Introduction Fervorous investigation and dialogue surrounding the true number of SARS-CoV-2 related deaths and implied infection fatality rates in India have been ongoing throughout the pandemic, and especially pronounced during the nation’s devastating second wave. We aim to synthesize the existing literature on the true SARS-CoV-2 excess deaths and infection fatality rates (IFR) in India, through a systematic search followed by viable meta-analysis. We then provide updated epidemiological model-based estimates of the wave 1, wave 2 and combined IFRs using an extension of the Susceptible-Exposed-Infected-Removed (SEIR) model, using data from April 1, 2020 to June 30, 2021. Methods Following PRISMA guidelines, the databases PubMed, Embase, Global Index Medicus, as well as BioRxiv, MedRxiv, and SSRN for preprints (accessed through iSearch), were searched on July 3, 2021 (with results verified through August 15, 2021). Altogether using a two-step approach, 4,765 initial citations were screened resulting in 37 citations included in the narrative review and 19 studies with 41 datapoints included in the quantitative synthesis. Using a random effects model with DerSimonian-Laird estimation, we meta-analyze IFR1 which is defined as the ratio of the total number of observed reported deaths divided by the total number of estimated infections and IFR2 (which accounts for death underreporting in the numerator of IFR1). For the latter, we provide lower and upper bounds based on the available range of estimates of death undercounting, often arising from an excess death calculation. The primary focus is to estimate pooled nationwide estimates of IFRs with the secondary goal of estimating pooled regional and state-specific estimates for SARS-CoV-2 related IFRs in India. We also try to stratify our empirical results across the first and the second wave. In tandem, we present updated SEIR model estimates of IFRs for waves 1, 2, and combined across the waves with observed case and death count data from April 1, 2020 to June 30, 2021. Results For India countrywide, underreporting factors (URF) for cases (sourced from serosurveys) range from 14.3-29.1 in the four nationwide serosurveys; URFs for deaths (sourced from excess deaths reports) range from 4.4-11.9 with cumulative excess deaths ranging from 1.79-4.9 million (as of June 2021). Nationwide pooled IFR1 and IFR2 estimates for India are 0.097% (95% confidence interval [CI]: 0.067 – 0.140) and 0.365% (95% CI: 0.264 – 0.504) to 0.485% (95% CI: 0.344 – 0.685), respectively, again noting that IFR2 changes as excess deaths estimates vary. Among the included studies in this meta-analysis, the IFR1 generally appear to decrease over time from the earliest study end date to the latest study end date (from 4 June 2020 to 6 July 2021, IFR1 changed from 0.199 to 0.055%), whereas a similar trend is not as readily evident for IFR2 due to the wide variation in excess death estimates (from 4 June 2020 to 6 July 2021, IFR2 ranged from (0.290-1.316) to (0.241-0.651) %). Nationwide SEIR model-based combined estimates for IFR1 and IFR2 are 0.101% (95% CI: 0.097 – 0.116) and 0.367% (95% CI: 0.358 – 0.383), respectively, which largely reconcile with the empirical findings and concur with the lower end of the excess death estimates. An advantage of such epidemiological models is the ability to produce daily estimates with updated data with the disadvantages being that these estimates are subject to numerous assumptions, arduousness of validation and not directly using the available excess death data. Whether one uses empirical data or model-based estimation, it is evident that IFR2 is at least 3.6 times more than IFR1. Conclusion When incorporating case and death underreporting, the meta-analyzed cumulative infection fatality rate in India varies from 0.36%-0.48%, with a case underreporting factor ranging from 25-30 and a death underreporting factor ranging from 4-12. This implies, by June 30, 2021, India may have seen nearly 900 million infections and 1.7-4.9 million deaths when the reported numbers stood at 30.4 million cases and 412 thousand deaths (covid19india.org) with an observed case fatality rate (CFR) of 1.35%. We reiterate the need for timely and disaggregated infection and fatality data to examine the burden of the virus by age and other demographics. Large degrees of nationwide and state-specific death undercounting reinforce the call to improve death reporting within India.

/pdf/sars-cov-2-infection-fatality-rates-in-india-systematic-hfddre6ebw.pdf

SARS-CoV-2 infection fatality rates in India: systematic review, meta-analysis and model-based estimation

Đặt vấn đề: Thủy đậu là bệnh da nhiễm trùng cấp tính do virus Varicella Zoster gây ra với biểu hiện lâm sàng là các mụn nước, mụn nước rốn lõm cùng tồn tại rải rác khắp cơ thể. Bệnh lây truyền do hít phải virus trong giọt nước bọt lơ lửng trong không khí hoặc tiếp xúc trực tiếp với dịch tiết của thương tổn trên da người bệnh. Mục tiêu nghiên cứu: Mô tả đặc điểm lâm sàng của bệnh nhân thủy đậu tại Bệnh viện Da liễu thành phố Cần Thơ năm 2020-2022. Đối tượng và phương pháp nghiên cứu: Mô tả cắt ngang trên 228 bệnh nhân được chẩn đoán thủy đậu điều trị tại Bệnh viện Da Liễu thành phố Cần Thơ năm 2020-2022. Kết quả: Bệnh thường gặp ở nhóm tuổi 20-39 tuổi, ở cả hai giới. Bệnh gặp nhiều nhất vào tháng 1. Đa số trường hợp không rõ yếu tố dịch tễ và chưa chủng ngừa. Triệu chứng sốt chiếm tỉ lệ cao nhất. Tất cả trường hợp có mụn nước, mụn nước rốn lõm và nhiều hơn một loại thương tổn cùng tồn tại trên một vùng da. Thương tổn phân bố rải rác khắp cơ thể. Vị trí gặp nhiều nhất là ở đầu mặt cổ và ở thân mình. Tỷ lệ sẹo của nhóm nhập viện trước 72 giờ so với nhóm nhập viện sau 72 giờ khác biệt có ý nghĩa thống kê. Kết luận: Bệnh thuỷ đậu thường gặp ở nhóm tuổi 20-39 tuổi, ở cả hai giới với biểu hiện là mụn nước, mụn nước rốn lõm, thương tổn nhiều lứa tuổi cùng tồn tại, phân bố rải rác khắp cơ thể. Đa số trường hợp không rõ yếu tố dịch tễ và chưa chủng ngừa.

/pdf/dac-diem-lam-sang-cua-benh-nhan-thuy-dau-tai-benh-vien-da-2xx5tz7v.pdf

Đặc điểm lâm sàng của bệnh nhân thủy đậu tại bệnh viện da liễu thành phố cần thơ năm 2020-2022

During the COVID-19 pandemic, the risk of childhood infectious diseases was increased. Post-COVID-19 escalation of chickenpox cases, becoming an emerging public health concern. Thus, the study was designed to compare chickenpox prevalence and Varicella zoster virus (VZV) genotypes circulating before, during, and post-COVID-19 in Pakistan.A total of 267 lesion specimens collected from tertiary care hospitals, and chickenpox outbreaks from Pakistan were analysed by a two-amplicon approach with phylogenetic analysis.Among suspected cases, overall 178/267 were VZV positive. Majority (84.2 %; 150/178) cases were of post-COVID-19 pandemic time. Small outbreaks occurred soon after COVID-19 in Rawalpindi and Islamabad (Pakistan), 40 positive cases out of 178 cases were outbreak cases. There was first time detection of the M4 genotype, which was significantly associated with disease severity (p = 0.0006) and post-COVID-19 chickenpox outbreaks in 2021 (77.9 %; 46/59; p < 0.00001). However, in pre-COVID-19 only M2 genotype was detected. The M2 prevalence varied from 2019 (100 %; 19/19) to 2022 (3.2 %; 3/91). However, the most prevalent strain of 2022 belonged to the M1 genotype (64.8 %; 59/91).A significant rise in chickenpox cases detected soon after COVID-19 in Pakistan, and oscillation of different VZV genotypes with first time detection of M4 genotype is an alarming situation. This demands further detailed genotypic studies on transmission dynamics of a rare M4 with other genotypes to protect the local population and restrict spread in other regions. 

A hidden dilemma; post COVID-19 first detection of Varicella zoster M4 genotype from Pakistan

Background: There are recent advances in the management of COVID19 infection, but there is still a need to develop methods of predicting the course of the illness which are reliable yet easy to perform. Determining the rate and timing of detection of total SARSCoV2 anti-nucleocapsid antibodies may help to predict the course of illness in COVID19. Methodology: Patients with COVID19 infection admitted at Ramaiah medical college hospital were categorized based on clinical severity into asymptomatic, mild-moderate and severe/critical illness. Their blood samples were collected at three different time intervals with respect to onset of clinical symptoms to test for the presence of total Anti SARSCoV2 N antigen antibodies (IgG and IgM) and the rate of seroconversion. Results: The findings of this prospective study on the antibody response to COVID19 infection failed to demonstrate a significant difference with respect to anti-nucleocapsid antibody titers among those with mild and severe categories of infection. However based on the results of the present study, it appears that the virus is able to suppress the generation of antibodies and in the process, escape the clutches of the host immune system. Conclusion: The progression or recovery from COVID19 disease can be possibly determined by the rate of seroconversion of total COVID19 anti-nucleocapsid antibodies. 

Total SARSCoV2 Anti-Nucleocapsid Antibodies Levels in Patients Hospitalised with COVID-19 Infection- A Prospective Study

Background The immune response after SARS-CoV-2 is complex and may be affected by severity of the disease, race, etc. The present study was conducted to assess the serial antibody response among the COVID-19 patients admitted in the hospital. Methods The study was conducted between July and October 2020 in a dedicated COVID-19 hospital. All consented patients underwent serial testing of antibodies using a rapid chromatographic immunoassay-based qualitative IgG/IgM kit every third day until their discharge or death. The data about age, sex, severity of disease, length of stay, onset of symptoms, date of molecular testing were also collected. Appropriate statistical tests were used. Results The mean age of 1000 COVID-19 patients was 47.5 ± 17.9 years. Out of the total, 687 (68.7%) were males. With respect to severity, 682 (68.2%) were asymptomatic/mild, 200 (20%) were moderate and 118 (11.8%) were severe cases. The seroconversion percentage increased from 12.8% to 97.9% and 16.3% to 80.9% for IgG and IgM respectively in 21 days. The median time for seroconversion was 10 days (IQR:6–12 days) for IgG and eight days (IQR: 6–11 days) for IgM. At the time of discharge (median nine days), detectable IgG and IgM antibodies were present in 502 (52.46%) and 414 (43.26%) participants respectively. Seroconversion was associated with days after the symptoms, increasing severity of the disease and the presence of co-morbidity. Conclusion Seroconversion increased during the period of observation. The severe/moderate cases of COVID-19 tend to have an early seroconversion as compared to the asymptomatic/mild cases. Only half of the patients were seroconverted at discharge.

Seroconversion among COVID-19 patients admitted in a dedicated COVID hospital: A longitudinal prospective study of 1000 patients

Serial antibody response among hospitalized coronavirus disease 2019 cases in India.

Background: Chicken pox is an acute, common, and highly contagious disease caused by the varicella zoster virus (VZV). Chicken pox is predominantly a childhood disease characterized by pruritic vesicular exanthema with systemic symptoms such as fever, loss of appetite, and malaise. Primary infection tends to occur at a younger age and is usually benign in immunocompetent children but can be life-threatening in adults and immunocompromised individuals, with an attack rate approaching >85% after exposure. This study attempts to evaluate the trend of chickenpox cases in a residential hostel in Ramgarh. Methods: This was a record based descriptive study done using reported Chicken Pox cases in the OPDs during the period from January 2015 to December 2018. Monthly average for meteorological data (Min and Max temperature, Precipitation and Humidity) for Ramgarh was recorded for the study period. Seasonality and trend was identified for chicken pox cases during this period by plotting the monthly number of clinically diagnosed cases over time period to identify any repeated pattern. Poisson’s distribution was used to estimate association between meteorological variables and incidence of chickenpox cases. Results: Analysis revealed strong correlations (r=0.7553, p<0.0001) between humidity and precipitation. There was a significant correlation between Incidence of varicella and meteorological factors under study (all p<0.05). Conclusions: The findings of this study will aid in forecasting epidemics and in preparing for the impact of climate change on the varicella epidemiology through the implementation of public health preventive measures such as promoting good hygiene practices, temporary   closure of educational institutions, active vaccination and campaigns that include press releases and media events to encourage preventive activities.

/pdf/seasonal-variation-and-role-of-meteorological-conditions-in-42rur0qk7b.pdf

Seasonal variation and role of meteorological conditions in reported chicken pox cases in a residential hostel of Ramgarh

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Serial antibody response among hospitalized coronavirus disease 2019 cases in India.

Seasonal variation and role of meteorological conditions in reported chicken pox cases in a residential hostel of Ramgarh