Universidad Espíritu Santo - Ecuador, Samborondón, Guayaquil, Ecuador.
Hospital Universitario Reina Sofía, Córdoba, Andalucía, Spain.
J Prim Care Community Health. 2021 Jan-Dec;12:21501327211054989. doi: 10.1177/21501327211054989.
The SARS-CoV-2 pandemic is affecting millions of people living in rural areas of Low- and Middle-Income Countries and is causing an already anticipated devastating effect on the health and economics of these populations. More information is needed to modify behaviors that may counterbalance the consequences of mass spread of the virus in these underserved communities. This study aimed to identify factors associated with a persistent SARS-CoV-2 seronegative status 1 year after a massive infection outbreak in middle-aged and older adults living in rural Ecuador.
Individuals enrolled in the Atahualpa Project Cohort as of March 2020 received 5 rounds of tests for determination of SARS-CoV-2 antibodies in blood. Individuals who remained seronegative up to April 2021 were considered "persistently seronegative." An adjusted Poisson regression model was fitted to estimate the incidence risk ratio of factors directly or inversely associated with a persistent seronegative status.
A total of 673 individuals received baseline tests. Thirty-one declined consent or died and 429 seroconverted, leaving 213 seronegative subjects. Average SARS-CoV-2 incidence rate was 9.87 events (95% C.I.: 8.91-10.83) per 100 person-months of observation. The use of flushing toilet systems (instead of open latrines) increased 1.5 times the possibility of remaining seronegative. Likewise, every additional bedroom in the house increased by 15% the possibility of remaining seronegative. In contrast, every additional person in the house and having high cholesterol levels significantly reduced the possibility of remaining seronegative.
The use of flushing toilet systems and the number of bedrooms in the house directly influenced the possibility of remaining seronegative among individuals living in this rural setting. Study results also demonstrated a sustained transmission of the virus even after a significant proportion of the population has been infected. Our findings reinforce the mass spread of SARS-CoV-2 in rural communities.
SARS-CoV-2 大流行正在影响中低收入国家农村地区的数百万人，并对这些人群的健康和经济造成预期的破坏性影响。需要更多的信息来改变行为，以抵消病毒在这些服务不足的社区大规模传播的后果。本研究旨在确定与生活在厄瓜多尔农村的中年和老年人在大规模感染爆发一年后持续 SARS-CoV-2 血清阴性状态相关的因素。
截至 2020 年 3 月，参加阿塔瓦尔帕项目队列的个体接受了 5 轮血液 SARS-CoV-2 抗体检测。截至 2021 年 4 月仍呈血清阴性的个体被认为是“持续血清阴性”。使用调整后的泊松回归模型来估计与持续血清阴性状态直接或间接相关的因素的发病风险比。
共有 673 名个体接受了基线测试。31 人拒绝同意或死亡，429 人血清转化，留下 213 名血清阴性者。平均 SARS-CoV-2 发病率为每 100 人-月 9.87 例（95%CI：8.91-10.83）。使用冲洗式厕所系统（而非开放式厕所）使保持血清阴性的可能性增加了 1.5 倍。同样，房屋中每增加一个卧室，保持血清阴性的可能性增加 15%。相反，房屋中的人数增加和高胆固醇水平显著降低了保持血清阴性的可能性。
在这个农村环境中，使用冲洗式厕所系统和房屋中的卧室数量直接影响了个体保持血清阴性的可能性。研究结果还表明，即使已经有很大一部分人口感染了病毒，病毒仍在持续传播。我们的研究结果强化了 SARS-CoV-2 在农村社区的广泛传播。
