What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study.

Autor:	Gill CJ; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA cgill@bu.edu., Mwananyanda L; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA., MacLeod WB; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA., Kwenda G; Biomedical Sciences, University of Zambia, Ridgeway Campus, Lusaka, Lusaka, Zambia., Pieciak RC; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA., Etter L; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA., Bridges D; Program for Applied Technology in Health (PATH), Lusaka, Zambia., Chikoti C; Avencion Limited, Lusaka, Zambia., Chirwa S; Avencion Limited, Lusaka, Zambia., Chimoga C; Avencion Limited, Lusaka, Zambia., Forman L; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA., Katowa B; Macha Research Trust, Choma, Southern Province, Zambia., Lapidot R; Pediatric Infectious Diseases, Boston Medical Center, Brookline, Massachusetts, USA., Lungu J; Avencion Limited, Lusaka, Zambia., Matoba J; Macha Research Trust, Choma, Southern Province, Zambia., Mwinga G; Avencion Limited, Lusaka, Zambia., Mubemba B; Wildlife Sciences, The Copperbelt University, Kitwe, Copperbelt, Zambia., Mupila Z; Avencion, Lusaka, Zambia., Muleya W; Biomedical Sciences, University of Zambia School of Veterinary Medicine, Lusaka, Lusaka, Zambia., Mwenda M; Program for Applied Technology in Health, Lusaka, Zambia., Ngoma B; Avencion Limited, Lusaka, Zambia., Nakazwe R; Biomedical Sciences, University of Zambia University Teaching Hospital, Lusaka, Lusaka, Zambia., Nzara D; Avencion Limited, Lusaka, Zambia., Pawlak N; Tufts University School of Medicine, Boston, Massachusetts, USA., Pemba L; Avencion Limited, Lusaka, Zambia., Saasa N; University of Zambia School of Veterinary Medicine, Lusaka, Zambia., Simulundu E; Macha Research Trust, Choma, Southern Province, Zambia., Yankonde B; Avencion Limited, Lusaka, Zambia., Thea DM; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 Dec 06; Vol. 12 (12), pp. e066763. Date of Electronic Publication: 2022 Dec 06.
DOI:	10.1136/bmjopen-2022-066763
Abstrakt:	Objectives: To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia. Design: A systematic, postmortem prevalence study. Setting: A busy, inner-city morgue in Lusaka. Participants: We sampled a random subset of all decedents who transited the University Teaching Hospital morgue. We sampled the posterior nasopharynx of decedents using quantitative PCR. Prevalence was weighted to account for age-specific enrolment strategies. Interventions: Not applicable-this was an observational study. Primary Outcomes: Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time. Secondary Outcomes: Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates. Results: From 1118 decedents enrolled between January and June 2021, COVID-19 was detected among 32.0% (358/1116). Roughly four COVID-19+ community deaths occurred for every facility death. Antemortem testing occurred for 52.6% (302/574) of facility deaths but only 1.8% (10/544) of community deaths and overall, only ~10% of COVID-19+ deaths were identified in life. During peak transmission periods, COVID-19 was detected in ~90% of all deaths. We observed three waves of transmission that peaked in July 2020, January 2021 and ~June 2021: the AE.1 lineage and the Beta and Delta variants, respectively. PCR signals were strongest among those whose deaths were deemed 'probably due to COVID-19', and weakest among children, with an age-dependent increase in PCR signal intensity. Conclusions: COVID-19 was common among deceased individuals in Lusaka. Antemortem testing was rarely done, and almost never for community deaths. Suspicion that COVID-19 was the cause of deaths was highest for those with a respiratory syndrome and lowest for individuals <19 years. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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