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BackgroundThere is inconclusive evidence whether pregnancy exacerbates COVID-19 symptoms or not, and scarce data from the Middle East and North Africa region. The aim of this study was to investigate the association between pregnancy and COVID-19 symptoms in Qatar. MethodsThis cross-sectional study was carried out using data of all women with confirmed COVID-19, comparing pregnant and non-pregnant women of child-bearing age (18-49 years). Data of all COVID-19 cases were collected by the Ministry of Public Health (MoPH) in Qatar, between March and September 2020. Symptoms were compared by pregnancy status and classified into moderate and severe. Multivariable logistic and poisson regression was carried out to investigate the association between pregnancy and severity of COVID-19 symptoms. ResultsDuring the study period, 105744 individuals were diagnosed with COVID-19, 16908 were women of childbearing age. From that sample, 799 women who were pregnant (mean age 29.9 years (SD 5.2)) and 16109 women who were not pregnant (mean age 33.1 years (SD 7.8)). After multivariable logistic regression, pregnancy was associated with a 1.4-fold higher odds of reporting any symptoms of COVID-19 (OR 1.41, 95% CI 1.18-1.68), and 1.3-fold higher odds of reporting shortness of breath (OR 1.29, 95% CI 1.02-1.63). After multivariable poisson regression, pregnancy was also associated with a higher number of symptoms (IRR 1.03, 95%CI 0.98-1.08). ConclusionOur findings suggest that, in this setting, pregnant women are more likely to have symptomatic COVID-19, and shortness of breath, compared to non-pregnant women of childbearing age.
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BackgroundWaning immunity following administration of mRNA based COVID-19 vaccines remains a concern for many health systems. We undertook a study of SARS-CoV-2 infections, with and without requirement for intensive care to shed more light on the duration of vaccine effectiveness for protection against the need for intensive care. MethodsWe used a matched case-control study design with the study base being all individuals with first infection with SARS-CoV-2 reported in the State of Qatar between 1 Jan 2021 and 20 Feb 2022. Cases were those requiring intensive care while controls were those who recovered without need for intensive care. Vaccine effectiveness against requiring intensive care and number needed to vaccinate (NNV) to prevent one more case of COVID-19 requiring intensive care were computed for the mRNA (BNT162b2 / mRNA-1273) vaccines. ResultsVaccine effectiveness against requiring intensive care was 59% (95% confidence interval [CI], 50 to 76) between the first and second dose and strengthened to 89% (95% CI, 85 to 92) between the second dose and 4 months post the second dose in persons who received a primary course of the vaccine. There was no waning of vaccine effectiveness in the period from 4 to 12 months after the second dose. ConclusionsThis study demonstrates that vaccine effectiveness against requiring intensive care remains robust till at least 12 months after the second dose of mRNA based vaccines.
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ObjectivesThis study aims to estimate the prevalence and longevity of detectable SARS-CoV-2 antibodies as well as memory cells T and B after recovery. In addition, the prevalence of COVID-19 reinfection, and the preventive efficacy of previous infection with SARS-CoV-2 were investigated. Methods and analysesA synthesis of existing research was conducted. The Cochrane Library for COVID-19 resources, the China Academic Journals Full Text Database, PubMed, and Scopus as well as preprint servers were searched for studies conducted between 1 January 2020 to 1 April 2021. We included studies with the relevant outcomes of interest. All included studies were assessed for methodological quality and pooled estimates of relevant outcomes were obtained in a meta-analysis using a bias adjusted synthesis method. Proportions were synthesized with the Freeman-Tukey double arcsine transformation and binary outcomes using the odds ratio (OR). Heterogeneity between included studies was assessed using the I2 and Cochrans Q statistics and publication bias was assessed using Doi plots. ResultsFifty-four studies, from 18 countries, with around 12 000 000 individuals, followed up to 8 months after recovery were included. At 6-8 months after recovery, the prevalence of SARS-CoV-2 specific immunological memory remained high; IgG - 90.4% (95%CI 72.2-99.9, I2=89.0%, 5 studies), CD4+ - 91.7% (95%CI 78.2 - 97.1, one study), and memory B cells 80.6% (95%CI 65.0-90.2, one study) and the pooled prevalence of reinfection was 0.2% (95%CI 0.0 - 0.7, I2 = 98.8, 9 studies). Individuals previously infected with SARS-CoV-2 had an 81% reduction in odds of a reinfection (OR 0.19, 95% CI 0.1 - 0.3, I2 = 90.5%, 5 studies). ConclusionAround 90% of people previously infected with SARS-CoV-2 had evidence of immunological memory to SARS-CoV-2, which was sustained for at least 6-8 months after recovery, and had a low risk of reinfection. RegistrationPROSPERO: CRD42020201234 What is already known on this topicIndividuals who recover from COVID-19 may have immunity against future infection but the proportion who develop immunity is uncertain. Further, there is uncertainty about the proportion of individuals who get reinfected with COVID-19. What this study addsUsing data from 54 studies with follow up time up to 8 months after recovery, during the period February 2020-February 2021, we found that, post-COVID-19, up to 90% of individuals had antibodies and memory T and B cells against SARS-CoV-2. We also found a pooled prevalence of reinfection of 0.2%, and that infection conferred an 81% decrease in odds of reinfection with SARS-CoV-2, compared to unimmunized individuals without previous COVID-19. This review of 12 million individuals presents evidence that most individuals who recover from COVID-19 develop immunological memory to SARS-CoV-2, which was still detectable for up to 8 months. Further, reinfection after recovery from COVID-19 was rare during the first 8 months after recovery, with a prevalence below 1%, while prior infection confers protection with an odds ratio of 0.19 and a preventive efficacy of 80% at a baseline prevalence of 5% for COVID-19 in a community. Implications of all the available evidenceIndividuals with a history of COVID-19 infection have immunity against the disease for up to 8 months, although this period could be longer. These individuals could be prioritized last for COVID-19 vaccinations or considered for single dose vaccinations. StrengthsThis comprehensive review addresses key questions on prevalent immunological memory and risk of reinfection in individuals with prior confirmed COVID-19 using robust systematic review methods. LimitationsSome of the included studies which examined prevalent immunological memory were small studies which were affected by loss to follow up. The review did not examine evidence for immunity against the new divergent variants, which may be more likely to have immune evasion behaviour and may present a higher risk of reinfection. Lastly, the review did not examine the effect of the severity of COVID-19 on both immunological memory and the risk of reinfection.
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BackgroundThere is conflicting evidence about the risk of mortality and severe disease due to COVID-19 in people living with HIV (PLHIV). ObjectivesTo compare mortality, hospitalization, and the need for intensive care services due to COVID-19 between PLHIV and individuals without HIV based on data from the existing literature. MethodsA comprehensive search in PubMed, Cochrane Library, Scopus, China Academic Journals Full Text Database, the Database of Abstracts of Reviews of Effectiveness (DARE) and and the medRXIV and bioRxiv databases of preprints was carried out. Each data source was searched from 1 January 2020 to 20th of February 2021. Eligible studies were case control, cross-sectional and cohort studies where participants had confirmed COVID-19. From each study, data on numbers of PLHIV and individuals without HIV for each outcome were extracted. Study quality was assessed using the MethodologicAl STandard for Epidemiological Research (MASTER) scale. Data synthesis used a bias adjusted model and predefined age and geographical subgroups were analysed. ResultsOf a total of 2757 records identified, 11 studies, from 4 countries, the United Kingdom, Spain, the United States of America and South Africa, were included. The total participants assessed for the outcomes in this meta-analysis were 1 268 676 of which 13 886 were PLHIV. Overall, the estimated effect of HIV on mortality suggested some worsening (OR 1.3, 95% CI: 0.9 - 2.0, I2 = 78.6%) with very weak evidence against the model hypothesis at this sample size. However, in individuals aged <60 years, the estimated effect on mortality suggested more worsening in PLHIV (OR 2.7, 95% CI: 1.1 - 6.5, I2 = 95.7%) with strong evidence against the model hypothesis at this sample size. HIV was also associated with an estimated effect on hospitalization for COVID-19 that suggested worsening (OR 1.6, 95% CI: 1.3-2.1, I2 = 96.0%) also with strong evidence against the model hypothesis at this sample size. A secondary analysis of the included studies suggested no difference, by HIV status, in the prevalence of pre-existing conditions. ConclusionPeople living with HIV have higher risk of death and hospitalisation from COVID-19, compared to individuals without HIV. A secondary analysis suggests this is not due to associated comorbid conditions. The difference in mortality is exaggerated in those younger than 60 years of age. RegistrationPROSPERO: CRD42020221311 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221311) Evidence before this studyFindings from existing studies have shown conflicting evidence concerning the risk of severe COVID-19 and death from COVID-19 in people living with HIV (PLHIV) compared to people without HIV. Evidence from three existing systematic reviews suggests that the risk of severe COVID-19 and death from COVID-19 in PLHIV may be similar to that in individuals without HIV. However, findings from three large cohort studies and one meta-analysis of four studies suggest that the risk of death from COVID-19 in PLHIV may be higher than that in individuals without HIV. One of the large cohort studies, which is also included in the previous meta-analysis, consisted of individuals with unknown COVID-19 status, and therefore there is still debate concerning the risk of severe COVID-19 outcomes in PLHIV. Added value of this studyIn this meta-analysis of 11 studies with 1 268 676 individuals with confirmed COVID-19, we found a stronger difference in mortality by HIV status for those individuals below the age of 60 years, and over this age, HIV had an attenuated effect on mortality, suggesting that age-related mortality overshadows PLHIV related mortality. Further, PLHIV had increased odds of being hospitalized and needing intensive cares services, probably related to increased COVID-19 severity in PLHIV. A secondary analysis of the included studies suggested no difference in the prevalence of pre-existing conditions. Implications of all the available evidenceOur findings suggest that PLHIV are at higher risk than the general population and should be prioritized for vaccine coverage and monitoring if diagnosed with COVID-19. This is especially important for countries in Sub-Saharan Africa that have a high burden of HIV in the younger populations who are more vulnerable. StrengthsThis study was carried out rigorously following the PRISMA guidelines for systematic reviews and meta-analyses. We used a comprehensive search strategy across most of the main citation databases to ensure that no relevant studies were missed. We included studies where participants had confirmed COVID-19 only and we synthesized the findings from studies using a bias adjustment model that took into consideration the quality of included studies. LimitationsAll studies included in this review are observational studies and conclusions about causality require cautious interpretation. Due to a lack of data from included studies, we were not able to analyse the effect of being on treatment for HIV, and HIV control variables such as viral load and CD4 counts on COVID-19 hospitalization, intensive care services and mortality. Lastly most of the included studies had small samples overall or for PLHIV and this may affect the effect estimates in this analysis. Future research is therefore indicated to confirm these findings.
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ObjectiveTo synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. MethodsA comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. ResultsThirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0-1.3, I2 =0.0%), need for intensive care services (OR 1.1, 95%CI 0.9-1.4, I2 =0.0%), virological cure (OR 1.5, 95%CI 0.5-4.4, I2 =39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3-5.9, I2 =31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5-59.9, I2 =76.6%). ConclusionThere is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. RegistrationPROSPERO: CRD42020191353
