What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study.
BMJ Open
; 12(12): e066763, 2022 12 06.
Article
in En
| MEDLINE
| ID: mdl-36600354
ABSTRACT
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. PRIMARYOUTCOMES:
Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time. SECONDARYOUTCOMES:
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
COVID-19
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Child
/
Humans
Country/Region as subject:
Africa
Language:
En
Journal:
BMJ Open
Year:
2022
Document type:
Article
Affiliation country:
United States