ABSTRACT
PURPOSE: Antimicrobial resistance [AMR] has emerged as a global and national priority and establishing an effective surveillance system for antimicrobial resistance is an essential prerequisite for generating evidence for informed policymaking at both national and state levels. METHODS: Twenty-four laboratories were enrolled after assessment in the WHO-IAMM Network for Surveillance of Antimicrobial Resistance in Delhi [WINSAR-D]. The NARS- NET standard operating procedures were adopted along with its priority pathogen lists and antibiotic panels. The members were trained to use WHONET software and monthly data files were collected, collated, and analyzed. RESULTS: Multiple logistic issues such as procurement, erratic supply of consumables, non-availability of standard guidelines, lack of automated systems, high workload and low manpower were reported by the majority of member laboratories. Microbiological challenges such as differentiation between colonization and pathogen in absence of patient details, lack of confirmation of resistance, identification of isolates and lack of dedicated computer and genuine windows software for data were common to most laboratories. The total number of isolates of priority pathogens in 2020 was 31,463. Of these, 50.1% isolates were from urine 20.6% were from blood and 28.3% were from pus aspirate and other sterile body fluids. High levels of resistance were observed for all antibiotics. CONCLUSION: There are many challenges in generating quality AMR data in lower-middle-income countries. There is a need for resource allocation and capacity building at all levels to ensure the collection of quality assured data.
Subject(s)
Anti-Bacterial Agents , Body Fluids , Humans , Drug Resistance, Bacterial , Capacity Building , IndiaABSTRACT
Clinical and epidemiological characteristics of SARS-CoV-2 infection are now widely available, but there are few data on longitudinal serology in large cohorts, particularly from low-and middle-income countries. We established an ongoing prospective cohort of 3840 SARS-CoV-2 RT-PCR positive individuals in the Delhi-National Capital Region of India, to document clinical and immunological characteristics during illness and convalescence. The IgG responses to the receptor binding domain (RBD) and nucleocapsid were assessed at 0-7, 10-28 days and 6-10 weeks after infection. The clinical predictors of seroconversion were identified by multivariable regression analysis. The seroconversion rates in the post-infection windows of 0-7 days, 10-28 days and 6-10 weeks were 46%, 84.7% and 85.3% respectively (n=782). The proportion with a serological response increased with severity of COVID-19 disease. All participants with severe disease, 89.6% with mild to moderate infection and 77.3% of asymptomatic participants had IgG antibodies to the RBD antigen. The threshold values in the nasopharyngeal viral RNA RT-PCR in a subset of asymptomatic and symptomatic seroconverters were comparable (p value: 0.48), with similar results among non-seroconverters (p value: 0.16) (n=169). This is the first report of longitudinal humoral immune responses to SARS-CoV-2 infection over a period of ten weeks from South Asia. The low seropositivity in asymptomatic participants and differences between assays highlight the importance of contextualizing the understanding of population serosurveys. SummaryWe measured anti-SARS-CoV-2 RBD and NC protein IgG in a multi-hospital-based prospective cohort from northern India up to ten weeks post-infection. The lower seroconversion rate among asymptomatic RT-PCR positive participants has public health significance particularly for interpreting community seroprevalence estimates.
ABSTRACT
Objectives@#Healthcare workers (HCWs) are at a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the increased likelihood of clinical exposure during patient management. The study objective was to determine the seroprevalence of antibodies to SARS-CoV-2 and its predictors among hospital employees. @*Methods@#The cross-sectional study was conducted at a teaching hospital from August 2020 to September 2020 among 1,401 employees, including 1,217 HCWs, in New Delhi, India. The serum samples were examined for immunoglobulin G (IgG) antibodies to SARS-CoV-2 using the COVID Kavach-Anti-SARS-CoV-2 IgG Antibody Detection enzyme-linked immunosorbent assay kit. Data were collected electronically using the EpiCollect mobile platform. A p<0.05 was considered to indicate statistical significance. @*Results@#A total of 169 participants (12.1%) had detectable IgG antibodies to SARS-CoV-2. The highest seropositivity rate was observed in the administrative staff (20.1%), while it was lowest among medical doctors (5.5%, p<0.001). Male sex and ever having lived in a containment zone were independently associated with past infection with SARS-CoV-2. @*Conclusion@#The seroprevalence of SARS-CoV-2 infection in health workers may be lower than in the general population in New Delhi. However, nonpharmaceutical interventions were not associated with a reduction in the risk of acquisition of SARS-CoV-2.
ABSTRACT
Objectives@#Healthcare workers (HCWs) are at a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the increased likelihood of clinical exposure during patient management. The study objective was to determine the seroprevalence of antibodies to SARS-CoV-2 and its predictors among hospital employees. @*Methods@#The cross-sectional study was conducted at a teaching hospital from August 2020 to September 2020 among 1,401 employees, including 1,217 HCWs, in New Delhi, India. The serum samples were examined for immunoglobulin G (IgG) antibodies to SARS-CoV-2 using the COVID Kavach-Anti-SARS-CoV-2 IgG Antibody Detection enzyme-linked immunosorbent assay kit. Data were collected electronically using the EpiCollect mobile platform. A p<0.05 was considered to indicate statistical significance. @*Results@#A total of 169 participants (12.1%) had detectable IgG antibodies to SARS-CoV-2. The highest seropositivity rate was observed in the administrative staff (20.1%), while it was lowest among medical doctors (5.5%, p<0.001). Male sex and ever having lived in a containment zone were independently associated with past infection with SARS-CoV-2. @*Conclusion@#The seroprevalence of SARS-CoV-2 infection in health workers may be lower than in the general population in New Delhi. However, nonpharmaceutical interventions were not associated with a reduction in the risk of acquisition of SARS-CoV-2.
ABSTRACT
BackgroundThree rounds of a repeated cross-sectional serosurvey to estimate the seroprevalence and trends of SARS-CoV-2 were conducted from August-October 2020 in the state of Delhi in India in the general population aged [≥]5 years. MethodsThe selection of participants was through a multi-stage sampling design from all the 11 districts and 280 wards of the city-state, with two-stage allocation proportional to population- size. Household selected was via systematic random sampling, and individual participant selection through the age-order procedure. The blood samples were screened using the IgG ELISA COVID-Kawach kit (August Round), and the ERBALISA COVID-19 IgG (September and October) rounds. The seroprevalence was estimated by applying the sampling weights based on age and sex with further adjustment for the assay-kit characteristics. ResultsA total of 4267 (n=15046), 4311 (n=17409), and 3829 (n=15015) positive tests indicative of the presence of IgG antibody to SARS-CoV-2 were observed during the August, September, and October 2020 serosurvey rounds, respectively. The adjusted seroprevalence declined from 28.39% (95% CI 27.65-29.14) (August) to 24.08% (95% CI 23.43-24.74) (September), and 24.71% (95% CI 24.01, 25.42%) (October). The antibody positivity was highest in the [≥]50 and female age-group during all rounds of the serosurvey, while the decline was maximum among the younger age-group (5-17 years). On adjusted analysis, participants with lower per capita income, living in slums or overcrowded households, and those with diabetes comorbidity had significantly higher statistical odds of antibody positivity. ConclusionsDespite high IgG seroprevalence, there was evidence for waning of antibody positivity with the progression of the COVID-19 epidemic, implying a potential reduction in population immunity, especially if also associated with the lack of trained T cell immunity.
