Pandemic H1N1 Influenza Research Articles

Seasonality and immunity to laboratory-confirmed seasonal coronaviruses (HCoV-NL63, HCoV-OC43, and HCoV-229E): results from the Flu Watch cohort study.

Background: There is currently a pandemic caused by the novel coronavirus SARS-CoV-2. The intensity and duration of this first and second waves in the UK may be dependent on whether SARS-CoV-2 transmits more effectively in the winter than the summer and the UK Government response is partially built upon the assumption that those infected will develop immunity to reinfection in the short term. In this paper we examine evidence for seasonality and immunity to laboratory-confirmed seasonal coronavirus (HCoV) from a prospective cohort study in England. Methods: In this analysis of the Flu Watch cohort, we examine seasonal trends for PCR-confirmed coronavirus infections (HCoV-NL63, HCoV-OC43, and HCoV-229E) in all participants during winter seasons (2006-2007, 2007-2008, 2008-2009) and during the first wave of the 2009 H1N1 influenza pandemic (May-Sep 2009). We also included data from the pandemic and 'post-pandemic' winter seasons (2009-2010 and 2010-2011) to identify individuals with two confirmed HCoV infections and examine evidence for immunity against homologous reinfection. Results: We tested 1,104 swabs taken during respiratory illness and detected HCoV in 199 during the first four seasons. The rate of confirmed HCoV infection across all seasons was 390 (95% CI 338-448) per 100,000 person-weeks; highest in the Nov-Mar 2008/9 season at 674 (95%CI 537-835) per 100,000 person-weeks. The highest rate was in February at 759 (95% CI 580-975) per 100,000 person-weeks. Data collected during May-Sep 2009 showed there was small amounts of ongoing transmission, with four cases detected during this period. Eight participants had two confirmed infections, of which none had the same strain twice. Conclusion: Our results provide evidence that HCoV infection in England is most intense in winter, but that there is a small amount of ongoing transmission during summer periods. We found some evidence of immunity against homologous reinfection.

Reverse Zoonosis of COVID-19: Lessons From the 2009 Influenza Pandemic.

Over the past decade, pandemics caused by pandemic H1N1 (pH1N1) influenza virus in 2009 and severe acute respiratory syndrome virus type 2 (SARS-CoV-2) in 2019 have emerged. Both are high-impact respiratory pathogens originating from animals. Their wide distribution in the human population subsequently results in an increased risk of human-to-animal transmission: reverse zoonosis. Although there have only been rare reports of reverse zoonosis events associated with the ongoing coronavirus disease 2019 (COVID-19) pandemic from SARS-CoV-2 so far, comparison with the pH1N1 influenza pandemic can provide a better understanding of the possible consequences of such events for public and animal health. The results of our review suggest that similar factors contribute to successful crossing of the host species barriers in both pandemics. Specific risk factors include sufficient interaction between infected humans and recipient animals, suitability of the animal host factors for productive virus infection, and suitability of the animal host population for viral persistence. Of particular concern is virus spread to susceptible animal species, in which group housing and contact network structure could potentially result in an alternative virus reservoir, from which reintroduction into humans can take place. Virus exposure in high-density populations could allow sustained transmission in susceptible animal species. Identification of the risk factors and serological surveillance in SARS-CoV-2-susceptible animal species that are group-housed should help reduce the threat from reverse zoonosis of COVID-19.

Public health emergencies of international concern: a historic overview.

RationaleThe International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations.Key findingsSix events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013–2015, outbreak in Democratic Republic of Congo 2018–2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread.RecommendationsThe binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.

PIPDeploy: Development and implementation of a gamified table top simulation exercise to strengthen national pandemic vaccine preparedness and readiness

Successful emergency vaccination campaigns rely on effective deployment and vaccination plans. This applies to localised outbreaks as well as for pandemics. In the wake of the 2009 H1N1 influenza pandemic, analysis of the global Vaccine Deployment Initiative, through which the World Health Organization (WHO) donated pandemic influenza vaccines to countries in need, revealed that an absence of vaccine deployment plans in many countries significantly hindered vaccine deployment. Through the Pandemic Influenza Preparedness Framework adopted by the World Health Assembly in 2011, WHO is engaging in several capacity building activities to improve pandemic influenza preparedness and response and make provisions for access to vaccines and sharing of other benefits. The Framework calls for the development and exercise of operational plans for deployment of influenza vaccines to enhance pandemic preparedness. To this end, WHO has supported the development of PIPDeploy, an interactive, in-person table top simulation exercise to facilitate learning for emergency preparedness. It employs various game design elements including a game board, time pressure, leaderboards and teams to enhance participants’ motivation. PIPDeploy formed part of five WHO Pandemic Influenza Vaccine Deployment Workshops attended by national-level managers responsible for pandemic influenza vaccine response predominantly in non-producing countries. The purpose of this study was to describe the features and application of PIPDeploy, and present findings of the evaluation of participants’ experiences during the simulation involving a “hot wash” discussion and collection of quantitative data. The simulation’s instructional approach was widely accepted by participants, who reported that the format was novel and engaging. They reflected on its utility for identifying gaps in their own vaccine deployment plans and regulatory frameworks for importation of vaccine products. All participants found the simulation relevant to their professional objectives. A range of other potential applications were suggested, including PIPDeploy’s adaptation to sub-national contexts and to other epidemic diseases.

Seasonality and immunity to laboratory-confirmed seasonal coronaviruses (HCoV-NL63, HCoV-OC43, and HCoV-229E): results from the Flu Watch cohort study

Background: There is currently a pandemic caused by the novel coronavirus SARS-CoV-2. The intensity and duration of this first and second waves in the UK may be dependent on whether SARS-CoV-2 transmits more effectively in the winter than the summer and the UK Government response is partially built upon the assumption that those infected will develop immunity to reinfection in the short term. In this paper we examine evidence for seasonality and immunity to laboratory-confirmed seasonal coronavirus (HCoV) from a prospective cohort study in England. Methods: In this analysis of the Flu Watch cohort, we examine seasonal trends for PCR-confirmed coronavirus infections (HCoV-NL63, HCoV-OC43, and HCoV-229E) in all participants during winter seasons (2006-2007, 2007-2008, 2008-2009) and during the first wave of the 2009 H1N1 influenza pandemic (May-Sep 2009). We also included data from the pandemic and ‘post-pandemic’ winter seasons (2009-2010 and 2010-2011) to identify individuals with two confirmed HCoV infections and examine evidence for immunity against homologous reinfection. Results: We tested 1,104 swabs taken during respiratory illness and detected HCoV in 199 during the first four seasons. The rate of confirmed HCoV infection across all seasons was 390 (95% CI 338-448) per 100,000 person-weeks; highest in the Nov-Mar 2008/9 season at 674 (95%CI 537-835) per 100,000 person-weeks. The highest rate was in February at 759 (95% CI 580-975) per 100,000 person-weeks. Data collected during May-Sep 2009 showed there was small amounts of ongoing transmission, with four cases detected during this period. Eight participants had two confirmed infections, of which none had the same strain twice. Conclusion: Our results provide evidence that HCoV infection in England is most intense in winter, but that there is a small amount of ongoing transmission during summer periods. We found some evidence of immunity against homologous reinfection.

Physical interventions to interrupt or reduce the spread of respiratory viruses.

Physical interventions to interrupt or reduce the spread of respiratory viruses.

Harnessing the Power of Blockchains and Machine Learning to End the COVID-19 Pandemic.

The last catastrophic pandemic the world has seen was the 1918 H1N1 influenza pandemic, considering that it happened 102 years ago, one can perhaps leverage the technologic advancements over the past century to combat the current pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19), which has already infected more than 16 million people globally and shut down the majority of the daily activities of life. The danger and challenge of infectious diseases such as COVID-19 lies in their highly contagious nature, spreading like wildfire with the potential to infect the majority of the world's population unless drastic measures are undertaken. In some countries, the social distancing and quarantine measures are either insufficient or ineffective as the number of cases is still on the rise. A major issue causing this rise is that most COVID-19 carriers appear asymptomatic. Identifying infected individuals as well as healthy/immune ones is the most crucial step in halting the disease spread. This is where the role of mass screening comes in.

Serologically-Based Evaluation of Cross-Protection Antibody Responses among Different A(H1N1) Influenza Strains.

After the influenza H1N1 pandemic of 2009, the seasonal A/Brisbane/59/2007 strain was replaced by the A/California/07/2009 strain for the influenza virus vaccine composition. After several seasons with no indications on the occurrence of antigenic drift, A/Michigan/45/2015 was chosen as the H1N1 vaccine strain for the 2017/2018 season. Since the immune response to influenza is shaped by the history of exposure to antigenically similar strains, the potential cross-protection between seasonal human influenza vaccine strains and the emerging pandemic strains was investigated. Human serum samples were tested by hemagglutination inhibition and single radial hemolysis assays against A/Brisbane/59/2007, A/California/07/2009, and A/Michigan/45/2015 strains. Strong cross-reactions between A/California/07/2009 and A/Michigan/45/2015 strains were observed in 2009/2010, most likely induced by the start of the 2009 pandemic, and the subsequent post-pandemic seasons from 2010/2011 onward when A/California/07/2009 became the predominant strain. In the 2014/2015 season, population immunity against A/California/07/2009 and A/Michigan/45/2015 strains increased again, associated with strong cross-reactions. Whereas hemagglutination inhibition assay has a higher sensitivity for detection of new seasonal drift, the single radial hemolysis assay is an excellent tool for determining the presence of pre-existing immunity, allowing a potential prediction on the booster potential of influenza vaccines against newly emerging drifted strains.

Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey

BackgroundMore than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic. PurposeTo investigate predictors associated with global caregivers’ intent to vaccinate their children against COVID-19, when the vaccine becomes available. MethodAn international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020. Results65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine’s novelty (52%). ConclusionsThe majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine’s safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.

Intensive care back up for infectious disease disasters

HintergrundAusbrüche von Infektionskrankheiten stellen Krankenhäuser und Intensivstationen vor besondere Herausforderungen.Ziel der ArbeitEs werden grundlegende infektiologische Szenarien und ihre Bedeutung für die moderne Intensivmedizin dargestellt.Material und MethodenAusgewählte Erreger/Infektionskrankheiten, die das Potenzial haben, die Ressourcen der Intensivstationen deutlich zu belasten, werden beschrieben.ErgebnisseEine Intensivmedizinische Betreuung ist bei schweren Verläufen vieler Infektionserkrankungen notwendig. Im Rahmen von Epidemien/Pandemien kann es innerhalb kurzer Zeit zu einer Aufnahme von vielen kritisch kranken Patienten kommen. Beispiele dafür sind die Pandemie im Jahr 2009 durch das Influenzavirus H1N1, der Ausbruch einer Infektion mit enterohämorrhagischen Escherichia coli (EHEC) in Norddeutschland, der Ebola-Fieber-Ausbruch in den Jahren 2014/2015 und die Pandemie durch die Coronaviruserkrankung 2019 (COVID-19) im Jahr 2020. Multidisziplinäre Teams, die Entwicklung von Protokollen, eine adäquate Personalbesetzung und Schulungen sind erforderlich, um ein optimales Behandlungsergebnis zu erzielen. Dies beinhaltet insbesondere auch die Prävention von Infektionen des Gesundheitspersonals.DiskussionPandemien und Epidemien sind einzigartige Herausforderungen für die Bereitschaftsplanung der Intensivstation.

Providing Evidence-Based Practice During the COVID-19 Pandemic.

Providing Evidence-Based Practice During the COVID-19 Pandemic.

Age-Dependent Glycomic Response to the 2009 Pandemic H1N1 Influenza Virus and Its Association with Disease Severity.

Influenza A viruses cause a spectrum of responses, from mild coldlike symptoms to severe respiratory illness and death. Intrinsic host factors, such as age, can influence disease severity. Glycosylation plays a critical role in influenza pathogenesis; however, the molecular drivers of influenza outcomes remain unknown. In this work, we characterized the host glycomic response to the H1N1 2009 pandemic influenza A virus (H1N1pdm09) as a function of age-dependent severity in a ferret model. Using our dual-color lectin microarray technology, we examined baseline glycosylation and glycomic response to infection in newly weaned and aged animals, models for young children and the elderly, respectively. Compared to adult uninfected ferrets, we observed higher levels of α-2,6-sialosides, the receptor for H1N1pdm09, in newly weaned and aged animals. We also observed age-dependent loss of O-linked α-2,3-sialosides. The loss of these highly charged groups may impact viral clearance by mucins, which corresponds to the lower clearance rates observed in aged animals. Upon infection, we observed dramatic changes in the glycomes of aged animals, a population severely impacted by the virus. In contrast, no significant alterations were observed in the newly weaned animals, which show mild to moderate responses to the H1N1pdm09. High mannose, a glycan recently identified as a marker of severity in adult animals, increased with severity in the aged population. However, the response was delayed, in line with the delayed development of pneumonia observed. Overall, our results may help explain the differential susceptibility to influenza A infection and severity observed as a function of age.

Aerosolized pH1N1 influenza infection induces less systemic and local immune activation in the lung than combined intrabronchial, nasal and oral exposure in cynomolgus macaques.

Non-human primates form an important animal model for the evaluation of immunogenicity and efficacy of novel 'universal' vaccine candidates against influenza virus. However, in most studies a combination of intra-tracheal or intra-bronchial, oral and nasal virus inoculation is used with a standard virus dose of between 1 and 10 million tissue culture infective doses, which differs from typical modes of virus exposure in humans. This paper studies the systemic and local inflammatory and immune effects of aerosolized versus combined-route exposure to pandemic H1N1 influenza virus. In agreement with a previous study, both combined-route and aerosol exposure resulted in similar levels of virus replication in nose, throat and lung lavages. However, the acute release of pro-inflammatory cytokines and chemokines, acute monocyte activation in peripheral blood as well as increased cytokine production and T-cell proliferation in the lungs were only observed after combined-route infection and not after aerosol exposure. Longitudinal evaluation by computed tomography demonstrated persistence of lung lesions after resolution of the infection and a tendency for more lesions in the lower lung lobes after combined-route exposure versus upper and middle lung lobes after aerosol exposure. Computed tomography scores were observed to correlate with fever. In conclusion, influenza virus infection by aerosol exposure is accompanied by less immune-activation and inflammation in comparison with direct virus installation, despite similar levels of virus replication and development of lesions in the lungs.

PET in the diagnostic management of infectious/inflammatory pulmonary pathologies: a revisit in the era of COVID-19.

PET in the diagnostic management of infectious/inflammatory pulmonary pathologies: a revisit in the era of COVID-19.

The unique features of SARS‐CoV‐2 transmission: Comparison with SARS‐CoV, MERS‐CoV and 2009 H1N1 pandemic influenza virus

SummaryFrom 2002 to 2019, three deadly human coronaviruses (hCoVs), severe acute respiratory syndrome coronavirus (SARS‐CoV), Middle Eastern respiratory syndrome coronavirus (MERS‐CoV) and severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) emerged to produce outbreaks of SARS, MERS and coronavirus disease 2019 (Covid‐19), respectively. All three hCoVs are members of the Betacoronavirus genus in the subfamily Orthocoronavirinae and share many similarities in virology and epidemiology. However, the pattern and scale of Covid‐19 global spread is similar to 2009 pandemic H1N1 influenza (H1N1pdm09), rather than SARS or MERS. Covid‐19 exhibits high viral shedding in the upper respiratory tract at an early stage of infection, and has a high proportion of transmission competent individuals that are pre‐symptomatic, asymptomatic and mildly symptomatic, characteristics seen in H1N1pdm09 but not in SARS or MERS. These two traits of Covid‐19 and H1N1pdm09 result in reduced efficiency in identification of transmission sources by symptomatic screening and play important roles in their ability to spread unchecked to cause pandemics. To overcome these attributes of Covid‐19 in community transmission, identifying the transmission source by testing for virus shedding and interrupting chains of transmission by social distancing and public masking are required.

Treatment of Critically Ill Coronavirus Disease 2019 Patients With Adjunct Therapeutic Plasma Exchange: A Single-Center Retrospective Case Series

Treatment of Critically Ill Coronavirus Disease 2019 Patients With Adjunct Therapeutic Plasma Exchange: A Single-Center Retrospective Case Series

New 2013 incidence peak in childhood narcolepsy: more than vaccination?

Increased incidence rates of narcolepsy type-1 (NT1) have been reported worldwide after the 2009-2010 H1N1 influenza pandemic (pH1N1). While some European countries found an association between the NT1 incidence increase and the H1N1 vaccination Pandemrix, reports from Asian countries suggested the H1N1 virus itself to be linked to the increased NT1 incidence. Using robust data-driven modeling approaches, that is, locally estimated scatterplot smoothing methods, we analyzed the number of de novo NT1 cases (n = 508) in the last two decades using the European Narcolepsy Network database. We confirmed the peak of NT1 incidence in 2010, that is, 2.54-fold (95% confidence interval [CI]: [2.11, 3.19]) increase in NT1 onset following 2009-2010 pH1N1. This peak in 2010 was found in both childhood NT1 (2.75-fold increase, 95% CI: [1.95, 4.69]) and adulthood NT1 (2.43-fold increase, 95% CI: [2.05, 2.97]). In addition, we identified a new peak in 2013 that is age-specific for children/adolescents (i.e. 2.09-fold increase, 95% CI: [1.52, 3.32]). Most of these children/adolescents were HLA DQB1*06:02 positive and showed a subacute disease onset consistent with an immune-mediated type of narcolepsy. The new 2013 incidence peak is likely not related to Pandemrix as it was not used after 2010. Our results suggest that the increased NT1 incidence after 2009-2010 pH1N1 is not unique and our study provides an opportunity to develop new hypotheses, for example, considering other (influenza) viruses or epidemiological events to further investigate the pathophysiology of immune-mediated narcolepsy.

Reassortment Between Divergent Strains of Camp Ripley Virus (Hantaviridae) in the Northern Short-Tailed Shrew (Blarina brevicauda).

Genomic reassortment of segmented RNA virus strains is an important evolutionary mechanism that can generate novel viruses with profound effects on human and animal health, such as the H1N1 influenza pandemic in 2009 arising from reassortment of two swine influenza viruses. Reassortment is not restricted to influenza virus and has been shown to occur in members of the order Bunyavirales. The majority of reassortment events occurs between closely related lineages purportedly due to molecular constraints during viral packaging. In the original report of Camp Ripley virus (RPLV), a newfound hantavirus in the northern short-tailed shrew (Blarina brevicauda), phylogenetic incongruence between different genomic segments suggested reassortment. We have expanded sampling to include RPLV sequences amplified from archival tissues of 36 northern short-tailed shrews collected in 12 states (Arkansas, Iowa, Kansas, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, Ohio, Pennsylvania, Virginia, Wisconsin), and one southern short-tailed shrew (Blarina carolinensis) from Florida, within the United States. Using Bayesian phylogenetic analysis and Graph-incompatibility-based Reassortment Finder, we identified multiple instances of reassortment that spanned the Hantaviridae phylogenetic tree, including three highly divergent, co-circulating lineages of the M segment that have reassorted with a conserved L segment in multiple populations of B. brevicauda. In addition to identifying the first known mobatvirus-like M-segment sequences from a soricid host and only the second from a eulipotyphlan mammal, our results suggest that reassortment may be common between divergent virus strains and provide strong justification for expanded spatial, temporal, and taxonomic analyses of segmented viruses.

Insight View on Pandemic COVID-19: Worldwide Perspective with Homoeopathic Management through Repertorial Analysis

AbstractThe current outbreak of novel corona virus that began in China, created massive disaster worldwide resulting in thousands of deaths and enormous impact on health system and economic. This viral infection facilitates damage of alveolar macrophages and epithelial cells of lung caused by cytokine storm and deregulated immune responses and transmitted rapidly through the droplet infection via cough, sneeze and through contact. The reporting spectrum ranges from asymptomatic cases to symptomatic manifestations, fever, cough and shortness of breath with high-risk potential in systemic associated diseases of cardiovascular, diabetes and hypertension. The global impact of COVID-19 has been profound and the public health threat, it represents, is the most serious picture seen in a respiratory virus since the 1918 H1N1 influenza pandemic. As of now there are no vaccines or medicines approved for the SARS-CoV-2 infection; it is the time to look for other possible measures which can be possibly undertaken to combat the crisis. Keeping in mind this current scenario, there is a need to adopt an integrative approach in public health-care system and include complementary and alternative medicines in designing roadmap in battle against this malady. One of peculiar aspect of homoeopathy is individualisation. There is an inter-individual variation in reaction to a stimulus. Clinical presentation in a disease is significantly determined by the host immunogenetic mechanisms. Homoeopathy treatment is done on the basis of symptoms of the patient; this concept is relevant when we deal with the new diseases. As homoeopathic medicines stimulate the body's own defence mechanism rather than directly attacking specific pathogens, they have much to offer in the treatment of viral diseases. In this review, authors have collected symptoms from previous studies done in conventional medicine and homoeopathy. These symptoms are repertorised from two general and two clinical repertories. Frequently appearing medicines are examined with their symptoms in context of influenza-like illness. The review concludes with the key learning points about epidemiology, clinical features, prevention and homoeopathic management of COVID-19.

Estimates of the COVID-19 Infection Fatality Rate for 48 African Countries: A Model-based Analysis

Introduction: The infection fatality rate (IFR) is key to determining the effect of the pandemic at population level, as well as the effects of public policies and regulations. We examine global data from 48 African countries to estimate the SARS-CoV-2 IFR. Methods: We analyzed time series data on the confirmed cases and deaths from COVID-19 disease outbreak across Africa. We define IFR as the ratio of the number of deaths caused by COVID-19 (numerator) and the total number of people in the population who were infected by the virus (denominator). We controlled for the upward bias associated with the denominator, to accommodate for the untested individuals by adjusting for population density, population aged 65 years and older, population with basic handwashing facilities, extreme poverty, diabetes prevalence, and death rate from cardiovascular disease in a Bayesian prediction model based on the technique of Monte Carlo. Results: We analyzed data on the 135,126 confirmed cases and 3,922 deaths from COVID-19 disease outbreak in Africa through May 30, 2020. After adjusting for potential risk factors in the Bayesian model, we predicted a total of 1,686,879 COVID-19 infections, corresponding to 13 infections per confirmed case. The IFR in Africa was estimated to be 0.23% (95%CI: 0.14% to 0.33). Country-specific rates varied from 0.004% in Botswana and Central African Republic, to 1.53% in Nigeria, respectively. The estimated IFR is twelvefold higher than WHO reported estimate (0.02%) from the 2009 H1N1 influenza pandemic. The inverse distance weighted (IDW) interpolation map shows concentrations of extreme IFR in four countries: Morocco, Nigeria, Cameroon, and South Africa. Conclusion: The infection fatality rate of COVID-19 can vary substantially across different locations, and this may reflect differences in demographics, underlying health issues in the population, capacity of the healthcare system, positive health seeking behavior, as well as other factors. Variability in testing and cause-of-death data across African countries might have impacted on the results. Our model and our estimates can help disease and policy modelers to obtain more accurate predictions for the epidemiology of the disease and the effect of alternative policy strategies to contain this pandemic.