COVID-19 Lethality in Sub-Saharan Africa and Helminth Immune Modulation

Fonte, Luis; Acosta, Armando; Sarmiento, María E.; Ginori, María; Garcı́a, Gissel; Norazmi, Mohd Nor

doi:10.3389/fimmu.2020.574910

Cited by 35 publications

(54 citation statements)

References 24 publications

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“…Actually, the low intensity and lethality of the national epidemics in most African countries suggest hypothetical protective interactions of the high burden of tuberculosis (and/or BCG coverage) and tropical parasitic diseases, along with the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs [ [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] ]. However, the detection of a new variant of the SARS-CoV-2 in South Africa (variant 501Y·V2) in middle December 2020 with preliminary studies suggesting that the variant is associated with a higher viral load, which may suggest potential for increased transmissibility, might challenge the low transmissibility, low lethality trend observed so far in most African Countries [ 81 ].…”

Section: Evidence Of the Syndemic Nature Of The Sars-cov-2 Pandemicmentioning

confidence: 99%

The SARS-CoV-2 pandemic: A syndemic perspective

et al. 2021

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The SARS-CoV-2 pandemic has affected communities, populations, and countries throughout the world. As the SARS-CoV-2 pandemic developed, the extent to which the disease interacted with already existing endemic, non-communicable and infectious diseases became evident, hence deeply influencing health outcomes. Additionally, a synergistic effect has been demonstrated also with socio-economic, cultural, and contextual determinants of health which seem to contribute to poorer health and accumulating social disadvantages. In this essay, using as a starting point the syndemic theory that translates the cumulative and intertwined factors between different epidemics, we argue that the SARS-CoV-2 is a one health issue of a syndemic nature and that the failure to acknowledge this contributes to weakened policy-making processes and public health responses and ineffective health policies and programs.

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Section: Evidence Of the Syndemic Nature Of The Sars-cov-2 Pandemicmentioning

confidence: 99%

The SARS-CoV-2 pandemic: A syndemic perspective

et al. 2021

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“…Chronic and persistent parasitic infection is common in LIMCs, and chronic parasitic infections, possibly in part through direct modulation of the host's immune responses, have been shown to alter clinical outcomes to other infections [11,12]. Pre-existing parasitic infections may also modify the host's immune response to infection with SARS-CoV-2 with possible beneficial or detrimental effects [13][14][15][16][17][18][19]. Recent reports demonstrated an inverse correlation between the incidence of COVID-19 and with soil-transmitted helminths, schistosomiasis or malaria [20].…”

Section: Introductionmentioning

confidence: 99%

Effect of co-infection with parasites on severity of COVID-19

Gebrecherkos

Gessesse

Kebede

et al. 2021

Preprint

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. The effect of co-infection with parasites on the clinical features of COVID-19 is unknown. Methods: We prospectively enrolled consecutive COVID-19 patients and screened them for intestinal parasitic infections. Patients were followed during hospitalization for clinical outcomes. Patients with parasitic co-infection were compared to those without parasitic co-infection. The primary outcome was the proportion of COVID-19 patients who developed severe disease. Factors associated with the development of severe disease were determined by logistic regression. Results: A total of 515 patients with PCR-confirmed SARS-CoV-2 infection were screened for intestinal parasites, of whom 267 (51.8%) were co-infected with one or more parasites. Parasitic co-infection correlated inversely with COVID-19 severity. Severe COVID-19 was significantly higher in patients without parasites [47/248 (19.0%, CI: 14.52-24.35)] than in those with parasites [21/267 (7.9%, CI: 5.17-11.79)]; p<0.0001. There was a significantly higher proportion of patients who developed severe COVID-19 in the non-protozoa group [56/369 (15.2%, CI: 11.85-19.23)] as compared to the protozoa group [12/146 (8.2%, CI: 4.70-14.00)]; p=0.036. Significant higher proportion of the patients presented at baseline with severe COVID-19 in the helminth negative group [57/341 (16.7%, CI: 13.10-21.08)] than in the group with pre-existing helminth infection [11/174 (6.3%, CI: 3.51-11.11)]; p=0.001. In addition, after adjustment for age and presence of comorbidities, COVID-19 patients with any parasite co-infection [aOR 0.41 (95% CI: 0.22-0.77); p=0.006], or with protozoa co-infection [aOR 0.45 (95% CI: 0.21-0.98); p=0.044] as well as those with helminth co-infection [aOR 0.37 (95% CI: 0.17-0.80); p=0.011] had lower probability of developing severe COVID-19 compared with those without parasite, protozoa or helminth co-infection. Conclusion: Our results suggest that co-infection with parasitic co-infection appears to be associated with reduced COVID-19 severity. The results suggest that parasite-driven immunomodulatory responses may mute hyperinflammation associated with severe COVID-19.

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“…This notion is supported by the fact that enteric helminth protect against pulmonary virus infection through interaction with microbiota (McFarlane et al, 2017). Though Bradbury et al (2020) suggest that helminth co-infection might hasten COVID-19 severity, an alternative hypotheses suggested that helminths might indeed reduce the severity of SARS-CoV-2 infection (Fonte et al, 2020;Hays et al, 2020;Mbow et al, 2020). The later hypotheses are corroborated by the observed low fatality rate of COVID-19 in SSA setting and elsewhere in LMICs with potential high parasite loads (Fonte et al, 2020;Mbow et al, 2020).…”

Section: Impact Of Parasite-driven Microbiome Change On the Pathogenesis Of Covid-19mentioning

confidence: 99%

“…Though Bradbury et al (2020) suggest that helminth co-infection might hasten COVID-19 severity, an alternative hypotheses suggested that helminths might indeed reduce the severity of SARS-CoV-2 infection (Fonte et al, 2020;Hays et al, 2020;Mbow et al, 2020). The later hypotheses are corroborated by the observed low fatality rate of COVID-19 in SSA setting and elsewhere in LMICs with potential high parasite loads (Fonte et al, 2020;Mbow et al, 2020). Furthermore, the proponents of this hypotheses suggest to explore the effects of experimental helminth infection (EHI) on COVID-19 severity (Hays et al, 2020).…”

Section: Impact Of Parasite-driven Microbiome Change On the Pathogenesis Of Covid-19mentioning

confidence: 99%