In the United States, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, was first detected in late January 2020. Since then, several COVID-19 waves have occurred due to the emergence of highly infectious SARS-CoV-2 variants, such as B.1.617.2 (Delta) and B.1.1.529 (Omicron).
COVID-19 burden is monitored over time based on the number of infections, deaths, hospital visits, and hospital admissions. In contrast, seroprevalence within a population is determined at a particular point in time.
Study: Estimated SARS-CoV-2 antibody seroprevalence trends and relationship to reported case prevalence from a repeated, cross-sectional study in the 50 states and the District of Columbia, United States—October 25, 2020–February 26, 2022. Image Credit: Cryptographer / Shutterstock.com
Sero-surveillance studies, whether cohort or cross-section-based, have been challenged due to their inability to determine the national burden of COVID-19. One of the reasons for this limitation is that sero-surveillance is conducted in subnational geographical areas or targeted to a specific patient population.
A new The Lancet Regional Health study analyzed data from all cross-sectional, national, repeated, and all-aged SARS-CoV-2 seroprevalence studies to elucidate the nationwide temporal trends of COVID-19 prevalence. The main aim of this study was to determine the overall antibody seroprevalence trends in different subgroups based on age, sex, and urbanicity. Additionally, the authors analyzed changes in the serological estimates at different phases of the pandemic and across geographical areas.
About the study
Remnant sera samples were collected from commercial laboratories between October 25, 2020, and February 26, 2022. These laboratories regularly obtained sera specimens from all 50 U.S. states and the District of Columbia (D.C.) for routine screening, diagnostic, or clinical care.
These sera samples were used to determine SARS-CoV-2 antibodies using commercially available test kits that received Emergency Use Authorization from the U.S. Food and Drug Administration (FDA).
Initially, SARS-CoV-2 antibodies were estimated biweekly. After a break of 56 days, antibodies were tested monthly.
The authors obtained additional data, including the sex, age, state, ZIP code, and specimen collection dates. However, the study did not include vaccination status, race, and ethnicity.
In the study period, a total of 1,469,792 remnant serum samples were obtained, of which 58.9% belonged to women.
The most significant percentage of samples belonged to individuals between the ages of 18 and 49 years, while the smallest percentage was from those between 0 and 17 years of age. In addition, most samples came from metro areas, and several SARS-CoV-2 infection waves were recorded.
Interestingly, infection-induced seroprevalence was correlated with age, with the youngest group of zero- to 17-year-olds exhibiting the highest seroprevalence. An increase in seroprevalence was observed from 10.4% to 75.7% during the study period. An increase in seroprevalence from 9.2% to 64.5% was observed in individuals aged 18-49 years.
The lowest seroprevalence was found in people aged 65 years or older. Both males and females exhibited similar infection-induced seroprevalence estimates.
As compared to non-metro areas, metro areas consistently showed a lower seroprevalence. Conversely, the highest seroprevalence prevailed in midwestern and southern regions of the U.S.
Throughout the study period, a convex pattern was observed in the change ratio, defined as the ratio of the change in seroprevalence to the change in reported case prevalence. For example, southern U.S. states exhibited the highest ratios during the winters at 3.2 compared to approximately 1.5 during other periods.
Analysis of sero-surveillance data is critical because it provides insights into infection burden. The change ratio helps understand the infection burden based on officially reported case rates.
A sudden increase in the infection rate also questions vaccine efficacy. In the current study, the researchers observed that the change ratio was highest during periods of high viral transmission, particularly in the winter.
A change in seroprevalence may be observed relative to the changes in reported cases because of the availability and use of home testing for COVID-19. This emphasizes the importance of continual sero-surveillance, which can provide better insights into the actual infection burden.
Serosurveys could help detect population subgroups at the highest risk of infection and target them for interventions. Children, for example, had the highest seroprevalence and higher infection-to-case ratios, even though seroprevalence in children is typically underestimated compared to adults.
The current study has many limitations, including the lack of probabilistic sampling, a potential source of bias in serosurveys. Additionally, excluding samples from individuals frequently subjected to SARS-CoV-2 antibody testing could lead to an underestimation of seroprevalence.
Nevertheless, the current study indicated that sero-surveillance data did not fully capture the SARS-CoV-2 infection burden in the U.S. between late 2020 and early 2022.
Sero-surveillance data is crucial to understand vaccine effectiveness. It also provides a better understanding of the effect of COVID-19 at the community level and identifies subgroups at higher risk of infection. This information could help scientists and policymakers formulate better strategies to protect vulnerable populations.
- Wiegand, E. R., Deng, Y., Deng, X., et al. (2022) Estimated SARS-CoV-2 antibody seroprevalence trends and relationship to reported case prevalence from a repeated, cross-sectional study in the 50 states and the District of Columbia, United States—October 25, 2020–February 26, 2022. The Lancet Regional Health 18. doi:10.1016/j.lana.2022.100403
Governments seek buyer as Quebec COVID-19 vaccine manufacturer Medicago set to close
Quebec Economy Minister Pierre Fitzgibbon said Friday the province has had preliminary talks with potential buyers in the pharmaceutical sector to keep Medicago’s expertise and skilled workforce in Quebec. He said both the Quebec and federal governments would be willing to put in money to secure a deal.
“We can’t operate it ourselves; the government will not be the main shareholder,” Fitzgibbon said. “But if there is a pharmaceutical company that considers it’s worth continuing, we’re ready to help.”
Mitsubishi Chemical said Thursday it would stop marketing the Medicago-produced Covifenz vaccine, which is plant-based and was approved by Health Canada one year ago for adults aged 18 to 64.
The Japanese chemical company said it had been preparing to commercially produce the Covifenz vaccine but decided against doing so because of the “significant changes” in the COVID-19 vaccine environment. The company said it would dissolve Medicago because it is no longer “viable” to continue marketing its products.
“In light of significant changes to the COVID-19 vaccine landscape since the approval of Covifenz, and after a comprehensive review of the current global demand and market environment for COVID-19 vaccines and Medicago’s challenges in transitioning to commercial-scale production, the (company) has determined that it will not pursue the commercialization of Covifenz,” Mitsubishi Chemical said in a statement.
Following the announcement, Medicago issued a statement thanking its employees. “The Medicago team has pushed scientific boundaries and we know that they will continue to make incredible contributions to innovation and biopharmaceutical’s sector.”
Canada invested $173 million in Medicago in 2020 to support development of the Covifenz vaccine and help Medicago expand its production facility in Quebec City.
On Thursday, Innovation, Science and Industry Minister François-Philippe Champagne told reporters the federal government is in “solution mode.”
“Our first order of business is really to try to find a partner who can help us preserve the jobs, preserve the technology and the intellectual property,” Champagne said.
The minister acknowledged that mRNA vaccine technology for COVID-19 became dominant as it “seemed to be most effective.”
But Medicago’s plant-based vaccine was still “promising,” Champagne said.
“Everyone agreed that the plant-based vaccine could very well help in a future pandemic,” Champagne said.
Speaking to reporters on Montreal’s South Shore Friday, Fitzgibbon said the company informed the province at the end of December it intended to pull the plug on Medicago.
In May 2015, Quebec and Ottawa announced loans of $60 million and $8 million, respectively, for the construction of a complex in the Quebec City region to house Medicago’s activities.
“The challenge is not (getting the loan repaid), it’s how we can save the jobs, save this company,” Fitzgibbon said.
While Canada authorized Medicago’s vaccine in February 2022, it was rejected for emergency use by the World Health Organization in March because tobacco company Philip Morris was a minority shareholder in the company, contravening a policy adopted in 2005 by the United Nations agency.
Quebec City Mayor Bruno Marchand said on Twitter he was saddened by the closure of the company.
“My thoughts are with the families who learned some very sad news,” Marchand said Thursday evening. “We have to roll up our sleeves to keep all this expertise in the field of health innovation in Quebec City.”
This report by The Canadian Press was first published Feb. 3, 2023.
Sidhartha Banerjee, The Canadian Press
Bird flu keeps spreading beyond birds. Scientists worry it signals a growing threat to humans, too
As a deadly form of avian influenza continues ravaging bird populations around much of the world, scientists are tracking infections among other animals — including various types of mammals more closely related to humans.
Throughout the last year, Canadian and U.S. officials detected highly pathogenic H5N1 avian flu in a range of species, from bears to foxes. In January, France’s national reference laboratory announced that a cat suffered severe neurological symptoms from an infection in late 2022, with the virus showing genetic characteristics of adaptation to mammals.
Most concerning, multiple researchers said, was a large, recent outbreak on a Spanish mink farm.
Last October, farm workers began noticing a spike in deaths among the animals, with sick minks experiencing an array of dire symptoms like loss of appetite, excessive saliva, bloody snouts, tremors, and a lack of muscle control.
The culprit wound up being H5N1, marking the first known instance of this kind of avian influenza infection among farmed minks in Europe, notes a study published in Eurosurveillance this month.
“Our findings also indicate that an onward transmission of the virus to other minks may have taken place in the affected farm,” the researchers wrote.
Eventually, the entire population of minks was either killed or culled — more than 50,000 animals in total.
That’s a major shift, after only sporadic cases among humans and other mammals over the last decade, according to Michelle Wille, a researcher at the University of Sydney who focuses on the dynamics of wild bird viruses.
“This outbreak signals the very real potential for the emergence of mammal-to-mammal transmission,” she said in email correspondence with CBC News.
It’s only one farm, and notably, none of the workers — who all wore face shields, masks, and disposable overalls — got infected.
But the concern now, said Toronto-based infectious disease specialist Dr. Isaac Bogoch, is if this virus mutates in a way that allows it to become increasingly transmissible between mammals, including humans, “it could have deadly consequences.”
“This is an infection that has epidemic and pandemic potential,” he said. “I don’t know if people recognize how big a deal this is.”
H5N1 has high mortality rate
Among birds, the mortality rate of this strain of highly pathogenic avian influenza can be close to 100 per cent, causing devastation to both wild bird populations and poultry farms.
It’s also often deadly for other mammals, humans included.
The World Health Organization (WHO) has documented 240 cases of H5N1 avian influenza within four Western Pacific countries — including China, Cambodia, Laos, and Vietnam — over the last two decades. More than half of the infected individuals died.
Global WHO figures show more than 870 human cases were reported from 2003 to 2022, along with at least 450 deaths — a fatality rate of more than 50 per cent.
Bogoch said the reported death toll may be an overestimate, since not all infections may be detected, though it’s clear people can “get very, very sick from these infections.”
Most human infections also appeared to involve people having direct contact with infected birds. Real-world mink-to-mink transmission now firmly suggests H5N1 is now “poised to emerge in mammals,” Wille said — and while the outbreak in Spain may be the first reported instance of mammalian spread, it may not be the last.
“A virus which has evolved on a mink farm and subsequently infects farm workers exposed to infected animals is a highly plausible route for the emergence of a virus capable of human-to-human transmission to emerge,” she warned.
Louise Moncla, an assistant professor of pathobiology at the University of Pennsylvania school of veterinary medicine, explained that having an “intermediary host” is a common mechanism through which viruses adapt to new host species.
“And so what’s concerning about this is that this is exactly the kind of scenario you would expect to see that could lead to this type of adaptation, that could allow these viruses to replicate better in other mammals — like us.”
Surveillance, vaccines both needed
What’s more reassuring is the ongoing development of influenza vaccines, giving humanity a head start on the well-known threat posed by bird flu.
Wille noted the earlier spread of H7N9, another avian influenza strain which caused hundreds of human cases in the early 2010s, prompted similar concern that the virus would acquire the mutations needed for ongoing human-to-human transmission.
“However, a very aggressive and successful poultry vaccination campaign ultimately stopped all human cases,” she added.
But while several H5N1 avian influenza vaccines have been produced, including one manufactured in Canada, there’s no option approved for public use in this country.
To ward off the potential threat this strain poses to human health, Bogoch said ongoing surveillance and vaccine production needs to remain top-of-mind for both policy makers and vaccine manufacturers.
Dr. Jan Hajek, an infectious diseases physician at Vancouver General Hospital, also questioned whether it’s time to wind down global mink farming, given the spread of various viruses, from avian influenza to SARS-CoV-2, the virus behind COVID-19.
“We’re closely related to minks and ferrets, in terms of influenza risks … if it’s propagating to minks, and killing minks, it’s worrisome to us,” he said.
In 2021, B.C. officials announced an end to mink farming across the province, saying the farms can be reservoirs for viruses and represent an ongoing danger to public health. All mink farm operations must be shut down, with all of the pelts sold, by April 2025.
However, other provinces — and plenty of countries — do intend to keep their mink farms operating.
“Is it responsible to have these kinds of farming conditions where these types of events can occur?” questioned Moncla. “If we’re going to keep having these types of farms, what can we do to make this safer?”
6,654 students facing suspension due to out-of-date immunization records
The Windsor-Essex County Health Unit (WECHU) has issued about 6,654 suspension orders to students who do not meet immunization requirements.
WECHU completed a review of all elementary student immunization records in December and more than 12,000 students received a notice.
These students were either overdue for one or more vaccines required to attend school, or their immunization records were not updated with the health unit.
“While many of these vaccines are normally administered by primary health care providers, parents and guardians of children who received their vaccines from their health care provider still need to report this information to the health unit,” said a WECHU news release.
The Immunization of School Pupils Act (ISPA) (1990), Section 11, Subsections (1) and (2) requires public health units to maintain and review vaccine records for every student attending school and to enforce a school suspension for incomplete immunization information. As the next step of the ISPA enforcement process, orders were mailed out to students that do not meet this requirement.
WECHU said this is the final notice.
The suspension order notifies parents and guardians that immunization records must be updated to the WECHU by Thursday, March 16, at 6 p.m. or their child will be suspended for up to 20 days from school, starting Monday, March 20, 2023. Once parents and guardians provide the missing immunization information to the WECHU, the student is removed from the suspension list and can attend school again.
Under the ISPA , children can be exempted from immunization for medical reasons or due to conscience or religious belief.
Families can book immunization appointments with their health care provider and are reminded to update their child’s immunization records online at immune.wechu.org.
Catch-up immunization clinics are also being offered at the WECHU Windsor and Leamington offices and will continue until the end of March. Families can book an appointment at a WECHU clinic by visiting wechu.org/getimmunized or by calling the WECHU at 519-960-0231.
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