scholarly journals Clinical spectrum of coronavirus disease 2019 in Iceland: population based cohort study

BMJ ◽  
2020 ◽  
pp. m4529
Author(s):  
Elias Eythorsson ◽  
Dadi Helgason ◽  
Ragnar Freyr Ingvarsson ◽  
Helgi K Bjornsson ◽  
Lovisa Bjork Olafsdottir ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Case Definition ◽  
Population Screening ◽  
World Health ◽  
Rt Pcr ◽  
Case Definitions ◽  
Presenting Symptoms ◽  
Health Organization

Abstract Objective To characterise the symptoms of coronavirus disease 2019 (covid-19). Design Population based cohort study. Setting Iceland. Participants All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery. Main outcome measures Occurrence of one or more of 19 predefined symptoms during follow-up. Results Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease. Conclusion In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis.

scholarly journals The clinical spectrum of COVID-19: A population-based cohort study in Iceland

2020 ◽  
Author(s):  
Elias Eythorsson ◽  
Dadi Helgason ◽  
Ragnar Freyr Ingvarsson ◽  
Helgi K Bjornsson ◽  
Lovisa Bjork Olafsdottir ◽  
...  
Keyword(s):  
Cohort Study ◽  
Diagnostic Testing ◽  
Population Based ◽  
Case Definition ◽  
Clinical Spectrum ◽  
World Health ◽  
Contact Tracing ◽  
Case Definitions ◽  
Presenting Symptoms ◽  
Health Organization

Background: Previous studies on the epidemiology and clinical characteristics of COVID-19 have generally been limited to hospitalized patients. The aim of this study was to describe the complete clinical spectrum of COVID-19, based on a nationwide cohort with extensive diagnostic testing and a rigorous contact tracing approach. Methods: A population-based cohort study examining symptom progression using prospectively recorded data on all individuals with a positive test (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who were enrolled in a telehealth monitoring service provided to all identified cases in Iceland. Symptoms were systematically monitored from diagnosis to recovery. Results: From January 31 to April 30, 2020, a total of 45,105 individuals (12% of the Icelandic population) were tested for SARS-CoV-2, of whom 1797 were positive, yielding a population incidence of 5 per 1000 individuals. The most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 5.3% of cases reported no symptoms and 3.1% remained asymptomatic during follow-up. In addition, 216 patients (13.8%) and 349 patients (22.3%) did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. The majority (67.5%) of patients had mild symptoms throughout the course of the disease. Conclusion: In the setting of broad access to diagnostic testing, the majority of SARS-CoV-2-positive patients were found to have mild symptoms. Fever and dyspnea were less common than previously reported. A substantial proportion of patients did not meet recommended case definitions at the time of diagnosis.

scholarly journals Nucleic Acid Testing for Diagnosis of Perinatally Acquired Hepatitis C Virus Infection in Early Infancy

2020 ◽  
Author(s):  
Charitha Gowda ◽  
Stephanie Smith ◽  
Linda Crim ◽  
Katherine Moyer ◽  
Pablo J Sánchez ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antibody Test ◽  
Case Definition ◽  
Hcv Rna ◽  
Rt Pcr ◽  
Case Definitions ◽  
Loss To Follow Up ◽  
Perinatally Acquired

Abstract Background Most US children with perinatal hepatitis C virus (HCV) exposure fail to receive the recommended anti-HCV antibody test at age ≥18 months. Earlier testing for viral RNA might facilitate increased screening, but sensitivity of this approach has not been established. We hypothesized that modern HCV-RNA RT-PCR platforms would adequately detect infected infants. Methods Nationwide Children’s Hospital electronic health records from 1/1/2008 to 30/6/2018 were reviewed to identify perinatally exposed infants tested by HCV-RNA RT-PCR at age 2–6 months. Diagnostic performance was determined using a composite case definition: (1) infected children had positive repeat HCV-RNA testing or positive anti-HCV at age ≥24 months; (2) uninfected children lacked these criteria and had negative anti-HCV at age ≥18 months. Results 770 perinatally exposed infants underwent HCV-RNA testing at age 2–6 months. Of these, 28 (3.6%) tested positive; viremia was confirmed in all who underwent repeat testing (n = 27). Among 742 infants with negative HCV-RNA results, 226 received follow-up anti-HCV testing at age ≥18 months, of whom 223 tested negative. Three children had low-positive anti-HCV results at age 18–24 months that were negative upon retesting after age 24 months, possibly indicating waning maternal antibodies. Using the composite case definitions, early HCV-RNA screening demonstrated sensitivity of 100% (87.5–100%, Wilson-Brown 95% CI) and specificity of 100% (98.3–100%). Conclusions Modern HCV-RNA RT-PCR assays have excellent sensitivity for early diagnosis of perinatally acquired infection and could aid HCV surveillance given the substantial loss to follow-up at ≥18 months of age.

scholarly journals New World Health Organization reference values for semen analysis: where do we stand?

2013 ◽  
Vol 11 (2) ◽  
pp. 263-264 ◽  
Author(s):  
Marcelo Vieira
Keyword(s):  
World Health Organization ◽  
Reference Values ◽  
New World ◽  
Semen Analysis ◽  
Population Based ◽  
World Health ◽  
The World ◽  
Health Organization ◽  
References Values

Semen analysis is of paramount importance to study potential male fertility, couple's infertility, the effects of gonadotoxic agents on spermatogenesis and as follow-up test during treatment of male infertility. Since 1987, the World Health Organization proposes the standardization of this test and its reference values based on population-based data. The latest version of the World Health Organization guidelines was published in 2010. It introduced a new methodology that produced new references values, which triggered a discussion that lies inconclusive. We revised the original World Health Organization paper focusing on methodological changes and its results, the new references values and their impact on clinical practice.

scholarly journals Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252267
Author(s):  
U. B. Thulani ◽  
K. C. D. Mettananda ◽  
D. T. D. Warnakulasuriya ◽  
T. S. G. Peiris ◽  
K. T. A. A. Kasturiratne ◽  
...  
Keyword(s):  
Risk Prediction ◽  
Prediction Models ◽  
Medical Officer ◽  
Population Based ◽  
World Health ◽  
Risk Category ◽  
Risk Prediction Models ◽  
Risk Charts ◽  
Health Organization

Introduction and objectives There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. Method We selected 40–64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007–2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. Results Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10–19%, 20%-29%, 30–39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). Conclusions WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.

scholarly journals Incidence and Predictors of Lost to Follow up Among Children Attending ART Clinic at Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Tiruye Menshaw ◽  
Shiferaw Birhanu ◽  
Aklilu Endalamaw ◽  
Tigist Gébermaryam
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort ◽  
World Health ◽  
Loss To Follow Up ◽  
Immunodeficiency Virus ◽  
Health Organization ◽  
Dessie Referral Hospital

Abstract Background: Despite, antiretroviral therapy could reduce the transmission of human immunodeficiency virus and related morbidity, loss to follow up is a main challenge among children living with human immunodeficiency virus. Therefore, the aim of this study was to assess the incidence and predictors of loss to follow up among under 15 years old children attending antiretroviral therapy clinic at Dessie referral hospital, North east Ethiopia.Methods: A ten-year institution based retrospective cohort study was employed among 448 under 15 years’ old children who were enrolled on antiretroviral therapy. Data were entered and cleared using Epi- data version 3.1 and then exported to STATA version 14 for further statistical analysis. Kaplan Meier survival curve was used to estimate the survival time and log rank test was used to compare the survival time between different categories of the explanatory variables. Multivariable Cox proportional hazards model was fitted to identify predictors of loss to follow up and p-value < 0.05 was considered as statically significant.Results: The overall incidence rate of loss to follow up was 6.3 per100 children in years of observation. Being male (AHR=2.1, CI =1.37 ,3.34), age 1-5 years (AHR=1.6, CI=1.05,2.46), poor adherence to antiretroviral therapy (AHR = 6.6; CI=4.11,10.66), fair adherence to antiretroviral therapy (AHR= 2.2; CI = 1.13 ,4.20), regimen was not changed (AHR = 4.1; CI = 2.59 ,6.45), world health organization stage III and IV (AHR= 2.2; CI =1.40, 3.33) and height for age < -2 z score (AHR = 2.2; CI = 1.43, 3.44) were predictors of loss to follow up.Conclusion: The incidence rate of loss to follow was high. Age 1-5 years, world health organization stage III and IV, poor and fair adherence to antiretroviral therapy, regimen was not changed, being male and stunted were higher risk for loss to follow up. Therefore, close monitoring to the higher risk groups for loss to follow up highlighted in this study could decrease the rate of loss to follow up. Improving the adherence of children to antiretroviral therapy and nutritional support for stunted children were also recommended.

Measuring the incidence of adult community-acquired pneumonia in a Native American community

2010 ◽  
Vol 138 (8) ◽  
pp. 1146-1154 ◽  
Author(s):  
J. P. WATT ◽  
J. C. MOÏSI ◽  
R. L. A. DONALDSON ◽  
R. REID ◽  
S. FERRO ◽  
...  
Keyword(s):  
Native American ◽  
Population Based ◽  
Community Acquired Pneumonia ◽  
World Health ◽  
Case Definitions ◽  
Healthcare Facilities ◽  
Clinical Criteria ◽  
Vaccine Trials ◽  
White Mountain Apache ◽  
Health Organization

SUMMARYFew population-based studies have investigated the epidemiology of adult community-acquired pneumonia (CAP). We aimed to determine the incidence of CAP in a population at high-risk for pneumococcal disease and to evaluate a standardized method for interpreting chest radiographs adapted from the World Health Organization paediatric chest radiograph interpretation guidelines. We reviewed radiology records at the two healthcare facilities serving the White Mountain Apache tribe to identify possible pneumonia cases ⩾40 years of age. We categorized patients with clinical criteria and a physician diagnosis of pneumonia as clinical CAP and those with clinical criteria and an acute infiltrate as radiographic CAP. We identified 100 (27/1000 person-years) and 60 (16/1000 person-years) episodes of clinical and radiographic CAP, respectively. The incidence of CAP increased with age. Both radiographic and clinical CAP were serious illnesses with more than half of patients hospitalized. Our case definitions and methods may be useful for comparing data across studies and conducting vaccine trials.

scholarly journals Performance of influenza case definitions for influenza community surveillance: based on the French influenza surveillance network GROG, 2009-2014

2017 ◽  
Vol 22 (14) ◽  
Author(s):  
Jean-Sebastien Casalegno ◽  
Daniel Eibach ◽  
Martine Valette ◽  
Vincent Enouf ◽  
Isabelle Daviaud ◽  
...  
Keyword(s):  
Influenza Infection ◽  
Age Groups ◽  
Case Definition ◽  
World Health ◽  
Influenza Surveillance ◽  
Case Definitions ◽  
Surveillance Network ◽  
Increased Risk ◽  
Influenza Case ◽  
Health Organization

International case definitions recommended by the Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and the World Health Organization (WHO) are commonly used for influenza surveillance. We evaluated clinical factors associated with the laboratory-confirmed diagnosis of influenza and the performance of these influenza case definitions by using a complete dataset of 14,994 patients with acute respiratory infection (ARI) from whom a specimen was collected between August 2009 and April 2014 by the Groupes Régionaux d’Observation de la Grippe (GROG), a French national influenza surveillance network. Cough and fever ≥ 39 °C most accurately predicted an influenza infection in all age groups. Several other symptoms were associated with an increased risk of influenza (headache, weakness, myalgia, coryza) or decreased risk (adenopathy, pharyngitis, shortness of breath, otitis/otalgia, bronchitis/ bronchiolitis), but not throughout all age groups. The WHO case definition for influenza-like illness (ILI) had the highest specificity with 21.4%, while the ECDC ILI case definition had the highest sensitivity with 96.1%. The diagnosis among children younger than 5 years remains challenging. The study compared the performance of clinical influenza definitions based on outpatient surveillance and will contribute to improving the comparability of data shared at international level.

scholarly journals COVID-19 case definitions, diagnostic testing criteria, and surveillance across the pandemic's 25 highest burden countries

2021 ◽  
Author(s):  
Amitabh Suthar ◽  
Sara Schubert ◽  
Julie Garon ◽  
Alexia Couture ◽  
Amy Brown ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Case Definition ◽  
Surveillance Data ◽  
World Health ◽  
Case Definitions ◽  
Microsoft Excel ◽  
Eligibility Criteria ◽  
Health Organization ◽  
Suspect Case ◽  
Testing Criteria

Objective: We compared suspect, probable, and confirmed case definitions, as well as diagnostic testing criteria, used in the COVID-19 pandemic's 25 highest burden countries to aid interpretation of global and national surveillance data. Methods: We identified the COVID-19 pandemic's 25 countries with the highest disease burden based on the number of cumulative reported cases to the World Health Organization (WHO) as of 1 October 2020. We searched official websites of these countries for suspect, probable, and confirmed case definitions. Given that confirmation of COVID-19 usually requires diagnostic testing, we also searched for diagnostic testing eligibility criteria in these countries. Extracted case definitions and testing criteria were managed in a database and analyzed in Microsoft Excel. Findings: We identified suspect, probable, and confirmed case definitions in 96%, 64%, and 100% of countries, respectively. Testing criteria were identified in 100% of countries. 56% of identified countries followed WHO recommendations for using a combination of clinical and epidemiological criteria as part of the suspect case definition. 75% of identified countries followed WHO recommendations on using clinical, epidemiological, and diagnostic criteria for probable cases. 72% of countries followed WHO recommendations on using PCR testing for confirming a case of COVID-19. Finally, 64% of countries used testing eligibility criteria at least as permissive as WHO. Conclusion: There is marked heterogeneity in who is eligible for testing in countries and how countries define a case of COVID-19. This affects the ability to compare burden, transmission, and response impact estimates derived from case surveillance data across countries.

scholarly journals Usefulness of Clinical Definitions of Influenza for Public Health Surveillance Purposes

Viruses ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 95 ◽  
Author(s):  
Domínguez ◽  
Soldevila ◽  
Torner ◽  
Martínez ◽  
Godoy ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Age Groups ◽  
Sudden Onset ◽  
Case Definition ◽  
Sentinel Surveillance ◽  
World Health ◽  
Case Definitions ◽  
Surveillance Network ◽  
Health Organization ◽  
Epidemiological Characteristics

This study investigated the performance of various case definitions and influenza symptoms in a primary healthcare sentinel surveillance system. A retrospective study of the clinical and epidemiological characteristics of the cases reported by a primary healthcare sentinel surveillance network for eleven years in Catalonia was conducted. Crude and adjusted diagnostic odds ratios (aDORs) and 95% confidence intervals (CIs) of the case definitions and symptoms for all weeks and epidemic weeks were estimated. The most predictive case definition for laboratory-confirmed influenza was the World Health Organization (WHO) case definition for ILI in all weeks (aDOR 2.69; 95% CI 2.42–2.99) and epidemic weeks (aDOR 2.20; 95% CI 1.90–2.54). The symptoms that were significant positive predictors for confirmed influenza were fever, cough, myalgia, headache, malaise, and sudden onset. Fever had the highest aDOR in all weeks (4.03; 95% CI 3.38–4.80) and epidemic weeks (2.78; 95% CI 2.21–3.50). All of the case definitions assessed performed better in patients with comorbidities than in those without. The performance of symptoms varied by age groups, with fever being of high value in older people, and cough being of high value in children. In patients with comorbidities, the performance of fever was the highest (aDOR 5.45; 95% CI 3.43–8.66). No differences in the performance of the case definition or symptoms in influenza cases according to virus type were found.

scholarly journals Programme for Harmonization to the International Scale in Latin America for BCR-ABL1 quantification in CML patients: findings and recommendations

2020 ◽  
Vol 58 (12) ◽  
pp. 2025-2035
Author(s):  
María Sol Ruiz ◽  
María Belén Sánchez ◽  
Yuly Masiel Vera Contreras ◽  
Evangelina Agrielo ◽  
Marta Alonso ◽  
...  
Keyword(s):  
Latin America ◽  
Myeloid Leukemia ◽  
World Health ◽  
Molecular Response ◽  
Limit Of Quantification ◽  
International Scale ◽  
Deep Molecular Response ◽  
Health Organization ◽  
First Time

AbstractObjectivesThe quantitation of BCR-ABL1 mRNA is mandatory for chronic myeloid leukemia (CML) patients, and RT-qPCR is the most extensively used method in testing laboratories worldwide. Nevertheless, substantial variation in RT-qPCR results makes inter-laboratory comparability hard. To facilitate inter-laboratory comparative assessment, an international scale (IS) for BCR-ABL1 was proposed.MethodsThe laboratory-specific conversion factor (CF) to the IS can be derived from the World Health Organization (WHO) genetic reference panel; however, this material is limited to the manufacturers to produce and calibrate secondary reference reagents. Therefore, we developed secondary reference calibrators, as lyophilized cellular material, aligned to the IS. Our purpose was both to re-evaluate the CF in 18 previously harmonized laboratories and to propagate the IS to new laboratories.ResultsOur field trial including 30 laboratories across Latin America showed that, after correction of raw BCR-ABL1/ABL1 ratios using CF, the relative mean bias was significantly reduced. We also performed a follow-up of participating laboratories by annually revalidating the process; our results support the need for continuous revalidation of CFs. All participating laboratories also received a calibrator to determine the limit of quantification (LOQ); 90% of them could reproducibly detect BCR-ABL1, indicating that these laboratories can report a consistent deep molecular response. In addition, aiming to investigate the variability of BCR-ABL1 measurements across different RNA inputs, we calculated PCR efficiency for each individual assay by using different amounts of RNA.ConclusionsIn conclusion, for the first time in Latin America, we have successfully organized a harmonization platform for BCR-ABL1 measurement that could be of immediate clinical benefit for monitoring the molecular response of patients in low-resource regions.

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