2020 Issue 12
One new and one updated Cochrane review are available in Issue 12 of the Cochrane Database of Systematic Reviews.
New Cochrane Review
Bélard S, Ramharter M, Kurth F Paediatric formulations of artemisinin‐based combination therapies for treating uncomplicated malaria in children. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD009568. DOI: 10.1002/14651858.CD009568.pub2.
Sabine Bélard, Michael Ramharter, and Florian Kurth have completed this new review, which evaluates the evidence on the efficacy, safety, tolerability, and acceptability of paediatric artemisinin‐based combinations (ACT) formulations, such as granules, syrup, powder, or dispersible tablet, compared to tablet ACT formulations, for uncomplicated P falciparum malaria in children up to 14 years old. The review includes 3 relevant studies in 1306 children (aged 6 months to 11 years) with uncomplicated malaria, conducted in sub‐Saharan Africa between 2006 and 2015. All studies were funded by pharmaceutical companies that made child‐friendly formulations of the ACTs. In all 3 trials, both the paediatric and control ACT achieved failure rates of < 10% on day 28. Similar numbers of serious unwanted effects were reported for the usual crushed tablets and the dissolvable tablets (2 studies; 1197 children) or syrup (1 study; 267 children), but there appeared to be fewer drug‐related adverse events with dispersible ACT compared to crushed tablet (adult) ACT. Confidence in these results is low to moderate, because they come from a small number of studies, which were supported by manufacturers of the child‐friendly formulations. The authors conclude that current evidence supports use of paediatric ACTs in young children with malaria, but efforts should be made to develop further types of paediatric ACT formulations such as mini‐tablets and oro-dispersible films, and to assess the acceptability and consequent adherence to these medications.
Updated Cochrane Review
Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Probiotics for treating acute infectious diarrhoea. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD003048. DOI: 10.1002/14651858.CD003048.pub4.
This review was first published in 2004, and last updated in 2010. This update, prepared by Shelui Collinson and colleagues, included 36 new studies, for a total of 82 studies with of 12,127 participants (11,526 of these were children). Only published RCTs of live probiotics were included, and outcomes were revised. The authors did not detect a difference between taking a probiotic and taking a placebo or no additional treatment in the number of children who had diarrhoea longer than 48 hours (two studies in high‐income countries; 1770 children). It is uncertain whether taking probiotics affects the length of time that the symptoms of diarrhoea last (six studies; 3058 people). Taking probiotics may not have affected how many people had diarrhoea longer than 14 days (nine studies; 2928 people); or how many people were admitted to hospital with diarrhoea (six studies; 2283 people). Few studies reported on any unwanted effects of probiotics, and no serious unwanted effects were reported. These findings were not affected by age, nutritional and socioeconomic status, region, or rotavirus infection of participants, nor by whether they were taking antibiotic medicines or zinc supplements. The authors conclude that the review’ findings do not support recommendations for the use of specific probiotics for acute infectious diarrhoea in children. These conclusions are different from those of previous versions of the review, which supported the use of probiotics, and which were obtained from many small studies in this field. This new analysis shows that in this topic there is publication bias, with small studies demonstrating a positive effect more likely to be published, which skews the results.
2020 Issue 11
One new COVID-19 review, one new Cochrane review and one updated COVID-19 review are availablie in Issue 11 of the Cochrane Database of Systematic Reviews
New COVID-19 Review
Stegeman I, Ochodo EA, Guleid F, Holtman GA., Yang B, Davenport C, Deeks JJ, Dinnes J, Dittrich S, Emperador D, Hooft L, Spijker R, Takwoingi Y, Van den Bruel A, Wang J, Langendam M, Verbakel JY, Leeflang MMG. Routine laboratory testing to determine if a patient has COVID‐19. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD013787. DOI: 10.1002/14651858.CD013787
This new review, prepared by Inge Stegeman and colleagues of the Cochrane COVID-19 Diagnostic Test Accuracy Group, aims to assess the diagnostic accuracy of routine laboratory testing as a triage test to determine if a person has COVID‐19. Tests include counts of different types of white blood cells, and detection of markers that indicate organ damage and general inflammation. These tests are widely available and in some settings they may be the only tests available for diagnosis of COVID‐19. The authors identified 21 studies for inclusion, with 14,126 COVID‐19 patients and 56,585 non‐COVID‐19 patients in total. Studies evaluated a total of 67 different laboratory tests. Seventeen studies were done in China, and one each in Iran, Italy, Taiwan and the USA. Most studies used RT‐PCR to confirm COVID‐19 diagnosis. Of all the tests examined, only 3 had both sensitivity and specificity over 50%: 2 of these were markers for general inflammation (increases in interleukin‐6 and C‐reactive protein), and the third was for a decrease in lymphocyte count. Confidence in the evidence from this review is low because the studies were different from each other, which made them difficult to compare. The authors conclude that none of the tests performed well enough to be a standalone diagnostic test for COVID‐19 nor to prioritize patients for treatment, and they will mainly be used to provide an overall picture about the health status of the patient. The final COVID‐19 diagnosis has to be made based on other tests.
New Review
Agarwal R, Choi L, Johnson S, Takwoingi Y. Rapid diagnostic tests for Plasmodium vivax malaria in endemic countries. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD013218. DOI: 10.1002/14651858.CD013218.pub2
Ridhi Agarwal and colleagues in this new review assess the diagnostic accuracy of RDTs that specifically test for P vivax malaria. They included 10 studies that assessed the accuracy of six different RDT brands for detecting P vivax malaria, and were able to estimate the accuracy of 2 out of 6 RDT brands included, the CareStart Malaria Pf/Pv Combo test and the Falcivax Device Rapid test. The studies were conducted in Ethiopia (four studies), India (two studies) and Bangladesh, Brazil, Colombia, and Sudan (one study each). Compared with microscopy, the Care Start Malaria Pf/Pv Combo test performed well with 99% sensitivity and specificity (four studies). Compared with microscopy, the Falcivax Device Rapid test had a sensitivity of 77% and a specificity of 99% (two studies). The results are based on a small number of studies, and it was not possible to reliably assess all six brands of antibody test or compare their accuracy. Most studies included in this review had limitations: it was not clear how people were selected for testing, or how the study results were assessed and checked, which could have affected the results. More high‐quality studies in endemic field settings are needed to assess and compare the accuracy of RDTs designed to detect P vivax.
Updated COVID-19 Review
Islam N, Salameh J-P, Leeflang MMG, Hooft L, McGrath TA, Pol CB, Frank RA, Kazi S, Prager R, Hare SS, Dennie C, Spijker R, Deeks JJ, Dinnes J, Jenniskens K, Korevaar DA, Cohen JF, Van den Bruel A, Takwoingi Y, de Wijgert J, Wang J, McInnes MDF. Thoracic imaging tests for the diagnosis of COVID‐19. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD013639. DOI: 10.1002/14651858.CD013639.pub3
This is a 'living' systematic review'; searches are run and screened monthly, and the review was first published in September 2020. In this update, prepared by Nayaar Islam and colleagues at the Cochrane COVID-19 Diagnostic Test Accuracy Group, 34 studies with 9339 people are included: most studies (31 studies; 8014 participants) evaluated chest CT; three evaluated chest X‐rays (1243 participants) and one evaluated lung ultrasound (100 participants). Nineteen studies took place in Asia, 10 in Europe, four in North America and one in Australia. Participants were hospital inpatients (24 studies), and outpatients (4 studies); the setting was unclear in six studies. Pooled results showed that chest CT correctly diagnosed COVID‐19 in 89.9% of people who had COVID‐19. However, it incorrectly identified COVID‐19 in 38% of people who did not have COVID‐19. Correct diagnosis of COVID‐19 with chest X‐rays ranged from 57% to 89%, but incorrect diagnosis of COVID‐19 in people who did not have COVID‐19 ranged from 11% to 89%. Lung ultrasound correctly diagnosed COVID‐19 in 96% of people with COVID‐19, but it incorrectly diagnosed COVID‐19 in 38% of people who did not have COVID‐19. The uncertainty resulting from high or unclear risk of bias and the heterogeneity of included studies limit the ability to confidently draw conclusions; the evidence suggests that chest CT is better at ruling out COVID‐19 infection than distinguishing it from other respiratory problems. This review will be updated as more evidence becomes available. Future studies should predefine what a positive test is, and compare different types of imaging tests on similar groups of people.
2020 Issue 10
One new review and one protocol are available in Issue 10 of the Cochrane Database of Systematic Reviews
New Review
Furnival-Adams J, Olanga EA, Napier M, Garner P. House modifications for preventing malaria. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD013398. DOI: 10.1002/14651858.CD013398.pub2
Blocking house mosquito entry points or modifying house construction materials can reduce exposure of inhabitants to infectious bites. Joanna Furnival-Adams and her colleagues have completed this new review that investigates the effects of house modifications on malaria disease and transmission. Six cluster RCTs were identified, all conducted in sub‐Saharan Africa: three randomized by household, two by village, and one at the community level. All trials assessed screening of windows, doors, eaves, ceilings, or any combination of these. Only 2 of these trials were already published, while 4 were ongoing and not yet in the public domain. Both published trials showed a reduction in malaria in screened houses, to varying degrees of effect: one trial in Ethiopia showed that people living in screened houses were around 62% less likely to experience an episode of clinical falciparum malaria, and another trial in The Gambia showed that people living in screened houses were around 16% less likely to have P falciparum malaria parasites in their blood, and less likely to experience anaemia. Both trials were small and the consistency and size of the effects, and other factors that may enhance or mitigate the effects have not been clearly delineated. The results of the four trials awaiting publication will substantially add to the evidence base, when available.
New Protocol
Gannon BM, Colt S, Rogers LM, Garcia-Casal MN, Martinez RX, Lopez-Perez L, Ghezzi-Kopel K, Mehta S. Selected laboratory‐based biomarkers for assessing vitamin A deficiency in at‐risk individuals. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD013742. DOI: 10.1002/14651858.CD013742.
2020 Issue 9
One new review and two review updates are available in Issue 9 of the Cochrane Database of Systematic Reviews
New COVID-19 Review
Salameh J-P, Leeflang MMG, Hooft L, Islam N, McGrath TA, Pol CB, Frank RA, Prager R, Hare SS, Dennie C, Spijker R, Deeks JJ, Dinnes J, Jenniskens K, Korevaar DA, Cohen JF, Van den Bruel A, Takwoingi Y, de Wijgert J, Damen JAAG, Wang J, McInnes MDF. Thoracic imaging tests for the diagnosis of COVID‐19. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013639. DOI: 10.1002/14651858.CD013639.pub2.
As part of the Cochrane Library Covid-19 resources, the Cochrane COVID-19 Diagnostic Test Accuracy Group has created a suite of living systematic reviews to cover the roles of tests and characteristics in the diagnosis of COVID‐19. This review prepared by Jean-Paul Salameh and colleagues, aimed to determine the diagnostic accuracy of chest imaging (computed tomography (CT), X‐ray and ultrasound) in people with suspected or confirmed COVID‐19. The review 84 studies, falling into two categories: studies with participants with confirmed diagnoses of COVID‐19 at the time of recruitment (71 studies with 6331 participants) and studies with participants suspected of COVID‐19 (13 studies with 1948 participants). Among 71 studies that included confirmed cases, 41 studies had included symptomatic cases only, 25 studies had included cases regardless of their symptoms, five studies had included asymptomatic cases only; 70 studies were conducted in Asia, 2 in Europe, 2 in North America and one in South America. Risk of bias was high in most studies. Among the 13 studies that included suspected cases, 9 studies were conducted in Asia, and one in Europe. The review’s findings indicate that chest CT is sensitive but not specific for the diagnosis of COVID‐19 in suspected patients, meaning that CT may not be capable of differentiating SARS‐CoV‐2 infection from other causes of respiratory illness. There was overall poor study quality and high heterogeneity, which limits the ability to confidently draw conclusions based on the review’s results. The authors plan to update this review regularly as more research becomes available.
Updated COVID-19 Review
Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, Wagner G, Siebert U, Ledinger D, Zachariah C, Gartlehner G. Quarantine alone or in combination with other public health measures to control COVID‐19: a rapid review. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013574. DOI: 10.1002/14651858.CD013574.pub2.
This is an update of a COVID-19 review first published in April 2020. The review team, led by Barbara Nussbaumer‐Streit, has updated the search and identified 22 new included studies. The review now includes 51 studies; 4 observational studies and 28 modelling studies on COVID‐19, one observational and one modelling study on MERS, three observational and 11 modelling studies on SARS, and three modelling studies on SARS and other infectious diseases. Because of the diverse methods of measurement and analysis across the outcomes of interest, it was not possible to conduct a meta‐analysis and the authors undertook a narrative synthesis. Modelling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases may have averted 44% to 96% of incident cases and 31% to 76% of deaths compared to no measures based on different scenarios. When the models combined quarantine with other prevention and control measures, such as school closures, travel restrictions and social distancing, the models demonstrated that there may be a larger effect on the reduction of new cases, transmissions and deaths than measures without quarantine or no interventions. Very low‐certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths may be small for SARS, but might be larger for COVID‐19. The authors conclude that despite limited evidence, all the studies found quarantine to be important in reducing the number of people infected and the number of deaths. Results suggest that quarantine was most effective, and cost less, when it started earlier. Combining quarantine with other prevention and control measures may have a greater effect than quarantine alone.
Updated Review
Rodrigo C, Rajapakse S, Fernando D. Tafenoquine for preventing relapse in people with Plasmodium vivax malaria. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD010458. DOI: 10.1002/14651858.CD010458.pub3.
Rodrigo Chaturaka and colleagues have updated this review, which was first published in 2015. The US FDA has licenced tafenoquine 300 mg single dose for preventing relapse in vivax malaria, and the review update includes studies at this dose. Three individually randomized RCTs are included, all in endemic areas, and thus reporting recurrence. Trials compared tafenoquine with primaquine or placebo, and all participants received chloroquine to treat the asexual infection). In all trials, pregnant and G6PD‐deficient people were excluded. 300 mg single dose tafenoquine was shown to prevent relapses after clinically parasitologically confirmed P vivax malaria compared to no antihypnozoite treatment, and with no difference detected in studies comparing it to primaquine to date. However, the inability to differentiate a true relapse from a recurrence in the available studies may affect these estimates. The ability to administer tafenoquine as a single dose represents a significant advantage in terms of compliance.
2020 Issue 8
Two new reviews and one review update are available in Issue 8 of the Cochrane Database of Systematic Reviews
New COVID-19 Review
Dinnes J, Deeks JJ, Adriano A, Berhane S, Davenport C, Dittrich S, Emperador D, Takwoingi Y, Cunningham J, Beese S, Dretzke J, Ferrante di Ruffano L, Harris IM, Price MJ, Taylor-Phillips S, Hooft L, Leeflang MMG, Spijker R, Van den Bruel A. Rapid, point‐of‐care antigen and molecular‐based tests for diagnosis of SARS‐CoV‐2 infection. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013705. DOI: 10.1002/14651858.CD013705.
As part of the Cochrane Library Covid-19 resources, the Cochrane COVID-19 Diagnostic Test Accuracy Group has created a suite of living systematic reviews to cover the roles of tests and characteristics in the diagnosis of COVID‐19. This review prepared by Jacqueline Dinnes and colleagues, aimed to assess the diagnostic accuracy of point‐of‐care tests for detecting SARS‐CoV‐2 infection, largely based on remnant laboratory samples, to determine if a person presenting in the community or in primary or secondary care has current SARS‐CoV‐2 infection. The authors included 22 publications, reporting on a total of 18 study cohorts with 3198 unique samples, of which 1775 had confirmed SARS‐CoV‐2 infection. Ten studies took place in North America, two in South America, four in Europe, one in China and one was conducted internationally. Data for eight commercial tests (four antigen and four molecular) and one in‐house antigen test was analyzed. Patient selection was at high risk of bias in 50% of the studies because of deliberate over‐sampling of samples with confirmed COVID‐19 infection, and unclear in seven out of 18 studies because of poor reporting. For antigen tests, sensitivity varied considerably across studies (from 0% to 94%): the average sensitivity was 56.2% and average specificity was 99.5%. For rapid molecular assays, sensitivity showed less variation compared to antigen tests (from 68% to 100%), average sensitivity was 95.2% and specificity 98.9%. The authors comment that the findings currently have limited applicability, as it is uncertain whether tests will perform in the same way in clinical practice, and according to symptoms of COVID‐19, duration of symptoms, or in asymptomatic people.
New Review
Kay AW, González Fernández L, Takwoingi Y, Eisenhut M, Detjen AK, Steingart KR, Mandalakas AM. Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013359. DOI: 10.1002/14651858.CD013359.pub2.
Alexander Kay and colleagues in this new review aimed to determine the accuracy of Xpert MTB/RIF and Xpert Ultra in symptomatic children for diagnosing pulmonary tuberculosis, tuberculous meningitis, lymph node tuberculosis, and rifampicin resistance. For pulmonary tuberculosis, 299 data sets (68,544 participants) were available for analysis; for tuberculous meningitis, 10 data sets (423 participants) were available; for lymph node tuberculosis, 10 data sets (318 participants) were available; and for rifampicin resistance, 14 data sets (326 participants) were available. Thirty‐nine studies (80%) took place in countries with high tuberculosis burden. Risk of bias was generally low. Xpert MTB/RIF sensitivity was found to vary by specimen type, with gastric aspirate specimens having the highest sensitivity followed by sputum and stool, and nasopharyngeal specimens the lowest; specificity in all specimens was > 98%. Compared with Xpert MTB/RIF, Xpert Ultra sensitivity in sputum was higher and specificity slightly lower. Xpert MTB/RIF was accurate for detection of rifampicin resistance. Xpert MTB/RIF was sensitive for diagnosing lymph node tuberculosis. For children with presumed tuberculous meningitis, only few small studies of low certainty evidence were identified; the authors recommend that treatment decisions should be based on the entirety of clinical information and treatment should not be withheld based solely on an Xpert MTB/RIF result.
Updated Review
Milligan R, Daher A, Villanueva G, Bergman H, Graves PM. Primaquine alternative dosing schedules for preventing malaria relapse in people with Plasmodium vivax. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD012656. DOI: 10.1002/14651858.CD012656.pub3.
This review, first published in July 2019, has been updated by Rachel Milligan and co-authors. This version includes two new large important trials using higher dose for 7 days compared to high standard 14‐day course, for a total of 11 studies. All 11 trials included data for adults, and six trials included children under the age of 10 years; two trials included children from the age of six months.
Nine trials excluded pregnant women. Eight trials excluded people with G6PD deficiency. Trials did not detect a difference in recurrence between the following regimens: 1) 0.5 mg/kg/day for seven days versus standard 0.25 mg/kg/day for 14 days; 2) high‐standard 0.5 mg/kg/day for 14 days versus standard 0.25 mg/kg/day for 14 days; 3) 0.75 mg/kg/week for eight weeks versus high‐standard 0.5 mg/kg/day for 14 days; 4) 1 mg/kg/day for seven days versus high‐standard 0.5 mg/kg/day for 14 days. There were no differences detected in adverse events for Comparisons 1, 2 or 3, but there may be more serious adverse events with the high seven‐day course in Comparison 4. In conclusion, trials available to date do not detect a difference in efficacy between the regimen of 0.5 mg/kg/day for seven days and the standard (0.25 mg/kg/day) 14‐day regimen in G6PD‐normal patients. The authors recommend that new high quality randomized controlled trials are run, to help improve the certainty in different settings, such as the 0.5 mg/kg/day seven‐day and high‐standard 14‐day regimens in East Asia and Oceania (where the high standard course is current recommended), and to test modified or weekly regimens in G6PD‐deficient patients.
2020 Issue 7
Three new protocols and one new review are available in Issue 7 of the Cochrane Database of Systematic Reviews
New COVID-19 Review
Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MMG, Spijker R, Hooft L, Emperador D, Dittrich S, Domen J, Horn SR A, Van den Bruel A. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID‐19 disease. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013665. DOI: 10.1002/14651858.CD013665
As part of the Cochrane Library Covid-19 resources, the Cochrane COVID-19 Diagnostic Test Accuracy Group has created a suite of living systematic reviews to cover the roles of tests and characteristics in the diagnosis of COVID‐19. This review prepared by Thomas Struyf and colleagues, aimed to assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID‐19 clinics, has COVID‐19 disease or COVID‐19 pneumonia. 16 studies including 7706 participants are included. There were no studies from primary care settings, but the authors found 7 studies in outpatient clinics (2172 participants), and 4 studies in the emergency department (1401 participants), with data on 27 signs and symptoms, which fall into four different categories: systemic, respiratory, gastrointestinal and cardiovascular. Most had very low sensitivity and high specificity; only six symptoms had a sensitivity of at least 50% in at least one study: cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache. Seven studies carried a high risk of bias for selection of participants, and there were concerns about the applicability of these results; no studies included children and only one focused specifically on older adults. The authors conclude that, based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease, and more studies are urgently needed, especially those focusing on more specific symptoms such as loss of sense of smell, and studies in older adults.
New Protocols
Ciapponi A, Matthews S, Cafferata ML, Comandé D, Gibbons L, Núñez-González S, Buekens P, Arevalo-Rodriguez I. Laboratory tests for diagnosis of congenital Zika virus in fetuses and neonates. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013676. DOI: 10.1002/14651858.CD013676
Vonasek B, Ness T, Takwoingi Y, Kay AW, Wyk SS, Ouellette L, Marais BJ, Steingart KR, Mandalakas AM. Screening tests for active pulmonary tuberculosis in children. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013693. DOI: 10.1002/14651858.CD013693
Shapiro AE, Ross JM, Schiller I, Kohli M, Dendukuri N, Steingart KR, Horne DJ. Xpert MTB/RIF and Xpert Ultra assays for pulmonary tuberculosis and rifampicin resistance in adults irrespective of signs or symptoms of pulmonary tuberculosis. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013694. DOI: 10.1002/14651858.CD013694
2020 Issue 6
Three new protocols and two new reviews are available in Issue 6 of the Cochrane Database of Systematic Reviews
New COVID-19 Reviews
Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Spijker R, Taylor-Phillips S, Adriano A, Beese S, Dretzke J, Ferrante di Ruffano L, Harris IM, Price MJ, Dittrich S, Emperador D, Hooft L, Leeflang MMG, Van den Bruel A. Antibody tests for identification of current and past infection with SARS‐CoV‐2. Cochrane Database of Systematic Reviews 2020, Issue 6. Art. No.: CD013652. DOI: 10.1002/14651858.CD013652.
As part of the Cochrane Library Covid-19 resources, Jonathan Deeks and colleagues have created a suite of living systematic reviews to cover the roles of tests and characteristics in the diagnosis of COVID‐19. Following the emergence of COVID‐19 there has been a rapid and prolific industry activity to develop accurate antibody tests, and at the time of writing (21 May 2020), there were 279 antibody tests listed, 196 of which are produced by commercial companies and are commercially available.
This new review has the objective of assessing the diagnostic accuracy of antibody tests to determine if a person presenting in the community or in primary or secondary care has SARS‐CoV‐2 infection, or has previously had it. It includes both laboratory‐based methods ( enzyme‐linked immunosorbent assays (ELISA), chemiluminescence immunoassays (CLIA), other laboratory‐based methods (e.g. indirect immunofluorescence tests (IIFT), luciferase immunoprecipitation system (LIPS); and tests designed to be used at point‐of‐care: lateral flow assays, including both colloidal gold or fluorescence‐labelled immunochromatographic assays (CGIA or FIA).
This first version of the review includes both commercially available tests, which have regulatory approval, and in‐house assays and assays in development. Future versions of the review are likely to be restricted to only commercially available assays. The authors identified 57 publications reporting on a total of 54 study cohorts with 15,976 samples; studies were conducted in Asia (n = 38), Europe (n = 15), and the USA and China (n = 1). 38 studies that provided results based on the time since people first noticed symptoms were analyzed; antibody tests one week after first symptoms only detected 30% of people who had COVID‐19. Accuracy increased in week 2 with 70% detected, and was highest in week 3 (more than 90% detected). Little evidence was available after week 3. Tests gave false positive results in 2% of those without COVID‐19.
There were several limitations to the studies: most of them were small, did not use the most reliable methods and did not report their results fully, and were published quickly online as ‘preprints’, without undergoing peer-review. Also, most participants were in hospital with COVID‐19, so were likely to have more severe disease than people with mild symptoms who were not hospitalised, which means that we don't know how accurate antibody tests are for people with milder disease or no symptoms. The authors conclude that the design, execution and reporting of studies of the accuracy of COVID‐19 tests requires considerable improvement; ongoing updates of this living systematic review are planned.
New Reviews
Jullien S, Dissanayake HA, Chaplin M. Rapid diagnostic tests for plague. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD013459. DOI: 10.1002/14651858.CD013459.pub2.
Sophie Jullien, Harsha Dissanayake and Marty Chaplin are the authors of this new diagnostic review, which aims to determine the accuracy of the rapid diagnostic test (RDT) based on the antigen F1 (F1RDT), for detecting plague in people with suspected disease.
Plague is an ancient disease, caused by the bacteria Yersinia pestis; it is primarily a vector borne zoonosis, affecting rodents and other wild and domestic animals, and transmitted to humans by rodent fleas. Less frequently, plague can be transmitted through scratches or bites from infected animals, direct handling of infected animals, and human‐to‐human transmission by inhalation of droplets from people with pneumonic plague.
As of 2017, the Democratic Republic of the Congo (DRC), Madagascar, and Peru had the highest incidence of the disease, but new outbreaks are continuously being reported. F1RDT is the only RDT for plague that has been developed for clinical purposes, and it detects the F1 capsular antigen of Y pestis (F1RDT), which is present in large amounts in buboes, blood, and sputum from patients infected with plague. The test gives a semi‐quantitative result within 15 minutes according to the intensity of the line (from 1+ to 4+), although it is most commonly used as a qualitative test (positive or negative result). Currently, the F1RDT that is mainly used in the field is produced in Madagascar, although other versions are produced, but not licensed for use.
The review includes eight manuscripts reporting seven studies, conducted in three countries in Africa among adults and children with any form of plague. The reference standards were bacterial isolation by culture, polymerase chain reaction (PCR), and paired serology. Against culture, the F1RDT appeared highly sensitive for diagnosing either pneumonic or bubonic plague. For any form of plague and when compared to culture, F1RDT registered positive in 100% (sensitivity) of people who had plague and registered negative in 70% of people who actually did not have plague (specificity). In conclusion, F1RDT appears to be highly sensitive for pneumonic or bubonic plague, and as it is a simple test that can be performed at a patient's bedside in remote and low‐resource areas, it can assist with plague diagnosis for early management, and appropriate preventive measures to avoid spread of the disease. However, F1RDT does not fully replace culture, which provides additional information on resistance to antibiotics and bacterial strains.
New COVID-19 Protocols
McInnes MDF, Leeflang MMG, Salameh J-P, McGrath TA, Pol CB, Frank RA, Prager R, Hare SS, Dennie C, Spijker R, Deeks JJ, Dinnes J, Jenniskens K, Korevaar DA, Cohen JF, Van den Bruel A, Takwoingi Y, de Wijgert J, Damen JAAG, Hooft L. Imaging tests for the diagnosis of COVID‐19. Cochrane Database of Systematic Reviews 2020, Issue 6. Art. No.: CD013639. DOI: 10.1002/14651858.CD013639.
New Protocols
Florez ID, Sierra J, Pérez-Gaxiola G. Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhoea and severe dehydration in children. Cochrane Database of Systematic Reviews 2020, Issue 6. Art. No.: CD013640. DOI: 10.1002/14651858.CD013640.
Taylor M, Oliver S, Garner P. Mass drug administration for filariasis: community views and programme design influences ‐ a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2020, Issue 6. Art. No.: CD013638. DOI: 10.1002/14651858.CD013638.
2020 Issue 5
No publications produced for Issue 5
2020 Issue 4
Four new reviews and two new protocols are available in Issue 4 of the Cochrane Database of Systematic Reviews
New COVID-19 Reviews
Nussbaumer‐Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, Wagner G, Siebert U, Christof C, Zachariah C, Gartlehner G. Quarantine alone or in combination with other public health measures to control COVID‐19: a rapid review. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013574. DOI: 10.1002/14651858.CD013574
This review is part of Cochrane's work on Rapid Reviews in response to COVID-19. The review was commissioned by WHO and prepared by a Cochrane Austria team led by Barbara Nussbaumer‐Streit. The review’s aim is to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID‐19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease. It includes cohort studies, case‐control‐studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID‐19, as well as studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). The authors included 29 studies; 10 modelling studies on COVID‐19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis it was not possible to conduct a meta‐analysis and the authors conducted a narrative synthesis. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures. When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone. The authors conclude that quarantine is important in reducing incidence and mortality during the COVID‐19 pandemic, and it is important to constantly monitor the outbreak situation and the impact of the measures implemented. A summary of this review is also available as a podcast and as Cochrane Clinical Answers.
Paludan-Müller AS, Boesen K, Klerings I, Jørgensen KJ, Munkholm K. Hand cleaning with ash for reducing the spread of viral and bacterial infections: a rapid review. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013597. DOI: 10.1002/14651858.CD013597
New Reviews
Conterno LO, Turchi MD, Corrêa I, Monteiro de Barros Almeida RA. Anthelmintic drugs for treating ascariasis. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD010599. DOI: 10.1002/14651858.CD010599.pub2
A team from Brazil, led by Lucieni O Conterno, has completed this new review, which compares the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) used for treating people with Ascaris infection. Ascaris lumbricoides is a common infection, and mainly affects children living in low‐income areas. The authors included 30 parallel‐group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) were compared to placebo. Single‐dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure at 14 to 60 days and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. The authors conclude that albendazole, mebendazole, ivermectin are all effective against ascariasis, and it is unclear whether any outstanding questions regarding their use remain.
Murray M, Hine P. Treating progressive disseminated histoplasmosis in people living with HIV. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013594. DOI: 10.1002/14651858.CD013594 (28 Apr)
New Protocols
Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MMG, Spijker R, Hooft L, Van den Bruel A, Emperador D, Dittrich S. Diagnosis of SARS‐CoV‐2 infection and COVID‐19: accuracy of signs and symptoms; molecular, antigen, and antibody tests; and routine laboratory markers Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013596. DOI: 10.1002/14651858.CD013596.
Singh B, Ryan H, Kredo T, Chaplin M, Fletcher T. Chloroquine or hydroxychloroquine for prevention and treatment of COVID‐19. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013587. DOI: 10.1002/14651858.CD013587
2020 Issue 3
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2020 Issue 2
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2020 Issue 1
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