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SSRN; 2021.
Preprint in English | SSRN | ID: ppcovidwho-291888


Background: The dynamics of SARS CoV-2 transmission among urban centers in low- and middle-income countries (LMICs) remains poorly understood. We aimed to estimate the seroprevalence of SARS CoV-2 antibodies in Jakarta, Indonesia – the country in Southeast Asia with the highest number of reported cases and deaths, to increase knowledge of SARS CoV-2 transmission in large urban settings in Southeast Asia. Methods: We conducted a population-based serosurvey among individuals aged one year or older across Jakarta’s six districts. A stratified multi-stage sampling design was employed. Samples were stratified by district, slum and non-slum residency, sex, and age-group. Participants were interviewed to collect information on socio-demographic characteristics, weight and height measurements, and a history of COVID-19 diagnosis and/or recent contact. Blood samples were collected and tested for IgG against three different SARS-CoV-2 antigens using the Human IgG Tetracore® FlexImmArray™ SARS-CoV-2 Human IgG test. Seroprevalence was estimated after applying sample weights and adjusting for cluster characteristics. Findings: During March 2021, 4,919 individuals were enrolled in the study. The weighted estimate of seroprevalence was 44·5% (95% CI 42·5-46·5). Seroprevalence was highest among adults 30-49 years old, with higher seroprevalence detected in women and among those with a body mass index that was overweight or obese. Respondents residing in slum areas were 1·3-fold more likely to be seropositive than non-slum residents. We estimated that 4,717,000 of Jakarta’s 10·6 million residents had prior SARS CoV-2 infection. These findings suggest that for every reported confirmed case, approximately 10 infections were undiagnosed or underreported. Interpretation: Approximately one year after the first cases of COVID-19 were confirmed, close to half of Jakarta’s residents have been infected by SARS CoV-2. Urban centers in LMICs remain the places in the world most vulnerable to SARS CoV-2 transmission, as well as its adverse health and social consequences.

Am J Trop Med Hyg ; 103(2): 572-577, 2020 08.
Article in English | MEDLINE | ID: covidwho-459519


The COVID-19 pandemic, caused by SARS-CoV-2, have surpassed 5 million cases globally. Current models suggest that low- and middle-income countries (LMICs) will have a similar incidence but substantially lower mortality rate than high-income countries. However, malaria and neglected tropical diseases (NTDs) are prevalent in LMICs, and coinfections are likely. Both malaria and parasitic NTDs can alter immunologic responses to other infectious agents. Malaria can induce a cytokine storm and pro-coagulant state similar to that seen in severe COVID-19. Consequently, coinfections with malaria parasites and SARS-CoV-2 could result in substantially worse outcomes than mono-infections with either pathogen, and could shift the age pattern of severe COVID-19 to younger age-groups. Enhancing surveillance platforms could provide signals that indicate whether malaria, NTDs, and COVID-19 are syndemics (synergistic epidemics). Based on the prevalence of malaria and NTDs in specific localities, efforts to characterize COVID-19 in LMICs could be expanded by adding testing for malaria and NTDs. Such additional testing would allow the determination of the rates of coinfection and comparison of severity of outcomes by infection status, greatly improving the understanding of the epidemiology of COVID-19 in LMICs and potentially helping to mitigate its impact.

Coronavirus Infections/epidemiology , Malaria/epidemiology , Parasitic Diseases/epidemiology , Pneumonia, Viral/epidemiology , Syndemic , Betacoronavirus , COVID-19 , Coinfection/epidemiology , Coinfection/parasitology , Coinfection/virology , Developing Countries , Humans , Neglected Diseases/epidemiology , Pandemics , SARS-CoV-2 , Tropical Medicine