). The WHO probable case definition was met by 1.4%, while the first and second Mexican suspected case had sensitivities of 61 and 62% and specificities of 58 and 62%, respectively. Confirmed case by epidemiological contact had a low sensitivity (33%) but slightly higher specificity (77%). Conclusions: Case definitions should maximize sensitivity, especially in a high-transmission area such as Mexico City. The WHO suspected case definition has the potential for detecting most symptomatic cases. We underline the need for routine evaluation of case definitions as new evidence arises to maximize their usefulness.

scholarly journals SARS-CoV-2 genome datasets analytics for informed infectious disease surveillance

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 919
Author(s):  
Moses Effiong Ekpenyong ◽  
Ifiok James Udo ◽  
Mercy Ernest Edoho ◽  
EnoAbasi Deborah Anwana ◽  
Francis Bukie Osang ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Real Time ◽  
Disease Surveillance ◽  
Emerging Infectious Diseases ◽  
Cost Effective ◽  
Contact Tracing ◽  
Public Healthcare ◽  
Case Definitions ◽  
Smart Healthcare ◽  
Disease Case

Background: The COVID-19 pandemic has ravaged economies, health systems, and lives globally. Concerns surrounding near total economic collapse, loss of livelihood and emotional complications ensuing from lockdowns and commercial inactivity, resulted in governments loosening economic restrictions. These concerns were further exacerbated by the absence of vaccines and drugs to combat the disease, with the fear that the next wave of the pandemic would be more fatal. Consequently, integrating disease surveillance mechanism into public healthcare systems is gaining traction, to reduce the spread of community and cross-border infections and offer informed medical decisions. Methods: Publicly available datasets of coronavirus cases around the globe deposited between December, 2019 and March 15, 2021 were retrieved from GISAID EpiFluTM and processed. Also retrieved from GISAID were data on the different SARS-CoV-2 variant types since inception of the pandemic. Results: Epidemiological analysis offered interesting statistics for understanding the demography of SARS-CoV-2 and helped the elucidation of local and foreign transmission through a history of contact travels. Results of genome pattern visualization and cognitive knowledge mining revealed the emergence of high intra-country viral sub-strains with localized transmission routes traceable to immediate countries, for enhanced contact tracing protocol. Variant surveillance analysis indicates increased need for continuous monitoring of SARS-CoV-2 variants.  A collaborative Internet of Health Things (IoHT) framework was finally proposed to impact the public health system, for robust and intelligent support for modelling, characterizing, diagnosing and real-time contact tracing of infectious diseases. Conclusions: Localizing healthcare disease surveillance is crucial in emerging disease situations and will support real-time/updated disease case definitions for suspected and probable cases. The IoHT framework proposed in this paper will assist early syndromic assessments of emerging infectious diseases and support healthcare/medical countermeasures as well as useful strategies for making informed policy decisions to drive a cost effective, smart healthcare system.

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