Our understanding of the global scale of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains incomplete: Routine surveillance data underestimate infection and cannot infer ...on population immunity; there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS-CoV-2 seroprevalence studies, standardized to those described in the World Health Organization's Unity protocol (WHO Unity) for general population seroepidemiological studies, to estimate the extent of population infection and seropositivity to the virus 2 years into the pandemic.
We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between January 1, 2020 and May 20, 2022. The review protocol is registered with PROSPERO (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies-those aligned with the WHO Unity protocol-were extracted and critically appraised in duplicate, with risk of bias evaluated using a modified Joanna Briggs Institute checklist. 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 underascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% low- and middle-income countries LMICs) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/subnational scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vaccination was 59.2%, 95% CI 56.1% to 62.2%. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% 24.6 to 28.8 to 86.7% 84.6% to 88.5% in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% 8.3% to 11.0% in June 2020 to 95.9% 92.6% to 97.8% in December 2021, in European high-income countries HICs). After the emergence of Omicron in March 2022, infection-induced seroprevalence rose to 47.9% 41.0% to 54.9% in Europe HIC and 33.7% 31.6% to 36.0% in Americas HIC. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0 to 9 years and adults 60+ were at lower risk of seropositivity than adults 20 to 29 (p < 0.001 and p = 0.005, respectively). In a multivariable model using prevaccination data, stringent public health and social measures were associated with lower seroprevalence (p = 0.02). The main limitations of our methodology include that some estimates were driven by certain countries or populations being overrepresented.
In this study, we observed that global seroprevalence has risen considerably over time and with regional variation; however, over one-third of the global population are seronegative to the SARS-CoV-2 virus. Our estimates of infections based on seroprevalence far exceed reported Coronavirus Disease 2019 (COVID-19) cases. Quality and standardized seroprevalence studies are essential to inform COVID-19 response, particularly in resource-limited regions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The global surge in the omicron (B.1.1.529) variant has resulted in many individuals with hybrid immunity (immunity developed through a combination of SARS-CoV-2 infection and vaccination). We aimed ...to systematically review the magnitude and duration of the protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against infection and severe disease caused by the omicron variant.
For this systematic review and meta-regression, we searched for cohort, cross-sectional, and case–control studies in MEDLINE, Embase, Web of Science, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, the WHO COVID-19 database, and Europe PubMed Central from Jan 1, 2020, to June 1, 2022, using keywords related to SARS-CoV-2, reinfection, protective effectiveness, previous infection, presence of antibodies, and hybrid immunity. The main outcomes were the protective effectiveness against reinfection and against hospital admission or severe disease of hybrid immunity, hybrid immunity relative to previous infection alone, hybrid immunity relative to previous vaccination alone, and hybrid immunity relative to hybrid immunity with fewer vaccine doses. Risk of bias was assessed with the Risk of Bias In Non-Randomized Studies of Interventions Tool. We used log-odds random-effects meta-regression to estimate the magnitude of protection at 1-month intervals. This study was registered with PROSPERO (CRD42022318605).
11 studies reporting the protective effectiveness of previous SARS-CoV-2 infection and 15 studies reporting the protective effectiveness of hybrid immunity were included. For previous infection, there were 97 estimates (27 with a moderate risk of bias and 70 with a serious risk of bias). The effectiveness of previous infection against hospital admission or severe disease was 74·6% (95% CI 63·1–83·5) at 12 months. The effectiveness of previous infection against reinfection waned to 24·7% (95% CI 16·4–35·5) at 12 months. For hybrid immunity, there were 153 estimates (78 with a moderate risk of bias and 75 with a serious risk of bias). The effectiveness of hybrid immunity against hospital admission or severe disease was 97·4% (95% CI 91·4–99·2) at 12 months with primary series vaccination and 95·3% (81·9–98·9) at 6 months with the first booster vaccination after the most recent infection or vaccination. Against reinfection, the effectiveness of hybrid immunity following primary series vaccination waned to 41·8% (95% CI 31·5–52·8) at 12 months, while the effectiveness of hybrid immunity following first booster vaccination waned to 46·5% (36·0–57·3) at 6 months.
All estimates of protection waned within months against reinfection but remained high and sustained for hospital admission or severe disease. Individuals with hybrid immunity had the highest magnitude and durability of protection, and as a result might be able to extend the period before booster vaccinations are needed compared to individuals who have never been infected.
WHO COVID-19 Solidarity Response Fund and the Coalition for Epidemic Preparedness Innovations.
Knowledge produced by specialized professionals can be shared to promote public understanding and decision-making. During the COVID-19 pandemic, the application, translation, and dissemination of ...specialized knowledge has informed global policy responses and contributed to new vaccine technologies that protect against disease. However, the pandemic has also highlighted the potential impacts that ineffective knowledge dissemination and misinformation can have on health outcomes, which can further deepen health inequities between groups. Preliminary considerations are suggested for ways to foster a culture of knowledge sharing aimed at promoting global health equity.
This study examines the entanglement of empire and intimacy in the anti-Chinese movement of the late nineteenth-century American West. Situating this particular manifestation of race-making against ...the backdrop of nineteenth-century empire building, this article delineates how Euro-Americans pathologized Chinese migrants' sexual practices as contradictory to settler colonial futurity. It reads across Asian American history, the study of American empire, and the history of sexuality, historiographies that have at times woven in and out of conversation with one another, but nonetheless remain discrete.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Implication Statement
The Community Health and Social Medicine (CHASM) Incubator is a social impact venture that gives medical and other health care students the opportunity to develop initiatives ...that sustainably promote health equity for, and in partnership with, community partners and historically marginalized communities. Students learn how to develop projects with project management curricula, are paired with community health mentors, and are given seed micro-financing. As the first community health incubator driven by medical students, CHASM provides a framework for students interested in implementing sustainable solutions to local health disparities which extends the service-learning opportunities offered in existing curricula.
Knowledge produced by specialized professionals can be shared to promote public understanding and decision-making. During the COVID-19 pandemic, the application, translation, and dissemination of ...specialized knowledge has informed global policy responses and contributed to new vaccine technologies that protect against disease. However, the pandemic has also highlighted the potential impacts that ineffective knowledge dissemination and misinformation can have on health outcomes, which can further deepen health inequities between groups. Preliminary considerations are suggested for ways to foster a culture of knowledge sharing aimed at promoting global health equity.
Background: Whole-genome sequencing (WGS) has the potential to improve the understanding of tuberculosis (TB) epidemiology. However, standardized reporting is necessary to enhance the reproducibility ...and interpretation of WGS results in genomic epidemiologystudies of TB to better inform public health decision-making. In 2014, guidelines called STROME-ID were published to provide recommendations for reporting in genomic epidemiology studies. Reporting practices before and after its publication were compared, and the correlation between STROME-ID reporting quality and study-level characteristics were also explored. Methods: This study is registered on PROSPERO (CRD42017064395). MEDLINE, Embase Classic and Embase were searched on May 3, 2017 (updated April 23, 2019). 976 titles and abstracts were screened, with 114 full-texts eligible for inclusion. The proportion of STROME-ID criteria reported was tabulated for each article, and differences in means were compared before and after STROME-ID’s publication date using a t-test. A 6-month lag period after STROME-ID was included to account for articles in-press; sensitivity analyses were also performed. Quasi-Poisson and tobit regression were used to assess whether h-index (HI), journal impact factor (IF), sample size (SS), and geographic region of the senior author’s primary affiliation were correlated with the count and proportion of STROME-ID criteria met. Results: The proportion of applicable criteria met in included articles ranged from 16.3-75.0% (mean 49.9%, ± 11.88%), with no difference between mean proportions of criteria comparing before and after guideline publication. HI was not included in the adjusted regression analysis. Only SS was significantly associated with a greater proportion of STROME-ID criteria met. Conclusion: Reporting quality in genomic epidemiology studies of tuberculosis is variable, despite publication of STROME-ID guidelines. Future studies should investigate factors affecting adherence to these guidelines to improve the value and utility of evidence. Journal endorsement may be needed to support this.
Background
The declaration of Coronavirus disease 2019 (COVID‐19) as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 required rapid implementation of early ...investigations to inform appropriate national and global public health actions.
Methods
The suite of existing pandemic preparedness generic epidemiological early investigation protocols was rapidly adapted for COVID‐19, branded the ‘UNITY studies’ and promoted globally for the implementation of standardized and quality studies. Ten protocols were developed investigating household (HH) transmission, the first few cases (FFX), population seroprevalence (SEROPREV), health facilities transmission (n = 2), vaccine effectiveness (n = 2), pregnancy outcomes and transmission, school transmission, and surface contamination. Implementation was supported by WHO and its partners globally, with emphasis to support building surveillance and research capacities in low‐ and middle‐income countries (LMIC).
Results
WHO generic protocols were rapidly developed and published on the WHO website, 5/10 protocols within the first 3 months of the response. As of 30 June 2021, 172 investigations were implemented by 97 countries, of which 62 (64%) were LMIC. The majority of countries implemented population seroprevalence (71 countries) and first few cases/household transmission (37 countries) studies.
Conclusion
The widespread adoption of UNITY protocols across all WHO regions indicates that they addressed subnational and national needs to support local public health decision‐making to prevent and control the pandemic.
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