Transmissibility and pathogenicity of the severe acute respiratory syndrome coronavirus 2: A systematic review and meta-analysis of secondary attack rate and asymptomatic infection.

BACKGROUND: Understanding the transmissibility and pathogenicity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is crucial for control policies, but evidence remains limited. METHODS: We presented a systematic and meta-analytic summary concerning the transmissibility and pathogenicity of COVID-19. RESULTS: A total of 105 studies were identified, with 35042 infected cases and 897912 close contacts. 48.6% (51/105) of studies on secondary transmissions were from China. We estimated a total SIR of 7.8% (95% confidence interval [CI], 6.8%-8.8%), SAR of 6.6% (95% CI, 5.7%-7.5%), and symptomatic infection ratio of 86.9% (95%CI, 83.9%-89.9%) with a disease series interval of 5.84 (95%CI, 4.92-6.94) days. Household contacts had a higher risk of both symptomatic and asymptomatic infection, and transmission was driven between index cases and second-generation cases, with little transmission occurring in second-to-later-generation cases (SIR, 12.4% vs. 3.6%). The symptomatic infection ratio was not significantly different in terms of infection time, generation, type of contact, and index cases. CONCLUSIONS: Our results suggest a higher risk of infection among household contacts. Transmissibility decreased with generations during the intervention. Pathogenicity of SARS-CoV-2 varied among territories, but didn't change over time. Strict isolation and medical observation measures should be implemented.

Cost-Effectiveness of Public Health Measures to Control COVID-19 in China: A Microsimulation Modeling Study.

This study aimed to assess the cost-effectiveness of various public health measures in dealing with coronavirus disease 2019 (COVID-19) in China. A stochastic agent-based model was used to simulate the progress of the COVID-19 outbreak in scenario I (imported one case) and scenario II (imported four cases) with a series of public health measures. The main outcomes included the avoided infections and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to assess uncertainty. The results indicated that isolation-and-quarantine averted the COVID-19 outbreak at the lowest ICERs. The joint strategy of personal protection and isolation-and-quarantine averted one more case than only isolation-and-quarantine with additional costs. The effectiveness of isolation-and-quarantine decreased with lowering quarantine probability and increasing delay time. The strategy that included community containment would be cost-effective when the number of imported cases was >65, or the delay time of the quarantine was more than 5 days, or the quarantine probability was below 25%, based on current assumptions. In conclusion, isolation-and-quarantine was the most cost-effective intervention. However, personal protection combined with isolation-and-quarantine was the optimal strategy for averting more cases. The community containment could be more cost-effective as the efficiency of isolation-and-quarantine drops and the imported cases increases.

Delays in routine childhood vaccinations and their relationship with parental vaccine hesitancy: a cross-sectional study in Wuxi, China.

OBJECTIVES: This study aimed to examine childhood vaccination delay, explore the association between vaccination delay and parental vaccine hesitancy, and assess childhood vaccination delays during the coronavirus disease (COVID)-19 pandemic in China. METHODS: This cross-sectional survey was conducted in Wuxi City. Participants were recruited from local vaccination clinics. Questionnaires were used to collect information about socio-demographics, vaccine hesitancy, and immunization clinic evaluations. Vaccination records were obtained from the Jiangsu Information Management System of Vaccination Cases. RESULTS: Overall, 2728 participants were included. The coverage for seven category A vaccines (Expanded Program on Immunization (EPI)) was more than 95% at 24 months. The proportion of children vaccinated in a timely manner was the highest for the first dose of the hepatitis B vaccine (91.6%) and the lowest for the Bacillus-Calmette-Guerin vaccine (44.6%). More than 50% of the planned vaccinations were delayed in February and March 2020. The Vaccine Hesitancy Scale scores were not associated with vaccination delay (P = 0.842). Children's vaccination delays were negatively associated with parents who reported convenient access to clinics and satisfaction with immunization services (P = 0.020, P = 0.045). CONCLUSIONS: EPI is highly successful in China. Despite vaccination delays due to the COVID-19 pandemic, coverage was recovered after lockdown restrictions were eased.

Reporting of coronavirus disease 2019 prognostic models: the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis statement.

Evaluation of the validity and applicability of published prognostic prediction models for coronavirus disease 2019 (COVID-19) is essential, because determining the patients' prognosis at an early stage may reduce mortality. This study was aimed to utilize the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) to report the completeness of COVID-19-related prognostic models and appraise its effectiveness in clinical practice. A systematic search of the Web of Science and PubMed was performed for studies published until August 11, 2020. All models were assessed on model development, external validation of existing models, incremental values, and development and validation of the same model. TRIPOD was used to assess the completeness of included models, and the completeness of each item was also reported. In total, 52 publications were included, including 67 models. Age, disease history, lymphoma count, history of hypertension and cardiovascular disease, C-reactive protein, lactate dehydrogenase, white blood cell count, and platelet count were the commonly used predictors. The predicted outcome was death, development of severe or critical state, survival time, and length-of-hospital stay. The reported discrimination performance of all models ranged from 0.361 to 0.994, while few models reported calibration. Overall, the reporting completeness based on TRIPOD was between 31% and 83% [median, 67% (interquartile range: 62%, 73%)]. Blinding of the outcome to be predicted or predictors were poorly reported. Additionally, there was little description on the handling of missing data. This assessment indicated a poorly-reported COVID-19 prognostic model in existing literature. The risk of over-fitting may exist with these models. The reporting of calibration and external validation should be given more attention in future research.