Effects of mobility, immunity and vaccination on SARS-CoV-2 transmission in the Dominican Republic: a modelling study.

Background: COVID-19 dynamics are driven by a complex interplay of factors including population behaviour, new variants, vaccination and immunity from prior infections. We quantify drivers of SARS-CoV-2 transmission in the Dominican Republic, an upper-middle income country of 10.8 million people. We then assess the impact of the vaccination campaign implemented in February 2021, primarily using CoronaVac, in saving lives and averting hospitalisations. Methods: We fit an age-structured, multi-variant transmission dynamic model to reported deaths, hospital bed occupancy, and seroprevalence data until December 2021, and simulate epidemic trajectories under different counterfactual scenarios. Findings: We estimate that vaccination averted 7210 hospital admissions (95% credible interval, CrI: 6830-7600), 2180 intensive care unit admissions (95% CrI: 2080-2280) and 766 deaths (95% CrI: 694-859) in the first 6 months of the campaign. If no vaccination had occurred, we estimate that an additional decrease of 10-20% in population mobility would have been required to maintain equivalent death and hospitalisation outcomes. We also found that early vaccination with CoronaVac was preferable to delayed vaccination using a product with higher efficacy. Interpretation: SARS-CoV-2 transmission dynamics in the Dominican Republic were driven by a substantial accumulation of immunity during the first two years of the pandemic but, despite this, vaccination was essential in enabling a return to pre-pandemic mobility levels without considerable additional morbidity and mortality. Funding: Medical Research Council, Wellcome Trust, Royal Society, US CDC and Australian National Health and Medical Research Council.

Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study.

Background: Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence. Aim: This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions. Methods: We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach. Results: A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation). Discussion: By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.

Análisis del desempeño presupuestario del sector salud en el período 2019-2021. Resultados para Chile, Colombia, Guatemala, Honduras, Panamá, Perú, República Dominicana y Uruguay

Esta publicación analiza el grado de alineamiento entre la necesidad de priorizar el primer nivel de atención con el desempeño presupuestario en salud y la capacidad de absorción del sector salud del incremento de los recursos financieros en el periodo 2019 a 2021. La Estrategia de OPS/OMS para el Establecimiento de Sistemas de Salud Resilientes enfatiza la necesidad de priorizar las inversiones en el primer nivel de atención por su incidencia en los niveles de acceso y cobertura. En este ámbito, los presupuestos públicos sirven como el mecanismo por excelencia de revisión de políticas públicas donde se plasman las prioridades de los gobiernos y los diferentes actores del sistema de salud, se articula el modelo de atención y se reasignan recursos ante eventos de emergencia sanitaria. La relevancia del presupuesto público se manifiesta también en la propuesta de incrementar la inversión en salud proveniente de recursos públicos, principalmente ingresos generales (o impuestos) acercándose al 6% del PIB incluido en la estrategia de Salud Universal de la OPS/OMS. El periodo de análisis de esta publicación se caracterizó por un incremento sin precedentes en el flujo de recursos financieros hacia el sector salud para asegurar la capacidad de respuesta del sistema de salud frente a la emergencia sanitaria originada por la pandemia de la Covid-19. La mayor priorización de recursos públicos para salud se viabilizó a través de la implementación de diferentes mecanismos de expansión fiscal, y la utilización de recursos de emergencia; así como a través de las innovaciones en las reglas de gestión financiera pública. Del análisis en este documento elaborado para ocho países de la región utilizando información presupuestaria de acceso público se obtienen varias lecciones que relevan la importancia de fortalecer capacidades de gestión para una asignación más rápida, eficaz y equitativa que se traduzca a la vez en una ejecución presupuestaria más eficiente y equitativa de acuerdo con los objetivos sanitarios. Queda asimismo como tarea pendiente, el relacionar la asignación y uso de estos recursos con las barreras de acceso no-financieras y la interrupción de los servicios esenciales durante el mismo periodo.

Trust and COVID-19 vaccine hesitancy in the Dominican Republic: a national cross-sectional household survey, June-October 2021.

OBJECTIVE: This study investigates the role of trust in shaping COVID-19 vaccine acceptance in the Dominican Republic (DR) during the COVID-19 pandemic. DESIGN: Cross-sectional household survey. SETTING: Randomly selected households across 134 clusters in the DR, from 30 June 2021 to 12 October 2021. PARTICIPANTS: 5999 participants ≥16 years of age were enrolled. OUTCOME MEASURES: COVID-19 vaccine hesitancy (CVH) data were collected from participants ≥16 years of age and analysed as both an ordinal and binary variable. RESULTS: Overall, CVH was low (5.2% (95% CI 4.6% to 5.8%)), but more common among younger individuals, women and individuals of Mestizo ethnicity. Higher trust in local government, national government, scientists and local doctors (considered official sources) was associated with lower odds of CVH (OR 0.89 (95% CI 0.72 to 0.88), 0.89 (95% CI 0.81 to 0.98), 0.87 (95% CI 0.80 to 0.94) and 0.70 (95% CI 0.62 to 0.80), respectively). Higher trust in religious leaders, social media and traditional media (considered unofficial sources) was associated with higher odds of CVH, with respective ORs of 1.32 (95% CI 1.18 to 1.47), 1.30 (95% CI 1.19 to 1.41) and 1.08 (95% CI 0.97 to 1.22). CONCLUSION: We report findings on CVH from a national household survey in the DR and identify overall low rates of CVH but marked heterogeneity by age, gender and ethnicity. Trust in unofficial versus official sources of information is associated with increased CVH. These findings highlight and quantify the importance of trust as a key parameter when considering public health communication strategies.

Central America and the Dominican Republic at Crossroads: The Importance of Regional Cooperation and Health Economic Research to Address Current Health Challenges.

OBJECTIVES: We discuss key health challenges currently faced by countries in the Central America and Dominican Republic region after the COVID-19 pandemic. We highlight the influence of socioeconomic determinants for the challenging public health dynamics observed and the crucial roles that regional cooperation and health economic research can have for tackling such challenges. METHODS: We present a descriptive overview of the current situation of public finances and its effect on government capacity to improve social expenditure. We also discuss the impact of the COVID-19 pandemic crisis on social dynamics and living conditions in the region. RESULTS: Our analysis suggests that the interplay between all these factors is likely to have important consequences for health systems and population health in the post-pandemic period. Previous examples of successful cross-country cooperation in the region indicate the great potential that these initiatives have for supporting health system resilience against current challenges. Technical cooperation must be informed by (currently unavailable) research evidence that can guide decision making, especially health economic research to support national health resource allocation policies. Areas identified as priorities for applied health economic research include both macro and microeconomic analyses. CONCLUSIONS: Central America and the Dominican Republic face significant health challenges post-pandemic. Our article emphasizes the great potential that regional technical cooperation, informed by further health economic research, has to improve public policies and health governance in the region.

Análisis del desempeño presupuestario del sector salud en el período 2019-2021. Resultados para Chile, Colombia, Guatemala, Honduras, Panamá, Perú, República Dominicana y Uruguay / Analysis of the budgetary performance of the health sector in the period 2019-2021. Results for Chile, Colombia, Guatemala, Honduras, Panama, Peru, Dominican Republic and Uruguay

Esta publicación analiza el grado de alineamiento entre la necesidad de priorizar el primer nivel de atención con el desempeño presupuestario en salud y la capacidad de absorción del sector salud del incremento de los recursos financieros en el periodo 2019 a 2021. La Estrategia de OPS/OMS para el Establecimiento de Sistemas de Salud Resilientes enfatiza la necesidad de priorizar las inversiones en el primer nivel de atención por su incidencia en los niveles de acceso y cobertura. En este ámbito, los presupuestos públicos sirven como el mecanismo por excelencia de revisión de políticas públicas donde se plasman las prioridades de los gobiernos y los diferentes actores del sistema de salud, se articula el modelo de atención y se reasignan recursos ante eventos de emergencia sanitaria. La relevancia del presupuesto público se manifiesta también en la propuesta de incrementar la inversión en salud proveniente de recursos públicos, principalmente ingresos generales (o impuestos) acercándose al 6% del PIB incluido en la estrategia de Salud Universal de la OPS/OMS. El periodo de análisis de esta publicación se caracterizó por un incremento sin precedentes en el flujo de recursos financieros hacia el sector salud para asegurar la capacidad de respuesta del sistema de salud frente a la emergencia sanitaria originada por la pandemia de la Covid-19

Reaching "covidianidad": A qualitative study of the impact of the COVID-19 pandemic on the perceived mental health of health care workers in the Dominican Republic.

We aimed to explore how the COVID-19 pandemic affected the lives of healthcare workers (HCWs) in the Dominican Republic. We also aimed to identify the types of resources that HCWs felt were needed to support their mental health. We used purposive and convenience sampling in four health centers in the eastern Dominican Republic to recruit 28 HCWs (doctors, nurses, psychologists, and community health workers) between April 2021 and August 2021. Through semi-structured interviews, we elicited HCWs experiences during the pandemic and how they felt these experiences impacted their mental health. Interview transcripts were analyzed using an inductive/deductive thematic approach. Main stressors experienced during the pandemic by HCWs and their sequelae included anxiety due to misinformation and uncertainty, fear of the disease, the robustness of pandemic-related changes they faced in their work and daily life, and COVID-19's economic impact. HCWs reflected on protective factors that transformed their acute sense of crisis felt at the beginning of the pandemic into what HCWs referred to as "covidianidad [everyday COVID]", a situation that became manageable through mechanisms including social support, professional motivation, positive work environment and resilience. Lastly, HCWs identified stigmatization of and limited access to mental health services as challenges to supporting their mental health. While Dominican HCWs were vulnerable to the challenges posed by COVID-19 in sustaining their mental health, for many, the situation became manageable through the evolution of "covidianidad." Further research and interventions are needed to reduce stigmatization of mental health services and foment a positive environment for HCWs' mental health, to promote resiliency to future challenges.

Using Regional Sero-Epidemiology SARS-CoV-2 Anti-S Antibodies in the Dominican Republic to Inform Targeted Public Health Response.

Incidence of COVID-19 has been associated with sociodemographic factors. We investigated variations in SARS-CoV-2 seroprevalence at sub-national levels in the Dominican Republic and assessed potential factors influencing variation in regional-level seroprevalence. Data were collected in a three-stage cross-sectional national serosurvey from June to October 2021. Seroprevalence of antibodies against the SARS-CoV-2 spike protein (anti-S) was estimated and adjusted for selection probability, age, and sex. Multilevel logistic regression was used to estimate the effect of covariates on seropositivity for anti-S and correlates of 80% protection (PT80) against symptomatic infection for the ancestral and Delta strains. A total of 6683 participants from 134 clusters in all 10 regions were enrolled. Anti-S, PT80 for the ancestral and Delta strains odds ratio varied across regions, Enriquillo presented significant higher odds for all outcomes compared with Yuma. Compared to being unvaccinated, receiving ≥2 doses of COVID-19 vaccine was associated with a significantly higher odds of anti-S positivity (OR 85.94, [10.95-674.33]) and PT80 for the ancestral (OR 4.78, [2.15-10.62]) and Delta strains (OR 3.08, [1.57-9.65]) nationally and also for each region. Our results can help inform regional-level public health response, such as strategies to increase vaccination coverage in areas with low population immunity against currently circulating strains.

The effects of policy changes and human mobility on the COVID-19 epidemic in the Dominican Republic, 2020-2021.

Recent advances in technology can be leveraged to enhance public health research and practice. This study aimed to assess the effects of mobility and policy changes on COVID-19 case growth and the effects of policy changes on mobility using data from Google Mobility Reports, information on public health policy, and COVID-19 testing results. Multiple bivariate regression analyses were conducted to address the study objectives. Policies designed to limit mobility led to decreases in mobility in public areas. These policies also decreased COVID-19 case growth. Conversely, policies that did not restrict mobility led to increases in mobility in public areas and led to increases in COVID-19 case growth. Mobility increases in public areas corresponded to increases in COVID-19 case growth, while concentration of mobility in residential areas corresponded to decreases in COVID-19 case growth. Overall, restrictive policies were effective in decreasing COVID-19 incidence in the Dominican Republic, while permissive policies led to increases in COVID-19 incidence.

Genomic Surveillance of SARS-CoV-2 Variants in the Dominican Republic and Emergence of a Local Lineage.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that evolves over time, leading to new variants. In the current study, we assessed the genomic epidemiology of SARS-CoV-2 in the Dominican Republic. A total of 1149 SARS-CoV-2 complete genome nucleotide sequences from samples collected between March 2020 and mid-February 2022 in the Dominican Republic were obtained from the Global Initiative on Sharing All Influenza Data (GISAID) database. Phylogenetic relationships and evolution rates were analyzed using the maximum likelihood method and the Bayesian Markov chain Monte Carlo (MCMC) approach. The genotyping details (lineages) were obtained using the Pangolin web application. In addition, the web tools Coronapp, and Genome Detective Viral Tools, among others, were used to monitor epidemiological characteristics. Our results show that the most frequent non-synonymous mutation over the study period was D614G. Of the 1149 samples, 870 (75.74%) were classified into 8 relevant variants according to Pangolin/Scorpio. The first Variants Being Monitored (VBM) were detected in December 2020. Meanwhile, in 2021, the variants of concern Delta and Omicron were identified. The mean mutation rate was estimated to be 1.5523 × 10-3 (95% HPD: 1.2358 × 10-3, 1.8635 × 10-3) nucleotide substitutions per site. We also report the emergence of an autochthonous SARS-CoV-2 lineage, B.1.575.2, that circulated from October 2021 to January 2022, in co-circulation with the variants of concern Delta and Omicron. The impact of B.1.575.2 in the Dominican Republic was minimal, but it then expanded rapidly in Spain. A better understanding of viral evolution and genomic surveillance data will help to inform strategies to mitigate the impact on public health.

Epidemiología de las infecciones espiratorias agudas antes y en pandemia de Coronavirus en República Dominicana / Epidemiology of Acute Respiratory Infections before and during the Coronavirus pandemic in the Dominican Republic

Resumen Objetivo: El síndrome respiratorio severo por coronavirus del Síndrome Respiratorio Agudo Severo tipo 2 es el microorganismo responsable de causar el COVID-19, una patología con afectación predominantemente respiratoria que posee un comportamiento similar a los procesos virales respiratorios más comunes. El incremento de número de casos de Síndrome Respiratorio Agudo Severo tipo 2 reportados en cada país ha causado un desplazamiento de las infecciones respiratorias agudas (IRAs) causadas por otros patógenos hasta un 70% el número de casos reportado durante la pandemia. Material y métodos: Se realizó un estudio descriptivo y transversal, con recolección de datos retrospectiva de fuente secundaria utilizando como fuente de información los boletines epidemiológicos semanales desde la semana 1 del mes de Enero 2019 a la semana 53 del mes de Diciembre del 2020 del Sistema nacional de vigilancia Epidemiológica del Ministerio de Salud Pública a través de la Dirección General de Epidemiología. Resultados: Se observa disminución de los casos de infección respiratoria aguda con un incremento respectivo en los casos de COVID-19 al comparar los años 2019 y 2020. La provincia con mayor número de casos fue el Distrito Nacional. Conclusión: Es necesario evaluar el comportamiento del Síndrome Respiratorio Agudo Severo tipo 2 con relación a otros patógenos para identificar si las infecciones respiratorias agudas retornarán a un estado previo a la pandemia, cuando el uso de mascarillas ya no sea necesario, Síndrome Respiratorio Agudo Severo tipo 2 será el patógeno prevalente.

Abstract Objective: Severe respiratory syndrome due to coronavirus type 2 is the microorganism responsible for causing COVID-19, a pathology with predominantly respiratory involvement that has a similar behavior to the most common respiratory viral processes. The increase in the number of severe acute respiratory syndrome type 2 cases reported in each country has caused a displacement of acute respiratory infections (ARIs) caused by other pathogens up to 70% of the number of cases reported during the pandemic. Material and methods: This study is descriptive and cross-sectional with retrospective data collection from secondary sources using as a source of information the weekly epidemiological bulletins from week 1 of January 2019 to week 53 of December 2020 of the National Epidemiological Surveillance System of the Ministry of Public Health through the General Directorate of Epidemiology. Results: A decrease in cases of acute respiratory infection with a respective increase in cases of COVID-19 was observed when comparing the years 2019 and 2020. The province with the highest number of cases was the National District. Conclusion: The behavior of severe acute respiratory syndrome type 2 relative to other pathogens needs to be evaluated to identify whether acute respiratory infections will return to a pre-pandemic state when facemask use is no longer necessary severe acute respiratory syndrome type 2 will be the prevalent pathogen.

Population-Level Effectiveness of an Inactivated Whole-Virion COVID-19 Vaccine: A Test Negative Case-Control Study in the Dominican Republic.

Background: A continuing nationwide vaccination campaign began in the Dominican Republic on February 16, 2021 to prevent severe consequences of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Estimates of vaccine effectiveness under real-world conditions are needed to support policy decision making and inform further vaccine selection. Methods: We conducted a test-negative case-control study to assess the real-world effectiveness of nationwide coronavirus disease 2019 (COVID-19) vaccination program using an inactivated vaccine (CoronaVac) on preventing symptomatic SARS-CoV-2 infections and hospitalizations from August to November 2021 in the Dominican Republic. Participants were recruited from 10 hospitals in 5 provinces to estimate the effectiveness of full immunization (≥14 days after receipt of the second dose) and partial immunization (otherwise with at least 1 dose ≥14 days after receipt of the first dose). Results: Of 1078 adult participants seeking medical care for COVID-19-related symptoms, 395 (36.6%) had positive polymerase chain reaction (PCR) tests for SARS-CoV-2; 142 (13.2%) were hospitalized during 15 days of follow up, including 91 (23%) among 395 PCR-positive and 51 (7.5%) among 683 PCR-negative participants. Full vaccination was associated with 31% lower odds of symptomatic infection (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.52-0.93) and partial vaccination was associated with 49% lower odds (OR, 0.51; CI, 0.30-0.86). Among 395 PCR-positive participants, full vaccination reduced the odds of COVID-19-related hospitalization by 85% (OR, 0.15; 95% CI, 0.08-0.25) and partial vaccination reduced it by 75% (OR, 0.25; 95% CI, 0.08-0.80); full vaccination was associated with reduced use of assisted ventilation by 73% (OR, 0.27; 95% CI, 0.15-0.49). Conclusions: Given the ancestral and delta viral variants circulating during this study period, our results suggest that the inactivated COVID-19 vaccine offered moderate protection against symptomatic SARS-CoV-2 infections and high protection against COVID-19-related hospitalizations and assisted ventilation. This is reassuring given that, as of August 2022, an estimated 2.6 billion inactivated CoronaVac vaccine doses had been administered worldwide. This vaccine will become a basis for developing multivalent vaccine against the currently circulating omicron variant.

Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022.

To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.

Evaluation of sample pooling for the detection of SARS-CoV-2 in a resource-limited setting, Dominican Republic.

INTRODUCTION: COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing. MATERIALS AND METHODS: We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites. RESULTS: Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity. CONCLUSIONS: Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.

Evaluation of sample pooling for the detection of SARS-CoV-2 in a resource-limited setting, Dominican Republic / Evaluación del análisis de muestras agrupadas para la detección de SARS-CoV-2 en entornos con recursos limitados, República Dominicana

Introduction: COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing. Materials and methods: We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites. Results: Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity. Conclusions: Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.(AU)

Introducción: La COVID-19 es una amenaza de salud pública mundial. La RT-PCR es el método estándar para confirmar la infección. La estrategia de pruebas de muestras agrupadas puede reducir la carga de trabajo y la escasez de reactivos, y ser útil en países con escasos recursos. Evaluamos la detección del SARS-CoV-2 mediante esta estrategia en comparación con pruebas individuales. Materiales y métodos: Creamos 210 grupos de 245 muestras, de 4 a 10 muestras por grupo, cada uno con una muestra positiva. Realizamos extracción de ARN y qRT-PCR para detectar la presencia de la diana RdRp/E. Resultados: La combinación de hasta 3 muestras para la detección del SARS-CoV-2 podría ser una estrategia eficaz sin perder la sensibilidad. Conclusiones: Considerando la tasa de positividad en República Dominicana y que los grupos con más muestras tienen mayor probabilidad de obtener resultados falsos negativos, el tamaño óptimo para realizar esta estrategia es de 3 muestras.(AU)

Genome Sequence of a Recombinant SARS-CoV-2 Lineage XAM (BA.1.1/BA.2.9) Strain from a Clinical Sample in Santo Domingo, Dominican Republic.

Here, we report a recombinant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage XAM (Omicron BA.1.1/BA.2.9) strain that was collected in Santo Domingo, Dominican Republic. This demonstrates how SARS-CoV-2 variants can vary greatly between regions and thus underlines the great importance of regional genomic surveillance efforts.

Evaluation of sample pooling for the detection of SARS-CoV-2 in a resource-limited setting, Dominican Republic.

Introduction: COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing. Materials and methods: We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites. Results: Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity. Conclusions: Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.

Introducción: La COVID-19 es una amenaza de salud pública mundial. La RT-PCR es el método estándar para confirmar la infección. La estrategia de pruebas de muestras agrupadas puede reducir la carga de trabajo y la escasez de reactivos, y ser útil en países con escasos recursos. Evaluamos la detección del SARS-CoV-2 mediante esta estrategia en comparación con pruebas individuales. Materiales y métodos: Creamos 210 grupos de 245 muestras, de 4 a 10 muestras por grupo, cada uno con una muestra positiva. Realizamos extracción de ARN y qRT-PCR para detectar la presencia de la diana RdRp/E. Resultados: La combinación de hasta 3 muestras para la detección del SARS-CoV-2 podría ser una estrategia eficaz sin perder la sensibilidad. Conclusiones: Considerando la tasa de positividad en República Dominicana y que los grupos con más muestras tienen mayor probabilidad de obtener resultados falsos negativos, el tamaño óptimo para realizar esta estrategia es de 3 muestras.

Factores Asociados A Severidad Y Mortalidad En Pacientes Con Covid-19: Estudio Multicéntrico En República Dominicana / Factors associated with severity and mortality in patients with COVID-19: a multicentered study in Dominican Republic

Objetivo: identificar factores asociados a severidad y mortalidad por COVID-19. Material y métodos: estudio observacional multicéntrico retrospectivo de pacientes ingresados por COVID-19 en centros de una ciudad de la República Dominicana. Se reportaron datos demográficos, clínicos, terapéuticos y de laboratorio para su comparación entre pacientes con enfermedad severa y no severa, fallecidos y dados de alta. Resultados: los factores asociados a mayor riesgo de severidad y mortalidad fueron el sexo masculino, la hipertensión arterial, la cantidad de comorbilidades, el uso de fármacos previos, niveles elevados de marcadores inflamatorios, linfopenia, neutrofilia, entre otros. Mientras que el uso de inhibidores de la enzima convertidora de angiotensina se asoció a menor mortalidad. Conclusiones: la identificación de los factores asociados a progresión severa y mortal por COVID-19 contribuye a la toma temprana de decisiones relacionadas a la hospitalización y a pautas de manejo médico diferencial en quienes conllevan mayor riesgo de desenlaces adversos.

Objective: To identify factors associated with severity and mortality by COVID-19. Material and methods: Retrospective multicenter observational study of patients admitted with COVID-19 in health centers in a city of the Dominican Republic. Demographic, clinical, therapeutic and laboratory data were reported for comparison between patients with severe and non-severe disease, deceased and discharged. Results: Factors significantly associated with higher risk of severity and mortality were male sex, hypertension, number of comorbidities, drugs' used previously, high levels of inflammatory markers, lymphopenia, neutrophilia, among others. While the use of angiotensin converting enzyme inhibitors was associated with lower mortality. Conclusions: Identification of factors associated with severe and fatal progression of COVID-19 contributes to early clinical decision-making related to hospitalization and differential medical management in those at increased risk of adverse outcomes.

Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic.

Objective: To describe antimicrobial resistance before and after the COVID-19 pandemic in the Dominican Republic. Design: Retrospective study. Setting: The study included 49 outpatient laboratory sites located in 13 cities nationwide. Participants: Patients seeking ambulatory microbiology testing for urine and bodily fluids. Methods: We reviewed antimicrobial susceptibility reports for Escherichia coli isolates from urine and Pseudomonas aeruginosa (PSAR) from bodily fluids between January 1, 2018, to December 31, 2021, from deidentified susceptibility data extracted from final culture results. Results: In total, 27,718 urine cultures with E. coli and 2,111 bodily fluid cultures with PSAR were included in the analysis. On average, resistance to ceftriaxone was present in 25.19% of E. coli isolated from urine each year. The carbapenem resistance rates were 0.15% for E. coli and 3.08% for PSAR annually. The average rates of E. coli with phenotypic resistance consistent with possible extended-spectrum ß-lactamase (ESBL) in urine were 25.63% and 24.75%, respectively, before and after the COVID-19 pandemic. The carbapenem resistance rates in urine were 0.11% and 0.20%, respectively, a 200% increase. The average rates of PSAR with carbapenem resistance in bodily fluid were 2.33% and 3.84% before and after the COVID-19 pandemic, respectively, a 130% percent increase. Conclusions: Resistance to carbapenems in PSAR and E. coli after the COVID-19 pandemic is rising. These resistance patterns suggest that ESBL is common in the Dominican Republic. Carbapenem resistance was uncommon but increased after the COVID-19 pandemic.

Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic: a qualitative study.

BACKGROUND: Good governance and regulatory supervision are required to conduct research in an international public health emergency context and to ensure compliance with ethical standards. The "Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic" study is a regional effort in which research ethics stakeholders participated in addressing research ethics governance and preparedness response challenges to the COVID-19 pandemic in Central America and the Dominican Republic. METHODS: A qualitative action research study was conducted following a participatory approach. Research ethics stakeholders in Central America and the Dominican Republic were mapped; a regional webinar and three virtual workshops were conducted discussing research ethics governance, ethics review and collaborative research practice during the pandemic. A roundtable session presented results and obtained feedback on a draft of a policy to strengthen regional research ethics governance. RESULTS: Countries across Central America and the Dominican Republic are at different stages in their development of research ethics systems. Countries with more established systems before COVID-19 were better organized and prepared to respond. This finding argues against improvisation and supports further work on strengthening governance of research ethics systems. Community engagement in research ethics public policy-making is practically absent in the region. Research and research ethics collaboration schemes are lacking amongst the countries; however, there are incipient initiatives in the region, such as the Central America and Caribbean Network of Research Ethics Committees. A policy brief with recommendations on how to advance towards strengthening the governance of research ethics systems was prepared and submitted to the Central American Integration System for analysis and possible approval. CONCLUSION: National research ethics systems in Central America and the Dominican Republic were unprepared to respond to the COVID-19 pandemic with respect to research oversight and effective collaboration. In most cases, national research ethics systems were found to be weak, and regional research collaboration was practically absent. To promote collaboration, a joint strategy needs to be developed with a regional vision towards sharing knowledge and best practices.