ABSTRACT
Introduction les objectifs de ce travail étaient de décrire le profil clinique et épidémiologique des décès COVID-19 en Tunisie notifié à l´ONMNE (Observatoire National des Maladies Nouvelles et Émergentes) entre le 02 mars 2020 et le 28 février 2021 et de comparer la mortalité COVID-19 enregistrée en Tunisie aux données internationales. Méthodes nous avons mené une étude nationale descriptive longitudinale prospective auprès des données colligées à travers le système national de surveillance de l´infection au SARS-CoV-2 de l´ONMNE, Ministère de la Santé. Tous les décès COVID-19 survenus en Tunisie entre mars 2020 et février 2021 ont été inclus dans cette étude. Les données ont été colligées auprès des structures hospitalières, des municipalités et des directions régionales de la santé. Les notifications des décès ont été collectées à travers différentes sources d´information (méthode de triangulation): les directions régionales de santé, Le ShocRoom (Strategic Health Operations Center ou Centre stratégique d´opérations sanitaires), les structures sanitaires publiques et privés, la Cellule de Crise de la Présidence du Gouvernement, La Direction d´Hygiène et de protection de l´Environnement, le Ministère des Affaires Locales et de l´Environnement, dans le cadre de suivi des cas confirmés par l´équipe de l´ONMNE, les résultats RT-PCR/TDR positifs en post mortem. Résultats durant la période de l´étude, 8051 décès ont été enregistrés soit une mortalité proportionnelle de 10,4%. L´âge médian était de 73 ans avec un intervalle interquartile de 17 ans. Le sex-ratio (M/F) était de 1,8. Le taux brut de mortalité était de 69,1/100 000 habitants et la létalité était de 3,5%. L´étude de la courbe épidémique a montré 2 pics de décès le 29 octobre 2020 et le 22 janvier 2021 avec respectivement 70 et 86 décès notifiés. La distribution spatiale des décès a montré que la région du Sud tunisien avait enregistré le taux de mortalité le plus élevé. Les patients âgés de 65 ans et plus étaient les plus concernés (73,7% des cas) avec un taux brut de mortalité de 570,9/100 000 habitants et une létalité de 13,7%. Conclusion la stratégie de prévention basée sur les mesures de santé publique doit être renforcées par le déploiement rapide de la vaccination anti-COVID-19 surtout pour les populations à risque de décès.
ABSTRACT
Introduction: the purpose of this study was to describe the clinical and epidemiological features of COVID-19-related deaths in Tunisia notified at the ONMNE (National Observatory of New and emerging Diseases) between 2nd March 2020 and 28th February 2021 and to compare COVID-19-related deaths recorded in Tunisia with the international data. Methods: we conducted a national prospective longitudinal descriptive study of data collected from the National Surveillance System of SARS-CoV-2 infection of the ONMNE, Ministry of Health. All COVID-19-related deaths that occurred in Tunisia between March 2020 and February 2021 were included in this study. Data were collected from hospitals, municipalities and regional health departments. Death notifications were collected from multiple data sources (triangulation): The Regional Directorate of Basic Health Care, the ShocRoom (Strategic Health Operations Center), public and private health facilities, the Crisis Unit of the Presidency of the Government, the Directorate for Hygiene and Environmental Protection, the Ministry of Local Affairs and the Environment, as part of the follow-up of confirmed cases by the ONMNE team, positive RT-PCR / TDR post mortem results. Results: during this study, 8051 deaths were recorded, corresponding to a proportional mortality of 10.4%. The median age was 73 years, with an interquartile range of 17 years. Sex-ratio (M/F) was 1.8. The crude death rate was 69.1/100 000 inhabitants and fatality rate was 3.5%. The analysis of the epidemic curve showed 2 peaks of deaths on 29th October 2020 and 22nd January 2021, with 70 and 86 deaths notified respectively. The spatial distribution of mortality showed that the southern Tunisian region had the highest mortality rate. Patients aged 65 and over were most affected (73.7% of cases) with a crude mortality rate of 570.9/100,000 inhabitants and a fatality rate of 13.7%. Conclusion: prevention strategy based on public health measures must be reinforced by the rapid deployment of anti-COVID-19 vaccination, especially for people at risk of death.
Subject(s)
COVID-19 , Humans , Adolescent , Tunisia/epidemiology , Prospective Studies , SARS-CoV-2 , Public HealthABSTRACT
BACKGROUND: This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained). METHODS: Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs. RESULTS: Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was low in infection control, and PH laboratories. KAP mean scores for intermediate level attendees are comparable to advanced level. CONCLUSIONS: FETP-trained are having better KAP than non-FETP PHWs. Expanding the intermediate level, maintain the Rapid Response training and introduce the laboratory component are recommended to maximize the benefit from FETP. Infection control, antimicrobial resistance and coordination are areas where training should include.
Subject(s)
COVID-19 , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Humans , Male , Pandemics , Public Health , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
BACKGROUND: A wide range of neurological manifestations has been described in COVID-19. METHODS: In this nationwide retrospective observational study, patients in Tunisia diagnosed with COVID-19 between the 2nd of March and the 16th of May 2020 were contacted by telephone. We collected demographic and clinical data and specified characteristics and evolution of main neurological symptoms. RESULTS: Of 1034 confirmed COVID-19 patients, 646 were included (mean age 42.17 years old) and 466 (72.1%) had neurological symptoms. Neurological symptoms were isolated 22.7% (n = 106). Headache was the most frequent neurological symptom (n = 279, 41.1%): mainly frontotemporal (n = 143, 51.1%) and mild or moderate (n = 165, 59.1%). When associated with fever (n = 143, 51.3%), headache was more likely to be severe and present at onset. Recovery was reported in 83.2%. Smell and taste impairment were found in 37.9% (n = 245) and 36.8% (n = 238) respectively. Among them, 65.3% (156/239) were anosmic and 63.2% (146/231) were ageusic. A complete improvement was found in 72.1% (174/240) of smell impairment and in 76.8% (179/233) of taste impairment. Myalgia (n = 241, 37.3%) and sleep disturbances (n = 241, 37.3%) were also frequent. Imported cases had more neurological symptoms (p = 0.001). In 14.5%, neurological symptoms preceded the respiratory signs (RS). RS were associated with more frequent (p = 0.006) and numerous (p < 0.001) neurological symptoms. CONCLUSIONS: Neurological symptoms in COVID-19 are frequent, can be isolated and present at onset. A total recovery is the most recorded outcome. RS are predictive of neurological symptoms. Studies in to virus and host genetics should be considered to understand the different phenotypes.
Subject(s)
Ageusia/etiology , COVID-19/complications , Headache/etiology , Myalgia/etiology , Olfaction Disorders/etiology , Sleep Wake Disorders/etiology , Adult , Aged , Ageusia/epidemiology , Ageusia/physiopathology , COVID-19/epidemiology , Female , Headache/epidemiology , Headache/physiopathology , Humans , Male , Middle Aged , Myalgia/epidemiology , Olfaction Disorders/epidemiology , Olfaction Disorders/physiopathology , Retrospective Studies , Sleep Wake Disorders/epidemiology , Tunisia/epidemiology , Young AdultABSTRACT
The aim of this study is to test a pooling approach for the RT-PCR test to detect low viral loads of SARS-CoV-2. We found that a single positive specimen can still be detected in pools of up to 10. Each laboratory should conduct its own evaluation and validation of pooling protocols according to its specific context.