RESUMO
Background: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread to most countries around the world. Disproportionate spread of COVID-19 among the Indian community in Kuwait prompted heightened surveillance in this community. Aims: To study the epidemiological characteristics of COVID-19 patients and their contacts among the Indian community in Kuwait. Methods: Data collection was done as a part of contact tracing efforts undertaken by the Kuwaiti Ministry of Health. Results: We analysed contact-tracing data for the initial 1348 laboratory-confirmed Indian patients and 6357 contacts (5681 close and 676 casual). The mean (standard deviation) age of the patients was 39.43 (10.5) years and 76.5% of the cases were asymptomatic or had only mild symptoms. Asymptomatic patients were significantly older [40.05 (10.42) years] than patients with severe symptoms [37.54 (10.54) years] (P = 0.024). About 70% of the patients were living in shared accommodation. Most of the close contacts were living in the same household, as compared with casual contacts, who were primarily workplace contacts (P < 0.001). Among the different occupations, healthcare workers had the highest proportion of cases (18.4%). Among the 216 pairs of cases with a clear relationship between the index and secondary cases, the mean serial interval was estimated to be 3.89 (3.69) days, with a median of 3 and interquartile range of 1–5 days. Conclusion: An early increase in the number of COVID-19 cases among the Indian community could be primarily attributed to crowded living conditions and the high proportion of healthcare workers in this community.
Assuntos
Kuweit , Índia , COVID-19 , Busca de Comunicante , Pessoal de SaúdeRESUMO
BackgroundThe COVID-19 BNT162b2 vaccination roll-out in Kuwait started on 24 December 2020 followed by ChAdOx1 on 3 February 2021. The study objectives were to assess the factors associated with vaccine coverage and determine vaccine effectiveness (VE) against SARS-CoV-2 infection in a healthcare worker (HCW) population. MethodsThis retrospective cohort study was conducted among HCW working at a public secondary hospital in Kuwait. The follow-up period was from 24 December 2020 to 15 June 2021. The primary outcomes were vaccine coverage and PCR-confirmed SARS-CoV-2 infection for the VE analysis. Data on new SARS-CoV-2 infections (with or without symptoms) during study period in addition to HCWs characteristics (sex, age, nationality, and occupation) were extracted from the hospital records. The vaccine coverage and PCR-confirmed SARS-CoV-2 infections were cross-tabulated by the HCWs characteristics. Furthermore, we used Cox regression to estimate time-to-infection hazard ratios in vaccinated (first and second dose) compared to unvaccinated HCWs. Only one ChAdOx1 dose was given during the study period. ResultsThere were 3246 HCWs included in the analysis. The median age was 38 years (IQR = 33 - 44), 63.4% were females, 46.8% aged 31-40, and 82.3% were non-Kuwaitis. Overall, 82.1% of HCWs received at least one vaccine dose (50.4% received only one dose of ChAdOx1, 3.3% received one dose of BNT162b2, and 28.3% received two doses of BNT162b2). 17.9% of HCWs remained unvaccinated by the end of the study. A significantly lower vaccination coverage percentage was amongst female HCWs, younger age group (20 - 30 years old), and administrative/executive staff. Symptomatic SARS-CoV-2 PCR-confirmed infection prevalence was 7.3%. No asymptomatic infections were reported. The SARS-CoV-2 infection incidence rate was 126 per 100,000 person-days in the unvaccinated group; whereas, the incidence rates in the partially vaccinated groups ([≥] 28 days after ChAdOx1 first dose) and ([≥] 14 days after receiving BNT162b2 through receipt of second dose) were 31.4 and 10.9 per 100,000 person-days, respectively. In the fully vaccinated group ([≥] 14 days after BNT162b2 second dose), the incidence rate was 6.3 per 100,000 person-days. The estimated adjusted vaccine effectiveness of fully vaccinated was 94.5% (95% confidence interval [CI] = 89.4%-97.2%). The VE of partially vaccinated for ChAdOx1 and BNT162b2 was 75.4% (95% CI = 67.2%-81.6%) and 91.4% (95% CI = 65.1%-97.9%), respectively. ConclusionsBoth BNT162b2 and ChAdOx1 vaccines prevented most symptomatic infections in this population across age groups, nationalities, and occupations. A significant proportion (17.9%) of HCWs were unvaccinated despite the vaccine accessibility. The findings complement other VE studies and demonstrate the vaccine benefit among HCWs.
RESUMO
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a World Health Organization designated pandemic that can result in severe symptoms and death that disproportionately affects older patients or those with comorbidities. Kuwait reported its first imported cases of COVID-19 on February 24, 2020. Analysis of data from the first three months of community transmission of the COVID-19 outbreak in Kuwait can provide important guidance for decision-making when dealing with future SARS-CoV-2 epidemic wave management. The analysis of intervention scenarios can help to evaluate the possible impacts of various outbreak control measures going forward which aim to reduce the effective reproduction number during the initial outbreak wave. Herein we use a modified susceptible-exposed-asymptomatic-infectious-removed (SEAIR) transmission model to estimate the outbreak dynamics of SARS-CoV-2 transmission in Kuwait. We fit case data from the first 96 days in the model to estimate the basic reproduction number and used Google mobility data to refine community contact matrices. The SEAIR modelled scenarios allow for the analysis of various interventions to determine their effectiveness. The model can help inform future pandemic wave management, not only in Kuwait but for other countries as well.
RESUMO
IntroductionIdentifying patients with COVID-19, at risk of having a severe clinical course during their hospitalization is important for appropriate allocation of clinical resources. We recently described the Kuwait Progression Indicator based on laboratory findings, in an initial training cohort derived from the first series of 1096 consecutive patients admitted to Jaber Al-Ahmad Al-Sabah Hospital in Kuwait. The aim of this study was to validate the KPI scoring system in an independent cohort of patients with COVID-19. MethodologyData was collected prospectively for consecutive patients admitted to Jaber Al-Ahmad Al-Sabah Hospital in Kuwait between 24th February - 28th April 2020. Patients were grouped according to the severity of their clinical course as their main outcome, based on clinical and radiological parameters, with ICU admission and death as secondary outcomes. Model discrimination was assessed through the area under the receiver operating characteristic curve (AUC) while model calibration was assessed through a calibration plot and measures of slope and calibration in the large (CITL). ResultsOf 752 patients not used in model development previously, 414 met the criteria for inclusion in this validation study. The baseline characteristics for these 752 patients were similar to the patients that were included in our validation cohort. The area under the curve was equal to 0.904 (95% CI, 0.867-0.942), indicating good model discrimination. The calibration plot and CITL confirmed reasonably good model calibration. Sensitivity and specificity were above 90% for the low and high risk levels respectively. ConclusionsWe were able to validate our previously described laboratory based prognostic scoring system for COVID-19 patients, to predict which patients progressed to a severe clinical course.
