Epidemiological Characterization and Genetic Variation of the SARS-CoV-2 Delta Variant in Palestine.

The emergence of new SARS-CoV-2 variants in Palestine highlights the need for continuous genetic surveillance and accurate screening strategies. This case series study aimed to investigate the geographic distribution and genetic variation of the SARS-CoV-2 Delta Variant in Palestine in August 2021. Samples were collected at random in August 2021 (n = 571) from eight districts in the West Bank, Palestine. All samples were confirmed as positive for COVID-19 by RT-PCR. The samples passed the quality control test and were successfully sequenced using the ARTIC protocol. The Delta Variant was revealed to have four dominant lineages: B.1.617 (19%), AY.122 (18%), AY.106 (17%), and AY.121 (13%). The study revealed eight significant purely spatial clusters (p < 0.005) distributed in the northern and southern parts of Palestine. Phylogenetic analysis of SARS-CoV-2 genomes (n = 552) showed no geographically specific clades. The haplotype network revealed three haplogroups without any geographic distribution. Chronologically, the Delta Variant peak in Palestine was shortly preceded by the one in the neighboring Israeli community and shortly followed by the peak in Jordan. In addition, the study revealed an extremely intense transmission network of the Delta Variant circulating between the Palestinian districts as hubs (SHR ≈ 0.5), with Al-Khalil, the district with the highest prevalence of COVID-19, witnessing the highest frequency of transitions. Genetic diversity analysis indicated closely related haplogroups, as haplotype diversity (Hd) is high but has low nucleotide diversity (π). However, nucleotide diversity (π) in Palestine is still higher than the global figures. Neutrality tests were significantly (p < 0.05) low, including Tajima's D, Fu-Li's F, and Fu-Li's D, suggesting one or more of the following: population expansion, selective sweep, and natural negative selection. Wright's F-statistic (Fst) showed genetic differentiation (Fst > 0.25) with low to medium gene flow (Nm). Recombination events were minimal between clusters (Rm) and between adjacent sites (Rs). The study confirms the utility of the whole genome sequence as a surveillance system to track the emergence of new SARS-CoV-2 variants for any possible geographical association and the use of genetic variation analysis and haplotype networking to delineate any minimal change or slight deviation in the viral genome from a reference strain.

Prevalence of SARS-CoV-2 antibodies in the Palestinian population: A primary health center-based cross-sectional study.

This study aimed to assess the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) total antibodies in the north, middle, and south regions of West Bank and the prevalence of SARS-CoV-2 specific antibodies (IgA, IgM, and IgG) in the Palestinian population. This was a cross-sectional study. The serological and epidemiological data of 1269 persons were assessed. Participants were selected randomly among primary health care center attendees in Palestine between November 1, 2020 and December 31, 2020. All serum samples were tested for total antibodies using an enzyme-linked immunosorbent assay (ELISA) test. IgM, IgG, and IgA-specific antibody titers were measured using ELISA. The overall prevalence (with 95% confidence intervals [CIs]) of SARS-CoV-2 total antibodies and specific antibodies were estimated. A multivariate regression model was used to assess the predictive factors for SARS-CoV-2-specific antibodies. The overall seroprevalence of SARS-CoV-2 antibodies was 24·0% (95% CI, 21·7%-26·5%). Seroprevalence was significantly higher among people living in south West Bank (adjusted Odds ratio [aOR], 2·22; 95% CI: 1·58-3·11), people who had COVID-19 symptoms (aOR, 3·92; 95% CI, 2·83-5·43), people with a COVID-19 contact history (aOR, 1·44; 95% CI, 1·03-2·03), patients with hypertension (aOR, 1·57; 95% CI, 1·06-2·33), and non-smokers (aOR, 0·47; 95% CI, 0·31-0·72). A total of 171 blood samples from SARS-CoV-2-positive patients were chosen at random for additional serological testing. Specific IgM, IgG, and IgA antibodies were positive in 14·0% (95% CI, 9·2%-20·2%), 88·3% (82·5%-92·7%), and 42·1% (34·6%-59·9%) of the samples, respectively. SARS-CoV-2 antibodies were common among PHC center attendees and were significantly associated to sex, smoking, and COVID-19 contact history. However, considering that almost three-quarters of this population remains susceptible, maintaining public health measures and encouraging access to immunization is critical in protecting this population.

COVID-19 vaccine hesitancy among health care workers in Palestine: A call for action.

With the planned COVID-19 vaccine, vaccine hesitation is a great challenge, particularly for healthcare professionals. In this study, we examined the acceptance of the COVID-19 vaccine by health care workers, their concerns about it, and the reasons that might prevent them from getting vaccinated. We conducted a cross-sectional study using an anonymous online survey from December 25, 2020, to January 6, 2021. The questionnaire consisted of demographic characteristics (age, gender, profession, sector, medical history, and general health), COVID-19 related knowledge, and personal history of influenza vaccination. The intention to get the vaccine once it is available was directly asked, and attitudes towards the diseases and the vaccine were studied using a four-point Likert scale statement based on the health belief model's constructs. The study included 1159 HCWs; 62.9% were females, and 52.5% were between the ages of 30-49 years. The intention to get vaccinated was only 37.8% [95%CI: 35.0%-40.6%], while 31.5% were undecided, and 30.7% planned to refuse it. Higher levels of intention were reported among males (OR; 2.7, 95%CI: 2.0-3.7), younger ages (OR 1.7, 95%CI: 1.1-2.8), physicians (OR; 2.9, 95%CI: 2.0-4.0), HCWs at non-governmental settings (OR; 1.4, 95%CI: 1.1-1.9), those who previously received the influenza vaccine (OR 4.0, 95%CI: 2.3-7.1), and those who had higher COVID-19 related knowledge (OR; 1.7, 95%CI: 2.3-7.1). In conclusion, vaccine acceptance among HCWs was much lower than expected, which would greatly diminish the role of vaccination in reducing the burden of the COVID-19 pandemic throughout the community.