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1.
Breastfeed Med ; 15(8): 488-491, 2020 08.
Article in English | MEDLINE | ID: covidwho-628894

ABSTRACT

Background: Limited data are available on the perinatal and postnatal transmission of novel coronavirus disease 2019 (COVID-19). The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) recommended breastfeeding with necessary precautions to mothers with COVID-19. Case Presentation: A 20-year-old pregnant woman with no symptoms of COVID-19 presented to the hospital for delivery at 39 weeks of gestation. She was tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) because her father had been diagnosed with COVID-19. A nasopharyngeal swab RT-PCR test was positive for SARS-CoV-2. Therefore, the baby and the mother were cared for separately after delivery. Breast milk obtained after first lactation was tested by real-time RT-PCR and was positive for SARS-CoV-2. Conclusions: In this article, we aimed to report the presence of SARS-CoV-2 in breast milk. Although further studies are needed, this situation may have an impact on breastfeeding recommendations.


Subject(s)
Betacoronavirus/isolation & purification , Breast Feeding , Coronavirus Infections , Infectious Disease Transmission, Vertical/prevention & control , Milk, Human/virology , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Adult , Asymptomatic Diseases/therapy , Breast Feeding/adverse effects , Breast Feeding/methods , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Delivery, Obstetric , Female , Gestational Age , Humans , Infant, Newborn , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology
2.
Rev Inst Med Trop Sao Paulo ; 62: e65, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-750871

ABSTRACT

This narrative review summarizes the main aspects underlying the new coronavirus SARS-CoV-2, its epidemiology, pathophysiology, pointing to differences of SARS-CoV-2 main receptors ACE2, in terms of expression and the amount of soluble ACE2 in the circulation of children, men and women, and also in those with risk factors such as the smokers and pregnant women or presenting with comorbidities (diabetes, obesity, hypertension and other cardiovascular diseases, renal and CNS pre-existing diseases). Clinical manifestations in adults and children were also described, emphasizing the particularities already seen in children, regarding signs, symptoms, viral excretion time and the involvement of all organs and systems. The COVID-19 in the pediatric population was divided into two sections: one dedicated to previously healthy children and adolescents with COVID-19, and the other to those who live with comorbidities and acquired COVID-19. A few paragraphs were reserved to the recently described severe multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) that shares certain characteristics with Kawasaki disease. Some studies on the infection in pregnant and postpartum women, as well as neonates were shown. This review has also covered the laboratory diagnosis of COVID-19, passing through the imaging diagnosis made by the chest tomography revealing ground glass patching opacities, and results of non-specific exams such as the total blood with lymphopenia, the coagulation tests with increased prothrombin times, as well as marked increments of the D-dimer, troponin and proinflammatory cytokines. In the section devoted to the specific laboratory diagnosis of COVID-19, the most used RT-PCR protocols were described and some studies on the serological diagnosis with IgA, IgM and IgG detection were detailed, including the use of rapid immunochromatographic assays and discussing the ideal period after the onset of symptoms to perform each type of test. In the end, the management of pediatric patients with COVID-19 based mainly on supportive measures has been briefly commented.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Adolescent , Adult , Betacoronavirus , Child , Coronavirus Infections/therapy , Female , Humans , Infant, Newborn , Male , Pandemics , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/virology , Systemic Inflammatory Response Syndrome/virology
3.
Afr J Prim Health Care Fam Med ; 12(1): e1-e11, 2020 Aug 24.
Article in English | MEDLINE | ID: covidwho-749161

ABSTRACT

BACKGROUND: Diarrhoea remains a public health problem and an important cause of morbidity and mortality amongst children, mainly in low- and middle-income countries. In Namibia, the national prevalence of diarrhoea was 17%; it was responsible for 5% of all deaths in children under 5 years old and is the second leading cause of death. AIM: The purpose of this study was to assess the epidemiology and factors associated with acute diarrhoea amongst children less than 5 years of age in Engela district in the Ohangwena region, Namibia. SETTING: The study was conducted in Ohangwena Region in Namibia which extends east to west along the borders of the southern part of Angola. METHODS: A cross-sectional study was conducted. A structured questionnaire was administered through face-to-face interviews. Descriptive statistics were used to describe the socio-demographic and epidemiological data of diarrhoea and logistic regression analysis was used to determine the factors associated with the prevalence of diarrhoea. RESULTS: The study found a prevalence of 23.8% for diarrhoea in the 2 weeks period preceding the survey amongst children aged under 5 years. The prevalence of diarrhoea was statistically significantly associated with children (p 0.05). The strongest predictor of the prevalence of diarrhoea was the residential area 'informal settlement', with an odds ratio of 36.42. This implies that children living in the informal settlement are 36.42 times at risk of contracting diarrhoea as compared to those living in other residential areas. CONCLUSION: epidemiology; factors; diarrhoea; under-5 years children; Engela district; Ohangwena region; Namibia.


Subject(s)
Diarrhea/epidemiology , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Male , Namibia/epidemiology , Prevalence , Risk Factors , Socioeconomic Factors
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 582-590, 2020 May 28.
Article in English, Chinese | MEDLINE | ID: covidwho-745318

ABSTRACT

OBJECTIVES: To analyze the regional epidemic features of coronavirus disease 2019 (COVID-19) in Henan Province, China. METHODS: According to the data of COVID-19 patients and the resident population at the end of 2018 in Henan Province, statistical description and analysis of epidemiological characteristics of COVID-19 in Henan Province were conducted, including the time distribution, population distribution, and regional distribution. RESULTS: The cumulative incidence of COVID-19 in Henan Province was 1.32/100 000, the cure rate was 98.03%, and the fatality rate was 1.73% by March 9, 2020. The incidence curve showed that the epidemic peak reached from January 24 to January 28. The high-incidence area was Xinyang, with a standardized cumulative incidence rate of 4.36/100 000. There were 580 female COVID-19 patients (45.60%), 688 males (54.09%) in Henan Province. The incidence of males was 1.41/100 000, while the incidence of females was 1.23/100 000. The age with the highest incidence of COVID-19 in Henan Province was 20-69 years old (88.68%). The incidence rate was highest in men aged 30-39 (2.51/ 100 000), while the lowest rate in women aged 0-9 (0.16/100 000). There were 1 225 local patients (96.31%), and the rural patients (45.73%) were slightly higher than the urban patients (44.02%) in Henan Province. A total of 63.60% patients had traveled or lived in Hubei or contacted with people who came from Hubei to Henan. The proportion of patients whose family members suffered from COVID-19 was 32.70%. Global spatial autocorrelation analysis suggested that there was a statistically significant positive correlation in the spatial distribution of COVID-19 patients in Henan Province (Moran's I=0.248, Z=2.955, P<0.01). CONCLUSIONS: There are differences in the morbidity and mortality of COVID-19 patients in different areas of Henan Province, with epidemic peak reaching from January 24 to January 28. Henan is dominated by local patients, male patients, and patients with contact history in Hubei. The space appears to be moderately clustered.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , Betacoronavirus , Child , Child, Preschool , China/epidemiology , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Spatial Analysis , Young Adult
5.
BMC Pregnancy Childbirth ; 20(1): 511, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-744979

ABSTRACT

BACKGROUND: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. CASE PRESENTATION: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. CONCLUSIONS: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.


Subject(s)
Blood Coagulation Disorders/blood , Cesarean Section , Coronavirus Infections/blood , Liver Diseases/blood , Obesity, Maternal , Pneumonia, Viral/blood , Pregnancy Complications, Infectious/blood , Adult , Antithrombin III/metabolism , Apgar Score , Betacoronavirus , Blood Coagulation Disorders/etiology , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Diagnosis, Differential , Female , Fibrin Fibrinogen Degradation Products/metabolism , HELLP Syndrome/diagnosis , Humans , Infant, Newborn , Infant, Premature , L-Lactate Dehydrogenase/blood , Liver Diseases/etiology , Lung/diagnostic imaging , Male , Pandemics , Partial Thromboplastin Time , Platelet Count , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Sweden , Tomography, X-Ray Computed
6.
BMJ Case Rep ; 13(9)2020 Sep 02.
Article in English | MEDLINE | ID: covidwho-744831

ABSTRACT

On 31 December 2019, the first case of COVID-19, was reported in Wuhan. A public health emergency of international concern was declared on 30 January 2020 and the first case in Scotland, on 2 March. The effect of COVID-19 appears to be less in the paediatric population and there are fewer cases reported in the literature in comparison to the adult population. Here, we report a case of a previously well 5-week-old infant who presented with fever and increased sleepiness. There was no known contact with any unwell individuals. COVID-19 was identified through a septic screen work up. The infant's course was uneventful and she has made a full recovery. This case highlights the need to have a low index of suspicion in the diagnosis of COVID-19 and the need to be vigilant in use of personal protective equipment, even in paediatric patients with subtle symptoms.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Betacoronavirus , Coronavirus Infections/complications , Disorders of Excessive Somnolence/etiology , Fever/etiology , Humans , Infant, Newborn , Male , Pandemics , Pneumonia, Viral/complications , Treatment Outcome
7.
Rev Inst Med Trop Sao Paulo ; 62: e62, 2020.
Article in English | MEDLINE | ID: covidwho-740470

ABSTRACT

The consequences of COVID-19 infecting pregnant women and the potential risks of vertical transmission have become a major issue. Since little is currently known about COVID-19 in pregnancy, the understanding of COVID-19 in this particular group will be updated in time, and a comprehensive review will be useful to evaluate the impact of COVID-19 in pregnancy. Based on recently published literature and official documents, this review provides an introduction to the pathogenesis, pathology, and clinical features of COVID-19 and has focused on the current researches on clinical features, pregnancy outcomes and placental histopathological analysis from pregnant women infected with SARS-CoV-2 in comparison with SARS-CoV and MERS-CoV. These viruses trigger a cytokine storm in the body, produce a series of immune responses, and cause changes in peripheral leukocytes and immune system cells leading to pregnancy complications that may be associated with viral infections. The expression of ACE2 receptors in the vascular endothelium may explain the histological changes of placentas from pregnant women infected by SARS-CoV-2. Pregnant women with COVID-19 pneumonia show similar clinical characteristics compared with non-pregnant counterparts. Although there is no unequivocal evidence to support the fetal infection by intrauterine vertical transmission of SARS, MERS and SARS-CoV-2 so far, more and more articles began to report maternal deaths due to COVID-19. In particular, from February 26, 2020 (date of the first COVID-19 case reported in Brazil) until June 18, 2020, Brazil reported 124 maternal deaths. Therefore, pregnant women and neonates require special attention regarding the prevention, diagnosis and management of COVID-19.


Subject(s)
Betacoronavirus , Pneumonia, Viral , Pregnancy Complications, Infectious/virology , Brazil , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Humans , Infant, Newborn , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Pregnancy
8.
Rev Paul Pediatr ; 38: e2020165, 2020.
Article in Portuguese, English | MEDLINE | ID: covidwho-740454

ABSTRACT

OBJECTIVE: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Multiple Organ Failure , Pandemics , Pneumonia, Viral , Resuscitation , Shock , Systemic Inflammatory Response Syndrome , Clinical Deterioration , Clinical Laboratory Techniques/methods , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Fatal Outcome , Female , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Newborn, Diseases , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Pneumonia, Viral/blood , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Premature Birth , Respiration, Artificial/methods , Resuscitation/methods , Risk Factors , Shock/etiology , Shock/therapy , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology , Tomography, X-Ray Computed/methods
9.
Medicine (Baltimore) ; 99(33): e21284, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-740190

ABSTRACT

RATIONALE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which quickly spread throughout the world, has been putting medical workers all over the world in difficulty because of the high number of cases combined with the lack of information about the disease. Although pediatric cases are rare, the group age under 12 months has been in general more susceptible to develop severe forms of the disease compared with the patients in the age interval of 1 to 18 years. PATIENT CONCERNS: Three newborns have been tested positive for SARS-CoV-2 infection. One of them presented bilateral decreased air entry, while the other 2 had no respiratory symptomatology. All 3 developed diaper erythema and oral candidiasis. DIAGNOSIS: For building up the report, newborns that were positive for coronavirus disease 2019 (COVID-19) infection were included in the case series. The chest X-ray of the symptomatic patient revealed a medium degree of hilar parenchymal infiltration and a slight infiltration of the visceral pleura. INTERVENTIONS: The patients were admitted in our isolated neonatology ward. All of them received antifungal treatment for the oral candidiasis and topic cream for diaper erythema. The symptomatic patient also received prophylactic antibiotherapy, human immunoglobulins, aminophylline, and parenteral nutrition. OUTCOMES: All 3 neonates were discharged after 2 consecutive negative tests for SARS-CoV-2. Patients 1 and 2 fully recovered, whereas the condition of patient 3 improved. LESSONS: Even if there are only a few reported cases of neonates infected with COVID-19 and most of them present mild manifestations, newborns need a more careful insight because of the nonspecific symptomatology.


Subject(s)
Betacoronavirus , Candidiasis, Oral/virology , Coronavirus Infections/complications , Erythema/virology , Pneumonia, Viral/complications , Skin Diseases, Viral/pathology , Adolescent , Candidiasis, Oral/pathology , Child , Child, Preschool , Coronavirus Infections/virology , Erythema/pathology , Female , Humans , Infant , Infant, Newborn , Male , Pandemics , Pneumonia, Viral/virology , Romania/epidemiology , Skin Diseases, Viral/virology
10.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 1081-1086, jan.-dez. 2020. graf, ilus
Article in English, Portuguese | LILACS (Americas) | ID: covidwho-739493

ABSTRACT

Objetivo: Analisar os principais tipos de neoplasia malignas em pacientes de 0 a 19 anos de idade nas regionais de saúde do estado do Rio de Janeiro. Método: Estudo ecológico que analisou as neoplasias mais frequentes através dos dados contidos no Sistema de Informação Hospitalar em 2017. Os dados foram analisados através do cálculo da frequência relativa. O mapeamento realizado no TabWin. Resultados: foram observados 2.662 casos de neoplasias malignas na população de 0-19 anos de idade residentes nas regionais de saúde do Estado do Rio de Janeiro, sendo a Metropolitana I a de maior proporção e a leucemia o tipo de câncer infanto-juvenil mais frequente. Conclusão: apropriação desses dados torna possível concretizar estratégias para a construção de políticas públicas, visando medidas de prevenção, diagnosticas e tratamento vislumbrando maior sobrevida, melhor qualidade de vida e redução da taxa de mortalidade infanto-juvenil


Objective: The study's purpose has been to analyze the main types of malignant neoplasms among patients aged up to 19 years old across the regional health agencies from the Rio de Janeiro State. Methods: This ecological study analyzed the most frequent neoplasms using data from Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) [Hospital Information System of the Brazilian Unified Health System] referring to the year 2017. The data were analyzed by calculating relative frequencies. The mapping was performed through the use of TabWin software. Results: A total of 2,662 cases of malignant neoplasms among people aged up to 19 years old were distributed across the regional health agencies of Rio de Janeiro State. The Metropolitana I [Metropolitan I] regional health agency presented the highest proportion of cases, and leukemia was the most predominant type of childhood and adolescent cancer. Conclusion: Through the data collected from the SIH/SUS, this study showed that it is possible to implement strategies for implementing public policies, aiming at implementing measures to prevent, diagnose and treat childhood and adolescent cancer so that survival rates can increase, these patients' quality of life can improve, and infant mortality rates can decrease


Objetivo: Analizar los principales tipos de neoplasia malignas en los pacientes de 0 a 19 años de edad en las regionales de salud del estado de Rio de Janeiro. Método: Estudio ecológico que analizó las neoplasias más frecuentes a través de los dados contenidos en el Sistema de Información Hospitalar en 2017. Los dados fueron analizados por el calculo de la frecuencia relativa. La cartografía fue realizada por medio del TabWin. Resultados: fueron observados 2.662 casos de neoplasias malignas en la populación de 0-19 años de edad residentes en las regiones de salud del Estado de Rio de Janeiro, teniendo la Metropolitana I la región de mayor proporción y la leucemia el tipo de cáncer infantil juvenil más frecuente. Conclusión: apropiación destos dados torna posible concretizar estrategias para la construcción de políticas públicas, mirando medidas de prevención, diagnósticas y tratamiento vislumbrando mayor sobrevida, mejor calidad de vida y reducción de la taza de mortalidad infantil juvenil


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Child , Adolescent , Hospital Information Systems , Neoplasms/epidemiology , Quality of Life , Unified Health System , Leukemia , Infant Mortality , Morbidity Surveys , Child Mortality/trends
11.
Emerg Infect Dis ; 26(8): 1671-1678, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-737802

ABSTRACT

We describe the contact investigation for an early confirmed case of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the United States. Contacts of the case-patient were identified, actively monitored for symptoms, interviewed for a detailed exposure history, and tested for SARS-CoV-2 infection by real-time reverse transcription PCR (rRT-PCR) and ELISA. Fifty contacts were identified and 38 (76%) were interviewed, of whom 11 (29%) reported unprotected face-to-face interaction with the case-patient. Thirty-seven (74%) had respiratory specimens tested by rRT-PCR, and all tested negative. Twenty-three (46%) had ELISA performed on serum samples collected ≈6 weeks after exposure, and none had detectable antibodies to SARS-CoV-2. Among contacts who were tested, no secondary transmission was identified in this investigation, despite unprotected close interactions with the infectious case-patient.


Subject(s)
Betacoronavirus/pathogenicity , Contact Tracing/statistics & numerical data , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Betacoronavirus/genetics , Child , Child, Preschool , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Enzyme-Linked Immunosorbent Assay , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pneumonia, Viral/diagnosis , Public Health/methods , Reverse Transcriptase Polymerase Chain Reaction , Travel , Washington/epidemiology
12.
BMJ ; 370: m3320, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-737537

ABSTRACT

OBJECTIVE: To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). DESIGN: Living systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists. STUDY SELECTION: Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. DATA EXTRACTION: At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. RESULTS: 77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11 432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I2=74%; 5 studies; 80 521 women) and myalgia (0.48, 0.45 to 0.51; I2=0%; 3 studies; 80 409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I2=0%) and invasive ventilation (1.88, 1.36 to 2.60; I2=0%; 4 studies, 91 606 women). 73 pregnant women (0.1%, 26 studies, 11 580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I2=9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I2=0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I2=0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I2=12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I2=0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I2=0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I2=55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I2=1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I2=not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19. CONCLUSION: Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178076. READERS' NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/etiology , Coronavirus Infections/therapy , Female , Global Health/statistics & numerical data , Humans , Infant, Newborn , Intensive Care, Neonatal/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/etiology , Pregnancy Complications, Infectious/therapy , Premature Birth/epidemiology , Premature Birth/virology , Prognosis , Risk Factors
13.
J Korean Med Sci ; 35(34): e317, 2020 Aug 31.
Article in English | MEDLINE | ID: covidwho-736662

ABSTRACT

BACKGROUND: The novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak began in China in December last year, and confirmed cases began occurring in Korea in mid-February 2020. Since the end of February, the rate of infection has increased greatly due to mass (herd) infection within religious groups and nursing homes in the Daegu and Gyeongbuk regions. This mass infection has increased the number of infected people more rapidly than was initially expected; the epidemic model based on existing studies had predicted a much lower infection rate and faster recovery. METHODS: The present study evaluated rapid infection spread by mass infection in Korea and the high mortality rate for the elderly and those with underlying diseases through the Susceptible-Exposed-Infected-Recovered-Dead (SEIRD) model. RESULTS: The present study demonstrated early infection peak occurrence (-6.3 days for Daegu and -5.3 days for Gyeongbuk) and slow recovery trend (= -1,486.6 persons for Daegu and -223.7 persons for Gyeongbuk) between the actual and the epidemic model for a mass infection region compared to a normal infection region. CONCLUSION: The analysis of the time difference between infection and recovery can help predict the epidemic peak due to mass (or normal) infection and can also be used as a time index to prepare medical resources.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Models, Statistical , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , Coronavirus Infections/pathology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Nursing Homes/statistics & numerical data , Pandemics , Pneumonia, Viral/pathology , Republic of Korea/epidemiology , Time Factors , Young Adult
14.
J Perinatol ; 40(Suppl 1): 36-46, 2020 09.
Article in English | MEDLINE | ID: covidwho-733537

ABSTRACT

OBJECTIVES: To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. STUDY DESIGN: A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. RESULTS: Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. CONCLUSIONS: Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.


Subject(s)
Betacoronavirus , Coronavirus Infections , Hospital Administration , Intensive Care Units, Neonatal/organization & administration , Pandemics , Parents , Pneumonia, Viral , Visitors to Patients/statistics & numerical data , Cross-Sectional Studies , Hospital Design and Construction , Humans , Infant, Newborn , Organizational Policy , Patients' Rooms , United States
15.
Biomed Res Int ; 2020: 3149020, 2020.
Article in English | MEDLINE | ID: covidwho-733121

ABSTRACT

An outbreak of pneumonia, caused by a novel coronavirus (SARS-CoV-2), was identified in China in December 2019. This virus expanded worldwide, causing global concern. Although clinical, laboratory, and imaging features of COVID-19 are characterized in some observational studies, we undertook a systematic review and meta-analysis to assess the frequency of these features. We did a systematic review and meta-analysis using three databases to identify clinical, laboratory, and computerized tomography (CT) scanning features of rRT-PCR confirmed cases of COVID-19. Data for 3420 patients from 30 observational studies were included. Overall, the results showed that fever (84.2%, 95% CI 82.6-85.7), cough (62%, 95% CI 60-64), and fatigue (39.4%, 95% CI 37.2-41.6%) are the most prevalent symptoms in COVID-19 patients. Increased CRP level, decreased lymphocyte count, and increased D-dimer level were the most common laboratory findings. Among COVID-19 patients, 92% had a positive CT finding, most prevalently ground-glass opacification (GGO) (60%, 95% CI 58-62) and peripheral distribution opacification (64%, 95% CI 60-69). These results demonstrate the clinical, paraclinical, and imaging features of COVID-19.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Cough/etiology , Female , Fever/etiology , Humans , Infant , Infant, Newborn , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Tomography, X-Ray Computed , Young Adult
16.
PLoS One ; 15(8): e0238299, 2020.
Article in English | MEDLINE | ID: covidwho-732996

ABSTRACT

This paper seeks to determine which workers affected by lockdown measures can return to work when a government decides to apply lockdown exit strategies. This system, which we call Sequential Selective Multidimensional Decision (SSMD), involves deciding sequentially, by geographical areas, sectors of activity, age groups and immunity, which workers can return to work at a given time according to the epidemiological criteria of the country as well as that of a group of reference countries, used as a benchmark, that have suffered a lower level of lockdown de-escalation strategies. We apply SSMD to Spain, based on affiliation to the Social Security system prior to the COVID-19 pandemic, and conclude that 98.37% of the population could be affected. The proposed system makes it possible to accurately identify the target population for serological IgG antibody tests in the work field, as well as those affected by special income replacement measures due to lockdown being maintained over a longer period.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Return to Work/trends , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , Child , Child, Preschool , Coronavirus Infections/economics , Coronavirus Infections/mortality , Decision Making , Decision Trees , Humans , Infant , Infant, Newborn , Middle Aged , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/mortality , Spain , Young Adult
17.
MMWR Morb Mortal Wkly Rep ; 69(34): 1166-1169, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-732630

ABSTRACT

Although non-Hispanic American Indian and Alaska Native (AI/AN) persons account for 0.7% of the U.S. population,* a recent analysis reported that 1.3% of coronavirus disease 2019 (COVID-19) cases reported to CDC with known race and ethnicity were among AI/AN persons (1). To assess the impact of COVID-19 among the AI/AN population, reports of laboratory-confirmed COVID-19 cases during January 22†-July 3, 2020 were analyzed. The analysis was limited to 23 states§ with >70% complete race/ethnicity information and five or more laboratory-confirmed COVID-19 cases among both AI/AN persons (alone or in combination with other races and ethnicities) and non-Hispanic white (white) persons. Among 424,899 COVID-19 cases reported by these states, 340,059 (80%) had complete race/ethnicity information; among these 340,059 cases, 9,072 (2.7%) occurred among AI/AN persons, and 138,960 (40.9%) among white persons. Among 340,059 cases with complete patient race/ethnicity data, the cumulative incidence among AI/AN persons in these 23 states was 594 per 100,000 AI/AN population (95% confidence interval [CI] = 203-1,740), compared with 169 per 100,000 white population (95% CI = 137-209) (rate ratio [RR] = 3.5; 95% CI = 1.2-10.1). AI/AN persons with COVID-19 were younger (median age = 40 years; interquartile range [IQR] = 26-56 years) than were white persons (median age = 51 years; IQR = 32-67 years). More complete case report data and timely, culturally responsive, and evidence-based public health efforts that leverage the strengths of AI/AN communities are needed to decrease COVID-19 transmission and improve patient outcomes.


Subject(s)
Alaska Natives/statistics & numerical data , Coronavirus Infections/ethnology , Health Status Disparities , Indians, North American/statistics & numerical data , Pneumonia, Viral/ethnology , Adolescent , Adult , Aged , Betacoronavirus/isolation & purification , Child , Child, Preschool , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Severity of Illness Index , Treatment Outcome , United States/epidemiology , Young Adult
19.
BMC Med Res Methodol ; 20(1): 215, 2020 08 26.
Article in English | MEDLINE | ID: covidwho-730204

ABSTRACT

BACKGROUND: Collection of biospecimens is a critical first step to understanding the impact of COVID-19 on pregnant women and newborns - vulnerable populations that are challenging to enroll and at risk of exclusion from research. We describe the establishment of a COVID-19 perinatal biorepository, the unique challenges imposed by the COVID-19 pandemic, and strategies used to overcome them. METHODS: A transdisciplinary approach was developed to maximize the enrollment of pregnant women and their newborns into a COVID-19 prospective cohort and tissue biorepository, established on March 19, 2020 at Massachusetts General Hospital (MGH). The first SARS-CoV-2 positive pregnant woman was enrolled on April 2, and enrollment was expanded to SARS-CoV-2 negative controls on April 20. A unified enrollment strategy with a single consent process for pregnant women and newborns was implemented on May 4. SARS-CoV-2 status was determined by viral detection on RT-PCR of a nasopharyngeal swab. Wide-ranging and pregnancy-specific samples were collected from maternal participants during pregnancy and postpartum. Newborn samples were collected during the initial hospitalization. RESULTS: Between April 2 and June 9, 100 women and 78 newborns were enrolled in the MGH COVID-19 biorepository. The rate of dyad enrollment and number of samples collected per woman significantly increased after changes to enrollment strategy (from 5 to over 8 dyads/week, P < 0.0001, and from 7 to 9 samples, P < 0.01). The number of samples collected per woman was higher in SARS-CoV-2 negative than positive women (9 vs 7 samples, P = 0.0007). The highest sample yield was for placenta (96%), umbilical cord blood (93%), urine (99%), and maternal blood (91%). The lowest-yield sample types were maternal stool (30%) and breastmilk (22%). Of the 61 delivered women who also enrolled their newborns, fewer women agreed to neonatal blood compared to cord blood (39 vs 58, P < 0.0001). CONCLUSIONS: Establishing a COVID-19 perinatal biorepository required patient advocacy, transdisciplinary collaboration and creative solutions to unique challenges. This biorepository is unique in its comprehensive sample collection and the inclusion of a control population. It serves as an important resource for research into the impact of COVID-19 on pregnant women and newborns and provides lessons for future biorepository efforts.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/psychology , Patient Participation , Pneumonia, Viral/diagnosis , Pneumonia, Viral/psychology , Pregnancy Complications, Infectious/diagnosis , Specimen Handling , Adult , Female , Humans , Infant, Newborn , Pandemics , Patient Selection , Perinatal Care , Pregnancy , Pregnancy Complications, Infectious/psychology
20.
Commun Dis Intell (2018) ; 442020 Aug 18.
Article in English | MEDLINE | ID: covidwho-729850

ABSTRACT

Confirmed cases in Australia this reporting period (20 July to 2 August): 6,121 notifications, 71 deaths. Cumulative: 18,367 notifications, 240 deaths. Over the past fortnightly reporting period (20 July to 2 August), the number of new cases reported nationally increased from 3,462 in the previous fortnight to 6,121. The large increase in numbers is due to multiple epidemiologically-linked outbreaks across a range of settings and locations in Victoria (97%; 5,914 cases) with very few (207) cases reported by other jurisdictions in this reporting period. Of the 5,914 cases reported in Victoria, all were locally acquired. Of the remaining 207 cases nationally reported, only 23% were reported as locally acquired. ACT is the only jurisdiction reporting 0 cases, with its last case reported on 9 July. A total of 71 deaths were reported, all from Victoria. On average, 437 cases were reported each day over the reporting period, an increase from 247 cases per day over the previous fortnight. Testing rates remain high across all jurisdictions, with an overall positivity rate for the reporting period of 0.7%. Victoria reported a positivity rate of 1.7% for this reporting period; in all other jurisdictions the positivity rate was 0.07% or lower. Overall, syndromic surveillance of respiratory illness trends continues to show very low levels compared to previous years. 12% of cases have required hospitalisation or intensive care.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Australia/epidemiology , Betacoronavirus , Child , Child, Preschool , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , European Continental Ancestry Group/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , New South Wales/epidemiology , Oceanic Ancestry Group/statistics & numerical data , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Severity of Illness Index , Sex Distribution , Young Adult
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