Infectious Disease

Infections are on the rise in Africa while the severity of COVID-19 remains low

November 27, 2021

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Woodford, J. et al. Abstract 0906. Presented at: Annual Meeting of the American Society of Tropical Medicine & Hygiene; 17.-21. November 2021; virtual.

Disclosure:
Woodford reports to be a paid contractor for NIAID and NIH. The other authors do not report any relevant financial information.

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Screening in Mali, where 60% of people were infected with SARS-CoV-2, found no difference in rates of respiratory or gastrointestinal symptoms in those who were infected and those who were not, according to one study was.

John Woodford, MD, a malaria researcher at the National Institute of Allergy and Infectious Diseases, and colleagues performed an analysis of clinical information during a two-visit sero survey at three locations in urban and rural areas in Mali. Their results were presented at the meeting of the American Society of Tropical Medicine & Hygiene.

PerkinsDJ et al.  Abstract 1384. Presented at: Annual Meeting of the American Society of Tropical Medicine & Hygiene;  17.-21.  November 2021;  virtual.

Woodford, J. et al. Abstract 0906. Presented at: Annual Meeting of the American Society of Tropical Medicine & Hygiene; 17.-21. November 2021; virtual.

The first study visit with 2,533 participants was conducted from July to October 2020 before the malaria season. The second was completed in January 2021, shortly after the malaria season, with 2,672 participants.

On the first visit, when the researchers compared the seronegative ones with those that were seropositive, found that systemic symptoms were more common in the seropositive ones, such as: B. fever (8.5% vs. 4%), chills (1.7% vs. 0.4%), myalgia (3.5% vs. 0.7%) and headache (11% vs. 3.7%) %). At the second visit, after the malaria season, the seropositive subjects only experienced chills (3.7% vs. 2.1%) and fatigue (4.3% vs. 2.5%) more frequently.

In addition, “the respiratory and gastrointestinal symptoms on both visits were not clearly different based on serostatus,” the researchers reported.

“This is just not the level of symptoms, complications, hospitalizations and deaths seen in a population in the United States who has experienced such high exposure,” Woodford said in a press release. “As in the rest of sub-Saharan Africa, Mali’s population is relatively young. But this comparatively low exposure to the COVID-19 disease remained unchanged even after adjustment for age. “

The researchers said that COVID-19 rates could decrease to background levels during malaria transmission.

“Malaria can have a protective effect”

In another study presented at the conference Jane Achan, PhD, a senior research advisor to the Malaria Consortium, and colleagues studied malaria infections in hospitalized patients with COVID-19 in Uganda. They found that people with high exposure to malaria were less likely to develop severe COVID-19.

“We went into this project thinking that we would see a higher rate of negative results in people with a history of malaria infections because this was seen in patients co-infected with malaria and Ebola,” Achan said in the press release. “We were actually quite surprised to see the opposite – that malaria can have a protective effect.”

The researchers’ evaluation of 597 hospitalized patients showed that people with low exposure to malaria had a higher incidence of severe COVID-19 infections (30.2%) and a higher exposure to comorbidities such as high blood pressure (30.2%) and diabetes (22, 6%) and deaths (3.8%). Only 5% of patients with high exposure to malaria had a severe case of COVID-19, they found.

In participants with no comorbidities, those with low exposure to malaria still had a higher severity rate than those with high exposure to malaria (18.2% vs. 2%).

Worse results for Native Americans

A third study by Douglas J. Perkins, PhD, Director of the Center for Global Health at the University of New Mexico, and colleagues showed Native American populations were at higher risk for serious COVID-19 infection.

The Perkins team performed an analysis of 94 patients with COVID-19, including 45.7% who identified themselves as Native Americans. They defined severe infection as an increased viral load in the blood that was seen more frequently among Native American people (OR = 7.46; 95% CI 2.2-25.29), according to the results presented at the meeting.

SARS-CoV-2 peripheral blood or viraemia was cumulatively higher in Native American people over 14 days. Native American ancestry was associated with a higher risk of viraemia (OR = 4.73; 95% CI 1.67-13.43). Viraemia during hospitalization was associated with severe illness (OR = 9.19; 95% CI 3.33-25.34)

“These results may at least partially explain the disproportionate burden of disease from COVID-19 in this population,” wrote Douglas and colleagues. “It will be important to define the biological / molecular basis of these virological findings in future studies in order to develop interventions for improved clinical outcomes.”

References:

AchanJ. et al. Abstract 0029. Presented at: American Society of Tropical Medicine & Hygiene Annual Meeting; 17.-21. November 2021; virtual.

PerkinsDJ et al. Abstract 1384. Presented at: Annual Meeting of the American Society of Tropical Medicine & Hygiene; 17.-21. November 2021; virtual.

Woodford, J. et al. Abstract 0906. Presented at: Annual Meeting of the American Society of Tropical Medicine & Hygiene; 17.-21. November 2021; virtual.

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American Society for Tropical Medicine and Hygiene (ASTMH)

American Society for Tropical Medicine and Hygiene (ASTMH)

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