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Article ; Online: Heterogeneous Treatment Response by Race Cannot Be Claimed in the Absence of Evidence.

Merckx, Joanna / Kaufman, Jay S

2019 Volume 33, Issue 2, Page(s) e1

MeSH term(s)	African Americans ; Biomarkers ; Blood Pressure ; Humans ; Hypertension ; Renin
Chemical Substances	Biomarkers ; Renin (EC 3.4.23.15)
Language	English
Publishing date	2019-08-02
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	639383-4
ISSN	1941-7225 ; 1879-1905 ; 0895-7061
ISSN (online)	1941-7225 ; 1879-1905
ISSN	0895-7061
DOI	10.1093/ajh/hpz127
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Article ; Online: SARS-CoV-2 seroprevalence and determinants for salivary seropositivity among pupils and school staff: a prospective cohort study.

Merckx, Joanna / Callies, Milena / Kabouche, Ines / Desombere, Isabelle / Duysburgh, Els / Roelants, Mathieu

Epidemiology and infection

2023 Volume 151, Page(s) e75

Abstract: Representative school data on SARS-CoV-2 past-infection are scarce, and differences between pupils and staff remain ambiguous. We performed a nation-wide prospective seroprevalence study among pupils and staff over time and in relation to determinants of ...

Abstract	Representative school data on SARS-CoV-2 past-infection are scarce, and differences between pupils and staff remain ambiguous. We performed a nation-wide prospective seroprevalence study among pupils and staff over time and in relation to determinants of infection using Poisson regression and generalised estimating equations. A cluster random sample was selected with allocation by region and sociodemographic (SES) background. Surveys and saliva samples were collected in December 2020, March, and June 2021, and also in October and December 2021 for primary pupils. We recruited 885 primary and 569 secondary pupils and 799 staff in 84 schools. Cumulative seroprevalence (95% CI) among primary pupils increased from 11.0% (7.6; 15.9) at baseline to 60.4% (53.4; 68.3) in December 2021. Group estimates were similar at baseline; however, in June they were significantly higher among primary staff (38.9% (32.5; 46.4)) compared to pupils and secondary staff (24.2% (20.3; 28.8)). Infections were asymptomatic in 48-56% of pupils and 28% of staff. Seropositivity was associated with individual SES in pupils, and with school level, school SES and language network in staff in June. Associations with behavioural characteristics were inconsistent. Seroconversion rates increased two- to four-fold after self-reported high-risk contacts, especially with adults. Seroprevalence studies using non-invasive sampling can inform public health management.
MeSH term(s)	Adult ; Humans ; COVID-19/epidemiology ; Prospective Studies ; SARS-CoV-2 ; Schools ; Seroepidemiologic Studies ; Saliva/virology
Language	English
Publishing date	2023-04-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632982-2
ISSN	1469-4409 ; 0950-2688
ISSN (online)	1469-4409
ISSN	0950-2688
DOI	10.1017/S0950268823000584
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Article ; Online: SARS-CoV-2 infection prevention and control measures in Belgian schools between December 2020 and June 2021 and their association with seroprevalence: a cross-sectional analysis of a prospective cohort study.

Callies, Milena / Kabouche, Ines / Desombere, Isabelle / Merckx, Joanna / Roelants, Mathieu / Vermeulen, Melissa / Duysburgh, Els

BMC public health

2023 Volume 23, Issue 1, Page(s) 898

Abstract: Background: To protect school-aged children from the potential consequences of a new viral infection, public health authorities recommended to implement infection prevention and control (IPC) measures in school settings. Few studies evaluated the ... ...

Abstract	Background: To protect school-aged children from the potential consequences of a new viral infection, public health authorities recommended to implement infection prevention and control (IPC) measures in school settings. Few studies evaluated the implementation of these measures and their effect on SARS-CoV-2 infection rates among pupils and staff. The aim of this study was to describe the implementation of infection prevention and control (IPC) measures in Belgian schools and assess its relation to the prevalence of anti-SARS-CoV-2 antibodies among pupils and staff. Methods: We conducted a prospective cohort study in a representative sample of primary and secondary schools in Belgium between December 2020 and June 2021. The implementation of IPC measures in schools was assessed using a questionnaire. Schools were classified according to their compliance with the implementation of IPC measures as 'poor', 'moderate' or 'thorough'. Saliva samples were collected from pupils and staff to determine the SARS-CoV-2 seroprevalence. To assess the association between the strength of implementation of IPC measures and SARS-CoV-2 seroprevalence among pupils and staff, we conducted a cross-sectional analysis using the data collected in December 2020/January 2021. Results: A variety of IPC measures (ventilation, hygiene and physical distancing) was implemented by more than 60% of schools, with most attention placed on hygiene measures. In January 2021, poor implementation of IPC measures was associated with an increase in anti-SARS-CoV-2 antibody prevalence among pupils from 8.6% (95%CI: 4.5 - 16.6) to 16.7% (95%CI: 10.2 - 27.4) and staff from 11.5% (95%CI: 8.1 - 16.4) to 17.6% (95%CI: 11.5 - 27.0). This association was only statistically significant for the assessment of all IPC measures together in the population comprised of pupils and staff. Conclusions: Belgian schools were relatively compliant with recommended IPC measures at the school level. Higher SARS-CoV-2 seroprevalence among pupils and staff was found in schools with poor implementation of IPC measures, compared to schools with thorough implementation. Trial registration: This trial is registered under the NCT04613817 ClinicalTrials.gov Identifier on November 3, 2020.
MeSH term(s)	Child ; Humans ; Antibodies, Viral ; Belgium/epidemiology ; COVID-19/epidemiology ; COVID-19/prevention & control ; Cross-Sectional Studies ; Prospective Studies ; SARS-CoV-2 ; Seroepidemiologic Studies
Chemical Substances	Antibodies, Viral
Language	English
Publishing date	2023-05-16
Publishing country	England
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-15806-5
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Article ; Online: Use of Racial and Ethnic Categories in Medical Testing and Diagnosis: Primum Non Nocere.

Kaufman, Jay S / Merckx, Joanna / Cooper, Richard S

Clinical chemistry

2021 Volume 67, Issue 11, Page(s) 1456–1465

Abstract: Background: Use of race and ethnicity is common in medical tests and procedures, even though these categories are defined by sociological, historical, and political processes, and vary considerably in their definitions over time and place. Because all ... ...

Abstract	Background: Use of race and ethnicity is common in medical tests and procedures, even though these categories are defined by sociological, historical, and political processes, and vary considerably in their definitions over time and place. Because all societies organize themselves around these constructs in some way, they are undeniable facets of the human experience, with myriad health consequences. In the biomedical literature, they are also commonly interpreted as representing biological heterogeneity that is relevant for health and disease. Content: We review the use of race and ethnicity in medical practice, especially in the USA, and provide 2 specific examples to represent a large number of similar instances. We then critique these uses along a number of different dimensions, including limitations in measurement, within- versus between-group variance, and implications for informativeness of risk markers for individuals, generalization from arbitrary or nonrepresentative samples, perpetuation of myths and stereotypes, instability in time and place, crowding out of more relevant risk markers, stigmatization, and the tainting of medicine with the history of oppression. We conclude with recommendations to improve practice that are technical, ethical, and pragmatic. Summary: Medicine has evolved from a mystical healing art to a mature science of human health through a rigorous process of quantification, experimentation, and evaluation. Folkloric traditions, such as race- and ethnic-specific medicine will fade from use as we become increasingly critical of outdated and irrational clinical practices and replace these with personalized, evidenced-based tests, algorithms, and procedures that privilege patients' individual humanity over obsolete and misleading labels.
MeSH term(s)	Ethnicity ; Humans ; Medicine ; Mental Disorders ; Research Design
Language	English
Publishing date	2021-08-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80102-1
ISSN	1530-8561 ; 0009-9147
ISSN (online)	1530-8561
ISSN	0009-9147
DOI	10.1093/clinchem/hvab164
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Article: Unjustified assertions regarding race and ethnicity in clinical decision-making (Re: The effect of ethnicity on semen analysis and hormones in the infertile patient, CUAJ, Feb 2020).

Merckx, Joanna / Siddiqi, Arjumand / Kaufman, Jay S

Canadian Urological Association journal = Journal de l'Association des urologues du Canada

2020 Volume 14, Issue 4, Page(s) 143

Language	English
Publishing date	2020-04-01
Publishing country	Canada
Document type	Letter
ZDB-ID	2431403-1
ISSN	1911-6470
ISSN	1911-6470
DOI	10.5489/cuaj.6265
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Article ; Online: Step-Up Therapy in Black Patients with Asthma.

Merckx, Joanna / Kaufman, Jay S / Cooper, Richard S

The New England journal of medicine

2020 Volume 382, Issue 4, Page(s) 390–391

MeSH term(s)	Adult ; African Americans ; Anti-Asthmatic Agents ; Asthma ; Child ; Humans
Chemical Substances	Anti-Asthmatic Agents
Language	English
Publishing date	2020-01-23
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc1915819
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Article ; Online: Transmission of SARS-CoV-2 by Children.

Merckx, Joanna / Labrecque, Jeremy A / Kaufman, Jay S

Deutsches Arzteblatt international

2020 Volume 117, Issue 33-34, Page(s) 553–560

Abstract: Background: Six months into the COVID-19 pandemic, children appear largely spared from the direct effects of disease, suggesting age as an important predictor of infection and severity. They remain, however, impacted by far-reaching public health ... ...

Abstract	Background: Six months into the COVID-19 pandemic, children appear largely spared from the direct effects of disease, suggesting age as an important predictor of infection and severity. They remain, however, impacted by far-reaching public health interventions. One crucial question often posed is whether children generally transmit SARS-CoV-2 effectively. Methods: We assessed the components of transmission and the different study designs and considerations necessary for valid assessment of transmission dynamics. We searched for published evidence about transmission of SARS-CoV-2 by children employing a narrative review methodology through 25 June, 2020. Results: Transmission dynamics must be studied in repre - sentative pediatric populations with a combination of study designs including rigorous epidemiological studies (e.g. in households, schools, daycares, clinical settings) and laboratory studies while taking into account the social and socio-economic contexts. Viral load (VL) estimates from representative pediatric samples of infected children are missing so far. Currently available evidence suggests that the secondary attack rate stratified by age of the infector is lower for children, however this age pattern needs to be better quantified and understood. Conclusion: A generalizable pediatric evidence base is urgently needed to inform policy making now, later when facing potential subsequent waves, and extending through a future in which endemicity alongside vaccination may become the enduring reality.
MeSH term(s)	COVID-19 ; Child ; Coronavirus Infections/epidemiology ; Coronavirus Infections/transmission ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/transmission
Keywords	covid19
Language	English
Publishing date	2020-07-24
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2406159-1
ISSN	1866-0452 ; 1866-0452
ISSN (online)	1866-0452
ISSN	1866-0452
DOI	10.3238/arztebl.2020.0553
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Article ; Online: COVID-19 surveillance in the Flemish school system: development of systematic data collection within the public health school system and descriptive analysis of cases reported between October 2020 and June 2021.

Merckx, Joanna / Crèvecoeur, Jonas / Proesmans, Kristiaan / Hammami, Naïma / Denys, Hilde / Hens, Niel

BMC public health

2022 Volume 22, Issue 1, Page(s) 1921

Abstract: Background: The age-specific distribution of SARS-CoV-2 cases in schools is not well described. Reported statistics reflect the intensity of community transmission while being shaped by biases from age-dependent testing regimes, as well as effective age- ...

Abstract	Background: The age-specific distribution of SARS-CoV-2 cases in schools is not well described. Reported statistics reflect the intensity of community transmission while being shaped by biases from age-dependent testing regimes, as well as effective age-specific interventions. A case surveillance system was introduced within the Flemish school and health-prevention network during the 2020-2021 school year. We present epidemiological data of in-school reported cases in pre-, primary and secondary schools identified by the case surveillance system, in conjunction with test data and community cases from October 2020 to June 2021. Methods: We describe the development of the surveillance system and provide the number of reported cases and standardized rates per grade over time. We calculated absolute and relative differences in case incidence according to school grade (primary: grades 1-6, and secondary: grades 7-12) using grades 7-8 as a comparator, relating them to non-pharmaceutical infection prevention interventions. Cumulative population incidences (IP) stratified by age, province and socioeconomic status (SES) of the school population are presented with their 95% confidence intervals (CI). Results: A total of 59,996 COVID-19 cases were reported in the school surveillance system, with the highest population adjusted IP in grade 11-12 of 7.39% (95%CI 7.24-7.53) and ranging from 2.23% to 6.25% from pre-school through grade 10. Age-specific reductions in mask introduction and in-person teaching were temporally associated with decreased case incidence, while lower pupil SES was associated with an increase in cumulative cases (excess 2,739/100,000 pupils compared to highest SES tertile). Community testing volumes varied more for children compared to adults, with overall higher child test-positivity. Holidays influence capturing of cases by the system, however efficiency increased to above 75% after further automation and integration in existing structures. Conclusion: We demonstrate that effective integration of case surveillance within an electronic school health system is feasible, provides valuable data regarding the evolution of an epidemic among schoolchildren, and is an integral component of public health surveillance and pandemic preparedness. The relationship towards community transmission needs careful evaluation because of age-different testing regimens. In the Flemish region, case incidence within schools exhibited an age gradient that was mitigated through grade-specific interventions, though differences by SES remain.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Child ; Child, Preschool ; Data Collection ; Humans ; SARS-CoV-2 ; Schools ; Schools, Public Health
Language	English
Publishing date	2022-10-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-14250-1
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Article ; Online: Investigating changes in incidence and severity of pediatric appendicitis during the COVID-19 pandemic in Canada: an interrupted time series analysis.

Del Giorgio, Francesca / Habti, Merieme / Merckx, Joanna / Kaufman, Jay S / Gravel, Jocelyn / Piché, Nelson / Osmanlliu, Esli / Drouin, Olivier

World journal of pediatrics : WJP

2022 Volume 19, Issue 3, Page(s) 288–292

MeSH term(s)	Humans ; Child ; COVID-19 ; Incidence ; Interrupted Time Series Analysis ; Appendicitis/diagnosis ; Appendicitis/epidemiology ; Appendicitis/surgery ; Pandemics ; Canada/epidemiology ; Retrospective Studies ; Appendectomy
Language	English
Publishing date	2022-12-27
Publishing country	Switzerland
Document type	Letter
ZDB-ID	2236681-7
ISSN	1867-0687 ; 1708-8569
ISSN (online)	1867-0687
ISSN	1708-8569
DOI	10.1007/s12519-022-00656-9
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Article ; Online: Potential Biases in Test-Negative Design Studies of COVID-19 Vaccine Effectiveness Arising from the Inclusion of Asymptomatic Individuals

Ortiz-Brizuela, Edgar / Carabali, Mabel / Jiang, Cong / Merckx, Joanna / Talbot, Denis / Schnitzer, Mireille E.

medRxiv

Abstract: The test-negative design (TND) is a popular method for evaluating vaccine effectiveness (VE). A "classical" TND study includes symptomatic individuals tested for the disease targeted by the vaccine to estimate VE against symptomatic infection. However, ... ...

Abstract	The test-negative design (TND) is a popular method for evaluating vaccine effectiveness (VE). A "classical" TND study includes symptomatic individuals tested for the disease targeted by the vaccine to estimate VE against symptomatic infection. However, recent applications of the TND have attempted to estimate VE against infection by including all tested individuals, regardless of their symptoms. In this article, we employ directed acyclic graphs and simulations to investigate potential biases in TND studies of COVID-19 VE arising from the use of this "alternative" approach, particularly when applied during periods of widespread testing. We show that the inclusion of asymptomatic individuals can potentially lead to collider stratification bias, uncontrolled confounding by health and healthcare-seeking behaviors (HSBs), and differential outcome misclassification. While our focus is on the COVID-19 setting, the issues discussed may also be relevant in the context of other infectious diseases. This may be particularly true in scenarios where there is either a high baseline prevalence of infection, a strong correlation between HSBs and vaccination, different testing practices for vaccinated and unvaccinated individuals, or settings where both the vaccine under study attenuates symptoms of infection and diagnostic accuracy is modified by the presence of symptoms.
Keywords	covid19
Language	English
Publishing date	2023-11-16
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2023.11.16.23298633
Database	COVID19

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