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se hab&#237;an notificado un total de 509&#46;164 casos confirmados en todo el mundo<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46; En respuesta a su naturaleza altamente contagiosa y a la r&#225;pida transmisi&#243;n de persona a persona&#44; la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; declar&#243; oficialmente el brote de COVID-19 como pandemia el 11 de marzo de 2020<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Actualmente se est&#225;n investigando posibles vacunas y medicamentos antivirales espec&#237;ficos<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a>&#44; pero&#44; en espera de estos avances&#44; las medidas m&#225;s eficaces para prevenir y controlar el brote son el lavado frecuente de manos&#44; el distanciamiento social y la higiene respiratoria&#44; entre otras<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#46; Sin embargo&#44; debido a la r&#225;pida propagaci&#243;n de las infecciones&#44; las autoridades sanitarias de lugares como China&#44; Italia y Espa&#241;a han declarado un per&#237;odo de cuarentena para todas las poblaciones afectadas<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cuantificar la duraci&#243;n del per&#237;odo de incubaci&#243;n de la COVID-19&#44; es decir&#44; el tiempo que transcurre entre la exposici&#243;n al virus y la aparici&#243;n de los s&#237;ntomas cl&#237;nicos es una cuesti&#243;n de investigaci&#243;n fundamental&#44; ya que esta informaci&#243;n puede servir de base para las medidas de control de la salud p&#250;blica en relaci&#243;n con las enfermedades infecciosas&#44; incluida la duraci&#243;n adecuada del per&#237;odo de cuarentena<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En estudios recientes se han comunicado diversas estimaciones&#46; Uno de ellos&#44; basado en 10 casos confirmados en China&#44; inform&#243; de un per&#237;odo de incubaci&#243;n medio de 5&#44;2 d&#237;as &#40;intervalo de confianza &#91;IC&#93; del 95&#37;&#58; 4&#44;1 a 7&#44;0&#41; y un percentil 95 de la distribuci&#243;n de 12&#44;5 d&#237;as &#40;IC 95&#37;&#58; 9&#44;2 a 18&#44;0&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a>&#46; El per&#237;odo de incubaci&#243;n medio en 88 viajeros procedentes de Wuhan fue de 6&#44;5 d&#237;as &#40;IC 95&#37;&#58; 5&#44;6 a 7&#44;9&#41;&#44; mientras que el percentil 95 fue de 11&#44;3 d&#237;as &#40;IC 95&#37;&#58; 9&#44;1 a 15&#44;7&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> analizaron los datos disponibles p&#250;blicamente para 181 casos confirmados de China&#44; estimando una mediana del per&#237;odo de incubaci&#243;n de 5&#44;1 d&#237;as &#40;IC 95&#37;&#58; 4&#44;5 a 5&#44;8&#41; y un percentil 97&#44;5 de la distribuci&#243;n de 11&#44;5 d&#237;as &#40;IC 95&#37;&#58; 8&#44;2 a 15&#44;6&#41;&#46; El percentil 95 del per&#237;odo de incubaci&#243;n puede indicar cu&#225;ntos d&#237;as es necesario extender el per&#237;odo de cuarentena para asegurar la ausencia de enfermedad entre los individuos expuestos sanos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Varios de estos primeros informes consideran el per&#237;odo de incubaci&#243;n como una variable sim&#233;trica y estiman la media a trav&#233;s del punto medio&#59; sin embargo&#44; esto lleva a una sobreestimaci&#243;n de la distribuci&#243;n del per&#237;odo de incubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#46; El per&#237;odo de incubaci&#243;n se puede estimar por distribuciones param&#233;tricas tales como las distribuciones Gamma&#44; Weibull o LogNormal<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hasta el momento&#44; la OMS asume que el per&#237;odo de incubaci&#243;n de la COVID-19 se sit&#250;a entre 1 y 14 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a>&#44; y el Centro Europeo para la Prevenci&#243;n y el Control de las Enfermedades &#40;ECDC&#41; considera que el per&#237;odo medio es de 5&#44;1 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a>&#46; Se ha realizado una revisi&#243;n sistem&#225;tica de los estudios de investigaci&#243;n publicados con el fin de proporcionar una estimaci&#243;n m&#225;s precisa del per&#237;odo de incubaci&#243;n de la COVID-19&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">La revisi&#243;n sistem&#225;tica y el metaan&#225;lisis se han realizado de acuerdo con los &#237;tems de referencia para publicar Protocolos de Revisiones Sistem&#225;ticas y Metaan&#225;lisis&#58; Declaraci&#243;n PRISMA-P 2015<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Estrategia de b&#250;squeda y criterios de selecci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se llev&#243; a cabo una b&#250;squeda bibliogr&#225;fica en las bases de datos de PubMed&#44; Scopus&#47;EMBASE y la Biblioteca Cochrane&#44; con todos los documentos publicados desde el 1 de enero de 2020 hasta el 21 de marzo de 2020&#44; sin restricciones de idioma&#46; Se utiliz&#243; la siguiente estrategia de b&#250;squeda&#44; combinando todos los t&#233;rminos de inter&#233;s&#58; &#40;coronavirus &#91;Title&#47;Abstract&#93; OR COVID-19 &#91;Title&#47;Abstract&#93; OR SARS-CoV-2 &#91;Title&#47;Abstract&#93;&#41; AND incubation &#91;Title&#47;Abstract&#93; AND period &#91;Title&#47;Abstract&#93;&#46; Adem&#225;s&#44; se busc&#243; literatura gris &#40;informes gubernamentales e institucionales o estudios in&#233;ditos&#41; utilizando el motor de b&#250;squeda de Google&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se incluyeron estudios observacionales y experimentales que informan del per&#237;odo de incubaci&#243;n de la COVID-19&#46; Los estudios elegibles ten&#237;an que informar sobre el per&#237;odo de incubaci&#243;n medio de la COVID-19&#46; Se excluyeron los estudios que duplicaban otras publicaciones&#44; revisiones&#44; editoriales o cartas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el proceso de selecci&#243;n&#44; dos autores de la revisi&#243;n evaluaron de forma independiente todos los documentos obtenidos mediante la estrategia de b&#250;squeda&#46; Tras examinar los t&#237;tulos y res&#250;menes para eliminar los estudios no relacionados&#44; se recuper&#243; el texto completo de todos los registros restantes y se comprobaron en funci&#243;n de los criterios de elegibilidad&#46; Se resolvieron los desacuerdos mediante el debate y se consult&#243; a un tercer autor de la revisi&#243;n cuando fue necesario&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis de los datos</span><p id="par0065" class="elsevierStylePara elsevierViewall">De cada estudio se recogi&#243; la siguiente informaci&#243;n&#58; primer autor&#44; fecha de publicaci&#243;n&#44; origen de los datos&#44; tama&#241;o de la muestra&#44; edad media y rango de edad&#44; porcentaje de hombres en la muestra&#44; el modelo estad&#237;stico utilizado&#44; per&#237;odo medio de incubaci&#243;n con su IC del 95&#37;&#44; desviaci&#243;n est&#225;ndar &#40;DE&#41; y rango intercuart&#237;lico &#40;IQR&#41;&#44; y percentil 95 con su IC del 95&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dado que la COVID-19 se identific&#243; por primera vez en diciembre de 2019&#44; y ante la actual pandemia que azota al mundo no existen todav&#237;a estudios experimentales sobre el per&#237;odo de incubaci&#243;n&#44; muchos de los estudios de investigaci&#243;n existentes tienen por objeto proporcionar informaci&#243;n sobre el proceso del brote&#46; As&#237; pues&#44; no se ha evaluado la calidad del estudio en general&#44; sino que se ha realizado una evaluaci&#243;n de la calidad de los datos comunicados utilizando una versi&#243;n adaptada de los criterios utilizados por Awofisayo-Okuyelu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Los estudios individuales incluidos en el presente metaan&#225;lisis se han puntuado con arreglo a la siguiente lista de comprobaci&#243;n&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Fuente de los datos&#58; Los datos comunicados se basan en informes m&#233;dicos confirmados &#40;un punto&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Exposici&#243;n&#58; La exposici&#243;n est&#225; claramente definida &#40;un punto&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Diagn&#243;stico&#58; Todos los casos han sido confirmados microbiol&#243;gicamente &#40;un punto&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Precisi&#243;n de la medici&#243;n&#58; El tiempo de exposici&#243;n est&#225; claramente definido &#40;un punto&#41;&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n m&#225;xima de calidad fue de cuatro puntos&#46; Los estudios se clasificaron en calidad baja &#40;uno o dos puntos&#41; o alta &#40;tres o cuatro puntos&#41;&#44; seg&#250;n la puntuaci&#243;n&#44; y los estudios cuya puntuaci&#243;n fue de un punto se excluyeron del metaan&#225;lisis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un metaan&#225;lisis de los datos para la media y el percentil 95 del per&#237;odo de incubaci&#243;n&#44; aplicando un modelo de efectos aleatorios y evaluando la variabilidad entre-estudio mediante el Tau<span class="elsevierStyleSup">2</span> y la heterogeneidad mediante el test Q de Dixon y el estad&#237;stico I<span class="elsevierStyleSup">2</span> de Higgin<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; En los casos en que no se dispon&#237;a de la DE&#44; esta se estim&#243; utilizando el IC del 95&#37; despu&#233;s de obtener los registros&#44; de acuerdo con la f&#243;rmula&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0110" class="elsevierStylePara elsevierViewall">Donde T<span class="elsevierStyleInf">&#40;0&#44;975&#44; n-1&#41;</span> es el valor de la distribuci&#243;n <span class="elsevierStyleItalic">t</span> de Student&#44; con una probabilidad de colas del 97&#44;5&#37; y n-1 el grado de libertad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#46; La escala original se restaur&#243; usando la funci&#243;n exponencial&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La heterogeneidad se evalu&#243; mediante un an&#225;lisis de las siguientes variables moderadoras&#58; fecha de publicaci&#243;n&#44; modelo de distribuci&#243;n&#44; edad media&#44; rango de edad&#44; porcentaje de hombres y calidad del estudio&#46; Se excluyeron del metaan&#225;lisis los estudios en los que faltaban datos de algunas de las variables moderadoras&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados del metaan&#225;lisis se muestran como <span class="elsevierStyleItalic">forest plot</span>&#44; mostrando el primer autor&#44; la fecha de publicaci&#243;n&#44; el tama&#241;o de la muestra&#44; el tipo de modelo de distribuci&#243;n&#44; los efectos individuales con el IC del 95&#37;&#44; y el efecto global con el IC del 95&#37;&#46; Las notas a pie de p&#225;gina del diagrama muestran los resultados del test Q&#44; sus grados de libertad y el valor p asociado al estad&#237;stico I<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Finalmente&#44; evaluamos el sesgo de publicaci&#243;n visualmente por medio de un <span class="elsevierStyleItalic">funnel plot</span>&#46; Los an&#225;lisis se realizaron mediante la librer&#237;a metafor del paquete estad&#237;stico R&#44; v&#46;4&#46;0&#46;2&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0130" class="elsevierStylePara elsevierViewall">La b&#250;squeda proporcion&#243; 40 registros &#250;nicos&#46; Despu&#233;s de revisar los t&#237;tulos y res&#250;menes&#44; se examinaron los textos completos de 27 art&#237;culos&#58; 13 se excluyeron porque no informaban sobre el per&#237;odo medio de incubaci&#243;n o eran estudios bibliogr&#225;ficos&#46; Finalmente se incluyeron 14 estudios en la revisi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;8&#8211;10&#44;18&#8211;27</span></a>&#58; solo siete de ellos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#8211;10&#44;18&#8211;21</span></a> eran susceptibles de ser sometidos a un metaan&#225;lisis&#44; ya que el resto no proporcionaba ni el IC del 95&#37; ni la DE del per&#237;odo de incubaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; o faltaban algunas de las variables moderadoras&#46; Solo seis de ellos fueron incluidos en el metaan&#225;lisis del percentil 95 de la distribuci&#243;n del per&#237;odo de incubaci&#243;n&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las caracter&#237;sticas de los estudios incluidos&#46; En Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> se determina el per&#237;odo de incubaci&#243;n en dos muestras diferentes&#44; por lo que se incluyeron sus resultados en el metaan&#225;lisis&#44; como si provinieran de dos estudios separados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">El primer estudio se public&#243; el 29 de enero de 2020 y el &#250;ltimo el 18 de marzo de 2020&#46; Todos los datos recogidos proced&#237;an de las provincias chinas afectadas por COVID-19&#44; excepto los comunicados en Backer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&#44; que analizaron a viajeros provenientes de Wuhan&#44; y en el estudio de Ki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#44; realizado en Corea del Sur&#46; El estudio de Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> obtuvo la mejor puntuaci&#243;n de calidad &#40;cuatro puntos&#41;&#44; y el estudio de Leung<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> obtuvo la peor puntuaci&#243;n &#40;un punto&#41; y fue excluido del metaan&#225;lisis&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La edad media de las personas infectadas oscilaba entre los 35 y los 59 a&#241;os&#44; con una mayor incidencia en los hombres que en las mujeres&#44; en la mayor&#237;a de los estudios&#46; De los estudios que presentaron datos para la DE o el IC del 95&#37;&#44; el per&#237;odo medio de incubaci&#243;n m&#225;s corto que se comunic&#243; fue de 4&#44;9 d&#237;as &#40;Jiang et al&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#44; mientras que el m&#225;s largo fue de 7&#44;2 d&#237;as &#40;Leung&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#46; El percentil 95 para el per&#237;odo de incubaci&#243;n variaba entre 10&#44;6 d&#237;as y 14&#44;6 d&#237;as&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El tama&#241;o total de la muestra para el metaan&#225;lisis del per&#237;odo de incubaci&#243;n medio fue de 792 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#58; en el lado izquierdo&#41;&#46; La estimaci&#243;n conjunta del per&#237;odo medio de incubaci&#243;n fue de 5&#44;6 d&#237;as &#40;IC del 95&#37;&#58; 5&#44;1 a 6&#44;1&#41;&#46; El valor m&#225;s bajo notificado por los estudios incluidos fue de 5&#44;0 d&#237;as &#40;Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> y Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#41; y el m&#225;s alto de 6&#44;7 d&#237;as &#40;Tian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#41;&#46; Se observa una considerable heterogeneidad entre estudios &#40;I<span class="elsevierStyleSup">2</span> 83&#44;0&#37;&#44; p &#60; 0&#44;001&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Se analizaron las variables moderadoras para identificar y eliminar la heterogeneidad observada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La inclusi&#243;n del modelo estad&#237;stico de distribuci&#243;n y la calidad como variables moderadoras condujo a una reducci&#243;n significativa de la heterogeneidad &#40;I<span class="elsevierStyleSup">2</span>&#41;&#44; pasando del 83&#37; al 15&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">En la parte derecha de la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se muestra la estimaci&#243;n global del per&#237;odo medio de incubaci&#243;n&#44; seg&#250;n la calidad del estudio y el modelo estad&#237;stico utilizado&#46; Los estudios de baja calidad proporcionan estimaciones m&#225;s bajas del per&#237;odo medio de incubaci&#243;n&#44; que oscilan entre 4&#44;9 y 6&#44;0 d&#237;as&#46; Los estudios de alta calidad proporcionan estimaciones de 5&#44;6&#44; 6&#44;1 y 6&#44;7 d&#237;as&#44; seg&#250;n los modelos LogNormal&#44; Gamma y Desconocido&#44; respectivamente&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Un total de 489 personas aportaron datos para el an&#225;lisis del percentil 95 de la distribuci&#243;n del per&#237;odo de incubaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#58; en el lado izquierdo&#41;&#46; La estimaci&#243;n conjunta mostr&#243; 11&#44;2 d&#237;as &#40;IC del 95&#37;&#58; 10&#44;7 a 11&#44;8&#41;&#46; La estimaci&#243;n m&#225;s baja&#44; de 10&#44;6 d&#237;as&#44; fue presentada por Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; y la m&#225;s alta&#44; de 12&#44;5 d&#237;as&#44; por Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> Se observa una considerable heterogeneidad &#40;I<span class="elsevierStyleSup">2</span>&#58; 61&#44;7&#37;&#44; p &#61; 0&#44;02&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Tambi&#233;n se realiz&#243; un an&#225;lisis de las variables moderadoras&#44; incluyendo la edad media en el modelo y se elimin&#243; la heterogeneidad observada&#44; pasando del 61&#44;7 al 0&#44;0&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; El percentil global 95 del per&#237;odo de incubaci&#243;n variaba&#44; seg&#250;n la edad de los pacientes&#58; 10&#44;5&#44; 11&#44;5 y 12&#44;5 d&#237;as para 40&#44; 50 y 60 a&#241;os&#44; respectivamente&#46; As&#237; pues&#44; el percentil 95 aumenta un d&#237;a de media cuando la edad aumenta 10 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#58; en el lado derecho&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Debate</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los resultados del presente estudio muestran que el per&#237;odo medio de incubaci&#243;n de la COVID-19 es de 5&#44;6 d&#237;as &#40;IC del 95&#37;&#58; 5&#44;1 a 6&#44;1&#41; y puede variar seg&#250;n el modelo utilizado para su estimaci&#243;n y la calidad del estudio&#46; El percentil 95 de su distribuci&#243;n es de unos 11&#44;2 d&#237;as &#40;10&#44;7 a 11&#44;8&#41;&#44; y var&#237;a seg&#250;n la edad media de los pacientes&#44; aumentando un d&#237;a cada 10 a&#241;os&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">La OMS opera bajo el supuesto de que el per&#237;odo de incubaci&#243;n es de uno a 14 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a>&#44; mientras que el ECDC<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> utiliz&#243; la estimaci&#243;n de Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> y Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> de un per&#237;odo medio de 5&#44;1 d&#237;as en un informe t&#233;cnico publicado el 23 de marzo de 2020&#46; En la presente revisi&#243;n sistem&#225;tica y metaan&#225;lisis&#44; se han tenido en cuenta todos los datos publicados hasta la fecha&#44; lo que da lugar a una estimaci&#243;n de 5&#44;6 d&#237;as&#44; o un 9&#44;8&#37; mayor que la estimaci&#243;n utilizada por las autoridades europeas&#46; Aunque la magnitud de la diferencia no es grande&#44; podr&#237;a afectar a la modelizaci&#243;n predictiva de las curvas de incidencia que est&#225;n construyendo los diferentes equipos de investigadores epidemiol&#243;gicos<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En informes recientes se ha sugerido que tanto la incidencia como la severidad de las infecciones por COVID-19 difieren seg&#250;n el sexo&#44; especialmente entre los grupos de edad<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;20&#44;23</span></a>&#46; Asimismo&#44; estos hallazgos plantean la posibilidad de que la distribuci&#243;n del per&#237;odo de incubaci&#243;n tambi&#233;n podr&#237;a depender en cierta medida del sexo y la edad&#46; No se pudo evaluar esta posibilidad en la presente revisi&#243;n&#44; ya que los estudios no desglosaban sus datos seg&#250;n el sexo de los pacientes&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La presente revisi&#243;n s&#237; ha mostrado que el per&#237;odo medio de incubaci&#243;n estimado puede variar dependiendo del modelo param&#233;trico utilizado y de la calidad del estudio&#44; como se evidencia en el an&#225;lisis de las variables moderadoras &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Este fen&#243;meno debe interpretarse con cautela&#44; ya que podr&#237;a haber variables sociodemogr&#225;ficas y cl&#237;nicas no cuantificadas o heterogeneidad en la calidad de las fuentes de datos que podr&#237;an explicar estas diferencias&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En cuanto al percentil 95 de la distribuci&#243;n del per&#237;odo de incubaci&#243;n&#44; los resultados de esta revisi&#243;n muestran que este es de unos 11&#44;2 d&#237;as &#40;IC 95&#37;&#58; 10&#44;7 a 11&#44;8&#41;&#44; un d&#237;a m&#225;s que la estimaci&#243;n de Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; similar a los resultados de Backer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> de 11&#44;3 d&#237;as y los de Lauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&#44; que estiman 11&#44;5 d&#237;as con un percentil 97&#44;5&#46; Cuando se incluye la edad media de los pacientes como variable moderadora&#44; el percentil 95 aumenta un d&#237;a cuando la edad media aumenta 10 a&#241;os&#46; Por lo tanto&#44; el per&#237;odo de incubaci&#243;n depende de la edad del paciente&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">El percentil 95 del per&#237;odo de incubaci&#243;n es un factor importante para establecer la duraci&#243;n correcta de la cuarentena<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#44; especialmente para los profesionales de la salud durante esta emergencia sanitaria mundial&#46; Los resultados del metaan&#225;lisis muestran el l&#237;mite superior del IC del 95&#37; a los 13&#44;6 d&#237;as para la estimaci&#243;n del percentil 95&#44; cuando la edad media de los pacientes es de 60 a&#241;os&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">La estimaci&#243;n del per&#237;odo de incubaci&#243;n conlleva la dificultad inherente de establecer el momento exacto de la exposici&#243;n al virus entre los pacientes estudiados&#46; La principal limitaci&#243;n de este estudio ha sido la fiabilidad de las fuentes de datos y la heterogeneidad de los momentos de exposici&#243;n estimados por los estudios incluidos&#46; Para hacer frente a esta limitaci&#243;n&#44; se evalu&#243; la calidad de los datos comunicados&#44; excluyendo los estudios de baja calidad&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">El posible sesgo de publicaci&#243;n observado en los <span class="elsevierStyleItalic">funnel plots</span> &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Figura suplementaria S1 y Figura S2</a>&#46; Ver Anexo&#46; Material Adicional&#41; podr&#237;a ser otra limitaci&#243;n&#46; Sin embargo&#44; se han incluido todos los estudios publicados que cumpl&#237;an los criterios de elegibilidad porque se consider&#243; que este sesgo no es aplicable a este tipo de estudios descriptivos sin comparaci&#243;n de grupos&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n del presente metaan&#225;lisis ha sido que los datos proced&#237;an de pacientes con s&#237;ntomas&#46; Sin embargo&#44; Mizumoto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> estiman que el 17&#44;9&#37; de los casos son asintom&#225;ticos y&#44; por lo tanto&#44; nuestros hallazgos no pueden ser extrapolados a esta poblaci&#243;n&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusi&#243;n</span><p id="par0220" class="elsevierStylePara elsevierViewall">El tiempo medio desde la exposici&#243;n a la COVID-19 y la aparici&#243;n de los primeros s&#237;ntomas var&#237;a entre 5&#44;6 y 6&#44;7 d&#237;as&#44; seg&#250;n el modelo estad&#237;stico utilizado&#44; incluyendo estudios de alta calidad&#46; El percentil 95 del per&#237;odo de incubaci&#243;n var&#237;a de acuerdo con la edad media de los pacientes&#44; aumentando un d&#237;a cuando la edad media aumenta 10 a&#241;os&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Tanto los modelos predictivos de las curvas de incidencia como los per&#237;odos de cuarentena prescritos deben tener en cuenta estas cifras&#46; Es aconsejable recopilar datos sobre la edad y el sexo al calcular el per&#237;odo de incubaci&#243;n para analizar las posibles diferencias en los patrones epidemiol&#243;gicos basados en estas variables&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0230" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El per&#237;odo de incubaci&#243;n de la COVID-19 ayuda a determinar la duraci&#243;n &#243;ptima del per&#237;odo de cuarentena y a crear modelos predictivos de curvas de incidencia&#46; Se han reportado resultados variables en recientes estudios y&#44; por ello&#44; el objetivo de esta revisi&#243;n sistem&#225;tica es proporcionar una estimaci&#243;n m&#225;s precisa del per&#237;odo de incubaci&#243;n de la COVID-19&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda bibliogr&#225;fica en las bases de datos de Pubmed&#44; Scopus&#47;EMBASE y la Cochrane Library&#44; incluyendo todos los estudios observacionales y experimentales que reportaban un per&#237;odo de incubaci&#243;n y que se hab&#237;an publicado entre el 1 de enero y el 21 de marzo de 2020&#46; Se estim&#243; la media y el percentil 95 del per&#237;odo de incubaci&#243;n mediante metaan&#225;lisis&#44; teniendo en cuenta la heterogeneidad entre los estudios y el an&#225;lisis con variables moderadoras&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron siete estudios &#40;n &#61; 792&#41; en el metaan&#225;lisis&#46; La heterogeneidad &#40;I<span class="elsevierStyleSup">2</span> 83&#44;0&#37;&#44; p &#60; 0&#44;001&#41; disminuy&#243; significativamente cuando se tuvo en cuenta la calidad del estudio y el modelo estad&#237;stico utilizado como variables moderadoras &#40;I<span class="elsevierStyleSup">2</span> 15&#37;&#41;&#46; El per&#237;odo medio de incubaci&#243;n oscilaba entre 5&#44;6 &#40;IC 95&#37;&#58; 5&#44;2 a 6&#44;0&#41; y 6&#44;7 d&#237;as &#40;IC 95&#37;&#58; 6&#44;0 a 7&#44;4&#41;&#44; seg&#250;n el modelo estad&#237;stico utilizado&#46; El percentil 95 fue de 12&#44;5 d&#237;as cuando la edad media de los pacientes era de 60 a&#241;os&#44; aumentando un d&#237;a por cada 10 a&#241;os de edad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Seg&#250;n los datos publicados sobre el per&#237;odo de incubaci&#243;n de la COVID-19&#44; el tiempo medio entre la exposici&#243;n y la aparici&#243;n de los s&#237;ntomas cl&#237;nicos depende del modelo estad&#237;stico utilizado y el percentil 95&#44; de la edad media de los pacientes&#46; Se recomienda registrar el sexo y la edad en la recogida de los datos para poder analizar los posibles patrones diferenciales&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The incubation period of COVID-19 helps to determine the optimal duration of the quarantine and inform predictive models of incidence curves&#46; Several emerging studies have produced varying results&#59; this systematic review aims to provide a more accurate estimate of the incubation period of COVID-19&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">For this systematic review&#44; a literature search was conducted using Pubmed&#44; Scopus&#47;EMBASE&#44; and the Cochrane Library databases&#44; covering all observational and experimental studies reporting the incubation period and published from 1 January 2020 to 21 March 2020&#46;We estimated the mean and 95th percentile of the incubation period using meta-analysis&#44; taking into account between-study heterogeneity&#44; and the analysis with moderator variables&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We included seven studies &#40;n &#61; 792&#41; in the meta-analysis&#46; The heterogeneity &#40;I<span class="elsevierStyleSup">2</span> 83&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span> &#60; 0&#46;001&#41; was significantly decreased when we included the study quality and the statistical model used as moderator variables &#40;I<span class="elsevierStyleSup">2</span> 15&#37;&#41;&#46; The mean incubation period ranged from 5&#46;6 &#40;95&#37; <span class="elsevierStyleSmallCaps">C</span>I&#58; 5&#46;2 to 6&#46;0&#41; to 6&#46;7 days &#40;95&#37; CI&#58; 6&#46;0 to 7&#46;4&#41; according to the statistical model&#46; The 95<span class="elsevierStyleSup">th</span> percentile was 12&#46;5 days when the mean age of patients was 60 years&#44; increasing 1 day for every 10 years&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Based on the published data reporting the incubation period of COVID-19&#44; the mean time between exposure and onset of clinical symptoms depended on the statistical model used&#44; and the 95th percentile depended on the mean age of the patients&#46; It is advisable to record sex and age when collecting data in order to analyze possible differential patterns&#46;</p></span>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Origen de los datos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Modelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#37; hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo de incubaci&#243;n</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil 95</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IQR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 ene 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;15-89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;4&#44;1&#59; 7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;9&#44;2&#59; 18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Backer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viajeros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gamma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2-72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#44;6&#59; 7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;9&#44;1&#59; 15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;30-59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;4&#44;2&#59; 6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;8&#44;5&#59; 14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;9&#44;3&#59; 12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 feb 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 mar 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 Baja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Gamma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;3&#59; 5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 mar 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">181&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;2-80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;5&#59; 5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">11&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;8&#44;2&#59; 15&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jiang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2 Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;4&#59; 5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leung<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 mar 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Qian el al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Guan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Corea del Sur&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 mar 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4-10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 mar 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;10-76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;5&#44;2294&#59; 5&#44;9505&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Gamma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;3431&#59; 1&#44;8770&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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Período de incubación de la COVID-19: revisión sistemática y metaanálisis
Incubation period of COVID-19: A systematic review and meta-analysis
J.A. Quesadaa, A. López-Pinedaa,
Autor para correspondencia
adriannalp@hotmail.com

Autor para correspondencia.
, V.F. Gil-Guilléna, J.M. Arriero-Marínb, F. Gutiérreza,c, C. Carratala-Munueraa
a Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
b Departamento de Neumología, Universidad Hospital de San Juan de Alicante, San Juan de Alicante, España
c Departamento de Enfermedades Infecciosas, Universidad Hospital de Elche, Elche, España
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Uno de ellos&#44; basado en 10 casos confirmados en China&#44; inform&#243; de un per&#237;odo de incubaci&#243;n medio de 5&#44;2 d&#237;as &#40;intervalo de confianza &#91;IC&#93; del 95&#37;&#58; 4&#44;1 a 7&#44;0&#41; y un percentil 95 de la distribuci&#243;n de 12&#44;5 d&#237;as &#40;IC 95&#37;&#58; 9&#44;2 a 18&#44;0&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a>&#46; El per&#237;odo de incubaci&#243;n medio en 88 viajeros procedentes de Wuhan fue de 6&#44;5 d&#237;as &#40;IC 95&#37;&#58; 5&#44;6 a 7&#44;9&#41;&#44; mientras que el percentil 95 fue de 11&#44;3 d&#237;as &#40;IC 95&#37;&#58; 9&#44;1 a 15&#44;7&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> analizaron los datos disponibles p&#250;blicamente para 181 casos confirmados de China&#44; estimando una mediana del per&#237;odo de incubaci&#243;n de 5&#44;1 d&#237;as &#40;IC 95&#37;&#58; 4&#44;5 a 5&#44;8&#41; y un percentil 97&#44;5 de la distribuci&#243;n de 11&#44;5 d&#237;as &#40;IC 95&#37;&#58; 8&#44;2 a 15&#44;6&#41;&#46; El percentil 95 del per&#237;odo de incubaci&#243;n puede indicar cu&#225;ntos d&#237;as es necesario extender el per&#237;odo de cuarentena para asegurar la ausencia de enfermedad entre los individuos expuestos sanos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Varios de estos primeros informes consideran el per&#237;odo de incubaci&#243;n como una variable sim&#233;trica y estiman la media a trav&#233;s del punto medio&#59; sin embargo&#44; esto lleva a una sobreestimaci&#243;n de la distribuci&#243;n del per&#237;odo de incubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#46; El per&#237;odo de incubaci&#243;n se puede estimar por distribuciones param&#233;tricas tales como las distribuciones Gamma&#44; Weibull o LogNormal<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hasta el momento&#44; la OMS asume que el per&#237;odo de incubaci&#243;n de la COVID-19 se sit&#250;a entre 1 y 14 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a>&#44; y el Centro Europeo para la Prevenci&#243;n y el Control de las Enfermedades &#40;ECDC&#41; considera que el per&#237;odo medio es de 5&#44;1 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a>&#46; Se ha realizado una revisi&#243;n sistem&#225;tica de los estudios de investigaci&#243;n publicados con el fin de proporcionar una estimaci&#243;n m&#225;s precisa del per&#237;odo de incubaci&#243;n de la COVID-19&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">La revisi&#243;n sistem&#225;tica y el metaan&#225;lisis se han realizado de acuerdo con los &#237;tems de referencia para publicar Protocolos de Revisiones Sistem&#225;ticas y Metaan&#225;lisis&#58; Declaraci&#243;n PRISMA-P 2015<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Estrategia de b&#250;squeda y criterios de selecci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se llev&#243; a cabo una b&#250;squeda bibliogr&#225;fica en las bases de datos de PubMed&#44; Scopus&#47;EMBASE y la Biblioteca Cochrane&#44; con todos los documentos publicados desde el 1 de enero de 2020 hasta el 21 de marzo de 2020&#44; sin restricciones de idioma&#46; Se utiliz&#243; la siguiente estrategia de b&#250;squeda&#44; combinando todos los t&#233;rminos de inter&#233;s&#58; &#40;coronavirus &#91;Title&#47;Abstract&#93; OR COVID-19 &#91;Title&#47;Abstract&#93; OR SARS-CoV-2 &#91;Title&#47;Abstract&#93;&#41; AND incubation &#91;Title&#47;Abstract&#93; AND period &#91;Title&#47;Abstract&#93;&#46; Adem&#225;s&#44; se busc&#243; literatura gris &#40;informes gubernamentales e institucionales o estudios in&#233;ditos&#41; utilizando el motor de b&#250;squeda de Google&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se incluyeron estudios observacionales y experimentales que informan del per&#237;odo de incubaci&#243;n de la COVID-19&#46; Los estudios elegibles ten&#237;an que informar sobre el per&#237;odo de incubaci&#243;n medio de la COVID-19&#46; Se excluyeron los estudios que duplicaban otras publicaciones&#44; revisiones&#44; editoriales o cartas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el proceso de selecci&#243;n&#44; dos autores de la revisi&#243;n evaluaron de forma independiente todos los documentos obtenidos mediante la estrategia de b&#250;squeda&#46; Tras examinar los t&#237;tulos y res&#250;menes para eliminar los estudios no relacionados&#44; se recuper&#243; el texto completo de todos los registros restantes y se comprobaron en funci&#243;n de los criterios de elegibilidad&#46; Se resolvieron los desacuerdos mediante el debate y se consult&#243; a un tercer autor de la revisi&#243;n cuando fue necesario&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis de los datos</span><p id="par0065" class="elsevierStylePara elsevierViewall">De cada estudio se recogi&#243; la siguiente informaci&#243;n&#58; primer autor&#44; fecha de publicaci&#243;n&#44; origen de los datos&#44; tama&#241;o de la muestra&#44; edad media y rango de edad&#44; porcentaje de hombres en la muestra&#44; el modelo estad&#237;stico utilizado&#44; per&#237;odo medio de incubaci&#243;n con su IC del 95&#37;&#44; desviaci&#243;n est&#225;ndar &#40;DE&#41; y rango intercuart&#237;lico &#40;IQR&#41;&#44; y percentil 95 con su IC del 95&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dado que la COVID-19 se identific&#243; por primera vez en diciembre de 2019&#44; y ante la actual pandemia que azota al mundo no existen todav&#237;a estudios experimentales sobre el per&#237;odo de incubaci&#243;n&#44; muchos de los estudios de investigaci&#243;n existentes tienen por objeto proporcionar informaci&#243;n sobre el proceso del brote&#46; As&#237; pues&#44; no se ha evaluado la calidad del estudio en general&#44; sino que se ha realizado una evaluaci&#243;n de la calidad de los datos comunicados utilizando una versi&#243;n adaptada de los criterios utilizados por Awofisayo-Okuyelu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Los estudios individuales incluidos en el presente metaan&#225;lisis se han puntuado con arreglo a la siguiente lista de comprobaci&#243;n&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Fuente de los datos&#58; Los datos comunicados se basan en informes m&#233;dicos confirmados &#40;un punto&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Exposici&#243;n&#58; La exposici&#243;n est&#225; claramente definida &#40;un punto&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Diagn&#243;stico&#58; Todos los casos han sido confirmados microbiol&#243;gicamente &#40;un punto&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Precisi&#243;n de la medici&#243;n&#58; El tiempo de exposici&#243;n est&#225; claramente definido &#40;un punto&#41;&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n m&#225;xima de calidad fue de cuatro puntos&#46; Los estudios se clasificaron en calidad baja &#40;uno o dos puntos&#41; o alta &#40;tres o cuatro puntos&#41;&#44; seg&#250;n la puntuaci&#243;n&#44; y los estudios cuya puntuaci&#243;n fue de un punto se excluyeron del metaan&#225;lisis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un metaan&#225;lisis de los datos para la media y el percentil 95 del per&#237;odo de incubaci&#243;n&#44; aplicando un modelo de efectos aleatorios y evaluando la variabilidad entre-estudio mediante el Tau<span class="elsevierStyleSup">2</span> y la heterogeneidad mediante el test Q de Dixon y el estad&#237;stico I<span class="elsevierStyleSup">2</span> de Higgin<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; En los casos en que no se dispon&#237;a de la DE&#44; esta se estim&#243; utilizando el IC del 95&#37; despu&#233;s de obtener los registros&#44; de acuerdo con la f&#243;rmula&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0110" class="elsevierStylePara elsevierViewall">Donde T<span class="elsevierStyleInf">&#40;0&#44;975&#44; n-1&#41;</span> es el valor de la distribuci&#243;n <span class="elsevierStyleItalic">t</span> de Student&#44; con una probabilidad de colas del 97&#44;5&#37; y n-1 el grado de libertad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#46; La escala original se restaur&#243; usando la funci&#243;n exponencial&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La heterogeneidad se evalu&#243; mediante un an&#225;lisis de las siguientes variables moderadoras&#58; fecha de publicaci&#243;n&#44; modelo de distribuci&#243;n&#44; edad media&#44; rango de edad&#44; porcentaje de hombres y calidad del estudio&#46; Se excluyeron del metaan&#225;lisis los estudios en los que faltaban datos de algunas de las variables moderadoras&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los resultados del metaan&#225;lisis se muestran como <span class="elsevierStyleItalic">forest plot</span>&#44; mostrando el primer autor&#44; la fecha de publicaci&#243;n&#44; el tama&#241;o de la muestra&#44; el tipo de modelo de distribuci&#243;n&#44; los efectos individuales con el IC del 95&#37;&#44; y el efecto global con el IC del 95&#37;&#46; Las notas a pie de p&#225;gina del diagrama muestran los resultados del test Q&#44; sus grados de libertad y el valor p asociado al estad&#237;stico I<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Finalmente&#44; evaluamos el sesgo de publicaci&#243;n visualmente por medio de un <span class="elsevierStyleItalic">funnel plot</span>&#46; Los an&#225;lisis se realizaron mediante la librer&#237;a metafor del paquete estad&#237;stico R&#44; v&#46;4&#46;0&#46;2&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0130" class="elsevierStylePara elsevierViewall">La b&#250;squeda proporcion&#243; 40 registros &#250;nicos&#46; Despu&#233;s de revisar los t&#237;tulos y res&#250;menes&#44; se examinaron los textos completos de 27 art&#237;culos&#58; 13 se excluyeron porque no informaban sobre el per&#237;odo medio de incubaci&#243;n o eran estudios bibliogr&#225;ficos&#46; Finalmente se incluyeron 14 estudios en la revisi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;8&#8211;10&#44;18&#8211;27</span></a>&#58; solo siete de ellos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#8211;10&#44;18&#8211;21</span></a> eran susceptibles de ser sometidos a un metaan&#225;lisis&#44; ya que el resto no proporcionaba ni el IC del 95&#37; ni la DE del per&#237;odo de incubaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; o faltaban algunas de las variables moderadoras&#46; Solo seis de ellos fueron incluidos en el metaan&#225;lisis del percentil 95 de la distribuci&#243;n del per&#237;odo de incubaci&#243;n&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las caracter&#237;sticas de los estudios incluidos&#46; En Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> se determina el per&#237;odo de incubaci&#243;n en dos muestras diferentes&#44; por lo que se incluyeron sus resultados en el metaan&#225;lisis&#44; como si provinieran de dos estudios separados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">El primer estudio se public&#243; el 29 de enero de 2020 y el &#250;ltimo el 18 de marzo de 2020&#46; Todos los datos recogidos proced&#237;an de las provincias chinas afectadas por COVID-19&#44; excepto los comunicados en Backer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&#44; que analizaron a viajeros provenientes de Wuhan&#44; y en el estudio de Ki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#44; realizado en Corea del Sur&#46; El estudio de Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> obtuvo la mejor puntuaci&#243;n de calidad &#40;cuatro puntos&#41;&#44; y el estudio de Leung<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> obtuvo la peor puntuaci&#243;n &#40;un punto&#41; y fue excluido del metaan&#225;lisis&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La edad media de las personas infectadas oscilaba entre los 35 y los 59 a&#241;os&#44; con una mayor incidencia en los hombres que en las mujeres&#44; en la mayor&#237;a de los estudios&#46; De los estudios que presentaron datos para la DE o el IC del 95&#37;&#44; el per&#237;odo medio de incubaci&#243;n m&#225;s corto que se comunic&#243; fue de 4&#44;9 d&#237;as &#40;Jiang et al&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#44; mientras que el m&#225;s largo fue de 7&#44;2 d&#237;as &#40;Leung&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#46; El percentil 95 para el per&#237;odo de incubaci&#243;n variaba entre 10&#44;6 d&#237;as y 14&#44;6 d&#237;as&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El tama&#241;o total de la muestra para el metaan&#225;lisis del per&#237;odo de incubaci&#243;n medio fue de 792 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#58; en el lado izquierdo&#41;&#46; La estimaci&#243;n conjunta del per&#237;odo medio de incubaci&#243;n fue de 5&#44;6 d&#237;as &#40;IC del 95&#37;&#58; 5&#44;1 a 6&#44;1&#41;&#46; El valor m&#225;s bajo notificado por los estudios incluidos fue de 5&#44;0 d&#237;as &#40;Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> y Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#41; y el m&#225;s alto de 6&#44;7 d&#237;as &#40;Tian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#41;&#46; Se observa una considerable heterogeneidad entre estudios &#40;I<span class="elsevierStyleSup">2</span> 83&#44;0&#37;&#44; p &#60; 0&#44;001&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Se analizaron las variables moderadoras para identificar y eliminar la heterogeneidad observada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La inclusi&#243;n del modelo estad&#237;stico de distribuci&#243;n y la calidad como variables moderadoras condujo a una reducci&#243;n significativa de la heterogeneidad &#40;I<span class="elsevierStyleSup">2</span>&#41;&#44; pasando del 83&#37; al 15&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">En la parte derecha de la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se muestra la estimaci&#243;n global del per&#237;odo medio de incubaci&#243;n&#44; seg&#250;n la calidad del estudio y el modelo estad&#237;stico utilizado&#46; Los estudios de baja calidad proporcionan estimaciones m&#225;s bajas del per&#237;odo medio de incubaci&#243;n&#44; que oscilan entre 4&#44;9 y 6&#44;0 d&#237;as&#46; Los estudios de alta calidad proporcionan estimaciones de 5&#44;6&#44; 6&#44;1 y 6&#44;7 d&#237;as&#44; seg&#250;n los modelos LogNormal&#44; Gamma y Desconocido&#44; respectivamente&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Un total de 489 personas aportaron datos para el an&#225;lisis del percentil 95 de la distribuci&#243;n del per&#237;odo de incubaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#58; en el lado izquierdo&#41;&#46; La estimaci&#243;n conjunta mostr&#243; 11&#44;2 d&#237;as &#40;IC del 95&#37;&#58; 10&#44;7 a 11&#44;8&#41;&#46; La estimaci&#243;n m&#225;s baja&#44; de 10&#44;6 d&#237;as&#44; fue presentada por Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; y la m&#225;s alta&#44; de 12&#44;5 d&#237;as&#44; por Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> Se observa una considerable heterogeneidad &#40;I<span class="elsevierStyleSup">2</span>&#58; 61&#44;7&#37;&#44; p &#61; 0&#44;02&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Tambi&#233;n se realiz&#243; un an&#225;lisis de las variables moderadoras&#44; incluyendo la edad media en el modelo y se elimin&#243; la heterogeneidad observada&#44; pasando del 61&#44;7 al 0&#44;0&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; El percentil global 95 del per&#237;odo de incubaci&#243;n variaba&#44; seg&#250;n la edad de los pacientes&#58; 10&#44;5&#44; 11&#44;5 y 12&#44;5 d&#237;as para 40&#44; 50 y 60 a&#241;os&#44; respectivamente&#46; As&#237; pues&#44; el percentil 95 aumenta un d&#237;a de media cuando la edad aumenta 10 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#58; en el lado derecho&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Debate</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los resultados del presente estudio muestran que el per&#237;odo medio de incubaci&#243;n de la COVID-19 es de 5&#44;6 d&#237;as &#40;IC del 95&#37;&#58; 5&#44;1 a 6&#44;1&#41; y puede variar seg&#250;n el modelo utilizado para su estimaci&#243;n y la calidad del estudio&#46; El percentil 95 de su distribuci&#243;n es de unos 11&#44;2 d&#237;as &#40;10&#44;7 a 11&#44;8&#41;&#44; y var&#237;a seg&#250;n la edad media de los pacientes&#44; aumentando un d&#237;a cada 10 a&#241;os&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">La OMS opera bajo el supuesto de que el per&#237;odo de incubaci&#243;n es de uno a 14 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a>&#44; mientras que el ECDC<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> utiliz&#243; la estimaci&#243;n de Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> y Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> de un per&#237;odo medio de 5&#44;1 d&#237;as en un informe t&#233;cnico publicado el 23 de marzo de 2020&#46; En la presente revisi&#243;n sistem&#225;tica y metaan&#225;lisis&#44; se han tenido en cuenta todos los datos publicados hasta la fecha&#44; lo que da lugar a una estimaci&#243;n de 5&#44;6 d&#237;as&#44; o un 9&#44;8&#37; mayor que la estimaci&#243;n utilizada por las autoridades europeas&#46; Aunque la magnitud de la diferencia no es grande&#44; podr&#237;a afectar a la modelizaci&#243;n predictiva de las curvas de incidencia que est&#225;n construyendo los diferentes equipos de investigadores epidemiol&#243;gicos<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En informes recientes se ha sugerido que tanto la incidencia como la severidad de las infecciones por COVID-19 difieren seg&#250;n el sexo&#44; especialmente entre los grupos de edad<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;20&#44;23</span></a>&#46; Asimismo&#44; estos hallazgos plantean la posibilidad de que la distribuci&#243;n del per&#237;odo de incubaci&#243;n tambi&#233;n podr&#237;a depender en cierta medida del sexo y la edad&#46; No se pudo evaluar esta posibilidad en la presente revisi&#243;n&#44; ya que los estudios no desglosaban sus datos seg&#250;n el sexo de los pacientes&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La presente revisi&#243;n s&#237; ha mostrado que el per&#237;odo medio de incubaci&#243;n estimado puede variar dependiendo del modelo param&#233;trico utilizado y de la calidad del estudio&#44; como se evidencia en el an&#225;lisis de las variables moderadoras &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Este fen&#243;meno debe interpretarse con cautela&#44; ya que podr&#237;a haber variables sociodemogr&#225;ficas y cl&#237;nicas no cuantificadas o heterogeneidad en la calidad de las fuentes de datos que podr&#237;an explicar estas diferencias&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En cuanto al percentil 95 de la distribuci&#243;n del per&#237;odo de incubaci&#243;n&#44; los resultados de esta revisi&#243;n muestran que este es de unos 11&#44;2 d&#237;as &#40;IC 95&#37;&#58; 10&#44;7 a 11&#44;8&#41;&#44; un d&#237;a m&#225;s que la estimaci&#243;n de Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; similar a los resultados de Backer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> de 11&#44;3 d&#237;as y los de Lauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&#44; que estiman 11&#44;5 d&#237;as con un percentil 97&#44;5&#46; Cuando se incluye la edad media de los pacientes como variable moderadora&#44; el percentil 95 aumenta un d&#237;a cuando la edad media aumenta 10 a&#241;os&#46; Por lo tanto&#44; el per&#237;odo de incubaci&#243;n depende de la edad del paciente&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">El percentil 95 del per&#237;odo de incubaci&#243;n es un factor importante para establecer la duraci&#243;n correcta de la cuarentena<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#44; especialmente para los profesionales de la salud durante esta emergencia sanitaria mundial&#46; Los resultados del metaan&#225;lisis muestran el l&#237;mite superior del IC del 95&#37; a los 13&#44;6 d&#237;as para la estimaci&#243;n del percentil 95&#44; cuando la edad media de los pacientes es de 60 a&#241;os&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">La estimaci&#243;n del per&#237;odo de incubaci&#243;n conlleva la dificultad inherente de establecer el momento exacto de la exposici&#243;n al virus entre los pacientes estudiados&#46; La principal limitaci&#243;n de este estudio ha sido la fiabilidad de las fuentes de datos y la heterogeneidad de los momentos de exposici&#243;n estimados por los estudios incluidos&#46; Para hacer frente a esta limitaci&#243;n&#44; se evalu&#243; la calidad de los datos comunicados&#44; excluyendo los estudios de baja calidad&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">El posible sesgo de publicaci&#243;n observado en los <span class="elsevierStyleItalic">funnel plots</span> &#40;<a class="elsevierStyleCrossRef" href="#sec0060">Figura suplementaria S1 y Figura S2</a>&#46; Ver Anexo&#46; Material Adicional&#41; podr&#237;a ser otra limitaci&#243;n&#46; Sin embargo&#44; se han incluido todos los estudios publicados que cumpl&#237;an los criterios de elegibilidad porque se consider&#243; que este sesgo no es aplicable a este tipo de estudios descriptivos sin comparaci&#243;n de grupos&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n del presente metaan&#225;lisis ha sido que los datos proced&#237;an de pacientes con s&#237;ntomas&#46; Sin embargo&#44; Mizumoto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> estiman que el 17&#44;9&#37; de los casos son asintom&#225;ticos y&#44; por lo tanto&#44; nuestros hallazgos no pueden ser extrapolados a esta poblaci&#243;n&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusi&#243;n</span><p id="par0220" class="elsevierStylePara elsevierViewall">El tiempo medio desde la exposici&#243;n a la COVID-19 y la aparici&#243;n de los primeros s&#237;ntomas var&#237;a entre 5&#44;6 y 6&#44;7 d&#237;as&#44; seg&#250;n el modelo estad&#237;stico utilizado&#44; incluyendo estudios de alta calidad&#46; El percentil 95 del per&#237;odo de incubaci&#243;n var&#237;a de acuerdo con la edad media de los pacientes&#44; aumentando un d&#237;a cuando la edad media aumenta 10 a&#241;os&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Tanto los modelos predictivos de las curvas de incidencia como los per&#237;odos de cuarentena prescritos deben tener en cuenta estas cifras&#46; Es aconsejable recopilar datos sobre la edad y el sexo al calcular el per&#237;odo de incubaci&#243;n para analizar las posibles diferencias en los patrones epidemiol&#243;gicos basados en estas variables&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0230" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El per&#237;odo de incubaci&#243;n de la COVID-19 ayuda a determinar la duraci&#243;n &#243;ptima del per&#237;odo de cuarentena y a crear modelos predictivos de curvas de incidencia&#46; Se han reportado resultados variables en recientes estudios y&#44; por ello&#44; el objetivo de esta revisi&#243;n sistem&#225;tica es proporcionar una estimaci&#243;n m&#225;s precisa del per&#237;odo de incubaci&#243;n de la COVID-19&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda bibliogr&#225;fica en las bases de datos de Pubmed&#44; Scopus&#47;EMBASE y la Cochrane Library&#44; incluyendo todos los estudios observacionales y experimentales que reportaban un per&#237;odo de incubaci&#243;n y que se hab&#237;an publicado entre el 1 de enero y el 21 de marzo de 2020&#46; Se estim&#243; la media y el percentil 95 del per&#237;odo de incubaci&#243;n mediante metaan&#225;lisis&#44; teniendo en cuenta la heterogeneidad entre los estudios y el an&#225;lisis con variables moderadoras&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron siete estudios &#40;n &#61; 792&#41; en el metaan&#225;lisis&#46; La heterogeneidad &#40;I<span class="elsevierStyleSup">2</span> 83&#44;0&#37;&#44; p &#60; 0&#44;001&#41; disminuy&#243; significativamente cuando se tuvo en cuenta la calidad del estudio y el modelo estad&#237;stico utilizado como variables moderadoras &#40;I<span class="elsevierStyleSup">2</span> 15&#37;&#41;&#46; El per&#237;odo medio de incubaci&#243;n oscilaba entre 5&#44;6 &#40;IC 95&#37;&#58; 5&#44;2 a 6&#44;0&#41; y 6&#44;7 d&#237;as &#40;IC 95&#37;&#58; 6&#44;0 a 7&#44;4&#41;&#44; seg&#250;n el modelo estad&#237;stico utilizado&#46; El percentil 95 fue de 12&#44;5 d&#237;as cuando la edad media de los pacientes era de 60 a&#241;os&#44; aumentando un d&#237;a por cada 10 a&#241;os de edad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Seg&#250;n los datos publicados sobre el per&#237;odo de incubaci&#243;n de la COVID-19&#44; el tiempo medio entre la exposici&#243;n y la aparici&#243;n de los s&#237;ntomas cl&#237;nicos depende del modelo estad&#237;stico utilizado y el percentil 95&#44; de la edad media de los pacientes&#46; Se recomienda registrar el sexo y la edad en la recogida de los datos para poder analizar los posibles patrones diferenciales&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The incubation period of COVID-19 helps to determine the optimal duration of the quarantine and inform predictive models of incidence curves&#46; Several emerging studies have produced varying results&#59; this systematic review aims to provide a more accurate estimate of the incubation period of COVID-19&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">For this systematic review&#44; a literature search was conducted using Pubmed&#44; Scopus&#47;EMBASE&#44; and the Cochrane Library databases&#44; covering all observational and experimental studies reporting the incubation period and published from 1 January 2020 to 21 March 2020&#46;We estimated the mean and 95th percentile of the incubation period using meta-analysis&#44; taking into account between-study heterogeneity&#44; and the analysis with moderator variables&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We included seven studies &#40;n &#61; 792&#41; in the meta-analysis&#46; The heterogeneity &#40;I<span class="elsevierStyleSup">2</span> 83&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span> &#60; 0&#46;001&#41; was significantly decreased when we included the study quality and the statistical model used as moderator variables &#40;I<span class="elsevierStyleSup">2</span> 15&#37;&#41;&#46; The mean incubation period ranged from 5&#46;6 &#40;95&#37; <span class="elsevierStyleSmallCaps">C</span>I&#58; 5&#46;2 to 6&#46;0&#41; to 6&#46;7 days &#40;95&#37; CI&#58; 6&#46;0 to 7&#46;4&#41; according to the statistical model&#46; The 95<span class="elsevierStyleSup">th</span> percentile was 12&#46;5 days when the mean age of patients was 60 years&#44; increasing 1 day for every 10 years&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Based on the published data reporting the incubation period of COVID-19&#44; the mean time between exposure and onset of clinical symptoms depended on the statistical model used&#44; and the 95th percentile depended on the mean age of the patients&#46; It is advisable to record sex and age when collecting data in order to analyze possible differential patterns&#46;</p></span>"
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil 95</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IQR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 ene 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;15-89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;4&#44;1&#59; 7&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;9&#44;2&#59; 18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Backer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viajeros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gamma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2-72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#44;6&#59; 7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;9&#44;1&#59; 15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;30-59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;4&#44;2&#59; 6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;8&#44;5&#59; 14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linton et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 feb 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;30-59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;5&#44;0&#59; 6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;9&#44;3&#59; 12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tian et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 feb 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 Alta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 mar 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 Baja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Gamma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;4&#44;3&#59; 5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 mar 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 Baja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">LogNormal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">181&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;2-80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;5&#59; 5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">11&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;8&#44;2&#59; 15&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jiang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 feb 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;4&#44;4&#59; 5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leung<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 mar 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weibull&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4-10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 mar 2020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los estudios incluidos</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; IC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;5&#44;2294&#59; 5&#44;9505&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Modelo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Gamma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2527&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;-0&#44;0201&#59; 0&#44;9705&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Desconocido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3913&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;0&#44;3431&#59; 1&#44;8770&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-0&#44;7111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;-1&#44;1812&#59; -0&#44;2410&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
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