Early epidemiological investigations: World Health Organization UNITY protocols provide a standardized and timely international investigation framework during the COVID‐19 pandemic

Abstract

Background The declaration of Coronavirus disease 2019 (COVID‐19) as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 required rapid implementation of early investigations to inform appropriate national and global public health actions. Methods The suite of existing pandemic preparedness generic epidemiological early investigation protocols was rapidly adapted for COVID‐19, branded the ‘UNITY studies’ and promoted globally for the implementation of standardized and quality studies. Ten protocols were developed investigating household (HH) transmission, the first few cases (FFX), population seroprevalence (SEROPREV), health facilities transmission (n = 2), vaccine effectiveness (n = 2), pregnancy outcomes and transmission, school transmission, and surface contamination. Implementation was supported by WHO and its partners globally, with emphasis to support building surveillance and research capacities in low‐ and middle‐income countries (LMIC). Results WHO generic protocols were rapidly developed and published on the WHO website, 5/10 protocols within the first 3 months of the response. As of 30 June 2021, 172 investigations were implemented by 97 countries, of which 62 (64%) were LMIC. The majority of countries implemented population seroprevalence (71 countries) and first few cases/household transmission (37 countries) studies. Conclusion The widespread adoption of UNITY protocols across all WHO regions indicates that they addressed subnational and national needs to support local public health decision‐making to prevent and control the pandemic.

“I Teach, Therefore I Am”: The Serial Relationship between Perceived Vulnerability to Disease, Fear of COVID-19, Teacher Identification and Teacher Satisfaction

“…Since 2020, in order to curb the spread of COVID-19, governments around the world have implemented a range of physical distancing and other protective measures recommended by the World Health Organization [ 1 , 2 ]. School closure and suspension of face-to-face teaching was one of the most consistently applied strategies globally to mitigate the pandemic, and this strategy necessitated an abrupt shift from traditional classroom-based instruction to emergency remote teaching [ 3 ].…”

Household Transmission Investigation: Design, Reporting and Critical Appraisal.

“…The primary objective of the WHO's HHTI protocol is to gain an early understanding of the transmission dynamics within the household setting 4 . HHTIs are prospective case-ascertained studies that investigate confirmed cases and their household close contacts 5 . Effectively, the household transmission design is a study with two observational components (Figure 1): the identification of eligible COVID-19 cases from a source population (case series), and subsequent recruitment of all their household contacts on the basis of exposure to the primary case of COVID-19 within the household (cohort study).…”

“…JP Villanueva-Cabezas 1,2 ; Violeta Spirkoska 1,5 , Adrian J Marcato 1,3 ; Niamh Meagher 1,4 ; James E Fielding 1,4,5 ; Isabel Bergeri 6 ; Hannah Lewis 6 ; Marta Valenciano 6,7 ; Richard Pebody 8 ; David J Price 1,4…”

“…Following the emergence of SARS-CoV-2 and the subsequent pandemic of Coronavirus disease 2019 (COVID19), the World Health Organization (WHO) published a suite of investigation protocols collectively known as The Unity Studies 1 , which build upon the CONSISE protocols for standardized research of influenza 2 and other generic protocols 3 . The Unity Studies include a protocol for household transmission investigations (HHTI) 4 ; which are conducted to increase evidence-based knowledge for action in response to emerging pathogens such as COVID-19 5 .…”

“…The HHTI are prospective case-ascertained studies that seek to standardise data collection and analysis to rapidly determine critical epidemiological and clinical parameters of novel respiratory pathogens upon their emergence 4 . Consistent application of study methodology can also facilitate reliable comparison and aggregation of data at the regional and global level 5 . The WHO HHTI protocol provides guidelines for a targeted investigation within a defined population that may not readily mix with the community; thus, the HHTI design allows for the collection of rich epidemiological, virological and serological data, including: i) proportion of asymptomatic cases; ii) incubation period, duration of infectiousness and detectable shedding; iii) serial intervals; iv) reproduction numbers; v) clinical risk factors and clinical course and severity of disease; vi) high-risk population subgroups; vii) secondary infection rate and secondary clinical attack rate; and viii) patterns of healthcare-seeking 4 .…”