ABSTRACTBackgroundThe Sisonke open-label phase 3b implementation study aimed to assess the safety... more ABSTRACTBackgroundThe Sisonke open-label phase 3b implementation study aimed to assess the safety and effectiveness of the Janssen Ad26.CoV2.S vaccine among health care workers (HCWs) in South Africa. Here, we present the safety data.MethodsWe monitored adverse events (AEs) at vaccination sites, through self-reporting triggered by text messages after vaccination, health care provider reports and by active case finding. The frequency and incidence rate of non-serious and serious AEs were evaluated from day of first vaccination (17 February 2021) until 28 days after the final vaccination (15 June 2021). COVID-19 breakthrough infections, hospitalisations and deaths were ascertained via linkage of the electronic vaccination register with existing national databases.FindingsOf 477,234 participants, 10,279 (2.2%) reported AEs, of which 139 (1.4%) were serious. Women reported more AEs than men (2.3% vs. 1.6%). AE reports decreased with increasing age (3.2% for 18–30, 2.1% for 31-45, 1.8% f...
Additional file 1. STROBE Statement—checklist of items that should be included in reports of obse... more Additional file 1. STROBE Statement—checklist of items that should be included in reports of observational studies.
Supplemental Material, sj-pdf-1-std-10.1177_0956462420968998 for Quantifying geographical diversi... more Supplemental Material, sj-pdf-1-std-10.1177_0956462420968998 for Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa by Handan Wand, Gita Ramjee and Tarylee Reddy in International Journal of STD & AIDS
BackgroundHIV incidence among adolescent girls and young women (AGYW) remains high, with their ma... more BackgroundHIV incidence among adolescent girls and young women (AGYW) remains high, with their male partners a prominent factor in sustaining these elevated rates. Partnership characteristics remain important metrics for determining HIV risk, with evidence indicating that AGYW engaged in transactional and age-disparate relationships facing greater HIV exposure. This study examines the risk posed to AGYW in a relationship with a “Blesser” only, defined as male who provides his female partner with their material needs or desires in exchange for a sexual relationship and age-disparate (5 or more years older).MethodsA cross -sectional household based representative sample of AGYW (aged between 12–24 years) were enrolled in the study (n=18 926) from the districts of City of Johannesburg and Ekurhuleni in the Gauteng province and the Districts of eThekwini and uMgungundlovu in the province of KwaZulu-Natal (KZN) in South Africa between March 13, 2017 to June 22, 2018. Participants complet...
This study uses wastewater-based epidemiology (WBE) to rapidly and, through targeted surveillance... more This study uses wastewater-based epidemiology (WBE) to rapidly and, through targeted surveillance, track the geographical distribution of SARS-CoV-2 variants of concern (Alpha, Beta and Delta) within 24 wastewater treatment plants (WWTPs) in the Western Cape of South Africa. Information obtained was used to identify the circulating variant of concern (VOC) within a population and retrospectively trace when the predominant variant was introduced. Genotyping analysis of SARS-CoV-2 showed that 50% of wastewater samples harbored signature mutations linked to the Beta variant before the third wave, with the Delta variant absent within the population. Over time, the prevalence of the beta variant decreased steadily. The onset of the third wave resulted in the Delta variant becoming the predominant variant, with a 100% prevalence supporting the theory that the Delta variant was driving the third wave. In silico molecular docking analysis showed that the signature mutations of the Delta var...
Background: Couples ’ voluntary HIV counseling and testing (CVCT) is an evidence-based interventi... more Background: Couples ’ voluntary HIV counseling and testing (CVCT) is an evidence-based intervention that significantly reduces HIV incidence in couples. Despite the high prevalence of HIV and HIV couple serodiscordance in South Africa, there are few CVCT services. Methods: From February-June 2013, The Rwanda Zambia HIV Research Group provided support, training, and technical assistance for local counselors and promoters to pilot CVCT services in five hospital-based clinics in Durban, South Africa. Client-level data (age, gender, years cohabiting, pregnancy status, previous testing, antiretroviral treatment (ART) status, neighborhood, and test site) collected as a component of routine CVCT service operation is presented stratified by couple serostatus. Results: Twenty counselors and 28 promoters completed training. Of 907 couples (1,814 individuals) that underwent CVCT, prevalence of HIV was 41.8 % and prevalence of HIV serodiscordance was 29.5 % (19.3 % M-F+, 10.3 % M + F-). Most pa...
doses and there were no grade 4 laboratory toxicities. One case of uveitis (grade 4), occurred in... more doses and there were no grade 4 laboratory toxicities. One case of uveitis (grade 4), occurred in a patient taking
Medical male circumcision is a proven method of HIV risk reduction in men with no known direct be... more Medical male circumcision is a proven method of HIV risk reduction in men with no known direct benefit to women. We investigated the benefit of partner circumcision on women's health. We conducted a secondary analysis of 5,029 women enrolled in the Vaginal and Oral Interventions to Control the Epidemic trial across 15 African sites, to look at the impact of partner circumcision status on sexually transmitted infections, pregnancy, frequency of sex, and condom use in women. Of 4,982 participants with a baseline response, 31% had circumcised partners. Women with circumcised partners had a significantly reduced risk of syphilis acquisition, hazard ratio 0.51 (0.26, 1.00), p value = .05. Participants with uncircumcised partners were significantly less likely to have used a condom at the last sex act than the other two groups, adj. relative risk 0.86 (0.80, 0.92), adj. p value < .0001. We found no evidence of sexual risk compensation in women with circumcised partners.
Background: Gestational diabetes is characterized by three main factors: macrosomia, increased me... more Background: Gestational diabetes is characterized by three main factors: macrosomia, increased metabolic rate and large vascular cross sections. A critical and crucial finding in diabetic pregnancies is that significant acidaemia and hyperlacticemia can occur in fetuses in the absence of hypoxaemia. The increased metabolic rate results in significant increases in oxidative metabolism but this capacity is reduced in fetuses due to low pyruvate dehydrogenase activity increasing the risk for acidosis. This pathophysiology is not recognized by standard monitoring models which revolves around placental insufficiency which is in fact not the problem in a gestational diabetic pregnancy. A proposed risk scoring system has been developed based on our previous studies to risk categorise gestational diabetics in terms of fetal outcome.Methods: The diabetic cases from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariat...
Background The HIV-1 epidemic in sub-Saharan Africa is heterogeneous with diverse unevenly distri... more Background The HIV-1 epidemic in sub-Saharan Africa is heterogeneous with diverse unevenly distributed subtypes and regional differences in prevalence. Subtype-specific differences in disease progression rate and transmission efficiency have been reported, but the underlying biological mechanisms have not been fully characterized. Here, we tested the hypothesis that the subtypes prevalent in the East Africa, where adult prevalence rate is higher, have lower viral replication capacity (VRC) than their West African counterparts where adult prevalence rates are lower. Results Gag-protease sequencing was performed on 213 and 160 antiretroviral-naïve chronically infected participants from West and East Africa respectively and bioinformatic tools were used to infer subtypes and recombination patterns. VRC of patient-derived gag-protease chimeric viruses from West (n = 178) and East (n = 114) Africa were determined using a green fluorescent protein reporter-based cell assay. Subtype and re...
Background: Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and su... more Background: Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among school going adolescents. This study evaluates differences between in and out of school adolescent girls and the effect of exposure to CSE on key biomedical and behavioural indicators in South Africa. Methods: Data were collected from a household-based representative sample of adolescent girls (between the ages 12–18 years) in four high HIV prevalence DREAMS implementation districts in South Africa. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy and sexual behaviour, including condom use, incidence of age disparate relationships and transactional sex. Findings Attending school is associated with reduced adjusted odds of having engaged in sexual activity (AOR: 0·58, 95% CI: 0·48-0·70, p < 0·001); using condoms inconsistently in the previous 12 mo...
To investigate the associations between self-reported condom use and HIV, sexually transmitted in... more To investigate the associations between self-reported condom use and HIV, sexually transmitted infections (STIs) and pregnancy rates among women who enrolled in HIV biomedical intervention trials in South Africa. Data from 9948 women were analysed. Cox regression models were used to assess the associations between condom use and primary outcomes. Overall HIV, STI and pregnancy incidence rates were 7, 15 and 9 per 100 person/year. Women reporting condom use (65%) at last sex were younger, had more schooling, had fewer children and were more likely to be single/non-cohabiting, and hormonal injectables were the most common family planning method among women who reported using a condom at last sex. They were at increased risk of HIV (adjusted hazard ratio (aHR) 1.23, 95% CI 1.07, 1.43), STI (aHR 1.20, 95% CI 1.05, 1.34) and pregnancy (aHR 1.23, 95% CI 1.10, 1.40). In this population, self-reported condom users were identified as a proxy for a combination of high-risk sexual behaviours. ...
An understanding of HIV progression and factors that influence disease progression can have great... more An understanding of HIV progression and factors that influence disease progression can have great value in the development of new treatment strategies. Although Sub-Saharan Africa is noted for its high HIV prevalence there is an absence of research on the HIV progression and factors which affect it. A cohort of 336 ARV naive HIV positive individuals enrolled into the Sinikithemba study conducted in Durban, South Africa is studied. HIV progression is investigated through the application of a five state Markov model with reversible transitions. The four transient states are based on CD4 count intervals with ARV initiation as an absorbing fifth state. A key finding, consistent with previous research, is that the rate of decline in CD4 count tends to decrease at lower levels. It was also noted that patients enrolling with a CD4 count less than 350 have a far lower chance of immune recovery, and a substantially higher chance of immune deterioration compared to patients with a higher CD4 ...
The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a sho... more The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a short time. South Africa has the highest number of COVID-19 cases in Africa and understanding the country's disease trajectory is important for government policy makers to plan the optimal COVID-19 intervention strategy. The number of cases is highly correlated with the number of COVID-19 tests undertaking. Thus, current methods of understanding the COVID-19 transmission process in the country based only on the number of cases can be misleading. In light of this, we propose to estimate both the probability of positive cases per tests conducted (the positive testing rate) and the rate in which the positive testing rate changes over time (its derivative) using a flexible semi-parametric model. We applied the method to the observed positive testing rate in South Africa with data obtained from March 5th to September 2nd 2020. We found that the positive testing rate was declining from early ...
The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a sho... more The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a short time. South Africa has the highest number of COVID-19 cases in Africa and understanding the country’s disease trajectory is important for government policy makers to plan the optimal COVID-19 intervention strategy. The number of cases is highly correlated with the number of COVID-19 tests undertaking. Thus, current methods of understanding the COVID-19 transmission process in the country based only on the number of cases can be misleading. In light of this, we propose to estimate both the probability of positive cases per tests conducted (the positive testing rate) and the rate in which the positive testing rate changes over time (its derivative) using a flexible semi-parametric model. We applied the method to the observed positive testing rate in South Africa with data obtained from March 5th to September 2nd 2020. We found that the positive testing rate was declining from early Marc...
International Journal of Environmental Research and Public Health, 2021
Recent scientific trends have revealed that the collection and analysis of data on the occurrence... more Recent scientific trends have revealed that the collection and analysis of data on the occurrence and fate of SARS-CoV-2 in wastewater may serve as an early warning system for COVID-19. In South Africa, the first COVID-19 epicenter emerged in the Western Cape Province. The City of Cape Town, located in the Western Cape Province, has approximately 4 million inhabitants. This study reports on the monitoring of SARS-CoV-2 RNA in the wastewater of the City of Cape Town’s wastewater treatment plants (WWTPs) during the peak of the epidemic. During this period, the highest overall median viral RNA signal was observed in week 1 (9200 RNA copies/mL) and declined to 127 copies/mL in week 6. The overall decrease in the amount of detected viral SARS-CoV-2 RNA over the 6-week study period was associated with a declining number of newly identified COVID-19 cases in the city. The SARS-CoV-2 early warning system has now been established to detect future waves of COVID-19.
ABSTRACTBackgroundThe Sisonke open-label phase 3b implementation study aimed to assess the safety... more ABSTRACTBackgroundThe Sisonke open-label phase 3b implementation study aimed to assess the safety and effectiveness of the Janssen Ad26.CoV2.S vaccine among health care workers (HCWs) in South Africa. Here, we present the safety data.MethodsWe monitored adverse events (AEs) at vaccination sites, through self-reporting triggered by text messages after vaccination, health care provider reports and by active case finding. The frequency and incidence rate of non-serious and serious AEs were evaluated from day of first vaccination (17 February 2021) until 28 days after the final vaccination (15 June 2021). COVID-19 breakthrough infections, hospitalisations and deaths were ascertained via linkage of the electronic vaccination register with existing national databases.FindingsOf 477,234 participants, 10,279 (2.2%) reported AEs, of which 139 (1.4%) were serious. Women reported more AEs than men (2.3% vs. 1.6%). AE reports decreased with increasing age (3.2% for 18–30, 2.1% for 31-45, 1.8% f...
Additional file 1. STROBE Statement—checklist of items that should be included in reports of obse... more Additional file 1. STROBE Statement—checklist of items that should be included in reports of observational studies.
Supplemental Material, sj-pdf-1-std-10.1177_0956462420968998 for Quantifying geographical diversi... more Supplemental Material, sj-pdf-1-std-10.1177_0956462420968998 for Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa by Handan Wand, Gita Ramjee and Tarylee Reddy in International Journal of STD & AIDS
BackgroundHIV incidence among adolescent girls and young women (AGYW) remains high, with their ma... more BackgroundHIV incidence among adolescent girls and young women (AGYW) remains high, with their male partners a prominent factor in sustaining these elevated rates. Partnership characteristics remain important metrics for determining HIV risk, with evidence indicating that AGYW engaged in transactional and age-disparate relationships facing greater HIV exposure. This study examines the risk posed to AGYW in a relationship with a “Blesser” only, defined as male who provides his female partner with their material needs or desires in exchange for a sexual relationship and age-disparate (5 or more years older).MethodsA cross -sectional household based representative sample of AGYW (aged between 12–24 years) were enrolled in the study (n=18 926) from the districts of City of Johannesburg and Ekurhuleni in the Gauteng province and the Districts of eThekwini and uMgungundlovu in the province of KwaZulu-Natal (KZN) in South Africa between March 13, 2017 to June 22, 2018. Participants complet...
This study uses wastewater-based epidemiology (WBE) to rapidly and, through targeted surveillance... more This study uses wastewater-based epidemiology (WBE) to rapidly and, through targeted surveillance, track the geographical distribution of SARS-CoV-2 variants of concern (Alpha, Beta and Delta) within 24 wastewater treatment plants (WWTPs) in the Western Cape of South Africa. Information obtained was used to identify the circulating variant of concern (VOC) within a population and retrospectively trace when the predominant variant was introduced. Genotyping analysis of SARS-CoV-2 showed that 50% of wastewater samples harbored signature mutations linked to the Beta variant before the third wave, with the Delta variant absent within the population. Over time, the prevalence of the beta variant decreased steadily. The onset of the third wave resulted in the Delta variant becoming the predominant variant, with a 100% prevalence supporting the theory that the Delta variant was driving the third wave. In silico molecular docking analysis showed that the signature mutations of the Delta var...
Background: Couples ’ voluntary HIV counseling and testing (CVCT) is an evidence-based interventi... more Background: Couples ’ voluntary HIV counseling and testing (CVCT) is an evidence-based intervention that significantly reduces HIV incidence in couples. Despite the high prevalence of HIV and HIV couple serodiscordance in South Africa, there are few CVCT services. Methods: From February-June 2013, The Rwanda Zambia HIV Research Group provided support, training, and technical assistance for local counselors and promoters to pilot CVCT services in five hospital-based clinics in Durban, South Africa. Client-level data (age, gender, years cohabiting, pregnancy status, previous testing, antiretroviral treatment (ART) status, neighborhood, and test site) collected as a component of routine CVCT service operation is presented stratified by couple serostatus. Results: Twenty counselors and 28 promoters completed training. Of 907 couples (1,814 individuals) that underwent CVCT, prevalence of HIV was 41.8 % and prevalence of HIV serodiscordance was 29.5 % (19.3 % M-F+, 10.3 % M + F-). Most pa...
doses and there were no grade 4 laboratory toxicities. One case of uveitis (grade 4), occurred in... more doses and there were no grade 4 laboratory toxicities. One case of uveitis (grade 4), occurred in a patient taking
Medical male circumcision is a proven method of HIV risk reduction in men with no known direct be... more Medical male circumcision is a proven method of HIV risk reduction in men with no known direct benefit to women. We investigated the benefit of partner circumcision on women's health. We conducted a secondary analysis of 5,029 women enrolled in the Vaginal and Oral Interventions to Control the Epidemic trial across 15 African sites, to look at the impact of partner circumcision status on sexually transmitted infections, pregnancy, frequency of sex, and condom use in women. Of 4,982 participants with a baseline response, 31% had circumcised partners. Women with circumcised partners had a significantly reduced risk of syphilis acquisition, hazard ratio 0.51 (0.26, 1.00), p value = .05. Participants with uncircumcised partners were significantly less likely to have used a condom at the last sex act than the other two groups, adj. relative risk 0.86 (0.80, 0.92), adj. p value < .0001. We found no evidence of sexual risk compensation in women with circumcised partners.
Background: Gestational diabetes is characterized by three main factors: macrosomia, increased me... more Background: Gestational diabetes is characterized by three main factors: macrosomia, increased metabolic rate and large vascular cross sections. A critical and crucial finding in diabetic pregnancies is that significant acidaemia and hyperlacticemia can occur in fetuses in the absence of hypoxaemia. The increased metabolic rate results in significant increases in oxidative metabolism but this capacity is reduced in fetuses due to low pyruvate dehydrogenase activity increasing the risk for acidosis. This pathophysiology is not recognized by standard monitoring models which revolves around placental insufficiency which is in fact not the problem in a gestational diabetic pregnancy. A proposed risk scoring system has been developed based on our previous studies to risk categorise gestational diabetics in terms of fetal outcome.Methods: The diabetic cases from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariat...
Background The HIV-1 epidemic in sub-Saharan Africa is heterogeneous with diverse unevenly distri... more Background The HIV-1 epidemic in sub-Saharan Africa is heterogeneous with diverse unevenly distributed subtypes and regional differences in prevalence. Subtype-specific differences in disease progression rate and transmission efficiency have been reported, but the underlying biological mechanisms have not been fully characterized. Here, we tested the hypothesis that the subtypes prevalent in the East Africa, where adult prevalence rate is higher, have lower viral replication capacity (VRC) than their West African counterparts where adult prevalence rates are lower. Results Gag-protease sequencing was performed on 213 and 160 antiretroviral-naïve chronically infected participants from West and East Africa respectively and bioinformatic tools were used to infer subtypes and recombination patterns. VRC of patient-derived gag-protease chimeric viruses from West (n = 178) and East (n = 114) Africa were determined using a green fluorescent protein reporter-based cell assay. Subtype and re...
Background: Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and su... more Background: Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among school going adolescents. This study evaluates differences between in and out of school adolescent girls and the effect of exposure to CSE on key biomedical and behavioural indicators in South Africa. Methods: Data were collected from a household-based representative sample of adolescent girls (between the ages 12–18 years) in four high HIV prevalence DREAMS implementation districts in South Africa. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy and sexual behaviour, including condom use, incidence of age disparate relationships and transactional sex. Findings Attending school is associated with reduced adjusted odds of having engaged in sexual activity (AOR: 0·58, 95% CI: 0·48-0·70, p < 0·001); using condoms inconsistently in the previous 12 mo...
To investigate the associations between self-reported condom use and HIV, sexually transmitted in... more To investigate the associations between self-reported condom use and HIV, sexually transmitted infections (STIs) and pregnancy rates among women who enrolled in HIV biomedical intervention trials in South Africa. Data from 9948 women were analysed. Cox regression models were used to assess the associations between condom use and primary outcomes. Overall HIV, STI and pregnancy incidence rates were 7, 15 and 9 per 100 person/year. Women reporting condom use (65%) at last sex were younger, had more schooling, had fewer children and were more likely to be single/non-cohabiting, and hormonal injectables were the most common family planning method among women who reported using a condom at last sex. They were at increased risk of HIV (adjusted hazard ratio (aHR) 1.23, 95% CI 1.07, 1.43), STI (aHR 1.20, 95% CI 1.05, 1.34) and pregnancy (aHR 1.23, 95% CI 1.10, 1.40). In this population, self-reported condom users were identified as a proxy for a combination of high-risk sexual behaviours. ...
An understanding of HIV progression and factors that influence disease progression can have great... more An understanding of HIV progression and factors that influence disease progression can have great value in the development of new treatment strategies. Although Sub-Saharan Africa is noted for its high HIV prevalence there is an absence of research on the HIV progression and factors which affect it. A cohort of 336 ARV naive HIV positive individuals enrolled into the Sinikithemba study conducted in Durban, South Africa is studied. HIV progression is investigated through the application of a five state Markov model with reversible transitions. The four transient states are based on CD4 count intervals with ARV initiation as an absorbing fifth state. A key finding, consistent with previous research, is that the rate of decline in CD4 count tends to decrease at lower levels. It was also noted that patients enrolling with a CD4 count less than 350 have a far lower chance of immune recovery, and a substantially higher chance of immune deterioration compared to patients with a higher CD4 ...
The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a sho... more The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a short time. South Africa has the highest number of COVID-19 cases in Africa and understanding the country's disease trajectory is important for government policy makers to plan the optimal COVID-19 intervention strategy. The number of cases is highly correlated with the number of COVID-19 tests undertaking. Thus, current methods of understanding the COVID-19 transmission process in the country based only on the number of cases can be misleading. In light of this, we propose to estimate both the probability of positive cases per tests conducted (the positive testing rate) and the rate in which the positive testing rate changes over time (its derivative) using a flexible semi-parametric model. We applied the method to the observed positive testing rate in South Africa with data obtained from March 5th to September 2nd 2020. We found that the positive testing rate was declining from early ...
The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a sho... more The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a short time. South Africa has the highest number of COVID-19 cases in Africa and understanding the country’s disease trajectory is important for government policy makers to plan the optimal COVID-19 intervention strategy. The number of cases is highly correlated with the number of COVID-19 tests undertaking. Thus, current methods of understanding the COVID-19 transmission process in the country based only on the number of cases can be misleading. In light of this, we propose to estimate both the probability of positive cases per tests conducted (the positive testing rate) and the rate in which the positive testing rate changes over time (its derivative) using a flexible semi-parametric model. We applied the method to the observed positive testing rate in South Africa with data obtained from March 5th to September 2nd 2020. We found that the positive testing rate was declining from early Marc...
International Journal of Environmental Research and Public Health, 2021
Recent scientific trends have revealed that the collection and analysis of data on the occurrence... more Recent scientific trends have revealed that the collection and analysis of data on the occurrence and fate of SARS-CoV-2 in wastewater may serve as an early warning system for COVID-19. In South Africa, the first COVID-19 epicenter emerged in the Western Cape Province. The City of Cape Town, located in the Western Cape Province, has approximately 4 million inhabitants. This study reports on the monitoring of SARS-CoV-2 RNA in the wastewater of the City of Cape Town’s wastewater treatment plants (WWTPs) during the peak of the epidemic. During this period, the highest overall median viral RNA signal was observed in week 1 (9200 RNA copies/mL) and declined to 127 copies/mL in week 6. The overall decrease in the amount of detected viral SARS-CoV-2 RNA over the 6-week study period was associated with a declining number of newly identified COVID-19 cases in the city. The SARS-CoV-2 early warning system has now been established to detect future waves of COVID-19.
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Papers by Tarylee Reddy