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1. Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.

Author

UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition, UCL - (SLuc) Centre de pathologie sexuelle masculine, UCL - (SLuc) Service d'endocrinologie et de nutrition, Nachega, Jean B, Sam-Agudu, Nadia A, Machekano, Rhoderick N, Rabie, Helena, van der Zalm, Marieke M, Redfern, Andrew, Dramowski, Angela, O'Connell, Natasha, Pipo, Michel Tshiasuma, Tshilanda, Marc B, Byamungu, Liliane Nsuli, Masekela, Refiloe, Jeena, Prakash Mohan, Pillay, Ashendri, Gachuno, Onesmus W, Kinuthia, John, Ishoso, Daniel Katuashi, Amoako, Emmanuella, Agyare, Elizabeth, Agbeno, Evans K, Martyn-Dickens, Charles, Sylverken, Justice, Enimil, Anthony, Jibril, Aishatu Mohammed, Abdullahi, Asara M, Amadi, Oma, Umar, Umar Mohammed, Sigwadhi, Lovemore Nyasha, Hermans, Michel, Otokoye, John Otshudiema, Mbala-Kingebeni, Placide, Muyembe-Tamfum, Jean-Jacques, Zumla, Alimuddin, Sewankambo, Nelson K, Aanyu, Hellen Tukamuhebwa, Musoke, Philippa, Suleman, Fatima, Adejumo, Prisca, Noormahomed, Emilia V, Deckelbaum, Richard J, Fowler, Mary Glenn, Tshilolo, Léon, Smith, Gerald, Mills, Edward J, Umar, Lawal W, Siedner, Mark J, Kruger, Mariana, Rosenthal, Philip J, Mellors, John W, Mofenson, Lynne M, African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents, UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition, UCL - (SLuc) Centre de pathologie sexuelle masculine, UCL - (SLuc) Service d'endocrinologie et de nutrition, Nachega, Jean B, Sam-Agudu, Nadia A, Machekano, Rhoderick N, Rabie, Helena, van der Zalm, Marieke M, Redfern, Andrew, Dramowski, Angela, O'Connell, Natasha, Pipo, Michel Tshiasuma, Tshilanda, Marc B, Byamungu, Liliane Nsuli, Masekela, Refiloe, Jeena, Prakash Mohan, Pillay, Ashendri, Gachuno, Onesmus W, Kinuthia, John, Ishoso, Daniel Katuashi, Amoako, Emmanuella, Agyare, Elizabeth, Agbeno, Evans K, Martyn-Dickens, Charles, Sylverken, Justice, Enimil, Anthony, Jibril, Aishatu Mohammed, Abdullahi, Asara M, Amadi, Oma, Umar, Umar Mohammed, Sigwadhi, Lovemore Nyasha, Hermans, Michel, Otokoye, John Otshudiema, Mbala-Kingebeni, Placide, Muyembe-Tamfum, Jean-Jacques, Zumla, Alimuddin, Sewankambo, Nelson K, Aanyu, Hellen Tukamuhebwa, Musoke, Philippa, Suleman, Fatima, Adejumo, Prisca, Noormahomed, Emilia V, Deckelbaum, Richard J, Fowler, Mary Glenn, Tshilolo, Léon, Smith, Gerald, Mills, Edward J, Umar, Lawal W, Siedner, Mark J, Kruger, Mariana, Rosenthal, Philip J, Mellors, John W, Mofenson, Lynne M, and African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents

Abstract

IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES: Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to

Published
2022

2. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis.

Author

UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition, UCL - (SLuc) Service d'endocrinologie et de nutrition, Nachega, Jean B, Sam-Agudu, Nadia A, Machekano, Rhoderick N, Rosenthal, Philip J, Schell, Sonja, de Waard, Liesl, Bekker, Adrie, Gachuno, Onesmus W, Kinuthia, John, Mwongeli, Nancy, Budhram, Samantha, Vannevel, Valerie, Somapillay, Priya, Prozesky, Hans W, Taljaard, Jantjie, Parker, Arifa, Agyare, Elizabeth, Opoku, Akwasi Baafuor, Makarfi, Aminatu Umar, Abdullahi, Asara M, Adirieje, Chibueze, Ishoso, Daniel Katuashi, Pipo, Michel Tshiasuma, Tshilanda, Marc B, Bongo-Pasi Nswe, Christian, Ditekemena, John, Sigwadhi, Lovemore Nyasha, Nyasulu, Peter S, Hermans, Michel, Sekikubo, Musa, Musoke, Philippa, Nsereko, Christopher, Agbeno, Evans K, Yeboah, Michael Yaw, Umar, Lawal W, Ntakwinja, Mukanire, Mukwege, Denis M, Birindwa, Etienne Kajibwami, Mushamuka, Serge Zigabe, Smith, Emily R, Mills, Edward J, Otshudiema, John Otokoye, Mbala-Kingebeni, Placide, Tamfum, Jean-Jacques Muyembe, Zumla, Alimuddin, Tsegaye, Aster, Mteta, Alfred, Sewankambo, Nelson K, Suleman, Fatima, Adejumo, Prisca, Anderson, Jean R, Noormahomed, Emilia V, Deckelbaum, Richard J, Stringer, Jeffrey S A, Mukalay, Abdon, Taha, Taha E, Fowler, Mary Glenn, Wasserheit, Judith N, Masekela, Refiloe, Mellors, John W, Siedner, Mark J, Myer, Landon, Kengne, Andre-Pascal, Yotebieng, Marcel, Mofenson, Lynne M, Langenegger, Eduard, AFREhealth Research Collaboration on COVID-19 and Pregnancy, UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition, UCL - (SLuc) Service d'endocrinologie et de nutrition, Nachega, Jean B, Sam-Agudu, Nadia A, Machekano, Rhoderick N, Rosenthal, Philip J, Schell, Sonja, de Waard, Liesl, Bekker, Adrie, Gachuno, Onesmus W, Kinuthia, John, Mwongeli, Nancy, Budhram, Samantha, Vannevel, Valerie, Somapillay, Priya, Prozesky, Hans W, Taljaard, Jantjie, Parker, Arifa, Agyare, Elizabeth, Opoku, Akwasi Baafuor, Makarfi, Aminatu Umar, Abdullahi, Asara M, Adirieje, Chibueze, Ishoso, Daniel Katuashi, Pipo, Michel Tshiasuma, Tshilanda, Marc B, Bongo-Pasi Nswe, Christian, Ditekemena, John, Sigwadhi, Lovemore Nyasha, Nyasulu, Peter S, Hermans, Michel, Sekikubo, Musa, Musoke, Philippa, Nsereko, Christopher, Agbeno, Evans K, Yeboah, Michael Yaw, Umar, Lawal W, Ntakwinja, Mukanire, Mukwege, Denis M, Birindwa, Etienne Kajibwami, Mushamuka, Serge Zigabe, Smith, Emily R, Mills, Edward J, Otshudiema, John Otokoye, Mbala-Kingebeni, Placide, Tamfum, Jean-Jacques Muyembe, Zumla, Alimuddin, Tsegaye, Aster, Mteta, Alfred, Sewankambo, Nelson K, Suleman, Fatima, Adejumo, Prisca, Anderson, Jean R, Noormahomed, Emilia V, Deckelbaum, Richard J, Stringer, Jeffrey S A, Mukalay, Abdon, Taha, Taha E, Fowler, Mary Glenn, Wasserheit, Judith N, Masekela, Refiloe, Mellors, John W, Siedner, Mark J, Myer, Landon, Kengne, Andre-Pascal, Yotebieng, Marcel, Mofenson, Lynne M, Langenegger, Eduard, and AFREhealth Research Collaboration on COVID-19 and Pregnancy

Abstract

BACKGROUND: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

Published
2022

3. Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries

Author

Nachega, Jean B, Sam-Agudu, Nadia A, Machekano, Rhoderick N, Rabie, Helena, van der Zalm, Marieke M, Redfern, Andrew, Dramowski, Angela, O'Connell, Natasha, Pipo, Michel Tshiasuma, Tshilanda, Marc B, Byamungu, Liliane Nsuli, Masekela, Refiloe, Jeena, Prakash Mohan, Pillay, Ashendri, Gachuno, Onesmus W, Kinuthia, John, Ishoso, Daniel Katuashi, Amoako, Emmanuella, Agyare, Elizabeth, Agbeno, Evans K, Martyn-Dickens, Charles, Sylverken, Justice, Enimil, Anthony, Jibril, Aishatu Mohammed, Abdullahi, Asara M, Amadi, Oma, Umar, Umar Mohammed, Sigwadhi, Lovemore Nyasha, Hermans, Michel, Otokoye, John Otshudiema, Mbala-Kingebeni, Placide, Muyembe-Tamfum, Jean-Jacques, Zumla, Alimuddin, Sewankambo, Nelson K, Aanyu, Hellen Tukamuhebwa, Musoke, Philippa, Suleman, Fatima, Adejumo, Prisca, Noormahomed, Emilia V, Deckelbaum, Richard J, Fowler, Mary Glenn, Tshilolo, Léon, Smith, Gerald, Mills, Edward J, Umar, Lawal W, Siedner, Mark J, Kruger, Mariana, Rosenthal, Philip J, Mellors, John W, Mofenson, Lynne M, African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents, UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition, UCL - (SLuc) Centre de pathologie sexuelle masculine, and UCL - (SLuc) Service d'endocrinologie et de nutrition

Subjects
Male, Adolescent, SARS-CoV-2, Pneumonia, Viral, Oxygen Inhalation Therapy, COVID-19, Infant, Length of Stay, Respiration, Artificial, Child, Preschool, Pediatrics, Perinatology and Child Health, Outcome Assessment, Health Care, Humans, Female, Child, Child, Hospitalized, Pandemics, Africa South of the Sahara
Abstract

IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES: Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.

Published
2022

4. Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.

Author

Nachega, Jean B., Sam-Agudu, Nadia A., Machekano, Rhoderick N., Rabie, Helena, van der Zalm, Marieke M., Redfern, Andrew, Dramowski, Angela, O'Connell, Natasha, Pipo, Michel Tshiasuma, Tshilanda, Marc B., Byamungu, Liliane Nsuli, Masekela, Refiloe, Jeena, Prakash Mohan, Pillay, Ashendri, Gachuno, Onesmus W., Kinuthia, John, Ishoso, Daniel Katuashi, Amoako, Emmanuella, Agyare, Elizabeth, and Agbeno, Evans K.

Published
2022
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5. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis.

Author

Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, and Langenegger E

Subjects
Female, Pregnancy, Humans, Infant, SARS-CoV-2, Retrospective Studies, Hospital Mortality, COVID-19 Vaccines, Cohort Studies, Africa South of the Sahara epidemiology, COVID-19 epidemiology, Pregnancy Complications, Infectious
Abstract

Background: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice., Methods: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models., Results: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13)., Conclusions: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women., Competing Interests: Potential conflicts of interest. J. B. N. is an infectious disease internist and epidemiologist and Principal Investigator (PI) of NIH/FIC grant numbers 1R25TW011217-01, 1R21TW011706-01, and 1D43TW010937-01A1; and payment to University of Pittsburgh. N. A. S.-A. is a clinician-scientist in Pediatric Infectious Diseases and implementation research; she is supported by the NIH National Institute of Child Health and Human Development (NICHD) grant number R01HD089866; by an NIH/FIC award through the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) for the Central and West Africa Implementation Science Alliance (CAWISA) (payment to institution); and by NIH/FIC grant number 1D43TW012280-01. F. S., N. K. S., and A. P. are supported as PIs by NIH/FIC grant number 1R25TW011217-01. A. Z. is PIs of the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET; https://www.pandora-id.net) funded by the European Developing Countries Clinical Trial Partnership (EDCTP) and the European Union Horizon 2020 Framework Program for Research and Innovation, paid to institution (University College London, London, UK). R. N. M. reports grants or contracts unrelated to this work, and payment to their institution: NIH/FIC1D43TW010547-01—The African Center for Biostatistical Excellence (ACBE). P. J. R. reports the following grants or contracts unrelated to this work and paid to their institution: 5R01AI075045-12, 5R01AI139179-04, and 5R01AI117001-07. E. R. S. reports a Bill and Melinda Gates Foundation grant for a prospective meta-analysis of COVID-19 in pregnancy, unrelated to this work, and payment to George Washington University. A. B. reports grants or contracts unrelated to this work—NIH: IMPAACT Vice-chair Funding for P1106; and UNITAID: Benefit KIDS funding for PETITE Study. P. A. reports grants or contracts unrelated to this work and paid to the University of Ibadan, Nigeria: NIH/FIC R25 grant number 1R25TW011217-01 to AFREhealth. J. W. N. reports grants paid to the University of Pittsburgh from the NIH to the Pitt-Ohio State Clinical Trials Unit (UM1 AI068636), the University of Pittsburgh Virology Support Laboratory (UM1 AI106701), the I4C Martin Delaney Collaboratory for an HIV Cure (UM1 AI126603), the REACH Martin Delaney Collaboratory for HIV Cure (UM1 AI164565), and from the National Cancer Institute through Leidos contract numbers HHSN261200800001E and 75N91019D00024 USAID; Gilead Sciences, Inc; and Janssen Pharmaceuticals. J. W. N. also reports consulting fees from Gilead Sciences, Inc (Scientific Advisory Board), Accelevir Diagnostics (Consulting Agreement), and Merck (Consulting Agreement); shares from Abound Bio, Inc, share options from Co-Crystal Pharma, Inc, and share options from Infectious Diseases Connect; a consulting agreement with Xi’an Yufan Biotechnologies; and employment with the University of Pittsburgh. M. S. reports grants or contracts unrelated to this work and paid to their institution (MGH-Boston, MA, USA): NIH/NIA R01AG059504-03 and NIH/NHLBI R01 HL141053-04. A.-P. K. reports research support unrelate to this work paid to their institution (South African Medical Research Council): NIH/FIC 1R21TW011706-01-Dolutegravir, Weight Gain and Metabolic Outcomes in South Africa. L. M. reports consulting fees from the World Health Organization on COVID in pregnancy and mother to child SARS-CoV-2 transmission (this contract is now completed); and payment from Virology Education for a talk on SARS-CoV-2 in pregnancy and possibility of mother-to-child SARS-CoV-2 transmission for continuing education sponsored by Virology Education. M. Y. is PI of the NIH/National Institute of Allergy and Infectious Diseases (NIH/NIAID) grant number 5U01AI096299-13 of the Central Africa-International epidemiology to Evaluate AIDS (CA-IeDEA). M. Y. also reports grants or contracts unrelated to this work and paid to their institution: NIH grant numbers 5U01AI096299 (NIAID), R01HD087993 (NICHD), U54CA254568 (National Cancer Institute), and R01HD105526 (NICHD). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.)

Published
2022
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