Ratio of asymptomatic COVID-19 cases among ascertained SARS-CoV-2 infections in different regions and population groups in 2020: a systematic review and meta-analysis including 130 123 infections from 241 studies
IntroductionAsymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.MethodsIn t...
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| Published in | BMJ open Vol. 11; no. 12; p. e049752 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
British Medical Journal Publishing Group
07.12.2021
BMJ Publishing Group LTD BMJ Publishing Group |
| Series | Original research |
| Subjects | |
| Online Access | Get full text |
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| Abstract | IntroductionAsymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.MethodsIn this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command ‘metaprop’ was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).ResultsA total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%–29.1%) and 21.7% (16.8%–27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%–68.9%), children (32.1%, 24.2%–40.5%), and studies reporting screening programmes (36.0%, 24.6%–48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%–51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%–71.6%), followed by America (40.0%, 27.4%–53.3%), Europe (28.1%, 19.0%–38.1%) and Asia (18.1%, 13.2%–23.5%).ConclusionWe approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic. |
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| AbstractList | IntroductionAsymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.MethodsIn this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command ‘metaprop’ was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).ResultsA total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%–29.1%) and 21.7% (16.8%–27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%–68.9%), children (32.1%, 24.2%–40.5%), and studies reporting screening programmes (36.0%, 24.6%–48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%–51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%–71.6%), followed by America (40.0%, 27.4%–53.3%), Europe (28.1%, 19.0%–38.1%) and Asia (18.1%, 13.2%–23.5%).ConclusionWe approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic. Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.INTRODUCTIONAsymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.In this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command 'metaprop' was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).METHODSIn this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command 'metaprop' was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).A total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%-29.1%) and 21.7% (16.8%-27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%-68.9%), children (32.1%, 24.2%-40.5%), and studies reporting screening programmes (36.0%, 24.6%-48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%-51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%-71.6%), followed by America (40.0%, 27.4%-53.3%), Europe (28.1%, 19.0%-38.1%) and Asia (18.1%, 13.2%-23.5%).RESULTSA total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%-29.1%) and 21.7% (16.8%-27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%-68.9%), children (32.1%, 24.2%-40.5%), and studies reporting screening programmes (36.0%, 24.6%-48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%-51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%-71.6%), followed by America (40.0%, 27.4%-53.3%), Europe (28.1%, 19.0%-38.1%) and Asia (18.1%, 13.2%-23.5%).We approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic.CONCLUSIONWe approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic. Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups. In this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command 'metaprop' was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI). A total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%-29.1%) and 21.7% (16.8%-27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%-68.9%), children (32.1%, 24.2%-40.5%), and studies reporting screening programmes (36.0%, 24.6%-48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%-51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%-71.6%), followed by America (40.0%, 27.4%-53.3%), Europe (28.1%, 19.0%-38.1%) and Asia (18.1%, 13.2%-23.5%). We approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic. Introduction Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the rate of asymptomatic COVID-19 from published studies and compare this rate among different regions and patient groups.Methods In this systematic review and meta-analysis, electronic databases including Medline, Embase, PubMed and three Chinese electronic databases (Chinese National Knowledge Infrastructure [CNKI], WanFang Data and China Science, and Technology Journal Database [VIP]) were searched for literature published from 1 November 2019 to 31 December 2020. Original investigations with sample size (or number of subjects) not less than five were included for further analyses. Subgroup analyses were conducted according to different study types, study periods, geographical regions and patient demographics. The STATA (V.14.0) command ‘metaprop’ was implemented to conduct a meta-analysis of the pooled rate estimates of asymptomatic infections with exact binomial and score test-based 95% confidence interval (CI).Results A total of 130 123 ascertained COVID-19 infections from 241 studies were included in this meta-analysis, including 31 411 asymptomatic infections. The overall rate of asymptomatic infections was 23.6% (18.5%–29.1%) and 21.7% (16.8%–27.0%) before and after excluding presymptomatic cases, respectively. Subgroup analysis showed that significantly higher in pregnant women (48.8%, 28.9%–68.9%), children (32.1%, 24.2%–40.5%), and studies reporting screening programmes (36.0%, 24.6%–48.1%) conducted on or after 1 March 2020 (42.5%, 33.4%–51.9%). In terms of geographical region, the rate was the highest in Africa (64.3%, 56.7%–71.6%), followed by America (40.0%, 27.4%–53.3%), Europe (28.1%, 19.0%–38.1%) and Asia (18.1%, 13.2%–23.5%).Conclusion We approximated that one-fifth of COVID-19 infections are asymptomatic throughout the course of infection. Public health policies targeting these high-risk groups may be recommended to achieve early identification and more stringent containment of the pandemic. |
| Author | Wang, Jingxuan He, Daihai Chong, Ka Chun Li, Jinhui Chen, Xiao Huang, Ziyue Wong, Martin Chi-Sang Zhao, Shi |
| AuthorAffiliation | 2 Mianyang Maternal and Child Health Care Hospital , Mianyang , China 3 JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China 1 School of Public Health , Zhejiang University , Hangzhou , China 4 Department of Applied Mathematics , Hong Kong Polytechnic University , Hong Kong , China |
| AuthorAffiliation_xml | – name: 3 JC School of Public Health and Primary Care , The Chinese University of Hong Kong , Hong Kong , China – name: 4 Department of Applied Mathematics , Hong Kong Polytechnic University , Hong Kong , China – name: 2 Mianyang Maternal and Child Health Care Hospital , Mianyang , China – name: 1 School of Public Health , Zhejiang University , Hangzhou , China |
| Author_xml | – sequence: 1 givenname: Xiao surname: Chen fullname: Chen, Xiao organization: School of Public Health, Zhejiang University, Hangzhou, China – sequence: 2 givenname: Ziyue surname: Huang fullname: Huang, Ziyue organization: Mianyang Maternal and Child Health Care Hospital, Mianyang, China – sequence: 3 givenname: Jingxuan orcidid: 0000-0002-1570-7266 surname: Wang fullname: Wang, Jingxuan email: jxwang@link.cuhk.edu.hk organization: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China – sequence: 4 givenname: Shi surname: Zhao fullname: Zhao, Shi organization: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China – sequence: 5 givenname: Martin Chi-Sang surname: Wong fullname: Wong, Martin Chi-Sang organization: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China – sequence: 6 givenname: Ka Chun orcidid: 0000-0001-5610-1298 surname: Chong fullname: Chong, Ka Chun organization: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China – sequence: 7 givenname: Daihai orcidid: 0000-0003-3253-654X surname: He fullname: He, Daihai organization: Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China – sequence: 8 givenname: Jinhui orcidid: 0000-0002-2572-3454 surname: Li fullname: Li, Jinhui email: clairehh4588@gmail.com organization: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34876424$$D View this record in MEDLINE/PubMed |
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| Snippet | IntroductionAsymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to... Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to estimate the... Introduction Asymptomatic infection of SARS-CoV-2 may lead to silent community transmission and compromise the COVID-19 pandemic control measures. We aimed to... |
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| SubjectTerms | Age groups Asymptomatic Asymptomatic Infections - epidemiology Bias Child Citations Coronaviruses COVID-19 Disease transmission epidemiology Estimates Female Humans Infections infectious diseases Medical research Meta-analysis Pandemics Pathogens Population Population Groups Pregnancy Public Health SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Software Systematic review |
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| Title | Ratio of asymptomatic COVID-19 cases among ascertained SARS-CoV-2 infections in different regions and population groups in 2020: a systematic review and meta-analysis including 130 123 infections from 241 studies |
| URI | https://bmjopen.bmj.com/content/11/12/e049752.full https://www.ncbi.nlm.nih.gov/pubmed/34876424 https://www.proquest.com/docview/2685439053 https://www.proquest.com/docview/2608095271 https://pubmed.ncbi.nlm.nih.gov/PMC8655350 https://doaj.org/article/22f507058c024a36b5d8d6465e590565 |
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