INCIDÊNCIA DE CÂNCER BUCAL NO MARANHÃO, BRASIL: UM ESTUDO DE SÉRIE TEMPORAL / INCIDENCE OF ORAL CANCER IN MARANHÃO, BRAZIL: A TEMPORAL SERIES STUDY

Introdução: Os casos de câncer de boca (CB) não fazem parte da lista de agravos de notificação compulsória no Brasil, dificultando a vigilância epidemiológica e acompanhamento da magnitude deste agravo. Objetivo: Analisar a tendência temporal da incidência de CB e a letalidade da doença no Estado do Maranhão, no período de 2003 a 2005. Métodos: Estudo de série temporal retrospectivo com 136 realizados no Instituto Maranhense de Oncologia Aldenora Bello (IMOAB), em São Luís, MA, Brasil. Realizou-se análise descritiva e inferencial, com dados retrospectivos de prontuários dos pacientes (α=5%). Resultados: A incidência variou de 1,24 a 0,48 por 100 mil habitantes (p=0,157), e a de letalidade, de 0,24 a 0,06 (p=0,160). Verificou-se maior incidência dos casos em homens (56,62%), com idade superior a 40 anos (87,5%), com raça/cor branca (76,52%). O município do Estado com maior incidência da doença foi São Luís, totalizando quase a metade da casuística - 60 casos (44,78%). A idade média dos casos foi de 61,3 (±16,6) anos. O tipo histológico predominante foi o carcinoma epidermóide (n=86, 65,15%). Aslocalizações anatômicas mais frequentes foram língua (16,42%), orofaringe (14%) e parótida (14%) e a modalidade terapêutica mais empregada foi a cirúrgica (94,03%). Conclusão: As taxas de incidência e de letalidade mantiveram-se estáveis entre 2003 e 2005. Tais casos continuam sendo principalmente representados por carcinomas epidermóides, de língua, em homens e naqueles com idades mais avançadas. É alta a incidência de tumores malignos em glândulas salivares na população estudada.Palavras-chave: Neoplasias Bucais. Epidemiologia. Incidência. Letalidade.AbstractIntroduction: The cases of mouth cancer (MC) are not on the list of mandatory notifiable in Brazil; this makes it difficult the epidemiological vigilance and the monitoring the magnitude of this disease. Objective: To analyze time trends in the incidence of MC and case fatality in the state of Maranhão, in the period from 2003 to 2005. Methods: This study is temporal and retrospective, referring to cases with a primary diagnosis of MC (n = 136) in the Maranhense Institute of Oncology Aldenora Bello (IMOAB) in São Luís, Brazil. Descriptive and inferential analysis was held, with retrospective data from medical records of patients (α=5%). Results: The incidence rate of MC ranged from 1.24 to 0.48 per 100 000 inhabitants (p = 0.157) and the case fatality rate ranged from 0.24 to 0.06 (p = 0.160). A higher incidence of cases was verified in males (56.62%), aged 40 years (87.5%), ethnicity/color Caucasian (76.52%). The county in the state with the highest incidence of the disease was São Luís, totaling almost half of the sample - 60 cases (44,78%). The mean age of patients was 61.3 (±16.6) years. The predominant histological type was squamous cell carcinoma (n = 86, 65.15%). The most frequent anatomic locations of MC were tongue (16.42%), oropharynx (14%) and parotid (14%) and type of treatment that was most often used was the surgical one (94.03%). Conclusion: The incidence and mortality by MC remained stable over the period from 2003 to 2005. Such cases continue to be represented mainly by squamous cell carcinoma in the tongue, with higher incidence among males and older ages' patients. It is a high incidence of malignant tumors in salivary glands in the population studied.Keywords: Mouth Neoplasms. Epidemiology. Incidence. Mortality

O USO DA VARIÁVEL COR/RAÇA NAS PESQUISAS DE SAÚDE: UMA REVISÃO DA LITERATURA / THE USE OF THE RACE/SKIN COLOR VARIABLE IN HEALTH RESEARCHES: A LITERATURE REVIEW

Introdução: Em todo o mundo, cresceu o número de pesquisas dedicadas a avaliar diferentes aspectos da questão racial na saúde. Contudo, permanecem limitações teóricas, práticas e metodológicas relacionadas ao uso da variável cor/raça nesses estudos. Objetivo: Descrever os principais desafios e limitações no uso da variável cor/raça nas pesquisas de saúde e sugerir possibilidades de seu uso. Métodos: Realizou-se uma revisão da literatura por meio das bases de dados Pubmed® e Scielo®. Resultados: Observou-se que de modo recorrente, os estudos sobre a relação entre cor/raça e saúde sugerem que há uma diversidade nos conceitos de cor, raça e etnia, no sistema de terminologia ou classificação racial, nos métodos de coleta da variável, no formato e emprego da questão. Conclusão: Entretanto, o significado da variável cor/raça e o que ela é capaz de medir, reduz ou mesmo dissipa a problemática da presença dessa variável nas análises de saúde-doença-cuidado, devendo-se estimular os pesquisadores a refletirem e investigarem as desigualdades raciais na saúde dos vários grupos populacionais.Palavras-chave: Cor/raça. Pesquisas de saúde. Desigualdades raciais.AbstractIntroduction: The number of studies conducted to evaluate different aspects related to race on health has increased worldwide. However, there are theoretical, practical and methodological limitations, especially related to the use of the race/skin color in these studies. Objective: This study aimed to describe the main challenges and limitations in the use of race/skin color variable in health researches and suggest possibilities for its use. Methods: We performed a literature review using the Pubmed® and Scielo® databases. Results: We observed recursively that studies about the relationship between race/skin color and health suggest that there is diversity among some issues. Among these, we notice diversity related to concepts of color, race and ethnicity in the system of racial classification/terminology, the methods of collection of variable, as well as in the format and employment of questions. Conclusion: However, the meaning of the skin color/race variable and what it is able to measure reduces or even dissipates the issue of the presence of this variable in the analyzes of health-illness care. These doubts should encourage researchers to investigate and reflect about the racial inequalities in health of several population groups.Keywords: Skin color/race. Health researches. Racial inequalities

DESIGUALDADES SOCIOECONÔMICAS, DEMOGRÁFICAS E EM SAÚDE NO NORDESTE BRASILEIRO / SOCIOECONOMIC, DEMOGRAPHIC AND HEALTH INEQUALITIES IN NORTHEAST REGION OF BRAZIL

Introdução: O Brasil é um país com enormes desigualdades socioeconômicas, demográficas e em saúde. Entre os municípios brasileiros a situação da desigualdade é ainda mais marcante, principalmente na região nordeste do país. Objetivo: Analisar as desigualdades socioeconômicas, demográficas e de saúde nas cidades do nordeste brasileiro que apresentam diferentes Índices de Desenvolvimento Humano (IDH) 2000. Métodos: Trata-se de um estudo ecológico com base em dados secundários disponíveis nos sites do Programa das Nações Unidas para o Desenvolvimento, Instituto Brasileiro de Geografia e Estatística e Ministério da Saúde, referentes aos municípios de maior (Salvador-BA), médio (João Alfredo-PE) e menor (Manari-PE) IDH. Resultados: Observou-se que o Produto Interno Bruto de Salvador (BA), foi três vezes o de Manari (PE). A incidência de pobreza foi elevada (>58%) nas duas cidades de pior IDH. O grau de urbanização e o índice de Gini decrescem em direção as cidades de pior IDH. Manari (PE), teve a maior dependência de serviços públicos de saúde. A oferta de médicos e enfermeiros foi abaixo dos parâmetros recomendados em todas as cidades. Conclusão: As desigualdades inter-regional são significativas e inaceitáveis, apontando a necessidade de melhoras nas condições de vida da população nordestina no início desse século.Palavras-chaves: Índice de Desenvolvimento Humano. Cidades. Desigualdades. Condições de vida e saúde. Ecologia.AbstractIntroduction: Brazil is a country with wide socioeconomic, demographic and health inequalities. Among the Brazilian municipalities, the situation of inequality is even more striking, especially in the northeast region. Objectives: To analyze the socioeconomic, demographic and health inequalities in cities from northeastern Brazil that have different Human Development Index (HDI) 2000. Methods: Ecological study based on secondary data available on the websites ofthe United Nations Development Programme, Brazilian Institute of Geography and Statistics and Ministry of Health relating to municipalities with higher (Salvador - BA), intermediate (João Alfredo/PE) and lower (Manari/PE) HDI. Results: We observed that the gross domestic product in Salvador/BA was three times higher than in Manari/PE. The incidence of poverty was high (>58%) in the two cities that had the worst HDI. The degree of urbanization and the Gini index decrease toward the cities with worst HDI. Manari/PE had the greatest dependence on public health services. The supply of physicians and nurses was below the recommended parameters in all cities. Conclusion: Interregional inequalities are significant and unacceptable and that points out to the need for improvement of living conditions in the populations of the Northeast region at this century beginning.Keywords: human development indexes. Cities. Inequalities. Health and social conditions. Ecology

Mouthwash use and oral cancer: a systematic review and meta-analysis

OBJECTIVE: This study aimed to investigate the effect of mouthwash use on the development of oral cancer. METHODS: Observational studies with adult/older adult populations that have examined the association between mouthwash use and oral cancer were included. Electronic search was performed in July 2022, with no time or language restrictions. PubMed/Medline, Embase, and Web of Science databases were used, and the search was extended to theses and dissertations libraries, Google Scholar, reference lists, and other sources. Methodological quality was assessed using the Newcastle-Ottawa Scale and quantitative data synthesis was performed by random effects meta-analysis, with different subgroup analyses and meta-regression. This revision was registered in Prospero (CRD42020143307). RESULTS: Of the 4,094 studies identified in the search, 15 case-control studies were included in the review, totaling 6,515 cases and 17,037 controls. The meta-analysis included 17 measures of effect from 15 case-control studies. The pooled OR was 1.00 (95%CI: 0.79–1.26, n = 17 studies), but it was 2.58 (95%CI: 1.38–4.82, n = 2 studies) among those who had used mouthwashes three times or more times a day, and 1.30 (95%CI: 1.10–1.54, n = 4 studies) among those who had used mouthwashes for more than 40 years. CONCLUSIONS: We f ound e vidence t hat a h igh f requency o f m outhwash u se m ay b e associated with an increased risk of oral cancer. However, despite the biological plausibility for this association, we suggest caution upon interpretation of our findings due to the few number of studies that have investigated the mouthwash use frequency, which should be considered. Therefore, we recommend that future studies assess, in detail, the frequency, duration, and content of mouthwashes to increase the strength of evidence for a possible dose-response effect of mouthwashes on oral cancer risk

Estrutura e processo de trabalho na atenção primária e internações por condições sensíveis

OBJETIVO Investigar se características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica estão associadas ao número de internações por condições sensíveis à atenção primária. MÉTODOS Neste estudo ecológico, foram analisados dados de municípios brasileiros relativos a características sociodemográficas, de cobertura de programas assistenciais, de estrutura das unidades básicas de saúde e processo de trabalho das equipes de atenção básica. Os dados foram obtidos do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica, do Departamento de Informática do Sistema Único de Saúde, do Instituto Brasileiro de Geografia e Estatística e do Programa das Nações Unidas. Estimaram-se as associações por meio de coeficientes de regressão binomial negativa (β) e respectivos intervalos de confiança a 95%, com abordagem hierarquizada em três blocos (alpha = 5%). RESULTADOS Na análise ajustada, para o desfecho em 2013, no bloco distal, a cobertura do Programa Bolsa Família (β = -0,001) e de plano privado (β = -0,01) apresentaram associação negativa; e o índice de desenvolvimento humano (β = 1,13), a proporção de pessoa idosa (β = 0,05) e de menor de cinco anos (β = 0,05) e a cobertura da Estratégia de Agentes Comunitários de Saúde (β = 0,002) mostraram associação positiva com internações por condições sensíveis à atenção primária. No bloco intermediário, apresentaram associação negativa o horário mínimo (β = -0,14) e a disponibilidade de vacina (β = -0,16); e associação positiva, a disponibilidade de medicamentos (β = 0,16). No bloco proximal, apenas a variável apoio matricial (β = 0,10) mostrou associação positiva. Na análise ajustada do número de internações por condições sensíveis à atenção primária em 2014, as variáveis apresentaram o mesmo sentido de associação de 2013. CONCLUSÕES Características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica impactam no número de internações por condições sensíveis à atenção primária nos municípios brasileiros.OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities

APINHAMENTO DENTÁRIO EM ESCOLARES DE 7 A 15 ANOS DE IDADE EM SÃO LUIS, MARANHÃO / DENTAL CROWDING IN STUDENTS FROM 7 TO 12 YEARS OF AGE IN SÃO LUÍS, MARANHÃO

Introdução: O Apinhamento Dentário (AD) é caracterizado como a discrepância entre o espaço requerido e o espaço presente no arco dentário. Estudos mostram que é o tipo de má oclusão mais presente no Brasil e no mundo. Além de proporcionar uma estética ruim, favorece o aparecimento de cárie edoenças na gengiva. Objetivo: Estimar a prevalência de AD em escolares de São Luís (MA), avaliando os fatores associados. Métodos: Estudo transversal, utilizando-se um questionário como instrumento para coleta de dados. Realizou-se documentação fotográfica padronizada nos escolares para avaliação da presença de AD. As tomadas fotográficas foram efetuadas por três examinadores previamente treinados, consistindo em fotos digitais intraorais e extraorais. Para as avaliações estatísticas, empregou-se o teste de qui-quadrado de Pearson, com nível de significância de 5%. Resultados: Dos 251 alunos avaliados, 53.25% apresentaram AD em pelo menos um dos arcos dentários, sendo mais prevalente no arco inferior (28.45%). Evidenciou-se que o AD foi mais comum entre estudantesna faixa etária de 12 a 15 anos, se comparados àqueles com idade de 6 a 11 anos (p=0,034). Para as demais variáveis, não foram observadas diferenças estatisticamente significantes na distribuição desta má oclusão. Conclusão: Conclui-se que a prevalência de AD nas dentaduras mista e permanente dos escolares examinados em São Luís (MA) foi alta, sendo mais comum no arco inferior e nas crianças/jovens entre 12 e 15 anos.Palavras-chave: Má oclusão. Prevalência. Dentição mista.AbstractIntroduction: Dental Crowding is characterized as the discrepancy between the space required and the space available in the dental arch. Studies have shown that dental crowding is the most prevalent malocclusion in Brazil and in the world. In addition to the unfavorable effect on esthetics, dental crowding favors the appearance of caries and periodontal diseases. Objective: The objective of this study was to estimate the prevalence of dental crowding in students from São Luís, MA, Brazil, by evaluating the factors associated to this condition. Methods: We developed a cross sectional study using a questionnaire as a tool for data collection. We used standardized photographic documentation in all students in order to assess the presence of dental crowding. The photos were taken by three previously trained examiners. These photos consisted of extraoral and intraoral digital photos. For statistical analysis, we used the Pearson's chi-square test, with a significance level of 5%. Results: Of the 251 students assessed, 53.25% had crowded teeth in at least one of the dental arches, being more prevalent in the lower arch (28.45%). It was noticed that dental crowding was more common among students from the age group of 12 to 15 years compared to those with 6 to 11 years (p = 0.034). For the other variables, we did not observe statistically significant differences in the distribution of this malocclusion. Conclusion: There is a high prevalence of dental crowding in mixed and permanent dentition of all the students that took part of this study, being more common on the lower arch and in kids/young people from 12 to 15 years of age.Keywords: Malocclusion. Prevalence. Mixed Dentition

Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

Objective: To analyze the impact of the COVID-19 pandemic on dentists’ income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists’ income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class

Desafios no cuidado de crianças nascidas de mães com diagnóstico de COVID-19 durante a pandemia

Objetivo: Compreender os desafios no cuidado de crianças nascidas de mães com COVID-19 durante a pandemia.Método: Pesquisa qualitativa, realizada de novembro de 2020 a maio de 2021, em duas maternidades públicas, com mulheres que tiveram filhos na primeira onda da pandemia, diagnosticadas com COVID-19, durante a gestação e/ou parto. Realizaram-se 19 entrevistas semiestruturadas com análise temática. Utilizou-se do Interacionismo Simbólico como referencial teórico.Resultados: Identificaram-se mudanças nos cuidados a crianças recém-nascidas. No ambiente doméstico, as medidas de higiene com o recém-nascido foram redobradas, o isolamento social restringiu a rede de apoio e as mães se sentiram sozinhas e sobrecarregadas. No âmbito assistencial, houve retrocesso no cuidado neonatal e interrupção de cuidados profissionais, como suspensão de consultas.Conclusão: A pandemia reestruturou os modelos tradicionais de cuidados familiares, intensificou as dificuldades de acesso à saúde e expôs as crianças a riscos inerentes à falta de acompanhamento.Descritores: COVID-19. Cuidado da criança. Relações mãe-filho. Saúde da criança

Are mental health problems and depression associated with bruxism in children?

Renner AC, da Silva AAM, Rodriguez JDM, Simoes VMF, Barbieri MA, Bettiol H, Thomaz EBAF, Saraiva MC. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2011. (C) 2011 John Wiley & Sons A/S Abstract Objectives: Previous studies have found an association between bruxism and emotional and behavioral problems in children, but reported data are inconsistent. The objective of this study was to estimate the prevalence of bruxism, and of its components clenching and grinding, and its associations with mental problems and depression. Methods: Data from two Brazilian birth cohorts were analyzed: one from 869 children in Ribeirao Preto RP (Sao Paulo), a more developed city, and the other from 805 children in Sao Luis SL (Maranhao). Current bruxism evaluated by means of a questionnaire applied to the parents/persons responsible for the children was defined when the habit of tooth clenching during daytime and/or tooth grinding at night still persisted until the time of the assessment. Additionally, the lifetime prevalence of clenching during daytime only and grinding at night only was also evaluated. Mental health problems were investigated using the Strength and Difficulties Questionnaire (SDQ) and depression using the Childrens Depression Inventory (CDI). Analyses were carried out for each city: with the SDQ subscales (emotional symptoms, conduct problems, peer problems, attention/hyperactivity disorder), with the total score (sum of the subscales), and with the CDI. These analyses were performed considering different response variables: bruxism, clenching only, and grinding only. The risks were estimated using a Poisson regression model. Statistical inferences were based on 95% confidence intervals (95% CI). Results: There was a high prevalence of current bruxism: 28.7% in RP and 30.0% in SL. The prevalence of clenching was 20.3% in RP and 18.8% in SL, and grinding was found in 35.7% of the children in RP and 39.1% in SL. Multivariable analysis showed a significant association of bruxism with emotional symptoms and total SDQ score in both cities. When analyzed separately, teeth clenching was associated with emotional symptoms, peer problems, and total SDQ score; grinding was significantly associated with emotional symptoms and total SDQ score in RP and SL. Female sex appeared as a protective factor for bruxism, and for clenching and grinding in RP. Furthermore, maternal employment outside the home and white skin color of children were associated with increased prevalence of teeth clenching in SL. Conclusions: Mental health problems were associated with bruxism, with teeth clenching only and grinding at night only. No association was detected between depression and bruxism, neither clenching nor grinding. But it is necessary to be cautious regarding the inferences from some of our results

Population-based seroprevalence of SARS-CoV-2 and the herd immunity threshold in Maranhão

OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon